Joint statement on the outbreak of monkeypox in Germany by the medical-scientific societies DAIG, DGI, DGPI and GfV, the professional association dagnä and the DZIF in coordination with STIKO (27.05.2022)
27/05/2022
- May 2022
Summary
Rapidly increasing numbers of monkeypox virus infections are being recorded on at least four continents. Rapid and consistent action is required to limit the outbreak. Initially, target group-specific education and information ("awareness"), isolation of cases of infection, quarantine for close contacts and suspected cases as well as risk minimization in interpersonal contacts are particularly important. It must be quickly evaluated whether and how vaccination can help to limit the outbreak. Approved therapeutics should be made available for potentially severe courses of the disease.
Background
Since the first case of monkeypox was diagnosed in London, further cases have been reported in rapid succession on four continents. In Germany, the first case was diagnosed on May 19, 2022, and by May 24, 2022, around 250 confirmed cases worldwide had been reported to the World Health Organization (WHO). So far, the infections have mainly occurred in younger men who say they have sex with men, but there have also been intra-familial transmissions. In keeping with the poxvirus originating from West Africa, the clinical course of the disease has so far been relatively mild. Direct skin or mucous membrane contact or droplet infection is assumed to be the transmission route. The current incidence of infection is dynamic with increasing numbers of cases. Assessing the extent of the outbreak and tracing contact chains is challenging due to the long incubation period of 1-3 weeks.
Problem definition
To effectively contain the global outbreak, break the chains of infection and prevent entry into the animal kingdom outside the known endemic areas, decisive, rapid and coordinated action is required.
Proposed measures
- Outbreak management through non-pharmacological interventions
Due to the currently observed direct transmission from person to person, target group-specific and lifestyle-accepting education and information ("awareness" among potentially affected persons and medical staff) is of crucial importance. In particular, people who have not been vaccinated against smallpox without a vaccination certificate or vaccination scars should avoid contact with changing sexual partners or sharing beds and clothing.
Infected persons should remain in effective isolation for a period of 21 days. Inpatient hospital treatment solely for reasons of isolation is not necessary; inpatient admissions should primarily be for medical reasons in the event of severe clinical progression or imminent complications.
Contact persons with a relevant risk of infection and suspected cases should go into quarantine during the incubation period or until the infection has been ruled out with certainty.
Medical staff should wear suitable protective clothing (mask, gloves, gown) when treating the above-mentioned groups of people.
- Vaccinations
A non-replicative smallpox vaccine (MVA-BN) is licensed in the EU to protect against smallpox infections (variola major, orthopoxvirus) in adults. Based on animal data, this vaccine is also licensed in the USA and Canada for the prevention of monkeypox. Clinical efficacy data in humans could not be collected to a sufficient extent due to only sporadic cases of infection to date. A corresponding study has been running for some time. Data on tolerability are available, safety data and dosage recommendations in risk groups are available.
Vaccination could make a relevant contribution to increasing protection against infection and disease in birth cohorts that have not been vaccinated against smallpox (e.g. birth cohorts from the early 1970s onwards). Particularly in the vicinity of known infection clusters, vaccination could prevent infections or mitigate the course of the disease and significantly limit outbreaks.
This option should be reviewed by the EMA (EU approval) and STIKO (vaccination recommendation) in a timely manner. At the same time, availability should be checked and the procurement of vaccines in sufficient quantities as well as the organization and feasibility of vaccination recommendations should be prepared. Established infectious disease treatment centers and the public health service should be prepared for possible implementation.
- Examination of therapeutic options
Although the cases to date are characterized by a known mild course of West African monkeypox virus infection, therapeutic options should be available for vulnerable patient populations (e.g. relevant immunodeficiency). Tecovirimat, an antiviral drug, is currently approved in the EU for the treatment of monkeypox infection; an alternative is the non-approved antiviral drug brincidofovir. The availability of both must be ensured. Treatment should also be provided by established infectious disease treatment centers.
Further information:
Case definition:https://www.ecdc.europa.eu/en/publications-data/risk-assessment-monkeypox-multi-country-outbreak
Clinical description:https://www.cdc.gov/poxvirus/monkeypox/index.html
Frequently asked questions: https://www.rki.de/SharedDocs/FAQ/Affenpocken/affenpocken_gesamt.html
https://eacademy.escmid.org/escmid/2022/monkeypox-outbreak/363235