The excitement about monkeypox has subsided in the meantime, the infection rates are falling, but the outbreak is not completely over yet.

Since the beginning of the year, 109 nations have reported more than 78,000 cases and Germany now sits sixth on the list with around 3,670 infections, just ahead of Peru and Colombia, followed by the US and Brazil (28,650 and 9,260 cases) ahead of Spain, France and Great Britain is led.

A current study in the "British Medical Journal" now also provides new evidence for the suspicion that those affected are already contagious before they show the first symptoms, which would explain the dynamics that have occurred globally.

Sonya Kastilan

Editor in the "Science" department of the Frankfurter Allgemeine Sunday newspaper.

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The outbreak, which has been observed since May, was declared a "health emergency of international concern" by the World Health Organization on July 23, 2022, when the numbers rose rapidly - in countries where the pathogen is not yet endemic, but could well become so.

For the British study, 2,746 patients who had been proven to be infected were questioned in detail, data on contact persons evaluated and the course of the disease in Great Britain, where the epidemic peaked on July 9th, was taken into account.

The team led by Thomas Ward and Christopher Overton from the UK Health Security Agency used various model calculations to statistically evaluate the data.

The results suggest an average incubation time of 7.6 or 7.8 days (ranging from 6.5 to 9.9 days) before the first signs are noticed,

and a relatively long infectious phase.

In order to detect and shield 95 percent of those who may be infected, an isolation period of 16 to 23 days after contact would be necessary.

The fact that infected people had apparently already transmitted viruses to others even before symptoms appeared was indicated by the strikingly short "serial intervals" until the respective contact persons were also symptomatic.

In Germany, the number of cases reported weekly to the Robert Koch Institute in Berlin has been declining since August, with fewer than 20 cases reported per week in October.

The RKI continues to assess the risk to the health of the general population in Germany as low.

In this outbreak, transmission occurs primarily through close physical contact, mostly in the context of sexual activity, especially in men who have sexual contact with other men.

So far, only 19 cases involving women have been reported, as well as three cases involving male adolescents and two cases involving children under the age of 14.

For example, the median age of those affected is 37 in the UK, while in endemic countries previous outbreaks tended to affect younger people:

More infections if you look for them

However, scientists reported Thursday at the annual meeting of the American Society of Tropical Medicine and Hygiene that many more people are becoming infected with monkeypox than previously thought.

This is indicated by analyzes of samples from a remote area in the Democratic Republic of the Congo.

And it would not be long before such small local outbreaks developed into larger epidemics.

There was also evidence that, among other things, a virus strain is circulating there that leads to severe courses much more often than the one currently rampant worldwide.

The researchers from the American Centers for Disease Control and Prevention (CDC), Kinshasa School of Public Health and the Congolese Ministry of Public Health based their report on data on 1,463 cases that occurred in Tshuapa province between 2013 and 2017 and whose infection has been confirmed in the laboratory.

They determined the respective number of reproductions, the R value, which in the region has increased from 0.3 to 0.5 in the 1980s to 0.81.

Larger eruptions are becoming more likely.

The researchers also assume that "spillovers" occur regularly and more frequently.

People get infected from rodents, which are considered a natural reservoir for these pathogens.

It is usually children who are at the beginning of the chain of infection and then in turn infect members of their family.

CDC epidemiologist Kelly Charniga, who specializes in infectious diseases, warns that the more often this happens, the more chances the pathogen will eventually spread through person-to-person transmission alone.

More attention and help must now be given to those areas that are suffering most from the infectious disease today.

Where people are most at risk of contracting and sometimes dying from monkeypox.

This is the best way to prevent