Clinical and virological features of first human Monkeypox cases in Germany

Abstract In May 2022, human monkeypox infections including human-to-human transmission were reported in a multi-country outbreak in Europe and North America. With the first two German cases, we are providing clinical and virological findings, including the detection of monkeypox virus DNA in blood and semen. It is important to raise awareness among health professionals of the rapid and correct identification and diagnosis of this disease, which is probably still under-reported in Europe. We describe the first two cases of monkeypox (MPX) infections in Germany to highlight the importance of recent developments for health professionals worldwide and to share further observations related to human-to-human transmission in these cases. MPX is an orthopoxvirus infection that, with the exception of a few imported cases in the past, was previously thought to be endemic only in West and Central African countries [1, 2]. Beginning in 2018, the United Kingdom (UK) Health Security Agency has reported several imported cases associated with travellers from these countries [3]. One case reported on May 7, 2022, had a travel history to Nigeria. However, the two other cases within a family reported on May 13, 2022, neither had a travel history nor an epidemiological link to the previous case. On May 17, 2022, four additional UK cases were reported involving individuals who described themselves as belonging to the group of men who have sex with men (MSM). Subsequent testing for monkeypox virus (MPXV) in symptomatic MSM patients reporting to sexual health and sexually transmitted disease (STD) clinics in the UK and elsewhere revealed an increasing number of confirmed MPX cases in Europe [1].