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Content

Information about MPX in Berlin

Please note

The information about monkeypox virus (MPXV), symptoms and incubation periods and routes of transmission is based on previous knowledge from published literature and is subject to continuous updating. As more cases occur, more information on the pathogen, modes of transmission, and symptoms will become available. Physicians and health authorities are constantly learning more and the information presented here will be continuously adapted to new findings.

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Monkeypox (MPX) is a viral disease caused by the monkeypox virus (MPXV). The virus is related to the classical smallpox viruses (variola, smallpox). MPX has beena rare disease in Europe, so far thought to be transmitted mainly from rodents to humans. Human-to-human transmission occurs mainly in close contact.

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MPX cases have been detected in several countries in and outside Europe since mid-May 2022. This is a larger international outbreak, primarily affecting countries where MPX has not previously occurred. Spain, Portugal, the United Kingdom and Germany have been most affected to date
Berlin has by far the most MPX cases nationwide. Although anyone can become infected with MPXV, so far most cases have been found in gay and bisexual men and other men who have sex with men. In Berlin, only men have been affected so far. MPX are not a “gay disease,” however, and gay men should not be blamed for the outbreak. MPX are nothing to be ashamed of, and they are not associated with any particular sexual orientation.

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MPXV can be transmitted through close body contact (skin-to-skin), for example during sex. Crucial here are all situations in which the viruses from affected skin areas of a sick person come into contact with the skin and mucous membrane of another person. This can also be the case when kissing, caressing or cuddling. So far, however, sexual contacts seem to play the most important role in transmission, but MPXV can also be transmitted by droplets from the respiratory air during prolonged direct contact or by contaminated objects (e.g., clothing, bedding, and sex toys). Condoms do not provide sufficient protection against transmission. Decisive for transmission is direct contact with skin lesions (pimples, blisters, scabbed pustules, crusts).
Investigations by the Berlin health authorities have shown that at the beginning of the outbreak in Berlin, large events such as the GayPride Maspalomas in Gran Canaria, the Darklands Festival in Antwerp or the Snaxx party in Berlin may have played a role in the transmission. However, many cases also infect outside big events/parties.
Overall, most cases are now infected in Berlin and more than half have visited sex parties or clubs during the assumed infection period. However, about 20% of the Berlin cases have been infected while traveling outside Germany, where clubs, festivals and parties were often also visited.

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The time between contact with MPXV and the appearance of the first symptoms (incubation period) is usually between 5 and 21 days. For the cases reported in Berlin where an incubation period could be estimated, a median incubation period of about 9 days has been shown so far.
The disease itself usually lasts two to four weeks.

First signs are often the following:
- fever, chills
- muscle aches, back pain
- fatigue and headache
However, these first signs can also be absent!
A few (1-3) days after the onset of these first signs, affected individuals develop a rash or small skin lesions, often on or near the genitals or anus, but also on other areas such as the hands, feet, chest, or face.

These skin lesions go through several stages and may look like pigmented spots at first. They then develop into pimples or fluid-filled blisters that later form a scabby crust. Eventually, these crusts fall off and the lesions heal. The affected skin areas can be very painful or itchy and scars may remain for life after healing. The skin lesions can also be located on mucous membranes inside the body, e.g. in the mouth, vagina or anus.

Please note: Affected people may have all or only some of these symptoms. Most people with MPX develop a rash or isolated skin lesions. Some people have reported developing the rash or lesions before the flu-like initial symptoms appear (or without them at all). One may also have only very isolated skin lesions. MPXV can be transmitted from the onset of the first symptoms and until all skin lesions, including the scab, have healed and a new layer of skin has formed. This can take several weeks. So far, it is still unclear whether and for how long MPXV can be transmitted via semen/vaginal secretions. This is currently being investigated in numerous studies. To be on the safe side, you should continue to use condoms for sexual contact for 8 weeks after infection, even after all skin lesions have healed completely.

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Close sexual contact and direct skin contact have so far played the greatest role in transmission. Close skin contacts and sexual contacts with unknown persons, whose health status you cannot assess, carry a high risk of infection. Therefore, you can reduce your own risk of infection by reducing the number of sex partners whose health status you cannot assess. It is important to avoid close contact with people who have skin lesions or a rash, or who have flu-like symptoms such as fever and chills. Since it is primarily contact with the affected areas of skin that leads to transmission, even condoms do not provide adequate protection.
Attending outdoor events and festivals does not increase the risk of MPXV infection, but close physical contact, including sex, increases the risk of infection. Watch for the above symptoms and seek early medical attention if you or a current partner experience any of the above symptoms.

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If symptoms appear, a doctor should be consulted at an early stage. It is best to talk to your doctor’s office in advance by phone before going there. If you do not have health insurance, sexual health centers are also available in some districts. Checkpoint BLN also offers medical advice and diagnostics. Cover skin lesions and wear a medical mask on the way there and at the facilities.
Close physical contact (skin contact, sexual contact) should be avoided at all costs until symptoms have been medically cleared. Do not visit parties, festivals, saunas, dark rooms, etc. until your symptoms have been clearly diagnosed by a doctor. If you notice symptoms on yourself during a festival or club visit lasting several days, interrupt your visit there and seek medical attention. Inform people with whom you have had close contact about your symptoms.

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You should minimize the risk of passing the virus to other people. You can do this by considering the following points, at least until all skin lesions have healed completely and a new skin layer has formed:

- Refrain from close skin contact and sexual contact with other people (if you have been diagnosed with MPX infection, even before you discover skin lesions on yourself)
- Do not attend events, clubs or parties
- Avoid public transportation
- Cover affected areas of skin and wear a medical mask when in contact with other people (e.g., household contacts, roommates) or when outside your home
- Avoid contact with people who have impaired immune system function (e.g., untreated HIV patients, pregnant women and young children). These individuals are at particularl high risk of severe MPX infection and need special protection.
- Do not share clothes, towels, bed linen, etc. with other people.
- Maintain good hygiene at home, wash clothes and bed linen (with normal detergent) regularly
- Avoid contact with (domestic) animals. MPX is a disease that affects both humans and animals, which means you can infect your pets. To prevent MPXV from eventually establishing itself in wild animals such as rats in Berlin, it is important to avoid all contact with animals.
- So far it is unclear whether and how long MPXV can also be transmitted via semen/vaginal secretions. To be on the safe side, even after all skin lesions have completely healed, condoms should still be used for sexual contact for 8 weeks after infection.

Take care of your skin and keep the affected areas as clean as possible. Wash with a mild soap and ask for medication if the areas are painful or itchy. Remember to wash your hands thoroughly after touching the rash. This will help prevent infection and complications. If you notice swelling or redness around the affected areas of skin, or if you suddenly develop a fever, even if your symptoms had already improved, seek medical attention.

Do not scratch or prick the blisters, this will lead to further infections and complications and increase the risk of scarring!

Take care of yourself and your mental/psychological health. Seek support if you feel overwhelmed or burdened by your situation.

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