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General information

Monkeypox is a viral infection that causes a skin rash that can look like pimples or blisters. It was first identified in the 1950s from a colony of sick monkeys. The first human case was recorded in 1970. Most cases prior to the current 2022 global outbreak occurred in people in Central and West Africa who had contact with small mammals like monkeys, squirrels, and mice. Most infections outside of Africa have been travel-related.

The first case of the 2022 outbreak began with a cluster of cases found in the United Kingdom. The first case identified in the United States was reported on May 18, 2022. According to the U.S. Centers for Disease Control and Prevention (CDC), more than 102 countries have reported cases of monkeypox as of mid-July 2022. More than 59,000 cases have been confirmed worldwide. You can learn more about the global outbreak on the CDC map and case tracker

How it spreads

The monkeypox virus does not spread easily between people. It is spread through close, personal, often skin-to-skin contact. People who do not have symptoms are not considered infectious. 

Monkeypox can spread to anyone through close, personal, often skin-to-skin contact including: 

  • Direct contact with monkeypox rash, scabs, or body fluids from a person with monkeypox 
  • Touching objects, fabrics (clothing, bedding, or towels), and surfaces that have been used by someone with monkeypox 
  • Contact with fluid from the nose, mouth, throat, or lungs during prolonged face-to-face contact  
  • During pregnancy, the virus can spread to the fetus through the placenta 

It is not categorized as an STI. Monkeypox can be spread through many types of contact. However, during the current outbreak, many cases have spread through sexual encounters.   

At this time, the risk of monkeypox in the United States is believed to be low. Monkeypox spreads primarily through close contact. People who do not have monkeypox symptoms are not considered infectious. 

In this current outbreak, many of the cases are among social networks of people who self-identify as gay or bisexual and other men who have sex with men.  

People with weakened immune systems, children under eight years of age, people with a history of skin conditions like eczema, and people who are pregnant or breastfeeding may be more likely to get seriously ill. 

  • Avoid close contact with people who are infected with monkeypox or their personal belongings, such as their bedding or laundry. 
  • Wash your hands frequently and thoroughly. 
  • Wear a mask and gloves or other protection when caring for someone who has monkeypox or symptoms of the disease. 
  • Having multiple or anonymous sex partners may increase your chances for exposure to monkeypox. Limiting your number of sex partners may reduce risk of exposure.  

Symptoms and diagnosis

The first symptoms of monkeypox usually include fever, headache, exhaustion, muscle aches, sore throat, cough, and swollen lymph nodes. A few days after the start of these symptoms, a skin rash or skin spots appear. The rash changes over time. Symptoms may be different for different people. For example, some people may get a rash first and then show other symptoms. Others may only experience a rash. Symptoms are most often mild. The rash and flu-like symptoms may cause moderate discomfort. In rare cases, a more severe illness can occur that might require hospitalization. Symptoms usually appear one to two weeks after infection.

At first, the rash may start as flat reddish areas on the skin. Then, they develop into raised bumps. These bumps become filled with a clear fluid. These change to pus-filled bumps. The skin rash becomes crusty and forms scabs, which eventually fall off. The rash may affect only one area of the body. Or, it might spread across multiple parts of a person’s body. The CDC has examples of monkeypox rashes and blisters on their website. 

A provider swabs a blister or skin lesion to collect a sample. A laboratory uses the sample to diagnose monkeypox through special testing. 

People with monkeypox are contagious until all skin lesions have scabbed over and fallen off a person’s skin. The illness usually lasts for two to four weeks. 

Exposure

Symptoms usually appear within 7-14 days after exposure, with a range of 5-21 days.

Contact your health care provider if you think you’ve been exposed. You may be eligible for vaccination. Your provider will need to perform risk and exposure assessment. They may refer you for vaccination if you meet current CDC criteria for vaccination. 

As long as you do not have symptoms, you do not need to quarantine after you have been exposed. However, you should monitor yourself for symptoms.

Monitor your symptoms for 21 days after exposure. 

  • If you feel sick or feverish (have a fever of 100.4°F (38°C) or higher, chills, rash, or enlarged lymph nodes), immediately self-isolate and contact the health department immediately.  

  • If you do not have any symptoms, you may continue routine daily activities like going to work or school. However, you should not donate blood, cells, tissue, breast milk, semen, or organs during the 21-day monitoring period.

Vaccine

The JYNNEOS vaccine (also known as Imvamune or Imvanex) is available to people who live or work in Massachusetts and meet the current eligibility criteria. For information about vaccine access in New Hampshire, please check the New Hampshire Department of Health’s website. If you live in a different state, please check this website with updated monkeypox vaccine locations.

Your health care provider will need to perform risk and exposure assessment before referring you for vaccination. Once a provider confirms your eligibility, patients can make their own appointment. There are many locations offering the vaccine. You do not need to be an existing patient to make an appointment. You may need to call multiple clinics before finding one with available appointments. 

Please be aware that there is currently a limited supply of JYNNEOS. Vaccination is prioritized for individuals at the highest risk of exposure to someone with monkeypox.

Treatment

Many people infected with the monkeypox virus have a mild disease that does not require treatment. There are no treatments specifically for monkeypox virus infections. However, antivirals such as tecovirimat (TPOXX) may be recommended for people who have severe disease or are more likely to get severely ill. People with weakened immune systems, children under 8 years of age, people with a history of skin disorders like eczema, and people who are pregnant or breastfeeding may be more likely to get seriously ill. If you become infected with monkeypox and meet criteria for antiviral treatment, your health care provider may recommend treatment with tecovirimat.

Isolation should continue until all skin lesions have resolved, the scabs have fallen off, and a fresh layer of intact skin has formed. This will be determined by your health care provider and public health authorities.

Household pets

Animals infected with monkeypox can spread the virus to people. It is possible that people who are infected can spread monkeypox to animals through close contact. Close contact includes petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food. People with monkeypox should avoid contact with animals, including pets, to prevent spreading the virus. 

If you have monkeypox and did not have a close contact with pets after symptom onset, ask friends or family members who live in a separate home to care for the animal until you fully recover. After you have recovered, disinfect your home before bringing healthy animals back.

If you have monkeypox and had close contact with pets after your symptoms started, the pet should be kept at home and away from other animals and people for 21 days after the most recent contact. You should not take care of exposed pets. If possible, another household member should care of the animal until you are fully recovered.

If you have monkeypox and must care for your healthy pets during home isolation, wash your hands, or use an alcohol-based hand rub, before and after caring for them. It is also important to cover any skin rash to the best extent possible (i.e. long sleeves, long pants), and wear gloves and a well-fitting mask or respirator while providing care for your animals.

  • Do not put a mask on your pet.
  • Avoid close contact with your pet.
  • Ensure your pet cannot inadvertently come into contact with contaminated articles in the home such as clothing, sheets, and towels used by the person with monkeypox.
  • Do not let animals come into contact with rashes, used bandages, and body fluids.
  • Ensure food, toys, bedding, or other items that you provide for your animal during its isolation do not come in direct contact with skin or uncovered rash.

See the CDC website for more information about caring for pets: Pets in the Home | Monkeypox | CDC

More Information

Updated September 15, 2022