As experts learn more about monkeypox outbreaks, news and information changes. For the latest on monkeypox, please visit the Centers for Disease Control and Prevention.
What is monkeypox? | How serious is it? | Can you die from monkeypox? | What to do if you think you have it | Treatment | Prevention
Monkeypox is a rare infectious disease caused by the monkeypox virus. This virus is in the Orthopoxvirus genus, which also causes smallpox—but monkeypox is less contagious and causes a milder illness than smallpox. (The cowpox virus is also in this group of viruses.)
Monkeypox disease is typically geographically focused in tropical rainforest areas in central Africa and western African countries. In May 2022, confirmed new cases of monkeypox were reported in the United States. While the recent outbreak of this rare disease raises concern, monkeypox is most often a self-limited illness with a low fatality rate.
What is monkeypox?
Monkeypox is a viral zoonosis, which means it is a virus passed from infected animals to humans. While the virus is similar to what causes smallpox, it is different from the virus that causes COVID-19. Monkeypox has been reported in humans in several central and western African countries where it is considered endemic, or constantly present in that area. Monkeypox has also been reported in people throughout the world as sporadic clusters, usually related to international travel to endemic areas or imported infected animals.
The first cases of monkeypox were identified and named in 1958 when outbreaks of an unknown illness causing lesions was reported in groups of monkeys used for research. Monkeypox was first described as causing infection in a human in 1970 in the Democratic Republic of the Congo, where—in addition to west Africa—most present-day infections continue to be reported.
Presently, outbreaks have occurred in Africa and in other countries. Infection rates are much smaller in number (in the hundreds) than the COVID-19 pandemic, which has affected people in the millions.
In 2003, the first monkeypox outbreak happened in the United States. It was linked to contact with prairie dogs sold as household pets, which had been infected from co-habitant Gambian giant rats imported from Ghana. This outbreak resulted in approximately 50 reported human cases. Since then, sporadic cases have been reported in travelers from Nigeria to other countries, including the United States in July and November 2021.
Transmission
Monkeypox is contagious and while most cases are zoonotic, aka occurring after close or direct contact with infected animals such as rodents and primates, human-to-human transmission can occur. Transmission occurs through contact with bodily fluids, such as fluid-filled skin lesions, or face-to-face contact by respiratory droplets. You can also catch monkeypox through contact with materials, like clothes or bed sheets, contaminated with the virus.
Incubation period
Following transmission, the virus spreads to local lymph nodes and can then go on to infect other organs. This incubation period lasts about one to two weeks, after which symptoms develop.
Symptoms
Symptoms of monkeypox include fever, headache, muscle aches, swollen lymph nodes, and lesions.
Monkeypox lesions are similar to chickenpox. Lesions usually start in the mouth and throat before appearing on the skin and other parts of the body. The rash evolves from macules (lesions with a flat base) to papules (slightly raised, firm lesions) then vesicles (lesions filled with clear fluid) to pustules (lesions filled with yellow fluid). After this phase, pustules will begin to dry up, scab, and fall off. Once the lesions scab over, the infected person is no longer considered infectious.
Symptoms of monkeypox generally last two to four weeks, but severe cases can occur with long-lasting effects.
How serious is monkeypox?
At the time of publication, the recent outbreak of monkeypox includes reported cases in several countries including Australia, Canada, Israel, Italy, Spain, Sweden, the United Kingdom (UK), and the United States. The UK Health Security Agency (UKHSA), the Centers for Disease Control and Prevention (CDC), and the World Health Organization, among other public health organizations, continue to monitor this situation closely.
Catching monkeypox remains a low public health concern overall. The CDC has instituted a level 2 travel alert. This level travel alert recommends enhanced precautions, such as avoidance of close contact with notably sick people and dead or live wild animals—especially rodents and non-human primates that are known carriers of monkeypox.
Is monkeypox fatal?
The historical monkeypox death rate has been reported as exceeding 10%, with more recent data showing mortalities less than 5%. Children and those with weakened immune systems may be most susceptible to the disease and its complications.
What to do if you think you have monkeypox
Always contact your healthcare provider with any concerns or symptoms. If you believe you have been exposed to and or are sick with monkeypox, you should limit your exposure to other people until assessed and cleared by healthcare professionals or public health officials. Possible human cases will be reported to state health departments, who will go on to contact the CDC. Be cognizant if you develop a rash and have traveled to central or west African countries (or other parts of the world where confirmed cases have been reported) during the month before your symptoms appear—or if you have been in contact with someone with confirmed or suspected monkeypox. Upon initial contact tracing with the current outbreak, there may be some link to men who regularly have close or intimate contact with other men.
The rash associated with monkeypox can be mistaken with other more well-known diseases, so a lab-based test is important for a definitive diagnosis. The gold-standard test is detection of viral DNA by polymerase chain reaction (PCR), with samples obtained from the skin, fluid, or scabs collected from skin lesions or biopsy.
Monkeypox treatment
Monkeypox is often a self-limited infection requiring only supportive care to manage symptoms and treatment of any possible secondary bacterial infections that may occur. Available antivirals, like cidofovir and brincidofovir, have demonstrated efficacy against monkeypox in lab and animal studies, but efficacy in humans remains unknown. An antiviral medication known as tecovirimat received FDA approval in 2018 to treat smallpox, but there is currently no data on its efficacy in humans to treat monkeypox. Vaccinia immune globulin (VIG) is a final potential treatment option, but data is lacking and would be purely investigational.
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Monkeypox prevention
Preventing monkeypox infection is best accomplished by avoidance of contact with those known to be infected and any contaminated materials, practicing good hand hygiene, and limiting contact with both dead or live wild animals—including eating or preparing wild game, or using products derived from wild animals from Africa.
Vaccination against smallpox has proven to be approximately 85% effective in preventing monkeypox, so those with prior smallpox vaccination that become infected may present with a milder form of illness and perhaps contribute to the lower fatality rate observed present-day. Due to the eradication of smallpox based on broad vaccination campaigns, these first-generation vaccines are no longer available, and smallpox vaccination is not widely provided.
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There are currently two licensed vaccines for smallpox, Jynneos and ACAM2000, both of which are part of the U.S. Strategic National Stockpile (SNS). Jynneos is also licensed for monkeypox, and was FDA approved in 2019. This vaccine is administered as two subcutaneous injections, separated by four weeks. Jynneos may also be considered for post-exposure prophylaxis to minimize the potential development and/or severity of disease, and the first dose is recommended to be administered within 4 days from exposure to prevent disease; if administered between 4 to 14 days from exposure, vaccination may decrease disease severity but will unlikely prevent it. A recent news briefing at the CDC’s Emerging and Zoonotic Infectious Diseases Center has reported a request for release of the vaccine from the National Stockpile.
