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Monkeypox Q&A

July 29, 2022

What is monkeypox? 

Monkeypox is a rare disease that is caused by infection with the monkeypox virus which is related to the smallpox virus. While generally less severe and much less contagious than smallpox, monkeypox can be a serious illness. It spreads from infected humans, animals, and materials contaminated with the virus but primarily through close, personal, often skin-to-skin contact with people who have monkeypox symptoms, such as rash and sores.

Is monkeypox a new disease? 

No, monkeypox is not a new disease. Monkeypox was first discovered in 1958 in monkeys, hence the name 'monkeypox.' The first human case of monkeypox was recorded in 1970 in the Democratic Republic of Congo. Monkeypox is endemic (regularly found) in west and central African countries.

Should I be worried about monkeypox? 

There is a recent increase in reported cases where monkeypox is not commonly seen, like Europe and the United States, including California. While it's good to stay alert about any emerging public health outbreaks, the current risk of getting monkeypox in the general public is very low.

Monkeypox is a known illness that spreads through very close contact compared to other infectious diseases like COVID-19 that are primarily spread though very small particles in the air. Monkeypox is also thought to be most contagious when symptoms like a rash are present, making it easier for infected individuals to know when to stay away from others to prevent further spread.

Is monkeypox related to COVID-19? 

No, monkeypox is a completely different disease, is not related to COVID-19, and spreads differently. People are generally contagious when they have a rash or other symptoms, and monkeypox spread takes place through prolonged direct, close contact. This is different from COVID-19, which spreads easily through the air.

Does the monkeypox virus have variants? 

All viruses change and evolve over time. However, the monkeypox virus is a DNA virus which mutates slower than coronaviruses, which are RNA viruses.  There are two known families or “clades” of monkeypox virus. The clade recently identified in Europe and in the United States is the West African clade, which tends to cause less severe disease.  

Who can get monkeypox? 

Anyone can get monkeypox after having close physical contact with someone who has the infection, especially contact with infected lesions (sores), bodily fluids, or other contaminated surfaces. However, the current risk to the public is low.

In 2022, many cases of monkeypox have been reported in several countries that don't normally report monkeypox, like the United States, including in California. Though not exclusively, recent cases include gay, bisexual, trans, and other men who have sex with men, and household contacts. 

How is monkeypox transmitted? 

Monkeypox spreads primarily through direct contact with infectious sores, scabs, or body fluids, including during sex, as well as activities like kissing, hugging, massaging, and cuddling. Monkeypox can spread through touching materials used by a person with monkeypox that haven’t been cleaned, such as clothing, towels and bedding. It can also spread by respiratory secretions (talking, coughing, sneezing, breathing) during prolonged, close, face-to-face contact. 

 Monkeypox can be spread through:

  • Direct skin-skin contact with rash and sores, including through hugging, massaging and cuddling

  • Sexual/intimate contact, including kissing

  • Living in a house and sharing a bed with someone

  • Sharing towels or unwashed clothing

  • Respiratory secretions through prolonged face-to-face interactions (the type that mainly happen when living with someone or caring for someone who has monkeypox)

Monkeypox is NOT spread through:

  • Casual conversations

  • Walking by someone with monkeypox like in a grocery store

Scientists are still learning if monkeypox can be spread through:

  • Semen or vaginal fluids
  • Contact with people who have no symptoms (we think people with symptoms are most likely to spread it, but some people may have very mild illness and not know they are infected)

What are the signs and symptoms of monkeypox? 

Monkeypox might start with symptoms like the flu, with fever, low energy, swollen lymph nodes, and general body aches. Within 1 to 3 days (sometimes longer) after the appearance of fever, the person can develop a rash or sores. The sores will go through several stages, including scabs, before healing. They can look like pimples or blisters and may be painful and itchy.

The rash or sores may be located on or near the genitals (penis, testicles, labia, and vagina) or anus (butt) but could also be on other areas like the hands, feet, chest, and face. They may also be limited to one part of the body.

People with monkeypox may experience all or only a few of these symptoms. Most people with monkeypox will get the rash or sores. Sometimes the sores can be located in places that are difficult for someone to see.  Some people have reported developing the rash or sores before (or without) the flu-like symptoms.

When is monkeypox contagious? 

Monkeypox symptoms usually start within 2 weeks (but can be up to 3 weeks) after exposure to the virus. Usually, people are only thought to be contagious (infectious) when they have symptoms and until all sores, including scabs, have healed and a fresh layer of skin has formed. This can take several weeks. Researchers are still trying to understand if the virus can spread from someone who has no symptoms.

How serious is monkeypox?  

Monkeypox is usually a mild disease with symptoms lasting from 2 to 4 weeks. Certain groups of people may be at higher risk for severe disease. These groups include people with weakened immune systems, children under 8 years of age, people with a history of eczema, and people who are pregnant or breastfeeding.

Infections with the strain of monkeypox virus identified in this outbreak—the West African strain—are rarely fatal. Over 99% of people who get this form of the disease are likely to survive. Despite this, symptoms can be extremely painful, and people might have infections or permanent scarring resulting from the rashes and sores.

Is monkeypox a sexually transmitted infection (STI)? 

Monkeypox can spread from skin-to-skin contact, or because of contact with a contaminated surface or material (like bedding and clothing). This includes close or intimate physical contact, including sexual contact, especially when touching rashes or objects or surfaces (like bedding, towels or sex toys) with someone who has monkeypox. Scientists are investigating whether the virus could be spread by exposure to semen or vaginal fluids, but this has not been previously known to be how the virus spreads.

Monkeypox may look like sexually transmitted infections that cause a rash on the genitals and anus, including herpes and syphilis. Monkeypox may also cause rectal pain, which is a symptom of proctitis (inflammation of the rectum) and can be seen in other STIs  as well. It's always important to talk to a health care provider as soon as you notice unusual rashes or sores or have rectal pain. 

How is monkeypox prevented? 

There are number of ways to prevent the spread of monkeypox, including:

  • Talking to your sexual partner/s about any recent illness and being aware of new or unexplained sores or rashes on your body or your partner's body, including on the genitals and anus
  • Avoiding close contact, including  hugging, kissing, cuddling and sexual activity with people with symptoms like sores or rashes
  • Not sharing materials (e.g., utensils, cups, clothing, towels, bedding) with someone who has symptoms
  • Washing your hands often with soap and water or an alcohol-based hand sanitizer
  • Using appropriate personal protective equipment (PPE) (like a mask, gown and gloves) when caring for others with symptoms
  • Avoiding contact with infected animals 

What should someone do if they are exposed to monkeypox? 

Contact a health care provider as soon as possible and let them know you have been exposed to monkeypox. Health care providers can provide testing.

Health care providers and local health departments may also recommend a vaccine for those who are exposed to help prevent infection or decrease the seriousness of the illness. 

What should I do if I have symptoms of monkeypox?

Contact a health care provider as soon as possible and let them know you have symptoms.

People who have monkeypox symptoms should ideally isolate away from others until their symptoms have gone away completely and until all sores, including scabs, have healed and a fresh layer of skin has formed for at least 48 hours.  If needing to be around others, people with monkeypox should cover up sores and wear a mask. 

Standard laundry detergents are appropriate for cleaning clothes or linens (e.g., bedding and towels) used by someone with monkeypox.

What treatments are available for monkeypox?

Most infections are mild and will resolve without any treatment. There are currently no treatments specifically for monkeypox. However, given that monkeypox and smallpox viruses are genetically similar, antiviral drugs developed to protect against smallpox, such as tecovirimat (TPOXX), may be used to treat monkeypox. This treatment may be recommended for people who are more likely to get severely ill or for people with complications from the infection or symptoms not controlled with supportive care. People who may be at risk for more severe illness include those with a weakened immune system, children (particularly those less than 8 years of age), those who are pregnant or breastfeeding, and those with a history of certain skin diseases like eczema.

It is important to talk to your healthcare provider if you have symptoms of monkeypox and are experiencing pain or irritation due to the rash or sores. Your provider may be able to offer treatments that are not specific to monkeypox, but may help to reduce your symptoms, like prescribed mouth rinses, stool softeners for those with rectal pain, or topical gels or creams.

Do I need to get vaccinated against monkeypox?

The Centers for Disease Control and Prevention (CDC) and the California Department of Public Health (CDPH) recommend that people who have been exposed to monkeypox be given the vaccine to prevent them from developing the disease – this is called post-exposure prophylaxis or PEP. PEP can also be given to people who do not have a known exposure but are at risk for recent exposure to monkeypox cases. Vaccines are not recommended for people who have monkeypox.

Vaccination to prevent monkeypox infection, also called pre-exposure prophylaxis or PrEP, is recommended for people who are at risk for occupational exposure, like laboratory workers who perform monkeypox testing, and health care worker response teams designated by appropriate public health authorities.

Most health care workers are at low risk and are not recommended for vaccination at this time while vaccine supplies are limited. 

CDPH is making the JYNNEOS vaccine available to help limit the spread of monkeypox in communities where transmission is highest and with populations most at risk. However, there is currently an extremely limited supply from the Strategic National Stockpile. More doses should be arriving in California in the coming weeks. 

What do I need to know about the JYNNEOS vaccine?

JYNNEOS vaccine is administered in two injections in the upper arm at least four weeks apart. Most people who get the JYNNEOS vaccine have only minor reactions, like pain, redness, swelling and itching at the injection site, and less commonly, muscle pain, headache, fatigue (tiredness), nausea, chills and mild fever, and swollen glands. Currently, CDPH recommends that first doses be prioritized in order to reach as many people as possible. Second doses should be prioritized for people who are immunocompromised. Second doses can be offered to others as more doses of JYNNEOS become available. Learn more about the JYNNEOS vaccine

When should I get vaccinated for monkeypox if I have been exposed?

The Centers for Disease Control and Prevention (CDC) and the California Department of Public Health (CDPH) recommend that people who have been exposed to monkeypox be given the vaccine to prevent them from developing the disease – this is called post-exposure prophylaxis or PEP.  PEP can also be given to people who do not have a known exposure but are at risk for recent exposure to monkeypox cases. Vaccines are not recommended for people who have monkeypox.

PEP with the JYNNEOS vaccine should be given within 4 days from the date of exposure to help prevent onset of the disease. If given between 4–14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the disease.

For more information on the vaccine, visit the CDC JYNNEOS Vaccine Statement and the CDC's Consideration on Monkeypox Vaccine site.

How should healthcare facilities prioritize monkeypox vaccines for their healthcare workforce?

Current evidence shows that the risk for transmission of monkeypox to health care workers (HCW) is low.  While supplies of vaccine continue to be limited, CDPH recommends priority for vaccination to persons at risk in the community (with non-healthcare related exposures). In healthcare facilities, current infection control recommendations (including use of personal protective equipment or PPE) should be followed. PPE to prevent exposure is readily available and expected to be extremely effective.    

CDPH recommends following ACIP guidance related to pre-exposure prophylaxis (PrEP) for HCWs.  Specific eligibility guidance is provided in the footnote to Table 1: Research laboratory personnel working with orthopoxviruses, clinical laboratory personnel performing diagnostic testing for orthopoxviruses, and orthopoxvirus and health care worker response teams designated by appropriate public health and antiterror authorities.

Finally, it is not recommended to vaccinate HCWs in general.  There can be consideration to immunizing a limited group of health care workers who will be routinely and frequently caring for persons with monkeypox infection. This decision to immunize should be made in collaboration with your local health department.  

Could my pet get monkeypox?

Infected animals can spread monkeypox to people, and people who are infected can spread monkeypox to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food.

People with monkeypox should avoid contact with animals, including pets, domestic animals, and wildlife to prevent spreading the virus. Someone with monkeypox should ask another household member or outside friend/family member to care for pets until the person with monkeypox is fully recovered.

What is CDPH doing about monkeypox? 

CDPH has activated our public health response coordination center and is closely monitoring monkeypox transmission in the U.S. and California to ensure rapid identification of cases. CDPH is working with local health officials and the U.S. Centers for Disease Control and Prevention (CDC) to ensure appropriate care and response, including outreach and communications, laboratory testing, contact tracing, obtaining vaccine to support local vaccination efforts for people who may have been exposed and making antiviral treatment more widely available in California. 

Additionally, CDPH is promoting awareness amongst health care providers and the public about appropriate testing and infection control when patients with suspected monkeypox disease are cared for in healthcare settings. CDPH is working to help health care providers and the public become familiar with the symptoms and appearance of monkeypox. 

UC Davis Health: What is Monkeypox? Symptoms, Transmission and Vaccination Questions Answered


(Video courtesy of UC Davis Health)

InterPride: Monkeypox & Pride: Know Before You Go! 


(Video courtesy of InterPride)

Where can I find more information?

Originally published on June 6, 2022

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