Monkeypox

Learn about the signs and symptoms

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 Michigan. 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 symptom, and monkeypox spread takes place through prolonged direct, close contact.   This is different from COVID-19, which spreads through the air and can be spread when people do not have symptoms.

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 Michigan. 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 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 lesions
• 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. 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. Severe cases can occur, especially in 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 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, with infected people, especially when touching rashes or contaminated objects or surfaces. 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 rash on the genitals and anus, including herpes and syphilis. It’s always important to talk to a health care provider as soon as you notice unusual rashes or sores.

How is Monkeypox Prevented?

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

• Always talk 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 sex, with people with symptoms like sores or rashes
• Practicing good hand hygiene
• People who become infected should isolate until their symptoms are improving or have gone away completely. Rash should always be well covered until completely healed.
• Using appropriate personal protective equipment (PPE) (like a mask, gown and gloves) when caring for others with symptoms
• Avoiding contact with infected materials contaminated with the virus
• Avoiding contact with infected animals

What Should Someone do if they are Exposed to Monkeypox or have Symptoms?

Contact a health care provider as soon as possible and let them know you have symptoms or have been exposed to monkeypox. Health care providers can provide testing and care for people who are diagnosed with monkeypox.

What Teatments are Available for Monkeypox?

There are currently no treatments specifically for monkeypox. However, monkeypox and smallpox viruses are genetically similar, which means that 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, like patients with weakened immune systems, or people with complications from the infection or symptoms not controlled with supportive care.

If you have monkeypox symptoms such as a new or unexplained rash, talk to a health care provider, even if you don't think you had contact with someone who has monkeypox.  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 or topical gels or creams.

Do I Need to get Vaccinated against Monkeypox?

The Centers for Disease Control and Prevention (CDC) and Michigan Department of Health and Human Services (MDHHS) recommend that people aged 18 or older 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 have been present in settings where monkeypox cases have occurred.

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 clinicians and public health workers who collect monkeypox specimens.

MDHHS is making the JYNNEOS vaccine available to protect against monkeypox. However, there is currently an extremely limited supply from the Strategic National Stockpile. More doses should be arriving in Michigan in the coming weeks.

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.

When Should I get Vaccinated for Monkeypox if I Have Been Exposed?

The Centers for Disease Control and Prevention (CDC) and Michigan Department of Health and Human Services (MDHHS) recommend that people aged 18 or older 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 have been present in settings where monkeypox cases have occurred.

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 healthcare workers (HCW) is low.  While supplies of vaccine continue to be limited, MDHHS 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 PPE) should be followed. PPE to prevent exposure is readily available and expected to be extremely effective.

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 BEDHD Doing About Monkeypox?

BEDHD is closely monitoring monkeypox transmission in the U.S. and Michigan to ensure rapid identification of cases. MDHHS 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 treatment only available from the Strategic National Stockpile.

Additionally, BEDHD 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. Because monkeypox is rare and the possibility of transmission during intimate or sexual contact may not be well known, BEDHD is working to help health care providers and the public become familiar with the symptoms and appearance of monkeypox.