MPOX FAQs

About MPOX

Monkeypox is a rare disease that is caused by infection with the monkeypox virus. Monkeypox virus belongs to the Orthopoxvirus genus which includes the variola (smallpox) virus as well as the vaccinia virus, which is used in the smallpox vaccine.  Monkeypox is of public health concern because the illness is similar to smallpox and can be spread from infected humans, animals, and materials contaminated with the virus, but monkeypox is less transmissible than smallpox.  Monkeypox was first identified in 1958 and occurs primarily in Central and West African countries. Monkeypox cases have occurred in the U.S. (mostly related to international travel or importation of animals) but they remain very rare here.

Symptoms

In humans, symptoms of monkeypox can be similar but milder than symptoms of smallpox.

Symptoms can begin with:

• Fever
• Headache
• Muscle aches
• Backache
• Swollen lymph nodes
• Chills
• Exhaustion

Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient can develop a rash that progresses from being red and flat, to being a bump, to being water filled, to being pus-filled, to being a crust, often beginning on the face and then spreading to other parts of the body (like the extremities and genital areas).

The time from infection to symptoms for monkeypox is usually 7−14 days, but can range from 5−21 days. The illness typically lasts for 2−4 weeks.

Anyone who has symptoms of monkeypox, such as characteristic rashes or lesions, should contact a health care provider right away.

Transmission

Monkeypox is a viral infection that can spread through contact with body fluids, monkeypox sores, or shared items (such as clothing and bedding) that have been contaminated with fluids or sores of a person with monkeypox. Although monkeypox is not generally considered a sexually transmitted infection, it can be transmitted during sex through skin-to-skin and other intimate contact, regardless of gender or sexual orientation. Individuals with monkeypox may spread the virus through:

• Respiratory secretions through prolonged face-to-face interactions (the type that mainly happen when living with someone or caring for someone who has monkeypox)
• Direct skin-to-skin contact with rash lesions or infectious sores/scabs
• Sexual/intimate contact, including kissing, hugging, massaging and cuddling
• Living in a house and sharing a bed with someone
• Sharing towels or unwashed clothing

Monkeypox is NOT spread through casual brief conversations or walking by someone (like in a grocery store).

Monkeypox is contagious and spreads easily to others until scabs have fallen off and a new layer of skin has formed. To prevent the spread of monkeypox, PPHD recommends:

• Avoiding close physical contact with people who have symptoms, including sores or rashes
• Talking to your sexual partner(s) about any recent illness and being aware of new or unexplained sores or rashes
• Avoiding contact with contaminated materials
• Wearing personal protective equipment (i.e., mask, gloves, gown) if you cannot avoid close contact with someone who has symptoms
• Practicing good hand hygiene
• Speaking to your healthcare provider about getting tested if you have symptoms
• Staying in isolation until you are no longer considered infectious per public health guidance

Prevention

There are number of measures that can be taken to prevent infection with monkeypox virus:

• Isolate infected patients from others who could be at risk for infection.
• Practice good hand hygiene after contact with infected animals or humans. For example, washing your hands with soap and water or using an alcohol-based hand sanitizer.
• Avoid contact with animals that could harbor the virus (including animals that are sick or that have been found dead in areas where monkeypox occurs).
• Avoid direct contact with any materials, such as bedding or laundry, that has been in contact with a sick animal or patient. (Monkeypox virus can be killed with standard washing machine with warm water and detergent.)
• Use appropriate personal protective equipment (PPE) when caring for patients, which includes gown, gloves, respirator, and eye protection.
• Speak to your healthcare provider about getting tested if you have symptoms.
• See below for vaccine information.

Vaccine Eligibility

Due to a very limited supply of currently available vaccine from the federal government, PPHD is providing monkeypox vaccines by invitation only to the following select groups of persons identified through public health investigation, including:

• Persons confirmed by Public Health to have had high- or intermediate-risk contact with someone with monkeypox, as defined by CDC.
• Persons who attended an event/venue where there was high risk of exposure to an individual(s) with confirmed monkeypox virus through skin-to-skin or sexual contact. Public Health will work with event/venue organizers to identify persons who may have been present and at risk of exposure while at the venue.
• Gay or bisexual men and transgender persons 18 years and older who:
  • Were diagnosed with gonorrhea or early syphilis within the past 12 months; or
  • Are on HIV pre-exposure prophylaxis (PrEP); or
  • Attended or worked at a commercial sex venue or other venue where they had anonymous sex or sex with multiple partners (e.g., saunas, bathhouses, sex clubs, sex parties) within past 21 days; or
  • Had multiple or anonymous sex partners in the last 14 days including engaging in survival and/or transactional sex (e.g., sex in exchange for shelter, food and other goods and needs).

Public Health or clinic partners will directly communicate to eligible patients to provide details on how and where to access the JYNNEOS vaccine.

With the JYNNEOS vaccine supply extremely limited in the United States, residents who have not been contacted by Public Health or clinic partners are not able to be vaccinated at this time. Public Health will expand eligibility as additional doses are available in accordance with the national monkeypox vaccine strategy.

MPOX Q&A

What is MPOX?

Monkeypox is a rare disease that is caused by infection with the monkeypox virus and is related to the smallpox virus. It can be spread from infected humans, animals, and materials contaminated with the virus. While generally less severe and much less infectious than smallpox, monkeypox can be a serious illness.

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. The monkeypox is endemic (regularly found) in west and central African countries.

Should I be worried about MPOX?

While it's good to stay alert about any emerging public health outbreaks, the current risk of getting monkeypox 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 only typically contagious when symptoms like a rash are present, making it easier for infected individuals to isolate from others to prevent further spread.

Is monkeypox related to COVID-19?

No, monkeypox is a completely different disease and is not related to COVID-19. Monkeypox is much less contagious than COVID-19 and spreads much slower. This is partly because people with monkeypox are only usually contagious to people whom they've had very close contact with when they have symptoms like a rash, compared with COVID-19 which can spread through the air and when people do not have symptoms.

Does the monkeypox virus have variants?

All viruses change and evolve over time, however, the monkeypox virus mutates slower than coronaviruses.  There are two known variants of monkeypox virus - the variant recently identified in Europe and in the U.S. is the West African strain and tends to cause less severe disease.

Who can get MPOX?

Anyone can get monkeypox after having close physical contact with someone who has the infection, especially contact with infected lesions or other bodily fluids. 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 in the United States, including California. Though not exclusively, these cases include gay, bisexual, and other men who have sex with men, and household contacts.

How is monkeypox transmitted?

Monkeypox spreads primarily between people through direct contact with infectious sores, scabs, or body fluids, including during sex as well as activities like kissing and cuddling. It can be spread by respiratory secretions (talking, coughing, sneezing, breathing) during prolonged, face-to-face contact. At this time, it is not known if monkeypox can spread through semen or vaginal fluids. Monkeypox can also spread through touching contaminated materials, such as clothing and bedding.

What are the signs and symptoms of MPOX?

Monkeypox can 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 that progresses from red and flat, to a bump, to water-filled, to pus-filled, to a crust, often beginning on the face and then spreading to other parts of the body (like the arms, legs, and genitals). It may also be limited to one part of the body.

When is MPOX infectious?

Infection with monkeypox virus begins with an incubation period. A person is not contagious during this period. Usually, people are only infectious when they have symptoms, including rash.

The incubation period averages 7−14 days but can range from 5−21 days. During this period, a person does not have symptoms and may feel fine.

How serious is MPOX?

Most cases are mild but monkeypox can be severe and can also lead to death.

Is MPOX a sexually transmitted infection (STI)?

MPOX can spread from skin-to-skin contact, or because of contact with a contaminated surface or material. This includes close or intimate physical contact with infected people, including sexual contact, and especially when touching rashes or contaminated objects or surfaces. Scientists are trying to better understand if virus could be present in semen or vaginal fluids, but this has not previously been noted as a route of transmission.

How is MPOX prevented?

There are number of measures that can be taken to prevent infection with monkeypox virus, including:

• isolation of infected persons until their symptoms, including rash, has gone away completely,
• practicing good hand hygiene,
• avoiding close contact with people with symptoms like sores or rashes,
• avoiding contact with infected animals and materials contaminated with the virus,
• and using appropriate personal protective equipment (PPE) (like a mask, gown and gloves) when caring for others with symptoms.

What should someone do if they are exposed to MPOX 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 and local health departments may recommend a vaccine for those who are exposed to help prevent infection or decrease the seriousness of the illness.  Health care providers can also provide care for people who test positive.

Is there a MPOX vaccine?

• Two vaccines licensed by the U.S. Food and Drug Administration (FDA) are available for preventing monkeypox infection – JYNNEOS (also known as Imvamune or Imvanex) and ACAM2000. In the United States, there is currently a limited supply of JYNNEOS, although more is expected in coming weeks and months.
• There is an ample supply of ACAM2000. However, this vaccine should not be used in people who have some health conditions, including a weakened immune system, skin conditions like atopic dermatitis/eczema, or pregnancy. No data are available yet on the effectiveness of these vaccines in the current outbreak.
• People are considered fully vaccinated about 2 weeks after their second shot of JYNNEOS and 4 weeks after receiving ACAM2000. However, people who get vaccinated should continue to take steps to protect themselves from infection by avoiding close, skin-to-skin contact, including intimate contact, with someone who has monkeypox.
• To better understand the protective benefits of these vaccines in the current outbreak, CDC will collect data on any side effects and whether the way the person was infected makes any difference in how well the vaccine protects them.
• When properly administered before or after a recent exposure, vaccines can be effective tools at protecting people against monkeypox illness.

Vaccine Strategies to Prevent Monkeypox:

• Monkeypox Vaccine Post-Exposure Prophylaxis (PEP): For the current outbreak, this approach can be considered as “standard PEP” for monkeypox. People can be vaccinated following exposure to monkeypox to help prevent illness from monkeypox virus. It is important that states and other jurisdictions identify contacts of confirmed or probable monkeypox cases to offer vaccine for PEP and to monitor for any early signs of illness. CDC recommends that the vaccine be given within 4 days from the date of exposure for the best chance to prevent onset of the disease. If given between 4 and 14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the disease. However, when coupled with self-isolation and other prevention measures when symptoms first occur, PEP is important for controlling outbreaks and preventing further transmission of monkeypox.
• Outbreak Response Monkeypox Vaccine Post-Exposure Prophylaxis (PEP)++: For the current outbreak, this expanded approach can be considered as “individual-directed PEP” for monkeypox; public health officials refer to it as “expanded PEP” or “PEP plus-plus” or “PEP++”.  People with certain risk factors are more likely to have been recently exposed to monkeypox. The PEP++ approach aims to reach these people for post-exposure prophylaxis, even if they have not had documented exposure to someone with confirmed monkeypox. When coupled with self-isolation and other prevention measures when symptoms first occur, PEP++ may help slow the spread of the disease in areas with large numbers of monkeypox cases—which would suggest a higher level of monkeypox virus transmission.
• Monkeypox Vaccine Pre-Exposure Prophylaxis (PrEP): This approach refers to administering vaccine to someone at high risk for monkeypox (for example, laboratory workers who handle specimens that might contain monkeypox virus).  At this time, most clinicians in the United States and laboratorians not performing the orthopoxvirus generic test to diagnose orthopoxviruses, including monkeypox virus, are not advised to receive monkeypox vaccine PrEP.

Vaccine Eligibility Prioritization:

Due to a very limited supply of vaccine available from the federal government, the vaccine is available by invitation to the following groups only:

• Persons confirmed by Public Health to have had high- or intermediate-risk contact with someone with monkeypox, as defined by CDC.
• Persons who attended an event/venue where there was high risk of exposure to an individual(s) with confirmed monkeypox virus through skin-to-skin or sexual contact. Public Health will work with event/venue organizers to identify persons who may have been present and at risk of exposure while at the venue.
• Gay or bisexual men and transgender persons 18 years and older who:
  • Were diagnosed with gonorrhea or early syphilis within the past 12 months; or
  • Are on HIV pre-exposure prophylaxis (PrEP); or
  • Attended or worked at a commercial sex venue or other venue where they had anonymous sex or sex with multiple partners (e.g., saunas, bathhouses, sex clubs, sex parties) within past 21 days; or
  • Had multiple or anonymous sex partners in the last 14 days including engaging in survival and/or transactional sex (e.g., sex in exchange for shelter, food and other goods and needs).

Public Health or clinic partners will directly communicate to eligible patients to provide details on how and where to access the JYNNEOS vaccine.

With the JYNNEOS vaccine supply extremely limited in the United States, residents who have not been contacted by Public Health or clinic partners are not able to be vaccinated at this time. Public Health will expand eligibility as additional doses are available in accordance with the national monkeypox vaccine strategy.

What is CDPH doing about MPOX?

CDPH 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 laboratory testing, contact tracing, and obtaining vaccine to support local vaccination efforts for high-risk contacts (people who have been exposed).

Additionally, CDPH is promoting awareness amongst health care providers and the public, including appropriate infection control for monkeypox cases in the healthcare setting. Because monkeypox is rare and the possibility of transmission during intimate or sexual contact may not be well known, 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)

Where can I find more information?

• CDPH Monkeypox Health Alert
• CDPH Monkeypox homepage
• Centers for Disease Control and Prevention (CDC)- Monkeypox
• CDC – Monkeypox: Get the Facts
• World Health Organization (WHO)- Monkeypox

Image: MPOX virus, illustration. Maurizio de Angelis/Science photo library