What you need to know about monkeypox

As the number of monkeypox cases in the U.S. races past 5,000, many people are wondering just how worried they should be about a potential infection. While the World Health Organization (WHO) recently declared the monkeypox outbreak a “public health emergency of international concern,” local health experts say that education about the virus will play a vital role in slowing its spread.

Here are the most important facts to know about monkeypox and how to avoid getting it:

What is monkeypox?
Monkeypox is a viral infection caused by the monkeypox virus, which is in the same family of viruses as the one that causes smallpox. Until recently, it was rare, with most cases seen in Central and West African countries, primarily the Democratic Republic of Congo. However, many recent cases have been linked to international travel in non-African countries and attendance at events with activities in which people engage in close, sustained skin-to-skin contact.

How is monkeypox spread?
Monkeypox is usually spread via direct person-to-person contact through sores on the body, saliva or other body fluids. This can occur during sexual activity, kissing, cuddling or touching parts of the body of a person with monkeypox. It can also be spread by respiratory droplets during prolonged close (within 6 feet), face-to-face contact but this form of transmission is uncommon.

Additionally, handling clothing or linens that have been worn or used by someone with monkeypox can lead to infection. And pregnant people can spread the virus to their fetus through the placenta.

What are the symptoms of monkeypox?
According to Dr. Peter Binstock, chair of the Sharp HealthCare Infection Prevention Committee, some people with monkeypox have developed severe pain or complications necessitating medical treatment, including hospitalization, during the current outbreak.

Common symptoms of monkeypox include:

• Rash

• Fever

• Exhaustion

• Swollen lymph nodes

The rash evolves through stages — first resembling pimples, then blisters and firm pustules, then crusted sores. It can appear on the face, inside the mouth or on other parts of the body, including the hands, feet, chest, genitals and anus.

Some people notice a rash one to three days after experiencing a fever, with other symptoms following. Others may only have a rash, which can take several weeks to heal and can lead to scarring. In most people, symptoms — with or without a rash — develop 7 to 14 days after exposure but can occur up to 21 days after exposure. Additional symptoms include chills, headache, muscle aches and backache.

Who is at greatest risk of getting monkeypox?
According to the Centers for Disease Control and Prevention (CDC), the risk of monkeypox in the U.S. is currently believed to be low. However, anyone who comes into contact with a person with monkeypox can get it.

So far, most people with monkeypox have been adults. The WHO director recently reported that 98% of monkeypox cases worldwide have been reported in men who have sex with men. Gay, bisexual and other men who have sex with men are encouraged to reduce their number of sexual partners, reconsider sex with new partners, ask partners about recent illnesses or rashes, and exchange contact details with partners to enable follow-up, if needed.

Who may become severely ill if infected with monkeypox?
Like COVID-19, Dr. Binstock reports the virus is believed to be riskier for people with compromised immune systems. This includes those with HIV or individuals taking certain medications.

Others at risk for severe illness due to monkeypox include people who are younger than age 8 and people who are pregnant or breastfeeding. As with other pox viruses, there is concern a history of skin conditions, such as eczema, or atopic dermatitis, can increase the risk for serious illness due to monkeypox.

Complications of monkeypox infection include:

• Bacterial skin infection

• Gastroenteritis

• Pneumonia or other conditions

• Monkeypox rash involving the eyes, mouth or other areas of the body where infection might create a greater threat to health, including the genitals and anus

While no monkeypox-related deaths have been reported in the U.S. so far, the fatality rate for monkeypox in Africa has recently been estimated at around 3% to 6%. The strain of monkeypox responsible for infections in the U.S. has a reported mortality of 1%.

“With appropriate medical care, the fatality rate is probably much lower,” Dr. Binstock says. “However, monkeypox can lead to significant complications, such as secondary bacterial infections, severe pain and dehydration, that can be fatal if not treated properly.”

How can the spread of monkeypox be prevented?
Along with vaccination— recommended for people who have been in close contact with individuals who have monkeypox or who had multiple sexual partners in the past two weeks in an area with known monkeypox cases — the CDC recommends you:

• Avoid close, skin-to-skin contact with people who have a rash that looks like monkeypox.

• Do not touch the rash or scabs of a person with monkeypox.

• Do not kiss, hug, cuddle or have sex with someone with monkeypox.

• Do not share eating utensils or cups with a person with monkeypox.

• Do not handle or touch the bedding, towels or clothing of a person with monkeypox.

• Wash your hands often with soap and water or use an alcohol-based hand sanitizer.

What should you do if you think you may have monkeypox?
If you think you may have monkeypox, follow the CDC’s isolation guidelines:

• Contact your doctor.

• Remain isolated at home and away from people and pets unless it is necessary to see a healthcare provider or in an emergency. Cover the rash and sores with clothing, gloves or bandages; wear a well-fitting mask; and avoid public transportation when leaving the home for medical care or in an emergency.

• If a rash persists but all other symptoms have resolved, continue to cover all parts of the rash and wear a well-fitting face mask around others until rash crusts have fallen off and new skin forms.

• Until all symptoms have fully resolved, do not share items that have been worn, used or handled with other people or animals; wash and disinfect items that have been worn or handled and surfaces that have been touched; avoid close physical contact with other people; avoid crowds and congregate settings, such as residential facilities, dormitories and prisons; and wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially after direct contact with the rash.

“Talk with your doctor if you have come into contact with someone who has monkeypox, have had sex with multiple partners in areas where monkeypox is spreading or if you are experiencing symptoms,” Dr. Binstock says. “You can be tested for the virus, may be eligible for vaccination, and if your test result is positive, antiviral medications, such as tecovirimat — or TPOXX — may be used to treat your infection.”

Get monkeypox vaccine information and access to resources from the County of San Diego Health & Human Services Agency.