When the World Health Organization (WHO) and U.S. Centers for Disease Control and Prevention (CDC) declared the current monkeypox outbreak a public health emergency here and around the world, it left people with a lot of questions, including: What is monkeypox, exactly? What’s my risk for getting monkeypox? Do I or my children need the monkeypox vaccine?
Hilary Babcock, MD, Washington University infectious diseases doctor and BJC HealthCare chief quality officer, answers these questions and more.
What is monkeypox?
Monkeypox is a disease caused by the monkeypox virus, which is part of the same family of viruses as the one that causes smallpox. Although monkeypox symptoms are somewhat similar to smallpox, they are usually milder and infection with the strain circulating in the U.S. is rarely fatal, says Dr. Babcock.
Monkeypox is not related to the virus that causes chickenpox or shingles.
What are monkeypox symptoms?
In the current outbreak, monkeypox symptoms include:
An infected person can have one, some or all of these symptoms, and they can last for weeks.
Where did monkeypox come from and why are we worried about this outbreak?
The disease was named “monkeypox” when it was first discovered in 1958 in a group of monkeys used for research, but scientists think it probably originated in rodents. It was first diagnosed in humans in 1970.
In several countries in central or western Africa, monkeypox is endemic — meaning that cases are found there more frequently, at a fairly predictable level. Before the current outbreak, monkeypox cases outside of Africa were almost always linked to international travel to these countries or to infected animals imported from these countries.
Global health organizations are concerned about the current monkeypox outbreak because the virus has been spreading from person to person in countries where it is not endemic and cases are occurring that are not linked to travel.
On July 23, 2022, when the WHO declared monkeypox a global health emergency, cases had been reported from 75 countries. Cases have been found in both Missouri and Illinois and they continue to rise. This map shows the current extent of the outbreak.
How dangerous is monkeypox?
The mortality rate for the type of monkeypox identified in this outbreak is about 1%, according to the CDC. Although it is rare for people to die from monkeypox, those with weak immune systems, children under age 8, and pregnant or breastfeeding people are more likely to develop complications or die.
Monkeypox can be disfiguring and extremely painful, with lesions making eating, drinking, urinating and bowel movements difficult. Most hospitalizations during the current outbreak are for pain control, says Dr. Babcock.
How does monkeypox spread?
Monkeypox spreads through very close personal contact. The most common means of transmission is direct contact with an infected person’s monkeypox rash or scabs. The virus can also be transmitted through contact with the body fluids of an infected person; touching clothing, bedding or towels that came in contact with infected skin or body fluids; or having extended close contact with the respiratory secretions of an infected person, such as when sneezing or coughing.
Although monkeypox can be transmitted through sexual contact, the CDC explains that monkeypox is not strictly a sexually transmitted disease, but a disease for which sexual contact is one of the methods of transmission.
Dr. Babcock notes that because of the way it is transmitted, people are very unlikely to become infected with monkeypox through casual contact. Contact generally must be very close and more prolonged for the virus to spread.
“The virus tends to spread through members of closely linked social networks,” she says. “This is very different than COVID-19,” she says. “You’re not going to get it going to the grocery store.”
Who is at risk for getting monkeypox?
While anyone can contract monkeypox infection, in the current outbreak, the virus has spread primarily through close intimate contact among men who have sex with men and occasionally people who share a household with a person who is infected.
At this point, cases in children in the U.S. are rare and children are at low risk of catching monkeypox at school or daycare, says Dr. Babcock.
Efforts to contain the current monkeypox outbreak are important to keep the virus from spreading widely, she says.
“The virus spreads in closely linked social networks, but social networks are not closed networks,” Dr. Babcock notes. “Although the risk to any one person is currently very low, it’s not zero.”
What is the treatment for monkeypox?
There are no treatments developed specifically to treat the monkeypox virus. Sometimes the antiviral drug tecovirimat (TPOXX) is given to people who have or are at risk of severe disease.
Most treatment for monkeypox involves symptom management — mainly pain and fever control.
How do you avoid catching monkeypox?
The CDC recommends these three steps to avoid becoming infected with monkeypox:
Avoid close, skin-to-skin contact with people who have a rash that looks like monkeypox.
Don’t touch the rash or scabs of a person with monkeypox.
Don’t kiss, hug, cuddle or have sex with a person who has monkeypox.
Avoid touching objects or materials a person with monkeypox has used.
Don’t share utensils or cups with a person who has monkeypox.
Don’t handle or touch bedding, towels or clothing of a person with monkeypox.
Wash your hands often.
Wash your hands with soap and water or use alcohol-based hand sanitizer, especially after using the bathroom, before touching your face or before eating.
Who should get the monkeypox vaccine?
There are effective vaccines that are approved to prevent monkeypox. However, those vaccines are in short supply around the world and are currently recommended only for those at high risk for monkeypox. At this point, vaccine is being used for people who had or are likely to have close contact with a monkeypox case.
Currently, that is primarily men who have sex with men, and some others who have had extended close contact with a case. People who think they may have been exposed to monkeypox or think they are at high risk for contracting the disease should talk to their primary care doctor about whether they need to be vaccinated. Due to limited supply, vaccine is being distributed by health departments and is not available through individual providers.
Children do not need to be vaccinated against monkeypox at this time, says Dr. Babcock.
“There’s very little vaccine available and we want to get it to the people who need it most,” she says.
What should I do if I think I have monkeypox or have been exposed to the virus?
If you start experiencing symptoms of monkeypox or think you may have been exposed to the virus, you should call your primary care physician or the health department, or go to an urgent care center, says Dr. Babcock.
You should not go to a hospital emergency room.
“What we’re seeing are generally mild cases that don’t need hospital admission,” says Dr. Babcock.
She advises people to be informed, but not anxious, about the current outbreak if they’re not at high risk for catching the disease.
See more monkeypox information on the CDC website.
Click here for a copy of the CDC's informed consent form.