Monkeypox (Mpox)

Mpox, formerly known as monkeypox, is a viral illness that can affect anyone through close contact with an infected person or animal. Most people recover fully within a few weeks, but understanding the symptoms and how to protect yourself can help prevent the spread of this disease.

Table of contents

• What is mpox?
• How the disease spreads
• Signs and symptoms
• How mpox is diagnosed
• Treatment and care
• Prevention and protection
• Vaccination
• Special considerations

What is mpox?

Mpox is an infectious disease caused by the monkeypox virus, which belongs to the same family of viruses that causes smallpox^[1]. The virus was first discovered in 1958 when outbreaks occurred in colonies of monkeys kept for research, which is how it got its original name. However, the first human case was not recorded until 1970 in what is now the Democratic Republic of Congo^[8].

The disease has been renamed “mpox” to follow modern guidelines for naming illnesses that recommend avoiding names that could cause offense or unnecessary negative effects^[2]. While the disease itself has been renamed, the virus that causes it still carries its historic name.

Mpox is considered a zoonotic disease, meaning it can spread between animals and people^[2]. The virus is endemic to, or regularly found in, parts of Central and Western Africa. Scientists suspect that African rodents and non-human primates such as monkeys might harbor the virus and infect people^[2].

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monkeypox, mpox virus infection

How the disease spreads

There are two main types of monkeypox virus, called clades. Clade I is found in Central Africa and tends to cause more serious illness, though recent outbreaks have been less deadly. Clade II is found in East Africa and is generally less severe^[4]. A global outbreak of clade II mpox began in 2022 and continues today^[1].

Mpox spreads from person to person mainly through close contact with someone who has the disease. This includes skin-to-skin contact such as touching or sex, mouth-to-mouth or mouth-to-skin contact such as kissing, and being face-to-face with someone who has mpox during activities like talking or breathing close to one another^[1].

The virus can also spread through contact with contaminated materials such as clothing, bedding, or towels that have touched an infected person’s rash or body fluids^[1]. Additionally, people can catch mpox from infected animals through bites, scratches, or eating undercooked meat from an infected animal^[4].

During pregnancy, the virus may be passed from a pregnant person to the fetus, or to the newborn during or after birth^[1]. People remain infectious from the onset of symptoms until all lesions have scabbed and healed, and a fresh layer of skin has formed^[1].

It is important to note that anyone can get mpox through these types of contact. While cases have been identified in certain groups, particularly men who have sex with men during the 2022 outbreak, the disease is not limited to any specific population^[19].

Signs and symptoms

The time from exposure to the onset of symptoms, called the incubation period, typically ranges from three to seventeen days, though it can be as long as 21 days^[9][3]. Symptoms usually last from two to four weeks^[1].

Common symptoms of mpox include a skin rash or mucosal lesions which can last two to four weeks, accompanied by fever, headache, muscle aches, back pain, low energy, and swollen lymph nodes^[1]. The swollen lymph nodes are an important feature that can help distinguish mpox from other similar diseases^[17].

Not everyone with mpox develops all symptoms. Some people may experience only a rash with no other symptoms, while others may have flu-like symptoms first, followed by a rash. A few people do not develop a rash at all^[4].

The rash caused by mpox can appear as sores on the mouth, face, hands, feet, penis, vagina, or anus. Some people have a widespread rash covering many areas of the body, while others have only a few bumps or blisters^[4]. The rash goes through several stages over two to four weeks: it may start as flat, red bumps which can be painful, then the bumps become raised, turn into blisters, fill with pus, and finally crust over and fall off^[4].

Some people develop inflammation inside the rectum that can cause severe pain, as well as inflammation of the genitals that may cause difficulties urinating^[17]. People who have rash in or around the anus or genitals may benefit from sitting in a shallow warm bath, called a sitz bath, which can offer relief^[16].

How mpox is diagnosed

If you think you might have mpox, it is important to see a healthcare provider as soon as possible^[16]. Doctors typically diagnose mpox by examining the rash and taking a sample from the lesions to test for the virus^[1].

Diagnosis can be confirmed by testing a lesion for the virus’s DNA using a method called polymerase chain reaction (PCR)^[9]. This involves taking a tissue sample or swab from the rash or lesions. Healthcare providers may also take blood samples as part of the diagnostic process^[12].

It is important to distinguish mpox from other conditions that cause similar rashes, such as chickenpox or other skin infections^[9]. Your healthcare provider will consider your symptoms, exposure history, and test results to make an accurate diagnosis.

Treatment and care

Most people with mpox recover fully within two to four weeks without special treatment^[16]. The main approach to treatment is supportive care, which means managing symptoms such as pain and fever, with close attention to nutrition, hydration, skin care, prevention of secondary infections, and treatment of other conditions if present^[1].

For symptom relief, medicines like ibuprofen or acetaminophen can help reduce pain and fever. Your healthcare provider may prescribe stronger pain relievers if needed^[16]. For itching, oral antihistamines such as Benadryl and topical creams such as calamine lotion or petroleum jelly may provide relief^[16].

Caring for the rash is important. Try not to touch or scratch the rash, and do not lance or pop the lesions, as this does not speed recovery and can lead to infection^[16]. If you accidentally touch the rash, wash your hands immediately with soap and water. Topical gels containing benzocaine or lidocaine can be used for temporary pain relief^[16].

There is no specific treatment approved for mpox virus infections, but there are medications that were developed for smallpox that may help in severe cases^[10]. An antiviral drug called tecovirimat (also known as TPOXX) is available for certain patients with mpox. This medication is primarily used for people who are severely ill or at high risk for severe disease, such as those with weakened immune systems, pregnant people, or young children^[10].

However, recent clinical trials have shown that while tecovirimat is safe, it did not reduce the time it took for mpox lesions to heal compared to placebo^[10]. Despite this, the medication remains available for high-risk patient populations.

Most people can recover at home. It is important to stay hydrated by drinking plenty of fluids, eat nutritious foods, and get plenty of rest to allow your body to heal^[16]. If pain becomes severe and unmanageable at home, or if you develop complications such as severe eye infections, difficulty breathing, or other concerning symptoms, contact your healthcare provider immediately^[16].

Prevention and protection

There are several important steps you can take to protect yourself and others from mpox. The most important is to avoid close contact, including sexual contact, with people who have symptoms or a confirmed case of mpox^[22].

If you need to have contact with or live with someone who has symptoms, take these precautions: encourage the person to isolate and cover any skin lesions if possible, wear a face mask when in close proximity, avoid skin-to-skin contact, wear disposable gloves if you have direct contact with lesions, and wash your hands regularly with soap and water or alcohol-based hand sanitizer^[22].

Washing clothes, towels, bed sheets, and dishes used by someone with mpox in hot water with detergent is important^[22]. Clean and disinfect all surfaces that may have been touched by the infected person using household disinfectants^[20].

If you have mpox, there are important steps to prevent spreading it to others. Stay isolated at home or in another location for the duration of your illness^[20]. Friends, family, or others without an essential need to be in the home should not visit. Avoid close contact with others and with pets in the home^[20].

Cover your rash with gauze or bandages to limit spread to others and to the environment^[16]. Wear a well-fitting mask around other people until the rash and all other symptoms have resolved^[20]. Do not share potentially contaminated items such as bed linens, clothing, towels, drinking glasses, or eating utensils^[20].

If possible, use a separate bathroom. If there is not a separate bathroom in the home, clean and disinfect surfaces such as counters, toilet seats, and faucets after each use^[20]. You should remain isolated until all scabs have fallen off and a fresh layer of intact skin has formed^[20].

Vaccination

Vaccination is an important tool for preventing mpox. There are vaccines available, and vaccination should be considered along with other public health measures^[1]. People at high risk of the illness or who were recently exposed to the virus may be able to get the vaccine^[3].

No vaccine has been developed specifically against mpox, but smallpox vaccines have been found to be effective^[9]. Smallpox vaccination, which was routine in many countries until the 1970s, may be up to 85 percent effective against mpox^[24].

Healthcare experts recommend getting vaccinated if you are at higher risk for mpox^[4]. Vaccination can help prevent the illness or reduce its severity if you do become infected. A strategy called ring vaccination, which involves vaccinating an infected person’s contacts and their contacts, has been effective for smallpox and may also work for mpox^[24].

Special considerations

Certain groups of people may be at higher risk for severe mpox disease and complications. These include newborn babies, children (particularly those younger than eight years of age), people who are pregnant or breastfeeding, and people with underlying immune deficiencies such as from advanced HIV disease^[17][13].

During pregnancy, information about mpox infection is limited, but serious adverse pregnancy outcomes have been reported, including preterm birth, pregnancy loss, and stillbirth^[6]. The signs and symptoms of mpox appear similar in pregnant and non-pregnant people, but it is unknown if pregnant people are more susceptible to mpox or if infection is more severe during pregnancy^[6].

For pregnant people with suspected or confirmed mpox infection, enhanced precautions are required. The benefits of skin-to-skin contact with a newborn must be balanced with the risk of transmitting the virus, so direct contact between a patient in isolation for mpox and their newborn is not advised^[6]. Breast milk expressed from a person who is symptomatic or isolated should be discarded while breastfeeding is delayed^[6].

People with certain skin conditions, such as eczema or atopic dermatitis, may be at increased risk for more severe outcomes from mpox^[20]. Those who are severely immunocompromised are at particular risk of uncontrolled viral spread, which can be life-threatening^[10].

Severe disease due to mpox may include larger, more widespread lesions (especially in the mouth, eyes, and genitals), secondary bacterial infections of the skin or blood, and lung infections. Complications can include severe bacterial infection from skin lesions, mpox affecting the brain (encephalitis), heart (myocarditis), or lungs (pneumonia), and eye problems^[17].

According to available data, between 0.1 percent and 10 percent of people with mpox have died. The mortality rate varies depending on which clade of virus caused the infection and the person’s overall health status^[17][2]. Most deaths have been related to secondary infections and occurred in people with other health conditions^[15].