Monkeypox 101: Key Facts, Protection Strategies, and Latest Treatments

Mpox (previously monkeypox) virus outbreaks have become a concern in recent years, and global organizations like the World Health Organization (WHO) are taking note. The disease has spread rapidly at times and can potentially be dangerous. When we learn more about viral diseases, we can improve disease control and prevention, creating an opportunity to promote our own health and protect the well-being of those around us. Let’s take a closer look at the history of mpox, the symptoms it can cause, and essential strategies for protection.

What is monkeypox?

Monkeypox is a viral illness that was initially discovered in monkeys in 1958. The first cases of monkeypox were detected in humans in the 1970s. Although it gained its name because it was first detected in monkeys, it’s crucial to recognize that it can also be carried and transmitted between other animals and humans or from human to human.

In 2022, scientific and medical communities began transitioning to the name ‘mpox’ for improved clarity regarding its origins and to address the potential for stigmatization. Because many people seeking to learn more about the disease may still refer to the disease as monkeypox, this article uses the two terms interchangeably.

Interestingly, mpox is similar to smallpox, and smallpox vaccines offer some protection against mpox. Disease prevention efforts like widespread vaccination resulted in the declaration of a functional eradication of smallpox in 1980. As the focus on smallpox prevention has waned, the potential for more mpox outbreaks may increase.

In general, mpox has been considered less dangerous than smallpox. However, similar to other viruses, different strains or ‘clades’ of mpox have been discovered. Some of these may cause more severe illness or may be more likely to cause death.

Recent outbreaks of mpox in central and west Africa have been linked to clade 1b, which is associated with higher death rates. This has led the WHO to declare a public health emergency.

Symptoms and transmission

Most cases of mpox in humans could be traced back to central or western Africa in years past. Many cases were residents of the area, had traveled in the area, or had encountered infected animals or pets from these regions. However, a growing number of cases have also occurred in other countries worldwide in recent years. This has been considered a global outbreak.

Mpox typically spreads through direct contact rather than air but can be transmitted during prolonged face-to-face contact. It’s usually transmitted in the following ways:

• Close contact (e.g., skin-to-skin)
• Touching shared items (e.g., towels, sheets, or clothing)
• During pregnancy, from an infected mother to her child
• Contact with infected animals (e.g., bites, scratches, or handling infected meat or animal products)

It often takes about three weeks for symptoms to start, and people with the virus may be contagious up to about four days before symptoms begin. A rash that looks like blisters or pimples forms in numerous body areas, like the chest, hands, feet, or genitals. Scabs form as a result. Direct contact with broken skin, bodily fluids, or sexual contact with an infected person can result in transmission. Individuals remain contagious until scabs are no longer present and the areas fully heal, often two to four weeks after symptoms start.

Other symptoms of mpox can include:

• Muscle aches
• Fever
• Swollen lymph nodes
• Flu-like symptoms (e.g., exhaustion, headache, or cough)
• Bacterial skin infections associated with skin lesions

The symptoms can vary between individuals, and there is some potential overlap with other conditions. It’s essential to visit a healthcare professional. A laboratory test can help determine whether symptoms are caused by the mpox virus.

Monkeypox symptoms in kids

Cases of monkeypox in children cause similar symptoms along a similar timeline when compared to adults. Disease severity has been more of a concern in children, however. A higher rate of fatalities has been associated with mpox cases affecting children, particularly those under the age of 3–4. It is also suggested that fatality rates may be inflated due to underreporting of disease prevalence, but there may be a higher risk of death for younger individuals compared with adults.

General impact on health

Many cases of mpox are self-limiting and may ultimately not require treatment. Studies related to the longer-term impact of mpox infection are relatively limited. One study involving follow-up for up to six months reported a majority of people who have contracted mpox did not have lingering pain, scars, or other ailments affecting their lives.

Some individuals did experience lingering effects, however. Among individuals with more extensive infections or abscesses, scarring was more prominent, and a reduction in sexual function or overall quality of life was more likely. It’s important to seek care with your healthcare provider so any troubling symptoms can be managed effectively early on.

Globally, the WHO declared a Public Health Emergency of International Concern in August of 2024 to mobilize additional resources to help limit the spread of the virus. The Democratic Republic of the Congo (DRC) and its neighboring countries have been the focus of the current outbreak. As of mid-August 2024, there have been about 22,000 cases and more than 1,200 deaths associated with mpox in DRC.

Monkeypox vaccine

Among techniques for prevention, vaccines are often among the most effective options. Jynneos (international brand name Imvamune or Imvanex) has become the primary vaccine recommended during the current mpox outbreak.

Jynneos is a non-replicating, live-attenuated vaccinia vaccine. This means it uses a pox virus similar to mpox called the vaccinia virus to generate immunity. Because it doesn’t replicate, it cannot cause a viral illness.

This approach is similar to vaccines that protect against smallpox, like ACAM2000 (similar to Dryvax). Jynneos can also offer protection against smallpox. The vaccine was initially approved by the FDA in 2019 after safety evaluations determined no significant safety concerns. The vaccine has proved effective, offering protection against mpox strains circulating in late 2022 and early 2023 for an estimated 75% of individuals receiving one dose and 86% for those receiving two doses.

Key facts about the vaccine

Currently, the vaccine is recommended for specific groups of people who may be at a higher risk of exposure based on previous mpox spreading patterns. This includes individuals with occupational risk factors (i.e., healthcare workers) and sexual partners aged 18 and older of people assigned male at birth (AMAB) with other AMAB individuals, regardless of their gender identity, including those who are transgender and nonbinary, that have a history of the following within the last six months:

• A newly diagnosed sexually transmitted disease (STD)
• Multiple sex partners
• Sex at commercial venues
• Sex associated with large events in areas where mpox is circulating

The FDA also issued an emergency use authorization in 2022 for individuals under 18 at a high risk of exposure to mpox.

The vaccine is more effective when two doses are administered. Ideally, the second dose should be administered about 28 days after the first dose. Depending on the risk of exposure, additional boosters may be recommended on an individual basis. Boosters are often recommended within 2–10 years after initial vaccination.

Most vaccine side effects resolve on their own, but the severity can vary between individuals. The most common side effects of the mpox vaccine are:

• Injection site pain or swelling
• Headache
• Muscle aches
• Fever
• Fatigue

Jynneos became commercially available in the United States in 2024, allowing easier access. Speaking with your local healthcare provider can help you determine availability in your community — many clinics can order and administer the vaccine locally.

Does the smallpox vaccine protect against monkeypox?

The ACAM2000 vaccine was integral to eradicating smallpox and was routinely used in the United States until the early 1970s. Production methods have been updated over the years, but the mechanism of the action of the vaccine has remained consistent. It has also shown protective benefits for mpox and has been approved by the FDA to provide additional support during mpox outbreaks or crises.

However, it’s important to note that Jynneos is the preferred option when available. ACAM2000 has been associated with higher rates of side effects and is not recommended for individuals who are pregnant, have a weakened immune system or have certain other conditions. It’s important to discuss your health history with your healthcare providers to help weigh the benefits and risks of specific vaccines.

Latest treatment options

If you think you have been exposed to mpox or are starting to show symptoms, it’s critical to see a healthcare provider as soon as possible. This can help you confirm a diagnosis and receive appropriate care based on the severity of your symptoms. In many cases, a vaccine is recommended after suspected exposure to mpox.

Many recover with supportive care for rash-related symptoms or pain and do not need additional medications. For instance, diphenhydramine (Benadryl), calamine lotion, or Epsom salt baths can help with itching. Ibuprofen (Advil) and acetaminophen (Tylenol) can help with pain management.

Symptoms can become more severe for some, however, and may lead to eye infections, neurological conditions, or inflammation in or around the heart. Mpox may be more likely to cause concerning symptoms in individuals who are:

• Immunocompromised
• Pregnant
• Managing skin conditions like eczema
• Under the age of 18

New antiviral therapies are available through specific channels for these individuals or those who may experience severe complications.

Tecovirimat (TPOXX) is available through an Expanded Access-Investigational New Drug protocol in some clinic or hospital settings and to participants in an ongoing clinical trial (STOMP trial). Your local healthcare providers can help you determine whether you may be a good candidate for treatment and help you get involved if treatment is recommended. While tecovirimat has not reduced the length of time lesions are present, it has shown promising results in reducing the number of deaths in infected individuals.

Brincidofovir (Tembexa) is FDA-approved for treating smallpox and has been made available on a single-individual emergency-use basis for treating mpox. It is converted to cidofovir in the body, so it should not be combined with cidofovir. In practice, most individuals who receive brincidofovir are severely immunocompromized and also require therapy with tecovirimat.

Cidofovir (Vistide) is FDA-approved for eye infections caused by cytomegalovirus (CMV) in individuals with acquired Immunodeficiency syndrome (AIDS). Safety is a considerable concern due to possible side effects like kidney damage. Brincidofovir may be a safer option if emergency-use authorization is obtained.

How to protect yourself from monkeypox

It’s critical to be aware of how mpox is spread and who may be most at risk of severe illness. While it is not considered a sexually transmitted disease (STD) because it can also be spread in other ways, much of its transmission has been associated with sexual partners. Individuals with a weakened immune system may be at high risk for the development of severe disease.

Prevention strategies

To protect yourself and others, being aware of the geographic areas where mpox has been detected can be helpful. Of course, these areas can change over time, so staying up-to-date on what’s happening in your surrounding communities and any regions you travel to is beneficial.

Have open and honest conversations with your sexual partners about sexual history. Wearing protection like condoms is always recommended, but it’s essential to be aware that mpox can also spread from other parts of the body aside from the genitals. A condom will not reliably protect you from mpox in many cases.

Some individuals may be able to spread mpox without realizing they are infected. If you may be exposed while performing your job, or you or your sexual partner are at a high risk of exposure, a vaccination may be recommended. Vaccines can help slow down or prevent the spread of mpox in communities.

Precautions to take

If you have a confirmed mpox diagnosis, taking steps to prevent spreading it to others is critical. Some important considerations include:

• Avoiding travel until symptoms have resolved and your rash has fully healed (i.e., scabs are gone and new skin has formed).
• Regularly disinfecting surfaces in shared spaces like bathrooms and avoiding sharing objects or surfaces like towels, drinking glasses, bed sheets, or blankets.
• Covering furniture that cannot be washed.
• Wearing a mask and covering skin lesions when around others.
• Notify sexual partners and close contacts as soon as possible — vaccination may be recommended for these individuals and is ideally performed within four (up to 14) days of suspected exposure.

If you live with or care for someone managing mpox, remain mindful of close contact, shared objects or spaces, and wash your hands frequently. Consult your healthcare provider quickly to determine if a vaccine is recommended based on your circumstances.

Final thoughts

The spread of infectious diseases like mpox can be frightening, but there are steps you can take to protect yourself and the people around you. Stay informed about the spread of mpox and maintain open, honest communication with your partners. If you may have a higher risk of being exposed to mpox, getting vaccinated can help protect you and your community.