What to know about Mpox

Clinical Editor: Megan Dodson, PA-C

The WHO declared an mpox public health emergency on August 14, 2024 as cases continue to rise across the Democratic Republic of the Congo and other countries in Africa. This occurs as low-level mpox transmission continues in the US after the 2022 outbreak. Here’s everything we know about the disease so far:

Mpox (formerly known as monkeypox) is a disease caused by a virus in the same family as smallpox. However, it’s usually much less severe. The disease was given its name after it was first detected among colonies of laboratory monkeys in 1958. The first human case was reported in 1970. Since then, mpox has been primarily found in Central and West Africa, with most cases occurring in the Democratic Republic of Congo and Nigeria.

A new strain of mpox (clade 1b) has emerged since the mpox outbreak in 2022 (which was caused by the clade II strain).

Mpox is spread through close contact with an animal, human, or materials contaminated with the virus, such as clothing or bedding. The most common means of transmission for this current outbreak is skin-to-skin contact, and it can also be transmitted through respiratory droplets. Though mpox can be transmitted through close contact during sex, it is not a sexually transmitted disease.

Humans can also contract the virus from infected animals through a bite or scratch, or direct contact with their skin, blood, or feces.

Within 7 to 14 days of exposure, infected individuals typically experience flu-like symptoms such as fever, headache, muscle aches, chills and exhaustion, along with swollen lymph nodes and back ache. Within 1 to 3 days of having a fever, people develop a rash. The rash may start on the face or in the genital area, and then may spread to other parts of the body, including the arms, legs, hands, and feet. This rash, which can appear as raised, pearly, fluid-filled blisters, goes through several stages over the course of 2 to 4 weeks, before the lesions crust over and the scabs fall off. An individual with mpox is no longer considered contagious once all the scabs have fallen off and new skin has formed.

If you have symptoms consistent with mpox, take the following steps:

1. Isolate immediately, since individuals with mpox are contagious from the time that symptoms appear until the scabs fall off and new skin forms. Visit the CDC website for detailed guidance on how to remain isolated at home and keep household members safe. If you have symptoms such as body aches, fatigue, fever, headache, or swollen lymph glands, isolate while you reach out to your healthcare provider. Your healthcare provider can help you with a plan to determine whether your symptoms are due to mpox or other causes.
2. Reach out to your healthcare provider or local health department. They can discuss with you how to take care of yourself while you’re sick, and arrange for testing.
3. Notify anyone you've been in close contact with since your symptoms started.

Currently, there are no treatments specifically approved for mpox. However, mpox and smallpox viruses are genetically similar, which means that antiviral drugs developed to protect against smallpox may be used to treat mpox virus infections for people who are hospitalized with severe disease or are at higher risk of severe illness.

The antiviral medication TPOXX is an “investigational new drug” (IND) being studied as a potential treatment for mpox. It is not FDA-approved or authorized. Individuals who believe they might have mpox can contact the STOMP trial at 1-855-876-9997 to find out whether they are eligible for the trial and for treatment with TPOXX.

If you’re not sure if antiviral treatment is right for you, please reach out to your healthcare provider.

For those who are diagnosed with mpox and are not at high risk for severe illness though, there are a few ways to still manage symptoms without antiviral treatment. Here are a few steps you can take to feel better:

• Take pain relievers/fever reducers such as acetaminophen or ibuprofen
• Sitz baths may help lesions in the genital area feel better
• Calamine lotion for itching or painful sores
• Rest and fluids are also important to prevent dehydration.

If you’ve been exposed to a person or animal who is suspected of having or has been diagnosed with mpox, reach out to your healthcare provider or contact your local health department right away.

Post-exposure vaccination helps prevent mpox if given within 4 days after exposure. Vaccination up to 14 days after exposure may help make your symptoms less severe if you do get mpox. People who have been fully vaccinated or who have a history of confirmed mpox infection do not need post-exposure vaccination.

Close contacts may resume daily activities and are not required to quarantine. However, they are encouraged to monitor for symptoms for 21 days after the exposure and isolate immediately if symptoms develop.

Jynneos, a live vaccine designed for smallpox, is protective against mpox. It is expected to protect against all circulating strains of the virus. The vaccine schedule is two doses, 28 days apart. No boosters are recommended for the general population without occupational exposure.

The CDC recommends vaccination if:

• You had known or suspected exposure to someone with mpox
• You had a sex partner in the past 2 weeks who was diagnosed with mpox
• You are a gay, bisexual, or other man who has sex with men or a transgender, nonbinary, or gender-diverse person who in the past 6 months has had any of the following:
  • A new diagnosis of one or more sexually transmitted diseases (e.g., chlamydia, gonorrhea, or syphilis)
  • More than one sex partner
• You have had any of the following in the past 6 months:
  • Sex at a commercial sex venue (like a sex club or bathhouse)
  • Sex related to a large commercial event or in a geographic area (city or county for example) where mpox virus transmission is occurring
• You have a sex partner with any of the above risks
• You anticipate experiencing any of the above scenarios
• You are at risk for occupational exposure to orthopoxviruses (e.g., certain people who work in a laboratory or a healthcare facility).

Although the news of this outbreak may be alarming, public health experts have said that mpox is not likely to pose the same threat or have the same impact as COVID-19. While mpox can be transmitted between humans, it does not spread easily from person to person. Human transmission of mpox requires prolonged close contact, so it’s not thought to be as contagious or infectious as COVID-19. Additionally, most cases of mpox that have occurred in the U.S. have been mild and resolved on their own in a few weeks.

Originally published May 24, 2022.