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Monkeypox

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This webpage was created to inform and support nurses through this evolving public health emergency. ANA stands ready to help disseminate evidence-based information to both nurses and the public, and to counter misinformation and diminish stigma around the virus.

See also our recent news release: ANA Calls for a Swift and Coordinated Response to Contain the Monkeypox Outbreak.

 

NEW  Webinar - Preparing Nurses for Infectious Disease Threats This Fall and Winter: COVID-19, Monkeypox, Influenza, and Others. Monday Oct 24, 2022, 01:00 PM EST

This FREE webinar sponsored by APIC & ANA will describe the infectious diseases likely to be circulating this fall and winter, such as COVID-19, Monkeypox virus (MPV), influenza, and others. Learn about the infection prevention strategies needed to protect nurses from occupational exposure, and how to minimize spread from patient to patient in healthcare settings. Register HERE.

 

What is Monkeypox?

Monkeypox is a rare disease caused by infection with the monkeypox virus. Monkeypox virus is part of the same family of viruses as variola virus, the virus that causes smallpox. Monkeypox symptoms are similar to smallpox symptoms, but milder, and monkeypox is rarely fatal. Monkeypox is not related to chickenpox.

Monkeypox was discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research. Despite being named “monkeypox,” the source of the disease remains unknown. However, African rodents and non-human primates (like monkeys) might harbor the virus and infect people. The first human case of monkeypox was recorded in 1970. The CDC is currently tracking an outbreak of monkeypox that has spread across several countries that don’t normally report monkeypox, including the United States.

It is important to note that anyone can get monkeypox, and it is a public health concern for all of us. When we discuss Monkeypox, it is important that nurses and other clinicians keep our messages accurate and fact-based, and use language that does not marginalize or stigmatize those populations most affected.

To learn more information about Monkeypox, visit the CDC Monkeypox webpage, and FAQS, and the World Health Organization Monkeypox webpage.

To find data on the current Monkeypox Case Count, visit the CDC 2022 U.S. Map & Case Count, and the CDC 2022 Monkeypox Outbreak Global Map.

Transmission

Monkeypox is caused by a virus that can spread from animals to people. It can spread between people when someone has contact with someone who is infected with monkeypox or touches materials that are contaminated with the virus.

Monkeypox can spread to anyone through:

  • Direct contact with monkeypox rash or scabs on a person's skin.
  • Contact with objects, fabrics (clothing, bedding, or towels), and surfaces that have been used by someone with monkeypox.
  • Contact with respiratory secretions during prolonged, face-to-face contact.

Monkeypox can be spread during intimate contact, including:

  • Oral, anal, and vaginal sex, or touching the genitals or anus of a person with monkeypox.
  • Hugging, massage, kissing, or talking closely.
  • Touching fabrics, shared surfaces, and objects that were used by a person with monkeypox, such as bedding, towels, fetish gear and sex toys.

A pregnant person can spread the virus to their fetus through the placenta.

A person with monkeypox can spread it to others from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks.

To learn more about how monkeypox can spread, visit CDC's How it Spreads webpage.

Signs and Symptoms

People with monkeypox get a rash that may be located on or near the genitals (penis, testicles, labia, and vagina) or anus and could be on other areas like the hands, feet, chest, face, or mouth.

  • The rash will go through several stages, including scabs, before healing.
  • The rash can initially look like pimples or blisters and may be painful or itchy.

Other symptoms of monkeypox can include:

  • Fever
  • Chills
  • Swollen lymph nodes
  • Exhaustion
  • Muscle aches and backache
  • Headache
  • Respiratory symptoms (e.g. sore throat, nasal congestion, or cough)

You may experience all or only a few symptoms

  • Sometimes, people have flu-like symptoms before the rash.
  • Some people get a rash first, followed by other symptoms.
  • Others only experience a rash.

Monkeypox symptoms usually start within 3 weeks of exposure to the virus. If someone has flu-like symptoms, they will usually develop a rash 1-4 days later. Monkeypox can be spread from the time symptoms start until the rash has healed, all scabs have fallen off, and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks.

Visit the CDC Signs and Symptoms webpage for more comprehensive and detailed information.

Clinicians should visit the CDC Clinical Recognition webpage to find important information on key characteristics for identifying Monkeypox.

Testing, Treatment and Vaccination

Testing

When to Get Tested

People who think they have monkeypox, or have had close personal contact with someone who has monkeypox, should visit a healthcare provider to help them decide if they need to be tested. If your healthcare provider decides that you should be tested, they will work with you to collect the specimens and send them to a laboratory for testing.

Testing in the Healthcare Setting

Effective communication and precautionary measures between specimen collection teams and laboratory staff are essential to maximizing safety when manipulating specimens suspected to contain monkeypox virus. A labeling system should clearly distinguish all specimens, including those from patients with suspected monkeypox virus infection, which require special handling. Personnel who collect specimens should use personal protective equipment (PPE) in accordance with recommendations for healthcare settings.

Visit the CDC Preparation and Collection of Specimens webpage for more comprehensive and detailed information.

See also For Monkeypox Testing, Use Lesion Swab Samples to Avoid False Results: FDA Safety Communication July 15, 2022.

Treatment (from the CDC Interim Clinical Guidance for the Treatment of Monkeypox)

Many people infected with monkeypox virus have a self-limiting disease course in the absence of specific therapy. However, the prognosis for monkeypox depends on multiple factors, such as previous vaccination status, initial health status, concurrent illnesses, and comorbidities among others. Patients who should be considered for treatment following consultation with CDC might include:

  • People with severe disease (e.g., hemorrhagic disease, confluent lesions, sepsis, encephalitis, or other conditions requiring hospitalization)
  • People who may be at high risk of severe disease:
    • People who are immunocompromised
    • Pediatric populations, particularly patients younger than 8 years of age
    • People with a history or presence of atopic dermatitis, persons with other active exfoliative skin conditions (e.g., eczema, burns, impetigo, varicella zoster virus infection, herpes simplex virus infection, severe acne, severe diaper dermatitis with extensive areas of denuded skin, psoriasis, or Darier disease)
    • Pregnant or breastfeeding women
    • People with one or more complications (e.g., secondary bacterial skin infection; gastroenteritis with severe nausea/vomiting, diarrhea, or dehydration; bronchopneumonia; concurrent disease or other comorbidities)
  • People with monkeypox virus aberrant infections that include accidental implantation in eyes, mouth, or other anatomical areas where monkeypox virus infection might constitute a special hazard (e.g., the genitals or anus)

Currently there is no treatment approved specifically for monkeypox virus infections. However, antivirals developed for use in patients with smallpox may prove beneficial against monkeypox. The following medical countermeasures are currently available from the Strategic National Stockpile (SNS) as options for the treatment of monkeypox: Tecovirimat (also known as TPOXX, ST-246); Vaccinia Immune Globulin Intravenous (VIGIV); Cidofovir (also known as Vistide); and Brincidofovir (also known as CMX001 or Tembexa).

Monkeypox can commonly cause severe pain and can affect vulnerable anatomic sites, including the genitals and oropharynx, which can lead to other complications. See Clinical Considerations for Pain Management of Monkeypox for more information.

Visit the Patient’s Guide to Monkeypox Treatment with TPOXX, and the CDC Treatment Information for Healthcare Professionals webpage for more comprehensive and detailed information.

Vaccination

Because Monkeypox virus is closely related to the virus that causes smallpox, the smallpox vaccine can protect people from getting monkeypox. Past data from Africa suggests that the smallpox vaccine is at least 85% effective in preventing monkeypox. Vaccines are effective at protecting against monkeypox when given before exposure, and experts also believe that vaccination after a monkeypox exposure may help prevent the disease or make it less severe. The sooner an exposed person gets the vaccine, the better. The CDC recommends that the vaccine be given within 4 days from the date of exposure in order to prevent onset of the disease. If given between 4–14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the disease.

ACAM2000 and JYNNEOS (also known as Imvamune or Imvanex) are the two currently licensed vaccines in the United States. On August 9, 2022, the U.S. Food and Drug Administration issued an emergency use authorization (EUA) for the JYNNEOS vaccine to allow healthcare providers to use the vaccine by intradermal injection for individuals 18 years of age and older who are at high risk for infection. Find dosage and administration information on the ACAM2000 vaccine, and the Jynneos vaccine webpages.

Visit the CDC Healthcare Professionals Monkeypox and Smallpox Vaccine Guidance webpage for more comprehensive and detailed information.

See also the Vaccines: Monkeypox webpage for links to key monkeypox vaccine resources from Immunize.org, and other partners.

Infection Prevention in Healthcare Settings and at Home

Infection Prevention in Healthcare Settings

Human-to-human transmission of monkeypox virus occurs by direct contact with lesion material or from exposure to respiratory secretions. Reports of human-to-human transmission describe close contact with an infectious person. Transmission in healthcare settings has been rarely described.

Infection prevention and control recommendations for healthcare settings are provided in the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007). Recommendations and practices described in this 2007 guideline are intended to be used when providing care for any patient in a healthcare setting, including those with monkeypox infection. Additional supporting infection prevention and control information specific to Monkeypox is provided on the CDC Infection Prevention and Control of Monkeypox in Healthcare Settings webpage, which includes this recommendation for PPE:

PPE used by healthcare personnel who enter the patient's room should include:

  • Gown
  • Gloves
  • Eye protection (i.e., goggles or a face shield that covers the front and sides of the face)
  • NIOSH-approved particulate respirator equipped with N95 filters or higher

Additional information can be found in the CDC Clinician FAQS.

Infection Prevention at Home

Take the following steps to prevent getting monkeypox:

  • 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.
  • Avoid contact with objects and materials that a person with monkeypox has used.
    • 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, especially before eating or touching your face and after you use the bathroom.

Find additional information on the CDC Prevention webpage.

See also the CDC Safer Sex, Social Gatherings, and Monkeypox webpage.

If You Have Monkeypox at Home

CDC recommends that people with monkeypox remain isolated at home or at another location for the duration of illness, which typically lasts two to four weeks. Current data suggest people can spread monkeypox from the time symptoms start until all symptoms have resolved, including full healing of the rash with formation of a fresh layer of skin. However, if a person with monkeypox is unable to remain fully isolated throughout the illness, they should do the following:

  • While symptomatic with a fever or any respiratory symptoms, including sore throat, nasal congestion, or cough, remain isolated in the home and away from others unless it is necessary to see a healthcare provider or for an emergency.
    • This includes avoiding close or physical contact with other people and animals.
    • Cover the lesions, wear a well-fitting mask (more information below), and avoid public transportation when leaving the home as required for medical care or an emergency.
  • While a rash persists but in the absence of a fever or respiratory symptoms
    • Cover all parts of the rash with clothing, gloves, and/or bandages.
    • Wear a well-fitting mask to prevent the wearer from spreading oral and respiratory secretions when interacting with others until the rash and all other symptoms have resolved.
    • Masks should fit closely on the face without any gaps along the edges or around the nose and be comfortable when worn properly over the nose and mouth.
  • Until all signs and symptoms of monkeypox illness have fully resolved
    • Do not share items that have been worn or handled with other people or animals. Launder or disinfect items that have been worn or handled and surfaces that have been touched by a lesion.
    • Avoid close physical contact, including sexual and/or close intimate contact, with other people.
    • Avoid sharing utensils or cups. Items should be cleaned and disinfected before use by others.
    • Avoid crowds and congregate settings.
    • Wash hands often with soap and water or use an alcohol-based hand sanitizer, especially after direct contact with the rash.

Find additional information on the CDC Isolation and Prevention Practices for People with Monkeypox webpage.

Monkeypox in Special Populations

HIV

People with advanced HIV, and those who are not virologically suppressed with antiretroviral therapy can be at increased risk of severe disease related to monkeypox virus infection.

To learn more about how monkeypox can affect those with HIV visit the Monkeypox and HIV section of the CDC FAQS, and the CDC Clinical Considerations for Treatment and Prophylaxis of Monkeypox Virus Infection in People with HIV webpage.

See also the MMWR Interim Guidance for Prevention and Treatment of Monkeypox in Persons with HIV Infection, United States, August 2022, and the CDC Health Advisory Severe Manifestations of Monkeypox among People who are Immunocompromised Due to HIV or Other Conditions.

Pediatrics

Historically, monkeypox has been documented in children and adolescents living in endemic regions. Once illness occurs, the clinical presentation is expected to be similar to that in adults. However, it is not known whether children are more susceptible to monkeypox than adults or whether clinical outcomes differ from those in adults. Monkeypox can spread through contact with the fluids (e.g., lesion exudates and respiratory secretions) of people or animals with monkeypox or through contact with fomites (e.g., shared clothing, towels, toiletries, and bedding). Monkeypox also can be transmitted to the fetus during pregnancy or to the newborn by close contact during and after birth.

CDC Key points:

  • Monkeypox should be considered when children or adolescents present with a rash that could be consistent with the disease, especially if epidemiologic criteria are present.
  • Young children, children with eczema and other skin conditions, and children with immunocompromising conditions may be at increased risk of severe disease.
  • Treatment should be considered on a case-by-case basis for children and adolescents with suspected or confirmed monkeypox who are at risk of severe disease or who develop complications of monkeypox. Tecovirimat is the first-line medication to treat monkeypox, including in children and adolescents.
  • Children and adolescents with exposure to people with suspected or confirmed monkeypox may be eligible for post-exposure prophylaxis (PEP) with vaccination, immune globulin, or antiviral medication.

To learn more about how monkeypox can affect children, visit the CDC Clinical Considerations for Monkeypox in Children and Adolescents webpage, and the American Academy of Pediatrics Monkeypox FAQs.

Pregnancy and Breastfeeding

Data regarding monkeypox infection in pregnancy are limited. It is unknown if pregnant people are more susceptible to Monkeypox virus or if infection is more severe in pregnancy. Monkeypox virus can be transmitted to the fetus during pregnancy or to the newborn by close contact during and after birth.

The benefits of skin-to-skin contact and rooming-in on breastfeeding and infant physiology are well-known. However, given the risk of neonatal transmission of Monkeypox virus with close contact and potential for severe disease in newborns, direct contact between a patient in isolation for monkeypox and their newborn is not advised.

To learn more about how monkeypox can affect pregnancy and breastfeeding visit CDC Clinical Considerations for Monkeypox in People Who are Pregnant or Breastfeeding.

Schools, Child Care and Other Congregate Settings

Currently the risk of monkeypox to children and adolescents in the United States is low. However, this CDC webpage answers frequently asked questions about monkeypox in K-12 schools, early childcare and education programs, camps, sports leagues and other community settings serving children or adolescents. This information may also be helpful to parents who have questions about monkeypox.

Congregate living settings are facilities or other housing where people who are not related reside in close proximity and share at least one common room. This includes correctional and detention facilities, homeless shelters, group homes, college dormitories, and residential substance use treatment facilities. If a staff member, volunteer, or resident of a congregate living setting has a monkeypox virus infection, transmission could occur to others. See Considerations for Reducing Monkeypox Transmission in Congregate Living Settings for more information.

Education for Healthcare Clinicians

Here are videos and webinars to help educate and inform healthcare clinicians:

See also the CDC Clinician FAQS, and the CDC Information For Healthcare Professionals webpage.

The CDC Reducing Stigma in Monkeypox Communication and Community Engagement webpage is an excellent resource for emphasizing prevention strategies, symptom recognition, and the treatable nature of monkeypox to minimize fear and promote action and a sense of personal agency.

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