Monkeypox

Signs and symptoms

In humans, the symptoms of monkeypox are similar to but milder than the symptoms of smallpox.

The illness typically lasts 2–4 weeks.

Symptoms can include:

  • A rash that can look like pimples or blisters that appears on the face, inside the mouth, and on other parts of the body, such as hands, feet, chest, genitals, or anus
  • Fever
  • Headache
  • Muscle aches
  • Backache
  • Swollen lymph nodes (lymphadenopathy)
  • Chills
  • Exhaustion

The rash goes through different stages before healing completely.

Sometimes, people get a rash first, followed by other symptoms. Others may only experience a rash.

Generally, within 1–3 days (sometimes longer) after the appearance of fever, the patient develops the rash, often beginning on the face then spreading to other parts of the body.

Lesions progress through the following stages before falling off: macules, papules, vesicles, pustules, and scabs.

Transmission and incubation period

The incubation period for monkeypox (the time from exposure to symptoms) is roughly 1–2 weeks. This longer incubation period allows for potential post-exposure-prophylaxis of close contacts with immunization if contact tracing can be conducted and close contacts can be identified quickly.

Monkeypox spreads in different ways. The virus can spread from person-to-person through:

  • Direct contact with the infectious rash, scabs, or body fluids
  • Respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex
  • Touching items (such as clothing or linens) that previously touched the infectious rash or body fluids
  • Pregnant people can spread the virus to their fetus through the placenta.

It’s also possible for people to get monkeypox from infected animals, either by being scratched or bitten by the animal or by preparing or eating meat or using products from an infected animal.

Monkeypox can spread from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed.

People who do not have monkeypox symptoms cannot spread the virus to others. At this time, it is not known if monkeypox can spread through semen or vaginal fluids.

Prevention

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.
    • 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.

Isolation and monitoring of contacts

Individuals experiencing symptoms of monkeypox should isolate and seek testing and medical care as necessary. You are considered infectious and should isolate until the rash has fully healed and a fresh layer of skin has formed, which can take 2–4 weeks.

Close contacts should monitor for symptoms and check their temperature twice a day for 21 days from the time of their last known exposure to monkeypox. Medium and high-risk close contacts are recommended for vaccination, which generally would include those who had direct contact with, or were within six feet of the individual for three hours or more, while that individual was symptomatic. Contacts do not need to quarantine from work, school, or other activities as long as they remain symptom-free. If a contact develops symptoms within the 21-day period, they should isolate, seek testing, and contact their primary care provider as needed.

Treatment

There are no treatments specifically for monkeypox virus infections. However, monkeypox and smallpox viruses are genetically similar, which means that antiviral drugs and vaccines developed to protect against smallpox may be used to prevent and treat monkeypox virus infections.

Antivirals, such as tecovirimat (TPOXX), may be recommended for people who are more likely to get severely ill, like patients with weakened immune systems.

If you have symptoms of monkeypox, you should talk to your health care provider, even if you don’t think you had contact with someone who has monkeypox.

If you are a student and believe you may have monkeypox, or a new rash, or have been exposed to monkeypox, contact your campus health center or email the Office of the Chief Health Officer at cho@iu.edu for further guidance.