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Monkeypox Outbreak: What to Know About Variants and More

A computer image of a monkeypox virus
Uma Shankar Sharma/Getty Images

What's happening

The monkeypox outbreak is a global and national public health emergency.

Why it matters

To stop monkeypox from becoming a disease that regularly circulates in the US, we need to slow the outbreak with tools like vaccines and testing.

What it means for you

Anyone can get monkeypox, but men who have sex with men are currently the people most impacted. If you have an unexplained sore or think you may have been exposed, seek medical care.

The monkeypox outbreak is still growing as dozens of countries continue reporting cases. As of the end of last week, there have been more than 11,000 cases in the US alone. 

To reflect that monkeypox is no longer a regional illness concentrated in African countries, the World Health Organization announced Friday that it has changed the names of the two monkeypox variants or "clades" from the Congo Basin/Central Africa clade to "Clade I" and the West African clade to "Clade II." Clade II is the one currently circulating in the outbreak, it has two subvariants and it's typically less severe than Clade I. 

The WHO also said that it's still working on finding a new name for monkeypox, which was named before current practices on naming viruses and diseases were in place. Anyone can submit a new name idea by creating an account through the WHO. 

Monkeypox is a disease caused by an orthopoxvirus that belongs to the same family as the viruses that cause smallpox and cowpox. It's endemic in West and Central Africa, and reports of it in the US have been rare but not unheard of. (There were two reported cases in 2021 and 47 cases in 2003 during an outbreak linked to pet prairie dogs.) It's a zoonotic disease, which means it's transmitted from animals to humans. The way monkeypox is spreading effectively between people is new to this global outbreak.

Monkeypox symptoms might also be a little different compared with earlier outbreaks, and the disease appears to be spreading by way of "new modes of transmission, about which we understand too little," WHO Director General Dr. Tedros Adhanom Ghebreyesus said during a July 23 press conference. The CDC has warned that some cases of monkeypox might be getting missed in testing, and that the monkeypox rash could be mistaken for other common infections, like herpes.

Because most cases of monkeypox are occurring in men who have sex with men, there's a current link to sexual contact, and the WHO and the CDC have issued recommendations for safer sex for those who are at higher risk of getting monkeypox, including encouraging the exchange of contact information with sexual partners in case there's an exposure. But it's important to remember that anyone can get monkeypox, and the myth that only gay men are affected could have lasting consequences, including ignoring the potential spread of the outbreak in other populations.

"Stigma and discrimination can be as dangerous as any virus," Tedros said.

Here's what to know about monkeypox.

Four different photos of monkeypox blemishes and rashes

Examples of monkeypox "pox" or rashes. 

NHS England High Consequence Infectious Diseases Network

What happens now that monkeypox is a public health emergency in the US?

As of early August, monkeypox is a public health emergency in the US. The declaration will open up more funding and resources needed to respond to the outbreak, including vaccines, testing and treatments. The Biden administration announced the formation of a White House monkeypox response team to advise the administration on how to stop the outbreak. 

"We are applying lessons learned from the battles we've fought -- from COVID response to wildfires to measles, and will tackle this outbreak with the urgency this moment demands," White House National Monkeypox Response Coordinator Robert Fenton said in a press release

The federal responses come after criticism over inadequate vaccine access and testing, and a general lack of awareness of the outbreak. The US Department of Health and Human Services said last week that an additional 786,000 doses of monkeypox vaccine will soon be available to states. The CDC last month announced that the number of tests US labs could run for monkeypox grew from 6,000 to 80,000 specimens per week.

"This should end," Dr. Eric Cioe-Pena, director of global health for New York's Northwell Health, told Healthline. "If it becomes endemic, it's a failure of public health."

Is there a test for monkeypox? When should I get tested?

The test involves taking a swab from a lesion or sore to test for the virus that causes monkeypox. For people who first develop flulike symptoms before lesions or sores appear, that may mean waiting for lesions or "pox" to appear. But if you have symptoms, get tested and isolate at home. 

If you were exposed to monkeypox but don't have any symptoms, you don't need to isolate, according to the CDC. But you should continue to monitor yourself for symptoms and take your temperature twice daily, if you can. 

The CDC advises reminding your health care provider that monkeypox is circulating. If you think you have monkeypox but are turned down for a test, don't be afraid to seek a second or third opinion to get the care you need. Testing availability is expanding as the outbreak progresses, but because symptoms can vary and monkeypox was previously rare in the US, health providers may initially mistake it for other illnesses.

What are the symptoms of monkeypox?

Symptoms of monkeypox in humans are similar to (but usually significantly milder than) those of smallpox, which the WHO declared eliminated in 1980. 

A monkeypox infection can begin with flulike symptoms -- including fatigue, headache, fever and swollen lymph nodes -- followed by a rash, but some people will only develop the rash, according to the CDC. The monkeypox rash or individual sores can look like pimples or blisters and can be found pretty much anywhere on the body, including the hands, genitals, face, chest and inside the mouth or anus. Lesions can be flat or raised, full of clear or yellowish fluid and will eventually dry up and fall off.

You can spread monkeypox until the sores heal and a new layer of skin forms, according to the CDC. Illness typically lasts for two to four weeks. The incubation period ranges from five to 21 days, according to the CDC, which means people will most likely develop symptoms within three weeks of being exposed. For some people, monkeypox lesions can be very painful.

Monkeypox doesn't have the same ability to infect people that the virus that causes COVID-19 has, says Dr. Amesh Adalja, an infectious-disease expert and senior scholar at the Johns Hopkins Center for Health Security. Monkeypox is generally understood to not be contagious during the incubation period (the time between being exposed and symptoms appearing), so it "doesn't have that ability to spread the way certain viruses like flu or SARS-CoV-2 can," Adalja said, referring to the coronavirus.

How do you catch monkeypox?

Monkeypox spreads between people primarily through contact with infectious sores, scabs or bodily fluids, according to the CDC, but it can also spread through prolonged face-to-face contact via respiratory droplets or by touching contaminated clothing or bedding. (Think the close contact you'd have with a sexual partner, the contact you have with strangers dancing at a club, or the contact you have with a household member whom you kiss, hug or share towels with.) Research is underway on whether (or how well) monkeypox can be spread through semen or vaginal fluid.

The "close" in close contact is a key element in the transmission of monkeypox. That, along with the fact that the virus that causes monkeypox appears to have a slower reproduction rate than the COVID-19 virus, sets it apart from the ongoing COVID-19 pandemic, Dr. Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, said in June at a media briefing.

The majority of the cases in the US recently have been in men who have sex with men, the CDC says. Gay and bisexual communities tend to have particularly "high awareness and rapid health-seeking behavior when it comes to their and their communities' sexual health," Dr. Hans Henri P. Kluge, the WHO's regional director for Europe, said in a statement at the end of May, noting that those who sought early health care services should be applauded.

To help slow the spread of the disease, Tedros, the WHO director-general, on Wednesday said men who have sex with men should consider temporarily reducing the number of sexual partners they have, or making sure they get the contact information of all sexual partners, in case of an exposure. 

The CDC issued recommendations regarding safer sex and monkeypox if there's a chance you or a partner might have monkeypox and you decide to still have sex. The guidance includes alternatives to sex like mutual masturbation or virtual sex, avoiding kissing, and generally avoiding skin-to-skin contact.

Three vials of monkeypox vaccine

Depending on where they live, people at higher risk of catching monkeypox, including men with multiple recent sexual partners, may be able to get a monkeypox vaccine. However, supply has been limited and some people have reported trouble securing an appointment.

Getty Images

How severe is monkeypox? Is there treatment?

There are two clades or types of monkeypox virus, according to the WHO: the recently renamed Clade I and Clade II. Clade II, which has been identified in the recent cases, has had a fatality rate of less than 1% in the past. No deaths have been reported in the US. Clade I has a higher mortality rate of up to 10%, according to the WHO. 

Though the circulating strain of monkeypox is rarely fatal, according to the CDC, it can be very painful and may result in some scarring. Pregnant people, younger children, people with weakened immune systems and those with a history of eczema may be more likely to get seriously ill.

Antiviral medication like tecovirimat (TPOXX) can be used in people who are at risk of getting severely sick from monkeypox, according to the CDC. This treatment isn't approved specifically for monkeypox (it's meant for treating smallpox) and access to it has been restricted with paperwork and strict ordering instructions. However, the CDC recently loosened restrictions around the drug.

Pus filled monkeypox lesions on a hand

Monkeypox lesions progress through a series of stages before scabbing, according to the CDC. Though traditionally the rash starts on the face before becoming more widespread, monkeypox blemishes can be limited, resemble a pimple or other sore and aren't always necessarily accompanied by flulike symptoms.  

Getty Images/Handout

Is there a vaccine for monkeypox? 

Yes. The US Food and Drug Administration has approved Jynneos to prevent smallpox and monkeypox. Because monkeypox is so closely related to smallpox, vaccines for smallpox are also effective against monkeypox. In addition to Jynneos, the US has another smallpox vaccine in its stockpile, called ACAM2000. Because ACAM2000 is an older generation of vaccine with harsher side effects, it's not recommended for everyone, including people who are pregnant or immunocompromised.

Jynneos is the vaccine currently available to people who are at higher risk of getting monkeypox, or may have already been exposed to it. The FDA recently authorized a new way of giving people Jynneos that will stretch out the limited supply through intradermal vaccination, which requires a lower dose of vaccine compared to subcutaneous injection. (Basically, now people will get the vaccine under a top layer of skin as opposed to the standard shot that goes right into the arm.) 

Vaccinating people who've been exposed to monkeypox is what Adalja calls "ring vaccination," where health officials isolate the infected person and vaccinate their close contacts to stop the spread. But vaccinating people with a confirmed exposure, in addition to people at risk of being exposed in the near future, may be crucial to getting control of the outbreak, according to the White House's chief medical adviser, Dr. Anthony Fauci. 

Dr. Daniel Pastula, chief of neuroinfectious diseases and associate professor of neurology, medicine and epidemiology at the University of Colorado Anschutz Medical Campus, said the vaccine is used in people who've been exposed but aren't yet showing symptoms of monkeypox, because the incubation period for the disease is so long.

"Basically what you're doing is stimulating the immune system with the vaccine, and getting the immune system to recognize the virus before the virus has a chance to ramp up," Pastula said. 

Though health care and lab professionals who work directly with monkeypox are recommended to receive smallpox vaccines (and even boosters), the original smallpox vaccines aren't available to the general public and haven't been widely administered in the US since the early 1970s. Because of this, any spillover or "cross-protective" immunity from smallpox vaccines would be limited to older people, the WHO said

Read more about what we know about the monkeypox vaccine

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The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.