Dr. Jason Bowling clears up common questions about the monkeypox outbreak, including information on vaccines, transmission and treatment of the virus.
What is monkeypox?
Monkeypox is an orthopox virus. It is in the same family of viruses that includes smallpox, which people are very familiar with, and vaccinia virus. Vaccinia virus is important because it’s used in the vaccine that helps prevent smallpox and monkeypox.
What are the symptoms of monkeypox?
The symptoms of monkeypox are similar to the symptoms of smallpox, but they’re much milder. In a typical syndrome with monkeypox, people will start off with fever, muscle aches, fatigue — general non-specific viral infection symptoms.
After about a day or two of those symptoms, they can start to develop a rash, which classically began on the face, the arms and the legs, and maybe moves to the trunk.
What we’re seeing with the outbreak that started this year is that the symptoms can be a little bit different. Sometimes people don’t have the initial fever and muscle ache — they may just start off with a rash. And the rash may not be as distributed throughout the body. They may only have a few lesions.
Many of the people in this current outbreak have lesions in the genital area or perigenital area, so it’s a little bit different than the classic presentation we’re familiar with from prior outbreaks and infections with monkeypox.
When should I seek medical attention for monkeypox?
If you know that you’ve been exposed to somebody that has confirmed monkeypox, it’s important to reach out to your medical provider. Public health might be reaching out to you because they’re doing contact tracing on people that have known exposures so they can provide them with vaccine to hopefully reduce their risk of having monkeypox.
Otherwise, if you don’t have a known exposure but if you have a fever and a rash, that’s something you’d want to get evaluated. Again, this rash can look different for different people.
It tends to start as flat lesions and then it can progress to what looks like little bumps or pimples, and then move into blisters before it starts to scab over and eventually fall off with new skin, kind of like what you see with someone with chickenpox. The rash can be really painful initially, and then as it starts to scab and fall off, it can be really itchy.
How do I get tested for monkeypox?
Testing for monkeypox right now is through a PCR test, but it’s PCR testing of skin lesions, so you have to have the skin lesion or rash to get tested. Your provider will swab the top of the rash a couple of times, and those swabs will be sent off to the specialized lab where they do PCR testing to confirm that it’s monkeypox.
How serious is monkeypox? Is it fatal?
Monkeypox can be caused by a couple of different strains. Fortunately the strain that’s causing this current global outbreak and the cases in the United States is causing milder infections. So fortunately, most people who get monkeypox have symptoms that go away and they don’t end up in the hospital.
In the United States outbreak there haven’t been any deaths so far. It’s not as serious as it could be, and fortunately most people don’t end up in the hospital, but it’s still something to be aware of.
Does monkeypox leave lasting scars or consequences?
Monkeypox can leave scars. Any time you have a viral infection that causes a rash, there’s a potential that you could get an infection of the rash, you could get scars from that, similar to having chickenpox or other viruses that cause a rash.
But most people don’t. The lesions will resolve, they’ll scab over and the new skin will form.
And it doesn’t seem to cause long-lasting symptoms like we hear about with long-COVID. We’ll need to continue to follow this monkeypox outbreak, this is a little bit different than monkeypox outbreaks we’ve seen in the past, but so far we’re not seeing long-lasting symptoms other than the disease itself which lasts about two to four weeks. But after it’s resolved, people are not complaining of long-lasting symptoms.
How is monkeypox treated?
There is treatment for monkeypox. Fortunately most people in this outbreak have not required treatment, they’ve just have supportive care, which means they stay hydrated, they rest at home and they take some ibuprofen or Tylenol as needed for pain or fever. But they haven’t required specific treatment.
There is a treatment available through the CDC. This treatment is actually approved for smallpox, and it’s in the national stockpiles in case we had an outbreak of smallpox, which fortunately we do not have. But it can also be used to treat monkeypox, and it’s reserved for people who have severe cases of monkeypox.
So if it was a rare case that ended up in a hospital or an immunocompromised person, or somebody who had skin lesions in a place that was causing problems like in the throat and you were unable to eat or drink, that might be a good candidate for treatment.
Their provider would apply through the CDC to get this medication to treat it. The treatment comes in pill form that you can take by mouth, or through an IV, so you can get it in a couple of different ways.
How is monkeypox spread?
There is still some ongoing study with this outbreak so we can have a better understanding of that. The predominant way it’s being spread is by prolonged skin to skin contact with someone that has lesions of monkeypox. This can happen with close encounters, intimate encounters, sexual encounters, but it’s actually the skin to skin itself, not what we normally think of with sexually transmitted diseases where it’s being transmitted by other bodily fluids.
There’s still ongoing research to see what other bodily fluids contain monkeypox. It can also be transmitted if there is contaminated bed sheets or clothing from somebody that has the monkeypox lesions. Those pustules can have fluid in them and if that fluid contaminates sheets and someone handles those sheets, that’s another potential avenue of getting infected.
It can also be transmitted by large respiratory droplets, but it’s not clear how effective it’s transmitted in that way. They haven’t had, so far in this outbreak with these contact tracings, found anyone that’s contracting monkeypox from a casual conversation with somebody else. And even with somebody that’s traveled in an airplane close to somebody else with monkeypox, they haven’t seen transmission that way or through health care encounters.
So respiratory doesn’t seem to be as effective a means of transmission. It’d be something you’d be concerned about for household contact — someone that spends a prolonged time talking to somebody closely could potentially be a method of transmission.
How do you clean and disinfect surfaces that may have been contaminated with monkeypox?
Monkeypox is an envelope virus, which means it responds readily to disinfectants. It’s like SARS-CoV-2, the virus that causes COVID-19, or influenza virus, which causes the flu. All of those respond really well to EPA-registered disinfectants.
If you’re going to disinfect surfaces in your house to check the label. There’s an EPA-registered number on there and you can see if it’s registered for that. If it’s active against flu it’s going to be active against monkeypox.
Hand hygiene is important, so washing your hands with soap and water or an alcohol-based hand rub.
For silverware and plates, it’s important that you can use the dishwasher so you don’t have to use separate utensils if someone else in the house had monkeypox and you were trying to not get it yourself, it’s okay if you run it through the dishwasher with hot water and detergent or if you hand wash it with hot water and soap.
How long should people plan to isolate with a monkeypox infection?
The short answer is two to four weeks — it depends on the skin lesions.
One of the challenges with monkeypox infection is that it lasts for a while. A person can potentially be transmissible from the skin lesions, which are the major way that someone should transmit it to somebody else, until those skin lesions have scabbed or fallen off or new skin has grown there. That can take around two to four weeks in an average case of monkeypox, so people are potentially transmissible in that time period.
The CDC would ideally like somebody to stay home that whole time period, but practically speaking that may not be feasible. What’s important is if someone leaves the house, if they have to go to the grocery store or something else, is that they keep all of those skin lesions covered. They can wear long sleeves, they can wear pants and gloves.
It’s also recommended if they’re going to have prolonged face to face contact with somebody, the person with monkeypox should wear a well-fitting mask.
The FDA now allows a smaller dose of the JYNNEOS vaccine for monkeypox. How does that work?
JYNNEOS is the vaccine that’s currently available and recommended for preventing monkeypox. The challenge is there’s not a huge supply of that right now. The vaccine manufacturer is working on making more JYNNEOS vaccine so that we can distribute it more widely in the United States and globally so we can cut down this outbreak faster.
The initial dosing of the JYNNEOS vaccine — it’s a two-dose vaccine — you give a dose and four weeks later you give a second dose. It was studied by giving it through the subcutaneous tissue, which is the layer of fat right underneath the skin like a standard vaccine.
However, they’ve studied and seen that if you give the injection in the skin layer itself, not going through to the fat but stopping in the skin layer, you can still get a good immune response while using less vaccine. You can actually use one-fifth or 20% of the vaccine amount and still get a good response.
By doing that, we can extend the limited vaccine supply by five. So because of that, it’s recommended for people that are age 18 and older that are getting the monkeypox vaccine that it be administered in the skin layer itself so we can have more doses for everybody.