Monkeypox is a rare disease caused by infection with the monkeypox virus. Monkeypox virus is part of the same family of viruses as the Mariola 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. Before the 2022 outbreak, monkeypox had been reported in people in several central and western African countries. Previously, almost all monkeypox cases in people outside of Africa were linked to international travel to countries where the disease commonly occurs or through imported animals. These cases occurred on multiple continents.
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 (TPO X), could be given to 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 healthcare provider, even if you don't think you had contact with someone who has monkeypox.
Most people with monkeypox recover fully within 2 to 4 weeks without the need for medical treatment.
Signs and Symptoms
People with monkeypox get a rash that may be located on or near the genitals or butt hole 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.
How long do monkeypox symptoms last?
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.
If You Have a New or Unexplained Rash or Other Symptoms...
Avoid close contact, or being intimate with anyone, until you have been checked out by a healthcare provider.
If you don't have a provider or health insurance, visit a public health clinic near you.
When you see a healthcare provider, wear a mask, and remind them that this virus is circulating in the area.
Monkeypox Testing Basics
Currently, testing is only recommended if you have a rash consistent with monkeypox.
If you think you have monkeypox or have had close personal contact with someone who has monkeypox, consider taking precautions and visit a healthcare provider to help you decide if you need to be tested for monkeypox.
Where to Get Tested
Only a healthcare provider can order a monkeypox test. The healthcare provider may take a specimen and send it to a lab for testing, or they may send you to a lab for both specimen collection and testing.
Contact your local health department with any questions and to find out what the testing options are for your community.
What to Expect When You Get Tested
You will likely need to fill out paperwork before you get tested.
To get a specimen to test, the healthcare provider will use a swab to rub vigorously across lesions of your rash. They will take swabs from more than one lesion.
This swabbing may be uncomfortable, but is necessary to get enough material to detect the monkeypox virus from the specimens.
The specimens will be tested in a lab to see if the monkeypox virus is detected.
Results are usually available within a few days.
While you are waiting for your results, take precautions to avoid getting or spreading the monkeypox virus to others.
What Your Results Mean
If your test result is positive, take the necessary steps to protect yourself and others until you have completely recovered from your infection.
If your test result is negative: a negative test result means the test did not detect the virus, and you probably do not have monkeypox. Continue to take steps to protect yourself and others.
If your test result is inconclusive: that means that your test will need to be conducted again because not enough of the specimen was taken.
Paying for Testing
The cost of monkeypox testing depends on where you get it.
Tests conducted by public health departments are usually free.
Testing referrals from a private healthcare provider to a commercial lab or tests done in the hospital may involve a fee.
For information on testing options in your community, contact your local health department.
Preventing Spread to Others
If you have monkeypox, you are advised to stay at home (isolate) if you have monkeypox symptoms, including until your monkeypox rash has healed and a new layer of skin has formed. Staying away from other people and not sharing things you have touched with others will help prevent the spread of monkeypox. Monkeypox can also spread to animals, so staying away from pets, livestock and other animals is important.
Not every person has the same ability or resources to remain at home for a long time. The table below provides options for how to prevent spreading monkeypox to others, organized by the risk of spread. Whenever possible, higher risk options should be avoided, and the lowest risk options should be followed.
Living Space
Remain alone in a home or where only others with monkeypox are located.
Cover upholstered furniture and porous materials that cannot be washed with sheets, blankets, tarps, and other covers.
Remain in a separate room in a home or facility away from others who do not have monkeypox.
Cover all upholstered furniture and porous surfaces with sheets, blankets, tarps, or other covers.
Wear a well-fitting mask and cover lesions while around others.
Disinfect surfaces (doorknobs, countertops) between each use.
Share space with others, but avoid close contact.
Do not share a bed with another person.
Wear a well-fitting mask and cover lesions while around others.
Disinfect surfaces (doorknobs, countertops) between each use.
Bathroom
Use a separate bathroom not shared by others.
Use a shared bathroom, but disinfect surfaces (counters, toilet seats, faucets, shower, bathtub) between each use.
Do not share towels, washcloths, or objects in the bathroom like toothbrushes or drink from the same glass.
Use a shared bathroom that is cleaned frequently.
Clean shared objects between use.
Do not share towels or washcloths, even if they have been washed in-between use.
Shared Items (linens, clothing, cups, dishes, eating utensils, etc.)
Do not share items with others.
Wash any items that will be used by others with detergent (or soap) and water thoroughly after each use.
Leaving Home to Get Supplies or Care
Do not leave your home (except for emergencies).
Have all supplies delivered without direct contact with others.
Only leave home for emergencies and essential activities while wearing a well-fitting mask, with all lesions fully covered.
Walk, bike, or drive by yourself if you need to leave. Avoid public transit.
Disinfect any shared vehicles.
Avoid ride-share services.
Perform limited daily activities outside the home with all lesions fully covered and wearing a well-fitting mask.
Avoid public transit as much as possible. If public transit is your only option, try to avoid busy transit times and keep as much distance between yourself and others as possible.
If you use ride-share services, minimize the number of passengers in the vehicle, keep as much distance as possible from the driver, wear a mask, and open windows if possible.
Working Away from Home
Do not leave your home for work. Telework instead.
Work in a separate space away from others with all lesions fully covered and wearing a well-fitting mask. Limit your time in the workplace as much as you can. Do not use shared spaces like break rooms, common bathrooms, meeting rooms, etc.
Disinfect your work surfaces after you finish your work.
Walk, bike, or drive yourself if you need to travel to work. Avoid public transit.
Disinfect any shared vehicles.
Avoid ride-share services.
Maintain as much distance between yourself, co-workers, and the public as you can.
Wear a well-fitting mask and cover rash while around others.
Clean/disinfect surfaces that could be used by others in common areas like break rooms, bathrooms, meeting rooms, etc.
Avoid public transit as much as possible. When not feasible, try to avoid busy transit times and keep as much distance between yourself and others as possible.
If you use ride-share services, minimize the number of passengers in the vehicle, keep as much distance as possible from the driver, wear a mask, and open windows if possible.
Living with Animals
Avoid contact with any pets in the home or other animals, especially mammals.
Minimize petting/touching of pets and other animals.
If touching animals, keep the rash fully covered to avoid contact between the rash and the animal.
Wear a well-fitting mask.
Disinfecting Home and Other Non-Healthcare Settings
People with monkeypox who do not require hospitalization may be isolated at home. Monkeypox spreads between people through direct contact with an infectious rash, body fluids, or by respiratory secretions during prolonged, face-to-face contact. Transmission of the Monkeypox virus is possible from the onset of the first symptoms until the scabs have separated, and the skin has fully healed.
During the infectious period, body fluids, respiratory secretions, and lesion material from people with monkeypox can contaminate the environment. Poxviruses can survive in linens, clothing, and on environmental surfaces, particularly when in a dark, cool, and low humidity environments. In one study, investigators found a live virus 15 days after a patient's home was left unoccupied. Studies show that other closely related Orthopoxviruses can survive in an environment, similar to a household, for weeks or months. Porous materials (bedding, clothing, etc.) may harbor the live virus for longer periods than non-porous (plastic, glass, metal) surfaces.
Orthopoxviruses are very sensitive to UV light. Despite the ability of Orthopoxviruses to persist in the environment, they are also sensitive to many disinfectants, and disinfection is recommended for all areas (such as home and vehicle) where a person with monkeypox has spent time, as well as, for items considered to be potentially contaminated.
Disinfectant
Use an EPA-registered disinfectant, following the manufacturer's instructions. Follow all manufacturer directions for use, including concentration, contact time, and care and handling. When choosing a disinfectant, it is important to consider any potential health hazards, and not mix disinfectants or add other chemicals. More considerations can be found here: Hazard Communication for Disinfectants Used Against Viruses | NIO SH | CDC. Follow these steps for safe and effective disinfectant use:
Check that your product is EPA-registered: Find the EPA registration number on the product.
Read the directions: Follow the product's directions. Check "use sites" and "surface types" to make sure this is the right product for your surface. Next, read the "precautionary statements."
Pre-clean the surface: Make sure to wash the surface with soap and water if the directions mention pre-cleaning or if the surface is visibly dirty. Dirt can keep the disinfectant from working.
Follow the contact time: Follow the instructions: The surface should remain wet for the amount of time indicated to ensure the product is effective. Reapply if necessary.
Cleaning and Disinfection
During isolation at home, people with monkeypox should clean and disinfect the spaces they occupy regularly to limit household contamination.
ISOLATING ALONE IN HOME: People with monkeypox who are isolated alone at home should regularly clean and disinfect the spaces they occupy, including commonly touched surfaces and items, to limit household contamination. Perform hand hygiene afterward using an alcohol-based hand rub (ABHOR) that contains at least 60% alcohol, or soap and water if ABHOR is unavailable.
ISOLATING WITH OTHERS IN A HOME: People with monkeypox who are isolated in a home with others who don't have monkeypox should follow the isolation and infection control guidance, and any shared spaces, appliances, or items should be disinfected immediately following use.
People who have recovered from monkeypox and whose isolation period has ended should conduct thorough disinfection of all the spaces within the home with that they had been in contact. Follow the steps below to minimize the risk of infection to others in your home after recovery.
If cleaning and disinfection are done by someone other than the person with monkeypox, that person should wear, at a minimum, disposable medical gloves and a respirator or well-fitting mask.
Standard clothing that fully covers the skin should be worn, and then immediately laundered according to the recommendations below.
Hand hygiene should be performed using an ABHOR, or soap and water if ABHOR is unavailable.
Focus on disinfecting items and surfaces that were in direct contact with the skin of the person with monkeypox, or often in the presence of the person with monkeypox, during isolation. If unsure, disinfect.
Do not dry dust or sweep, as this may spread infectious particles.
Wet cleaning methods are preferred, such as disinfectant wipes, sprays, and mopping.
Vacuuming is acceptable by using a vacuum with a high-efficiency air filter. If not available, ensure the person vacuuming wears a well-fitting mask or respirator.
Clean and disinfect household in the following order:
General waste containment
Collect and contain in a sealed bag soiled waste such as bandages, paper towels, food packaging, and other general trash items.
Laundry
Gather contaminated clothing and linens before anything else in the room is cleaned. Do not shake the linens as this could spread infectious particles.
Hard surfaces and household items
Upholstered furniture and other soft furnishings
Carpet and flooring
Waste disposal
Laundry
Used or contaminated clothing, linens and bedding materials, towels, and other fabric items should be contained until laundering. When at all possible, people with monkeypox should handle and launder their soiled laundry. Laundry should not be mixed with that of other members of the household.
Follow these laundering procedures:
Handle soiled laundry according to standard practices, avoiding contact with contaminates from the rash that may be present on the laundry.
Soiled laundry should never be shaken or handled in a manner that may spread infectious particles.
In-home laundry facilities:
Transfer soiled laundry items to be laundered in an impermeable container or bag that can be disinfected afterward. Alternatively, a fabric bag may be used that can also be laundered along with the soiled items.
Wash laundry in a standard washing machine with detergent, following label instructions. Laundry sanitizers may be used, but are not necessary.
In-home laundry facilities not available:
When in-home laundry facilities (facilities not shared with other households) are not available, individuals should coordinate with their local public health department to determine appropriate laundering options.
Hard Surfaces (and non-porous car interiors)
Routinely clean and disinfect commonly touched surfaces and items (such as counters or light switches) using an EPA-registered disinfectant, following the manufacturer's instructions.
This includes surfaces like tables, countertops, door handles, toilet flush handles, faucets, light switches, and floors.
Include interior surfaces of refrigerator, freezer, other appliances, interior cabinet spaces, or drawers if they have been accessed by the person with monkeypox.
Items and surfaces within the home that have likely not been in contact with the person while sick with monkeypox does not need to be disinfected.
This includes clothing and items in drawers or boxes that have not been in contact with or the direct presence of the person with a monkeypox.
Wash soiled dishes and eating utensils in a dishwasher with detergent and hot water, or by hand with hot water and dish soap.
Upholstered Furniture, Carpet, and Soft Furnishing (and porous car interiors)
If the person with monkeypox had direct skin contact and/or excessive drainage of fluids from rashes onto soft furnishings, such as upholstered furniture, carpets, rugs, and mattresses, steam cleaning can be considered. Discuss with state or local health authorities for further guidance.
If the person with monkeypox had minimal contact with soft furnishings, disinfect the surface with a surface-appropriate disinfectant.
Waste Disposal
Generally, management of waste from homes, including those of people with monkeypox isolated at home, should continue as normal. Municipal waste management systems routinely collect and dispose of waste materials from individuals with infectious diseases, and can do so safely use existing procedures.
The person with monkeypox should use a dedicated, lined trash can in the room where they are isolated.
Any gloves, bandages, or other waste and disposable items that have been in direct contact with the skin should be placed in a sealed plastic bag, then thrown away in the dedicated trash can.
The person with monkeypox or other household members should use gloves when removing garbage bags and handling and disposing of trash.
If professional cleaning services are used, treat and/or dispose of the waste following applicable state, local, tribal, and territorial laws and regulations for waste management. For more information, the Department of Transportation has monkeypox-specific information in the federal interagency guidance for managing solid waste contaminated with an infectious substance.
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