UTSW
By Helen King, M.D.,
Internal Medicine – Infectious Diseases and Geographic Medicine
The recent headlines about monkeypox have people around the world worrying whether we’re facing another potential global pandemic. So far, the outbreak – a term for clusters of disease in unexpected places or in higher-than-average numbers – includes fewer than 2,000 confirmed cases worldwide. About 70 of those are in the U.S.
The current outbreaks started as travel-related infections and are now being spread person-to-person in at least 40 countries including the U.K., U.S., Spain, and Portugal. At the time of this writing, there was one confirmed case in Texas, in Dallas.
Monkeypox is not a novel virus; though we have not seen person-to-person spread to this scale in the past. Prior to 2022, the most recent notable outbreak of monkeypox in the U.S. occurred in 2003 and was limited to 47 cases in six Midwest states.
Even during the current outbreak, getting infected with monkeypox in the U.S. is unlikely. If exposed, an overwhelming majority of patients will develop only mild symptoms, which can include:
- Backache
- Chills
- Development of “poxes,” blister-like skin lesions
- Fatigue
- Fever
- Headache
- Muscle aches
- Swollen lymph nodes in the neck and underarms
- Rash
Over the course of the infection (usually 2-4 weeks), the rash will change from flat patches, to bumps, to fluid-filled lesions that scab over. When the rash and sores break out the patient is considered contagious.
Early reports of the current outbreak in the U.S. suggest some unique features of the rashes. The CDC reported on June 14 that many patients are developing rashes that start on mucosal surfaces, such as the mouth, genitals, or rectum rather than the face as traditionally seen with monkeypox. Additionally, many of the rashes have been scattered or localized to specific areas of the body rather than spreading from the face to the extremities. So far, a lower percentage of people are developing fevers, malaise, headaches, and swollen lymph nodes in this outbreak.
Most patients will fully recover at home without medical treatment. In rare instances of severe infection, effective treatment is readily available.
While the threat to the general population in the U.S. remains low, the COVID-19 pandemic taught us that cautious optimism must be balanced with appropriate precautions. Understanding how monkeypox spreads and what to do if you are exposed is a good first step in containing the outbreak.
History of monkeypox
The monkeypox virus is named due to its origins in the Congo, and the two predominant strains are Congo and West African. However, researchers are rallying to rename the disease due to the discriminatory and geographic stigmas associated with it.
There has been a concentrated effort to move toward more scientific names not tied to specific geographic regions – that’s why the novel coronavirus became COVID-19, for example. According to The Guardian, the World Health Organization is working with partners globally to rename the monkeypox virus strains.
Monkeypox belongs to the Orthopoxvirus genus, which includes several animal-associated poxes that can infect humans, such as camelpox that is found in Asian and African camels. Smallpox, which was eradicated in 1980, also belongs to this genus.
In 2003, the U.S. monkeypox outbreak was tracked back to human exposure to rodents that had been shipped to Texas from Ghana, and then to Illinois. That outbreak was quickly contained to the Midwest, and we hope the spread of this iteration will be contained swiftly as well.
How monkeypox spreads
Being bitten by or exposed to an infected animal can transfer the virus to humans. The current outbreak appears to be travel-related and from person-to-person spread.
Stateside, the virus has been spread among people through direct contact with monkeypox sores or bodily fluid, such as the fluid that seeps from a patient’s sores or close, prolonged exposure to respiratory droplets.
Unlike COVID-19, monkeypox virus is not novel and we have a basic understanding of the disease progression of monkeypox infection and how to contain the spread. Infections typically last 2-4 weeks, and symptoms generally begin 1-2 weeks after exposure. Mild symptoms such as fever and fatigue may come first, followed by skin lesions that flare up, scab over, and fall off without intervention. However, not all cases during the current outbreak have had fever before the rash.
Approximately 99% of patients with the current strain of monkeypox make a full recovery, though in severe cases infection can be fatal. Learn more from the CDC.
Anyone exposed to the virus can be infected. People who are at increased risk include:
- Individuals who have been bitten by or exposed to a live or dead infected animal
- Those with immunocompromising conditions such as cancer or HIV/AIDS
- Gay and bisexual men comprise many of the current U.S. cases, according to the CDC, though the agency emphasized that anyone can contract monkeypox through close personal contact regardless of sexual orientation.
What to do if you are exposed
If you don’t feel well, stay home and avoid close contact with others including pets – especially if you have an unusual rash. Call your doctor if you have symptoms and discuss your next steps.
Currently, people in the U.S. with monkeypox are advised to quarantine at home until symptoms resolve. The majority of patients will recover without medical intervention. In severe cases, patients may require hospitalization and medication to clear the virus.
Vaccines and treatments that are effective against smallpox also have effectiveness against monkeypox. These vaccines have been stockpiled globally in the event smallpox makes a recurrence – or monkeypox defies preliminary data and surges. One silver lining of the COVID-19 pandemic was defining and refining a swift and expedient vaccine distribution process.
Right now, there is no directive for mass vaccination like we saw with COVID-19 – even for healthcare providers – due to the very low number of cases and limited spread. However, if you have been exposed, talk with your doctor about whether you need to be vaccinated. People planning to travel to Western Europe or Africa should follow the CDC’s travel notice information to protect themselves and others.
Just as we’ve been doing the last few years, make sure to follow basic self-protection guidelines: wash your hands regularly, pay attention to potentially suspicious symptoms, and keep your distance from others if you are experiencing even mild symptoms.
We will be diligent in providing the most up-to-date information about monkeypox and how to guard against infection.
