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Monkeypox

Countries around the world that do not report monkeypox (MPV), including the United States, have seen a rise in cases due to a worldwide outbreak of monkeypox. While you should not panic, it's important to stay informed about MPV and understand the symptoms, how it spreads and what to do if you are exposed. 

What is monkeypox?

Monkeypox (MPV) is part of the same family of viruses as the variola virus, which causes smallpox. MPV symptoms are similar to smallpox symptoms, but milder, and MPV is rarely fatal.

MPV was first identified in 1958 following two outbreaks of a pox-like disease in colonies of monkeys kept for research. Despite being named “monkeypox,” the source of the disease remains unknown.

The first human case of MPV was recorded in the Democratic Republic of the Congo in 1970. Before the 2022 outbreak, MPV had been reported in people in several central and western African countries. Previously, almost all MPV cases in people outside of Africa were linked to international travel to countries where the disease commonly occurs or through imported animals.

How is monkeypox spread?

Anyone can get and spread monkeypox. The virus that causes MPV requires close, personal contact to spread.

Typically, the virus can spread through:

  • Direct contact with a rash or sores of someone who has the virus
  • Contact with clothing, bedding, and other items used by a person with MPV 
  • Prolonged face-to-face contact

While MPV is not, at this time, considered to be a sexually transmitted disease, it appears to be transmitted at a higher rate through sex, which has a high rate of skin-to-skin contact. Experts are also currently studying whether the virus can also spread through semen, saliva, feces, and other body fluids.

Many current cases are among gay, bisexual, and other men who have sex with men. However, it is important to emphasize that anyone can get and spread monkeypox. Transmission of MPV is related to behaviors rather than sexual orientation or gender identity.

What are the symptoms of monkeypox?

In the current outbreak, hospitalization and death from MPV are rare, but symptoms can still be painful and interfere with daily activities.

Symptoms usually start within two weeks of exposure, but in some cases, they may not appear for up to 21 days. Symptoms can last for two to four weeks. 

The most common symptom is a rash or sores. Oftentimes, people get a rash first, followed by other symptoms. Others only experience a rash. Symptoms usually appear one to two weeks after infection. Symptoms can be extremely painful, and people might have permanent scarring from the rash.

Symptoms of MPV can include:

  • Fever
  • Headache
  • Muscle aches and backache
  • Swollen lymph nodes
  • Chills
  • Exhaustion
  • Respiratory symptoms (e.g., sore throat, nasal congestion, or cough)
  • A rash that can look like pimples or blisters that appear on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus. The rash goes through different stages before healing completely.

What are the complications associated with monkeypox?

Complications can include inflammation of the lining of the rectum (proctitis), or sores that could result in scarring of the eye, mouth, anus, or urethra.

What should I do if I have symptoms?

If you start experiencing symptoms, even if they are mild, isolate yourself from others immediately and talk to your health care provider. If you do not have a health care provider, call 311 or search the NYC Health Map. A provider will check your symptoms and may order testing.

You should avoid all close physical contact with others, including other people in your household. Also, avoid clubs, parties, bars, and other crowded places.

The following may increase your risk for severe disease if you are infected: HIV; other conditions that weaken your immune system; and a history of atopic dermatitis or eczema. If you have one of these conditions, it is especially important to see a provider right away, if you have symptoms. 

To protect others while you are sick:

  • Avoid sex or being intimate with anyone until you have been checked by a provider.
  • Stay home and remain separate from other people in your household.
  • If you cannot fully separate from others in your household, wear a face mask and avoid physical contact. Wear clothing that covers your lesions when in shared spaces.
  • If you must leave home for essential needs or medical care, cover your rash and lesions with clothing, and wear a face mask.
  • Do not share or let others touch your clothing, towels, bedding, or utensils. Do not share a bed.
  • Do not share dishes, food, drink or utensils. Wash dishes with warm water and soap, or in a dishwasher.
  • Wash your hands and clean shared surfaces, such as countertops and doorknobs, often. Household members should also wash their hands often, especially if they touch materials or surfaces that may have come in contact with lesions.

Is there a treatment for monkeypox?

There is no specific treatment approved for MPV. Most people get better on their own without treatment. However, antivirals for smallpox may help. Your provider will help you find out if you are eligible for antiviral treatment. They may be able to prescribe medicine and provide information about symptom relief.

What can be done to prevent the spread of monkeypox?

The best way to protect yourself from MPV is to temporarily change or reduce behaviors that may increase your risk of being exposed. Here are some ways to reduce your chances of being exposed to MPV if you are sexually active:

  • If you or a partner has MPV or think you may have MPV, the best way to protect yourself and others is to avoid sex of any kind (oral, anal, vaginal) and kissing or touching each other’s bodies—while you are sick. Do not share any sex toys or gear or personal items like towels or toothbrushes. Especially avoid touching any rash
  • Take a temporary break from activities that increase exposure to MPV until you are two weeks after the second vaccine dose.
  • Limit your number of sex partners to reduce your likelihood of exposure.
  • Ask your partners if they have MPV symptoms or feel sick. If you or your partners are sick, especially if you or they have a new or unexpected rash or sore, do not have sex or close physical contact.
  • Avoid sex parties, circuit parties/raves, or other spaces where people are having sex, and other intimate contact with multiple people.
  • If you choose to have sex or other intimate contact while sick, cover all rashes and sores with clothing or sealed bandages. This may reduce the spread from contact with the rash or sores, but other methods of transmission may still be possible.
  • Condoms (latex or polyurethane) may protect your anus , mouth, penis or vagina from exposure to MPV.  However, condoms alone may not prevent all exposures to MPV since the rash can occur on other parts of the body.
  • Gloves (latex, polyurethane, or nitrile) might also reduce the possibility of exposure when touching intimate body parts. The gloves must cover all exposed skin and be removed carefully to avoid touching the outer surface.
  • Wash your hands, fetish gear, and bedding. Sex toys should be washed after each use or sex act.

Is there a vaccine for monkeypox?

Yes. Eligible New Yorkers who may have been recently exposed to MPV can get the JYNNEOS vaccine. Vaccination is free and available regardless of immigration status in New York City. The vaccine has two doses which are given at least four weeks apart.

Getting vaccinated after a recent exposure may reduce the chance of getting MPV, and it can reduce symptoms if you do get it.

Who is eligible to receive a monkeypox vaccine?

Eligibility for MPV vaccination may change as the outbreak evolves and based on vaccine supply. Currently, New Yorkers who meet all of the following conditions can now be vaccinated:

  • Gay, bisexual, or other men who have sex with men, and/or transgender, gender non-conforming, or gender non-binary
  • Age 18 or older
  • Have had multiple or anonymous sex partners in the last 14 days
  • If you have had MPV, then you likely have some protection against another infection and are currently not eligible to be vaccinated.
  • People who have been informed by the Health Department that they are a close contact of someone with MPV should also get vaccinated.

If you are eligible to be vaccinated, you should especially consider getting vaccinated if:

  • Your partners are showing symptoms of MPV, such as a rash or sores.
  • You met recent partners through online applications or social media platforms, or at clubs, raves, sex parties, saunas, or other large gatherings.
  • You have a condition that may increase your risk for severe disease if infected with MPV virus, such as HIV or another condition that weakens your immune system, or you have a history of atopic dermatitis or eczema.
  • We are still learning about how well the vaccine can protect you. Even after getting vaccinated, you should still take precautions, especially if you are at high risk for severe illness from MPV.

You can schedule a vaccination appointment in NYC via the city's online appointment page, VAX4NYC.

What if there is a confirmed case in my school?

Confirmed MPV cases should be treated as they would other communicable disease in your school, which is to follow guidance from the patient’s doctor for isolation and return to work. Your principal may contact their on-site nurse, DOE Office of School Health, or NYC DOHMH Bureau of Communicable Diseases for guidance regarding communicable disease. Refer to the Office of School Health’s Communicable Disease Reporting Guide for more instruction on the protocols for reporting diseases and outbreaks in schools. 

In general, the isolation guidance for a positive person is that they should not be reporting to work and school and isolate in a room or area separate from other family members and pets until all lesions have resolved, the scabs have fallen off, and a fresh layer of intact skin has formed. The illness typically lasts 2-4 weeks.

In addition, if a person is a confirmed positive case, the case is required to be reported to the DOHMH by their physician. The NYC Health Department will then conduct contact tracing with the patient and facilitate symptom monitoring and the administration of post-exposure prophylaxis to close contacts. Unless instructed to by the Health Department, there are generally no quarantine procedures for close contact exposures.

Lastly, members and administrators must be mindful of patient privacy. Stories, tweets and social media posts that single out groups of people without context to public health overall risk sensationalizing and stigmatizing vulnerable groups.

Additional Resources

The above factsheet was adapted based on the AFT Factsheet on Monkeypox and the NYC Department of Health Factsheet on Monkeypox.

For more information, check out the following online resources:

NYC Department of Health Factsheet on Monkeypox

NYC Department of Health guidance on preventing Monkeypox in schools, child care settings and after-school programs

CDC Factsheet on Monkeypox

CDC Guidance on Safer Sex & Social Gatherings

AFT Factsheet on Monkeypox

GLAAD Factsheet on Monkeypox