What Is Monkeypox, and How Worried Should You Be?

This past weekend, the director-general of the World Health Organization (WHO) elevated monkeypox to global health emergency status. Specifically, he declared it “a Public Health Emergency of International Concern.” This is the same designation that the WHO gave to COVID-19 back in January 2020, months before deeming it a full-blown pandemic.

If you’re worried that the world is about to get walloped by another super-contagious, potentially-fatal, never-before-seen virus, you can relax a little. Although monkeypox is clearly serious, it’s much less contagious than COVID. What’s more, it’s not a new virus, and vaccines against it already exist. It’s also rarely deadly, though being immunocompromised can put you at risk of serious illness and complications.  

Here’s what you should know about the monkeypox outbreak — and how to protect yourself.  

What Is Monkeypox?

Monkeypox is a virus that’s related to smallpox, and the symptoms are similar though monkeypox is usually much milder. Monkeypox usually causes a pimple- or blister-like rash that might appear on the face, inside the mouth, or on the hands, feet, chest, genitals, or anus. These pimples/blisters may be very painful, but that’s not always the case.  

Other common symptoms include: 

• Fever 
• Headache 
• Muscle aches 
• Swollen lymph nodes 

Monkeypox was first discovered in monkeys in 1958, though it wasn’t documented in humans until 1970. Since then, it’s mostly impacted people in central and western Africa, including those who had traveled to Africa or had contact with animals that came from there. Earlier this year, however, that changed: The virus has recently been diagnosed in people in several countries around the world, including those that have not historically had cases of it.  

Numbers are now quickly rising. In May, there were only 226 known cases of monkeypox spread throughout 21 countries; as of late July, there are more than 4,000 just in the United States. Germany, Spain, France, and the United Kingdom are also reporting an alarmingly high number of cases.  

No one knows exactly what’s driving this outbreak, but it’s possible that the relaxation of COVID-related travel restrictions has made it easier to spread. Experts have also noted that while anyone can get monkeypox, most current cases have been diagnosed in men who have sex with men (MSM).  

Monkeypox is not technically considered a sexually transmitted infection, because at this time it is not known whether it is spread through semen or vaginal fluids. However, intimate contact definitely increases the risk of transmission, because of the extended, close contact that’s involved. 

How Do You Get Monkeypox?

Unlike COVID, which is easily transmitted via tiny aerosol particles that may linger in the air for hours and get inhaled, you have to actually touch monkeypox in order to contract it. Most people get it when they touch an animal or person who has been infected.  

You’re most likely to get monkeypox if you make contact with the rash or scabs of someone who has it. You can also get it through contact with respiratory droplets or oral fluids, which is most apt to happen if you hug, kiss, or have sex with someone who has the virus. (These respiratory droplets are too large to be airborne).  

Monkeypox can also live on surfaces, possibly for up to 15 days. If you touch clothing, towels, bedding, or other objects that have been contaminated, you could contract the virus. You should also know that monkeypox takes a while to incubate; it might be four to 21 days after exposure before you exhibit any symptoms.   

If you have signs of monkeypox, call or visit your health care provider. If the doctor suspects monkeypox, they will test a blood sample or examine fluid taken from a rash under a microscope.  

How Is Monkeypox Treated?

Monkeypox usually gets better on its own, but the rash might be painful and the recovery process can take two to four weeks. For most people, over-the-counter pain and fever medications and oatmeal baths are enough to keep them comfortable.   

In rare cases, however, the virus leads to serious complications that can land you in the hospital. For this reason, people who are believed to be at high risk might be candidates for a drug called tecovirimat (TPOXX) if they contract the virus. TPOXX is an antiviral drug that is only FDA-approved for smallpox, but experts believe that it may work for monkeypox as well.  

If you’re high risk and have simply been exposed to monkeypox, you might instead be given a vaccine to reduce the chances of becoming seriously ill. This strategy, which is known as “post-exposure prophylaxis” (PEP), is being used because there is currently a limited supply of the JYNNEOS vaccine. (There is another monkeypox vaccine, called ACAM2000, but it can’t be used by people who are immunocompromised.)   

Who’s high risk? People with some types of cancer, those who have HIV/AIDS, and organ transplant recipients all fall into this category, as do children under 8.

According to the Centers for Disease Control and Prevention (CDC), the high-risk category also includes people who take tumor necrosis factor (TNF) inhibitors or high-dose corticosteroids, as well as those who have an autoimmune disease “with immunodeficiency as a clinical component.”  

How Concerned Should You Be?

Because monkeypox was previously so rare, rheumatologists don’t currently have a lot of information about how it might impact their patients.

“In countries where [human monkeypox] is endemic, bacterial skin infections and pneumonia are among the observed complications of infection,” says Jeanne Gosselin, MD, a rheumatologist at the University of Vermont Medical Center and Assistant Professor of medicine in the Division of Rheumatology at the Larner College of Medicine. “These complications would likely be concerning in our immunosuppressed rheumatology patients, but there are no studies to date looking at outcomes in patients with rheumatic diseases on immunosuppressive medication.” 

If you develop any signs of monkeypox, such as fever and/or a new, unexplained rash, your best bet is to contact your doctor for guidance.

“As I’ve done for the past 2.5 years of the [COVID] pandemic, I’ll continue to encourage my patients to call if they have a febrile illness or other signs of infection,” says Dr. Gosselin. “It gives us, as rheumatologists, the chance to ascertain illness severity, hold immunosuppressive medications if necessary, and mobilize the resources we have to try and prevent serious outcomes.”  

How Can You Prevent Monkeypox?

The good news is that if you’re still taking precautions to avoid COVID — masking, social distancing, practicing good hand washing — then there’s an excellent chance that you’re well-protected from monkeypox. And if you’ve recently eased up a little, you don’t need to panic and go back into lockdown mode for the sake of dodging monkeypox.  

“The emergence of yet another infection while we’re still dealing with COVID-19 can be stressful, but it’s important for patients to remember that monkeypox is not coronavirus. “Monkeypox infection likely requires skin-to-skin contact, including genital mucosa, or prolonged contact with respiratory secretions,” says Dr. Gosselin.  

Although two monkeypox vaccines are currently on the market, the ACAM2000 vaccine can’t be used by people who are immune-compromised. The other option, JYNNEOS, is currently in limited supply, but production is currently ramping up.  

For now, the best way to protect yourself from monkeypox (unless you’ve been advised by your doctor to seek out a vaccine) is to avoid close contact with anyone who has a rash that looks like monkeypox. You shouldn’t share eating utensils or touch their bedding or towels, either. It’s also smart to wash your hands frequently with soap and water or use an alcohol-based sanitizer. If someone in your home has monkeypox, they should isolate in a separate room.  

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