Monkeypox: What you need to know

What is monkeypox (mpox)?

Monkeypox (mpox) is a rare viral disease. It’s caused by the monkeypox virus, a cousin of the smallpox virus.

An outbreak being spread between humans was named a national health emergency on Aug. 4, 2022. The World Health Organization declared the monkeypox spread a global health emergency in July 2022.

Note: On Nov. 28, 2022, the World Health Organization announced it will begin transitioning from the term "monkeypox," to "mpox," referring to the disease as both for a year while it completely phases out "monkeypox." WHO is responsible for assigning names to new diseases.

How prevalent is monkeypox (mpox)?

As of November 2022, there have more than 2,000 confirmed cases of monkeypox (mpox) in Los Angeles County and more than 29,000 cases in the United States.

UCLA Health experts are monitoring the situation to ensure that we are well-prepared to treat you if you test positive for monkeypox (mpox).

How does monkeypox (mpox) spread?

The 2022 outbreak of monkeypox appear to have spread through close human-to-human contact with someone who has the virus. This may mean:

• Skin-to-skin contact, including (but not only) during sex and other intimate contact
• Contact with bodily fluids, monkeypox sores or shared items such as clothing or bedding
• Prolonged face-to-face interaction with someone who has the virus

Although monkeypox (mpox) can spread through respiratory droplets, the droplets typically don’t travel more than a few feet and prolonged face-to-face contact is required. Transmission through brief contact, such as walking past an infected person, has not been reported.

What are the symptoms of monkeypox (mpox)?

Although monkeypox is a cousin of smallpox, the disease it causes isn’t as severe. Most people who have the monkeypox (mpox) virus experience mild flu-like symptoms, such as:

• Body aches
• Chills
• Fatigue
• Fever
• Headaches
• Swollen lymph nodes

Most patients with monkeypox (mpox) first develop fever, with or without chills, fatigue, body aches and swollen lymph nodes and then develop a distinctive rash with sores (lesions). These may look initially like pimples or spots on the skin, and then may change appearance. Usually these symptoms affect your hands, face, and the soles of your feet. Because many of the current cases have been spread through sexual contact, patients can have monkeypox (mpox) lesions on their genitals or anal area, or in their mouth.

Patients usually develop mpox symptoms within five to 21 days of exposure. The infection usually lasts between two and four weeks. Most people who get monkeypox don’t require hospitalization and recover at home.

Who is eligible for the monkeypox (mpox) vaccine?

Supply of the monkeypox vaccine, which is approved by the FDA, is currently limited. The Los Angeles Department of Public Health is prioritizing first vaccine doses to as many eligible people as possible. When supply expands, they will start offering second doses.

The vaccine is currently only available to men who have sex with men or transgender women who meet the following criteria:

• Have had gonorrhea, chlamydia or early syphilis in the past 12 months
• Are on HIV pre-exposure prophylaxis (PrEP)
• Have visited or worked at a bath house or commercial sex venue in the past 21 days
• Have had multiple or anonymous sex partners in the last 14 days
• Are not stably housed or have exchanged sex for money, goods or services

It’s also available by invitation only to people who:

• Have had confirmed intermediate- or high-risk contact with someone who has monkeypox (mpox)
• Have attended an event or venue where exposure risk was high

If you are eligible for the monkeypox vaccine, please visit this website to sign up online. UCLA Health has very limited doses of the vaccine available by invitation only to those who meet certainly eligibility criteria. We hope to have more vaccines in the coming weeks.

How is the monkeypox (mpox) vaccine given?

The monkeypox (mpox) vaccine is given in two doses, four weeks apart. You are considered fully vaccinated about two weeks after the second shot. Even if you’ve been exposed to monkeypox, experts believe that vaccination can prevent or reduce severity of the disease. Currently, with limited availability, health departments are prioritizing first vaccine doses, and second doses may be delayed.

Does the smallpox vaccine protect against monkeypox (mpox)?

Researchers believe that adults who received the smallpox vaccine have some immunity against mpox. According to the Centers for Disease Control and Prevention (CDC), past data shows that the smallpox vaccine could be around 85% effective in preventing monkeypox, although these numbers are estimates. Most healthy adults who received the smallpox vaccine (which was routinely given in the U.S. until 1972) experience only mild symptoms of a monkeypox infection.

What if I think I’ve been exposed to monkeypox (mpox)? Do I need to get tested?

If you have been exposed to monkeypox or think you may have mpox, contact your primary care provider. Your provider can assess your symptoms or possible exposure and obtain a specimen for testing.

If you don’t have a primary care provider, you can call the Los Angeles County help line by dialing 211. You may also visit a Los Angeles County Public Health Sexual Health Clinic.

How can I protect myself from contracting monkeypox (mpox)?

The CDC has provided some general guidance on how to protect yourself from getting monkeypox . This guidance includes:

• Avoid close, skin-to-skin contact with people who have a rash that looks like monkeypox
• Do not touch the rash or scabs of a person with mpox.
• Do not hug, kiss, cuddle or have sex with someone with mpox.
• Avoid contact with objects and materials that a person with mpox has used.
• Do not share eating utensils or cups with a person with mpox.
• Do not handle or touch the bedding, towels or clothing of a person with mpox.
• Wash your hands often with soap and water and use an alcohol-based hand sanitizer, especially before eating or touching your face and after you use the bathroom.

The CDC farther shared information on how to make informed choices when you are in situations or places where monkeypox could be spread. This document includes information on how you can lower your risk during sex (PDF), and how to lower the chance of getting monkeypox (mpox) at a party, club or festival.

What are the treatments for monkeypox (mpox)?

Most cases of mpox are mild. Rest and home remedies including sitz baths, topical Vaseline, antihistamines (Benadryl) for itching, and pain medications, such as acetaminophen (Tylenol) or ibuprofen (Advil), may be all you need to recover. If you’re eligible, getting the vaccine even after exposure to the monkeypox virus can prevent or reduce the severity of your infection.

Investigational treatments are available for certain types of patients, such as those who have very weak immune systems or those with severe symptoms, such as uncontrollable pain. These treatments are not readily available and can only be offered as part of a research study. There are designated hospitals throughout Los Angeles County — including UCLA Health — that are equipped to handle patients who have mpox and require hospital admission.

Your physician can offer you personalized guidance regarding mpox treatment, including referring you to an infectious disease specialist for treatment with antiviral drugs based on your eligibility.

I’m pregnant. Should I be worried about monkeypox (mpox)?

Unfortunately, there are limited data on monkeypox (mpox) infection during pregnancy. It is unknown whether pregnant people are more susceptible to monkeypox virus or whether infection is more severe in pregnancy. In historical studies describing smallpox infections in pregnant individuals, more severe infections were described during pregnancy.

Watch the below webinar to learn more about monkeypox and pregnancy: 

What should I do if I am exposed or infected while pregnant or breastfeeding?

The approach to evaluating a patient with suspected monkeypox virus infection is the same for pregnant and nonpregnant people. If a patient presents with signs and symptoms that could suggest monkeypox virus infection, testing should be considered, especially if the person has risk factors for monkeypox virus infection.

If a pregnant person has a significant exposure to a monkeypox infection, prevention using the JYNNEOS vaccine is recommended within four days of exposure to reduce the likelihood of infection, or between four and 14 days postexposure to reduce the severity of symptoms. While data are limited regarding the use of this vaccine in pregnancy, animal studies have shown no concerns and the vaccine format is similar to others that have been used safely in pregnancy. The Society for Maternal-Fetal Medicine recommends that this vaccine should not be withheld from pregnant individuals at risk, and that a discussion with the patient regarding risks and benefits of vaccine vs. infection should take place. The ACAM2000 vaccine, which uses a format with live, reproducing viruses, should not be used in pregnancy.

If a person who is breastfeeding has mpox, their provider should discuss the risks and benefits of continuing to breastfeed during an active infection. Because the monkeypox virus is spread through close contact and neonatal monkeypox infections may be severe, delaying breastfeeding until all lesions have resolved, the scabs have fallen off, and a fresh layer of intact skin has formed should be considered. Using a breast pump will allow patients to maintain their supply during a pause in breastfeeding.

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