What is Monkeypox?

Situation update:

As of June 28, 2022 there have been 306 confirmed cases from 28 U.S. states, including 66 from California, 5 of which are in Alameda County residents. Reports from investigations in several countries and the U.S., including in California, suggest that person-to-person transmission through close contact is fueling spread and that clinical case presentations have not always been characteristic of classic monkeypox infections.  In this outbreak, US cases of monkeypox have been identified since early May 2022; many of the cases have involved men who identify as transgender, gay, bisexual or have sex with men (MSM) without a history of travel to an endemic country. For information on the first 17 cases reported in the US see Monkeypox Outbreak — Nine States, May 2022 | MMWR (cdc.gov).  All patients described in the MMWR and cases reported since are in adults.

Currently, the risk of getting monkeypox is very low for the general public.

Health Advisory and resources:

CDPH Health Advisory | CDPH Testing Guidance
 CDC Health AdvisoryCDC Monkeypox Webpage | CDC Monkeypox Fact Sheet
ACPHD Health Advisory | Monkeypox FAQ | Alameda County Press Release June 9, 2022

Monkeypox (ca.gov)
U.S. Monkeypox Outbreak 2022: Situation Summary | Monkeypox | Poxvirus | CDC
Monitoring People Who Have Been Exposed | Monkeypox | Poxvirus | CDC

Monkeypox is a rare disease which is caused by the monkeypox virus and can affect both humans and non-human primates. Monkeypox belongs to the Orthopoxvirus genus which also includes the variola (smallpox) virus. The symptoms of monkeypox are similar but milder than smallpox. Monkeypox occurs primarily in Central and West Africa and has been rarely exported to other regions where the virus is thought to spread to people from infected animals when people kill or prepare meat for consumption; however, there were two confirmed cases in the US in 2021 and an outbreak in 2003.

Early symptoms of monkeypox include flu-like illness (fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion) followed by a rash typically beginning on the face and spreading to other parts of the body. More recently cases have been reported with rash only appearing in the genital and perianal area.

Key Characteristics for Identifying Monkeypox

Monkeyplox lesions on handMonkeypox lesion on skinMonkeypox lesions on handMonkeypox lesions on body Monkeypox lesion on wrist

  • Lesions are typically well circumscribed, deep seated, and often develop umbilication (resembles a dot on the top of the lesion)
  • Lesions are relatively the same size and same stage of development on a single site of the body (ex: pustules on face or vesicles on legs)
  • Fever before rash
  • Lymphadenopathy common
  • Disseminated rash is centrifugal (more lesions on extremities, face)Monkeypox Lesions on different body parts
  • Lesions on palms, soles
  • Lesions are often described as painful until the healing phase when they become itchy (crusts)

However, many of the current cases present with new spots, ulcers or blisters on any part of their body.

How does it spread?

Monkeypox can spread from infected animals to humans, mainly in areas where monkeypox is endemic. Once the virus jumps to people, human-to-human transmission can occur via contact with monkeypox lesions or bodily fluids, with the virus entering through small cuts in the skin or prolonged face-to-face contact via respiratory droplets. It can also be contracted by contact with clothing or linens contaminated with material from monkeypox lesions. CDC emphasizes that unlike COVID-19, monkeypox transmission occurs only with close contact.

Prevention

Any person (of any gender or sexual orientation) who has direct contact with an infected person, including skin-to-skin and/or sexual contact, can get monkeypox. Steps for self-protection include asking intimate and other sexual partners about symptoms, avoiding skin-to-skin or face-to-face contact with anyone who has symptoms, keeping hands clean with water and soap or alcohol-based hand rub, and maintaining respiratory etiquette.

Detection and care

Currently, a person with monkeypox is considered infectious when they have symptoms. If a person with monkeypox or their recent sexual partners (from the last 21 days) have unusual sores or a rash, especially if accompanied by fever or a feeling of discomfort or illness, they should contact their health care provider and be evaluated. If someone is suspected or confirmed as having monkeypox, they should isolate, abstain from sex (including oral sex) and avoid sharing bedding, towels, and clothing until the scabs have fallen off and fresh skin has formed underneath. During this period, patients can get supportive treatment to ease monkeypox symptoms. Anyone caring for a person sick with monkeypox should use appropriate personal protective measures, including wearing a mask and gloves and cleaning objects/surfaces that have been touched.

Reporting

Any rash-like illness consistent with the clinical descriptions above during travel or upon return should be immediately reported to a health care professional, including information about all recent travel, sexual history, and smallpox immunization history.


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