Mpox (previously called Monkeypox)

Mpox is a rare disease caused by infection with the mpox virus. Mpox virus is part of the same family of viruses as variola virus, the virus that causes smallpox. Mpox symptoms are similar to smallpox symptoms, but milder, and mypox is rarely fatal. Mpox is not related to chickenpox.

Mpox was discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research. Despite originally being named “monkeypox,” the source of the disease remains unknown. However, African rodents and non-human primates (like monkeys) might harbor the virus and infect people. The first human case of mpox was recorded in 1970. The CDC is currently tracking an outbreak of mpox that has spread across several countries that don’t normally report mpox, including the United States.

It is important to note that anyone can get mpox, and it is a public health concern for all of us. When we discuss mpox, it is important that nurses and other clinicians keep our messages accurate and fact-based, and use language that does not marginalize or stigmatize those populations most affected.

To learn more information about mpox, visit the CDC Mpox webpage, and FAQS, and the World Health Organization Mpox webpage.

To find data on the current Mpox Case Count, visit the CDC 2022 U.S. Map & Case Count, and the CDC 2022 Mpox Outbreak Global Map.

Mpox is caused by a virus that can spread from animals to people. It can spread between people when someone has contact with someone who is infected with mpox or touches materials that are contaminated with the virus.

Mpox can spread to anyone through:

• Direct contact with mpox rash or scabs on a person's skin.
• Contact with objects, fabrics (clothing, bedding, or towels), and surfaces that have been used by someone with mpox.
• Contact with respiratory secretions during prolonged, face-to-face contact.

Mpox can be spread during intimate contact, including:

• Oral, anal, and vaginal sex, or touching the genitals or anus of a person with mpox.
• Hugging, massage, kissing, or talking closely.
• Touching fabrics, shared surfaces, and objects that were used by a person with mpox, such as bedding, towels, fetish gear and sex toys.

A pregnant person can spread the virus to their fetus through the placenta.

A person with mpox can spread it to others from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks.

To learn more about how mpox can spread, visit CDC's How it Spreads webpage.

People with mpox get a rash that may be located on or near the genitals (penis, testicles, labia, and vagina) or anus and could be on other areas like the hands, feet, chest, face, or mouth.

• The rash will go through several stages, including scabs, before healing.
• The rash can initially look like pimples or blisters and may be painful or itchy.

Other symptoms of mpox can include:

• Fever
• Chills
• Swollen lymph nodes
• Exhaustion
• Muscle aches and backache
• Headache
• Respiratory symptoms (e.g. sore throat, nasal congestion, or cough)

You may experience all or only a few symptoms

• Sometimes, people have flu-like symptoms before the rash.
• Some people get a rash first, followed by other symptoms.
• Others only experience a rash.

Mpox symptoms usually start within 3 weeks of exposure to the virus. If someone has flu-like symptoms, they will usually develop a rash 1-4 days later. Mpox can be spread from the time symptoms start until the rash has healed, all scabs have fallen off, and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks.

Visit the CDC Signs and Symptoms webpage for more comprehensive and detailed information.

Clinicians should visit the CDC Clinical Recognition webpage to find important information on key characteristics for identifying Mpox.

Testing

When to Get Tested

People who think they have mpox, or have had close personal contact with someone who has mpox, should visit a healthcare provider to help them decide if they need to be tested. If your healthcare provider decides that you should be tested, they will work with you to collect the specimens and send them to a laboratory for testing.

Testing in the Healthcare Setting

Effective communication and precautionary measures between specimen collection teams and laboratory staff are essential to maximizing safety when manipulating specimens suspected to contain mpox virus. A labeling system should clearly distinguish all specimens, including those from patients with suspected mpox virus infection, which require special handling. Personnel who collect specimens should use personal protective equipment (PPE) in accordance with recommendations for healthcare settings.

Visit the CDC Preparation and Collection of Specimens webpage for more comprehensive and detailed information.

See also For Mpox Testing, Use Lesion Swab Samples to Avoid False Results: FDA Safety Communication July 15, 2022.

Treatment (from the CDC Interim Clinical Guidance for the Treatment of Mpox)

Many people infected with mpox virus have a self-limiting disease course in the absence of specific therapy. However, the prognosis for mpox depends on multiple factors, such as previous vaccination status, initial health status, concurrent illnesses, and comorbidities among others. Patients who should be considered for treatment following consultation with CDC might include:

• People with severe disease (e.g., hemorrhagic disease, confluent lesions, sepsis, encephalitis, or other conditions requiring hospitalization)
• People who may be at high risk of severe disease:
  • People who are immunocompromised
  • Pediatric populations, particularly patients younger than 8 years of age
  • People with a history or presence of atopic dermatitis, persons with other active exfoliative skin conditions (e.g., eczema, burns, impetigo, varicella zoster virus infection, herpes simplex virus infection, severe acne, severe diaper dermatitis with extensive areas of denuded skin, psoriasis, or Darier disease)
  • Pregnant or breastfeeding women
  • People with one or more complications (e.g., secondary bacterial skin infection; gastroenteritis with severe nausea/vomiting, diarrhea, or dehydration; bronchopneumonia; concurrent disease or other comorbidities)
• People with mpox virus aberrant infections that include accidental implantation in eyes, mouth, or other anatomical areas where mpox virus infection might constitute a special hazard (e.g., the genitals or anus)

Currently there is no treatment approved specifically for mpox virus infections. However, antivirals developed for use in patients with smallpox may prove beneficial against mpox. The following medical countermeasures are currently available from the Strategic National Stockpile (SNS) as options for the treatment of mpox: Tecovirimat (also known as TPOXX, ST-246); Vaccinia Immune Globulin Intravenous (VIGIV); Cidofovir (also known as Vistide); and Brincidofovir (also known as CMX001 or Tembexa).

Mpox can commonly cause severe pain and can affect vulnerable anatomic sites, including the genitals and oropharynx, which can lead to other complications. See Clinical Considerations for Pain Management of Mpox for more information.

Visit the Patient’s Guide to Mpox Treatment with TPOXX, and the CDC Treatment Information for Healthcare Professionals webpage for more comprehensive and detailed information.

Vaccination

Because Mpox virus is closely related to the virus that causes smallpox, the smallpox vaccine can protect people from getting mpox. Past data from Africa suggests that the smallpox vaccine is at least 85% effective in preventing mpox. Vaccines are effective at protecting against mpox when given before exposure, and experts also believe that vaccination after a mpox exposure may help prevent the disease or make it less severe. The sooner an exposed person gets the vaccine, the better. The CDC recommends that the vaccine be given within 4 days from the date of exposure in order to prevent onset of the disease. If given between 4–14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the disease.

ACAM2000 and JYNNEOS (also known as Imvamune or Imvanex) are the two currently licensed vaccines in the United States. On August 9, 2022, the U.S. Food and Drug Administration issued an emergency use authorization (EUA) for the JYNNEOS vaccine to allow healthcare providers to use the vaccine by intradermal injection for individuals 18 years of age and older who are at high risk for infection. Find dosage and administration information on the ACAM2000 vaccine, and the Jynneos vaccine webpages.

Visit the CDC Healthcare Professionals Mpox and Smallpox Vaccine Guidance webpage for more comprehensive and detailed information. To find a mpox vaccine, use the Vaccine Locator. 

See also the Vaccines: Mpox webpage for links to key mpox vaccine resources from Immunize.org, and other partners.

Infection Prevention in Healthcare Settings

Human-to-human transmission of mpox virus occurs by direct contact with lesion material or from exposure to respiratory secretions. Reports of human-to-human transmission describe close contact with an infectious person. Transmission in healthcare settings has been rarely described.

Infection prevention and control recommendations for healthcare settings are provided in the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007). Recommendations and practices described in this 2007 guideline are intended to be used when providing care for any patient in a healthcare setting, including those with mpox infection. Additional supporting infection prevention and control information specific to mpox is provided on the CDC Infection Prevention and Control of Mpox in Healthcare Settings webpage, which includes this recommendation for PPE:

PPE used by healthcare personnel who enter the patient's room should include:

• Gown
• Gloves
• Eye protection (i.e., goggles or a face shield that covers the front and sides of the face)
• NIOSH-approved particulate respirator equipped with N95 filters or higher

Additional information can be found in the CDC Clinician FAQS.

Infection Prevention at Home

Take the following steps to prevent getting mpox:

• Avoid close, skin-to-skin contact with people who have a rash that looks like mpox.
  • Do not touch the rash or scabs of a person with mpox.
  • Do not kiss, hug, 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 or use an alcohol-based hand sanitizer, especially before eating or touching your face and after you use the bathroom.

Find additional information on the CDC Prevention webpage.

See also the CDC Safer Sex, Social Gatherings, and Mpox webpage.

If You Have Mpox at Home

CDC recommends that people with mpox remain isolated at home or at another location for the duration of illness, which typically lasts two to four weeks. Current data suggest people can spread mpox from the time symptoms start until all symptoms have resolved, including full healing of the rash with formation of a fresh layer of skin. However, if a person with mpox is unable to remain fully isolated throughout the illness, they should do the following:

• While symptomatic with a fever or any respiratory symptoms, including sore throat, nasal congestion, or cough, remain isolated in the home and away from others unless it is necessary to see a healthcare provider or for an emergency.
  • This includes avoiding close or physical contact with other people and animals.
  • Cover the lesions, wear a well-fitting mask (more information below), and avoid public transportation when leaving the home as required for medical care or an emergency.
• While a rash persists but in the absence of a fever or respiratory symptoms
  • Cover all parts of the rash with clothing, gloves, and/or bandages.
  • Wear a well-fitting mask to prevent the wearer from spreading oral and respiratory secretions when interacting with others until the rash and all other symptoms have resolved.
  • Masks should fit closely on the face without any gaps along the edges or around the nose and be comfortable when worn properly over the nose and mouth.
• Until all signs and symptoms of mpox illness have fully resolved
  • Do not share items that have been worn or handled with other people or animals. Launder or disinfect items that have been worn or handled and surfaces that have been touched by a lesion.
  • Avoid close physical contact, including sexual and/or close intimate contact, with other people.
  • Avoid sharing utensils or cups. Items should be cleaned and disinfected before use by others.
  • Avoid crowds and congregate settings.
  • Wash hands often with soap and water or use an alcohol-based hand sanitizer, especially after direct contact with the rash.

Find additional information on the CDC Isolation and Prevention Practices for People with Mpox webpage.

HIV

People with advanced HIV, and those who are not virologically suppressed with antiretroviral therapy can be at increased risk of severe disease related to mpox virus infection.

To learn more about how mpox can affect those with HIV visit the Mpox and HIV section of the CDC FAQS, and the CDC Clinical Considerations for Treatment and Prophylaxis of Mpox Virus Infection in People with HIV webpage.

See also the MMWR Interim Guidance for Prevention and Treatment of Mpox in Persons with HIV Infection, United States, August 2022, and the CDC Health Advisory Severe Manifestations of Mpox among People who are Immunocompromised Due to HIV or Other Conditions.

Pediatrics

Historically, mpox has been documented in children and adolescents living in endemic regions. Once illness occurs, the clinical presentation is expected to be similar to that in adults. However, it is not known whether children are more susceptible to mpox than adults or whether clinical outcomes differ from those in adults. Mpox can spread through contact with the fluids (e.g., lesion exudates and respiratory secretions) of people or animals with mpox or through contact with fomites (e.g., shared clothing, towels, toiletries, and bedding). Mpox also can be transmitted to the fetus during pregnancy or to the newborn by close contact during and after birth.

CDC Key points:

• Mpox should be considered when children or adolescents present with a rash that could be consistent with the disease, especially if epidemiologic criteria are present.
• Young children, children with eczema and other skin conditions, and children with immunocompromising conditions may be at increased risk of severe disease.
• Treatment should be considered on a case-by-case basis for children and adolescents with suspected or confirmed mpox who are at risk of severe disease or who develop complications of mpox. Tecovirimat is the first-line medication to treat mpox, including in children and adolescents.
• Children and adolescents with exposure to people with suspected or confirmed mpox may be eligible for post-exposure prophylaxis (PEP) with vaccination, immune globulin, or antiviral medication.

To learn more about how mpox can affect children, visit the CDC Clinical Considerations for Mpox in Children and Adolescents webpage, and the American Academy of Pediatrics Mpox FAQs.

Pregnancy and Breastfeeding

Data regarding mpox infection in pregnancy are limited. It is unknown if pregnant people are more susceptible to mpox virus or if infection is more severe in pregnancy. Mpox virus can be transmitted to the fetus during pregnancy or to the newborn by close contact during and after birth.

The benefits of skin-to-skin contact and rooming-in on breastfeeding and infant physiology are well-known. However, given the risk of neonatal transmission of Mpox virus with close contact and potential for severe disease in newborns, direct contact between a patient in isolation for mpox and their newborn is not advised.

To learn more about how mpox can affect pregnancy and breastfeeding visit CDC Clinical Considerations for Mpox in People Who are Pregnant or Breastfeeding.

Schools, Child Care, Workplaces and Other Congregate Settings

Currently the risk of mpox to children and adolescents in the United States is low. However, this CDC webpage answers frequently asked questions about mpox in K-12 schools, early childcare and education programs, camps, sports leagues and other community settings serving children or adolescents. This information may also be helpful to parents who have questions about mpox.

The risk of mpox spreading in most workplaces is low, however employers and workers can take steps to prevent the spread of mpox in the workplace. Employers should provide information about preventing mpox to workers who may have close physical contact with others or handle potentially contaminated objects or materials. For more information, see the Mpox Virus OSHA Fact Sheet, and the CDC Workplaces and Businesses Toolkit.

Congregate living settings are facilities or other housing where people who are not related reside in close proximity and share at least one common room. This includes correctional and detention facilities, homeless shelters, group homes, college dormitories, and residential substance use treatment facilities. If a staff member, volunteer, or resident of a congregate living setting has a mpox virus infection, transmission could occur to others. See Considerations for Reducing Mpox Transmission in Congregate Living Settings for more information.

Here are videos and webinars to help educate and inform healthcare clinicians:

• Improving the Clinical Care and Treatment of Patients with Mpox Virus. FREE 1 CNE On-Demand Webinar
  This FREE webinar sponsored by APIC & ANA will provide up-to-date information for clinical history and physical assessment to identify patients with mpox, and resources to provide care. It will also include practical information on prevention and control measures for both healthcare workers and patients. Register here. Instructions for obtaining CNE: Attendees that do not have an APIC account can complete their registration by creating a free account. After receiving a confirmation email, watch the on-demand webinar, complete an evaluation and create a downloadable CNE certificate. See also the ANA/APIC Resource Toolkit.
• Preparing Nurses for Infectious Disease Threats This Fall and Winter: COVID-19, Mpox, Influenza, and Others. FREE 1 CNE On-Demand Webinar
  This FREE webinar sponsored by APIC & ANA will describe the infectious diseases likely to be circulating this fall and winter, such as COVID-19, Mpox virus (MPV), influenza, and others. Learn about the infection prevention strategies needed to protect nurses from occupational exposure, and how to minimize spread from patient to patient in healthcare settings. Register here.
  Instructions for obtaining CNE: Attendees that do not have an APIC account can complete their registration by creating a free account. After receiving a confirmation email, watch the on-demand webinar, complete an evaluation and create a downloadable CNE certificate.
• Practical Tips for Healthcare Workers During the Current Mpox Outbreak. An informational webinar given August 30th, 2022, by the Association for Professionals in Infection Control and Epidemiology (APIC) in collaboration with the ANA. See also the ANA/APIC Healthcare Worker Mpox Exposure Screening Tool, referenced in this webinar. 
• How to administer a JYNNEOS vaccine intradermally. CDC YouTube video August 10, 2022
• CDC and FDA Update: Interim Clinical Considerations for Mpox Vaccination. Webinar (showing intradermal vaccination technique) August 11, 2022
• Mpox Outbreak: Updates on the Epidemiology, Testing, Treatment, and Vaccination (cdc.gov) Webinar July 26, 2022
• Mpox: Updates about Clinical Diagnosis and Treatment (cdc.gov) Webinar June 29, 2022
• What Clinicians Need to Know about Mpox in the United States and Other Countries (cdc.gov) Webinar May 24, 2022

See also the CDC Clinician FAQS, and the CDC Information For Healthcare Professionals webpage.

The CDC Reducing Stigma in Mpox Communication and Community Engagement webpage is an excellent resource for emphasizing prevention strategies, symptom recognition, and the treatable nature of mpox to minimize fear and promote action and a sense of personal agency.

CDC Mpox Technical Reports for the 2022 Multi-National Monkeypox Outbreak

CDC Mpox - What’s New & Updated webpage

Communication Resources

• CDC Mpox Graphic Resources
• CDC Mpox Print Resources
• CDC Mpox Videos

ICN Statement July 25, 2022:

Mpox - “Protect nurses, combat stigma” says International Council of Nurses

The White House

• President Biden Announces Team to Lead Mpox Response. AUGUST 02, 2022
• FACT SHEET: Biden-Harris Administration's Mpox Outbreak Response, JUNE 28, 2022