How Do You Get Monkeypox? A Comprehensive Guide to Transmission, Symptoms, and Prevention

Monkeypox, recently renamed mpox, is a viral illness that has raised global health concerns. Understanding how mpox spreads is crucial for effective prevention and control. This article provides a detailed explanation of mpox transmission, symptoms, risk factors, and preventive measures, empowering you with the knowledge to protect yourself and your community.

Understanding Monkeypox Transmission: How Does Mpox Spread?

Mpox transmission can occur through different pathways, bridging from animal sources to humans and further spreading between people. The monkeypox virus has two main types, or clades: clade 1 (formerly clade I) and clade 2 (formerly clade II). Clade 1, typically found in Central Africa, is known to cause more severe illness and higher mortality rates compared to clade 2, which is more common in West Africa and associated with less severe disease. Both clades can spread globally, often linked to international travel or the trade of animals.

Animal to Human Transmission (Zoonotic Transmission)

Mpox is a zoonotic disease, meaning it can spread from animals to humans. This typically happens through direct contact with infected animals. Here are the primary ways mpox can jump from animals to humans:

Animal Bites or Scratches: Being bitten or scratched by an infected animal can directly introduce the virus into your body.
Contact with Animal Waste or Body Fluids: Exposure to the bodily fluids (like blood, saliva, pus from lesions) or waste of an infected animal can also lead to transmission.
Handling Infected Animals (Especially in Endemic Regions): In areas where mpox is prevalent in animals, handling wild animals, particularly during activities like hunting, trapping, skinning, cooking, or preparing bushmeat, increases the risk of infection. Rodents and non-human primates are known hosts of the monkeypox virus.

While rodents like gerbils, hamsters, and guinea pigs can be infected with related viruses, mpox cases in these specific pets haven’t been reported yet. The susceptibility of domestic pets like cats and dogs to mpox is still under investigation, but health authorities suggest that close contact with infected humans could potentially transmit the virus to pets. If you have concerns about your pet’s risk, consulting a veterinarian is advisable.

Human to Human Transmission

Mpox can also spread effectively from person to person. This type of transmission is a significant factor in recent global outbreaks. The virus spreads through:

Direct Contact with Rash, Scabs, or Body Fluids: The most direct way to contract mpox from another person is by touching the characteristic rash, scabs, or fluids (pus, blood) from mpox lesions.
Close, Face-to-Face Contact and Respiratory Droplets: Prolonged face-to-face contact, especially within close proximity, can lead to transmission through respiratory droplets. This is particularly relevant in household settings or caregiving situations.
Intimate Activities and Sexual Contact: Mpox can spread during intimate contact, including sexual activity. Direct skin-to-skin contact during sex, as well as contact with lesions in the genital or anal areas, can facilitate transmission.
Contact with Contaminated Objects (Fomites): The virus can survive on surfaces and objects contaminated with rash material or body fluids. Touching items like clothing, bedding, towels, or utensils that have been used by someone with mpox can lead to infection.
Mother to Fetus Transmission: A pregnant person infected with mpox can pass the virus to their unborn baby through the placenta.

What are the Symptoms of Mpox?

Mpox symptoms typically appear within 3 weeks (usually 6 to 13 days) after exposure. The illness often begins with flu-like symptoms, followed by the characteristic rash.

Initial flu-like symptoms may include:

Fever and Chills
Headache
Muscle aches and Backache
Swollen Lymph Nodes
Sore Throat
Runny or Stuffy Nose
Cough
Fatigue (Feeling very tired)

One to four days after the onset of these symptoms, the distinctive mpox rash emerges. Key features of the mpox rash include:

Appearance and Progression: The rash starts as flat spots (macules), which evolve into small bumps (papules), then fluid-filled blisters (vesicles), and finally pus-filled blisters (pustules). These pustules eventually scab over before resolving.
Location: The rash often begins on the face, hands, or feet, and can then spread to other parts of the body. It can also appear in the genital area, mouth, or throat.
Number of Lesions: The number of rash spots can vary significantly, from a single lesion to numerous spots covering large areas of the body.
Duration of Infectiousness: Individuals with mpox remain contagious from the onset of symptoms until all rash lesions have scabbed over and the scabs have fallen off, which typically takes 2 to 4 weeks.

It is important to seek medical attention promptly if you develop a new rash or experience mpox symptoms, even if you are unsure about exposure to mpox.

Who is at Higher Risk of Serious Mpox Illness?

While most individuals with mpox recover fully without serious complications, certain groups are at increased risk of developing severe illness:

People with Weakened Immune Systems: Individuals with conditions like HIV/AIDS, organ transplant recipients, or those undergoing immunosuppressive therapies are more vulnerable to severe mpox.
Young Children (Especially under 1 year old): Infants and young children are at higher risk of severe outcomes.
People with a History of Eczema: Pre-existing skin conditions like eczema can increase the severity of mpox skin manifestations.
Pregnant Individuals: Pregnant people are at higher risk, and mpox infection during pregnancy can pose risks to both the mother and the fetus.

Infection with clade 1 of the monkeypox virus is also associated with a higher likelihood of severe disease compared to clade 2.

How to Prevent Mpox?

Preventing mpox involves multiple strategies aimed at reducing the risk of animal-to-human and human-to-human transmission.

Mpox Vaccination: Vaccination is a highly effective preventive measure. The Jynneos vaccine is approved for mpox prevention in adults 18 years and older who are at risk of exposure. Two doses given four weeks apart are needed for full vaccination. Vaccination may be recommended for:
- Individuals who know or suspect they have been exposed to mpox or have had a recent sexual partner diagnosed with mpox.
- People with sexual risk factors, such as men who have sex with men, particularly those with new sexually transmitted infections or multiple partners.
- Laboratory workers, healthcare workers, and animal handlers who may be occupationally exposed.
Avoid Contact with People Who Have Mpox: Limit close contact with individuals who have a rash that could be mpox. If you are caring for someone with mpox, take precautions to minimize your exposure.
Avoid Contact with Animals That Could Carry Mpox: In areas where mpox is present in animals, avoid contact with rodents and non-human primates. Be cautious when handling or preparing wild game.
Practice Good Hand Hygiene: Wash your hands frequently with soap and water, especially after contact with potentially contaminated surfaces or people. If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol.
Safe Handling of Contaminated Materials: If you are caring for someone with mpox, wear gloves and a mask when handling their clothing, bedding, and other items. Wash contaminated items thoroughly.

Mpox Diagnosis and Treatment

Mpox diagnosis is typically made by a healthcare professional based on clinical evaluation and laboratory testing.

Diagnosis: A healthcare provider will assess your symptoms, examine the rash, and inquire about potential exposures. Fluid samples from rash lesions can be collected and tested in a laboratory to confirm mpox infection.
Treatment: For most people, mpox treatment focuses on alleviating symptoms. This may include pain relief with over-the-counter medications and measures to prevent skin damage from the rash. In cases of severe illness or for individuals at high risk of complications, antiviral medications may be considered under the guidance of a healthcare professional.

If you suspect you have mpox, it is crucial to isolate yourself at home and avoid close contact with others, including pets, until you are no longer contagious (when all lesions have healed).

Mpox in the U.S.

Mpox remains relatively rare in the United States, and the virus does not spread as easily as some other infectious diseases. However, it is essential to be aware of the symptoms and transmission routes. If you develop a new rash or experience mpox-like symptoms, promptly contact your healthcare provider for evaluation and guidance. Taking preventive steps, especially if you are at higher risk of exposure, is crucial for minimizing your risk of mpox infection.

Expert Source: Pritish K. Tosh, M.D.

References:

Goldman L, et al., eds. Smallpox, monkeypox, and other poxvirus infections. In: Goldman-Cecil Medicine. 27th ed. Elsevier; 2024.
Signs and symptoms. Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/mpox/symptoms/index.html. Accessed Aug. 22, 2024.
Interim clinical considerations for use of JYNNEOS vaccine for mpox prevention in the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/mpox/clinicians/vaccines/vaccine-considerations.html. Accessed Aug. 22, 2024.
Clinical recognition. Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/mpox/clinicians/clinical-recognition.html. Accessed Aug. 22, 2024.
About mpox. Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/mpox/about/index.html. Accessed Aug. 21, 2024.
How it spreads. Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/mpox/if-sick/transmission.html. Accessed Aug. 22, 2024.
Mpox (monkeypox). World Health Organization. https://www.who.int/news-room/fact-sheets/detail/monkeypox. Accessed Aug. 22, 2024.
Mpox in animals and pets. Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/mpox/veterinarian/mpox-in-animals.html. Accessed Aug. 22, 2024.
AskMayoExpert. Mpox: Considerations for supportive care management of mpox based on symptoms. 2024.
How to protect yourself. Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/mpox/prevention/protect-yourself.html. Accessed Aug. 22, 2024.
Mpox vaccine recommendations. Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/mpox/vaccines/vaccine-recommendations.html. Accessed Aug. 22, 2024.
Clinical quick reference. Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/mpox/clinicians/clinical-guidance-quick-reference.html. Accessed Aug. 21, 2024.
What to do if you are sick. Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/mpox/if-sick/what-to-do.html. Accessed Aug. 21, 2024.
U.S. Mpox Case Trends Reported to CDC. Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/mpox/response/2022/mpx-trends.html. Accessed Aug. 21, 2024.