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The United States on Aug. 4 declared the spread of hMPXV (monkeypox, also known as human monkeypox virus) a public health emergency. The World Health Organization declared hMPXV a global health emergency July 23.
The rare virus is contagious but doesn’t spread as easily as COVID-19 or respiratory viruses, according to OHSU experts. Most people who are infected are recovering in two to four weeks without medical treatment.
“It’s important to keep in mind that monkeypox is much harder to get than the cold, the flu or COVID-19,” said OHSU’s Dr. Marcel Curlin, an infectious-disease expert who has spent years studying and treating HIV.
“It’s primarily spread through prolonged and close skin-to-skin contact. Monkeypox is not being broadly transmitted in the general community.”
Most people infected with hMPXV in this outbreak are men who have sex with men. OHSU and other health officials are concerned about making sure people in this group get the care they need and are not stigmatized. OHSU officials are also concerned with making sure LGBTQ and communities of color have access to care.
As of Aug. 17, Oregon had reported 116 confirmed and presumed infections, mostly in the Portland area and Lane County, including one involving a child. A limited supply of vaccines is available.
The virus is part of a family of viruses called poxviruses that include smallpox. Poxviruses cause a painful rash that can look like pimples or blisters. A poxvirus infection can also cause health problems and, rarely, death.
The virus was first reported in 1958 after it sickened monkeys in a research center in Denmark. The virus became known as monkeypox even though the monkeys were not the source. Scientists believe rodents carry the virus.
The World Health Organization is discussing a name change. One possible name is orthopoxvirus, after the genus (a biological category) that the virus belongs to.
The first human case of monkeypox was reported in 1970. In 2003, the United States had an outbreak of 47 cases in six states linked to pet prairie dogs.
Symptoms typically last two to four weeks.
The virus spreads mostly through direct or indirect contact with an infected person’s skin lesions, body fluids or personal items, such as clothing, bedding or towels.
OHSU experts say that casual contact, such as a handshake, is highly unlikely to spread hMPXV. Scientists are studying whether the virus can spread through airborne droplets but believe that’s rare.
If you are pregnant and become infected with hMPXV, you can pass it:
Anyone can get hMPXV. But as of late July, about 99% of cases were among men, and at least 95% among men who have sex with men, according to the WHO. Most cases reported in Oregon so far have been in men.
People who have not gotten a smallpox vaccine also may be more vulnerable to the virus, the CDC says. The United States stopped routine smallpox vaccinations in 1972.
(For those who have had a smallpox vaccination, though, one childhood dose can offer up to 75 years of protection, OHSU researchers found.)
Rochelle Walensky, director of the Centers for Disease Control and Prevention, said Aug. 4 that the people who face the most health risk from being infected with monkeypox are gay and bisexual men who:
The agency is focusing on getting this group, about 1.7 million people in the U.S., vaccinated first.
OHSU experts note that people in this group also face a higher risk of getting hMPXV because they are more likely to have riskier sexual practices. Everyone, regardless of whether they get an hMPXV vaccine, should follow recommendations for preventing HIV and hMPXV.
The CDC also offers advice for safer sex and social gatherings during the hMPXV outbreak.
OHSU experts recommend that you avoid:
The CDC recommends that people consider limiting sex partners and avoiding sex parties to reduce the risk of getting the virus until they are vaccinated.
If you share a household or health care setting with an infected person, you can use common household disinfectants to kill hMPXV on shared surfaces and personal items.
If you think you have been exposed to hMPXV, OHSU experts encourage you to:
If you develop symptoms, you are encouraged to:
An incubation period is the time between getting infected and showing symptoms. OHSU experts say the incubation period for hMPXV is usually seven to 14 days but can range from five to 21 days.
Infected people should be considered contagious from the time their symptoms start until the scabs from their rash fall off and a new layer of skin has formed.
OHSU experts say that once people have recovered from hMPXV, they can no longer spread it.
No. While people can get hMPXV during sex, it is not considered a sexually transmitted disease because it can spread in other ways.
Yes. Ask your health care provider about getting a test. If you do not have a health care provider, call your local public health department:
The U.S. Food and Drug Administration has approved two vaccines for poxviruses, the family of viruses that includes hMPXV:
Neither vaccine contains smallpox or hMPXV. Both are made from a related virus that does not cause disease in humans. Both spur the immune system to make antibodies to fight infection.
Both vaccines may have side effects including pain, swelling, fever and rash.
Both Jynneos and ACAM2000 have FDA approval for use against poxviruses. That means they were cleared for use after extensive testing in people.
Jynneos is linked to few possible complications. It can be given even to people with weakened immunity.
ACAM2000 is linked to a risk of myocarditis and pericarditis, potentially serious inflammation of the heart muscle and surrounding tissue. Risk is higher for those who have never had a smallpox vaccine, such as most people under age 60.
The CDC says ACAM2000 should not be given to people who:
ACAM2000 is given in one dose with a two-pronged needle. The needle is dipped in vaccine and then used to quickly prick a small section of arm skin multiple times.
Jynneos is given in two shots, typically 28 days apart. There is a very small supply of the vaccine in Oregon, so the Oregon Health Authority is asking health providers to limit doses to people at high risk of infection. OHSU is reserving its supply of the vaccine for patients with HIV.
OHA is focusing on offering first doses now to protect as many people as possible. It plans to give second doses in two to three months when more vaccine is available.
FDA and CDC leaders said they prefer the recommended schedule of two doses 28 days apart.
“A single dose of this vaccine will not provide the kind of protection over time that is necessary if people continue this risky behavior,” said Peter Marks, who oversees vaccines for the FDA. “So the two-dose regimen is the best that we can do to make sure that we actually have people get the protection that the vaccine is intended to provide.”
The Oregon Health Authority said several studies on people who got Jynneos or ACAM2000 showed first doses provided strong protection. For people who may not respond as well to the vaccines, the OHA said it would offer second doses as close to 28 days as possible after the first dose.
The Oregon Health Authority says the vaccine is best used to protect people who know they have been exposed to an infected person.
OHSU experts say getting a vaccine within four days of exposure can stop an infection. Getting a vaccine within 14 days of exposure can reduce the length and severity of an infection.
If you have been exposed, call your health care provider or your local public health department to ask for a vaccine:
The virus can cause more severe disease in children, according to OHSU experts. But health officials do not recommend hMPXV vaccines for children at this time because of limited supply.
No. OHSU experts say most Americans older than 60 have had the smallpox vaccine, which protects against hMPXV. OHSU researchers found that the smallpox vaccine provides immunity for up to 75 years after a single childhood dose.
Most people who get monkeypox recover without treatment within two to four weeks.
For more serious cases, the CDC and FDA allow the use of tecovirimat, or TPOXX, an antiviral drug approved for smallpox.
Tecovirimat is in limited supply in Oregon. OHSU is working with state health officials to ensure the safety of those who receive tecovirimat.
The virus can cause a range of complications such as:
The WHO says the case fatality ratio (the portion of diagnosed cases that lead to death) has been 3% to 6% in recent years. Because not all cases are diagnosed or reported, the fatality rate among all cases is lower.
No deaths from the current outbreak of hMPXV have been reported in the United States.
Health officials say two strains of monkeypox have been reported. The strain that is spreading now causes milder disease.
Contact your public health department:
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