We get it. You’re tired. Not only is COVID-19 still here, but now we have another potential pandemic on our hands: monkeypox.
The good news is, monkeypox probably won’t become the global catastrophe COVID-19 has. The bad news is, monkeypox is still a serious illness that is rapidly spreading in the U.S.
One in five Americans is afraid of getting monkeypox, according to a recent survey. If you’re among them, we have the answers you need to help put your mind at ease.
How worried should I be about monkeypox?
As of August 2022, there are more than 300 cases of monkeypox in Washington state and more than 16,000 across the U.S.
On July 28, the World Health Organization (WHO) declared the current monkeypox outbreak a global health emergency, and the White House followed suit on Aug. 4. King County declared a health emergency Aug. 19.
All of that sounds pretty worrisome, right? Not to downplay the current outbreak, which is impacting many people, but monkeypox is not as dangerous as COVID-19.
First off, monkeypox isn’t as contagious as COVID-19. There are two types of monkeypox: Clade I and Clade II. Clade I is more contagious and deadly, but thankfully Clade II, which is less serious, is the type spreading in the current outbreak.
“For COVID-19, you go to a public event, chatting at a restaurant, eating at a restaurant — those are exposures. That’s not the type of exposure we're talking about here with monkeypox, we’re talking about much more intimate exposures, definitive contact exposures, or contact with things like sheets or clothing that a person with monkeypox has used,” explains Dr. Shireesha Dhanireddy, medical director of UW Medicine’s Infectious Disease and Travel Medicine Clinic at Harborview Medical Center.
Second, monkeypox is less likely to mutate rapidly the way COVID-19 has, as it is a DNA virus, not an RNA virus like the SARS-CoV-2 virus that causes COVID-19.
What is monkeypox?
Monkeypox is an orthopoxvirus related to smallpox, a devastating virus that was eradicated worldwide in 1980 and for which the first-ever vaccine was successfully used.
Contrary to its name, monkeypox doesn’t primarily infect monkeys, though it can, and the first case was discovered in a monkey. It is a type of zoonotic disease, meaning it can spread between humans and non-human animals.
And though we understand the urge to relate the two, monkeypox is not related to chickenpox even though they have similar names. Chickenpox is caused by a different virus called varicella-zoster.
How do I know if my skin rash is a monkeypox symptom?
First off, most people who get monkeypox develop other symptoms — like a fever, fatigue and head and body aches — before they develop a rash.
If you think those new bumps on your skin are monkeypox and you’re tempted to Google what monkeypox lesions look like … don’t.
The only way to know for sure if you have monkeypox rather than some other illness is to get tested by your doctor.
“If you have painful lesions or if you have multiple lesions throughout your body and are experiencing systemic symptoms, it is worthwhile to discuss with your provider about getting tested for monkeypox first, and then, if that's positive, to get a referral for treatment,” Dhanireddy says.
If you really want to know what a monkeypox rash can look like, Dhanireddy recommends consulting photos on the Centers for Disease Control and Prevention (CDC) website.
While monkeypox sores may look like other types of skin conditions, they usually feel pretty different — as in, pretty painful, particularly in sensitive body areas, like genital, oral and anal areas.
“We know that when it affects mucosal surfaces like the rectum and in the mouth, it can be very painful,” Dhanireddy says. “And people do get concerned about the lesions being potentially scarring and disfiguring.”
Other monkeypox symptoms can cause discomfort, too, such as fever, headache, muscle aches, swollen lymph nodes, chills and fatigue. The illness can last from two to four weeks — which isn’t the worst thing ever, but also really sucks.
How do people get monkeypox?
Monkeypox spreads through skin-to-skin contact, particularly contact with an infected person’s lesions or rash. However, it’s important to note: monkeypox is not traditionally a sexually transmitted infection (STI), even though in the current outbreak it is primarily spreading through intimate, sexual contact.
In some central and western African countries, monkeypox is considered endemic — meaning it is always present in some communities, usually because of people coming into contact with infected animals.
The fact that monkeypox is now spreading regularly from one person to another is new and concerning.
“Up until just recently, it was fairly rare to see human infection — and certainly not to this kind of outbreak level in countries that had never been reported to have it before,” Dhanireddy says. “Prior to this outbreak, we had seen little handfuls of outbreaks related to exposures potentially to animals — back in 2003, for example, related to prairie dogs from Africa that were imported.”
Researchers are still determining if and how often monkeypox spreads in other ways, such as through respiratory droplets or contact with porous surfaces an infected person touched (such as bedding).
Also, let’s get one thing (not) straight: monkeypox is not a “gay disease.” Monkeypox can infect anyone; it just so happens it currently is spreading among men who have sex with men and transgender people.
If you’re thinking the current risk of stigma around monkeypox, considering it is affecting mostly gay and bisexual men, echoes the HIV/AIDS epidemic of the ’80s and ’90s, you’re not wrong. As we learned from that outbreak, it’s important not to promote stigma around infection and the people who are affected.
Am I at higher risk for monkeypox if I’m pregnant?
Recently, the first case of monkeypox from the current outbreak was detected in a pregnant woman.
“Pregnancy is also a relatively immunocompromised state, so those individuals may be at higher risk for getting more severe disease,” Dhanireddy says.
It is possible to transmit the monkeypox virus to your baby if you’re infected when you give birth or shortly after. Researchers don’t yet know how often this happens or if monkeypox can cause complications during pregnancy. However, monkeypox does not appear to cause serious complications the way smallpox did, and antiviral treatment is available for pregnant people with monkeypox.
Given that monkeypox is spread through close skin-to-skin contact, someone with monkeypox should not breastfeed while they are infectious.
Are my kids at risk for monkeypox?
Children under eight and children with immunocompromising conditions are at higher risk for severe illness, according to the CDC.
There is not a lot of research on how monkeypox affects children in general, though the CDC states that the disease affects them much the same way it affects adults.
The current outbreak is caused by a type of monkeypox, called Clade II, that is not deadly. According to the CDC, most children who get monkeypox will not need treatment or hospitalization and symptoms will resolve on their own. However, treatment is available for children if necessary.
Currently, very few children are affected by the current outbreak. In kids, it is far more likely that they have something like hand, foot and mouth disease, which is common in children and easy for them to catch.
If your child has been ill and developed a rash, lesions or bumps consistent with monkeypox, contact your child’s healthcare provider.
Is there a monkeypox vaccine?
Yes, there are actually two vaccines for monkeypox, one of which is approved specifically to prevent monkeypox and the other which was approved to prevent smallpox and is being used to prevent monkeypox.
Because there is currently high demand and limited supply, only people most at risk for monkeypox can get vaccinated. This includes people who recently had a high-risk exposure to someone with monkeypox as well as those with a high risk for exposure, though that latter demographic could change as monkeypox spreads.
The smallpox vaccine, ACAM2000, is only for people who aren’t immunocompromised or pregnant. It also isn’t safe for people who have eczema.
JYNNEOS, the monkeypox-specific vaccine, is safer for anyone but is in short supply. It also requires two doses to be completely effective.
“Right now, given the limited supply, we're really prioritizing those first doses in the supply that we have. And then, as supply increases, that second dose will be available,” Dhanireddy says. As of Aug. 23, public health started offering a limited number of second doses.
How to get testing or treatment for monkeypox
If you think you might have monkeypox, talk with your doctor. You will need to wear a mask and cover any lesions when going to an in-person appointment to avoid spreading the infection, though it may be possible to do a virtual appointment instead.
Testing for monkeypox is available. UW Medicine is offering monkeypox testing at many of its clinics and hospitals.
There is treatment available for people who think they may have been exposed to monkeypox, and an antiviral treatment called TPOXX (tecorvirima) for people who are diagnosed.
“Even though monkeypox isn’t as infectious as omicron, I do want to stress that it is still important to take it seriously and to really think about how you can protect yourself, how you can protect others in the community, how you can be aware of the signs and symptoms to get prompt testing and the need for isolation if you are infected,” Dhanireddy says.