Monkeypox (hMPXV): Frequently Asked Questions

What you need to know about symptoms, exposure, vaccines and protecting your health

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The United States on Aug. 4 declared the spread of monkeypox, also known as human monkeypox virus or hMPXV, a public health emergency. The World Health Organization declared hMPXV a global health emergency July 23.

In Oregon, OHSU experts say the rare virus is contagious but doesn’t spread as easily as COVID-19 or respiratory viruses. Most people who are infected are recovering in two to four weeks without medical treatment.

Dr. Marcel Curlin.
Dr. Marcel Curlin

“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 Sept. 21, Oregon had reported 204 confirmed and presumed infections, mostly in the Portland area and Lane County, including one involving a child. A limited supply of vaccines is available.

OHSU has limited supplies of the Jynneos vaccine. See: "Who can get vaccinated at OHSU?"

Deciding what to call the virus

OHSU is using the word monkeypox here because it’s the word people use to find information online. OHSU is dedicated to providing facts that help protect public health, especially in vulnerable communities.

We also know the term is stigmatizing. It perpetuates harmful stereotypes. It is being used as a slur against people of color and against members of the LGBTQ community. It is also a misnomer because experts say hMPXV probably comes from rodents.

For now, we have made the difficult decision to share important information in a way that helps people find it. The World Health Organization is considering changing the name, and we hope it does so soon. We will monitor the situation and make changes as needed.

Monkeypox basics

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. It became known by its current name even though the monkeys were not the source. Scientists believe rodents carry the virus.

The first human case was reported in 1970. In 2003, the United States had an outbreak of 47 cases in six states linked to pet prairie dogs.

The virus became known as monkeypox after it was first discovered in monkeys. It’s a misnomer, though, because scientists say the virus probably comes from rodents.

The World Health Organization is considering a name change. One possible name is orthopoxvirus, after the genus (a biological category) that the virus belongs to. The WHO invited the public to register and suggest new names in an online portal. The organization has not said when a new name will be announced.

The WHO also renamed two variants to remove geographic references. Variants are also known as clades, so the WHO is calling the variants Clade I and Clade II.

Learn more:

No.  While people can get hMPXV during sex, it is not considered a sexually transmitted disease because it can spread in other ways.

Health officials say two strains of monkeypox have been reported. The strain that is spreading now causes milder disease.

Monkeypox symptoms and spread

Symptoms typically last two to four weeks.

The first symptoms are:

  • Fever
  • Intense headache
  • Swollen lymph nodes
  • Back pain
  • Muscle aches
  • Lack of energy

Next symptoms are:

  • Within one to three days of the fever, an infected person will develop a painful rash that looks like pimples or blisters.
  • The skin bumps (lesions) most commonly form on the face, hands and feet, and in the mouth and throat. They can also form on the genitals and eyes.
  • The bumps fill with fluid and then turn into scabs.
Visual Examples of MonkeyPox Rash

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:

  • To your fetus through the placenta.
  • To your newborn during close contact after birth.

    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.

    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.

    The CDC has received one report of a possible reinfection in the current outbreak, which as of Sept. 19 consisted of nearly 24,000 cases in the United States.

    Infectious-disease experts say that, based on what we know about closely related viruses, people who get infected or vaccinated should have long-term immunity.

    Immunity can weaken for several reasons:

    • Medications and medical treatments that suppress the immune system
    • Untreated or unknown HIV infection

    Information is limited on how long the vaccine remains effective. The CDC recommends Jynneos booster doses for hMPXV every two or 10 years if you remain at risk for infection.

    The virus can cause a range of complications such as:

    • Scarring
    • Secondary infections, including tonsillitis
    • Pneumonia
    • Vision loss
    • Pregnancy complications including pregnancy loss

      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.

      Two deaths from monkeypox have been reported in the U.S. 

      Monkeypox prevention

      OHSU experts recommend that you avoid:

      • Having unprotected contact with an infected person’s skin lesions, body fluids or personal items.
      • Having lengthy face-to-face contact (within 6 feet) with an infected person without masks.

      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. Learn more.

      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.)

      See these related questions to learn more about who the Oregon Health Authority and OHSU consider at high risk of getting hMPXV:

      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 the virus are men who have sex with men and who:

      • Have HIV or
      • Take medication called PrEP to reduce the risk of getting HIV

      The agency is focusing on getting this group, about 1.7 million people in the U.S., vaccinated first.

      OHSU experts note that it's important for everyone, regardless of whether they get an hMPXV vaccine, to follow recommendations for preventing HIV and hMPXV. The CDC also offers advice for safer sex and social gatherings during the hMPXV outbreak.

      Monkeypox vaccines

      The U.S. Food and Drug Administration has approved two vaccines for poxviruses, the family of viruses that includes hMPXV:

      • Jynneos has emergency authorization for use in people ages 18 and older who are at high risk of infection with hMPXV. It can also be used for people under 18 under FDA “expanded access” rules, which include informed consent and other criteria.
      • ACAM2000 is approved for use against smallpox in people who are considered at high risk of infection. The FDA has made it available for use against hMPXV under “expanded access” rules.

      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:

      • Have severely weakened immunity
      • Are living with HIV
      • Have skin conditions such as eczema or psoriasis
      • Have heart disease
      • Have eye disease treated with topical steroids
      • Are pregnant
      • Are less than 12 months old

        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 doses, typically 28 days apart. 

        After exposure: 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.

        Before exposure: The Oregon Health Authority says some people at high risk of infection should get or be considered for vaccination. See "Who should get the Jynneos vaccine?" below.

        OHSU has limited supplies of Jynneos. See "Who can get vaccinated at OHSU?" below to learn who qualifies.

        Limited supplies of vaccine are available for people who have been exposed to hMPXV or who are considered at high risk of infection.

        OHSU has limited supplies of the Jynneos vaccine. We are offering both the first and second doses.

        After exposure:

        If you’ve been exposed to hMPXV, you should get vaccinated right away, ideally within four days of exposure.

        You qualify for vaccination at OHSU if you:

        • Are 18 or older
        • Do not have symptoms that are or could be from monkeypox (rash, fever, swollen lymph nodes, muscle aches, backache or headache)
        • Have been exposed to hMPXV in the last 14 days

        You do not have to be an OHSU patient.

        Before exposure:

        OHSU is offering pre-exposure vaccinations to OHSU patients who are at higher risk of hMPXV infection.

        You qualify for vaccination at OHSU if you are an OHSU patient, 18 or older, and you:

        • Have engaged in sex work or exchanged sex for something of value in the last 14 days

        OR

        • Are a man (cis- or transgender), a transgender woman or a nonbinary person who has sex with men, and at least one of the following:
          • Have had more than one male sex partner in the last 14 days
          • Take medication called PrEP to reduce the risk of getting HIV
          • Live with HIV
          • Have been diagnosed with an STI (sexually transmitted infection) in the last three months

        OHSU patients: Call 503-494-5455, and choose option 2.

        Other community members: If you qualify for a Jynneos vaccine but are not an OHSU patient, please check back for information on OHSU community clinics. They will be open for appointments soon. You can also contact your public health department:

        Under Oregon Health Authority guidelines, people should get or be considered for a Jynneos vaccination right away if they:

        • Have been in contact with people who have a presumed or confirmed case of hMPXV.
        • Have been in contact with people considered highly likely to have hMPXV, and if the person seeking vaccination would be unable to get vaccinated quickly otherwise.
        • Anticipate having or have had recent direct skin-to-skin contact with at least one other person and know people in their social circles or communities who have had hMPXV.
        • Take part in sex work or have any kind of sex in exchange for something.
        • Are a man (cis- or transgender), a transgender woman or a nonbinary person who has sex with men and who:
          • Has had more than one sex partner in an area where hMPXV has been spreading in the last 14 days.
          • Is taking medication called PrEP to reduce the risk of getting HIV.
          • Is living with HIV and/or has been diagnosed with an STI (sexually transmitted infection) in the last three months.

        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.

        Monkeypox exposure, testing and treatment

        If you think you have been exposed to hMPXV, OHSU experts encourage you to:

        • Check yourself for symptoms for 21 days after your most recent exposure. This includes taking your temperature twice a day to check for fever. (The Oregon Health Authority recommends checking for a new rash,  a fever of 100.4 or higher, swollen lymph nodes and chills.)
        • Stay away from group events.
        • Avoid public transportation.
        • Avoid donating blood, tissue, breast milk, semen or organs.

        If you develop symptoms, you are encouraged to:

        • Stay away from people and pets (isolate).
        • Seek testing and medical care.
        • Cover your lesions if possible.
        • Wear a mask.
        • Keep your used clothing and bedding in a separate bag or container that can be disinfected, and wash your clothing and bedding separately from other laundry.

          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:

            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.

            Most people who get hMPXV can take care of themselves at home. The most common concerns are rashes (lesions), pain and itching.

            How to care for rashes:

            • Keep them clean and dry.
            • Cover them with gauze, long sleeves, pants or gloves.
            • Avoid scratching a rash, popping a lesion or picking a scab.
            • Avoid shaving the skin around rashes or lesions.
            • Apply povidone-iodine ointment (Betadine) to reduce the risk of spreading the virus and to help speed healing.
            • If a lesion is producing fluid, dispose of any soaked gauze where others can’t come into contact with it. Place clothing or bedding that has come into contact with the fluid in a separate bag or container that can be washed or disinfected afterward.

            If you touch a rash:

            • Wash your hands with soap and water or a hand sanitizer with alcohol in it.
            • Avoid touching sensitive body parts such as the eyes, nose, mouth, genitals or anus. A rash that gets in the eyes can cause vision loss.

            If you have rash on your hands:
            Wear gloves when touching shared surfaces or objects. Reusable gloves should be washed with soap and water after each use.

            If you have a rash in your mouth:
            Rinse with salt water several times a day. If the rash is painful, talk to a health care provider about a prescription mouthwash or a local anesthetic.

            How to manage pain or itching:

            Pain: Take ibuprofen (Advil, Motrin) or acetaminophen (Tylenol).

            Itching:

            • Take an oral antihistamine (Benadryl).
            • Apply a numbing gel (lidocaine), steroid cream, calamine lotion or ointment (Aquaphor, Vaseline).

            In general:

            • Stay home and rest as much as possible.
            • Wear a mask around others if you have a rash in your mouth or throat.
            • Drink lots of fluids.

            When to seek medical care:

            Pain: if you have pain that cannot be managed with over-the-counter medications.

            Rashes:

            • If a rash spreads toward an eye or another area that may be especially sensitive, including broken skin.
            • If rashes spread over more than 5% or 10% of your body surface (the arm is about 9% of your total body surface).

            Infection: If you think you have signs of a secondary infection, including:

            • Fever (100.4 or higher)
            • Chills or sweats
            • Swollen lymph nodes
            • New rash