Monkeypox: What to Know About the New Public Health Emergency, From Symptoms to Risk

Dado Ruvic | Reuters

The monkeypox outbreak is becoming a U.S. public health emergency.

On Thursday, Health and Human Services Secretary Xavier Becerra — the country's top health official — said the Biden administration would officially designate monkeypox as a nationwide public health emergency. The declaration will accelerate vaccine distribution and facilitate access to emergency funding, among other national efforts to combat the outbreak.

Cases of the virus have topped 6,600 across 48 states, Washington, D.C., and Puerto Rico, and the announcement follows similar state-level declarations from California, Illinois and New York. The World Health Organization labeled monkeypox a public health emergency of international concern last month, and as of last week, 78 countries have reported more than 18,000 cases. Five deaths have been reported so far. 

The virus's quick spread has made it difficult for health officials to effectively communicate safety protocols, leading to confusion and even panic: Who's at risk? How worried should you be? What can you do to protect yourself, especially with many people still reeling from the Covid-19 pandemic? Should you get a vaccine?

Here's what you need to know:

What are monkeypox's symptoms?

The virus itself isn't new: It has historically spread at low levels in parts of West and Central Africa. The current outbreak is so unusual because monkeypox typically isn't found in Europe and North America at all.

Infections typically last two to four weeks, and often begin with symptoms similar to the flu — including a fever, muscle aches, headaches, chills, exhaustion and swollen lymph nodes — according to the Centers for Disease Control and Prevention. Symptoms can progress to a rash with red raised bumps on the skin, which then turns into pus-filled blisters before eventually drying out and falling off.

That rash can develop all over your body, including on your face, hands, feet, genitals and inside the mouth, the CDC says.

The severity of those symptoms can differ between individuals, says Dr. Cindy Prins, an epidemiologist at the University of Florida. She says some infected people may develop a widespread rash, while others may not get one at all.

Monkeypox isn't a particularly lethal virus: Only five deaths have been reported worldwide so far, and the CDC says more than 99% of people infected can expect to survive. But getting infected can be a very painful experience, especially depending on where on the body you develop lesions, Prins says.

How do I know if I'm at risk of monkeypox?

Prins says monkeypox predominantly spreads through prolonged skin-to-skin contact with an infected person who has a lesion. It can also spread through body fluids, contaminated bed sheets, clothing and other materials.

Technically, the virus can also transmit through respiratory droplets from coughing, sneezing or talking, Prins adds — but you'd have to be in close contact with an infected person for several hours for such transmission to occur.

That means it's not considered a sexually transmitted disease. But around 99% of cases in the U.S. are linked to male-to-male sexual contact, according to the WHO. The organization noted that most of reported cases are in men, often those who identify as gay, bisexual and other men who have sex with men. Transgender people and sex workers may also be at some risk, the WHO added.

You're primarily at risk if you have sex with multiple or anonymous partners, says Dr. Beth Thielen, a faculty member at the University of Minnesota Medical School's division of pediatric infectious diseases. She warns against stigmatizing gay and bisexual men, emphasizing that anyone — women and children included — can contract monkeypox by coming into contact with infected persons or materials.

"I want people who maybe aren't engaged in those risk activities to know that they can still get it. It's not a reason to think that they're at no risk at all," Thielen says.

What can I do to protect myself?

The CDC recommends avoiding skin-to-skin contact with people who have a rash that looks like monkeypox. You should also refrain from sharing eating utensils or cups with such people, and touching potentially contaminated items like bedding, clothes and towels until you have time to do your laundry.

Exercise caution in social gatherings — including raves, parties or clubs with minimal clothing and lots of skin-to-skin contact, and enclosed spaces like saunas or sex clubs — and wash your hands often with soap and water or alcohol-based hand sanitizer, the agency adds.

Thielen says sexually active individuals — particularly those at high risk — should consider temporarily altering their activities. Prins recommends talking to your partner or partners about their own risk of infection, and whether or not they've been exposed to the virus.

If you develop symptoms or learn that you've been exposed, contact your health care provider immediately to determine if you should get tested, Prins says. You should also isolate at home while actively infected, to avoid spreading it to others.

Should I get a monkeypox vaccine?

The CDC recommends vaccination for people who are at high risk, or have already been exposed to the monkeypox virus. The agency says getting vaccinated four to 14 days after your exposure may not prevent illness, but can help reduce any symptoms you may develop.

If you don't fall into either category, you probably don't need to get vaccinated — at least, for now. "We don't have the resources to vaccinate the whole population," Thielen says. "We're specifically tailoring vaccination strategies to folks that are at the highest risk."

Currently, there are two monkeypox vaccines available in the U.S. The first is the smallpox vaccine: Past data from Africa suggests that it's at least 85% effective in preventing monkeypox, according to the CDC.

The second is a two-dose vaccine called Jynneos that is "better tolerated," meaning people experience fewer serious side effects from it, says Dr. Dean Blumberg, chief of the division of pediatric infectious diseases at UC Davis Health.

Blumberg says Jynneos is relatively limited in supply, which helps explain the vaccine shortages seen across the country. More shots are on the way from Denmark, where Jynneos is manufactured: Last week, Becerra said 786,000 additional doses will be distributed once the U.S. Food and Drug Administration clears them for use.

For now, if you're struggling to find available vaccines near you, try clinics that treat or screen for sexually transmitted infections, Thielen advises. Prins also recommends visiting walk-in clinics if appointments aren't unavailable, and frequently checking for new appointments to open up.

"More vaccines are coming, so those appointments should be opening up more and more over the next month or so," Prins says.

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