Monkeypox Information

Monkeypox Virus
Monkeypox is a rare disease caused by infection with the monkeypox virus. Monkeypox virus is part of the same family of viruses that causes smallpox (orthopox viruses). Monkeypox symptoms are similar to smallpox symptoms but milder, and monkeypox is rarely fatal. Monkeypox is not related to chickenpox (caused by the varicella-zoster virus, a type of herpes virus).

There are two known types (clades) of monkeypox virus: West African and Congo Basin. The 2022 Monkeypox Outbreak is being caused by infections of the West African clade. The Congo Basin clade has historically caused more severe disease and is thought to be more transmissible.

Zoonotic Diseases
Monkeypox is a zoonotic disease - infectious diseases that are transmitted between species, from animals to humans. In Africa, evidence of monkeypox virus infection has been found in many animals including rope squirrels, tree squirrels, Gambian pouched rats, dormice, different species of monkeys and others. Further studies are needed to identify the exact reservoir(s) and how virus circulation is maintained in nature.

Previous Outbreak
In 2003, the first monkeypox outbreak outside of Africa occurred in the United States midwest, with more than 70 cases linked to contact with infected pet prairie dogs that had been in contact with other imported, infected animals.

Symptoms of Monkeypox
Monkeypox often starts with flu-like symptoms, followed by a rash or sores. If someone has flu-like symptoms, they will usually develop a rash 1-4 days later.

Common initial symptoms may include:

• Fever*
• Headache
• Swollen lymph nodes*
• Chills
• Muscle aches and backache
• Exhaustion
• New skin rash that can look like pimples, blisters or ingrown hairs.
  • It can look similar to rashes from other diseases such as syphilis, herpes, and chickenpox.

People who do not have monkeypox symptoms cannot spread the virus to others.

*Prior to the 2022 outbreak, fever and swollen lymph nodes were commonly associated with infections by the West African clade monkeypox virus, but these have not always occurred during the current outbreak. Rash and fever are the two most common symptoms experienced by individuals.

How Long Do Symptoms Last?
The monkeypox rash goes through different stages before healing completely. The illness typically lasts 2-4 weeks. Sometimes, people get a rash first, followed by other symptoms. Others only experience a rash.

Transmission
Monkeypox can be spread from the time symptoms start until the rash has healed, all scabs have fallen off, and a fresh layer of skin has formed.

Monkeypox spreads between people through:

• Direct contact with an infectious rash (which can look like pimples or blisters), scabs or bodily fluids
• Respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex
• Touching items (such as clothing or linens) that previously touched the infectious rash or body fluids
• Through the placenta of a pregnant woman to the fetus
• Living in a house and sharing a bed with someone

Other ways monkeypox may spread:
It’s also possible for people to get monkeypox from infected animals, either by being scratched or bitten by the animal or by preparing or eating meat or using products from an infected animal.

Monkeypox is NOT spread through:

• Casual brief conversations
• Walking by someone with monkeypox, like in a grocery store

General Precautions
Take the following steps to prevent getting monkeypox:​

• Avoid close, skin-to-skin contact with people who have a rash that looks like monkeypox.
• Do not touch the rash or scabs of a person with monkeypox.
• Do not kiss, hug, cuddle or have sex with someone with monkeypox.
• Do not share eating utensils or cups with a person with monkeypox.
• Do not handle or touch the bedding, towels, or clothing of a person with monkeypox.
• Wash your hands often with soap and water or use an alcohol-based hand sanitizer.
• If traveling to Central or West Africa, avoid contact with animals that can spread monkeypox virus, usually rodents and primates. Also, avoid sick or dead animals, as well as bedding or other materials they have touched.
• Healthcare providers treating potentially-infected patients should ensure that the patient is properly isolated and that the appropriate personal protective equipment (PPE) is used.

Home Precautions
If you have a friend or family member that has been diagnosed with monkeypox (or orthopox):

• Try to avoid direct skin contact with them if possible, or prolonged face-to-face contact in the same room
• If you must be within 6 feet of them, you should wear a respirator or well-fitting mask and they must wear a well-fitting mask
• If possible, have the positive individual use a designated bathroom and minimize use of other shared spaces. If they cannot isolate from others in the household, clean commonly touched surfaces and items after they leave the shared space.

Individuals Exposed to Monkeypox
Contacts of animals or people confirmed to have monkeypox:

• Should monitor for symptoms for 21 days after their last exposure, including two temperature checks daily for fever and examining the body for new rash.
  • If fever or rash develop, contacts should self-isolate and notify their medical provider
     
• Contacts who do not develop symptoms (remain asymptomatic) can continue their routine daily activities.
• Contacts should not donate blood, cells, tissue, breast milk, semen, or organs while in the symptom monitoring period.

Individuals Diagnosed with Monkeypox
Individuals diagnosed with monkeypox should isolate at home as much as possible except to seek medical care.

Living with Others & Pets:

• CDC Link: Preventing Spread to Others
• CDC Link: Pets in the Home

Taking care of yourself:

• The most important thing is to try to not touch or scratch the rash.
  • Avoid wearing contact lenses to reduce the chance of spreading the rash to your eyes.
  • Use gauze or bandages to cover the rash to limit spread to others and to the environment.
     
• Don’t lance (pop) or scratch lesions from the rash.
  • This does not speed up recovery and can spread the virus to other parts of the body or increase the chance of spreading the virus to others
  • Open lesions may become infected by bacteria.
     
• Do not shave the area with the rash until the scabs have fallen off and a new layer of skin has formed.
  • Shaving can spread the virus and cause more lesions.
     
• Keep skin lesions/rash clean and dry when not showering or bathing.
• Wash hands often with soap and water or use an alcohol-based hand sanitizer, especially after direct contact with the rash.
  • If you have rash on your hands, be careful when washing or using sanitizer so as not to irritate the rash.
     
• If you have rash on your hands, wear gloves that are non-irritating when handling common objects or touching surfaces in shared spaces.
  • If you can, use disposable gloves that can be discarded after each use (e.g., latex, polyurethane, or nitrile gloves). Reusable gloves should be washed with soap and water between use.
     
• Wear a well-fitting mask around other people until the rash and all other symptoms have resolved.
• Eat healthy and get plenty of rest to allow your body to heal.

Managing Symptoms:

• Medicines like ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) can help you feel better. Your healthcare provider may prescribe stronger pain relievers as well.
• For rash in the mouth, rinse with salt water at least four times a day.
  • Prescription mouthwashes, sometimes called miracle or magic mouthwash, or local anesthetics like viscous lidocaine can be used to manage pain.
     
• Topical benzocaine/lidocaine gels can be used for temporary relief. Oral antihistamines such as Benadryl and topical creams such as calamine lotion or petroleum jelly may help with itching.
• Soaking in a warm bath (using oatmeal or other over-the-counter bath products for itchy skin) may offer some relief to the dry, itchy sensations that can come with the rash.
• Contact your healthcare provider if pain becomes severe and unmanageable at home.

Testing
At this time, the risk to the general public in most places appears to be low.

• Individuals who believe they were exposed to monkeypox or have an illness that could be monkeypox should contact their healthcare provider.
• Testing involves swabbing 1 or more lesion

Treatment
There is no treatment specifically for monkeypox.

• Most people with monkeypox recover fully within 2 to 4 weeks without the need for medical treatment.
• Antivirals, such as tecovirimat (TPOXX), may be recommended for people who are more likely to get severely ill, like patients with weakened immune systems.

Vaccination
Human monkeypox vaccine and treatments are not available through routine providers due to limited supply, though the health department can assist your medical provider in coordinating these resources.​​

• The JYNNEOS vaccine is the preferred vaccine to protect against monkeypox. This is a 2-dose vaccine, with dose 2 given 28 days after the first dose. It takes about 2-weeks after the second dose for immune protection to reach its maximum.

People more likely to be able to get the monkeypox vaccine in Ohio at this time:

• People who have been identified by public health officials as a contact of someone with monkeypox
• People who are aware that one of their sexual partners in the past 2 weeks has been diagnosed with monkeypox
• People who had multiple sexual partners in the past 2 weeks in an area with known/high monkeypox trasmission
• Laboratory workers who perform testing for orthopoxviruses
• Laboratory workers who handle cultures or animals with orthopoxviruses
• Some designated healthcare or public health workers

Centers for Disease Control & Prevention (CDC)

• Monkeypox Virus
• Frequently Asked Questions
• Preventing Spread to Others
• Pets in the Home
• Isolation and Infection Control At Home
• Disinfecting Home and Other Non-Healthcare Settings