Monkeypox is a rare disease that is caused by infection with monkeypox virus. Monkeypox virus belongs to the family Poxviridae which also includes variola virus (the cause of smallpox), vaccinia virus (used in the smallpox vaccine), and cowpox virus. These are enveloped viruses.
Monkeypox (MPX) was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name ‘monkeypox.’ The first human case of MPX was recorded in 1970 in the Democratic Republic of Congo during a period of intensified effort to eliminate smallpox.
The natural reservoir of MPX remains unknown. However, African rodent species are suspected to play a role
in transmission, according to the CDC.
As of May 2022, MPX is a rapidly evolving public health situation. To view the most up-to-date information and recommendations, please visit https://www.cdc.gov/poxvirus/monkeypox/index.html or https://www.canada.ca/en/public-health/services/diseases/monkeypox.html
To view the most up-to-date infection control recommendations in healthcare settings, visit
It’s not clear how people in the current 2022 clusters were exposed to monkeypox. Healthcare providers should be alert for patients who have rash illnesses consistent with monkeypox, regardless of whether they have travel or specific risk factors for monkeypox.
In humans, the symptoms of monkeypox are similar to but milder than the symptoms of smallpox. Monkeypox begins with fever, headache, muscle aches, and exhaustion. The incubation period (time from infection to symptoms) for monkeypox is usually 7−14 days but can range from 5−21 days.
Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a rash, often beginning on the face then spreading to other parts of the body.
Lesions progress through the following stages before falling off: macules, papules, vesicles, pustules, and finally scabs. The illness typically lasts for 2−4 weeks. In Africa, MPX has been shown to cause death in as many as 1 in 10 persons who contract the disease. As of July 2022, there have been no recorded deaths in the
US, and only 5 deaths worldwide despite over 14,000 cases.
Transmission of MPX virus occurs when a person comes into contact with the virus from an animal, human, or materials contaminated with the virus. The virus enters the body through broken skin (even if not visible), respiratory tract, or mucous membranes (eyes, nose, or mouth). Human-to-human transmission includes direct contact with body fluids/respiratory secretions or lesion material, and indirect contact with lesion material, such as through contaminated clothing or linens. Animal-to-human transmission may occur by bite or scratch, bush meat preparation, direct contact with body fluids or lesion material, or indirect contact with lesion material, such as through contaminated bedding.
Currently, there is no proven, safe treatment for MPX virus infection. For purposes of controlling a MPX outbreak in the United States, smallpox vaccine, antivirals, and vaccinia immune globulin (VIG) can be used. Learn more from CDC aboutLearn more from CDC about smallpox vaccine, antivirals, and VIG treatments.
There are a number of measures that can be taken to prevent infection with MPX virus:
- Isolate suspected and/or confirmed patients from others who could be at risk for infection. In healthcare settings, because of theoretical risk of airborne transmission of MPX, airborne precautions should be applied whenever possible.
- Practice good hand hygiene after contact with infected animals or humans. For example, washing your hands with soap and water or using an alcohol-based hand sanitizer.
- Use personal protective equipment (PPE) when caring for patients.
JYNNEOSTM (also known as Imvamune or Imvanex) is an attenuated live virus vaccine which has been approved by the U.S. Food and Drug Administration for the prevention of monkeypox. The Advisory Committee on Immunization Practices (ACIP) is currently evaluating JYNNEOSTM for the protection of people at risk of occupational exposure to orthopoxviruses such as smallpox and monkeypox in a pre-event setting.
Healthcare Infection Control Recommendations
A combination of Standard, Contact and Droplet precautions should be used for any patient with fever and vesicular/pustular rash. Airborne precautions should be applied if there is a strong suspicion of MPX. Confirmed patients should be placed in an airborne infection isolation room, if available. Masking of the patient (if tolerated) is also recommended in the presence of others. Additionally:
- Personal protective equipment should be donned before entering the patient’s room and used for all patient contact. All PPE should be disposed of prior to leaving the isolation room where the patient is admitted.
- Per CDC, optimal personal protective measures include:
- Use of disposable gown and gloves for patient contact.
- Use of NIOSH-certified N95 (or comparable) filtering disposable respirator that has been fit-tested for the healthcare worker using it, especially for extended contact in the inpatient setting.
- Visit The National Personal Protective Technology Laboratory (NPPTL) for frequently asked questions and answers about wearing respirators versus surgical masks.
- Use of eye protection (e.g., face shields or goggles), as recommended under standard precautions, if medical procedures may lead to splashing or spraying of a patient’s body fluids.
- Proper hand hygiene after all contact with an infected patient and/or their environment during care.
- Correct containment and disposal of contaminated waste (e.g., dressings) in accordance with facility-specific guidelines for infectious waste or local regulations pertaining to household waste.
- Care when handling soiled laundry (e.g., bedding, towels, personal clothing) to avoid contact with lesion material.
- Soiled laundry should never be shaken or handled in a manner that may disperse infectious particles.
- Care when handling used patient-care equipment in a manner that prevents contamination of skin and clothing.
- Ensure that used equipment has been cleaned and reprocessed appropriately.
- Ensure procedures are in place for cleaning and disinfecting environmental surfaces in the patient care environment.
Cleaning and Disinfection of Environmental Surfaces
- Diligent environmental cleaning and disinfection and safe handling of potentially contaminated materials is important, especially if there are any body fluids.
- The CDC recommends that “activities such as dry dusting, sweeping, or vacuuming should be avoided. Wet cleaning methods are preferred.”
- There are no specific disinfectant efficacy claims for MPX virus available to date.
- The EPA recommends use of a registered disinfectant that has emerging viral pathogen (EVP) language and a claim against non-enveloped viruses.
- As of May 25 th , 2022 the CDC recommends that “Standard cleaning and disinfection procedures should be performed using an EPA-registered hospital-grade disinfectant with an emerging viral pathogen claim. Products with emerging viral pathogen claims may be found on EPA List Q. Follow the
manufacturer’s directions for concentration, contact time, and care and handling.”
Monitoring MPX Exposures
Contacts of animals or people confirmed to have monkeypox should be monitored for symptoms for 21 days after their last exposure. CDC exposure guidance for clinicians is available at https://www.cdc.gov/poxvirus/monkeypox/clinicians/monitoring.html.
Guidelines and Recommendations/Resources
The table below highlights the products meeting these criteria for the U.S.: