Mpox ,or monkeypox, is a disease caused by the MPOX virus, which spreads primarily through close contact between people.
The manifestation of mpox typically includes fever, intense headache, muscle aches, back pain, low energy, swollen lymph nodes, and a skin rash or lesions. The rash usually begins within one to three days of the start of a fever. Lesions can be flat or slightly raised, filled with clear or yellowish fluid, and can then crust, dry up and fall off. The number of lesions on one person can range from a few to several thousand. The rash tends to be concentrated on the face, palms of the hands, and soles of the feet. They can also be found on the mouth, genitals, and eyes.
Symptoms typically last between 2 to 4 weeks and go away on their own without treatment. If you think you have symptoms that could be monkeypox, seek advice from your health care provider. Let them know if you have had close contact with someone who has suspected or confirmed mpox.
In most cases, the symptoms of mpox go away on their own within a few weeks, but in some individuals, they can lead to medical complications and even death. Newborns, children, and people with underlying immune deficiencies may be at risk of more serious symptoms and death from mpox.
Complications from severe cases of mpox include skin infections, pneumonia, confusion, and eye infections which can lead to loss of vision. Around 3–6% of reported cases have led to death in endemic countries in recent times, often in children or persons who may have other health conditions. It is important to note that this may be an overestimate because surveillance in endemic countries is limited.
Mpox can spread to people when they come into physical contact with an infected animal. Animal hosts include rodents and primates. The risk of catching mpox from animals can be reduced by avoiding unprotected contact with wild animals, especially those that are sick or dead (including their meat and blood). In endemic countries where animals carry mpox, any foods containing animal meat or parts should be cooked thoroughly before eating.
Regardless of the clade, mpox can spread to anyone through close personal contact with an infected person. This includes:
Direct skin-to-skin contact with the rash and scabs of an infected person.
Contact with saliva, respiratory secretions (mucus, snot), and bodily fluids, or lesions around the anus, rectum, or vagina.
- Pregnant individuals with mpox can transmit the virus to the fetus during pregnancy, or to the newborn during and after birth.
Close direct contact with a person with active lesions can lead to the acquisition of the disease, especially during intimate contact, which includes:
- Oral, anal, or vaginal sex, or touching the genitals (penis, testicles, labia, and vagina) or anus.
- Hugs, massages, and kisses.
- Prolonged face-to-face interactions (such as talking or breathing).
Anyone who has close physical contact with someone who has symptoms of mpox, or with an animal with the virus is at the highest risk of infection. People who were vaccinated against smallpox are likely to have some protection against mpox infection. However, younger people are unlikely to have been vaccinated against smallpox because smallpox vaccination stopped worldwide after smallpox became the first human disease to be eradicated in 1980. Even though people who have been vaccinated against smallpox will have some protection against monkeypox, they also need to take precautions to protect themselves and others.
Newborns, children, and people with underlying immune deficiencies may be at risk of more serious symptoms and death from mpox. Health workers are also at higher risk due to longer virus exposure.
You can reduce your risk by limiting contact with people who have suspected or confirmed mpox.
If you do need to have physical contact with someone who has mpox because you are a health worker or live together, encourage the person with the virus to self-isolate and cover any skin lesion if they can (e.g., by wearing clothing over the rash). When you are physically close to them, they should wear a medical mask, especially if they are coughing or have lesions in their mouth. You should wear one also. Avoid skin-to-skin contact whenever possible and use disposable gloves if you have any direct contact with lesions. Wear a mask when handling any clothes or bedding if the person cannot do it themselves.
Regularly clean your hands with soap and water or an alcohol-based hand rub, especially after contact with the person with the virus, their clothes, bed sheets, towels, and other items or surfaces they have touched or that might have come into contact with their rash or respiratory secretions (e.g., utensils, dishes). Wash the person’s clothes, towels and bedsheets, and eating utensils with warm water and detergent. Clean and disinfect any contaminated surfaces and dispose of contaminated waste (e.g., dressings) appropriately.
Children, like adults, are susceptible to infection. Unlike adults, children have not been vaccinated against smallpox, which offers some protection against monkeypox. Additionally, they may not have been previously exposed to the virus. Those living in crowded conditions, such as those impacted by the current outbreak in Congo, may also have close contact with infected family members.
Children are often more likely to have severe symptoms than teenagers and adults. The virus can also be transmitted to the fetus or newborn through birth or early physical contact.
In the Americas, as of mid-August 2024, the most affected population has primarily been adult men (94%)
If you think you have symptoms or have been in close contact with someone with mpox, contact your health worker for advice, testing, and medical care. If possible, self-isolate and avoid close contact with others. Clean hands regularly and take the steps listed above to protect others from infection. Your health worker will collect a sample from you for testing so that you can get appropriate care.
Mpox symptoms often resolve on their own without the need for treatment. It is important to take care of the rash by letting it dry if possible or covering it with a moist dressing to protect the area if needed. Avoid touching any sores in the mouth or eyes. Mouth rinses and eye drops can be used as long as cortisone-containing products are avoided. Vaccinia immune globulin (VIG) may be recommended for severe cases. An antiviral that was developed to treat smallpox (tecovirimat, commercialized as TPOXX) was also approved for the treatment of mpox in January 2022.
Since 1970, cases of monkeypox have been recorded in 11 African countries: Benin, Cameroon, Central African Republic, Democratic Republic of the Congo, Gabon, Ivory Coast, Liberia, Nigeria, Republic of the Congo, Sierra Leone, and South Sudan.
Occasionally, cases occur in non-endemic countries. They are usually reported in people who have traveled to endemic countries. An outbreak was caused by contact with animals that had been infected by other small, imported mammals.
In May 2022, multiple cases of monkeypox began to be identified in several non-endemic countries, including in the Region of the Americas. This outbreak is responsible for the cases reported in the Americas to date (August 2024).
In July 2022, the WHO Director-General determined that the monkeypox outbreak constituted a Public Health Emergency of International Concern (PHEIC), and in May 2023, he announced that the outbreak was no longer an emergency due to the sustained decrease in the number of cases.
In August 2024, the resurgence of monkeypox in the Democratic Republic of the Congo and an increasing number of countries, along with the emergence and rapid spread of a new strain of the virus, named Ib, in eastern Democratic Republic of the Congo, led the WHO Director-General to declare a new PHEIC.
Mpox can spread from one person to another through close physical contact, including sexual contact. It is currently not known whether monkeypox can be spread through sexual transmission routes (e.g., through semen or vaginal fluids), but direct skin-to-skin contact with lesions during sexual activities can spread the virus.
Mpox rashes are sometimes found on genitals and in the mouth, which is likely to contribute to transmission during sexual contact. Mouth-to-skin contact could thus cause transmission where skin or mouth lesions are present.
Mpox rashes can resemble some sexually transmitted diseases, including herpes and syphilis. This may explain why several of the cases in the current outbreak have been identified amongst men seeking care in sexual health clinics.
The risk of catching mpox is not limited to people who are sexually active or men who have sex with men. Anyone who has close physical contact with someone with the virus is at risk. Anyone who has symptoms that could be mpox should seek advice from a health worker immediately.
Mpox is spread from person to person through close physical contact. The risk of mpox is not limited to people who are sexually active or men who have sex with men. Anyone who has close physical contact with someone who is infectious is at risk. Anyone who has symptoms that could be mpox should seek advice from a health care provider immediately. This includes people who have connections to communities where cases have been reported.
Several of the cases that have been reported from non-endemic countries have been identified in men who have sex with men. These cases were identified at sexual health clinics. The reason we are currently hearing more reports of cases of mpox in communities of men who have sex with men may be because of positive health-seeking behavior in this demographic. Mpox rashes can resemble some sexually transmitted diseases, including herpes and syphilis, which may explain why these cases are being picked up at sexual health clinics. It is likely that as we learn more, we may identify cases in the broader community
We have seen messages stigmatizing certain groups of people around this outbreak of mpox. We want to make it very clear that this is not right. First of all, anyone who has close physical contact of any kind with someone who has mpox is at risk, regardless of who they are, what they do, who they choose to have sex with, or any other factor. Secondly, stigmatizing people because of an illness or a disease is unacceptable. Stigma is only likely to make things worse and stop us from ending this outbreak as fast as we can. We need to all pull together to support anyone who has been infected or who is helping to take care of people who are unwell. We know how to stop this disease, and how we can all protect ourselves and others. Stigma and discrimination are never okay, and it is not okay in relation to this outbreak. We are all in this together.
The disease is called monkeypox because it was first identified in colonies of monkeys kept for research in 1958. It was not detected in humans until 1970.
After a series of consultations with global experts, the WHO decided to use the term “mpox” to refer to this disease. The reasons behind this decision are explained here.
There are two major clades of the virus that cause mpox: clade I and clade II. The latter caused the global outbreak that began in 2022.
It is known that clade I causes more severe cases and more deaths than clade II in places where it is endemic. However, differences between previous outbreaks—such as the affected population groups—do not allow for definitive conclusions.
WHO public health advice to prevent and treat mpox applies to either clade.
In 2023, a new type of clade I virus, called clade 1b, was reported for the first time in the Democratic Republic of the Congo. It has been spreading through sexual contact and other types of close contact. Studies are being conducted to understand the characteristics of this new strain.
More than 120 countries have reported mpox cases between January 2022 and August 2024, with over 100,000 laboratory-confirmed cases and more than 220 deaths.
In the Americas, mpox outbreaks up to August 2024 have primarily affected men (94%), with transmission predominantly sexual among gay, bisexual, and other men who have sex with men. This infection can also occur in populations with extensive sexual networks, such as sex workers.
The WHO Director-General has issued temporary recommendations to countries following the declaration of the PHEIC. https://www.who.int/news/item/19-08-2024-first-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-upsurge-of-mpox-2024
These include recommendations on:
Emergency coordination
Disease surveillance and laboratory diagnostic capacity
Clinical care for mpox patients
International travel and trade
Vaccination
Risk communication and community engagement
Funding and integration of mpox into existing health programs
Research gaps
Reporting to WHO
These temporary recommendations are issued for Member States experiencing a resurgence of mpox, including but not limited to the Democratic Republic of the Congo, Burundi, Kenya, Rwanda, and Uganda.
Additionally, the current standing recommendations for mpox apply to all countries and have been extended until August 20, 2025.
Mpox Vaccines Q&A
The vaccines produced for Smallpox can protect against mpox. These vaccines include a) Dryvax, a vaccine licensed in the 1930s by the US Food and Drug Administration (FDA); b) ACAM2000, licensed in 2007; and c) a newer vaccine that was developed for smallpox (MVA-BN, also known as Imvanex, Imvamune, or Jynneos) approved by the National Regulatory Authorities of the European Union, Canada and United States to prevent smallpox and mpox.
Since smallpox was eradicated in 1980, most of these vaccines are not widely available and there is no certainty as to when they will be available to the public. In some countries, vaccines may be available in limited quantities and for use in accordance with national guidance.
Some studies shown that people who have been vaccinated against smallpox could have some protection against mpox. These persons may require a single booster dose.
In the current epidemiological situation of mpox outbreaks outside of endemic countries, PAHO and WHO do recommend that only close contacts of a mpox case should be offered vaccination.
PAHO and WHO do not recommend mass vaccination. Regardless of vaccine supply, mass vaccination of the population is not required nor recommended for mpox. Every effort must be made to control human-to-human spread of mpox through early case-finding and diagnosis, isolation, and contact-tracing.
A close contact is a person who, has been exposed to someone who is a confirmed or probable case of mpox, beginning from when symptoms first appeared to when all scabs have fallen off, under the following circumstances:
- Face-to-face exposure (including health workers without appropriate personal protective equipment [PPE]).
- Direct physical contact (including health workers without appropriate PPE), including sexual contact.
- Contact with contaminated materials such as clothing or bedding (including health workers without appropriate PPE).
The vaccines against mpox provide a level of protection against both infection and severe disease. The results of studies on the efficacy of these vaccines show that they offer good protection against mpox . Other studies on the use of mpox vaccines will provide additional information on their efficacy in different contexts.
After receiving the vaccine, it is important to continue taking precautions to avoid infection . This is because developing immunity can take several weeks, and some people may not respond adequately to the vaccinen. For those who contract mpox following vaccination, the vaccine still offers protection against severe disease and hospitalization.
All available vaccines against mpox can cause adverse effects. When vaccination is offered to a close contact of a confirmed case, it is important to inform the person of the possible side effects of the vaccination and to offer alternative infection control measures, if possible, to ensure that decisions are made considering the risks and benefits.
In 2022, through its Revolving Fund for Access to Vaccines, PAHO negotiated a deal with the manufacturer of the third-generation vaccine, and 13 countries in the region have been able to access doses of this vaccine since then. Following the PHEIC in August 2024, PAHO will adhere to technical recommendations including on global supply if the acquisition of more doses for the region is required.
Although vaccines are an important tool, they are not the only tool. Increased disease surveillance and community involvement are crucial to stopping mpox. Currently, mass vaccination is not recommended.
No. There is no evidence of a causal link between the COVID-19 vaccines and the recent spread of mpox in Europe and the Americas. Mpox has been circulating in central and west Africa since its first detection in animals in 1958 in the Democratic Republic of the Congo, long before the COVID-19 virus was discovered, and the vaccines were developed.