Questions and answers on monkeypox

What is monkeypox?

Human monkeypox is a viral disease that comes from animals and is caused by the monkeypox virus.

Symptoms include lesions that may be difficult to distinguish from other poxvirus infections and, to some extent, chickenpox.

There are two clades described for the monkeypox virus: Clade I and Clade II. Clade I has been associated with more severe disease and higher mortality than Clade II.

What are the symptoms of monkeypox?

Monkeypox often begins with a combination of the following symptoms:

The rash usually first appears on the face and spreads to other parts of the body, including the hands and feet. The skin lesions often first present as spots which evolve to fluid-filled blisters, then crusts and scabs before the skin heals completely.

    Social media card: Monkeypox symptoms

     

    In the 2022 monkeypox outbreak, several new observations were made. Infected people

    • may not experience the initial symptoms before the rash appears
    • may present with very few or even only one lesion, or even no rash
    • may only have anal inflammation and pain
    • may not experience any symptoms.

    How can you get monkeypox?

    Monkeypox does not spread easily between people. Person-to-person transmission occurs through

    • close contact with skin lesions of an infected person
    • respiratory droplets in prolonged face-to-face contact
    • contact with infected surfaces.

    In the current outbreak, most diagnosed human monkeypox cases are among men who have sex with men. Evidence suggests transmission occurred during sexual intercourse.

    How severe is monkeypox?

    Monkeypox usually causes mild to moderate symptoms like fever, backache and itching, and/or pain from the skin rash. Most people recover within weeks.

    In the 2022 monkeypox outbreak, most patients have been managed through home isolation with supportive care. About 10–13% of infected people have required hospitalisation, usually for the management of pain, dehydration, or skin infections. In rare instances, they were hospitalised for more severe complications such as myocarditis (heart inflammation) and encephalitis (brain inflammation).

    A few deaths have also been reported due to these complications, but the death rate in the 2022 monkeypox outbreak in Europe is currently around 0.02%.

    What is currently happening with monkeypox in Europe?

    In the 2022 outbreak,  cases of monkeypox have mostly been seen in countries where it is not common among groups of men who have sex with men, aged between 18–50 years.

    What is the origin of this outbreak?

    Scientists believe that the virus was introduced in Europe by a person who was infected in Africa in the spring of 2022. This is because the virus circulating in the 2022 monkeypox outbreak belongs to Clade IIb, which originates from West Africa,

    Why has WHO declared this outbreak a public health emergency of international concern?

    On 23 July 2022, the WHO declared that the multi-country outbreak of monkeypox is a public health emergency of international concern (PHEIC). Declaring a PHEIC is the highest level of global public health alert under the International Health Regulations.

    The declaration of a PHEIC can improve coordination, cooperation, and global solidarity in responding to an outbreak. This can lead to a coordinated response that better protects vulnerable groups and those at risk.

    To read more on how this decision was taken, see the Director-General of WHO’s press release here.

    Can monkeypox be transmitted by contact with contaminated objects?

    The monkeypox virus is quite stable in the environment, and studies in the current outbreak have shown it can remain on household surfaces at least 15 days after contamination. Common disinfectants can kill the monkeypox virus when used correctly.

    Given that in the 2022 outbreak, there were very few cases outside close networks of the main risk group, transmission through contact with objects out in public is expected to be very rare.  

    Is monkeypox airborne?

    Monkeypox is passed on mainly through close direct contact (including sexual contact) or contact with the lesions of an infected person. This is considered the main mode of transmission in the 2022 outbreak. The monkeypox virus in dust can also be infectious (e.g. during the changing of bedding of an infected person).

    Laboratory testing of monkeypox patients shows the presence of the virus in their throat, supporting droplet transmission. However, there are no definitive evidence from the 2022 outbreak pointing to respiratory transmission, including airborne transmission.

    Is monkeypox the same as chickenpox or shingles?

    The monkeypox rash can be confused with the chickenpox rash, which is the same virus that causes shingles. Monkeypox and shingles both manifest with a painful skin rash, but they are not the same.

    How can I protect myself against monkeypox?

    To protect yourself against monkeypox, you should

    • stay up to date and stick to reliable sources of information about the symptoms of monkeypox and the outbreak situation
    • practise good hand hygiene (appropriate handwashing) and respiratory etiquette
    • avoid touching skin lesions of people infected with monkeypox with your bare hands, wear disposable gloves, and observe strict hand hygiene.

    A vaccine is available in the EU that provides protection (see: “Is there a vaccine against monkeypox?).

    More information on how monkeypox is passed on and its symptoms can be found in this ECDC leaflet: “Navigating monkeypox: considerations for gay and bisexual men and other men who have sex with men”

    How can I protect others against monkeypox?

    If you have monkeypox, you should

    • remain isolated until no new lesions appear, the scabs fall off and your skin heals completely
    • avoid close contact with other people, particularly if they are infants, pregnant women or immunosuppressed
    • avoid close contact with pets such as dogs and cats, hamsters, bunnies, mice, and rats
    • abstain from sexual activity and close physical contact until the rash heals
    • remain in your own room when at home
    • use designated household items (clothes, bed linen, towels, eating utensils, plates, glasses), which should not be shared with other members of the household.

    If you need to visit your health provider or have a solitary walk, keep your rash covered and wear a medical face mask.

    Close contacts of monkeypox cases should self-monitor for symptoms for 21 days after the last exposure and should especially avoid close physical contact with young children, pregnant women and immunocompromised people.

    More information on navigating monkeypox can be found in this ECDC factsheet: “Navigating monkeypox: considerations for gay and bisexual men and other men who have sex with men”

    How is monkeypox treated?

    Treatment is mainly supportive for most cases and aims to alleviate the fever, the itching and possible pain from the rash and keep the infected person well hydrated.

    In addition, infected people should keep areas with the rash as clean as possible to help prevent secondary infections. Wash with mild soap will help prevent infection and complications. If swelling or redness develops around the rash, or if fever suddenly develops, even though symptoms were improving, medical advice is needed.  

    One antiviral drug – tecovirimat (TPOXXTM) – is currently authorised in the EU for the treatment of monkeypox. Depending on the decision of the treating physician patients can be offered this treatment, which helps control symptoms.

    Can condoms prevent the transmission of the monkeypox virus?

    It is currently unclear if transmission of the virus can occur through semen and, if so, for how long after the disappearance of symptoms. Condoms alone cannot provide full protection against transmission of the monkeypox virus, as contact with skin lesions may be sufficient for transmission to occur. As a precaution, condom use is recommended during sexual activities for 12 weeks after recovery from monkeypox disease.

    How worried should we be about the current outbreak?

    Europe is the second most affected region in the 2022 monkeypox outbreak. The likelihood of further spread of the virus through close contact with an infected case particularly among men who have sex with men is considered to be high.

    The likelihood of transmission to people without close contact with an infected person is considered to be very low. Sporadic cases as a result of such transmissions are expected.

    Public health authorities and sexual health clinics should prioritise the identification, management and contact tracing of monkeypox cases, as well as immunisation of close contacts of cases and other individuals at substantial risk of exposure according to national guidelines.

    For more individual advice, see the question “how to protect myself from monkeypox”

    Are children at risk for monkeypox?

    So far less than 1% of all detected cases have been among children. Some cases outside the most affected groups are expected.The overall risk from monkeypox to children in the EU is low. All of these cases have been mild and have resulted in full recovery.

    ECDC advises national public health authorities to include general practitioners and paediatricians in awareness training for monkeypox so that it is considered among the possible causes of rash in children.

    See also “How can I protect myself from monkeypox?”

    Is there a vaccine against monkeypox?

    In the EU/EEA, one vaccine (IMVANEXTM) is currently authorised for use to protect against smallpox and monkeypox in adults.

    Vaccination is an important tool in preventing the spread of monkeypox. Vaccinated individuals should continue to protect themselves from infection, as it may take several weeks to develop protective immunity after vaccination.

    More information on the available vaccine against monkeypox in the EU can be found at the European Medicines Agency (EMA) website:

    Who can get vaccinated against monkeypox?

    The vaccine currently authorised for use to protect against monkeypox can be used either for close contacts of cases of monkeypox, or for people at increased risk of exposure to monkeypox. Mass vaccination against monkeypox is not currently recommended.

    In the 2022 outbreak, only people at risk of infection are considered for vaccination. This may also vary from country to country. Risk groups may include:

    • close contacts of someone with monkeypox from either sexual, household or occupational contact
    • individuals considered at substantial risk of exposure (e.g., men who have sex with other men with multiple partners, or who engage in group sex, or had sex at commercial sex venues, especially in areas where monkeypox transmission is occurring)
    • individuals at risk of occupational exposure, such as healthcare workers.

    Monkeypox is an unusual disease – why is it attracting such attention now?

    Since it was first recognised as a human disease in 1970, monkeypox cases have been increasingly reported in several African countries due to a combination of factors, including both increased exposure to animals that carry the virus, as well as improved surveillance and laboratory capacity in Africa.

    The first outbreak of monkeypox reported outside Africa was in the United States in 2003, following the importation of infected animals. No human-to-human transmission was documented in that outbreak. More recently, in 2018 and 2019, four travellers, two from the United Kingdom, one from Israel, and one from Singapore, all with travel history to Nigeria, were diagnosed with monkeypox.

    In the 2022 outbreak, there has been an unusual incidence of cases infected in the community without travel links. In addition, it is disproportionally affecting specific groups, i.e. men who have sex with men, as the virus has entered internationally connected sexual networks of people with multiple partners and spreads through close or sexual contact.

    Is there a connection between monkeypox infection and the COVID-19 vaccine?

    COVID-19 vaccines, including commonly used mRNA vaccines, do not weaken the immune system and monkeypox is not a consequence of vaccinations. There is no evidence from any clinical studies that link the monkeypox virus, which has existed for decades, to COVID-19 vaccines.

    Why does ECDC recommend that cases should avoid contact with pets?

    Some pets, particularly rodents, are thought to be susceptible to the monkeypox virus. If these pets transmit the disease to wild animals, there is a risk that the disease could become endemic in Europe.

    As a result, close collaboration between human and veterinary public health authorities is needed to prevent the disease from being transmitted to wildlife.

    More information on monkeypox and animals can be found in the European Food Safety Authority (EFSA) factsheet:

    What is ECDC doing to control monkeypox in the EU/EEA countries?

    ECDC has developed risk assessments of the monkeypox outbreak in EU/EEA countries, urging national public health authorities to:

    • Raise awareness by appropriately targeted communication to those most at risk for transmission or severe disease, including the active involvement of key stakeholders at the community level.
    • Facilitate early diagnosis of cases through easy access to health services with well-informed clinicians and accessible diagnostics and management guidance.
    • Facilitate early detection of cases by implementing contact tracing in outbreak settings.
    • Facilitate and monitor the isolation of infected people.
    • Implement appropriate infection prevention and control measures in healthcare settings.
    • Implement a national vaccination strategy against monkeypox.

    In addition, ECDC, in many cases in collaboration with WHO Regional Office for Europe and community stakeholders, has developed guidance for health professionals and for risk communication and community engagement. They are available here: