Understanding Monkeypox (hMPXV)

Monkeypox (hMPXV) is a disease caused by a virus not commonly seen in the United States, but regularly seen in other parts of the world. It is a known virus characterized by a rash and often includes flu-like symptoms. It usually is spread through close physical contact.

There are currently several thousand cases of monkeypox in the U.S., including over 200 in Oregon, and some in Clackamas County.

Oregon Health Authority launched a new website dedicated to helping people in Oregon learn more about the ongoing outbreak that has affected thousands worldwide. The new website includes a data dashboard with Oregon case counts, information for the public, clinicians, public health and community organizations; the website is also available in Spanish.

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Who is most at risk?

Anyone can get monkeypox if they are exposed, usually through close skin-to-skin contact with a lesion or open sore. A majority, but not all, of the cases currently in the U.S. have been among men who have sex with men. Learn more about risk factors identified in Oregon cases of monkeypox.

Most people with monkeypox recover in 2-4 weeks without serious complications. There have been very few deaths associated with the current monkeypox outbreak around the world. However, the disease can be uncomfortable or painful, and can potentially cause scarring. The disease can be more serious for people who are:

Immunocompromised (including people who are taking immune-compromising medications, are undergoing cancer treatment, have had organ transplants, or are living with HIV or other immune-compromising conditions).
Young kids and children
Pregnant

How it spreads

In relative terms, monkeypox is not very transmissible and does not spread like COVID-19. Monkeypox spreads primarily through close skin-to-skin contact. This may include sex, cuddling, massage and kissing.

Much less often, monkeypox could spread through contact with towels, clothing or other objects that have been in contact with monkeypox lesions. Large respiratory droplets or oral fluids that might come from prolonged face-to-face contact could also transmit the virus, but it is uncommon and has not been a signficant route of transmission in this outbreak.

At this time, there is no evidence of monkeypox being transmitted by attending an outdoor event with fully clothed people; trying on clothes or shoes at a store; traveling in an airport, on a plane or on other public transportation; swimming in a pool or body of water; using a public restroom; or casual contact with other people.

Symptoms

Everyone with monkeypox gets a rash or sores (pox). The rash can look similar to other things like acne, bug bites, or some sexually transmitted diseases. The rash may be hard to see. It can be painful or itchy and occur anywhere on the body including:

Face
Hands
Genital area
Mouth
Anus
Rectum

The rash starts as raised bumps that then fill with fluid (clear to cloudy), turn into open sores, then scab over and disappear. This process usually takes 2-4 weeks.

Flu-like symptoms

Some people also get flu-like symptoms before the rash appears, such as:

Fever
Swollen lymph nodes
Chills
Headache
Muscle aches
Fatigue

If you have symptoms or think you have been exposed, contact your doctor or clinic if you develop a new, unexplained, rash or sores on any part of your body. Cover your rash with clothing or bandages if possible.

Avoid sex or other close, intimate contact until you have been checked out.
Avoid gatherings, especially if they involve close, personal, skin-to-skin contact.

Preventing monkeypox

Surveillance and rapid identification of new cases are critical for outbreak containment. During human monkeypox outbreaks, close contact with infected persons is the most significant risk factor for monkeypox virus infection. To prevent the spread of the virus:

Don’t have skin-to-skin contact such as through sex or other intimate contact if you or your partner have symptoms of monkeypox. Condoms do not prevent the spread of the virus (but do prevent spread of other infections).
Ask potential partners about illnesses or rashes.
Consider limiting partners you engage in intimate contact or sex with until two weeks after you have received a second dose of the monkeypox vaccine.
Wear gloves when handling materials such as bedding that have been used by someone with the virus.
Wash hands thoroughly if you have contact with someone with monkeypox.
If you get symptoms, stay home until you can connect with a health care provider.
Advice for social gatherings like raves, parties, clubs and festivals.

Vaccines

Vaccines are available and are effective at protecting people against monkeypox before exposure. It can also help prevent disease or make it less severe after exposure. The CDC recommends the vaccine be given within four days of exposure to prevent onset of the disease. It is also recommended up to 14 days after exposures to reduce the symptoms.

OHA Expanded JYNNEOS vaccine eligibility as of 9/14/22 to include:

Anyone who knows other people in their social circles or communities who have had monkeypox, and who regularly has direct skin-to-skin contact with people in that social circle.

Eligibility also continues to include:

individuals identified by public health departments as close contacts to a known monkeypox case;
Anyone who has had close contact with someone with monkeypox
Laboratory workers routinely performing monkeypox testing
Clinicians with a high risk occupational exposure

Vaccine to protect against monkeypox is specifically recommended for anyone:

Whose healthcare provider recommends vaccination against monkeypox
Who has had direct and extended skin-to-skin contact with someone with monkeypox
Who is living with HIV
Who has considered taking HIV PrEP, has been recommended to take HIV PrEP, or is already taking HIV PrEP
Who, in the past year, has been diagnosed with gonorrhea, chlamydia or syphilis
Who, in the past year, has had sex with an anonymous partner, attended a sexon-site venue, or has had group sex
Who trades sex for money, goods, or services
Who works in sex-on-site venues or dance in adult entertainment venues

Risk of monkeypox infection likely increases with the number and frequency of these criteria. See further eligibility information from OHA.

Public Health is working with community groups and healthcare providers to reach out to those who might be most at risk. If you consider yourself at risk for monkeypox and would like to schedule a vaccine, Clackamas County Public Health is offering vaccine clinics for monkeypox on Thursdays at Clackamas Town Center from 11 a.m. to 7 p.m.(closed 2-3 p.m. for lunch).

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Other sites offering vaccines for monkeypox
Vaccine Administration Record - English
Registro De Administración De La Vacuna Contra - Spanish

Additional resources

Testing and treatment

Testing

Testing for monkeypox is available. Ask a health care provider about testing if you develop a new rash/bumps/sores, especially if you have traveled in the last month to other areas in the world where cases have been found or you know you have been in contact with anyone with the infection.

Treatment

Effective therapeutics have already been developed and are available through healthcare providers. The antiviral TPOXX (tercovirimat), for example, was developed specifically for smallpox but works for all orthopoxviruses including monkeypox. This treatment can prevent serious complications in those at risk, and can decrease the severity of pain and other symptoms for those diagnosed with monkeypox. Healthcare providers can visit the OHA website for information on obtaining TPOXX for patients with monkeypox.

Other mitigation measures

COVID-19 mitigation measures, like masks, improved ventilation and filtration and frequent cleaning of high touch surfaces, will help with reducing spread of any viral illness in the community.