Monkeypox is a viral zoonotic disease, caused by monkeypox virus, recognized as the most important orthopoxvirus infection after the eradication of smallpox.

This course offers public health officers and health workers in-depth information to understand the epidemiology, modes of transmission, clinical presentation, diagnostics, and treatment of monkeypox, as well as the strategies needed for effective prevention and outbreak investigation and response.

Monkeypox symptoms

People with monkeypox get a rash that may be located on or near the genitals (penis, testicles, labia, and vagina) or anus (butthole) and could be on other areas like the hands, feet, chest, face, or mouth.

The rash will go through several stages, including scabs, before healing.
The rash can initially look like pimples or blisters and may be painful or itchy.

Other symptoms of monkeypox can include:

Fever
Chills
Swollen lymph nodes
Exhaustion
Muscle aches and backache
Headache
Respiratory symptoms (e.g. sore throat, nasal congestion, or cough)

You may experience all or only a few symptoms

Sometimes, people have flu-like symptoms before the rash.
Some people get a rash first, followed by other symptoms.
Others only experience a rash.

How long do monkeypox symptoms last?

Monkeypox symptoms usually start within 3 weeks of exposure to the virus. If someone has flu-like symptoms, they will usually develop a rash 1-4 days later.

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. The illness typically lasts 2-4 weeks.

If You Have a New or Unexplained Rash or Other Symptoms...

Avoid close contact, including sex or being intimate with anyone, until you have been checked out by a healthcare provider.
If you don’t have a provider or health insurance, visit a public health clinic near you.
When you see a healthcare provider, wear a mask, and remind them that this virus is circulating in the area.

Monkeypox Testing Basics

When to Get Tested

Currently, testing is only recommended if you have a rash consistent with monkeypox.
If you think you have monkeypox or have had close personal contact with someone who has monkeypox, consider taking precautions and visit a healthcare provider to help you decide if you need to be tested for monkeypox.

Where to Get Tested

Only a healthcare provider can order a monkeypox test. The healthcare provider may take a specimen and send it to a lab for testing or they may send you to a lab for both specimen collection and testing.
Contact your local health department with any questions and to find out what the testing options are for your community.

What to Expect When You Get Tested

You will likely need to fill out paperwork before you get tested.
To get a specimen to test, the healthcare provider will use a swab to rub vigorously across lesions of your rash. They will take swabs from more than one lesion.
This swabbing may be uncomfortable but is necessary to get enough material to detect the monkeypox virus from the specimens.
The specimens will be tested in a lab to see if the monkeypox virus is detected.
Results are usually available within a few days.
While you are waiting for your results, take precautions to avoid getting or spreading monkeypox virus to others.

What Your Results Mean

If your test result is positive, take the necessary steps to protect yourself and others until you have completely recovered from your infection.
If your test result is negative: a negative test result means the test did not detect the virus and you probably do not have monkeypox. Continue to take steps to protect yourself and others.
If your test result is inconclusive: that means that your test will need to be conducted again because not enough of the specimen was taken.

Paying for Testing

The cost of monkeypox testing depends on where you get it.

Tests conducted by public health departments are usually free.
Testing referrals from a private healthcare provider to a commercial lab or tests done in the hospital may involve a fee.
For information on testing options in your community contact your local health department.

How It Spreads

Close or Intimate Contact

Monkeypox can spread to anyone through close, personal, often skin-to-skin contact, including:

Direct contact with monkeypox rash, scabs, or body fluids from a person with monkeypox.
Touching objects, fabrics (clothing, bedding, or towels), and surfaces that have been used by someone with monkeypox.
Contact with respiratory secretions.

This direct contact can happen during intimate contact, including:

Oral, anal, and vaginal sex or touching the genitals (penis, testicles, labia, and vagina) or anus (butthole) of a person with monkeypox.
Hugging, massage, and kissing.
Prolonged face-to-face contact.
Touching fabrics and objects during sex that were used by a person with monkeypox and that have not been disinfected, such as bedding, towels, fetish gear, and sex toys.

A person with monkeypox can spread it to others from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The illness typically lasts 2–4 weeks

Monkeypox and Pregnancy

A pregnant person can spread the virus to their fetus through the placenta.

Infected Animals

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.

Scientists are Still Researching

If the virus can be spread when someone has no symptoms
How often monkeypox is spread through respiratory secretions, or when a person with monkeypox symptoms might be more likely to spread the virus through respiratory secretions.
Whether monkeypox can be spread through semen, vaginal fluids, urine, or feces.

How to Protect Yourself

Monkepox Prevention Steps

Take the following three 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.

Avoid contact with objects and materials that a person with monkeypox has used.

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.

Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially before eating or touching your face and after you use the bathroom.

In Central and 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.

Vaccines

CDC recommends vaccination for people who have been exposed to monkeypox and people who may be more likely to get monkeypox.

People more likely to get monkeypox include:

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 monkeypox

People whose jobs may expose them to orthopoxviruses, such as:
- Laboratory workers who perform testing for orthopoxviruses
- Laboratory workers who handle cultures or animals with orthopoxviruses
- Some designated healthcare or public health workers

Vaccine protection

The preferred vaccine to protect against monkeypox is JYNNEOS, which is a two-dose vaccine. It takes 14 days after getting the second dose of JYNNEOS for its immune protection to reach its maximum.

The ACAM2000 vaccine may be an alternative to JYNNEOS. ACAM2000 is a single-dose vaccine, and it takes four weeks after vaccination for its immune protection to reach its maximum. However, it has the potential for more side effects and adverse events than JYNNEOS. It is not recommended for people with severely weakened immune systems and several other conditions.

People should take precautions to reduce their exposure to monkeypox until immune protection from vaccines has reached its maximum. Consult your healthcare provider to see if you should get vaccinated against monkeypox, and if you should receive ACAM2000 instead of JYNNEOS.

Safer Sex, Social Gatherings, and Monkeypox

While CDC works to contain the current monkeypox outbreak and learn more about the virus, this information can help you make informed choices when you are in situations or places where monkeypox could be spread. Monkeypox is not considered a sexually transmitted disease, but it is often transmitted through close, sustained physical contact, which can include sexual contact.

How can a person lower their risk during sex?

Vaccination is an important tool in preventing the spread of monkeypox. But given the current limited supply of vaccine, consider temporarily changing some behaviors that may increase your risk of being exposed. These temporary changes will help slow the spread of monkeypox until vaccine supply is adequate.

Reducing or avoiding behaviors that increase risk of monkeypox exposure is also important when you are between your first and second shots of vaccine. Your protection will be highest two weeks after your second dose of vaccine.

Make a habit of exchanging contact information with any new partner to allow for sexual health follow-up, if needed.

Talk with your partner about any monkeypox symptoms and be aware of any new or unexplained rash or lesion on either of your bodies, including the mouth, genitals (penis, testicles, vulva, or vagina), or anus (butthole). If you or your partner has or recently had monkeypox symptoms, or you have a new or unexplained rash anywhere on your body, do not have sex and see a healthcare provider. In some cases, symptoms may be mild, and some people may not even know they have monkeypox.

If you or a partner has monkeypox or think you may have monkeypox, the best way to protect yourself and others is to avoid sex of any kind (oral, anal, vaginal) and kissing or touching each other’s bodies—while you are sick. Especially avoid touching any rash. Do not share things like towels, fetish gear, sex toys, and toothbrushes.

Even if you feel well, here are some ways to reduce your chances of being exposed to monkeypox if you are sexually active:

Take a temporary break from activities that increase exposure to monkeypox until you are two weeks after your second dose. This will greatly reduce your risk.
Limit your number of sex partners to reduce your likelihood of exposure.
Spaces like back rooms, saunas, sex clubs, or private and public sex parties, where intimate, often anonymous sexual contact with multiple partners occurs—are more likely to spread monkeypox.
Condoms (latex or polyurethane) may protect your anus (butthole), mouth, penis, or vagina from exposure to monkeypox. However, condoms alone may not prevent all exposures to monkeypox since the rash can occur on other parts of the body.
Gloves (latex, polyurethane, or nitrile) might also reduce the possibility of exposure if inserting fingers or hands into the vagina or the anus. The gloves must cover all exposed skin and be removed carefully to avoid touching the outer surface.
Avoid kissing or exchanging spit since monkeypox can spread this way.
Masturbate together at a distance without touching each other and without touching any rash.
Have virtual sex with no in-person contact.
Consider having sex with your clothes on or covering areas where rash is present, reducing as much skin-to-skin contact as possible. Leather or latex gear also provides a barrier to skin-to-skin contact; just be sure to change or clean clothes/gear between partners and after use.
Be aware that monkeypox can also spread through respiratory secretions with close, face-to-face contact.
Remember to wash your hands, fetish gear, sex toys, and any fabrics (bedding, towels, clothes) after having sex. Learn more about infection control.

What should a person do if they have a new or unexplained rash or other symptoms?

Avoid sex or being intimate with anyone until you have been checked out by a healthcare provider.
If you don’t have a provider or health insurance, visit a public health clinic near you.
When you see a healthcare provider, wear a mask, and remind them that this virus is circulating in the area.
Avoid gatherings, especially if they involve close, personal, skin-to-skin contact.

Think about the people you have had close, personal, or sexual contact during the last 21 days, including people you met through dating apps. To help stop the spread, you might be asked to share this information if you have received a monkeypox diagnosis.

How can a person lower the chance of getting monkeypox at places like raves, parties, clubs, and festivals?

When thinking about what to do, seek out information from trusted sources like the local health department. Second, consider how much close, personal, skin-to-skin contact is likely to occur at the event you plan to attend. If you feel sick or have a rash, do not attend any gathering, and see a healthcare provider.

Festivals, events, and concerts where attendees are fully clothed and unlikely to share skin-to-skin contact are safer. However, attendees should be mindful of activities (like kissing) that might spread monkeypox.
A rave, party, or club where there is minimal clothing and where there is direct, personal, often skin-to-skin contact has some risk. Avoid any rash you see on others and consider minimizing skin-to-skin contact.
Enclosed spaces, such as back rooms, saunas, sex clubs, or private and public sex parties where intimate, often anonymous sexual contact with multiple partners occurs, may have a higher likelihood of spreading monkeypox.

Other Resources

Monkeypox and Safer Sex [PDF – 2 MB]

Pets in the Home

Infected animals can spread Monkeypox virus to people, and it is possible that people who are infected can spread Monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food.

People with monkeypox should avoid contact with animals, including pets, domestic animals, and wildlife to prevent spreading the virus. If your pet is exposed to monkey pox:

Do not surrender, euthanize, or abandon pets just because of a potential exposure or Monkeypox virus
Do not wipe or bathe your pet with chemical disinfectants, alcohol, hydrogen peroxide, or other products, such as hand sanitizer, counter-cleaning wipes, or other industrial or surface cleaners.

If the person with monkeypox did NOT have close contact with pets after symptom onset, ask friends or family members who live in a separate home to be the animal’s caretaker until the person with monkeypox fully recovers. Close contact includes petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food.

After the person with monkeypox is recovered, disinfect your home before bringing healthy animals back; follow Disinfecting Home and Other Non-Healthcare Settings.

Pets that had close contact with a symptomatic person with monkeypox should be kept at home and away from other animals and people for 21 days after the most recent contact. Infected people should not take care of exposed pets. The person with monkeypox should avoid close contact with the exposed animal, and when possible, ask another household member to care for the animal until the person with monkeypox is fully recovered.

In some cases, it may be necessary to isolate and care for animals that have been exposed to monkeypox in a location other than the home. For example, people who are immunocompromised, pregnant, have young children present (<8 years of age), or with a history of atopic dermatitis or eczema, should not provide care for animals that had close contact to a person with monkeypox as they may be at increased risk for severe outcomes from monkeypox disease.

If you have monkeypox and must care for your healthy pets during home isolation, wash your hands, or use an alcohol-based hand rub, before and after caring for them. It is also important to cover any skin rash to the best extent possible (i.e. long sleeves, long pants), and wear gloves and a well-fitting mask or respirator while providing care for your animals.

Do not put a mask on your pet.
Avoid close contact with your pet.
Ensure your pet cannot inadvertently come into contact with contaminated articles in the home such as clothing, sheets, and towels used by the person with monkeypox.
Do not let animals come into contact with rashes, bandages, and body fluids.
Ensure food, toys, bedding, or other items that you provide for your animal during its isolation do not come in direct contact with skin or uncovered rash.

What to do if a pet shows signs of monkeypox

While we do not know all the symptoms infected animals may have, watch the animal for potential signs of illness including lethargy, lack of appetite, coughing, nasal and/or eye secretions or crust, bloating, fever, and/or pimple- or blister-like skin rash. Call your veterinarian if you notice an animal appears sick within 21 days of having contact with a person who has probable or confirmed monkeypox. A veterinarian can help notify your state public health veterinarian [136 KB, 7 pages] or state animal health official.

Transmission has occurred from persons with monkeypox to their pet dog while isolating at home. Signs of monkeypox in dogs includes development of a new rash, which to-date have been located on the abdomen and anus.
Do not euthanize pets with suspected monkeypox unless directed by a veterinarian.
Do not wipe or bathe your pet with chemical disinfectants, alcohol, hydrogen peroxide, or other products, such as hand sanitizer, counter-cleaning wipes, or other industrial or surface cleaners.

Steps to take if you think your pet has monkeypox

Get your pet tested if they have had close contact with a person with probable or confirmed monkeypox and they have a new rash or two other clinical signs. Call your veterinarian if you notice an animal appears sick within 21 days of having contact with a person who has probable or confirmed monkeypox. A veterinarian can help notify your state public health veterinarian [136 KB, 7 pages] or state animal health official.
- Possible clinical signs of monkeypox in animals include lethargy, lack of appetite, coughing, bloating, nasal and/or eye secretions or crust, fever, and/or pox-like skin lesions (may initially resemble a pimple or blister before progression to a characteristic monkeypox lesion) or rash.
Separate the sick pet or animal from other animals and minimize direct contact with people for at least 21 days after becoming ill or until fully recovered.
- It is preferable to keep animals with signs of illness isolated in their home and away from anyone who has not had monkeypox.
- People who are immunocompromised, pregnant, have young children present (<8 years of age), or with a history of atopic dermatitis or eczema, should not provide care for ill animals that had close contact with a person with monkeypox.
Wash your hands often and use personal protective equipment (PPE) when caring for and cleaning up after sick animals. PPE includes wearing gloves, using eye protection (safety glasses, goggles, or face shield), wearing a well-fitting mask or respirator (ideally a disposable NIOSH-approved N95 filtering facepiece respirator), and wearing a disposable gown.
- If a disposable gown is not available, wear clothing that fully covers the skin (i.e. long sleeves, long pants), and immediately remove and launder clothing after contact with the animal, animal enclosures, or animal bedding.
- Carefully remove PPE to avoid self-contamination.
- Use an alcohol-based hand rub or wash hands with soap and water after PPE has been removed.
Consult your local public health department for guidelines for waste disposal, but general precautions include:
- Use a dedicated, lined trash can for all potentially contaminated waste.
- Do not leave or dispose of waste outdoors as Monkeypox virus infections in wildlife may occur.
- If appropriate for the species and your plumbing system, flush animal waste down the toilet.
- Disposable animal housing, disposable rodent bedding, and animal waste that cannot be flushed down the toilet should be sealed in a bag and disposed of properly to prevent these materials from infecting people or other animals, including wild animals and household pests like mice and rats. Follow guidelines for Disinfecting Home and Other Non-Healthcare Settings.
Bedding, enclosures, food dishes, and any other items in direct contact with infected animals must be properly disinfected following the Disinfecting Home and Other Non-Healthcare Settings.
Soiled laundry and bedding (including disposable rodent bedding) should not be shaken or otherwise handled in a manner that may disperse infectious particles.
For household disinfection, follow Disinfecting Home and Other Non-Healthcare Settings.

What to Do If You Are Sick

There is no treatment specifically for monkeypox. Because the viruses that cause monkeypox and smallpox are closely related, drugs and vaccines developed to treat and protect against smallpox may be effective for monkeypox.

However, the type of treatment for a person with monkeypox will depend on how sick someone gets or whether they’re likely to get severely ill. Most people with monkeypox recover fully within 2 to 4 weeks without the need for medical treatment.

Some people, like those with a weakened immune system or genital or rectal rashes, may need treatment. Drugs used to treat monkeypox require a prescription and must be requested by a healthcare provider through the local or state health department.

Taking Care of Yourself

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, increase the chance of spreading the virus to others, and possibly cause the open lesions to 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 Your 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. Oral antiseptics like chlorhexidine mouthwash can be used to help keep the mouth clean.

Contact your healthcare provider if pain becomes severe and unmanageable at home.

Rash Relief

The most important thing is to try to not touch or scratch the rash. This can spread the rash to other parts of the body, increase the chance of spreading the virus to others, and possibly cause open lesions to become infected by bacteria. If you do accidentally touch the rash, wash your hands with soap and water and avoid touching sensitive areas like your eyes, nose, mouth, genitals and rectum (butthole).

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.

People who have the rash in or around their anus (butthole) or genitals (penis, testicles, labia, vagina), or perineum (taint) may also benefit from a sitz-bath. A sitz bath is a round, shallow basin that can be purchased online or at a pharmacy. Most fit over the rim of a toilet but can also be placed in a bathtub. There is also the option to sit in a bathtub with shallow water. Your healthcare provider may prescribe medication like povidone-iodine or other products to be added to the water in a sitz bath. Adding Epsom salt, vinegar, or baking soda to the water can be soothing.

Preventing Spread to Others

If you have monkeypox, you are advised to stay at home (isolate) if you have monkeypox symptoms, including until your monkeypox rash has healed and a new layer of skin has formed. Staying away from other people and not sharing things you have touched with others will help prevent the spread of monkeypox. Monkeypox can also spread to animals, so staying away from pets, livestock and other animals is important.

Not every person has the same ability or resources to remain at home for a long period of time. The table below provides options for how to prevent spreading monkeypox to others, organized by the risk of spread. Whenever possible, higher risk options should be avoided, and the lowest risk options should be followed.

Notifying Close Contacts

It’s important to notify your close contacts that they may have been exposed to monkeypox as soon as possible, so they can watch for signs and symptoms, get tested and isolate if they have symptoms, and consider getting vaccinated. By letting your close contacts know they may have been exposed to monkeypox, you are helping to protect them and everyone around them.

If you are unable to notify your close contacts yourself, your local health department may be able to help. They may be able to notify your close contacts for you without disclosing your information.

Who Are Your Close Contacts?

Determine if someone is considered a close contact. A close contact is anyone, since the start of your monkeypox symptoms you:

Have had sex with; this includes oral, anal, and vaginal sex.
Have hugged, cuddled, or kissed.
Shared cups, utensils, towels, clothing, bedding, blankets, or other objects and materials with.
Have touched or who came in contact with the rash on your body.

Make a List of Close Contacts to Notify

Think about:

Who are your sex partners?
Who lives with you (including family members, roommates, or overnight guests)?
Who have you recently played sports with where you had direct skin-to-skin contact?
Who have you recently had direct skin-to-skin contact with? Consider the following:
- In-person meetings or gatherings you attended
- People you have met with recently (i.e., for a home visit, at a restaurant, for drinks, for dancing, for exercise, or for a party)
- Appointments with health care providers, including dentists
- People who have provided you services, such as childcare providers, house cleaners, barbers, hairdressers, nail salon workers, massage therapists, adult care workers, etc.
- People you work or volunteer with outside of the home.

Tips on What to Say

An example of what you can say to your close contacts could be:

“Hi. I need to talk to you about something important, do you have a few minutes to talk privately? I was diagnosed with monkeypox (or tested positive) on [xxx date]. Monkeypox can be transmitted through close or intimate contact. Since we spent time together on [xxx date], I wanted to let you know so you can follow CDC recommendations or contact the health department for more information. CDC says people should check for symptoms, get tested ASAP if you have symptoms, isolate away from others if you have symptoms or test positive, and see a healthcare provider if your symptoms are severe. They have more information on their website, as well at www.cdc.gov/monkeypox.”

Disinfecting Home and Other Non-Healthcare Settings

This document provides considerations on cleaning and disinfecting settings such as homes and cars that may be contaminated with Monkeypox virus. This information applies to the Clade IIb of Monkeypox virus only.

Purpose of Home Disinfection

People with monkeypox who do not require hospitalization may be isolated at home. Monkeypox spreads between people through direct contact with an infectious rash, body fluids, or by respiratory secretions during prolonged, face-to-face contact. Transmission of Monkeypox virus is possible from the onset of the first symptoms until the scabs have separated and the skin has fully healed.

During the infectious period of time, body fluids, respiratory secretions, and lesion material from people with monkeypox can contaminate the environment. Poxviruses can survive in linens, clothing and on environmental surfaces, particularly when in dark, cool, and low humidity environments. In one study, investigators found live virus 15 days after a patient’s home was left unoccupied. Studies show that other closely related Orthopoxviruses can survive in an environment, similar to a household, for weeks or months. Porous materials (bedding, clothing, etc.) may harbor live virus for longer periods of time than non-porous (plastic, glass, metal) surfaces.

Orthopoxviruses are very sensitive to UV light. Despite the ability of Orthopoxviruses to persist in the environment, they are also sensitive to many disinfectants, and disinfection is recommended for all areas (such as home and vehicle) where a person with monkeypox has spent time, as well as, for items considered to be potentially contaminated.

Disinfectant

Use an EPA-registered disinfectant, in accordance with the manufacturer’s instructions. Follow all manufacturer directions for use, including concentration, contact time, and care and handling. When choosing a disinfectant, it is important to consider any potential health hazards, and do not mix disinfectants or add other chemicals. More considerations can be found here: Hazard Communication for Disinfectants Used Against Viruses | NIOSH | CDC. Follow these steps for safe and effective disinfectant use:

Check that your product is EPA-registered: Find the EPA registration number on the product.
Read the directions: Follow the product’s directions. Check “use sites” and “surface types” to make sure this is the right product for your surface. Next, read the “precautionary statements.”
Pre-clean the surface: Make sure to wash the surface with soap and water if the directions mention pre-cleaning or if the surface is visibly dirty. Dirt can keep the disinfectant from working.
Follow the contact time: Follow the instructions: The surface should remain wet for the amount of time indicated to ensure the product is effective. Reapply if necessary.

Cleaning and Disinfection

During isolation at home, people with monkeypox should clean and disinfect the spaces they occupy regularly to limit household contamination.

ISOLATING ALONE IN HOME: People with monkeypox who are isolating alone at home should regularly clean and disinfect the spaces they occupy, including commonly touched surfaces and items, to limit household contamination. Perform hand hygiene afterwards using an alcohol-based hand rub (ABHR) that contains at least 60% alcohol, or soap and water if ABHR is unavailable.
ISOLATING WITH OTHERS IN HOME: People with monkeypox who are isolating in a home with others who don’t have monkeypox should follow the isolation and infection control guidance, and any shared spaces, appliances, or items should be disinfected immediately following use.

People who have recovered from monkeypox and whose isolation period has ended should conduct a thorough disinfection of all the spaces within the home that they had been in contact with. Follow the steps below to minimize risk of infection to others in your home after recovery.

If cleaning and disinfection is done by someone other than the person with monkeypox, that person should wear, at a minimum, disposable medical gloves and a respirator or well-fitting mask.
Standard clothing that fully covers the skin should be worn, and then immediately laundered according to recommendations below.
Hand hygiene should be performed using an ABHR, or soap and water if ABHR is unavailable.
Focus on disinfecting items and surfaces that were in direct contact with the skin of the person with monkeypox, or often in the presence of the person with monkeypox, during isolation. If unsure, disinfect.
Do not dry dust or sweep as this may spread infectious particles.
- Wet cleaning methods are preferred such as disinfectant wipes, sprays, and mopping.
- Vacuuming is acceptable using a vacuum with a high-efficiency air filter. If not available, ensure the person vacuuming wears a well-fitting mask or respirator.

Clean and disinfect household in the following order:
1. General waste containment
  1. Collect and contain in a sealed bag any soiled waste such as bandages, paper towels, food packaging, and other general trash items.
2. Laundry
  1. Gather contaminated clothing and linens before anything else in the room is cleaned. Do not shake the linens as this could spread infectious particles.
3. Hard surfaces and household items
4. Upholstered furniture and other soft furnishing
5. Carpet and flooring
6. Waste disposal

Laundry

Used or contaminated clothing, linens and bedding materials, towels, and other fabric items should be contained until laundering. When at all possible, people with monkeypox should handle and launder their own soiled laundry. Laundry should not be mixed with that of other members of the household.

Follow these laundering procedures:

Handle soiled laundry according to standard practices, avoiding contact with contaminates from the rash that may be present on the laundry.
Soiled laundry should never be shaken or handled in a manner that may spread infectious particles.
In-home laundry facilities:
- Transfer soiled laundry items to be laundered in an impermeable container or bag that can be disinfected afterwards. Alternatively, a fabric bag may be used that can also be laundered along with the soiled items.
- Wash laundry in a standard washing machine with detergent, following label instructions. Laundry sanitizers may be used but are not necessary.
In-home laundry facilities not available:
- When in-home laundry facilities (facilities not shared with other households) are not available, individuals should coordinate with their local public health department to determine appropriate laundering options.

Hard Surfaces (and non-porous car interiors)

Routinely clean and disinfect commonly touched surfaces and items (such as counters or light switches) using an EPA-registered disinfectant in accordance with the manufacturer’s instructions.

This includes surfaces like tables, countertops, door handles, toilet flush handles, faucets, light switches, and floors.
Include interior surfaces of refrigerator, freezer, other appliances, interior cabinet spaces, or drawers if they have been accessed by the person with monkeypox.
Items and surfaces within the home that have likely not been in contact with the person while sick with monkeypox do not need to be disinfected.
- This includes clothing and items in drawers or boxes that have not been in contact with, or in the direct presence of the person with monkeypox.
Wash soiled dishes and eating utensils in a dishwasher with detergent and hot water or by hand with hot water and dish soap.

Upholstered Furniture, Carpet and Soft Furnishing (and porous car interiors)

If the person with monkeypox had direct skin contact and/or excessive drainage of fluids from rashes onto soft furnishings, such as upholstered furniture, carpets, rugs, and mattresses, steam cleaning can be considered. Discuss with state or local health authorities for further guidance.
If the person with monkeypox had minimal contact with soft furnishings, disinfect the surface with a surface-appropriate disinfectant.

Waste Disposal

Generally, management of waste from homes, including those of people with monkeypox isolating at home, should continue as normal. Municipal waste management systems routinely collect and dispose of waste materials from individuals with infectious diseases and can do so safely using existing procedures.

The person with monkeypox should use a dedicated, lined trash can in the room where they are isolating.
- Any gloves, bandages, or other waste and disposable items that have been in direct contact with skin should be placed in a sealed plastic bag, then thrown away in the dedicated trash can.
- The person with monkeypox or other household members should use gloves when removing garbage bags and handling and disposing of trash.
If professional cleaning services are used, treat and/or dispose of waste in accordance with applicable state, local, tribal, and territorial laws and regulations for waste management. For more information, the Department of Transportation has monkeypox-specific information in Appendix F-2 of the federal interagency guidance for managing solid waste contaminated with a Category A infectious substance.

Treatment

There are no treatments specifically for monkeypox virus infections. However, monkeypox and smallpox viruses are genetically similar, which means that antiviral drugs and vaccines developed to protect against smallpox may be used to prevent and treat monkeypox virus infections.

Antivirals, such as tecovirimat (TPOXX), may be recommended for people who are more likely to get severely ill, like patients with weakened immune systems.

If you have symptoms of monkeypox, you should talk to your healthcare provider, even if you don’t think you had contact with someone who has monkeypox.

Most people with monkeypox recover fully within 2 to 4 weeks without the need for medical treatment.

What Healthcare Professionals Should Know

Monkeypox Case Definition
Clinicians should test patients with rash consistent with monkeypox, which involves lesions that are firm or rubbery, well-circumscribed, deep-seated, and often develop umbilication during the pustular stage.
Some patients present with a febrile prodrome, which might include malaise, chills, headache, or lymphadenopathy.
The rash associated with monkeypox can be confused with other diseases that are encountered in clinical practice (e.g., secondary syphilis, herpes, chancroid, and varicella zoster).
Although most cases in the current outbreak to date have occurred among gay, bisexual, and other men who have sex with men, any patient, regardless of sexual or gender identity, with rash consistent with monkeypox should be considered for testing. Close physical contact with a person’s infectious lesions or respiratory secretions or exposure to contaminated materials such as clothing or bedding can result in transmission.
Information on infection prevention and control in healthcare settings is provided on the CDC website Infection Control: Healthcare Settings.
Clinicians may consult their local health department for questions about monkeypox, including about testing.
Orthopoxvirus Vaccine Guidance for Persons at Risk of Occupational

Case Definitions† for Use in the 2022 Monkeypox Response

Suspect Case

New characteristic rash* OR
Meets one of the epidemiologic criteria and has a high clinical suspicion† for monkeypox

Probable Case

No suspicion of other recent Orthopoxvirus exposure (e.g., Vaccinia virus in ACAM2000 vaccination) AND demonstration of the presence of
- Orthopoxvirus DNA by polymerase chain reaction of a clinical specimen OR
- Orthopoxvirus using immunohistochemical or electron microscopy testing methods OR
- Demonstration of detectable levels of anti-orthopoxvirus IgM antibody during the period of 4 to 56 days after rash onset

For Health Departments
Please see CDC’s Case Reporting Recommendations for Health Departments for more information about data collection for case reporting and specimen collection.

Confirmed Case

Demonstration of the presence of Monkeypox virus DNA by polymerase chain reaction testing or Next-Generation sequencing of a clinical specimen OR isolation of Monkeypox virus in culture from a clinical specimen

Epidemiologic Criteria

Within 21 days of illness onset:

Reports having contact with a person or people with a similar appearing rash or who received a diagnosis of confirmed or probable monkeypox OR
Had close or intimate in-person contact with individuals in a social network experiencing monkeypox activity, this includes men who have sex with men (MSM) who meet partners through an online website, digital application (“app”), or social event (e.g., a bar or party) OR
Traveled outside the US to a country with confirmed cases of monkeypox or where Monkeypox virus is endemic OR
Had contact with a dead or live wild animal or exotic pet that is an African endemic species or used a product derived from such animals (e.g., game meat, creams, lotions, powders, etc.)

Exclusion Criteria

A case may be excluded as a suspect, probable, or confirmed case if:

An alternative diagnosis* can fully explain the illness OR
An individual with symptoms consistent with monkeypox does not develop a rash within 5 days of illness onset OR
A case where high-quality specimens do not demonstrate the presence of Orthopoxvirus or Monkeypox virus or antibodies to orthopoxvirus

†Clinical suspicion may exist if presentation is consistent with illnesses confused with monkeypox (e.g., secondary syphilis, herpes, and varicella zoster).

*The characteristic rash associated with monkeypox lesions involve the following: deep-seated and well-circumscribed lesions, often with central umbilication; and lesion progression through specific sequential stages—macules, papules, vesicles, pustules, and scabs.; this can sometimes be confused with other diseases that are more commonly encountered in clinical practice (e.g., secondary syphilis, herpes, and varicella zoster). Historically, sporadic accounts of patients co-infected with Monkeypox virus and other infectious agents (e.g., varicella zoster, syphilis) have been reported, so patients with a characteristic rash should be considered for testing, even if other tests are positive.

Categorization may change as the investigation continues (e.g., a patient may go from suspect to probable).

Monkeypox and Smallpox Vaccine Guidance

When properly administered before an exposure, vaccines are effective at protecting people against monkeypox.

ACAM2000 and JYNNEOSTM (also known as Imvamune or Imvanex) are the two currently licensed vaccines in the United States to prevent smallpox.

Pre-Exposure Prophylaxis To Prevent Monkeypox

The Advisory Committee on Immunization Practices (ACIP) recommends that people whose jobs may expose them to orthopoxviruses, such as monkeypox, get vaccinated with either ACAM2000 or JYNNEOS to protect them if they are exposed to an orthopoxvirus. This is known as pre-exposure prophylaxis (PrEP). People who should get PrEP include:

Clinical laboratory personnel who perform testing to diagnose orthopoxviruses, including those who use polymerase chain reaction (PCR) assays for diagnosis of orthopoxviruses, including Monkeypox virus
Research laboratory workers who directly handle cultures or animals contaminated or infected with orthopoxviruses that infect humans, including Monkeypox virus, replication-competent Vaccinia virus, or recombinant Vaccinia viruses derived from replication-competent Vaccinia virus strains
Certain healthcare and public health response team members designated by public health authorities to be vaccinated for preparedness purposes

People who can get PrEP if they want to receive it include healthcare personnel who administer ACAM2000 or anticipate caring for many patients with monkeypox.

At this time, most clinicians in the United States and laboratorians not performing the orthopoxvirus generic test to diagnose orthopoxviruses, including monkeypox, are not advised to receive orthopoxvirus PrEP. Laboratorians should consult with laboratory biosafety officers and supervisors to identify risks and precautions, depending on the type of work they are doing. Regardless of whether they get PrEP, clinicians and laboratorians should use recommended infection control practices; these are important to preventing any infection.

ACAM2000 is administered as a live Vaccinia virus preparation that is inoculated into the skin by pricking the skin surface. Following a successful inoculation, a lesion will develop at the site of the vaccination (i.e., a “take”). The virus growing at the site of this inoculation lesion can be spread to other parts of the body or even to other people. Individuals who receive vaccination with ACAM2000 must take precautions to prevent the spread of the vaccine virus and are considered vaccinated within 28 days.

JYNNEOSTM is administered as a live virus that is non-replicating. It is administered as two subcutaneous injections four weeks apart. There is no visible “take” and as a result, no risk for spread to other parts of the body or other people. People who receive JYNNEOS TM are not considered vaccinated until 2 weeks after they receive the second dose of the vaccine.

CDC, in conjunction with the Advisory Committee on Immunization Practices (ACIP), provides recommendations on who should receive smallpox vaccination in a non-emergency setting. At this time, vaccination with ACAM2000 is recommended for laboratorians working with certain orthopoxviruses and military personnel. On November 3, 2021, ACIP voted to recommend JYNNEOS pre-exposure prophylaxis as an alternative to ACAM2000 for certain persons at risk for exposure to orthopoxviruses.

Vaccine Effectiveness

Because Monkeypox virus is closely related to the virus that causes smallpox, the smallpox vaccine can protect people from getting monkeypox. Past data from Africa suggests that the smallpox vaccine is at least 85% effective in preventing monkeypox. The effectiveness of JYNNEOSTM against monkeypox was concluded from a clinical study on the immunogenicity of JYNNEOS and efficacy data from animal studies.

Smallpox and monkeypox vaccines are effective at protecting people against monkeypox when given before exposure to monkeypox. Experts also believe that vaccination after a monkeypox exposure may help prevent the disease or make it less severe.

Receiving Vaccine After Exposure to Monkeypox Virus

The sooner an exposed person gets the vaccine, the better.

CDC recommends that the vaccine be given within 4 days from the date of exposure in order to prevent onset of the disease. If given between 4–14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the disease.

Revaccination After Exposure

Persons exposed to monkeypox virus and who have not received the smallpox vaccine within the last 3 years, should consider getting vaccinated.

The sooner the person receives the vaccine, the more effective it will be in protecting against monkeypox virus.

Vaccine Risks vs. Monkeypox Disease

For most persons who have been exposed to monkeypox, the risks from monkeypox disease are greater than the risks from the smallpox or monkeypox vaccine.

Monkeypox is a serious disease. It causes fever, headache, muscle aches, backache, swollen lymph nodes, a general feeling of discomfort, exhaustion, and severe rash. Studies of monkeypox in Central Africa—where people live in remote areas and are medically underserved—showed that the disease killed up to 11% of people infected.

In contrast, most people who get the smallpox or monkeypox vaccine have only minor reactions, like mild fever, tiredness, swollen glands, and redness and itching at the place where the vaccine is given. However, these vaccines do have more serious risks, too.

In certain groups of people, such as people with serious immune system problems, complications from ACAM2000 can be severe. If you have concerns about whether you should receive ACAM2000, talk to your healthcare provider. This vaccine has the potential for more side effects and adverse events than the newer vaccine, JYNNEOS.

Publications

Monkeypox Outbreak — Nine States, May 2022
Centers for Disease Control and Prevention (CDC).
Source: MMWR Morb Mortal Wkly Rep 2022;71:764–769.

Use of JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) for Preexposure Vaccination of Persons at Risk for Occupational Exposure to Orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022.
Centers for Disease Control and Prevention (CDC).
Source: MMWR Morb Mortal Wkly Rep 2022;71:734–742.

Monkeypox in a Traveler Returning from Nigeria — Dallas, Texas, July 2021.
Centers for Disease Control and Prevention (CDC).
Source: MMWR Morb Mortal Wkly Rep 2022;71:509–516.

Notes from the Field: Responding to an Outbreak of Monkeypox Using the One Health Approach — Nigeria, 2017–2018.
Centers for Disease Control and Prevention (CDC).
Source: MMWR Morb Mortal Wkly Rep 2018;67:1040–1041.

Emergence of Monkeypox — West and Central Africa, 1970–2017.
Centers for Disease Control and Prevention (CDC).
Source: MMWR Morb Mortal Wkly Rep 2018;67:306–310.

Strengthening of Surveillance during Monkeypox Outbreak, Republic of the Congo, 2017.
Centers for Disease Control and Prevention (CDC).
Source: Emerg Infect Dis. 2018;24(6):1158-1160.

Reemergence of Human Monkeypox in Nigeria, 2017.
Centers for Disease Control and Prevention (CDC).
Source: Emerg Infect Dis. 2018;24(6):1149-1151.

Multistate outbreak of monkeypox—Illinois, Indiana, and Wisconsin, 2003.
Centers for Disease Control and Prevention (CDC).
Source: MMWR Morb Mortal Wkly Rep. 2003 Jun 13;52(23):537-540.

Update: multistate outbreak of monkeypox—Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003.
Centers for Disease Control and Prevention (CDC).
Source: MMWR Morb Mortal Wkly Rep. 2003 Jun 20;52(24):561-564.

The detection of monkeypox in humans in the Western Hemisphere.
Reed KD, Melski JW, Graham MB, Regnery RL, Sotir MJ, Wegner MV, Kazmierczak JJ, Stratman EJ, Li Y, Fairley JA, Swain GR, Olson VA, Sargent EK, Kehl SC, Frace MA, Kline R, Foldy SL, Davis JP, Damon IK.
Source: N Engl J Med. 2004 Jan 22;350(4):342-350.

Monkeypox transmission and pathogenesis in prairie dogs.<<br /> Guarner J, Johnson BJ, Paddock CD, Shieh WJ, Goldsmith CS, Reynolds MG, Damon IK, Regnery RL, Zaki SR; Veterinary Monkeypox Virus Working Group.
Source: Emerg Infect Dis. 2004 Mar;10(3):426-431.

Human monkeypox infection: a family cluster in the midwestern United States.
Sejvar JJ, Chowdary Y, Schomogyi M, Stevens J, Patel J, Karem K, Fischer M, Kuehnert MJ, Zaki SR, Paddock CD, Guarner J, Shieh WJ, Patton JL, Bernard N, Li Y, Olson VA, Kline RL, Loparev VN, Schmid DS, Beard B, Regnery RR, Damon IK.
Source: J Infect Dis. 2004 Nov 15;190(10):1833-40

Extensive lesions of monkeypox in a prairie dog (Cynomys sp).
Langohr IM, Stevenson GW, Thacker HL, Regnery RL.
Source: Vet Pathol. 2004 Nov;41(6):702-707.

Evaluation of human-to-human transmission of monkeypox from infected patients to health care workers.
Fleischauer AT, Kile JC, Davidson M, Fischer M, Karem KL, Teclaw R, Messersmith H, Pontones P, Beard BA, Braden ZH, Cono J, Sejvar JJ, Khan AS, Damon I, Kuehnert MJ.
Source: Clin Infect Dis. 2005 Mar 1;40(5):689-694. Epub 2005 Feb 7.

Characterization of acute-phase humoral immunity to monkeypox: use of immunoglobulin M enzyme-linked immunosorbent assay for detection of monkeypox infection during the 2003 North American outbreak.
Karem KL, Reynolds M, Braden Z, Lou G, Bernard N, Patton J, Damon IK.
Source: Clin Diagn Lab Immunol. 2005 Jul;12(7):867-872.

Clinical characteristics of human monkeypox, and risk factors for severe disease.
Huhn GD, Bauer AM, Yorita K, Graham MB, Sejvar J, Likos A, Damon IK, Reynolds MG, Kuehnert MJ.
Source: Clin Infect Dis. 2005 Dec 15;41(12):1742-1751.

Clinical manifestations of human monkeypox influenced by route of infection.
Reynolds MG, Yorita KL, Kuehnert MJ, Davidson WB, Huhn GD, Holman RC, Damon IK.
Source: J Infect Dis. 2006 Sep 15;194(6):773-780. Epub 2006 Aug 8.

Monkeypox zoonotic associations: insights from laboratory evaluation of animals associated with the multi-state US outbreak.
Hutson CL, Lee KN, Abel J, Carroll DS, Montgomery JM, Olson VA, Li Y, Davidson W, Hughes C, Dillon M, Spurlock P, Kazmierczak JJ, Austin C, Miser L, Sorhage FE, Howell J, Davis JP, Reynolds MG, Braden Z, Karem KL, Damon IK, Regnery RL.
Source: Am J Trop Med Hyg. 2007 Apr;76(4):757-768.

Monkeypox-induced immunity and failure of childhood smallpox vaccination to provide complete protection.
Karem KL, Reynolds M, Hughes C, Braden Z, Nigam P, Crotty S, Glidewell J, Ahmed R, Amara R, Damon IK.
Source: Clin Vaccine Immunol. 2007 Oct;14(10):1318-1327.

Spectrum of infection and risk factors for human monkeypox, United States, 2003.
Reynolds MG, Davidson WB, Curns AT, Conover CS, Huhn G, Davis JP, Wegner M, Croft DR, Newman A, Obiesie NN, Hansen GR, Hays PL, Pontones P, Beard B, Teclaw R, Howell JF, Braden Z, Holman RC, Karem KL, Damon IK.
Source: Emerg Infect Dis. 2007 Sep;13(9):1332-1339.

CDC Monkeypox: Causes, Symptoms, Treatment & Prevention