Mpox Frequently Asked Questions

About Mpox

How is mpox spread?

Transmission of mpox requires close contact with a symptomatic person. Brief interactions that do not involve physical contact and health care interactions conducted using appropriate protective equipment are not high risk.

The mpox virus can be transmitted from person to person in the following ways:

  • Direct contact with the skin or body fluids of an infected person (including sexual or intimate contact)
  • Contact with virus-contaminated objects (such as bedding, clothing, fetish gear, or sex toys)
  • Respiratory droplets during direct and prolonged face-to-face contact
  • Spread to baby during pregnancy or spread to newborn during or after birth

Some people are contagious before their symptoms appear. People with a confirmed case of mpox are contagious starting four days before they develop symptoms and continue to be contagious until the scabs fall off the rash. A person with mpox should isolate from others until the scabs fall off.

Humans can also get mpox from contact with infected animals.

What are the symptoms?

Mpox can cause a range of symptoms including the following:

  • Fever
  • Headache
  • Swollen lymph nodes
  • Subsequently, a rash that can appear anywhere on the body

Some people may not have any symptoms before the start of the rash. Some people initially have pain in the anal region, with or without other symptoms such as fever and headache. For some people, the rash might only be on the genitals or anal region. For others, the rash might cover a larger area of the body. Over time, the rash will usually turn into raised bumps, which then fill with fluid. The rash eventually scabs over, and the scabs fall off.

Most people recover in 2-4 weeks although the lesions can leave scars. The disease can be serious, especially for immunocompromised people, children, and pregnant people.

People with symptoms of mpox should contact their primary health care provider or clinic. Before the visit, they should tell the provider or clinic that they are concerned about mpox and tell them whether they recently had close contact with a person who had a similar rash or who was diagnosed with mpox. If you don't have one, find a provider.

How long is the incubation period (the time from when you get exposed to potentially developing symptoms)?

The incubation period (time from exposure to the start of symptoms) for mpox is usually 7-14 days but can range from 3-17 days. It is recommended to monitor symptoms for up to 21 days from the day you were exposed to someone with mpox.

Most people recover in 2-4 weeks although the lesions can leave scars. The disease can be serious, especially for immunocompromised people, children, and pregnant people.

People with symptoms of mpox should contact their primary health care provider or clinic. Before the visit, they should tell the provider or clinic that they are concerned about mpox and tell them whether they recently had close contact with a person who had a similar rash or who was diagnosed with mpox. If you don't have one, find a provider.

Who is at risk?

Anyone can get mpox, but some people are at a higher risk. Mpox is primarily spread through close (skin to skin) contact. It also can be spread through respiratory droplets during prolonged face-to-face contact but does not spread through the air over longer distances. Brief interactions that do not involve physical contact and health care interactions conducted using appropriate protective equipment are generally considered low risk. Anyone who is sexually active is at risk, and risk increases with more sexual partners.

Other risk factors may include travel to areas where mpox is spreading; close, non-sexual contact with someone who is infected; or contact with sick animals. To protect yourself and others from mpox  Washington State Department of Health (DOH) recommends the following measures:

  • Practicing safe sex and harm reduction methods such as reducing your number of sexual partners
  • Avoiding sexual contact with anyone who has open wounds, sores, or rashes
  • Avoiding other skin-to-skin contact with anyone who has open wounds, sores, or rashes, or anyone who is infected with mpox
  • Getting vaccinated if you meet criteria for receiving JYNNEOS
  • Washing hands often
What should I do if I have been exposed?

If you have had close contact with a person who has confirmed or probable mpox, getting vaccinated right away may prevent an infection. Close contact can include sexual contact, being together for several hours, hugging, cuddling, kissing, or sharing items (such as bedding, clothing, sex toys etc.).

CDC recommends that the vaccine be given within four days from the date of exposure to prevent onset of the disease. If given between four and 14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the infection. See where you can get a vaccine in your area.

Monitor your symptoms for 21 days from the last time you had close contact with a person who has confirmed or probable mpox. If you develop a new or unexplained rash, or have other mpox symptoms, see a healthcare provider to get a test.

Contact your health care provider or your local health department for more information if you think you’ve been exposed. If you don't have a provider, find a provider.

What should I do if I think I have mpox or test positive for mpox?

If you have a new or unexplained rash and think you may have had close contact with someone who could have mpox in the last 21 days, talk to your medical provider or local clinic to find out if you should be tested, get vaccinated, or receive antiviral medication. If you don't have one, find a provider. If you already have symptoms of mpox, the mpox vaccine is not recommended.

You can spread mpox starting 4 days before you have symptoms until the rash has fully healed, which can take two to four weeks. To keep from spreading the infection, the following measures are recommended:

  • Separate yourself from other people and animals (mammals)
  • Restrict family, friends, or other visitors to those with an essential need to be in the home
  • Wear a well-fitting medical mask when in close contact with others at home
  • Do not let others touch your skin, especially any areas with a rash. Consider wearing disposable gloves if you have lesions on your hands and live with others.
  • Stay home except for getting health care. If you have a medical appointment, call the office before you go in to see if they have any special procedures for you to follow.
  • Keep lesions covered and remain separate until the rash is gone, all scabs have fallen off, and the skin below is healed
  • Do not share bedding, towels, dishes, or utensils
  • 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
  • Wash your own laundry and dishes
  • Routinely clean and disinfect commonly touched surfaces and items
  • Have somebody else take care of animals (mammals) like pets and livestock
  • Avoid use of contact lenses to prevent unintentional infection of the eye
  • Avoid shaving rash-covered areas of your body
  • Do not use commercial travel (airplane, bus, train/light rail, taxi, rideshare services)
  • Do not kiss, hug, cuddle, sleep, or have sex with others

If you are infected with mpox and are in severe pain, or you are more likely to become severely ill, you may need antiviral treatment. Have your health care provider call your local health department for information. If you have rectal mpox symptoms, the following guidelines can help ease discomfort.

What causes mpox? How did it get to humans?

Mpox was discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research. The first human case was recorded in 1970. Despite previously being named "monkeypox," the source of the disease remains unknown. However, African rodents and non-human primates (like monkeys) might harbor the virus and infect people.

We are seeing more cases of mpox now for several reasons:

  • The main reason is that we no longer vaccinate against smallpox. Smallpox vaccination also protected people against mpox.
  • Some cases of mpox in the past probably were misdiagnosed as smallpox, so we see more cases now partly due to more accurate testing
  • Globally, recent cases of mpox are often linked to international travel and close, intimate/sexual contact
Is mpox deadly?

Infections of mpox in the United States are fortunately rarely fatal.

  • People with weakened immune systems, children under eight years of age, people with a history of eczema, and people who are pregnant or breast/chest feeding may be more likely to get seriously ill or die
  • While mpox is rarely fatal, symptoms can be extremely painful, and people might have permanent scarring resulting from the rash
If I have mpox, do I need to stay home or go to the hospital?

If you suspect you have mpox, isolate yourself from others in a single-person room if available and immediately talk to your health care provider. Ask if you need to go to a medical office or the hospital. It is important to call as soon as you think you have symptoms of the disease because antiviral treatments may be available for those at high risk of severe illness. If you have been exposed and do not have symptoms yet, you may be able to be vaccinated. If you don't have one, find a provider.

Here are some strategies for isolating at home.

What are some examples of the mpox rash?

Mpox lesions (rash) often start as pimple-like raised bumps, which then fill with fluid. The rash eventually scabs over, and the scabs then fall off. If you have a new or unexplained rash and think you may have had close contact with someone who could have mpox in the last 21 days talk to your medical provider to find out if you should be tested. If you don't have one, find a provider.

Mpox on hands
Mpox blister
Mpox on thumb
Mpox on shoulders

Testing

How do I get tested?

If you have symptoms of mpox, or have been in close contact with someone diagnosed with mpox in the last 21 days, contact a health care provider to see if you should be tested.

In addition, commercial labs are now able to test for mpox. Find a provider.

Can physicians and other medical providers order a mpox test in Washington?

Yes. Here’s how testing currently works in our state:

  • People who have symptoms of mpox (including a rash on one or more parts of the body) should visit a health care provider. If the provider suspects mpox, they will swab the rash for testing. Providers may test for other conditions at the same time and may need to take other kinds of samples. If you don't have one, find a provider.
  • These swabs (specimens) are sent to a laboratory for testing. Specimens might go to the Washington State Public Health Lab or to other clinical labs in the area.
  • If a specimen tests positive, the state or local health jurisdiction will contact the patient. Public health will recommend what actions to take, including if the person needs to isolate or if they need to be assessed by a health care professional. They also will ask questions to see if any people the patient has been in close contact with need vaccination, testing, or treatment.

Treatment

What is the treatment for people with mpox?

Most people recover without treatment. Antiviral medications are available to treat mpox in specific circumstances. If symptoms have not started, post-exposure vaccination may be an option. Post-exposure vaccination can reduce symptoms or prevent symptoms.

Read more information on how to take care of yourself when diagnosed with mpox.

If you have rectal mpox symptoms, the following guidelines can help ease discomfort.

Who should be treated?

Anybody with severe pain, having widespread infection, at higher risk of getting severe illness, or experiencing infection in sensitive sites should ask their health care provider about being treated. If you don't have one, find a provider. People who are at risk for severe infection, include:

  • People with severe symptoms such as:
    • Bleeding or infected sores
    • Lesions that have merged into larger lesions
    • Symptoms that require hospitalization
  • People with rash or lesions in the eye, mouth, throat, genitals, and anus (butthole)
  • People with weakened immune systems
  • Children under 8 years of age
  • People with an active skin condition/disease such as eczema or psoriasis
  • People who are pregnant or breast/chest feeding

Treatment can start before testing if mpox is highly suspected and there is severe infection or risk for severe infection. Your local health department may help to locate antiviral medications.

Vaccines

What vaccine is available for protection against developing mpox?

JYNNEOS vaccine is available for both prevention of mpox and post-exposure prophylaxis. JYNNEOS is safe to administer to people with HIV and eczema or other exfoliative skin conditions.

Pregnancy and breastfeeding don't disqualify you from receiving JYNNEOS. While there are no data in people who are pregnant or breastfeeding, animal data do not show evidence of reproductive harm.

Please see the JYNNEOS Special Considerations (CDC) section for guidance on precautions and additional clinical considerations for the use of JYNNEOS.

Who should receive mpox vaccination?

You can receive mpox vaccination if any of the following apply:

  • You had known or suspected exposure to someone with mpox
  • You had a sex partner in the past two weeks who was diagnosed with mpox
  • You are a gay, bisexual, or other man who has sex with men or a transgender, nonbinary, or gender-diverse person who in the past six months has had any of the following:
    • A new diagnosis of one or more sexually transmitted infections (STIs; e.g., chlamydia, gonorrhea, or syphilis)
    • More than one sex partner
  • You have had any of the following in the past six months:
    • Sex at a commercial sex venue (like a sex club or bathhouse)
    • Sex related to a large commercial event or in a geographic area (city or county for example) where mpox virus transmission is occurring
    • Sex in exchange for money or other items
  • You have a sex partner with any of the above risks
  • You anticipate experiencing any of the above scenarios
  • You have HIV or other causes of immune suppression and have had recent or anticipate future risk of mpox exposure from any of the above scenarios
  • You work in settings where you may be exposed to mpox (e.g., through working with orthopoxviruses in a laboratory)

You are considered fully vaccinated two weeks after the second dose. Even when fully vaccinated, you should continue other safety and prevention practices such as not having skin-to-skin contact with someone who has a rash or has a confirmed or probable case of mpox.

More Information

How many doses of JYNNEOS vaccine should I receive?

JYNNEOS is administered as two doses delivered 28 days (four weeks) apart. People with moderate and severe immunosuppression should get the second dose as close to the 28-day mark as possible.

When should I get mpox vaccination?

CDC recommends that JYNNEOS be given within four days from the date of exposure to prevent onset of the disease. If given between four and 14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the infection. JYNNEOS is a series of two doses given 28 days apart.

Where can I get mpox vaccination?

If you qualify, you can get vaccinated by your medical provider or local health jurisdiction. If you don't have one, find a provider. JYNNEOS vaccine is a two-dose series with the first dose given as soon as possible after exposure, and the second dose given 28 days later. You should receive your second dose from the same place as your first dose.

Check and see if a Care-a-Van Event near you is offering JYNNEOS.

Should I get the vaccine if I was exposed to mpox and developed symptoms?

No, there is no known benefit for offering vaccination once someone has developed symptoms of mpox. People who have developed symptoms of mpox should see a health care provider to get tested. The health care provider might also recommend antiviral treatment depending on the individual situation.

When am I fully protected after vaccination?

A person is fully protected two weeks after the second dose is administered. People who get vaccinated should continue to take steps to protect themselves from infection by avoiding close, skin-to-skin contact, including intimate contact, with someone who has mpox and get tested if they develop any mpox symptoms.

Is the vaccine safe?

JYNNEOS is fully licensed by the U.S. Food and Drug Administration (FDA) and recommended by the CDC’s Advisory Committee on Immunization Practices for prevention of mpox. Ongoing safety monitoring occurs even after licensing.

Adverse reactions after JYNNEOS include injection site reactions such as pain, swelling, and redness. Fatigue, headache, and muscle pain were the most common systemic reactions observed after receiving JYNNEOS in a clinical trial.

Adverse events that occur in a recipient following mpox or smallpox vaccination should be reported to the Vaccine Adverse Event Reporting System (VAERS). Reporting is encouraged for any clinically significant adverse event, even if it is uncertain whether the vaccine caused the event. Vaccine administration errors can be reported whether or not associated with an adverse event. Information on how to submit a report to VAERS is available online or by calling 1-800-822-7967.

Can I get JYNNEOS at the same time as other vaccines?

JYNNEOS may be given at the same time as other vaccines. Certain people at increased risk of a condition called myocarditis (swelling of the heart muscle), including adolescents or young adult males, might consider waiting four weeks after JYNNEOS vaccination before getting an mRNA COVID-19 vaccine.

Does the COVID-19 vaccine work against mpox?

No. Vaccines work differently depending on the virus they are targeting. The COVID-19 vaccine was developed to help prevent serious illness and death from COVID-19. It does not prevent any other disease, like flu or mpox. Only the licensed mpox and smallpox vaccinations work against mpox infection.

Should health care professionals get vaccinated?

Health care professionals who do not perform diagnostic testing for mpox are not recommended to receive vaccination.

Can I travel out of country without the mpox vaccination?

There are no travel restrictions or requirement for the mpox vaccine to travel. However, many countries require other vaccines before you travel, so check with your local health department or your health care provider before traveling internationally to make sure you have all the vaccines you need. If you don't have one, find a provider.

For Health Care Providers

What are the clinical features of mpox? What does the rash look like?

See the CDC Clinical Recognition webpage for information on diagnosing mpox disease, including photos of rashes.

Is there a lab test to determine if my patient has mpox?

Yes, an mpox infection is typically diagnosed through a PCR test performed on a swab of a lesion. Testing is available at commercial and academic clinical laboratories as well as the Washington State Public Health Laboratories (WSPHL). Testing by WSPHL requires approval from the patient’s local health jurisdiction.

If I am testing a patient for mpox, what other testing and treatment should I consider?

Most people who receive mpox testing should also be tested for HIV and other STIs (e.g., syphilis, gonorrhea, chlamydia). Many people who receive mpox testing would also benefit from HIV pre-exposure prophylaxis (PrEP).

I diagnosed my patient with another infection (e.g., syphilis, gonorrhea, chlamydia). Can I assume that they don't have mpox?

Co-infections with mpox and STIs have been reported, so the presence of an STI does not rule out mpox infection. If the patient’s clinical presentation is compatible with mpox disease, you should still consider mpox testing. See CDC guidance for further information: See CDC clinical FAQs for further information.

How available is the vaccine?

The federal government provides JYNNEOS without cost to Washington State Department of Health (DOH), and DOH provides it to you without. DOH has supply available and you can order in 20-vial increments.

Where and how can we get the vaccine?

To order Mpox vaccine, providers need a Health Partner Ordering Portal (HPOP) account to make an order. For assistance with setting up an HPOP account please reach out to: mcm@doh.wa.gov

Providers can request JYNNEOS vaccine here (https://forms.office.com/g/1zngtyPUWw) and orders can be shipped directly to provider clinics. Local health jurisdictions do not need to request vaccines on their behalf. 

To help minimize overstocking, please place orders in increments of 20 vials and for an amount to cover a 2–3-week period. Shipments can take up to 2-3 days to receive from date of order. 

When is someone with mpox contagious?

It is possible that people with an mpox infection might be contagious prior to symptom onset, or even if they have an entirely asymptomatic infection. A person with mpox is considered to be contagious from four days before the first symptom began until all the scabs have fallen off and a fresh layer of intact skin has formed.

Who is at higher risk for severe mpox?

According to the CDC, people who are at risk for severe infection include the following:

  • People with severe symptoms such as:
    • Bleeding or infected sores
    • Lesions that have merged into larger lesions
    • Symptoms that require hospitalization
  • People with rash or lesions in the eye, mouth, throat, genitals, and anus (butthole)
  • People with weakened immune systems
  • Children under 8 years of age
  • People with an active skin condition/disease such as eczema, psoriasis, or atopic dermatitis
  • People who are pregnant or breast/chest feeding

Providers should strongly consider antiviral treatment for these populations; see CDC treatment guidance for more information.

What are the clinical considerations for people living with HIV?

According to the CDC, people with HIV-associated immunosuppression or people with HIV who are not virologically suppressed can be at increased risk of severe mpox disease. See CDC clinical considerations for people living with HIV for more information on treatment and prophylaxis for mpox in people living with HIV.

Which medications can be given to treat mpox?

The medication most commonly used is tecovirimat (TPOXX), which is approved for smallpox and is available for treatment of mpox under an expanded access new investigational drug protocol.

Oral TPOXX remains available to treat eligible patients with mpox under the ongoing NIH-supported STOMP trial. Providers are encouraged to inform patients of the availability of TPOXX treatment through STOMP. Interested participants can contact one of the clinical research sites or contact the call center at 1-855-876-9997.

For those who cannot enroll in STOMP due to eligibility criteria and/or accessibility to trial sites (remote consent is available), TPOXX remains available under the CDC-held expanded access Investigational New Drug (EA-IND) protocol. Request a consultation with CDC Emergency Operations at 770-488-7100 if you have a patient who requires oral or intravenous (IV) TPOXX or who is in an urgent clinical situation.

The Administration for Strategic Preparedness $ Response (ASPR) will continue monitoring any changes to mpox cases and update the TPOXX Operational Guidance accordingly.

What are the clinical considerations for pain management for people with mpox?

The CDC provides detailed information about pain control including treatments for specific symptoms and lesion sites.

What should I do if my patient might have been exposed to someone with mpox?

Contact your local health jurisdiction, who can help assess the exposure and determine if post-exposure prophylaxis (vaccination) is recommended. CDC recommends post-exposure prophylaxis be given within four 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. 

If the patient is asymptomatic, counsel the patient about the symptoms of mpox, as well as the need to isolate and contact a health care provider if symptoms occur. If the patient is symptomatic, evaluate the patient for mpox, and consider mpox testing. If you decide to proceed with mpox testing, advise the patient to isolate at home while the test is pending. 

What should I tell a patient with mpox about the expected course of illness?

The clinical course of mpox is variable. Counsel the patient about potential complications and reasons to seek follow-up care. The duration of symptoms and the contagious period also vary; usually the contagious period lasts for two to four weeks. People with mpox are no longer contagious when all the scabs on the skin have fallen off and a fresh layer of intact skin has formed underneath. CDC provides more information on the clinical course of illness.

What advice should I give my patient with mpox about reducing the risk of transmission to others? 

CDC provides detailed information on reducing the risk of transmission including steps that people with mpox can take, how long they need to isolate, and prevention measures for their home.

What PPE should be used for health care personnel who enter the room of a person with suspected or confirmed mpox?

According to the CDC, health care personnel should use a gown, gloves, eye protection, and a NIOSH-approved particulate respirator equipped with N95 filters or higher.

Where can I find information on infection control for mpox in health care settings?

CDC provides detailed information on infection control including patient placement, PPE, waste management, environmental infection control steps, and other topics.

Where can I find more clinical guidance on mpox?

Please visit CDC mpox website for any additional, up-to-date clinical guidance.

Where can I find more information available about mpox and pets/animals?

We are still learning which species of animals can be infected with mpox. However, it is possible that people with mpox could transmit to animals. Patients with mpox should be advised to avoid contact with mammals. See the Washington State Guidelines on Mpox in Animals for more information.