Monkeypox

Monkeypox virus (MPV) infection can cause an illness that includes rashes and other symptoms. It does not commonly occur in the United States, but there is currently an outbreak of MPV with cases spreading in Washington state and across the country, as well as in other countries. MPV can spread person-to-person with any kind of close, skin-to-skin contact, regardless of sexual orientation or gender identity. Anyone can get MPV. MPV can also spread between animals and from animals to people. 

Frequently asked questions

MPV Cases

Maps and case counts (CDC):

Washington state case counts

Updated August 8, 2022 at 1:00 p.m. PT

County

Number of cases

Benton 1
Clark 3
Cowlitz 1
King 180
Kitsap 2
Lewis 1
Mason 1
Pierce 11
Snohomish 5
Spokane 1
Whatcom 1
Yakima 4
Non-WA Resident 2
Total cases 213

About the data

  • Positive cases of orthopoxvirus are considered likely MPV and included in case counts.
  • Total case count includes people who may have been exposed in another state but tested positive in Washington. 
  • The Washington State Department of Health (DOH) makes every effort to publish updates daily, Monday through Friday (except for state holidays). 
  • Due to processing, there may be some lag time between when a local health jurisdiction confirms a positive test and when that information is added to the data above.

What to do if you have been exposed to MPV

If you have had close contact with a person who has confirmed or probable MPV, getting vaccine promptly may prevent an infection. Close contact can include being together for several hours, hugging, cuddling, kissing, or sharing a bed.

Contact your healthcare provider or the county health department for information.

What to do if you have symptoms of MPV

You can spread MPV from the start of symptoms until the rash has fully healed, which can take two to four weeks. To keep from spreading the infection:

  • Separate yourself from other people and from animals (mammals).
  • Restrict family, friends, or other visitors to those with an essential need to be in the home.
  • Wear well-fitting medical mask when in close contact with others at home.
  • Stay home except for getting health care.
  • 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 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 inadvertent infection of the eye.
  • Avoid shaving rash-covered areas of the body as this can lead to spread of the virus
  • Do not use commercial travel (airplane, bus, taxi, shared car).
  • Do not kiss, hug, cuddle, sleep, or have sex with others.

If you have severe pain or a rash that is spreading on your body, you may need antiviral treatment. Have your health care provider call your county health department for information.

Vaccination is not recommended for someone who was exposed and developed disease symptoms.

What to do if you test positive for MPV

You can spread MPV from the start of symptoms until the rash has fully healed, which can take two to four weeks.

To keep from spreading the infection:

  • Separate yourself from other people and from animals (mammals).
  • Do not kiss, hug, cuddle, sleep, or have sex with others.
  • Do not share bedding, towels, dishes, or utensils.
  • Wash your own dishes and laundry, and do not shake out dirty laundry.
  • Have somebody else take care of animals like pets and livestock.
  • Do not use commercial travel (airplane, bus, taxi, shared car).

If you have having severe pain or a rash that is spreading on your body, you may need antiviral treatment. Have your healthcare provider call your county health department for information.

Vaccination is not recommended for someone who was exposed and developed disease symptoms. If indicated, anti-viral treatment is more effective. 

Frequently Asked Questions

About MPV

How is MPV spread?

Transmission of MPV requires close interaction with a symptomatic individual. Brief interactions that do not involve physical contact and healthcare interactions conducted using appropriate protective equipment are not high risk.

The MPV virus can be transmitted from person to person by:

direct contact with the skin or body fluids of an infected person (including sexual contact), or contact with virus-contaminated objects (such as bedding or clothing), or respiratory droplets during direct and prolonged face-to-face contact.

People with a confirmed case of MPV are contagious as soon as they develop symptoms and continue to be contagious until the scabs fall off the rash. A person with MPV should isolate from others until the scabs fall off.

Humans can also get MPV from contact with infected animals.

What are the symptoms?

MPV can cause flu-like symptoms, swollen lymph nodes, and a rash that can appear anywhere on the body. In the current outbreak, many cases have presented with lesions on the genitals or in the anal area. Some people have initially had rectal pain, with or without flu-like symptoms. Some people may not have any symptoms prior to the start of the rash.

Rash will turn into raised bumps, which then fill with fluid. The rash eventually scabs over, and the scabs fall off. Typically, the rash is mostly on the face, arms, legs, and hands. However, if a person was infected during sexual contact, the rash might only be on the genitals. If a person was infected through anal sex, they may develop anal or rectal irritation.

The incubation period (time from exposure to the start of symptoms) for MPV is usually 7-14 days but can range from 5-21 days.

Most people recover in 2-4 weeks, but the disease can be serious, especially for immunocompromised people, children, and pregnant people.

People who may have symptoms of MPV should contact their healthcare provider. Before the visit, they should notify their healthcare provider that they are concerned about MPV, and whether they recently had close contact with a person who had a similar rash or a person who has been diagnosed with MPV.

Who is at risk?

Anyone can get MPV, but some people are at a higher risk. Unlike the virus that causes COVID-19, MPV is primarily spread through close contact and 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.

While the current cases nationally and internationally mainly involve men who have sex with men, anyone who is sexually active with multiple partners or who are partners with someone who has sex with multiple partners can be at risk for being exposed to MPV.

Other risk factors may include travel to areas where MPV is spreading, close, non-sexual contact with a known case, or contact with sick animals. To protect yourself and others from MPV or sexual infectious diseases, DOH recommends practicing safe sex methods, practice harm reduction, and avoiding sexual contact with anyone who has open wounds, sores, or rashes

What needs to be done to bring MPV under control in Washington state?

Controlling the outbreak is possible. MPV is not COVID – it is mostly spread through close, skin-to-skin contact, and is far less likely to be spread in the air.

  • To stop MPV in the U.S., we must stop the person-to-person transmission, and we need to make sure we prevent transmission to pets and wildlife.
  • To bring MPV under control, we need to:
    • focus on rapid identification of cases,
    • help those who test positive to isolate as long for as long as they still have any rashes, and
    • make sure people know they should avoid skin to skin and sexual contact while they have a rash.
What is the difference between a confirmed and a probable MPV case?

A probable case is someone who tests positive for orthopoxvirus (a group of viruses that includes MPV and smallpox) and negative for smallpox. The Washington State Public Health Laboratories and some clinical laboratories can do this testing.

A confirmed case is someone who tests positive for MPV virus.

In Washington state, we begin treatment, case investigation, and contact tracing as soon as someone gets a test result that identifies them as a probable or confirmed case.

Can animals, especially pets, get MPV?

Mammals can get MPV virus. Here’s how to prevent spreading the virus to animals.

What should people do if they think they have MPV?

We encourage anyone who has a rash and thinks they may have had close, skin-to-skin contact with someone who could have MPV in the last 21 days to talk to their medical provider and find out if they should be tested.

What is the difference between MPV, measles, and chickenpox?

MPV is a rare viral disease. Infection can spread from certain animals to humans, and also from one person to another.

  • The illness may begin with fever, headache, muscle aches, backache, swollen lymph nodes (swollen glands), a general feeling of discomfort, and exhaustion. A few days later, the person may develop a specific rash.
  • In the current outbreak, many cases have presented without any pre-rash symptoms, and some have developed different types of rashes.
  • Routine vaccine is not available. A limited amount of vaccine is being given to people at high risk for infection.

Chickenpox is a very contagious disease caused by the varicella-zoster virus.

  • It causes a blister-like rash, itching, tiredness, and fever.
  • Chickenpox used to be very common in the United States. Each year, chickenpox caused about 4 million cases, about 10,600 hospitalizations and 100 to 150 deaths.
  • Routine vaccine is available to prevent chickenpox.

Measles is a very contagious disease caused by a virus.

  • It spreads through the air when an infected person coughs or sneezes.
  • Measles starts with a cough, runny nose, red eyes, and fever. Then a rash of tiny, red spots breaks out. It starts at the head and spreads to the rest of the body.
  • Routine vaccine is available to prevent measles.
What causes MPV? How did it get to humans?

MPV was discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research.

Despite being named “MPV,” the source of the disease remains unknown. However, African rodents and non-human primates (like monkeys) might harbor the virus and infect people.

  • The first human case of MPV was recorded in the Democratic Republic of the Congo in 1970.
  • Prior to the 2022 outbreak, MPV had been reported in people in several central and western African countries.
  • Almost all MPV cases in people outside of Africa were linked to international travel to countries where the disease commonly occurs or through imported animals.
How is MPV spread?

The MPV virus can be spread from person to person by:

  • direct contact with the skin or body fluids of an infected person (including sexual and non-sexual contact), or
  • contact with virus-contaminated objects (such as bedding or clothing), or
  • respiratory droplets during direct and prolonged face-to-face contact.

People who do not have MPV symptoms cannot spread the virus to others.

At this time, it is not known if MPV can spread through semen or vaginal fluids.

People who get MPV are contagious as soon as they develop symptoms and continue to be contagious until the scabs fall off the rash. A person with MPV should isolate from others until the scabs fall off.

Is MPV deadly?

There are two types of MPV virus: West African and Congo Basin. Infections in the current outbreak are from the West African type.

Infections with the type of MPV virus identified in the 2022 outbreak—the West African type—are rarely fatal.

  • More than 99% of people who get this form of the disease are likely to survive. However, people with weakened immune systems, children under 8 years of age, people with a history of eczema, and people who are pregnant or breastfeeding may be more likely to get seriously ill or die.
  • Although the West African type is rarely fatal, symptoms can be extremely painful, and people might have permanent scarring resulting from the rash.
  • The Congo Basin strain has a fatality rate around 10%. This strain is not associated with the current outbreak.
  • In this current outbreak, no one in the US has died of MPV, although, globally, a couple of people have died.
If you have MPV, do you need to stay home or go to hospital?

If you suspect you have MPV, isolate yourself from others in a single person room if available and immediately consult your health care provider.

What groups are more at risk for severe infections?

There is no particular age group that is more vulnerable to MPV than others.

However, people with weakened immune systems, children under 8 years of age, people with a history of eczema, and people who are pregnant or breastfeeding may be more likely to get seriously ill or die.

What does MPV look like?
Monkeypox lesions

Testing

How do I get tested?

Public health officials encourage anyone who has symptoms of mpv, or anyone who has been in close contact with someone diagnosed with MPV in the last 21 days, to contact a health care provider to see if they should be tested. Providers should have a high level of suspicion if patients present with a rash, especially if they also report recent sexual or close contact with a possible case.

Infections with the strain of MPV virus identified in this outbreak are rarely fatal. Most do not require hospitalization. To date, no one in the U.S. has died of MPV.

People infected with the virus usually recover in two to four weeks, but the disease can be serious, especially for immunocompromised people, children, people with a history of eczema, or people who are pregnant or breastfeeding.

The good news is that Washington state has no shortage of testing capacity for MPV. The Washington State Public Health Laboratory (PHL) has been able to test every suspect case that medical providers in our state have reported to their local health departments. In addition, commercial labs such as University of Washington, LabCorp, and Quest are now able to test for MPV.

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

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

  • People who have symptoms of MPV (including a rash on one or more parts of the body) should visit a healthcare provider. If the healthcare provider suspects MPV, they will swab some of the rash bumps for testing. Providers may test for other conditions at the same time and may need to take other kinds of samples.
  • These swabs (specimens) are sent to a laboratory for testing. Specimens might go to the Washington State Public Health Laboratories or to other clinical labs in the area.
  • If a specimen tests positive, the state or local health department will contact the patient and let them know. Public health will recommend what actions to take, including if the person needs to isolate, and will ask questions to see if any people who have been in close contact with need treatment.
Is there a shortage of available testing?

There is no shortage of testing in Washington state.

Orthopoxvirus testing is done by the Washington State Public Health Laboratories and specific clinical laboratories.

Are we undercounting cases because of testing issues?
  • Cases may have gone unrecognized in the US and around the world because of the unusual clinical presentation of this current outbreak, not because of testing shortages in the US.
  • Unusual clinical presentation includes different symptoms, including rashes on different parts of the body and transmission through sexual contact, which was not common before this current outbreak.
  • For current counts see: 2022 U.S. Map & Case Count | Monkeypox | Poxvirus | CDC

Treatment

What is the treatment for people with MPV?

antiviral medications are used to treat MPV.

Who should be treated?
  • Anybody with severe pain, widespread infection, or infection of the eyes should ask their healthcare provider about being treated. The local health jurisdiction may help to locate the antiviral medications.
  • Anybody at risk for severe infection should be treated. This includes people with weakened immune systems, children under 8 years of age, people with a history of eczema, and people who are pregnant or breastfeeding.
  • Treatment can start before testing if MPV is highly suspected and there is severe infection or risk for severe infection.

Vaccines to prevent MPV

What about the vaccine?

To help stop the spread of MPV virus, the Centers for Disease Control and Prevention (CDC) announced plans to distribute a limited amount of a vaccine called JYNNEOS in the US, including to Washington state. Because there is a very limited supply of this vaccine, Washington has received a very small amount of vaccine so far (Washington received less than 400 courses during Phase I).

The federal government is allocating vaccine in three phases based on the number of cases in each state. The majority of Phase I and 2 doses are being sent to local health jurisdictions and will be used to vaccinate high- and intermediate-risk close contacts of confirmed and probable cases (a strategy called “post-exposure prophylaxis”).

A small number of doses will also be given as pre-exposure vaccination to high-risk workers who test MPV samples, such as lab workers.  Local health jurisdictions may also use remaining vaccine to vaccinate other people who are at high risk for contracting MPV. With the current limited amount of vaccine in Washington, there are no plans to hold mass vaccination clinics. Most healthcare providers do not have access to the vaccine yet.

Washington expects to receive a larger supply of vaccine in late August (Phase 3). How vaccine will be divided up, and who in Washington will be able to receive it, will depend on how much vaccine the state receives and where cases are located.

For now, if you believe you have had recent close contact with someone who was diagnosed with MPV and need a vaccine, please reach out to your healthcare provider.

What does the vaccine do?

For people who have had recent contact with someone who tested positive for MPV , the vaccine can reduce the chance of developing a MPV infection. Considerations for Monkeypox Vaccination | Monkeypox | Poxvirus | CDC

Two currently licensed vaccines, JYNNEOSTM (also known as Imvamune or Imvanex) and ACAM2000, are available in the United States to prevent smallpox (which is a type of orthopox virus).

  • Both help protect people from the MPV virus, which is also an orthopox virus. JYNNEOS is also licensed specifically to prevent MPV.
  • These vaccines are available from the US Strategic National Stockpile (SNS).
  • Both JYNNEOS and ACAM2000 can be used before and after exposure to MPV in an outbreak setting.
  • At present DOH is not offering ACAM2000 due to the higher risk of side effects and sufficient supply of JYNNEOS.
  • In the United States, there is currently a limited supply of JYNNEOS, although more is expected in coming weeks and months.
  • There is an ample supply of ACAM2000. However, this vaccine has more side effects and should not be used in people who have some health conditions, including a weakened immune system, skin conditions like atopic dermatitis/eczema, or pregnancy.
  • No data are available yet on the effectiveness of these vaccines in the current outbreak.
Who is eligible to be vaccinated right now?
  • Most of the doses available now will be used to vaccinate high- and intermediate-risk close contacts of confirmed and probable MPV cases.
  • A limited number of doses will be given as pre-exposure prophylaxis to laboratory workers who directly handle MPV specimens.
  • As additional vaccine is sent to Washington State, we hope to offer vaccine to more people, including groups of people who have not been exposed to MPV yet but may be at risk of exposure.
  • Currently, vaccination to prevent MPV is not recommended for the general public.
What is considered a close contact?

A close contact is a person who:

  • Had contact with someone who had a rash that looks like MPV or someone who was diagnosed with confirmed or probable MPV. This could include close contact with the clothing, bedding, towels, etc. used by the person who has MPV.
  • Had skin-to-skin contact with someone in a social network experiencing MPV activity, this includes men who have sex with men.li>
  • Had contact with a dead or live wild animal or exotic pet that exists only in Africa or used a product derived from such animals (e.g., game meat, creams, lotions, powders, etc.
How much vaccine has the federal government allotted to Washington state?

compared to other jurisdictions, Washington state has been allotted several hundred courses of the two-dose JYNNEOS vaccine.

  • Of that allotment, most courses have already been distributed to jurisdictions with known cases and close contacts.
  • The federal government will allot additional vaccine as it becomes available.
  • With the current limited amount of vaccine in Washington, there are no plans to hold mass vaccination clinics, and most health care providers do not have access to the vaccine yet
  • It is unknown how many additional doses of vaccine Washington state will eventually receive for Phase 3 of the federal government’s vaccine distribution plan.
  • Washington has enough vaccine to offer vaccine to all high- and intermediate-risk close contacts of confirmed cases.
Where can I get a vaccination?
  • People identified as close contacts of known cases can get vaccinated by their medical providers.
  • Health care providers work with the local health jurisdictions to secure the vaccine.
  • The 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.
Should health care professionals get vaccinated?

The CDC does not believe health care professionals are at high risk for exposure to MPV and does not currently recommend vaccination for most medical providers.

Will there be mass vaccination sites?

Without additional supplies from CDC, Washington state has no plans to hold vaccination clinics or distribute vaccine to providers.

Does the COVID-19 vaccine work for MPV?

No. Vaccines work differently depending on the virus they are protecting against.

  • The COVID-19 vaccine was developed to help prevent serious illness and death from COVID-19.
Can people travel out of country without chicken and MPV vaccination?

There are no travel restrictions or requirement for the MPV vaccine to travel.

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