Washington DC, United States — Over the past two weeks, cases of monkeypox have been reported to the World Health Organization (WHO) from several non-endemic countries with no direct travel links to an endemic area.

The Pan American Health Organization (PAHO)/WHO has prepared a comprehensive questions and answers page to update the general public on the outbreak and address any concerns that may arise.

What is monkeypox?

Monkeypox is a disease caused by the monkeypox virus. It is a viral zoonotic disease, meaning that it can spread from animals to humans. It can also spread between people.

Where is monkeypox typically found?

Monkeypox is commonly found in central and west Africa where there are tropical rainforests and where animals that may carry the virus typically live. People with monkeypox are occasionally identified in other countries outside of central and west Africa, following travel from regions where monkeypox is endemic.

What are the manifestation of monkeypox?

The manifestation of monkeypox typically includes fever, intense headache, muscle aches, back pain, low energy, swollen lymph nodes, and a skin rash or lesions. The rash usually begins within one to three days of the start of a fever. Lesions can be flat or slightly raised, filled with clear or yellowish fluid, and can then crust, dry up and fall off. The number of lesions on one person can range from a few to several thousand. The rash tends to be concentrated on the face, palms of the hands, and soles of the feet. They can also be found on the mouth, genitals, and eyes. Symptoms typically last between two to four weeks and go away on their own without treatment. If you think you have symptoms that could be monkeypox, seek advice from your health-care provider. Let them know if you have had close contact with someone who has suspected or confirmed monkeypox.

Can people die from monkeypox?

In most cases, the symptoms of monkeypox go away on their own within a few weeks, but in some individuals, they can lead to medical complications and even death. Newborns, children, and people with underlying immune deficiencies may be at risk of more serious symptoms and death from monkeypox.

Complications from severe cases of monkeypox include skin infections, pneumonia, confusion, and eye infections which can lead to loss of vision. Around three–six per cent of reported cases have led to death in endemic countries in recent times, often in children or persons who may have other health conditions. It is important to note that this may be an overestimate because surveillance in endemic countries is limited.

How does monkeypox spread from animals to humans?

Monkeypox can spread to people when they come into physical contact with an infected animal. Animal hosts include rodents and primates. The risk of catching monkeypox from animals can be reduced by avoiding unprotected contact with wild animals, especially those that are sick or dead (including their meat and blood). In endemic countries where animals carry monkeypox, any foods containing animal meat or parts should be cooked thoroughly before eating.

How does monkeypox spread from person to person?

People with monkeypox are infectious while they have symptoms (normally for between two and four weeks). You can catch monkeypox through close physical contact with someone who has symptoms. The rash, bodily fluids (such as fluid, pus, or blood from skin lesions), and scabs are particularly infectious. Clothing, bedding, towels, or objects like eating utensils/dishes that have been contaminated with the virus from contact with an infected person can also infect others.

Ulcers, lesions, or sores in the mouth can also be infectious, meaning the virus can spread through saliva. People who closely interact with someone who is infectious, including health workers, household members, and sexual partners are therefore at greater risk for infection.

The virus can also spread from someone who is pregnant to the foetus from the placenta, or from an infected parent to child during or after birth through skin-to-skin contact.

It is not clear whether people who do not have symptoms can spread the disease.

Who is at risk of catching monkeypox?

Anyone who has close physical contact with someone who has symptoms of monkeypox, or with an infected animal is at the highest risk of infection. People who were vaccinated against smallpox are likely to have some protection against monkeypox infection. However, younger people are unlikely to have been vaccinated against smallpox because smallpox vaccination stopped worldwide after smallpox became the first human disease to be eradicated in 1980. Even though people who have been vaccinated against smallpox will have some protection against monkeypox, they also need to take precautions to protect themselves and others.

Newborns, children, and people with underlying immune deficiencies may be at risk of more serious symptoms and death from monkeypox. Health workers are also at higher risk due to longer virus exposure.

How can I protect myself and others against monkeypox?

You can reduce your risk by limiting contact with people who have suspected or confirmed monkeypox.

If you do need to have physical contact with someone who has monkeypox because you are a health worker or live together, encourage the infected person to self-isolate and cover any skin lesion if they can (eg, by wearing clothing over the rash). When you are physically close to them, they should wear a medical mask, especially if they are coughing or have lesions in their mouth. You should wear one also. Avoid skin-to-skin contact whenever possible and use disposable gloves if you have any direct contact with lesions. Wear a mask when handling any clothes or bedding if the person cannot do it themselves. Regularly clean your hands with soap and water or an alcohol-based hand rub, especially after contact with the person who is infected, their clothes, bed sheets, towels, and other items or surfaces they have touched or that might have come into contact with their rash or respiratory secretions (eg, utensils, dishes). Wash the person’s clothes, towels and bedsheets, and eating utensils with warm water and detergent. Clean and disinfect any contaminated surfaces and dispose of contaminated waste (eg, dressings) appropriately.

Can children get monkeypox?

Children are typically more prone to have severe symptoms than adolescents and adults. The virus can also be passed to a foetus or to a newborn through birth or early physical contact.

What should I do if I think I may have monkeypox?

If you think you have symptoms or have been in close contact with someone with monkeypox, contact your health worker for advice, testing, and medical care. If possible, self-isolate and avoid close contact with others. Clean hands regularly and take the steps listed above to protect others from infection. Your health worker will collect a sample from you for testing so that you can get appropriate care.