May 24, 2022 – After 2 years of hearing about the coronavirus, there’s now another infectious disease on Americans’ radars: monkeypox.

There is now one confirmed case and four suspected cases of the monkeypox virus – a rare disease closely related to smallpox – in the U.S., according to the CDC.

There are two strains of the virus: one out of Central Africa, and another from West Africa that is less severe. The strain from West Africa has been behind recent monkeypox cases. The confirmed case in the U.S. is a male in Massachusetts who had recently traveled to Canada.

The four suspected cases – one in Florida, one in New York City, and two in Utah – were all identified in males. They have tested positive for orthopox, the family of viruses that includes monkeypox and smallpox.

People with suspected cases had also recently traveled internationally, but specific locations aren’t being disclosed because of privacy concerns, according to Jennifer McQuiston, DVM, deputy director of the CDC’s Division of High Consequence Pathogens and Pathology.

There is also a presumptive case of the virus in Seattle with a male who had recently returned from a country with monkeypox cases, local health officials reported on Monday.

There are currently over 90 confirmed cases and around 28 suspected cases of monkeypox in a dozen countries, according to the World Health Organization.

This outbreak is unusual as cases have popped up in areas of the world where the virus is rarely seen, such as Australia, Canada, and the U.K., as well as other countries in Europe.

In the U.S., the CDC suspects that more cases of monkeypox will likely be discovered in the coming days and weeks.

While monkeypox is a cause of concern, quarantine to help stop its spread probably isn’t needed, according to President Joe Biden.

“I just don’t think it rises to the level of the kind of concern that existed with COVID-19, and the smallpox vaccine works for it,” he said at a recent news conference.

Why Is Monkeypox Spreading Now?

Reasons behind the current global outbreak are unknown or at least haven’t been made available, says Aaron Glatt, MD, chair of the Department of Medicine at Mount Sinai South Nassau hospital in New York state.

But while some monkeypox questions remain unanswered, the virus is hardly novel.

Monkeypox is endemic in Western and Central Africa, where most cases have been found since the virus’s discovery. Over the last 5 years, many monkeypox cases have appeared in Nigeria, which led to infections in at least nine people in various parts of the world who had recently returned from the country, McQuiston told reporters at a recent news conference.

Human monkeypox cases have been previously discovered in the U.S., including two people who had traveled to Nigeria in 2021.

Forty-seven confirmed and likely cases were also found in the U.S. in 2003. Those were closely linked to animals imported from Ghana, according to the CDC.

But recent global cases of monkeypox were found in people who hadn’t visited West African or other countries where the virus is often found. Infected people had traveled to Canada and countries in Europe, where cases were reported in late April and early May.

What Are Symptoms of Monkeypox?

Symptoms of monkeypox are similar but less severe than those of the smallpox virus. They normally appear a week or two after exposure to the virus, though it can take longer in some cases.

Monkeypox normally starts with flu-like symptoms, including fever, chills, a headache, and achy muscles.

Unlike smallpox and chickenpox, swollen lymph nodes are also common. (Worth noting: Despite similar-sounding names and descriptions, chickenpox is caused by the varicella-zoster virus, meaning it is not related to the monkeypox virus.)

After 1 to 3 days of these symptoms, a rash usually develops on your face, then can spread to the rest of your body.

Next, the most notable symptoms can develop: flat, circular lesions in different parts of the body that eventually turn into bumps filled with a clear fluid.

These bumps eventually become crusty before falling off.

Recovery usually takes 2 to 4 weeks, even without specific treatment.

How Does Monkeypox Spread? Monkeypox is largely transmitted through close, skin-to-skin contact with people who have lesions as a result of the virus.

You can also catch the virus through respiratory droplets if you’re around an infected person with lesions in their mouth for an extended period.

“What we are talking about here is close contact – it’s not a situation where if you are passing someone in the grocery store, they're going to be at risk for monkeypox,” says McQuiston.

To prevent the spread of the virus, it’s best to quarantine people who have it and to follow up with their close contacts, the CDC says.

Some health experts also suggest a “ring vaccination” strategy to curb monkeypox spread, which means vaccinating close contacts of a person infected with the virus.

Are There Vaccines for Monkeypox?

The smallpox vaccine is at least 85% effective against the monkeypox virus, according to the CDC.

The U.S. currently has one antiviral and two FDA-approved vaccines for smallpox prevention.

One – a newer vaccine by the name of Jynneos – is also approved to fight against monkeypox. Those 18 years old or older can receive the two-dose vaccine if they are considered high risk for smallpox or monkeypox.

The U.S. has around 1,000 Jynneos vaccine doses and has requested more from the National Stockpile for certain “high-risk contacts of some of the early patients,” McQuiston says.

The U.S. also has more than 100 million doses of an older smallpox vaccine, called ACAM2000. But health officials are hesitant to give it to the public because it can have severe side effects.

These side effects can be particularly dangerous for people who are immunocompromised or those who have eczema, according to John Brooks, MD, a medical epidemiologist in the CDC’s Division of HIV/AIDS Prevention.

Right now, smallpox vaccines will mostly go to people who have been exposed to monkeypox or who “have a significant reason to get the vaccine,” Glatt says.

“You wouldn’t give this to the general population at this point in time.”

How Are Monkeypox Cases Confirmed?

Testing is done in two stages.

First, patient test samples are sent to state laboratories to be tested for orthopox.

If tests come back positive, the samples are sent to the CDC for monkeypox testing.

Do I Have to Find a Special Kind of Doctor for Monkeypox Treatment?

If you suspect you contracted monkeypox, you can visit your local doctor’s office.

“This is a disease we’re asking front-line providers to be vigilant for because it can be managed or diagnosed in a general physician's office using routine standard precautions,” Brooks says.

Protection against monkeypox for health care workers includes wearing gloves, an N95 respirator, face mask, and possibly a protective gown, he says.

Who Is Most Vulnerable to the Monkeypox Virus?

Anybody can become infected and spread monkeypox after being closely exposed to the virus.

That said, most recent cases around the world have been identified in parts of the gay and bisexual communities, as well as other men who have sex with other men.

And while monkeypox is not classified as an STD, the virus can spread “during sexual and intimate contact, as well as with personal contact in shared bedding and clothing,” according to Brooks.

Monkeypox can also be mistaken for certain STDs, particularly when there are virus sores in the genital and anus regions, he says.

“One thing I want to say about the disease is how the disease presents, these lesions and rashes have been a little atypical than what we expect,” Brooks says.

“In one case, a doctor thought the person had very severe herpes at first.”

Anyone who notices an unexplained rash should reach out to their doctor right away to check for monkeypox infection and STDs, he says.

How Dangerous Is the Monkeypox Virus?

The current monkeypox outbreak in the U.S. and Europe has resulted in mild symptoms.

But the virus can cause serious health problems, particularly for immunocompromised people, as well as those with certain skin conditions, like eczema.

Lesions that develop in certain parts of the body can be particularly harmful. Lesions in the eye could damage your vision, according to McQuiston.

And if the virus causes your lymph nodes to swell, it could be hard for you to breathe.

“Luckily we do have antivirals that are available for treatment, which can be used in persons that we think may be at higher risk for severe disease or have severe disease already,” says Brooks.

How Is Monkeypox Different From COVID-19?

The viruses differ in two major ways, according to the CDC.

COVID-19 is highly contagious, mostly through liquid droplets released when infected people talk, cough, or sneeze.

Monkeypox, on the other hand, is largely spread through bodily fluid, virus sores, and respiratory droplets of people with lesions in their mouths and throats due to infection.

Secondly, the COVID-19 virus affects the upper respiratory tract, leading to symptoms like a sore throat and coughing, vs. the monkeypox’s flu-like symptoms.

“Early in COVID-19, we didn’t have a lot of information, and things changed as we learned more,” McQuiston says. “We do know a lot about monkeypox from many decades of studying it, and respiratory spread is not the predominant worry.”

Given that the monkeypox is a zoonotic virus, meaning it comes from animals, it can jump into humans and other species in what’s called a “spillover event.”

But cats, dogs, and other pets are likely not at high risk of infection, McQuiston says.

“During the monkeypox outbreak in 2003, we did extensive testing of a lot of different animal species, and we did not see spread during that outbreak to domestic pets,” she says.

“But I think this is an area we are going to continue to watch carefully.”

If I Get a Smallpox Vaccine to Fight Against Monkeypox, Would the Protection Decrease Over Time?

Many older adults are likely already vaccinated against smallpox. While there’s probably some benefit, protection likely wanes over time, says Glatt.

“Even those people, if they were exposed, would probably need a second dose of smallpox vaccine.”

Could Monkeypox Be the Next Pandemic?

The likelihood of a monkeypox pandemic is extremely unlikely, Glatt says.

“The routes of transmission are dissimilar to COVID-19,” he says. “You really need prolonged, close contact, and it’s not well-spread human-to-human. COVID-19 is extremely well-spread human-to-human.”

To learn more about monkeypox symptoms and prevention, click here.

CDC: “Monkeypox in the United States.”

News release, World Health Organization.

Aaron Glatt, MD, chair, Department of Medicine, Mount Sinai South Nassau.

Jennifer McQuiston, DVM, deputy director, Division of High Consequence Pathogens and Pathology, CDC.

John Brooks, MD, medical epidemiologist, Division of HIV/AIDS Prevention, CDC.

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