Everything you need to know about the monkeypox

On May 7, health authorities in the United Kingdom reported a case of monkeypox in a person who had just returned from a trip to Nigeria. The case was unusual but not very concerning; a limited number of travel-related cases of monkeypox occur from time to time. Between 2018 and 2021, the UK recorded seven similar incidents. But the instances kept coming this year.

Everything you need to know about the monkeypox
Everything you need to know about the monkeypox

By May 16, the UK had reported six new cases, all of which were unrelated to travel and suggested domestic transmission. Portugal reported five confirmed cases and more than 20 probable cases on May 18. The first case in the United States was reported the same day by health authorities in Massachusetts. Meanwhile, Spain declared an epidemic after 23 patients exhibited indications of the rare virus. Following then, there were cases in Italy and Sweden.

Previously, monkeypox transmission essentially died out on its own. The virus, according to experts, is not readily transmissible. Even nevertheless, the instances kept pouring. The international epidemic had reached 300 patients in over 20 countries by May 26. The United States had just nine confirmed cases at the time, but the Centers for Disease Control and Prevention declared that domestic community transmission was already underway. In early June, the worldwide number had surpassed 1,300 cases from 31 countries, including 45 in the United States.

As June rolled into July, health professionals all across the globe struggled to deal with the rapidly spreading disease. The World Health Organization labeled the monkeypox epidemic a public health emergency of worldwide concern on July 23, with over 16,000 cases reported from more than 70 countries (PHEIC). It is the highest level of notice issued by the EPA, and many health experts believe it should have been reached in June.

Soon after the PHEIC statement, the United States took the worldwide lead in the number of monkeypox cases. With nearly 6,600 cases in 48 states, the US authorities declared the epidemic a public health emergency on August 4.

There have been over 30,000 monkeypox cases recorded from at least 88 countries as of August 9, little over four months after the first case was identified in the UK, with at least 11 fatalities. The number of cases in the United States has already surpassed 8,900.

The following is a handy reference guide to all of the critical facts on this global and national health disaster. As new information becomes available, the guide will be updated on a regular basis.

What exactly is monkeypox?

The pathogen

Monkeypox is a virus—specifically, an enclosed double-stranded DNA virus. It is a member of the Poxviridae family, which also contains the variola virus, which causes smallpox. The monkeypox virus produces an illness comparable to its extinct sibling, however the sickness (also known as monkeypox) is often milder.

monkeypox virus

Animals serve as hosts

The term “monkeypox” is a little misleading. The virus was named after being identified in 1958 among monkeys at a research facility in Copenhagen, Denmark. After shipments of Asian monkeys arrived from Singapore, the virus caused two non-fatal outbreaks at the institution that year.

However, monkeys are not the only or even the major host for the virus; the study animals were just where the virus was discovered. Rope squirrels, tree squirrels, Gambian pouched rats, dormice, and prairie dogs are among the non-human primates and rodents that may be infected by the virus. It’s still unknown which species serve as its reservoir—its native host—but specialists believe it’s most likely rodents, not monkeys.

Where it is often found

The monkeypox virus is endemic in Western and Central African nations, mostly in tropical rainforest settings. Monkeypox is considered endemic in Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana (identified in animals only), Côte d’Ivoire, Liberia, Nigeria, the Republic of the Congo, and Sierra Leone, according to the WHO.

In 1970, a 9-month-old infant boy in the Democratic Republic of the Congo was diagnosed with monkeypox.


Monkeypox virus is classified into two clades depending on geography: the West African clade and the Congo Basin clade. According to the WHO, the West African clade is regarded milder than the Congo Basin clade, with a case fatality rate of 3.6 percent compared to 10.6 percent for the Congo Basin clade. Cameroon serves as the dividing line for the geographical distributions of the clades. It is the only nation where both clades have been discovered.

The present epidemic is dominated by the milder West African clade.

Controversies regarding naming

During the current epidemic, the misnomer virus and illness names, as well as the geographically connected clade names, have all garnered criticism. Health professionals now consider them to be deceptive, stigmatizing, and discriminatory. As a result, the International Committee on Taxonomy of Viruses, which has jurisdiction over viral nomenclature, is contemplating altering the virus’s name. The WHO, which has control over the disease’s nomenclature, is contemplating replacing it. However, such adjustments might take a long period and will need scientific community support.

What are the signs and symptoms of monkeypox?

People infected with the virus typically exhibit symptoms six to thirteen days after infection, although the incubation period may vary from five to twenty-one days.

Historically, monkeypox infections begin with a flu-like sickness that lasts one to three days and includes symptoms such as:

  • Fever
  • Chills
  • A severe headache
  • Lymph nodes swollen
  • Back pain
  • Muscle pain
  • Fatigue/energy deficiency
  • Sore throat, nasal congestion, and cough are examples of respiratory symptoms.
  • In certain cases, gastrointestinal symptoms such diarrhea, nausea, and vomiting may occur.
Monkeypox Symptoms

The distinctive rash generally appears after this stage of the sickness. Lesions have historically developed all over the body, with a focus on the face and extremities, notably the palms of the hands and soles of the feet. The lesions progress through four phases, starting as flat, discolored patches (macules) and progressing to elevated, painful lesions (papules). They subsequently fill with clear fluids (vesicles), followed by pus (pustules). Finally, the pustules crust over and fall off, leaving a scab.

This rash might continue anywhere from two to four weeks. Only until all of the lesions’ scabs have come off and a new layer of skin has developed in their place is a person deemed no longer infectious.

Secondary infections, bronchopneumonia, sepsis, encephalitis (brain inflammation), and an eye infection, which may result in vision loss, are all possible complications of monkeypox. Those with impaired immune systems, youngsters, and pregnant women are most vulnerable to catastrophic results.

As previously stated, the past death rate for infections with the milder West African haplogroup is estimated to be 3.6 percent, whereas the fatality rate for infections with the Congo Basin clade has been 10.6 percent.

How the illness manifests itself in this outbreak

Many cases in this epidemic do not match the mold of prior monkeypox illnesses. Many instances, for example, have been connected to sexual behavior. As a result, numerous patients have experienced lesions in the oral, vaginal, and anal regions. Sometimes the rashes may not cover the whole body, and there may just be a few or even a single lesion.

Furthermore, some infected persons do not have a flu-like sickness before developing a rash. Some people get it after getting a rash, whereas others don’t. Because of this, many instances have been misdiagnosed as common sexually transmitted illnesses such as herpes, syphilis, and gonorrhea. Many patients have described the sores as terrible, and others have been hospitalized for pain relief. Finally, several people have experienced rectal symptoms such as discomfort, swelling, and passing stools containing pus or blood.

In a recent question-and-answer session, Rosamund Lewis, WHO’s technical director for monkeypox, said, “We’re seeing novel forms of sickness.” Conditions “that may be exceedingly painful and need medical attention, such as secondary infections or inflammation or swelling of the rectum,” she noted, are among the new signs.

Though fatalities in the current epidemic have been infrequent, some have occurred in persons with impaired immune systems. Others have occurred in apparently healthy patients after encephalitis, a recognized consequence of monkeypox.

In the past

In the decades after monkeypox was identified, researchers have thought of it as a virus that is difficult to transmit. Prior to the present epidemic, human infections were normally only seen when the virus spread from an endemic animal host. Hunters and others who worked with bushmeat were the most vulnerable. The virus may also be transmitted by being bitten or scratched by an infected animal.

The virus did not spread far in previous spillover instances. According to the WHO, the longest reported chains of transmission prior to the current epidemic involved just six to nine consecutive leaps from person to person until transmission stopped. Those transmission chains were often restricted to health care providers and household members who had close, intimate, and extended contact with an infected individual.

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The current outbreak’s spread

The virus is certainly propagating in longer chains in the current epidemic. So far, it’s not obvious why. Experts believe it is due to the discontinuation of smallpox vaccination, which would have provided cross-protection; an evolution of the virus that allowed it to spread more easily; the use of a new route of transmission—i.e., through sexual networks during sexual activity; or some combination of those factors.

Nonetheless, monkeypox has not completely transformed throughout this epidemic. It is still not a virus that is readily transmitted. The great majority of cases are the result of sexual interaction. As previously, transmission occurs via close, sometimes intimate, protracted contact—skin-to-skin contact and close face-to-face encounters over time.

In this epidemic, the CDC defines this as “oral, anal, and vaginal intercourse or touching the genitals (penis, testicles, labia, and vagina) or anus (butthole) of a person with monkeypox.” Hugging, rubbing, kissing, and face-to-face contact are all transmission hazards, as is “touching textiles and items during sex that have not been sterilized and were used by a person with monkeypox, such as bedding, towels, fetish gear, and sex toys,” according to the CDC.

“What we’re talking about here is close contact,” said Capt. Jennifer McQuiston, deputy head of the CDC’s Division of High Consequence Pathogens and Pathology, at a May news conference. “It’s not a circumstance where you pass someone in the grocery store and they’re at danger for monkeypox.”

The possibility of transmission through respiratory droplets has sparked concern and disinformation online. The pathway is assumed to be linked to lesions in the mouth or throat. However, discussions of “respiratory droplets” have brought up unpleasant memories of the pandemic’s early days, with some thinking that monkeypox is comparable to the respiratory infection SARS-CoV-2. To clarify, monkeypox is not the same as SARS-CoV-2. They are two very distinct viruses.

Despite the semantics of “airborne” transmission, the monkeypox virus does not remain in the air, travel long distances, or transmit via the air in short bursts. So far, health authorities have not documented examples of anyone being sick just by sharing airspace with someone.

This corresponds to previous observations. Over the years, a few travel-related instances have prompted health authorities in the United States and the United Kingdom to carefully monitor airline passengers who were in close proximity to an infected individual. This method has not yielded any results. Between 2018 and 2021, seven travel-related incidents were recorded in the United Kingdom. Four of the cases were directly imported, two were via home contacts, and one was from a health care professional.

For the time being, the current epidemic is predominantly spreading via the sexual networks of men who have sex with men (MSM), with transmission taking place during sexual encounters. The overwhelming majority of infected individuals are MSM guys.

Unknowns about transmission

While sex seems to be the primary mode of transmission in this epidemic, monkeypox is not a sexually transmitted virus. Nonetheless, it behaves substantially like one and often masquerades as common STIs. It is still unknown if monkeypox spreads by sperm, vaginal fluids, feces, or urine.

Another major question is whether the virus spreads from persons who have little or no symptoms (asymptomatic spread). Previously, lesions filled with virions were thought to be the primary danger for transmission. It is yet unknown if the virus may spread before patients acquire or become aware of lesions.

Who is in danger?

Though anybody may get infected with monkeypox, MSM are currently the most vulnerable. Prevention strategies and public health response efforts should target these populations, according to health experts.

“This transmission pattern provides both an opportunity and a problem since the populations impacted suffer life-threatening prejudice in certain countries,” WHO Director-General Tedros Adhanom Ghebreyesus said before calling the epidemic a PHEIC.

Public health professionals are concerned about the rise of MSM. Some have publicly expressed concern that disclosing the real transmission path in this epidemic might exacerbate the stigma of MSM. This has, in some cases, generalized the danger, leading those who are at low risk to believe they are at high risk—for example, by implying that the virus is “airborne.” Others, on the other hand, have become angry that the fear of stigma has become a barrier to action, preventing health professionals from firmly adopting the essential targeted tactics.

Officials have modified and refined their approach in recent weeks. The US Centers for Disease Control and Prevention offers a full information on how MSM members may enjoy safer sex. Last Monday, WHO Director-General Tedros Adhanom Ghebreyesus expressly recommended males who have sex with men to reduce their risk by “limiting your number of sexual partners, evaluating intercourse with new partners, and sharing contact data with any new partners to allow follow-up if necessary.”

Though MSM are most vulnerable right now, health professionals warn that everyone should take monkeypox seriously. The longer it may spread, the more it will infiltrate new networks of individuals and even establish itself in places where the virus is not widespread. Some health experts believe the virus might even spread back into animal populations in other nations, establishing new animal reservoirs that could pose a persistent danger of transmission in the future. However, the likelihood of this occurring is considered extremely low. During a previous epidemic in the United States involving prairie dogs, for example, no dissemination to other species was seen. (See below for further information.)

How to Safeguard Yourself

The CDC offers a thorough advice on safer sex for members of the MSM community to avoid its further spread in that group. Some health professionals, including the World Health Organization’s Director-General, have urged that MSM restrict the number of sexual partners they have and avoid anonymous encounters.

There are also two vaccination alternatives for people who are at risk, which are mentioned in the next section.

In general, health experts advise individuals to avoid skin-to-skin contact with someone who has a monkeypox-like rash. Do not touch such a rash or come into close contact with someone who has monkeypox (cuddling, embracing, or having sex). Additionally, avoid contact with objects that have come into touch with an infected individual, such as dining utensils, beds, towels, and clothing. Finally, maintain proper hand hygiene by often washing your hands and using alcohol-based hand sanitizers while out and about.

Vaccines and therapies for monkeypox


To prevent monkeypox, two vaccinations are utilized. ACAM2000 is an old-fashioned smallpox vaccination. This is a one-time dosage of a live replicating viral vaccination. Maximum immune protection takes four weeks to develop following the dose. However, since the virus replicates, it poses substantial hazards, including the possibility of death in one to two instances out of a million doses provided. It is not advised for persons who have weakened immune systems or other underlying problems. As a result, in this epidemic, it is not the chosen vaccination.

The alternative, preferable choice is the two-dose Jynneos vaccine, which is a live, non-replicating virus vaccination approved by the Food and Drug Administration to prevent monkeypox as well as smallpox. The two doses are given 28 days apart, and the vaccination takes 14 days to provide optimum protection following the second injection.

The vaccine may also be taken immediately after an exposure, albeit its post-exposure effectiveness is uncertain. The CDC advises that post-exposure immunization take place within four days of exposure. The vaccination may only lessen symptoms beyond that time, rather than preventing sickness, according to the CDC.

monkeypox vaccine
monkeypox vaccine


In general, the effectiveness of these vaccinations against monkeypox is unknown. The majority of the vaccination evidence is based on smallpox research, animal studies, and observational data, rather than big, rigorous clinical trials. According to the CDC, previous smallpox immunization was 85 percent effective in preventing monkeypox in an observational study conducted in Zaire in the 1980s. However, that research did not include persons who had received the Jynneos vaccination.


The scarcity of vaccinations has been a larger issue in this epidemic than the unclear effectiveness. Most crucially, vaccination doses are not accessible in nations where the monkeypox virus is widespread in animal populations, presenting a clear disparity that has sparked outrage among public health professionals. Although high-income nations have access to vaccination supplies, there are insufficient to fulfill demand.


The Food and Drug Administration stated on Tuesday, August 9, that it was authorized a new method of administering the limited supply of Jynneos vaccinations to extend out the dosages for those aged 18 and higher. Instead of injecting the vaccine subcutaneously (under the skin), one-fifth of a dosage may be injected into the top layer of skin, creating a bubble. This intradermal injection has the potential to boost immune responses while boosting supply up to fivefold.

“In recent weeks, the monkeypox virus has continued to spread at such a pace that it is evident that our present vaccine supply will not match current demand,” FDA Commissioner Robert Califf said in a statement Tuesday. “The FDA swiftly investigated additional scientifically suitable ways to ensure that all affected persons have access to the vaccination.” By expanding the quantity of accessible doses, more people who wish to get vaccinated against monkeypox will be able to do so.”

So far in the epidemic, the United States has only received 1.1 million doses, which is insufficient to vaccinate individuals at high risk, including as members of the MSM community, contacts of sick persons, and health care providers. Dawn O’Connell, assistant secretary for Preparedness and Response at the Department of Health and Human Services, said at a news conference on August 9 that the new approach will expand supplies to up to 2.2 million doses of the 441,000 doses left to be provided.

Outside experts praised the dose-reduction initiative, but the efficiency of this method is unknown, and it is possible that those who are now vaccinated may need more doses in the future. Furthermore, it is uncertain how fast and easily the new administration technique will be used in vaccination clinics.


There are many therapies available for patients who fall ill with monkeypox. Though many individuals may have self-limiting infections that do not need specialist treatment, those with severe infections or consequences, those with high-risk characteristics, children, and pregnant women may be candidates for specialized therapy.

These are some examples:

  • Tecovirimat is an antiviral medication (also known as TPOXX, ST-246)
  • Cidofovir is an antiviral medication (also known as Vistide)
  • Brincidofovir is an antiviral medication (also known as CMX001 or Tembexa)
  • Vaccinia Immune Globulin Intravenous (VIGIV), which has been used to treat smallpox vaccine problems.

There is no evidence of effectiveness against monkeypox for any of these therapies. According to media reports, physicians have had difficulty obtaining some drugs, most notably TPOXX.

What we know so far about previous outbreaks

As previously stated, the current epidemic is unique in terms of scale, mode of transmission (MSM sexual networks), and illness presentation. However, this is not the first outbreak of the virus since it was found in Danish laboratory monkeys in 1958.

Epidemiologists observed an epidemic at Rotterdam Zoo in the Netherlands in 1964, which started with the arrival of diseased anteaters. The virus then spread to orangutans, gorillas, monkeys, chimps, a gibbon, and a marmoset, killing many of them.

In 2003, the United States had the first epidemic of human cases outside of Africa. In this epidemic, infected mice brought from Ghana were kept with pet prairie dogs, who became sick and subsequently spread the virus to humans. In all, 47 confirmed or suspected monkeypox cases were reported in six states: Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin. All of the sick humans had direct touch with a prairie dog that was diseased. There was no evidence of person-to-person transmission. There was also no indication that additional animals were affected.

After decades of no monkeypox cases, Nigeria witnessed an epidemic in 2017 that is currently continuing. In the following years, a few travel-related monkeypox cases have traveled from Nigeria to the United States, United Kingdom, Singapore, and Israel.

How is monkeypox transmitted?

In general, the monkeypox virus spreads by direct touch, close-range respiratory droplets over time, and contact with highly infected objects, such as bed linens and garments that have come into contact with people’s skin sores. The lesions, which are teeming with virions, are regarded as the principal source of worry.

The virus may also be passed from a pregnant woman to a fetus. During pregnancy, infections may cause problems, congenital abnormalities, and stillbirths.

The virus is predominantly spreading in the present epidemic via sexual networks of men who have sex with men (MSM) during sexual activity.

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