NIAID image of monkeypox viruses as seen under a microscope

Your Questions About Monkeypox Answered

Monkeypox is not going to become the next COVID, but it still warrants attention.

Jason Zucker, MD
Jason Zucker

The disease, which is caused by a virus, was first discovered in the 1950s in a colony of research monkeys in Europe (hence the name, monkeypox). The virus was eventually traced back to western and central Africa, where the first recorded human case was documented in 1970.

The virus occasionally infects people in Africa, particularly those who come in close contact with wildlife. This year, about 1,400 cases have been detected in Africa, though more cases may have been unreported.

Though outbreaks outside of Africa have happened before—including in the United States—the current outbreak is the largest and most widespread, with close to 1,600 cases now confirmed in Europe, Asia, and the Americas.

We spoke with Jason Zucker, MD, assistant professor of medicine in the Division of Infectious Diseases at Columbia University Vagelos College of Physicians and Surgeons, about monkeypox and what people in the United States need to know.

How worried should people be about monkeypox?

I think there's reason to be concerned about monkeypox, because there are more than 1,600 cases now in countries where the virus is not endemic. Given how cases are rising in this country and others, and the outstanding investigations being done by our public health organizations, it is likely that we are having local, person-to-person, transmission of this virus.

At the same time, monkeypox does not spread as easily as the coronavirus. When you look at the epidemiological investigations that have been done—and monkeypox is not a novel virus, we have been following outbreaks for decades—the virus is spread primarily through close contact: kissing, skin-to-skin contact, and the sharing of towels, sheets, and other objects.

We’ll learn more with time, but the epidemiologic data we have on monkeypox does not support a link to airborne transmission as it did with the coronavirus, where we saw large increases in cases among health care workers and people who did not have close contact with each other.

What signs and symptoms people should be aware of?

Monkeypox often starts with non-specific symptoms, things like fever, headaches, feeling run down, and swollen lymph nodes. After these symptoms the rash starts and can last for 2-3 weeks. The lesions can start on multiple parts of the body and progress through different stages until eventually scabbing over.

Though many of the pictures of monkeypox seen on the internet show the characteristic lesions, in this outbreak lesions have been presenting differently and often do not resemble those pictures.  

This includes lesions primarily or only in the genital and perianal area and sometimes occurring without fever, headaches, or any of the other systemic symptoms. The lesions can easily be confused with herpes or syphilis lesions, which can also occur at the same time. This is a great reminder that you should go and see your doctor any time you have abnormal skin lesions.  

Since thinking about monkeypox is relatively new for many U.S. providers, if you have lesions that are unusual to you, go see your doctor and ask them about monkeypox to help raise their suspicion. For clinicians, especially given the presentations during this current outbreak, it’s a great reminder about the importance of taking a good history, including a sexual history, and remembering to add monkeypox to our differential along with traditional sexually transmitted infections.

How can people avoid monkeypox?

The first thing to remember that this disease is not limited to men who have sex with men. It was introduced first into that community, so that's who seeing it first and experiencing most current cases. But just like other diseases, there's no reason it can't spread to other communities via sexual or other close contact.

It is important that we make sure that the communities currently at greatest risk are aware of this disease. The CDC just put out a document on social gathering, safer sex, and monkey pox, which has a lot of things that people can do to lower the chance of getting monkeypox. The most important step is to talk to your partners; find out about recent illnesses, ask about rashes, or sores, and check yourself and your partner out prior to sex. If you yourself have lesions, make sure they stay covered and see a clinician to figure out what's going on.

Does smallpox vaccination help?

Routine smallpox vaccination ended in this country in 1972, but the vaccine definitely provides some level of protection against monkeypox, as high as 85%, because the two viruses are closely related. It's unclear how much of that protection decreases over time, but it is definitely providing some level of protection.

We are now bringing the vaccine back for people who may have been exposed to monkeypox in this outbreak, or who are close contacts of a person with monkeypox. The sooner an exposed individual gets the vaccine the better, but the goal is to give the vaccine within 4 days of exposure to prevent disease and between 4 and 14 days to reduce symptoms of the disease. This type of vaccination strategy has helped contain other outbreaks.

How is monkeypox treated and what’s the prognosis?

This outbreak is cause by the West African strain, which has a much better overall prognosis, than the other, Congo Basin strain. The disease caused by the West African strain has a 1% to 3% mortality, however the good news is that is not what we have seen in this outbreak, in which the majority of patients have not required medical treatment. Only a very small number of patients required any medical treatment at all, and most patients will get better on their own.

There are novel antivirals developed for smallpox that may be useful for people with monkeypox, and those might be options for some people.

Should we be paying more attention to monkeypox and other diseases?

I think it's a great reminder that infectious diseases are not a “local” problem. In our interconnected world anything that can spread between people and/or animals can potentially spread anywhere in the world, and diseases that may seem endemic to one region can spread at any point in time.

I think we have a responsibility to invest in researching these diseases, developing treatments, vaccines, and cures, not just because it’s the right thing to do. But also because even if these diseases are not yet occurring where we live, you never know when they will be.