Mpox

What is mpox?

From: MedlinePlus, National Library of Medicine

Mpox, which used to be called monkeypox, is a disease caused by the monkeypox virus. This virus is in the same family of viruses as the smallpox virus.

Mpox can be spread between animals and people, but it's mainly spread through close contact with someone who has it. It is found regularly in parts of Central, Eastern and West Africa. The virus that causes it has been found in small rodents, monkeys, and other mammals that live in these areas.

Some outbreaks of mpox have affected people in many countries around the world, including the United States.

What are the types of monkeypox viruses?

From: MedlinePlus, National Library of Medicine

There are two types of monkeypox viruses:

• Clade I is regularly found in Central and Eastern Africa. It causes more severe illness and deaths than clade II.
• Clade II is regularly found in West Africa. Infections from clade II are less severe. Most people who get this type will survive. This type is the cause of the global mpox outbreak that peaked in 2022 but has continued to decrease.

How does mpox spread?

From: MedlinePlus, National Library of Medicine

Mpox spreads in different ways:

• Through close, personal contact with someone who has the virus: Through direct contact with their rash, scabs, or body fluids By breathing in the virus during prolonged, face-to-face contact During intimate physical contact such as kissing, cuddling, hugging, massage or sex
• During pregnancy, from the mother to the fetus.
• From touching items (such as clothes, bedding, or towels) that were used by someone who has the virus
• From infected animals: By being scratched or bitten by the animal By preparing or eating meat or using products from the animal

Someone who has mpox can spread it from the time their symptoms start until their rash has fully healed, all scabs have fallen off, and a fresh layer of skin has formed. This usually takes 2-4 weeks.

Researchers have found that some people can spread mpox to others from 1 to 4 days before their symptoms appear. It is not known how often this happens.

What are the symptoms of mpox?

From: MedlinePlus, National Library of Medicine

The symptoms of mpox usually start within 3 weeks from the time you were exposed to the virus. The symptoms may include:

You may have all or only a few symptoms:

• A rash with sores that can look like pimples or blisters. It could be on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus. It goes through different stages, including scabs, before healing. This can take 2-4 weeks.
• Fever.
• Chills.
• Swollen lymph nodes ("swollen glands").
• Exhaustion.
• Headache.
• Muscle aches and backache.
• Respiratory symptoms, such as a sore throat, nasal congestion, or cough.
• You may get a rash first, followed by other symptoms
• You may have flu-like symptoms and then develop a rash 1-4 days later
• You may only get a rash

How is mpox diagnosed?

From: MedlinePlus, National Library of Medicine

To find out if you have mpox, your health care provider:

• Will ask about your symptoms and medical history.
• Will look at your rash.
• Will take a sample of tissue from one of the sores so it can be tested for the monkeypox virus.
• May do blood tests to check for monkeypox virus or for antibodies to the virus. Antibodies are proteins that your immune system makes to fight foreign substances such as viruses and bacteria.

What are the treatments for mpox?

From: MedlinePlus, National Library of Medicine

There are no treatments specifically for mpox, but many people get better on their own.

Since mpox and smallpox are similar, antiviral medicines that treat smallpox may also help treat mpox. Antiviral medicines may be recommended for people have severe mpox or are at risk of severe mpox, for example because they:

• Have immune system, for example from HIV or other conditions
• Are pregnant
• Are children, especially those under age 1
• Have certain active skin conditions that can cause widespread infection, such as eczema, impetigo, or psoriasis

If you have mpox, it is recommended that you stay home from the time you have symptoms until your mpox rash has healed and a new layer of skin has formed. It would be best to stay in a separate room from your family members and pets if you can.

Can mpox be prevented?

From: MedlinePlus, National Library of Medicine

JYNNEOS is a vaccine that can help prevent mpox (and smallpox). The vaccine is given in two doses 4 weeks apart. Getting both doses gives the best protection.

The vaccine is recommended for people who are at risk of mpox, for example because they:

Check with your provider to see if the vaccine is recommended for you.

There are also other steps you can take to help prevent mpox:

• Had or think they could've had exposure to someone with mpox
• Are a man who has sex with men, who in the last 6 months had: One or more sexually transmitted infections (STIs) More than one sexual partner Sex at a commercial sex venue (like a sex club or bathhouse) Sex at a large public event where people had spread mpox
• Had a sex partner who is at risk of mpox
• Expect to be in any of these situations
• Are at risk of exposure at work, for example at a lab or healthcare facility
• Will be traveling to an area where there is an outbreak and, while there, will likely have sex: With a new partner At a commercial sex venue or large public event In exchange for money or drugs
• Avoid close, skin-to-skin contact with the mpox rash. So, while a person is sick with mpox: Do not touch their rash or scabs Do not kiss, hug, cuddle, or have sex with them
• Avoid contact with items that were used by someone who has mpox: Do not touch the bedding, towels, or clothing of a person who has mpox Do not share eating utensils or cups with them If you or someone you live with has mpox, clean and disinfect your home
• Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially after contact with sick people.

Which doctor should you see?

The suggested department for discussing Mpox is Infectious Diseases, with a general physician / infectious disease specialist as the relevant type of clinician. General physician / Family Medicine; paediatrician for children. Referral depends on symptoms.

This is an editorial referral starting point. The appropriate clinic depends on the person’s age, symptoms, previous diagnosis and local services. The first clinician can decide whether another specialty or a team is needed; a department label does not confirm the diagnosis.

How to prepare for an assessment

Bring a short timeline of the main symptoms: when they first appeared, whether they are constant or episodic, what seems to change them, and how they affect daily activities. Include previous reports, discharge summaries, current medicines and supplements, allergies, and any relevant family history. A dated record is more useful than trying to match every feature in an online article.

Ask the clinician what is already established and what remains uncertain. If a test is suggested, ask what question it answers, what its limitations are and how the result would change the next step. The information here is not an instruction to arrange every possible test. In children, bring growth, developmental and school information if it is relevant to the concern.

• Which exposure or organism is suspected, and what evidence would confirm it?
• Are precautions, vaccination or advice for close contacts relevant to this infection?
• What should happen if symptoms worsen or do not improve as expected?

Treatment discussions and follow-up

Where the source describes treatments, these are an overview of possible care, not a prescription for an individual. Ask which option applies to the confirmed diagnosis, what benefit is expected, what adverse effects to watch for and how progress will be assessed. Availability, approvals and local practice can differ from the country described in the source.

Before leaving the appointment, clarify the next review date, who will communicate results, and whom to contact if the situation changes. Discuss difficulties with sleep, work, school, mobility, eating or emotional wellbeing when these are relevant. Practical support may require coordination between the treating clinician and other services.

When to seek emergency help

Severe breathing difficulty, collapse, new stroke-like symptoms, a seizure that is prolonged or repeated without recovery, uncontrolled major bleeding, or an immediate risk of self-harm require emergency help. In India, call 112 or reach the nearest emergency department. This is a general, non-exhaustive warning list; it is not a condition-specific triage tool.