By Dr. Katie E. Golden, MD

The 2022 monkeypox outbreak has reached North Carolina and Mecklenburg county. While the risk to the general public remains low, we want you to make sure you have all the information you need as the outbreak evolves. But most importantly, know that you don’t need to worry. We’ve got you — pox or not. 

What is Monkeypox?

Monkeypox is an infection caused by a virus. It was first discovered in monkeys in Africa in the 1950s. The first known human case was not until the 1970s. Prior to the 2022 outbreak, most cases of monkeypox occurred in Africa. And most of these cases and small outbreaks occurred when humans came into contact with sick animals — like rodents, squirrels, or monkeys. The only major outbreak in the US before now occurred in 2003. The outbreak affected less than 100 people, and no one died.

How does monkeypox spread?

Humans can get monkeypox when they come into close contact with someone who is sick. They can catch the virus from another human in a few ways: 

  • Direct skin–to–skin contact. The virus lives inside the rash that develops during infection. So if someone comes into contact with the rash, they can contract the infection. Experts believe the current outbreak is mainly due to the skin contact that occurs during sexual activity or intercourse. But other activities — like hugging, touching, playing — can also spread the virus.  
  • Contact with shared surfaces. Experts also believe someone can come into contact with the virus on the surface of objects — like bedding, clothing, door handles, etc. And it’s possible the virus can remain active for days to even weeks this way.
  • Inhaled large respiratory droplets. The virus can also be found in bodily fluids, including spit or sputum. Monkeypox, unlike other viruses, requires pretty large respiratory droplets if it is going to travel this route. This usually requires that someone is in close proximity with someone who is sick (less than 3 feet) and for a long period of time (several hours).
  • Pregnancy. The virus can pass through the placenta, so a pregnant person can pass the virus to their growing fetus.

And don’t forget that someone could contract the virus OG style — from contact with an infected animal. This can occur with direct contact with the animal’s body fluids — like blood, or the fluid inside in the pox-like rash. It can also happen when someone is bit by an infected animal.

What are the symptoms?

The most characteristic symptom of monkeypox is the rash. It changes in appearance from day to day as the infection evolves. It usually starts as red dots that progress to small, blister-like pustules. The pustules eventually crust and scab over, then completely resolve. 

The rash can start or spread to any body part. In the 2022 outbreak, many cases begin in the genital or anal area. But it also commonly affects the face, arms, and chest. Some people also develop it on the hands, feet, eyes, or mouth.

Some people only develop the rash. Others have additional symptoms, which can start before or after the rash. This commonly includes fevers, body aches, headaches, fatigue and malaise.

Symptoms usually start within 3 weeks of exposure, and usually last 2-4 weeks.

Is monkeypox deadly?

The monkeypox death rate has varied from outbreak to outbreak, and ranges from 0 to 11%. There have been many outbreaks without any associated deaths (like in the US in 2003). The death rate may be higher in people with immunocompromise. This includes people at the extremes of age (very old or very young), or those with medical conditions that weaken their immune system. 

How is it treated?

There is no treatment for monkeypox. But most people fully recover without any specific treatment. Experts are currently exploring whether smallpox treatments may also be effective against monkeypox, but this is still experimental for now.

There is a vaccine that is available to help prevent infection. The CDC recommends vaccination if you:

  • Have come into contact with someone with monkeypox
  • Have recently had sex with someone who has monkeypox 
  • Have multiple sexual partners in an area with known monkeypox
  • Work in a laboratory and or medical clinic that brings you into close contact with the virus

The current vaccine requires two doses. And you don’t reach full immunity until 2 weeks after your second dose.

What to do if you think you have monkeypox

If you think you may be sick with monkeypox, call your healthcare provider to figure out your next steps. In many cases, you can care for yourself at home without any specific treatment. And they can also provide next steps if you are someone who is at risk for developing a more severe infection. But as always, if you are worried and you can’t get in touch with your provider, the emergency room is always an option. It is important to alert first responders and emergency room staff right away that you are concerned about monkeypox, so they can minimize risk to themselves and other patients.