What is monkeypox disease?
Monkeypox is a zoonotic (transmissible from animals to humans) viral infection caused by the monkeypox virus, which belongs to the genus orthopoxvirus, the same family as smallpox. Although historically considered rare and endemic in some African countries, its global impact has increased significantly in recent years.
The monkeypox epidemic has evolved, with many regions experiencing significant increases in cases. As of mid-2024, many African countries, including the Democratic Republic of the Congo (DRC), have been heavily affected by ongoing outbreaks with hundreds of cases and a higher mortality rate (up to 3–4%) compared to previous waves. The Africa Centers for Disease Control and Prevention (ACDC) declared a public health emergency in August 2024 due to the increasing mortality rate and the continued spread of the virus.
Outside of Africa, many countries in Europe, Asia, and North America have also reported new cases. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) are actively monitoring outbreaks, particularly those of clades IIa and IIb, which are the most prevalent strains of the virus globally.
How is monkeypox transmitted?
Monkeypox is spread primarily from person to person through close contact (skin-to-skin, mouth-to-mouth or mouth-to-skin contact, and also face-to-face contact) with someone who has monkeypox. Direct contact with infected body fluids, skin lesions, or objects containing the virus is primarily effective in spreading the disease. Human-to-human transmission is also possible through respiratory droplets during prolonged close contact. Therefore, it is important to be careful in crowded and airless environments.
People with monkeypox are considered contagious until all skin lesions have crusted over, the crusts have fallen off and a new layer of skin has formed underneath, and all lesions in the eyes and body (mouth, throat, eyes, vagina, and anus) have healed, a process that usually takes 2 to 4 weeks.
It is also possible for the virus to remain on clothing, bedding, towels, electronic devices, and surfaces that a person with monkeypox has touched for a while. Someone else who touches these items can become infected, especially if they have cuts or scrapes or if they touch their eyes, nose, mouth, or other mucous membranes without washing their hands. Cleaning and disinfecting surfaces/objects and cleaning your hands after touching contaminated surfaces/objects can help prevent this type of transmission.
The virus can also be transmitted to a fetus during pregnancy, to a baby or child through skin-to-skin contact during or after birth, or from a parent with monkeypox through close contact.
Although cases of monkeypox from an asymptomatic (not showing symptoms) person have been reported, there is still limited information about whether the virus can be transmitted from an infected person before symptoms appear or after the lesions have healed.
In most cases, monkeypox symptoms go away on their own within a few weeks with painkillers or fever reducers. However, for some people, the disease can be severe or lead to complications or even death. Newborns, children, pregnant people, and people with underlying immune deficiencies, such as advanced HIV disease, may be at greater risk of severe disease and death.
What are the symptoms of monkeypox?
Some people may have less severe symptoms, while others may develop more serious illness. Some of the symptoms seen include:
- Common symptoms of monkeypox include a rash that can last 2 to 4 weeks. This may begin with or be followed by fever, headache, muscle aches, back pain, low energy, and swollen glands (lymph nodes).
- The rash may affect the face, palms of the hands, soles of the feet, groin, and genitals. These lesions may also be found in the eyes, mouth, throat, anus, rectum, or vagina. The number of sores can range from one to several thousand.
- Some people develop inflammation inside the rectum (proctitis), which can cause severe pain, and inflammation of the genitals, which can cause difficulty urinating.
- Severe disease from monkeypox can include larger, more widespread lesions (especially in the mouth, eyes, and genitals), bacterial infections of the skin or blood, and lung infections.
- Complications can include severe bacterial infection from skin lesions, problems affecting the brain (encephalitis), heart (myocarditis), or lungs (pneumonia).
- People with severe monkeypox may need to be hospitalized and may need supportive care and antiviral medications to reduce the severity of the lesions and shorten the healing time.
How is monkeypox treated?
Because monkeypox is closely related to smallpox, smallpox vaccine, particularly the JYNNEOS vaccine, has been used to prevent and control monkeypox outbreaks. However, the vaccine is most effective when administered before exposure or within 4 days of exposure to prevent the onset of disease.
Vaccination efforts have focused on high-risk groups, including healthcare workers, people with weakened immune systems, and people living in areas with active outbreaks.
Jynneos and ACAM2000 are FDA-approved for use against poxviruses. This means they have been approved for use in humans after extensive testing. Jynneos has few possible complications. It can be given to people with compromised immune systems. ACAM2000 carries a risk of myocarditis and pericarditis. The risk is higher in people who have never had a smallpox vaccine, such as most people under the age of 60. The US Centers for Disease Control and Prevention (US CDC) says ACAM2000 should not be given to:
- Those who are severely immunocompromised
- Those living with HIV
- Those with skin conditions such as eczema or psoriasis
- Those with heart disease
- Those with eye disease treated with topical steroids
- Those who are pregnant
- Those under 12 months of age
Additionally, antiviral treatments such as TPOXX have been used for patients with severe monkeypox infections or those at high risk of complications. However, the effectiveness of these treatments continues to be reviewed as more data from recent cases become available.
Frequently Asked Questions About Monkeypox
1-How long is monkeypox contagious?
Infected people should be considered contagious from the time their symptoms start until the rash scabs over and a new layer of skin forms.
2- What is the incubation period for monkeypox?
The incubation period is the time between being infected and the appearance of symptoms. Experts say the incubation period for the virus is usually 7 to 14 days, but can range from 5 to 21 days.
3-Can someone who has had monkeypox get it again?
Infectious disease experts say that based on what we know about closely related viruses, people who are infected or vaccinated should have long-term immunity. Immunity can be weakened for a variety of reasons, including:
- Immunosuppressive drugs and medical treatments
- Untreated or unknown HIV infection
There is limited information about how long the vaccine remains effective.
4- Can monkeypox cause death?
The WHO says the case fatality rate (the fraction of diagnosed cases that lead to death) has been between 3% and 6% in recent years. The death rate among all cases is lower because not all cases are diagnosed or reported.
5- How can I protect myself from monkeypox?
You can take these precautions to protect yourself from infection:
- Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially before eating or touching your face and after using the toilet. Hand washing is one of the best ways to protect yourself, your family, and your friends from getting sick.
- Do not have unprotected contact with skin lesions, body fluids, or personal items of an infected person.
- Do not have prolonged face-to-face contact with an infected person without wearing a mask.
- The US CDC recommends that people limit sexual partners to reduce the risk of contracting the virus until they are vaccinated.
- If you share a home or healthcare setting with an infected person, you can use common household disinfectants to kill the virus on shared surfaces and personal items.
6. Who is at risk of monkeypox?
Anyone can get the virus. However, most cases have been in men, most often men who have sex with men, according to the WHO.
The US CDC says that people who have not been vaccinated against smallpox may also be more vulnerable to the virus. Some researchers say that a single dose of smallpox vaccine can provide protection for up to 75 years in childhood. Smallpox vaccine has not been administered in Turkey since 1980. The last smallpox case in our country was seen in 1957.
7- How can I prevent spreading monkeypox virus to my relatives?
If you have been infected with the monkeypox virus, your doctor will advise you on what to do. In the meantime, it is important to avoid close contact with others until your lesions have completely healed. If it is recommended that you isolate at home, protect the people you live with as much as possible by:
- Isolate in a separate room.
- Use a separate bathroom or clean surfaces you touch after each use.
- Avoid using a vacuum cleaner. (Vacuuming can spread virus particles and cause others to become infected.)
- Use separate kitchenware, electronic devices, or clean them thoroughly with soap and water/disinfectant after use.
- Do not share towels, bedding, or clothing.
- Wash your laundry in hot water above 60 degrees.
- Open windows frequently to ventilate your room.
- Encourage everyone in your household to sanitize their hands regularly.
If you cannot avoid being in the same room or close contact with another person while isolating at home, then here are some things you can do to limit your risks:
- Avoid touching each other.
- Clean your hands frequently with soap and water or an alcohol-based hand sanitizer.
- Cover skin rashes with clothing or bandages. When you re-isolate, be sure to remove any clothing to help the rash heal faster.
- Open windows throughout the house.
- Make sure everyone is wearing well-fitting medical masks.
- Stay at least 3 feet (1 meter) away from each other.
- If you can’t do your own laundry, wear a mask and disposable gloves and follow the laundry precautions outlined above.
8- Should children be vaccinated against monkeypox?
According to experts, the virus can cause more serious illness in children. The CDC recommends that childrenn says that if they have close personal contact with someone who has or may have smallpox, they may be eligible for the vaccine.
9- Should people aged 60 and over be vaccinated?
Assuming that people aged 60 and over in Turkey have received the smallpox vaccine, experts state that this vaccine provides immunity for up to 75 years after a single dose administered in childhood. However, since information on the vaccine is constantly updated, it is important to follow authoritative sources of information on the subject.
10-When should I go to the doctor urgently?
If the rash spreads to the eye or another area that may be particularly sensitive and covers more than 5% or 10% of your body surface, if you think you have secondary infection symptoms including a new rash, if you have pain that cannot be controlled with painkillers, if you have fever (38 degrees and above), shivering/sweating, or swollen lymph nodes, you should urgently go to a health center.