Mpox Q&A: What you need to know about mpox

Monkeypox virus (MPXV) has a likely historic reservoir host in small mammals (monkeys and rodents) found in forested areas of Central and West Africa. Since its discovery in 1958, the virus has also been sporadically reported to cause infections in humans through contact with infected animals or from eating infected meat, resulting in a rash-like illness called mpox disease. However, the infection now circulates sustainably in certain populations worldwide.

In humans, the most common symptom is an evolving rash on the skin that develops into itchy or painful lesions that can become infected. The rash can affect the palms of hands, soles of feet, face, mouth, throat, groin, genital areas and anus. This may also be preceded by fever, muscle aches, chills, exhaustion, headaches, sore throat, or swollen and painful lymph nodes (raised glands, particularly in the groin and potentially in the neck, under the chin and in the armpits).

For most people, symptoms usually resolve on their own after 14–21 days. However, some people may require medical assistance to treat secondary infections and local pain. 

People who have been in close contact with someone who has mpox are at risk of infection. This includes skin-to-skin contact (such as touching or sex), mouth-to-mouth or mouth-to-skin contact (such as kissing), and face-to-face contact (such as talking or breathing while close, which can transmit infectious respiratory particles). 

People who have contact with clothing, bedding, towels, objects (including needles, such as for tattooing), electronics and other surfaces that have been touched by someone with mpox are also at risk.

Groups at highest risk of severe disease from mpox include pregnant women, young children and people who are immunocompromised, such as people with poorly controlled HIV.

Avoid close contact with anyone who has mpox.

If you are travelling to any of the countries affected by the ongoing mpox outbreaks:

• avoid contact with people who have mpox symptoms
• practise safer sex if you are engaging in sexual activities
• avoid unprotected contact with wild animals (including their meat and blood)
• cook thoroughly any food containing animal parts or meat before eating
• clean your hands frequently with soap and water or an alcohol-based hand rub.

Someone who has contracted mpox usually starts to show symptoms 6–13 days after their infection, but in some cases, it can take up to 21 days.

If you think you might have mpox or have been in contact with someone who has mpox:

• consult your doctor or health-care provider straight away
• isolate from others until you have been evaluated and tested by health professionals.

If you have symptoms of mpox:

• inform people with whom you have been in close contact since the onset of your symptoms; and
• isolate yourself from others until all your lesions have crusted over, the scabs have fallen off and a new layer of skin has formed underneath.

If you are advised to isolate at home, protect those you live with as much as possible by:

• asking friends and family to help you by delivering things you need;
• isolating in a separate room;
• using a separate bathroom or cleaning touched surfaces after each use;
• cleaning and disinfecting frequently touched surfaces with soap and water and a household disinfectant;
• avoiding sweeping/vacuuming (this might disperse virus particles and cause others to become infected);
• using separate utensils, objects and electronics, or cleaning them well with soap and water/disinfectant before sharing;
• not sharing towels, bedding or clothes;
• doing your own laundry (lift bedding, clothes and towels carefully without shaking them; put materials in a plastic bag before carrying them to the washing machine; and wash them with hot water over 60 °C);
• opening windows for good ventilation; and
• encouraging everyone in the house to clean their hands regularly with soap and water or an alcohol-based hand sanitizer.

WHO recommends that people at high risk of becoming infected with mpox get vaccinated and complete the vaccination series (receive all recommended doses). This includes men who have sex with men (MSM) and trans people with multiple male partners, as well as all other people with multiple sexual partners, such as sex workers.

Health workers at risk of repeated exposure, laboratory personnel working with orthopoxviruses, clinical laboratory and health-care personnel performing diagnostic testing for mpox, and outbreak response team members should also be protected through vaccination.

WHO/Europe encourages countries offering vaccination to ensure equitable and effective access to vaccines for these groups. This includes rolling out vaccination programmes in settings such as sexual health clinics, HIV centres, pharmacies, community-based organizations, sex-on-premises venues and large gathering events as an effective way to reach many of the highest-risk groups.

Although vaccination is not a silver bullet, it offers an extra level of protection – together with other preventive measures – and reduces the risk of severe disease if infection does occur.

Vaccination is not recommended solely because someone has a higher risk of severe disease (such as with children, pregnant women and people who are immunosuppressed) unless they also have a high risk of being exposed to mpox. However, people living with HIV should be considered high priority among these groups.

Vaccines reduce the risk of getting infected. While infection can still occur after vaccination, the risk of developing severe disease is lower.

Vaccination can also be offered to help prevent infection after high-risk exposure to the virus if given within 4 days of first exposure (and up to 14 days in the absence of symptoms).

In case of limited vaccine supply, people at risk of developing more severe disease, if exposed, should be given priority in vaccination.

Large gay-bisexual-MSM-focused events and side events can be good opportunities for event organizers and health authorities and providers to reach all affected populations with health advice, testing and vaccination.

Important advice includes:

• keeping conversations open with peers and sexual partners about mpox;
• staying up to date with the latest information from official sources;
• getting tested;
• taking a break from events and contacting a health-care provider if symptoms compatible with mpox appear (typically a rash);
• getting vaccinated/receiving all vaccine doses if vaccination is available; and
• practising safer sexual behaviour and good hygiene, including regular handwashing, to help to limit transmission of the virus.

WHO encourages organizers of mass gatherings to:

• make mpox-related information available before, during and after an event;
• extend mpox information and advice to side events at sex-on-premises venues;
• share local information on where to get tested, and where to get vaccinated if eligible and if vaccination is available;
• have a refund policy in place and encourage people who develop mpox symptoms or are close contacts to skip the event and receive reimbursement for their tickets; and
• use mailing lists and other communication channels (social media, phone messaging groups) to encourage people who are symptomatic or close contacts to connect with their local public health authority and get tested.

WHO encourages owners of venues and spaces that host or hold sex-on-premises events to:

• coordinate with the organizers of the event to be held in their venue, including on how to communicate information about mpox and follow up with attendees after the event; and
• if appropriate and possible, consider vaccination for staff and encourage relevant staff members to seek vaccination.

WHO encourages event organizers that promote and organize sex-on-premises events to:

• assist with post-event surveillance for mpox and follow up with attendees for a health check and testing for mpox and other sexually transmitted infections (STIs);
• work with venue owners, promoters and community influencers to develop a process to support cases of mpox by providing information about health care and testing and encouraging notification of close contacts;
• ensure that information on safe behaviours for attendees is available, including through flyers, information accompanying tickets, the event website and posters in the event space; and
• consider partnering with sexual health clinics or service provider organizations to facilitate referrals for testing for HIV, STIs and other infections at sex-on-premises events.