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Monkeypox is dominating headlines across the country—and the world—as cases continue to spread. To date, there have been more than 6,000 cases in the U.S., according to data from the Centers for Disease Control and Prevention (CDC). And as cases increase, it’s understandable to wonder how monkeypox spreads.
Monkeypox is not nearly as infectious as COVID-19, says Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York, but cases have shown up across the world in areas where the disease isn’t usually seen. Accurate global estimates are tough to come by, but the World Health Organization (WHO) has the global case count at 16,000 as of July 23. The WHO has also declared monkeypox a public health emergency of international concern, which is defined as “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response.”
The CDC recently updated its guidance on monkeypox and how it spreads to include a request that people who are infected “wear a well-fitting mask” to “prevent the wearer from spreading oral and respiratory secretions” if they need to be around others, raising some questions about whether monkeypox is airborne. (More on that in a moment.)
Ahead, infectious disease experts share everything you need to know about the disease—including how it spreads, monkeypox symptoms, and preventative measures.
How does monkeypox spread?
There has been a lot of question about this lately, given that monkeypox has suddenly shown up in areas where it’s not usually present. While monkeypox is endemic (meaning, it’s constantly around at some level) in central and west Africa, it’s unusual for it to be seen in so many different areas at once.
People typically get monkeypox when they come into contact with the virus from an animal, a person, or materials contaminated with the virus, according to the CDC. The virus can then enter the body through broken skin or the eyes, nose, or mouth. It’s also possible to get monkeypox by being bitten or scratched by an infected animal, or by having direct or indirect contact with body fluids or lesions from infected people.
The CDC also said that monkeypox has been spread through fomites, which are objects, surfaces, or materials that can carry infectious particles. “Fomites are inanimate objects such as articles of clothing that could harbor a pathogen and can be a route of transmission for monkeypox,” infectious disease expert Amesh A. Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security, says. Even bedsheets can be a fomite, Dr. Russo says. “Bedsheets could become contaminated with a combination of fluid or scabs from a person infected with monkeypox,” he says. “Another person could come into contact with those sheets or bedding through micro-breaks in their skin and become infected.”
The CDC says in guidance on cleaning after someone has monkeypox that the virus can live on surfaces like sheets for up to 15 days. But the organization also notes that orthopoxviruses like monkeypox can survive in an environment similar to a house “for weeks or months,” noting that porous materials like beds and clothes can harbor live virus for longer periods of time than non-porous (aka plastic, glass, and metal) surfaces.
While fomites can play a role in the spread of monkeypox, Dr. Schaffner says this is something you’re unlikely to pick up on the street or at the grocery store. “This is not COVID,” he says.
Is monkeypox spread through sex?
But the current global outbreak seems to have a link to sex—although public health officials have made a point to say that monkeypox is not a sexually transmitted infection. The virus has mostly shown up in men who have sex with men and lesions in some cases have been restricted to the genital area, which “suggest transmission occurred during sexual intercourse.” according to the European Centre for Disease Prevention and Control (ECDC).
But Dr. Adalja points out that it’s possible to spread monkeypox through sexual contact without it being an STI. “Sexual interaction involves very close contact and pathogens can use that contact to transmit, even if they are not strictly sexually-transmitted infections,” he says. “Skin-to-skin contact and exposure to respiratory droplets that can facilitate transmission in these encounters.”
An STI usually means that a virus or disease is spread through sexual fluids, like vaginal secretions or semen, Dr. Russo explains. “If you’re being semantically correct, it’s technically not a sexually transmitted infection,” he says. “You could go through that intimate contact without having sexual intercourse and still acquire the infection through the intimate contact with skin and/or respiratory droplets that are produced through kissing.”
“Monkeypox is not a virus that infects the sexual organs the way gonorrhea or syphilis does,” says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine. “It’s not the sexual act that is so important, it’s more the skin-to-skin contact.”
Is monkeypox airborne?
While the CDC is recommending masking to prevent the spread of monkeypox, it’s not considered an airborne virus. “Monkeypox does not spread through airborne particles or droplets, therefore, is not considered to be an airborne virus,” explains Rafael E. Pérez-Figueroa, M.D., M.P.H., associate dean of Community Engagement and Public Health Practice at the Rutgers School of Public Health. “Airborne transmission occurs when small virus particles become suspended in the air and can stay there for periods of time. These particles can spread on air currents and infect people in far distances. That is not the case with the monkeypox virus.”
That said, monkeypox can be found “in droplets like saliva or respiratory secretions that drop out of the air quickly,” Dr. Pérez-Figueroa said. But, he added, “long range or airborne transmission of monkeypox has not been reported. Currently, scientists are studying how often the virus spread through respiratory secretions and when those secretions are more infective.”
Why is the CDC recommending masks to prevent the spread of monkeypox?
The recommendation is a little more specific than people are interpreting it. “At this point, there is no evidence that wearing a mask would be protective of monkeypox transmission in the community,” Dr. Pérez-Figueroa says. But, he points out “wearing an N95 mask, gloves, gowns, and eye protection is recommended for caregivers of people with monkeypox” and “people infected should wear a mask if they must be around others.”
Basically, if you know you have monkeypox or will be interacting with people who have monkeypox, it’s a good idea to mask up. But you don’t need to wear a mask in public settings over monkeypox fears (although it could help lower your risk of contracting COVID).
“Most cases of monkeypox report close contact with an infected person,” Dr. Pérez-Figueroa says. “We don’t know the exact role of direct contact versus respiratory secretions in transmission. However, evidence suggests that is more likely to get monkeypox from direct contact.”
What are the symptoms of monkeypox?
Monkeypox has symptoms that are similar to smallpox, although they’re often milder in monkeypox patients. Monkeypox typically lasts for two to four weeks, according to the CDC and usually starts with these flu-like symptoms:
Swollen lymph nodes
A few days after the original symptoms show up, a person will develop a rash that starts on the face and spreads to other areas of the body, the CDC says. (However, Dr. Russo points out, that some people with recent cases of monkeypox have had a rash that is just restricted to the genital area.) The rash usually goes through different phases before it clears. Those include:
Macules (flat, discolored bumps)
Papules (raised area of skin)
Pustules (small bumps that contain pus)
Scabs (dry, crusty bumps)
How to protect yourself from monkeypox
In general, experts say most people don’t need to worry about monkeypox as of now. “The threat of monkeypox from this outbreak is low to the general public,” Dr. Adalja says. “If there are people who are at risk because of their sexual activities, they should be aware of the fact it is spreading within a sexual network and be cognizant whether or not anyone they’ve been around has lesions consistent with monkeypox.”
Dr. Russo also recommends that you avoid “close intimate contact” with someone who has monkeypox symptoms or that you know has had contact with someone with monkeypox. “It does take a large exposure to get it,” he says. “This is not something you’ll pick up by passing someone on the street.”
This article is accurate as of press time. However, some of the information may have changed since it was last updated. While we aim to keep all of our stories up to date, please visit online resources provided by the CDC and WHO to stay informed on the latest news. Always talk to your doctor for professional medical advice.
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