How Does Mpox (Previously Known as Monkeypox) Spread? Infectious Disease Experts Explain

How Does Mpox (Previously Known as Monkeypox) Spread? Infectious Disease Experts Explain

Mpox (previously known as monkeypox) dominated headlines last summer, as the virus that causes distinct lesions slowly spread across the country—and the world. While the virus was mostly brought under control within a matter of months, it’s still out there. And, unfortunately, cases are expected to rise again this summer.

The Centers for Disease Control and Prevention recently issued a warning about a possible resurgence in mpox in the U.S., noting that “the outbreak is not over.”

“Spring and summer season in 2023 could lead to a resurgence of mpox as people gather for festivals and other events,” the health alert reads, before encouraging healthcare providers to look out for new cases.

Mpox is not nearly as infectious as COVID-19, but it can and does spread—and many people are fuzzy on the details of how that works, says Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York. Here’s what you need to know about how mpox spreads, plus how to protect yourself.

How does mpox (monkeypox) spread?

Last year, mpox started spreading in areas where it’s not usually present, raising a lot of questions about how it spreads. 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 elsewhere.

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.

Can you get mpox from animals?

Yes, you can get mpox from animals and, in fact, this is what the CDC most warned about for travelers before the mpox outbreak started last year. Anyone with close personal contact with an animal infected with mpox can get the virus, the CDC warns.

The most common way that people become infeced from animals is having direct contact with the infectious rash, scabs, crusts or fluids from sores, saliva, or infected bodily fluids, including respiratory secretions, from animals, per the CDc.

But it’s also possible to get infected by coming into contact with pee or poop from an infected animal, the CDC says. People can spread mpox to animals, too, through close personal contact, like petting, cuddling, hugging, kissing, and sharing sleeping areas.

Worth noting, per Dr. Russo: While it’s possible to get mpox through animals, this isn’t the main way the virus is spreading in the U.S. now.

Can you get monkeypox from surfaces?

Mpox can 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 mpox,” 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 mpox,” 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 this isn’t the main way the virus has spread in the U.S., Dr. Russo says it can happen. “Fomite spread is still possible—it’s just not the dominant mechanism,” he says. “One should not share sheets and towels with someone who is infected.”

But Dr. Russo says that people shouldn’t stress about getting mpox from grocery carts and public transportation handles. “There’s nothing in life that’s zero risk, but this isn’t a huge concern,” he says.

Is monkeypox spread through sex?

Mpox is not a sexually transmitted infection, but it can spread during sex and other close personal contact, Dr. Russo says. 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?

This is a little confusing. The CDC recommends that someone who has mpox wear a “well-fitting mask” if they live with others, and if they need to leave home for any reason. But the agency doesn’t recommend universal masking to lower your risk of getting mpox.

“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.”

Is there a mpox vaccine?

Yes, there is an mpox vaccine. It’s called Jynneos and it’s given in two doses, with the second dose given four weeks after the first. “Although the vaccine is imperfect, it’s critical for people who are in an at-risk population to get the shot to decrease the spread,” Dr. Russo says. (The vaccine’s efficacy in reducing the risk of mpox is as high as 89% in some studies.)

“Vaccination was a critical component in bringing the outbreak under control,” Dr. Russo says, adding that “good judgement around sexual practices was probably even more important.”

For the record, the CDC recommends mpox vaccination for people who are gay, bisexual, or a man who has sex with men or a transgender, nonbinary, or gender-diverse person who in the past six months has had a diagnosis of one or more sexually transmitted diseases. People with HIV, those who have had a suspected exposure to mpox, and those who work in settings where they may be exposed to the virus should also get vaccinated, per the CDC.

Why is the CDC recommending masks to prevent the spread of monkeypox?

The recommendation is pretty specific. “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.”

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 mpox symptoms or that you know has had contact with someone with mpox. “This is not something you’ll pick up by passing someone on the street,” he says. “Unprotected, anonymous sex is really the main concern.”

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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