The CDC’s Newest Monkeypox Guidance: What You Need to Know About Rising Cases

The CDC’s Newest Monkeypox Guidance: What You Need to Know About Rising Cases
  • More than 2,000 monkeypox cases have been reported in the United States this year.

  • Two cases of the rare illness were reported in the U.S. last year.

  • Infectious disease experts are keeping an eye on larger clusters appearing around the world.

Public health officials in the U.S. are increasingly warning about the spread of monkeypox, with some suggesting it will get worse before it gets better.

Former FDA Commissioner Scott Gottlieb, M.D., said recently on CBS’ “Face the Nation” that, “at this point, we’ve failed to contain this.” He continued, “We’re now at the cusp of this becoming an endemic virus, with this now become something that’s persistent that we need to continue to deal with.”

Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases, told CNN on Saturday that monkeypox is “something we definitely need to take seriously. We don’t know the scope and the potential of it yet, but we have to act like it will have the capability of spreading much more widely than it’s spreading right now.”

As of now, more than 2,000 monkeypox cases have been identified in the U.S. since May 2022—a huge jump from the 65 cases detected in mid-June. “The case count continues to rise daily,” guidance from the Centers for Disease Control and Prevention (CDC) that was released in June reads, before noting that there have been cases with “uncharacteristic features” that have “raised concern that some cases are not being recognized and tested.”

The guidance also contains this chilling note: “The current identification of West African monkeypox cases in many countries that do not have endemic disease and involving patients with no direct travel history to an area with endemic monkeypox, suggests person-to-person community spread.”

This isn’t the first time monkeypox has shown up in the U.S. There were two cases reported in the country last year—one in a Maryland man who had recently returned from Nigeria, and the other in a Texas resident who had also recently returned from Nigeria. Those cases marked the first time the U.S. had seen monkeypox since 2003, per the Centers for Disease Control and Prevention (CDC). However, the number of cases of monkeypox seen this year in the country are highly unusual.

While monkeypox is rare and isn’t considered to be a highly infectious virus that’s easily spread between people, infectious disease experts say that the latest string of cases is puzzling. “There’s a lot we don’t know at this point,” says Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York. “There may be some new epidemiology and new modes of transmission that we don’t understand. We need to sort that out.”

Monkeypox isn’t a virus most people in the United States are familiar with, so it might be unclear how to interpret this news. Should you be concerned? Are we at risk of a monkeypox outbreak? Can you get monkeypox from touching surfaces? How long can it live on surfaces? Here, infectious disease experts explain everything you need to know about the illness.

What is monkeypox?

Monkeypox is a rare disease caused by the monkeypox virus, according to the CDC. It was first discovered in 1958, when two outbreaks of a pox-like disease happened in colonies of monkeys that were kept for research.

The first human case of monkeypox was reported in 1970 in the Democratic Republic of Congo. Since then, other cases have been reported in people in other central and western African countries. The monkeypox virus is related to the variola virus, which causes smallpox.

Monkeypox cases are rare overall, but are most common in the Democratic Republic of Congo, which sees more than 1,000 recorded cases a year, per CDC data. The last documented cases of monkeypox in the U.S. were in 2003, when a small outbreak led to 47 cases linked to a shipment of animals imported from Ghana.

What are the symptoms of monkeypox?

The signs of monkeypox are similar to those of smallpox, but often milder. Overall, monkeypox lasts for two to four weeks. The illness starts with these symptoms, according to the CDC:

  • Fever

  • Headache

  • Muscle aches

  • Backache

  • Swollen lymph nodes

  • Chills

  • Exhaustion

Within a few days, an infected person will develop a rash that usually starts on the face and spreads to other parts of the body. The bumps then go through different stages before they fall off:

  • Macules (flat, discolored bumps)

  • Papules (raised area of skin)

  • Vesicles (blisters)

  • Pustules (small pumps that contain pus)

  • Scabs (dry, crusty bumps)

What does the CDC guidance say?

The CDC guidance reiterates how monkeypox usually shows up in people, before breaking down what cases in the U.S. have looked like. All patients have had a rash, the CDC says, but it’s been a little different from the standard monkeypox rash.

“Although the characteristic firm, deep-seated, well-circumscribed and sometimes umbilicated rash has been observed, the rash has often begun in mucosal areas—e.g., genital, perianal, oral mucosa—and in some patients, the lesions have been scattered or localized to a specific body site rather than diffuse and have not involved the face or extremities,” the guidance reads. “In some instances, patients have presented with symptoms such as anorectal pain, tenesmus [feeling like they need to poop], and rectal bleeding which upon physical examination, have been found to be associated with visible perianal vesicular, pustular, or ulcerative skin lesions,” it continues.

The lesions have sometimes been in different stages in different areas of the body, like vesicles and pustules existing side-by-side, the CDC says. “In addition, prodromal symptoms including fever, malaise, headache, and lymphadenopathy have not always occurred before the rash if they have occurred at all,” the guidance reads.

There’s also this to consider, per the CDC: Symptoms may be similar to STIs like syphilis and herpes. The CDC is urging doctors with patients who have these symptoms to test them for monkeypox.

How do you get monkeypox?

Monkeypox spreads to a person when they come into contact with the virus from an animal, a person, or materials contaminated with the virus, the CDC says. The virus can then enter the body through broken skin or the eyes, nose, or mouth.

You can also get the virus from an animal by being bitten or scratched, preparing bush meat, or by having direct or indirect contact with body fluids or lesions from infected people. The main disease carrier of monkeypox is unknown, although African rodents are suspected, says infectious disease expert Amesh A. Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security.

It’s not very contagious, but it can spread from person to person, says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine. The CDC notes that human-to-human transmission is thought to mostly happen through large respiratory droplets. These can’t travel more than a few feet and people need to have “prolonged” face-to-face contact in order to spread the virus.

But the latest cluster of cases has experts wondering if the virus has mutated to be more contagious and easily spread between people. “The current cluster of cases in Europe, U.K., and Canada is a little different in that many cases are not linked to known travel-related cases, suggesting a chain of transmission exists that is not well known,” Dr. Adalja says. “Several of the cases are in men who have sex with men, suggesting sexual transmission and the involvement of sexual networks which is new.”

“Historically, monkeypox wasn't that infectious from humans to humans and it died out on its own,” Dr. Russo says. “But there’s no clear epidemiological link with many of these cases. That’s a little concerning.”

How long can monkeypox live on surfaces?

The CDC warns that you can get monkeypox by touching items like clothes or linens that “previously touched the infectious rash or body fluids” of someone with monkeypox, which raises some eyebrows now that the virus has been detected in nearly every state in the U.S. And, if you’re traveling, it’s understandable to have concerns about getting monkeypox from hotel bed sheets or even picking it up from things like grocery cart handles or subway poles.

Officials in San Francisco warn that the monkeypox virus can live on surfaces like sheets for up to 15 days. The CDC also says in guidance for disinfecting homes and healthcare settings that have come into contact with people with monkeypox that similar orthopoxviruses 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.

“Monkeypox can be transmitted through linens and how viable it remains after time will depend upon the conditions,” Dr. Adalja says.

But while the monkeypox virus can create fomites (i.e. contaminated surfaces that can spread disease), it’s not a huge concern outside of sharing unwashed bedsheets or towels, Dr. Russo says. Meaning, it’s unlikely you’ll pick this up from a grocery cart or subway pole.

“There’s never the zero chance something can happen in medicine, but the chance is very close to zero,” Dr. Russo says. “Monkeypox in terms of fomite transmission is primarily in individuals that share bedding and towels. You need to have exposed skin and someone needs to be exposed to that.”

How is monkeypox treated?

There’s no “proven, safe” treatment for monkeypox virus, the CDC says online. However, the agency says, the smallpox vaccine and antivirals like cidofovir can be used to both prevent and treat infections.

Can you die from monkeypox?

Monkeypox can be serious and could kill as many as one in 10 people who become infected with it in Africa, the CDC says.

While Dr. Russo says that people “shouldn’t panic” over monkeypox, he does admit that there’s “some concern” over how this is spreading right now. “We’re getting this cryptic transmission somehow,” he says. “If it transmits a little better than it has in the past, the possibility exists that it could spread in the U.S.” He adds, “Let’s hope that’s not the case.”

Dr. Adalja says that there will “likely be more cases in the U.S.” but says that “threat to the general public is low.”

“The smallpox vaccine and antivirals are always the backstop if needed,” Dr. Adalja says.

How to protect yourself from monkeypox

The CDC says that monkeypox and other orthopoxviruses are “sensitive” to many disinfectants. The virus should also be killed on clothing and bedding when it goes through the washing machine with detergent, the CDC says.

“Standard washing of sheets is all that is necessary,” Dr. Adalja says. And, while fomites can spread monkeypox, Dr. Adalja says it’s not the main way the virus is spreading. “I do not think that the general public needs to take special precautions when touching doorknobs, for example,” he says.

If you’re concerned, though, Dr. Russo points out that monkeypox is an enveloped virus that can easily be killed with soap and water or the use of sanitizers. “If you feel like you might have touched something that was contaminated, go ahead and wash your hands,” he says. “But I really wouldn’t worry about this.”

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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