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Human monkeypox is a viral disease caused by the monkeypox virus, which belongs to the same family of viruses as smallpox. Monkeypox symptoms are less severe than smallpox (eradicated in 1980), less contagious, and rarely fatal. Monkeypox is not related to chickenpox. Since May 2022, Monkeypox has started to spread globally, including in the United States.

While some facts are not known at this early date, this fact sheet provides information to help you understand monkeypox symptoms, how it spreads, and what to do to prevent spread once you are exposed. There are several aspects of monkeypox transmission that require more scientific research. The IBT Safety and Health Department will update important information as it becomes available.

Current US and Global Situation

A national ‘Public Health Emergency’ (PHE) has been declared due to an outbreak of monkeypox across the United States. Three states – IL, CA, and NY – have also declared a state of emergency. The CDC reports that monkeypox cases[1] are increasing daily.

The World Health Organization (WHO) declared monkeypox a ‘Public Health Emergency of International Concern’in July 2022,a term given to the most serious global disease outbreaks (COVID-19 and polio). Almost 40,000 cases of monkeypox have been reported in 93 countries, most of which do not normally report monkeypox. The rate of transmission is increasing in some parts of the world, including the U.S.

Symptoms and Diagnosis

People who think they have monkeypox or have had close personal contact with someone who has been infected with monkeypox should visit a healthcare provider to help them decide if they need to be tested.

• Monkeypox symptoms usually start within three weeks of exposure to the virus.
  • It is usually a self-limited disease lasting from two to four weeks.
• Scientists are still researching if the virus can be spread when someone has no symptoms.

• Symptoms typically include fever, rash, and swollen lymph nodes and may lead to a range of medical complications.
  • If someone has flu-like symptoms, they will usually develop a rash one – four days later.

• Severe cases can occur, more commonly among young children (less than 8 years of age), pregnant or immunocompromised individuals, and individuals with a history of atopic dermatitis or eczema. These individuals may be at an especially increased risk for severe outcomes from monkeypox disease.[2]

Transmission/Infection[3]

• A person with monkeypox can spread it to others from when symptoms start until the rash has fully healed and a fresh layer of skin has formed. The illness typically lasts two-four weeks.
  • Whether people who do not have monkeypox symptoms can spread the virus to others is currently being researched.

Monkeypox spreads from person to person in a few ways:

• Close personal often skin-to-skin contact including:
  • Direct contact with monkeypox rash, scabs, or body fluids from a person with monkeypox, including during intimate contact (kissing, cuddling, or sex).
  • Touching objects, fabrics (clothing, bedding, or towels), and surfaces that have been used by someone with monkeypox and have not been disinfected.

• Contact with respiratory secretions during prolonged, face-to-face contact or intimate physical contact.
• Transmission through respiratory droplet particles usually requires prolonged face-to-face contact, which puts health workers, household members, and other close contacts of active cases at greater risk.
• Long-range airborne transmission similar to COVID-19 has not been reported but is under study.
  • The virus may spread to a fetus through the placenta.

• Monkeypox is zoonotic, meaning it can spread between animals and people as well. People with monkeypox should avoid contact with pets, domestic animals, and wildlife, to prevent spreading the virus[4].

Prevention

• Per the CDC, people with monkeypox should remain in isolation for the duration of the illness, which typically lasts two to four weeks. However, if a person with monkeypox is unable to remain fully isolated throughout the illness, the CDC provides some recommendations in its document ‘Isolation and Prevention Practices for People with Monkeypox[5]:
  • Those confirmed as having monkeypox should wear a well-fitted mask if they must be close to others in the home or a healthcare setting.
  • Masks should fit closely on the face without any gaps along the edges or around the nose and be comfortable when worn properly over the nose and mouth.
  • Cover the lesions and avoid public transportation when leaving the home as required for medical care or an emergency.

• CDC recommends vaccination for people who have been exposed to monkeypox and people who may be more likely to get monkeypox. Additional information about vaccination can be found here.

• Because there are limitations in our knowledge about the effectiveness of vaccines in the current outbreak, people who are vaccinated should continue to take steps to protect themselves from infection by avoiding close, skin-to-skin contact, including intimate contact, with someone who has monkeypox.

ANYONE in close personal contact with a person with monkeypox can get it and should take steps to protect themselves[6]:

• Avoid close, skin-to-skin contact with people with a rash that looks like monkeypox.
  • Do not touch the rash or scabs of a person with monkeypox.
  • Do not kiss, hug, cuddle or have sex with someone with monkeypox.
• Avoid contact with objects and materials that a person with monkeypox has used.
• Do not share eating utensils or cups with a person with monkeypox.
• Do not handle or touch the bedding, towels, or clothing of a person with monkeypox.
• Wash your hands often.
  • Wash your hands often with soap and water, or use an alcohol-based hand sanitizer, especially before eating or touching your face and after you use the bathroom.

Vaccination[7]

• CDC recommends vaccination for people who have been exposed to monkeypox and people who may be more likely to get monkeypox. People can be vaccinated after known or presumed exposure to someone with monkeypox. Current eligibility includes:

• People who public health officials have identified as a contact of someone with monkeypox.
• People who are aware that one of their sexual partners in the past two weeks has been diagnosed with monkeypox.
• People who had multiple sexual partners in the past two weeks in an area with known monkeypox.

• Vaccination before exposure to monkeypox, called pre-exposure prophylaxis (PrEP), is available for people in certain occupational risk groups (e.g., laboratory personnel performing diagnostic testing for monkeypox virus and members of health care worker response teams designated by appropriate public health and anti-terror authorities). CDC is not currently encouraging pre-exposure vaccination for most U.S. healthcare workers.

• Two vaccines may be used for the prevention of monkeypox disease:
• JYNNEOS is a two-dose vaccine.  Maximum immune protection is reached 14 days after getting the second dose.
• The ACAM2000 vaccine may be an alternative to JYNNEOS. ACAM2000 is a single-dose vaccine, and it takes four weeks after vaccination for its immune protection to reach its maximum. ACAM200, however, has the potential for more side effects and adverse events than JYNNEOS. It is not recommended for people with severely weakened immune systems.

• People should take precautions to reduce their exposure to monkeypox until immune protection from vaccines has reached its maximum.

Treatment[8]^,[9]

• Most people with monkeypox recover fully within 2 to 4 weeks without needing medical treatment.

• If you have symptoms of monkeypox, you should talk to your healthcare provider, even if you don’t think you had contact with someone who has monkeypox.

• Many infected people can isolate[10] themselves at home with advice from their healthcare provider about over-the-counter topical agents, antihistamines, and pain medication. Medical treatment for monkeypox would aim to:
• alleviate symptoms
• manage complications
• prevent long-term effects
• provide fluids and food to maintain adequate nutritional status
• treat bacterial infections that may result from primary symptoms.

There is no treatment specifically for monkeypox. Because the viruses that cause monkeypox and smallpox are closely related, medication and vaccines developed to treat and protect against smallpox may be effective for monkeypox. The type of treatment for a person with monkeypox will depend on how sick someone gets or whether they’re likely to get severely ill.

• Some people, like those with a weakened immune system or genital or rectal rashes, may need treatment. Medications used to treat monkeypox require a prescription and must be requested by a healthcare provider.

• Antivirals, such as tecovirimat (TPOXX), may be recommended for people who are more likely to get severely ill, like patients with weakened immune systems.

Employer Responsibilities and Worker Protections

Workers in certain jobs and tasks may have an increased risk of occupational exposure to monkeypox. It is the employer’s responsibility to conduct a hazard assessment of the workplace and the workers’ tasks to determine if personal protective equipment (PPE) is deemed necessary.  The employer would be required to provide PPE to the employee at no cost, as well as provide training on how to use and maintain the PPE correctly per the Personal Protective Equipment standard promulgated in Title 29 Code of Federal Regulation Subpart I.

In healthcare settings, isolate infected patients from others who could be at risk for infection.

• Use personal protective equipment (PPE) when caring for patients.
• Detailed infection prevention and control guidance for healthcare settings can be found here:

• Laundry—When handling dirty laundry from people with known or suspected monkeypox infection, staff, volunteers, or residents should wear a gown, gloves, eye protection, and a well-fitting mask or respirator.  PPE is not necessary after the wash cycle is completed.
• Cleaning and disinfection—Staff, volunteers, or residents should wear a gown, gloves, eye protection, and a well-fitting mask or respirator when cleaning areas where people with monkeypox spent time. Use products on EPA’s list of disinfectants for Emerging Viral Pathogens
• WASH YOUR HANDS often. Handwashing with soap and water or using an alcohol-based hand rub are both effective.
• Your employer must provide a lavatory with clean hot and cold running water and hand soap or similar cleansing agent per 29 CFR 1910.141 (OSHA Sanitation standard).

If you feel sick:

• Do not come to work.
  • Use paid leave, FMLA protections if these are available to you.
• See your healthcare provider. If you do not have a provider or health insurance, visit a public health clinic near you.

CDC does not currently have standalone workplace guidance for monkeypox. If a person is suspected of having Monkeypox in the workplace, CDC’s guidance, ‘Considerations for Reducing Monkeypox Transmission in Congregate Living Settings[11]’, can be applied to the workplace.

References

Centers for Disease Control and Prevention (CDC)

• www.cdc.gov/poxvirus/monkeypox/faq.html, www.cdc.gov/poxvirus/monkeypox/index.html
• Considerations for Reducing Monkeypox Transmission in Congregate Living Settings
• Centers for Disease Control: English/Spanish 800-232-4636 – Other Languages 877-696-6775

Environmental Protection Agency (EPA)

• EPA Releases List of Disinfectants for Emerging Viral Pathogens (EVPs) Including Monkeypox | US EPA

For more information, contact the IBT Safety and Health Department at (202) 624-6960 and visit https://teamstersafety.org.

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[1] 2022 U.S. Map & Case Count www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html

[2] Clinician FAQs | Monkeypox | Poxvirus | CDC  www.cdc.gov/poxvirus/monkeypox/clinicians/faq.html

[3] How it Spreads | Monkeypox | Poxvirus | CDC  www.cdc.gov/poxvirus/monkeypox/transmission.html

[4] Pets in the Home | Monkeypox | Poxvirus | CDC  www.cdc.gov/poxvirus/monkeypox/specific-settings/pets-in-homes.html

[5] Isolation and Prevention Practices for People with Monkeypox | Monkeypox | Poxvirus | CDC www.cdc.gov/poxvirus/monkeypox/clinicians/isolation-procedures.html

[6] “While anyone can catch monkeypox if they have close contact with someone who has monkeypox, regardless of gender identity or sexual orientation, many of those affected in the current global outbreaks are gay, bisexual, or other men who have sex with men.” Technical Report: Multi-National Monkeypox Outbreak, United States, 2022 | Monkeypox | Poxvirus | CDC  www.cdc.gov/poxvirus/monkeypox/clinicians/technical-report.html  

[7] Vaccines | Monkeypox | Poxvirus | CDC  www.cdc.gov/poxvirus/monkeypox/vaccines.html

[8] What to Do If You Are Sick | Monkeypox | Poxvirus | CDC www.cdc.gov/poxvirus/monkeypox/if-sick/what-to-do.html

[9] Treatment | Monkeypox | Poxvirus | CDC  www.cdc.gov/poxvirus/monkeypox/treatment.html

[10]Isolation and Prevention Practices for People with Monkeypox | Monkeypox | Poxvirus | CDC www.cdc.gov/poxvirus/monkeypox/clinicians/isolation-procedures.html

[11]Congregate Living Settings | Monkeypox | Poxvirus | CDC www.cdc.gov/poxvirus/monkeypox/specific-settings/congregate.html