Mpox is still around

Close Contact

Monkeypox can spread through close contact, such as

• Direct skin contact with monkeypox rashes or scabs from an infected person.
• Contact with saliva, respiratory secretions (mucus, phlegm), and bodily fluids or lesions around the anus, rectum, or vagina from an infected person.
• Pregnant individuals with monkeypox can transmit the virus to the fetus during pregnancy or to the newborn during and after delivery.

Direct Contact

• Oral, anal, or vaginal sexual intercourse, or contact with genitalia (penis, testicles, labia, and vagina) or the anus.
• Hugging, massaging, and kissing.
• Extended face-to-face interactions (e.g., talking or breathing).

Contact with Objects

Monkeypox can spread through contact with objects, such as fabrics and surfaces that have not been disinfected after being used by an infected person. This includes items like clothing, bedding, towels, fetish gear, or sex toys.

When can a person spread monkeypox?

• From the onset of symptoms until the rash has completely healed and new skin has formed.
• Some individuals can spread monkeypox to others 1 to 4 days before symptoms appear.
• Currently, there is no evidence indicating that asymptomatic individuals can spread the virus to others.

Infected Animals

Monkeypox can spread from animals to humans, such as

• Through small wild animals in West and Central Africa, where monkeypox is endemic.
• Close direct contact with infected animals, bodily fluids, or waste, or being bitten or scratched.
• During activities like hunting, trapping, or processing infected wildlife in areas where monkeypox is endemic.

People are less likely to contract monkeypox from pets, but it is possible. Close contact with infected pets, including petting, hugging, wrestling, kissing, licking, and sharing bedding or food, can transmit monkeypox to humans.

Ways to Reduce the Risk of Monkeypox Transmission Between Animals and Humans

• Avoid close contact with animals that may have monkeypox.
• Individuals with monkeypox should avoid contact with animals, including pets, to prevent the spread of the infection.
• Scientists continue to research:
  • The frequency with which asymptomatic individuals can spread the virus.
  • How the monkeypox virus can spread through respiratory secretions.
  • Whether monkeypox can spread through semen, vaginal fluids, urine, or feces.

Scientists continue to research

• The frequency with which asymptomatic individuals can spread the virus.
• How the monkeypox virus can spread through respiratory secretions.
• Whether monkeypox can spread through semen, vaginal fluids, urine, or feces.

When to Get Tested

Currently, testing is only recommended if you have a rash consistent with monkeypox. If you think you have monkeypox or have had close contact with someone who has monkeypox, you should consider taking precautions and see a healthcare provider to help decide whether you need to be tested for monkeypox.

Testing Locations

Only healthcare providers can order monkeypox tests. They may collect samples and send them to a laboratory for testing, or they may refer you to a laboratory to collect and test the samples themselves.

Contact your local health department if you have any questions and to inquire about testing options for your community.

Testing Procedure

You may need to fill out paperwork before being tested. To collect samples for testing, the healthcare provider will use a swab to vigorously rub the lesions of the rash, collecting samples from more than one lesion. This sample collection may feel uncomfortable, but it is necessary to obtain sufficient material to test for the monkeypox virus.

The samples will be sent to a laboratory to determine if the monkeypox virus is present. Test results typically come back within a few days. While waiting for results, take precautions to avoid contracting or spreading the monkeypox virus to others.

What Are the Test Results?

• If your test result is positive, take the necessary steps to protect yourself and others until you have fully recovered from the infection.
• If your test result is negative: A negative result means that the virus was not detected, and you may not have monkeypox. Continue to take precautions to protect yourself and others.
• If your test result is inconclusive: This means your test needs to be repeated due to insufficient sample collection.

Testing Costs

The cost of monkeypox testing depends on where you are tested.

• Testing conducted by public health departments is usually free of charge.
• Tests ordered by private healthcare providers sent to commercial laboratories or tests performed in hospitals may incur costs.
• For information about testing options in your community, contact your local health department.

Reducing the Spread of Monkeypox in Shared Living Settings

Monkeypox is a disease that can cause symptoms similar to the flu and rashes. In general, contagious diseases related to person-to-person contact may spread more easily in places where people live together, and may spread among staff (both paid and unpaid) and residents. For this document, shared living settings refer to places or other residences where non-related individuals live in close proximity and share at least one common room, such as a bedroom, kitchen, bathroom, or living room. Shared living settings may include

• Quarantine facilities
• Shelters for homeless individuals, emergency accommodations, and shelters for victims of domestic violence, as well as temporary housing
• Group homes
• Dormitories in higher education institutions, such as colleges and universities
• Residential facilities for workers
• Inpatient substance abuse treatment facilities
• Assisted living communities
• Hotels, motels, and hostels

If a monkeypox patient is found in a shared living setting, consider taking the following actions

Communicate with Staff and Residents: Provide clear information to staff and residents about monkeypox prevention, including the possibility of transmission through close and prolonged physical contact, including sexual activity. Offer prevention advice, including considerations for safer sexual practices.

Consider and Implement the Following

• Medical examination and assessment for staff and residents suspected of having monkeypox.
• Isolate staff members with monkeypox from the shared living setting until they are fully recovered.
• Isolate residents with monkeypox from others as much as possible until the rash has completely healed and new skin has formed, which typically takes two to four weeks.
• Some shared living settings may be able to provide in-place isolation, while others may need to relocate residents for off-site isolation. The isolation area should have a door that can be closed and a bathroom that other residents do not use.
• Multiple individuals diagnosed with monkeypox may be able to stay in the same room.
• If full isolation guidelines cannot be followed, consult the CDC about monkeypox prevention.
• Consult your state, local, or territorial health department before ending isolation.

Reduce the number of staff entering the isolation area.

• Limit staff in the isolation area to only those necessary for operations in that space.
• Residents not in isolation for monkeypox should not enter the isolation area.
• Residents with monkeypox should regularly assist in cleaning and disinfecting the isolation area they occupy to limit contamination.

Manage waste appropriately.

• In general, waste management should continue as usual. The facility should adhere to state and local regulations for waste management, storage, treatment, and disposal. Healthcare facilities should follow specific guidelines for that setting.
• Individuals with monkeypox should use lined trash cans designated for their room and dispose of it separately. Gloves, bandages, or other waste and disposable items that come into direct contact with the skin should be placed in a sealed plastic bag and thrown away in designated trash cans.
• Those with monkeypox or other staff in the facility should wear gloves when removing trash bags and handle and dispose of waste properly.

If Someone May Have Been Exposed

The facility should work with the state, local, or territorial health department to identify and monitor the health of staff or residents who may have had close contact with individuals with monkeypox. Contact tracing can help identify those who may have been infected and prevent further cases. However, this may not be possible in all settings.

• State, local, or territorial health departments can provide post-exposure vaccination for those who may have been exposed to monkeypox.
• In settings where contact tracing cannot be performed, staff and residents who spent time in the same area as someone with monkeypox should be considered to have a moderate or low exposure level, depending on the nature of the setting and contact (e.g., level of crowding). Post-exposure vaccination is not necessary for low or moderate exposure unless deemed appropriate by state or local health departments.
• Ensure Access to Handwashing: Soap and water or hand sanitizer with at least 60% alcohol should be readily available at all times and at no cost to all staff and residents. Anyone who comes into contact with the rash or clothing, bedding, or surfaces that may have come into contact with the rash should wash their hands immediately.
• Provide Appropriate Personal Protective Equipment (PPE): Employers are responsible for ensuring staff are protected from exposure to the monkeypox virus and do not come into contact with hazardous chemicals used for cleaning and disinfecting. Staff entering the isolation area should wear gowns, gloves, eye protection, and NIOSH-certified respirators with N95 filters or higher. Staff should consult CDC guidelines for cleaning and disinfecting homes, workplaces, and other community settings for monkeypox for more details on how to clean and disinfect the isolation area.

If You Have Been Notified That You Are a Close Contact of a Monkeypox Patient, It Is Important to Take Steps to Protect Your Health and the Health of Others.

Steps to Follow

Step 1: Monitor for Monkeypox Symptoms for 21 Days from the Date of Last Exposure

Monkeypox patients may develop rashes on any part of the body, such as the genitals, anus, hands, feet, chest, face, or mouth. The rash goes through several stages, including scabbing before healing. Initially, the rash may look like pimples or blisters and can be painful or itchy. Sometimes, patients may experience flu-like symptoms before the rash appears; in others, the rash occurs first, followed by other symptoms. Some individuals may only have a rash. Other symptoms of monkeypox may include:

• Fever
• Chills
• Swollen lymph nodes
• Severe fatigue
• Muscle and back pain
• Headache
• Respiratory symptoms (e.g., sore throat, nasal congestion, or cough)

Patients may experience all or some of these symptoms.

Step 2: Get Vaccinated

• Close contacts of monkeypox patients can receive the vaccine to prevent or reduce the severity of the disease.
• Getting vaccinated as soon as possible after exposure (ideally within 4 days if the exposure was within 14 days) is most effective in preventing the disease or reducing symptoms.
• Learn more about the monkeypox vaccine, including who should get vaccinated, where to get it, costs, and other information.
• If you need help deciding whether to get vaccinated, consult your healthcare provider or contact your local health department. They can assist you in determining if the vaccine is appropriate for you.

Step 3: See a Doctor If You Have a New or Unexplained Rash or Other Symptoms of Monkeypox

If you do not have a primary care physician or health insurance, contact your local health department to find out how to access healthcare services in your community.

• Stay away from others and avoid sharing items until you see a doctor.
• Before your appointment, cover all rashes with clothing, gloves, or bandages, wear a mask, and inform them that you may have monkeypox.
• Do not touch or scratch the rash, as it may spread to other parts of your body, increase the risk of spreading the virus to others, and possibly lead to bacterial infections in open wounds.

Monkeypox Testing

Currently, testing is recommended only if you have a rash consistent with monkeypox. Your doctor will help determine whether you need to be tested and can order the monkeypox test. They may collect samples and send them to a lab for testing, or they might refer you to a lab to collect samples and perform tests.

If the test results are positive, follow your doctor’s instructions.

• Wash your hands frequently and avoid touching your face.
• Stay in an area away from others until your rash has healed, all scabs have fallen off, and new skin has formed.
• If you must be around others, cover all lesions, wear a snug-fitting mask, and clean and disinfect your living space frequently.
• Avoid contact with individuals who may be at high risk of severe illness, such as children under 1 year old, pregnant individuals, and those with weakened immune systems or specific skin conditions. Avoid contact with pets as well.

It is important to notify your close contacts as soon as possible that they may have been exposed to monkeypox.

What to Do If You Are Sick?

There is no specific treatment for monkeypox, as the virus that causes monkeypox is closely related to the one that causes smallpox. The drugs and vaccines developed to treat and prevent smallpox may also be effective against monkeypox.

However, treatment for monkeypox patients will depend on the severity of the symptoms or the likelihood of severe illness. Most patients will recover normally within 2 to 4 weeks without the need for medical treatment.

Some patients, such as those with weakened immune systems or those with rashes on the genitals or anus, may require treatment. Medications used to treat monkeypox require a prescription and must be requested through the treating physician via the local or state health department.

Self-Care

• Cover the rash with gauze or bandages to limit spread to others and the environment.
• Do not puncture or scratch the pus-filled bumps from the rash. Doing so does not help them heal faster and may cause the virus to spread to other parts of the body, increase the risk of spreading to others, and may lead to bacterial infections in open wounds.
• Do not shave the affected area until the scabs have fallen off and new skin has formed. Shaving may spread the virus and cause more bumps.
• Keep the lesions on the skin/rash clean and dry when not showering.
• Wash hands frequently with soap and water or use alcohol-based hand sanitizer, especially after direct contact with the rash.

If you have a rash on your hands, be careful when washing your hands or using hand sanitizer to avoid irritating the rash.

• If you have a rash on your hands, wear non-irritating gloves when handling common objects or touching surfaces in public areas. If possible, use disposable gloves that can be discarded after each use (e.g., rubber, polyurethane, or nitrile gloves). Reusable gloves should be washed with soap and water between uses.
• Wear a snug-fitting mask when around others until all rashes and other symptoms have resolved.
• Eat nutritious food and get plenty of rest to help your body recover.

Managing Symptoms

Medications such as ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) can help relieve symptoms. Doctors may prescribe stronger pain medications as well.

For mouth lesions, rinse with saltwater at least four times a day. Prescription mouthwash, sometimes called magic or wonderful mouthwash, or topical anesthetics like viscous lidocaine can be used to relieve pain. Antiseptic mouthwashes like chlorhexidine mouthwash can be used to help maintain oral hygiene.

Contact your treating physician if the pain is severe and cannot be managed at home.

Relieving Rash Symptoms

The most important thing is to try not to touch or scratch the rash. Doing so may spread the rash to other parts of the body, increase the risk of spreading to others, and may lead to bacterial infections in open wounds. If you inadvertently touch the rash, wash your hands with soap and water and avoid touching sensitive areas such as the eyes, nose, mouth, genitals, and anus.

You can use benzocaine/lidocaine gel topically for temporary relief. Oral antihistamines like Benadryl and topical creams like calamine lotion or petroleum jelly may help relieve itching.

Soaking in a warm bath (using oatmeal or commercially available anti-itch bath products) may help relieve the dry and itchy sensation associated with the rash.

Those with rashes in or around the anus or genitals (penis, scrotum, vulvar labia, vagina) or perineum may benefit from a sitz bath. A sitz bath is a shallow round basin that can be purchased online or at pharmacies. Most can be placed on the rim of a toilet but can also be placed in a bathtub. Alternatively, sitting in a bathtub with shallow water may also be an option. Your doctor may prescribe medications such as povidone-iodine or other products to add to the sitz bath water. Adding Epsom salt, vinegar, or baking soda to the water may also help relieve symptoms.

Preventing Spread to Others

If you have monkeypox, you should stay at home (isolate) if you have symptoms of monkeypox, including until the monkeypox rash has healed and new skin has formed. Staying away from others and not sharing items with others will help prevent the spread of monkeypox. Monkeypox patients should regularly clean and disinfect their living areas to limit household contamination.

If you cannot completely isolate while you are ill, take precautions to limit the risk of spreading monkeypox to others, such as:

• Wearing a snug-fitting mask and covering lesions when near others.
• Disinfecting surfaces in shared bathrooms or rooms after each use.
• Avoiding sharing items (e.g., towels, washcloths, drinking from the same cup).
• Covering upholstered furniture and non-washable porous materials.

Monkeypox can also spread to animals, so it is important to stay away from pets, livestock, and other animals.

Informing Close Contacts

If you are diagnosed with monkeypox, it is important to inform your close contacts that they may have been exposed to monkeypox as soon as possible, so they can monitor for symptoms and signs, get tested, and isolate if they become symptomatic. They should consider getting vaccinated if they were exposed within the last 14 days, especially within 4 days of exposure. Vaccination offers the best chance of prevention.

Who Are Close Contacts?

A close contact is anyone who has been in contact with a person exhibiting monkeypox symptoms through:

• Sexual activity, including oral, anal, or vaginal contact.
• Touching or being in close proximity to the rash of a monkeypox patient.
• Hugging, close physical contact, kissing, or prolonged skin-to-skin contact.
• Sharing drinking glasses, eating utensils, towels, clothing, bedding, or other personal items with a monkeypox patient.

Making a List of Contacts to Notify

• Who are your sexual partners?
• Who lives with you (including family members, roommates, or overnight guests)?
• Who have you had prolonged skin-to-skin contact with recently? Consider the following:
  • Gatherings or events you attended.
  • Individuals you encountered recently (e.g., visiting someone’s home, at a restaurant, drinking together, dancing, exercising, or at a party).
  • Individuals you played contact sports with (e.g., basketball or wrestling).
  • Appointments with healthcare providers, including dentists.
  • Individuals who provided services to you, such as babysitters, cleaners, barbers, hairdressers, nail salon staff, therapists, adult caregivers, etc.
  • Individuals you work or volunteer with outside the home.

Tips for Preparing and What to Say

If you feel uncertain about notifying your contacts, preparing in advance may help make the conversation smoother. Here are some tips that may be helpful:

• Think about how you would like to be informed in a similar situation.
• Consider safety and privacy. If texting or emailing, think about whether others might read your communication. If notifying by phone, ask your contact if they are in a place where they can talk privately.
• Speaking out loud may help you think about what to say and how to say it before actually reaching out.
• Consider the individual and be prepared to calmly handle the various reactions you might receive.

Examples of What You Can Say to Your Close Contacts

“Hi, I want to talk to you about something important. Do you have a moment to talk privately? I was diagnosed with monkeypox (or tested positive) on [xxx]. Monkeypox can spread through close contact, so since we spent time together on [xxx], I wanted to let you know. You should monitor for symptoms and get tested right away if you have any symptoms.”

Alternative Ways to Notify Your Close Contacts

If you cannot notify your close contacts yourself, there are other options for you:

• Help from the Health Department: You may be contacted by public health officials from your local health department, typically referred to as disease intervention specialists or DIS. They may reach out to discuss your diagnosis, answer any questions you have, and if you need help, they will notify your contacts confidentially. They will protect your privacy and not disclose any information about you. When they notify your contacts, they will link them to services that may be needed, including medical care, testing, treatment, and/or vaccination as appropriate. However, some health departments may not be able to provide this service depending on local resources.
• Anonymous Notification Services: You can use a trusted online service that can notify your contacts about potential exposure to monkeypox while protecting your identity. One such website is tellyourpartner.org. This service is free, and you can explore the site beforehand to learn more about how they protect your privacy and the language to use when notifying. This site will also inform your contacts where they can find more information about monkeypox.

Choose the method of notifying your contacts that you feel most comfortable with. You can use different methods for each contact. It is essential to ensure your contacts have the necessary information in a timely manner to make informed decisions about their health and prevent the spread of monkeypox to others.

Your Home When Someone is Sick

To prevent the spread to others when at home (self-isolation), those with monkeypox should follow the guidelines in this section until the monkeypox rash has healed and new skin has formed.

Self-Isolation at Home

During home isolation, individuals with monkeypox should clean and disinfect their living spaces to reduce the risk of infecting others. If you have a rash on your hands, wear gloves when cleaning and disinfecting items. Dispose of the gloves after use and wash your hands with soap and water.

Self-Isolation with Others at Home

Guidelines for self-isolation and infection control should be followed if a person with monkeypox lives with others during isolation. Ways to prevent the spread to others include:

• If cleaning and disinfecting is done by someone other than the person with monkeypox (e.g., a family member or non-infected friend), they should protect themselves by wearing disposable gloves, a snug-fitting mask or respirator (like N95), and clothing that covers arms and legs completely.
• Avoid sharing items that may be contaminated with the virus, such as bed linens, clothing, towels, handkerchiefs, drinking glasses, or eating utensils until those items have been disinfected as described in the section on cleaning and disinfecting various surfaces.
• Cover upholstered furniture and porous materials that cannot be washed with sheets, blankets, tarps, and other coverings.
• Those who recover from monkeypox and can end self-isolation should clean and disinfect the entire living space, including frequently touched surfaces, shared items, or items that may have been used by others in the home, and objects or fabrics used during isolation.

How to Protect Yourself While Cleaning and Disinfecting at Home

Protect yourself by following these steps for safe and effective cleaning and disinfecting:

• If your disinfectant product label does not indicate it is effective for both cleaning and disinfecting, clean dirty surfaces with soap and water before disinfecting.
• Use an EPA-registered disinfectant from List Q: Disinfectants for Emerging Viral Pathogens. Always read the product label to ensure it is suitable for the type of surface you are disinfecting (e.g., hard surfaces or soft surfaces).
• Always follow the label instructions to ensure safe and effective use of the product.
• Check the product label to see if personal protective equipment (PPE) is necessary (e.g., gloves and safety goggles) for safe usage.
• Do not dry dust or sweep, as this may aerosolize virus-laden dust particles into the air.
• Use wet cleaning methods such as disinfectant wipes, sprays, and mopping.
• Vacuuming is acceptable if you use a vacuum with a high-efficiency air filter. If a high-efficiency air filter is not available, ensure the person vacuuming wears a respiratory mask (e.g., N95).
• Wash hands with soap and water for 20 seconds after cleaning. Be sure to wash your hands immediately after removing gloves.
• If soap and water are not available, use hand sanitizer that contains at least 60% alcohol.
• If visibly dirty, wash hands with soap and water before using hand sanitizer.

Clean and disinfect in the following order to reduce the spread of the virus in the household

1. Collect and dispose of general waste, such as bandages, paper towels, food packaging, and other general trash.
2. Laundry.
3. Hard surfaces.
4. Soft surfaces.
5. Carpets and rugs.
6. Dispose of waste generated from cleaning and disinfecting (e.g., disinfectant wipes).
7. Wash hands.

How to Clean and Disinfect Various Surfaces

Used Fabric

Contaminated fabrics, meaning those used by a monkeypox patient, should not be mixed with other laundry.

• Place soiled clothing, bed linens, blankets, towels, and other used or contaminated fabrics into:
  • A waterproof container or bag that can be disinfected or discarded afterward.
  • A washable fabric bag that can be laundered with dirty or contaminated fabrics.
• Do not shake or handle soiled or contaminated fabrics in a way that could aerosolize virus particles into the air.
• Wash laundry in a regular washing machine with detergent, following the instructions on the label. A laundry disinfectant may be used but is not necessary.

Alternatives When You Cannot Wash Laundry at Home

While using laundry services outside the home by someone who is isolating due to monkeypox may not be the best method, some may not be able to wash laundry at home. If possible, a monkeypox patient should wait until isolation is over before washing and drying laundry. If laundry must be done outside the home before isolation ends, the following options may be considered:

• The monkeypox patient can wash laundry themselves at a self-service laundromat, following recommended precautions for monkeypox prevention.
• Family members or friends who are asymptomatic or have no confirmed monkeypox and can follow appropriate precautions (e.g., wearing gloves, a snug-fitting mask or respirator such as N95, and clothing that covers exposed skin) may wash and dry laundry outside the home.
• If using commercial laundry services for contaminated laundry (e.g., clothing, bed linens, and blankets), coordinate with the health department and the laundry service beforehand to ensure staff are aware of the appropriate precautions.
• Dry cleaning is not recommended.

Hard Surfaces (Non-Porous)

Clean and disinfect frequently touched surfaces regularly using soap and water and EPA-registered disinfectants from List Q: Disinfectants for Emerging Viral Pathogens that are suitable for hard surfaces. Frequently touched items include surfaces like tables, countertops, doorknobs, toilet handles, faucets, light switches, and floors.

• Clean and disinfect surfaces inside the refrigerator, freezer, other appliances, storage cabinets, or drawers if used by a monkeypox patient.
• Wash dirty dishes and utensils in a dishwasher with detergent and hot water or wash by hand using hot water and detergent.

Soft Surfaces (Porous)

If a monkeypox patient has had direct skin contact or bodily fluids from the rash have spilled onto soft surfaces like upholstered furniture, carpets, or bath mats, you may be able to use steam cleaning. Disinfecting some soft surfaces, such as mattresses, may be impossible if they are heavily contaminated with fluids from the rash and may need to be discarded and replaced. If the monkeypox patient has not had much contact with soft furniture, disinfect the surfaces with an EPA-registered disinfectant for emerging viral pathogens suitable for soft surfaces.

Waste Disposal

Monkeypox patients should use a waste container with a liner and designate it solely for use in the isolation room. Collect all contaminated waste, such as bandages, paper towels, food packaging, and other general waste, and ensure it is placed in a securely sealed bag.

• Gloves, bandages, or other disposable waste and items that have directly contacted the skin should be placed in a securely sealed plastic bag and then disposed of in a designated trash bin.
• The monkeypox patient or other household members should wear gloves when removing trash bags and when handling and disposing of waste.

Cleaning and Disinfecting in Workplaces and Community Settings

If an employer, administrator, or operator is informed that a person suspected or confirmed to have monkeypox is present in your establishment, clean and disinfect that area, focusing on items and surfaces that have been in direct contact with the skin of the monkeypox patient.

If you use cleaning services from a contractor or commercial laundry, discuss potential risks with the contractor so cleaning staff can employ appropriate precautions. For restaurants, bars, and other establishments with special cleaning and hygiene requirements, ensure compliance with state and local regulations.

How to Protect Employees When Cleaning and Disinfecting in the Workplace

Employees cleaning and disinfecting areas or laundering items for those suspected or confirmed to have monkeypox should wear personal protective equipment (PPE). PPE can help protect employees from exposure to the monkeypox virus and harmful chemicals used for cleaning and disinfecting.

Provide recommended PPE for protection against the monkeypox virus, including

• A snug-fitting mask or NIOSH-certified particulate respirator with N95 or higher filters.
• Gloves.
• Gowns.
• Eye protection.

Do not dry dust or sweep, as this may aerosolize virus-laden dust particles into the air.

• Use wet cleaning methods such as disinfectant wipes, sprays, and mopping.
• Vacuuming is acceptable if you use a vacuum with a high-efficiency air filter. If a high-efficiency air filter is not available, ensure that the person vacuuming wears a respiratory mask (e.g., N95).

Employees should wash their hands with soap and water for 20 seconds after cleaning, ensuring they wash their hands immediately after removing gloves.

• If soap and water are not available, use hand sanitizer that contains at least 60% alcohol.
• If hands are visibly dirty, always wash hands with soap and water before using hand sanitizer.

How to Protect Yourself

The following five steps can help you protect yourself from monkeypox.

Step 1: Get Vaccinated!

• The JYNNEOS vaccine is recommended to prevent monkeypox. Receiving both doses of the vaccine provides the best protection. You should get two doses spaced 4 weeks apart.
• Even if it has been more than 4 weeks since you received your first vaccine dose, you should get the second dose as soon as possible.
• If you have previously recovered from monkeypox, you do not need to get vaccinated.
• Use the monkeypox vaccine locator to find nearby healthcare facilities that offer monkeypox vaccinations.
• Check with your healthcare provider to see if they recommend you receive the monkeypox vaccine.

Step 2: Reduce the Risk of Monkeypox During Sex or Social Gatherings

• If you are at risk for monkeypox but have not received both vaccine doses, consider temporarily changing activities that involve close personal contact (such as sexual activity).
• Dance parties, gatherings, or clubs with minimal clothing and direct contact are often skin-to-skin interactions and carry certain risks. Avoid rashes you see on others and consider minimizing skin-to-skin contact.

Step 3: Avoid Close Contact with Anyone Who Has a Rash That Looks Like Monkeypox

• Rashes may appear on the hands, feet, chest, face, or mouth, as well as in other areas such as the genitals (penis, testicles, labia, vagina). Do not touch the rash or scabs of anyone who has monkeypox.
• Do not kiss, hug, engage in close contact, or have sex with someone who has monkeypox.
• In areas where monkeypox is endemic, particularly in Central or West Africa, avoid contact with animals that can carry the monkeypox virus, such as rodents and monkeys. Direct contact with infected animals can also pose a risk of virus transmission.

Step 4: Avoid Contact with Objects and Materials Used by Someone with Monkeypox

• Do not share eating utensils or drinking glasses with someone who has monkeypox.
• Do not handle or touch the bedding, towels, or clothing of someone who has monkeypox.
• If you or someone you live with has monkeypox, follow cleaning and disinfecting procedures in your home.

Step 5: Wash Your Hands Frequently

• Wash your hands often with soap and water or use hand sanitizer, especially before eating or touching your face, and after using the restroom.
• Handwashing is one of the best ways to protect yourself, your family, and your friends from illness.

Monkeypox and HIV

People living with HIV have a higher risk in the current cases of monkeypox infection. We still do not know if having HIV increases the chances of contracting the monkeypox virus (mpox) upon exposure. However, we do know that people with HIV are at a higher risk of experiencing severe monkeypox symptoms and may die if infected with the monkeypox virus.

If you have HIV, you should follow the same recommendations as everyone else to protect yourself from monkeypox, including getting vaccinated, taking HIV medication as prescribed, and maintaining an undetectable viral load. These are the best things you can do to stay healthy, and they also help prevent the sexual transmission of HIV to partners who do not have HIV.

Monkeypox Vaccine and People Living with HIV

JYNNEOS is a two-dose vaccine authorized for the prevention of monkeypox and is considered safe and effective for people with HIV. This is the vaccine currently being used in the United States.

You may have heard about monkeypox PEP (post-exposure prophylaxis), which can be confusing because we also use the term HIV PEP for HIV prevention. Here’s a simple explanation of what they mean:

• HIV PEP is a medication that can reduce the chances of HIV infection after potential exposure to the virus.
• Similarly, monkeypox PEP refers to the administration of the monkeypox vaccine to reduce the risk of contracting monkeypox after potential exposure to MPXV.

Monkeypox Infection in People Living with HIV

• Limited information indicates that people with HIV, especially those with low CD4 cell counts (<350 cells/mL) or those who cannot suppress their viral load, are more likely to require hospitalization and may die if infected with monkeypox compared to those without HIV.
• Monkeypox treatment is safe and may be used to treat those at high risk of severe illness from monkeypox. If you have HIV, consult your healthcare provider about treatment options you should consider.
• Based on the information we have, monkeypox treatments have minimal interactions with HIV medications. If you have HIV, please inform your healthcare provider before starting monkeypox treatment.
• HIV pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) remain effective in preventing HIV, even if you have monkeypox or are receiving treatment for monkeypox. If your healthcare provider prescribes HIV PrEP or HIV PEP, you should continue taking the medication as directed.

How to Reduce Risk During Sexual Activity

Vaccination is a key tool in preventing the spread of monkeypox. JYNNEOS is a two-dose vaccine developed to prevent monkeypox. Receiving both doses provides the best protection against monkeypox. Those who have received only one dose should still get the second dose, even if it has been more than 28 days since the first dose. If you are at risk for monkeypox but have not yet received both doses of the vaccine, making some temporary changes to your sexual practices may help reduce your risk of exposure to the virus.

Reducing or avoiding behaviors that increase the risk of exposure to monkeypox is important during the period between receiving the first and second doses of the vaccine. Your protection will be highest two weeks after receiving the second dose of the vaccine.

• Exchange Contact Information: Share contact information with new partners so that sexual health can be monitored if necessary.
• Discuss Symptoms: Talk to your partner about monkeypox symptoms and be cautious of any new or unexplained rashes or lesions on your body and your partner’s body, including in the mouth, genitals (penis, testicles, vulva, or vagina), or anus. If you or your partner have or recently had monkeypox symptoms, or if you have any new or unexplained rashes on any part of your body, do not have sexual intercourse and seek healthcare. In some cases, symptoms may be mild, and some individuals may not realize they have monkeypox.

If you or your partner has monkeypox or suspects that you may have it, the best way to protect yourself and others is to avoid all forms of sexual activity (oral, anal, vaginal) and kissing or touching each other’s bodies while you are sick. Specifically, avoid touching any rashes. Do not share items such as towels, fetish equipment, sex toys, and toothbrushes.

How to Reduce the Risk of Monkeypox Exposure if You Continue to Have Sex

1. Take a Break: Temporarily refrain from activities that increase exposure to monkeypox until two weeks after receiving the second vaccine dose. This can significantly reduce your risk.
2. Limit Partners: Reduce the number of sexual partners to decrease the chance of exposure.
3. Be Cautious in Certain Settings: Places such as back rooms, saunas, sex clubs, or private and public sex parties, where there is close sexual contact and often anonymous encounters with multiple partners, are more likely to spread monkeypox.
4. Use Condoms: Latex or polyurethane condoms may help protect your anus, mouth, penis, or vagina from monkeypox exposure. However, condoms alone may not prevent all exposure to monkeypox, as rashes can occur on other parts of the body.
5. Wear Gloves: Latex, polyurethane, or nitrile gloves can reduce the chance of exposure if fingers or hands are inserted into the vagina or anus. Gloves should cover all skin that may touch and should be removed carefully to avoid touching the outside surface.
6. Avoid Kissing or Saliva Exchange: Monkeypox can spread this way.
7. Masturbate Together: You can help each other while keeping distance and avoiding contact, ensuring not to touch any rashes.
8. Virtual Sex: Engage in virtual sex without actual physical contact.
9. Consider Clothing: Engage in sexual activity while wearing clothes or covering areas with rashes, minimizing skin-to-skin contact as much as possible. Leather or latex gear can create a barrier to skin contact, but ensure to change or clean clothing/equipment between partners and after use.
10. Be Aware of Respiratory Secretions: Monkeypox can also spread through respiratory secretions during close face-to-face contact.
11. Wash Hands and Items: After sexual activity, wash your hands, fetish equipment, sex toys, and linens (bed sheets, towels, clothing).

What to Do If You Have a Rash or Other Symptoms?

• Avoid sexual activity or close contact with others until you have been evaluated by a healthcare provider.
• If you don’t have a provider or health insurance, visit a local public health clinic.
• When meeting with a healthcare provider, wear a mask and inform them that this virus is spreading in the area.
• Avoid gatherings, especially those involving close contact and direct skin-to-skin interaction.
• Think about individuals with whom you have had close contact, including those met through dating apps, in the past 21 days. You may be asked to share this information if diagnosed with monkeypox.

How to Reduce the Risk of Monkeypox Infection at Parties, Clubs, and Festivals?

1. Stay Informed: Research monkeypox in your area from reliable sources, such as your local health department.
2. Get Vaccinated: Vaccination is a key tool in stopping the spread of monkeypox. Get both doses before attending any gathering that may have monkeypox present.
3. Assess Close Contact: Consider how much close contact, intimacy, and direct skin-to-skin interaction will occur at the event you plan to attend.
4. Stay Home if Unwell: If you feel unwell or have a rash, do not attend any gatherings and seek healthcare.

Social Gatherings Are Not All the Same

• Festivals, events, and concerts where participants are fully dressed and unlikely to have direct skin contact are safer. However, participants should be cautious of activities (such as kissing) that may spread monkeypox.
• Raves, parties, or clubs with less clothing and direct, intimate contact are riskier. Avoid any rashes you see on others and consider minimizing direct skin contact.
• Enclosed spaces such as back rooms, saunas, sex clubs, or private and public sex parties with close sexual contact are often anonymous with multiple partners and may be more likely to spread monkeypox.

Get Vaccinated if You

• Are a man who has sex with men or a man who has sexual relations with other men in other forms, or are transgender, gender non-conforming, or gender diverse, and in the past 6 months you have had or expect to have:
  • One or more sexually transmitted infections (STIs)
  • More than one sexual partner, or engage in sexual or intimate contact anonymously
  • Sexual relations in a sex work venue
  • Sexual relations associated with a large public event in a geographical area experiencing an outbreak of monkeypox

Get Vaccinated if You

• Have had sexual or intimate contact with someone at risk for monkeypox, as described above
• Have had sexual or intimate contact with someone who may have monkeypox. Get vaccinated as soon as possible after exposure, regardless of your gender identity or gender expression
• Receive both doses of the vaccine

Unless there is a medical reason you cannot receive the vaccine, such as a severe allergy (e.g., anaphylaxis) after receiving a prior dose of the vaccine, or a severe allergy to any component of the vaccine.

The monkeypox vaccine is effective in protecting you from monkeypox.

Receiving two doses provides the best protection. Get dose 1, wait 4 weeks, then get dose 2. If you cannot receive the second dose on schedule, you should get it as soon as possible to complete the vaccination series. You will achieve maximum protection two weeks after receiving the second dose of the vaccine.

The CDC recommends getting the monkeypox vaccine if

• You have had contact with or suspect exposure to someone with monkeypox
• You have had sexual partners in the past 2 weeks diagnosed with monkeypox
• You are a man who has sex with men, or a man who has sexual relations with men, or are transgender, gender non-conforming, or gender diverse, and in the past 6 months have had any of the following:
  • A new diagnosis of one or more STIs (e.g., chlamydia, gonorrhea, or syphilis)
  • More than one sexual partner

In the past 6 months, you have experienced any of the following

• Sexual relations in a sex work venue (e.g., sex clubs or saunas)
• Sexual relations related to a large commercial event or in a geographical area (e.g., a city or county) experiencing an outbreak of the mpox virus
• You have a partner who has the above risks
• You anticipate encountering the above situations
• You are at risk of exposure to orthopoxvirus through your work (e.g., certain individuals working in labs or healthcare settings)

You should NOT get vaccinated if

• You have a severe allergy (e.g., anaphylaxis) after receiving a previous dose of the JYNNEOS vaccine or to any component of the vaccine. Consult your healthcare provider if you have allergies to the antibiotics gentamicin or ciprofloxacin, or to chicken or egg proteins.

Vaccination

The vaccine can be administered subcutaneously, meaning the vaccine is injected into the fat layer just under the skin at the back of the upper arm (above the triceps muscle) or intradermally, which can be injected into the lower arm or other areas, including the upper back beneath the shoulder blade or the skin of the shoulder above the deltoid muscle. You and your provider can discuss which method to use. Intradermal vaccination may leave visible marks on your lower arm. If this concerns you, you have several options:

• Request subcutaneous vaccination
• Request vaccination at the skin of the upper back (below the shoulder blade) or the skin of the shoulder (above the deltoid muscle)
• If you have a history of keloid scarring (thick, raised scars), ask for subcutaneous vaccination
• If you are under 18 years old, you should receive subcutaneous vaccination

Both intradermal and subcutaneous vaccinations are equally effective in preventing monkeypox.

Although studies suggest that the first dose of the JYNNEOS vaccine provides some protection against monkeypox, two doses are recommended for stronger protection. Regardless of whether you receive the vaccine intradermally or subcutaneously, you should receive both doses. The second dose should be given 4 weeks (28 days) after the first. If you cannot receive the second dose on schedule, you should get it as soon as possible to complete the series.

Side Effects

Not everyone experiences side effects, but some do. The most common side effects after receiving the JYNNEOS vaccine include pain, redness, and itching at the injection site. You may experience fever, headache, fatigue, nausea, chills, and muscle aches. These are signs that your immune system is responding, not that you are sick. When receiving the JYNNEOS vaccine intradermally, some report less pain after the injection, but more side effects such as itching, swelling, redness, thickening of the skin, and discoloration at the injection site. Some side effects may last for several weeks. If you are concerned about receiving the vaccine intradermally, you can request a subcutaneous injection in the fat layer just beneath the skin at the back of your upper arm (triceps).

How Long Does the Vaccine Take to Work?

You may start to have an immune response after receiving the first dose of the JYNNEOS vaccine, but it takes two weeks after the second dose to achieve maximum protection. It is still unknown how long the protection will last or if it may wane over time. The CDC is analyzing current data and conducting studies to enhance knowledge about the effectiveness of the JYNNEOS vaccine in the monkeypox outbreak, including how long protection may last. These studies will inform future vaccine recommendations.

Where Can You Get Vaccinated?

In some large cities, monkeypox vaccines may be available at health departments, public health clinics, or hospitals.

Vaccine Costs

• After April 1, 2024, the cost of the JYNNEOS vaccine may be covered by some health insurance plans.
• Federal agencies are working to include the JYNNEOS vaccine in their programs to support wider access to this vaccine, including for the uninsured and underinsured populations.

Two doses of the JYNNEOS vaccine can protect most people against monkeypox, but no vaccine is 100% effective. Therefore, in some rare cases (less than 1%), individuals who have received both doses of the vaccine may still contract monkeypox. If someone who has been fully vaccinated contracts monkeypox, their symptoms are often much less severe.

What We Know

• The CDC recommends vaccination for individuals at risk of contracting monkeypox.
• Completing both recommended doses of the vaccine will help reduce the chances of infection and spreading monkeypox.
• Infection after vaccination is still possible, as no vaccine is 100% effective.
• If you have a rash or other symptoms of monkeypox, you should get tested, even if you have been vaccinated or have previously had monkeypox.
• The vaccine may help protect you from severe infection, hospitalization, and death.
• Research shows that whether you receive the vaccine in the upper layer of the skin on the lower arm, shoulder blade, or shoulder (intradermally), or in the fat layer at the back of the upper arm (subcutaneously), it provides good protection against monkeypox.
• Currently, receiving more than two doses of the monkeypox vaccine, such as a booster dose, is not recommended unless you work with the monkeypox virus or other orthopox viruses in a research laboratory.
• Studies have shown that individuals with multiple sexual partners are more likely to contract monkeypox even after completing both vaccine doses. It is possible that a higher chance of exposure to monkeypox could increase your risk, even if you are fully vaccinated.

What We Don’t Know

• The reasons why some individuals contract monkeypox after vaccination.
• Evidence suggests that the vaccine remains effective and that booster doses are not necessary, but we do not know how long the vaccine will protect against monkeypox.

What is Being Done to Find Answers

• The CDC and its partners are studying how long the monkeypox vaccine can protect people from infection.
• The CDC is working closely with local and state partners to gather information on:
  • How the virus spreads
  • The number of people vaccinated, whether they are fully vaccinated, and when they received their vaccine
• The CDC is monitoring reports of individuals diagnosed with monkeypox after receiving two doses of the vaccine.

What You Can Do

• Check if you should receive the monkeypox vaccine.
• Get both doses of the vaccine for the best protection. If you have only received one dose, it is never too late to get the second dose.
• Even if you have been vaccinated, continue to reduce your risk of monkeypox infection.
• See a doctor and get tested if you have a rash, even if you have been vaccinated or have previously had monkeypox.
• Pay attention to guidance from public health and community leaders on how to prevent monkeypox, which may include some temporary changes to your sexual practices. Recommendations may include:
  • Short-term changes to sexual practices to help limit the spread
  • Limiting new or multiple sexual partners
  • Avoiding sexual activity in places that may be associated with the spread of monkeypox.

What You Need to Know

• There are currently no FDA-approved treatments specifically for monkeypox. Antiviral medications approved for the treatment of smallpox may help treat monkeypox due to the similarities between the viruses that cause monkeypox and smallpox.
• The antiviral tecovirimat (TPOXX) has been used to treat monkeypox through expanded access programs during the outbreak that began in 2022. It is used for individuals with severe monkeypox symptoms or those at high risk of severe illness (such as individuals with weakened immune systems, like those with uncontrolled HIV or skin conditions like atopic dermatitis).
• Tecovirimat may help treat severe monkeypox affecting the eyes, mouth, throat, genitals, and anus. However, it is currently unknown how effective tecovirimat is in treating monkeypox.
• Researchers are testing the safety and efficacy of tecovirimat for all monkeypox patients. If you have monkeypox, your healthcare provider may ask you to consider participating in this research, known as the STOMP trial.
• The severity of the illness may depend on an individual’s immune system. For most people without weakened immune systems, supportive care and pain management are usually sufficient.
• If you have symptoms of monkeypox, you should see a healthcare provider, even if you have been vaccinated against monkeypox. If you think you might benefit from tecovirimat, ask your provider.

About Tecovirimat

• Tecovirimat (TPOXX) is typically prescribed for individuals with severe monkeypox symptoms or those at high risk of severe illness.
• Tecovirimat can reduce the amount of virus in the body and may help treat severe monkeypox affecting the eyes, mouth, throat, genitals, and anus.
• Studies have shown that tecovirimat can be an effective treatment for orthopoxviruses (such as the virus causing monkeypox) in animals and is safe for use in healthy individuals without viral infection.
• However, there is insufficient information to determine whether tecovirimat is safe and effective for treating monkeypox patients, so it is still considered an investigational drug for monkeypox. The term “investigational” means that the drug is still undergoing testing to determine its safety and efficacy for specific diseases.
• If you are prescribed tecovirimat, you will be asked to sign a consent form stating that you understand that tecovirimat is an investigational drug not yet approved by the FDA for treating monkeypox.
• Conducting studies to evaluate the safety and efficacy of tecovirimat in monkeypox patients is essential. If your healthcare provider thinks you have monkeypox, they may ask you to consider participating in a clinical trial called the Tecovirimat Study for Human Monkeypox Virus (STOMP).
• STOMP is trying to find out how effective tecovirimat is against monkeypox infection in humans. Researchers are looking for individuals who may have monkeypox to participate in studies that will provide them with more information.
• Participation in STOMP is voluntary. You are not obligated to enroll in the trial. If you decide not to participate, your provider may still prescribe tecovirimat if you are severely ill or at high risk of severe illness.
• If you are part of the STOMP trial, you may be in a group receiving either the actual drug or a placebo, and you will not know which one you receive, or you may be in a group where everyone receives tecovirimat.
• During the trial, you will need to keep a daily log to track your symptoms and perform daily self-examinations of your skin at home. If you live near a trial site, you will receive health checks there. If you do not live near a trial site, you can enroll remotely and receive remote health checks.

Is Tecovirimat Right for You?

Your healthcare provider may prescribe tecovirimat for

• Individuals with severe monkeypox symptoms, such as:
  • Sores or rashes that are bleeding or infected
  • Lesions that coalesce into larger sores
  • Other conditions requiring hospitalization
• Individuals with weakened immune systems, such as those with uncontrolled HIV, leukemia, lymphoma, or autoimmune diseases, or those undergoing chemotherapy or who have previously received organ transplants.
• Individuals with rashes or lesions in sensitive areas like the eyes, mouth, throat, genitals, and anus, which are at risk for severe illness both in the short term (pain, swelling, pus accumulation, etc.) and long term (scarring, etc.).
• Individuals with ongoing skin conditions, such as atopic dermatitis, eczema, psoriasis, impetigo, severe acne, herpes, or burns.
• Children, especially those under 1 year old.
• Individuals who are pregnant or breastfeeding.

How to Pay for Tecovirimat

Currently, tecovirimat is provided at no cost.

Contact Your Healthcare Provider

• If you have symptoms of monkeypox, even if you have been vaccinated against monkeypox.
• To inquire whether tecovirimat is appropriate for you.
• If your monkeypox symptoms worsen.

Overview

Monkeypox (formerly known as “monkey pox”) is a disease caused by infection with the monkeypox virus. This virus is in the same family as the virus that causes smallpox. Patients with monkeypox often develop a rash, accompanied by other symptoms. The rash goes through several stages, including a scab phase, before healing completely. Monkeypox is not related to chickenpox.

Monkeypox is a zoonotic disease, meaning it can spread between animals and humans. The disease is endemic, meaning it regularly occurs in certain parts of Central and West Africa. The virus that causes monkeypox can be found in small rodents, monkeys, and other mammals living in these areas.

Discovery and History

The monkeypox virus was discovered in 1958 during outbreaks of a smallpox-like disease in research monkeys. Despite being initially named “monkeypox,” the exact source of the disease remains unclear. Scientists suspect that rodents in Africa and non-human primates (such as monkeys) may be the natural reservoir for the virus and can transmit it to humans.

The first recorded case of monkeypox in humans was in 1970 in what is now the Democratic Republic of the Congo. In 2022, monkeypox spread worldwide. Before this, cases of monkeypox elsewhere were rare and often linked to travel or the importation of animals from the regions where monkeypox is endemic.

In 2022, the World Health Organization renamed the disease to align with modern naming conventions. These guidelines suggest that disease names should avoid causing offense to cultural, social, national, regional, professional, or ethnic groups, and reduce unnecessary negative impacts on trade, travel, or animal welfare. However, the virus that causes this disease still retains its historical name.

Types of Virus

There are two types of monkeypox virus

• Clade I causes more severe illness and has a higher mortality rate, sometimes resulting in death for up to 10% of patients, although recent outbreaks have had lower mortality rates. Clade I is endemic to Central Africa.
• Clade II is the type that caused the global outbreak starting in 2022. Infections from Clade II are less severe, with more than 99.9% of infected individuals surviving. Clade II is endemic to West Africa.

Both types of the virus can spread through

• Direct contact with infected animals.
• Close contact (including intimate or sexual contact) with monkeypox patients.
• Direct contact with contaminated materials.

Risk of Severe Illness

While most cases of monkeypox are not life-threatening, some individuals may be at higher risk of severe illness, including

• Those with severely weakened immune systems.
• Children under 1 year old.
• Individuals with a history of atopic dermatitis (eczema).
• Pregnant individuals.

Preventing Monkeypox

There are several ways to protect yourself and others from monkeypox, including

• Avoiding close skin-to-skin contact with individuals who have rashes resembling monkeypox and animals that may carry the monkeypox virus.
• Reducing the risk of monkeypox transmission during sexual activities or social gatherings.
• Getting vaccinated against monkeypox.