Since May 2022, the CDC and other public health agencies began tracking multiple cases of monkeypox in countries that typically don’t report monkeypox, including the U.S. The multi-country monkeypox outbreak was declared a global public health emergency by the World Health Organization (WHO). On August 4, 2022, monkeypox was declared a public health emergency in the U.S. Monkeypox Outbreak Global Map.
What is Monkeypox?
Monkeypox results from infection by the monkeypox virus. The monkeypox virus is an Orthopoxvirus and is an enveloped double-stranded DNA virus. Other notable viruses within this group of viruses include the variola virus which causes smallpox, the vaccinia virus which is used to make the smallpox vaccine and the cowpox virus. Monkeypox, however, is considered to be milder and less infectious than smallpox.
Monkeypox primarily occurs in Central and West Africa, often in proximity to tropical rainforests and has been increasingly appearing in urban areas.
What are the symptoms of Monkeypox?
Symptoms of monkeypox are similar, but less severe, to smallpox. The incubation period before symptoms onset is 7-14 days but can range from 5-21 days. Initial symptoms include:
- Muscle aches
- Swollen lymph nodes
- A rash that can look like pimples or blisters that appears on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus.
Within 1-3 days after the onset of fever, individuals infected with monkeypox develop a rash, beginning on the face and then spreading to other parts of the body. Lesions progress through a series stages. The rash begins with flat red marks, which then become raised, then the raised areas fill with clear or yellow fluid, then develop scabs, then fall off.
Sometimes, people get a rash first, followed by other symptoms. Others only experience a rash.
Illness typically lasts for 2−4 weeks and resolves without treatment.
The prognosis for monkeypox depends on multiple factors such as previous vaccination status, initial health status, concurrent illnesses, and comorbidities among others.
How is the monkeypox virus transmitted?
Transmission of monkeypox virus occurs when a person comes into contact with the virus from an animal, human, or materials contaminated with the virus. The virus enters the body through broken skin (even if not visible), respiratory tract, or the mucous membranes (eyes, nose, or mouth). Most cases are zoonotic and occur after contact with an infected animal. Animal-to-human transmission may occur by bite or scratch, bush meat preparation, direct contact with body fluids or lesion material, or indirect contact with lesion material, such as through contaminated bedding.
Monkeypox spreads between people primarily through direct contact with infectious sores, scabs, or body fluids. It also can be spread by respiratory secretions during prolonged, face-to-face contact. Monkeypox can spread during intimate contact between people, including during sex, as well as activities like kissing, cuddling, or touching parts of the body with monkeypox sores.
The CDC is advising that anyone with symptoms of monkeypox, especially with a rash that looks like monkeypox, seek medical care immediately. CDC currently recommends that people infected with monkeypox wear a mask if they must be around others in their homes if close, face-to-face contact is likely.
What can be done to prevent infection with monkeypox virus?
- Avoid contact with people and animals infected with the monkeypox virus.
- Avoid contact with any materials, such as bedding, that has been in contact with an infected person or sick animal.
- Practice good hand hygiene after contact with infected animals or humans (e.g., washing hands with soap and water or using an alcohol-based hand sanitizer)
- People infected with the monkeypox virus should isolate from others who could be at risk for infection.
- Use PPE when caring for an individual infected with the monkeypox virus.
CDC recommends vaccination for people who have been exposed to monkeypox and people who are at higher risk of being exposed to monkeypox. Considerations for Monkeypox Vaccinations. Two vaccines licensed by the U.S. Food and Drug Administration (FDA) are available for preventing monkeypox infection:
- JYNNEOS, a two-dose vaccine which takes 14 days after the second dose to become most effective. This is the preferred vaccine.
- ACAM2000, a single-dose vaccine that takes four weeks to become most effective and has more side effects than JYNNEOS. As a result, ACAM2000 is not recommended for immunocompromised people.
What treatments are available for monkeypox virus infections?
Currently there is no specific treatment approved specifically for monkeypox virus infections. However, because monkeypox virus is closely related to the virus that causes smallpox, antivirals developed for use in patients with smallpox may prove beneficial. Treatment of monkeypox patients is typically dependent on the symptoms.
Where can individuals get tested for monkeypox?
Currently, testing is only recommended for individuals who have a rash consistent with monkeypox. Only a healthcare provider can order a monkeypox test. Individuals should contact their local health department with any questions and to find out what the testing options are available in the local community.
Is the Monkeypox outbreak similar to COVID-19?
Monkeypox virus is a completely different virus than the viruses that cause COVID-19 or measles. It is not known to linger in the air and is not transmitted during short periods of shared airspace. Monkeypox spreads through direct contact with body fluids or sores on the body of someone who has monkeypox, or with direct contact with materials that have touched body fluids or sores, such as clothing or linens. It may also spread through respiratory secretions when people have close, face-to-face contact.
According to experts at the World Health Organization, they do not currently expect the monkeypox outbreak to develop into a pandemic level event, and that they assess the overall public health risk at the global level to be moderate.
The monkeypox strain causing the current outbreak is much less deadly than COVID-19 (the US had >10,000 monkeypox cases to date with none of them resulting in deaths) and is much less transmissible than COVID-19.
What actions should food establishments take?
Food establishments should ensure that they have strong food safety programs in place and ensure employees are washing hands properly, practicing good personal hygiene, avoiding bare hand contact with ready-to-eat foods, staying home when sick, and are following proper cleaning and sanitation procedures.
Employee health policies should be re-examined and updated to ensure ill food workers are excluded from working in a food establishment. Allow for flexibility with work conditions in order to encourage employees, as well as family members/caregivers, with symptoms or exposure to monkeypox, to stay at home.
How should food establishments respond if an employee is diagnosed with, or suspected to have, monkeypox?
Employees who are diagnosed with monkeypox, suspected to have monkeypox or have symptoms of monkeypox should be excluded from working in the food establishment.
- Employees who are suspected of having monkeypox should be medically evaluated and tested for monkeypox.
- Employees who have symptoms of monkeypox, should talk to their healthcare provider, even if they haven’t had contact with someone who has monkeypox.
- Employees diagnosed with monkeypox should isolate away from others at home until they are fully recovered. Decisions about discontinuation of isolation and when an employee can return to work should be made in consultation with the local health department and healthcare provider.
If a person diagnosed with monkeypox, food establishments should work with their local health department to identify, notify and monitor employees who might have had close contact with the individual. It is important to note that people who do not have monkeypox symptoms cannot spread the virus to others and transmission of monkeypox requires prolonged close contact with a symptomatic individual; therefore, excluding employees with symptoms of monkeypox plays a key role in prevention.
According to the CDC, contacts who remain asymptomatic can be permitted to continue routine daily activities (e.g., go to work, school).
Hand Hygiene and Cleaning Procedures
Surfaces that are contaminated, or may be contaminated, with the monkeypox virus should be cleaned and disinfected. EPA’s List Q includes a list of registered disinfectants for use against Emerging Viral Pathogens (EVP), including the monkeypox virus. According to EPA’s EVP guidance, the monkeypox virus is a Tier 1 (enveloped virus), therefore, disinfectants effective against the monkeypox virus are identified for use against Tier 1 viruses on EPA’s List Q. Products should always be used according to the manufacturer’s directions for concentration, contact time, and care and handling.
Hand hygiene (i.e., hand washing with soap and water or use of an alcohol-based hand rub) after touching lesion material, clothing, linens, or environmental surfaces that may have had contact with lesion material.
Soiled dishes and eating utensils should be washed in a dishwasher or by hand with warm water and soap.
Laundry (e.g., bedding, towels, clothing) may be washed in a standard washing machine with warm water and detergent; bleach may be added but is not necessary.
Cornell Monkeypox Factsheet for the Food Industry
FDA Monkeypox Response
EPA – List Q for Emerging Viral Pathogens
World Health Organization
New Jersey Department of Agriculture