Monkeypox spreads mainly through direct contact with infected sores or respiratory secretions during prolonged intimate contact, such as kissing, cuddling or sex, according to the U.S. Centers for Disease Control and Prevention.

Although the risk of monkeypox to the general public is low, health officials continue to warn people to take precautions against the spread of the rare virus in the United States and much of Europe.

More than 400 cases of monkeypox had been reported in 29 states, the District of Columbia and Puerto Rico, according to the U.S. Centers for Disease Control and Prevention (CDC), with at least 65 confirmed and probable cases in California, including one presumptive case in Orange County. (Reported case numbers are as of June 28.) 

“Cases in the United States have so far been limited to those who traveled to a region where the disease is endemic or through direct physical contact with an infected person,” says Shruti K. Gohil, MD, MPH, associate director of epidemiology and infection prevention at UCI Health. (Reported case numbers are as of June 28.) 

Even so, she says, local health officials remain vigilant.

“While monkeypox is not as transmissible as COVID-19, our team at UCI Health and many others in the infectious disease research community are keeping a sharp eye on the progress of this emerging public health risk.”

What is monkeypox?

Monkeypox is caused by a virus that is native to the central and west African countries of Benin, Cameroon, the Central African Republic, Côte d'Ivoire, the Democratic Republic of the Congo, Gabon, Ghana (in animals only), Liberia, Nigeria, Sierra Leone and South Sudan. 

The concern is that monkeypox is now infecting people who haven't traveled to these countries. According to the World Health Organization (WHO), more than 80% of the 3,200 monkeypox cases worldwide were detected in Europe. WHO and the CDC have issued travel alerts in an effort to prevent the disease from spreading and becoming endemic around the world.

There are two strains of the virus, the Congo basin strain, which has a mortality rate of 10%, and the milder West African strain, which has a mortality rate of 3.6%. The current outbreak involves the West African strain. So far only one death has been reported, according to WHO Director-General Dr. Tedros Adhanom Ghebreyesus.

In general, however, the virus is not as dangerous or as contagious as COVID-19 and most people with monkeypox don’t get sick enough to be hospitalized, Gohil says.

How does it spread?

Monkeypox spreads mainly from person to person through:

• Direct contact with the infectious rash, scabs or body fluids
• Respiratory secretions during prolonged, face-to-face contact or intimate physical contact, such as kissing, cuddling or sex
• Direct contact with clothing, bed linens or other items that have been exposed to the infectious rash or body fluids

According to the CDC, pregnant people can spread the virus to their fetus via the placenta. It isn’t known whether the virus can spread through semen or vaginal fluids. But the virus also can be transmitted by a bite or scratch from an infected animal, or by preparing or eating the meat of an infected animal.

What are the symptoms?

Gohil says symptoms appear seven to 21 days after exposure and may include fever, headache, sore throat and cough. Lymph nodes may swell in the neck, armpits or groin on one or both sides of the body. Other symptoms may include:

• Muscle aches
• Backache
• Chills
• Exhaustion

Within three days of the onset of symptoms, a rash appears, although some people may see the rash first or only develop a rash. The monkeypox rash involves painful, round, fluid-filled sores that eventually open then scab over, a process that can take several weeks. Until the lesions are completely healed, the virus can still spread to others. Sores sometimes appear inside the mouth, which means that infected patients can spread the virus through respiratory droplets.

Gohil says most people experience mild symptoms that clear up. Outcomes may be more serious for those who have comorbidities, concurrent illnesses or are immunocompromised.

There are no treatments specifically for the monkeypox virus, but the CDC says its genetic similarity to the smallpox virus means that vaccines and antiviral drugs for the latter can be effective. People with weakened immune systems who are more likely to get seriously ill may be candidates for antiviral drugs such as tecovirimat.

How can I protect myself?

Gohil recommends good hand hygiene, masking and avoiding direct contact with people who have — or may have been exposed to — monkeypox.

“As with many other diseases, you can protect yourself by frequently washing your hands or using alcohol-based hand sanitizer and avoiding contact with someone who is ill,” she says.

The CDC recommends that anyone with a rash or suspicious lesions that resemble monkeypox contact their healthcare provider immediately and avoid exposing others. If possible, let a staff member know you suspect monkeypox as soon as you arrive in the event they need to isolate you. Avoid traveling by public transportation until a healthcare professional has cleared you.