People with monkeypox get a rash that may be located on or near the genitals (penis, testicles, labia, and vagina) or anus, and could be on other areas like the hands, feet, chest, face, or mouth. The rash will go through several stages, including scabs, before healing. The rash can initially look like pimples or blisters and may be painful or itchy.

Other symptoms of monkeypox can include:

You may experience all or only a few symptoms.

Sometimes, people have flu-like symptoms before the rash. Some people get a rash first, followed by other symptoms. Others only experience a rash.

(CDC)

Monkeypox symptoms usually start within 5-21 days after exposure to the virus. If someone has flu-like symptoms, they will usually develop a rash 1-4 days later.

Monkeypox can be spread from the time symptoms start until the rash has healed, all scabs have fallen off, and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks. (CDC)

Historically transmission of monkeypox has often resulted from animal exposure in endemic areas; however, most cases in the current outbreak have resulted from direct, prolonged skin-to-skin contact with active lesions.

Although not observed in the current outbreak, transmission is also theoretically possible through contact with contaminated objects (e.g., towels, bedding, or other fomites containing body fluids) or prolonged face-to-face close contact (i.e., >3 hours, within 6 feet) with an ill person.

Transmission risk overall is low (basic reproduction number ~2), and the greatest risk occurs following intimate, skin-to skin contact. (OHA Investigative Guidelines)

Festivals, events, and concerts where attendees are fully clothed and unlikely to share skin-to-skin contact are safer. However, attendees should be mindful of activities (like kissing) that might spread monkeypox.

A rave, party, or club where there is minimal clothing and where there is direct, personal, often skin-to-skin contact has some risk. Avoid any rash you see on others and consider minimizing skin-to-skin contact. (CDC)

A person is considered exposed if, during the time that the confirmed or presumptive case was ill and still had a rash, any of the following occurred: 

• Had contact with a confirmed or presumptive case’s skin or bodily fluids 

• Had oral, anal, or vaginal sex with a confirmed or presumptive case 

• Had contact with the soiled clothing, bedding, dressings, or other garments or personal items, including fetish gear and sex toys, used by an ill confirmed or presumptive case   

• Activities resulting in contact between sleeves and other parts of an individual’s clothing and the patient’s skin lesions or bodily fluids, or their soiled linens or dressings (e.g., turning, bathing, or assisting with transfer) while wearing gloves but not wearing a gown 

• Was otherwise within 6 feet for at least 3 hours of an unmasked confirmed or presumptive case without wearing a surgical mask. (OHA Investigative Guidelines)

If you had close contact with someone ill with hMPXV, public health staff may check in with you to gather more information. This will help determine your level of risk and whether you should receive a vaccine. Giving someone vaccine after they are exposed can help prevent infection or severe symptoms.

 • If you had a high- or medium-risk exposure:
Watch for fever and other symptoms as listed below. Vaccine is recommended.

• If you had a low-risk exposure: Watch for fever and other symptoms. No vaccine is needed. Watch for symptoms Anyone who was exposed to hMPXV virus should watch for these symptoms: 

• new rash 

• fever > 100.4 

• swollen lymph glands 

• chills 

Check your temperature twice a day. 

Watch for symptoms for 21 days after your last exposure.

Symptoms may start anywhere between days 5 and 21. If you get these symptoms, isolate yourself from others and call your local health department for more advice.

As long as you do not have symptoms, you can continue work, school, and other activities. Avoid further close contact with the sick person until that person’s rash is completely gone. Don’t donate blood, semen, breast milk, tissue, or make similar donations while you are watching for symptoms. If you had a high-risk exposure, avoid travel by public transportation until your 21-day monitoring is over. If you are a healthcare worker, let your employer know about the exposure. (OHA)

If you have questions about being a contact of a case that are not answered here, we are always happy to have a phone conversation at 541-682-4041

ISOLATING ALONE AT HOME: People with monkeypox who are isolating alone at home should regularly clean and disinfect the spaces they occupy, including commonly touched surfaces and items, to limit household contamination. Perform hand hygiene afterwards using an alcohol-based hand rub (ABHR) that contains at least 60% alcohol, or soap and water if ABHR is unavailable. (CDC)

ISOLATING WITH OTHERS IN HOME: People with monkeypox who are isolating in a home with others who don’t have monkeypox should follow the isolation and infection control guidance, and any shared spaces, appliances, or items should be disinfected immediately following use.

People with monkeypox should wear a surgical mask when they are not isolated. Disposable gloves should be worn for direct contact with lesions and disposed of after use. Hand hygiene with soap and water or an alcohol-based rub should be performed by cases and by any individuals who touch lesion material, clothing, linens, or environmental surfaces in contact with lesion material.

The preferred vaccine to protect against monkeypox is JYNNEOS, which is a two-dose vaccine. JYNNEOS (also known as Imvamune or Imvanex) is a replication-deficient vaccinia-based live virus vaccine approved for prevention of monkeypox infection. 

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. However, it has the potential for more side effects and adverse events than JYNNEOS. It is not recommended for people with severely weakened immune systems and several other conditions. Consult your healthcare provider to see if you should get vaccinated against monkeypox, and if you should receive ACAM2000 instead of JYNNEOS. 

(OHA Investigative Guidelines) 

The initial dose should be administered as soon as possible following exposure and ideally within 4 days in order to prevent illness.  

 
It may provide benefit in decreasing illness severity if given within 14 days of exposure. 

 
Given current supply constraints, first doses should be prioritized, with second doses administered 2-3 months later rather than at 28 days except for people who are immunocompromised or pregnant, who should receive their second dose four weeks after the initial dose.

OHA Monkeypox Home Page with Case Counts