The monkeypox outbreak continues to spread around the world, prompting the World Health Organization on Saturday to declare it a public health emergency of international concern. The designation means a coordinated international response is needed to prevent further spread of the virus and could prompt member countries to invest more in vaccines, treatments and other resources to contain the disease.
Many of these critical tools are not yet widely available, even in the United States. Public health messages about individual risk and access to care have not always been clear; clinics performing tests and health department staff tracking patients often lack coordination; vaccine dissemination has lagged; and treatment options remain unclear.
To make things more complicated, the symptoms of monkeypox can look different in some cases. People who get sick don’t always have the traditional fever, aches and rashes all over the body. Many patients develop only a few pustules, mostly in the genital area. And according to health officials, the disease mostly spreads through networks of men who have sex with men.
While prevention is still critical, we asked experts to explain what steps you should take to get vaccinated, tested and treated if you suspect infection or have recently been exposed to monkeypox.
Who is eligible for the vaccine? And where can you get it?
Two vaccines originally developed for smallpox and held in the United States national stockpile can help prevent monkeypox infections. The one most commonly used for monkeypox is called Jynneos. It consists of two doses given four weeks apart. But because its supply is limited and controlled by the federal government, it is not widely available to the public. Instead, the vaccine is largely offered to two groups of people: healthcare or laboratory workers who might handle infected samples, and people who have had confirmed or suspected exposure to monkeypox.
The vaccine can work even if given after someone has been exposed, and the Centers for Disease Control and Prevention recommends that people get vaccinated within four days of the date of exposure for the best chance of preventing monkeypox. You can make an appointment for the vaccine through your local or state health department.
You can also get a shot up to two weeks after exposure to help reduce symptoms, although vaccination more than four days after exposure may not prevent the disease.
“You should still take all preventive measures for several weeks after vaccination,” said Dr. Sharon Green, an infectious disease expert at the University of Massachusetts Chan School of Medicine in Worcester. Whether pre- or post-exposure, people are generally considered fully protected two weeks after receiving their second dose, she said. However, some researchers suggest that even a single dose of Jynneos may help slow the spread of monkeypox.
Several states with high monkeypox cases have expanded their eligibility criteria for the vaccine to include anyone at high risk of getting it. For example, in New York and New Jersey, you can also get the vaccine if you attended an event where there was known exposure to monkeypox, or if you identify as gay, bisexual, a man who has sex with men, transgender, gender non-conforming or non-binary and have had multiple sexual partners or anonymous partners during the last 14 days. But it can be difficult to get an appointment for the vaccine, as rollout has run into several roadblocks and delays.
When should you get tested?
Experts agree that vaccination and prevention must be prioritized to slow the current epidemic. But if you start to notice red lesions, pimples, or pustules, you should contact your primary care physician and let him know that you suspect a monkeypox infection. Your doctor will take a swab from the lesion and give you a test for monkeypox. You can also get tested at urgent care centers or sexual health clinics and through other health care providers.
The test is a polymerase chain reaction, or PCR, similar to those for Covid-19, which detects some of the virus’s genetic material. But testing capacity is still limited. Samples can only be sent to a public health laboratory or one of five commercial laboratories for analysis. And although turnaround times have improved, results can take anywhere from 24 hours to three days or more.
There is no home test for monkeypox. And even in a clinic, health care workers need a swab lesion to perform a monkeypox test, said Dr. William Morris, chairman of the division of laboratory medicine and pathology at Mayo Clinic and president of Mayo Clinic Laboratories, which developed one of the the commercial diagnostic tests for monkeypox. If you don’t have any symptoms or only have a fever and flu-like symptoms, there’s still no way to test for monkeypox, Dr. Morris said.
Another problem is that some healthcare workers may not know or recognize monkeypox when patients come for diagnosis. Monkeypox lesions, especially in the genital areas, can look very similar to the symptoms of more common diseases, such as herpes or syphilis.
“If the lesion looks like monkeypox, people should just get it tested,” said Dr. Bernard Cummins, medical director of infection prevention at Mount Sinai Health System.
Finally, some healthcare workers may be unsure of how contagious the lesions are. “I hear anecdotal reports of patients being rejected,” Dr. Kemins said. “People haven’t seen this disease before, you know, and there’s just fear of the unknown. But health care transmission of monkeypox is so rare that health care workers should not worry about contracting monkeypox on the job as long as they wear appropriate personal protective equipment.
What is the treatment process for monkeypox?
Once you get a diagnosis, treating monkeypox mainly involves controlling the symptoms, Dr. Cummins said. Patients with anal or rectal lesions may experience severe pain, especially during defecation, and in these cases the doctor may prescribe pain relievers or recommend stool softeners and shallow sitz baths used to relieve pain or itching in the genital area, he said. Patients with mouth sores may have difficulty swallowing and may be given medication to help with this. Some may develop secondary bacterial infections and require antibiotic treatment, especially if they have large, open lesions.
Antivirals, such as tecoxiramit or TPOXX, are usually only recommended for people who have more systemic symptoms or a full-body rash and are at high risk of complications from monkeypox. Doctors must request the drug from government stockpiles, fill out extensive paperwork and obtain informed consent from patients to receive the treatment.
“This is not a medicine that sits on the shelf in the pharmacy or in the clinic,” said Dr. Sandro Cinti, an infectious disease physician at the University of Michigan in Ann Arbor.
Regardless of whether they can receive antiviral treatment, patients should isolate themselves at home as soon as they develop symptoms of monkeypox. As with Covid-19, they should avoid close contact with friends, family members and pets, cover any skin rashes as much as possible and wear good quality masks if they need to come into contact with other people for medical cares. The CDC recommends limiting your exposure to others and remaining in isolation until all lesions are completely healed. You’re out of the woods only after the lesions have covered up, the scabs have fallen off, and a new layer of intact skin has formed. And this can take a long time – from two to four weeks.
“This presents us with a real dilemma,” Dr Cummins said. While health experts can hope that people will be able to take necessary sick days or work from home, it is unrealistic to expect that everyone who becomes infected will be able to strictly follow these guidelines. “This makes it even more important for people to be aware and careful about the spread of the virus.”
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