Monkeypox

Monkeypox Disease

As of 6/21/2022 3,098 cases identified globally in 41 countries. 141 of all cases within the United States and 7 cases confirmed in Massachusetts.

 

Monkeypox spreads in different ways. The virus can spread from person-to-person through:

direct contact with the infectious rash, scabs, or body fluids

respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex

touching items (such as clothing or linens) that previously touched the infectious rash or body fluids

pregnant people can spread the virus to their fetus through the placenta

It’s also possible for people to get monkeypox from infected animals, either by being scratched or bitten by the animal or by preparing or eating meat or using products from an infected animal.

Monkeypox can spread from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. This can take several weeks. People who do not have monkeypox symptoms cannot spread the virus to others. At this time, it is not known if monkeypox can spread through semen or vaginal fluids.

Incubation period

Infection with monkeypox virus begins with an incubation period. A person is not contagious during this period.

  • Incubation period averages 7−14 days but can range from 5−21 days.
  • A person does not have symptoms and may feel fine.

Prodrome

Persons with monkeypox will develop an early set of symptoms (prodrome). A person may sometimes be contagious during this period.

  • The first symptoms include fever, malaise, headache, sometimes sore throat and cough, and lymphadenopathy (swollen lymph nodes).
  • Lymphadenopathy is a distinguishing feature of monkeypox from smallpox.
    • This typically occurs with fever onset, 1–2 days before rash onset, or rarely with rash onset.
    • Lymph nodes may swell in the neck (submandibular & cervical), armpits (axillary), or groin (inguinal) and occur on both sides of the body or just one.

Rash

Following the prodrome, lesions will develop in the mouth and on the body. Lesions progress through several stages before falling off. A person is contagious from the onset of the enanthem through the scab stage.

Key Characteristics of Monkeypox Rash
Key characteristics of Monkeypox rash
More Monkeypox Rash Photos
Photo Credit: NHS England High Consequence Infectious Diseases Network
MonkeyPox Rash Collage
Enanthem Through the Scab Stage
StageStage DurationCharacteristics
Enanthem 
  • The first lesions to develop are on the tongue and in the mouth.
Macules1−2 days
  • Following the enanthem, a macular rash appears on the skin, starting on the face and spreading to the arms and legs and then to the hands and feet, including the palms and soles.
  • The rash typically spreads to all parts of the body within 24 hours becoming most concentrated on the face, arms, and legs (centrifugal distribution).
Papules1−2 days
  • By the third day of rash, lesions have progressed from macular (flat) to papular (raised).
Vesicles1−2 days
  • By the fourth to fifth day, lesions have become vesicular (raised and filled with clear fluid).
Pustules5−7 days
  • By the sixth to seventh day, lesions have become pustular (filled with opaque fluid) – sharply raised, usually round, and firm to the touch (deep seated).
  • Lesions will develop a depression in the center (umbilication).
  • The pustules will remain for approximately 5 to 7 days before beginning to crust.
Scabs7−14 days
  • By the end of the second week, pustules have crusted and scabbed over.
  • Scabs will remain for about a week before beginning to fall off.
 

Rash resolved

Pitted scars and/or areas of lighter or darker skin may remain after scabs have fallen off. Once all scabs have fallen off a person is no longer contagious.

 

Clinical Recognition | Monkeypox | Poxvirus | CDC