Monkeypox (Mpox)

Mpox is naturally occurring in central and west Africa and is endemic in parts of the continent, with more than 1,000 cases reported annually in the Democratic Republic of the Congo in recent years. Nigeria has reported ongoing spread of mpox since 2017, when the virus re-emerged after nearly 40 years with no reported cases. Analysis by CDC experts has found that there are at least 2 genetically distinct variants of mpox virus circulating in the current outbreak, both of which share common ancestors of strains present in Nigeria since 2017. This shows it’s likely that there were at least 2 separate instances in which the virus spread from animals to people in Nigeria, then began to spread person-to-person through close contact. The current outbreak includes many cases from around the world with no reported travel to these areas.

Recent cases of mpox have been identified on every continent except Antarctica, including in the United States and in Colorado.

State epidemiologists are coordinating across Colorado and with the CDC to monitor the progression and spread of the virus and learn more about transmission. Coloradans can track Colorado’s mpox cases on the CDPHE website. You also can track cases across the United States and across the globe on the CDC website.

Anyone can get mpox. Mpox is spread when a person has close contact with someone who has mpox. Close contact includes:

• direct contact with the infectious rash, scabs, or body fluids
• respiratory secretions during prolonged face-to-face contact
• intimate contact including kissing, sex, or touching the genitals
• touching items (clothing, bedding) that have touched the infectious rash or body fluids

It is not yet known if mpox can spread through semen or vaginal fluids.

Mpox can spread from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed, typically a time period of 2-4 weeks.

The risk of mpox infection is low to the general public, but anyone can get mpox if they have close personal contact with someone who has symptoms of mpox. People with mpox in the current outbreak generally report having close, sustained physical contact with other people who have mpox. Recent data suggests men who have sex with men are at a higher risk, as well as people who have recently travelled to or from areas where mpox has been reported.

Symptoms of mpox often begin with fever, headache, muscle aches, swollen lymph nodes, and exhaustion. Most people get a rash 1-3 days after they first start feeling sick. The rash can look like pimples or blisters and usually appears first on the face and then spreads to the rest of the body, including the hands, feet, chest, inside of the mouth, genitals, or anus.

Sometimes people get a rash first, then other symptoms. Others only get a rash.

The rash goes through different stages before healing completely. This usually takes about 2-4 weeks.

If you have been in contact with someone who has tested positive for mpox, contact a health care provider as soon as you can, or public health may reach out to you with instructions on how to monitor for symptoms. Some people who may have been recently exposed could be eligible for a vaccine. Mpox vaccines can help keep you from getting sick if you get vaccinated within 4 days of exposure. If you get the vaccine between 4 and 14 days after exposure, it can help prevent severe illness.

Anyone with symptoms of mpox should self-isolate (if possible) and contact a health provider as soon as possible. If you have a rash, cover any lesions or sores and wear a mask before coming into close contact with anyone. Your health care provider may swab skin lesions to test for and confirm the presence of the virus.

If you test positive, stay home, avoid contact with others, and cover any skin lesions or sores. Your provider or the health department will give you instructions on how to isolate away from other people until you feel better. Most people recover from mpox within 2-4 weeks.

You should take the following steps to prevent getting mpox:

• Avoid contact with people who have suspected or confirmed mpox
  • Do not touch the rash or lesions of someone with mpox
  • Do not kiss, hug, cuddle, or have sex with someone who has mpox
  • Do not share eating utensils, cups, or toothbrushes with someone who has mpox
• Avoid contact with materials that have been in contact with someone who has mpox
  • This includes clothing, bedding, towels, etc.
  • If you must handle contaminated materials, wear a mask and disposable gloves when doing so and wash materials with warm water and detergent
• Wash your hands often with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer
• Clean and disinfect any contaminated surfaces and dispose of contaminated waste properly
• Avoid contact with animals that may be infected (including sick or dead animals, especially in areas where mpox has been confirmed) and anything they may have touched
• Use appropriate protective equipment when caring for someone with mpox
  • If you need to have contact with someone who has mpox, encourage the infected person to cover skin lesions and wear a medical mask. You also should wear a mask and avoid skin-to-skin contact if possible. If you can’t avoid having direct contact with lesions, use disposable gloves

If you are sick with mpox:

• Isolate at home
• If you have an active rash or other symptoms, stay in a separate room or area away from people or pets you live with, if possible

If you have been in contact with someone who has confirmed mpox:

• Contact your health care provider and ask about testing and vaccination
• Monitor yourself for symptoms
• If you develop symptoms, self-isolate immediately and contact the Health Department or your health care provider for guidance

People can get mpox if they have close, skin-to-skin contact with someone who has mpox. Early indications are that events with activities in which people engage in close, sustained skin-to-skin contact have resulted in cases of mpox. If you plan to attend an event, consider how much close, personal, skin-to-skin contact is likely to occur there. If you feel sick or have a rash, do not attend any gathering and see a health care provider.

Talk to your partner about any recent illness and be aware of any new or unexplained rash on your body or your partner’s body, including the genitals and anus. If you or your partner have recently been sick, currently feel sick, or have a new or an unexplained rash, do not have sex and see a health care provider.

If you or a partner has mpox, the best way to protect yourself and others is to avoid sex of any kind, not kiss or touch each other’s bodies while you are sick, especially any rash, and not share personal items like towels, clothing, or toothbrushes.

Poxviruses have been found to survive on linens, clothing, and environmental surfaces for long periods of time, especially in dark, cool, and low-humidity environments. It is not yet known exactly how long mpox can survive on surfaces. Therefore, it is important to properly clean and disinfect to reduce your risk of exposure to mpox.

• Hard surfaces: It is important to disinfect surfaces (such as counters, door handles, floors, etc.) with an EPA-registered disinfectant. Mpox is considered a tier 1 virus. You can view the list of approved disinfectants on List Q. When disinfecting, it is important that you follow all the manufacturer’s directions for use, including concentration, handling, and contact time (the amount of time a surface needs to remain wet with disinfectant for it to be effective). Additionally, some disinfectants may require you to wash the surface with soap and water to pre-clean.
• Porous surfaces: Used linens, towels, clothing, and other fabric items should be contained until washed. Try to use gloves and avoid shaking dirty laundry when handling these items to help protect you from exposure. Dirty items can be washed in a standard washing machine with detergent, following linen/clothing label instructions. Steam cleaning can be considered for items that cannot be laundered, such as upholstered furniture, carpet, and soft furnishings.
  
  

For more information about infection prevention:

• In your home: https://www.cdc.gov/poxvirus/monkeypox/specific-settings/home-disinfection.html
• In health care settings: https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html
• In congregate settings: https://www.cdc.gov/poxvirus/monkeypox/specific-settings/congregate.html

Public health experts recommend mpox testing for people who have a new rash, lesions, or sores with pus and could have had close contact with someone who was infected with mpox.

The test for mpox involves swabbing a skin lesion. Providers send the swab into a lab for testing to detect viruses in the orthopoxvirus genus. Typically, you should receive your test result within 48 hours. You will receive your result from the same health care provider that performed your test. In the event that the provider cannot reach you, or if additional information is needed, the Health Department may also reach out.

If you are experiencing symptoms of mpox or think you have been exposed to mpox, you  should first contact your primary care provider to discuss testing since many providers can now submit specimens through commercial laboratory networks and bill your insurance to cover the cost.

If you do not have a primary care provider or do not have insurance, the Weld County Health Department Clinic also has mpox testing available at no cost to you if you have an active rash you suspect may be mpox. Walk-ins are accepted but appointments are encouraged to decrease wait time. Please cover any lesions or sores and wear a well-fitting mask over your nose and mouth when you come in for testing. To register for an appointment, please fill out the Mpox Test Screening Form.

You can also refer to CDPHE for a list of other testing providers, which is updated as more locations become available.

There are 2 approved vaccines that can prevent mpox in people who are exposed to the virus: JYNNEOS and ACAM2000. Colorado currently has an extremely limited supply of JYNNEOS, a fully FDA-approved vaccine for people age 18 and older.

JYNNEOS contains small amounts of a live, non-replicating virus called the Vaccinia virus. This virus is in the same family as mpox and smallpox. The vaccine teaches your body how to fight off the Vaccinia virus. Because this virus is very similar to mpox, your body will also be better able to fight off mpox after you have been vaccinated. Clinical studies suggest the JYNNEOS vaccine is at least 85% effective in preventing mpox.

For maximum benefit, 2 doses of the vaccine are needed. Schedule your 2nd dose 4 weeks after your first. You will be considered fully vaccinated against mpox 2 weeks after receiving your 2nd dose.

Coloradans who are currently eligible for a mpox vaccine include:

• Anyone (any sexual orientation or gender identity) who has had close physical contact with someone who has mpox in the last 14 days.
• Anyone (any sexual orientation or gender identity) who:
  • Has multiple or anonymous sexual partners, or
  • Has close physical contact with other people in a venue where anonymous or group sex may occur, or
  • Was diagnosed with gonorrhea or syphilis in the past six months, or
  • Is living with HIV, or
  • Already uses or is eligible for HIV PrEP (medication to prevent HIV, e.g. Truvada, Descovy, or Apretude), or
  • Engages in commercial and/or transactional sex (e.g. sex in exchange for money, shelter, food, and other goods or needs).
• Anyone (any sexual orientation or gender identity) identified by public health as a known high-risk contact of someone who has mpox.

People who already have symptoms of mpox (fever, rash, etc.) should not get vaccinated.

The Weld County Health Department has a limited supply of vaccine available to eligible individuals. To see if you are eligible, please fill out the Mpox Vaccine Eligibility and Interest Form. If eligible, someone from the Health Department will contact you about scheduling a vaccine appointment. 

If you are a health care worker or public health worker who may have been exposed to mpox in the workplace and would like to be put on a standby list to receive a vaccine, please fill out the Health Care Worker Pre-exposure Prophylaxis Vaccine Wait List Form. 

CDPHE also has a vaccine eligibility and interest form available for eligible Coloradans who meet the criteria or you can find available appointment and clinic locations statewide through PrepMod. You can also find a list of vaccine providers on the CDPHE Mpox webpage.

The most common side effects are pain, redness, swelling, hardness, and itching at the injection site. Side effects can also include soreness, headache, fatigue, nausea, and chills.