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What You Need to Know About Monkeypox

The warning signs and symptoms, plus how to protect yourself as cases rise in the U.S.

Monkeypox Virus Present In Human Vesicular Fluid.
BSIP/UIG Via Getty Images

Since declaring monkeypox a national emergency on Aug. 4, the federal government has accelerated efforts to get a limited supply of monkeypox vaccines to Americans most likely to be exposed to the virus, while also urging the public to take precautions against infection.

The U.S. Department of Health and Human Services on Aug. 15 announced it would release 442,000 doses for state, local and territorial health departments, double what it had previously anticipated, thanks to a plan implemented the previous week to stretch the nation’s limited supply of monkeypox vaccine by giving people a smaller dose that research suggests is nearly as effective at preventing infection. More than 630,000 doses have already been shipped, but federal health officials have suggested they would need about 3.2 million shots to vaccinate all those considered at highest risk of monkeypox, according to the Associated Press.

The Centers for Disease Control and Prevention (CDC) says that since mid-May more than 11,890 probable or confirmed cases have been detected in 49 states, Puerto Rico and the District of Columbia. No cases have been reported in Wyoming. The monkeypox virus is spreading mostly through close, intimate contact with someone who has monkeypox, the CDC says.

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The World Health Organization (WHO) in July declared the outbreak a global emergency — its highest level of alert. Since May, nearly 90 countries have reported more than 31,000 cases of monkeypox.

WHO Director-General Tedros Adhanom Ghebreyesus made the decision to ensure that the world takes the current outbreaks seriously. California, New York, Illinois, New York City and San Francisco have all recently declared monkeypox a public health emergency, according to The New York Times.

Health officials are urging people who suspect they may have the disease to see a physician and get tested. “Many of these global reports of monkeypox cases are occurring within sexual networks,” Inger Damon, M.D., director of the CDC’s Division of High-Consequence Pathogens and Pathology, said in a statement. “However, health care providers should be alert to any rash that has features typical of monkeypox. We’re asking the public to contact their health care provider if they have a new rash and are concerned about monkeypox.” ​

What is it?

A relative of smallpox and cowpox, the monkeypox virus was first discovered in 1958, when two outbreaks of a poxlike disease occurred in colonies of monkeys kept for research, according to the Center for Genome Sciences at the U.S. Army Medical Research Institute of Infectious Diseases. The first human case was recorded in 1970 in the Democratic Republic of the Congo.

The largest previous U.S. outbreak of monkeypox occurred in 2003, when 47 cases were reported in the Midwest among individuals who became ill after having contact with pet prairie dogs that had been housed near a shipment of small mammals from Ghana. Tests confirmed that among those mammals, two African giant pouched rats, nine dormice and three rope squirrels were infected with monkeypox virus, according to the CDC.

What are the symptoms?

Monkeypox symptoms typically begin about a week or two after infection, according to the CDC.

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Early symptoms include:

  • Fever
  • Headache
  • Muscle aches
  • Backache
  • Swollen lymph nodes
  • Chills
  • Exhaustion

Soon after experiencing a fever (typically within one to three days, but sometimes longer), people infected with monkeypox develop a rash, which may be located on or near the genitals and could be on other areas, like the hands, feet, chest, face or mouth. As with smallpox, pimples form, fill with pus and leave pockmarks upon healing. Most infections last two to four weeks.

But a recent study, published in The Lancet Infectious Diseases, found that the primary symptoms of monkeypox have shifted in the current outbreak, with individuals less likely to have fatigue and fever than in previous outbreaks and more likely to have genital rashes.

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The researchers suggest in a press release that the change is likely related to who is being infected. The study involved 54 participants from the United Kingdom, who were diagnosed in May, at the beginning of the outbreak. The patients, whose median age was 41, all identified as men who have sex with men. Forty-nine presented with lesions and rashes on their genitals or anal regions. Only five patients required hospitalization, and no one died.

How does it spread?

You can get the virus through exposure to an infected animal or person. “Animal-to-human transmission may occur by bite or scratch, bush meat preparation, direct contact with body fluids or lesion material, or indirect contact with lesion material, such as through contaminated bedding,” the CDC reports.

Human-to-human transmission is thought to occur primarily through large respiratory droplets inhaled during prolonged face-to-face contact. “Other human-to-human methods of transmission include direct contact with body fluids or lesion material and indirect contact with lesion material, such as through contaminated clothing or linens,” according to the CDC. The latest outbreak, however, “has been transmitted primarily by close skin-to-skin contact,” according to the WHO. 

In the U.S., 99 percent of monkeypox cases are among men. Of those, 94 percent reported sexual contact with other men in the three weeks before they developed symptoms, according to the CDC.

The U.K. study affirms that sexual contact is likely the most common way that monkeypox is currently being transmitted.

Forty-seven of 52 men who answered questions about their recent sexual history said they had had at least one new sexual partner in the three weeks prior to symptoms. Twenty-nine of the 52 had more than five sexual partners in the 12 weeks before their monkeypox diagnosis, according to the press release.

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Am I at risk?

Unless you come in direct contact with an infected person, you are at little risk of developing monkeypox, according to health officials.

But you can take steps to prevent getting monkeypox, according to CDC recommendations:

1. Do not touch the rash or scabs of a person with monkeypox.

2. Do not kiss, hug, cuddle or have sex with someone with monkeypox.

3. Do not share eating utensils or cups with a person with monkeypox.

4. Do not handle or touch the bedding, towels or clothing of a person with monkeypox.

5. Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially before eating or touching your face and after you use the bathroom.

The CDC also recommends vaccinations to lower your risk during sex but notes that the supply is limited. It suggests sexually active adults pay close attention to any new or unexplained rash or lesion on the body of either partner and be aware of monkeypox symptoms. If you or your partner experiences symptoms, avoid sex and see a health care provider. The CDC also cautions that in some cases symptoms may be mild, and some people may not realize they have been infected.

Vaccines

Two vaccines are available for monkeypox.

Jynneos, a two-dose vaccine, has FDA approval for the prevention of monkeypox and smallpox disease in adults 18 years of age and older determined to be at high risk of infection.

ACAM2000, a single-dose vaccine, has FDA approval for smallpox. It is being made available for use against monkeypox under an Expanded Access Investigational New Drug (EA-IND) protocol.

The ACAM2000 vaccine has the potential for more side effects and adverse events. As such, the CDC says the Jynneos vaccine is preferred, and it does not recommend ACAM2000 for people with severely weakened immune systems and several other conditions.

With supplies limited, the CDC recommends shots should go first to people most likely to get monkeypox — men who engage in sex with men and with multiple partners in areas where the virus is spreading.

Another high-risk group includes people whose job may expose them to monkeypox, such as lab workers who test for the virus and researchers who handle samples of it. Health care providers who treat people with monkeypox can also get the shot, CDC guidance says.

Finally, you should get vaccinated if you know you were exposed to monkeypox, since the vaccine can work to prevent the onset of disease or limit the severity of illness even after exposure. And the sooner you get it, the better: The CDC recommends getting the vaccine within four days of exposure.

The latest CDC information on monkeypox is available at cdc.gov/monkeypox.  

Editor's note: This story, originally published May 26, 2022, has been updated to include new information.

Peter Urban is a contributing writer and editor who focuses on health news. Urban spent two decades working as a correspondent in Washington, D.C., for daily newspapers in Connecticut, Massachusetts, Ohio, California and Arkansas, including a stint as Washington bureau chief for the Las Vegas Review Journal. His freelance work has appeared in Scientific American, Bloomberg Government, and CTNewsJunkie.com.

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