News coverage of the ongoing global monkeypox outbreak has been intense. With news that the World Health Organization (WHO) has declared monkeypox a public health emergency of international concern (PHEIC), many may be recalling the early days of the COVID-19 pandemic, when the WHO declared it a PHEIC (on Jan. 30, 2020).
You may be wondering if this is something that could impact you personally – or your business. It’s important to know that monkeypox is not the same type of virus and does not pose the risk that COVID-19 poses.
This post will provide a general overview of the virus, public health guidance on the impact this virus is having, how hospitals can ensure the safety of their staff during this outbreak, and whether other businesses should prepare for community spread.
Since early May, public health organizations around the globe, including the WHO and the Centers for Disease Control and Prevention (CDC), have been closely monitoring an outbreak caused by monkeypox spreading globally. As of July 25, 2022, there have been almost 17,000 confirmed cases globally, including almost 3,000 in the U.S., with case numbers continuing to rise as the outbreak and surveillance expand.
What is monkeypox?
Monkeypox is a rare viral infection, usually found in forested areas of Central and West Africa. The disease originates in animals, but in the last 50 years or so has also been reported in humans. There are two types (or clades) of the virus, with the less severe West African clade causing the current outbreak.
The "pox" in its name may remind people of chickenpox – but they are different viruses, so previous exposure to chickenpox does not protect you from monkeypox.
However, monkeypox is distantly related to smallpox, as both viruses are in the orthopoxvirus family. Because of this relationship, the smallpox vaccine can protect people from getting monkeypox. (For those who received that vaccine as a child decades ago, it's unclear how much residual protection remains – according to the CDC, several people infected in this outbreak had previously been vaccinated against smallpox decades prior. The WHO says to continue to take precautions to protect yourself and others.)
Who is most at risk from monkeypox?
People who live with or have close contact with someone with monkeypox are most at risk.
People at potentially heightened risk of infection include healthcare workers, commercial sex workers, household members where an infected person is present, and other close contacts of active cases, such as sexual partners. Other groups at the highest risk of severe disease from monkeypox include pregnant women, young children, and immunocompromised individuals. These groups need to be especially protected to prevent infection.
While the most recent outbreak appears to have disproportionately affected people who self-identify as gay, bisexual or men who have sex with men, it is important to stress that monkeypox can affect anyone who comes into close, prolonged contact with an infected (and symptomatic) individual or their infected belongings. It would therefore be wrong to stigmatize anyone for the outbreak.
Can I get monkeypox while out in public settings?
The risk to the general public is low based on available information. It's unlikely you will be exposed to monkeypox while out in public settings like grocery stores or the mall, as you won't have the prolonged exposure this virus requires. The CDC recommends that if you plan to attend a crowded event, consider how much close, personal, skin-to-skin contact is likely to occur there. For more information on this, visit https://www.cdc.gov/poxvirus/monkeypox/specific-settings/social-gatherings.html.
How does monkeypox spread?
Monkeypox does not normally spread easily between people as it requires very close physical contact to allow the virus to enter the body, such as:
- Direct skin-to-skin contact with rash lesions or bodily fluids
- Sexual/intimate contact, including kissing, cuddling, massaging, and talking closely
- Living in a house and sharing a bed with someone
- Handling contaminated items in a home with an infected person (including towels, bedding, unwashed clothing, electronics, and shared surfaces such as counters or light switches)
- Respiratory secretions through prolonged face-to-face interactions (the type that mainly happens when living with someone or caring for someone who has monkeypox)
- Being scratched or bitten by an infected animal or eating meat, or using products from an infected animal (currently, this risk applies to endemic countries in Africa)
Monkeypox is NOT spread by:
- Walking close to someone with monkeypox, like in a grocery store
Key areas scientists are still investigating:
- If transmission is possible through:
-- Semen, vaginal fluids, blood, amniotic fluid, or breastmilk
-- Contact with infected people who have no symptoms or mild/early symptoms
What are the symptoms of monkeypox?
The most common symptoms are flu-like and include fever, headache, aching muscles, back pain, low energy, and swollen lymph nodes. This is followed or accompanied by a rash on the face, palms of the hands, soles of the feet, chest, genitals, or anus.
Most of those infected with monkeypox will recover within a few weeks without needing treatment. However, the disease can be more severe, especially in young children, pregnant women, and immunocompromised individuals.
How long is someone infectious?
Based on currently available data, only those displaying symptoms are contagious. Generally, monkeypox can spread from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The initial symptoms present, on average, 8 days after exposure and are followed by a rash 12-16 days after exposure. The illness typically lasts 2-4 weeks.
How is monkeypox prevented?
There are several ways to prevent the spread of monkeypox, including:
- Always talking to your sexual partner/s about any recent illness and being aware of new or unexplained sores or rashes on your body or your partner's body, including on the genitals and anus
- Avoiding close contact, including sex, with people with symptoms like sores or rashes
- Avoiding contact with infected animals
- Avoiding contact with materials contaminated with the virus
- Isolation of infected persons until their symptoms, including rash, have gone away completely
- Using appropriate personal protective equipment (PPE) (like a mask, gown, and gloves) when caring for others with symptoms
- Practicing good hand hygiene
- Disinfecting frequently touched surfaces and devices if someone in your home is infected
- The CDC recommends vaccination for people who have been or may have been exposed to monkeypox and those at higher risk of being exposed.
For those living with someone exposed or diagnosed with monkeypox, visit this CDC page on "Isolation and Infection Control: Home."
What efforts are underway to contain this outbreak?
The strategy to contain this outbreak involves extensive case finding, contact tracing, patient isolation, and vaccination of close contacts. Public health agencies around the globe are working diligently to control this outbreak by raising awareness of this virus in at-risk communities and educating healthcare workers to be able to identify cases.
Is this going to turn into a pandemic?
Public health officials do not believe this outbreak possesses a COVID-style pandemic risk for several reasons, including the availability of existing vaccines such as the smallpox vaccine, the longer incubation time (allowing for vaccination of close contacts), the low reproductive number (an infected person can transmit to approximately 1-2 people), and the low rate of mutations.
How can healthcare workers protect themselves?
According to the CDC, the risk of monkeypox for most front-line healthcare workers is low, and transmission in healthcare facilities has been rarely described. The CDC recommends standard precautions for all patients, including those with suspected or confirmed monkeypox infection, and provides additional supporting infection prevention and control information specifically intended for healthcare settings. Healthcare workers can further reduce risk by properly donning and doffing personal protective equipment, practicing good hand hygiene<, and following their facility's infection control practices, including standard cleaning and disinfection using EPA-registered hospital-grade disinfectants found on the list of Disinfectants for Emerging Viral Pathogens (EVPs) Including Monkeypox.
Should other businesses prepare?
It's important to remember that unlike COVID-19, which had significant and lasting effects on many businesses, monkeypox is a rare virus that spreads through close physical contact. However, remember that other viruses, like norovirus, do easily spread on surfaces, and as temperatures drop in the northern hemisphere, we enter cold and flu season. Continue to follow your existing disinfection protocols for frequently touched surfaces and encourage employees to practice good hand hygiene.
Do PURELL® products kill monkeypox?
The U.S. Food and Drug Administration (FDA) does not allow manufacturers of hand sanitizer or soap to make claims regarding the efficacy of these products against monkeypox or any virus. A claim around the efficacy of PURELL® Hand Sanitizer against any specific virus, including monkeypox, would be an off-label claim and not permitted under the FDA rules.
PURELL® Surface Sanitizer and Disinfectant Sprays and Wipes have demonstrated effectiveness against viruses like monkeypox virus on hard, nonporous surfaces. Therefore, PURELL® Surface Sanitizer and Disinfectant Spray (EPA Reg. No. 84150-3 and 84150-4) can be used against monkeypox virus when used in accordance with the directions for use against Feline Calicivirus (30-second kill time) on hard nonporous surfaces. PURELL® Surface Sanitizer and Disinfectant Wipes (EPA Reg. No. 84150-1) can be used against monkeypox virus when used in accordance with the directions for use against Feline Calicivirus (5-minute kill time) on hard nonporous surfaces. These products are included in the EPA List of Disinfectants for Emerging Viral Pathogens (EVPs) Including Monkeypox. Please note that these claims are only applicable in the United States.
Additional information on this global outbreak is available on the below public health sites. The CDC has a FAQ available at: https://www.cdc.gov/poxvirus/monkeypox/faq.html, and the WHO has a Q&A available at: https://www.who.int/news-room/questions-and-answers/item/monkeypox.
About the Authors:
James Bingham, MS
Megan DiGiorgio, MSN, RN, CIC, FAPIC