Monkeypox Infectious Disease Frequently Asked Questions

1. What is monkeypox?

Monkeypox is a zoonotic disease caused by infection with the monkeypox virus, which is divided into clade type I and clade type II. Sources of infection include people with monkeypox and infected primates such as rodents, monkeys and apes. In the past, monkeypox outbreaks were mainly endemic in Africa, and gradually spread to most countries and regions around the world after 2022. The clinical manifestations mainly include fever, rash, lymphadenopathy and other symptoms.

2. What are the main manifestations of monkeypox patients?

The rash is the most common symptom, and may be preceded by fever, headache, fatigue, and swollen lymph nodes. The rash is mostly seen on the face and limbs, and can also appear in the mouth, anus, genitals and other parts, and the anal rash is easy to cause bacterial infection, and the appearance of abscesses and ulcers affects bowel movements.

3. Who are the susceptible people to monkeypox?

The population is generally susceptible. Previous smallpox vaccination has some degree of cross-protection against the monkeypox virus.

4. How long is the incubation period for monkeypox?

The incubation period of monkeypox is generally 5~21 days, and most of them are 6~13 days.

5. What is the prognosis for monkeypox?

Monkeypox is a self-limiting disease, most cases have mild symptoms, and most patients will have symptoms that disappear within a few weeks after symptomatic and supportive treatment. For young children, pregnant women, and immunocompromised people (eg, HIV-infected patients with low CD4 cell counts, patients with hematologic malignancies, etc.), severe illness or death may occur if treatment is not prompt.

6. Why has the World Health Organization once again declared the monkeypox outbreak a "Public Health Emergency of International Concern"?

In July 2022, the World Health Organization (WHO) declared the monkeypox outbreak a "Public Health Emergency of International Concern (PHEIC)", triggering the outbreak by the monkeypox branch type II virus. Through global joint efforts, the epidemic was quickly and effectively controlled, and the World Health Organization declared the lifting of the monkeypox emergency in May 2023.

In September 2023, the I.b variant of the monkeypox virus clade was detected in the Democratic Republic of the Congo (DRC), and the outbreak gradually spread to neighboring countries, causing sustained community transmission and the risk of spreading to countries outside Africa. Available data suggest that infection with clade I.b variants may cause more severe symptoms and a higher risk of severe disease and death than clade II. On August 14, 2024, the World Health Organization (WHO) once again declared the monkeypox outbreak a "Public Health Emergency of International Concern".

7. What are the similarities and differences between Monkeypox Clade Type I and Clade II viruses?

Based on the existing data and related studies, the similarities between the monkeypox clade type I and clade II viruses are mainly as follows: the transmission route is mainly direct contact with the secretions and exudates of the lesion site of the patient; After infection, it can cause symptoms such as rash, fever, and swollen lymph nodes. The main differences between the two are: in terms of geographical distribution, there are both clad type I and type II viruses circulating in Africa, and most countries and regions outside Africa are only clad type II viruses; In terms of population distribution, there was no significant gender difference in monkeypox cases reported in Africa, with a high proportion of adolescents and children aged 15 years and younger, and the cases of branch II virus infection reported in countries and regions outside Africa were mainly young and middle-aged men who had sex with men. In terms of disease severity, cases of clade type I virus infection have a wider range and more number of rashes, and may be at higher risk of severe disease and death.

8. What is China's response to the monkeypox outbreak?

After the first local case of monkeypox was reported in China in June 2023, monkeypox was quickly included in the management of Category B infectious diseases, and prevention and control measures for Category B infectious diseases were adopted. We have always adhered to the principle of "prevention first, prevention and treatment combined, precise prevention and control, and rapid disposal", implemented measures of "early detection, early reporting, early isolation, and early treatment", carried out multi-channel monitoring of medical institutions, key populations, inbound personnel, and key venues, strengthened epidemic analysis and risk research and judgment, and carried out targeted health education and comprehensive intervention for key populations. Persist in detecting and controlling all of them, and stop the spread of the epidemic in a timely manner to ensure that the overall national monkeypox epidemic is at a low epidemic level.

9. What is the situation of monkeypox epidemic in China?

The monkeypox epidemic in China currently maintains a low epidemic level, with cases reported in most provinces, more than 90% of the cases are male, mainly transmitted through close contact such as gay sex with men, and more than 40% of the cases are previously HIV-infected people. At present, the virus gene sequencing of confirmed cases in China is all clad type II. virus, and no clad type I virus has been found, so it is necessary to dynamically track and assess the international epidemic situation and the risk of clad type I virus importation, and make preparations for prevention and control.

10. What measures has China taken to further prevent and respond to the imported monkeypox outbreak?

China has conscientiously summarized the experience of the prevention and control of the new crown epidemic and the effective practices since monkeypox was included in the management of Class B infectious diseases, further strengthened joint prevention and control, and established and improved departmental consultation and coordination mechanisms; Strengthen the health and quarantine of inbound personnel, carry out health education for people going to key countries and regions, advocate personal protection, do a good job of health monitoring after returning to China, and strictly prevent the import and transmission of monkeypox virus, especially branch type I virus; Strengthen multi-channel monitoring of the epidemic, prepare training drills and epidemic prevention materials, and ensure that the imported epidemic of monkeypox can be dealt with in a timely and effective manner.

11. What are the modes of transmission of the monkeypox virus?

Regardless of whether it is a branch of monkeypox type I virus or a branch type II virus, the current transmission route is mainly direct contact with the lesion secretions and exudates of patients, and the common direct contact methods include sexual activity, close contact within the family, medical care contact, etc. Contact with the environment and objects contaminated by the virus can also cause infection, but the transmission efficiency is lower than that of direct contact.

According to the World Health Organization, prolonged close inhalation of respiratory droplets can also be infected, but this mode of transmission is rare. The results of epidemiological investigation in China show that among family members, colleagues and other people who have been in close contact with monkeypox cases, there is no infection through respiratory transmission.

12. How are monkeypox and AIDS transmitted?

Both monkeypox and AIDS can be transmitted through sexual activity, and monkeypox is more likely to be infected through direct contact with secretions and exudates from the lesion site of the case during sexual activity. HIV is mainly transmitted through the exchange of bodily fluids during sexual activity, and people living with HIV cannot be infected through daily contact such as shaking hands and hugging. Therefore, the correct use of condoms can effectively prevent the transmission of HIV, but it cannot completely prevent the transmission of monkeypox. In addition, immunocompromised AIDS patients infected with monkeypox have more severe clinical symptoms and a higher risk of severe disease and death.

13. Is there currently a vaccine to prevent monkeypox?

At present, four monkeypox vaccines have been approved for the prevention of monkeypox infection abroad, and these four vaccines were originally developed for the prevention of smallpox. There is currently no approved monkeypox vaccine in China. Relevant departments are organizing forces to speed up the scientific research, review and approval of monkeypox vaccines, and promote product development and marketing as soon as possible.

14. Why does the smallpox vaccine work to prevent monkeypox?

Monkeypox virus and smallpox virus belong to the genus orthopoxvirus of the poxviridae family and share some common antigenic characteristics, so previous smallpox vaccination has a certain role in preventing monkeypox. But monkeypox and smallpox are two different diseases, and smallpox is a virulent infectious disease that has been eradicated by humans; Monkeypox is an emerging infectious disease, and the case fatality rate is much lower than that of smallpox, and the transmission law and pathogenic mechanism of monkeypox virus need to be further observed and studied.

15. Will a monkeypox patient be reinfected after recovery?

Monkeypox patients will produce protective antibodies in their bodies after recovery, which can prevent reinfection within a certain period of time, but reinfection may occur after the protective antibodies decline, and there have been cases of reinfection after monkeypox patients have recovered.

16. What should I do if a pregnant woman has monkeypox?

Pregnant women are at higher risk of severe disease after monkeypox infection, and the monkeypox virus can be transmitted to the fetus through the placenta, which can lead to miscarriage, stillbirth, or premature birth. The monkeypox virus can also be transmitted to newborns during and after childbirth through close contact, and newborns are at high risk of severe disease after being infected with monkeypox.

If pregnant women have a history of monkeypox exposure or symptoms such as fever, rash, and swollen lymph nodes, they should go to a medical institution for investigation in a timely manner, and take necessary preventive and therapeutic measures under the guidance of doctors to reduce the risk of transmission and severe disease.

17. What is the difference between the symptoms of monkeypox and chickenpox?

Monkeypox and chickenpox are infectious diseases caused by different viruses, and the causative agent of chickenpox is the varicella-zoster virus. Both have rash symptoms, the rash caused by monkeypox is mostly spherical, the texture is hard, the scab falls off in about 2~4 weeks, and some can leave scars; The rash caused by chickenpox is mostly a vesicular rash, with thin blister walls, which scab off in about 1~2 weeks, and generally does not leave a scar.

18. How can monkeypox patients avoid infecting their family members during home treatment?

After joint assessment by medical institutions and disease control agencies, confirmed cases of monkeypox with mild disease and conditions for home isolation and treatment can be treated in home isolation. During the period of home isolation and treatment, a single person should live in a single room; Avoid direct skin or mucous membrane contact with others; Use of individual cutlery, towels, bedding, etc.; Clean and disinfect the patient's contact and home environment.

19. What should monkeypox patients pay attention to when treating them at home?

Patients with monkeypox should pay attention to supplementing nutrition and hydration during home treatment, keep the skin, mouth, eyes and nose clean and moisturized, and avoid scratching the skin at the rash site to avoid infection. Those with high body temperature can be physically cooled, and those with more than 38.5°C can take antipyretic analgesics to reduce fever. Analgesics may be used when pain in the rash area is severe. Complications such as skin infections and corneal lesions should be treated with antimicrobial drugs, eye drops, vitamin A and other drugs as prescribed.

20. How to take personal protection when caring for monkeypox patients treated at home?

Caregivers should wear surgical masks, disposable latex gloves, etc., wash hands in a timely manner after touching patients and their belongings, and ventilate, clean and disinfect the patient's living room every day. At the same time, caregivers should do a good job of monitoring their own health and seek medical attention in time if there is an abnormality.

21. How to disinfect items, places and environments that may be contaminated by monkeypox patients?

The monkeypox virus is resistant to dryness and low temperatures, and can survive for months on scabs, soil, and surfaces such as clothing and bedding. The virus is sensitive to heat and can be inactivated by heating to 56°C for 30 minutes or 60°C for 10 minutes, and can effectively inactivate the virus with commonly used disinfectants and ultraviolet light. For hands, it is recommended to disinfect them by rubbing them together with hand sanitizer. For the environment and surfaces, disinfectants containing chlorine, chlorine dioxide, hydrogen peroxide and other disinfectants can be selected to wipe or spray for disinfection. For textiles such as clothing and bed sheets, disinfection methods such as thermal disinfection, chlorine-containing disinfectant or quaternary ammonium disinfectant immersion can be selected.

22. How can close contacts of monkeypox patients self-manage?

Those who are judged to be close contacts of monkeypox patients can conduct self-health monitoring for 21 days under the guidance of CDC professionals. During the period, you should avoid close contact with others such as sexual acts and avoid donating blood; Measure your body temperature and monitor your symptoms every day, and if you have symptoms such as rash, fever, and swollen lymph nodes, you should see a doctor in time, and take the initiative to inform your doctor of your exposure history. Wear a surgical mask, long clothes and trousers on the way to and when visiting the hospital, make sure to cover all damaged skin, and avoid public transportation as much as possible.

23. How can I prevent monkeypox in my daily life?

Be the first person responsible for your own health, understand the knowledge of monkeypox prevention and control, enhance your awareness of self-protection, reduce high-risk behaviors, and reduce the risk of transmission. Do not come into contact with primates such as wild or unknown rodents, monkeys and apes in your daily life.

When traveling to monkeypox-endemic areas, you should learn about the monkeypox epidemic situation in your destination in advance, do a good job of personal protection, avoid contact with local wild animals, and avoid close contact with monkeypox patients or people with suspicious symptoms; Comply with the relevant regulations of the national entry and exit administration, and cooperate with the entry and exit quarantine and testing.

24. What should I pay attention to when returning (entering) from an area where monkeypox is endemic?

Persons from countries (regions) where monkeypox outbreak occurs, if they have been in contact with monkeypox patients or have symptoms such as fever, headache, back pain, myalgia, swollen lymph nodes, rash and mucosal rash, should take the initiative to declare to the customs when entering the country, and cooperate with the customs staff to implement medical quarantine measures in accordance with the prescribed procedures.

Other personnel should carry out self-health monitoring after entering the country, seek medical attention in time if they have symptoms such as fever, rash, and swollen lymph nodes, and take the initiative to inform medical staff of their travel and residence history in monkeypox-endemic areas.

25. What are the sources of authoritative information about monkeypox?

You can log on to the websites and official accounts of the China Center for Disease Control and Prevention and local centers for disease control and prevention to learn about the authoritative information on monkeypox epidemic prevention and control, master the knowledge and skills of monkeypox prevention and control, scientifically understand the hazards of the disease, and avoid panic.