Monkeypox

Also called MPX

Monkeypox is a viral infection that causes a rash. It is spread through close skin-to-skin physical contact with someone who has symptoms.

What is monkeypox (MPX)?

Monkeypox is caused by monkeypox virus. It is called ‘monkeypox’ because it was first found in monkeys. Most people recover fully without treatment but in some cases, people can get seriously ill. 

Since May 2022, there has been a global increase in monkeypox cases reported from multiple countries where monkeypox is not usually seen. See 2022 monkeypox outbreak global map.

In New Zealand, monkeypox is a notifiable disease which means it must be reported to the local medical officer of health. This will help to improve the national response and to contain the spread should a large number of cases occur in New Zealand. 

Read about how to isolate and prevent infecting others if you have monkeypox.

What are the symptoms of MPX?

The incubation period is 12 days, meaning that it takes 12 days for the symptoms to appear following infection with the virus. The first symptoms of monkeypox are usually:

  • headache
  • fever (greater than 38°C)
  • chills
  • muscle aches
  • backache
  • swollen lymph nodes (this is a symptom that differs from chickenpox
  • chills
  • exhaustion.

A characteristic rash generally appears after a few days. It usually starts on the face and then spreads to other parts of the body. It may also appear on the palms of hands and soles of the feet, inside the mouth, or on the genitals.
Image credit: NHS England High Consequence Infectious Diseases Network

The rash associated with monkeypox involves vesicles or pustules (like big pimples). The number of lesions varies from a few to several thousand. The rash changes and goes through different stages, like chickenpox, before finally becoming a scab that falls off. The symptoms usually go away by themselves within 2–4 weeks.

It is usually a mild illness, but a small number of people become very unwell. 

How is MPX spread?

While monkeypox doesn't easily spread between people, it can be caught from:

  • direct contact with the infectious rash, scabs, or body fluids (such as pus or blood)
  • contact with saliva from an infected person, such as during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex
  • touching clothing, bedding, towels or objects like eating utensils/dishes that have been contaminated with the virus from contact with an infected person
  • pregnant people spreading the virus to their foetus through the placenta.

Monkeypox can spread from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks.

People who don't 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.

What if I develop symptoms?

MPX is not very infectious. To get infected you need to be in close contact (usually skin to skin or shared respiratory droplets) with a case while they are infectious. Therefore, it is more likely to occur in people coming from a country with a known outbreak.

If you think you may have been exposed and you develop symptoms, particularly a rash, isolate from others, and seek medical advice from your doctor or nearest hospital. They may see you via a telehealth consultation, but if they want to see you in person wear a mask and if you have a rash or blisters make sure they are covered.

Many illnesses can cause similar symptoms so it may not be monkeypox but it's important to get help. Contact a sexual health clinic for free advice, call your GP or ring Healthline on 0800 611 116.

Read more about what to do if you develop symptoms of MPX. 

What do I do if I have been in contact with a case?

If you have been in contact with a MPX case, you'll be assessed to see if you are a high risk close contact, a moderate risk close contact or a casual contact. No contacts need to quarantine unless they develop symptoms.

High risk close contacts

Definition: You're a high risk close contact if you have had direct physical contact with:

  • skin or mucous membranes of a case (mucous membranes are the moist inner lining of areas like the nose, mouth, vagina or urethra)
  • crusts from lesions or bodily fluids of a case
  • potentially contaminated materials – bed linens, healthcare equipment.

It also includes any household contacts who have had close physical contact with the case or contaminated materials, eg bedding or clothing.

Management: 

  • Monitor symptoms for 21 days after your last contact with the case. This means taking your temperature every day and watching for signs/symptoms of MPX. A public health official will stay in contact with you to check if you are developing symptoms.
  • If you do develop symptoms, isolate immediately and contact Public Health for advice.
  • Wear a mask when around others.
  • If you're travelling outside the region/country, advise public health so your management can be transferred.
  • Advise public health if you work in healthcare.
  • Avoid high-risk activities including sexual activity, kissing, and other skin-to-skin contact with others.

Moderate risk close contacts

Definition: You're a moderate risk close contact if you have had indirect contact: 

  • in an enclosed poorly ventilated indoor space within 1 metre of a case for more than 3 hours
  • through sitting beside a case on a plane.

It also includes household contacts who have not had any direct physical contact but have spent more than 3 hours with a case.

Management: 

  • Passively monitor symptoms for 21 days after your last contact with the case. This means taking your temperature every day and watching for signs/symptoms of MPX. 
  • If you develop symptoms, isolate immediately and contact Public Health for advice.

Casual contacts

Definition: You're a casual contact if you are one or more of the following:

  • A household members who hasn't spent time with or had direct physical contact with the case or contaminated materials from the case.
  • A work colleagues in the same workspace as the case.
  • A healthcare worker who was wearing appropriate PPE throughout your interaction with a case.
  • A person on a plane with the case, but not sitting beside the case.

It also includes anyone who has had any unlisted exposure that doesn’t meet the criteria above to a probable or confirmed MPX case. The Ministry of Health have provided more information on defining the type of contact for household members and healthcare workers. 

Management:

  • No routine monitoring required. 

Read more about what to do if you are a close contact of a case. 

How can I look after myself if I have MPX?

Treatment involves managing the symptoms so make sure you:

  • Drink plenty of fluid so you stay well hydrated.
  • Eat well.
  • Get plenty of rest.
  • Take pain medicine (paracetamol) if needed for pain and fever.

How can I prevent getting MPX?

Limiting risks

If you have been in contact with a person or animal with monkeypox, be careful to wash your hands really thoroughly. Wash your hands with soap and water and dry them properly, or use an alcohol-based hand sanitiser.

Avoid close contact with people with suspected or confirmed monkeypox and don't share their clothing or bedding.

If you are travelling to a country where monkeypox is known to be present, avoid contact with animals that could have the virus (including animals that are sick or that have been found dead in areas where monkeypox occurs).

Vaccination

There is no specific vaccine for monkeypox but some Smallpox vaccines can provide protection. The Ministry of Health is working with Pharmac to explore options for access to Smallpox vaccines that can be considered for the targeted prevention of monkeypox. 

Learn more

You can read more about monkeypox and what the Ministry of Health is doing by clicking on the links below:

Monkeypox factsheet Te Aka Whai Ora & Te Whatu Ora, NZ 
Monkeypox – isolation and infection prevention and control advice for people isolating at home
Ministry of Health, NZ
Monkeypox Ministry of Health, NZ
Ministry continues to monitor Monkeypox situation Ministry of Health news article, NZ

References

Monkeypox – symptoms, treatment and outcome  DermNet NZ, 2022
Monkeypox Ministry of Health, NZ, 2022
Ministry continues to monitor Monkeypox situation Ministry of Health news article, NZ, 2022
Monkeypox World Health Organisation, 2022

Credits: Health Navigator Editorial Team. Reviewed By: Dr Minja Bojic, Primary Care Clinical Lead, Northern Region Health Coordination Centre Last reviewed: 02 Aug 2022