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Organism, Causative agent, Etiologic agent

The infectious agent of monkeypox disease is the monkeypox virus, a species in the genus Orthopoxvirus and the family Poxviridae.

Transmission Routes

Monkeypox virus can spread when a person comes into contact with the virus from an infected animal, infected person, or materials contaminated with the virus. The virus can also cross the placenta from the mother to the fetus.

Person-to-person transmission of monkeypox is primarily through direct contact with infectious lesions, scabs, or body fluids. However, prolonged exposure to an infected person’s respiratory secretions can also transmit the virus. A person with monkeypox is infectious to others from their symptom onset to until their rash has fully healed.

Examples of activities that may spread monkeypox from one person to another are wrestling, cuddling, kissing, or intimate sexual contact, including oral, anal, and vaginal sex, massage, mutual masturbation, or touching fabrics and objects that a person with monkeypox used during sex. At this time, it is not known if monkeypox can spread through semen or vaginal fluids.

Healthcare providers can become exposed to monkeypox virus while caring for infected patients. Unprotected contact with a patient’s skin, lesions, or body fluids (e.g. ungloved contact; splashing of patient’s saliva into eyes or mouth) could expose a person to monkeypox virus. Being in a patient’s room or within six feet of a patient during aerosolizing procedures (e.g. shaking used linens; contact with oral secretions or skin lesions) without the use of eye protection, a respirator or other personal protective equipment (PPE) can lead to exposure. Patient interactions where a healthcare provider uses Standard Precautions are generally not considered high risk.

There have been no documented cases of sick people infecting animals with monkeypox virus. However, it is possible that monkeypox virus may spread from animals to people through the bite or scratch of an infected animal, handling infected wild game, or using or consuming products made from infected animals. It is unknown what animal maintains the virus in nature, although African rodents are suspected of being involved in monkeypox transmission to people. A 2003 outbreak of monkeypox in the United States that caused 35 confirmed human cases in six states was associated with exposure to prairie dogs housed with small mammals imported from Africa by a Texas animal distributor.

Signs and Symptoms

Monkeypox is a severe acute illness, usually with sudden onset of initial symptoms of fever, headache, muscle aches, backache, swollen lymph nodes (lymphadenopathy), chills, and exhaustion. Clinically, the disease closely resembles smallpox, but lymphadenopathy is a more prominent feature in the early stage of monkeypox disease.

Shortly afterwards, a rash develops, usually starting on the face and spreading to other body parts. Lesions typically begin to form simultaneously and evolve together on any part of the body as they progress from small red bumps to larger pus-filled bumps to scabs before falling off. Monkeypox may not always appear the same way and could be clinically confused with a chickenpox or shingles (varicella zoster virus) or a sexually transmitted infection (STI) like syphilis or herpes. The illness typically lasts for 2−4 weeks. If someone has a very weak immune system, then the rash and illness could present differently.

Monkeypox is a serious illness, which can be painful and require hospitalization. In recent years, the case fatality rate has been 3 to 6%, and the number of deaths from monkeypox disease has been higher in young children. 

The incubation period (time from infection to symptoms) for monkeypox is usually 7−14 days but can range from 5−21 days. The rash typically begins within 5 days of the first symptoms.


People can take several measures to prevent infection with the monkeypox virus:

  • Avoid contact with people who have a new or unknown rash, lesions, or scabs. This contact can happen during activities such as wrestling, cuddling, or intimate sexual contact.
  • Avoid contact with animals that could harbor the virus, such as prairie dogs, rabbits, rope squirrels, Gambian rats, wallabies, and African tree squirrels. This includes sick or dead animals from areas where monkeypox is endemic (Central or West Africa).
  • Avoid contact with any materials, such as bedding that has been in contact with a sick person or animal.
  • Isolate infected patients from others who could be at risk for infection. For example, after consulting with your local or state health department, patients who do not require hospitalization for medical indications may be isolated at home using protective measures. 

  • The home and other areas where an infected person spent significant time should be cleaned using an EPA registered disinfectant. Cleaning methods such as disinfectant wipes, sprays, and mopping are preferred. Dry dusting and sweeping should be avoided, as these activities might spread infectious particles.
  • Use personal protective equipment (PPE) and follow standard donning and doffing procedures when caring for patients. PPE used by healthcare personnel who enter the patient’s room should include a gown, gloves, eye protection (i.e., goggles or a face shield covering the front and sides of the face), NIOSH-approved N95 filtering facepiece or equivalent, or a higher-level respirator. 
  • Practice good hand hygiene after contact with infected animals or humans. For example, washing your hands with soap and water or using an alcohol-based hand sanitizer, when soap and water are not available.
  • JYNNEOS (also known as Imvamune or Imvanex) is an attenuated live virus vaccine approved by the U.S. Food and Drug Administration to prevent monkeypox. On November 3, 2021, The Advisory Committee on Immunization Practices (ACIP) unanimously voted to recommend JYNNEOS pre-exposure prophylaxis as an alternative to the live smallpox vaccine ACAM2000 for certain persons at risk for exposure to orthopoxviruses. ACIP evaluated JYNNEOS to protect research laboratory personnel, clinical laboratory personnel performing diagnostic testing for orthopoxviruses, designated response team members, and health care personnel who administer ACAM2000 or care for patients infected with orthopoxviruses.


Currently, there is no specific treatment approved for monkeypox virus infections. However, treatment developed for use in patients with other viral illness may prove beneficial. These medical countermeasures are currently available from the CDC in consultation with the state health department. Healthcare providers should contact EAIDU monitoring as soon as monkeypox is suspected.

Texas Trends 

In 2021, a Texas resident was diagnosed with monkeypox after traveling to Nigeria.

In May 2022, in response to the multi-country outbreak of monkeypox in non-endemic countries, the Centers for Disease Control and Prevention (CDC) and the Texas Department of State Health Services (DSHS), along with local and regional public health departments, have implemented enhanced surveillance measures to identify cases of monkeypox in Texas quickly. These measures include providing education and outreach to public health agencies and clinicians in Texas, evaluating persons with suspicion of monkeypox, and monitoring contacts of confirmed cases for symptom development. A  map of the cases reported in the United States can be found on the CDC’s website (U.S. Monkeypox 2022: Situation Summary).


Monkeypox Health Alert 2022

Last updated August 10, 2022