FactCheck.org’s Q&A on Mpox: Separating Fact from Fiction

Editor’s Note: This Q&A has been updated for May 2022. Last summer witnessed a widespread outbreak of mpox, previously known as monkeypox. Starting in May 2022, cases of mpox began to appear in Europe and other regions outside of Central and West Africa, where the disease typically occurs sporadically. Individuals all over the world, particularly gay men and men who have sex with men, developed painful and infectious lesions associated with mpox, with some fatalities reported. By late July 2022, the World Health Organization (WHO) declared the growing outbreak a public health emergency of international concern. The United States also declared mpox a public health emergency in early August, with over 6,600 cases reported in the country by that time. However, the situation has improved over the past year. After peaking in mid-August 2022, and with the implementation of widespread vaccination campaigns in several countries, the outbreak began to subside in December. The number of daily cases globally decreased from over 1,000 to fewer than 75 by the end of the year, and from over 400 to fewer than 10 in the U.S., with further declines since then. As a result, the U.S. ended its mpox emergency in January, followed by the WHO in May. However, it is important to note that the outbreak is not completely over. Even a single confirmed case of mpox is considered an outbreak in a country. With the arrival of warmer weather and Pride month, health officials and experts are concerned about the possibility of a resurgence in mpox cases. In mid-May, the Centers for Disease Control and Prevention (CDC) assessed the risk of a resurgent mpox outbreak as “substantial.” In this article, we provide an update on the disease, discuss the unique aspects of the current outbreak, and offer advice on how individuals can protect themselves.

What is mpox?
Mpox is a rare disease caused by the monkeypox virus, which belongs to the same orthopoxvirus genus and poxvirus family as the more deadly and contagious smallpox virus, according to the CDC. Mpox is the new name for monkeypox, adopted by the World Health Organization (WHO) and the CDC in November to address concerns about stigmatization and align with best practices for disease naming. However, the virus name remains unchanged. The International Committee on the Taxonomy of Viruses is currently in the process of renaming the virus, a decision that was already underway before the outbreak occurred. Mpox is characterized by a distinctive rash and shares similarities in presentation with smallpox, although it causes lymph node swelling and is generally less severe. Mpox is a zoonotic disease, meaning that the virus is transmitted to humans from animals. People typically contract the infection sporadically in the forested regions of Central and West Africa, where the disease is endemic, through contact with an infected animal. Once infected, individuals can transmit the virus to others, but close contact is necessary. Although mpox was initially discovered in lab monkeys in 1958 (hence the name), the virus is not exclusively found in monkeys. Various species, including rope and tree squirrels, Gambian pouched rats, and dormice, can carry the virus. The natural host and source of the virus remain unknown, but it is likely to be a rodent. There are two main clades, or types, of the monkeypox virus: clade I (previously known as the Congo Basin clade) and a less lethal clade II (also formerly known as the Congo Basin clade, but now renamed). The current outbreak is caused by a subtype of the less severe clade, known as clade IIb.

When did the outbreak start, and what makes it unusual?
The mpox outbreak for 2022-2023 was initially identified in the U.K. in May 2022, although it likely began earlier. On May 13, 2022, the U.K. reported one probable and two confirmed cases of mpox from a single household to the World Health Organization. These cases involved individuals who had not traveled to an mpox-endemic area. Subsequently, additional mpox cases were detected in the U.K., as well as in other parts of Europe, Australia, Canada, and the U.S., primarily among men who have sex with men. As of June 19, mpox has spread to 112 countries, affecting nearly 88,000 people and resulting in 147 deaths. In the U.S., as of June 21, over 30,000 cases have been reported, including 43 deaths. The size and geographic scope of this outbreak, along with the demographics of the affected population, make it highly unusual. Normally, mpox is extremely rare outside of Africa, and cases are typically imported without further transmission. The first reported mpox outbreak outside of Africa occurred in the U.S. in 2003, when imported rodents from Ghana infected pet prairie dogs, which then transmitted the disease to humans. That outbreak involved 47 confirmed or probable cases, according to the CDC. However, the current outbreak has demonstrated person-to-person transmission on a scale never seen before. As the WHO states, “This is the first time that cases and sustained chains of transmission have been reported in countries without direct or immediate epidemiological links to areas of West or Central Africa.” The outbreak has also been unique due to the high concentration of cases among men who have sex with men. Of the reported mpox cases with information on sex or sexual orientation, 96.2% were in men, and 84.1% were in men who have sex with men, according to WHO data as of June 19. This does not mean that only these individuals can contract mpox, but it indicates an elevated risk.

What are the symptoms, and how severe is mpox?
Symptoms of mpox typically appear within one to two weeks after infection and resemble those of smallpox. The most common symptom is a rash, which can range from a single small lesion to a widespread eruption. Other symptoms include fever, headache, swollen lymph nodes, muscle aches, fatigue, chills, sore throat, and respiratory symptoms. In previous outbreaks, mpox usually began with fever, muscle aches, and a sore throat, followed by the development of a rash on the face that spread to other parts of the body, including the palms and soles. However, in the current outbreak, many patients develop a rash as the initial symptom or may never experience other symptoms, and the rash often remains localized. It is common for the first lesions to appear in genital areas or around the anus or mouth. Some patients may also experience rectal pain and bleeding. Initially, the rash is flat and then becomes raised and filled with fluid and pus, eventually forming scabs that fall off. The lesions are typically painful until they crust over, at which point they may become itchy. Mpox is generally a mild disease, with most individuals recovering within two to four weeks. However, the disease can be painful and highly uncomfortable. Severe cases and fatalities are possible. According to the WHO, patients can develop secondary skin infections, experience vision loss, become dehydrated or malnourished, and develop sepsis or inflammation in various organs. Individuals who are immunocompromised, including those with uncontrolled HIV, are at a higher risk of experiencing more severe disease, as are pregnant individuals and children. Fortunately, the virus responsible for the current outbreak belongs to the less lethal clade II, which has been shown to cause death in approximately 1% of affected individuals in Africa, compared to clade I, which can result in mortality rates of up to 10%, according to the WHO. However, the current outbreak’s death rate appears to be much lower than 1%, which could be attributed to improved case identification, better access to healthcare, or differences in the prevalence of immunosuppressed individuals within populations. In the U.S., the mortality rate for mpox is 0.14%. A CDC review of mpox-related deaths as of March found that “nearly all” of the fatalities were individuals who were immunocompromised, with the majority having HIV.

How is the virus transmitted, and how contagious is it?
Mpox initially spreads to humans from infected animals in endemic areas, often through bites, scratches, or any contact with the animal’s body or lesion fluids. Once humans are infected, they can transmit the virus to others through close contact. Direct contact with an infected person’s skin, particularly the rash, scabs, and fluid from the lesions, is the most common route of transmission. In the 2022-2023 outbreak, sexual contact has been the primary mode of transmission. Many patients have reported mpox rashes on their genitals or in their mouths. Therefore, mpox is considered sexually transmissible, although there is ongoing debate about whether it should be classified as a sexually transmitted infection (STI). While sexual contact is a significant mode of transmission, other forms of close contact can also facilitate the spread of the virus.



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