Monkeypox is an infectious disease caused by the Monkeypox virus of the Orthopoxvirus genus. It is endemic in West and Central Africa. In 2022, monkeypox spread to nonendemic regions and was declared a public health emergency of international concern by the WHO. Monkeypox is primarily transmitted via skin-to-skin contact with lesions from an infected individual or from a bite or scratch from an infected animal. Clinical features include flu-like symptoms, lymphadenopathy, and a painful, vesicular rash that typically develops 1–4 days after the onset of fever. Diagnosis is confirmed by PCR from a sample of the lesion. Affected individuals generally recover within 2–4 weeks with supportive treatment. Individuals with severe disease may be treated with antivirals. Two vaccines are currently available for use against monkeypox.
- Endemic in West and Central Africa 
- Travel-associated outbreak in the UK in May 2022, with subsequent cases in continental Europe, North America, South America, and Australia 
- On July 23, 2022, the WHO declared the monkeypox outbreak a public health emergency of international concern. 
Epidemiological data refers to the US, unless otherwise specified.
- Pathogen: Monkeypox virus (dsDNA virus of the Orthopoxvirus genus in the family Poxviridae) 
- Reservoir: rodents, apes, monkeys, humans 
- Incubation period: 5–21 days 
Risk factors for monkeypox infection and groups at risk include:
- MSM) with multiple partners  (
- Occupational exposure
- Exposure to animal reservoirs
- Typically lasts 1–4 days
- Characteristic monkeypox rash 
- Upper respiratory
Perform a thorough clinical evaluation and obtain PCR testing if indicated.
While PCR testing alone is required to diagnose monkeypox, additional laboratory studies (e.g., CBC, CMP) can identify individuals with severe disease who have indications for inpatient management and/or antiviral therapy.
PCR testing 
- Characteristic monkeypox rash
- OR clinical suspicion and the presence of one or more of the following within 21 days of symptom onset:
- Close or intimate contact with someone who has:
- A similar rash
- Confirmed or probable monkeypox
- Travel to a country with monkeypox cases or to an endemic region
- Contact with animals, or products derived from animals, known to carry monkeypox
- Close or intimate contact with someone who has:
Contact the local or state health department for further guidance on testing.
- Isolate patients during evaluation.
- Obtain two separate swabs from multiple lesions (if present).
- Do not unroof lesions prior to swabbing.
- Send samples for nonvariola Orthopoxvirus PCR test.
Advise patients to remain isolated while awaiting test results, which may take 2–3 days.
Severe monkeypox (or risk factors for severe monkeypox)
- Consult infectious diseases.
- Consider antiviral treatment.
- Monitor and treat in an inpatient setting.
- Mild or uncomplicated disease: outpatient management
- Provide supportive care.
- Educate about infection prevention and control measures.
- Report cases to the local department of health.
Severity assessment 
- Severe monkeypox 
- Risk factors for severe monkeypox 
Isolation recommendations may vary regionally and may change as the mechanisms of the spread of monkeypox infection are better understood.
- Outpatient: Isolate at home until the illness has resolved.
- Hospitalized individuals: Isolate in a single-person room with a dedicated bathroom with:
- during aerosol-generating procedures
- Sexual abstinence until all crusted lesions have healed
- Consistent use of condoms for at least 12 weeks after recovery
Advise patients to avoid the following until all lesions have healed: close contact with people and animals, using contact lenses, shaving skin with lesions, and sharing household or personal items.
Patients are contagious until crusts have fallen off and new skin has formed.
- Antiviral therapy
- Intravenous vaccinia immune globulin: unknown effectiveness but can be considered in severe cases
Supportive care 
- Skin lesions
- Oral lesions
- Additional considerations
- Sepsis or septic shock
- Bacterial superinfection (e.g., cellulitis, abscess, necrotizing soft tissue infection)
- Blindness (following corneal infection)
- Acute respiratory distress syndrome
- Hemorrhagic disease
We list the most important complications. The selection is not exhaustive.
- Affected individuals typically recover within 2–4 weeks. 
- Mortality: 1–10% (esp. children and immunocompromised individuals)
Primary prevention 
- Indication: all patients with any known monkeypox exposure
- Duration: 21 days
- Activity restrictions are not required during monitoring.
- If symptoms develop, isolate until evaluation by a health care provider.
- Indication: prolonged, close contact of lesions, body fluids, or fomites in an infected individual and mucus membranes or broken skill in an exposed individual
- Preventive if administered within 4 days of exposure
- has been considered for use in the 2022 monkeypox outbreaks in different parts of the world.
- Vaccinia immune globulin: for individuals with severe T-cell immunodeficiency in whom vaccination is contraindicated