Last updated: November 17, 2023

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Summarytoggle arrow icon

Mpox (monkeypox) is an infectious disease caused by the Monkeypox virus of the Orthopoxvirus genus. It is endemic in West and Central Africa. In 2022, mpox spread to nonendemic regions and was declared a public health emergency of international concern by the WHO. In the wake of the 2022 epidemic, the WHO changed the name of the disease from monkeypox to mpox because of concerns about stigmatizing language. Mpox 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 mpox.

Epidemiologytoggle arrow icon

  • Endemic in West and Central Africa [2]
  • Travel-associated outbreak in the UK in May 2022, with subsequent cases in continental Europe, North America, South America, and Australia [3]
  • On July 23, 2022, the WHO declared the mpox outbreak a public health emergency of international concern. [4]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Clinical featurestoggle arrow icon

Diseases with a similar blistering appearance such as chickenpox and smallpox typically do not cause lymphadenopathy.

Diagnosticstoggle arrow icon

Perform a thorough clinical evaluation and obtain PCR testing if indicated.

While PCR testing alone is required to diagnose mpox, 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 [9][10][11]


  • Characteristic mpox 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:
    • Travel to a country with mpox cases or to an endemic region
    • Contact with animals, or products derived from animals, known to carry mpox


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.

Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Managementtoggle arrow icon

Approach [8][10][11]

Severity assessment [8][10]

Infection control [8][10]

Isolation recommendations may vary regionally and may change as the mechanisms of the spread of mpox infection are better understood.

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.

Pharmacotherapy [10]

The following therapies can be used off-label under expanded access (compassionate use) protocols.

Supportive care for mpox [8][10]

Complicationstoggle arrow icon

We list the most important complications. The selection is not exhaustive.

Prognosistoggle arrow icon

Preventiontoggle arrow icon

Primary prevention [12][13]

Two live Vaccinia virus vaccines are available.

  • Preparations
    • JYNNEOS: 2 doses given 4 weeks apart (vaccine is effective 2 weeks after the second dose)
    • ACAM2000: single dose (vaccine is effective after 28 days)
  • Indications
    • Occupational exposure
    • Exposure to animal reservoirs
    • Sexual exposure
      • Bisexual, gay, or other MSM, and transgender or nonbinary individuals with an STI and/or ≥ 1 sex partner within the past 6 months
      • Individuals who have had sex at a commercial sex venue and/or sex in association with a large public event in an area with a known mpox outbreak within the past 6 months
      • Sexual partners of any of the above individuals
    • Immunosuppression and recent or anticipated potential exposure to mpox

Secondary prevention [10][12]

Mpox postexposure prophylaxis

Monitoring for clinical features of mpox

  • Indication: all patients with any known mpox exposure
  • Duration: 21 days
  • Activity restrictions are not required during monitoring.
  • If symptoms develop, individuals should isolate until evaluation by a health care provider.

Referencestoggle arrow icon

  1. Monkeypox. Updated: May 19, 2022. Accessed: June 22, 2022.
  2. Multi-country monkeypox outbreak in non-endemic countries. Updated: May 29, 2022. Accessed: May 30, 2022.
  3. WHO Director-General declares the ongoing monkeypox outbreak a Public Health Emergency of International Concern. Updated: July 23, 2022. Accessed: August 2, 2022.
  4. Clinical management and infection prevention and control for monkeypox: Interim rapid response guidance. Updated: June 10, 2022. Accessed: August 1, 2022.
  5. del Rio C, Malani PN. Update on the Monkeypox Outbreak. JAMA. 2022.doi: 10.1001/jama.2022.14857 . | Open in Read by QxMD
  6. Monkeypox. Updated: July 22, 2022. Accessed: August 16, 2022.
  7. Guarner J, del Rio C, Malani PN. Monkeypox in 2022—What Clinicians Need to Know. JAMA. 2022; 328 (2): p.139.doi: 10.1001/jama.2022.10802 . | Open in Read by QxMD
  8. $Contributor Disclosures - Mpox. All of the relevant financial relationships listed for the following individuals have been mitigated: Joanna Jan (medical editor, is an independent contractor for GoodRx, and is a shareholder in GoodRx, Biocept, and Rite Aid). None of the other individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.
  9. Mpox Vaccination. Updated: February 6, 2023. Accessed: November 6, 2023.
  10. Rao AK, Petersen BW, Whitehill F, et al. Use of JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) for Preexposure Vaccination of Persons at Risk for Occupational Exposure to Orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR Morb Mortal Wkly Rep. 2022; 71 (22): p.734-742.doi: 10.15585/mmwr.mm7122e1 . | Open in Read by QxMD
  11. Monkeypox: experts give virus variants new names. Updated: August 12, 2022. Accessed: August 24, 2022.
  12. Rimoin AW, Mulembakani PM, Johnston SC, et al. Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo. Proceedings of the National Academy of Sciences. 2010; 107 (37): p.16262-16267.doi: 10.1073/pnas.1005769107 . | Open in Read by QxMD
  13. Thornhill JP, Barkati S, Walmsley S, et al. Monkeypox Virus Infection in Humans across 16 Countries — April–June 2022. N Engl J Med. 2022.doi: 10.1056/nejmoa2207323 . | Open in Read by QxMD

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