Mpox

Mpox is a rare viral illness that has not often been seen in the United States, although sporadic outbreaks have occurred in the past. It can cause a rash that looks like bumps, blisters, or ulcers. Some people have flu-like illness before the rash develops. Most people recover in 2–4 weeks, but the disease can be serious, especially for children and people who are immune compromised or pregnant.

How mpox is spread

Mpox can spread between people through close physical contact (skin-to-skin), including sexual contact, with a person who has mpox or contact with objects that have been used by a person with mpox.

Anyone can be infected with mpox if they have close physical contact with someone who has mpox, regardless of gender identity or sexual orientation. However, many of those affected in the current global outbreak are among gay and bisexual men, or other people assigned male at birth who have sex with men, including non-binary, genderqueer and/or transgender people.

Routes of transmission include:

• Direct physical contact with mpox rash, sores, or scabs from a person with mpox; CDC believes this is currently the most common way that it is spreading in the U.S.
• Kissing or other prolonged face-to-face contact due to respiratory droplets or oral fluids (i.e., saliva)
• During sex through skin-to-skin and other intimate sexual contact
• Contact with objects, fabrics (e.g., clothing, bedding, or towels), and surfaces that have been used by someone with mpox is possible

Signs and symptoms of mpox

The illness can begin with flu-like symptoms, including fever, headache, back and muscle aches, swollen lymph nodes, and general exhaustion, followed by a rash (usually painful) that can look like pimples or blisters.

• Symptoms usually start within 2 weeks of exposure to the virus; however, symptom onset can occur up to 3 weeks later.
• People usually develop a rash or sores within 1-3 days of symptoms beginning.
• The rash or sores may appear like a sexually transmitted infection, especially if the rash or sores are located around the genitals or anus. The rash or sores may appear on or near the genitals or anus, but sometimes appear in other areas, such as the hands, feet, chest, face, or in the mouth.
• Sores often go through several stages before healing, which takes about 3 weeks.
• An individual is considered contagious once symptoms appear; they remain contagious until all sores have healed, a new layer of skin is formed, and scabs have fallen off. 

You can reduce your risk by taking the following precautions:

• Avoid close physical contact (including sexual contact) with people who are sick or have a rash and their household/contaminated items. Do not kiss, hug, or share eating utensils, cups, towels, or bedding.
• Decrease the number of sex and intimate contact partners.
• Do not go to places like bathhouses or other public sex venues. 
• Avoid gatherings where people wear minimal clothing and have direct, intimate, skin-to-skin contact. For those who attend these gatherings, avoid contacting rashes or sores you see on others and minimize skin-to-skin contact.
• Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially before eating or touching your face and after you use the bathroom.
• Follow CDC guidance for social gatherings.

Settings and events where attendees are fully clothed and unlikely to have prolonged skin-to-skin contact are low risk (e.g., University classrooms and workplaces). However, if attending an event, please avoid activities like kissing or sharing drinks and eating utensils that can increase the risk for spreading mpox.

Researchers who work with the mpox virus should follow the biosafety and occupational health requirements outlined in their Biological Use Authorization Letter.

Clinical settings, including UW Medicine and School of Dentistry, should follow their unit’s infection prevention practices for treating patients with known or suspected mpox.

Contact your healthcare provider immediately for an evaluation if you develop a new, unexplained, rash or lesions on any part of the body. They can help get you access to the appropriate testing, if needed. In addition:

• Avoid sex or other close, intimate contact with others until you have been evaluated.
• Cover any rashes you may have.
• Avoid gatherings until symptoms have resolved, especially if they involve close, personal, skin-to-skin contact or prolonged face-to-face contact.
• Talk to your partner(s) about any recent illness and be aware of new or unexplained sores or rashes on your body or your partner’s body, including on the genitals and anus.

If a healthcare provider suspects or confirms you have mpox

Isolate at home until the rash has fully resolved, the scabs have fallen off, and a fresh layer of intact skin has formed. This is when you are no longer contagious to others. Please note this may last between 2 and 4 weeks.

• Stay home and separate from other people and pets in your household. If you cannot fully separate from others in your household, wear a facemask and avoid physical contact.  
• Wear clothing that covers your lesions when in shared spaces. If you must leave home for essential needs or medical care, cover your rash/sores with clothing and wear a facemask.
• Do not share or let others touch your clothing, towels, bedding, or utensils. Do not share a bed. Handle and do your own laundry, if possible.
• Do not share dishes, food, drinks, or utensils. Wash dishes with warm water and soap or in a dishwasher.
• Wash your hands often. Household members should also wash their hands often, especially if they touch materials or surfaces that may have come in contact with your rash or sores.
• Clean and disinfect shared surfaces, such as countertops and doorknobs, frequently.
• Follow CDC mpox isolation guidelines. In addition, follow any additional guidelines provided by your healthcare provider.
• Follow the Mpox Infection Prevention and Isolation Guidelines for University Residence Halls and Shared Living Spaces if these apply to your living situation
• Ask your healthcare provider about treatment options.

Reporting

While most individuals in the UW community are not required to report a mpox infection to the University; please notify Environmental Health & Safety in the following scenarios:

• Students in University residence halls: If a healthcare provider suspects or confirms mpox infection, notify Environmental Health & Safety for isolation guidelines to limit spread.
• Exposure due to University workplace or instructional activities or at a University setting: If units, personnel, and students have questions or concerns about potential exposure to mpox in a University setting or due to University work or instructional activities, notify Environmental Health & Safety. 

Outside of the above scenarios, reporting a suspected or confirmed infection to the University is not required.

Personnel with questions about leave and accommodations needed while they are isolating can contact their supervisor, or a human resources consultant or academic human resources business partner for assistance.

Students may choose to contact their instructors to make up coursework when isolating at home; however, students are not required to share personal health information with their instructors.

Mpox vaccines, when properly administered before or after a recent exposure, can be an effective tool for protecting people against mpox illness and can make it less severe. 

Supplies of the mpox vaccine are currently limited, both locally and nationally. Many health jurisdictions are prioritizing vaccination to those who are at high risk for infection. Availability of vaccines is expected to change as the outbreak evolves. The U.S. Department of Health and Human Services announced an enhanced strategy to vaccinate and protect at-risk individuals from mpox.

Talk with your healthcare provider if you have questions about getting vaccinated against mpox.

UW Medicine has guidance for vaccine eligibility and distribution on the UW Medicine mpox webpage.

King County has a limited supply of mpox vaccine and is currently prioritizing those at high risk for infection. Visit the Public Health – Seattle & King County mpox vaccine Q&A page for more information.

Pierce County is working with the Washington State Department of Health to develop their vaccine strategy. Visit the Tacoma-Pierce County Health Department mpox website for more information.

Visit the Washington state, King, Pierce, and Snohomish health department websites, the CDC Mpox webpage, or the World Health Organization Mpox website for more information.

Public health entities nationally and internationally are still learning about the behaviors that may put people at increased risk and we will continue to share information with the community as we learn more.

Decreasing risk of stigma

The UW Advisory Committee on Communicable Diseases is committed to informing the UW community about health issues that may affect them. We recognize that there is risk for stigma or discrimination when communicating about a new disease outbreak. We all have a responsibility to call out any stigmatizing words or actions related to mpox virus and instead, share factual information so that people can make the best decisions for their own health and the health of our community.