**UNDER REVIEW** Mpox (Monkeypox) Frequently Asked Questions

What is mpox?

Mpox is an uncommon infection that produces a spotty, itchy and sore rash, and sometimes a fever. It can affect the whole body or there may be a small number of lesions just in one area. It is caused by a virus - the monkeypox virus - which is found naturally in some animals in Central and West Africa. It does not spread easily between people. It takes close contact to spread. The biggest risk of spread between people is through sexual contact or close contact with household members.

It can also be spread through:

• touching clothing, bedding or towels used by someone with the mpox rash
• touching mpox skin blisters or scabs
• the coughs or sneezes of a person with mpox

Mpox infection is usually a self-limiting illness and most people recover within weeks, although it can occasionally cause severe complications including death.

Why is mpox in the news now?

Mpox is in the news now because there have been many thousands of cases of mpox in countries where the virus is not found naturally, and mpox has now been confirmed in Ireland. For the latest figures on case numbers globally see the 2022 Mpox Outbreak Global Map. This outbreak is unusual because the vast majority of the cases do not have a travel link to Central or West Africa. Also, many of the cases in this outbreak are men who self-identify as gay, bisexual or other men who have sex with men (gbMSM).

How can you catch mpox?

You can catch mpox if you:

• Come in contact with the rash, rash fluid or scabs of a person who has mpox, especially if you are caring for the sick person, living with the sick person, or if you are the sexual partner of a sick person
• Touch objects contaminated by an infected person such as bed linen, towels or clothing
• Are in close contact with an infected person and breathe in the virus which can be passed on when they cough or sneeze.

You can also catch mpox in countries where mpox is found naturally in animals if you:

• Touch or handle an animal that is infected with mpox
• Are bitten or scratched by an animal with mpox
• Eat bushmeat that is infected with mpox (especially if it has not been thoroughly cooked, or if the meat is still bloody)
• Touch objects contaminated by infected animals (such as bedding), or products from infected animals (such as animal hides).

An infected person can pass the infection on to another person (especially sexual partners, and household members). Occasionally, mpox can be passed to other people who are in close contact with the sick person.

What are the symptoms of mpox?

Mpox symptoms can appear in two stages, however, some people may only have a rash:

• Initial symptoms: The first stage usually begins with a sudden onset of fever (higher than 38.5⁰C) and chills, followed by a bad headache, swollen glands (in the neck, under the arms, in the groin) and exhaustion. There may also be muscle ache, backache, cough and runny nose, and gastrointestinal symptoms (vomiting and diarrhoea).  Not everyone with mpox has these initial symptoms.
• Rash: 1 to 3 days after the fever starts, an itchy rash appears. It may first appear on the face and spread to other parts of the body. The rash generally is only seen on the face, palms of the hands, soles of the feet and occasionally in the mouth. The rash starts like pimples, that grow and turn into sores. Scabs then form, which eventually drop off. Following sexual contact, the rash can also be found in the genitals and around the anus, and may not spread elsewhere. Not everyone will experience all the symptoms of mpox. Rash in the anogenital area, or complications of the rash such as rectal pain, may be the main symptom. Some people may have only a small number of lesions. The images below (courtesy of UKHSA) show the different stages of the mpox rash.

Images courtesy of UK Health Security Agency

Mpox infection is usually a self-limiting illness and most people recover within weeks, although it can occasionally cause severe complications, including death. In endemic Mpox infection, severe illness has been seen in people with very weak immune systems, pregnant women and in very small babies.

In which countries is mpox found naturally in animals?

Monkeypox virus is found naturally in certain Central and West African countries. Mpox has been found in Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ivory Coast, Liberia, Nigeria, the Republic of the Congo and Sierra Leone. Mpox is not found naturally in animals in Ireland.

There are two main clades (variants) of mpox: Clade one (I) (formerly Congo Basin clade) and Clade two (II) (formerly West African clade). Clade II consists of two subclades (IIa and IIb). Clade IIb is the primary group of variants circulating in the 2022 global outbreak.

How infectious is mpox?

Mpox, fortunately, is not very infectious. If a person catches mpox, they generally begin to develop symptoms after about 1 to 2 weeks (but symptoms can take up to 3 weeks to appear). The person is infectious (they can pass the infection on to other people) from the point at which they develop a fever (or just before the rash appears if they don’t have a fever), until their rash is completely healed.

How long are people sick with mpox?

People with mpox generally recover in 2 to 4 weeks, depending on the severity of their infection.

How is mpox diagnosed?

If mpox is suspected, samples are taken from the skin rash and sent away to a specialist lab. If you don’t have a rash but have other symptoms, a swab from your throat might be taken.

Can mpox be treated?

There is no medicine that can cure mpox but sometimes medicines against viruses in general can be used to lessen the impact of the disease. Mostly, management of mpox involves treating any uncomfortable symptoms, such as pain or itch, keeping the person warm, comfortable and relaxed, and making sure they get plenty of fluids. This allows the person’s own body defences to fight the infection. The great majority of people with mpox make a full and uneventful recovery. If a person becomes unwell and needs to go to hospital they will be isolated in a separate, special hospital room so that the risk of further spread is kept to a minimum.

Who is at risk of catching mpox from a person with mpox?

Mpox can be passed to other people who are in close contact with someone with mpox. Contact with household members or sexual contact poses the biggest risks of person-to-person spread. It is important that any further spread of the infection is stopped, therefore, household and sexual contacts, and any other people who had close contact with the person with mpox, will be monitored for three weeks to make sure they don’t develop symptoms.

Why are there cases in the gbMSM community?

Anyone, regardless of their sexuality, can get mpox if in close physical contact with a case. However, many of the cases in the current multi-country outbreak are in men who self-identify as gay, bisexual or other men who have sex with men (gbMSM).

A community engagement response is underway to create awareness within the gbMSM community about mpox and its symptoms, including the development of key messaging that is informative but does not stigmatise. This has been designed by representatives from man2man.ie and MPOWER in collaboration with the HSE and has been recognised as best practice in Europe. [Epi Insight article]

As the virus spreads through close contact, the HSE is advising those who self-identify as gbMSM to be alert to any unusual rashes or vesicular lesions (fluid filled blisters) on any part of their (or their partner’s) body, including their genitalia and anus. If they do notice any such changes, they should contact their local STI Clinic or their General Practitioner (GP) for advice. They should keep away from other people and not engage in sexual contact until they have been seen.

A list of public STI services is available on the HSE’s Sexual Wellbeing website https://www.sexualwellbeing.ie/sexual-health/hse-sti-services-in-ireland.html.

How do I reduce my risk of mpox if I have multiple sexual partners?

• As mpox is passed on through very close contact, sexual contact can result in transmission. Those with multiple sexual partners might consider limiting sexual contact during this time and should be alert to the symptoms of mpox. Anyone, regardless of their sexuality, can get mpox.
• Condoms may be useful to reduce mpox transmission during some types of sex, but because mpox can be transmitted through close contact with rash on parts of the body that condoms don't cover, they won't offer full protection.
• If you have a rash, contact your local sexual health clinic. Keep away from other people and do not engage in sexual contact until you have been seen. A list of public STI services is available on the HSE’s Sexual Wellbeing website https://www.sexualwellbeing.ie/sexual-health/hse-sti-services-in-ireland.html.

I think I have an mpox rash, what do I do?

If you have a rash that looks like an mpox rash, contact your local sexual health clinic or general practitioner. Keep away from other people and do not engage in sexual contact until you have been seen.

Who is a close contact of a person with mpox?

A person with mpox infection may pass on the infection to close contacts from the time they have symptoms until the rash is fully healed. A close contact is someone who has been in close proximity to the person with mpox (this can mean sexual or household contacts and health & care workers caring for the patient) during the time the person may have been infectious.

Public Health doctors will ask the person with mpox who they were in contact with during the time that they had symptoms. Public Health doctors will then determine who needs to be followed up as a close contact. Close contacts will be asked to monitor themselves for symptoms of mpox for 21 days. Depending on how a person was exposed and their personal circumstances, some close contacts may be advised to reduce contact with vulnerable people (those with very weak immune systems, pregnant women, and young children) and avoid close physical contact. Some contacts may need to avoid sexual contact during their period of monitoring.

Is there a vaccine against mpox?

Please see the latest HSE advice on mpox vaccination. 

How do I reduce my risk of mpox if I am travelling to a country with naturally occurring mpox?

• Try to avoid people who are sick, especially if they have a fever or rash.
• If you are staying with someone who is sick, make sure they are seen by a doctor.
• If you are caring for a sick person, make sure to wear rubber/latex gloves, a splash-proof gown and a facemask.
• After seeing or caring for a sick person, make sure to wash your hands thoroughly.
• If you eat bushmeat and other meats, make sure they are thoroughly cooked, and hot through.
• If you are handling any animals (especially sick animals), make sure you wear rubber/latex gloves and thoroughly wash your hands afterwards.
• Avoid contact with any bedding that has been in used for a sick animal

If you get sick while you are away, be sure to contact a doctor to get medical advice.

Version 5.3
Last updated: 18 October 2022