Human monkeypox, a rare but contagious illness that descends from the same family of virus that causes smallpox and cowpox, is spreading in several countries, including the U.S., that don’t normally experience outbreaks.

So far more than 100 cases have been reported in Maryland, and hundreds more have been identified in New York, California, Florida, Texas and elsewhere across the country. In all, there have been more than 4,600 cases in the U.S. since the spring.

The World Health Organization declared a global public health emergency last week in response to the growing case counts, the highest designation it can give to a harmful virus spread.

While infections have been primarily concentrated among men who have sex with men, anyone who is exposed to someone with the disease is at risk of contracting it. Monkeypox spreads via intimate and prolonged contact with an infected person, who will often have a rash, scabs or sores. It can also spread via respiratory droplets or by touching items that previously had contact with an infected person’s bodily fluids.

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Here’s a roundup of what you should know about the monkeypox outbreak, sourced from a slate of regional experts in public health, epidemiology and infectious diseases.

Have a question that isn’t answered here? Send us a note and we’ll get back to you.

Why is there a monkeypox outbreak and when did it start?

The source of the monkeypox outbreak isn’t known. Clusters of human monkeypox cases began being identified in several countries in May, and health officials reported the first case in Maryland last month. Europe currently is considered the epicenter of the outbreak.

This is the first instance of a human monkeypox outbreak outside of Central and West African countries, said Dr. Amesh Adalja, an infectious disease physician and senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health.

Adalja said monkeypox isn’t considered a threat to the general public at this point. For now, the focus and resource prioritization is being centered on gay men, bisexual men and men who have sex with men, where a large portion of the cases have been identified. It is not considered a sexually transmitted infection, though it is believed it can spread during sexual contact.

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“It technically can spread in respiratory droplets, but that’s not what is driving transmission,” Adalja said. “We need to concentrate our efforts based on what epidemiology is telling us and right now, it’s heavily being driven by men who have sex with men.”

Is monkeypox preventable?

Until monkeypox vaccines become more widely available, there are steps that can minimize the threat of exposure, said Amit “Mickey” Dhir, a nurse practitioner at Chase Brexton Health Care, a regional health care provider that specializes in serving marginalized and medically underserved communities.

Dhir said those steps include avoiding close contact — including skin-to-skin and sexual contact — with people who have a rash, even rashes that may not look like monkeypox. People should also avoid touching others’ rashes and scabs; sharing utensils, skin care products, bedding, towels, clothing, sex toys and other sex fetish gear; and minimizing prolonged, face-to-face contact with people who may have been exposed.

People should also consider exercising caution in certain situations such as bathhouses, saunas, hot pools or other areas where there could be sexual activity, Dhir said.

How easily does it spread?

Dhir said monkeypox doesn’t spread easily: It requires prolonged, intimate contact with someone who is infected.

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That said, there’s still much that remains unknown about this particular outbreak. For this reason, Dhir recommends weighing day-to-day activities — such as going to the mall to try on clothes — more carefully than usual.

“People do not have to cancel their travel plans,” Dhir said. “Out of caution, I recommend people wear masks … especially in crowded locations, in indoor, public venues or other crowded events.”

I’m considered high-risk of contracting monkeypox but can’t find a vaccine appointment. What do I do?

The U.S. Centers for Disease Control and Prevention has prioritized a small number of people for vaccines at this time: those who have been exposed to monkeypox or have had close contact with someone diagnosed with monkeypox; people who have had recent sexual contact with someone diagnosed with monkeypox; people with multiple sexual partners in the past two weeks in an area with known monkeypox cases; and people whose jobs might have exposed them, such as health care providers, laboratory workers and those handling animals with monkeypox.

Federal regulators are sending vaccine doses to state health departments, and individual states are using different guidelines to decide who gets vaccines. People who think they may have been exposed to someone with monkeypox should contact their health care providers as soon as possible.

The Baltimore City Health Department is holding a certain number of doses for people who have been exposed. It’s not clear how many more vaccines will arrive in the coming weeks or when supply is expected to increase. For now, 200 doses have been allocated to the city, with 200 more expected to complete a two-shot series, state health officials said.

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“Vaccines have been distributed by portion of the population at higher risk as well as the number of cases,” Maryland Department of Health spokesman Chase Cook said. “We are working with our federal partners to order as much vaccine as possible.”

I think I’ve been exposed to someone with monkeypox. What are my next steps?

State health officials said people who have been exposed to monkeypox should follow the treatment and prevention recommendations of health care providers and seek out testing to confirm spread. People without health providers or health insurance can visit this website to find a health department near them.

It can take anywhere from five to 21 days for the first symptoms of monkeypox to appear. People aren’t considered contagious during the incubation period.

“You become contagious when you develop symptoms, which is why it’s a containable virus,” Hopkins’ Adalja said. “If you can get the vaccine within four days, you can blunt the ability of the virus to cause disease and decrease the severity of infection.”

Jean Murray, Luminis Health’s director of infection prevention and epidemiology, said symptoms of monkeypox can vary, sometimes starting as a fever or headache, and can include muscle aches, swollen lymph nodes, chills, exhaustion, and rashes that can resemble pimples or blisters.

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These rashes can appear on the face, hands, feet, chest and genitals, or inside the mouth or anus.

“The sores can be painful, especially in certain parts of the body, such as your genitals or in the mouth,” Murray said. “Calamine lotion can help soothe itchy blisters caused by monkeypox. Avoid the use of ointments. Washing the lesions with soap and water and covering them with loose clothing will help keep them clean and dry and prevent skin infections.”

Murray also said the course of an illness can last several weeks, and infected individuals should remain isolated until the lesions heal into new, healthy skin.

State health officials also said those who may have been exposed should avoid close physical contact with others until they have spoken to their health care providers.

Can monkeypox be fatal?

The CDC reports that people with the monkeypox virus identified in this outbreak — the West African type — are not considered at risk of fatality. More than 99% of people who get this form of the disease are likely to survive, according to the agency. Some cases can be extremely painful, however, and could lead to permanent scarring.

There also are some groups that are considered more at risk of serious infection, including people with weakened immune systems, children under 8 years of age, people with a history of eczema and people who are pregnant or breastfeeding.

“Most at risk are those with close contact and also people with suppressed immune systems: those are the folks we are focusing on,” Dhir, of Chase Brexton, said. “As for toddlers and kids, I wouldn’t consider them high risk in terms of close contacts — these are generally adults with more intimate contact.”

How can I get a vaccine? When will more doses become available?

More vaccines are becoming available each day but for now remain extremely limited. Health officials in other states are deviating from the recommended two-dose vaccine regimen and offering more people first doses, similar to what happened in the first months of the COVID-19 vaccine being made available.

There are two vaccines in the Strategic National Stockpile for infection prevention: JYNNEOS and ACAM2000. JYNNEOS is in extremely high demand because it can be administered to most people and is thought to have less severe side effects. It is not recommended for people who have experienced allergic reactions to past JYNNEOS vaccinations or who are allergic to its vaccine ingredients. ACAM2000 is not recommended for people who are immune suppressed, people with eczema and people who are pregnant.

Also used to prevent smallpox infections, ACAM2000 is a live virus vaccine that stays in the body for long periods of time. People in close contact with those who have been vaccinated with ACAM2000 can contract the live virus. It can also cause myocarditis, or inflammation around the heart muscle. So far, states have not ordered ACAM2000.

“Because JYNNEOS is available, and monkeypox is not as lethal as smallpox, we can use the safer alternative [to ACAM2000] that’s out there,” Adalja said.

Are the vaccines considered effective?

The vaccines are considered effective at preventing monkeypox, though there isn’t much data available.

“We don’t know what these vaccines are going to do in the current outbreaks. The data we have is from animal studies, and animal studies show it has been effective,” Dhir said.

What is the statewide plan for addressing outbreaks in nursing homes and other congregate care settings?

State health officials said they are monitoring facilities but have no evidence of transmission in congregate care centers at this time. Most people do not require the vaccine right now, Dhir said.

“In any pandemic, we need to prioritize where this is happening and get there first,” he said. “Gay and bisexual men are making up a disproportionate number of cases, and we are responding appropriately.”

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