UPDATE: 26 MAY 2022

Monkeypox outbreak
UPDATE AND ADVICE FOR HEALTH WORKERS
MONKEYPOX UPDATE

Most of the new

cases of
monkeypox are
reported in non-
endemic countries
Monkeypox, a zoonotic disease, is endemic
in West and Central Africa

• Since May 2022, several non-endemic countries in

four WHO regions have reported monkeypox cases
• Rare cases of monkeypox in other countries are
usually linked to travel to endemic countries
• However, most of the current cases do not have any
history of travel to endemic countries
• Therefore, the current outbreaks are unusual and
different from previous travel-related outbreaks

Photo: Skynews.com 2
Distribution of confirmed and suspected cases of monkeypox in non-endemic
countries between 13 to 21 May 2022

https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385
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WHAT IS MONKEYPOX?

Monkeypox is a
viral zoonotic
disease
Monkeypox is caused by the monkeypox
virus

• It is part of the Orthopoxvirus genus which includes

variola virus (smallpox) and cowpox virus
• There are two main strains, one more virulent and
transmissible (Congo Basin clade) than the other
(West African clade). The less virulent West African
clade has been identified among the current cases
• The reservoir host is still unknown, although rodents
are suspected to play a part in the endemic setting

Photo: CDC 4
Recognizing monkeypox
Signs and symptoms:
• Monkeypox is usually a self-limited disease and typically lasts 2 to 4
weeks
• It may be severe in children, pregnant women or persons with immune
suppression due to other health conditions
• The incubation period is usually 6 to 13 days and can range from 5
to 21 days
• Typical symptoms include fever, headache, muscle aches, backache,
lack of energy, swollen lymph nodes and a skin rash or lesions
• Swelling of the lymph nodes is a distinctive feature of monkeypox
Photo: CDC
compared to other diseases that may initially appear similar
(chickenpox, measles)
• The skin eruption begins within 1 to 3 days after fever onset. The rash
often begins on the face, then spreads to other parts of the body
• The rash evolves from macules (lesions with a flat base) to papules
(slightly raised firm lesions), vesicles (lesions filled with clear fluid),
pustules (lesions filled with yellowish fluid), and crusts which dry up and
fall off
• The case fatality ratio has been reported to around 3% in the African
setting, with most deaths occurring in younger age groups

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Transmission and risk of
infection
Monkeypox virus is transmitted from one person to
another by close contact

• A person with monkeypox remains infectious while they have

symptoms, normally for between 2 and 4 weeks
• Monkeypox virus is transmitted from one person to another by close
contact with lesions, body fluids and contaminated materials
such as bedding, clothing or eating utensils
• Ulcers, lesions or sores in the mouth can also be infectious, Photo: livemint.com
meaning the virus can spread through saliva
• People who closely interact with someone who is infectious, including
health workers, household members and sexual partners are at
greater risk of infection
• Transmission can also occur via the placenta from mother to fetus
(which can lead to congenital monkeypox) or during close contact
during and after birth

https://www.who.int/news-room/fact-sheets/detail/monkeypox
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Monkeypox protective measures
Protect yourself and others
• Avoid close contact with people who have suspected or confirmed
monkeypox

When caring for a person with monkeypox:

• Encourage the person to cover any lesions with a light bandage
or clothing if possible

• Wear a medical mask and ask the patient to wear one also

• Avoid skin-to-skin contact and use disposable gloves

• Clean hands regularly with soap and water or alcohol-based

hand rub, especially after contact with the patient or contaminated
materials such as bedding, clothing or eating utensils

• Wash clothes, towels, bedsheets and eating utensils with warm

water and detergent

• Wear a mask when handling any clothes or bedding

• Clean and disinfect any contaminated surfaces and dispose of

contaminated waste

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ADVICE FOR HEALTH WORKERS

Managing the spread

of monkeypox
Early detection, isolation and treatment of
persons with monkeypox could control the
spread of the disease

• Any person with suspected or confirmed monkeypox

should be isolated until their lesions have crusted and the
scabs have fallen off
• As soon as a suspected case is identified, contact tracing
should be initiated
• Contacts should be monitored daily for the onset of
symptoms for a period of 21 days
• Asymptomatic contacts should not donate blood, cells,
tissue, organs, breast milk, or semen while they are under
symptom surveillance
• Asymptomatic contacts can continue daily activities such
as work and school (i.e., no quarantine is necessary)
• Health workers who have unprotected exposures (i.e., not
wearing appropriate PPE) to patients with monkeypox or
contaminated materials do not need to be excluded from
work if asymptomatic, but should undergo active
surveillance for symptoms, at least twice daily for 21 days
following the exposure
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Photo: CDC
ADVICE FOR HEALTH WORKERS

Diagnosing a
monkeypox infection
Nucleic acid amplification tests such as Polymerase chain
reaction (PCR) is the preferred laboratory test

• If monkeypox is suspected, health workers should

collect a lesion sample and transport it safely to a
laboratory with appropriate capability
• Optimal diagnostic samples for monkeypox are from
skin lesions, the roof or fluid from vesicles and
pustules and dry crusts
• Lesion samples must be stored in a dry, sterile tube
and kept cold

https://openwho.org/courses/monkeypox-intermediate 9
Photo: WHO
 ADVICE FOR HEALTH WORKERS

Clinical care and therapeutics

Clinical care should focus on alleviating symptoms, manage
complications and prevent long-term consequences of monkeypox

Clinical care
• Skin care:
➢ Wash skin lesions with soap and water or povidone-iodine solution
➢ Treat secondary bacterial infections with topical or oral antibiotics as needed

• Eye care:
➢ Prevent corneal scarring and visual impairment with vitamin A supplementation where needed,
protective eye pads and ophthalmic antibiotics or antivirals as needed
• Mouth care:
➢ Wash mouth with warm clean salted water
➢ Use oral analgesic medication to minimize mucosal pain from mouth sores and encourage food
and fluid intake
Therapeutics
• Tecovirimat is an antiviral approved for the treatment of monkeypox by the European Medicines Agency
(EMA) in January 2022. However, It is not yet widely available
• Provide Vitamin A supplements according to standard recommendations, especially for children as it plays
an important role in all stages of wound healing and eye health 10
https://openwho.org/courses/monkeypox-intermediate
ADVICE FOR HEALTH WORKERS

Vaccines against
monkeypox
In the past, vaccination against smallpox was
demonstrated to be about 85% effective in
preventing monkeypox Photo: CDC

• At the present time, the original smallpox vaccines are no

longer available to the general public
• Research has yielded several safer vaccines for smallpox
• In 2019, one new vaccine was approved for the
prevention of smallpox and monkeypox
• Availability of this two-dose vaccine remains limited
• Member States may want to consider vaccination of close
contacts as post-exposure prophylaxis or pre-exposure
vaccination of laboratory personnel and health workers

https://openwho.org/courses/monkeypox-intermediate 11
WHO and Member State public
health actions
✓ WHO and partners are working with Member States to understand the source and characteristics of the
current outbreaks and raise awareness of monkeypox symptoms and protective measures

✓ WHO has developed surveillance case definitions and new guidance for laboratory testing for the
current monkeypox outbreak in non-endemic countries

✓ Public health investigations are ongoing, including extensive case finding and contact tracing, laboratory
investigation, clinical management and isolation provided with supportive care

✓ Genomic sequencing has been undertaken to determine the monkeypox virus clade(s) in this outbreak

✓ Vaccination for monkeypox is being deployed in some countries to manage close contacts, such as
health workers. WHO is convening experts to discuss recommendations on vaccination

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Additional resources
Multi-country monkeypox
outbreak in non-endemic Key facts about
countries Monkeypox
https://www.who.int/news-room/fact-
https://www.who.int/emergencies/disease- sheets/detail/monkeypox
outbreak-news/item/2022-DON385

OpenWHO: Monkeypox
introduction WHO website:
https://openwho.org/courses/monkeypox- Monkeypox
introduction https://www.who.int/health-
https://openwho.org/courses/variole-du- topics/monkeypox/#tab=tab_1
singe-introduction

OpenWHO: Monkeypox
epidemiology, preparedness Monkeypox Q&A
and response
https://www.who.int/philippines/news/q-a-
https://openwho.org/courses/monkeypox- detail/monkeypox
intermediate

https://openwho.org/courses/variole-du-
singe-intermediaire/

Monkeypox outbreak toolbox Monkeypox: public health advice

for gay, bisexual and other men
https://www.who.int/emergencies/outbreak-
toolkit/disease-outbreak-
who have sex with men
toolboxes/monkeypox-outbreak-toolbox https://www.who.int/publications/m/item/monke
ypox-public-health-advice-for-men-who-have-
sex-with-men
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