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Monkeypox

Find answers to frequently asked questions about Monkeypox. The information, and resources, below are updated regularly, so make sure to check back often to ensure you are receiving the most up to date information. 

Monkeypox is a viral infection caused by the monkeypox virus that can infect animals and humans and has historically spread at low levels in countries across Central and Western Africa.  

In May 2022, public health officials began tracking a global outbreak of monkeypox that has spread across several countries that don’t normally report monkeypox. The monkeypox virus spreads mostly through close, intimate contact with someone who has monkeypox. Cases currently appear to be spreading within sexual and social networks and have been observed among men who have sex with men. However, the risk of monkeypox is not limited to people who are sexually active or men who have sex with men. Anyone can get or pass along monkeypox. BPHC wants to reiterate that stigmatizing people because of a disease is never acceptable. We need to advocate against stigma and discrimination: We are all in this together. 

All Boston residents living in the City of Boston who are diagnosed with monkeypox are contacted and followed by the Boston Public Health Commission’s Infectious Diseases Bureau  throughout their disease course to provide information and support. 

The Basics

The Basics

Monkeypox is not a gay disease. The risk of monkeypox is not limited to people who are sexually active or men who have sex with men.

Anyone can get or spread monkeypox. Monkeypox is most commonly spread through close and sustained intimate contact, including:

  • Direct “skin to skin” or “skin to mouth” contact with monkeypox rash, sores, or scabs:
  • Sexual contact
  • Touching, hugging, massaging, kissing
  • Prolonged face to face contact with respiratory droplets from a person with monkeypox (less common)
  • Pregnant people can spread the virus to their fetus through the placenta
  • Animal to human transmission is also possible, ex. by being scratched or bitten by the animal or by preparing or eating meat or using products from an infected animal.

A person with monkeypox is considered infectious from the beginning of symptoms. They can stay that way until sores have crusted, scabbed over, fallen off, and a fresh layer of healthy skin has formed underneath. This can often take several weeks.

Our priority is to raise awareness of monkeypox among our residents, communities, and healthcare partners. This is important because:
  1. Infected people can notice their symptoms early, stay away from others, and seek care from a healthcare provider.
  2. Public health authorities and medical providers can identify cases early and notify close contacts and those who may have been exposed to monkeypox so they can be vaccinated to prevent infection. 
  3. Individuals can learn how to protect themselves from getting infected

Vaccination

Vaccination
When properly administered before or soon after exposure, vaccines can help protect against monkeypox illness.

The vaccine most commonly used for preventing monkeypox infection is JYNNEOS (also known as Imvamune or Imvanex) which has been licensed by the U.S. Food and Drug Administration (FDA). The JYNNEOS vaccine requires two shots, 28 days apart for maximum effectiveness. People are considered fully vaccinated about two weeks after their second shot. However, people who get vaccinated should continue to protect themselves from infection by avoiding close, skin-to-skin contact, including intimate contact, with someone who has monkeypox.

According to the Massachusetts Department of Public Health, vaccination will be available to individuals who live or work in Massachusetts and meet the CDC’s current eligibility criteria, prioritizing those who are most at risk of exposure to an individual with monkeypox. This includes:

  • Known contacts identified by public health via case investigation, contact tracing, and risk exposure assessments (this may include sexual partners, household contacts, and healthcare workers); as well as
  • Presumed contacts who meet the following criteria:
    • Know that a sexual partner in the past 14 days was diagnosed with monkeypox
    • Had multiple sexual partners in the past 14 days in a jurisdiction with known monkeypox

The Massachusetts Department of Public Health will expand eligibility if and when more doses are received from the CDC.

JYNNEOS vaccine is available to individuals who live or work in Massachusetts and meet the CDC’s eligibility criteria. See above for eligibility details.

Administration of JYNNEOS will be by appointment only at one of the designated health care locations listed below. Healthcare providers are responsible for performing risk and exposure assessment prior to referring a patient for vaccination. Once a provider confirms vaccine eligibility, patients can make their own appointment, noting their provider determined the patient eligible for JYNNEOS.

Vaccine appointments are available from: 

  • Fenway Health (Boston): Appointments can be made by calling 617-927-6060 Monday through Friday between 9 AM and 5 PM 
  • Massachusetts General Hospital Sexual Health Clinic (Boston): Appointments can be made by calling 617-726-2748 Monday through Friday between 8 AM and 4:30 PM 
  • Boston Medical Center (Boston): Appointments can be made by calling 617-414-2803 Monday through Friday between 9 AM and 5 PM 
  • Outer Cape Cod Health Services (Provincetown): Appointments can be made by calling 508-905-2888 Monday through Friday between 8 AM and 5 PM  
  • JRI Health (Framingham)Register for an appointment directly with JRI Health. Appointments can also be made by calling 508-935-2960 Mondays and Fridays between 8 AM and 4 PM and Tuesday through Thursdays between 8 AM and 6:30 PM
  • Greater Lawrence Family Health Center (Lawrence): Appointments can be made by calling 978-557-2319 Monday through Friday from 8 AM to 4 PM
  • Health Innovations (Randolph): Appointments can be made by calling 339-987-1956 Monday through Friday between 10 AM and 5 PM
  • Baystate Medical Center Brightwood Health Center (Springfield): Appointments can be made by calling 413-794-4458 Monday through Friday between 8 AM and 5 PM
  • Tapestry Health (Springfield): Appointments can be made by calling 413-586-2016, extension 121, Monday through Friday between 8 AM and 4 PM
  • AIDS Project Worcester and University of Massachusetts Medical Center (Worcester): Appointments can be made by calling 508-755-3773, extension 113, Monday through Friday between 9 AM and 5 PM
  • Seven Hills Behavioral Health (New Bedford): Appointments can be made by calling 774-634-3725 Monday through Friday between 9 AM and 5 PM
  • Cambridge Health Alliance (Cambridge/Somerville): Appointments can be made by calling 781-338-0104 Monday through Friday between 9 AM and 5 PM
  • East Boston Neighborhood Health Center (Boston): Appointments can be made by calling 617-568-4500 Monday through Friday between 8 AM and 5 PM

Please be aware that there is currently a limited supply of JYNNEOS. Vaccination is prioritized for individuals at the highest risk of exposure to someone with monkeypox.

To stay up to date on vaccine information, bookmark and visit the Mass. Department of Public Health vaccination webpage.

Prevention

Prevention
  • Getting vaccinated against monkeypox can protect you from getting sick if you are exposed to monkeypox.
  • Avoid physical and sexual contact with anyone who has a new rash or sores or who feels ill.  
  • Talk to your partners about getting vaccinated against monkeypox and check in with each other about new or unexplained sores or rashes on your bodies, as well as recent illnesses.
  • Avoid touching or kissing any rashes or sores.
  • Avoid sharing items such as towels, clothing, linens, or sex toys with others, especially if they feel ill. Wash these items regularly.
  • Wash your hands regularly.
  • Minimize skin-to-skin contact when attending large events or parties.
  • If you believe you have been recently exposed to monkeypox, getting vaccinated against monkeypox can protect you from getting sick. Vaccination with JYNNEOS will be available in a limited supply to individuals who live or work in Massachusetts and are at highest risk for monkeypox infection, including within 4 days of known exposure to monkeypox to avoid infection or between 4- and 14-days post-exposure to reduce severity of symptoms.

    The Massachusetts Department of Public Health will expand eligibility if and when more doses are received from the CDC.

     
      • Talk to your healthcare provider about getting vaccinated against monkeypox infection.
      • Avoid sex of any kind.
      • Do not kiss or touch each other's bodies while you are sick, especially any rash or sores.
      • Do not share things like towels, fetish gear, sex toys, and toothbrushes.
      • Have virtual sex with no in-person contact.
      • Masturbate together at a distance of at least six feet.
      • Have sex with your clothes on, or cover areas where there are rashes or sores, to avoid skin-to-skin contact.
      • Avoid kissing.
      • Wash your hands, fetish gear, sex toys and any fabrics (bedding, towels, clothing) after having sex.
      • Limit your partners to avoid chances for monkeypox to spread.

      Symptoms

      Symptoms
      The most common symptom of monkeypox infection is a rash that looks like raised bumps, pimples, or fluid-filled sores. The rash can be painful and sores can vary from a few to many. They can appear anywhere on the face, arms, feet, and body, including the genitals or anus, and can be confused with syphilis, herpes, and other sexually transmitted infections. Eventually, the bumps get crusty, scab over and fall off. An infected person is considered contagious until they fall off and a layer of fresh, new skin develops. 

        Most people fully recover after 2-4 weeks. 

        People can also develop the following “flu-like” symptoms 1-3 days before or with rash onset:

        • Fever
        • Headache
        • Muscle aches
        • Backache
        • Swollen lymph nodes
        • General feeling of discomfort and exhaustion

        If You Feel Sick

        If You Feel Sick

        There are several treatment options to improve the symptoms of monkeypox, including antiviral treatment and supportive care. We recommend that residents infected with monkeypox reach out to their healthcare provider to discuss these options to ensure they are safe and appropriate.  

        Antiviral treatment or TPOXX: 

        According to the CDC, you may be eligible for antiviral treatment, tecovirimat or TPOXX, if you have or are at high risk of severe disease, including if you have an immunocompromising condition, if you have monkeypox lesions in the mucus membranes, including eyes, mouth, genitals, or anus, if you are pregnant or breastfeeding, in pediatric patients, or if you experience other complications from MPV infection, such as secondary skin infections, nausea, vomiting, or diarrhea, or dehydration. For additional information, please visit the CDC website. 

        Supportive care 

        Supportive care includes maintenance of adequate fluid balance, pain management, treatment of bacterial superinfections of skin lesions and treatment of co-occurring sexually transmitted or superimposed bacterial skin infections. Below is general information on treatment options to improve the most common symptoms of monkeypox infections, including itching and pain. However, we recommend discussing these symptoms directly with your healthcare provider for specific guidance. 

        Skin care and itching 

        Skin lesions should be kept clean and dry when not showering or bathing to prevent bacterial superinfection.  

        Pruritus or itching can be managed with oral antihistamines and unscented or plain topical agents such as calamine lotion or petroleum jelly. 

        For oral or mouth lesions, compounds such “magic” or “miracle” mouthwashes (prescription solutions used to treat mucositis) can be used to manage pain. Oral antiseptics can be used to keep lesions clean (e.g., chlorhexidine mouthwash). Topical benzocaine/lidocaine gels can be used for temporary relief, especially to make eating and drinking easier, but should be limited to recommended doses. 

        Pain control 

        For painful genital and anorectal lesions, warm sitz baths lasting at least 10 minutes several times per day may be helpful. Pat the area dry. Topical benzocaine/lidocaine gels or creams at the recommended doses may also provide temporary relief. 

        Proctitis can occur with or without internal lesions and, though often manageable with appropriate supportive care, can progress to become severe and debilitating. Stool softeners such as docusate should be initiated early. Sitz baths, as described above, are also useful for proctitis, and may calm inflammation. Similarly, over the counter pain medications such as acetaminophen can be used. Pain from monkeypox proctitis may require prescription medications, use of which should be balanced with the possibility of side effects, like constipation. Proctitis may additionally be accompanied by rectal bleeding. Though rectal bleeding has been observed to be self-limited, patients with rectal bleeding should be evaluated by a healthcare provider. 

        Nausea and vomiting 

        Nausea and vomiting may be controlled with anti-emetics as appropriate. Diarrhea should be managed with appropriate hydration and electrolyte replacement. The use of anti-motility agents is not generally recommended given the potential for ileus, unless discussed or prescribed by a healthcare provider. 

        If you are a healthcare provider seeking additional information on TPOX eligibility, please see CDC guidance. If you are a patient infected with monkeypox and believe you may be eligible for TPOXX, we recommend asking healthcare provider about treatment. 

         

        References: 

        Centers for Disease Control and Prevention, “Guidance for Tecovirimat Use Under Expanded Access Investigational New Drug Protocol during 2022 U.S. Monkeypox Cases”, July 15, 2022 

        NYC Health, “Interim Guidance for Treatment of Monkeypox”, July 2, 2022 

         

         

          • Stay home, stay away from others, including pets, and seek a doctor immediately.
          • When you visit a healthcare provider, call beforehand, cover your lesions and wear a mask if possible.
          • Avoid sex and intimacy until a doctor has checked you out. Remind your doctor that this virus is circulating in the area.
          • Avoid gatherings, especially if there will be close or skin-to-skin contact.
          • Think about your close or sexual contacts within the last 21 days, including people you met through dating apps. You might be asked to share this information to help stop the spread.
           
             

              Caring for Someone with Monkeypox

              Caring for Someone with Monkeypox
              People who work in healthcare, such as providers and support staff who may be in contact with people with monkeypox and their linens or items, should wear personal protective equipment to avoid exposure. They should also regularly wash their hands and use gowns, gloves, N95 or higher respirators, and eye protection.
              • Wear a mask and gloves when you are close to them or touching their bedding, clothing, or linens. 
              • Regularly wash your hands.
              • Practice physical distancing when possible.
              Watch: What is the current status of monkeypox?

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