Monkeypox Frequently Asked Questions

The vaccine most commonly used for preventing monkeypox infection is JYNNEOS 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.

As of October 3, 2022, vaccination will be available to individuals who live or work in Massachusetts and meet the CDC’s current eligibility criteria, which have recently expanded to include individuals at potential risk for monkeypox in addition to those with possible recent exposure to an individual with monkeypox:

Persons eligible for post-exposure vaccination (PEP) 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

In addition, CDC now allows for pre-exposure vaccination (PrEP) of persons at risk for monkeypox which includes: 

• Gay, bisexual, and other men who have sex with men, transgender, gender non-conforming, or nonbinary people who  
  • Have had a diagnosis of or have sought testing for one or more sexually transmitted diseases (i.e., chancroid, chlamydia, gonorrhea, or syphilis) in the past year 
  • Are living with HIV infection 
  • Are on or are eligible to be on HIV PrEP 
  • Have recently had more than one sex partner 
• People who:
  • Have had sex at a private or commercial sex venue (e.g., sex party, bathhouse) 
  • Have had sex in association with a large public event (e.g., rave, circuit party) in a geographic area where monkeypox transmission is occurring 
• Sexual partners of people with the above risks 
• People who anticipate experiencing the above risks 

When you request vaccine, you will not be asked which of these criteria applies to you. It is sufficient to say that you consider yourself to be at risk for monkeypox. 

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.

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.

• 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.

The best way to protect yourself and others is to:

• 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.

The following can lower the chance of spreading the virus:

• 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.

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

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
• you have monkeypox lesions in the mucus membranes, including eyes, mouth, genitals, or anus
• you are pregnant or breastfeeding, in pediatric patients, or
• 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.

Taking these additional steps may help protect you from the virus:

• 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.