Monkeypox Facts and Fiction

Monkeypox was largely unknown outside of the medical community—and the tropical African countries originally affected—before the recent global outbreak, with cases known in 70 countries. Coming into focus after years of the COVID pandemic, the disease has garnered no small amount of controversy and misinformation. A refresher of the facts may be helpful.

Monkeypox is not usually fatal, though scarring is common. The illness generally lasts a few weeks, though the period of transmissibility is shorter, and beyond the skin lesions can include fever, swollen lymph nodes, and other flu-like symptoms.

Though it may not have been well known, monkeypox is not a novel virus, the way COVID-19 was. Conflating the two is easy to do, but monkeypox is better understood by the scientific community than COVID-19 was at the beginning of the pandemic. Scientists have voiced concerns about the potential for a serious outbreak among an unvaccinated population since the mid-2000s. Monkeypox, first discovered in lab animals in the 1950s and in humans in the 1970s, is of the orthopoxvirus genus and poxviridae family, as is smallpox, though less transmissible and far less often fatal than smallpox. Smallpox vaccines offer some protection against monkeypox, but vaccines specifically formulated for monkeypox have been available since 2019.

Despite the name, it is not related to chicken pox, nor is it found exclusively in primates. Many mammals, especially rodents, can be infected. The first known cases in the U.S. were connected to infected prairie dogs kept as pets. Transmission is zoonotic, meaning it is passed between animals. Unprotected contact between humans and infected animals, possibly through hunting or the illicit trade of wild animals, may have been the origin of transmission to human beings.

Perhaps the most prevalent misunderstanding is mischaracterizing monkeypox as a disease transmissible specifically through gay sex, because of its prevalence in gay, especially male, populations in America. While sexual contact of any kind can be a means of transmission, it is inaccurate at best, and dangerously homophobic at worst, to think it is specific to any one population. Transmission occurs when skin comes in contact with the virus. Certain kinds of epithelial tissue, especially mucus membranes, are more vulnerable. Open wounds and skin conditions such as eczema also increase the chance of infection. Since monkeypox originated in Africa, media depictions of the disease often show African people in articles, despite that this is a global phenomenon. There is no age group, ethnicity, or sexual orientation that is inherently more susceptible.

Monkeypox can live on inorganic surfaces, especially on porous materials in damp or dark places, for weeks, though it is sensitive to many disinfectants and UV light. Airborne transmission through water droplets is possible, though rare. In keeping with both scientific research and general best practices, frequent hand washing is strongly recommended.

The director general of the World Health Organization has declared a “public health emergency of global concern,” overriding a 6-9 decision from the WHO Emergency Committee against such a designation. The American Medical Association released updates, effective immediately, to the CPT codes for one orthopoxvirus test and two vaccines. For more information on the code updates, see our sister publication, ICD10monitor.