Questions and answers about monkeypox

Predominant symptoms of monkeypox include fever, rash ,enlarged lymph nodes, muscle aches, and chills. Most patients with monkeypox have a mild illness. Symptom onset is 7-13 days after exposure, but can be as long as 3 weeks.

updated October 1, 2022

Several poxviruses infect humans, ranging from the deadly smallpox to the contagious but not serious molluscum contagiosum. Now more than 30 countries, including the United States are experiencing an outbreak of monkeypox, which the World Health Organization is calling a”a public health emergency of international concern.”

What is monkeypox?

Monkeypox, an orthopoxvirus, was first isolated in the late 1950s from a colony of sick monkeys in Copenhagen Denmark. The virus is related to the variola, smallpox, and vaccinia, coxpox, viruses. The first known human case was found in the Democratic Republic of the Congo in 1970.

Where is monkeypox found?

Since routine smallpox immunization ended, most cases have occurred in Central and West Africa. Sporadic cases have been reported in several non-endemic countries, typically in returning travelers.

A person with monkeypox can spread it to others from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The illness typically lasts 2–4 weeks

Centers for Disease Control and Prevention
As of September 13, 2022 there are 59,000 global cases and 22,000 United States cases of monkeypox.
worldwide cases of monkeypox as of SEPTEMBER 13, 2022

How does it spread?

The virus is typically acquired through contact with an infected animal’s bodily fluids or through a bite.

Human-to-human transmission can also occur through close contact with infectious skin lesions. Direct contact with lesions that contain the virus can easily transmit the disease .

Transmission can also occur through large respiratory droplets, and prolonged face-to-face contact (eg, within 6 feet for ≥3 hours in the absence of personal protection equipment [PPE]).

What are the symptoms of monkeypox?

Onset of monkeypox infection is 5 days to 3 weeks after exposure.

Predominant symptoms of monkeypox include

  • fever,
  • rash,
  • enlarged lymph nodes,
  • sore throat,
  • muscle aches,
  • chills,
  • headache

The rash is similar to that of smallpox or chickenpox. The illness usually lasts 2 to 4 weeks.

How do doctors diagnose monkeypox?

Doctors usually suspect monkeypox based on symptoms, especially a suspicious rash. Testing is done on specimens collected by swabbing monkeypox lesions, but should only be obtained by professionals wearing appropriate PPE.

CDC is working with state and local health officials to identify people who may have been in contact with individuals who have tested positive for monkeypox, so they can monitor their health.

CDC website
This electron microscopic (EM) image depicted a monkeypox virion, obtained from a clinical sample associated with the 2003 prairie dog outbreak. It was a thin section image from of a human skin sample. On the left were mature, oval-shaped virus particles, and on the right were the crescents, and spherical particles of immature virions.

This electron microscopic (EM) image depicted a monkeypox virion, obtained from a clinical sample associated with the 2003 prairie dog outbreak. It was a thin section image from of a human skin sample. On the left were mature, oval-shaped virus particles, and on the right were the crescents, and spherical particles of immature virions. credit CDC, Cynthia S. Goldsmith, Russell Regnery

What treatments are available?

Most patients have mild disease and recover with home supportive care, similar to influenza, COVID, and other viral infections. For the seriously ill patient, medically supervised supportive care is necessary until recovery.

The antiviral agents, tecovirimat and brincidofovir, approved for treatment of smallpox in the United States, work for monkeypox in animals and are likely to work in humans.

Can monkeypox be prevented?

When a rash is present, persons with suspected monkeypox should be considered infectious and be isolated until all scabs separate and results of testing are negative.  

Detailed information on infection control precautions to reduce transmission of monkeypox in the home is on the CDC website.

Persons with close contact with an infected animal or person should be monitored for symptoms for 21 days after their last exposure .

Detailed information on the approach to monitoring after an exposure can be found on the CDC website.

Is there a vaccine?

The JYNNEOS vaccine is approved for prevention of smallpox and monkeypox. It is the primary vaccine being used during this outbreak in the U.S.

The ACAM2000 vaccine is an alternative to JYNNEOS. It is also approved to help protect against smallpox and monkeypox.

Facts about JYNNEOS vaccine 2 dose vaccine, maximum immunity 14 days after dose 2

Is monkeypox fatal?

In Central Africa, the fatality rate is approximately 10 percent, generally in the second week of illness.

In the 2003 outbreak in the United States, none of the 34 confirmed cases died, although a few became seriously ill, requiring hospitalization.

Exploring the HEART of international health

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Dr Aletha

cover image by Jerney Furman

How to survive an active shooter

Shootings in the United States have resulted in numerous casualties across diverse demographics. An active shooter poses a significant threat, necessitating preparedness. The recommended response includes three strategies: RUN to safety, HIDE if escape is impossible, and FIGHT as a last resort. Prioritizing personal and collective safety is crucial.

updated April 18, 2025

It has been almost three years since I wrote this post, but the situation has not changed. Shootings still happen at schools, universities, homes, and businesses regularly. And our communities seem powerless to stop them.

Within the past year there have been shootings causing injuries and fatalities in a church, a grocery, an elementary school, a holiday celebration, and a medical office.

Among the dead are employees, customers, grade school age children, teachers, physicians, a receptionist, a patient and spouse.

Ethnically they were Caucasian, Black, Asian, and Hispanic. Men and women, boys and girls. And these are just the ones that I remember reading about.

What is an active shooter?

An active shooter is an individual actively engaged in killing or attempting to kill people in a populated area, 

Active Shooter Resources-FBI

We are all at risk. Although we trust the police to repond and rush to our aid, they won’t save everyone. We must know what to do to save ourselves and those around us.

Safety professionals offer these guidelines that we should learn and remember. In the panic of the moment it will be difficult to think through a rational plan to survive. Be prepared every day; that may be the day you need it.

How to survive

RUN

  1. Wherever you are, always know where the exits are, preferably ones you can easily and quickly reach; locate at least 2 if possible in case one becomes inaccessible.  
  2. Your first response to a threat should be escape; run to the nearest exit as soon as safely possible; go, even if others are not willing to go with you.
  3. Leave your stuff behind. Run with empty hands up and visible.
  4. Listen to police and answer their questions, try to give them accurate information about what is happening. Get away to a safe place and stay out of the responders’ way.

HIDE

  1. If escape is not possible, then hide, preferably in a locked room. Push heavy furniture against the door.
  2. Silence your cell phone when hiding. If you can, call 911 but don’t speak if you might be heard by the shooter; just leave the line open so the dispatcher can hear.

FIGHT

  1. If neither escape or hiding is possible, then engage the shooter, try to disable the person with the gun.
  2. If you’ve been hiding, make a plan to defend yourself. If you are with other people, work together.
  3. Aim to control the weapon; work together to disable the shooter with anything you can use as a weapon. Attack the shooter verbally, yelling.

A coordinated ambush can incapacitate the attacker. You are fighting for your life-don’t fight fair.

Active Shooter Resources-FBI

This video from the FBI website graphically shows what to do when confronted with an active shooter situation, then details each step. Well worth watching.

Active Shooter Booklet from Homeland Security Download

Exploring the HEART of health and safety

Funerals for two physician victims of shootings happened in my city. We need action to end this vicious cycle of violence that has become another pandemic.

Note that these guidelines should coordinate with protocols in place at your school, church, or workplace. Your primary goal should always be your own safety, and that of others if possible.

photos of 2 men and 2 women who were victims of a mass shooting

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