Why Is Mpox a Global Emergency? Here’s What You Need to Know About Outbreaks, Transmission, and Rash Stages (With Pictures)

Mpox is a viral infection. Anyone can get mpox. Most commonly, it’s spread through sexual or intimate contact with an infected person. 

Its name comes from the fact that it was first identified in monkeys, and its infection causes a pox-like rash. In the past, most mpox cases and outbreaks occurred in Central and West Africa when humans came into contact with sick animals. 

But in May 2022, mpox started spreading around the world, through human-to-human contact. Authorities identified several small clusters of people with mpox across North America and Europe. 

Since then, numbers have been on the rise. According to the CDC, there has been a 125% increase in new U.S. cases, compared to this time last year. 

A large and rapidly spreading outbreak of a newer, deadlier strain of the virus in the Democratic Republic of the Congo (DRC) and neighboring countries prompted the World Health Organization (WHO) to declare it a “public health emergency of international concern” in August 2024. 

What is mpox?

Mpox is a disease caused by a virus of the same name. The mpox virus belongs to the same family as the smallpox virus, and it leads to a similar rash. But mpox is less contagious and less deadly than smallpox. 

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Scientists first discovered mpox in monkeys, but the virus also infects rodents and squirrels that live in Central and West Africa. It’s still not known which animals are responsible for most cases of human infections.

The disease (and the virus) was previously referred to as “monkeypox.” But, in 2022, the WHO announced it would be using the term “mpox,” to avoid what it said was “racist and stigmatizing” language around the previous term.

Mpox global health emergency: How we got here

In the last 3 years, the WHO has twice declared mpox outbreaks to be global health emergencies: once in July 2022, and again in August 2024. 

Here’s how the current situation developed. 

Before 2022

The first human case was identified in the 1970s in the DRC. And until 2022, most human cases of mpox were in Central and West Africa, as a result of direct human contact with body fluids from sick animals, or through a bite. 

There have been small clusters and outbreaks in countries outside Africa, where the virus is less common. Before 2022, the last outbreak in the U.S. was in 2003. It started with imported infected rodents from Ghana. About 70 people were infected, and no one died. 

2022

In 2022, mpox cases appeared in never-before-seen numbers outside of Africa — including in the U.S. This current outbreak peaked in July and August 2022, and it’s still ongoing. This was the first mpox outbreak that the WHO designated a global emergency. 

2023

Since 2023, infectious disease officials have been closely watching a specific outbreak of mpox in the DRC caused by a new and deadlier strain of the mpox virus, clade 1b (more on this below). This ongoing outbreak is the largest the country has ever seen. It’s also deadlier than any previous mpox outbreak. 

2024

The outbreak in the DRC is now spreading rapidly to nearby Central and Eastern African countries — 13 in total so far. These include countries that have never before had any documented cases of mpox, like Burundi, Kenya, Rwanda, and Uganda. 

The CDC is watching and preparing for the outbreak’s arrival in the U.S, and it urges clinicians to be vigilant. So far, there have been no reported cases of this deadly type of mpox in the U.S. The CDC and U.S. Department of Health and Human Services say they’re ready — and that the risk to the general public is very low.

What causes mpox?

The mpox infection and disease is caused by the mpox virus. There are two types of mpox virus, called clade I and clade II: 

• Clade 2 is the less severe type of mpox. It’s the one responsible for the 2022 global outbreak. 

• Clade 1 is the more severe type of mpox. It’s the strain responsible for the 2023-24 outbreak in the DRC and other Central and Eastern African countries. 

Both types of the virus can spread through direct contact. More on transmission below. 

Mpox death rate 

The mpox death rate has varied from outbreak to outbreak. It has ranged from 0% to 11%, depending on the strain and where the outbreak is. In many outbreaks, it hasn’t been deadly at all. 

The death rate may be higher in people who have weak immune systems — like very young infants or older adults. It may also be more serious when the level of initial exposure is higher — like when an infected animal bites someone (rather than coming into contact with the rash). But overall, very few people die from mpox.

Symptoms of mpox

Symptoms often show up 7 to 14 days after someone is exposed and infected. But it can be as short as 5 days — or as long as 21 days. This timeframe between infection and symptoms is also known as the “incubation period.” You aren’t contagious with mpox until your symptoms start.

The symptoms of mpox usually last 2 to 4 weeks. The most recognizable sign of mpox is a rash. 

Some people may experience additional symptoms. These can start before or after the rash — or not at all. They include:

• Headaches

• Muscle aches

• Fever

• Chills

• Swollen lymph nodes

• Fatigue

What does mpox rash look like?

The rash is the most common symptom of mpox. It usually begins about 7 days after infection. It can begin anywhere and then spread to other areas on the body. 

Below are some images of what a monkeypox rash can look like.

In many cases, the rash begins in the genital area or around the anus. But it can also start on the face, arms, legs, or chest, as well as in the eyes and mouth. It can be itchy or painful.

The mpox rash typically goes through these different stages: 

• Macules: Flat, red or violet-brown patches (depending on your underlying skin tone) appear.

• Papules: Raised, red or violet-brown bumps appear.

• Vesicles: Clear, fluid-filled blisters develop.

• Pustules: Blisters become pus-filled, firm to the touch, and can be painful. 

• Scabs: Eventually, the bumps will start to crust over and form scabs. 

• Healing: Finally, the scabs will fall off, revealing new skin underneath. 
  

Some people may develop scarring from the rash that can take longer to go away. These can be keloid scars or just small areas of darker or lighter skin. 

How do you get mpox?

Human-to-human transmission of mpox requires close contact with someone who’s sick. There are two main ways that mpox spreads between humans.

1. Contact with body fluids or infected skin lesions 

The virus can be found in bodily fluids and the rash that forms during infection. So, you can be exposed to the virus if you have physical contact with someone who’s sick. This includes:

• Skin-to-skin contact: like hugging, touching, or playing

• Sexual intercourse: including oral, anal, and vaginal sex 

• Contact with surfaces: most common with objects that someone with mpox touched during sex, like bedsheets or sex toys 

2. Large respiratory droplets

Experts believe that mpox can also spread through contact with respiratory droplets. But the good news is that mpox needs much bigger droplets to travel than other viruses. This means it can only travel a few feet from the person who’s infected. So, experts think that to catch the virus this way, someone needs to be very close to someone who’s sick — and for a long period of time. 

Humans can also get mpox from contact with infected animals. Before 2022, this is how most people got infected. 

How long is mpox contagious?

People infected with mpox are contagious from the start of symptoms, right through to when the mpox rash has healed. 

Once the rash has scabbed over, and all the scabs have fallen off, you’re no longer contagious.

It can take up to 4 weeks between the first symptom appearing and a fresh layer of skin forming under each blister. 

How do you treat mpox?

There’s no cure for mpox, but most people fully recover from an infection without any specific treatment. Some people may need supportive care to help them along. 

Supportive treatment may include:

• Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) to help with fever 

• Salt rinses, chlorhexidine mouthwash, or local anesthetic mouth spray for mouth pain

• Antihistamine pills — like loratadine (Claritin) — for itch

• Home remedies applied to the skin, like calamine lotion, petroleum jelly, or oatmeal baths

• Intravenous (IV) fluids to help people at risk of dehydration, like very young children or older adults

A few of the medications that treat smallpox might be helpful for mpox too. This is because these infections are similar and belong to the same family of viruses. But scientists still aren’t sure how effective they are for humans. They’re not being routinely used.

How do you prevent mpox

Hands-down, the best way to prevent becoming infected with mpox is to get vaccinated. 

The mpox vaccine (JYNNEOS) is a 2-dose vaccine that you get 4 weeks apart. It works very well to prevent mpox — provided you get both doses. 

But not everyone needs it. The CDC recommends vaccination for all the following “at risk” groups. 

High-risk groups who should get the mpox vaccine 

The following should get the mpox vaccine:

1. Anyone (regardless of sexual or gender identity) who has or has had sexual or intimate contact with someone who has mpox, could have mpox, or is at risk of mpox (see next bullet)

2. All men who have sex with men

3. Trans, gender non-binary, or gender-diverse folks who’ve recently had (last 6 months) or expect to have: one or more sexually transmitted infections (STIs), multiple sexual partners, or sex at a commercial sex venue or large pubic event 

If you think you could’ve been exposed to mpox, get vaccinated as soon as possible. 

Travel precautions

Since August 7, 2024, the CDC has updated its travel precautions for travelers to the DRC and neighboring countries. 

The Travel Health Notice recommends:

• Vaccination for those with risk factors (see above)

• Immediate medical care for anyone who has traveled to the region in the last 21 days and develops a new skin rash on any part of the body 

• All travelers to avoid close contact with anyone who could be infected with mpox (for example, people with skin rashes) 

• All travelers to avoid contact with dead or live wild animals, including consuming meat or other meat products from wild animals 

• Extreme caution for people who’re unable to be vaccinated, including pregnant people and young infants, people who’re immunocompromised, and those with eczema or active skin conditions

Best hygiene practices for preventing mpox

In addition to getting the 2-part mpox vaccine, there are other habits and behaviors that can help lower your chances of becoming infected: 

• Avoid direct skin-to-skin contact at large gatherings, especially if you notice a rash.

• Avoid direct skin-to-skin or mouth-to-skin contact with a person with a rash.

• Don’t share cups, utensils, or other household items with a person with known mpox.

• Wash your hands well and often at large gatherings, especially before eating, touching your face, and after using the bathroom. 

Why trust our experts?

Written by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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