Monkeypox (mpox)

Mpox is in the same family as smallpox, but much milder. With this outbreak, people are often noticing the rash or rectal discomfort first before any other symptoms. The rash can occur all over the body and will go through stages, starting as a flat rash or red bump becoming a blister or pimple filled with pus and then the center of the lesion will fall inward with the boarders remaining raised like a belly button. Finally, the lesions will scab over. As part of this outbreak these rashes are occurring in sensitive areas including the genitals, penis, rectum, and mouth. The rash can be associated with significant swelling and pain as it progresses and people with rectal symptoms are sometimes experiencing bleeding. The illness can include swollen lymph nodes, particularly in the groin if the rash is in the genital area, exhaustion, muscle aches, and fever or chills. However, many patients may only have the rash. The rash typically takes 2-4 weeks to heal. Once the skin underneath is healed the scabs will fall off and at this point the person is no longer infectious.

Suspicion for mpox should be heightened if a rash occurs in a person who:

1. Had contact with someone who had a rash that looks like monkeypox or someone who was diagnosed with confirmed or probably mpox.
2. Had skin-to-skin contact with someone in a social network experiencing mpox activity, including gay men, men who have sex with men, and transfeminine women.
3. In the last 14 days had multiple or an anonymous sex partner(s) and may meet partners through online websites, digital apps, and/or clubs and parties
4. Traveled outside the U.S. to a country, particularly Europe, with recently confirmed cases of monkeypox or where mpox activity has been ongoing

Mpox can spread to anyone through prolonged close, personal, often skin-to-skin contact including:

• Direct contact with mpox rash, sores, or scabs
• Sharing items (such as bed linens or towels) that have been used by someone with mpox and where fluid and virus from the rash has contaminated the item.
• Through respiratory secretions during prolonged face-to-face contact.

This contact can happen during intimate sexual contact including:

• Oral, anal, and vaginal sex
• Hugging, massage, or mutual masturbation
• Kissing and talking closely
• Touching fabrics and objects during sex that were used by a person with mpox, such as bedding, towels, and sex toys

We know the virus can be spread in fluid or pus from mpox sores, and are trying to better understand how often the virus is present in semen or vaginal fluids. Testing has demonstrated the virus in seminal fluid.

Antiviral medication is available and may shorten the course and severity of illness. We are recommending and providing treatment for anyone who is more likely to get severely ill as well as anyone with lesions of their genitals, rectum, mouth, or near their eyes where progression of those lesions can be painful and potentially debilitating Otherwise, mpox will resolve on its own in most cases. The antiviral tecovirimat (TPOXX), is available through expanded access from the CDC as part of an investigational protocol. Whitman-Walker Health can evaluate patients and if it is determined that treatment is needed oversee this treatment with signed informed consent

Current FDA approved vaccinations against smallpox are also effective for monkeypox and are gradually becoming more widely available! Jynneos is an attenuated live virus vaccine which has been approved by the U.S. Food and Drug Administration for the prevention of monkeypox. DC Health is making limited appointments available on their website.

Before exposure or unknown if exposed: (Pre-exposure, also being called PEP++)

• Gay, bisexual, and other men 18 and older who have sex with men and have had multiple (more than one) sexual partners or any anonymous sexual partners in the last 14 days or
• Transgender women or nonbinary persons assigned male at birth who have sex with men or
• Sex workers (of any sexual orientation/gender) or
• Staff at establishments where sexual activity occurs (e.g., bathhouses, saunas, sex clubs).

After known exposure: (Post-exposure, PEP)

• Persons Exposed to monkeypox virus in the last 14 days and who have not received the smallpox vaccine within the last 3 years.
• Vaccination is most effective at preventing mpox if given within 4 days of exposure

Older adults who were vaccinated against smallpox as children are still recommended to receive the Jynneos vaccine if they fall into either of the above categories.

First, pre-register for the vaccine here. Then reach out to your primary care provider or us at ??CH number so that they can help you contact the health department to get an urgent vaccine appointment.

You can pre-register for a vaccine appointment on the DC mpox website. Anyone who is interested in being vaccinated can pre-register. DC Health will collect demographic and risk data when you preregister and is offering appointments to folks with an eye on equity and minimizing risk. Once you have pre-registered keep an eye out for an email invitation to make an appointment. When you get this invitation, you will have 24 hours to accept this appointment. We strongly recommend that if you are a man, transgender woman, or nonbinary person assigned male at birth who has sex with men, and you have had multiple partners in the last 14 days that you be vaccinated as soon as possible. We expect that vaccine access will continue to improve over the coming weeks. We will continue to update you as more information becomes available.

Yes. There is a vaccine called the Jynneos vaccine. This vaccine is a weakened (attenuated) live virus vaccine that is FDA approved for protection against smallpox and mpox. The Jynneos vaccine is recommended for those at risk of mpox with this current outbreak. The vaccine is effective at protecting people against monkeypox illness.

Weakened live virus vaccines are made of live virus that is unable to replicate itself. Other weakened live virus vaccines that you may be familiar with are the measles, mumps, rubella (MMR) vaccine, the influenza (flu) vaccine, the varicella (chicken pox) vaccine and the yellow fever vaccine. 

The vaccine is very well tolerated, and the most common side effect is soreness, redness, swelling, and itching at the injection site. Other side effects include fatigue, muscle pain, headache, and nausea. Allergic reactions to the vaccine are extremely rare.

The safety of the vaccine has been studied in those who are living with HIV. And people with well controlled HIV respond well to the vaccine. Immunocompromised persons, including those receiving immunosuppressive therapy, may have a diminished immune response to the vaccine. This means that they may not be fully protected from mpox even after receiving the vaccine.

The vaccine is given as part of a series with a total of 2 doses. The second dose should be given at least 4 weeks after the first dose has been received and is given to extend immunity. You will start to build protection in the days and weeks following the first injection and should have immunity from the vaccine two weeks after your first dose. While this is normally a 2-dose vaccine, due to a limited supply, DC Health has moved to a single dose strategy for folx who are not immunocompromised. This means that they are delaying the second dose for folx. Evidence shows that the first dose solidly protects people from Mpox up to as much as 2 years.

Experts do believe the vaccine can be used for PEP. The vaccine can reduce the risk of infection if given within four days after exposure and should reduce the risk of serious illness if given within 14 days after exposure. The sooner you get the vaccine after exposure the more likely it is to work. If you have a known exposure to mpox please contact your local health department for vaccination. If you are a DC resident, please contact DC Health and Wellness Center at 202-741-7692.

Generally, you are a candidate for the vaccine if you have an exposure to a person with a confirmed case of monkeypox. This is what is described as post-exposure prophylaxis (PEP) in the question above.

Additionally, people with certain risk factors are more likely to have been recently exposed to monkeypox. The vaccine may be recommended for people with risk factors even if they have not had documented exposure to someone with confirmed monkeypox.

As of right now, the DC Department of Health has identified the groups below as candidates for the vaccine:

• D.C. residents who are at least 18 years old and who are:
  • Gay, bisexual, and other men 18 and older who have sex with men and have had multiple or anonymous sexual partners in the last 14 days) or
  • Transgender women or nonbinary persons assigned male at birth who have sex with men or
  • Sex workers (of any sexual orientation/gender) or
  • Staff (of any sexual orientation/gender) at establishments where sexual activity occurs (e.g., bathhouses, saunas, sex clubs).