Earlier this month, Connecticut saw its first cases of monkeypox in adults, making the virus a reality in the community. (Visit this CDC webpage for a breakdown of cases by state.)

As if COVID-19 and parechovirus weren’t enough, parents are concerned. What should you know, and how worried do you need to be at this point? Dr. Ian Michelow, Division Head of Infectious Diseases and Immunology at Connecticut Children’s, answers some questions.  

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Q: What is monkeypox, exactly?

A: Monkeypox is a virus in the smallpox family that started in Africa, but has made its way to other countries, including the U.S. and now the state of Connecticut. (Yes, smallpox went away completely decades ago thanks to vaccination and herd immunity—a major milestone in the world of disease!)

Even though monkeys can be infected with monkeypox, they are not the main culprits for spreading it! In the late 1950s, there was an outbreak of the virus in a lab that contained monkeys. Some time later, scientists discovered that certain rodents in parts of Africa carried the virus and can spread it to humans. It wasn’t until 1970 that the first human case of monkeypox was seen.

Since then, the only other significant outbreak in the U.S. was in 2003 in the Midwest. All 47 infected people had come into contact with pet prairie dogs that had been housed with rodents imported from Africa.

Q: What are the symptoms of monkeypox?

A: Here’s what to watch out for:

  • Skin lesions that look like a fluid- or pus-filled bump or blister—this is often a telltale sign. These can be anywhere on the body, in any quantity, and they often itch or hurt. The rash may look like chickenpox, shingles, herpes simplex, or molluscum (a harmless viral infection). At first, it may look like a regular small pimple, but monkeypox progresses over several days to form a blister with a central pit or dimple.
  • Fever and fatigue (just like the flu)—this may or may not happen, but if it does, it is likely to happen during a five- day period before the rash appears.
  • Headaches and muscle aches—again, these typically occur in the five days before the rash appears, but they can be related to other infections, such as Covid-19 or the flu; if they persist, call the doctor.
  • Swollen lymph nodes or glands—these are usually in the same area where the rash appears.

Bottom line: If you see a rash with any of the above symptoms, whether or not you suspect exposure to someone with monkeypox, give the doctor a call.

Q: How do you get monkeypox?

A: People get monkeypox through direct contact with someone who is infected or by sharing personal items that have been contaminated. Think: touching someone’s monkeypox lesions, or sleeping in bedding, wearing clothes or using towels contaminated with fluid from monkeypox blisters. 

Intimate physical or sexual contact plays a major factor in the spread of monkeypox more than anything else at this point.

>Related: How to Talk to Teens About Dating Safely

Q: How worried should we be? Does this come close to COVID-19-level worry? Is the world going to shut down again?

A: Please don’t panic—this virus does not pose the same type of global threat as COVID-19 does because it doesn’t spread as easily and is much less likely to cause a deadly disease. Even if cases increase, here’s what works in our favor:

  • Monkeypox is not as contagious as COVID-19, so it’s thought not to spread as quickly.
  • Unlike COVID-19, monkeypox is not spread easily through respiratory droplets or aerosols; it requires direct contact with blister fluid.
  • People with monkeypox aren’t contagious until symptoms appear, even though the incubation period is one to two weeks.

Q: Who is at greatest risk for severe complications from monkeypox?

A:. Young children, pregnant women and people who have weakened immune systems are at greatest risk for developing severe disease.

Q: Is there an at-home test for monkeypox?

A: No—you need to see a medical professional who will do a simple skin swab of a lesion and send the sample to a lab that performs specialized PCR tests. As the saying goes, don’t try this at home! 

Q: Is there a monkeypox vaccine?

A: Yes, there are two monkeypox vaccines. The newest vaccine is licensed only for people 18 or older. The other vaccine may be useful for children who have been exposed to someone with confirmed monkeypox, but there is very little experience with its use in children. The CDC has a stockpile that officials are working on to distribute to states as needed, should we get to that point as a nation.

Q: Is there a monkeypox antiviral treatment?

A: Yes, it’s called TPOXX (tecovirimat), which is actually FDA-approved for the treatment of smallpox. The FDA can provide this antiviral for adults and children under a non-research arrangement with hospitals.

Most people, however, don’t need treatment because the recovery rate is so high.  There are exceptions, though. For example, people with certain underlying skin or immunocompromising conditions, or pregnant women—may benefit from TPOXX if they are infected.

Q: Many of us fought chickenpox before a vaccine became available. Is monkeypox more severe than chicken pox?

A: Right now, experts are saying it’s no more or less severe than chickenpox. Everyone is different, though. Some cases are very mild with a subtle rash and others are more severe. So far there have been no deaths in cases of monkeypox identified in the US.  

Q: So—if you’ve had chickenpox, can you still get monkeypox?

A: Yes. Because chickenpox is caused by a virus that is unrelated to monkeypox, having had natural chickenpox infection or chickenpox (varicella) vaccine in the past will not protect you from monkeypox.

Monkeypox under a microscope

Q: Again—from one worried parent to another—why is this happening!?

A: We wish we had all the answers, but scientists do not know yet why monkeypox is spreading around the world now, whereas in the past, outbreaks of monkeypox outside Africa could easily be contained. It is possible that:

1. The monkeypox virus recently changed to make it more contagious or it may be spreading more easily among people who are no longer protected by smallpox vaccines that were discontinued in the 1970s in the US and Europe.
2. The monkeypox virus is spreading more easily among people who are no longer protected by smallpox vaccines that were discontinued in the 1970s (smallpox vaccines are ~85% effective at preventing its related virus, monkeypox, so people born after that time are no longer immune to monkeypox).

Q: If anyone in my family tests positive, do we have to quarantine? For how long?

A: A person who is infected with monkeypox should quarantine at home until the rash has fully resolved, the scabs have fallen off, and a fresh layer of intact skin has formed. 

That person should isolate themselves from other family members and pets, and shouldn’t share linens, towels, utensils or any other objects. They should keep the skin lesions covered if possible. The infected person and other household members should wear a face mask when within six feet of each other until the rash has fully healed.

The CDC shares more on this right here.

Q: What can we do to protect ourselves from or fight against monkeypox?

A:  Let’s use the tools we’ve had to put into practice during the COVID-19 pandemic. Most of all, make sure to practice good personal hygiene and sanitize your and your children’s hands properly. Stay on top of case counts in your area and report any symptoms to your doctor. Talk to your teens about safe sex. Keep exercising caution as you would for any illness.

>Related: 24 Questions for Your Teen to Ask Their Doctor 

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