Mpox (monkeypox)

Since May of 2022, there have been cases of confirmed mpox (monkeypox) in Europe and in Denmark.   Often the onset of mpox is seen with a rash and lesions similar to chicken pox, as well as influenza like symptoms, such as chills, headaches, muscle pains, and fatigue.

Mpox is usually mild and most people recover within 2-4 weeks without treatment.  However is can be very painful, especially if the rash in located in and around the rectum. There is also a risk of scarring after the lesions have healed. 

Anyone can get mpox, however the majority of cases in this outbreak have been among men, who have sex with other men. Therefore, it is particularly important that this group is aware of the symptoms, especially if they have multiple partners. 

Mpox often begins with influenza-like symptoms, which include fever, headaches, muscle aches, swollen glands, chills and fatigue.  You are only infectious when you are symptomatic. Transmission of the disease most frequently during direct contact with lesions. Contact with a single blister can infect someone. Transmission between people rarely happens with normal social interaction, but can happen by close physical contact such as sexual activities, or if you sleep in the same bed as someone with mpox.

The guidelines for handling mpox in the Danish health care system can be found here in Danish: Retningslinjer for håndtering af abekopper i Danmark

Questions and answers about mpox (monkeypox)

1. What is mpox?

Mpox is an illness caused by the mpox virus, which is related to the smallpox virus. It is a zoonotic disease, meaning it can spread from animals to humans. It can spread from person to person through close physical contact, for example between people in the same household or sexual partners. During the summer of 2022 an outbreak of mpox happened in Denmark as a part of a larger outbreak in Europe. The first case of mpox in Denmark was confirmed in May 2022. The outbreak was contained in Denmark in the fall of 2022, but there are still cases of mpox in Europe.

2. What are the symptoms of mpox?

The symptoms of mpox include a rash with lesions similar to chickenpox. Some people get many lesions, while others get only a few, sometimes less than 10. Even with very few lesions, a person is contagious. 

The disease often starts with common illness symptoms such as chills, fever, headache, muscle aches, back pain, and exhaustion. Swelling of the glands is also common. During the current outbreak in Europe, the disease usually starts with a few lesions or a rash around the genitals and rectum, which can later spread to more parts of the body. 

Mpox is usually mild and most people recover within 2-4 weeks without treatment, but mpox can be painful, especially if the rash is located in and around the rectum. There is a risk of scarring after the lesions have healed.

Contact your general practitioners by telephone if you have symptoms and you think you may be infected with mpox, for example from a sexual partner. It is important not to show up physically at your general practitioner, so you do not risk infecting someone else.

3. How does mpox spread?

Transmission between people often happens through close physical contact. The virus is transmitted by touching the lesions or wounds of an infected person, but can also be transmitted through the airway if you are close to an infected person when they chough or speak loudly. The virus can also spread through objects carrying the virus such as towels, bed sheets and clothes.

Transmission between people rarely happens during normal social interaction, but can happen through close physical contact for example between people living together or sexual partners. We have not seen household infections in Denmark as a part of the outbreak in 2022.

A person is contagious from the first onset of symptoms. See ‘What are the symptoms of mpox?’ to read about the symptoms.

The time from a person is infected until they have  their first symptoms (the incubation period) is 6-16 days, but may be shorter and can be up to 21 days. You cannot infect others with mpox before the onset of symptoms. 

Currently majority of cases have been in men who have sex with other men and have multiple partners, however it is important to know anyone can get mpox if they are exposed to the virus. Mpox is usually mild and most people recover within 2-4 weeks without treatment, but mpox can be painful, especially if the rash or lesions are located in and around the rectum.

4. Who is offered vaccination against mpox?

The Danish Health Authority recommends vaccination to a specific group of people who are at a higher risk of infection. Vaccination is also recommended for those who are close contacts to people with known cases of mpox, if they are at a high risk of catching monkey pox.

Vaccination against mpox does not guarantee that you cannot be infected and infect others. Because of this, it is still important to be cautious of mpox symptoms. If you have symptoms, you should avoid close physical contact with other people, until you know, whether you do have mpox, and until you are completely healed. 

Preventative vaccination of a specific group with high risk of infection

During the current outbreak, most of the cases are men, who have sex with other men and have multiple partners. Many of the cases are also in preventative PrEP-treatment to avoid infection with hiv, or are hiv-positive.

On that basis, using markers of high-risk behavior, vaccination are offered to:

• People in PrEP-treatment to prevent hiv.
• People who are not in PrEP-treatment, but who eligibly for PrEP-treatment. This may be people who have chosen not to receive PrEP-treatment to prevent hiv, are allergic or are in hiv treatment.
• If you do not receive PrEP-treatment to prevent hiv, you can be offered vaccination if you live up to one of the following criteria:
  • A man, who has sex with men, and has had unprotected anal intercourse with at least two male partners within the last 12 weeks. Known HIV-negative partner from a committed relationship are excluded.
  • A man, who has sex with men, and has had syphilis within the last 24 weeks
  • A man, who has sex with men, and has had chlamydia or gonorrhea within the last 24 weeks

Vaccination of close contacts

If you are close contacts with someone who has been infected with mpox, you can be offered vaccination to minimize the risk of severe illness. A doctor will decide if you are offered a vaccine.  

Close contacts are: 

• All household contacts or household-like contacts, e.g. people who have slept in a room/tent together, partners who do not live together. 
• Sexual contacts, who had sex while had mpox and symptoms of mpox, during sexual contact. You are still close contacts, despite used condoms. 
• People, who have had unprotected direct contact with skin and bodily fluids or potentially contaminated material e.g. clothing/bedding. This also includes health and laboratory personnel who have been in contact with contaminated material without protective equipment’s.  
• Healthcare workers, who have had close physical contact with an infected person, e.g. performed procedures with risk of infection without the use of protective equipment. 

Read more about, where you can get a mpox vaccine in your region:

• Capital Region of Denmark (in English)
• Region Zealand (in Danish)
• Region of Southern Denmark (in Danish)
• Central Region Denmark (in Danish)
• North Denmark Region (in Danish)

5. Is mpox a sexually transmitted disease?

Mpox spread from close physical contact, therefore there is a risk of infection, during sexual activity with a person who is infected with mpox. This is in regards to all type of sexual contact, vaginal sex, anal sex, oral sex and sex where genitals touch. Risk of infection is reduced by the use of condoms, but it does not guarantee prevention of infection. 

During the current outbreak, lesions are primarily developing around the genitals, which increases the risk of transmission during sexual activity.

If you have had sex with multiple partners, you should be more attentive of symptoms, such rashes or lesion, on both yourself and your partner. Especially men who have sex with men, and have multiple partners, should be closely pay attention to influenza like symptoms, which are often the first onset of symptoms for mpox. 

If you have symptoms, you should avoid close physical contact with other people, until you know, whether you do have mpox, and until you are completely healed. Contact your doctor to be tested. 

6. Who is at risk of being infected with mpox?

People who are close physical contacts with a person who have mpox symptoms are at risk of being infected. There can be a bigger risk of infection, if you often have close physical contact to people, such as having multiple changing sexual partners. The outbreak was contained in Denmark in the fall of 2022, but there are still cases of mpox in Europe, so pay attention if you are going abroad and are having sex with new partners. 

People who are vaccinated against smallpox are expected to have a certain level of immunity against severe illness. In Denmark, we stopped vaccinating with the smallpox vaccine in 1977. For all intents and purposes, everyone born before 1970 is assumed to be vaccinated against smallpox. 

7. Are men who have sex with men at higher risk of infection?

Mpox infects through close physical contact. Anyone can be infected with mpox, despite gender, sexuality and age. 

So far, almost all cases of infection in Denmark and Europe have been men who have sex with men. Due to this, this group in particular have to pay more attention, if they have new and potentially changing partners. It is a good idea to get gather contact information of sexual partners, which can be helpful, if needed to contact close contacts. 

Men who have sex with men, who do not have multiple changing partners, are no more at risk than others are, who are in close physical contact with an infected person. 

8. What should I do if I suspect that I am infected?

If you have symptoms, you should avoid close physical contact with other people, until you know, whether you do have mpox, and until you are completely healed. 

If you have symptoms of mpox, you should avoid sexual or other close physical contact with people. 

Contact your general practitioners by telephone if you have symptoms and you think you may be infected with mpox, for example from a sexual partner. It is important not to show up physically at your general practitioner, so you do not risk infecting someone else.

9. What should I do if I test positive for mpox? 

If you have tested positive for mpox, you should follow the following recommendation for isolation: 

You should not have close contact to other people. Be especially careful around young children, pregnant people, the elderly or immunosuppressed people.  

• Do not have any sexual activity with others 
• Get help buying groceries, if possible 
• Be in another room than with those who live with 
• If possible you a separate bathroom from those who you live with. If not possible, then make sure to use your own towel and clean the bathroom each time. You should clean the toilet, handles and other surfaces you touch. 
• Cover chairs/sofas etc. that you use with a sheet or blanket. Something you can wash in minimum 80 degrees, when you are finished isolating. 
• Wash all you close in minimum 60 degrees – underwear, towels and linens should be washed in 80 degrees. 
• Thoroughly clean your living accommodation following isolation. It is a good idea to buy HEPA filters to your vacuum cleaner, which can help remove remains of virus from you house. 
• You should put plasters and other types of dressing in a separate sealed plastic bag before throwing it out. 
• You can go on walks if you keep at minimum a one meters distance from other people and to your best ability cover lesions on your body with clothes. 
• You can break isolation when all your lesions and scabbed over and fully healed. It can take between 2-4 weeks. 

10. What should I do if I have been in contact with someone who is infected with mpox?

The Danish Patient Safety Authority or a doctor will contact you, if you are a close contact to someone with mpox. They will inform you, on what to do, and asses if you are eligible for a vaccine against mpox. 

If someone with mpox informs you that you are a close contact, you should contact your doctor or the department of infectious medicine in the region you live in. They will assess if you need a vaccine. 

Close contacts are: 

• All household contacts or household-like contacts, e.g. people who have slept in a room/tent together or partners who do not live together. 
• Sexual contacts, who had sex while had mpox and symptoms of mpox, during sexual contact. You are still close contacts, despite having used a condom. 
• People, who have had unprotected direct contact with skin and bodily fluids or potentially contaminated material e.g. clothing/bedding. This also includes health and laboratory personnel who have been in contact with contaminated material without protective equipment’s.  
• Healthcare workers, who have had close physical contact with an infected person, e.g. performed procedures with risk of infection without the use of protective equipment. 

Contact your general practitioners by telephone if you think you may be infected with mpox, you should avoid close physical contact with other people, until you know, whether if you do have mpox, and until you are completely healed. 

11. How to prevent being infected with mpox?

Infection with mpox can be avoided by paying close attention if you have symptoms and you can avoid infecting other, if you have mpox. Pay close attention to rashes, itching and stinging around the groin area.

During the outbreak in 2022, most of the cases are men, who have sex with other men and have multiple partners. Therefore, this group has to pay attention to symptoms.

Talk with you sexual partners about the risk of infection.

Use condoms, when you have sex. Condoms can minimize the risk of infection, but does not guarantee you will not be infected. 

When you have sex with a new partner, it is a good idea to get their contact information, in case you need to contact each other. 

12. What type of treatment does people infected with mpox get?

Majority of people who are ill with mpox, do not need treatment. Symptoms usually last between 2-4 weeks, and it normally resolves itself. 

If a person needs treatment, they will usually be treated for the symptoms or complication that can arise while being sick with mpox. It could be pain-relieving treatment, if your lesions are causing you pain around the rectum or anywhere else it hurts. 

13. Does the vaccine against smallpox also help protect against mpox?

People who are vaccinated against smallpox are expected to have a certain level of immunity against severe illness. In Denmark, we stopped vaccinating with the smallpox vaccine in 1977. For all intended purposes, everyone born before 1970 is assumed to be vaccinated against smallpox. 

14. Should I be aware of anything in particular if I have pets?

If you wish to know more about pets in regards to mpox, you can read more on the Ministry of Food, Agriculture and Fisheries of Denmark´s website: Fødevarestyrelsen