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How serious?
Risk of death
Yes
Vaccine available?
Time to symptoms
Countries affected
Active outbreaks
Mpox spreads through close physical contact. Risk for most travelers is low. Avoid close skin-to-skin contact with anyone showing a rash. Pre-exposure vaccination (MVA-BN/Jynneos) is available for high-risk groups. Monitor outbreak alerts for your destination.
Viral zoonotic disease causing fever, lymphadenopathy, and progressive skin lesions. WHO declared PHEIC in 2024 for clade I outbreak. Vaccine (Jynneos/Imvanex) available.
Symptoms | Frequency | Severity | Onset |
|---|---|---|---|
| Fever | 62% | Mild | Early |
| Swollen lymph nodes | 56% | Mild | Early |
| Back pain | 24% | Mild | Early |
| Chills | 20% | Mild | Early |
| Fatigue | 41% | Mild | Early |
| Headache | 31% | Mild | Early |
| Malaise | 35% | Mild | Early |
| Myalgia | 31% | Mild | Early |
| Arthralgia | 10% | Mild | Early |
| Loss of appetite | 25% | Mild | Early |
| Sore throat | 17% | Mild | Early |
| Rash | 95% | Moderate | Peak |
| Vesicular rash | 90% | Moderate | Peak |
| Skin ulcer | 30% | Moderate | Peak |
| Itching | 40% | Mild | Peak |
| Abdominal pain | 12% | Mild | Peak |
| Conjunctivitis | 10% | Mild | Peak |
| Edema | 15% | Mild | Peak |
| Nausea | 10% | Mild | Any phase |
Mpox (formerly monkeypox) is a zoonotic viral disease caused by the monkeypox virus, a member of the Orthopoxviridae family closely related to the variola (smallpox) virus. The disease was first identified in laboratory monkeys in 1958 and first detected in humans in the Democratic Republic of the Congo in 1970.
Two distinct clades of the virus are recognized, with significantly different clinical profiles. Clade I (Congo Basin) causes more severe disease with case fatality rates of 1–10%, while Clade IIb was responsible for the unprecedented 2022 global outbreak that spread to over 110 countries, primarily through sexual networks, with a much lower fatality rate of less than 0.1%.
Mpox presents with a characteristic progression from prodromal fever and lymphadenopathy to a vesiculopustular rash that evolves through distinct stages over 2–4 weeks. The prominent lymphadenopathy is a key distinguishing feature from smallpox. Since the cessation of routine smallpox vaccination in the 1980s, population immunity to orthopoxviruses has waned, contributing to the increased incidence of mpox in endemic regions and the potential for global spread.
Mpox virus is maintained in a zoonotic reservoir, likely involving African rodents (rope squirrels, tree squirrels, Gambian pouched rats, dormice), though the definitive reservoir has not been conclusively identified. Human infection can occur through direct contact with infected animals (bites, scratches, bushmeat handling) or through human-to-human transmission via close physical contact, respiratory droplets during prolonged face-to-face interaction, and contact with contaminated materials.
The 2022 global outbreak (Clade IIb) revealed a previously underappreciated transmission route: close intimate and sexual contact, particularly among men who have sex with men (MSM). This outbreak resulted in over 87,000 confirmed cases across 110 countries, fundamentally changing our understanding of mpox epidemiology. Subsequently, a Clade I outbreak beginning in 2023 in the DRC and neighboring countries raised further concerns due to higher severity and spread through both sexual and household contact.
The incubation period ranges from 5 to 21 days, typically 6–13 days. Patients are considered infectious from symptom onset until all lesion crusts have separated and new epithelium has formed, a process that takes 2–4 weeks. The illness is generally self-limiting, but immunocompromised individuals, children, and pregnant women are at higher risk of severe disease.
Most mpox infections are self-limiting, but certain presentations require urgent medical evaluation. Seek immediate care for extensive rash involving more than 100 lesions, particularly if lesions are confluent or hemorrhagic, as these indicate severe disease requiring hospitalization and possible antiviral therapy.
Ocular involvement is a serious complication — any eye pain, redness, vision changes, or periorbital swelling requires emergency ophthalmological assessment, as mpox keratitis can lead to corneal scarring and permanent vision loss. Similarly, severe proctitis with rectal pain, bleeding, or inability to pass stool requires urgent evaluation, as secondary bacterial infection and rectal abscess may develop.
Signs of secondary bacterial infection — increasing redness, warmth, swelling around lesions, purulent discharge with foul odor, or spreading cellulitis — necessitate prompt medical review and antibiotic treatment. In immunocompromised individuals (particularly those with advanced HIV and CD4 counts below 200), mpox can present with persistent, progressive lesions that fail to resolve, requiring prolonged antiviral therapy. Children under 8 years and pregnant women with suspected mpox should be evaluated urgently due to higher complication rates.
Most common signs and symptoms
Mpox typically begins with a prodromal phase lasting 1–5 days, characterized by fever (often 38.5–40.5°C), intense headache, lymphadenopathy, back pain, myalgia, and profound fatigue. The lymphadenopathy — involving cervical, submandibular, axillary, or inguinal nodes — is a distinguishing clinical feature that helps differentiate mpox from smallpox and varicella.
The rash appears 1–3 days after fever onset and follows a characteristic synchronous evolution through defined stages: macules (flat lesions) → papules (raised lesions) → vesicles (fluid-filled) → pustules (pus-filled) → crusts. The distribution is classically centrifugal, beginning on the face and spreading to the extremities including palms and soles. Lesions within a given area tend to be at the same stage of development, unlike varicella where lesions appear in successive crops.
During the 2022 Clade IIb outbreak, atypical presentations were common: many patients had fewer lesions concentrated in the anogenital and perioral regions, sometimes without a preceding systemic prodrome. Some cases presented with proctitis, pharyngitis, or penile edema. These variant presentations highlight the importance of considering mpox in the differential diagnosis of genital ulcerative disease, particularly in sexually active individuals.
Knowing the symptoms is the first step to a quick response.
Typical disease course:
2022+ outbreak features: Genital/perianal lesions, proctitis, fewer lesions (sometimes <10), atypical distribution. Lymphadenopathy is a hallmark distinguishing mpox from other vesicular diseases.
How this disease is identified
The gold standard for mpox diagnosis is real-time PCR testing of lesion material. Specimens are ideally collected by vigorously swabbing the surface of a lesion or de-roofing a vesicle/pustule and swabbing the base. PCR can detect orthopoxvirus DNA and differentiate between mpox clades through specific assays. Sensitivity is highest when lesions are in the vesicular or pustular stage.
Orthopoxvirus-specific PCR is the first-line test, as it detects all members of the genus. Positive results are then followed by mpox-specific confirmatory PCR and clade determination, which has prognostic implications given the differing severity profiles of Clade I and Clade IIb. Viral culture is available in specialized biosafety level 3 laboratories but is not used for routine diagnosis.
Serological testing has limited utility for acute diagnosis because of extensive cross-reactivity among orthopoxviruses and because individuals previously vaccinated against smallpox will have pre-existing antibodies. Electron microscopy can identify orthopoxvirus particles in lesion specimens but cannot distinguish between virus species. Clinical diagnosis should be suspected in any patient presenting with a vesiculopustular rash and lymphadenopathy, particularly with relevant epidemiological links (travel to endemic areas, known contact with a confirmed case, or membership in an affected community).
Available treatment methods
Management of mpox is primarily supportive for the majority of cases. This includes maintaining adequate hydration, managing pain and fever with paracetamol or NSAIDs, and meticulous wound care to prevent secondary bacterial infection. Lesions should be kept clean and dry, and patients should avoid scratching to reduce the risk of scarring and bacterial superinfection.
Tecovirimat (TPOXX/ST-246), an antiviral originally developed for smallpox, is available for mpox treatment under various access programs (FDA approval for smallpox, expanded access/compassionate use for mpox). Tecovirimat inhibits the VP37 protein essential for viral egress and has shown efficacy in animal models. It is typically reserved for severe cases, immunocompromised patients, or those at high risk of complications. Cidofovir and brincidofovir are alternative antivirals with in vitro activity against orthopoxviruses but carry higher toxicity profiles, particularly nephrotoxicity with cidofovir.
Vaccinia immune globulin (VIG) may be considered for severely immunocompromised patients. Pain management is critical, particularly for patients with severe proctitis or pharyngitis — topical lidocaine, stool softeners, and in some cases opioid analgesics may be necessary. Bacterial superinfection of skin lesions should be treated with appropriate antibiotics based on culture results.
Most cases are effectively treated with early diagnosis.
How to protect yourself
Vaccination is the primary biomedical prevention strategy for mpox. MVA-BN (marketed as Jynneos in the US, Imvanex in Europe) is a non-replicating modified vaccinia Ankara vaccine administered as two subcutaneous doses 28 days apart. Real-world effectiveness data from the 2022 outbreak demonstrated approximately 85% protection after two doses. Pre-exposure vaccination is recommended for individuals at higher risk, including men who have sex with men with multiple partners, sexual health clinic attendees, and laboratory personnel working with orthopoxviruses.
Post-exposure prophylaxis (PEP) with MVA-BN vaccine within 4 days of exposure can prevent disease onset, and vaccination within 4–14 days may reduce disease severity. The older generation smallpox vaccine (ACAM2000) provides cross-protection but is a replicating virus with a higher side effect profile and is contraindicated in immunocompromised individuals, pregnant women, and those with eczema.
Behavioral prevention measures are equally important. During outbreaks, reducing the number of sexual partners and avoiding skin-to-skin contact with individuals who have unexplained rash or lesions significantly reduces transmission risk. Contact tracing and isolation of confirmed cases remain essential public health tools. In endemic regions, avoiding contact with wild animals, particularly rodents and primates, and thoroughly cooking all animal products reduces zoonotic transmission risk.
Preparation is the best protection.
Mpox is endemic in Central and West Africa, particularly the Democratic Republic of the Congo, which reports the highest number of cases. Since the 2022 global outbreak, sporadic cases continue to occur worldwide, though at significantly reduced numbers compared to the peak.
Travelers to Central and West Africa should be aware of the risk and consider pre-exposure vaccination with MVA-BN (Jynneos/Imvanex), particularly if they anticipate close contact with local populations, plan to visit healthcare facilities, or have risk factors for exposure. The two-dose vaccine series should ideally be completed at least 2 weeks before departure.
During travel, avoid direct contact with wild animals, particularly rodents and primates. Do not handle or consume bushmeat. Practice good hand hygiene and avoid sharing bedding or towels with anyone who has an unexplained rash. If you develop an unexplained rash with vesicles or pustules, particularly accompanied by fever and lymphadenopathy, within 21 days of potential exposure, isolate yourself, cover the lesions, and seek medical evaluation promptly. Inform healthcare providers of your travel history and any known exposures.
Statistics and geographic data
Mpox was first identified in humans in 1970 in the Democratic Republic of the Congo. For decades, it was considered a rare zoonotic disease confined to the Congo Basin and West Africa, with sporadic outbreaks typically involving fewer than 100 cases. The cessation of routine smallpox vaccination, which provided cross-protection against mpox, led to a gradual increase in susceptible populations and rising case numbers from the 1980s onward.
The 2022 global outbreak marked a paradigm shift in mpox epidemiology. Beginning in May 2022, cases were reported in non-endemic countries across Europe, the Americas, and beyond, ultimately affecting over 110 countries with more than 87,000 confirmed cases and approximately 140 deaths. The WHO declared it a Public Health Emergency of International Concern (PHEIC) in July 2022. This outbreak was predominantly driven by Clade IIb transmission through sexual networks, with a median patient age of 34 years and over 95% of cases in men.
In 2023–2024, attention shifted to a Clade I outbreak centered in the DRC, which reported over 14,000 suspected cases in 2023 alone — a record for any single country. This outbreak involved both sexual and household transmission, affected children disproportionately, and raised concerns about the potential for international spread of the more virulent clade. The WHO declared a second PHEIC in August 2024 in response to Clade I spread to neighboring countries.
Who is most at risk
Risk factors for mpox infection vary between endemic and non-endemic settings. In endemic regions of Central and West Africa, risk is associated with proximity to wildlife reservoirs — living near forests, handling or consuming bushmeat, and occupational exposure (hunters, farmers). Children in endemic areas are disproportionately affected and have higher case fatality rates.
During the 2022 global Clade IIb outbreak, the primary risk factor was close intimate or sexual contact within sexual networks, particularly among men who have sex with men with multiple partners. Attendance at large gatherings involving close physical contact was identified as a risk factor in several outbreak investigations. This epidemiological pattern is specific to the Clade IIb outbreak and does not define the disease — mpox can infect anyone through close contact.
Immunocompromised individuals, especially those with advanced HIV (CD4 count <200 cells/µL), are at significantly higher risk of severe and prolonged disease. Children under 8 years, pregnant women, and individuals with active eczema or other exfoliative skin conditions are also at elevated risk of complications. Healthcare workers involved in the care of mpox patients without appropriate personal protective equipment face occupational risk, underscoring the importance of contact and droplet precautions.
Potential complications
The most common complication of mpox is secondary bacterial infection of skin lesions, occurring when the protective barrier of vesicles and pustules is disrupted by scratching or inadequate wound care. Staphylococcus aureus and Streptococcus pyogenes are the most frequently implicated organisms. Cellulitis, abscess formation, and rarely septicemia can result if bacterial superinfection is not treated promptly.
Ocular complications represent one of the most serious sequelae. Corneal infection (keratitis) can result from autoinoculation — transferring virus from skin lesions to the eyes — or from direct extension of periorbital lesions. Without treatment, mpox keratitis can progress to corneal scarring and permanent visual impairment. Historical data from endemic settings suggest ocular involvement in 2–5% of unvaccinated cases.
Severe proctitis was a prominent complication during the 2022 outbreak, often causing intense rectal pain, tenesmus, bloody discharge, and difficulty with defecation. Some patients required hospitalization for pain management and monitoring. Respiratory complications including bronchopneumonia can occur, particularly with extensive oropharyngeal involvement. In immunocompromised patients, persistent viremia with progressive necrotic skin lesions, visceral organ involvement, and secondary infections can result in a protracted and potentially fatal course. Scarring, particularly facial scarring, is common after resolution and may have lasting psychological and social impact.
Expected outcomes and recovery
Clade II (global outbreak, 2022–2024): CFR <0.1% in immunocompetent individuals. Self-limiting.
Clade I (Central African): CFR 1–10% (higher in children and immunocompromised).
Complications:
Secondary bacterial skin infections: most common.
Proctitis (in MSM transmission): painful, may require hospitalization.
Encephalitis: rare (<0.1%).
Ocular involvement: may cause permanent visual impairment.
Immunocompromised (advanced HIV): severe, prolonged, potentially fatal disease.
Recovery: Most patients recover within 2–4 weeks. Scarring may occur at lesion sites. Post-infectious fatigue is common.
This disease is vaccine-preventable. Effective protection is available through vaccination.
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Find a vaccination clinic →The content on this page is for informational and educational purposes only. It does not constitute medical advice, diagnosis, or treatment recommendations. If you have health concerns, consult a qualified healthcare professional. Medova is not a medical service provider.
Full terms of useGeographic distribution and active outbreaks
| Flag | Country | Risk level |
|---|---|---|
 | Democratic Republic of the Congo | High risk |
 | Uganda | High risk |
 | Burundi | High risk |
 | Rwanda | High risk |
 | Ghana | High risk |
 | Nigeria | High risk |
 | Côte d'Ivoire | High risk |
 | Central African Republic | High risk |
 | Congo | High risk |
 | Cameroon | High risk |
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