Mpox (Monkeypox)

Mpox is typically an acute illness, usually with the sudden onset of the following symptoms:

• Fever
• Headache
• Muscle aches and backache
• Swollen lymph nodes (lymphadenopathy)
• Chills
• Exhaustion
• Respiratory symptoms (such as cough, nasal congestion, and sore throat)

Shortly afterwards, usually within 1 to 4 days, a rash develops. The rash may appear initially like pimples or blisters and may be painful or itchy. These lesions will then progress through several stages before healing. Lesions can appear anywhere on the body.

Mpox can be confused with other diseases, such as chickenpox, shingles, molluscum contagiosum, hand, foot, and mouth disease, syphilis, herpes, and other diseases.

It is important to note that mpox may not always appear the same way for everyone. In some cases, lesions may be the only symptom experienced. In others, the rash may appear before other symptoms.

Mpox can spread to anyone, most often through close, skin-to-skin contact, as well as:

•  Direct, close contacts with the rash, scabs, or body fluids from a person with mpox.
• Touching objects, fabrics (clothing, bedding, towels, and other items), or surfaces that have been used by someone with mpox.
• Contact with saliva or respiratory droplets from someone with mpox.

Texans can help protect themselves against mpox through the following steps:

• Get vaccinated against mpox (see section below).
• Take steps to lower your risk during sex or social gatherings.
  • Talk with your partner about mpox symptoms and be aware of any new or unexplained rash or lesion on either of your bodies.
  • Do not have sex if you or your partner has a new or unexplained rash.
  • Exchange contact information with any new partner to allow for sexual health follow-up.
  • Limit your number of partners to reduce your likelihood of exposure.
  • Although condoms will not protect you completely from mpox, they can be help protect certain areas of your body during intercourse.
  • Refer to the CDC’s website for additional details and guidance.
• Avoid close, skin-to-skin contact with others that have a rash or lesions.
• Avoid contact with objects and materials that a person with mpox has used.
  • Do not share utensils or cups.
  • Do not handle or touch the bedding, towels, or clothing of a person with mpox.
  • If you or someone you live with has mpox, follow the steps for cleaning and disinfection on the CDC’s website.
• Wash your hands often.
  • Use soap and water whenever possible.
  • Use an alcohol-bases hand sanitizer.

There are two vaccines that may be used for the prevention of mpox. The most common vaccine, JYNNEOS, is currently available in Texas and may be given to anyone who requests mpox vaccination. The Advisory Committee on Immunization Practices recommends that people ≥18 years of age with risk factors for mpox be vaccinated, before an exposure, with two doses of the JYNNEOS vaccine 28 days apart unless they were previously infected with mpox or already received two doses. People who have only received one dose of the JYNNEOS vaccine and did not receive the second dose within 28 days should receive the second dose as soon as possible, regardless of the amount of time that has elapsed since the first dose.

Individuals should discuss vaccination with their healthcare provider or contact their local health department to see where vaccinations are available.

During the summer of 2022, mpox cases were identified in countries that have not historically reported mpox cases, including the United States. Whole genome sequencing data indicates that these cases are being caused by Clade II MPXV; no case of mpox caused by Clade I MPXV have been detected in the United States during this outbreak. During 2022, Texas reported 2,970 probable and confirmed cases of mpox (see table below). Cases of mpox have continued to be reported in Texas in 2023 and 2024, although at a much slower rate than 2022.

Table. Texas Mpox Cases by Public Health Region, 2022

During the summer of 2021, a case of mpox was identified in a Texas resident that had recently traveled to Nigeria. This case was not associated with the ongoing outbreak of mpox in countries that have not historically reported mpox as demonstrated by whole genome sequencing. No additional cases were reported that were associated with this case.

Prior to 2022, the largest outbreak of mpox in the United States was in 2003 when 47 probable and confirmed cases were reported in six states (Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin). Although no cases were reported in Texas, investigators determined the source of the outbreak to be pet prairie dogs that had been infected after being housed near small mammals imported from Ghana; these animals were originally imported from Ghana to Texas.