Monkeypox is continuing to spread in Washington, with cases roughly doubling each week. As of late July, 109 cases were identified statewide.

Currently, a majority of the confirmed cases in Washington are through local transmission, rather than contact with travel, the state Department of Health said. King County, the state’s most populous area, has about 90% of the cases.

​​Monkeypox is a viral zoonosis, a disease transmitted to humans from animals, with symptoms similar to smallpox, albeit less severe. 

Endemic to Central and West Africa, monkeypox has been spreading rapidly and widely since May through human-to-human transmission — especially sexual contact — in countries where it is uncommon. On July 23, with over 3,000 cases detected in 47 countries, the World Health Organization declared it a global emergency.

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Rising community spread of the virus is now the real concern, said Dr. Shireesha Dhanireddy, an infectious disease expert at UW Medicine. She added that greater local access to testing may also contribute to the growing number of cases.   

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In early July, UW Medicine’s virology lab, the largest genomic sequencing lab in the state, became one of the few in the country to establish PCR testing for monkeypox.

How does monkeypox spread? Who is getting infected?

Monkeypox can affect anyone — regardless of gender or sexual orientation — who has close contact with an infected person. 

This may include direct contact, sexual or not, with respiratory secretions, skin lesions or body fluids of an infected person or contact with virus-contaminated objects like dishes, utensils, clothing, bedding or electronics.

Following current global trends, cases in Washington so far have been concentrated among men who have sex with men, and those with multiple partners. Previous outbreaks did not disproportionately affect men who have sex with men. Health care professionals are working to address this new trend without discriminating or stigmatizing

“I saw my first case in late May and started treatment then and since Pride weekend, I feel like we’ve had a significant growth in the number of cases,” Dhanireddy said. 

It is not clear if monkeypox can be sexually transmitted. The CDC are still investigating if the virus could be present in semen, vaginal fluids or fecal matter.  

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The risk is more prevalent in places where there is close, intimate skin-to-skin contact, regardless of sexual orientation, Dhanireddy said. Open-mouth kissing also raised the risk of exposure. 

“Rather than saying it’s all gay men, or queer or transgender, it’s really thinking about the epidemiologic risk in those kinds of sexual contact events and just the sheer number of partners meaning higher risk of exposure,” Dhanireddy said. 

People with multiple sex partners in the last few months are at greater risk of exposure. 

”If you have had more than 10 partners in the past three months, and if you’ve had gonorrhea or syphilis, indicating you’ve got a high risk of exposure, those are also risk factors,” Dhanireddy said. 

Just as infected animals can spread the monkeypox virus to people, it is possible infected people can spread the virus to animals through close contact. This includes petting, cuddling or sleeping on the same bed.

Symptoms and signs

Symptoms usually start within three weeks of exposure to the virus. While in previous monkeypox outbreaks, a rash developed soon after the infected person experienced flu-like symptoms, in the current outbreak, the rash precedes other symptoms. Swollen lymph nodes are another sign of monkeypox.

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The rash can look like pimples or blisters and may be painful or itchy. It may appear on or near the genitals but also on other areas like the hands, feet, chest or face. 

Prevention

As a preventive measure, the CDC recommends avoiding close, skin-to-skin contact or sharing objects with people who may be infected or have a rash that looks like monkeypox. 

Wash your hands often with soap and water or use an alcohol-based hand sanitizer, and use EPA-approved cleaning products to wipe down and disinfect surfaces shared with someone who has monkeypox.

Care

For people diagnosed with monkeypox, the CDC recommends isolation and refraining from sex as they heal. Avoid all contact with pets and other animals.

Monkeypox is contagious from the time symptoms start until the rash has healed, all scabs have fallen off and a fresh layer of skin has formed which can take several weeks.

“If you’re not able to isolate completely, make sure you cover your lesions, and try to sleep separately from housemates,” Dhanireddy said. 

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Infectious disease experts say the monkeypox virus is unlikely to affect people at airports or on public transportation as the coronavirus has.

“It is really just close intimate contact,” Dhanireddy said. “So if someone’s lesions are covered up, and they’re on public transportation, wearing a mask and practicing hand hygiene, the risk is very low.”

To care for lesions, the WHO recommends keeping them dry and uncovered when alone, cleaning your hands before and after touching the rash, rinsing skin with antiseptic soap and the mouth with saltwater. To manage discomfort, the WHO advises taking warm baths with baking soda or Epsom salts and using over-the-counter paracetamol painkillers. Routinely disinfect frequently touched surfaces, and keep the windows open for good air circulation.

More about monkeypox

While having sex with condoms may help, condoms alone are likely not enough to prevent monkeypox, the CDC said. 

For people who have had a close exposure with an infected person, are asymptomatic and within the two-week window, talk to your health care provider as you may be eligible for the vaccine. 

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Further guidance from the CDC for sexually active people potentially exposed to the virus is available here

Guidance on pet care and monkeypox is available here.

Post-recovery

Once recovery and isolation are complete, the CDC recommends a thorough cleaning and disinfection of all the spaces within the home in the following order:

  1. Collect in a sealable bag all soiled waste like bandages, paper towels, food packaging and other trash.
  2. Gather contaminated clothing and linens before anything else in the room is cleaned. Do not shake the linens as this could spread infectious particles. Wash them with standard detergent.
  3. Using EPA-approved disinfectants, clean hard surfaces and household items. Then move on to upholstered furniture and other soft furnishings with surface-appropriate cleaners. Steam cleaning can be considered.
  4. Finally, work on the carpet and flooring and dispose of all contaminated waste.

If the cleaning is carried out by someone other than the person with monkeypox, they should wear full clothes covering all skin, disposable medical gloves and a respirator or well-fitting mask.

Do not dry dust or sweep as this may spread infectious particles, though vacuuming is acceptable with a high-efficiency air filter. Wet cleaning methods like disinfectant wipes, sprays and mopping are better. 

More guidelines on cleaning and disinfecting the household post-recovery are available here.