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Will an mpox outbreak return this summer? These pictures can help identify symptoms

Mpox cases have increased in Chicago in recent weeks, prompting some concern that the summer months could lead to another outbreak.

Cases of mpox, the disease formerly known as monkeypox, peaked in July and August last year in the U.S. and have drastically declined since, with a seven-day average of zero new cases in late April, per data from the Centers for Disease Control and Prevention. But a growing number of cases in Chicago have authorities concerned that the summer could bring another nationwide mpox outbreak. Familiarizing yourself with mpox aka monkeypox pictures and symptoms can help keep your community safe.

Pictures of monkeypox symptoms and rash from UK Health Security Agency.
Pictures of monkeypox symptoms and rash from UK Health Security Agency.GOV.UK

On Monday, Howard Brown Health, an LGBTQ-focused clinic in Chicago, shared that it had seen eight new cases of mpox since April 17, compared to one case in the previous three months. This marks the city's highest number of new cases since November 2022. Infections that spread through sexual contact tend to increase during the summer, and NBC News reported there's concern among experts that this could happen with mpox cases, as well.

The mpox virus spreads through close, usually skin-to-skin contact and results in a rash and flu-like symptoms, such as fever, aches, sore throat and cough. The 2022 outbreak was driven primarily by sex between men, but it can also spread outside this community.

Over the past three weeks, eight countries have had a slight increase in new mpox cases, said Dr. Rosamund Lewis, the technical lead for mpox at the World Health Organization. Many of the new cases are in people who have received vaccines against mpox.

While breakthrough cases with mpox are possible, experts stress that vaccines can reduce the severity of symptoms and are crucial to prevent a resurgence of the virus.

“Without renewed vaccination and prevention efforts, we are at risk for a resurgence of mpox,” Dr. Demetre Daskalakis, the deputy coordinator of the White House national mpox response, told NBC News. “Vaccine is a really important tool, even if it’s not perfect.”

It's possible that vaccines and immunity from previous infections could prevent another outbreak the size of last year's, NBC News reported. But it's unclear how much immunity is needed and whether people will return to sexual behaviors that they stopped last year to curb the spread of the outbreak.

Still, it's not yet time to panic about a possible surge of mpox cases, Daskalakis said. Rather, the new cases in Chicago should be a "call to action," he added. “We have the tools to take care of this,” he said. “We just have to get it done.”

The monkeypox outbreak first hit the U.S. in May 2022, and cases ticked up rapidly over the summer, hitting a peak of 736 new cases in one day in late August, per CDC data. The U.S. has had more cases than any other country — over 30,000 — and 42 deaths.

Once September hit, the number of new mpox cases in the U.S. dropped. The seven-day average of reported new cases hit 100 on Sept. 28, 2022, down from 471 just seven weeks prior.

The decrease, driven by declining rates in major cities like New York and Los Angeles, may've been due to vaccines and the most at-risk communities changing their behavior. People of color have being disproportionately affected by the outbreak.

The monkeypox outbreak was declared a national public health emergency in the U.S. in early August, shortly after the World Health Organization also declared it a public health emergency of international concern, its highest alert.

Monkeypox pictures and rash

Mpox is a rare disease that’s usually found in Central and West Africa. In humans, there are two types of mpox virus, which WHO recently renamed: clade one, formerly known as the Congo Basin variant, and clade two, formerly known as the West African clade. Clade two drove the 2022 outbreak and has a survival rate of 99% whereas clade one has a 10% fatality rate.

Monkeypox symptoms usually appear within three weeks of exposure. Usually, flu-like symptoms will appear first, followed by a rash one to four days later. The rash may be on or near the genitals or anus, as well as other parts of the body, such as the hands, feet, chest, face or inside the mouth, according to the CDC. The illness typically lasts two to four weeks.

monkeypox pictures
Pictures of monkeypox symptoms and rash, from the CDC.CDC

Some of the most common mpox symptoms reported in the current outbreak have been lesions around the genitals and anus, fever, swollen lymph nodes, oral sores and pain when swallowing, per WHO. In some patients, the rash has appeared before flu-like symptoms, and it only affected one part of the body, such as the genitals. (In other patients, it started around the genitals or anus and then spread.)

A recent study in the journal BMJ found that almost half of the 197 participants, all of whom had tested positive for mpox, had lesions on the skin or mucus membranes as their only symptom, or their systemic symptoms, like fever, appeared after the lesions. The study authors also noted the "predilection" of the lesions to the genital and anal areas, as well as in and around the mouth and throat. Also, some patients had solitary lesions that did not spread.

The study authors theorized that these trends may be due to the virus spreading from sex and the rash popping up where the virus entered the body as the first symptom. Most cases in the outbreak have been tied to sex between men, another study found.

The first U.S. monkeypox case was in May in a Massachusetts man who’d traveled to Canada, and his rash first appeared around his anus and genitals, according to a June CDC report. Also this past May, a New York City resident with mpox was treated for an oral lesion and rash around the anus initially presumed to be a common sexually transmitted infection. Another mpox patient in New York City told that their symptoms started out like the flu before sores appeared on the face and anus.

monkeypox picture
A picture of a monkeypox lesion from New York City resident Jack Richards, who was diagnosed with monkeypox in July and shared their story with TODAY.Courtesy Jack Richards

What does monkeypox look like?

Many mpox patients have been sharing pictures and videos of their symptoms to raise awareness and stem the spread. A 40-year-old man from Texas who goes by Silver Steele on social media shared a photo timeline of his mpox rash, which has gone viral. He told his first symptom was a few small blisters; a few days after they appeared, he experienced flu-like symptoms.

Prior to this pandemic, mpox symptoms usually began with fever, headache, back aches and lethargy lasting one to two days, according to Lewis. Traditionally, next a rash will appear, which starts as red discoloration in the skin. It usually starts on the face and then progresses to the arms and legs, then hands and feet, and then the rest of the body. This phase also lasts one to two days. Next comes what are referred to as papules, when the rash becomes raised on the skin, instead of flat. This also lasts one to two days.

monkeypox pictures

Next is the vesicle phase, or as Lewis called them, “blisters,” when lesions are raised and filled with clear fluid, usually starting on the fourth or fifth day of symptoms and lasting another one to two days.

Vesicles are followed by pustules, when the blisters “fill with a whitish fluid that looks like pus,” Lewis said, usually around the sixth or seventh day of symptoms. According to the CDC, they’re usually “firm to the touch,” develop a dent in the center (called an umbilication) and last an additional five to seven days. (The BMJ study on symptoms in the 2022 monkeypox outbreak noted that some participants' lesions did not become pustular or ulcerated.)

Monkeypox pictures
In this Centers for Disease Control and Prevention handout graphic, symptoms of one of the first known cases of the monkeypox virus are shown on a patient's hand May 27, 2003.CDC via Getty Images

After about two weeks of symptoms, the lesions then start to crust and scab over, and the scabs last for another week before falling off. Scars and skin discoloration may persist after the scabs are gone, but you’re no longer contagious after the scabs have all fallen off.

Monkeypox pictures
In this Centers for Disease Control and Prevention handout graphic, symptoms of one of the first known cases of the monkeypox virus are shown on a patient's hand June 5, 2003.Getty Images

How is monkeypox transmitted

Mpox symptoms are similar to those of smallpox, including fever, headaches, muscle aches, chills exhaustion and a rash similar to pimples or blisters, which can pop up on the face, in the mouth, on the hands, feet, chest, genitals or anus. But mpox is much less contagious than smallpox. There is no specific treatment for mpox, but the smallpox vaccine, antivirals and other treatments can be used to control an outbreak.

According to the CDC, the mpox virus spreads primarily through direct contact with the sores or bodily fluids of someone infected with mpox or materials that have come in contact with bodily fluids or sores of an infected person. It may also spread through contact with respiratory secretions. These methods of transmission may occur during intercourse or other sexual contact, such as kissing, massaging or hugging, or through prolonged face-to-face interactions.

It's still unknown whether mpox can spread if a person was exposed but doesn't have any symptoms, how often it's spread through respiratory secretions, or if it can spread through semen, vaginal fluids, urine or feces.

To prevent the spread of monkeypox, the CDC recommends:

  • Avoiding skin-to-skin contact with people who have a rash that looks like mpox
  • Not touching the rash or scabs of person with mpox
  • Not kissing, hugging, cuddling or having sex with someone with mpox
  • Not sharing eating utensils or cups with a person with mpox
  • Not touching bedding, towels or clothing of a person with mpox

The virus can also spread from animals to humans through a bite or scratch by handling wild game or using products made from infected animals. And there's reason to believe mpox can spread from humans to animals, previously reported. Medical journal The Lancet recently investigated the "first case of a dog with confirmed mpox virus infection that might have been acquired through human transmission." No cases had been reported in domesticated animals prior, the study authors noted.

Monkeypox vaccines

The Jynneos vaccine appears to be effective at protecting against mpox, according to CDC data, which found that unvaccinated men eligible for the vaccine were 14 times more likely to develop mpox than men who'd received at least one dose. Roughly 800,000 doses have been administered in the U.S. to people at high risk of becoming infected with mpox.

The CDC recommends anyone exposed to mpox or with an increased risk of exposure be vaccinated against it.

If you're concerned that you've been exposed to mpox or have monkeypox symptoms, visit a heath care provider, the CDC advises. If you believe you have mpox symptoms, you should also avoid contact with other people and animals until you test negative.