Monkeypox pictures aren't for the faint of heart, but they can help identify monkeypox symptoms amid the outbreak of the virus, which has ballooned to almost than 17,000 cases in the United States, according to the U.S. Centers for Disease Control and Prevention. Earlier this month, the Biden administration declared monkeypox a public health emergency.
Last month, the World Health Organization also declared a public health emergency of international concern, its highest alert. Since 2007, only six other outbreaks have qualified: COVID-19, Zika, H1N1 flu, polio and Ebola twice, NBC News reported.
Cases around the world have been steadily increasing since May, when WHO and the CDC first started tracking the outbreak, which is believed to have started in Europe. The outbreak is unlikely to lead to COVID-level pandemic restrictions, as the monkeypox virus doesn't appear to spread as easily, and it's been around for decades, so there are vaccines and treatments for it, experts previously told TODAY. In fact, officials in Britain said Monday its daily case rate is showing "signs of slowing," with about 29 new ones a day compared to 52 in the last week in June, the Associated Press reported.
Meanwhile, new daily cases in the U.S. have been ticking up, according to the CDC. Earlier this week, the country reported 676 new cases of monkeypox, its third-highest daily case count since the outbreak began. As of data from Thursday, the U.S. case total stands at 16,926, and around the world, it's 46,724, per the CDC. The U.S. has more monkeypox cases than any other country in the outbreak.
The states with the highest case rates are currently: New York with 3,117 cases; California with 3,068 and Florida with 1,713. Overall, monkeypox has been confirmed in 50 states, Puerto Rico and the District of Columbia. At least 17 cases of monkeypox in kids have been reported in the U.S, per the CDC.
U.S. officials declaring the outbreak a public health emergency will ideally lead to more emergency funds, health agencies collecting more data and easier access to vaccines and treatments. Meanwhile, WHO's declaration means the United Nations agency recommends a coordinated international response to prevent the outbreak from escalating into a pandemic.
So far in the outbreak, at least 13 people have died, six in areas that haven't historically reported monkeypox: Brazil, Cuba, Ecuador, India and Spain, per the CDC. About 10% of cases have required hospitalization to manage the pain of the lesions caused by the virus, WHO's director-general said at a recent press briefing.
Monkeypox pictures and timeline
Monkeypox is a rare disease that’s usually found in Central and West Africa. There are two types of monkeypox 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 is driving the current outbreak and has a survival rate of 99% whereas clade one has a 10% fatality rate.
Monkeypox symptoms usually start to appear one to two weeks after exposure, but the incubation period can be as short as five days or as long as 21 days, according to the CDC.
In this outbreak, symptoms have sometimes looked different from “the classical clinical picture for monkeypox,” WHO has said. Historically, monkeypox has started with flu-like symptoms, such as fever, before a rash appears, which usually has started on the face before spreading to the hands and rest of the body.
However, the most common symptoms in this monkeypox outbreak have included: lesions around the genital and anus, fever, swollen lymph nodes, oral sores and pain when swallowing, according to WHO. In this outbreak, rashes around the anus and genitals have not always spread to other parts of the body, and rashes have often appeared before other symptoms like fever.
A recent study in the journal BMJ found that almost half of the 197 participants, all of whom had tested positive for monkeypox, 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 differences 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 monkeypox was treated for an oral lesion and rash around the anus initially presumed to be a common sexually transmitted infection. Another monkeypox patient in New York City told TODAY that their symptoms started out like the flu before sores appeared on the face and anus.
Many monkeypox 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 monkeypox rash, which has gone viral. He told TODAY his first symptom was a few small blisters; a few days after they appeared, he experienced flu-like symptoms.
Prior to this pandemic, monkeypox symptoms usually began with fever, headache, back aches and lethargy lasting one to two days, explained Rosamund Lewis, WHO’s head smallpox secretariat. 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.
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 current monkeypox outbreak noted that some participants' lesions did not become pustular or ulcerated.)
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.
The CDC is in encouraging anyone who develops a new, unexplained rash on any part of the body, regardless of the presence of fever or chills, to seek medical attention immediately and avoid contact with others.
Monkeypox symptoms and transmission
Monkeypox 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 monkeypox is much less contagious than smallpox. There is no specific treatment for monkeypox, but the smallpox vaccine, antivirals and other treatments can be used to control an outbreak.
The CDC released a statement clarifying how the monkeypox virus spreads. "The virus is not known to linger in the air and is not transmitted during short periods of shared airspace," unlike COVID and measles, the statement explained.
It added that the virus spreads through direct contact with the sores or bodily fluids of someone infected with monkeypox or materials that have come in contact with bodily fluids or sores of an infected person. It may also spread through prolonged, close face-to-face contact through respiratory secretions.
In cases of monkeypox from close contact between two people, it's difficult to know exactly how the virus spreads because it can be either due to skin-to-skin contact in a sexual situation or face-to-face contact and droplets. Monkeypox can spread during sex, kissing, cuddling, or touching parts of the body with sores.
To prevent the spread of monkeypox, the CDC recommends:
- Avoiding skin-to-skin contact with people who have a rash that looks like monkeypox
- Not touching the rash or scabs of person with monkeypox
- Not kissing, hugging, cuddling or having sex with someone with monkeypox
- Not sharing eating utensils or cups with a person with monkeypox
- Not touching bedding, towels or clothing of a person with monkeypox
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 monkeypox can spread from humans to animals, TODAY previously reported. Medical journal The Lancet recently investigated the "first case of a dog with confirmed monkeypox virus infection that might have been acquired through human transmission." No cases had been reported in domesticated animals prior, the study authors noted.
Monkeypox virus outbreak 2022
The multi-country outbreak, which the World Health Organization has been tracking since May, has not yet been linked to any areas where the virus is usually found.
"This is the first time we're seeing cases across many countries at the same time in people who have not traveled to the to the endemic regions in Africa," Lewis said in May when asked why there's so much concern now even though the disease has been around for at least 40 years.
The current outbreak is being primarily driven by sex between men, according to one of the first peer-reviewed papers analyzing recent cases. In New York City, the epicenter for the virus in the U.S., 11 woman have been reported to have the virus, compared to 1,938 in men, according to NYC Health. In the BMJ study, all 197 participants identified as men, and 196 identified as gay; 96% reported recent sexual contact.
"The clinical presentation of these infections suggest that sexual transmission, not just close physical contact, may be helping spread the virus among this population," Jennifer Nuzzo, an epidemiologist at Brown University, told NBC News.
But it's important to note that anyone can get monkeypox through close contact and that it's "not a gay disease," Andy Seale, adviser to WHO’s HIV, hepatitis and sexually transmitted infection programs, said early on in the outbreak. More recently, the WHO stressed that there's no evidence to suggest the outbreak will stay within the community of men who have sex within men, CNBC reported.
“This really might be the canary in the mine that’s alerting to us a new disease threat that could spread to other groups,” Dr. Catherine Smallwood, senior emergency officer at WHO, told CNBC.
The U.S. government has been criticized for its response to the monkeypox outbreak, it has recently been increasing its efforts to address it. There's currently a limited supply of vaccines that protect against monkeypox, but more will be available in the coming weeks and months, according to the CDC. The U.S. has also ramped up its monkeypox testing capacity, thanks to collaborations with some of the biggest commercial labs, like Labcorp.
The CDC recommends anyone exposed to monkeypox or with an increased risk of exposure, like people who work with monkeypox lab samples, be vaccinated against the disease. However, eligibility for the monkeypox vaccine depends on where you live; in New York City, for example, you must be a nonbinary or transgender person or a man who has sex with men who's multiple or anonymous sex partners within the past 14 days. Contact your local health department to find out if you qualify for a vaccine.
If you're concerned that you've been exposed to monkeypox or have monkeypox symptoms, visit a heath care provider the CDC advises. If you believe you have monkeypox symptoms, you should also avoid contact with other people and animals until you test negative.