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The Centers for Disease Control and Prevention are working to help by providing advice to U.S. state, tribal, local, and territorial health departments on tracking potential cases, contact tracing, and responding to additional identified cases

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Centers for Disease Control and Prevention

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Learn more about monkeypox in the United States.

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The World Health Organization supports Member States with surveillance, preparedness and outbreak response activities for monkeypox in affected countries

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Overview

Mpox (monkeypox) is an infectious disease caused by the monkeypox virus. It can cause a painful rash, enlarged lymph nodes and fever. Most people fully recover, but some get very sick.

Anyone can get mpox. It spreads from contact with infected:

persons, through touch, kissing, or sex

animals, when hunting, skinning, or cooking them

materials, such as contaminated sheets, clothes or needles

pregnant persons, who may pass the virus on to their unborn baby.

If you have mpox:

Tell anyone you have been close to recently

Stay at home until all scabs fall off and a new layer of skin forms

Cover lesions and wear a well-fitting mask when around other people

Avoid physical contact.

The disease mpox (formerly monkeypox) is caused by the monkeypox virus (commonly abbreviated as MPXV), an enveloped double-stranded DNA virus of the Orthopoxvirus genus in the Poxviridae family, which includes variola, cowpox, vaccinia and other viruses. The two genetic clades of the virus are clades I and II.

The monkeypox virus was discovered in Denmark (1958) in monkeys kept for research and the first reported human case of mpox was a nine-month-old boy in the Democratic Republic of the Congo (DRC, 1970). Mpox can spread from person to person or occasionally from animals to people. Following eradication of smallpox in 1980 and the end of smallpox vaccination worldwide, mpox steadily emerged in central, east and west Africa. A global outbreak occurred in 2022-2023. The natural reservoir of the virus is unknown - various small mammals such as squirrels and monkeys are susceptible.

Transmission

Person-to-person transmission of mpox can occur through direct contact with infectious skin or other lesions such as in the mouth or on genitals; this includes contact which is

face-to-face (talking or breathing)

skin-to-skin (touching or vaginal/anal sex)

mouth-to-mouth (kissing)

mouth-to-skin contact (oral sex or kissing the skin)

respiratory droplets or short-range aerosols from prolonged close contact

The virus then enters the body through broken skin, mucosal surfaces (e g oral, pharyngeal, ocular, genital, anorectal), or via the respiratory tract. Mpox can spread to other members of the household and to sex partners. People with multiple sexual partners are at higher risk.

Animal to human transmission of mpox occurs from infected animals to humans from bites or scratches, or during activities such as hunting, skinning, trapping, cooking, playing with carcasses, or eating animals. The extent of viral circulation in animal populations is not entirely known and further studies are underway.

People can contract mpox from contaminated objects such as clothing or linens, through sharps injuries in health care, or in community setting such as tattoo parlours.

Signs and symptoms

Mpox causes signs and symptoms which usually begin within a week but can start 1-21 days after exposure. Symptoms typically last 2-4 weeks but may last longer in someone with a weakened immune system.

Common symptoms of mpox are:

For some people, the first symptom of mpox is a rash, while others may have different symptoms first.

The rash begins as a flat sore which develops into a blister filled with liquid and may be itchy or painful. As the rash heals, the lesions dry up, crust over and fall off.

Some people may have one or a few skin lesions and others have hundreds or more. These can appear anywhere on the body such as the:

palms of hands and soles of feet

face, mouth and throat

groin and genital areas

anus.

Some people also have painful swelling of their rectum or pain and difficulty when peeing.

People with mpox are infectious and can pass the disease on to others until all sores have healed and a new layer of skin has formed.

Children, pregnant people and people with weak immune systems are at risk for complications from mpox.

Typically for mpox, fever, muscle aches and sore throat appear first. The mpox rash begins on the face and spreads over the body, extending to the palms of the hands and soles of the feet and evolves over 2-4 weeks in stages - macules, papules, vesicles, pustules. Lesions dip in the centre before crusting over. Scabs then fall off. Lymphadenopathy (swollen lymph nodes) is a classic feature of mpox. Some people can be infected without developing any symptoms.

In the context of the global outbreak of mpox which began in 2022 (caused mostly by Clade IIb virus), the illness begins differently in some people. In just over a half of cases, a rash may appear before or at the same time as other symptoms and does not always progress over the body. The first lesion can be in the groin, anus, or in or around the mouth.

People with mpox can become very sick. For example, the skin can become infected with bacteria leading to abscesses or serious skin damage. Other complications include pneumonia, corneal infection with loss of vision; pain or difficulty swallowing, vomiting and diarrhoea causing severe dehydration or malnutrition; sepsis (infection of the blood with a widespread inflammatory response in the body), inflammation of the brain (encephalitis), heart (myocarditis), rectum (proctitis), genital organs (balanitis) or urinary passages (urethritis), or death. Persons with immune suppression due to medication or medical conditions are at higher risk of serious illness and death due to mpox. People living with HIV that is not well-controlled or treated more often develop severe disease.

Diagnosis

Identifying mpox can be difficult as other infections and conditions can look similar. It is important to distinguish mpox from chickenpox, measles, bacterial skin infections, scabies, herpes, syphilis, other sexually transmissible infections, and medication-associated allergies. Someone with mpox may also have another sexually transmissible infection such as herpes. Alternatively, a child with suspected mpox may also have chickenpox. For these reasons, testing is key for people to get treatment as early as possible and prevent further spread.

Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for mpox. The best diagnostic specimens are taken directly from the rash - skin, fluid or crusts - collected by vigorous swabbing. In the absence of skin lesions, testing can be done on oropharyngeal, anal or rectal swabs. Testing blood is not recommended. Antibody detection methods may not be useful as they do not distinguish between different orthopoxviruses.

More information on laboratory confirmation of mpox can be found here.

Treatment and vaccination

The goal of treating mpox is to take care of the rash, manage pain and prevent complications. Early and supportive care is important to help manage symptoms and avoid further problems.

Getting an mpox vaccine can help prevent infection. The vaccine should be given within 4 days of contact with someone who has mpox (or within up to 14 days if there are no symptoms).

It is recommended for people at high risk to get vaccinated to prevent infection with mpox, especially during an outbreak. This includes:

health workers at risk of exposure

men who have sex with men

people with multiple sex partners

sex workers.

Persons who have mpox should be cared for away from other people.

Several antivirals, such as tecovirimat, originally developed to treat smallpox have been used to treat mpox and further studies are underway. Further information is available on mpox vaccination and case management.

Self-care and prevention

Most people with mpox will recover within 2-4 weeks. Things to do to help the symptoms and prevent infecting others:

Do

stay home and in your own room if possible

wash hands often with soap and water or hand sanitizer, especially before or after touching sores

wear a mask and cover lesions when around other people until your rash heals

keep skin dry and uncovered (unless in a room with someone else)

avoid touching items in shared spaces and disinfect shared spaces frequently

use saltwater rinses for sores in the mouth

take sitz baths or warm baths with baking soda or Epsom salts for body sores

take over-the-counter medications for pain like paracetamol (acetaminophen) or ibuprofen.

Do not

pop blisters or scratch sores, which can slow healing, spread the rash to other parts of the body, and cause sores to become infected; or

shave areas with sores until scabs have healed and you have new skin underneath (this can spread the rash to other parts of the body).

To prevent spread of mpox to others, persons with mpox should isolate at home, or in hospital if needed, for the duration of the infectious period (from onset of symptoms until lesions have healed and scabs fall off). Covering lesions and wearing a medical mask when in the presence of others may help prevent spread. Using condoms during sex will help reduce the risk getting mpox but will not prevent spread from skin-to-skin or mouth-to-skin contact.

Outbreaks

After 1970, mpox occurred sporadically in Central and East Africa (clade I) and West Africa (clade II). In 2003 an outbreak in the United States of America was linked to imported wild animals (clade II). Since 2005, thousands of suspected cases are reported in the DRC every year. In 2017, mpox re-emerged in Nigeria and continues to spread between people across the country and in travellers to other destinations. Data on cases reported up to 2021 are available here.

In May 2022, an outbreak of mpox appeared suddenly and rapidly spread across Europe, the Americas and then all six WHO regions, with 110 countries reporting about 87 thousand cases and 112 deaths. The global outbreak has affected primarily (but not only) gay, bisexual, and other men who have sex with men and has spread person-to-person through sexual networks. More information on the global outbreak is available here with detailed outbreak data here;

In 2022, outbreaks of mpox due to Clade I MPXV occurred in refugee camps in the Republic of the Sudan. A zoonotic origin has not been found.

WHO response

The global outbreak of mpox was declared a public health emergency of international concern (PHEIC) on 23 of July 2022. WHO published a strategic preparedness and response plan for mpox and a suite of technical guidance documents. Surveillance, diagnostics, risk communication and community engagement remain central to stopping the outbreak and eliminating human-to-human transmission of mpox in all contexts.

More information can be found here. Questions and answers are here and public health advice is here.

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WHO fact sheet on monkeypox: includes key facts, definition, outbreaks, transmission, symptoms, diagnosis, treatment, prevention, WHO response.

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This article was posted on 07/30/2022 and talks about how NYC declared Monkeypox a global health emergency

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New York City declares monkeypox a public health emergency

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New York City accounts for about a quarter of all confirmed monkeypox cases nationwide.

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This is a short video of a person's experience with monkeypox along with some basic information for all to know

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Everything We Know About Monkeypox | Insider News

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The article was published on 07/29/2002 and it talks about three main points: Spread, Vaccination, and Treatment.

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Three Pressing Questions About Monkeypox: Spread, Vaccination, Treatment

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Containing the outbreak, scientists say, will depend on better understanding the virus’s transmission and how well available tools work.

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This article gives you a brief rundown of what Monkeypox is who spreads it

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Monkeypox is a rare but potentially serious disease that is caused by the monkeypox virus. Monkeypox virus is from the same family of viruses as the smallpox virus. It is also less severe and transmissible than smallpox. Monkeypox can spread from infected humans, animals, and materials contaminated with the virus.

Monkeypox virus is characterized by a new, unexplained rash and skin lesions. It is usually found in Central and West Africa and normally does not spread in the United States. However, since May 2022, there has been an outbreak of monkeypox in several countries where the virus is not usually found, including in the United States.

While anyone can develop and spread monkeypox after being exposed to the virus, the Centers for Disease Control and Prevention (CDC) reports that most cases of monkeypox in the U.S. have occurred among gay, bisexual, trans, and other men who have sex with men (MSM). The overall risk to the public remains low.

Wisconsin has confirmed cases of orthopoxvirus, presumed to be monkeypox, in Wisconsin residents. View current case counts.

Monkeypox does not spread easily from person to person. People must have close, sustained contact with an infected person to get the virus. People usually become infected with monkeypox:

By having direct contact with the skin lesions or body fluids of an infected person,

Through sharing items, such as bedding or clothing of an infected person, or

Through prolonged exposure to an infected person's respiratory secretions.

Monkeypox can also be spread to people from animals through bites, scratches, preparation of meat or use of a product from an infected animal.

Most people who have monkeypox recover without needing treatment within two to four weeks. While there is no specific treatment for monkeypox, antiviral medications that have been used to treat smallpox can be used. People who have been exposed to someone with monkeypox may be eligible to receive a vaccine to prevent the onset of disease or reduce the severity of symptoms. DHS will work with healthcare providers to obtain vaccines and treatment when necessary.

If you were exposed to monkeypox, monitor for symptoms for 21 days after your date of last exposure. It is important to check your temperature two times per day during your monitoring period. If symptoms begin, contact a doctor immediately and isolate away from others.

You can continue daily activities, like going to work or school, if you do not develop any symptoms. If your partner has monkeypox, avoid sex or being intimate until all sores have healed and a fresh layer of skin has formed. Do not handle or touch the bedding, towels, or clothing of a person with monkeypox. Standard household cleaning products and disinfectants should be used to wash any surfaces and materials that have been touched by someone who has monkeypox, followed by handwashing.

Since monkeypox is most often spread from person to person, contact tracing is also an important tool that can be used to help limit the spread of disease.

Find clinical guidance on testing, vaccine administration, reporting, and more on our monkeypox webpage for health professionals.

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Monkeypox is a rare but potentially serious disease that is caused by the monkeypox virus. Monkeypox virus is from the same family of viruses as the smallpox virus. It is also less severe and transmissible than smallpox. Monkeypox can spread from infected humans, animals, and materials contaminated with the virus.

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This articles answers some of the most common questions about the new disease

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Overview

What is monkeypox?

Monkeypox is a rare disease caused by the monkeypox virus. It leads to rash and flu-like symptoms. Like the better known virus that causes smallpox, it is a member of the family called orthopoxvirus.

Monkeypox was discovered in 1958 when two outbreaks of a pox-like disease occurred in groups of monkeys being used for research. It's spread mainly through human contact with infected rodents, but can sometimes be spread through skin-to-skin contact with an infected person. There are two known types (clades) of monkeypox virus - one that originated in Central Africa and one that originated in West Africa. The current world outbreak (2022) is caused by the less severe West African clade.

How common is monkeypox?

Monkeypox is rare. But the number of cases is increasing in Africa, as well as in regions that haven't seen these infections before.

Where else is monkeypox found?

For decades, Monkeypox was mostly been seen in Africa. However, it's occasionally found in other countries, including the United States. In the spring of 2003, the first outbreak of monkeypox outside of Africa occurred in the United States. A shipment of infected animals from Ghana was imported into Texas. The infected rodents spread the virus to pet prairie dogs, which then infected 47 people in the Midwest.

As international travel becomes more common, viruses that were once fairly confined to certain locations can more easily spread around the world. In the summer of 2021, a case of monkeypox was found in a U.S. resident who had traveled from Nigeria to the United States. Then, 2022 brought outbreaks to regions outside of Africa, including Europe, the Americas and Australia.

Who does monkeypox affect?

Anyone can get monkeypox. In Africa, most cases are among children under 15 years old. Outside of Africa, the disease appears to be more common in men who have sex with men, but there are numerous cases in people who don't fall into that category.

Symptoms and Causes

Monkeypox causes pus-filled blisters that crust over and fall off. (Image courtesy of the U.S. Centers for Disease Control and Prevention.)

What are the signs and symptoms of monkeypox?

After exposure, it may be several days to a few weeks before you develop symptoms. Early signs of monkeypox include flu-like symptoms like:

After a few days, a rash often develops. The rash starts as flat, red bumps, which can be painful. Those bumps turn into blisters, which fill with pus. Eventually, the blisters crust over and fall off - the whole process can last two to four weeks. You can also get sores in your mouth, vagina or anus.

Not everyone with monkeypox develops all of the symptoms. In fact, in the current (2022) outbreak, many cases aren't following the usual pattern of symptoms. This atypical presentation includes only a few lesions, no swollen lymph nodes, less fever and other signs of illness. You can have it and not know it. But even if you don't show many signs of infection, you can spread still spread it to others through prolonged close contact.

How do you catch monkeypox?

Monkeypox is spread when you come into contact with an animal or a person infected with the virus. Animal-to-person transmission occurs through broken skin, like from bites or scratches, or through direct contact with an infected animal's blood, bodily fluids or pox lesions (sores).

Monkeypox can spread from person to person, but it's less common. Person-to-person spread (transmission) occurs when you come in contact with the sores, scabs, respiratory droplets or oral fluids of an infected person usually through close, intimate situations like cuddling, kissing or sex. Research is ongoing, but researchers aren't sure if the virus is transmitted through semen or vaginal fluids.

You can also get monkeypox by coming into contact with recently contaminated materials like clothing, bedding and other linens used by an infected person or animal.

Diagnosis and Tests

How is monkeypox diagnosed?

Because monkeypox is rare, your healthcare provider may first suspect other rash illnesses, such as measles or chickenpox. But swollen lymph nodes usually distinguish monkeypox from other poxes.

To diagnose monkeypox, your healthcare provider takes a tissue sample from an open sore (lesion). Then they send it to a lab for polymerase chain reaction (PCR) testing (genetic fingerprinting). You may also need to give a blood sample to check for the monkeypox virus or antibodies your immune system makes to it.

Management and Treatment

Is monkeypox curable?

Monkeypox is usually a self-limited disease with symptoms lasting from two to four weeks. Most people with monkeypox get better on their own without treatment. Following diagnosis, your healthcare provider will monitor your condition and try to relieve your symptoms, prevent dehydration and give you antibiotics to treat secondary bacterial infections if they develop.

There's currently not an approved antiviral treatment for monkeypox. Antiviral drugs may help, but they haven't been studied as a treatment for monkeypox. Several investigational antivirals with activity against monkeypox are available, but only as part of a research study.

Prevention

How do you prevent monkeypox virus?

A smallpox vaccine provides protection against monkeypox, but its use is currently limited to clinical trials. Prevention depends on decreasing human contact with infected animals and limiting person-to-person spread. The best way to help prevent spread the monkeypox virus is to:

Avoid contact with infected animals (especially sick or dead animals).

Avoid contact with bedding and other materials contaminated with the virus.

Thoroughly cook all foods that contain animal meat or parts.

Wash your hands frequently with soap and water.

Avoid contact with people who may be infected with the virus.

Practice safe sex, including the use of condoms and dental dams.

Wear a mask that covers your mouth and nose when around others.

Clean and disinfect frequently touched surfaces.

Use personal protective equipment (PPE) when caring for people infected with the virus.

Outlook / Prognosis

How long does monkeypox last?

Monkeypox normally takes about two to four weeks to run its course. If you are exposed to monkeypox, your provider will monitor you until the rash resolves.

Is monkeypox fatal?

The less severe West African clade is causing the current world outbreak (2022). No one has died from this outbreak to date. But, monkeypox can lead to other problems (complications) like pneumonia and infections in your brain ( encephalitis) or eyes, which can be fatal.

Living With

How do I take care of myself?

If have monkeypox symptoms, there are over-the-counter medications that can help you feel better, including:

Pain relievers and fever reducers. Medicines like ibuprofen (Advil®, Motrin®) and acetaminophen (Tylenol®) can help you feel better.

Oatmeal baths. Soaking in a warm bath with colloidal oatmeal can relieve the dry, itchy feeling that comes with skin rashes.

Isolate yourself if you're infected. Avoid contact with others until all your lesions have scabbed.

Cover single or local lesions. Use gauze or bandages to limit spread to others and the environment.

Take good care. It's important to stay home and rest when you're sick, wear a mask around others and drink plenty of fluids.

Avoid contact with pets (especially rodents).

When should I see my healthcare provider?

Call your healthcare provider if you:

Feel sick with fever, aches or swollen lymph nodes.

Have a new rash or sores.

Have been in close contact with an infected person.

When should I go to the ER?

Seek medical care if you develop the following symptoms:

Trouble breathing.

New or worsening chest pain.

Stiff neck.

Are confused or can't think clearly.

Difficulty speaking or moving.

Loss of consciousness.

Seizures.

Frequently Asked Questions

What is the difference?

Monkeypox vs. chickenpox

Although they both cause skin rashes, monkeypox and chickenpox are caused by different viruses. Monkeypox is an orthopoxvirus, while chickenpox is a herpes virus. Both viruses can be spread through skin-to-skin or prolonged face-to-face contact, but chickenpox is very contagious and spreads more easily than monkeypox. People with monkeypox are more likely to have swollen lymph nodes than people with chickenpox.

The rashes act differently too. While the chickenpox rash can appear in waves, monkeypox sores develop at the same time. Chickenpox symptoms - including the rash - tend to get better within two weeks, while it takes two to four weeks for monkeypox to resolve.

Monkeypox vs. smallpox

Smallpox and monkeypox are both part of the orthopoxvirus family, so they're caused by similar but distinct viruses. Thanks to effective vaccines, smallpox was eradicated (is no longer a circulating disease) by 1980. Smallpox was very contagious and spread more easily than monkeypox. Monkeypox symptoms are similar to but milder than smallpox symptoms.
A note from Cleveland Clinic
The last two years have been incredibly challenging - the COVID-19 pandemic changed so much about the way we lived and worked. Now, just as we're starting to ease back into regular life, we're hearing a lot of media stories about monkeypox as an emerging threat. But monkeypox is a rare disease. It's spread through close contact like kissing and sex, though we're still learning about how monkeypox spreads in humans. The best way to protect yourself is to avoid contact with people who are infected, wash your hands frequently and wear a face mask in crowded, indoor spaces. Early symptoms of monkeypox are flu-like and include fever, chills and body aches. After a few days, a rash will begin to develop. See your healthcare provider if you develop symptoms.

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Monkeypox is a rare disease caused by the monkeypox virus. It leads to rash and flu-like symptoms. Like the better known virus that causes smallpox, it is a member of the family called orthopoxvirus. Monkeypox was discovered in 1958 when two outbreaks of a pox-like disease occurred in groups of monkeys being used for research.

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This article gives a backstory and history about Monkeypox

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Since it was first identified in a colony of monkeys in Copenhagen in 1958, monkeypox has been largely overlooked by the Western world. An infectious poxvirus that causes fever, chills and rashes, the disease is endemic, or consistently regionally present, in ten African countries. Until recently, however, it was rarely found in Europe and the Americas-a trend that has, historically, led Western public health officials to disregard its spread elsewhere.

"It's a phenomenon of 'not in my backyard,'" says Martin Hirsch, editor-in-chief of the Journal of Infectious Diseases and an immunologist at Harvard University. "There's not much interest in Western health groups about something that's only circulating in Africa."

This May, as news broke of a multi-country monkeypox outbreak, sensationalized headlines and public hysteria (much of it tinged with racism and homophobia) suggested that the disease was poised to kickstart another pandemic. But while there's cause for concern-at least 2,103 cases have been recorded in 42 countries,and the disease appears to be spreading more rapidly than before-monkeypox is not a novel threat. Western countries that previously paid little attention to the disease can learn much from African scientists who have studied it for decades.

Believed to have been circulating for thousands of years, monkeypox is mired in misconception. Even its name is something of a misnomer: Monkeys (and humans) are just incidental hosts of the disease, which is thought to be found primarily in rodents. While monkeypox is more common in central and western Africa, it's misleading to describe the virus as "being African," wrote more than 20 scientists in a recent paper detailing the need for a non-discriminatory, non-stigmatizing name for the disease. (Monkeypox will soon be renamed to reflect this aim.) In fact, the virus' continued presence in Africa is largely the result of unequal access to global vaccine stockpiles and healthcare resources.

"Remember, the first monkeypox was actually found in a laboratory in Denmark, not Africa," says Oyewale Tomori, a virologist at Redeemer's University and the former president of the Nigerian Academy of Science.

A cousin of the far deadlier smallpox virus, monkeypox primarily spreads through direct contact with an infected person's bodily fluids, sores or scabs. Airborne exposure through respiratory droplets is possible but less common and admittedly understudied.

The current outbreak appears to be spreading mainly among men who have sex with other men (MSM)-a trend that has drawn parallels with the HIV/AIDS epidemic, which disproportionately affected the LGBTQ community at its height in the late 1980s and early '90s. Scientists are not entirely sure why the disease is spreading this way, but early findings suggest it "may have made its way into highly interconnected sexual networks within the MSM community, where it can spread in ways that it cannot in the general population," per Science magazine.

The story of monkeypox and poxviruses more generally is part of a larger narrative about global health inequities and scientific progressivism, which refers to how science is often portrayed in an irrevocably linear, victorious way that elides the incremental nature of most discoveries. Amid the current outbreak, monkeypox's long-neglected history renders the disease simultaneously obscure and subject to heightened scrutiny-both to the detriment of public health.

Monkeypox's past is inextricable from that of smallpox, which is believed to have first appeared around 10,000 B.C.E. One of humanity's deadliest diseases, smallpox killed more than 300 million people worldwide in the 20th century alone. From sniffing up dried smallpox scabs to puncturing people with iron needles dipped in smallpox pustules, communities in Africa, India, China, Turkey and other non-Western nations have long sought to prevent the virus' spread. (These measures, known as inoculation or variolation, involve immunizing a patient by infecting them with a mild form of a virus.) But inoculation only arrived in Europe in the early 18th century, when Lady Mary Wortley Montagu, wife of the British ambassador to the Ottoman Empire, brought the practice back to England after learning about it from Turkish women.

Around that same time, in 1721, a smallpox epidemic in the colony of Massachusetts led Reverend Cotton Mather and physician Zabdiel Boylston to similarly experiment with the procedure. Today, celebrations of the pair's tenacious efforts tend to erase the contributions of Onesimus, the enslaved man who introduced Mather to inoculation-a practice Onesimus learned in his native West Africa. Otherwise, much about him remains unknown, including his original name and place of birth. As Princeton historian Elise A. Mitchell explains, "The silences surrounding Onesimus are produced at ... four moments: [H]is history is obscured in Mather's records, the archives, our historical narratives and our sense of his historical significance."

Inoculation's roots in non-Western cultures made the practice highly contested, condemned as everything from Orientalism to an African conspiracy. In Boston, a local doctor-the only man in the city with a medical degree- decried it as a plot by enslaved Africans to infect their enslavers. The backlash was so intense that someone threw a bomb through the window of Mather's house, attaching a warning that read, "Cotton Mather, you dog, dam you! I'll inoculate you with this; with a pox to you."

What is popularly known about the history of smallpox generally begins and ends with Edward Jenner, an English surgeon who performed the world's first vaccination in 1796. Powel H. Kazanjian, an infectious diseases physician and historian at the University of Michigan, says that Jenner is at the forefront of this history because he feeds neatly into the story of Western medicine's authority.

In all likelihood, the commonly cited tale about Jenner's discovery of vaccination is flat-out wrong. Popular lore suggests that Jenner saw the " rosy, unblemished complexion" of a local milkmaid and theorized that infection by cowpox would offer protection against smallpox. But this " Myth of the Milkmaid," in the words of pathology expert Arthur W. Boylston, neglects the work of country doctor John Fewster, who discovered the protective nature of cowpox in the 1760s, decades before Jenner. Boylston argues that Jenner's biographer invented the milkmaid story to safeguard his subject's reputation and allow a more triumphalist narrative to take root, rather than one based on gradual scientific progress.

What was truly heroic, according to Hirsch, was the smallpox eradication effort, which he describes as "one of the great hallmarks of Western medicine." While the aim had long been discussed, only in 1959 did it become an explicit goal of the World Health Organization (WHO). The year prior, Viktor Zhdanov of the U.S.S.R. presented a theoretical foundation for eradicating smallpox at a Minneapolis meeting of the World Health Assembly. In an attempt to rally support, Zhdanov quoted a letter from President Thomas Jefferson to Jenner: "It is owing to your discovery ... that in the future the peoples of the world will learn about this disgusting smallpox disease only from ancient traditions."

At the time, the WHO's director-general estimated that eradicating smallpox from endemic regions would require vaccination of 80 percent of the population and cost nearly $100 million. But lack of funding, vaccine donations and personnel stalled the program for several years. India, for instance, had to halt its ambitious eradication effort when emergency appeals for vaccines went unheeded.

In 1967, the WHO reignited the initiative under the moniker the Intensified Smallpox Eradication Programme (SEP). A confluence of factors sparked the fresh interest, including the appointment of WHO leaders who were bullish about the project, technological developments that enabled mass vaccination (such as the jet injector and bifurcated needle), and greater commitments of support from the United States. The organization's strategy eventually moved away from mass vaccination to identifying new cases, isolating the infected and vaccinating all potential close contacts. Ten years later, the last endemic smallpox case was recorded in Somalia; in 1980, the WHO declared smallpox eradicated.

But this milestone came at a significant cost. Then a United Nations medical officer, American epidemiologist Lawrence Brilliant described the extreme lengths of public health officials' surveillance and containment strategy in his 1985 book, The Management of Smallpox in India. As Brilliant wrote, Operation Smallpox Zero began in 1975 with village-to-village searches that soon escalated into house-to-house and room-to-room searches. Patients with a rash and fever were found guilty of having smallpox until proven innocent, and informants received cash rewards for identifying those infected. Guards were posted to contain isolated individuals, and teams on motorbikes and Jeeps combed through all villages within a ten-mile radius of known (or suspected) smallpox cases. Everyone in a one-mile radius was given the vaccine, regardless of whether they had already been vaccinated.

Paul Greenough, a historian at the University of Iowa, argues that the last steps of the vaccination campaign in South Asia were rooted in intimidation, coercion and resistance. Expatriate epidemiologists, many of them from the U.S., descended onto India and Bangladesh. Given fuel, transportation and cash not typically afforded to local health officials, these epidemiologists were officially considered advisors but operated with impunity. Their singular focus on smallpox, to the exclusion of all other concerns, made their eradication efforts ring hollow with the locals. In one case study described by Greenough, a starving Bangladeshi woman refused the vaccine until she was given food. As senior WHO epidemiologist Stanley Music recounted, "She said that if I didn't care whether or not she died of starvation, why should I care if she got smallpox!" She was vaccinated without her consent.

In an unpublished dissertation, Music offered more details on the program's relentless approach:

The initial stage in the evolution of a coherent containment policy was marked by an almost military style attack on infected villages. ... In the hit-and-run excitement of such a campaign, women and children were often pulled out from under beds, from behind doors, from within latrines, etc. People were chased and, when caught, vaccinated.

With the SEP hanging in the balance in South Asia, the ends, officials concluded, justified the means.

Smallpox vaccines provide some protection against the closely related monkeypox virus. Since the 1970s, though, many countries have stopped vaccinating against the now-eradicated disease.

The first case of human monkeypox was identified in a 9-month-old boy in the Democratic Republic of the Congo (DRC) in 1970. The WHO subsequently reported 54 cases between 1970 and 1979 and 338 cases between 1981 and 1986; given high smallpox immunization rates during this period, the increase was probably the result of increased surveillance and case identification.

Over the past 30 years, amid waning smallpox vaccine coverage, Africa has reported dozens of monkeypox outbreaks and an untold number of cases, at least in the tens of thousands. In the U.S., however, these events "didn't really raise any alarm," says Hirsch.

A 2003 outbreak of monkeypox in the U.S. proved to be a different story. Three-year-old Schyan Kautzer was the first person infected in the country. Red welts flared all over her body after she was bitten by one of her two pet prairie dogs. As Kautzer's mother told the Washington Post, "The bite on her finger just kept getting bigger and bigger. All she did was sleep or cry. She couldn't eat anything. Her glands swelled up so much on her neck you could see them popping out." One of the family's prairie dogs died, but they kept the second, named Chuckles, after he made a full recovery.

In total, the Centers for Disease Control (CDC) recorded 71 monkeypox cases during the outbreak. Most of the patients had been around prairie dogs, with human-to-human transmission not suspected as a source of infection. The culprits behind the outbreak were likely Gambian giant pouched rats that had been imported from Ghana and housed next to a shipment of prairie dogs. After the CDC banned the importation of African rodents into the U.S., the outbreak was quickly controlled -and forgotten.

While Western countries have largely avoided other monkeypox outbreaks, African countries haven't been so fortunate. Between November 2005 and November 2007, a study found that monkeypox cases in the DRC spiked 20-fold compared with the 1980s. In Nigeria, a severe 2017 outbreak occurred almost 40 years after the country's last reported case. Again, the response outside Africa was minimal. "Why should the West care?" Tomori asks.

Monkeypox is the latest example of a disease being neglected by countries not yet affected. Similar responses-or lack thereof-took place with Ebola, Zika and countless other infectious diseases. "That's the troubling, disconcerting thing," says Kazanjian. "We only care about people in our own land."

He adds, "Once the victim changes, concern about the disease heightens."

Indeed, reminiscent of Covid-19 vaccine hoarding, Western countries have been buying up smallpox vaccines from biotech company Bavarian Nordic, which recently entered into a series of lucrative deals with multiple undisclosed nations. Last week, the WHO announced plans to share some of the 31 million smallpox vaccines in its stockpile, sparking speculation that the agency will end up "distributing scarce vaccine doses to rich countries that can otherwise afford them," per the Associated Press (AP).

In Africa, where case counts are currently three times higher than usual, conservative treatments remain the norm, with vaccines and antivirals unavailable in much of the continent. This year, officials have reported more than 1,400 cases and 66 deaths in Cameroon, Central African Republic, Congo and Nigeria, according to the Africa Centers for Disease Control and Prevention. But public health officials have "no clear path for how poorer countries [like these ones] will be able to get vaccines," says Brook Baker, a law expert at Northeastern University who studies access to medicine, to the AP.

As Baker predicts, "Rich countries will protect themselves while people in the global south die."

Media coverage of the outbreak has reflected Western bias, too. Many news reports featured images of Black monkeypox patients, making them the face of an outbreak that's in the headlines because it's spread to Europe and the U.S. "This is your pox, not ours," Tomori says. "Why are you putting the figure of a person who is not from Europe?" The racialized images have, in turn, elicited fear among Western audiences and perpetuated a narrative of an "African" disease and an epidemic-ridden continent. "This wild thing from Africa," Tomori scoffs. "Newspapers sell better when you have some exotic story to put out there."

The history of poxviruses has long been characterized by a certain myopia, with the early work of African, Indian, Chinese and Turkish civilizations; Onesimus' contributions to Boston's inoculation campaign; and vaccine coercion by the SEP all overlooked. Monkeypox is the latest casualty of this myopia, historically neglected and dismissed.

The stakes are high. Beyond its racist and homophobic overtones, the global monkeypox response has been fraught with problems, including significant underreporting, testing bottlenecks and CDC-WHO feuding. Experts are also concerned that monkeypox could "take up permanent residence in wildlife outside of Africa," making outbreaks more frequent and potentially creating new variants, per Science magazine.

"The world is a small place," Tomori says. "This is not an African thing; it could happen anywhere."

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What You Need to Know About the History of Monkeypox

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Since it was first identified in a colony of monkeys in Copenhagen in 1958, monkeypox has been largely overlooked by the Western world. An infectious poxvirus that causes fever, chills and rashes, the disease is endemic, or consistently regionally present, in ten African countries.