Travel Health Update With On Call’s Chief Medical Officer: Monkeypox

Post Updated on 10/18/22

In the U.S., monkeypox was declared a public health emergency – and the WHO declared that the monkeypox outbreak spreading globally is a public health emergency of international concern. With these important updates, should those with upcoming travel plans be worried? According to On Call’s Chief Medical Officer, Dr. Michelle Nathan, “The risk to travelers at this time is relatively low – in fact, a traveler is probably more likely to experience a routine travel hiccup such as a flight delay or missing luggage versus contracting monkeypox!”

Even with the risk to travelers being quite low, it’s still important to understand the virus, how it’s spread, and most importantly – how to prevent it. Dr. Nathan shares the latest travel health information on monkeypox below:

What is monkeypox?
Dr. Nathan: Monkeypox is a rare viral illness that is caused by an orthopoxvirus.  This is the same class of viruses that causes smallpox. There are two strains of monkeypox; the current outbreak is the less severe West African strain.  The disease is rarely fatal and over 99% of people who are infected are likely to survive.  Before the current outbreak, the disease was reported mainly in Central and West African countries, and cases outside Africa were linked to international travel to those areas.

What populations are most at risk for monkeypox?
Dr. Nathan: The good news is that global monkeypox cases are currently on the decline, particularly in areas that have access to vaccinations and strong public education campaigns. However, there are certain populations that are more at risk for monkeypox. This includes people with job-related exposures such as laboratory workers who test for or handle animals with monkeypox, and designated healthcare/public health workers. Other people at risk include known contacts of someone with monkeypox, people with a sexual partner in the past two weeks that has been diagnosed with monkeypox, and people with multiple sexual partners in an area with known monkeypox. The CDC and WHO note that gay, bisexual and men who have sex with men make up the majority of the cases in the current monkeypox outbreak.  But it’s important to know that anyone who has been in close personal contact with someone who has monkeypox is at risk.

What are the most common monkeypox symptoms?
Dr. Nathan: The most recognizable symptom is the itchy and often painful rash.  The rash often looks like pus filled blisters, which then crust over, scab, and eventually heal. In this outbreak, the rash is often starting in genital areas and not spreading to other parts of the body.  Other symptoms include fever, chills, muscle/body aches, headache, and fatigue.  Some people have flu-like symptoms before the rash.

Is there a test for monkeypox? How is someone diagnosed with the virus?
Dr. Nathan: Yes, there is a test for monkeypox, but at this time, testing for the virus is only done in laboratories. In order to get diagnosed with the virus, a traveler would need to see a medical provider—there are no home test options for monkeypox at this time.

Is there a vaccine available?
Dr. Nathan: There are two smallpox vaccines that are effective against monkeypox.  The preferred vaccine (Jynneos) is a two-dose regimen, and it provides maximum immunity 14 days after the second dose.  There is a single dose vaccine (ACAM 2000) that has more side effects and adverse effects than the two-dose regimen.  This vaccine reaches maximum immunity four weeks after vaccination.

Who is the vaccine typically recommended for?
Dr. Nathan: The CDC recommends vaccination for people who might have been exposed to monkeypox.  This includes 1) a person who has been identified as a contact of someone with monkeypox, 2) a person who knows that one of their sexual partners in the past two weeks has been diagnosed with monkeypox, and 3) a person who has had multiple sexual partners in the past two weeks in an area with known monkeypox.  The CDC has expanded the vaccination group to people who might be exposed to monkeypox in the future.  This includes 1)men who have sex with other men or transgender or nonbinary person and in the past 6 months have had a new diagnosis of a sexually transmitted disease or more than one sex partner, 2)a person who in the last 6 months has had sex at a commercial sex venue, or sex in an area where monkeypox transmission is occurring, 3)a person whose sexual partner identifies with one of the above scenarios, and 4) a person who anticipates experiencing any of the above scenarios.

Are there currently any vaccine requirements for monkeypox in places that travelers should be aware of?
Dr. Nathan: At this time, there are no vaccine requirements or travel restrictions related to monkeypox.  Some countries have isolation recommendations for those who test positive or have contact with a known positive case. For now, those who present with symptoms of monkeypox or are a suspected contact should avoid travel, isolate, and notify local authorities.  Others can continue traveling while avoiding contact with individuals who may be sick.

How easy is it to catch monkeypox while traveling?
Dr. Nathan: The risk of contracting monkeypox during travel is low and mostly preventable.  Monkeypox is transmitted through close, skin-to-skin contact, particularly with the rash, scabs, or body fluids of someone who has monkeypox.

Can one get monkeypox from their seat on an airplane, car/bus, or train?
Dr. Nathan: A person needs to be exposed to enough virus to get infected from it.  The virus can survive on surfaces, but not in high enough quantities to actually cause infection.  Nonporous surfaces (plastics, glass, metal, etc.) do not harbor the bacteria as well as porous materials (fabrics), so it’s extremely unlikely that one would get infected from contact with those surfaces.

Some health experts say the virus can be transmitted through infected linens. How worried should travelers be about their accommodations?
Dr. Nathan: Fortunately, washing fabric with regular laundry detergent decontaminates infected fabrics/linens.  So as long as the linens are washed, there is no risk of transmission in accommodations.

Can the virus be transmitted in public swimming areas?
Dr. Nathan: Monkeypox is not waterborne, and it is unlikely that it would spread in swimming areas.  There is also very little person-to-person contact in swimming, also making it unlikely for any transmission to occur in swimming areas.  However, travelers should be careful to avoid sharing towels and clothing in swimming areas.

What are the best ways to avoid monkeypox while traveling?
Dr. Nathan: The best ways to avoid monkeypox is to avoid individuals who are infected and activities that can spread monkeypox.  Do not have contact with people who have a rash that looks like monkeypox.  Avoid contact with materials, particularly fabrics, that a person with monkeypox has used.  Avoid social settings where there may be direct, personal, skin-to-skin contact.  Avoid sexual contact with any partners that you think may have monkeypox. If traveling to Central or West Africa, avoid contact with animals that can spread monkeypox (usually rodents and primates) and sick/dead animals.

What should travelers do if they suspect they have monkeypox while traveling?
Dr. Nathan: Isolate and avoid contact with other people while you are sick and seek medical care before proceeding with any onward travel. The medical provider will evaluate the patient and determine if testing is necessary. Note: depending on the area of the world, obtaining medical care can present some challenges— travelers should work with their organization’s travel risk management provider for resources and assistance with obtaining the medical attention they need in their destinations.

Want to Learn More?

For over 25 years, On Call International has provided fully-customized travel risk management and global assistance services protecting millions of travelers, their families, and their organizations. Contact us today and watch our video to learn more. You can also stay in touch with On Call’s in-house risk management, travel health and security experts by signing up for our quarterly Travel Risk Management (TRM) newsletter.

The information provided within this post has been compiled from a multitude of available sources, and is based on the current news and situational analysis at the time of writing.