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What is Monkeypox and How Do We Respond?

At the end of last week, monkeypox was declared a public health emergency by the Biden administration and as a result, I'm noticing some concern from my clients. My approach to something new has always been to go to the numbers and do my proper research to understand how I need to respond. In this situation, even as a practitioner in California, where there's been a high incidence of cases in comparison to other states, I'm not very worried about monkeypox. While I do work in a profession that requires skin-to-skin contact, understanding exactly how the virus is transmitted, that the smallpox vaccine helps protect against infection, and the incidence rates of monkeypox has made me realize there's a low likelihood that I will contract or spread this virus in my practice.

In this post, I wanted to take a second to share with you what we know about monkeypox and how I’m handling the news of this outbreak with my clients. For reference, I've sourced my information for this newsletter from the CDC. The title of each section below is linked to the CDC webpage where this information was gathered.

Monkeypox is a rarely fatal disease caused by the monkeypox virus. This virus is from the same family as the Variola virus (smallpox) and causes similar, but milder symptoms.

Monkeypox is not new and was discovered in 1958 when the pox-like disease first occurred in colonies of monkeys kept for research. In 1970, the first human case of monkeypox was recorded. Prior to 2022, the disease mostly occurred in Central and Western Africa, however, monkeypox has been recorded on multiple continents, mostly linked to imported animals and international travel to the areas where the disease commonly occurs.

The CDC describes the signs & symptoms of monkeypox as follows:

  • People with monkeypox get a rash that may be located on or near the genitals (penis, testicles, labia, and vagina) or anus (butthole) and could be on other areas like the hands, feet, chest, face, or mouth.

  • The rash will go through several stages, including scabs, before healing.

  • The rash can initially look like pimples or blisters and may be painful or itchy.

Other symptoms of monkeypox can include:

  • Fever

  • Chills

  • Swollen lymph nodes

  • Exhaustion

  • Muscle aches and backache

  • Headache

  • Respiratory symptoms (e.g. sore throat, nasal congestion, or cough)

You may experience all or only a few symptoms:

  • Sometimes, people have flu-like symptoms before the rash.

  • Some people get a rash first, followed by other symptoms.

  • Others only experience a rash.

These symptoms usually start within 3 weeks of exposure to the virus. If flu-like symptoms have developed, a rash usually follows within 1-4 days. Monkeypox can be spread from the time symptoms start, until the rash has completely healed and fresh skin has formed which takes around 2-4 weeks.

Monkeypox is mostly spread through direct contact with the rash via:

  • Skin to skin contact

  • Bodily fluids from the rash and respiratory secretions

  • Objects, fabrics, or surfaces used or touched by someone with monkeypox

I want to note the CDC has listed massage as one of the ways that this virus can be spread, but in my opinion, this is meant in more of an intimate way than a professional massage as it is listed along with kissing and hugging. Here is the complete list of ways that direct contact with the rash can occur, taken directly from the CDC website:

  • Oral, anal, and vaginal sex or touching the genitals (penis, testicles, labia, and vagina) or anus (butthole) of a person with monkeypox.

  • Hugging, massage, and kissing.

  • Prolonged face-to-face contact.

  • Touching fabrics and objects during sex that were used by a person with monkeypox and that have not been disinfected, such as bedding, towels, fetish gear, and sex toys.

So, I want to stress that this disease is most commonly spread through contact with a visible rash. The photo at the top of this newsletter is just one example of how the rash can look. We as massage therapists will be able to see this rash and avoid it as we do with many skin conditions including ringworm, athlete’s foot, warts, and so much more. I recommend taking some time to search for different examples of what this rash can look like so you can know it when you see it.

The CDC is clear that we are still in the process of understanding the following:

  • If the virus can be spread when someone has no symptoms

  • How often monkeypox is spread through respiratory secretions, or when a person with monkeypox symptoms might be more likely to spread the virus through respiratory secretions.

  • Whether monkeypox can be spread through semen, vaginal fluids, urine, or feces.

Do not work on clients who have a rash resembling monkeypox, as the virus is most commonly spread through direct contact with the pox themselves. If you encounter a client who has shown up and seems to have symptoms of monkeypox, ask them to reschedule their appointment and recommend that they go see their doctor. When cleaning up your space after this kind of encounter, wear gloves and make sure to disinfect your space properly.

All this being said, the likelihood that someone will come to your practice with monkeypox is much lower than the likelihood someone will show up with COVID or even the common cold. Below I share the details of the current incidence rates of monkeypox in the US.


Over 7,510 cases have been confirmed as of 8/7/22. The states with the highest totals of confirmed cases are:

  • California- 826

  • Texas- 606

  • Florida- 633

  • Illinois- 602

  • New York- 1,862

  • Georgia- 596

There is a vaccine for monkeypox, but there's a limited supply because before the recent outbreak, this virus wasn't incredibly common. The CDC is not recommending that everyone receive vaccination for monkeypox, rather, they recommend individuals who are more likely to get the virus to consider inoculation including:

  • People who have been identified by public health officials as a contact of someone with monkeypox

  • People who are aware that one of their sexual partners in the past 2 weeks has been diagnosed with monkeypox

  • People who had multiple sexual partners in the past 2 weeks in an area with known monkeypox

  • People whose jobs may expose them to orthopoxviruses, such as:

    • Laboratory workers who perform testing for orthopoxviruses

    • Laboratory workers who handle cultures or animals with orthopoxviruses

    • Some designated healthcare or public health workers

It's also important to note that because this disease is closely related to the smallpox virus, the smallpox vaccine can protect people from getting monkeypox. The CDC states that, "past data from Africa suggests that the smallpox vaccine is at least 85% effective in preventing monkeypox." So, if you received the smallpox vaccination, you're likely to already be protected against infection.

What I'm Doing in My Practice

In my practice, I'm writing a newsletter to my clients to educate them about monkeypox and let them know that I'm taking every precaution to keep both them and myself safe. With the rise of the COVID pandemic in 2020, my practice has many preventative measures already in place including air filters, wearing face masks, and detailed disinfecting procedures after each session. I'm not adding anything new in response to monkeypox. Instead I've taken the time to educate myself on the signs and symptoms, as well as the mode of transmission, to know how to prevent infection.

I hope this information was helpful to you. I think we're all still very reasonably shell shocked from COVID and the thought of another pandemic is incredibly overwhelming. However, as bodyworkers, it's important that we educate ourselves and our clients on the facts so that we can appropriately respond to Monkeypox.


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