What to Do If You Are Sick

Taking care of yourself

• Use gauze or bandages to cover the rash to limit spread to others and to the environment.
• Wash hands often with soap and water or use an alcohol-based hand sanitizer, especially after direct contact with the rash.
  • If you have rash on your hands, be careful when washing or using sanitizer so you don't irritate the rash.
• If you have rash on your hands, wear gloves that are don't irritate your skin when you're handling or touching shared items or surfaces. If you can, use disposable gloves that can be thrown away after each use (e.g., latex, polyurethane, or nitrile gloves). You can wash reusable gloves with soap and water after you use them.
• Wear a well-fitting mask around other people until the rash has healed and all other symptoms have gone away.
• Stay hydrated, eat healthy, and get plenty of rest to allow your body to heal.

Getting help

Managing your symptoms

Medicines like ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) can help you feel better. Your healthcare provider may prescribe stronger pain relievers as well.

Rash care

The most important thing is to try not to spread the rash to other parts of the body, spread the virus to others, and possibly cause open lesions to become infected by bacteria. To keep this from happening:

• Do not touch or scratch the rash.
• Don't lance (pop) lesions from the rash. This doesn't speed up recovery.
• Don't shave areas with the rash until the scabs have fallen off and a new layer of skin has formed.

If you do accidentally touch the rash, wash your hands with soap and water and avoid touching sensitive areas like your eyes, nose, mouth, genitals and rectum (butthole).

Monkeypox rash relief

Topical benzocaine/lidocaine gels can be used for temporary relief. Oral antihistamines such as diphenhydramine (Benadryl) and topical creams such as calamine lotion or petroleum jelly may help with itching.

Soaking in a warm bath (using oatmeal or other over-the-counter bath products for itchy skin) may offer some relief to the dry, itchy sensations that can come with the rash.

People who have the rash in or around their anus (butthole) or genitals (penis, testicles, labia, vagina), or perineum (taint) may also benefit from a sitz bath. A sitz bath is a round, shallow basin that can be purchased online or at a pharmacy. Most fit over the rim of a toilet but can also be placed in a bathtub. There is also the option to sit in a bathtub with shallow water. Your healthcare provider may prescribe medication like povidone-iodine or other products to be added to the water in a sitz bath. Adding Epsom salt, vinegar, or baking soda to the water can be soothing.

If you have rash in your mouth, you can rinse with salt water several times per day. Prescription mouthwashes, sometimes called miracle or magic mouthwash, or local anesthetics like viscous lidocaine can be used to manage pain. You can use oral antiseptics like chlorhexidine mouthwash to help keep the mouth clean.

When extra help is needed

If you're very sick with monkeypox or may be at a higher risk of getting very sick, there are some medications that may be used to treat monkeypox. These medications are not FDA-approved for monkeypox and are only available under special permission from FDA. These medications include tecovirimat (TPOXX), cidofovir, and brincidofovir.

Your healthcare provider may prescribe these medicines to use alone, in combination with each other, or in combination with other treatments.

People who are severely ill from monkeypox may have:

• Rash that covers many areas of the skin
• Symptoms of the disease that affect your airway for breathing, heart, or nervous system
• Rash around or in the eyes

People who may be at higher risk of becoming severely ill from monkeypox include:

• People with severely weakened immune systems, including with HIV that isn't controlled, those with certain cancers or organ transplants, and people taking medicines that make your immune system not work as well like chemotherapy or some steroids.
• People with active skin conditions like atopic dermatitis, eczema, psoriasis, or Darier disease
• Women who are pregnant or were recently pregnant
• Children under the age of 1

Talk to your healthcare provider to see if you are eligible to receive these medications.

These anti-viral medications aren't for people who have milder monkeypox symptoms or aren't at high risk of becoming severely ill because they may not help, and medications have potential side effects. Using these medications also can increase the chance that the virus that causes monkeypox will develop resistance to the treatment. If that happens, these medications may not work for people who are severely ill with monkeypox.

Preventing spread to others

If you have monkeypox, you are advised to stay at home (isolate) if you have monkeypox symptoms, including until your monkeypox rash has healed and a new layer of skin has formed. Staying away from other people, avoiding close physical contact, and not sharing things you have touched with others will help prevent the spread of monkeypox. Monkeypox can also spread to animals, so it's important to stay away from pets, livestock, and other animals.

Wash hands often with soap and water or use an alcohol-based hand sanitizer, especially after direct contact with the rash. People with monkeypox should clean and disinfect the spaces they occupy regularly to limit household contamination.

If you cannot isolate completely while you are sick, take precautions to limit the risk of spreading monkeypox to others, such as:

• Use gauze or bandages to cover the rash to limit spread to others and to the environment.
• If you have rash on your hands, wear non-irritating gloves when handling common objects or touching surfaces in shared spaces
• Wear a well-fitting mask when you're around others.
• Disinfect surfaces in shared bathrooms or rooms between each use.
• Avoid sharing objects (e.g., towels, washcloths, drinking from the same glass).
• Cover upholstered furniture and porous materials that cannot be washed.

Monkeypox and animals

Scientists are still learning about which mammals can be infected with monkeypox virus, but currently, they believe that any mammal could be infected.

How to care for pets if you have monkeypox

• Avoid contact with animals to prevent the virus from spreading. This includes pets, domestic animals, and wildlife.
• Ask friends or family members who live in a separate home to care for your animals until you fully recover. After you recover, clean and disinfect your home before bringing healthy animals back.
• People who are at increased risk for severe monkeypox should not care for animals that had close contact with a person with monkeypox.

If you think your pet has monkeypox

• Possible symptoms of monkeypox in pets include rash, lethargy, lack of appetite, coughing, bloating, nasal and/or eye secretions or crust, fever, and/or pox-like skin sores (may initially resemble a pimple or blister first).
• If your pet had close contact with a person with probable or confirmed monkeypox and they have a new rash or two other symptoms, get your pet tested for monkeypox.
• Call your veterinarian if you notice an animal appears sick within 21 days after contact with a person with probable or confirmed monkeypox. A veterinarian can help notify your state public health veterinarian or state animal health official, who can assist with getting high-risk pets tested.
• Separate the sick animal from other pets and animals.
• Limit direct contact between the animal and people for at least 21 days until they are fully recovered or a veterinarian tells you it's safe.
• Wash your hands often and wear clothing that covers your skin when caring for and cleaning up after sick animals. Wash your clothes after caring for sick animals.
• Disinfect animal bedding, enclosures, food dishes, and any other items in direct contact with infected animals.
• Do not shake soiled laundry and bedding (including disposable rodent bedding).

Notifying close contacts

If you have been diagnosed with monkeypox, notify your close contacts as soon as possible to let them know they may have been exposed to monkeypox. They should:

• Get vaccinated if it's been less than 14 days since you had close contact, ideally within 4 days from exposure.
• Watch for signs and symptoms
• Get tested for monkeypox
• Stay away from other people and animals if they have symptoms

Letting your close contacts know they may have been exposed to monkeypox helps protect them and everyone around them.

Who are close contacts?

A close contact is anyone who was exposed to someone with monkeypox symptoms through:

• Having sex, which includes oral, anal, or vaginal sex.
• Touching or having close contact with the rash of a person with monkeypox.
• Hugging, cuddling, kissing, massaging, or having other prolonged skin-to-skin contact.
• Sharing cups, utensils, towels, clothing, bedding, blankets, or other personal items used by someone with monkeypox.

Make a list of close contacts to notify

• Who were/are your sex partners?
• Who lives with you (including family members, roommates, or overnight guests)?
• Who have you recently had prolonged skin-to-skin contact with? Consider the following:
  • In-person meetings or gatherings you attended.
  • People you have met with recently (i.e., for a home visit, at a restaurant, for drinks, for dancing, for exercise, or for a party).
  • People you played contact sports with (for example, basketball or wrestling).
  • Appointments with health care providers, including dentists.
  • People who have provided you services, such as childcare providers, house cleaners, barbers, hairdressers, nail salon workers, massage therapists, adult care workers, etc.
  • People you work or volunteer with outside of the home.

What to say

If you are feeling a little uncertain about notifying your contacts, it can be helpful to prepare beforehand to make sure the communication goes smoothly. Below are few tips that may be useful:

• Think through how you would want to be notified in the same situation.
• Consider safety and privacy. If texting, messaging, or emailing, consider whether other people might be able read your communication. If you are notifying by phone, first ask your contact if they are in a place where they can speak privately.
• Saying the words out loud can help you think through what you want to say and how you want to say it before you reach out.
• Consider the person and prepare how you would want to calmly react to the different types of responses you might get.

An example of what you can say to your close contacts could be:

"Hi. I need to talk to you about something important. Do you have a few minutes to talk privately? I was diagnosed with monkeypox (or tested positive) on [xxx date]. Monkeypox can spread through close or intimate contact. Since we spent time together on [xxx date], I wanted to let you know. You should check for symptoms and get tested ASAP if you have symptoms. The CDC has information on their website at www.cdc.gov/monkeypox."

Other options for notifying close contacts

If you are unable to notify your close contacts yourself, there may be other available options:

• Health department assistance. A public health professional from your local health department, typically called a disease intervention specialist (DIS), may contact you. A DIS may discuss your diagnosis, answer any questions you have, and, if you want help, confidentially notify your contacts. They will protect your privacy and not disclose anything about you. When they notify your contacts, they will connect them to services that they may need, including medical care, testing, treatment, and/or vaccines, as appropriate and depending on local resources.
• Anonymous notification services. You can use a reputable, online service that can notify your contacts of their possible exposure to monkeypox while staying anonymous. You can first explore the site to learn more about how they protect your privacy and the language that will be used in the notification. This site also will let your contacts know where they can get more information about monkeypox.

Choose the method that you're most comfortable with. You can use different methods for different contacts. The important thing is to make sure that your contacts have the information they need in time to make decisions about their health and prevent spreading monkeypox to others.