Key Facts
- Though it is possible to transmit and contract monkeypox through respiratory secretions, it is most often spread through direct contact with an infected person’s rash, scabs, or body fluids.
- Airborne transmission involves a different mechanism than that found in transmission via respiratory secretions. Airborne transmission occurs when small virus particles are suspended in the air for long periods of time (as was the case with COVID 19).
- By contrast, respiratory secretions in which monkeypox viral particles may be found drop out of the air quickly. As such, airborne transmission has not been reported as of this writing.
- Scientists are researching how often monkeypox is spread through respiratory secretions, as well as at what time during infection a person with monkeypox symptoms may be more likely to spread the virus by that means.
As monkeypox cases increased around the world by August 2022, so too did misinformation about the possible ways it can be transmitted from person to person. Once such claim held that the smallpox-related virus could spread through airborne droplets. Some social media users presented the “airborne” argument to imply the monkeypox outbreak has parallels to the COVID-19 pandemic and to advocate the precautions of social distancing and masking.
As those and similar claims took off, the hashtag #MonkeypoxIsAirborne started to trend on Twitter on Aug. 2, 2022.
It is true that the monkeypox virus can be spread through respiratory secretions, but the way in which secretions spread is different than the way respiratory droplets (such a those that carry COVID-19) spread. As such, comparisons between the two aren't really valid.
Monkeypox is a different virus than SARS-CoV-2, the coronavirus responsible for COVID-19 infection, and behaves in different ways. The Centers for Disease Control and Prevention (CDC) reports that unlike COVID-19, monkeypox “is not known to linger in the air and is not transmitted during short periods of shared airspace.” It is far more common that the virus is spread through direct contact with an infected person’s rash, scabs, or body fluids.
We should also note the ways in which airborne transmission differs from transmission via respiratory secretions. Airborne transmission occurs when small virus particles are suspended in the air for long periods of time, as is the case with COVID. On the other hand, respiratory secretions that monkeypox viral particles may be found in drop out of the air quickly. As such, long-range (airborne) transmission has not been reported for monkeypox as of this writing. Scientists are researching how often monkeypox is spread through respiratory secretions, as well as at what time during infection a person with monkeypox symptoms may be more likely to spread the virus by that means.
A Brief Look at the Monkeypox Virus
Monkeypox is caused by the monkeypox virus. Infected individuals often experience rashes and sores that resemble those of smallpox, in addition to a fever and swollen lymph nodes. Symptoms generally last between two and four weeks but often resolve on their own. Case fatality is between 3 and 6%, reports the World Health Organization (WHO).
“Monkeypox spreads through direct contact with body fluids or sores on the body of someone who has monkeypox, or with direct contact with materials that have touched body fluids or sores, such as clothing or linens. It may also spread through respiratory secretions when people have close, face-to-face contact,” wrote the CDC. “In the current monkeypox outbreak, we know that those with disease generally describe close, sustained physical contact with other people who are infected with the virus.”
The first confirmed U.S. case of monkeypox occurred in April and was announced the following month, making it just one of just three such infections in the last 20 years.
By July, more than 16,000 cases had been confirmed worldwide, with almost 3,000 in the U.S.
In August, at least three states (including California, Illinois, and New York) declared states of emergency as a preemptive measure to contain the virus. A sizeable number of cases to date have been confirmed in men who have sex with men, but this is not to say that gay or bisexual men are more susceptible to the virus. Monkeypox is not a “gay disease,” but its reemergence has opened a conversation about possibly classifying it as an STD because close physical contact, notably during sex, is such a major factor in its spread (please note, however, that sexual contact is not the only way monkeypox is transmitted).
Determining Whether Monkeypox Is 'Airborne'
Most monkeypox patients have reported close contact with an infected person, and while the CDC notes that some studies suggest viral transmission through respiratory secretion is uncommon, it is possible.
“While we do not know with certainty what role direct physical contact has versus the role of respiratory secretions, in instances where people who have monkeypox have travelled on airplanes, no known cases of monkeypox occurred in people seated around them, even on long international flights,” wrote the CDC.
But, as noted above, airborne transmission and transmission through respiratory secretions are different different mechanisms.
Here are examples of instances in which monkeypox can and can't spread, according to the CDC:
• No: Casual conversations. Walking by someone with monkeypox in a grocery store. Touching items like doorknobs.
• Yes: Direct skin-skin contact with rash lesions. Sexual/intimate contact. Kissing while a person is infected.
• Yes: Living in a house and sharing a bed with someone. Sharing towels or unwashed clothing.
• Yes: Respiratory secretions through face-to-face interactions (the type that mainly happen when living with someone or caring for someone who has monkeypox).
• Maybe/Still learning: Contact with semen or vaginal fluids.
• Unknown/Still learning: Contact with people who are infected with monkeypox but have no symptoms (We think people with symptoms are most likely associated with spread, but some people may have very mild illness and not know they are infected).
In June, CDC Director Dr. Rochelle Walensky and Dr. Demetre Daskalakis, director of the CDC’s Division of HIV Prevention, further detailed how monkeypox modes of transmission:
There Is Still a Lot that We Don’t Know
Scientists are still researching how often monkeypox is spread through respiratory secretions, as well as when an infected person may be more likely to spread the virus through this method. Researchers are also looking into whether monkeypox can be spread through semen, vaginal fluids, urine, or feces.
While health officials continue to get a hold on the outbreak, they recommend avoiding close skin-to-skin contact with infected individuals, including objects that they come into contact with, and washing hands often. Infected people should wear a mask when they are in close contact with others or when face-to-face contact is likely.