Anyone can get monkeypox. The virus spreads through close physical contact, and no one is biologically immune to it. That said, certain groups face significantly higher risk based on how the virus transmits and how their immune systems respond. Understanding who is most likely to encounter the virus, and who faces the most serious outcomes, can help you assess your own level of risk.
How Monkeypox Spreads
Monkeypox requires close contact to pass from person to person. The primary route is direct skin-to-skin contact with the rash, scabs, or body fluids of someone who is infected. This includes saliva, respiratory secretions, and fluids from lesions around the genitals or rectum. The virus can also spread through contaminated objects like bedding, towels, clothing, and sex toys.
Importantly, monkeypox does not spread through the air the way flu or COVID does. You won’t catch it from sitting in a classroom, riding a bus, or swimming in a pool. A person is contagious from the time symptoms start until the rash fully heals and fresh skin has formed underneath. There is no evidence that people without symptoms can spread the virus.
Pregnant women with monkeypox can pass the virus to the fetus during pregnancy or to the newborn during and after birth.
Who Has Been Most Affected
During the 2022 global outbreak, gay, bisexual, and other men who have sex with men were disproportionately affected. This wasn’t because of any biological susceptibility but because of how the virus moved through sexual and intimate contact networks. CDC modeling found that one-time sexual partnerships, while representing less than 3% of total daily partnerships among men who have sex with men, accounted for roughly 50% of all transmission.
Men with more than one partner in a three-week period had 1.8 to 6.9 times the risk of acquiring monkeypox compared to men with only one partner. The risk scaled with the number of partners: those in the highest activity group, averaging about seven partners over three weeks, faced the greatest odds. Casual and one-time encounters together drove the vast majority of spread, while transmission within main partnerships accounted for only 13 to 16% of cases.
None of this means monkeypox is exclusively a sexually transmitted infection. It can spread through any prolonged skin-to-skin contact, including hugging, massage, and kissing. During the 2022 outbreak, about 1.5% of nonsexual close contacts developed symptoms within 21 days of exposure. The virus simply found its most efficient transmission pathway through sexual networks.
Who Faces the Most Serious Illness
Three groups face higher risk of severe disease: young children, immunocompromised individuals, and pregnant women. For most healthy adults, monkeypox is painful and unpleasant but resolves on its own. For these vulnerable groups, the stakes are higher.
Pregnancy carries particular risks. With clade I, the more virulent strain circulating primarily in Central Africa, 75% of confirmed pregnant cases in one study from the Democratic Republic of Congo resulted in fetal death. Complications included stillbirth, miscarriage, and a condition called congenital monkeypox syndrome, where the fetus develops widespread skin lesions and organ damage. Clade IIb, responsible for the 2022 global outbreak, caused far fewer fetal complications and had an overall fatality rate below 0.1%, though spontaneous abortions were still reported.
People with weakened immune systems, whether from HIV, organ transplant medications, or cancer treatment, can develop more widespread and prolonged infections. Their bodies struggle to contain the virus, leading to larger rash coverage and slower healing.
Why the Viral Strain Matters
Two main clades of monkeypox circulate globally, and they differ dramatically in severity. Clade I, found primarily in Central Africa, carries a fatality rate around 10%. Clade IIb, which caused the 2022 worldwide outbreak, kills fewer than 0.1% of those infected. Lab studies confirm the difference is real: clade Ib spreads more aggressively in cell cultures, causes more severe lung damage in animal models, and disseminates to internal organs in ways clade IIb does not.
Clade Ib, a newer sublineage, is currently spreading across Central and West Africa with sustained human-to-human transmission. Unlike clade IIb, it has not become significantly weakened through its adaptation to human hosts. Where you are geographically and which strain is circulating in your area meaningfully changes your risk profile.
Risk From Animals
Monkeypox originally jumps to humans from animals, though this route is far less common than person-to-person spread during outbreaks. In Central and West Africa, people have contracted the virus through hunting, handling bushmeat, or contact with wild mammals. Squirrels, particularly rope squirrels, appear to be the most likely natural reservoir based on ecological modeling. Other implicated species include pouched rats, chimpanzees, and several other rodents and primates.
The virus has traveled internationally through animal trade. A 2003 outbreak in the United States was traced to a shipment of wild rodents from Ghana. If you handle exotic animals imported from regions where monkeypox is endemic, you face a small but real risk of zoonotic transmission.
Household Contacts
Living with someone who has monkeypox puts you at measurable risk. A pooled analysis of outbreaks in Central Africa found that unvaccinated household contacts had a secondary attack rate of about 8%, meaning roughly 1 in 12 household members got infected. During the 2022 U.S. outbreak, the rate among nonsexual close contacts was lower, around 1.5%, likely reflecting differences in contact patterns and awareness.
The virus is remarkably persistent on surfaces. In one case study from a Dallas household, viable virus was recovered from surfaces 15 days after the infected person had left. On fabrics, related poxviruses have remained detectable for 28 to 70 days under favorable conditions. In cool, dry, UV-protected environments, viral particles can survive for months. Thorough disinfection of shared spaces, bedding, towels, and clothing is critical if someone in your home is infected.
Who Has Some Protection
If you were vaccinated against smallpox before 1980, when routine vaccination ended worldwide, you likely retain partial protection. A study in the Democratic Republic of Congo found that previously vaccinated individuals had a 5.2-fold lower risk of monkeypox, translating to an estimated vaccine effectiveness of about 81%. That protection has waned over decades, but it still offers a meaningful buffer that younger, unvaccinated generations lack.
The modern JYNNEOS vaccine, developed specifically for monkeypox and smallpox, provides about 82% effectiveness after two doses. For people at ongoing risk, booster doses are recommended every 2 to 10 years. The older ACAM2000 vaccine triggers neutralizing antibodies in over 95% of recipients and showed 100% protection against lethal doses in animal studies, but it carries more side effects and isn’t suitable for immunocompromised individuals.
If you have no history of smallpox vaccination and haven’t received JYNNEOS, you have essentially no pre-existing immunity to monkeypox. That describes the majority of people alive today, since routine smallpox vaccination stopped more than four decades ago.