Anyone can get mpox, but the risk is not evenly distributed. Your likelihood of infection depends on how you’re exposed, where you live or travel, and how well your immune system functions. The World Health Organization currently rates the risk to the general population as low in most countries, while specific groups face moderate to meaningful risk based on sexual behavior, occupation, immune status, or age.
Men Who Have Sex With Men
Gay, bisexual, and other men who have sex with men (MSM) have been disproportionately affected in the global outbreak that began in 2022 and continues today. This isn’t about sexual orientation itself. It’s about the type of close, prolonged skin-to-skin contact that occurs during sex, combined with network dynamics that allowed the virus to spread quickly through interconnected sexual networks. The virus has been detected in semen, genital and rectal lesions, feces, and saliva of confirmed cases, and the more invasive the route of exposure (such as intercourse versus touching a contaminated surface), the more severe the resulting illness tends to be and the shorter the incubation period.
As of mid-2025, the newer clade Ib strain is circulating locally in several countries including Italy, the Netherlands, Portugal, Spain, and the United States, with most detections occurring among MSM. This pattern has held across multiple continents and WHO regions. Condoms alone are not sufficient protection because the virus also spreads through prolonged face-to-face contact and skin-to-skin contact with lesions anywhere on the body.
People With Weakened Immune Systems
Mpox hits hardest in people whose immune systems are compromised, particularly those with advanced, uncontrolled HIV. Data from Nigeria’s 2017-2018 outbreak found that four of seven deaths among 122 mpox patients occurred in people with untreated advanced HIV. Those individuals developed more widespread rashes, higher rates of secondary bacterial infections, and significantly longer illnesses compared to people without HIV.
The 2022 U.S. outbreak confirmed the same pattern. The CDC documented 47 severe mpox cases among people with advanced uncontrolled HIV. All 47 were hospitalized, experienced prolonged illness or complications, and five died. Researchers have described this severe, tissue-destroying form of mpox as behaving like an AIDS-defining condition, with widespread skin damage, systemic complications, and a high death rate. Even among people living with HIV who were on treatment and had controlled viral loads, worse rectal disease was reported.
Other forms of immunosuppression, such as organ transplant medications or cancer treatment, also raise concern, though the strongest evidence comes from people with poorly controlled HIV.
Children in Endemic Regions
In Central Africa, the risk profile looks very different from the global outbreak. In the Democratic Republic of Congo, where clade I mpox circulates, children under 15 make up more than half of all cases. This is driven largely by zoonotic exposure (contact with infected animals) and household transmission in settings with limited healthcare access. Clade I is also the more dangerous strain, with a case fatality rate of 5 to 10%, compared to less than 3% for clade II, the strain behind most cases outside Africa. Children with clade I infections can develop severe systemic illness including widespread lesions, dehydration, secondary bacterial infections, and in rare cases, brain inflammation.
Pregnant People
Mpox during pregnancy carries real risks for the fetus. A systematic review of outcomes found that while 84.8% of pregnancies resulted in live births and no maternal deaths were reported, adverse outcomes included miscarriage (9.1%), stillbirth (6.1%), and four cases of death in the womb. Complications for the mother included reduced amniotic fluid, liver problems, infection of the amniotic membranes, and abnormal fetal heart rate. At least one study confirmed vertical transmission, meaning the virus passed from mother to baby through the placenta.
Healthcare and Laboratory Workers
People who work directly with mpox patients or handle laboratory specimens face occupational exposure risk. The CDC categorizes this risk by the type of contact that occurs. High-risk exposure means unprotected contact between broken skin or mucous membranes and a patient’s lesions, body fluids, or contaminated materials like linens. This includes incidents like an accidental splash of saliva to the eyes or a needlestick with a contaminated sharp. Intermediate risk includes touching a patient’s lesions or contaminated materials with intact skin, or being in the room without full protective equipment during procedures that generate aerosols.
Workers in either category are monitored for symptoms and may be offered preventive vaccination. Those with only brief, incidental proximity to a patient who has covered lesions face minimal risk.
People Exposed Through Contaminated Surfaces
You don’t need direct contact with an infected person to be exposed. The mpox virus is remarkably durable on household surfaces. In a CDC study of a Texas household, viable virus was recovered from surfaces 15 days after the infected person had left. Porous materials like bedding, towels, and clothing were far more likely to harbor live virus: 60% of porous surface samples grew viable virus, compared to just 5% of hard surfaces like metal and plastic. Under certain conditions, related viruses have remained detectable on fabrics for 28 to 70 days.
This means household contacts of someone with mpox, especially those sharing bedding, towels, or laundry, face meaningful exposure risk even without direct skin contact. Careful handling and washing of potentially contaminated fabrics matters.
People With Zoonotic Exposure
In West and Central Africa, where mpox is endemic, the virus circulates in small wild rodents and primates. People who hunt, trap, or process wild animals in these regions are at risk of zoonotic transmission through bites, scratches, or direct contact with an infected animal’s fluids or waste. This route of infection is a primary driver of cases in endemic areas and is especially relevant for rural communities that depend on bushmeat.
Who Should Get Vaccinated
The CDC recommends the mpox vaccine for several groups. If you’ve had known or suspected exposure to someone with mpox, or a sexual partner diagnosed with mpox in the past two weeks, you’re eligible. Beyond exposure-based eligibility, the CDC recommends vaccination for gay, bisexual, and other MSM, as well as transgender and nonbinary individuals, who in the past six months have had a new sexually transmitted infection diagnosis, more than one sexual partner, sex at a commercial venue like a bathhouse, or sex connected to a large public event or in an area with active transmission.
Vaccination is also recommended if you’re traveling to a country with a clade I outbreak and anticipate sexual contact with new partners, at commercial venues, or in exchange for money or goods. Laboratory workers and certain healthcare workers with occupational exposure risk are also eligible. If your sexual partner falls into any of these categories, you qualify too.