Clade II Monkeypox in in Liberia and Sierra Leone

Level 4 - Avoid All Travel
Level 3 - Reconsider Nonessential Travel
Level 2 - Practice Enhanced Precautions
Level 1 - Practice Usual Precautions
Map of western African with Sierra Leone and Liberia shaded. Names and boundary representation are not necessarily authoritative.
Liberia and Sierra Leone (View larger)
What is monkeypox?

Monkeypox is a disease caused by infection with Monkeypox virus. Monkeypox is endemic in forested areas of Central and West Africa.

Both clades of monkeypox can be spread, treated, and prevented the same way, but affected populations and geographic spread can be very different.

People in recent outbreaks usually get monkeypox through intimate or close contact, including sex or massage, with an infected person. Monkeypox can also be transmitted through contact with the skin lesions or bodily fluids of infected wild animals (alive or dead in endemic areas) or humans through contact with materials contaminated with the virus such as bedding, clothing, and dishes.

Symptoms often include fever (≥100.4°F), rash, headache, muscle aches, and swollen lymph nodes. Fever is not always present.

There is a vaccine available for monkeypox for those with certain risk factors.

Key points

  • There are outbreaks of clade II monkeypox in Liberia and Sierra Leone, where monkeypox is endemic. Unlike the ongoing global clade II monkeypox outbreak that began in 2022, which has primarily affected gay, bisexual, and other men who have sex with men (MSM), these outbreaks have affected males and females approximately equally. 
  • Person-to-person transmission has occurred during this outbreak, including through sexual or other intimate contact.
  • Monkeypox vaccination is recommended for travelers to Liberia and Sierra Leone who anticipate the following sexual activities (regardless of sexual orientation) during travel to certain countries with sustained person-to-person transmission of clade II monkeypox:
    • Sex with a new partner
    • Sex at a commercial sex venue (e.g., sex club or bathhouse)
    • Sex or intimate contact (e.g. massage) in exchange for money, goods, drugs, or other trade
    • Sex in association with a large public event (e.g., rave, party, or festival)
  • For those recommended to receive monkeypox vaccination, get two doses of the JYNNEOS vaccine at least 28 days apart.
    • If you are at risk for monkeypox and have only received one dose, get a second dose as soon as possible.
    • It takes about two weeks after the second dose for maximum protection against monkeypox. Be sure to plan ahead.
    • Whether or not you’re fully vaccinated when you travel, protect yourself from monkeypox. 
  • All people should avoid situations that might increase their risk for monkeypox, but especially people with risk factors for infection and/or who are at risk for severe disease (e.g., pregnant women, infants younger than 1 year, people with eczema or active skin conditions, and people who are immunocompromised). 
  • If you travel to Liberia or Sierra Leone:
    • Learn more about which activities may increase your risk for monkeypox and how you can reduce your risk of monkeypox, including getting vaccinated if you are eligible.
    • Avoid close contact with people who are sick with signs and symptoms of monkeypox, including those with skin or genital lesions.
    • Avoid contact with contaminated materials used by people who are sick (such as clothing, bedding, or materials used in healthcare settings) or that came into contact with wild animals.
    • Avoid contact with wild animals (alive or dead), such as small mammals, including rodents (rats, squirrels), and non-human primates (monkeys, apes).
    • Avoid eating or preparing meat from wild animals (bushmeat) or using products (creams, lotions, powders) derived from wild animals.
  • Seek medical care immediately if you develop new, unexplained skin rash (lesions on any part of the body), with or without fever and chills, and avoid contact with others.
    • Tell your doctor or healthcare provider where you traveled during the last 21 days before developing symptoms.
  • If you are sick and could have monkeypox, follow isolation and infection control measures at home and during travel. See additional information about what to do if you are sick with monkeypox.

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