Mpox Incubation Period Varies Depending on Type of Exposure

Author: European Centre for Disease Prevention and Control (ECDC)
Published: 16 Jun 2022 - Updated: 28 Aug 2025
Publication Details: Peer-Reviewed, Informative

Contents: Synopsis - Definition - Introduction - Main - Insights, Updates - Related Publications

Synopsis: This peer-reviewed article explores how the incubation period for mpox differs based on the nature of exposure, drawing from an analysis of confirmed cases in the Netherlands where invasive contact, such as through broken skin or mucous membranes during close interactions, typically results in symptoms appearing around nine days later, while less direct exposures stretch that to about thirteen days, averaging 8.5 days overall. Backed by rigorous statistical modeling and health authority data, this research provides a solid foundation for understanding the virus's timeline, making it a valuable resource for guiding quarantine protocols, contact tracing, and public health strategies that can save lives by catching outbreaks early. It's especially relevant for folks navigating health challenges, like seniors or those with disabilities, who often benefit from clear, evidence-based info to protect themselves against infectious diseases that could hit harder due to underlying conditions or limited mobility.

Topic Definition: Mpox

Mpox is a zoonotic pox virus infection that can occur in both humans and some other animals. Mpox in humans and animals is caused by infection with the mpox virus - a double-stranded DNA virus in the genus Orthopoxvirus, family Poxviridae. Two recognized distinct types are described as the Congo Basin clade and the milder West African clade.

Introduction

During the currently evolving outbreak of mpox cases worldwide, 31 cases have been confirmed in the Netherlands up to 31 May 2022. Efforts to stop the spread of infection focus on active case finding, contact tracing of close contacts, and their isolation or quarantine. Related recommendations from public health bodies on the need for active monitoring and isolation for a minimum of 21 days after the last day of exposure are based on the known mpox incubation period (up to 21 days).

Main Content

Observed Incubation Periods Vary Depending on Type of Exposure

Miura et al. [1] analyzed data of 18 cases confirmed in the Netherlands who reported the date of onset of symptoms and the most likely date of exposure. Depending on the transmission route, the typical duration of the incubation period for mpox varies from 9 days following complex and invasive exposure, e.g., contact with broken skin, to around 13 days after non-invasive exposure such as droplet transmission or contact with intact skin.

In their rapid communication published in Eurosurveillance, the authors argue that "given the particular types of exposures and differences in route of transmission, the incubation period for mpox in the current outbreaks may also have a different duration."

All 31 laboratory-confirmed mpox cases detected in the Netherlands until the end of May 2022 were among men between 23-64 years old who self-identified as men who have sex with men. Miura et al. analyzed the distribution of the incubation periods based on the information about symptom onset and exposure histories for mpox among 18 of them. They used a likelihood-based approach, which allows for exposure to be a single time point or a time interval.

Mean Incubation Period Estimated at 8.5 Days

Among the analyzed cases in this outbreak and using this best-fitting (lognormal) distribution, the mean incubation period of mpox was estimated to be 8.5 days (95% credible intervals: 6.6-10.9 days), with the 5th percentile of 4.2 days and the 95th percentile of 17.3 days.

This means the incubation period is in line with the typical timeline for so-called complex invasive exposure, and "direct contact between respective broken skin or mucous membranes during sexual activity might be the most likely route of transmission among cases reported" in the Netherlands.

Based on this, Miura et al. estimate that the percentage of people with mpox that would develop symptoms only after 21 days is approximately two percent, thus supporting the current use of 21 days for quarantining or other approaches to avoid infectious contacts.

The authors note that:

"More epidemiological information on details of possible exposure routes is required to establish whether the results of the current study are generalizable to other men who have sex with men cases in the current outbreak and to what extent the incubation period differs between alternative transmission routes."

References:

[1] Miura Fuminari, van Ewijk Catharina Else, Backer Jantien A., Xiridou Maria, Franz Eelco, Op de Coul Eline, Brandwagt Diederik, van Cleef Brigitte, van Rijckevorsel Gini, Swaan Corien, van den Hof Susan, Wallinga Jacco. The estimated incubation period for mpox cases was confirmed in the Netherlands in May 2022. Euro Surveill. 2022;27(24).

[2] Mpox is a zoonotic disease, i.e., it can be transmitted between animals and humans via direct or indirect contact. Following the eradication of smallpox and the end of universal smallpox vaccination, mpox is currently the most prevalent human orthopoxvirus infection. See: European Centre for Disease Prevention and Control. Mpox multi-country outbreak - 23 May 2022. ECDC: Stockholm; 2022.

Insights, Analysis, and Developments

Attribution/Source(s): This peer reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by European Centre for Disease Prevention and Control (ECDC) and published on 16 Jun 2022, this content may have been edited for style, clarity, or brevity.