Monkeypox (mpox)

Summary

• Mpox (previously known as monkeypox is a rare but potentially serious viral disease.
• Mpox  does not easily spread between people. It usually requires very close contact or contact with contaminated surfaces or items.
• Until recently, mpox was associated with endemic countries in Central and West Africa.
• From May 2022, there has been an outbreak of mpox affecting countries outside of endemic areas, including Australia.
• Most cases in Australia have been acquired overseas. A smaller but significant number of cases have been acquired within Australia.
• Individuals at greater risk should be aware of the symptoms and the risk of mpox, particularly if travelling to places with mpox cases.
• Vaccination against mpox is safe and effective.
• Vaccination appointments are currently available in Tasmania for those who are eligible.
• If you develop mpox symptoms or are concerned you had contact with someone with mpox, please seek medical care. Call ahead to make sure you can be isolated away from others and make sure you wear a mask when attending the clinic or hospital.

What is mpox (monkeypox)?

Mpox is a rare but potentially serious disease that is caused by infection with the monkeypox virus. Mpox is endemic in Central and West Africa – this means it is typically confined to these regions.

Since May 2022, mpox cases have been reported in many countries where it was not usually found. Most of these cases did not report international travel to countries where mpox was endemic meaning that it is spreading in new areas.

Cases have been reported in Australia. Most of these cases have been associated with overseas travel. However, there is also evidence of local transmission. People need to be aware of mpox symptoms and how to protect themselves against infection.

What are the symptoms?

Symptoms usually start 1 to 2 weeks after exposure to a person with mpox but can begin between 5 and 21 days. Early symptoms may include:

• Fevers
• Headache
• Chills
• Muscle aches
• Backache
• Swollen lymph nodes
• Exhaustion

A rash caused by mpox may begin with or a few days after early symptoms. The rash can be painful, widespread or confined to smaller areas of skin, and affect any part of the body including:

• Genitals
• Anus or buttock area
• Groin
• Inside the mouth
• On the face
• Palms of hands
• Soles of feet

The rash changes and goes through different stages. It usually begins as flat lesions or spots, developing into lesions filled with clear fluid (vesicles), then the lesions fill with yellowish pus-like fluid (pustules) which then dry up, scab over and fall off.

The symptoms usually resolve within 2 to 4 weeks. Severe symptoms and complications are uncommon but can occur.

How is it spread?

Mpox does not spread easily between people. Transmission requires close, prolonged contact. It does not spread via casual social contact.

Person-to-person spread may occur through:

• Direct physical contact with the infectious rash, lesions, scabs, or body fluids.
• Respiratory secretions during prolonged face-to-face contact or during intimate physical contact such as kissing, cuddling or sex.
• Contact with clothing or linen (such as bedding or towels) used by a person while infectious.

In areas where mpox is typically found, spread may also occur when a person comes into close contact with the blood, bodily fluids, or lesions of infected animals (such as a rodents) or by eating meat from an infected animal, particularly wild game.

People with mpox are contagious from the time that they develop their first symptoms until after the lesions have dried, crusted, and fallen off (approximately two weeks).

Incubation period

The incubation period is the time from exposure to a disease to the onset of symptoms. For mpox, this is typically 7 to 14 days from exposure but can range between 5 to 21 days following exposure. Anyone who comes into prolonged physical or intimate contact with someone who has mpox should closely monitor for symptoms for 21 days following exposure.

Who is at risk?

Anyone who has had close, prolonged, or intimate contact with a person infectious with mpox is at risk.

Before recent international cases, mpox was usually only seen in people who had recently travelled from a country where mpox is common. However, transmission is now occurring in other countries including Australia.

The overall risk to the Australian community is very low.

People who have recently returned from overseas or interstate areas where there have been cases, who were sexually active and/or have attended large parties or gatherings while travelling may be at increased risk and should watch for symptoms.

Young children, the elderly, pregnant people, and people with multiple medical problems or weakened immune systems may be at higher risk of severe disease.

How is it diagnosed?

Clinical history, examination, and a link to a suspected or confirmed case may lead a doctor to suspect mpox. The diagnosis can be confirmed in a laboratory by testing a swab of the rash or sores.

How is it treated?

Mpox is usually a mild illness with most people recovering within a few weeks. There are no specific treatments for mild to moderate mpox other than supportive measures such as pain medicines or other treatments to relieve symptoms.

Rarely, people may develop severe illness and need treatment in hospital. Antiviral medicines, intravenous fluids, and supportive medicines may be required for severe illness.

How is it prevented?

Several measures can be taken to prevent infection with mpox:

• If you are worried you have mpox, or have had contact with someone with mpox, seek medical review. Wear a mask and call ahead to say you are worried about mpox.
• Avoid close contact with people who are suspected or confirmed to have mpox. This includes avoiding contact with their clothing, bedding, or linen.
• Vaccination has an important role in preventing mpox (see below). Vaccination is currently available for free in Tasmania to eligible persons. It may also be given to certain high-risk contacts, as soon as possible after exposure to a case of mpox.
• If you are travelling interstate or overseas to countries where there have been mpox cases and may be sexually active and/or attend large parties or gatherings when travelling, you should be aware of the risk of mpox. Seek advice from local health authorities if you think you might have been exposed.
• If you may have had contact with a case of mpox, please monitor for symptoms and contact the Communicable Diseases Prevention Unit (CDPU - see below for details).
• Stay vigilant with hygiene measures including washing hands with soap and water or alcohol-based sanitiser.
• People who have mpox are advised to isolate from others until their rash has fully resolved. This will be advised by their doctor in discussion with the CDPU.
• People travelling to endemic countries should avoid contact with sick or dead animals that could be infected with mpox (rodents, marsupials, primates) and should refrain from eating or handling wild game (bush meat).

Vaccination

The mpox vaccine available in Australia is called JYNNEOS. It is safe to use for people aged over 16 years, including people who are immunocompromised and people living with HIV.

Two doses of the vaccine are required for maximum protection, given at least 28 days apart.

It can be given at the same time as most other vaccines. If you’ve been vaccinated against COVID-19 in the last 4 weeks, check with your health care provider first to see if you need to wait before you’re vaccinated against mpox.

JYNNEOS is a new vaccine so we’re still learning about it, however information from clinical trials shows the vaccine should be effective in preventing mpox.

When to get mpox vaccine

Vaccination with JYNNEOS can be before or after exposure to mpox. Vaccination may prevent mpox or result in milder disease.

The best time for people to get the vaccine is before they are exposed to mpox. The vaccine takes approximately 14 days before it is effective.

Individuals who have been vaccinated should ensure they follow public health advice to minimise their risk of contracting mpox.

If a person is exposed to mpox, receiving a vaccination within 4 days after the first exposure will provide the highest chance of avoiding disease. Though less ideal, vaccination can occur up to 14 days after exposure.

Anyone at-risk who is planning interstate or overseas travel to areas experiencing an outbreak should be vaccinated 4-6 weeks before they depart to allow for maximum protection.

Eligibility for vaccine:

After exposure to mpox

It is recommended that people who have already been exposed to mpox get a vaccination within 4 days of their exposure. Though less ideal, vaccination can be given up to 14 days after exposure.

Before exposure to mpox

Vaccine is currently available for free in Tasmania and recommended for eligible persons aged 16 years and older, including:

• all sexually active gay, bisexual, non-binary people assigned male at birth, trans people, and other men who have sex with men (including with cis and trans men)
• sexual partners of the people above and
• sex workers

Eligibility may be subject to change.

Two doses are required for optimal protection and are given at least 28 days apart.

For more information about those at greatest risk of exposure and severe outcomes read ATAGI guidance.

Any questions about availability of vaccine should be discussed with the Immunisation Team in the Communicable Diseases Prevention Unit (CDPU) by contacting the Public Health Hotline (details below).

Where to get mpox vaccine

Free and confidential mpox vaccination appointments are available through certain sexual health clinics and health services for eligible people over the age of 16 in Tasmania.

Alternatively for more information, or to speak to someone about mpox vaccination, call the Public Health Hotline on 1800 671 738 for more information.

What should I do if I develop symptoms?

If you develop mpox symptoms, and particularly if you develop a rash and a fever and swollen lymph nodes, you should immediately seek medical care. Call your GP or hospital to let them know you will be attending and have concerns about mpox. If you have a rash or blisters, make sure these are covered by clothing or dressings. Wear a mask when outside your home or in your home if you can’t isolate from others in your home. Avoid close contact with others, including sexual activity.

Be very careful with hygiene including washing hands with soap and water or using an alcohol-based sanitiser.

What should I do if I have contact with someone who has mpox?

If you have had contact with someone who has mpox, please call the Communicable Diseases Prevention Unit on 1800 671 738 (option 3) to speak to a Communicable Diseases Clinical Nurse Consultant.

Information for Clinicians

With this emerging outbreak, clinicians should be vigilant for clinical presentations that may be mpox and consider testing where risk factors are present. Clinicians should also consider the possibility of alternative diagnoses such as measles, chickenpox or shingles, Herpes Simplex infection, and syphilis.

Testing for mpox requires approval from the Communicable Diseases Prevention Unit (CDPU) in Public Health Services. This will ensure judicious use of testing resources and advice regarding specimen collection and infection prevention and control measures.

If you suspect mpox, isolate the patient and implement standard and transmission-based contact and droplet precautions. After taking a history, including sexual and recent travel history, contact the CDPU (details below) to discuss testing.

Where to get help

• In an emergency call ‘000’ (triple zero) for an ambulance
• You can also present to the emergency department of your nearest hospital or speak to your General Practitioner. Wear a face mask and call ahead to say you may have mpox.
• For other queries, contact the Communicable Diseases Prevention Unit (CDPU) on 1800 671 738 (option 3 to speak to a Communicable Diseases Clinical Nurse Consultant) or via fax (6173 0821).
• Mpox - Centres for Diseases and Prevention
• MPOX - Australian Government website

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