Mpox (monkeypox)

Mpox is a disease caused by the monkeypox virus. It belongs to the Orthopoxvirus genus family which includes the variola virus (the virus that causes smallpox).

Mpox is endemic or usually present in Central and West Africa. Infections outside these regions are usually linked to international travel.

Since May 2022, cases have been reported in countries where the disease is not endemic or usually present including Australia. The current outbreak is rapidly changing. Mpox does not spread easily between people, but anyone can contract it. Many infections in the current outbreak are among gay, bisexual or other men who have sex with men and have been contracted overseas. There have been cases of local transmission in Australia, with the potential for further local transmission.

Signs and Symptoms

Mpox is usually mild. Symptoms usually include fever, rash, rectal pain, and swollen lymph nodes. The rash often begins on the face and extremities.

The incubation period (time from contact with the virus to the onset of the first symptoms) is usually 7 to 14 days but can range from 5 to 21 days.

Symptoms of the infection can be divided into 2 stages:

1)   Symptoms in the first zero to 5 days include:

• fever
• headache
• back pain and muscle aches
• lack of energy
• swelling of the lymph nodes (lymphadenopathy)
• rectal pain

2)   A rash can start one to 5 days after the fever. The rash is usually more concentrated on the face, arms, or legs but can be localised on certain areas of the body.

Some patients only notice a few pimple-like lesions in the genital area or buttocks.

The rash goes through different stages. It usually starts flat, then becomes raised and fills with fluid, then pus. The rash eventually crusts into a scab and then falls off. The number of lesions varies from a few to several hundred.

Treatment

As the illness is usually mild, most cases can be managed at home with rest and oral fluids. Paracetamol and ibuprofen can lower temperature or fevers and reduce discomfort.

Recovery usually takes a few weeks. Rarely, severe cases can occur.

Some therapies are available for high-risk people, such as people with weakened immune systems. An infectious diseases specialist should be consulted if additional therapies are required.

Transmission

Person-to-person transmission can occur through:

• close physical contact with skin lesions/rash
• infectious body fluids, including semen
• contaminated materials or items such as clothing, bedding or towels

Transmission via respiratory droplets is less common and usually requires prolonged face-to-face contact.

Transmission may occur between sexual partners during intimate contact such as kissing, sex, or skin-to-skin contact with the infectious skin rash.

People are infectious when symptoms start and must isolate until the rash and lesions have crusted, scabs have fallen off and a new layer of skin has formed underneath.

It is unknown how long the virus stays in body fluids including semen or genital secretions. As a precaution, condoms should be used during sex for 8 weeks after release from isolation. Studies are needed to understand this risk better.

Prevention

Avoid contact with any materials such as clothing, bedding or towels that have been in contact with an infected person.

Always practice good hand hygiene. Regularly wash hands for 20 seconds with soap and running water or alcohol-based hand sanitiser.

Be aware of the risk of mpox if travelling overseas or in other states/territories where cases have been reported, especially if planning to have sex or attend large or intimate social gatherings such as raves, parties, clubs or festivals. Consider how close and skin-to-skin contact can be avoided. Always practice safe sex but be aware that condoms may not completely protect from the virus as transmission can occur during any skin-to-skin contact.

People travelling to countries where mpox is usually present, such as in Central and West Africa, should avoid contact with sick or dead animals (rodents, marsupials, primates), and should avoid eating or handling wild game (bush meat).

If you have had contact with someone with mpox contact your local doctor or public health unit.

Seek medical attention if you get symptoms or have travelled to a location where cases have been occurring. Wear a mask and cover any lesions or blisters.

Vaccination

Smallpox vaccines are effective against mpox since the 2 viruses are closely related. However, people who have received smallpox vaccines in childhood can still catch mpox as the protection decreases over time. There are 2 smallpox vaccines approved for use in Australia, JYNNEOS® and ACAM2000™. JYNNEOS® is the preferred vaccine for Australia based on its safety profile and because it is easier to administer.

The Australian Technical Advisory Group on Immunisation (ATAGI) provides clinical guidance on mpox vaccination for people who are at high-risk of exposure to mpox.

The eligibility criteria to receive the mpox vaccine in Queensland has expanded.

In addition to the key risk groups recommended by ATAGI to receive vaccination, individuals eligible to receive mpox vaccination at no cost* include:

• all sexually active gay, bisexual and other men who have sex with men (cis and trans)  and their sexual partners
• sex workers
• vaccination may also be considered for:
  • laboratory staff who analyse mpox specimens, based on a local risk assessment
  • healthcare workers at higher risk of exposure to individuals with mpox, including workers in primary care, sexual health clinics, hospital staff and others, based on a local risk assessment. The risk of transmission should be also minimised by using appropriate infection control measures.

Further information on mpox vaccines can be found on the Australian Government Department of Health website.
Vaccination with JYNNEOS® vaccine has been made available through several Mpox Vaccination Centres. This clinic finder map can be used to locate your nearest vaccination centre.

As vaccine supply increases into 2023, the number of Mpox Vaccination Centres may also increase.

* If you are accessing a GP clinic for vaccination, ask your vaccination provider if a consultation fee applies

Other resources

Mpox (monkeypox) | Australian Government Department of Health and Aged Care

Queensland Positive People – What’s the deal with monkeypox?

Queensland Council for LGBTI Health – MPXV (Monkeypox)

World Health Organization - Monkeypox outbreak situation

Help and assistance

Get qualified health advice 24/7 for the cost of a local call on 13 HEALTH (13 43 25 84).

If you are in an emergency situation, call 000 immediately.

For further assistance, please contact your local doctor, community health centre or nearest public health unit