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Monkeypox

Monkeypox (MPX) 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).

Monkeypox 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. Monkeypox 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: 

Monkeypox 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.

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

Transmission: 

Monkeypox is spread through close contact with an infected person, or through an infected animal (dogs, rodents, marsupials, primates), or material contaminated with the virus.

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 close contact, including sharing beds and intimate sexual activity with someone who has monkeypox.

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 monkeypox 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 monkeypox 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 monkeypox 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 monkeypox since the 2 viruses are closely related. However, people who have received smallpox vaccines in childhood can still catch monkeypox 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 Monkeypox vaccination for people who are at high-risk of exposure to Monkeypox.

Monkeypox vaccination is recommended and available at no cost*, for the following at-risk groups:

1.  Post-exposure prophylaxis (PEP): Anyone categorised by public health authorities as a high-risk monkeypox contact in the past 14 days.

2.  Gay, bisexual and other men who have sex with men (GBMSM) at increased risk of monkeypox infection including those:

  • Living with HIV.
  • With a recent history of multiple sexual partners, participating in group sex, or attending sex on premises venues.
  • With a recent sexually transmitted infection or those being advised to take HIV PrEP due to a high number of sexual partners. While some people prescribed HIV PrEP are monogamous with a HIV positive partner, this category can also capture those with multiple partners who are at high risk.
  • Recommended from other service providers, such as sexual health clinics.

3.  Sex workers, particularly those whose clients are in the high-risk categories listed above.

4.  Anyone in the above high-risk categories planning to travel to a country experiencing a significant outbreak, with vaccination recommended a minimum of 4–6 weeks before departure.

5.  Anyone at greater risk of a poor clinical outcome from monkeypox infection, such as immunocompromised individuals.

Further information on Monkeypox vaccines can be found on the Australian Government Department of Health website.

Vaccination has been made available through a number of Monkeypox Vaccination Centres. This clinic finder map can be used to locate your nearest vaccination centre.

As more vaccine supply increases throughout the remainder of 2022 and into 2023, the number of Monkeypox Vaccination Centres may increase.

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