Local transmission of mpox in Victoria

What is the issue?

Three new locally acquired cases of mpox (previously called monkeypox) have been confirmed in Victoria in the past week. Prior to this, the most recent cases were reported in January 2024.

Mpox is a viral infection that usually results in a mild illness. Most people recover within a few weeks. However, some people may develop severe illness and require hospitalisation.

Since May 2022, there has been a large international outbreak of mpox that is predominantly impacting men who have sex with men.

Although mpox has generally been declining worldwide, new cases continue to be reported in many countries. The majority of cases reported in the past month (March 2024) were in African and European regions; however, new cases are still being recorded in South-East Asia and Western Pacific regions, including countries such as Thailand and Vietnam. Cambodia recorded its first case of mpox in March 2024. These trends and recent local cases indicate there is an ongoing risk of mpox in Victoria from both local and overseas transmission.

Who is at risk?

While the current outbreak has predominantly impacted men who have sex with men, anyone who has been in close and usually prolonged intimate contact with someone with mpox is at risk.

Symptoms and transmission

Symptoms can occur up to 21 days after being exposed to mpox.

Symptoms may include fever, chills, tiredness, headache, sore throat, muscle aches, swollen lymph nodes and rash. The rash can appear as vesicles, pustules or ulcers and affect any part of the body, including the anogenital area. Other symptoms may include pain on urination (urethritis) or rectal pain, bloody stools and/or diarrhoea (proctitis). Infection can still occur in vaccinated people, but symptoms may be less severe.

Mpox can spread from person-to-person through close or prolonged skin-to-skin contact, for example during sexual contact, as well as contact with contaminated items or surfaces and respiratory droplets.

People with mpox are considered infectious from the time they develop their first symptoms and until rash lesions have crusted, scabs have fallen off and a fresh layer of skin has formed underneath.

Recommendations

For people at increased risk of mpox

• If you have symptoms of mpox, restrict contact with others and seek urgent medical care and testing from your GP or local sexual health clinic. Make sure to wear a mask, cover any exposed rash lesions and call ahead.
• Get vaccinated if you are eligible to receive the mpox vaccine.
• Two doses of mpox are required for optimal protection. If you have not had your second dose, get it now.
• Limiting the number of sexual partners can reduce your risk of exposure to mpox.
• Exchange contact information with your sexual partners to assist with contact tracing if needed.

For more information on measures to prevent the spread of mpox, see the Better Health Channel mpox webpage.

For more information for men who have sex with men, visit Thorne Harbour Health website.

For clinicians

• Clinicians should test for mpox in all patients presenting with compatible symptoms, in particular, those presenting with a genital rash, lesions, or proctitis.
• Cases of mpox can occur in vaccinated and partially vaccinated individuals. Case reports of atypical and attenuated presentations in vaccinated and partially vaccinated people are increasing and clinicians should be alert to this possibility, particularly in those with risk factors.
• Request mpox PCR on suitable samples such as swabs of rash lesion material (fluid or base of lesion), anorectal swab for patients presenting with proctitis or a nasopharyngeal / throat swab. Mark samples as “urgent” and send to the Victorian Infectious Diseases Reference Laboratory (VIDRL) via your routine pathology provider. Approval from the Department of Health is not required for mpox testing.
• Any suspected or confirmed mpox cases should be urgently notified to the Department of Health by calling 1300 651 160.
• In patients presenting with genital or anal lesions/symptoms, testing for other sexually transmitted infections including herpes simplex virus, syphilis, chlamydia and gonorrhoea is recommended.
• Review the mpox vaccination status of all eligible patients. Offer mpox vaccination to those who are unvaccinated and offer the second dose if they are due or overdue. Providers are encouraged to record mpox vaccinations to the AIR.

For more information, including mpox vaccination, see the Department of Health mpox webpage.

Mpox vaccine eligibility

In Victoria, the mpox vaccine (JYNNEOS®) is available free-of-charge for eligible people who meet any of the following criteria:

• Post exposure vaccination for high-risk close contacts of mpox cases.
• All sexually active gay and bisexual men (cis and trans).
• Sexual partners of the above.
• Sex workers.
• Laboratory workers who analyse specimens from mpox cases.
• Healthcare workers at higher risk of exposure to patients with mpox (following risk assessment).

See mpox disease information and advice for more information.

How to access vaccines

Mpox vaccines are available through certain sexual health clinics, hospitals, GPs and community pharmacies. Your Local Public Health Unit can help you find a provider in your area. Select your nearest metropolitan or rural LPHU to locate your closest provider.

Other locations include:

• Melbourne Sexual Health Centre
• Thorne Harbour Health
• Northside Clinic
• Collins Street Medical Centre
• Prahran Market Clinic

Clinics may not always be able to accept new patients. Please note that while the vaccine is free of charge, consultation may not be. Please speak to the relevant clinic to verify consultation-related fees.