Mpox

The vaccine for mpox is a two-dose vaccine, preferably administered into the upper arm. There needs to be a minimum of 28 days between doses.   

Vaccination is highly effective, and a person will start to build protection in the days and weeks after their first dose, but it takes two weeks before it is effective. More information about the vaccine is available here. 

Side effects can occur but are usually mild and do not last long. Common side effects include:

• Pain where you received the injection, redness, swelling, hardening, or itch
• Muscle aches
• Headache
• Fatigue
• Nausea
• Chills and fever

Anyone categorised by public health authorities as a high-risk contact of someone with mpox should get the vaccine. Speak to your local public health unit, GP or healthcare professional about vaccine access if you have been told this could apply to you.   

If you have symptoms of mpox it is important to be checked by a healthcare provider. Consult with your sexual health clinic or GP as soon as possible, and before accessing a vaccine appointment.   

Mpox does not spread easily between people. Transmission may occur through:   

• Close, personal contact including skin-to-skin contact with mpox skin rashes, sores, or scabs. This includes contact during intimate or sexual activity, such as:
  • Oral, anal, and vaginal sex
  • Touching and skin-to-skin contact
  • Hugging and kissing
• Contact with clothing, bedding, towels or other objects used by an infected person
• Respiratory droplets (from coughs and sneezes) from a person with mpox, usually from extended face-to-face contact.

It is unknown whether mpox is spread via sexual fluids. Although condoms do not provide complete protection against mpox, they can reduce the risk of developing sores on areas that are covered. It is important to practice safe sex and wear a condom when engaging in sexual activity to prevent the spread of other sexually transmitted infections.

Mpox can affect anyone who comes into direct contact with someone who is infected. However, currently mpox is largely impacting gay, bisexual or other men who have sex with men.   

People at increased risk of mpox infection include but are not limited to gay, bisexual and other men who have sex with me who:

• are living with HIV
• have multiple sex partners, participate in group sex or attend sex on premises venues
• have had a sexually transmitted infection or have been advised to take HIV PrEP
• have received a recommendation to receive vaccination from other service providers, such as sexual health clinics
• are experiencing homelessness, use drugs or have psychiatric illness.

To lower the risk of infection, gay, bisexual or other men who have sex with men can:

• Get vaccinated.
• Avoid contact, including sexual contact, with people who are unwell or have compatible symptoms (such as sores).
• Use a condom when engaging in any sort of sexual activity. This can reduce the chance of getting sores in sensitive areas and prevent other sexually transmitted infections.
• Avoid skin-to-skin contact, especially with anyone with a rash or sores.
• Wash hands often.

People with mpox may get a range of symptoms throughout the illness. Symptoms usually start within 3 weeks of exposure to the virus and include:

• A rash on or near the genitals or near the anus, or on other parts of the body such as the hands, feet, chest, face, or inside the mouth.
• Fever, chills, headache, muscle aches and backache, exhaustion, and swollen lymph nodes.
• Respiratory symptoms like sore throat, nasal congestion, or cough.

The rash can look different from person to person and during the different times of the illness. It can resemble a pimple or a blister, that can later develop a scab. It might have one spot or many. It may also be painful or itchy.

Usually if an infected person has flu-like symptoms, they will develop a rash 1-4 days later. However, some people may develop a rash-first, followed by other symptoms. Other people may only experience a rash.

If you develop mpox symptoms, and particularly if you develop a rash, you should isolate away from others and seek medical care at your GP clinic, the Melbourne Sexual Health Centre, or your nearest sexual health service. Call ahead of time to let them know you will be attending so they can ensure you are isolated away from others. If you have a rash or blisters, make sure these are covered, and make sure you wear a mask to prevent spread to others. 

It is important that people with symptoms avoid close contact with others, including sharing beds, touching skin-to-skin, and sexual activity.  

Mpox can be spread from the time symptoms start until the rash has healed, all scabs have fallen off, and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks. 

If you are travelling overseas and are sexually active whilst travelling, or if you attend large parties or other places where sex or intimate contact or other skin-to-skin contact occurs, vaccination is recommended 4-6 weeks before departure.  

Seek advice from local health authorities if you think you might have been exposed.  

If you have recently returned from overseas and were sexually active whilst travelling or attended large parties where sex or intimate or other skin-to-skin contact occurred, we advise you watch for symptoms. If you develop symptoms, you should seek medical attention and isolate away from others. 

Mpox is an urgent notifiable condition, in accordance with Victorian statutory requirements. Medical practitioners and pathology services must notify cases to the Department of Health or your local public health unitby telephone upon initial diagnosis or clinical suspicion (which includes suspicion to test for mpox) as soon as practicable and within 24 hours. 

Notify any suspected or confirmed case to the Department of Health or your local public health unit by calling 1300 651 160 (available 24/7). 

Mpox can affect anybody, although the current multinational outbreak has disproportionately affected gay, bisexual and other men who have sex with men. Whilst most cases diagnosed in Victoria have been acquired overseas, there has been local transmission. Mpox should be considered in anybody who has a consistent clinical syndrome (see below). 

Mpox can be transmitted through direct contact (such as with lesions or scabs, bodily fluids or contaminated objects) or through respiratory droplets. People with mpox are infectious from the time they develop their first symptom until the vesicles have scabbed over and the scabs have fallen off. Isolate the case until all lesions have crusted, scabs have fallen off and a fresh layer of skin has formed underneath.

Most – but not all – people who experience mpox experience an initial prodrome of symptoms that can include: a rash, fever, sore throat, aches and pains, fatigue, and/or swollen lymph nodes.  

The characteristic skin rash usually begins within 1-4 days of fever onset and progresses for a period of 2-3 weeks. The rash follows a similar progression to chickenpox; it can begin as macules that evolve to papules, vesicles and then pustules. The lesions eventually crust over; these crusts dry up and fall off.   

Some cases in the current global outbreak of mpox have had atypical presentations e.g. lack of prodrome, a single skin lesion only, or with proctitis or urethritis. A high index of suspicion should be applied to anybody presenting with skin lesions that are otherwise unexplained, or proctitis. 

Sampling procedures vary depending on the phase of the rash. Specific packaging and transport of samples are required. Appropriate personal protective equipment (PPE) should be worn while collecting samples from patients suspected of mpox virus infection. This includes fluid repellent surgical mask, gloves, disposable fluid resistant gown, and eye protection – face shields or goggles.  

Suitable sample types for mpox PCR include fluid or tissue from a suspected mpox lesion, the crust of a suspected mpox lesion, or skin biopsy of affected tissue. Swabs should be taken from the base of an affected lesion, which may need to be deroofed if a crust is present.  

In addition, nasopharyngeal or throat swab should be performed in all suspected cases, and rectal swab can be performed if proctitis is present.   

At the current time, given there is a significant overlap between mpox and other sexually transmissible infections (STIs), consider testing for concurrent STIs. Similarly, consider testing for mpox when testing for other STIs with similar signs and symptoms. A dedicated swab is needed for mpox testing so additional samples will be required for testing other STIs.  

See Mpox – Laboratory case definition for further advice on specimen collection, handling and transport. 

Medical practitioners no longer need approval from the Department of Health to test for mpox. Work with your usual laboratory, who will forward specimens on to the Victorian Infectious Diseases Reference Laboratory (VIDRL).

VIDRL is running an additional mpox PCR test that differentiates between clades I and II. To date, all mpox infections in Australia have been clade II, which is largely a sexually transmitted infection. However, due to concerns about clade I and its likely wider transmissibility, there is a need to identify clade I infections for more urgent public health action. Clinicians are advised to ask suspected mpox cases about travel to Africa. If there is a history of travel to Africa, please note this on the VIDRL request. If the test is positive for mpox on PCR and there is a travel history, VIDRL will perform the additional PCR that identifies the clade, and this will be available within one hour of the initial positive mpox PCR. Any clade I infections will be notified to the clinician and Local Public Health Units.

Remember that all suspected cases should be notified to either WPHU by calling 1800 497 111 or the Department of Health by calling 1300 651 160 (available 24/7).

Standard and transmission-based precautions – including contact and droplet precautions – are considered the minimum level of PPE when caring for a person with suspected, probable, or confirmed mpox. This includes:  

• Fluid repellent surgical mask
• Gloves
• Disposable fluid resistant gown
• Eye protection – face shields and gowns

Health workers may consider applying a fit-checked particulate filter respirator (PFR) – P2/N95 or equivalent, when providing certain care that might be higher risk, such as showering patients; handling contaminated linen, clothing, or towels; conducting procedures involving the oropharynx.  

See ICEG Interim Guidance on Mpox for Health Workers for more information. 

Suspected and confirmed cases do not need to isolate.

Confirmed cases should keep lesions covered when around other people or animals – using a bandage or dressing and then cover with clothing. They should stay in a separate room and use a separate bathroom if possible. Due to the risk of onward transmission, they should not share any household items such as towels, bed linen or clothes with others, and ensure any shared surfaces are disinfected after contact. Cases should not have close or intimate contact with others, including all sexual activity. 

Those with mpox should also avoid close contact with immunosuppressed people, pregnant women, and children aged under 12 years until all lesions are fully healed. 

Confirmed cases will be contacted by the local public health unit to ensure they are aware of the recommended precautions to take.

The decision to “clear” a person with mpox (that is, assess the person as not infectious to others), can be made by the person’s treating clinician. A clinical review should be arranged once the patient reports their symptoms are improved. The clinician should inform the Department of Health or the local public health unit monitoring the case of the outcome of the assessment. WPHU can be contacted by calling 1800 497 111 or emailing wphu@wh.org.au.    

A person with mpox can be cleared when the following criteria is met:   

• they are clinically well: any symptoms (such as fevers, malaise, swollen lymph nodes) must have resolved, AND  

• there have been no new lesions for at least 48 hours, there are no mucous membrane lesions and all lesions in exposed areas have crusted, the scabs have fallen off, and an intact fresh layer of skin has formed underneath. Lesions on unexposed skin must also have crusted over but if not fully healed (e.g., where a scab is still present) must continue to be covered when in contact with other people.   

Intimate or sexual contact should be avoided until the scabs have fallen off. Although it is not clear if transmission via sexual fluids is possible – it is recommended to use a condom during sex for 12 weeks after leaving isolation. In addition, patients should continue to avoid close contact with immunosuppressed people, pregnant women, and children aged under 12 years until all lesions are fully healed.  

Local public health units can provide clearance letters to people with mpox if required (for example, to support their return to the workplace). 

The management of a confirmed case of mpox is the responsibility of the treating doctor. This includes notifying the patient of the diagnosis, clinical management, and assessment for case clearance. If a case is diagnosed by an emergency department and subsequently discharged home, follow up should be handed over to the case’s usual GP, or an appropriate sexual health centre or infectious diseases unit.  

Mpox is generally a self-limiting infection. Most cases will not require specific treatment other than supportive management or treatment of complications (e.g. antibiotics for secondary cellulitis).  

Mpox skin and mucosal lesions can be painful, and adequate pain relief is a requirement of clinical care. Inadequate pain relief is the most common indication for emergency department presentation. It is also important to provide advice to minimise the risk of secondary infection of mpox lesions.  

For further advice, refer to the Australian Human Mpox Treatment Guidelines.  

Additional resources are available for managing symptoms at home, such as those produced by CDC and by BMJ. 

Antivirals are generally not required.  If further information is required, please contact an infectious diseases physician or refer to the Australian Human Mpox Treatment Guidelines.    

Postexposure Prophylaxis: Vaccination may be warranted for susceptible high-risk contacts following a risk benefit assessment within 4 days of exposure if there are no contraindications.  See Victorian Department of Health Mpox website for more information on vaccination eligibility criteria.   

High-risk individuals: Certain high-risk individuals are eligible for vaccination prior to exposure. See Victorian Department of Health Mpox website for information on current vaccination eligibility criteria and availability. 

Healthcare workers: Certain laboratory and healthcare workers may be eligible for vaccination. See Victorian Department of Health Mpox website for more information on current vaccination eligibility criteria.   

While mpox can affect anybody, a significant majority of cases in the current global outbreak are amongst gay, bisexual and other men who have sex with men (MSM). The MSM community has a longstanding history of experiencing stigmatisation, including in healthcare environments, and it is important to avoid applying further stigma.  

It is important to remember that mpox is not known to be a sexually transmitted infection, although we are still learning about this disease. Most cases in the current outbreak have been acquired through close physical contact, which includes activity with sexual partners. In addition, anybody can be affected, regardless of sexual preferences.