A person with MPX is thought to be most infectious from the time they develop any symptoms until all scabs have healed and a fresh layer of skin has formed. This may take several weeks.
Transmission between people can occur through:
Although the virus is not a sexually transmitted infection (STI), transmission can occur through intimate physical contact during sex. In this case, it is likely that infectious skin rashes, blisters or sores are the mode of transmission.
The virus can also pass to the foetus via the placenta during pregnancy.
If you are in these groups and think you may be at risk, we urge you to be aware of the symptoms and to seek medical help straight away if you develop any of those symptoms.
If infected, infants, young children, pregnant women and people who are immunocompromised are at higher risk of becoming severely unwell.
MPX illness is usually mild and people typically recover within a few weeks without specific therapies.
Signs and symptoms of monkeypox infection can include:
The rash changes and goes through different stages, before forming a scab and falling off. It can appear as lesions (pimples, blisters or sores, which can then burst to form ulcers or scabs). These can vary in size and number with as little as a single lesion to several thousand. The lesions look like blisters similar to chickenpox, but larger.
Typically, the rash starts on the face, including in the mouth, and spreads to other parts of the body including the hands, feet, and chest. In this outbreak, some people have reported a rash appearing in the genital and perianal regions without spreading to other areas of the body. Some people only experience this rash with no other symptoms. Other people have had anorectal pain with no other symptoms. The rash can be painful, especially if the lesions join together or appear in the mouth or rectum.
There are a few measures people can take to help prevent infection:
People with probable or confirmed MPX should immediately isolate until all blisters or sores have healed and a fresh layer of skin has formed to prevent further spread of the disease. If you are a suspected case, you should isolate until you return a negative result.
Healthcare providers with inpatients in acute settings with confirmed or probable MPX should isolate them in a room with a private bathroom.
Please refer to the current treatment guidelines by the Australian Department of Health
Weekly evidence surveillance for randomised controlled trials on MPX treatments is underway. Current treatments under review and consideration include Tecovirimat, Brincidofovir, Cidofovir and vaccinia immune globulin.
There are smallpox vaccines available in Australia that are thought to be effective against MPX. Vaccines can be given either before or after a person is exposed to the virus but vaccinating before exposure is recommended for the best protection.
If a person is exposed to MPX, receiving a vaccination within 4 days after first exposure to MPX will provide the highest chance of avoiding the disease.
People who have received smallpox vaccines can still catch MPX. Infection control measures should also be used to contain the spread of MPX.
There are 2 vaccines approved for use in Australia:
JYNNEOS® is the preferred vaccine for use in Australia based on its safety profile and because it is easier to administer.
Where JYNNEOS® is not suitable or not available, ACAM2000™ may be considered for healthy, non-pregnant adults.
As with any vaccine, vaccination with JYNNEOS® or ACAM2000™ should only take place after a person and their healthcare professional have assessed the possible risks and benefits of receiving the vaccine, and the person has provided informed consent.
Both of the available vaccines may result in mild or serious side effects listed below:
JYNNEOS®: common side effects include local injection site reactions (pain, redness, swelling and hardening), muscle aches, headache, fatigue, nausea and chills.
ACAM2000™: a small bump at the vaccination site which becomes a blister, then a scab. A permanent scar may occur around the vaccination site. Wound care may be required around the vaccination site.
Following vaccination, people who receive ACAM2000™ should also:
There is a globally limited supply of the JYNNEOS® vaccine and high international demand.
The Australian Government, in conjunction with states and territories, has secured an initial supply of JYNNEOS® and is working with the manufacturer to secure more.
Given vaccine supply is limited, access to vaccines will initially be prioritised to support strong outbreak management, and this may include those who are:
States and territories are responsible for administration of the vaccine in their jurisdiction. This includes how and where it will be available and who will be prioritised to receive the vaccine. These decisions will be informed by local risk factors, such as local outbreaks and vaccine supply.
States and territories will provide further advice on how the vaccine can be accessed within their jurisdiction.
The Australian Technical Advisory Group on Immunisation (ATAGI) has recommended key risk groups for vaccination against MPX to support states and territories to prioritise their supply. This includes:
Anyone in the above risk categories who is planning to travel to a country experiencing a significant outbreak, with vaccination recommended 4-6 weeks prior to departure.
Anyone at greater risk of a poor clinical outcome from MPX infection, such as individuals with immunocompromise.
Immunisation providers who are administering the ACAM2000™ smallpox vaccine can be found at the Australian Government website on MPX vaccines here.
CDC recommends initiating vaccination within 4 days following the date of exposure for the best chance to prevent onset of the disease.
If initiated between 4 and 14 days following the date of exposure, vaccination might be less effective. Benefits might still outweigh risks when administering vaccine more than 14 days after exposure in some clinical situations (e.g., for a severely immunosuppressed person with a recent sex partner confirmed to have monkeypox).
Vaccination given after the onset of signs or symptoms of monkeypox is not expected to provide benefit.
JYNNEOS® is a modified vaccinia Ankara strain vaccine (MVA-BN) that contains a virus that has been altered so it cannot multiply in the human body. JYNNEOS® is manufactured by Bavarian Nordic.
It is given as 2 doses, at least 28 days apart for people 18 years and over.
The Australian Technical Advisory Group on Immunisation (ATAGI) has advised that vaccination with JYNNEOS® in children can be considered, especially for people in high-risk groups aged 16 years and older, after discussing the risks and benefits with their vaccine provider.
JYNNEOS® can be injected subcutaneously (under the skin, preferably into the upper arm) or intradermally (into the outer layers of skin). However, intradermal administration of this vaccine is not recommended for anyone with a weakened immune system or a history of keloid scarring. It is also not preferred as a first dose for post-exposure vaccination.
JYNNEOS® is not currently registered in Australia. It has been made available under an exemption provided by section 18A of the Therapeutic Goods Act 1989, which ensures that vaccines are available urgently to deal with a threat to public health. JYNNEOS® is registered with both the US Food and Drug Administration and the European Medicines Agency.
Further information is available in the JYNNEOS® vaccine information sheet.
ACAM2000™ is a live-attenuated smallpox vaccine that is also effective against MPX. ACAM2000™ is manufactured by Emergent BioSolutions.
Administration of ACAM2000™ requires specialised training and facilities.
ACAM2000™ is not suitable for:
The Taskforce have developed a MPX glossary to help consumers understand terms often used only by health professionals and other types of researchers.
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