Changes to mpox vaccine eligibility criteria

What is the issue?

There have now been 24 confirmed cases of mpox in Victoria since 18 April 2024. Twenty-one of these cases were locally acquired. 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 gay, bisexual and other 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 globally in March 2024 were in African, European, Western Pacific, and South-East Asia regions, and the Americas.

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 gay, bisexual and other 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. Atypical or attenuated clinical presentations can occur particularly in fully or partially or vaccinated individuals.

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 meet the eligibility criteria to receive the free mpox vaccine.
• Two doses of mpox are required for optimal protection against transmission and severe disease. If you have not had your second dose, get it now.
• No vaccine is 100 per cent effective and mpox may occur in vaccinated people.
• Consider limiting the number of your sexual partners during the current outbreak and ensure that you have their contact details so that if a partner develops mpox you can be contacted and offered vaccination (post-exposure prophylaxis). Consider limiting sexual partners for three weeks following your return from overseas countries where there are active mpox outbreaks.
• Mpox can also be prevented by avoiding contact with people with suspected or confirmed mpox. This includes contact with any potentially contaminated materials, such as bedding and towels, that have been in contact with an infected person.
• 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, particularly among those with risk factors such as men who have sex with men (including those who may identify as heterosexual), and those with international travel history. This includes those who present with proctitis (anorectal pain with or without anal lesions).
• 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), including anorectal swab for patients presenting with proctitis and pharyngeal swabs. 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.
• Immunisation providers can order mpox vaccine through Onelink online.

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

Mpox vaccine eligibility

Eligibility criteria for free mpox vaccination has been updated. Primary prevention vaccination (PPV) and post-exposure preventative vaccination (PEPV) eligibility criteria have now been expanded to include additional at-risk groups.

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

Post-exposure preventative vaccination (PEPV) preferably in 4 days, in accordance with clinical guidance from the Australian Technical Advisory Group on Immunisation for:

• High-risk contacts of mpox cases
• Attendees of Sex-on-premises venues and public or private events (particularly where sexual or intimate contact has occurred) in areas where local transmission of mpox is occurring.

Eligible people for primary preventative vaccination (PPV) include:

• Sexually active gay, bisexual or other men who have sex with men.
• Sexually active transgender and gender diverse people, if at risk of mpox exposure.
• Sex workers, particularly those whose clients are at risk of mpox exposure.
• Sexual partners (including anonymous or intimate contacts) of the above groups.
• Sex-on-premises venue staff and attendees.
• People living with HIV, if at risk of mpox exposure, and their partners.
• Laboratory personnel working with orthopoxviruses.
• Vaccination may also be considered for healthcare workers at risk of exposure to patients with mpox, based on local risk assessments. This may include primary care, sexual health clinics, hospital staff and others. The risk of transmission should also be minimised by using infection control measures.

See mpox disease information and advice for more information.

How to access vaccines

Mpox vaccines are widely available through sexual health clinics, hospitals, general practitioners, Aboriginal health services, councils 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
• Sexual Health Victoria

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 and vaccine availability.