Mpox is spreading across Victoria

What is the issue?

Cases of mpox are continuing to increase across Victoria and other Australian jurisdictions. In August 2024, Australia recorded the second highest number of confirmed cases of mpox in the world. The mpox outbreak in 2024 is now much larger than the 2022 outbreak. As of 17 October, 330 mpox cases have been notified in Victoria since April 2024 and there have been 27 hospitalisations.

In Victoria, mpox has mostly affected gay, bisexual, and other men who have sex with men (GBMSM), however, it can affect anyone. There have now been several cases in females in Victoria and heterosexual transmission has been reported.

To help prevent further transmission in Victoria, clinicians are requested to increase testing for mpox and promote vaccination in at-risk groups.

There is an outbreak of a more severe strain of the monkeypox virus (Clade Ib) in parts of central Africa. This strain has not been found in Australia so far, but there is a risk of importation through international travel.

For further information on mpox, see the Department of Health page on mpox.

Who is at risk?

In Victoria at present, GBMSM (including those who identify as heterosexual) and their sexual partners are most at risk. Venues or events where close intimate or sexual contact occurs carry a higher risk of mpox transmission, particularly where casual or group sex occurs.

However, anyone can become infected, and anyone who has been in close and usually prolonged intimate contact with someone with mpox is at risk. While vaccination decreases the risk of mpox, those who are vaccinated, particularly if not fully vaccinated, may still become infected.

Symptoms and transmission

Symptoms may include lesions or rashes anywhere on the body, including the anogenital area. Other symptoms may include pain on urination (urethritis) or rectal pain, bloody stools and/or diarrhoea (proctitis). General symptoms include fever, chills, tiredness, headache, sore throat, muscle aches and swollen lymph nodes. Most people experience mild illness and recover within a few weeks, but severe illness can occur.

Mpox can spread from person-to-person through close (skin-to-skin) or prolonged contact, for example during sexual contact, as well as contact with contaminated items or surfaces, and respiratory droplets. Symptoms can occur up to 21 days after being exposed to mpox.

Recommendations

For GPs and other clinicians

Who to test

• Test all sexually active people with compatible symptoms, regardless of sexual orientation, vaccination status or travel history. If testing for herpes simplex virus, test for mpox.
• Remain aware of the possibility of mpox infection in any patient.
• Be alert to the possibility of atypical and attenuated presentations in people who are fully and partially vaccinated. Some patients have had multiple presentations to healthcare prior to diagnosis.

How to test

• Most testing occurs in primary care settings and can be easily and safely done. The risk to healthcare workers is very low and can be further reduced with use of appropriate personal protective equipment (PPE). This includes gloves, eye protection, gown and surgical mask. See the Public Health Laboratory Network (PHLN) guidance for further advice on PPE.
• Request mpox PCR on suitable swabs (e.g. rash/lesion, anorectal, pharyngeal) and send to VIDRL via your routine pathology provider. See the PHLN guidance for further advice on testing.

Advice and notification

• Advise patients to cover lesions and abstain from sexual activity while awaiting the result. Advise to wear a mask if oral, throat or respiratory symptoms.
• Recommendations for case and contact management have recently changed. See mpox factsheet for updates to patients who are tested for mpox. If positive, the Local Public Health Unit will provide further advice.
• Any suspected or confirmed mpox cases should be urgently notified to the Local Public Health Unit by calling 1300 651 160.
• If mpox is suspected in a returned traveller or someone who has had contact with a returned traveller from affected countries in Africa, contact your Local Public Health Unit immediately.

Vaccinate

• Offer free JYNNEOS® vaccine to all eligible GBMSM, their sexual partners and sex workers. Refer to the mpox immunisation page for eligibility.
• Check that eligible patients have had two doses of vaccine. Give the second dose if it is due.
• If your clinic does not offer vaccination, refer patients to the Mpox immunisation providers list to find a provider.

For more information, see:

• Department of Health mpox disease information and advice page

For people at increased risk of mpox

• Take measures to protect yourself and others. Avoid sexual activity if you have any symptoms of mpox, consider limiting sexual partners, and keep contact details of new partners.
• Mpox vaccine is free for eligible groups. Two doses of mpox are required for optimal protection. If you haven’t had your second dose, get it now. See Mpox immunisation providers list to find a provider of mpox vaccine.
• If you develop symptoms, restrict contact with others and get tested at your GP or sexual health clinic. Make sure to wear a mask, cover any exposed lesions and call ahead.
• For more information on measures to prevent the spread of mpox, see:
  • Better Health Channel mpox page
  • Advice for people with mpox page.