What is mpox?

Mpox (previously called monkeypox) is a rare infectious disease caused by the mpox virus. This virus is related to the virus that causes smallpox.

Mpox is mostly found in tropical rainforest areas of Central and West Africa. outside of Africa are usually linked to travellers who visit that region and spread the infection when they leave. Since May 2022, there has been increased spread of mpox in many countries in Europe and North America. Mpox has also been reported within Australia.

How does mpox spread?

You can catch mpox after having close contact with an infected person, infected animal, or materials contaminated with the virus.

Person-to-person spread

You can catch mpox from an infected person by:

• breathing in respiratory droplets from coughs or sneezes of an infected person, or if these droplets land in your eyes, nose or mouth — you usually need prolonged contact to catch the virus
• having physical contact with infected bodily fluids, rashes, sores, scabs or blisters — for example, from touching, kissing or sexual contact
• touching contaminated objects used by an infected person — such as bedding, towels or clothing

Animal-to-person spread

Mpox is known as a zoonotic disease, which means that this virus spreads between animals and humans.

Outside Africa, animal-to-human transmission is generally rare. In Africa, mpox may be found in some wild animals, such as rats or squirrels.

Mpox can spread from animals to people, through:

• bites and scratches
• contact with infected blood, fluids or the skin of the animal or its bedding
• eating or preparing meat from an infected animal

Mpox can also spread during pregnancy through the placenta to an unborn baby.

What are the symptoms of mpox?

First symptoms of mpox include feeling generally unwell with ‘flu-like’ symptoms. The symptoms of mpox are usually mild and most people recover within 2 to 4 weeks.

Early (non-rash) symptoms

Early symptoms of mpox include:

• fever, headache, chills
• joint pains, backache, muscle aches
• swollen lymph nodes (swollen glands)
• extreme tiredness

Symptoms begin 5 to 21 days after exposure to the virus.

Onset of rash

Usually, the rash develops 1 to 5 days after a fever and other non-rash symptoms.

The mpox virus causes a specific type of rash, that sometimes looks similar to large chickenpox blisters.

The mpox rash usually appears similar to the images bellow.

Progression of rash

As the disease progresses, your rash goes through stages and changes appearance. Your rash starts off as flat red spots. It then develops into pustules (sores filled with yellowish fluid) and then it becomes crusty, scabs and falls off.

The rash may occur on any part of your body, including your face and inside your mouth, your chest, back, arms and hands, legs and feet and the genital and perianal regions (around your anus). The rash can be painful, especially if the sores or blisters join up, or if you have sores in your mouth or in or around your rectum (bottom end of your colon).

Some people have just a few sores, while others can have several thousand. The sizes of your sores can also vary from small to very large.

In rare cases you may not develop a rash. Instead, you may have rectal pain, infection or bleeding.

Mpox can potentially cause a serious illness. The risk of more severe symptoms is higher for infants, young children, people who are pregnant or with reduced immunity.

How soon after exposure to mpox will I develop symptoms?

Usually you will develop symptoms 7 to 14 days after you have been exposed to a person with mpox.

It can take as little as 5 days or as long as 21 days after exposure to develop any symptoms. The time it takes for symptoms to appear is called the incubation period.

When should I see my doctor?

Contact your doctor or local hospital for urgent medical attention if you develop the symptoms of mpox or similar ones and:

• you have recently returned from overseas, or
• you think you may have been exposed to mpox in Australia or overseas

Phone ahead, wear a face mask, cover any sores and avoid close contact with other people when you visit the doctor or hospital.

Isolate at home and avoid close physical and intimate contact with others until you get medical advice.

Mpox is a nationally notifiable disease. This means that your doctor must tell the

Department of Health and Aged Care if you have a diagnosis of mpox. The Department needs to monitor and track all cases of mpox in order to find outbreaks and improve healthcare responses.

How is mpox diagnosed?

Your healthcare professional can diagnose you with mpox by collecting some fluid from the blisters or the scabs of your rash. Your sample will be sent to a laboratory and tested for mpox. You should isolate at home until your doctor notifies you of your results.

How is mpox treated?

Most people have mild mpox and do not need specific treatment, although your doctor may prescribe treatment for symptoms or complications. For example, you may need pain medicines or antibiotics if you develop a skin infection from your rash.

If you have severe mpox or serious complications, you may need antiviral medicines, intravenous (IV) fluids or other medicines. Depending on your situation you may need treatment at a hospital that can give you the appropriate care or at an outpatient clinic.

You should isolate at home until all your blisters or sores have healed and a healthy layer of skin has grown over the sore.

Can mpox be prevented?

How you can protect yourself from getting mpox:

• Ask your doctor about vaccination against smallpox, which can also protect you against the mpox virus.
• Practice good hand hygiene. If you are caring for someone with mpox, use protective equipment such as gloves, facemasks, eye protection and disposable gowns.
• Cover your nose and mouth when you cough or sneeze. Keep your distance from people who are coughing or sneezing.
• Avoid physical contact with an infected person and any of their objects such as their tissues, linens or towels. Clean and disinfect any contaminated surfaces.
• Avoid contact with wild animals or any animals that may carry the mpox virus if you are travelling to West or Central Africa. Avoid handling or eating bush meat (wild game).
• Use a condom if you are having sexual contact while traveling or attending events where intimate contact with could occur. Condoms may not be enough to prevent catching mpox.

If you are infected with mpox you can help to prevent spreading it:

• Isolate from other people and follow your doctor’s instructions until your sores are fully healed.
• Avoid any sexual activity until all skin sores are fully healed, scabs have fallen off and a new layer of healthy skin has grown over the sore. Use condoms for 12 weeks after recovery.
• Practice careful hand hygiene, cover your nose and mouth when you sneeze or cough if you cannot isolate alone. Wear a facemask around other people and keep your rash covered.

Contact tracing and isolation of infected people can help prevent the spread of monkeypox.

Can I be vaccinated for mpox?

There are 2 smallpox vaccines approved for use in Australia that can help protect you from mpox disease:

1. 3^rd generation JYNNEOS®
2. 2^nd generation ACAM2000™ — only suitable for healthy, non-pregnant adults

These vaccines can be given:

• before you are exposed to mpox as a primary preventative vaccination (PPV) — previously referred as pre-exposure prophylaxis (PrEP)
• after you have been exposed to mpox as a post-exposure preventative vaccination (PEPV) — previously known as post-exposure prophylaxis (PEP)

It’s best to have the vaccine before you are exposed to the virus. Your doctor will recommend 2 doses, around 28 days apart, and ideally 2 weeks before you come into contact with the virus.

If you don’t have the vaccine before you come into contact with the mpox virus, you have the best chance of avoiding the disease if you are vaccinated within 4 days after exposure.

You can still catch mpox even if you have been vaccinated.

JYNNEOS is the preferred vaccine because it is easier to take and has fewer adverse (side) effects.

The Australian Technical Advisory Group on Immunisation (ATAGI) has identified groups of people at higher risk of catching mpox disease. They recommend that people who belong to these at-risk groups see their doctor for vaccination:

• people who are gay, bisexual and men who have sex with men (GBMSM)
• sex workers, especially those who have clients that are in high-risk categories of catching mpox
• anybody in a high-risk group who is planning on travelling to a country with a significant outbreak, or planning on doing a high-risk activity whilst travelling should seek vaccination advice 4 to 6 weeks before travel
• anyone at risk of getting severe mpox if infected, such as people who are immunocompromised
• healthcare professionals who are vaccinating people with the ACAM2000™ vaccine

More information on the mpox vaccine and how to access vaccination is available from the Department of Health and Aged Care.

Complications of mpox

Complications of mpox include severe dehydration from vomiting or diarrhoea. You may also be unable to drink enough because of sores in your mouth.

Other serious complications of mpox include secondary infections such as:

• cellulitis (skin infection)
• bronchopneumonia (lung infection)
• sepsis (a severe whole body response to infection)
• encephalitis (brain infection)
• infection of your cornea, scarring of your eye and loss of vision

Most people will recover from mpox without problems.

Larger skin sores may leave a scar when they heal.

Rarely, death may occur.

Resources and support

• Visit the Department of Health and Aged Care website for the latest information about mpox in Australia.
• Read more about mpox (monkeypox) on the Department of Health
• NSW Health website has information pages about mpox in Arabic, Chinese, Vietnamese and Spanish.
• Visit the Department of Health and Aged Care fact sheet for further information on:
  • mpox signs and what to look out for
  • the mpox vaccine and high risk groups
  • mpox health alerts for travellers