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.

Historically, mpox was mostly found in tropical rainforest areas of Central and West Africa. However, 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.

Infection mostly happens from direct skin to skin or sexual activity. People at highest risk of mpox in Australia are men who have sex with men.

Since January 2023, there has been an outbreak of a more severe strain of Mpox in central and eastern Africa.

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

Mpox in Australia is mainly spread through close physical contact including sexual activity, such as:

• direct skin to skin contact with infected rashes, sores, scabs or blisters, for example from touching or kissing
• contact with semen and other body fluids from a person with mpox

Mpox may also spread by:

• touching contaminated objects used by an infected person — such as bedding, towels or clothing
• extended face to face contact with a person with mpox, through coughing or sneezing, but this is rare

You may be infectious up to 4 days before symptoms start.

If you are pregnant, mpox can be passed from you to your baby through the placenta.

Animal-to-person spread

Mpox is 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

What are the symptoms of mpox?

The symptoms of mpox are usually mild and most people recover within 2 to 4 weeks. The risk of more severe symptoms is higher for infants, young children, people who are pregnant or people with reduced immunity.

Symptoms begin 3 to 21 days after exposure to the virus.

The usual symptoms of mpox include:

• rashes, pimple-like lesions or sores
• ulcers, lesions or sores in the mouth
• rectal pain (pain in and around the anus) which may occur without a rash

Some people may get early symptoms which can include:

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

The mpox virus causes a specific type of rash, that sometimes looks similar to large chickenpox blisters. The rash usually develops 1 to 5 days after a fever and other non-rash symptoms.

However, some people may catch mpox and not have a rash.

Stages of mpox rash

The rash goes through different stages and changes appearance. It starts off as flat red spots, then develops into pustules (sores filled with yellowish fluid). Eventually it becomes crusty, scabs and falls off.

It may occur on any part of your body, including your face and inside your mouth, your chest, back, arms and hands, legs and feet, genitals, anus or buttocks. 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.

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.

When should I see my doctor?

Contact your doctor for medical attention if you develop the symptoms of mpox and you think you may have been exposed to mpox in Australia or overseas.

If your symptoms are severe, or you’re worried, contact your nearest hospital for urgent medical attention.

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 to help prevent the spread of mpox.

How is mpox diagnosed?

Your healthcare professional can diagnose you with mpox by collecting a swab of your rash or throat, or other areas depending on your symptoms. Your sample will be sent to a laboratory and tested. You should isolate at home until you get your result.

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 sores.

Can mpox be prevented?

Vaccination is the best way to prevent mpox infection. Other ways you can protect yourself from getting mpox include:

• avoiding close contact with people who have mpox or mpox symptoms
• avoiding contact with materials such as clothing, bedding or towels from a person with mpox
• practicing good hand hygiene. If you are caring for someone with mpox, use protective equipment such as gloves, facemasks, eye protection and disposable gowns.
• cleaning and disinfecting any contaminated surfaces
• avoiding contact with wild animals or any animals that may carry the mpox virus if you are travelling to parts of Africa. Avoid handling or eating bush meat (wild game).
• practicing safe sex and using a condom (but be aware that condoms may not be enough to prevent catching mpox, as the virus can spread through skin-to-skin contact)
• exchanging contact information with sexual partners. This means that if a partner develops mpox you can be contacted and offered vaccination to prevent mpox (post-exposure preventative vaccination).

What vaccines are available for mpox?

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

1. 3rd generation JYNNEOS®
2. 2nd 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 likely 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.

Who should be vaccinated?

In Australia, vaccination against mpox is recommended for the following groups:

• gay, bisexual or other men who have sex with men (GBMSM), including transgender and gender-diverse people
• sex workers, particularly those whose clients are at risk of mpox exposure
• people with HIV, if at risk of mpox exposure
• other individuals whose sexual networks might include GBMSM
• laboratory personnel working with orthopoxviruses

Vaccination may also be considered for:

• healthcare workers at risk of exposure to patients with mpox

Eligibility for vaccination varies by state and territory, so check your local health department website for further advice.

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

Complications of mpox

Most people will recover from mpox without problems.

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

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.
• The NSW Health website has information pages about mpox in Arabic, Indonesian, Chinese, Thai, Vietnamese, Portuguese and Spanish.
• Read these Department of Health and Aged Care fact sheets for further information on:
  • mpox signs and what to look out for
  • the mpox vaccine and high risk groups
  • mpox health alerts for travellers