Monkeypox

What is monkeypox?

Monkeypox is a rare infectious disease caused by the monkeypox virus. This is related to the virus that causes smallpox.

Monkeypox is mostly found in tropical rainforest areas of Central and West Africa, with cases outside Africa usually linked to travellers who visit that region and spread the infection when they leave. In 2022, there has been increased spread of monkeypox in many countries in Europe and North America, with a few cases now reported within Australia.

Monkeypox is usually a mild disease that generally resolves in 2 to 4 weeks. But it can potentially be a serious illness. The risk of more severe symptoms is higher in children or people with reduced immunity.

How does monkeypox spread?

You can catch monkeypox through close contact with an infected person or animal, or through material contaminated with the virus.

Person-to-person spread

Monkeypox can spread from an infected person to another via:

• infected droplets from coughs or sneezes being inhaled or landing in the eyes, nose or mouth (extended close contact is usually needed)
• physical contact with infected bodily fluids or scabs or blisters — for example, from touching, kissing or sexual contact
• touching bedding, towels or clothing used by an infected person

Animal-to-person spread

In the past, outside Africa, animal-to-human transmission has been rare and would generally start when an infected animal had been imported and infected local animals. In Africa, monkeypox may be found in some wild animals, such as rodents like rats or squirrels.

Monkeypox can be 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 monkeypox?

The symptoms of monkeypox are similar to those of smallpox but are generally milder. They include:

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

A rash may appear 1 to 5 days after the fever starts. Usually the rash begins as flat, red spots, often in the mouth or on the face first. Then the rash spreads to other parts of the body — usually the arms and legs, rather than the trunk. The rash may also appear on the palms and soles, inside the mouth, on the genitals and on the eyes. In some recent cases, the rash has started in the genital and rectal areas and has not always spread to other areas of the body. In some of these cases, there has also been rectal discomfort.

The rash changes its appearance, going through different stages. Eventually it develops into pustules (lesions filled with yellowish fluid) which then crust and fall off. The number of lesions can vary from a few to several thousand.

The symptoms usually clear up after 2 to 4 weeks. Children may have more severe disease. People with immune deficiencies are more at risk of complications.

How soon after exposure to monkeypox do symptoms appear?

The time it takes symptoms to appear after exposure to an infected person (incubation period) is usually 1 to 2 weeks for monkeypox, but can range from 5 to 21 days.

When should I see my doctor?

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

• you have recently returned from overseas, or
• you may have been in contact with a monkeypox case in Australia or overseas

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

Aside from this, you should isolate at home and avoid close contact with others until you have medical advice.

How is monkeypox diagnosed?

If you have symptoms of monkeypox, the diagnosis can be confirmed by testing fluid from the blisters or the scabs from the rash.

How is monkeypox treated?

There is no specific treatment for monkeypox in Australia. Treatment is aimed at relieving symptoms. For most people, monkeypox will be mild. Someone with monkeypox will only need simple pain medicines, such as paracetamol, and to stay hydrated.

When a person’s symptoms are severe, or there are complications, they may need intravenous fluids and other medicines.

Can monkeypox be prevented?

There are several things that can help prevent monkeypox:

• Vaccination against smallpox is 85 per cent effective in preventing monkeypox.
• Travellers to West or Central Africa should avoid contact with wild animals or any animals that may carry the monkeypox virus. They should also avoid handling or eating bush meat (wild game).
• Practising good hand hygiene may protect you from being infected. If caring for someone who has monkeypox, use personal protective equipment such as gloves, facemask, eye protection and disposable gowns.
• If you are diagnosed with monkeypox, isolate from other people as per your doctor’s instructions, normally until the rash has gone.
• If you are diagnosed with monkey pox, refrain from sexual activity until all skin lesions are completely healed, scabs have fallen off and a new layer of skin has formed. Continue to use condoms for 8-12 weeks after recovery.
• Contact tracing and isolation of infected people can help prevent the spread of monkeypox.

Can I be vaccinated for monkeypox?

Due to the current limited supply of the vaccine, the Australian Technical Advisory Group on Immunisation (ATAGI) has recommended certain higher risk groups for vaccination against monkeypox. This includes:

• anyone considered by public health authorities as a high risk monkeypox contact in the past 14 days
• gay, bisexual and other men who have sex with men who are at the highest risk of monkeypox infection. Risk criteria for infection may include:
  • those living with HIV
  • a recent history of multiple sexual partners, participating in group sex, or attending sex on premises venues
  • recent sexually transmitted infection or those being advised to take HIV pre-exposure prophylaxis (PrEP) due to number of sexual partners
  • recommendation from other service providers, such as sexual health clinics
• sex workers, particularly those whose clients are in high-risk categories
• anyone in the above risk categories who is planning travel to a country experiencing a significant outbreak, with vaccination recommended 4 to 6 weeks before departure
• immunisation providers who are administering the ACAM2000™ smallpox vaccine

Whilst there are 2 vaccines approved for use in Australia, JYNNEOS® is the preferred vaccine, with ACAM2000™ being given only when JYNNEOS® is not suitable or available. The Australian Government has secured an initial supply of the JYNNEOS® smallpox vaccine and is working with the vaccine’s manufacturer to secure more.

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

Complications of monkeypox

Most people will recover from monkeypox without problems. However, complications can include secondary infections, pneumonia, sepsis (a severe response to infection), encephalitis (inflammation of the brain) and eye infection resulting in loss of vision.

Larger skin lesions may leave a scar when they heal.

Rarely, death may occur — this is estimated at between 1 and 10 per cent of cases, depending on which type of the virus (Congo Basin or West African) a person has.a