MPOX (Monkeypox)

What is MPOX?

We spoke with to The Doherty Institute about the virus on our podcast Well Well Well here. (aired 26 May 2022)

What are the symptoms of MPOX?

The incubation period (the time from infection to the onset of symptoms) of MPOX is usually 1-2 weeks days but can be up to 21 days.

Symptoms include fever, headache, muscle aches, low energy, swollen lymph nodes and a skin rash or lesions (symptoms are similar to COVID or the flu).

The rash usually begins within one to three days of the start of a fever and tends to be more concentrated on the face, arms and legs. It can also be found on the mouth, genitals and eyes.

How is MPOX transmitted?

MPOX is transmitted through close physical contact with someone who has symptoms.

The rash, bodily fluids (such as fluid, pus or blood from skin lesions) and scabs are particularly infectious. Ulcers, lesions or sores in the mouth can also be infectious, meaning the virus can spread through saliva.

Clothing, linens or objects that have come into contact with a person who has MPOX can also infect others.

MPOX is not classified as a sexually transmitted infection, but it can be spread in sexual networks through direct contact during sex or clothing and bedding used by someone with MPOX .

How is MPOX treated?

Most people with MPOX have a mild self-limiting illness and recover within a few weeks without specific treatment.

There are some therapies available for the treatment of MPOX, particularly for people at high-risk such as those who are immunosuppressed.

Am I at greater risk if I’m HIV-positive?

HIV positive people on effective antiretroviral treatment are at no greater risk than HIV-negative people.

However, if a person is severely immunocompromised and not on HIV antiviral medication MPOX can be of greater severity and duration.

There is very limited evidence on MPOX in people living with HIV, and most is based on research in countries where access to treatment is low, and experience far negative health outcomes than in Australia.

At the moment people living with HIV should follow the same advice as the general population.

Should evidence emerge that people with suppressed immune systems are at greater risk of MPOX, or ill-health from catching the virus, then updated information and advice will be made available.

Why are cases of MPOX being detected among gay, bisexual and men who have sex with men?

It’s really important you’re aware of your HIV status. Find out more about getting tested here. Experiencing MPOX alongside untreated HIV or STIs may make your symptoms worse.

A large number of cases detected overseas are among gay, bisexual or men who have sex with men. One reason for this is the behaviour of gay, bisexual or men who have sex with men to actively seek out sexual health advice. Because MPOX rashes can resemble some STIs, such as herpes or syphilis, cases are being detected in sexual health clinics around the world.

The risk of MPOX is not limited to gay, bisexual and men who have sex with men. Anyone who has close contact with someone infectious is at risk.

Stigmatising people because of a disease is never okay. Anyone can get or pass on MPOX regardless of their sexuality.

What if I have recently returned from overseas?

People who have recently returned from overseas, have attended any dance parties, sex parties or saunas – especially in Europe – and who develop any symptoms, particularly an unusual rash or swollen lymph nodes, should seek medical advice immediately.

You should stay at home and remain isolated until given further advice by your treating doctor. If you are presenting to a clinic or emergency department, call to let them know you are attending, wear a mask, on arrival inform the reception staff and wait to be isolated until seen.

MPOX can be transmitted to pets. If you are isolating and experiencing symptoms, it is recommended that you isolate away from any pets.

MPOX can also be transmitted via clothing and other materials, so it is recommended that you wash all clothing items, towels and sex toys that you took overseas.

The MPOX rash can appear at multiple sites across the body. It is suggested that you check your genital areas for any new spots and lesions and seek medical advice immediately.

To reduce your risk of acquiring MPOX there are some practices and behaviours you can adopt.

If you are planning to travel overseas:

If you are planning to travel overseas, it is important to stay informed and remain aware of developments. The situation with MPOX is changing rapidly.

• Book an appointment to get your MPOX vaccine. Ensure there are two weeks between getting the vaccine and engaging in behaviour that may expose you to MPOX . It takes at least two weeks to offer initial protection against MPOX.
• Follow public health alerts and advice from local health authorities of the countries you are visiting.
• If visiting festivals or large events, keep alert of any event updates (before and after) from organisers.

Be aware and exercise caution if you plan to attend any large-scale pride events, sex parties or SOPVs, particularly in places where there are identified cases of MPOX.

If you are staying home, when it comes to sex:

• You can limit the number of sexual partners you have. Whilst MPOX is not a sexually transmitted infection, it is easily transmitted during sex. Limiting the number of partners you have reduces your risk of coming into contact with someone who has the virus. It can also be helpful to swap contact information with your hook-ups so that if either of you develop symptoms, you can contact each other to go and get tested.
• When having sex there are ways to limit your contact, so maybe don’t kiss or cuddle (even if that’s your thing), avoid using spit for lube, and wash your hands and body parts after sex.
• You can create a sex bubble. Similar to what some guys put into action during COVID, you can have a select group of people where you are only having sex with each other. This could be 3 or 4 or 5 people. Each person agrees that they’d be happy to be part of the bubble and doesn’t have sex outside of that. This limits the possibility that you and anyone else in your sex bubble will come into contact with the virus.
• If you have an open relationship, you might want to consider making it a closed relationship for a small period of time. The less people you play with, the less likely you are to come into contact with the virus.
• You can can look into other ways to get off when you are by yourself. Looking for ideas? Check out tips our community came up with for Sex & COVID or listen to WellWellWell’s episode on Sex, Intimacy & COVID-19.

When it comes to going around town there are some behaviours that may expose you to MPOX more than others.:

• Dancing at a crowded party inside with non-fully clothed people can expose you more to MPOX compared to dancing at a party outside with mostly clothed people.
• Don’t share drinks when you are out and about with friends – everyone sticks with their own glass;
• Don’t share personal items, such as towels or toothbrushes.
• Better to stay in your own bed than to sleep in someone else’s bed sheets.

The most effective way to prevent MPOX is to get vaccinated when you can.

MPOX vaccine appointments are now available in South Australia.

MPOX (monkeypox) is vaccine-preventable; however, the supply of vaccines against MPOX both globally and in Australia is limited.

The eligibility criteria to receive mpox vaccine in South Australia has been expanded.

People eligible to receive the vaccine include:

• Post-exposure preventive vaccination (PEPV) for close contacts of mpox cases;
• Primary preventive vaccination (PPV) for:
  • all sexually active gay, bisexual or other men who have sex with men (including cis and trans men);
  • sexual partners of the people above; and
  • sex workers.

More information on MPOX vaccine availability and how to book an appointment can be found on the  SHINE SA and Adelaide Sexual Health Centre websites.

SA Health will continue to keep the South Australian community informed as both the epidemiological situation and availability of vaccines for MPOX evolve.

What vaccine is available?

The vaccine that is currently available to prevent MPOX is the JYNNEOS smallpox vaccine.

What is the JYNNEOS vaccine?

The JYNNEOS vaccine is the vaccine being offered to community members during the MPOX vaccination program. It is a two-dose vaccine given four weeks apart. It is administered by injection, usually in the upper arm, and is safe to use in people who are immunocompromised.

JYNNEOS is one of two vaccines used for MPOX currently approved in Australia.

The other vaccine, ACAM2000, is associated with rare but serious side effects and adverse events, especially in certain groups of people such as those who are severely immunosuppressed. Because of this, ACAM2000 is not recommended for mass vaccination.

How does the JYNNEOS vaccine work?

The JYNNEOS vaccine is a two-dose vaccine, given at least 28 days apart. A person will start to build protection in the days and weeks after their first dose but will not have full immunity from the vaccine until two weeks after the second dose.

How effective is the JYNNEOS vaccine?

The World Health Organization (WHO) describes the vaccine’s efficacy as 85%, in other words preventing 17 out of every 20 infections. It should be noted that studies have been limited and there is a need to grow the evidence in this area.

Protection increases in the weeks following your vaccination. Your clinical provider will be able to provide more information.

What are the common side effects of the JYNNEOS vaccine?

Side effects are common but usually mild. Most people have redness, swelling and pain where they get the shot. Tiredness, headache and muscle pain can also occur after vaccination.

Can I have the JYNNEOS vaccine at the same time as the COVID-19 booster/vaccine?

An older version of the smallpox vaccine carries a risk of heart muscle or heart lining inflammation, especially when given at the same time as mRNA vaccines such as those used for COVID-19. It is not known if the vaccine being used during this rollout (JYNNEOS) also carries these risks.

Do I need a Medicare card to receive the vaccine?

No. While some vaccination sites may ask you to bring a Medicare card along to your appointment, MPOX vaccines are available at no charge to everyone regardless of their Medicare status.

I am planning to travel overseas, should I get the JYNNEOS vaccine?

People who are deemed at high risk of MPOX infection – such as gay, bisexual and other men who have sex with men that have a history of multiple sexual partners – who are planning to travel to a country with a significant MPOX outbreak should get vaccinated.

But be sure you plan early and to take into account the limited supply. You will need at least four weeks between your two doses, and another two weeks after your second dose to get full protection from the vaccines.

I think I may have been exposed to MPOX. Am I eligible for the JYNNEOS vaccine?

Anyone categorised by public health authorities as a high risk MPOX contact in the past 14 days should get the vaccine. Speak to your GP or healthcare professional about vaccine access if you are a close contact.

I think I may have symptoms of MPOX . Am I eligible for the JYNNEOS vaccine?

If you have symptoms of MPOX it is important to speak to a healthcare provider first before accessing a vaccine appointment. Contact your regular healthcare provider and let them know before attending that you might be experiencing symptoms.