Get To Know Monkeypox (MPXV)

What is Monkeypox (MPXV)?

MPXV is a rare viral infection that does not spread easily between people and is usually associated with travel to Central or West Africa, where it is endemic.

Cases of MPXV have been identified in several non-endemic countries in recent weeks, including across Europe and the United States.

It typically begins with influenza-like illness and swelling of the lymph nodes, then progresses to a widespread rash on the face and body.

MPXV is usually a self-limited disease with symptoms lasting from 2 to 4 weeks.

What are the symptoms of MPXV?

The incubation period (the time from infection to the onset of symptoms) of MPXV 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 MPXV transmitted?

MPXV 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 MPXV can also infect others.

MPXV 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 MPXV.

How is MPXV treated?

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

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

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

There is minimal evidence on MPXV in people living with HIV, and most are based on research in countries where access to treatment is low, and experience far more 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 MPXV, or ill health from catching the virus, then updated information and advice will be made available.

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

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 MPXV rashes can resemble some STIs, such as herpes or syphilis, cases are being detected in sexual health clinics around the world.

The risk of MPXV 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 MPXV 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.

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

MPXV 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 MPXV 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.

How is Monkeypox (MPXV) prevented?

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

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

Book an appointment to get your MPXV vaccine. Ensure two weeks between getting the vaccine and engaging in behaviour that may expose you to MPXV. It takes at least two weeks to offer initial protection against MPXV.

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 MPXV.

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

• You can limit the number of sexual partners you have. Whilst MPXV 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 develops symptoms, you can contact each other to go and get tested.
• You may also want to consider using condoms for receptive anal sex to reduce the risk of anal transmission.
• Although sex (especially receptive anal sex) can put you at risk of getting Monkeypox, limiting some of your skin-to-skin contact with your partner may help as well as washing your hands and body parts after sex. Maybe don’t kiss or cuddle (even if that’s your thing), avoid using spit for lube and not sharing sex toys.
• 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 fewer people you play with, the less likely you are to come into contact with the virus.
• You can look into other ways to get off when you are by yourself. Revisit your favourite porn, think about checking out the porn on Twitter, or consider skyping or having sex online (which also has some privacy considerations that need to be thought about).
• When it comes to going out, some activities can put you at greater risk than others. There are some simple steps you can take to protect yourself from monkeypox:
• Check yourself for symptoms before heading out. If you are unwell or have a rash, you should stay home and seek a medical opinion.
• Consider the type of event and venue you attend- dancing in crowded venues with non-fully clothed people that results in prolonged skin to skin contact can expose you to monkeypox.
• Don’t share personal items, such as towels, toothbrushes or sex toys.
• Better to stay in your own bed than to sleep on someone else’s bed sheets.

The most effective way to prevent monkeypox is to limit your sexual partners and get vaccinated when you can.

Tell me about the Monkeypox (MPXV) vaccine?

Monkeypox (MPXV) vaccine appointments are now available in Victoria.

As there is a very limited supply of the vaccine, they will be limited people in Victoria who meet the following eligibility criteria:

• Post-exposure prophylaxis for close contacts of Monkeypox cases (within 4 days);
• HIV-negative and HIV-positive gay, bisexual, and other men, non-binary people assigned male at birth, or trans people who have sex with men (including cis and trans men);
• With an STI in the last 12 months OR
• Intending to engage in sexual practices during overseas travel to Europe or North America before 31 October OR
• Who attend sex on premises venues;
• Sexually active GBM MSM (including cis and trans men) who are homeless, or have significant drug use or psychiatric illness; and
• Sex workers who engage in sex with GBM MSM.

How does the vaccine work?

The JYNNEOS vaccine is a two-dose vaccine. There needs to be a minimum of 28 days or four weeks between doses.
At the moment, Australia is focusing on providing the first shot to as many at risk people as possible.
While supply is limited, second doses can be administered to people who meet the criteria for 'immunocompromised'. The JYNNEOS vaccine is safe to use in people who are immunocompromised.
Vaccination is highly effective, and a person will start to build protection in the days and weeks after their first dose. It takes four weeks for someone to reach their highest level of protection following their first dose. It should be noted that studies have been limited and there is a need to grow the evidence in this area.

Who is considered 'immunocompromised' with regard to the MPX vaccine?

At least 28 days after receiving the first dose, second doses of the MPX vaccine can be administered to people who meet the criteria for 'immunocompromised'.

The Victorian criteria for ‘immunocompromise’ in relation to monkeypox vaccination eligibility has been informed by expert opinion and is subject to updates by the Australian Technical Advisory Group on Immunisation (ATAGI). The criteria include:

• Primary immunodeficiency or acquired immunodeficiency: HIV/AIDS with CD4 count <200, or uncontrolled viraemia
• Haematologic neoplasms: leukaemias, lymphomas, myelodysplastic syndromes, multiple myeloma and other plasma cell disorders, post-transplant: solid organ (on immunosuppressive therapy), haematopoietic stem cell transplant (within 24 months), primary immunodeficiency,
• Receipt in the last 3 months any of:
  • Chemotherapy or whole-body radiotherapy
  • High-dose corticosteroids (≥ 20 mg of prednisone per day, or equivalent) for at least 14 days in 1 month, or pulse corticosteroid therapy
  • Biological agents and other treatments that deplete or inhibit B- or T-cell function (anti-CD20 antibodies, BTK inhibitors, JAK inhibitors, sphingosine 1-phosphate receptor modulators, anti-CD52 antibodies, anti-complement antibodies, anti-thymocyte globulin)
  • Selected conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) including mycophenolate, methotrexate (more than 0.4 mg/kg/week), leflunomide, azathioprine (at least 3 mg/kg/day), 6-mercaptopurine (at least 1.5 mg/kg/day), alkylating agents (eg, cyclophosphamide, chlorambucil), and systemic calcineurin inhibitors (eg, cyclosporin, tacrolimus)

Where can I get the vaccine?

For now, you can book a vaccine appointment at the following locations. Other sites will be added once more vaccine supply is available.

Thorne Harbour Health – PRONTO Clinic, 200 Hoddle Street, Abbotsford, VIC, 3067, (03) 9416 2889;

Thorne Harbour Health – Centre Clinic, 3A/79-81 Fitzroy Street, St Kilda, VIC, 3182, (03) 9525 5866;
( Thorne Harbour are taking expressions of interest via an online form which can be found here: https://thorneharbour.typeform.com/MPXEOI )

Collins Street Medical Centre, Level 7/267 Collins Street, Melbourne, VIC, 3000, (03) 8575 6900;

Prahran Market Clinic, Prahran Central Shopping Centre Mezzanine Level, 325 Chapel Street, Prahran, VIC, 3181, (03) 9514 0888;

Northside Clinic, 370 St Georges Road, Fitzroy North, VIC, 3068, (03) 9485 7700.

Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, VIC, (03) 9341 6200.

For individuals who fulfil the criteria for vaccination and reside in regional Victoria, email your closest regional Local Public Health Unit (LPHU).

Ovens Murray phu@awh.org.au

Barwon South West phu@barwonhealth.org.au

Gippsland/La Trobe phu@lrh.com.au

Goulburn Valley phu@gvhealth.org.au

Ballarat/Grampians phu@bhs.org.au

Loddon Mallee phu@bendigohealth.org.au

What if I am not eligible?

If you do not fit the current eligibility criteria there is no need to book an appointment. More vaccines are on the way. We expect vaccine eligibility criteria to change once more vaccines are available.

What vaccine is available?

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

What is the JYNNEOS vaccine?

The JYNNEOS vaccine is the vaccine being offered to community members during the monkeypox 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 MPXV 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.

How are the JYNNEOS vaccines being distributed?

There is significant global demand for this vaccine. Victoria has received a limited supply from the Commonwealth Government. Because of this initially limited supply, vaccines will be offered in a phased approach with priority given to those most at risk.

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, MPXV 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 MPXV 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 MPXV 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 MPXV. Am I eligible for the JYNNEOS vaccine?

Anyone categorised by public health authorities as a high risk MPXV 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 MPXV. Am I eligible for the JYNNEOS vaccine?

If you have symptoms of MPXV 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.

Are more supplies of the JYNNEOS vaccine on their way?

Yes. The federal and state governments are working to secure more supplies of the vaccine. As more vaccines become available, more people can get vaccinated against MPXV.

For more information about Monkeypox, head to https://www.health.vic.gov.au/infectious-diseases/monkeypox