In Australia, there have been 62 cases of mpox (formerly called monkeypox) notified in 2024, with 42 of these cases in Victoria, and three new cases in South Australia without a history of recent travel.
Mpox may present with a prodromal illness of fever, malaise, headache, myalgia and lymphadenopathy, followed by a maculopapular body rash that may lead to vesicles and pustules, and may look like molluscum contagiosum. Cases may present with lesions without a preceding prodromal illness; lesions may first appear in the genital area or buttocks, or the patient may present with penile oedema or rectal pain and bleeding without visible lesions. Most cases self-resolve within two to four weeks. Immunocompromised and pregnant persons, and infants and young children, are more at risk of severe disease. Severe manifestations such as encephalitis, corneal inflammation, and pneumonia, can occur, as well as secondary bacterial skin infections. Mpox can occur in people who have been fully vaccinated using 2 doses of smallpox vaccine, however the illness tends to run a milder course.
The incubation period is 4-21 days. The infectious period is considered from symptom onset until all scabs have healed and a fresh layer of skin has formed. This may take several weeks. Mpox is spread directly from close contact with lesions, and via body fluids e.g. during sexual contact. It can spread indirectly through contact with contaminated materials, e.g. bed linen and respiratory droplets.
Doctors are reminded to:
- Offer pre-exposure prophylaxis, using vaccination, to those currently eligible in SA: all sexually active gay, bisexual or other men who have sex with men (including cis and trans men); sexual partners of these persons; and sex workers. Clinicians may order mpox vaccine from the Communicable Disease Control Branch (CDCB) and offer to patients directly. For more information visit the SHINE SA and Adelaide Sexual Health Centre websites.
- Consider mpox in individuals with compatible clinical features including a rash or other lesions that could be consistent with mpox, such as proctitis or anogenital lesions.
- Have a high index of suspicion for mpox where there is recent travel or contact with a known or suspected case.
- Consider relevant differential diagnoses, such as varicella, HSV, syphilis, and other sexually transmitted infections, depending on the clinical findings.
- Discuss suspected cases with your local infectious diseases (ID) specialist immediately.
- Notify suspected cases to CDCB urgently by phoning 1300 232 272 (24 hours/7 days). Public health follow-up of cases of mpox is coordinated through CDCB.
- Arrange testing for suspected cases at Adelaide Sexual Health Centre (phone 7117 2800), or Sefton Park Hospital Avoidance Supported Discharge Service (phone 0435 475 190) (if after hours/weekend). If other options are unavailable arrange testing through the closest metropolitan public emergency department (ED) or selected rural hospitals: Berri, Gawler, Mt Gambier, Murray Bridge, Port Augusta, Port Lincoln, Port Pirie, Victor Harbour, Wallaroo, and Whyalla. These sites have been provided with mpox kits with the required consumables and instructions. Telephone the ‘external’ clinical microbiologist at SA Pathology on 8222 3000 prior to sending the patient to a mpox collection site. The clinical microbiologist will assist in coordinating specimen transport and testing within the laboratory.
- Do not test for mpox without using a mpox kit unless advised to do so by SA Pathology. In rural areas, the preferred testing method will be determined in discussion with the clinical microbiologist. Mpox collection kits are available in SA Pathology regional laboratories.
- Wear appropriate PPE in healthcare settings: P2/N95 mask, gloves, gown and eye protection.
- Isolate cases in a negative pressure room, or if unavailable, a single room.
Dr Louise Flood - Deputy Director, Communicable Disease Control Branch (CDCB)
For all enquiries, please contact the CDCB on 1300 232 272
