MPOX update
Concerning low rates of double vaccination against mpox among people with HIV
Update | December 2024
The World Health Organisation has declared a Public Health Emergency of International Concern for a new strain of mpox (Clade Ib). This strain has been increasingly reported in Central and Western Africa, in multiple European countries, India, Thailand, and Malaysia.
The spread of this strain of mpox has Australian experts concerned as it is unclear if it is more harmful than the Clade 2 virus in Australia, especially for people with HIV who are not fully vaccinated with two separate doses of vaccine.
Mpox is making a big comeback, and the number of new cases is increasing daily. When mpox was first reported in Australia in 2022, a free vaccination program targeting at risk populations was rolled out quickly and largely prevented a national epidemic. Local programs provided two free doses of the mpox vaccine JYNNEOS that was safe and effective for people with HIV.
In 2023 new notifications were so low (n=26) that experts believed Australia had virtually eliminated mpox. Today, however, new notifications of mpox are increasing daily at a rate not previously seen in Australia. Most new notifications are among gay, bisexual, and other men who have sex with men, including many people living with HIV.
Mpox: Cumulative confirmed and suspected cases, Australia.
Confirmed cases are verified through laboratory testing.
Suspected cases are those where mpox is based on an individual’s initial clinical signs and symptoms, but not yet confirmed through laboratory testing.
At the time of writing, 1137 new cases of mpox have been reported so far in 2024, with 612 in NSW and 383 in Victoria, and the number of new notifications is growing daily.
A new strain of mpox
There are two known clades (strains) of the mpox virus: clade I and clade II. The mpox that reached Australia in 2022 was from clade II, however the current mpox epidemic is driven by clade Ib. Clade Ib is concerning experts as it is causing more mortality than clade II in Central Africa where it is an endemic virus and has been for many years.
It is unclear if this increased severity of disease is related to the virus itself or to health service issues in Africa such as access to testing and treatment and people in remote areas not receiving timely care.
New Clade 1b infections have been reported outside of Africa. While no cases of mpox clade Ib have yet been reported in Australia, experts believe that it is only a matter of time before this new strain of Clade Ib reaches Australia. This has experts concerned about the potential impact on people with HIV, especially those who are not fully protected against mpox.
However, most new cases of mpox are among unvaccinated people and those who have received only one dose of the JYNNEOS vaccine. The JYNNEOS vaccine offers up to 90% protection when people receive two doses at least 28 days apart, as opposed to as low as 36% protection from only one dose, and 0% from no doses.
Source: ATAGI Statement on the prevention of Mpox 2024.
HIV and mpox
People with HIV are overrepresented in mpox notifications, both in terms of incidence and severity of disease. Experts are not sure why this is but believe those most at risk of acquiring mpox and having more severe outcomes and are those with a lower CD4 count and/or people not taking HIV treatment.
People with HIV who may be immunocompromised from other illnesses or their treatment (e.g. receiving chemotherapy for cancer) are also at greater risk of more severe infection.
Where to get vaccinated
People with HIV should make an appointment with their HIV prescriber. It is important to call first and ask if you can make an urgent appointment for an mpox vaccination. Otherwise, you can find your nearest vaccination hub on this interactive map.
While double vaccination with JYNNEOS is the most effective way to prevent mpox, there is still a risk of infection after only one dose of the vaccine, so it is important to take certain steps to reduce the chance of catching or spreading mpox until you achieve maximum protection.
More information available at Mpox information hub or ACON or Thorne Harbour.
If you have symptoms
If you think you have symptoms of mpox it is important to immediately self-isolate and contact your GP, local sexual health clinic or the NSW Sexual Health Infolink on 1800 451 624. Important information about preventing transmission to others can be found here in several languages.
Translated mpox information from the Department of Health
Get the MPOX vaccine – now is the time!
Update | September 2024
In recent months an increasing number of mpox (Monkey Pox) cases have been detected in Australia. For people who are immunocompromised, including people with HIV, mpox may be more serious.
People who are HIV positive, particularly gay and bisexual men who are sexually active, should receive two doses of the MPOX vaccine.
The vaccines are available through public sexual health clinics and LGBTIQA+ health clinics. Vaccination is free and no Medicare card is required.
NAPWHA President Scott Harlum says is vital that we have full vaccine coverage across the community of people with HIV, particularly those who have treatment resistance or have other illnesses associated with HIV, because they may be risk of more severe reactions from MPOX infection.
“We know that two doses of the vaccine will reduce the severity of symptoms relating to mpox infection.” he said.
Health Equity Matters’ CEO Dash Heath-Paynter said the new strain, known as clade Ib, had been confirmed in several African countries with one case in Sweden in a traveller returning to the country from Africa.
“We do not know how quickly this new strain will move or how it is transmitted. Currently, Australia has a small number of active mpox cases among gay and bisexual men. It’s vital men who have sex with men are vaccinated as soon as possible,” he said. Vaccination involves to doses at least 28 days apart.
The World Health Organization (WHO) has declared a public health emergency of international concern (PHEIC), its highest level of alert.
Mpox can appear as a rash or lesion and is transmitted in Australia through sexual contact between men and can cause serious illness in people with compromised immunity.
You must have two doses. Anyone who has only received one dose of the vaccine should get a second dose at least 28 days after the first.
For more information ask your doctor, HIV community organisation or your nearest sexual health service (see location map in the link below).
Find a service, anywhere in Australia
What is MPOX?
MPOX (formerly known as MonkeyPox) is a viral infection that does not spread easily between people and is usually associated with travel to Central or West Africa, where it is endemic. It is spread by skin-to-skin contact with someone who has MPOX, including during sex and through sexual networks.
Since mid-2022, there has been a global increase in MPOX cases reported from multiple countries where MPOX is not usually seen. Most of the cases are in men who have sex with men.
MPOX is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks. Severe cases can occur.
How is MPOX Transmitted?
MPOX is transmitted through close physical contact with someone who has the virus – in particular through sexual or intimate contact. While MPOX is not classified as a sexually transmitted infection (STI), sexual contact with someone who has the virus poses a high risk of transmission. 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.
MPOX Symptoms
Initial symptoms can include fever, headache, muscle aches, low energy, and swollen lymph nodes (similar to COVID or the flu) before progressing to a skin rash or lesions. The rash usually begins within one to three days of the start of a fever. The rash or lesions can also be found on the face, arms, and legs as well as in the mouth and around the genitals/anus.
Because MPOX rashes can resemble some STIs (for example herpes), it is important to contact your GP or local sexual health clinic and let them know about your symptoms when you make an appointment.
The incubation period (the time from infection to the onset of symptoms) of MPOX is usually 7-14 days, but it can be as short as 1-2 days or as long as 21 days.
While symptoms are typically mild, for some people with moderate to serious cases MPox can be quite painful.
How is MPOX Treated?
Most people with MPOX have a mild illness meaning that it resolves 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.
HIV and MPOX
We know that people living with HIV do make up a higher than expected number of cases from outbreaks in Europe and the Americas. Why this is isn’t well understood, as most is based on research in countries where access to HIV treatment is low, which is very different to how we manage HIV 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.
We encourage any gay, bisexual or MSM person living with HIV to consider MPOX vaccination. (See Vaccination section below). Other people living with HIV who are concerned about MPOX should speak with you HIV GP to find out more information.
MPOX Vaccination
A safe and effective vaccine that protects against monkeypox is available now. These vaccines are safe for people living with HIV.
The vaccine is provided free of charge. Maximum protection requires 2 doses of vaccine given at least 28 days apart. It takes 2 weeks for each dose of vaccine to reach the highest level of protection in your body. Vaccinate ahead of travel and party events and as soon as possible in your state or territory.
States and territories are responsible for rolling out the vaccine in their jurisdiction, including how and where it will be available and who gets access.
Recently returned from overseas? Or heading overseas soon?
People who have recently returned from overseas, have attended any dance parties, sex parties or saunas – especially in Europe – and who develop any of these symptoms, particularly an unusual rash, should seek medical advice immediately.
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.
- 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 sex parties or SOPVs, particularly in places where there are identified cases of MPOX.
You can reduce your risk of contracting MPOX by:
- Avoiding contact, including sexual contact, with people who are unwell or have compatible symptoms.
- Avoid skin-to-skin contact, particularly with any rash or lesions.
- Avoid contact with clothing, bedding or objects that have been in contact with or used by people with MPOX.
As always, practice good hygiene, self-isolate if unwell and seek medical attention if you develop any symptoms.
NAPWHA is continuing to monitor developments and will provide updates to our communities as the situation evolves.
Other MPOX Information and Resources
Information and research regarding MPOX is emerging, and regularly updated. Below is a list of trusted links to evidence-based resources to stay up to date with MPOX in Australia and globally.
- MPOX 101
- Factsheets – AFAO & ASHM
- SmartTraveller
- Queensland
QPP
QLD Government
- Tasmania
tasCAHRD
Tasmanian Government
- Western Australia
WAAC
Healthy WA
TraX Study
