What we should know about Monkeypox (MPX)

This article was updated on 24/08/2022 to reflect changing contexts and new information.

 

After three years of living with COVID-19, and the Omicron surge we are currently experiencing, there is a sense of viral fatigue across the Victorian community. We have had multiple vaccinations to protect against COVID-19 and sacrificed many of our social freedoms and community connections. We thank and acknowledge our communities in rising to these challenges. 

As people living with HIV, we have a proud history of protecting ourselves and others and a unique and intimate understanding of virology, sexual health and prevention. Putting this knowledge into action will be vital to respond to MPX in the months ahead. 

Many of us have felt distressed and concerned with the news of a significant global outbreak of MPX. Rather than be overwhelmed by the potential historical stigma triggers which we know only too well, with focus on the association between MPX and men who have sex with men (MSM), facts and practical information are the key to staying on top of this emerging health issue. 

What is MPX?

MPX is endemic in Central and West Africa and has been increasingly appearing in urban areas. It is thought that the end of the smallpox vaccination program, which also protects against MPX, has led to an increase in the number and geographical spread of MPX cases. 

There has been a large recent increase in MPX cases in countries outside Central and West Africa. Local person-to-person transmission has occurred in these countries. The number of reported cases worldwide is growing daily, with more severe cases requiring hospitalisation. To date, 12 deaths have been recorded during the 2022 outbreak, and most of these have occurred in Central and West Africa.  

The first Australian case was reported in May 2022 from a returned overseas traveller. As of 22 August 2022, Victoria has 42 reported cases. Almost all of these have been from returned overseas travellers, but there have been cases of local person-to-person transmission. 

Who can get MPX?

“Although many of those affected in the current global outbreak are MSM, the virus can be acquired by anyone who has been a close contact with someone with MPX.” (New York Department of Health AIDS Institute) 

Although the prevention focus should be targeted toward MSM, as with HIV, it would be unwise to suggest only MSM should be concerned about potential exposure to the MPX virus. Every person in the HIV community should be aware of MPX. 

Signs and symptoms of MPX

The main symptom is a rash that varies from blisters or pimples to ulcers. It is often found on the genital or anal areas but it can be on other parts of the body such as face, hands and feet and inside the mouth. Sometimes there are no other symptoms and, in some cases, there is no rash. 

Other MPX symptoms can include fever, chills, sore throat, muscle aches, headache, backache, swollen lymph nodes and exhaustion. In some cases, people may have pain urinating, or rectal pain, blood in their poo, and diarrhoea. 

For most people MPX is mild but it can be severe for some people. 

MPX is transmitted via:

• Direct skin-to-skin contact with an infectious rash, scabs or body fluids (including semen) 
• Exposure to respiratory excretions during prolonged face-to-face contact or intimate physical contact, such as kissing, cuddling, or sex 
• Touching objects or fabrics (clothing, towels or linen) that have had contact with infected areas of someone with active infection. 

What do I do if I think I have been exposed?

If you think you have been exposed to MPX or have MPX symptoms, phone your GP/doctor or sexual health service. Phone ahead to make an appointment. This will allow others to provide you the best care and reduce the risk of MPX transmission. 

How can we prevent the transmission of MPX?

Some strategies and suggestions for prevention include: 

• Keeping up to date about vaccination eligibility criteria and availability and getting vaccinated as soon as you can 
• Hand washing and mask wearing 
• LPV suggests men who have sex with men, including trans and gender diverse folks, reduce casual sexual contacts until they have accessed vaccination.  Consider setting up a bubble, similar to during COVID, to limit possible exposure.  Keeping partners’ contact details will help with contact tracing.
• Continuing (or getting back to) regular STI testing is also important, and gay and bisexual MSM who have recently had an STI are currently eligible for a vaccine. 

What does it mean for people living with HIV?

There is no evidence that people with HIV with an undetectable (suppressed) virus should be more likely to get MPX or to experience more severe disease. 

However, people with undiagnosed HIV, advanced HIV or those who are not virally suppressed may be at risk of severe disease. 

MPX will resolve itself in most cases, but it can be very serious for some, including people who may be immune compromised. 

Most people in Australia living with HIV have access to HIV medication, and people with an undetectable viral load and are at no greater risk of having more severe MPX than people who are HIV negative. However, people with advanced HIV or who are not virally suppressed may be at risk of severe disease. We are concerned about people who are living with undiagnosed HIV, people who are not on HIV treatment and people on treatment with a detectable viral load. To prevent severe MPX it is important for people at risk of HIV to get regularly tested for HIV, and for people living with HIV to begin treatment or stay on treatment. 

Treatment and vaccination

The Jynneos (Imvanume or Imvanex) vaccine prevents MPX infection and is the only MPX vaccination safe for adults with HIV regardless of CD4 count. It does contain live virus but does not replicate in humans. 

Jynneos can also be used after exposure to MPX virus and may prevent MPX or decrease the severity of MPX symptoms (similar to what we know as PEP following exposure to HIV). It must be given within four days after possible infection with MPX. 

Victorian vaccination roll-out for MPX

In Victoria, MPX vaccination will be available free-of-charge for specific priority groups.  While a large shipment of MPX vaccinations is expected later this year, current supplies of vaccine are very limited. Currently, the following groups are eligible for the vaccination in order of priority: 

• Post-exposure prophylaxis for high-risk close contacts of MPX cases (within 4 days) 
• Laboratory workers who analyse specimens from MPX cases 
• Sexually active HIV positive gay, bisexual and other men who have sex with men (GBM MSM) (including cis and trans men) with an STI in the last 12 months OR intending to engage in sexual practices that put them at higher risk of STIs during overseas travel to Europe or North America before 31 October OR Who attend sex on premises venues 
• Sexually active HIV negative GBM MSM (including cis and trans men) with an STI in the last 12 months OR intending to engage in sexual practices that put them at higher risk of STIs 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 
• Sex workers who engage in sex with GBM MSM 

MPX vaccinations will be available from the following metropolitan locations, and regional local public health units: 

• Melbourne Sexual Health Centre 
• Thorne Harbour Health (express your interest in accessing vaccination when it becomes available here) 
• Northside Clinic 
• Collins Street Medical Centre 
• Prahran Market Clinic 

Clinics may not always be able to accept new patients. Please note that while the vaccine is free of charge, consultation may not be. Please speak to the relevant clinic to verify consultation-related fees. 

More clinics and access points will be able to provide the vaccine as additional stock becomes available. 

For individuals who fulfil the criteria for vaccination and reside in regional Victoria, please email your closest regional Local Public Health Unit (LPHU). Contacts can be found be scrolling to the bottom the page. 

What can we do?

Seek out reliable information sources such as the Department of Health’s monkeypox page.

Follow information across our community-controlled organisation networks such as:

• Thorne Harbour Health 
• National Association of People Living with HIV Australia (NAPWHA) 
• Australian Federation of AIDS Organisations (AFAO) 

If you are a person living with HIV in need of support, you can contact Living Positive Victoria via email.