Public health priority: Urgent.
PHU response time: Respond to any report of monkeypox disease on day of notification. Enter suspected, probable and confirmed cases on NCIMS within 1 working day.
PHUs should refer to the
CDNA Monkeypox virus infection case and contact management guidelines (also detailed below).
Both confirmed cases and probable cases should be notified. A suspected case definition has been developed in response to the current multi-country outbreak of monkeypox virus infection in non-endemic countries and may be discontinued as the outbreak evolves. Suspected cases should not be notified to the National Notifiable Disease Surveillance System (NNDSS) but should be reported to state and territory public health units.
A confirmed case requires
laboratory definitive evidence only.
A probable case requires laboratory suggestive evidence
and clinical evidence.
A clinically compatible illness with rash1,2,3 on any part of the body with or without one or more classical symptom(s) of monkeypox virus infection:
A suspected case requires clinical evidence4and epidemiological evidence.
Testing is performed at jurisdictional public health laboratories. Prior to testing, suspected cases must be notified through the relevant state or territory public health unit (PHU).
The testing laboratory should be contacted to arrange receipt of specimens. Specific advice from the medical microbiologist at the testing laboratory may be sought to obtain advice on specimen collection, safe packaging, and transport.
Appropriate personal protective equipment (PPE) should be worn while collecting samples from patients suspected of monkeypox virus infection. This includes:
Lesion material should be collected from persons with suspected monkeypox virus infection with an active lesion or rash. Acceptable sample types include lesion fluid, lesion tissue, lesion crust or skin biopsy.
It is advisable to collect a sample from more than one lesion where able, however excessive sample collection should be discouraged to minimise risk to healthcare workers or laboratory personnel.
Material should be collected using a sterile dry swab. Do not use transport medium, which both dilutes the sample and risks leakage. For further advice, including on safe handling and transport of specimens refer to
Monkeypox (Monkeypox Virus) - Laboratory case definition.
Urgent: suspected, probable or confirmed cases should be notified immediately to the relevant PHU or communicable diseases unit.
PHUs should begin follow-up investigation for all probable and confirmed cases on the day of notification to identify the source of exposure (e.g. another case or an environmental source) and contacts.
PHUs should ensure suspected cases are rapidly and safely tested for Orthopoxvirus infection and that they isolate until a result is received.
PHUs should ensure that action has been taken to:
Monkeypox is generally a self-limiting infection. Most cases will not require specific treatment other than supportive management or treatment of complications (e.g. antibiotics for secondary cellulitis).
Advice on clinical management should be sought from an infectious disease physician. If antiviral treatment is indicated, it should be initiated in consultation with an infectious disease physician.
Standard and transmission based precautions, including contact and droplet precautions, are considered the minimum level of PPE when caring for a person with suspected, probable, and confirmed monkeypox. This includes:
Health workers may consider applying a fit-checked particulate filtrate respirator (PFR) - P2/N95 or equivalent, when providing certain care for a patient with probable or confirmed monkeypox, including but not limited to:
For further advice, refer to the Australian Human Monkeypox Treatment Guidelines.
Isolation is an effective measure to reduce the spread of disease. Isolation of monkeypox cases should occur during the presumed and known infectious periods, including the prodomal and rash stages of the illness.
Isolation should be in a separate room. Cases should use designated household items (clothes, bed linen, towels, crockery and cutlery). Cases should not leave the home except as required for follow-up medical care, or for solo outdoor exercise. If a case leaves the home, they should wear a surgical mask and cover their rash.
Cases should avoid close contact with wildlife and in particular rodents (mice, rats, hamsters, gerbils, guinea pigs, squirrels etc), due to the possibility of human-to-animal transmission.
Household members should avoid physical contact with the case.
If isolation from the rest of the household is not possible, this should be discussed with the PHU; moving the case from the household should be considered, particularly if there are children or pregnant women in the household.
Careful hand and respiratory hygiene are recommended for the case and everyone in the household; a surgical face mask should be used when in the same room as other people if this is unavoidable.
Cases isolating in the community setting should be provided with their PHU or communicable diseases unit contact number to seek advice or support where required.
Alert local doctors, sexual health clinics, emergency departments and laboratories in the areas where the monkeypox case may have acquired infection or was infectious and not all contacts were able to be identified.
Contacts of people confirmed to have monkeypox virus infection should monitor for symptoms for
21 days after their last exposure. All contacts should be encouraged to practise good hand hygiene and respiratory etiquette.
Transmission of monkeypox virus occurs when a person comes into close contact with the virus from an animal, human, or materials contaminated with the virus. Human-to-human transmission occurs through mucous membrane or non-intact skin contact with infectious material from skin lesions of an infected person; through respiratory droplets in prolonged face-to-face contact; and through fomites.
All medium and high-risk contacts should be instructed to monitor their temperature and watch for signs and symptoms. Additional measure, including consideration of post-exposure prophylaxis, may be considered (as per Table 1).
If any clinically compatible symptoms develop, medium and high-risk contacts should isolate and:
People involved in brief indirect contact with a case, or indirect contact wearing appropriate personal protective equipment (PPE) are at low risk of transmission and do not routinely require follow up. However, on a case-by-case basis public health units may advise low-risk contacts to monitor for signs and symptoms.
See Table 1 for detailed guidance for management of contacts.
High testing priority if compatible symptoms develop.
21 days from last exposure: