NSW-specific management​ of suspected, confirmed and probable cases and contacts.

Last updated: 07 October 2022
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Suspected

Case notification and actions

Public Health Unit (PHU) should begin follow-up investigation (Figure 1) following notification of a suspected case of monkeypox. PHU should ensure that action has been taken to:

  • notify the Communicable Disease Branch (CDB) through CD on-call and enter case details in NCIMS
  • interview the case (or caregiver) if deemed necessary at this time using the NSW monkeypox case questionnaire to ascertain:
    • onset date and symptoms of the illness
    • travel history including flight details (dates, flight number, seat number, etc)
    • exposures to a confirmed or probable case and nature of contact with a confirmed or probable case
    • history of sexual contact and intimate partners within the 21 days prior to first symptom onset (prodrome symptoms, or rash in the absence of prodrome symptoms), including from overseas
    • smallpox vaccination status and date of vaccination (if vaccinated)
    • other relevant clinical findings to exclude other common causes of rash
    • people that they have had contact with since symptom onset
  • remind suspected case to isolate and avoid contact with others until a result is available
  • if monkeypox is suspected, collect samples per the PHLN guidelines and send these to the NSW Health Pathology-ICPMR laboratory at Westmead Hospital or SEALS laboratory (Randwick) for monkeypox virus testing
  • discuss with notifier if relevant pathology specimens have been collected and transportation to reference laboratories arranged
  • provide collectors and laboratory staff with information about infection control requirements (refer to Monkeypox Laboratory Case Definition - Specimen collection and handling).

If required and on a case-by-case basis, the Communicable Diseases Branch (CDB) can convene an urgent Expert Panel meeting to discuss the clinical, epidemiological and laboratory information for the management of the suspected case. The Expert Panel may comprise of:

  • Health Protection NSW
  • Westmead Hospital Infectious Diseases/Clinical Microbiologist physicians
  • Public Health Unit / treating clinician or ID physician / Sexual Health Clinic.

If the initial test result is negative for orthopoxvirus or monkeypoxvirus, the PHU should work with the treating clinician to contact the suspected case to inform them of the result and, if they are a contact of a confirmed case, advise them to continue to monitor for any clinically compatible symptoms for 21 days after their last exposure. If they develop any symptoms, they should be advised to call ahead before presenting to their GP for assessment and testing.

Confirmed and probable cases

Case notification and actions

  • Following notification of an orthopoxvirus or monkeypoxvirus PCR positive result, CDB can convene an urgent Expert Panel meeting to discuss the case, for example, if the case has a complex past medical history, multiple high-risk contacts, or high-risk exposures.
  • Interview the case (or caregiver) if not previously done using the NSW monkeypox case questionnaire to ascertain:
    • onset date and symptoms of the illness
    • travel history including flight details (dates, flight number, seat number, etc)
    • exposures to a confirmed or probable case and nature of contact with a confirmed or probable case
    • history of sexual contact and intimate partners within the 21 days prior to first symptom onset (prodrome symptoms, or rash in the absence of prodrome symptoms), including from overseas
    • smallpox vaccination status and date of vaccination (if vaccinated)
    • other relevant clinical findings to exclude other common causes of rash
    • people that they have had contact with since symptom onset.
  • The Expert Panel can advise on the appropriate actions to be taken for the clinical management of the case and assessment of contacts.
  • The PHU should ensure the case has been informed of their result, provided with the case factsheet and advised on infection control measures using the Clinical Excellence Commission: Household cleaning and disinfection information - Monkeypox fact sheet for household cleaning and disinfection.
  • Cases can be discussed and confirmed at the daily briefings. If the case is unable to isolate at home, other appropriate accommodation options for either other household members or the case should be explored, that is, friends, family, LHD facilities (to be arranged by LHD).
  • Household cleaning and disinfection advice has been published by the CEC and contains information about isolation in shared residences: Clinical Excellence Commission: Household cleaning and disinfection information - Monkeypox fact sheet.
  • If clinically indicated by Westmead Hospital Infectious Diseases/Clinical Microbiologist physicians, cases or high-risk contacts may be isolated and managed at the NSW Biocontainment Centre (NBC) at Westmead Hospital, especially in the event of a person being high-risk of severe illness due to pregnancy, immunocompromise or children.
  • Vaccination with Smallpox vaccine [JYNNEOS®] should be discussed with high-risk and in some instances medium-risk contacts. Refer to the MPX PEP Protocol.
  • Clearance from isolation decisions will be undertaken by the treating clinician or local infectious diseases service and the local PHU.
  • Cases leaving home self-isolation must be informed by the PHU of the necessity of household cleaning and disinfection and given the Clinical Excellence Commission: Household cleaning and disinfection information - Monkeypox fact sheet to provide advice on cleaning and disinfection.

Clinical management of cases in the community

The PHU should arrange for the cases to be medically monitored while in home self-isolation by clinicians in the local health district, either:

  1. an engaged sexual health physician in the relevant LHD, with co-share arrangement with local ID service to take calls after hours or weekends or where advice sought, or
  2. a GP to whom the patient may already be known, with co-share arrangement with local ID service to take calls after hours or weekends or where advice sought, or
  3. the local ID service (with delegation to a service such as HiTH).

If a patient in the community requires a medical review (for example, surgical, ophthalmological, medical) with concerns that they have complications, this should be escalated to Westmead Hospital Infectious Diseases/Clinical Microbiologist physicians On Call so that they can facilitate transfer and assessment.

Figure 1. Monkeypox case notification procedure

PHUs are advised to follow the below procedure for any confirmed, probable or suspected monkeypox cases:

Suspected case - Enter in NCIMS and Notify CD on call. PHU to interview case, ensure speciman has been referred to ICPMR or SEALS for confirmatory testing. Samples can be forwarded to iCPMR for WGS. CDB to convene expert panel if required. If initial test is negative, treating clinician to inform case and if person is a contact of MCPV case, advise them they must continue to monitor for symptoms for 21 days after last exposure. PHU to update event in NCIMS. If initial test is positive, for confirmed or probable case: 1. Case notification - clinician is to inform case of result and PHU provides case with fact sheet and advice on IPC and HH cleaning. 2. Case isolation - Isolation can be private residence or in the case of vulnerable people at risk, NBC at Westmead Hospital or LHD accommodation. 3. Contact management - PHU to identify high-risk and medium-risk contacts, enter in NCIMS and provide fact sheets. Case PHU to notify other PHUs if high- and medium-risk contacts live in their jurisdiction and have been assigned to them for follow-up. CDB/Health Protection to manage and follow up  with high and medium risk contacts via Whispir 21 days after last exposure. PHU to identify low risk contacts and provide fact sheet if necessary. 4. Infection prevention and control - Refer to guidance from CEC for IPC in healthcare facilities and in private residences.

NSW specific contact management

Contacts of probable and confirmed cases of monkeypox virus infection should be instructed to monitor their temperature and watch for signs and symptoms daily for 21 days after their last exposure.

Follow up of contacts using Whispir survey

  • PHUs should enter medium- and high-risk contacts in NCIMS and link to the probable or confirmed case to facilitate regular monitoring for symptoms for 21 days after the last exposure. If the case's NCIMS number is unknown, contact CD On-Call.
  • PHU is responsible for making initial contact with all high and medium risk contacts of their cases, entering them into NCIMS, providing them with the high and medium risk contact factsheets, and informing them of follow-up process via Whispir.
  • Where a contact resides in a different jurisdiction to the case, the PHU should still enter that contact into NCIMS, set the owning jurisdiction to the PHU of contact's residence, and advise the PHU by email (or telephone on weekends) that there are new contacts in their PHU for follow-up.
  • CDB will manage the follow-up of contacts using Whispir and record responses in NCIMS.

Low risk contacts

Low-risk contacts can be followed up at PHU discretion and supplied with the low-risk contact fact sheet.

Contact fact sheets

There are three contact fact sheets available:

Infection prevention and control

Infection prevention and control in healthcare facilities

Guidance on infection prevention and control in community, hospital, and institutional settings including sexual health clinics, primary care, and laboratories is available from Clinical Excelence Commission: Infection Prevention and Control Information for clinicians - Monkeypox.

Infection prevention and control in a private residence

Guidance on how to clean and disinfect a private residence for monkeypox cases who are isolating at home is available from Clinical Excellence Commission: Household Cleaning and Disinfection Information – Monkeypox.

Infection prevention and control in hotels and other community accommodation

Guidance on recommendations from an infection prevention and control perspective for infectious cleans as may be requested by NSW Health Protection: Clinical Excellence Commission cleaning and disinfection information - Hotels.

Adverse events following immunisation

  • The PHU should routinely check NCIMS workflows for contacts who have reported compatible symptoms and action according to the SoNG. An adverse event following immunisation (AEFI) is an unwanted or unexpected event occurring after the administration of vaccine(s). AEFIs are notifiable conditions under the Public Health Act 2010. Public Health Units are required to manage all AEFI reported following vaccination with a monkeypox vaccine in accordance with the Adverse event following immunisation (AEFI) control guideline.
  • In addition, vaccine recipients who have enrolled in the AusVaxSafety program and have reported medical attendance or a suspected serious AEFI (Refer to Table 1) are required to be followed up and contacted by the PHU using the password protected Vaxtracker portal. All suspected AEFI must be entered into NCIMS and reported to the Therapeutic Goods Administration (TGA) as per the AEFI Control Guidelines.

Criteria for follow up of AusVaxSafety participants reporting medical attendance or a suspected serious AEFI

  • ​All emergency presentations
    • those who needed to go to ED/hospital
  • GP presentations
    • serious/unexpected or unusual events
    • responses that indicate a *common/expected/resolved event, do not require follow up.

*As reported in the product information for the vaccine.


Current as at: Friday 7 October 2022
Contact page owner: Centre for Population Health