What is mpox (monkeypox)?

Mpox is a viral infection that causes a rash. It is spread by skin-to-skin contact with someone who has mpox. Most people recover within a few weeks.

Since May 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.

While most mpox cases in NSW have been acquired overseas, a small number have acquired their infections in Australia.

Symptoms usually begin 7-14 days after exposure. This can be as short as a few days or as long as 21 days.

Mpox symptoms may include:

• rashes, pimple-like lesions or sores, particularly in areas that are hard to see such as the genitals, anus or buttocks. and on the face, arms and legs.
• ulcers, lesions or sores in the mouth.
• people can experience fever, headache, muscle aches, backache, swollen lymph nodes, chills and/or exhaustion prior to the rash or lesions developing.

The lesions start as a flat red rash that develops into pustules, which then form crusts or scabs and fall off.

The risk of severe disease and complications such as secondary infection, sepsis and encephalitis is likely to be increased in people with immunocompromise, young children and pregnant women.

For more information, read the NSW Health mpox (monkeypox) fact sheet.

How does mpox spread?

Mpox mainly spreads from one person to another by direct skin-to-skin contact. It may be spread by breathing in droplets breathed out by someone who has mpox during prolonged close contact, but this is rare. It can also be spread through contact with infected bodily fluids or contaminated objects, such as bedding or clothes.

Mpox may be passed on during sex. It is not known how long the mpox virus remains present in semen and other bodily fluids. People who have mpox should abstain from sex for the duration of their infection. People who have recovered from mpox should use condoms when engaging in sexual activity for 12 weeks after recovery.

People with mpox are infectious from the time they first get symptoms until all the lesions have crusted, the scabs have fallen off and a fresh layer of skin has formed underneath.

Why am I receiving this information?

You have been identified to be a contact of someone who has mpox. You are considered to be a high-risk contact because you:

• are living with someone with mpox
• have been in close direct contact through broken skin or mucous membranes, with someone with mpox whilst they were symptomatic. This might be direct contact, with the case themselves or contaminated material (such as bed linen), crusts or bodily fluids.

What should high-risk contacts do?

High-risk contacts will be contacted every day by their local Public Health Unit for 21 days after their exposure.

For 21 days from the last time you were exposed to someone who has mpox, you should:

• monitor for any signs or symptoms of mpox as listed above.
• take your temperature twice a day.
• *ideally work from home as this will reduce your contact with other people. If unable to do so, in most circumstances you should be able to attend your workplace if you are asymptomatic, closely monitor for symptoms and wear a surgical mask. Attendance at work should be discussed with your local Public Health Unit.
• avoid visiting high-risk settings (e.g., healthcare, childcare, or aged care facilities), unless seeking urgent medical attention or advised otherwise by your Public Health Unit (such as if this is your usual place of work and you have been told you are safe to continue to physically attend).
• avoid close physical contact with others. You should keep a distance of 1.5m at all times from others. This includes people you live with.
• wear a surgical mask when outside the home and when in the same room as other people.
• **avoid close contact with those at potential higher risk of infection (this includes infants, older people, immunocompromised people, and people who are pregnant).
• abstain from sexual activity.
• regularly wash your hands with soap and water or use an alcohol-based hand sanitiser.
• clean surfaces regularly with disinfectant.
• avoid contact with animals, particularly dogs and pet rodents (for example, hamsters, gerbils, mice, rats, guinea pigs).
• not donate blood, cells, tissue, breast milk, semen, or organs.

*If you work in a high-risk environment such as in healthcare, childcare, disability or aged care, the Public Health Unit will give you advice on what to do. Individuals will be assessed on a case-by-case basis.

**If you cannot avoid close contact from household members who are at higher risk of infection, you should contact your local Public Health Unit. They may need to help you find alternative accommodation where you can safely self-isolate until the 21-day period is over.

Vaccination

High-risk contacts will be offered the smallpox vaccine as post-exposure prophylaxis (PEP), ideally within 4 days but up to 14 days post exposure to mpox.

Smallpox vaccines can provide protection against mpox because the two viruses are closely related. The new vaccine against smallpox (JYNNEOS) has fewer side effects than previous smallpox vaccines and can be safely used by all groups of people, including those who are immunocompromised.

Vaccination in children or pregnant women

JYNNEOS is also the preferred vaccine in those who are pregnant or breastfeeding. The vaccine may also be considered in children on an off-label basis depending on a risk-benefit assessment. Find out more about vaccination against mpox.

What to do if you develop symptoms

If you develop symptoms, you should:

• self-isolate at home and avoid all unnecessary contact with other people. If travelling home to self-isolate, go directly home, wear a surgical mask and cover any exposed lesions.
• contact your doctor and let them know you have been identified as a high-risk contact of someone with mpox. Your doctor should be able to advise on any tests that you may need.
• notify the Public Health Unit (1300 066 055) as soon as possible.

If you are concerned about any symptoms you may have, call your doctor for immediate care or call Triple Zero (000) immediately in an emergency.

What to do if you need to see your doctor or get tested in person

Depending on your symptoms your doctor may ask you to get tested in person. When travelling to either your doctor’s surgery or other healthcare facility, you should:

• wear a surgical mask
• cover any exposed lesions
• travel directly to and from the testing site (e.g. your healthcare provider or pathology centre)
• on arrival, inform the healthcare workers that you are a high-risk contact of someone with mpox.

Further information

For more information, read the NSW Health mpox (monkeypox) fact sheet. You can also call your local Public Health Unit on 1300 066 055.

For free help in your language, call the Translating and Interpreting Service on 13 14 50.