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.

What are the symptoms?

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 genital excretions. 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 medium-risk contact because you have been in:

• direct contact through intact skin 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.
• indirect contact for a prolonged period of time with someone with mpox.
• indirect contact during any procedure that may create aerosols from oral secretions, skin lesions or resuspension of dried exudates.

What should medium-risk contacts do?

Medium-risk contacts may be contacted by their local Public Health Unit for 21 days after their exposure for an assessment of progress.

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.
• if working in a high-risk setting such as in healthcare, childcare, disability or aged-care ensure you are symptom free before going to work and wear a surgical mask at work at all times. Your Public Health Unit will be able to advise if there are any concerns.
• regularly wash your hands with soap and water or use an alcohol-based hand sanitiser.
• *avoid close contact with those at potential higher risk of infection (for example, infants, older people, immunocompromised people, and people who are pregnant).
• avoid visiting high-risk settings (for example, healthcare, childcare or aged care facilities), unless seeking medical attention or for work-purposes.
• not donate blood, cells, tissue, breast milk, semen, or organs.
• on a case-by-case basis, you may also be asked by your local Public Health Unit to record your temperature twice a day.

*If you cannot avoid close contact from household members who are at higher risk of infection such as pregnant women and children, you should contact your local public health unit. Depending on your risk, they may need to help you find alternative accommodation where you can safely isolate until the 21-day period is over.

Vaccination

Medium-risk contacts may be offered the smallpox vaccine as post-exposure prophylaxis (PEP), ideally within 4 days but can be up to 14 days post exposure. Your local Public Health Unit will advise further.

Smallpox vaccines can provide protection against mpox because the two viruses are closely related. A 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. Read more about vaccination against mpox.

What to do if you develop symptoms

• Self-isolate at home and avoid all unnecessary contact with other people. If travelling home to self-isolate, you should go directly home, wear a mask and cover any exposed lesions. If you are unable to self-isolate, call the Public Health Unit on 1300 066 055.
• Contact your doctor and let them know you have been identified as a medium-risk contact of someone with mpox and have symptoms. 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 (for example, your healthcare provider or pathology centre)
• inform the healthcare workers that you are a medium-risk contact of someone with mpox on arrival.

If you do not own a private vehicle or have other testing-related questions, please contact your local Public Health Unit for advice on 1300 066 055.

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.