Mpox

Question 1

Is mpox nationally notifiable?

Answer 1

Yes - urgent, labs and doctors
Respond within 24hrs

Question 2

What is the organism responsible for MPOX?

Answer 2

Monkeypox virus (orthopox virus) - similar to smallpox, vaccinia virus
Two distinct clades (Ia/Ib, IIa/IIb)
* I - Congo Basin / Central African; more severe historically
* II - West African

The clades refer to the different genetic lineages of the monkeypox virus.

Question 3

What is the reservoir for Mpox?

Answer 3

Remains unknown however isolated from several African rodents and primates.

Question 4

Which clades have been implicated in the recent global outbreak in 2022?

Answer 4

Clade IIb
However since 2024, Ib also spreading internationally

Question 5

When was mpox declared a PHEIC by the WHO?

Answer 5

• 2022
• Then again in 2024 following spread of clade Ib

Question 6

How is MPOX primarily transmitted?

Answer 6

• Zoonosis - animals to human
• Person to person spread - contact with lesions, droplets fomites, sexual, vertical

Usually requires close prolonged contact

Person to person transmission occurs through contact with lesions, droplets, and fomites.

Question 7

What are the clinical features of MPOX?

Answer 7

May have prodrome (fever, malaise, LA, back pain) and rash (macular 🡪 papular 🡪 vesicular 🡪 pustular 🡪 scabs)

Rash can be generalized or localised, with recent outbreaks showing genital/perianal lesions, urethritis, proctitis (severe pain)

Question 8

Who are considered high-risk groups for MPOX?

Answer 8

• Unvaccinated
• Immunocompromised (incl. HIV infection)
• MSM and female partnesr of MSM
• Children
• Pregnant

These groups may be more susceptible to severe disease.

Question 9

What settings are high-risk for transmission?

Answer 9

• Households
• SOPVs
• Events, parties, venues where skin-to-skin or other intimate contact occurs
• Healthcare settings
• Endemic countries
• Potentially schools / ECECs but insufficient evidence in Australia to date

Question 10

What are the case definitions for MPOX?

Answer 10

• Confirmed: PCR/culture
• Probable: orthopox + clinical
• Suspected: clinical + epi

The definitions help classify cases for outbreak management.

Question 11

What is the incubation period for MPOX?

Answer 11

Approx 1 week

8 days, range 3-21 days

This period is the time from exposure to the onset of symptoms.

Question 12

When is the infectious period for mpox?

Answer 12

4 days prior to symptom onset (prodrome, rash, proctitis) to symptom resolution.

If lesions - until scabs have fallen off with fresh skin underneath
If no lesions - 21 days after diagnosis
ASx - 21 days after positive test

This period indicates when transmission to others is possible.

Question 13

What are the clinical symptoms?

Answer 13

• Self-limiting disease lasting 2-4 weeks
• Prodrome, LA, fever, headache, myalgia, arthralgia, back pain, sore throat
• Maculopapular rash
• Urethritis, proctitis, oral lesions

Question 14

What is the CFR?

Answer 14

0-11% globally

Clade 1 higher CFR than II

Question 15

What was the status of MPOX as of May 2023?

Answer 15

PHEIC stood down; decline in cases worldwide, but ongoing transmission in some countries

MPOX is no longer a CDINS in Australia.

Question 16

What prevention activities are available for mpox?

Answer 16

• Education - target high-risk groups
• Partnerships with SH clinics, s100 prescribing GPs,
• Local community engagement - LGBTQIA+, PLHIV, SOPVs, sex workers
• Safe sex and hand hygiene
• Smart Traveller advice
• Active case finding during times of sustained local transmission
• Vaccination - JYNNEOS / ACAM2000; as PEP of PPV (primary preventive vaccination)

Question 17

What vaccination is available for high-risk individuals for MPOX?

Answer 17

JYNNEOS (highly attenuated vaccinia vaccine) - 2 doses, 28 days apart
ACAM2000 - other smallpox vaccine; difficult to deliver (intradermal); rare but serious adverse events

It requires 2 doses 28 days apart and is available for GBMSM at increased risk of MPOX.

Question 18

What are the recommended prevention strategies for MPOX?

Answer 18

• Condom use
• Limiting sexual contact after returning from overseas
• Educational material for priority groups

Engagement with local organizations is also emphasized.

Question 19

What actions should be taken if someone is a confirmed case of MPOX?

Answer 19

Case interview - DRSVECTA - sx, exposure hx, vaccination, contacts
T- clinician; TPOXX if severe; clearance by clinician
I- do not visit high-risk settings (healthcare, childcare); sleep in separate room; no sharing of linen, crockery, bedding
E - condom use 12 weeks post clearance

Restrictions include avoiding high-risk settings and contact with others.

Question 20

What should high-risk contacts of MPOX do?

Answer 20

T - Post-exposure prophylaxis (PEP) with JYNNEOS within 4 days
I - restrictions for 21 days (close contact, sex, high-risk settings, avoid vulnerable people, WFH where possible
M - active monitoring
E - sx, transmission, seek help / test

This includes avoiding close contact and high-risk settings.

Question 21

What precautions are recommended in hospital settings for MPOX?

Answer 21

Contact and droplet precautions.
ICEG guidance

ICEG = infection prevention and control expert group

Question 22

What other actions should be taken at SOPVs?

Answer 22

• Cleaning / disinfection
• Notify patrons
• Increase community comms (engagement with orgs)

Question 23

True or False: MPOX has emerged as the most significant orthopox virus for public health since the eradication of smallpox in 1980.

Answer 23

True

This highlights the public health importance of MPOX.