Mpox declared a global emergency

Mpox transmission is increasing in NSW

On 9 September 2024, a NSW Health distributed a new Mpox alert to notify GPs and clinicians that mpox cases are continuing to increase with 236 cases notified in NSW since mid-June 2024, and 13 hospitalisations. All cases are male, and almost all are men who have sex with men (MSM).

There have been no hospitalisations in people who have received two vaccinations.

Key messages:

• Test all sexually active people with symptoms, regardless of vaccination status, sexual orientation or travel history.
• If mpox is suspected in a returned traveller from Africa, call the PHU immediately on 1300 066 055.
• Refer all eligible patients to receive mpox vaccination at a participating clinic. A Medicare card is not required.
• Ensure eligible patients receive two doses of mpox vaccine administered at least 28 days apart, as per ATAGI advice.
• People travelling to areas where mpox cases are circulating, including endemic Africa, are currently not eligible to receive the mpox vaccine.

Australian health authorities are monitoring the evolving epidemiology of mpox after the World Health Organization (WHO) declared mpox a global emergency. The Department of Health and Aged Care has updated its mpox webpage to reflect this.

ATAGI interim statement published July 2024 advises:

• those who received their first dose of mpox vaccine more than 28 days ago to have their second dose as soon as possible, to maximise protection. 
• booster doses of mpox vaccine are not recommended for people who are already fully vaccinated with a 2-dose course, including those with severe immunocompromise.  

Mpox vaccine eligibility criteria

The JYNNEOS vaccine is free in NSW for eligible groups of people. Two doses are required. A Medicare card is not needed. See eligibility criteria to be vaccinated against mpox in NSW. People travelling are currently not eligible to receive the mpox vaccine.

Mpox vaccination clinics

The JYNNEOS vaccine is only available at participating clinics in NSW. Mpox vaccine is not available to general practices or pharmacies. List of mpox vaccination clinics in CESPHN:

• RPA Sexual Health Clinic, Camperdown
• Kirkton Road Centre, Darlinghurst
• Short Street Sexual Health Clinic, Kogarah
• The Albion Centre – Surry Hills
• Sydney Sexual Health Clinic, Sydney CBD
• RPA HealthOne Green Square, Zetland

An Mpox alert was distributed to general practitioners on 2 August 2024, please review the alert and be mindful of Mpox presentations.

Mpox can mimic other infections (e.g. genital herpes or syphilis) and symptoms can be subtle, particularly in people who are fully or partially vaccinated.

• Presentations can vary: 1-2 lesions at a single site, disseminated lesions, proctitis without lesions
• When present, lesions are usually on the anogenital or oral skin or mucosa, but can occur anywhere
• Only some cases have a prodrome (fever, malaise, myalgia, and/or lymphadenopathy)

Test all men who have sex with men (MSM) with compatible symptoms, regardless of vaccination status, travel history, or past history of mpox. This includes proctitis without visible lesions. If mpox is considered the most likely diagnosis, notify the public health unit (PHU) by telephone as soon as practicable – 1300 066 055.

Encourage vaccination in all gay, bisexual, and other MSM, their sexual partners and sex workers.

Further information

• See previous CESPHN Mpox alert here
• See previous NSW Health alerts here
• Clinical advice on any aspect of mpox testing, management or vaccination, visit the relevant HealthPathway depending on the region in which the patient lives:
  • South Eastern Sydney HealthPathway
  • Sydney HealthPathway