Mpox cases increasing on the Gold Coast

Mpox (previously called monkeypox) is an infection caused by a virus belonging to the same family as smallpox viruses.

Mpox has historically occurred mainly in Central and West Africa, but since May 2022, there has been an increase in mpox infections in many parts of the world where the illness has not previously been seen. Local transmission of mpox Clade IIb has occurred in Queensland and interstate. Mpox is mainly spread through very close or intimate contact with someone infected with mpox¹.

Mpox on the Gold Coast

Mpox cases have been increasing in the Gold Coast area. There have been 14 confirmed cases in the preceding month which have been largely unrelated and likely acquired locally, hence it is expected that cases will continue to rise. All cases to date in Queensland have been among gay, bisexual men and other men who have sex with men.

Prevention

Clinicians should identify patients that are eligible for preventative vaccination. In Queensland, mpox vaccination is free (a Medicare card is not required) and recommended for the following groups¹:

• all sexually active gay, bisexual and other men who have sex with men (cis and trans) and their sexual partners (including anonymous or intimate contacts)
• sex workers
• people living with HIV who are at risk of exposure to mpox
• people whose occupations might put them at increased risk, including, but not limited to:
  • sex-on-premises venue staff
  • laboratory staff who analyse mpox specimens, based on a local risk assessment
  • healthcare workers at higher risk of exposure to individuals with mpox, including workers in primary care, sexual health clinics, hospital staff and others, based on a local risk assessment. The risk of transmission should also be minimised by using appropriate infection control measures.

Mpox vaccination is not recommended as a routine travel vaccine, including for travel to endemic Africa where clade Ib is circulating, unless an individual has current eligibility for an mpox vaccination in Queensland. Travelers should be aware of the risk of mpox if travelling overseas where cases have been reported.

Currently, JYNNEOS® is the preferred mpox vaccine for use in Australia based on its safety profile and easy administration use. Two doses of the vaccine, given subcutaneously at least 28 days apart are required for best protection against mpox. Jynneos is currently provided as under s19A of the TGA Act. Queensland Health mpox vaccine provider finder² can be found here and high risk patients should be encouraged to make an appointment for immunisation.

If your service would like to register to be a mpox vaccine provider please contact QHIP-ADMIN@health.qld.gov.au.

For further information:
HealthPathways: Mpox (formerly Monkeypox)

Notification

Clinicians should have a high index of suspicion for mpox especially in high-risk populations e.g. gay, bisexual men and other men who have sex with men and notify their local Public Health Unit (PHU) on clinical suspicion while facilitating appropriate testing³.

Clinical Features

• Mpox usually has a prodrome of lymphadenopathy, fevers, headaches, myalgia, arthralgia, back pain or sore throat lasting 1-5 days.
• Followed by a skin eruption phase that can last weeks: typically a maculopapular rash which progresses to papules, vesicles and pustules. Skin lesions may be generalised or confined to the anogenital region and typically crust over within 14-21 days³.
• Proctitis can also feature.

Testing

Can be done by collecting a sterile dry swab (e.g. nylon, polyester or Dacron)⁴.

• Of the base of skin lesions, ensure cellular material from the lesion base is collected. This may require deroofing the lesion. If only a macular rash is present, a nasopharyngeal or throat swab is appropriate.
• For patients presenting with proctitis, swab the anorectal mucosa, avoiding excess faeces contamination.
• Nasopharyngeal and throat swabs are also suitable specimens, particularly early in the disease.

It is recommended at least two swabs from morphologically distinct lesions and/or anatomical locations are collected. Ensure swabs sites are clearly labelled.

Appropriate personal protective equipment (PPE) should be worn during specimen collection as detailed below with specimen containers wiped down using a suitable detergent before being placed into pathology bag.

Personal Protective Equipment (PPE)⁵

Standard, contact and droplet precautions are considered the minimum level of PPE when caring for a person with suspected, probable, and confirmed monkeypox. This includes:

• Fluid repellent surgical mask
• Gloves
• Disposable fluid resistant gown
• Eye protection – face shields or goggles

Consider the use of dedicated patient equipment, or single use equipment, to limit disease spread associated with reuse of shared patient equipment.

Post consultation with a person with suspected, probable, or confirmed monkeypox, hand hygiene, high touch surfaces, used equipment and linen should be managed according to detailed advice outlined here: https://www.health.gov.au/sites/default/files/2022-12/iceg-interim-guidance-on-monkeypox-for-health-workers.pdf

References:

1. Queensland Health. Mpox (previously known as monkeypox) Fact Sheet. Updated 16 July 2024. Accessed 6 September 2024. Available from: https://www.qld.gov.au/health/condition/infections-and-parasites/viral-infections/mpox-monkeypox
2. Queensland Health. Mpox (monkeypox) vaccination centres. Queensland government. Updated August 7, 2024. Accessed September 5, 2024. Available from: https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/immunisation/monkeypox-vaccination-centres
3. Communicable Diseases Network Australia. Mpox CDNA Series of national guidelines. Australian Government Department of Aged Care. Updated December 20, 2022. Accessed August 28, 2024. Available from: https://www.health.gov.au/sites/default/files/2022-12/monkeypox-virus-infection-cdna-national-guidelines-for-public-health-units.pdf
4. Public Health Laboratory Netw Mpox (monkeypox virus infection) laboratory case definition. Updated July 17, 2023. Accessed August 28, 2024. Available from: https://www.health.gov.au/sites/default/files/2023-07/monkeypox-laboratory-case-definition.pdf

Australian Government Department of Health and Aged Care. Infection Prevention and Control Expert Group – Interim guidance on monkeypox for health workers. Updated 24 October 2022. Accessed 6 September 2024. Available from: Infection Prevention and Control Expert Group – Interim guidance on monkeypox for health workers