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4 Aug 2022

Australia moving slowly forward with Monkeypox vaccine

The Australian Technical Advisory Group on Immunisation (ATAGI) has recommended monkeypox vaccines for key risk groups, including gay, bisexual and men who have sex with men who are at high risk of exposure.

Several months after community transmission of Monkeypox in non-endemic countries was established, the World Health Organisation has declared that the continuing spread of Monkeypox is now a public health emergency of international concern.
From a World Health Organisation perspective, that’s as serious as things get. It’s a big deal. The last time that the WHO declared a public health emergency of international concern – a PHEIC – was for the outbreak of Covid-19.
A PHEIC is defined by WHO as a public health risk that potentially requires a coordinated international response.
Based on the WHO’s current assessment, the risk globally is assessed as “moderate” while in Europe that risk is “high”.
The current data from WHO indicates over 16K confirmed monkeypox cases, spread across 75 countries. There have been five deaths recorded in connection to this current outbreak. Currently, most cases are in Europe.
As we have seen from the beginning of this outbreak, the WHO has confirmed that the majority of cases continues to be detected within men who have sex with men. Monkeypox is not a Sexually Transmitted Infection but it is spread by close or intimate contact and sex is a really effective way for Monkeypox to spread. There’s nothing about Monkeypox that limits it to men who have sex with men, it’s just that we’re the demographic that it’s made initial contact with.
The general consensus is that health agencies in countries such as the UK – which is pretty much the epicentre of this outbreak – has been slow. It now seems to be accepted that a vaccination programme is going to be the most effective way to navigate this outbreak. Availability of vaccines has been limited but is now ramping up.
Stay in touch with your local sexual health service and get vaccinated when a vaccine is available to you.
What is Monkeypox?
The name “monkeypox” comes from the first documented cases of the illness, in 1958, when two outbreaks occurred in colonies of monkeys kept for research.
But monkeys aren’t major carriers. Instead, the virus is generally spread by squirrels, pouched rats, dormice or another rodent.
How do you catch Monkeypox?
Primarily, from an animal bite, scratch or contact with the animal’s bodily fluid. Then the virus can spread to other people through coughing and sneezing or contact with pus from the lesions.
Symptoms are likely to appear somewhere between 5-21 days after exposure to the virus.
The lesions from monkeypox are similar to those from a smallpox infection.
It’s previously been thought that transmission of Monkeypox between people was a very low risk but this current outbreak appears to be spreading very effectively between people.
Health experts are speculating that the end of vaccination programs against Smallpox has left us vulnerable to a Monkeypox outbreak.
How dangerous is Monkeypox?
Monkeypox can be a nasty illness – it causes fever, body aches, enlarged lymph nodes and, eventually, painful, fluid-filled blisters on the face, hands and feet. One version of monkeypox is quite deadly and kills up to 10% of people infected. The version currently being detected from this cluster is milder. Its fatality rate is less than 1%. A case generally resolves in two to four weeks.
If you have it, you’ll probably need to isolate at home until you’ve recovered.
What should I do if I think I might have been exposed to Monkeypox?
If you notice any unusual rashes or lesions, and you think you might have been exposed to the virus through sexual contact, then contact your local sexual health service for advice.

The Australian Technical Advisory Group on Immunisation (ATAGI) has recommended monkeypox vaccines for key risk groups, including gay, bisexual and men who have sex with men who are at high risk of exposure.

ATAGI also updated its earlier guideline and in addition to the ACAM2000 vaccine, it has recommended the use of JYNNEOS (MVA-BN) vaccines for monkeypox.

Following the update to the vaccination guidelines, Australia’s chief medical officer Professor Paul Kelly on Thursday declared monkeypox as a “Communicable Disease Incident of National Significance”. 

Although endemic in Central and West Africa, we are currently experiencing transmission of the virus around the world - over 20,000 cases have been confirmed in over 70 countries.

In Australia, the numbers of confirmed cases remain small - just over 40, most of whom are returned international travellers.

The majority of cases continue to be detected within men who have sex with men. Monkeypox is not a Sexually Transmitted Infection but it is spread by close or intimate contact and sex is a really effective way for Monkeypox to spread. There’s nothing about Monkeypox that limits it to men who have sex with men, it’s just that we’re the demographic that it’s made initial contact with.

ATAGI has identified five key risk groups for whom monkeypox vaccines are recommended including, gay, bisexual and men who have sex with men (GBMSM) “who are at the highest risk of monkeypox infection due to having a high number of sexual contacts”.

GBMSM who are living with HIV, have a recent history of multiple sexual partners, participating in group sex or attending sex on premises venues, or are on PrEP are eligible to receive the monkeypox vaccine. 

“Wider vaccination of low-risk gay, bisexual and men who have sex with men or the general population is not recommended at this time, due to the current epidemiology, low risk of infection and limited vaccine supply,” ATAGI said. 

The other key risk groups include sex workers, anyone categorised as a high risk monkeypox contact and immunisation providers. ATAGI has also recommended that those in the key risk groups planning to travel to a country which is experiencing “significant outbreak” should get vaccinated four to six weeks before departure. 

For those who have received a smallpox vaccine more than a decade ago, a booster is recommended.

What is Monkeypox?

The name “monkeypox” comes from the first documented cases of the illness, in 1958, when two outbreaks occurred in colonies of monkeys kept for research.

But monkeys aren’t major carriers. Instead, the virus is generally spread by squirrels, pouched rats, dormice or another rodent.

How do you catch Monkeypox?

Primarily, from an animal bite, scratch or contact with the animal’s bodily fluid. Then the virus can spread to other people through coughing and sneezing or contact with pus from the lesions.

Symptoms are likely to appear somewhere between 5-21 days after exposure to the virus.

The lesions from monkeypox are similar to those from a smallpox infection.

It’s previously been thought that transmission of Monkeypox between people was a very low risk but this current outbreak appears to be spreading very effectively between people.

Health experts are speculating that the end of vaccination programs against Smallpox has left us vulnerable to a Monkeypox outbreak.

How dangerous is Monkeypox?

Monkeypox can be a nasty illness – it causes fever, body aches, enlarged lymph nodes and, eventually, painful, fluid-filled blisters on the face, hands and feet. One version of monkeypox is quite deadly and kills up to 10% of people infected. The version currently being detected from this cluster is milder. Its fatality rate is less than 1%. A case generally resolves in two to four weeks.

If you have it, you’ll probably need to isolate at home until you’ve recovered.

What should I do if I think I might have been exposed to Monkeypox?

If you notice any unusual rashes or lesions, and you think you might have been exposed to the virus through sexual contact, then contact your local sexual health service for advice.

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