What is monkeypox? Information from Victorian Department of Health

Key messages

  • Monkeypox is a rare disease that is caused by infection with the monkeypox virus.
  • There have been several cases of monkeypox reported internationally and local transmission has occurred among these cases.
  • The spread of monkeypox typically requires prolonged face-to-face contact. It may spread from person-to-person through skin-to skin contact, contact with infected surfaces or items, and respiratory transmission.
  • There is currently one case of monkeypox identified in Victoria, a man in his 30s who recently returned from the United Kingdom and is isolating away from the community.
  • The case was infectious while travelling on the following flights: 
    • flight EY10 which departed London on 14 May and landed in Abu Dhabi at 0615 
    • flight EY462 which departed Abu Dhabi on 15 May and landed in Melbourne at 0545 on 16 May.
  • As a precaution, anyone who travelled on these flights is being urged to monitor for symptoms. Anyone developing symptoms should seek medical care, wearing a mask and calling ahead to make sure they can be isolated away from others.
  • Clinicians should consider testing for monkeypox in returned travellers with compatible symptoms.

What is the issue?

Monkeypox is endemic in Central and West Africa. When cases are detected outside Africa they are usually identified in returned travellers who visited endemic areas.

A recent increase in monkeypox cases have been reported in multiple overseas countries. Local person-to-person transmission is suspected to have occurred among international cases via direct intimate contact with other people who are infected with monkeypox.

This disease is usually self-limiting with symptoms resolving within a few weeks. However, severe illness can develop in a small percentage of people confirmed with monkeypox. 

Children unvaccinated against smallpox are at higher risk of severe disease and death.

Who is at risk?

In endemic countries monkeypox is spread via interaction with animals (typically rodents) or consumption of wild game. 

Monkeypox cases seen outside of endemic countries is typically due to international travel. Local community transmission is however suspected to have occurred among the recent international cases. Those who are at increased risk have had direct and often intimate contact with someone with monkeypox.

Symptoms and transmission

The first symptoms of monkeypox are usually fever, chills ,muscle aches, backache, swollen lymph nodes, chills, and exhaustion.

After a few days, the characteristic blistering rash usually appears in the mouth, and on the face and then spreads to other parts of the body. It may also appear on the palms of hands and soles of the feet, inside the mouth, or on the genitalia. The number of lessons varies from a few to several thousands. The rash changes and goes through different stages, like chickenpox, before finally becoming a scab that falls off.

The symptoms usually resolve by themselves within a few weeks. 

Person-to-person transmission of monkeypox occurs with very close contact with infected people (such as skin-to skin contact during intimate or sexual contact) and can also spread through respiratory droplets and contact with ‘fomites’ or infected surfaces (such as contaminated clothing, towels or furniture). 

The incubation period typically varies from 6 – 13 days from exposure but may be up to 21 days.  

People with monkeypox are contagious from the time that they develop their first symptoms (which is usually fever, but occasionally starts with a rash) and until rash lesions crust, dry or fall off. 

Recommendations

For the public

Anyone who develops symptoms, particularly if they have recently travelled overseas or had contact with a case, is being urged to seek medical care, wearing a mask and calling ahead to make sure they can isolate away from others.  

As a precaution, passengers on the same flight as the infected case are also being urged to monitor for symptoms and to isolate if symptoms develop: 

  • flight EY10 which departed London on 14 May and landed in Abu Dhabi at 0615 
  • flight EY462 which departed Abu Dhabi on 15 May and landed in Melbourne at 0545 on 16 May.

The Department of Health is contacting those seated in the closest vicinity of the case.

Avoid close contact with people who have suspected or confirmed monkeypox infection.

People travelling to endemic countries in central and west Africa should avoid contact with sick animals (dead or alive) that could harbour monkeypox virus (rodents, marsupials, primates) and should refrain from eating or handling wild game (bush meat). 

Staying vigilant with hygiene measures including washing hands with soap and water or alcohol- based sanitiser is important. 

For health professionals

Clinicians should be aware of compatible clinical presentation in travellers returning from an endemic area or affected countries. Information on recent travel history, contacts and immunisation should be elicited. 

Clinicians should consider the possibility of monkeypox as well as alternative diagnoses such as measles, varicella zoster, Herpes Simplex and Varicella Zoster Virus infections, and syphilis.

Any patient with suspected monkeypox should seek medical care wearing a mask and be isolated from others.   

Notify any suspect cases to the Department of Health by calling 1300 651 160.

Timely contact tracing and surveillance measures are essential to prevent secondary cases. Vaccination may be offered to close contacts within 4 days of exposure. 

Healthcare workers caring for suspected or confirmed monkeypox patients should implement both standard contact and airborne precautions. 

Collection of specimens should be discussed with the on-call medical microbiologist at the Victorian Infectious Diseases Reference Laboratory (VIDRL) by calling 9342 8000 and asking to be put through to the VIDRL on-call laboratory manager. Sampling procedures may vary depending on the phase of the rash, and specific packaging and transport of samples are required.