The World Health Organization (WHO) has declared monkeypox a global public health emergency.
Such a designation – the highest level of global alert – currently also applies to Covid-19 and polio.
In Australia, more than 40 cases of monkeypox have been identified. The country’s chief medical officer, Prof Paul Kelly, in late July declared it a “communicable disease incident of national significance” which means coordinated resources – including medicines, and public health campaigns – are needed to tackle it.
Europe remains the epicentre of the outbreak.
So should Australians be worried?
What are the symptoms of monkeypox?
The monkeypox virus leads to flu-like symptoms including fever, headaches, body aches and chills. It also causes a rash that may look like pimples, blisters, lesions or sores.
The rash usually occurs on the face before spreading to other parts of the body, including the palms of the hands and the soles of the feet. However, in this outbreak, it is being seen especially on the genital and perianal regions of affected people, Prof Kelly, said. People might only develop a couple of sores.
Most cases of monkeypox in Australia have been among people aged 21 to 40 years. “The experience internationally and in Australia to date is most cases have been among gay, bisexual and other men who have sex with men,” Kelly said.
Condoms are not effective at preventing the transmission of monkeypox.
“Although monkeypox is not usually considered a sexually transmissible infection, physical contact with an infected person during sexual intercourse carries a significant risk of transmission. Intimate physical contact such as hugging, kissing and sexual activities represent a risk of infection, with infectious skin sores being the likely mode of transmission,” the chief medical officer said.
It’s important to note that the risk of monkeypox is not limited to men who have sex with men. Anyone who has close contact with someone who is infectious is at risk.
Kelly said: “It is far less harmful than Covid-19 and there have been no deaths reported during the current outbreak outside of countries where the virus is endemic.” Monkeypox is also “far less transmissible” than Covid, he said.
Is there a monkeypox vaccine?
Yes. Information about the vaccines available in Australia, and who is recommended to receive them, can be found here. Currently, only close contacts of cases and those at high risk of infection, as well as some health workers, are recommended for vaccination.
How concerned should Australia be?
According to Peter Collignon, professor of infectious disease at the Australian National University, while monkeypox is “not highly transmissible from person to person” there needs to be a public awareness campaign, especially targeting at-risk groups such as men who have sex with men, as most cases have been identified in this group.
“It’s obviously spreading,” he said. “If you look at the numbers, it’s not exploding like a respiratory virus, so this is very different to Covid and contact tracing is easier. But we will see more numbers and that’s why we need to diagnose the cases quickly.”
When was monkeypox first identified?
The first case of monkeypox anywhere was recorded in 1970 in the Democratic Republic of the Congo in central Africa, during intense efforts to find and eliminate smallpox.
When the virus appears outside Africa, it is because someone travelled to an endemic region, became infected and returned home. But it is increasingly being found in cases who had not travelled overseas before being diagnosed, which means local transmission is occurring.
Rising transmission flagged
There are two strains of monkeypox: a Central African strain with a fatality rate of 10.6%, and a West African strain with a much lower mortality rate of between 1% and 3.6%. The latter is the strain that is spreading including in the UK and Australia.
But there have been warnings in the past that countries outside Africa have become too complacent about the virus due to its rarity. A study published in the journal PLOS Neglected Tropical Diseases in February found monkeypox cases, though rare, are rising.
The study authors reviewed monkeypox data from many countries and studies, and found “an escalation of monkeypox cases, especially in the highly endemic DRC, a spread to other countries, and a growing median age from young children to young adults”.
“These findings may be related to the cessation of smallpox vaccination, which provided some cross-protection against monkeypox, leading to increased human-to-human transmission,” the study found.
“The appearance of outbreaks beyond Africa highlights the global relevance of the disease.”
The authors urged increased worldwide surveillance and detection of monkeypox cases to understand its changing epidemiology, and described it as a “resurging disease”.
