Australians heading to Sydney WorldPride who are eligible for mpox (previously monkeypox) vaccination are being encouraged to roll up their sleeves and get a jab ahead of the global LGBTIQ+ festival later this month.
More than 500,000 people, including thousands of international visitors, are expected to celebrate the 17-day event in Sydney, which includes the annual Sydney Gay and Lesbian Mardi Gras.
Globally, mpox cases have declined steeply since they peaked in August 2022, including in Australia, where no new cases have been recorded this year.
But ongoing, low-level transmission in other non-endemic countries has prompted health authorities to recommend festival attendees at risk of infection protect themselves by getting vaccinated.
"Over the last couple of months, we've seen an average of 50 cases a day globally, mainly in the US and South America," said Vincent Cornelisse, a sexual health physician and senior lecturer at the Kirby Institute.
"It's quite likely we'll see visitors from both of these places come to WorldPride, and there's a real possibility a few of these people might have undiagnosed mpox infections."
Mpox can affect anyone, but more than 95 per cent of cases in the recent global outbreak have been among gay and bisexual men, and other men who have sex with men.
Dr Cornelisse said it was unlikely Australia would see a large outbreak of mpox, but that it made sense for people to take precautions because of "how uncomfortable" an infection could be, as well as the potential for more serious complications.
In January, writing in an opinion piece in the Star Observer, federal Health Minister Mark Butler also urged eligible Australians — especially those from rural and regional areas — to make a vaccine appointment as soon as possible.
"We know uptake in country areas for the vaccines lags behind our big cities — and that many people living in rural and regional areas will travel to Sydney to celebrate WorldPride," Mr Butler wrote.
"So, I particularly encourage anyone in a country area who will be attending WorldPride and is not yet vaccinated to act now."
Mpox sexually transmitted in recent outbreak
Symptoms of mpox include a distinctive rash or skin lesions (bumps that turn into pimples, blisters or sores, and that may burst to form ulcers or scabs) as well as fever, headache, fatigue and swollen lymph nodes.
The virus spreads through close physical contact, including direct contact with body fluids or skin lesions.
In the past, mpox hasn't been considered a sexually transmitted infection (STI), but recent epidemiological data suggests sexual encounters are largely driving transmission.
"During this outbreak, mpox is sexually transmitted, particularly through close skin-to-skin contact," said Dr Cornelisse.
"There's possibly also a role for transmission through semen."
Transmission can also occur through contaminated clothing or bedding, and less commonly, through respiratory droplets during prolonged face-to-face contact.
While mpox illness is usually mild and most people recover within a few weeks, the virus can cause severe disease, particularly among people who are immunocompromised.
In Australia, vaccination is recommended for sexually active gay and bisexual men and other men who have sex with men, as well as sexual partners of these men, and sex workers.
There are two vaccines available that are effective against mpox. The preferred vaccine is given as two doses, 28 days apart, and is most effective two weeks after the second dose.
But with WorldPride just days away, Dr Cornelisse said even one dose will offer "a pretty decent amount of protection".
"There's also probably a lot of people who may have had their first dose several months ago who can still go and get their second dose. It doesn't matter if you're late."
While the best time for people to receive a vaccine is before they are exposed, vaccines can also be given after mpox exposure (ideally within four days) to reduce the risk of disease.
Vaccine willingness high but mpox concern has waned
So far, more than 50,000 mpox vaccine doses have been administered in Australia.
Social and behavioural scientist James MacGibbon, who recently undertook research with Dr Cornelisse to better understand Australians' attitudes and behaviours regarding mpox, said there was generally a good level of awareness among people at increased risk and that most appeared willing to get vaccinated.
"Among gay, bisexual and other men who have sex with men, there is a very high willingness to receive a vaccine," said Dr MacGibbon from UNSW's Centre for Social Research in Health.
However, the research also found people less concerned about mpox were less likely willing to receive a vaccine, he said.
"I think that's important to have in mind now because case numbers globally are a lot lower than they were last year, so some people may not perceive themselves to be at any risk, but [lower case numbers] doesn't mean there are low levels of mpox circulating."
At sexual health clinics in Sydney, concern about mpox has wavered in recent months, Dr Cornelisse said.
"It's entirely understandable given that we haven't seen any new cases in Australia since November, but as I always remind people … it hasn't gone away globally."
Prioritising safe sex at WorldPride
In addition to taking precautions around mpox, WorldPride attendees are also being encouraged to prioritise safe sex more generally, with STIs on the rise in NSW, including antimicrobial-resistant gonorrhoea and syphilis.
"Sexual health services in Sydney are fully prepared for an increased demand for services during WorldPride, and we're expecting that we'll probably see more gonorrhoea and more syphilis during that time," Dr Cornelisse said.
For that reason, it's important that people who take HIV prevention medication — commonly known as PrEP — ensure they have adequate supplies ahead of the festival, he said.
Dr Cornelisse added that COVID-19 had changed the way many people have sex — "in terms of the number of sexual partners they might have for fear of COVID exposure" — which had, in turn, changed the way people look after their sexual health.
"We know many people who were using PrEP prior to COVID stopped using it during COVID, and the worry is that some of those people may not have returned to using PrEP, and are now entering a few months of fun and frivolity where they may be exposed to HIV," he said.
"I would strongly encourage anyone who thinks they might have casual sexual contact during WorldPride to think about going either back onto PrEP or to start PrEP to ensure their HIV risk is managed appropriately."
Matthew Vaughan, director of HIV and sexual health at peak LGBTIQ+ body ACON, said it was also a good idea for people to get a sexual health check — usually provided for free at sexual health clinics — ahead of World Pride.
"That means if you've picked up any STIs unknowingly, you can get that detected and treated," he said.
He also urged festival attendees to be up to date with their COVID-19 vaccines, and to keep an eye on themselves — including monitoring for any symptoms of mpox or COVID — and the people around them.
"One of the great things about our community is the way we come together through moments like this — that great Australian sense of mateship, of looking out for one another.
"If you see someone that's not having a good time, make sure you take care of them and get help if needed."
