Disease control efforts can draw on lessons from the past and prevent the epidemic from becoming established in Australia
Monkeypox belongs to the genus Orthopoxvirus and is related to variola, the virus that causes smallpox. As such, smallpox vaccines also prevent monkeypox. It has an incubation period of 5–21 days and transmits while symptomatic. It remains infectious until the skin lesions have scabbed and healed (2–3 weeks). It is a zoonotic infection with occasional human to human transmission in close contacts.1 In West Africa, most cases have been in children. Before this outbreak, the clinical presentation has been described as including fever, malaise, and lymph adenopathy, with the rash appearing first inside the mouth. A rash on the face and lymphadenopathy occur in most cases, followed by a rash on the palms and soles, and body and genital rash in 30% of cases. Monkeypox is usually a self‐limited disease with the symptoms lasting from 2 to 4 weeks. However, complications can occur — particularly in children and in immunodeficient individuals — including eye infection, blindness, skin infection, sepsis, encephalitis and pneumonia. In Africa, the West African clade has a case fatality rate of 3.6% compared with 10.6% for the Congo basin clade.2
- 1. Fine PEM, Jezek Z, Grab B, Dixon H. The transmission potential of monkeypox virus in human populations. Int J Epidemiol 1988; 17: 643‐650.
- 2. Bunge EM, Hoet B, Chen L, et al. The changing epidemiology of human monkeypox — a potential threat? A systematic review. PLoS Negl Trop Dis 2022; 16: e0010141.
- 3. Vaughan A, Aarons E, Astbury J, et al. Two cases of monkeypox imported to the United Kingdom, September 2018. Euro Surveill 2018; 23: 1800509.
- 4. Nguyen PY, Ajisegiri WS, Costantino V, et al. Reemergence of human monkeypox and declining population immunity in the context of urbanization, Nigeria, 2017–2020. Emerg Infect Dis 2021; 27: 1007‐1014.
- 5. Kennedy RB, Lane JM, Henderson DA, Poland GA. Smallpox and vaccinia. In: Orenstein W, Offit P, Edwards KM, Plotkin S; editors. Plotkin’s vaccines; 7th ed. United Kingdom: Elsevier, 2017.
- 6. MacIntyre CR, Costantino V, Chen X, et al. Influence of population immunosuppression and past vaccination on smallpox reemergence. Emerg Infect Dis 2018; 24: 646‐653.
- 7. Costantino V, Trent MJ, Sullivan JS, et al. Serological immunity to smallpox in New South Wales, Australia. Viruses 2020; 12: 554.
- 8. Monkeypox tracker: HealthMap, 2022. https://monkeypox.healthmap.org/ (viewed June 2022).
- 9. Perez Duque M, Ribeiro S, Martins JV, et al. Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022. Euro Surveill 2020; 27: 2200424.
- 10. World Health Organization. WHO monkeypox research: what are the knowledge gaps and priority research questions? [webinar]. 2–3 June 2022. https://www.who.int/news‐room/events/detail/2022/06/02/default‐calendar/who‐monkeypox‐research‐‐what‐are‐the‐knowledge‐gaps‐and‐priority‐research‐questions (viewed June 2022).
- 11. Mauldin MR, McCollum AM, Nakazawa YJ, et al. Exportation of monkeypox virus from the African continent. J Infect Dis 2022; 225: 1367‐1376.
- 12. Isidro J, Borges V, Pinto M, et al. Multi‐country outbreak of monkeypox virus: genetic divergence and first signs of microevolution [website]. Virological.org, 2022. https://virological.org/t/multi‐country‐outbreak‐of‐monkeypox‐virus‐genetic‐divergence‐and‐first‐signs‐of‐microevolution/806 (viewed June 2022).
- 13. Yu J, Raj SM. Efficacy of three key antiviral drugs used to treat orthopoxvirus infections: a systematic review. Global Biosecurity 2019; http://doi.org/10.31646/gbio.12.
- 14. Centers for Disease Control and Prevention. Monkeypox and smallpox vaccine guidance. Atlanta, GA: CDC, 2022. https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox‐vaccine.html (viewed June 2022).
- 15. Mohanty B, Costantino V, Narain J, et al. Modelling the impact of a smallpox attack in India and influence of disease control measures. BMJ Open 2020; 10: e038480.
- 16. Eckart RE, Love SS, Atwood JE, et al. Incidence and follow‐up of inflammatory cardiac complications after smallpox vaccination. J Am Coll Cardiol 2004; 44: 201‐205.
- 17. Rao AK, Petersen BW, Whitehill F, et al. Use of JYNNEOS (smallpox and monkeypox vaccine, live, nonreplicating) for preexposure vaccination of persons at risk for occupational exposure to orthopoxviruses: recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR Morb Mortal Wkly Rep 2022; 71: 734‐742.
- 18. Lessard BD, Kurucz N, Rodriguez J, et al. Detection of the Japanese encephalitis vector mosquito Culex tritaeniorhynchus in Australia using molecular diagnostics and morphology. Parasit Vectors 2021; 14: 411.
- 19. Australian Government Department of Health. Monkeypox (MPX). https://www.health.gov.au/health‐alerts/monkeypox‐mpx/about (viewed June 2022).
- 20. Grulich AE, Guy R, Amin J, et al; Expanded PrEP Implementation in Communities New South Wales (EPIC‐NSW) research group. Population‐level effectiveness of rapid, targeted, high‐coverage roll‐out of HIV pre‐exposure prophylaxis in men who have sex with men: the EPIC‐NSW prospective cohort study. Lancet HIV 2018; 5: e629‐e637.
- 21. Kupferschmidt K. Monkeypox vaccination plans take shape amid questions. Science 2022; 376: 1142‐1143.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.