Monkeypox (MPX)

Last updated: 29 September 2022

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About Monkeypox (MPX)

Monkeypox (MPX) is a viral disease that can be transmitted by close contact with skin lesions, body fluids, respiratory droplets and contaminated materials. MPX is zoonotic, which means it can pass between animals and humans. 

MPX was first identified in humans in 1970 in the Democratic Republic of the Congo and has been endemic in Western and Central Africa for many years. 

A global MPX outbreak commenced in May 2022. Cases have now been reported in more than 80 countries.

MPX in New Zealand

The number of MPX cases detected in New Zealand is updated weekly each Thursday.

No new MPX cases in New Zealand – there remain 9 confirmed cases.

  • There are no new cases as at 10.45am 28 September 2022 since the 9* cases notified in the 22 September update.
  • All 9 confirmed cases were overseas during the incubation period, meaning infections were likely acquired overseas.
  • There is no evidence of community transmissionm and public health staff have assessed the risk of transmission from these cases as low.

* The ninth case, while reported in the media update of the 22 September 2022, is being formally recorded in this current week. The week is counted as cases reported from 10.46am Wednesday to 10.45am Wednesday, and the ninth case was notified following 10.45 Wednesday 21 September 2022.

Transmission

MPX is a rare infection and the risk of it spreading widely in New Zealand remains low as it is not very contagious. There is currently no detected community transmission within New Zealand.

MPX is generally transmitted through:

  • close physical, intimate or sexual contact with someone who has MPX, via skin-to-skin contact
  • direct contact with the skin rashes, lesions, scabs or bodily fluids of someone with MPX
  • touching the clothing, bedding or towels used by someone with an MPX rash.

MPX can also be passed on through breathing in droplets that have been exhaled by someone who has the virus. As this requires prolonged contact and for people to be very close together, the risk of the virus spreading in this way is very low.

Typically, a person with MPX is infectious and can pass the virus on to others from when they first develop symptoms until their lesions or scabs crust, dry or fall off. The infectious period will normally last for around two to four weeks.

While anyone can get MPX, the current global outbreak has disproportionately impacted:

  • men who have sex with men (MSM)
  • people who have sex with MSM. This may include people of any gender or sexual identity, whether they are transgender or cisgender, and non-binary people.

There is higher risk for these communities, particularly if there are multiple or anonymous sexual partners.

Anyone who will have close physical or sexual contact while overseas, or with people who’ve recently been overseas, is advised to be mindful of MPX symptoms. This is particularly important for MSM, their sexual partners and anyone who has multiple or anonymous sexual partners.

Symptoms

Most people with MPX will develop a rash, spots or blisters on the infection site. These may spread to other parts of the body such as the palms of the hand, soles of the feet, inside the mouth, or on the genitals.

Other common symptoms can include:

  • cold and flu symptoms such as a fever, chills or swollen glands
  • headache
  • muscle and body aches
  • backache
  • tiredness

The rash associated with MPX may be generalised or localised and typically progresses through four stages:

  • Macular – flat, discoloured lesions
  • Papular – solid, raised lesions
  • Vesicular – fluid-filled lesions
  • Pustular – pus-filled lesions

Once the rash associated with MPX has progressed through these stages, the lesions typically turn to scabs that will crust, dry or fall off.

MPX symptoms usually resolve by themselves within two to four weeks.

Advice for people with MPX symptoms

If you think you may have been exposed to MPX or if you develop symptoms, especially a rash, you should stay home, self-isolate and seek medical advice. You can contact your nearest sexual health clinic, your GP, or Healthline on 0800 611 116.

If you need to visit a medical practice or hospital for care, you should call ahead before visiting to let them know you are coming and tell them about your symptoms. To avoid passing on MPX to others, wear a well-fitted medical mask, cover any rashes or blisters on your skin, and travel via private transport.

Getting tested

Tests for MPX can be carried out at a medical practice or a sexual health clinic. You cannot get an MPX test from a COVID-19 Community Testing Centre.

While the test will be free, you may be charged consultation costs or other costs related to processing the test.

The test for MPX involves a swab of any lesions on your skin and/or a throat swab. The test needs to be carried out by a medical professional and cannot be done by a patient themselves.

It normally takes around 48 hours to get a result from the test. You will be told this by the medical practice or clinic you visited. If the test shows you have MPX, a public health professional will be in touch shortly after to provide further advice.

While you’re waiting for your result it’s important to stay home, self-isolate and avoid close contact with other people, including those you live with.

What happens if you test positive for MPX

If a test shows you have MPX you’ll need to stay home and self-isolate. This will reduce the risk of you passing on the virus to others. Self-isolation means staying away from work, not having visitors in your home, and avoiding close contact with other people you live with where possible.

While you’re at home, health staff will be in contact regularly to check on you. They will also provide advice on what to expect with your symptoms, and advice about cleaning, masks and waste disposal.

You’ll also be asked to provide information on where you’ve been recently and who you’ve been in close contact with, to check whether you may have passed the virus on to others.

You can finish self-isolating once all scabs or lesions have fallen off and new skin has formed where these were. This normally happens around two-to-four weeks after catching the virus. You will need to have a final check-up by a health professional to finish isolating.

Help and support for people self-isolating

The manaaki support for whānau isolating with MPX varies across New Zealand. A health professional will update you on the support available in your location when they inform you that you have MPX.

People experiencing hardship can also apply for financial support from the Ministry of Social Development. To check if you are eligible, visit https://check.msd.govt.nz/ or call 0800 559 009 (Mon-Fri 7am–6pm; Sat 8am-1pm).

If you need mental health advice or support while isolating, free call or text 1737 anytime. There are also a range of dedicated LGBTQI support services available.

Privacy

MPX is a private health matter. If you catch MPX your private details will be kept confidential. You will not be required to tell anyone you have MPX, besides a health professional.

Health staff may need to notify the people you’ve had close contact with or the people you live with that they are at risk of developing MPX. Your employer may also need to be notified if there was a risk of you passing on the virus to others while at work, although they will be required to keep any details private. You can also request a medical note stating you have a notifiable illness and need to stay home.

Your details won’t be shared with anyone without this being discussed with you first.

If health staff cannot directly reach people you’ve had close or sexual contact with, they may need to publicise some information about at-risk locations. This won’t involve sharing any identifiable information and will only happen when absolutely necessary to alert others to the risk of getting MPX. It will also always be discussed with you first.

Treatment

MPX skin lesions can sometimes become very itchy and may cause severe pain. You can take paracetamol to help treat your symptoms (especially if you have a fever) and manage any pain. If the lesions are very itchy you can take an antihistamine such as cetirizine. Your doctor can also prescribe stronger pain relief if it is required.

People with MPX are advised to keep any lesions clean – especially those in sensitive areas – to reduce the chance of infection. You can do this by washing your skin with a soap bar and warm water. If a lesion or area becomes infected it may suddenly become red and tender, and potentially shiny, swollen and hot. You may feel very unwell if this happens.

Emergency care

Occasionally, people with MPX can become very sick. If you are feeling very unwell, have severe shortness of breath or severe pain, please call an ambulance on 111 and let them know that you have MPX. Please wear a mask when the ambulance arrives.

What to do if you are a close contact of someone with MPX

If you are identified as a close contact of a person with MPX, you will be contacted by a health professional and asked to monitor your symptoms for 21 days from when you last had close contact with the case.

Health staff will provide you with guidance on how to identify symptoms and other requirements. Depending on the extent of your contact with the case, you may be asked to share regular updates on your symptoms with health staff.

If you develop any symptoms you will be required to self-isolate and seek further medical advice.

If you are assessed as having a high risk of developing MPX, you will also be advised to:

  • wear a mask when around others
  • let health staff know leaving the country within the 21 days
  • avoid high-risk activities, including sexual activity, kissing and other skin-to-skin contact with others.

If you have been exposed to MPX and have not heard from a health professional, call Healthline for free on 0800 611 116, or contact your GP or nearest sexual health clinic. You may be at risk of getting the virus and may need to get tested if you have symptoms.

Preventing MPX transmission

Anyone who will have close physical or sexual contact while overseas, or with people who’ve recently been overseas, is advised to be mindful of MPX symptoms. This is particularly important for MSM, their sexual partners, and anyone who has multiple or anonymous sexual partners.

To reduce the risk of catching MPX while overseas, or if you are having close skin-to-skin contact with people who have recently been overseas, it’s advised you:

  • avoid close physical or sexual skin-to-skin contact with someone who has MPX or MPX symptoms
  • avoid direct contact with the skin rashes, lesions, scabs or bodily fluids of someone with MPX
  • avoid physical contact with the clothing, bedding or towels of a person with MPX.

People travelling to countries where MPX is endemic (eg, Western Africa) should also avoid contact with any animals that could harbour the virus, especially any that are sick or have been found dead in areas where MPX occurs.

Safe sex advice

While wearing a condom is good safe sex practice, it does not necessarily prevent MPX transmission. This is because MPX can also be passed from person to through physical or sexual skin-to-skin contact, contact with a MPX case’s lesions, or contact with clothing, bedding or towels used by someone with MPX.

See also What to do if you develop MPX symptoms.

Vaccination

Te Whatu Ora (Health New Zealand) is working with Pharmac to secure a national supply of a smallpox vaccine known as Imvanex or Jynneos. Vaccines designed for smallpox are also considered effective against MPX because the two viruses are similar.

In future, targeted vaccinations will form part of New Zealand’s response to MPX, alongside contact tracing and health promotion. Information about how the vaccine will be made available will be confirmed in due course.

Animals and MPX

MPX has the potential to pass between animals and humans, although this is extremely rare.

As a precautionary measure, anyone who is a probable or confirmed MPX case should avoid close contact with animals, including domestic animals at home (such as cats, dogs, and ferrets), livestock, and other captive animals, as well as wildlife. People with MPX should be particularly vigilant around animals known to be susceptible to the MPX virus such as rodents.

It is also important to ensure that all rubbish, including medical waste, is not accessible to rodents and other scavenger animals and is disposed of in a safe manner.

More information is available from the World Organisation for Animal Health

Infection Prevention and Control

Detailed guidance on infection prevention and control for MPX can be downloaded from this page. Separate guidance has been prepared for:

  • healthcare providers and health settings
  • people isolating at home
  • people isolating in accommodation
  • accommodation providers
  • sex-on-premises venues.

Primary health and sexual health care

Clinicians are asked to look out for signs and symptoms consistent with MPX.

This is particularly important when seeing patients from groups disproportionately impacted by the current global MPX outbreak, which includes:

  • men who have sex with men (MSM)
  • people who have sex with MSM including transgender, cisgender and non-binary people
  • anyone with two or more sexual partners or any anonymous sexual partners

Information about all recent travel, sexual history and smallpox immunisation history should be collected where MPX is suspected.

Ensure that appropriate infection prevention controls such as a well-fitting mask and good hand hygiene are in place ahead of the consultation.

Clinicians must inform their local Medical Officer of Health on suspicion of any MPX case, prior to the collection of any test samples.

Cases under investigation should be advised to isolate and avoid close contact (including kissing or sexual contact) with others while waiting for test results. Probable and confirmed cases are required to isolate.

Detailed guidance for clinicians along with an MPX factsheet and awareness poster can be downloaded from this page. Guidance is also available from HealthPathways or the Communicable Disease Control manual.

 
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