By Stephen Brook
The monkeypox virus is surging in Melbourne, with health officials unable to explain the emergence of about 20 locally acquired and mystery cases of the infectious disease amid a vaccine shortage.
There have been about 91 monkeypox cases nationwide since May, including 40 in Victoria. Numbers have grown since early August, when 25 cases were confirmed in the state but only a few were locally acquired.
An image showing oval-shaped monkeypox virions (left) under the microscope.Credit: US Centers for Disease Control
Previously, most cases were among travellers returning from overseas, but now locally transmitted cases are rapidly increasing.
“We are pretty concerned about the increase in local transmission particularly as it doesn’t appear to be happening in other states,” Associate Professor Deborah Friedman told The Sunday Age. “We don’t really know why.
“There are currently 40 cases of monkeypox recorded in Victoria, about half of which have been locally acquired.”
“Within two weeks we have seen a quite substantial increase in locally acquired cases, so it is now 50 per cent.”
Victoria had access to vaccines at the same time as NSW, which has 41 cases and only a small number of local transmissions of the virus.
Monkeypox, which is related to smallpox, produces painful skin lesions and can require hospitalisation.
“The number of people diagnosed with monkeypox in Victoria is increasing due to local transmission ... We have potentially had some [different gay] venues and events,” Friedman said.
The disease, which is not classified as sexually transmitted, has so far predominantly affected gay men and has spread mainly through prolonged intimate skin-to-skin contact.
“We need to let guys know that this is happening in Melbourne right now and they need to be informed in making their own decisions.”
Simon Ruth, Thorne Harbour Health
One gay club night in Fitzroy has gone on hiatus due to the emerging risks associated with the virus as more and more gay men return from virus hotspots on the European and North American summer party circuit.
Australian Federation of AIDS Organisations deputy chief executive Heath Paynter said men returning from virus hotspots should avoid prolonged contact with people.
“Abstinence is not a mid-to-long term solution to controlling any infectious disease, but we think it is reasonable to ask men who have returned from settings where there are community cases of monkeypox to avoid sexual contact or physical contact for two weeks, so they can monitor for any symptoms that might indicate monkeypox infection,” Paynter said.
But Simon Ruth, chief executive Thorne Harbour Health – Australia’s oldest LGBTQ health organisation – said asking gay men to not have sex “certainly wouldn’t work”.
“Abstinence isn’t practical and not a viable option for some people,” Ruth said.
“We need to let guys know that this is happening in Melbourne right now and they need to be informed in making their own decisions.”
What are the symptoms?
- Rashes, pimple-like lesions or sores, particularly in areas that are hard to see such as the genitals, anus or buttocks, and on the face, arms and legs.
- Ulcers, lesions or sores in the mouth.
- People can experience fever, headache, muscle aches, backache, swollen lymph nodes, chills and/or exhaustion prior to the rash or lesions developing.
- Symptoms usually begin 7-14 days after exposure, but sometimes in just a few days or up to 21 days.
Friedman said people returning from an international hotspot should monitor for symptoms and consider limiting their partners.
“People need to make their own decisions about their own behaviours. It is sensible for people to understand they could be incubating the virus and it could be prudent to limit their interaction over that time period.
“Anyone can contract monkeypox and it’s not going to happen through casual or limited contact with a person.”
Victoria’s Department of Health was unable to explain some transmissions, Friedman said.
“Contact tracing relies on people exchanging contact details with intimate partners. Contract tracing fails when this information is not available,” she said.
“I have no doubt we can significantly limit this outbreak and ultimately end it with contact tracing and vaccination.”
Ruth said Australia had not done enough to procure vaccines. “They should be releasing what they have in the national stockpile and hitting Melbourne hard to prevent it spreading around the country.”
A naked night, dubbed Adam, for gay men held at the Sircuit club on Fitzroy’s Smith Street shut down temporarily earlier this month.
“Adam and Sircuit have made the joint decision to immediately put the regular Monday Adam event at Sircuit on hiatus due to the emerging and changing health risks of monkeypox within our community,” club promoters said in a statement.
“While no cases have been attributed to the Adam event, we both believe it is in the best interests of our community and indeed the wider community that this hiatus happens.”
The Sircuit Bar in Fitzroy.Credit: Chris Hopkins
“Adam will continue to monitor the situation whilst engaging with relevant health authorities and will resume when it is deemed appropriate to do so and vaccines are widely available.”
Professor Andrew Grulich, head of the HIV epidemiology and prevention program at the Kirby Institute at the University of New South Wales, said shutting down Adam was “a sensible response”.
“There is strong evidence that transmission on the dance floor is extremely uncommon,” he said.
“There is a lot of hugging and kissing on dance floors, so transmission is theoretically possible but in reality, it is extremely uncommon.
“In your average nightclub, where people are clothed, transmission is unlikely. However, from what [I understand] about this event, the chances of skin-to-skin contact potentially involving broken skin would be very high. A precautionary response would be to pause events like this until people are fully vaccinated. That means two doses, four weeks apart.”
Australia has acquired 450,000 doses of the new third-generation monkeypox vaccine, including 100,000 to arrive this year and 350,000 next year. Victoria received 3500 doses earlier this month.
“The first consignment of approximately 22,000 have already arrived, with the remaining expected to arrive in the last quarter of 2022 and into 2023,” a federal Department of Health spokeswoman said.
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