Is Australia ready for monkeypox?

Lessons must be learned from the introduction of dengue and Japanese encephalitis into Australia to ensure the outbreak of monkeypox in humans is stopped and to prevent monkeypox from becoming established in animal hosts in Australia, say two of Australia's leading public health and biosecurity experts.

Writing in the Medical Journal of Australia, Professor Raina MacIntyre, and Professor Andrew Grulich, from the Kirby Institute at UNSW Sydney, said that "Australia has had enormous success with HIV control, and can draw on this infrastructure, community groups and expertise, as well as the COVID-19 infrastructure."

"Active surveillance and containment are essential, ideally with antivirals and third generation smallpox vaccines for close contacts for immediate use," they said.

MacIntyre and Grulich warned, however, that the current burden of COVID-19 on the healthcare system "may pose a challenge if the monkeypox epidemic becomes large in Australia."

"COVID-19 pandemic fatigue may also mean people are less inclined to follow health advice," they wrote.

"Vaccination of close contacts should be the first step.

"Given the concentration of cases in men who have sex with men, if cases increase we may also need to consider offering vaccine to men who have sex with men who report multiple partners, as is currently occurring in Montreal, Canada.

"Finally, the [monkeypox] epidemic has occurred during a period of transition from one government to another, so agility and good communication are important.

"We have the expertise, the resources, and the tools to mount a rapid and successful response."

MacIntyre and Grulich said Australia's LGBTQI+ health organizations would be central to an effective response to monkeypox.

"Gay, bisexual and other men who have sex with men who have recently returned from overseas, particularly from Europe, should watch for symptoms of the disease, and if concerned, visit their general practitioner or local sexual health clinic," they wrote.

"[LGBTQI+ organizations] have already issued alerts, educating community members about the mode of transmission, the symptoms, and the need for symptomatic persons to seek medical assistance and to isolate.

"Such community-led initiatives are crucial in facilitating trust in the response.

"Monkeypox is likely to spread more widely than only among men who have sex with men.

"Stigmatizing people with monkeypox and people who may be perceived at high risk must be avoided, as this may lead to decreased testing and reduced engagement with health advice."