Sydney Mpox surge serves as cautionary tale as world braces for new variants | World News

Jason Gale

Australia's success in virtually eliminating MPOX within six months of the 2022 outbreak has now been overshadowed by a sudden and alarming resurgence, highlighting the challenges ahead as the world braces for potentially even more dangerous variants.

In late 2022 and early this year, the country went several months without a reported case, thanks to free vaccinations for at-risk groups, proactive safe-sex messaging and increased public awareness. No cases were reported even in March 2023, when Sydney welcomed more than 20,000 international visitors for the World Pride festival. For the whole of the year, only 26 cases were reported.

Now, a new strain of the monkeypox virus is threatening to cause a more severe outbreak in Australia and around the world. In a dramatic turn of events, Australia confirmed 179 cases in August alone, more than the previous two years combined. Nearly 400 cases have been reported so far in 2024.

While Australia has yet to report any cases of the more dangerous Ib strain, the sudden increase in infections caused by the less severe IIb variant highlights the importance of maintaining high vaccination rates, even if current vaccinations may not provide full protection.

More than 550 cases have been reported in Australia so far, but only one in a woman, suggesting transmission is almost exclusively through sexual contact between men.

“In Australia, the short-term response definitely needs to be to increase vaccination of gay and bisexual men,” said Andrew Grulich, head of HIV epidemiology and prevention at the Kirby Institute at the University of New South Wales in Sydney. “We need to make gay men aware that HIV has resurfaced and will continue to do so effectively, so the way forward is to get vaccinated.”

The rapid introduction of a smallpox vaccine effective against the closely related monkeypox virus, along with rapid case detection and isolation, helped contain the explosive MPOX clade IIb outbreak that infected more than 95,000 people worldwide in 2022.

Vaccination campaign

Through June, Australia had reported no more than 62 MPOX cases per month, protecting gay and bisexual men from the disease that causes excruciatingly painful lesions, helping to drive up vaccination rates among at-risk men to nearly 90% in cities including England, Washington and New York.

Community surveys in Australia's most populous states, New South Wales and Victoria, found that only half of gay and bisexual men had been vaccinated, leaving many at risk, Grlic said. Nearly two-thirds of the cases last month were in Sydney and other parts of New South Wales.

Victoria's Director-General of Health Claire Looker said most cases in Victoria's current outbreak were occurring in people who have not been vaccinated or have only had one dose, and that two doses of the vaccine were needed for maximum protection.

Scientists from the UK's Health Security Agency estimated last week that two doses of Bavarian Nordic's smallpox vaccine are 82% effective in preventing smallpox. About half of the cases in England last year were in vaccinated patients, but no vaccinated smallpox patients were hospitalized. This suggests the Danish company's vaccine “probably protects against severe disease,” the researchers said.

Dr Christopher Fairlie, director of the Melbourne Sexual Health Centre and professor of public health at Monash University, said that after vaccination, MPOX symptoms are much milder and systemic symptoms such as fever, body aches, fatigue and swollen lymph nodes are less frequent or less noticeable. Some patients may only have one or two lesions, which can be mistaken for other diseases such as syphilis or genital herpes.

But Fairlie said people with unhealed wounds were at risk of spreading the infection through physical contact, so early case identification was key to stopping further spread.

“If you find a place, please come and see it,” he said.

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