Australia’s gay sex scene has been put on high alert after the nation recorded its first two cases of monkeypox which are believed to be sex-related.
Two men from Sydney and Melbourne have both returned from Europe infected with the rare tropical disease.
The Victorian case is known to have been in the UK where there are currently nine cases, which are all among men from the gay and bisexual community.
On Friday, NSW Health’s chief medical officer Dr Kerry Chant sent out the urgent warning for gay men to watch out or the symptoms and seek help immediately if worried.
‘We’re particularly urging men who are gay or bisexual or men who have sex with men to be aware of any unusual rashes or lesions and to contact by phone to sexual health clinic or GP without delay if they have any concerns,’ she said.
A Sydney man in his 40s developed a mild illness several days after arriving home and his GP found the telltale monkeypox symptoms of blisters and rashes.
Another case in Victoria has also now been reported in a man in his 30s who had been on a trip to the UK and developed symptoms after his return on May 16.
Urgent testing identified the Sydney man has been infected with a probable case of monkeypox and medics are now conducting follow up tests for final confirmation.
The Australian cases come after new cases were detected in Italy and Sweden, just days after nine cases were found in the UK.
The Italian patient tested positive at a hospital in Rome after returning from the Canary Islands and the Swede was diagnosed in Stockholm.
The latest cases bring the number of countries outside of Africa with confirmed or suspected cases to eight.
Australian health authorities are on high alert over fears a global outbreak of deadly monkeypox could arrive Down Under after the UK was rocked by a string of cases
Patients with confirmed monkeypox have now also been recorded in the UK, US, Spain and Portugal, while Canada is probing potential cases.
Experts fear the known cases are the tip of the iceberg, with the majority of patients not linked to each other, suggesting it is spreading more widely.
The outbreak has been described as ‘unusual’ by experts because person-to-person transmission of monkeypox was thought to be extremely rare.
NSW Health revealed the Sydney man and a household contact are isolating at home under the supervision of his local GP and state health officials.
One in ten of those infected dies from the rare African-originated disease which leaves victims pockmarked with painful, ugly blisters and rashes over their body.
It’s highly infectious between people in close proximity but can only be spread through bodily fluids or very close face-to-face contact in droplets of breath.
In the UK and Spain, the virus outbreak appears to have been confined to gay or bisexual men – but none of the latest cases had a direct connection with Africa.
Until now, it had never been found to be transmitted sexually.
But it was known that it could be passed on through close contact with the likes of body fluids, respiratory droplets and lesions — meaning it was theoretically possible to transmit through sex.
NSW Chief Health Officer Dr Kerry Chant said NSW Health has taken steps to ensure it identifies and reacts to any potential cases, including alerting sexual health clinics.
‘NSW Health has issued a clinician alert to GPs and hospitals across the state, said Dr Chant, and warned sexual health services to also be on the lookout for cases.
‘We will be speaking with GPs about this issue again today,’ Dr Chant said.
‘Cases are occasionally reported in non endemic countries in returning travellers or their close contacts, or in owners of imported pets.
Nurses and doctors are being advised to stay ‘alert’ to patients who present with a new rash or scabby lesions (like above)
‘People can contract monkeypox through very close contact with people who are infected with the virus,’ Dr Chant said.
‘The infection is usually a mild illness and most people recover within a few weeks.’
NSW Health said it will continue to work closely with colleagues throughout Australia to monitor for cases and ensure the best clinical response if any are identified.
Victoria and NSW health officials will be giving a further update on the spread of the disease on Friday afternoon.
There is no vaccine or treatment for monkeypox, but the smallpox vaccine was found to be 85 per cent effective against the disease.
However smallpox vaccine is in short supply across the world after the disease was eradicated globally 40 years ago and smallpox jabs were no longer required.
Pharmaceutical firm Bavarian Nordic plans to release a monkeypox version of a modified smallpox vaccine, but it will not be available before 2023.
The US has placed an initial $170 million order for the prospective long-life freeze-dried vaccine, with an option for another $255million order, for a total of 13 million doses, costing around $30 a dose.
Seven other countries outside of Australia and Africa have now confirmed or suspected cases of monkeypox. Patients with confirmed monkeypox have been recorded in the UK, US, Spain, Sweden, Italy and Portugal, while Canada is probing potential cases
MONKEYPOX: Strain ‘spreads sexually’ and is as deadly as the original Wuhan Covid variant – but a jab exists
What is monkeypox?
Monkeypox is a rare viral infection which people usually pick up in the tropical areas of west and central Africa.
It is usually spread through direct contact with animals such as squirrels, which are known to harbour the virus.
However, it can also be transmitted through very close contact with an infected person.
Monkeypox was first discovered when an outbreak of a pox-like disease occurred in monkeys kept for research in 1958.
The first human case was recorded in 1970 in the Democratic Republic of Congo and the infection has been reported in a number of central and western African countries since then.
Only a handful of cases have been reported outside of Africa until now and they were confined to people with travel links to the continent.
How deadly is it?
Monkeypox is usually mild, with most patients recovering within a few weeks without treatment. Yet, the disease can prove fatal.
However it can kill up to 10 per cent of people it infects.
The milder strain causing the current outbreak kills one in 100 — similar to when Covid first hit.
Monkeypox shuts down some aspects of your body’s ability to fight infections.
Because of the presence of other viruses and bacteria which your body can’t fight off, in the worst cases patients can succumb to a lethal shock throughout the body and blood poisoning.
Death is more likely to occur in younger patients. The skin lesions are painful and disfiguring, and can be the source of further infections.
Is there a cure?
Because monkeypox is closely related to the virus that causes smallpox, jabs for smallpox can also protect people from getting monkeypox.
One vaccine, Imvanex, was shown to be around 85 per cent effective in preventing monkeypox infection.
Antivirals and pooled blood from individuals vaccinated against smallpox can be used to treat severe cases.
How does it spread?
Monkeypox is not a sexually transmitted infection by nature, though it can be passed on by direct contact during sex.
Contagious lesions, through which infections are most likely to be passed on, can appear on any part of the body.
The infection can also be passed on through contact with clothing or linens used by an infected person.
Until now, monkeypox had only ever been detected in four countries outside of Africa – the UK, US, Israel and Singapore.
And all of those cases had travel links to Nigeria and Ghana.
Are gay men at greater risk?
Most of the British and Spanish cases are gay or bisexual men, which officials say is ‘highly suggestive of spread in sexual networks’.
The sexuality of patients in other countries has not been disclosed.
Health chiefs in the UK have issued a direct plea to men who have sex with men, telling them to come forward if they develop a rash on their face or genitals.
What are the symptoms?
Initial symptoms of monkeypox include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.
But its most unusual feature is a rash that often begins on the face, then spreads to other parts of the body, commonly the genitals, hands or feet.
The rash changes and goes through different stages before finally forming a scab, which later falls off.
What do I do if I have symptoms?
Anyone worried that they could be infected with monkeypox is advised to make contact with clinics ahead of their visit.
Health chiefs say their call or discussion will be treated sensitively and confidentially.
Until now, monkeypox cases were confined to travellers and their relatives returning from western and central Africa, where the virus is endemic.
Initial symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.
A rash can develop, often beginning on the face, then spreading to other parts of the body including the genitals.
The rash changes and goes through different stages, and can look like chickenpox or syphilis, before finally forming a scab, which later falls off.
Monkeypox has an incubation period of up to 21 days, meaning it can take three weeks after an infection for symptoms to appear.
Positive cases and their contacts are being made to isolate for 21 days. Monkeypox can kill up to one in ten people who get it but the new cases have the West African variant, which is deadly for around one in 100.
Macquarie University Emeritus Professor Peter Curson warns that it will be very difficult to prevent the spread of monkeypox
Sydney’s Macquarie University Emeritus Professor Peter Curson told Daily Mail Australia the virus is very difficult to screen for.
‘It’s certainly a serious viral infection once it’s broken out and it would be very difficult to screen for it.
‘We really do not fully understand what it is, how it is or what we should do.’
‘We’re really not fully apprised of how to control it or what drugs to use, or indeed, perhaps, to recognise some of the symptoms early on.
‘You can go and visit a place like the Congo or Nigeria, be exposed to an infection, and a week or two later, get a flight to Australia showing no symptoms.
‘And yet within a week or two after that you can go down with an interesting viral infection.’
He said the Covid pandemic had shown medical science was still in a life or death battle with disease.
‘We do honestly believe that we have beaten have won the fight against infectious diseases, but nothing can be further from the truth as Covid demonstrated,’ he said.
‘Given the tremendous movement of people around the world – and the quickness one can return home having been exposed while showing absolutely no symptoms – how does one control the spread of an outbreak of new infectious diseases?
‘It will be very difficult.’
Australian medics have been told to watch out for symptoms which can be confused with less dangerous conditions like chickenpox, measles, syphilis or shingles
The announcement the virus has arrived in Australia comes as nine people have been diagnosed with monkeypox in the UK.
Two are known to each other but have no connection to any of the previous cases, in a sign the virus is spreading in the community for the first time.
All seven UK cases have tested positive for the West African strain of the virus, which is believed to be milder than other versions.
Health authorities in the UK have now launched an urgent investigation to discover the source of the new infections.
The initial case of the UK outbreak is believed to have been brought into the country by a victim who contracted the disease while travelling through Nigeria, where the virus is endemic.
Sexual health clinics in London have now reportedly introduced strict social distancing rules in waiting rules in a bid to avoid any further infections.
Although 10 per cent of victims can die from monkeypox, most recover within a few weeks after suffering the painful lesions and flu-like symptoms.
Unusually though, studies in Africa found the incurable disease was more deadly in younger people.
The tropical disease is carried in the wild by monkeys, rats, rabbits, squirrels and other small mammals.
An outbreak in the US in 2003 was traced to the importation of exotic pets into the country from Africa.
It can spread to humans through direct contact with the blood, bodily fluids, or lesions of an infected animal, or eating under-cooked meat of infected animals.
It is potentially far more infectious than Covid-19, with the World Health Organisation saying its R number is 2, compared to the various strains of Covid which has seen R numbers range from 0.6 to 1.6.
However in practice, monkeypox symptoms are far more obvious and the disease is more easily contained, limiting its real world spread.
An outbreak in the US last year saw more than 200 people being tracked for symptoms after a Texas man returned from Nigeria with the disease. A second case was later found in Maryland.
A 2020 WHO report said human-to-human transmission of the virus is rare and that the longest chain of cases appears to only have been six people before it ended.
The report said: ‘The epidemic risk for humans is considered to be small.’