Vigilance urged as monkeypox continues to spread

More locally transmitted monkeypox cases have been reported in the past week, as authorities consider the best approach to ensure limited vaccine supplies have the most impact.
 
So far there have been 92 cases reported in the country, mostly in Victoria and NSW, although cases have also been detected in Queensland, Western Australia, South Australian and the ACT.
 
Most of the officially recorded cases remain among people who acquired the disease abroad before it was detected on their return to Australia. Even though official numbers still remain much lower relative to many other countries, Victoria in particular has seen a significant increase in local transmission rates in the past month.
 
The Victorian Department of Health issued an updated warning last weekend prompted by the rising number of monkeypox cases, more than 95% of which have been recorded among men who have sex with men.
 
It also highlighted limits to vaccination during August and September, stating that ‘existing vaccine supply has been largely rolled out through sexual health clinics’ in Victoria.
 
‘Preventive measures including limiting sexual partners are very important for people who are not vaccinated,’ the state’s health authority said.
 
The detection of the first locally transmitted case in NSW was also announced by NSW Health on Sunday.
 
Around 22,000 doses of the third generation vaccine, Jynneos, which is manufactured by Bavarian Nordic, arrived in Australia earlier this month in the face of worldwide supply shortages.
 
Another 78,000 doses are due to arrive at the end of September according to Nine Newspapers, with the remainder of the 450,000 doses ordered by the Federal Government expected next year.
 
It is stated as the preferred vaccine by the Australian Technical Advisory Group on Immunisation (ATAGI), although the ACAM2000 smallpox vaccine also been approved for use against monkeypox. However, the latter vaccine is contraindicated for the severely immunocompromised and those living with HIV.
 
Currently the Jyneos vaccines are being limited to people considered a high risk, including close contacts of existing cases, those living with HIV, and those with a recent history of having multiple sexual partners or attending sex on premises venues.
 
Professor Andrew Grulich of the Kirby Institute said the reason for the recent rise in locally transmitted cases is unclear.
 
‘We don’t really know the specific factors about the jump over the last several days in Victoria, but we do suspect they’ll be the same as we’re seeing in Northern Europe and North America, which is sustained sexual transmission among gay and bisexual men,’ he told ABC Radio National.
 
Vaccination will be crucial in the efforts to contain the disease’s spread Professor Grulich added, while indicating that new approaches might be needed to maximise the impact.
 
‘We do need to get people vaccinated before we see large scale transmission, we do have an opportunity to make that happen now,’ he said.
 
‘And that’s why there’s a lot of research happening into how we can use what are called dose sparing regimens where we can use less vaccine administered in a slightly different fashion to lead to the same immune response in the person who gets vaccinated.
 
‘That’s what they’ve actually started doing in the last couple of weeks in the US.
 
‘And that approach can lead to vaccinating five times as many people as you’d otherwise be able to do.’
 
Professor Grulich said he hopes vaccination eligiblity will be extended to all gay and bisexual men once there is greater supply of vaccines in the country.
 
Last week, the World Health Organization (WHO) reported there had been more than 35,000 monkeypox cases worldwide across 92 countries and territories, including 12 deaths.
 
The WHO declared the disease a public health emergency of international concern on 23 July, with Australia’s Chief Medical Officer Professor Paul Kelly calling it a disease of national significance a few days later.
 
Prior to May this year, monkeypox had never been recorded in Australia. The earliest cases in the country were detected by GPs.
 
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