Mpox is a viral disease that can be transmitted by close contact with skin lesions, body fluids, respiratory droplets and contaminated materials.
Outside of very close contacts, it’s not very contagious and the risk of the virus spreading widely remains low. This is not going to be "another covid".
Common symptoms include skin changes, such as a rash, blisters or lesions. Some people also get cold and flu symptoms, fever, swollen glands or muscle aches.
Community HealthPathways (linked in the files below) has localised advice about how to recognise, manage and notify this illness and a great place to start.
On 6 October 2022 Aotearoa New Zealand experienced a brief outbreak of mpox. This update (August 2024) follows a WHO announcement that a current outbreak in some African countries with a more infectious "clade" or type of Mpox has reached a level to be of international concern.
On 14 August 2024, WHO declared mpox a global public health emergency of international concern (PHEIC), its highest form of alert, following an outbreak of clade Ib mpox in the Democratic Republic of Congo (DRC) spreading to neighbouring countries including Burundi, Rwanda, Uganda, Central African Republic, and Kenya.
WHO’s risk assessment as of 13 August 2024, is that the public health risk of clade Ib mpox:
Te Whatu Ora and the Ministry of Health are closely monitoring the situation and are considering the implications for Aotearoa.
There are two genetically and clinically distinct clades or subtypes of MPXV, I (Ia and Ib) and II, and they are endemic to central and west Africa respectively.
Clade I has previously been observed to be more transmissible and to cause a higher proportion of severe infections than clade II mpox. The ongoing global mpox outbreak that began in 2022 is caused by MPXV clade II, and sporadic cases continue to be reported worldwide, including Aotearoa.
Clade I mpox is of heightened concern for multiple reasons, and it appears to be behaving differently with changes to the populations affected. In the current epidemic in the DRC, most cases are in people under age 15 years of age, with approximately equal numbers of men and women affected. Clade I can be both sexually and non-sexually transmitted. By comparison, clade II mpox primarily affects gay, bisexual, and other men who have sex with men (MSM).
A response to mpox caused by clade I in Aotearoa would need to be broader than a focus on this cohort and MSM networks.
The WHO Director-General has extended the Standing Recommendations for a further 12 months and released temporary recommendations for mpox, and Te Whatu Ora is working with the Ministry of Health to consider how these can be applied and implemented in Aotearoa’s setting.
ESR has updated their mpox risk assessment for Aotearoa and determines:
Aotearoa is prepared to respond to an mpox outbreak.
Te Whatu Ora and the Ministry of Health are planning to strengthen testing and referral pathways to facilitate timely identification and diagnosis of clade I mpox cases, considering the increased public health risk it presents. They are also reviewing the evidence of effectiveness of vaccines and anti-viral medications for the treatment of clade I mpox.
Several diagnostic laboratories in Aotearoa and ESR’s reference laboratory can test for mpox. In addition, ESR and the Canterbury Health Lab (CHL) have a clade-specific polymerase chain reaction (PCR) test which can distinguish between clade I and clade II. If a clade I case is identified, ESR has the capacity to sequence the virus to determine lineage.
Local laboratories that can test for mpox have provided reassurance that their test can detect the most recent clade Ib subtype as a positive result. However, current testing settings are such that these laboratories cannot distinguish between clade I and clade II without further testing.
WHO strongly advise countries need diagnostic capacities capable of detecting both MPXV clades. The Public Health Agency (PHA) is evaluating the current state of readiness of the diagnostic laboratory network, for the purposes of clinical diagnosis and epidemiological surveillance.
Preventative treatment by way of a vaccine is already available under Section 29, and work is continuing with MedSafe to seek provisional approval for the vaccine.
The Communicable Disease Control Manual includes a chapter on mpox to provide guidance on the public health management of cases and contacts. This guidance relates specifically to clade II mpox.
It is unknown whether the epidemiological trends of clade 1 mpox observed in affected African countries will be seen in other countries due to differences in the prevalence of comorbidities, sociocultural factors, access to healthcare and the level of reporting, among other factors. To date, there has been one reported case of clade 1 mpox outside of Africa (in Sweden) who had been traveling in Africa.
Te Whatu Ora is closely monitoring emerging data to get an understanding of whether changes to national clinical guidance and public health advice to support the management of clade I mpox will be required.
Global surveillance continues and NPHS intelligence continues to monitor the domestic situation.
Mpox information on the Ministry of Foreign Affairs and Trade’s Safe Travel website has been updated. This includes prevention advice for people travelling to mpox-affected countries.
Te Whatu Ora will continue to monitor this situation closely and will communicate updates as they receive them. If you have any questions, please contact the National Protection Clinical Team.
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