The mpox virus causes flu- or cold-like symptoms, as well as lesions. Photo: SERGII IAREMENKO/SCIENCE PHOTO L
A new outbreak of mpox (formerly known as monkeypox) is threatening New Zealand's queer community.
Cases of mpox clade II, the more common of two variants of the virus, were encountered by several people at a Winter Pride event in Queenstown during the last week of August.
The virus, which first reached New Zealand shores in July of 2022, is currently seeing a spike in cases across Europe, The United States, and Australia.
Te Whatu Ora says the risk of a wide-spread outbreak in New Zealand remains low. However, Burnett Foundation Aotearoa chief executive Joe Rich worries about the greater risk the virus poses to gay, bisexual and other men who have sex with men (MSM).
"It can be incredibly uncomfortable. But it is treatable," he says.
"Those that do get it report extreme levels of discomfort sometimes requiring hospital level care and morphine to deal with the pain."
The strain suspected to be in New Zealand is different from the more deadly clade I currently spiking across Africa.
"There are no cases of clade I in Aotearoa, or our neighbouring countries," Te Whatu Ora says.
"Mpox clade II is the most common type seen worldwide and all mpox cases reported in Aotearoa to date have been clade II."
What is mpox?
Te Whatu Ora's website identifies mpox as a viral disease commonly transmitted through contact with blisters or lesions from someone who has the virus.
Common symptoms of mpox are flu- or cold-like symptoms such as fevers, muscle aches and swollen lymph nodes, as well as lesions on or around the genital area.
Rich says not everybody who attended the Winter Pride event needs to be concerned, but if you are experiencing the symptoms, or have been notified as a contact, you should refrain from sex and get tested at a local sexual health clinic.
He says vaccines are the best way to proactively prevent against the latest outbreak.
National Public Health Service medical officer of health Dr Matt Reid says those considered to be at high risk of transmitting mpox can receive appropriate advice and treatment by booking a consultation with a health professional.
"During the consultation, a medical practitioner discusses the individual's risk of exposure to mpox, and the options available. These include protective and preventative measures," he says.
Burnett Foundation Aotearoa chief executive Joe Rich. Photo: RNZ / Jake McKee
Who is considered high risk?
In Aotearoa New Zealand, gay, bisexual and other men who have sex with men have the highest risk of transmitting mpox.
Auckland University researcher and associate professor of social and community health Peter Saxton believes this is due to the community's close sexual networks.
"We are a globally interconnected community and vaccine coverage among New Zealand men who have sex with men remains woefully low."
However, the LGBT+ community's long history of sexual health awareness made the country's last outbreak easier to manage.
"Historically we've seen very good engagement with sexual health care by our communities," Saxton says.
"Having lived through the HIV epidemic ... we're aware of how quickly cases can spread around our communities."
Trans and non-binary people who have sex with MSM are also considered high risk, and are eligible for free vaccinations through their GP, as well as anyone who is a close contact of someone who has been infected with mpox.
Dr Peter Saxton. Photo: RNZ / Jake McKee
Do MSM need to change their sexual behaviour?
"Not at this stage," Rich says.
"If we were dealing with a large-scale outbreak the advice might change.
"We're a sex-positive organisation and we want to encourage people to do things to protect themselves, which in this case is getting the vaccine, before we try to encourage people to stop having an enjoyable sex life."
Reducing or changing sexual activity due to illness can be a difficult subject for gay and bisexual men due to stigma perpetuated during the HIV/AIDS epidemic - but Saxton wants all MSM, even those "in the closet" or "DL", not to hesitate to seek care if they are experiencing symptoms
"People should be alert, but absolutely this is not something that should mark someone out as being a gay or bisexual man," he says.
"Just pay attention to the information that trusted organisations like Burnett Foundation Aotearoa are giving."
How can MSM best protect themselves against mpox?
Rich says vaccines are still the best way to protect against mpox.
"Two doses are the ideal level of protection. And they don't always protect you from getting it, but it will significantly reduce the severity of the symptoms."
However, Saxton says the current law makes access to the mpox vaccine more difficult.
"Commercial events haven't been confident they can communicate information about the vaccine and mpox risks without falling foul of the Medicines Act."
The vaccine is currently unapproved in New Zealand, meaning it is only able to be made available through section 29 of the Medicines Act 1981. Body Positive New Zealand's website says this "allows for 'unapproved' vaccines to be provided to individual medical practitioners for a particular patient after assessing the patient's needs".
Saxton is calling on Te Whatu Ora to advocate for the approval of the vaccine.
"We know that if government releases the tools and the resources, the communities can rally and deliver this at scale and really quickly," he said.
"The first thing Te Whatu Ora can do is to proactively get the mpox vaccine approved by Medsafe."
Reid says Te Whatu Ora remains well-prepared to deal with cases of mpox.
"NPHS continues to update mpox clinical advice for healthcare professionals and information to the public," he says.
"If you're in Auckland, you can book an appointment by calling Auckland Sexual Health Service on 0800 739 432. If you are based outside of Auckland, please contact your local sexual health service."
