Mpox cases in Australia have risen by 570 per cent since July, but ...

At the end of March, the total number of confirmed cases of mpox in Australia this year was no more than six.

By the end of June, that number had increased to 108.

But in the months since, the virus has surged in Australia, with cases acutely increasing by more than 570 per cent.

Between July and yesterday, 616 new notifications of mpox were recorded, according to public figures from the Department of Health, bringing Australia's total cases in 2024 so far to 724.

Australia's two most populous states, Victoria and New South Wales, have accounted for the vast majority of these cases, with the latter recording more than half of the country's mpox notifications this year so far.

"We're seeing out the largest outbreak we've had so far of [mpox] in Australia around now," said Andrew Grulich, an epidemiologist and scientia professor at the University of New South Wales' (UNSW) Kirby Institute.

"The real action that we need is that gay and bisexual men need to get vaccinated."

Mpox, which is closely related to the smallpox virus, spreads through close contact — either directly through the skin or body fluids or contaminated materials like clothing.

Initially, an infection begins with flu-like symptoms, before typically progressing into a series of painful sores, blisters or rashes across the body — including the mouth, genitals, hands or torso — that, on average, take between two and four weeks to clear.

Anyone can contract mpox, but the disease has typically been associated with men who have sex with men, spreading through sexual contact. 

Of Australia's total ever notifications of mpox, only two have been identified as female.

Mpox first came to international attention in 2022 when the spread of the strain, or clade, 2b resulted in a global health emergency, with the United States alone reporting roughly 3,000 cases a week at its peak.

Australia was largely unaffected by this first global wave. But now, roughly two years later, the numbers of Clade 2b have flipped, with the US currently now reporting an average of four cases a day.

In July 2022, mpox came to international attention when the World Health Organization declared it a global emergency. (Getty Images: Xinhua News Agency)

There is no single clear explanation as to what's behind this sudden rise of mpox cases. But one factor that could be contributing to it are Australia's vaccination rates.

"We have an effective vaccine, and we just need to increase vaccination rates," Professor Grulich told the ABC.

The preferred mpox vaccine, known as Jynneos, is widely available in the country. 

Recommended to be administered in two doses, the vaccine doesn't entirely prevent mpox but it has been shown to reduce the severity of its symptoms.

Andrew Grulich has urged gay and bisexual men to get vaccinated. (Supplied: UNSW)

Yet despite its accessibility, mpox vaccine rates are low. 

According to federal health data, there have been 106,519 vaccine doses administered in Australia, with 22,795 vaccine doses administered this year so far — less than 6,000 being in NSW.

Research mirrors these findings. 

According to a UNSW survey of 4,252 gay and bisexual men in NSW, Victoria and the ACT, only 42 per cent were fully vaccinated, while 26 per cent of those who had more than 10 recent sexual partners were unvaccinated.

"Until we get much higher rates of general population immunity, we're going to see some ongoing transmission of this," Professor Grulich said.

One theory for the low uptake of mpox vaccination is the disease's spread in Australia being underestimated.

"It hit hard in North America and Europe, so there was a lot of fear. A lot of people got [mpox]. And because they had access to vaccines available, they had very high rates of vaccine uptake," Professor Grulich said.

One Australian survey in 2022 found that, of the 1,733 gay and bisexual males interviewed, 15 per cent were open to getting vaccinated for mpox but only once cases increased.

But the reason could also be something more nuanced, with mpox spreading through populations less likely to be vaccinated.

Matthew Shields, a Sydney sexual health physician and GP, said the infection was "moving more into outer-metro settings".

Matthew Shields said that the rise of mpox could be because the disease spreading through outer metro communities. (Supplied: Taylor Square Private Clinic)

The bulk of Dr Shields's male patients who have sex with men have been vaccinated since 2022. 

He said where vaccinations were low and where cases were increasing, were in Sydney's outer suburbs, where men who had sex with men were also less likely to engage with health providers.

"They may not disclose their sexual practices to health providers and doctors … and perhaps getting them vaccinated for mpox is a bit more of a challenge."

Those reasons as to why men in suburban and regional Australia aren't engaging with health providers could range from a lacking awareness of mpox to barriers in accessing healthcare. But another factor could be avoidance.

"Unfortunately, there's a lot of stigma attached to nearly every STI," said Matthew Vaughan, the director of HIV and sexual health at community advocacy organisation ACON.

"And while you know things like chlamydia and gonorrhoea are part of often common community vernacular, [mpox] is one of those [diseases] at the moment that is still relatively unknown."

ACON's Matthew Vaughan said there are a handful of reasons why vaccination rates are low, including stigma over mpox. (Supplied: ACON)

Research has found that this stigma, or the perceived stigma, can prevent gay and bisexual men seeking healthcare in Australia, including treatment for STIs and HIV.

Those who have contracted mpox have reported the experience of stigma. 

One UNSW survey found, in 2022, some Australians with mpox were left feeling vilified by healthcare workers.

The same year, the method of administering mpox vaccinations — done then to preserve doses during a shortage of the Jynneos vaccine — left a distinct discolouration at the injection site that lasted weeks, raising concerns that those vaccinated could be publicly outed.

"If you're not open about your sexuality for any reason, somebody knowing that you've had [the mpox] vaccine is going to lead to that connotation or association and that stigma," Mr Vaughan said.

Looking forward, Mr Vaughan said the solution to increasing vaccinations was simply raising awareness of its importance.

"It's moving it up the priority scale," he said.

"That's the best thing that we can do for our community — have a high vaccination rate."