1C - Mpox response
Tracks
Track 3
| Tuesday, June 10, 2025 |
| 11:00 AM - 12:30 PM |
| Room E2 |
Speaker
Ms Jacq Prestedge
Research Program Manager
The University Of Melbourne
Mpox in Victoria: A public health laboratory response to guide outbreak management
Abstract
Background: In 2022, an unprecedented global outbreak of mpox (formerly monkeypox) occurred, with over 70,000 cases reported worldwide by October. Victoria, Australia experienced its own outbreak first in 2022, then a re-emergence in 2024 with sustained local transmission, prompting a comprehensive public health response. The Victorian Infectious Diseases Reference Laboratory (VIDRL) played a crucial role in the diagnostic and genomic surveillance efforts during this outbreak.
Findings: VIDRL’s response to the mpox outbreak in Victoria, which has resulted in over 400 cases since 2022 has encompassed three key areas: 1) Outbreak characterisation: Clinical studies in collaboration with Melbourne Sexual Health Centre assessed viral culture infectivity across different sample types and infection durations, informing isolation guidelines for individuals. 2) Diagnostics: VIDRL evaluated commercial RT-PCR assays for Orthopoxvirus and monkeypox virus (MPXV) detection and assessed a syndromic viral vesicular panel for simultaneous detection of MPXV and other causative pathogens of vesicles. VIDRL developed and implemented multiplex MPXV testing for diagnosis with clade differentiation and have developed a CRISPR-Cas diagnostic with potential point-of-care application. 3) Genomic characterisation: Surveillance in 2022 and 2024 identified multiple clade IIb lineages, suggesting repeated virus introductions from 2022-2024, and subsequent local transmission. Genomic analysis revealed within-host diversity and confirmed the continued efficacy of existing vaccinia virus vaccines against new MPXV variants as part of vaccine immunogenic prediction studies.
Conclusion: The work performed at VIDRL contributed to understanding MPXV transmission, diagnostics, and genomic epidemiology in the Victorian context and played a crucial role in informing public health strategies for mpox management in Victoria. As mpox epidemiology continues to evolve, VIDRL's ongoing efforts in assay standardisation, adaptation of innovative testing approaches, and integration of genotypic and phenotypic viral characterisation will be critical for maintaining an effective and adaptive public health response for emerging infectious disease threats.
Findings: VIDRL’s response to the mpox outbreak in Victoria, which has resulted in over 400 cases since 2022 has encompassed three key areas: 1) Outbreak characterisation: Clinical studies in collaboration with Melbourne Sexual Health Centre assessed viral culture infectivity across different sample types and infection durations, informing isolation guidelines for individuals. 2) Diagnostics: VIDRL evaluated commercial RT-PCR assays for Orthopoxvirus and monkeypox virus (MPXV) detection and assessed a syndromic viral vesicular panel for simultaneous detection of MPXV and other causative pathogens of vesicles. VIDRL developed and implemented multiplex MPXV testing for diagnosis with clade differentiation and have developed a CRISPR-Cas diagnostic with potential point-of-care application. 3) Genomic characterisation: Surveillance in 2022 and 2024 identified multiple clade IIb lineages, suggesting repeated virus introductions from 2022-2024, and subsequent local transmission. Genomic analysis revealed within-host diversity and confirmed the continued efficacy of existing vaccinia virus vaccines against new MPXV variants as part of vaccine immunogenic prediction studies.
Conclusion: The work performed at VIDRL contributed to understanding MPXV transmission, diagnostics, and genomic epidemiology in the Victorian context and played a crucial role in informing public health strategies for mpox management in Victoria. As mpox epidemiology continues to evolve, VIDRL's ongoing efforts in assay standardisation, adaptation of innovative testing approaches, and integration of genotypic and phenotypic viral characterisation will be critical for maintaining an effective and adaptive public health response for emerging infectious disease threats.
Ms Ellen Donnan
Manager
Health Protection Nsw
New South Wales experience of the largest Australian mpox outbreak to date
Abstract
Background
In 2022, there was a global outbreak of clade IIb mpox predominantly affecting gay, bisexual and other men who have sex with men (GBMSM). Australia reported relatively few mpox cases in 2022 compared to other countries. In 2024, Australia experienced a much larger outbreak of mpox (1,412 notifications) of which more than half (726) were NSW residents.
Methods
We report on the NSW 2024 mpox outbreak and response. All monkeypox virus PCR positive cases notified to NSW Health during 2024 were included. Cases were interviewed allowing the collection of demographic, clinical and risk factor data. Actions taken by NSW Health to respond to the outbreak were reviewed.
Results
NSW reported 726 mpox cases in 2024; the majority were in GBMSM. Most were acquired in NSW. Notifications peaked in September 2024, with 226 notifications and decreased to 30 notifications in December 2024. 39% had received two doses of JYNNEOS vaccine. The NSW outbreak was managed through case and contact follow-up, awareness raising and promotion of vaccination. Clinical alerts were utilised to increase awareness of symptoms (including that symptoms may be attenuated or mimic other conditions) with GPs and hospitals. Targeted campaigns and public alerts were run in conjunction with community partners, urging at-risk people to get vaccinated, recognise the symptoms and seek testing. NSW Health also expanded vaccination providers and sites, including at sex on premise venues, to increase accessibility to at-risk groups.
Conclusion
Despite current control, there is ongoing risk of transmission with low levels of circulating virus in the community leading up to potential amplification events such as the Sydney Mardi Gras. Ongoing overseas importation of both clade I and clade II remains a risk. Balancing risk communication and potential stigma were paramount. Ongoing public health action, including vaccination promotion and awareness raising is critical to mpox prevention.
In 2022, there was a global outbreak of clade IIb mpox predominantly affecting gay, bisexual and other men who have sex with men (GBMSM). Australia reported relatively few mpox cases in 2022 compared to other countries. In 2024, Australia experienced a much larger outbreak of mpox (1,412 notifications) of which more than half (726) were NSW residents.
Methods
We report on the NSW 2024 mpox outbreak and response. All monkeypox virus PCR positive cases notified to NSW Health during 2024 were included. Cases were interviewed allowing the collection of demographic, clinical and risk factor data. Actions taken by NSW Health to respond to the outbreak were reviewed.
Results
NSW reported 726 mpox cases in 2024; the majority were in GBMSM. Most were acquired in NSW. Notifications peaked in September 2024, with 226 notifications and decreased to 30 notifications in December 2024. 39% had received two doses of JYNNEOS vaccine. The NSW outbreak was managed through case and contact follow-up, awareness raising and promotion of vaccination. Clinical alerts were utilised to increase awareness of symptoms (including that symptoms may be attenuated or mimic other conditions) with GPs and hospitals. Targeted campaigns and public alerts were run in conjunction with community partners, urging at-risk people to get vaccinated, recognise the symptoms and seek testing. NSW Health also expanded vaccination providers and sites, including at sex on premise venues, to increase accessibility to at-risk groups.
Conclusion
Despite current control, there is ongoing risk of transmission with low levels of circulating virus in the community leading up to potential amplification events such as the Sydney Mardi Gras. Ongoing overseas importation of both clade I and clade II remains a risk. Balancing risk communication and potential stigma were paramount. Ongoing public health action, including vaccination promotion and awareness raising is critical to mpox prevention.
Dr Ned Latham
Public Health Medicine Advanced Trainee
Health Protection NSW
Features of mpox in fully vaccinated people: an outbreak investigation, NSW, 2024
Abstract
BACKGROUND
Since 2022, clade IIb mpox outbreaks have occurred in previously non-endemic countries, primarily amongst men who have sex with men. Two doses of modified vaccinia Ankara vaccine (MVA) are recommended for people at risk. Infections in fully vaccinated people have been infrequently described. Consequently, evidence that MVA-induced antibodies wane within a year remains of unclear clinical significance. We aimed to describe mpox cases arising during an outbreak in New South Wales (NSW), and to determine whether vaccination was associated with less severe disease.
METHODS
We included all mpox cases notified in NSW between 20 June – 20 November 2024 in this outbreak investigation. Cases and their clinicians were interviewed to obtain epidemiologic and clinical information. We used logistic regression to explore the relationship between factors indicative of exposure risk and/or likelihood of testing and being fully vaccinated. Risk ratios were calculated for clinical outcomes. Some specimens underwent whole genome sequencing.
RESULTS
There were 674 confirmed cases notified. All sequenced specimens (n=102, 15.1%) were clade IIb. Vaccination status was ascertained for most (n=663, 98.4%) with 37.9% fully vaccinated, 10.9% partially vaccinated, and 51.3% unvaccinated. Median time between vaccination and symptom onset was 21.8 months (IQR 19.5–23.0 months). Factors independently associated with being fully vaccinated included sex on premises venue attendance (aOR 1.69 [95%CI 1.15–2.48]) and having a sexually transmissible infection notified in the past year (aOR 1.63 [1.14–2.33]). Compared to unvaccinated cases, those who received two MVA doses were less likely to be hospitalised (RR 0.11 [95%CI 0.03–0.43]), have extragenital lesions (RR 0.45 [0.36–0.56]) or prodromal symptoms (RR 0.72 [0.64–0.80]).
CONCLUSIONS
Being fully vaccinated was associated with factors suggestive of greater exposure risk and/or likelihood of testing. Two MVA doses reduced the risk of disseminated disease and hospitalisation, including amongst cases vaccinated more than 1.5 years prior.
Since 2022, clade IIb mpox outbreaks have occurred in previously non-endemic countries, primarily amongst men who have sex with men. Two doses of modified vaccinia Ankara vaccine (MVA) are recommended for people at risk. Infections in fully vaccinated people have been infrequently described. Consequently, evidence that MVA-induced antibodies wane within a year remains of unclear clinical significance. We aimed to describe mpox cases arising during an outbreak in New South Wales (NSW), and to determine whether vaccination was associated with less severe disease.
METHODS
We included all mpox cases notified in NSW between 20 June – 20 November 2024 in this outbreak investigation. Cases and their clinicians were interviewed to obtain epidemiologic and clinical information. We used logistic regression to explore the relationship between factors indicative of exposure risk and/or likelihood of testing and being fully vaccinated. Risk ratios were calculated for clinical outcomes. Some specimens underwent whole genome sequencing.
RESULTS
There were 674 confirmed cases notified. All sequenced specimens (n=102, 15.1%) were clade IIb. Vaccination status was ascertained for most (n=663, 98.4%) with 37.9% fully vaccinated, 10.9% partially vaccinated, and 51.3% unvaccinated. Median time between vaccination and symptom onset was 21.8 months (IQR 19.5–23.0 months). Factors independently associated with being fully vaccinated included sex on premises venue attendance (aOR 1.69 [95%CI 1.15–2.48]) and having a sexually transmissible infection notified in the past year (aOR 1.63 [1.14–2.33]). Compared to unvaccinated cases, those who received two MVA doses were less likely to be hospitalised (RR 0.11 [95%CI 0.03–0.43]), have extragenital lesions (RR 0.45 [0.36–0.56]) or prodromal symptoms (RR 0.72 [0.64–0.80]).
CONCLUSIONS
Being fully vaccinated was associated with factors suggestive of greater exposure risk and/or likelihood of testing. Two MVA doses reduced the risk of disseminated disease and hospitalisation, including amongst cases vaccinated more than 1.5 years prior.
Ms Annabeth Simpson
Senior Research Officer
National Centre For Immunisation Research And Surveillance
Uptake of mpox vaccine and estimated coverage in targeted populations, Australia.
Abstract
Background
In August 2022, Australia initiated a funded mpox vaccination program, following the World Health Organization’s declaration of a public health emergency of international concern due to mpox outbreaks in non-endemic countries, primarily affecting gay, bisexual and other men who have sex with men (GBMSM). A two-dose schedule of JYNNEOS vaccine is recommended for at-risk groups including sexually active GBMSM. Estimating mpox vaccination coverage is challenging due to the absence of precise population denominator data for GBMSM. We aimed to describe mpox vaccine uptake and estimate coverage among GBMSM.
Methods
Australian Immunisation Register (AIR) data at 6 February 2025 was used to calculate the number of mpox vaccine doses administered/received, by state/territory, provider setting, sex and age group. GBMSM population denominators by age group and state/territory were estimated using data from the third Australian Study of Health and Relationships, which provides national data on sexual health, behaviours and identity. Mpox vaccination coverage was calculated as the percentage of the relevant estimated population with recorded mpox vaccine doses in AIR.
Findings
Between 1 January 2022 and 31 December 2024, 114,622 doses of mpox vaccine were administered to 66,801 people, with the highest number (49,419) in 2022. Almost half of doses (43.7%) were administered in general practice. Most doses were administered in New South Wales (45,983;40.1%) and Victoria (40,020;34.9%). Of people who received at least one dose, 47,345/66,801 (70.9%) received two or more. Most recipients were male (94.2%), and one-third (33.9%) were aged 30–39 years. Coverage estimates will be presented.
Conclusion
Monitoring mpox vaccine uptake and coverage is essential for optimising the public health benefits of this important nationally funded program, identifying any coverage gaps and guiding future vaccination strategies and outbreak preparedness.
In August 2022, Australia initiated a funded mpox vaccination program, following the World Health Organization’s declaration of a public health emergency of international concern due to mpox outbreaks in non-endemic countries, primarily affecting gay, bisexual and other men who have sex with men (GBMSM). A two-dose schedule of JYNNEOS vaccine is recommended for at-risk groups including sexually active GBMSM. Estimating mpox vaccination coverage is challenging due to the absence of precise population denominator data for GBMSM. We aimed to describe mpox vaccine uptake and estimate coverage among GBMSM.
Methods
Australian Immunisation Register (AIR) data at 6 February 2025 was used to calculate the number of mpox vaccine doses administered/received, by state/territory, provider setting, sex and age group. GBMSM population denominators by age group and state/territory were estimated using data from the third Australian Study of Health and Relationships, which provides national data on sexual health, behaviours and identity. Mpox vaccination coverage was calculated as the percentage of the relevant estimated population with recorded mpox vaccine doses in AIR.
Findings
Between 1 January 2022 and 31 December 2024, 114,622 doses of mpox vaccine were administered to 66,801 people, with the highest number (49,419) in 2022. Almost half of doses (43.7%) were administered in general practice. Most doses were administered in New South Wales (45,983;40.1%) and Victoria (40,020;34.9%). Of people who received at least one dose, 47,345/66,801 (70.9%) received two or more. Most recipients were male (94.2%), and one-third (33.9%) were aged 30–39 years. Coverage estimates will be presented.
Conclusion
Monitoring mpox vaccine uptake and coverage is essential for optimising the public health benefits of this important nationally funded program, identifying any coverage gaps and guiding future vaccination strategies and outbreak preparedness.
Ms Ela Naruka
Research Officer
The Kirby Institute
HIV notifications among people from Culturally and Linguistically Diverse backgrounds in Australia
Abstract
Background:
Australia has a large culturally and linguistically diverse (CALD) population with 30% of the population born overseas and 22% speaking a language other than English at home. People born overseas are contributing increasingly to notifications of HIV. We analysed data from the National HIV Registry to determine trends in HIV new diagnoses in Australia among people from CALD backgrounds.
Methods:
We defined people from CALD backgrounds as ‘people who were born in non-main English-speaking countries AND/OR spoke non-English language at home’. We analysed HIV notifications data between 2014-2023, and described demographics, HIV exposure risk, CD4+ count, HIV subtypes, stages of HIV and time between year of arrival and HIV diagnosis for the CALD population.
Results:
The number of HIV notifications among people from CALD backgrounds declined by 21.5% over the study period, however the decline between 2019 - 2021 was likely to be influenced by restrictions due to COVID-19. The proportion of HIV notifications were highest among people born in Southeast Asia (55%) and attributed to exposure risk category of men who have sex with men (MSM) (61%), during the study period.
The percentage of notifications diagnosed late (CD4+ count <350cells/µL at diagnosis) among people from CALD backgrounds increased from 36% in 2014 to 45% in 2023. The proportion of late diagnosis increased in both exposure risk categories: MSM (from 26% in 2014 to 39% in 2023) and heterosexual exposure (from 48% in 2014 to 57% in 2023).
Conclusion:
This is a novel analysis of HIV notifications among people from CALD backgrounds in Australia. During the study period, HIV notifications among people from CALD backgrounds have slightly declined in Australia, however late diagnosis has increased especially among people reporting heterosexual exposure as risk category, suggesting a lack of services targeting people from CALD backgrounds and initiatives to raise awareness about HIV testing.
Australia has a large culturally and linguistically diverse (CALD) population with 30% of the population born overseas and 22% speaking a language other than English at home. People born overseas are contributing increasingly to notifications of HIV. We analysed data from the National HIV Registry to determine trends in HIV new diagnoses in Australia among people from CALD backgrounds.
Methods:
We defined people from CALD backgrounds as ‘people who were born in non-main English-speaking countries AND/OR spoke non-English language at home’. We analysed HIV notifications data between 2014-2023, and described demographics, HIV exposure risk, CD4+ count, HIV subtypes, stages of HIV and time between year of arrival and HIV diagnosis for the CALD population.
Results:
The number of HIV notifications among people from CALD backgrounds declined by 21.5% over the study period, however the decline between 2019 - 2021 was likely to be influenced by restrictions due to COVID-19. The proportion of HIV notifications were highest among people born in Southeast Asia (55%) and attributed to exposure risk category of men who have sex with men (MSM) (61%), during the study period.
The percentage of notifications diagnosed late (CD4+ count <350cells/µL at diagnosis) among people from CALD backgrounds increased from 36% in 2014 to 45% in 2023. The proportion of late diagnosis increased in both exposure risk categories: MSM (from 26% in 2014 to 39% in 2023) and heterosexual exposure (from 48% in 2014 to 57% in 2023).
Conclusion:
This is a novel analysis of HIV notifications among people from CALD backgrounds in Australia. During the study period, HIV notifications among people from CALD backgrounds have slightly declined in Australia, however late diagnosis has increased especially among people reporting heterosexual exposure as risk category, suggesting a lack of services targeting people from CALD backgrounds and initiatives to raise awareness about HIV testing.
Mr Wondimeneh Shiferaw
Phd Student
Uq
Sexually Transmissible Infections Acquired Abroad: Insights from Australian Surveillance Data
Abstract
Abstract
Background: International travel is a significant contributor to the acquisition of sexually transmissible infections (STIs). Despite the high volume of outbound travel from Australia, peaking at 10.8 million travellers in 2023, limited data exist on the burden of overseas-acquired STIs.
Objective: To estimate the burden and trends of overseas-acquired STIs (gonorrhoea, syphilis, and chlamydia) in Australia.
Methods: This study analysed STI notifications from Australia’s National Notifiable Diseases Surveillance System from January 2017 to December 2023. Geographical origins of overseas-acquired cases were visualised on a map, and temporal trends were assessed across pre-COVID-19, pandemic, and post-pandemic periods.
Results: Of 188,788 notified STI cases, 11,782 (6.2%) were acquired overseas. Males accounted for 63% of these cases, with young adults aged 20–24 years representing 24.6%. Overseas-acquired cases rose nearly three-fold from 1,444 (12.3%) in 2017 to 4,044 (34.3%) in 2019, before sharply declining during the COVID-19 pandemic (479 [4.1%] in 2020; 213 [1.8%] in 2021). Of all overseas-acquired STIs cases, 6,270 (53.2%) were chalmydia, 2,972 (25.2%) gonorrhea and 2,551 (21.6%) syphilis. Most cases with known countries of acquisition (n=5,431) were linked to Southeast Asia (n=2,390, 44.6%), the Americas (n=663, 12.4%), and Northwest Europe (n=580, 10.8%).
Conclusions: Overseas-acquired STIs were highest before the pandemic, primarily driven by travel to regions with high prevalence of STIs such as Southeast Asia. The variation of origins of acqusition and demogrpahic trends identified in this study highlight the critical need for tailored safer-sex advice during pre-travel consultations, particularly for males and young adults travelling to high-risk destinations.
Background: International travel is a significant contributor to the acquisition of sexually transmissible infections (STIs). Despite the high volume of outbound travel from Australia, peaking at 10.8 million travellers in 2023, limited data exist on the burden of overseas-acquired STIs.
Objective: To estimate the burden and trends of overseas-acquired STIs (gonorrhoea, syphilis, and chlamydia) in Australia.
Methods: This study analysed STI notifications from Australia’s National Notifiable Diseases Surveillance System from January 2017 to December 2023. Geographical origins of overseas-acquired cases were visualised on a map, and temporal trends were assessed across pre-COVID-19, pandemic, and post-pandemic periods.
Results: Of 188,788 notified STI cases, 11,782 (6.2%) were acquired overseas. Males accounted for 63% of these cases, with young adults aged 20–24 years representing 24.6%. Overseas-acquired cases rose nearly three-fold from 1,444 (12.3%) in 2017 to 4,044 (34.3%) in 2019, before sharply declining during the COVID-19 pandemic (479 [4.1%] in 2020; 213 [1.8%] in 2021). Of all overseas-acquired STIs cases, 6,270 (53.2%) were chalmydia, 2,972 (25.2%) gonorrhea and 2,551 (21.6%) syphilis. Most cases with known countries of acquisition (n=5,431) were linked to Southeast Asia (n=2,390, 44.6%), the Americas (n=663, 12.4%), and Northwest Europe (n=580, 10.8%).
Conclusions: Overseas-acquired STIs were highest before the pandemic, primarily driven by travel to regions with high prevalence of STIs such as Southeast Asia. The variation of origins of acqusition and demogrpahic trends identified in this study highlight the critical need for tailored safer-sex advice during pre-travel consultations, particularly for males and young adults travelling to high-risk destinations.
Dr Elizabeth Bennett
Principal Public Health Medical Officer
Department Of Health Victoria
A comparative analysis of Victorian mpox outbreaks 2022-2025
Abstract
Introduction
A global outbreak of the viral disease mpox commenced in 2022. Australia experienced two distinct outbreak periods in 2022 and 2024, mainly affecting Victoria and New South Wales.
Aim
We aimed to compare the epidemiological features of Victorian cases between the two outbreak periods to inform control efforts.
Methods
We extracted records of confirmed mpox cases in Victoria from the Public Health Event Surveillance System (PHESS) and categorised cases by notification date: pre-2024 outbreak (May 2022 to March 2024), and 2024 outbreak (April 2024 to January 2025). Demographic, clinical and risk characteristics were compared across these periods.
Results and discussion
Between May 2022 and January 2025, 578 mpox cases were notified in Victoria; 499 were during the 2024 outbreak. In both outbreaks, cases had a median age of 36 years and 99% were male, with 6 female cases and one child case in the 2024 outbreak. Local transmission dominated the 2024 outbreak; imported cases decreased from 44% to 3%. Geographic distribution of cases shifted from northern to central and western Melbourne. Male-to-male sexual contact was identified in 90% of cases in both time periods.
The 2024 outbreak saw an increase in cases living with HIV (13% to 23%) and cases on HIV pre-exposure prophylaxis (PrEP) (43% to 61%), reflecting rapid community uptake of PrEP. Vaccination rates (two doses) among cases rose from 11% to 41%.
No deaths were reported. Hospitalisation and emergency department presentations decreased from 11% to 9% and 15% to 10% respectively, likely due to increased vaccination uptake or reduced case ascertainment.
Conclusion
This analysis highlights the shifting epidemiology of mpox in Victoria since its emergence. The 2024 outbreak was larger, with broader geographic and demographic distribution and decreased case severity. Increased involvement of people engaged in HIV prevention and care demonstrates an opportunity to improve vaccination uptake in these cohorts.
A global outbreak of the viral disease mpox commenced in 2022. Australia experienced two distinct outbreak periods in 2022 and 2024, mainly affecting Victoria and New South Wales.
Aim
We aimed to compare the epidemiological features of Victorian cases between the two outbreak periods to inform control efforts.
Methods
We extracted records of confirmed mpox cases in Victoria from the Public Health Event Surveillance System (PHESS) and categorised cases by notification date: pre-2024 outbreak (May 2022 to March 2024), and 2024 outbreak (April 2024 to January 2025). Demographic, clinical and risk characteristics were compared across these periods.
Results and discussion
Between May 2022 and January 2025, 578 mpox cases were notified in Victoria; 499 were during the 2024 outbreak. In both outbreaks, cases had a median age of 36 years and 99% were male, with 6 female cases and one child case in the 2024 outbreak. Local transmission dominated the 2024 outbreak; imported cases decreased from 44% to 3%. Geographic distribution of cases shifted from northern to central and western Melbourne. Male-to-male sexual contact was identified in 90% of cases in both time periods.
The 2024 outbreak saw an increase in cases living with HIV (13% to 23%) and cases on HIV pre-exposure prophylaxis (PrEP) (43% to 61%), reflecting rapid community uptake of PrEP. Vaccination rates (two doses) among cases rose from 11% to 41%.
No deaths were reported. Hospitalisation and emergency department presentations decreased from 11% to 9% and 15% to 10% respectively, likely due to increased vaccination uptake or reduced case ascertainment.
Conclusion
This analysis highlights the shifting epidemiology of mpox in Victoria since its emergence. The 2024 outbreak was larger, with broader geographic and demographic distribution and decreased case severity. Increased involvement of people engaged in HIV prevention and care demonstrates an opportunity to improve vaccination uptake in these cohorts.
