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Monkeypox

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Reporting Obligations

Suspect, probable, and confirmed cases should be reported to the Health Unit by completing pages 1–4 of the Reporting Form and faxing to 613-345-5777.

Epidemiology

Aetiologic Agent

Infectious agent for Monkeypox is the Monkeypox virus a species of Orthopoxvirus. There are two genetically distinct clades of monkeypox virus: the West African clade and the Congo Basin clade. The West African clade is the one circulating in Canada and beyond Africa at this time.

The West African clade of monkeypox virus is generally associated with less severe disease compared to the Congo Basin clade. The virus causes a disease with symptoms similar to, but less severe than smallpox. Monkeypox is typically mild and self-limiting, with most people recovering within 2–4 weeks. However, severe illness can occur in some individuals.

Clinical Presentation

A prodrome period may occur lasting 1–3 days and includes: fever, chills, myalgias, fatigue, headache, backache, and sometimes sore throat and cough. Lymphadenopathy is a prominent feature in the prodrome and early stages of monkeypox illness. This is followed by a progressively developing rash over the next week or so. Lesions progress through stages of macules, papules, vesicles, pustules to crusts/scabs before falling off, and all lesions are usually at the same stage. Complications[1] of monkeypox can include secondary infections, bronchopneumonia, sepsis, encephalitis, infection of the cornea with ensuing loss of vision, and myocarditis.

Please refer to CDC’s Clinical Recognition for examples of Monkeypox rashes.

Modes of Transmission

Monkeypox – Monkeypox virus is a completely different virus than the viruses that cause COVID-19 or measles. It is not known to linger in the air and is not transmitted during short periods of shared airspace. Monkeypox spreads through direct contact with body fluids or sores on the body of someone who has monkeypox, or with direct contact with materials that have touched body fluids or sores, such as clothing or linens. It may also spread through respiratory secretions when people have close, face-to-face contact.

CDC Monkeypox Response: Transmission | CDC Online Newsroom | CDC

Incubation Period

From 6–13 days; commonly 5–21 days from infection to onset of illness.

Period of Communicability

While monkey pox is communicable during the prodromal period, the highest risk of communicability is during the rash phase until all lesions have crusted, fallen off, and new skin has formed, about 2 to 4 weeks.

Risk Factors/Susceptibility

Please see Table 2 of PHO’s Interim Case and Contact Management for assessing exposure risk.

The key to prevention is to:

Be aware, know about symptoms, know what to do, and know how to reduce the risk (see above).

There are number of measures that can be taken to prevent infection with monkeypox virus:

  • Avoid contact with any materials, such as bedding, that has been in contact with a sick animal.
  • Isolate infected people from others who could be at risk for infection.
  • Practice good hand hygiene after contact with infected animals or humans. For example, washing your hands with soap and water or using an alcohol-based hand sanitizer.
  • Use personal protective equipment (PPE) when caring for patients.
  • Avoid contact with animals that could harbor the virus (including animals that are sick or that have been found dead in areas where monkeypox occurs).

There may be some protection for individuals who previously received Smallpox vaccine. [2]

Imvamune® vaccine for post-exposure prophylaxis (PEP) is available for adults 18 years of age and over, who meet the definition of a high risk contact of a confirmed or probable case. Provision of Imvamune® vaccine requires a risk assessment by the public health unit. Please call the Infectious Diseases program at 1-800-660-5853, extension 2222, for more details and to discuss ordering and administration.

Diagnosis and Laboratory Testing

Refer to PHOL’s Laboratory testing information at: Monkeypox Virus – Public Health Ontario

Treatment

Tecovirimat (TPoxx®), is available for the treatment of hospitalized severely ill patients. Hospital clinicians can request product by contacting the Ministry of Health Emergency Operations Centre at [email protected] or by calling the Healthcare Provider Hotline at 1-866-212-2272.

Case and Contact Management

All individuals for whom monkeypox testing is being performed should be advised to self-isolate at home (or in the community) pending test results.

Confirmed or probable cases in whom hospitalization is not clinically indicated should self-isolate at home until the end of the period of communicability for a monkeypox case (i.e., until lesion scabs have fallen off and new intact skin has formed below, a process which varies by individuals but typically takes 2–4 weeks).

  • Ending of the self-isolation period should be assessed on an individual case basis and in consultation with the local public health unit.

Detailed information on isolation, waste management in the home, and caring for pets is available PHOs Interim Case and Contact Guideline.

Contact Tracing is conducted by Public Health according to PHOs Interim Case and Contact Guideline – see above.

Additional Resources

Ministry of Health. Emergency Planning and Preparedness: Monkeypox virus. Monkeypox Virus (gov.on.ca)

Ministry of Health. Q&A for Monkeypox Interim Vaccine Guidance for Post-Exposure Prophylaxis (PEP) and How to Access Tecovirimat

Public Health Ontario Monkeypox Interim Case Contact Guideline

Ministry of Health. Monkeypox Vaccne (Imvamune®) Guidance for Health Care Providers

Ministry of Health. Monkeypox Vaccine Information Sheet.

Public Health Ontario

References

Ministry of Health and Long-Term Care, Infectious Diseases Protocol, 2022.