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Emergency Planning and Preparedness

Monkeypox Virus

Monkeypox is an orthopoxvirus caused by the Monkeypox virus (MPXV), typically transmitted from animals to humans, that 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.

Monkeypox is considered to be endemic in countries from central and western Africa. Since May 2022, numerous cases of monkeypox have been reported from several countries where monkeypox is not endemic, including Canada. This represents a highly unusual event.

When spread does occur, transmission is primarily through respiratory secretions or direct or indirect contact with body fluids, material from skin lesions, and contaminated materials. People can lower their risk of exposure to monkeypox by maintaining physical distance and employing frequent hand and respiratory hygiene, including masking.

Although the risk for monkeypox is low, anyone who has had close physical contact with someone who has monkeypox or contaminated surface or is concerned about symptoms they are experiencing should self-isolate and contact a health care professional. Prior vaccination against smallpox provides some cross-protection against monkeypox.

Ontario has made monkeypox a reportable disease and positive test results are sent to the local public health unit. This will support public health officials with case and contact management. Ontario is currently providing the Imvamune® vaccine as part of a targeted effort to contain onwards transmission of monkeypox.

The Ministry of Health is working collaboratively with Public Health Ontario, the Public Health Agency of Canada, and public health units to monitor for cases in Ontario.

Health Sector Resources

Document Title

Date

Monkeypox Vaccine (Imvamune®) Guidance for Health Care Providers September 30, 2022
Monkeypox Vaccine Information Sheet June 14, 2022
Imvamune® Vaccine Storage and Handling Guidance September 30, 2022
Memo - Chief Medical Officer of Health: Monkeypox June 16, 2022
Monkeypox Antiviral Guidance for Health Care Providers August 5, 2022
Monkeypox Antiviral Information Sheet June 30, 2022
Fact Sheet: Monkeypox - Reference guide comparing monkeypox, chickenpox, and hand-foot-and-mouth disease July 13, 2022

Recommendations for the management of cases and contacts of monkeypox in Ontario

November 18, 2022

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Key Facts

  • Monkeypox is typically found in parts of central and west Africa. It does not usually circulate in humans or animals in Canada.
  • Initial symptoms of monkeypox may include fever, chills, headache, swollen lymph nodes, muscle pain, and fatigue followed by a rash or sores, usually one to three days later, on the palms of the hands, on the soles of the feet, inside the mouth, and/or on the genitals. In some cases, the rash is the first symptom.
  • Monkeypox is usually mild. It typically goes away on its own within two to four weeks.
  • Those who have close contact with someone who has monkeypox infection while the person has symptoms are at risk of getting the virus.
  • Severe cases are more common among newborns, children, pregnant people, and people who are immunocompromised. You can reduce your risk of getting monkeypox by avoiding close contact with people who have confirmed monkeypox or people with symptoms that might be due to monkeypox infection.

How does monkeypox spread?

Monkeypox can spread from person-to-person through respiratory secretions or through close, physical contact with someone who has monkeypox (especially from contact with the rash, bodily fluids, and/or scabs).

Monkeypox can also spread by touching materials and objects (e.g. clothing, bedding, towels, eating utensils, and dishes) that may be contaminated.

Monkeypox can also spread from someone who is pregnant to the fetus, or from a parent to a child during or after birth.

What should I do if I’ve been to a venue where there was someone with suspected or confirmed monkeypox?

Monitor for signs and symptoms for 21 days from the day you may have been exposed to someone with monkeypox. See below for what to do if you develop symptoms of monkeypox.

What should I do if I’ve been in contact with someone who has monkeypox?

Monitor for signs and symptoms of monkeypox for 21 days from the day of your last exposure to the person with suspected or confirmed monkeypox. See below for what to do if you develop symptoms of monkeypox.

Consider wearing a mask (medical mask preferred) when you are in indoors with other people.
Local public health units will work to identify and notify close contacts of a person with monkeypox and may:

  • Advise you to avoid non-essential interactions with people at higher risk of severe monkeypox illness.
  • Advise you on whether Imvamune® vaccine may help prevent monkeypox infection or reduce the risk of severe illness.  

What should I do if I develop symptoms of monkeypox?

If you develop symptoms of monkeypox (including fever, headache, muscle aches, swollen lymph nodes, and/or rash or sores) you should contact a health care provider to get advice on testing and/or medical care and tell them if you think you have had contact with a person with monkeypox. You should also follow the recommendations below:

  • Self-isolate at home if possible and avoid close contact with others, until you receive information from your local public health unit about when to end isolation. Stay in a separate room or area away from other people in the home and use a separate bathroom.
  • Wear a medical mask.
  • Cover any rashes or sores as best as possible when you are unable to avoid close contact with other people.
  • People should not visit a person with monkeypox symptoms unless it is for an essential purpose.
  • People with monkeypox symptoms should avoid contact with those at higher risk of severe illness including people who are pregnant or immunocompromised, and children under age 12 years.

Clean your hands and the environment:

  • Clean your hands often with soap and water or an alcohol-based hand sanitizer, including after touching the rash or sores, clothing, or objects and surfaces that may have had contact with the rash or sores.
  • Clean and disinfect contaminated surfaces (e.g., bathroom, if shared) after use with regular household cleaning/disinfectants according to the manufacturer’s instructions.
  • Do not share dishes or utensils when eating; however, dishes/utensils can be used by others in the home if these are properly washed between uses either in a dishwasher or in a sink, using warm water and soap.
  • Avoid direct contact with any laundry/linens that have touched the rash, bodily fluids, and scabs of the person with monkeypox symptoms. Handle laundry/linens with care and avoid shaking. Laundry can be cleaned in a washing machine with warm water and detergent.

What to do if I have been tested or test positive for monkeypox?

If you’ve been tested for monkeypox, self-isolate at home until your test results are known. If your test results are negative, you can stop self-isolating. If you test positive, continue to self-isolate at home until a staff person from your local public health unit contacts you to provide further information about monkeypox, including how to prevent spreading monkeypox to others and when you can end your self insolation.
If you need to seek medical care:

  • Call a health care provider ahead of time to inform them of your health status, that you are being tested for monkeypox, and about any contact you had with a person with suspected or confirmed monkeypox.
  • Wear a medical mask when seeking medical care.

Is there a vaccine for monkeypox?

Imvamune® vaccine is approved in Canada for protection against smallpox, monkeypox, and other orthopoxvirus-related illnesses. Imvamune® is not a treatment for monkeypox and must be given before you have symptoms of monkeypox.

Given the current epidemiology in in Ontario, Imvamune® should be offered as a two-dose primary series, with at least 28 days between first and second doses for individuals currently eligible for pre-exposure or post-exposure vaccination. Certain research laboratory employees are also eligible for two doses of Imvamune®. This approach will continue to be evaluated with any changes in the epidemiology and vaccine. Although two doses are available, one dose provides good protection.

Currently, in Ontario, Imvamune® may be received as:

  • Pre-Exposure Prophylaxis (PrEP), which means receiving the vaccine prior to any monkeypox exposure (for those who are likely to be exposed).
  • Post-Exposure Prophylaxis (PEP), which means receiving the vaccine after a potential exposure. The vaccine should ideally be given within 4 days but can be given up to 14 days after the last exposure.

If you think you have been exposed to monkeypox, contact your local public health unit to see if you may be eligible to receive vaccine.

If you have monkeypox symptoms, you should contact a health care provider to get advice on testing and/or medical care.

Who is at higher risk for monkeypox and eligible for pre-exposure prophylaxis (PrEP) vaccine?

  1. Two-spirit, non-binary, transgender, cisgender, intersex, or gender-queer individuals who self-identify or have sexual partners who self-identify as belonging to the gay, bisexual, pansexual and other men who have sex with men (gbMSM) community AND at least one of the following:

    • Have or had a confirmed sexually transmitted infection within the last year,
    • Have or are planning to have two or more sexual partners or are in a relationship where at least one of the partners may have other sexual partners,
    • Have attended venues for sexual contact (e.g., bath house, sex clubs) recently or may be planning to, or who work/volunteer in these settings
    • Have had anonymous sex (e.g., using hookup apps) recently or may be planning to, and/or are a sexual contact of an individual who engages in sex work.
  2. Individuals who self-identify as engaging in sex work or are planning to, regardless of self-identified sex or gender.

Household and/or sexual contacts of those identified for PrEP eligibility in parts 1 or 2 above AND who are moderately to severely immunocompromised or pregnant may be at higher risk for severe illness from a monkeypox infection. These individuals may be considered for PrEP and should contact their healthcare provider (or their local public health unit) for more information.

What treatment is available for monkeypox?

Symptoms usually go away on their own without the need for any treatment. In specific rare situations, your healthcare provider may recommend a medication for monkeypox.

Supportive care for managing symptoms includes:

  • Letting the rash dry or covering the rash with a moist dressing to protect the area, if needed.
  • Avoiding touching any sores in the mouth or eyes. If needed, mouth rinse or eye drops can be used, but products containing cortisone should be avoided.

How can I care for someone with monkeypox infection, or with symptoms that may be due to monkeypox infection?

If you need to provide care to someone with monkeypox symptoms or confirmed to have monkeypox, you should:

  • Encourage the person to cover their rash and sores as best as they can (e.g., wearing a long sleeve shirt and long pants).
  • Wear a medical mask and encourage the person to wear a medical mask when you are physically close to them.
  • Avoid skin-to-skin contact.
  • If you provide direct care that may involve touching the rash and sores, wear a medical mask and use disposable gloves.
  • Follow the guidelines above in Clean your Hands and the Environment.

What animals can get monkeypox?

Several types of animals have been found to be susceptible to monkeypox, including rodents (e.g., rats, mice, hamsters, gerbils, squirrels, chipmunks), rabbits, hedgehogs, opossums, and non-human primates (e.g., monkeys).

Recently, monkeypox was reported on a dog that had close contact with its infected owners. As such, precautions should be taken to prevent exposure of the virus to domestic and wild mammals.

Veterinarians that suspect an animal has been infected with monkeypox should call the Ontario Ministry of Agriculture Food and Rural Affairs at 1-877-424-1300 to discuss management plans.

I have companion animals in my home. What precautions should I take?

As the risk of infection in different animal species is unclear, it is best to find someone else to take care of your pet until you are no longer infectious.

Precautions to help reduce the risk of monkeypox transmission to your pets, or to other people via your pets include:

  • Avoid close or prolonged contact with pets and their belongings (e.g., avoid touching, snuggling, kissing animals, having animals sleep in your bed etc.) and their belongings.
  • Individuals with underlying health conditions, or children under the age of 5, should avoid being caregivers to exposed or infected animals.
  • While infectious, keep your pets in the home, if possible. For dogs that need to go outside periodically, keep them on leash and avoid contact with other people and animals.
  • While infectious, wear personal protective equipment and perform hygiene measures, as recommended to reduce the risk of transmission to other people, when interacting with animals, their food, and supplies.

If you have any questions about the health or care of your animals when you are exposed or infected with monkeypox, please contact your veterinarian

What if my pet becomes sick while I still have monkeypox?

Seek care from a veterinary telemedicine service, to assess if the animal’s condition can be managed at home.

If your animal must be examined directly by a veterinarian or requires other procedures that cannot be reasonably delayed until your own infection is resolved, your veterinarian should be advised that your pet may have been exposed to monkeypox.

I own or work with livestock or poultry, and I have, or think that I may have been exposed to, monkeypox. What should I do?

As a precaution, any person who has, or may have been exposed to, monkeypox should not work with livestock or poultry until they are advised by their physician or a public health official that they don’t pose any risk for transmission of the virus.

Animal owners are responsible for providing basic care for their animals including food, water, and shelter. Livestock and poultry producers should always have a plan in place for others to provide care for their animals in case of emergencies, including the need to self-isolate due to illness or to avoid contact with animals if exposed.

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Additional Resources

Public Health Ontario - Monkeypox | Public Health Ontario
Public Health Agency of Canada - Monkeypox: For health professionals - Canada.ca
United States Centres for Disease Control - Monkeypox | Poxvirus | CDC
United States Centres for Disease Control - 2022 Monkeypox Outbreak Global Map | Monkeypox | Poxvirus | CDC

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For More Information

Ministry of Health
Health System Emergency Management Branch
1075 Bay Street, Suite 810
Toronto, Ontario
Canada M5S 2B1
Fax : 416-212-4466
TTY : 1-800-387-5559
E-mail : emergencymanagement.moh@ontario.ca

 

Health workers and health sector employers can call the Healthcare Provider Hotline for more information
Toll free : 1-866-212-2272

CritiCall Ontario provides a 24 hour call centre for hospitals to contact on-call specialists; arrange for appropriate hospital bed access and facilitate urgent triage for patients
1-800-668-4357

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