Emergency Planning and Preparedness
MPOX Virus
MPOX (formerly known as monkeypox) is an orthopoxvirus caused by the MPOX virus, typically transmitted from animals to humans, that causes a disease with symptoms similar to, but less severe than, smallpox. MPOX is typically mild and self-limiting, with most people recovering within two to four weeks. However, severe illness can occur in some individuals.
MPOX is considered to be endemic in countries from central and western Africa. Since May 2022, numerous cases of MPOX have been reported from several countries where MPOX 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 MPOX by maintaining physical distance and employing frequent hand and respiratory hygiene, including masking.
Although the risk for MPOX is low, anyone who has had close physical contact with someone who has MPOX 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 MPOX.
Ontario has made MPOX 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 MPOX.
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 |
|---|---|
| MPOX Vaccine (Imvamune®) Guidance for Health Care Providers | December 14, 2022 |
| MPOX Vaccine Information Sheet | December 14, 2022 |
| Imvamune® Vaccine Storage and Handling Guidance | January 11, 2023 |
| Memo - Chief Medical Officer of Health: MPOX | June 16, 2022 |
| MPOX Antiviral Guidance for Health Care Providers | December 14, 2022 |
| MPOX Antiviral Information Sheet | December 14, 2022 |
| Fact Sheet: MPOX - Reference guide comparing MPOX, chickenpox, and hand-foot-and-mouth disease | July 13, 2022 |
|
Recommendations for the management of cases and contacts of MPOX in Ontario |
February 14, 2023 |
|
Information for Clinicians |
March 10, 2023 |
Key Facts
- MPOX is typically found in parts of central and west Africa. It does not usually circulate in humans or animals in Canada.
- Initial symptoms of MPOX 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.
- MPOX is usually mild. It typically goes away on its own within two to four weeks.
- Those who have close contact with someone who has MPOX 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 MPOX by avoiding close contact with people who have confirmed MPOX or people with symptoms that might be due to MPOX infection.
How does MPOX spread?
MPOX can spread from person-to-person through respiratory secretions or through close, physical contact with someone who has MPOX (especially from contact with the rash, bodily fluids, and/or scabs).
MPOX can also spread by touching materials and objects (e.g. clothing, bedding, towels, eating utensils, and dishes) that may be contaminated.
MPOX 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 MPOX?
Monitor for signs and symptoms for 21 days from the day you may have been exposed to someone with MPOX. See below for what to do if you develop symptoms of MPOX.
What should I do if I’ve been in contact with someone who has MPOX?
Monitor for signs and symptoms of MPOX for 21 days from the day of your last exposure to the person with suspected or confirmed MPOX. See below for what to do if you develop symptoms of MPOX.
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 MPOX and may:
- Advise you to avoid non-essential interactions with people at higher risk of severe MPOX illness.
- Advise you on whether Imvamune® vaccine may help prevent MPOX infection or reduce the risk of severe illness.
What should I do if I develop symptoms of MPOX?
If you develop symptoms of MPOX (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 MPOX. 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 MPOX symptoms unless it is for an essential purpose.
- People with MPOX 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 MPOX 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 MPOX?
If you’ve been tested for MPOX, 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 MPOX, including how to prevent spreading MPOX 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 MPOX, and about any contact you had with a person with suspected or confirmed MPOX.
- Wear a medical mask when seeking medical care.
Is there a vaccine for MPOX?
Imvamune® vaccine is approved in Canada for protection against smallpox, MPOX, and other orthopoxvirus-related illnesses. Imvamune® is not a treatment for MPOX and must be given before you have symptoms of MPOX.
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 MPOX 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 MPOX, contact your local public health unit to see if you may be eligible to receive vaccine.
If you have MPOX symptoms, you should contact a health care provider to get advice on testing and/or medical care.
Who is at higher risk for MPOX and eligible for pre-exposure prophylaxis (PrEP) vaccine?
- 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.
- 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 MPOX 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 MPOX?
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 MPOX.
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 MPOX infection, or with symptoms that may be due to MPOX infection?
If you need to provide care to someone with MPOX symptoms or confirmed to have MPOX, 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 MPOX?
Several types of animals have been found to be susceptible to MPOX, including rodents (e.g., rats, mice, hamsters, gerbils, squirrels, chipmunks), rabbits, hedgehogs, opossums, and non-human primates (e.g., monkeys).
Recently, MPOX 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 MPOX 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 MPOX 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 MPOX, please contact your veterinarian
What if my pet becomes sick while I still have MPOX?
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 MPOX.
I own or work with livestock or poultry, and I have, or think that I may have been exposed to, MPOX. What should I do?
As a precaution, any person who has, or may have been exposed to, MPOX 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.
Additional Resources
Public Health Ontario - MPOX | 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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