Health Care Professionals: Monkeypox virus (MPXV)

Please note that this page is currently under construction and more content will follow. In the interim, Ottawa Public Health offers the following links for information:

Background information

  • Monkeypox virus overview: includes information on transmission and clinical signs / symptoms as well as links to important documents and resources (Ontario Ministry of Health).
  • Pathogen Safety Data Sheet for Monkeypox: provides referenced technical information on the infectious agent, transmission, etiology, treatment and vaccination, and IPAC precautions (Public Health Agency of Canada).
  • Information for clinicians: includes detailed clinical information on treatment, case and contact management, and vaccination (USA Centers for Disease Control and Prevention).
  • Monkeypox detailed fact sheet: Provides an overview of the virus, transmission, epidemiology, clinical considerations including treatment, case and contact management, and prevention (World Health Organization).
Laboratory testing
  • Testing information for monkeypox virus: provides information on the indications for testing, specimen collection and handling, test requisitions, reporting, and testing methods (Public Health Ontario).

Health Care Professional Monkeypox FAQ

Who should be tested for monkeypox?

Individuals with a compatible clinical illness in which monkeypox is suspected should be tested. Symptoms can vary and our understanding of the current monkeypox outbreak continues to evolve. See the weekly provincial Epidemiological Summary for characteristics of cases to date and a brief discussion of risk factors. 

Approval for monkeypox testing is not required, nor is it required to contact Public Health Ontario (PHO) Customer Service Centre prior to specimen submission. 

Contact PHO Customer Service (416-235-6556/1-877-604-4567) or after hours the on-call Duty Officer (416-605-3113) if you wish to consult PHO prior to sample collection and shipment. 

How do I collect specimens for monkeypox testing?

Submit a maximum of 3 skin lesion specimens per individual – sensitivity improves little beyond swabbing 3 lesions. Select skin lesions from different anatomical locations or from lesions that differ in appearance. To collect adequate viral DNA, vigorously swab the lesion; it is not necessary to de-roof the lesion before swabbing. Skin lesion swabs or skin lesion material are most sensitive for the detection of monkeypox virus; nasopharyngeal (NP) / throat swabs and blood specimens are generally not recommended in individuals who have skin lesions that can be tested. If individuals do not have skin lesions but monkeypox is suspected, please submit a blood sample along with an NP or throat swab.  

Use the PHO General Test Requisition, and note the following requirements for each specimen type:

  1. Lesion material (e.g., fluid, crust, scab) or swab of lesion: 
    • Sterile tube/container (note: submit a dry swab or reduce the viral transport media volume to <1mL to avoid excessive dilution of the sample); or 
    • Virus culture collection kit (order # 390081)
  2. NP and/or throat swab:  
    • Sterile tube/container (note: submit a dry swab or reduce the viral transport media volume to <1mL to avoid excessive dilution of the sample); or
    • Virus respiratory collection kit (order # 390082)
  3. Serum sample:
    • Red top or serum separator tubes 

To order testing supplies from PHOL, complete the Requisition for Specimen Containers and Supplies

Visit Monkeypox Virus | Public Health Ontario for more details on monkeypox testing in Ontario. 

Are there additional IPAC requirements for monkeypox testing?

See PHO’s Infection Prevention and Control (IPAC) Recommendations for Monkeypox in Health Care Settings. In outpatient settings, it is recommended to place an individual with suspect, probable or confirmed monkeypox infection in a single-patient room, with the door closed. If a single-patient room is not available, then precautions should be taken to minimize exposure to surrounding individuals, such as having the patient don a medical mask, maximizing distancing from others and covering exposed skin lesions with clothing, sheet or gown as best as possible. An airborne infection isolation room (AIIR) is not required for monkeypox specimen collection. 

Appropriate PPE when assessing individuals with signs or symptoms of monkeypox includes gloves, gown, eye protection, and fit-tested N95 respirator. Healthcare providers should maintain these additional precautions until all scabs have fallen off and new skin is present.

Can I request testing for other pathogens on the specimen?

Indicate on all requisitions that the patient is suspected of having monkeypox. All other tests ordered will be put on hold until Monkeypox virus testing is completed.  

Testing for herpes viruses (e.g. Herpes simplex, Varicella) and Enterovirus may be ordered on the same specimens being tested for monkeypox – these will be performed once monkeypox testing is completed. If any other tests are required, submit additional specimens.

How do I send the specimens to the Public Health Ontario Lab (PHOL)?

You can use your typical lab courier service for sending specimens to the Public Health Ontario Lab (PHOL) for monkeypox testing. Please complete the PHO General Test Requisition, and clearly mark the outer packaging with “TU 0886” (see below). 

Effective June 2, 2022, clinical specimens from patients undergoing Monkeypox testing have been temporarily reclassified as UN3373 Biological Substance, Category B for land transport. The exemption applies to transportation by land (in a road vehicle, railway vehicle, vessel, between two points in Canada). In addition to the routine Category B requirement, the outer packaging must be marked, on a contrasting background, with “TU 0886”, “Temporary Certificate – TU 0886” or “Certificat Temporaire – TU 0886”. For full details on packaging and transporting, see the Temporary Certificate TU 0886

Note: At this time, specimens requiring air transport still require Category A packaging and transportation.

Sample label for taping onto Category B box:

Sample label for land transportation of monkeypox testing specimens, indicating that the specimen is biological substance category B, with temporary certificate code TU 0886, and that in case of damage or leakage, one should notify local authorities immediately and call 1-888-226-8832.

How do I notify OPH that an individual has or may have monkeypox infection?

Monkeypox is reportable immediately to Ottawa Public Health (this includes suspect cases for whom lab results are not yet available): 

  • Monday to Friday from 8:30 am to 4:30 pm: Call 613-580-2424, extension 24224 or fax 613-580-9640. A generic webform and reporting form (pdf - 235 KB) are available for your convenience. 

  • After hours, on weekends, or holidays: Call 3-1-1 

Do individuals tested for monkeypox need to isolate?

Any patient you suspect has monkeypox (including anyone you test for monkeypox) must isolate at home until they have been contacted by OPH and advised that they can discontinue isolation. Further instructions on self-isolation for individuals and their caregivers can be found on the provincial Monkeypox Virus (gov.on.ca) page. 

Infection Prevention and Control
Reporting to Public Health

Monkeypox is reportable immediately to Ottawa Public Health (this includes suspect cases for whom lab results are not yet available):

  • Monday to Friday from 8:30 am to 4:30 pm: Call 613-580-2424, extension 24224 or fax 613-580-9640. A generic webform and reporting form (pdf - 235 KB) are available for your convenience.
  • After hours, on weekends, or holidays: Call 3-1-1
Vaccination
The Imvamune® live non-replicating vaccine for monkeypox is available to select eligible persons for both Post-Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP). Please direct eligible persons interested in accessing this vaccine to our general monkeypox virus page for more information.
Physician Resources
Patient resources

Contact us

For more information, contact Ottawa Public Health at 613-580-6744. Please provide your designation and reason for calling to ensure call priority.

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