Health Care Professionals: mpox (formerly Monkeypox) virus

Background information

  • Mpox (monkeypox) virus overview: includes information on transmission and clinical signs / symptoms as well as links to important documents and resources (Ontario Ministry of Health)
  • Mpox fact sheet: provides an overview of the virus, transmission, epidemiology, clinical considerations including treatment and prevention (World Health Organization)
Laboratory testing
  • Testing and management of mpox: provides information on the clinical presentation, management, and testing for mpox in primary care (Ontario Health)
  • Testing information for mpox virus: provides information on the indications for testing, specimen collection and handling, test requisitions, reporting, and testing methods (Public Health Ontario Laboratory)
Infection Prevention and Control
Reporting to Public Health

Mpox is reportable immediately to Ottawa Public Health (this includes those tested 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 mpox 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 mpox virus page for more information.
Health Care Professional mpox FAQ

Who should be tested for mpox?

Individuals with a compatible clinical illness and mpox is suspected should be tested. 

Mpox can have range of clinical presentations; common symptoms include fever, new rash/lesions in the mouth, genital, and/or peri-anal region, rectal pain, and lymphadenopathy. Symptoms of mpox in vaccinated individuals may be milder or subclinical; in at-risk groups, such as those with new and/or multiple partners, use a lower threshold to test. Although most cases in Ontario have been identified among men who have sex with men, anyone can acquire mpox infection.

Approval for mpox virus 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 mpox testing?

Submit a maximum of three skin lesion specimens per individual – sensitivity improves little beyond swabbing three 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 mpox 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 mpox 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. 

Are there additional IPAC requirements for mpox testing?

See PHO’s Infection Prevention and Control (IPAC) Recommendations for mpox in Health Care Settings. In outpatient settings, it is recommended to place an individual with suspect, probable or confirmed mpox 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 mpox specimen collection. 

Appropriate PPE when assessing individuals with signs or symptoms of mpox 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 mpox. All other tests ordered will be put on hold until mpox 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 mpox. 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 Laboratory (PHOL) for mpox testing. Please complete the PHO General Test Requisition, and clearly mark the outer packaging with “TU 0886” (see below). 

Effective July 25, 2022, clinical specimens from patients undergoing mpox 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 and information from PHOL. 

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.

Do individuals tested for mpox need to isolate?

Any patient you suspect has mpox (including anyone you test for mpox) should be advised of mitigation measures to reduce transmission. Individuals do not need to self-isolate but should adhere to risk mitigation measures (see below) if all of the following criteria are met:

  • All skin lesions can be covered
  • There are no or mild systemic symptoms, including absence of fever
  • The individual can adhere to risk mitigation measures outlined in the guidance

Individuals unable to adhere to risk mitigation measures should self-isolate. If symptoms progress or the individual is no longer able to adhere to risk mitigation measures such that the above criteria are no longer met, the individual should self-isolate.

If it is not feasible to assess whether someone with suspected or confirmed mpox infection should be self-isolating, please consider recommending self-isolation until further assessed by OPH. Please flag this when reporting to OPH so that OPH can contact and assess the individual in a timely manner.

Risk mitigation measures include:

  • Performing frequent hand hygiene.
  • Covering skin lesions (e.g., bandages, long sleeves, long pants, gloves).
  • Wear a medical mask for source control (if safe and tolerated) if there are lesions inside the mouth/oral cavity and/or respiratory symptoms such as a cough or sore throat present.
  • Avoiding close or direct contact with individuals at higher risk of severe mpox illness where feasible (i.e., people who are immunocompromised and/or pregnant, children under 12 years of age), if possible.
  • Avoiding interactions where prolonged close, direct skin-to-skin contact with others may occur (e.g., sexual contact, large crowds, participation in contact sports such as wrestling).
  • Avoiding congregate settings (e.g., homeless shelter, long-term care facility), if possible.
  • Avoiding use of shared recreational water facilities (e.g., pool, hot tub).
Additional Physician Resources
Patient resources

Contact us

Monday to Friday from 8:30 am to 4:30 pm: Call 613-580-2424, extension 24224, select your language of choice by pressing 1 or 2 and then and leave a detailed, confidential message including your contact information.

After hours, on weekends, or holidays: Call 3-1-1 and ask to speak to Public Health on call. To have your call prioritized as a health care provider, please identify yourself and your reason for calling; your call will be prioritized for answer by the next available public health nurse.

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