Health Care Professionals: mpox (formerly Monkeypox) virus

• 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)

Who to test for mpox

• Testing is recommended for individuals with a compatible clinical illness where mpox is suspected. 

• 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. 

Collecting 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. 

Testing for other pathogens

• Testing for herpes viruses (e.g. herpes simplex, varicella) may be ordered on the same specimens being tested for mpox. Swabs from lesions and nasopharyngeal specimens submitted from pediatric patients (< 18 years) will be tested for Enterovirus. If any other tests are required, submit additional specimens.

Sending 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, including travel and exposure history. Clearly mark the outer packaging with “TU 0886” on a contrasting background; this is the certificate number required per the Transportation of Dangerous Goods Act. 

• IPAC Recommendations for mpox in Health Care Settings (Public Health Ontario): summary of recommended routine and additional precautions.

Are there additional IPAC requirements for mpox testing?

• See PHO’s 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. Note that in the absence of respiratory symptoms, an N95 respirator may not be required. Healthcare providers should maintain these additional precautions until all scabs have fallen off and new skin is present.

Management of Patients Tested for Mpox

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).

For more information, refer to Recommendations for the management of cases and contacts of mpox in Ontario.

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

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.

• Recommendations for the management of cases and contacts of mpox in Ontario, Ontario Ministry of Health
• Case Definitions and Disease-Specific Information Disease: Smallpox and other Orthopoxviruses including mpox, Ontario Ministry of Health
• Mpox in Ontario: epidemiological summary from Public Health Ontario (search epidemiological summary) for characteristics of cases to date and risk factors.

• Mpox page for the general public, Ottawa Public Health
• About mpox, U.S. Centers for Disease Control and Prevention