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Note: Consistent with the World Health Organization’s November 28, 2022 announcement, OPH will now refer to human monkeypox disease as mpox.
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)
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| Infection Prevention and Control |
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| Reporting to Public Health |
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Mpox is reportable immediately to Ottawa Public Health (this includes those tested for whom lab results are not yet available):
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| 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, use a lower threshold to test. 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:
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:
Do individuals tested for mpox need to isolate?Any patient you suspect has mpox (including anyone you test for mpox) should be advised to 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 mpox virus (gov.on.ca) page. |
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| Patient resources |
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