Monkeypox virus

Last revised: September 29, 2022

What is monkeypox?

Monkeypox is a rare viral disease caused by a virus usually found to be endemic in Central and Western Africa. Since May 2022, there have been cases of monkeypox in several countries where the disease is not normally found, including Canada. Ottawa Public Health announced the first confirmed case of monkeypox in Ottawa on June 17, 2022. The virus enters the body through broken skin, the respiratory tract or the mucous membranes, like the eyes, nose, or mouth. Monkeypox symptoms typically last from 2 to 4 weeks. In some cases, people can develop health complications from monkeypox which can lead to severe outcomes. Safe and effective vaccination along with prevention measures such as practicing safe sex, limiting the number of sexual partners, isolation when having symptoms, and avoiding sharing objects with an infected person will limit the spread of monkeypox.

Anyone can get infected and spread monkeypox if they come into close contact with someone who has the virus, regardless of sex, race, gender or sexual orientation. The monkeypox virus can affect anyone who is in close contact with an infected person such as direct contact with their body fluids, respiratory droplets, sores or by coming into contact with items they may have been in contact with. Currently, person to person transmission is occurring in Canada. In line with international trends, the majority of cases in Canada to date are men who reported intimate sexual contact with other men. However, it's important to stress that the risk of exposure to the monkeypox virus is not exclusive to any group or setting. According to the Public Health Agency of Canada (PHAC) the risk of infection is low for the general population.

What is Ottawa Public Health’s role?

Ottawa Public Health will follow up with and provide guidance and self-isolation instructions to those who are confirmed to have monkeypox and any possible contacts. Ottawa Public Health continues to work closely with the Ministry of Health and Public Health Ontario, local infectious disease experts and health care providers to limit the spread of monkeypox in the community.

Symptoms, prevention and testing

Commons signs and symptoms

  • Fever 
  • Chills

  • Headache

  • Muscle aches

  • Exhaustion 

  • Swollen lymph nodes 

  • New rash or lesions--(usually appears a few days after other symptoms on the faceand the extremities.) 

The incubation period (time between exposure/ infection and when symptoms begin) is typically six to 13 days, and can be up to 21 days. 

Monkeypox infection can appear similar to other infectious diseases, such as chickenpox, or several sexually transmitted infections (such as herpes or gonorrhea). This is why it's important to consult a health care provider and be tested.

If you think that you may have the signs and symptoms of monkeypox, and or are a close contact of someone who has confirmed monkeypox, please contact your health care provider for an assessment as soon as possible. Limit your contact with others and self-isolate.  

Most transmission of monkeypox in Canada has occurred between close contacts like intimate partners or household members.

Think you may have been exposed to monkeypox?

If you think you may have come in contact with someone who has symptoms of monkeypox, you should monitor yourself for symptoms for 21 days and contact Ottawa Public Health at 613-580-6744 for further assessment to see if post exposure prophylaxis, vaccination or testing is recommended.

If no symptoms appear after 21 days, you can continue with normal activities. If symptoms develop, you should self-isolate immediately and get tested for monkeypox.

How to get tested for monkeypox

There are two ways to get tested for monkeypox in Ottawa.

  1. Contact your healthcare provider
  2. Contact Ottawa Public Health at 613-580-6744 for further assessment and book an appointment for monkeypox testing at the Sexual Health Clinic on 179 Clarence Street in Ottawa.

What to do if you have been tested for monkeypox

If you have been tested for monkeypox, it is important to self-isolate at home until you receive negative test results. Ottawa Public Health will follow up with you if your test result is positive and advise on next steps.

If you test positive for monkeypox you should self-isolate at home until lesion scabs have fallen off and new intact skin has formed below. This recovery period typically takes two to four weeks.

If you have been tested for monkeypox or are experiencing symptoms you should:

  • Not attend work, school, or public areas

  • Stay in a separate room or area away from other household members 

  • Use a separate bathroom if available, including using separate towels

  • If unable to separate from household members you should:

    • Wear a medical mask

    • Cover skin lesions as much as possible (e.g., long sleeves, long pants)

    • Maintain a physical distance of at least two meters from others

  • Avoid sexual contact

  • Avoid leaving the home unless seeking urgent medical care

  • Avoid household visitors

  • Avoid contact with those at higher risk of severe monkeypox illness including people who are immunosuppressed or pregnant, and/or children under 12 years of age

  • Avoid contact with animals, including household pets as the virus can be spread to animals.

    • Keep your pets in the home and if possible, ask someone else in the home who is not sick to care for the pet.
    • Avoid close contact or prolonged contact with pets including touching, snuggling and kissing.
    • If having to care for the pet, you should wear a mask and wash hands with soap and water immediately before and after touching pets, their food, or supplies. If lesions are present on the hands, wear disposable gloves.

How to prevent the spread of monkeypox

To lower your overall risk of getting infected with and spreading the monkeypox virus, we recommend to:

  • Get vaccinated for monkeypox if eligible
  • Use condoms
  • Practice safe sex and having fewer sexual partners, particularly those who are anonymous, even when they don't have symptoms
  • Follow good hand hygiene. Wash your hands with soap and water or use an alcohol-based hand sanitizer.
  • Not kiss, hug, cuddle or have sex with someone who has or may have monkeypox. 
  • Avoid skin to skin contact with monkeypox rashes or lesions.
  • Avoid sharing objects such as toothbrushes, utensils, sex toys or drug equipment.
  • Clean and disinfect high touch surfaces (such as door handles and phones).
  • Avoid touching bedding and laundry that has been in contact with a person or animal that may have the virus.
  • Avoid contact with sick or dead animals
  • Use personal protective equipment (PPE) when caring for someone at home who has the virus, including a medical mask and disposable gloves for direct contact with lesions. 

Our observations are that close sexual contact remains the primary way that monkeypox is being transmitted in our community. If airborne transmission played a more significant role in overall transmission of monkeypox, we would anticipate a greater incidence of sporadic infections in the community across different age groups and demographics. 

In line with international trends, the majority of cases in Canada to date are men who reported intimate sexual contact with other men. However, it's important to stress that the risk of exposure to the monkeypox virus is not exclusive to any group or setting. According to the Public Health Agency of Canada (PHAC) the risk of infection is low for the general population.

Vaccination

Imvamune® is a vaccine that helps protect against monkeypox infection. Imvamune® is a live, non-replicating vaccine. The vaccine contains a very weakened form of a virus similar to the one that causes monkeypox and cannot make you sick. When a person is given the vaccine, the immune system will produce its own protection in the form of antibodies against the virus.  A single dose is expected to provide reasonable protection by two to four weeks following vaccination. A second dose produces a slightly higher response and may provide longer-lasting protection. If you are not eligible to receive a second dose, monitor for changes to the Ontario Ministry of Health recommendations and eligibility and return for a second dose if you become eligible. Imvamune® can be used to protect individuals before an exposure to the monkeypox virus (this is called Pre-Exposure Prophylaxis or PrEP) or to protect individuals after being exposed to the monkeypox virus (this is called Post-Exposure Prophylaxis or PEP).

Getting your first dose for protection before an exposure to the monkeypox virus

Check to see if you are eligible for your first dose and book an appointment online

  • You can also book and/or cancel an appointment by telephone at 613-691-5505.

Cancel your appointment

Who can receive their first dose for protection before an exposure to the monkeypox virus? 

Based on the Ontario Ministry of Health guidelines, the following groups are eligible for an Imvamune® vaccine for protection before an exposure to monkeypox if they meet one of the following criteria :

a) Two-spirited, non-binary, trans- or cis-gender individuals who self-identify or have sexual partners who self-identify as belonging to the gay, bisexual and other men who have sex with men (gbMSM) community AND at least one of the following:

  • Have received a diagnosis of bacterial STI (i.e., chlamydia, gonorrhea, syphilis) in the past two months;
  • Have had two or more sexual partners or may be planning to;
  • Have attended venues for sexual contact (i.e., bath houses, sex clubs) or may be planning to, or who work/volunteer in these settings; or
  • Have had anonymous sex (e.g., using hookup apps) or may be planning to; and/or
  • Are a sexual contact of an individual who engages in sex work.

b) Any individual who engages in sex work or may be planning to.

c) Household and/or sexual contacts of those identified for PrEP eligibility in parts (a) and/or (b) above AND who are moderately to severely immunocompromised or pregnant may be offered may be offered the Imvamune® vaccine. 

Getting your second dose for protection before an exposure to the monkeypox virus

We anticipate that the province of Ontario will soon expand the group of people who can receive a second dose of the monkeypox vaccine for pre-exposure protection. Please note that a second dose can only be given 28 days after receiving a first dose. OPH will be reaching out starting the week of October 3, 2022, via telephone and/or email messaging to individuals who received their first dose of the monkeypox vaccine at an OPH clinic and offer to book their second dose appointment at that time. 

Current eligibility for second doses

Eligibility for second doses of Imvamune® for protection before an exposure to the monkeypox virus

Laboratory employees working directly with replicating orthopoxviruses are eligible to receive two doses of Imvamune at least 28 days apart as post-exposure prophylaxis or pre-exposure prophylaxis if there is an ongoing risk of exposure.

Individuals who are moderately to severely immunocompromised and who are eligible for the monkeypox vaccine for protection before an exposure, or who have their first dose of the vaccine, and have an ongoing risk of exposure are eligible to receive two doses (total) the monkeypox vaccine at least 28 days apart.

If you are eligible for a second dose, call 613-691-5505 anytime Monday to Friday between 8:30 am and 4:30 pm to book a vaccine appointment

 

Moderately to severely immunocompromised

Moderately to severely immunocompromised is defined as:

  • Individuals receiving dialysis (hemodialysis or peritoneal dialysis)
  • Individuals receiving active treatment1 (e.g., chemotherapy, targeted therapies, immunotherapy) for solid tumour or hematologic malignancies
  • Recipients of solid-organ transplant and taking immunosuppressive therapy
  • Recipients of chimeric antigen receptor (CAR)-T-cell therapy or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
  • Individuals with moderate to severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • Individuals with HIV with current CD4 count ≤ 200/mm3 or CD4 fraction ≤ 15% or detectable viral load (i.e., not suppressed)
  • Individuals receiving active treatment with the following categories of immunosuppressive therapies: anti-B cell therapies2 (monoclonal antibodies targeting CD19, CD20 and CD22), high-dose systemic corticosteroids (refer to the Canadian Immunization Guide for suggested definition of high dose steroids), alkylating agents, antimetabolites, or tumor-necrosis factor (TNF) inhibitors and other biologic agents that are significantly immunosuppressive.

For more details, please go to page 10 of this document.

How are you prioritizing who will receive their second dose first?

We are awaiting further guidance from the province and will update our web page OttawaPublicHealth.ca/Monkeypox once prioritization is determined. 

I did not receive my first dose at an Ottawa Public Health Clinic, will I be able to get my second dose at an OPH clinic?

Yes, once you are eligible for a second dose you can contact Ottawa Public Health at 613-580-6744 to book your second dose appointment. Online appointment booking for second doses will also be available in the near future.

Do I have to show proof of vaccination of my first dose of the monkeypox vaccine before receiving my second dose?

If you receive a call from Ottawa Public Health regarding booking your second dose, then you will not need to provide a proof of vaccination. However, if you received your vaccine outside of an OPH clinic or of Ontario you will need to provide the date and location of where you received your first dose of the monkeypox vaccine.

Who can receive the vaccine for protection after being exposed to the monkeypox virus?

Imvamune® vaccine eligibility after being exposed to the monkeypox virus

If you have been identified as a high risk contact or an intermediate risk contact of a confirmed or probable case of monkeypox, you will be contacted by Ottawa Public Health directly and may be offered an appointment to receive the monkeypox vaccine for Post-Exposure Prophylaxis (PEP).

View clinic locations

Clinic locations:

Who should not receive the Imvamune® monkeypox vaccine?

Anyone who does not meet the current eligibility criteria outlined by the Ontario Ministry of Health is not eligible to receive the monkeypox vaccine.

Individuals who have been a confirmed case of monkeypox in the current outbreak are NOT recommended to receive the monkeypox vaccine at this time; this is based on the limited utility of the vaccine given that these persons are expected to have natural immunity due to recent infection.

People with signs and symptoms of Monkeypox infection should NOT receive the Imvamune monkeypox vaccine as it is not intended for the treatment of Monkeypox. Do not attend an Imvamune clinic if you have symptoms.

People who have a confirmed allergy to any of the vaccine ingredients or its container are not eligible for the monkeypox vaccine. Ingredients of the Imvamune® vaccine are:

  • Tromethamine (trometamol, Tris)

  • Sodium chloride

  • Water for injection

  • Hydrochloric acid

  • Bromobutyl rubber stopper

Imvamune® may also contain trace amounts of:

  • Gentamicin

  • Ciprofloxacin

  • Egg cell DNA and protein

  • Benzonase

If you have an allergy to eggs, gentamicin or ciprofloxacin, or an antibiotic in the same class as gentamicin (aminoglycosides) or ciprofloxacin (quinolones), please call 613-580-6744 for more information about eligibility for Imvamune®.

For Pre-Exposure Prophylaxis, it is currently recommended that people wait at least four weeks after receiving a live vaccine and at least two weeks after receiving an inactivated vaccine before receiving the monkeypox vaccine.

What should I expect after I receive the vaccine?

Side effects may develop in the few days after receiving the vaccine. Although most of these side effects are not serious to your health, they may make you feel unwell for a few days. The side effects should go away on their own.

Common side effects of Imvamune® include pain, swelling, redness and itchiness at the injection site where the needle was given. Applying a cool, damp cloth where the vaccine was given may help with pain and swelling.

Other common side effects can include fatigue, headache, body aches, nausea, loss of appetite, joint pain, chills and fever. If needed, pain or fever medication (such as acetaminophen or ibuprofen) may help.

People who have atopic dermatitis (eczema) may experience more side effects than others and may also experience a flare-up or worsening of their condition.

If you develop any serious signs or symptoms that could be an allergic reaction within four hours of being vaccinated, call 9-1-1 right away. Symptoms of an allergic reaction include:

  • Swelling of the face, tongue or throat
  • Difficulty breathing or wheezing
  • Hives (bumps on the skin that are often very itchy)

You should also seek medical attention right away if you develop any symptoms that could be related to your heart such as chest pain or discomfort, shortness of breath, and a fast or irregular heartbeat.

If you have concerns about the symptoms you develop after receiving the vaccine, contact your healthcare provider. Any adverse events following vaccination should be reported to your local public health unit.

Is the vaccine safe and effective?

Yes, Imvamune® is safe to receive. If you received another vaccination in the past 4 weeks, please let your health care provider know before getting Imvamune®. If you are less than 18 years of age, pregnant, breastfeeding, or are immunocompromised you should speak to your health care provider. Your health care provider will review the risks and benefits of receiving the monkeypox vaccine.

At this time, Ontario is using a single dose approach for Imvamune®. Second doses are limited to certain eligible individuals. A single dose is expected to provide reasonable protection by two to four weeks following vaccination. A second dose produces a slightly higher response and may provide longer-lasting protection. If you are not eligible to receive a second dose, monitor for changes to the Ontario Ministry of Health recommendations and eligibility and return for a second dose if you become eligible. See “Who is eligible for the Imvamune® monkeypox vaccine?” for more information.

We know that vaccination is not a 100% guarantee of not being infected with the virus that causes monkeypox. A single dose is expected to provide reasonable protection by two to four weeks following vaccination.  Waiting a full month after vaccination before resuming higher risk sexual contact, using condoms, staying home when having symptoms and having fewer sexual partners helps lower the risk of getting monkeypox. 

We have not seen many “breakthrough” cases of monkeypox where individuals had been vaccinated more than 4 weeks before developing monkeypox symptoms.

Although there is a relatively small sample size number of people being infected with monkeypox in Ottawa, we are beginning to see a much smaller number of people who have received the vaccine and have been infected with the virus that causes monkeypox. It is important to note that the majority of these vaccinated individuals had not been vaccinated for more than a month prior to being infected with the virus that causes monkeypox. Therefore, their vaccine-induced immune response was not yet fully developed before they were exposed to monkeypox. 

Monkeypox cases in Ottawa

If you want to know more about the numbers of confirmed, suspect or probable cases, you can visit the Public Health Ontario page (updated Tuesdays and Fridays).  

Background information 

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