Monkeypox

Monkeypox is a viral illness most commonly found in parts of Central and West Africa. The virus is usually spread to humans by touching or being bitten by an infected animal such as rodents or non-human primates. Monkeypox may spread from human to human but this is rare. Outside of Africa, cases have usually been linked to international travel or imported animals from these regions.

Images of individual monkey pox lesions (source: UK Health Security Agency).

In May 2022, human cases of monkeypox were identified in several countries where it is not typically found and the Public Health Agency of Canada (PHAC) has confirmed cases in Canada. Investigations are ongoing, but many of the global cases identified to date have reported close or intimate contact with other cases, or sexual contact with anonymous partners such as at a bar or party. The Public Health Agency of Canada (PHAC) is aware of and monitoring for potential risks to Canadians and is working with provincial and territorial partners to monitor for and investigate potential cases.

Public health authorities and clinicians in Canada are advised to be vigilant and consider monkeypox when patients present with an unusual, unexplained rash and other clinical signs consistent with monkeypox (e.g. fever, headache, and/or lymphadenopathy), particularly in individuals who may have been exposed. Clinicians are encouraged to consult infectious disease specialists when assessing a suspected monkeypox case.


Symptoms

Symptoms are typically flu-like, and can include:

  • fever,
  • headache,
  • muscle aches,
  • back aches,
  • chills,
  • exhaustion, and
  • swollen lymph nodes.

Several days after these symptoms appear, a rash may appear anywhere on the body, but is typically found on the face, palms of the hands and soles of the feet. The lesions progress through four stages (macular, papular, vesicular, to pustular) before scabbing over and resolving, over a period of two to three weeks. Although this virus is not known to be a sexually transmitted infection, close intimate contact during sex is known to be a risk factor, and the lesions may start and be localized to the sites of contact (e.g. genital lesions).

The severity of illness depends on the health of the infected individual, how they were exposed, and the strain of the infecting virus. There are two strains. The West African strain, which has been identified in the current global outbreak, typically causes milder illness than the Central African strain. In previous outbreaks, monkeypox infection has caused death in between 0 to 10 per cent of those infected, with the higher rate seen among those infected with the Central African strain.

Transmission

In countries where monkeypox is commonly found, the virus is believed to mainly spread to humans through direct contact with an infected animal (i.e. via a bite or scratch, or though bush meat preparation).

Monkeypox does not generally spread easily between people. Human-to-human transmission can occur with:

  • prolonged face to face contact via respiratory droplets,
  • direct contact with monkeypox lesions or bodily fluids,
  • indirect contact with contaminated surfaces and materials, such as bedding and clothes.

A person is considered infectious for five days prior to the onset of the rash and until all the skin lesions have resolved.

Diagnosis and Testing

Health care providers should discuss all suspected cases with an Infectious Disease specialist to coordinate appropriate testing and management. The diagnosis is confirmed by PCR laboratory testing.


Treatment

Most cases are self-limited, which means they don’t require treatment, and resolve within 2 to 4 weeks. It is unknown whether or not a person with severe monkeypox infection will benefit from treatment with antivirals, although their use may be considered on a case by case basis.

Prevention

Individuals with symptoms of monkeypox should speak with their health care provider and avoid contact with others to help prevent the spread of this infection.

During their infectious period (from the start of their symptoms until their rash has resolved), individuals should:

  • Isolate at home, and physical distance from others in the home,
  • Wear a well-made, well-fitting mask (if sharing space with others),
  • Cover any lesions,
  • Avoid sharing objects or exposing other people to clothes, linens, or other materials used,
  • Practice proper hand hygiene (washing with soap and water for at least 15 seconds) and respiratory etiquette, and
  • Call ahead, if seeking health care, and let them know you have symptoms of monkeypox to avoid exposing other people. Wear a well-made, well-fitting mask and cover any lesions.

Public health will follow-up on close contacts of cases. Close contacts will be asked to monitor for symptoms including fever, chills, swollen lymph nodes, and skin rashes for 21 days. During this monitoring period, close contacts should:

  • Limit your contact with the person who is a suspected case if you live with them, avoid sleeping in the same bed, and wear a mask if sharing the same space;
  • Practice general hygiene measures including proper hand hygiene (washing with soap and water for at least 15 second) and respiratory etiquette;
  • Not donate blood, cells, tissue, breast milk, semen, or organs;
  • Avoid sexual contact with others; and
  • If symptoms develop, isolate at home and follow guidance above to prevent spread to others. Notify public health or Health Links – Info Santé (204-788-8200 or toll-free at (1-888-315-9257)) of your symptoms. You should be assessed by your health care provider. Call ahead and let them know you have been exposed to monkeypox and have symptoms, to avoid exposing other people. Wear a well-made, well-fitting mask and cover any lesions.

Vaccine Eligibility

Imvamune® is the name of the vaccine used to protect against the monkeypox virus. Imvamune® is approved by Health Canada for use in adults who are assessed as being at high-risk for exposure to monkeypox. Limited supply of the vaccine is available in Manitoba.

Imvamune® can be used in two different ways:

  • Before exposure to monkeypox virus
    • This is called pre-exposure prophylaxis. By giving the vaccine before exposure to the virus, it can help protect against monkeypox.
  • After exposure to monkeypox virus and before you develop symptoms
    • This is called post-exposure prophylaxis. If the vaccine is given shortly after exposure to monkeypox, it may help prevent the disease or make it less severe.

More information on Imvamune® and vaccination can be found in the monkeypox vaccine factsheet.

Eligibility for pre-exposure prophylaxis:

Eligible individuals are cisgender, transgender or two-spirit people who self-identify as belonging to the gay, bisexual and other men who have sex with men (gbMSM) community and who meet at least one of the following criteria:

  • Have received a diagnosis of chlamydia, gonorrhea, and/or syphilis in the past two months,
  • Have had two or more sexual partners in the last 21 days,
  • Have attended locations for sexual contact (e.g. bath houses or sex clubs) or are planning to,
  • Have had anonymous sex in the past 21 days (i.e. using apps, online sites, formal/informal gatherings) or are planning to, or
  • Engage in sex work or plan to, either as a worker or a client.

Note: at this time, due to the limited vaccine supply, individuals will be provided with a single dose of vaccine for pre-exposure prophylaxis.

Preventive immunization for eligible people can be booked at three locations in Winnipeg using the online booking tool at https://patient.petal-health.com/login?groupId=6032 beginning August 8, 2022: 

  • Klinic Community Health, 167 Sherbrook St.,
  • Access Winnipeg West, 280 Booth Dr., and
  • Our Own Health Centre, 230 Osborne St.

People who do not have internet access can call Health Links-Info Santé at 204-788-8200 or 1-888-315-9257, as they can use the online tool to book an appointment on behalf of the caller. Note: online booking is available for eligible people who are 18 years and older. Individuals who are younger than 18 years old should contact their local public health office to discuss if pre-exposure vaccination is right for them.

Individuals outside of Winnipeg should contact their local public health office to schedule an immunization. Public health will also be reaching out to eligible populations to support immunization efforts.

Eligibility for post-exposure prophylaxis:

  • Close contacts of a confirmed or probable monkeypox case

If you are a close contact of a confirmed or probable monkeypox case, contact your local public health office or Health Links – Info Santé (204-788-8200 or toll free at 1-888-315-9257). Note: even if you have already received a dose of Imvamune® for pre-exposure prophylaxis, you may be eligible for a second dose as post-exposure prophylaxis.

For more information about the monkeypox vaccine, contact your local public health office, Health Links – Info Santé (204-788-8200 or toll free at 1-888-315-9257), or your health care provider.



Manitoba Health Resources

For Health Care Providers

For the Public


Other Resources

Communicable Disease Control (CDC)
Public Health
Manitoba Health

4th Floor - 300 Carlton St.
Winnipeg MB  R3B 3M9  CANADA

Health Links – Info Santé
204-788-8200 or 1-888-315-9257

Ask Health