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Local Update On Monkeypox

UPDATED August 29, 2022: Currently the risk of monkeypox to residents of Simcoe Muskoka is very low.

The health unit continues to closely monitor the situation and advise anyone who develops symptoms or who has had contact with a suspected or known case of monkeypox to contact their healthcare provider immediately.

Individuals who are awaiting test results or have a confirmed monkeypox infection must remain isolated. For further information, please refer to the health unit’s guidance for self-isolation.

NEW: The Ministry of Health has updated the Monkeypox Vaccine (Imvamune®) Guidance for Health Care Providers (Version 2.2 – August 24, 2022) to reflect expanded eligibility for Imvamune®. For details, see the Monkeypox vaccine (Imvamune®) eligibility expansion expander bar below.

NOTE:  Pre-exposure prophylaxis vaccine is available by appointment at clinics being held at the Gilbert Centre in Barrie to protect those most at risk of contracting the monkeypox virus. For details, see the Monkeypox Vaccine and Clinics expander bar below.

Monkeypox is a rare disease caused by the monkeypox virus. It is part of the same family as smallpox, though typically less severe. It is found mostly in areas of Africa but has been seen in other areas of the world. Monkeypox causes flu-like symptoms such as fever and chills, and a rash develops within a few days. There is no proven treatment for monkeypox, although antiviral treatment is available for severe cases. Monkeypox usually goes away on its own.

Monkeypox typically does not spread easily between people. Person-to-person spread may occur through:

  • sexual or intimate contact with an infected person
  • contact with clothing or linens (such as bedding or towels) used by an infected person
  • direct contact with monkeypox skin lesions or scabs
  • respiratory transmission from an individual with monkeypox.

The virus enters the body through broken skin (even if not visible), the respiratory tract or the mucous membranes (eyes, nose or mouth).

Monkeypox is usually a mild illness, with most people recovering on their own after a few weeks; however, some may have severe illness and need to be hospitalized. People typically develop symptoms five to 21 days after being exposed to the monkeypox virus. Symptoms occur in two stages and typically last from two to four weeks.

In stage one, symptoms may include:

  • fever
  • chills
  • swollen lymph nodes
  • headache
  • muscle pain
  • joint pain
  • back pain
  • exhaustion

In stage two of the illness, a rash develops - usually within one to three days (sometimes longer) after the fever starts. The rash often starts on the face or extremities, however it can affect other parts of the body, such as the hands, feet, mouth and genitals.

The rash can last between 14 and 21 days and changes through different stages before finally forming a scab which later falls off.

Imvamune® vaccine is approved in Canada for protection against monkeypox. The vaccine contains weakened virus and cannot make you sick. The vaccine can be used for protection against monkeypox before getting exposed to the virus (pre-exposure prophylaxis) or after being exposed (post-exposure prophylaxis). Read more about the vaccine here.

Pre-Exposure Prophylaxis:

NEW: In partnership with the Gilbert Centre, SMDHU is offering pre-exposure prophylaxis vaccination clinics to protect those most at risk of contracting the monkeypox virus.

Vaccination clinics are being offered at the Gilbert Centre's InclusHIV Care Clinic, 562-80 Bradford St. in Barrie, by appointment only for:

  • Tuesday, September 6
  • Friday, September 23

Appointments can be booked by calling the Gilbert Centre's InclusHIV Care Clinic at 705-790-6748. 

The vaccine is also available at other locations in Ontario. The full list of clinics and who is eligible is available on the Gay Men's Sexual Health Alliance website.  

Post-Exposure Prophylaxis:

Vaccination after exposure to monkeypox infection may prevent infection or lessen disease severity. When the vaccine is used as post-exposure prophylaxis, it should be given within four days, but can be given up to 14 days after the last exposure. Please contact your primary care provider if you are concerned that you have been exposed to monkeypox.

The Ministry of Health has updated the Monkeypox Vaccine (Imvamune®) Guidance for Health Care Providers (Version 2.2 – August 24, 2022) to reflect expanded eligibility for Imvamune®.

The following is a summary of the updates:
Use of Imvamune® in Ontario

  • Ontario continues to use a single dose of Imvamune® strategy to limit ongoing transmission in the populations most at risk of exposure to the monkeypox virus.
  • Two doses are now recommended for moderately to severely immunocompromised individuals and certain research laboratory employees.

 

First Dose Eligibility:

  • The following groups are now eligible for first doses of Imvamune® vaccine for pre-exposure prophylaxis:

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 2 months;
  • Have had 2 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

** Household and/or sexual contacts of those identified for PrEP eligibility in parts (a) and (b) above AND are moderately to severely immunocompromised or pregnant may be at higher risk for severe illness from a monkeypox infection may be considered for PrEP and should contact their healthcare provider (or their local public health unit) for more information.

 

Second Dose Eligibility for Moderately to Severely Immunocompromised Individuals

  • Individuals who meet the Provincial eligibility criteria (above) and are moderately to severely immunocompromised as per Provincial guidelines (see Appendix A) are eligible to receive two doses of Imvamune® at least 28 days apart as PrEP. They require a referral letter or proof of medication (prescription or medication) in order to get the second dose. Prescriptions or medications must have been refilled within the last 6 months

 

Individuals who have had Previous Monkeypox Infection:

  • Individuals who have been a confirmed case of monkeypox in the current outbreak are NOT recommended to receive the Imvamune® 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.

 

Research Laboratory Employees

  • Research laboratory employees working directly with replicating orthopoxviruses, are eligible to receive two doses of Imvamune® vaccine at least 28 days apart as PEP or PrEP if there is an ongoing risk of exposure. For PrEP, referral letter is required.

 

Individuals with History of Previous Smallpox Vaccine

  • Individuals eligible for Imvamune® as PreP or PEP who previously received either an older generation replicating (live) smallpox vaccine or Imvamune® vaccine can be re-vaccinated:

a. For individuals with a history of receiving 1 dose of a live smallpox vaccine, a single dose of Imvamune® is recommended.

b. For individuals who completed a 2-dose series of Imvamune® more than 2 years ago, a single booster dose of Imvamune® is recommended.

c. For individuals who completed a 2-dose series of Imvamune® within the last 2 years, no further doses are recommended.
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