Monkeypox

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What is monkeypox?

Monkeypox is a rare disease that is caused by infection with Monkeypox virus. Monkeypox virus is related to the smallpox virus, but typically causes a less serious disease including a rash or sores (pox), often with an earlier flu-like illness. Most cases of monkeypox have occurred in individuals living in Central and West Africa, however, as of May 2022, cases have been identified in several countries where it is not typically found, including Canada.

Current epidemiological information suggests that infections in non-endemic areas, including Ontario, are spreading via close physical contact with an individual who is infectious with monkeypox, and many (but not all) cases self-identify as men who have sex with men (MSM).

How is monkeypox spread?

Monkeypox spreads in different ways. The virus can spread from person-to-person through:

  • direct contact with the infectious rash, scabs, or body fluids
  • respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex
  • touching items (such as clothing, towels or linens) that previously touched the infectious rash or body fluids
  • pregnant people can spread the virus to their fetus through the placenta

While this route of transmission has not been seen in the current outbreak in non-endemic countries, direct contact with infected animals is also a way that the virus can spread.

Monkeypox can spread from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks. People who do not have monkeypox symptoms cannot spread the virus to others. At this time, it is not known if monkeypox can spread through semen or vaginal fluids.

What symptoms should I watch for?

Symptoms can occur on average 7 to 14 days after contact with an individual infected with monkeypox but can range from 5 to 21 days. Symptoms of monkeypox can include:

  • Early flu-like symptoms:
    • Fever
    • Headache
    • Muscle aches and backache
    • Swollen lymph nodes
    • Chills
    • Exhaustion
  • A rash or sores, sometimes located on or near the genitals or anus, but sometimes in other areas like the hands, feet, chest, or face – sores will go through several stages before healing
  • Sores may be inside the body, including the mouth, vagina, or anus
  • Some people experience a rash or sore first, followed by other symptoms and some only experience a rash or sores.

How do I get tested for monkeypox?

Individuals who have symptoms consistent with monkeypox, especially those with a high-risk exposure to a human case of monkeypox or a history of travel to a region that has reported confirmed cases of monkeypox, should be tested. Assessment by a health care provider is required who will order the appropriate testing if clinically indicated.

All individuals who are tested for monkeypox must self-isolate until the infection is ruled out by laboratory testing. Those that test positive must isolate until no longer contagious (e.g., scabs have fallen off and new skin has formed underneath, typically 2-4 weeks).

If you have been in close contact with an individual infected with monkeypox, monitor for signs and symptoms for 21 days from the day you may have been exposed. If you develop symptoms of monkeypox, you should contact a health care provider to get advice on testing and/or medical care and tell them if you think you have had contact with a person with monkeypox. Self-isolate at home if possible and avoid close contact with others until you receive information from the Simcoe Muskoka District Health Unit.

What is the treatment for Monkeypox?

For mild infections, most people will recover on their own within 2-4 weeks with supportive care including rest, fluids, and pain relievers. Supportive care for managing symptoms includes:

  • Letting the rash dry or covering the rash with a moist dressing to protect the area, if needed.
  • Avoiding touching any sores in the mouth or eyes. If needed, mouth rinse or eye drops can be used, but products containing cortisone should be avoided.

Tecovirimat (TPoxx®) has been approved by Health Canada to treat very sick patients in hospital with monkeypox infection.

Imvamune® vaccine was approved by Health Canada in 2020 for adults 18 years of age and older who have been in close contact with someone with monkeypox. Close contacts may be recommended to receive Imvamune® vaccine by their health care provider to help prevent them from getting sick. Imvamune® vaccine is not recommended for people who have had minimal or no exposure to monkeypox. Some communities where monkeypox cases have been identified are being offered vaccination as pre-exposure protection. Current clinic locations and dates can be found on the Gay Men's Sexual Health Alliance website.

How do I protect myself and others?

There are number of measures that can be taken to prevent infection with monkeypox virus:

  • Practice good hand hygiene by washing your hands with soap and water or using an alcohol-based hand sanitizer when hands are not visibly dirty
    • Wash your hands after handling nose or throat secretions (e.g., after disposal of facial tissues containing nose and throat secretions)
  • Ask people if they have symptoms before you have close contact
  • Do not share personal items such as water bottles, straws, eating utensils, cigarettes, toothbrushes, linens, clothing, or anything else that has been in contact with saliva, nose or throat secretions
  • Cough or sneeze into your elbow and encourage others to do the same
  • If you are ill, stay at home and isolate yourself from others
  • Clean hands, objects, surfaces, bedding, towels, and clothes regularly
  • Condoms and dental dams can be used to protect against monkeypox but may not provide full protection, as they do not always cover the lesions/rash completely
  • Wear a medical mask and use disposable gloves if caring for an individual infected with monkeypox.