Monkeypox

How Monkeypox Spreads

Monkeypox typically spreads from a person with the virus to others through:

• Prolonged close contact with respiratory droplets from breathing, talking, coughing or sneezing.
• Skin-to-skin contact with lesions, blisters, rashes.
• Contact with objects, fabrics and surfaces used by someone who has the virus.

The virus enters the body through breaks in the skin or through the eyes and mouth.

Someone with monkeypox can usually pass on the virus when they develop a skin rash or blisters, but it may also spread when they have early symptoms including fever and headache.

Symptoms & Diagnosis

Symptoms usually start within six to 13 days after being exposed to monkeypox, but can start anywhere from five to 21 days after exposure.

Symptoms include:

• Fever
• Headache
• Muscle aches
• Backache
• Swollen lymph nodes
• Chills
• Feeling extremely tired
• Cough or sore throat (sometimes)
• Runny nose
• Rash with blisters that can appear one to three days after fever, but in some cases, can appear before fever or other symptoms. The rash usually begins as flat red spots (that can look like pimples or heat rash), which turn into blisters and then form a crust. In some cases, the rash appears around the mouth, genital or anorectal (bum) areas.

Monkeypox is diagnosed by a healthcare provider, based on symptoms and a laboratory test.

More Information:

• CDC: Visual examples of monkeypox rash
• Gay Men’s Sexual Health Alliance: Photos of Monkeypox Lesions

How to Prevent the Spread of Monkeypox

• Consider limiting the number of people you have close skin-to-skin contact with.
• Avoid touching blisters or rashes on another person.
• Talk to sexual partners about sexual health and use barriers such as gloves and condoms.
• Avoid sharing objects that come into contact with another person’s body fluids such as toothbrushes, sex toys and drug use supplies.
• Avoid prolonged close face-to-face contact with others, especially indoors.
• Wear a mask in indoor public spaces, when possible.
• Clean and disinfect frequently-touched surfaces (such as door handles, countertops and phones) and fabrics (such as clothing and bedding). Standard household cleaners/disinfectants/detergents can be used to kill the virus on surfaces.
• Avoid touching bedding and laundry that has been in contact with someone who has monkeypox.
• Stay home if you are sick, and encourage others to do the same.
• Clean your hands with soap and water or use an alcohol-based hand sanitizer.
• Get vaccinated, if eligible.

If you are caring for someone who has monkeypox at home:

• Use personal protective equipment (PPE), including disposable gloves and mask.
• Encourage the person to cover their rash and blisters (use bandages, wear a long sleeve shirt and long pants) and to wear a mask when you are close to them.
• Avoid skin-to-skin contact, including contact with blisters.
• Clean your hands with soap and water after each contact with the person.

What to do if You Think You Have Monkeypox

If you think you have monkeypox, it is important to isolate right away and contact a health care provider.  For more information on how to self-isolate, visit the Monkeypox Self-Isolation Guidance page.

You can get tested for monkeypox at a healthcare provider’s office, local walk-in clinic or sexual health clinics. Call in advance to make sure that monkeypox testing is available. Please do not call or go to an emergency department for testing. Only go to the emergency department if you need emergency care.

The most accurate monkeypox test is a swab of the fluid from bumps, blisters, sores or scabs.   Throat and nose swabs, as well as a blood test are available but less accurate.  A health care provider will decide which test is recommended.

Toronto Public Health will contact and give guidance to people who test positive for monkeypox as well as known close contacts of someone who tests positive.

People who have been in contact with a person who has monkeypox should monitor themselves for symptoms for 21 days. If no symptoms appear you can continue with normal activities. If symptoms develop, you should isolate and contact a healthcare provider.

Most people recover from monkeypox on their own within 2 to 4 weeks. However, some people can get seriously sick. Most people do not require treatment for monkeypox.

Monkeypox Vaccine & Eligibility

Imvamune® vaccine is approved in Canada for protection against monkeypox. The vaccine contains modified virus and cannot make you sick.

The vaccine can be used for protection against monkeypox before getting exposed to the virus (Pre-Exposure Prophylaxis – PrEP) or after being exposed (Post-Exposure Prophylaxis – PEP). It is not used as a treatment if you already have monkeypox. At this time, people who have or have had monkeypox are not eligible for the vaccine because they have natural immunity.

After getting the vaccine, it takes two weeks to build protection. During these two weeks, consider reducing your number of close contacts, including sex partners.

Toronto Public Health continues to follow federal and provincial guidance on the administration of Imvamune vaccines to protect at-risk populations against the monkeypox virus.

Because of the limited vaccine supply, right now Ontario is using a single dose of Imvamune to reduce the risk of monkeypox transmission. However, two doses are recommended for moderately to severely immunocompromised individuals and certain research laboratory employees.

Based on Ontario Ministry of Health guidelines, the vaccine is available for the following eligible groups:

For Pre-Exposure Prophylaxis (PrEP)

1. 1. Two-spirited, non-binary, transgender men and women 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:
      • Diagnosed with a bacterial sexually transmitted infection (STI) in the past two months (e.g. chlamydia, gonorrhea, or syphilis);
      • Recently had two or more sexual partners or may be planning to;
      • Recently attended venues for sexual contact (e.g. bathhouses, sex clubs) or may be planning to, or who work/volunteer in these settings;
      • Recently had anonymous/casual sex (e.g. using hook up apps) or may be planning to;
      • A sexual contact of an individual who engages in sex work
   2. Anyone who engages in sex work or may be planning to.
   3. Household and/or sexual contacts of people who are eligible for PrEP – listed above in parts (a) or (b) – AND have a weak immune system or are pregnant. These individuals should contact a healthcare provider or Toronto Public Health for more information.

For Post-Exposure Prophylaxis (PEP)

• People who have a known exposure/close contact with someone with monkeypox can get the vaccine.
• When the vaccine is used as PEP, it should be given within four days, but can be given up to 14 days after the last exposure.

Second Dose Eligibility

Based on Ontario Ministry of Health guidelines, the following groups are eligible for two vaccine doses given 28 days apart:

• Individuals who meet the Provincial eligibility criteria for PrEP and are moderately to severely immunocompromised. A referral letter from a healthcare provider or proof of medication (see page 11) is required in order to get the second dose.
• Research laboratory employees working directly with replicating orthopoxviruses. This completed form must be provided.

Contact a healthcare provider or Toronto Public Health to find out if you are eligible for PrEP or PEP. The vaccine is free and available to all eligible people. No ID or OHIP required. Appointments are preferred but walk ins are welcome.

Wait to get vaccinated if you have any COVID-19 symptoms and/or you are required to self-isolate.

If you think you have monkeypox, isolate right away and contact a health care provider. Do not visit any monkeypox vaccination clinics.

Vaccine Side Effects & Risks

Side Effects

The vaccine may cause some side effects. Most are mild to moderate, and do not last longer than seven days. Common side effects include:

• Redness, pain or swelling at the injection site.
• Feeling tired
• Headache
• Muscle aches

Contact a health care provider or go to the nearest emergency department if you have any of these symptoms after getting the vaccine:

• Hives
• Swelling of the face or mouth
• Trouble breathing or shortness of breath
• Chest pain or a pounding heart

Vaccine Ingredients & Allergies:

Individuals who are allergic or hypersensitive to any vaccine ingredient should speak with a healthcare provider before getting the vaccine. Learn more about the list of ingredients.

Imvamune may contain trace amounts of antibiotics (gentamicin and ciprofloxacin) and egg products. People with known hypersensitivity to these products are still able to safely get the vaccine, but should be monitored for an extra 15 minutes (30 minutes total) after getting vaccinated.

Contact a health care provider or go to the nearest emergency department if you have any of these symptoms after getting the vaccine:

• Hives
• Swelling of the face or mouth
• Trouble breathing or shortness of breath
• Chest pain or a pounding heart

Getting the vaccine at the same time as another vaccine:

Right now, we don’t have information about getting Imvamune at the same time as other vaccines. It is recommended:

• Not to delay getting Imvamune if you were exposed to monkeypox or are at high risk of exposure, even if you have recently gotten another vaccine, as the benefits are bigger than the risks.
• To wait 4 weeks before or after getting Imvamune and another vaccine if you have not been exposed to monkeypox or are not at high risk of exposure.
• To speak with a healthcare provider if you are getting Imvamune less than 4 weeks before or after another vaccine, as this may make the second vaccine less effective.

Adverse Events Following Immunization (AEFI):

An AEFI is any time you feel unwell more than what you were told to expect after getting a vaccine. If you think you are experiencing an AEFI, contact a health care provider.

Your health care provider will report the AEFI to Toronto Public Health (TPH). TPH will help the health care provider investigate if your illness was caused by the vaccine. TPH reports AEFIs to the Ontario Ministry of Health, Public Health Ontario, and the Public Health Agency of Canada to make sure that vaccines continue to be safe. Companies that make vaccines do not help investigate AEFIs.

Clinics

Toronto Public Health (TPH) and community partners will be hosting the following Monkeypox vaccination clinics for at-risk populations.

People who meet the provincial criteria for vaccination to prevent monkeypox infection can book an appointment at a City-run clinic through the TPH Booking System. Appointments are preferred but walk ins are also accepted. An OHIP card is not required. The vaccine is free and available to all eligible people.

Metro Hall

Day(s) and hour of operation: Mondays to Thursdays, 12 p.m. to 6 p.m.; Sundays 10 a.m. to 4 p.m.

Address: 214 Wellington St. W., Main Floor

Use the Metro Hall entrance accessible from the north side of Wellington St., east of John St.

(View map of clinic location at Metro Hall)

Accessibility: This clinic location is accessible. Please bring all required mobility devices with you. From the main floor of Metro Hall, clinic access is via an accessibility elevator or a short flight of stairs.

Cloverdale Mall

Day(s) and Hours of Operation: Tuesdays to Fridays, 12 p.m. to 6 p.m.; Saturdays 10 a.m. to 4 p.m.

Address: 250 The East Mall

The clinic is located at the north end of mall (in the previous Target store location). Enter the clinic via the exterior entrance only.

(View map of clinic location within Cloverdale Mall)

Accessibility: This clinic location is accessible. Please bring all required mobility devices with you.

Parking: Free parking is available at the mall. Parking at the north end of the mall is closest to the clinic.

1 Eglinton Square (Eglinton Ave. & Pharmacy Ave.)

Day(s) and Hours of Operation: Tuesday to Friday, noon to 6 p.m. and Saturday, 10 a.m. to 4 p.m. First day of operation is Saturday, September 3.

Address: 1 Eglinton Square , Units 36-37

(Location map to be added)

Accessibility: This clinic location is accessible. Please bring all required mobility devices with you. The clinic is on the main floor so there is no need to use an elevator and there are no stairs involved.

Parking: Free parking is available in the Eglinton Square plaza parking lot. The clinic is close to the Metro and TD entrance.

The 519

Day(s) and Hours of Operation: Wednesday, August 31, 2 p.m. to 6:30 p.m.

Address: 519 Church St., Toronto

The following community clinics are available by appointment only. Please call or visit the website of the clinic you wish to visit directly to book your appointment.

 

Safer Six

Day(s) and Hours of Operation

• Monday: 3-7:30 p.m.
• Tuesday: 3-6:30 p.m.
• Wednesday: 3-7 p.m.
• Friday: 3-7 p.m.
• Saturday: 9 a.m. -12 p.m.

Address: 27 Roncesvalles Avenue – Suite 505, Toronto

Phone: (647) 657-4033

Visit the Safer Sex website for more information.

Specialty Health Clinic

Day(s) and Hours of Operation: Mondays to Fridays, 10 a.m.- 6 p.m.

Address: 34 Wellesley Street E, first floor

Phone: (416) 972-9131

Accommodations at City-run Clinics

The following City-run clinics provide the Monkeypox vaccine: Metro Hall, Cloverdale Mall, and 1940 Eglinton Ave E.

All City-run clinics are able to offer accommodation.

Vaccine Clinic Accessibility

Each City-run clinic has parking near the entrance, ramps, elevators, and wheelchairs. Staff are also on site at each clinic to support if required. Clients who need a care provider or service animal with them will be accommodated. There are also privacy rooms available upon request. If you require an accommodation, alert a staff member upon arrival or at any time while at the clinic.

Vaccine Clinic Accommodation Request

You may request an accommodation ahead of attending a City-run clinic. You will be asked the date and time when you plan to access your vaccination dose and a public health nurse will contact you within two business days to confirm the details of your request.

Request an Accommodation

Monkeypox Cases in Toronto

To view the latest data on Monkeypox in Toronto, visit Public Health Ontario’s Monkeypox webpage.

More Information

• Monkeypox Virus Overview (Ontario Ministry of Health)
• Monkeypox: What We Know (Gay Men’s Sexual Health Alliance) – translated information available
• Monkeypox: Questions and Answers (World Health Organization)

Resources

Document Image	Description	Translations
Prevent the Spread of Monkeypox Poster	Download the Prevent the Spread of Monkeypox Poster	Spanish
Preventing Monkeypox Spread Checklist	Download the Preventing Monkeypox Spread Checklist Poster
Reduce the Spread of Monkeypox When Using Drugs Poster	Download the Reduce the Spread of Monkeypox When Using Drugs Poster	Spanish
Monkeypox Self-Screening Poster	Download the Help Stop the Spread of Monkeypox Poster
Monkeypox Fact Sheet	Download the Monkeypox Fact Sheet	Spanish
Monkeypox Vaccine Fact Sheet	Download the Monkeypox Vaccine Fact Sheet	Arabic | Chinese – Simplified | Korean | Somali | Spanish | Urdu | Vietnamese
Monkeypox Stigma & Discrimination	Download the Monkeypox Stigma & Discrimination Poster
Differences between Monkeypox, Chickenpox, and Hand, Foot & Mouth Disease	Download the Differences between Monkeypox, Chickenpox, and Hand, Foot & Mouth Disease Poster