Mpox

How Mpox Spreads

Mpox can spread from person to person through:

• Close/intimate or sexual contact (skin to skin)
• Direct contact with rashes, sores, scabs and bodily fluids
• Respiratory secretions (such as when a person coughs or sneezes)
• Contact with materials that have been contaminated with the virus (such as bedding, linens, towels, dressings, needles, eating utensils and dishes)

Someone with mpox can pass on the virus when they develop a skin rash or sores, but it may also spread when they have early symptoms including fever and headache. Recent evidence suggests that some people can spread the virus up to four days before symptoms begin.

Mpox can also be spread from someone who is pregnant to the fetus or from a parent to a child during or after birth.

Symptoms & Diagnosis

Symptoms usually start within six to 13 days after being exposed to mpox but can start anywhere from five to 21 days after exposure. Most people recover from mpox on their own within two to four weeks.

Symptoms include:

• Fever
• Chills
• Muscle aches
• Feeling tired
• Headache
• Backache
• Sore throat and cough
• Swollen lymph nodes
• Rash or sores 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), which turn into blisters and then form a crust. The rash usually (but not always) starts on the face and then spreads elsewhere on the body. The rash may affect the inner parts of the mouth, tongue and genitals, as well as the palms of hands, soles of the feet and bum areas.

Mpox is diagnosed by a health care provider, based on symptoms and a laboratory test.

More Information:

• CDC: Mpox Rash Photos

How to Prevent the Spread of Mpox

• If eligible, get vaccinated with both doses of the vaccine.
• During periods of outbreaks, consider limiting the number of people you have close physical contact with, including sexual contact, as an extra precaution.
• Avoid touching rashes or sores 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.
• Maintain good hand hygiene and respiratory etiquette, including:
  • Wash or sanitize hands often.
  • Cover your cough or sneeze with a tissue, your sleeve or arm.
• 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.
• Stay home if you are sick and encourage others to do the same. Consider wearing a high quality, well-fitting mask when around others or in indoor public settings.

If you are living with and/or caring for someone who has mpox:

• Use personal protective equipment (PPE), including disposable gloves and medical mask.
• Encourage the person to cover their rash or sores (use bandages, wear a long sleeve shirt and long pants) and to wear a medical mask when you are close to them.
• Avoid skin-to-skin contact, including contact with rashes or sores.
• Clean your hands often with soap and water or using an alcohol-based hand sanitizer after each contact with the person and after handling clothing, linens, or environmental surfaces that may have come into contact with fluid from rashes or sores.
• Avoid shaking soiled laundry. Laundry can be washed in a standard washing machine with warm water and detergent.

What to do if You Think You Have Mpox

If you think you have mpox, it is important to take precaution measures and/or isolate right away and contact a health care provider for advice on testing and medical care.  For more information on precaution measures and how to self-isolate, visit the Mpox: Self-Isolation Guidance webpage.

You can get tested for mpox at health care provider offices, local walk-in clinics or at sexual health clinics. Call in advance to make sure that mpox testing is available and tell them if you have had contact with a person with mpox.

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

People who have been in contact with a person who has mpox may be recommended to get post-exposure vaccination. They should monitor themselves for symptoms for 21 days. If symptoms develop, they should contact a health care provider.

About the Mpox Vaccine

The Imvamune^® vaccine is approved in Canada for protection against mpox. The vaccine:

• Requires two doses*, given 28 days apart, for full protection. It is important to get both doses as soon as possible, especially before travel. If you have received a first dose of the MPOX vaccine at least 28 days ago, get your second dose now.
• Is safe and effective for both clade I and clade II. People with the vaccine have less severe symptoms, and studies have shown that two doses of Imvamune® reduces the risk of mpox by 66 to 83 percent.
• Contains modified virus and cannot make you sick.
• Can be used before getting exposed to the virus (pre-exposure vaccination) or within 14 days after being exposed (post-exposure vaccination).
• Should be given to someone who got a smallpox vaccine in the past, to ensure protection against mpox.
• Takes two weeks after vaccination to give you protection. During these two weeks, consider reducing your number of close contacts, including sex partners.

*The second vaccine dose is a full dose exactly like the first.

Get Two Doses for the Best Protection

A CDC study showed that:

• The risk of getting mpox was lower for vaccinated people than those who were not vaccinated.
• There was an even lower risk for people who got two doses rather than just one.

The study recommends that eligible people should get two doses of the mpox vaccine for the best protection.

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
• Nausea

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 vaccine 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

Adverse Events Following Immunization (AEFI)

An AEFI is an unexpected reaction or event after getting a vaccine. If you think you are experiencing an AEFI, contact a health care provider. To learn more about AEFIs and how they are reported, visit the Adverse Events Following Immunization (AEFI) webpage.

Vaccine Eligibility

Toronto Public Health continues to follow federal and provincial guidance on the administration of Imvamune® vaccines to protect at-risk populations against the mpox virus. Imvamune is not currently available to travellers unless they meet eligibility criteria below.

Based on Ontario Ministry of Health guidelines, two vaccine doses, given at least 28 days apart, are available to eligible groups. Two doses of the vaccine provide the best protection. Booster doses are not currently recommended.

The vaccine is free and available to all eligible people. No ID or OHIP required. If you have questions about your eligibility for vaccination, contact a health care provider or Toronto Public Health.

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

Eligible Groups for Pre-Exposure Vaccination

1. Two-Spirit, non-binary, transgender, cisgender, intersex, or gender-queer individuals who self-identify as belonging to the gay, bisexual, pansexual and other men who have sex with men (gbMSM) community AND who meet one or more of the following:
   1. 1. Have more than one partner
      2. Are in a relationship where at least one of the partners has other sexual partners
      3. Have had a confirmed sexually transmitted infection (STI) within the last year
      4. Have attended venues for sexual contact (such as bathhouses and sex clubs)
      5. Have had anonymous sex (such as using hookup apps) recently
2. Sexual partners of individuals who meet the criteria above
3. Sex workers (regardless of gender, sex assigned at birth, or sexual orientation) or who are a sexual contact of an individual who engages in sex work
4. Staff or volunteers in sex-on-premises venues where workers may have contact with objects or materials potentially contaminated with mpox
5. Individuals who engage in sex tourism (regardless of gender, sex assigned at birth, or sexual orientation)
6. Individuals who anticipate experiencing any of the above scenarios

Household contacts of people who are eligible for pre-exposure vaccination listed above AND who are moderately or severely immunocompromised (have a weak immune system) or are pregnant may be at higher risk for severe illness from a mpox infection. These individuals may be considered for pre-exposure vaccination and should contact a health care provider or Toronto Public Health for more information.

If you already got a smallpox vaccine

If you are eligible to get Imvamune® as pre- or post-exposure vaccination and already got a smallpox vaccine (either an older generation replicating (live) smallpox vaccine or Imvamune®) in the past, you should still get vaccinated for mpox with two doses as you may not be protected.

Research Laboratory Employees

Research laboratory employees working directly with replicating orthopoxviruses are eligible to receive two doses of Imvamune, 28 days apart. These individuals may be offered an additional dose after 2 years if they remain at risk of occupational exposure.

Eligibility for Post-Exposure Vaccination

• Toronto Public Health will assess the risk of exposure to a person to see if the vaccine is recommended.
• People who have a known exposure/close contact with someone with mpox, or an exposure in a setting where mpox is spreading, should contact Toronto Public Health to find out if the vaccine is recommended to them.
• When the vaccine is used as post-exposure vaccination, it should be given within four days, but can be given up to 14 days after the last exposure.
• Individuals who have had one dose as post-exposure vaccination can get a second dose at least 28 days later.
  • People who are under the age of 18 should consult a health care provider before getting their second dose.

If you think you have mpox, contact a health care provider.

The vaccine is not used as a treatment if you already have mpox. At this time, people who have or had mpox are not eligible for the vaccine.

Getting the vaccine at the same time as another vaccine

Imvamune® vaccination can be given on the same day or at any time before or after other vaccines.

Where to get Vaccinated

Eligible residents are encouraged to start or complete the two-dose vaccination series for the best protection (booster doses not currently recommended).

The mpox vaccine is not available to travellers unless they meet eligibility criteria.

Toronto Public Health Clinics

Get vaccinated at a Toronto Public Health clinic (appointments added regularly) by appointment only. You do not need to have an Ontario Health Card or health insurance to be given this vaccine at Toronto Public Health vaccination clinics.

Post-Exposure Vaccination

Individuals who require post-exposure vaccination should contact Toronto Public Health at 416-338-7600 (TTY: 416-392-0658) or publichealth@toronto.ca, Monday to Friday from 8:30 a.m. to 4:30 p.m. Service available in multiple languages.

More Information

• Mpox (Ontario Ministry of Health)
• Mpox: Questions and Answers (World Health Organization)

Resources

Document Image	Description	Translations
Prevent the Spread of Mpox Poster	Download the Prevent the Spread of Mpox Poster
Mpox Self-Screening Poster	Download the Help Stop the Spread of Mpox Poster
Mpox Stigma & Discrimination	Download the Mpox Stigma & Discrimination Poster