MPOX

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

• Skin-to-skin contact with lesions, blisters, rashes.
• Contact with objects, fabrics and surfaces used by someone who has the virus.
• Recent evidence has shown that contact with respiratory droplets from breathing, talking, coughing or sneezing has not been linked to the spread of MPOX.

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

Someone with MPOX 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 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
• 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 in or around the mouth, throat, genital or anorectal (bum) areas.

MPOX 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 MPOX Lesions

• If eligible, get vaccinated. Book an appointment at a City-run immunization clinic.
• Consider limiting the number of people you have close physical contact with, including sexual contact.
• 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.
• Wear a mask in indoor public spaces especially if you have a cough or sore throat.
• 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 MPOX.
• 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.

If you are caring for someone who has MPOX 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.

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

You can get tested for MPOX at a healthcare provider’s office, local walk-in clinic or sexual health clinics. Call in advance to make sure that MPOX 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.

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, and avoid sexual contact with others, for 21 days. If no symptoms appear you can continue with normal activities. If symptoms develop, you should isolate and contact a healthcare provider.

The Imvamune^® vaccine is approved in Canada for protection against MPOX. Eligible groups can book an appointment at a City-run immunization clinic. The vaccine:

• Requires two doses*, given 28 days apart, for full protection. It’s 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, book your second dose now.
• Is safe and effective. People with the vaccine have less severe symptoms, and studies have shown that 2 doses of Imvamune® reduces the risk of MPOX by 66-83%.
• 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 new 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.

Vaccine Side Effects:

The vaccine may cause some side effects. Most are mild to moderate, and do not last longer than 7 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 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.

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.

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 provides the best protection.

The vaccine is free and available to all eligible people. No ID or OHIP required. Appointments are available for TPH-fixed site vaccination clinics. If you have questions about your eligibility for vaccination, contact a healthcare provider or Toronto Public Health.

Eligible Groups for Pre-Exposure Vaccination:

a. Two-Spirit, non-binary, transgender, cisgender, intersex, or gender-queer individuals who self-identify or have sexual partners who self-identify as belonging to the gay, bisexual, pansexual and other men who have sex with men (gbMSM) community AND at least one of the following:

• Had a confirmed sexually transmitted infection (STI) within the last year ;
• Have or are planning to have two or more sexual partners or are in a relationship where at least one of the partners may have other sexual partners;
• Have attended venues for sexual contact (e.g. bathhouses, sex clubs) recently or may be planning to, or who work/volunteer in these settings;
• 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. Individuals who self-identify as engaging in sex work or are planning to, regardless of self-identified sex or gender.

c. Research laboratory employees working directly with replicating orthopoxviruses.

Household and/or sexual contacts of people who are eligible for Pre-Exposure Vaccination listed above in parts (a) or (b) above AND who are moderately or severely immunocompromised (have a weak immune system) or are pregnant may be at risk for severe illness from a MPOX infection. These individuals may be considered for Pre-Exposure Vaccination, and should contact a healthcare provider or Toronto Public Health for more information.

Eligibility for Post-Exposure Vaccination:

• Toronto Public Health will assess the risk of exposure of 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 healthcare provider before getting their 2^nd dose.

Contact a healthcare provider or Toronto Public Health to find out if you are eligible for vaccination. The vaccine is free and available to all eligible people. No ID or OHIP required. Appointments are needed for City-run immunization clinics.

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

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

The vaccine is not used as a treatment if you already have MPOX. At this time, people who have or have had MPOX are not eligible for the vaccine because they have immunity from the infection.

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 immunized for MPOX as you may not be protected.

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 MPOX or are at high risk of exposure, even if you have recently gotten another vaccine, as the benefits are bigger than the risks.
• If timing can be planned, it’s recommended to:
  • Wait at least two weeks before or after getting the Imvamune vaccine before getting another non-live vaccine (e.g. flu or meningococcal).
  • Wait at least four weeks before or after getting the Imvamune vaccine before getting another live vaccine (e.g. Shingles or MMR) or a COVID-19 vaccine.
• These suggested waiting periods are an added safety measure that may help identify if any side effects are from one vaccine or the other
• Speak with a healthcare provider if you are getting Imvamune less than four weeks before or after another live vaccine, as this may make the second vaccine less effective.

As part of our MPOX outreach to reduce the spread of the virus in our communities, Toronto Public Health is sending text messages to remind residents to get a 1st and 2nd dose of the MPOX vaccine, if eligible.

The text message is from a 393939 number and includes a secure link to book an appointment at a City-run immunization clinic or to learn more about the MPOX virus. You can opt out of the text message by replying “STOP MpoxTO” within 12 hours of receiving the message or contact us by phone or email.

Toronto Public Health will never ask for your banking or personal identification information. If you have any questions, contact 416-338-7600 (press option 7) or publichealth@toronto.ca.

If you didn’t receive a text message from Toronto Public Health, check to see if you are eligible for the MPOX vaccine.

All City-run clinics are accessible and able to offer accommodation. Visit our City immunization clinics webpage to learn more or if you would like to request an accommodation ahead of attending the clinic.

Toronto Public Health (TPH) and community partners will be hosting the following MPOX vaccination clinics for eligible groups.

City-run clinics

People who meet the provincial criteria for vaccination to prevent MPOX infection can book an appointment at any one of our TPH-fixed site vaccination clinics through the TPH Booking System. An OHIP card is not required. The vaccine is free and available to all eligible people.

The 519

Day(s) and Hours of Operation: Wednesdays, 1 p.m. to 6 p.m.

Address: 519 Church St., Toronto

No appointment needed. Walk-in available.

Safer Six

Day(s) and Hours of Operation:

• Tuesday: 10 a.m. to 5 p.m.
• Wednesday: 9 a.m. to 1 p.m.
• Thursday: 2 p.m. to 7 p.m.
• Saturday: 9 a.m. to 12 p.m.

Address: 27 Roncesvalles Avenue – Suite 505, Toronto.

To book an appointment please visit the Safer six website for more information.

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

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