Mpox

Mpox can spread from person to person through:

• Close/intimate or sexual contact (skin to skin).
• Direct contact with skin lesions, 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, lesion dressings, needles, eating utensils and dishes).

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

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), which turn into blisters and then form a crust. The rash usually 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: Visual examples of mpox rash 

• 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 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.
• 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.
• If you have come into contact with someone with mpox, avoid non-essential interactions with people at higher risk of severe mpox illness (including people who are pregnant, immunocompromised, and children under the age of 12).
• 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 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 often with soap and water or 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 blisters.
• Avoid shaking soiled laundry. Laundry can be washed in a standard washing machine with warm water and detergent.

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

You can get tested for mpox at select 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 and avoid close 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 health care provider.

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. 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 per cent.
• 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.

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. 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 COVID-19 symptoms 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 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:
   1. Had a confirmed sexually transmitted infection (STI) within the last year;
   2. 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;
   3. Have attended venues for sexual contact (such as bathhouses and sex clubs) recently or may be planning to, or who work/volunteer in these settings;
   4. Have had anonymous sex or may be planning to; and/or
   5. Are a sexual contact of an individual who engages in sex work.
2. Individuals who self-identify as engaging in sex work or are planning to, regardless of self-identified sex or gender.

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 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 immunized for mpox as you may not be protected.

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 health care provider before getting their second dose.

If you think you have mpox, isolate right away and 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 have had mpox are not eligible for the vaccine because they have immunity from the infection.

Getting the vaccine at the same time as another vaccine

Right now, we do not 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 (such as flu or meningococcal).
  • Wait at least four weeks before or after getting the Imvamune® vaccine before getting another live vaccine (such as 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 health care 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.

Individuals who are eligible for a mpox vaccine are encouraged to get the vaccine where they access sexual health services or book an appointment at a Toronto Public Health Sexual Health Clinic.

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.

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