Monkeypox virus is an orthopoxvirus that causes a disease with symptoms similar to, but less severe than, smallpox and is endemic to parts of Central and West Africa. There are two clades (strains) of monkeypox: the Central African clade and the West African clade. Human infections with the Central African clade are typically more severe and have a case fatality rate around 10%. Illness with the West African clade is usually self-limiting within 2-3 weeks with a case fatality rate around 1%. Previously, cases of monkeypox in countries other than those in Central and West Africa have only been identified as a direct result of travel to these regions.
As of May 2022, many countries where monkeypox is not endemic have documented clusters of cases which are not linked to direct travel to Central or West Africa. For more information see the GLOBAL.hEALTH Monkeypox Outbreak Tracker. Current epidemiological analysis suggest that these infections 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).
For a rapid review of the evidence related to a specific aspect or emerging issue related to the 2022 worldwide monkeypox outbreak review Public Health Ontario’s “What We Know So Far” document.
To view the latest data on Monkeypox in Toronto, visit Public Health Ontario’s Monkeypox webpage.
Prior to the current outbreak, monkeypox infections have been thought to follow a fairly typical pattern, as outlined below. However, some jurisdictions with new outbreaks of monkeypox are noticing atypical presentations which may include:
Monkeypox is spread to people through direct contact with the bodily fluids or lesions of infected animals or people, via respiratory droplets from an infected person, or from mother to fetus. In can also be transmitted indirectly through contact with materials contaminated with the virus, such as bedding and clothing.
Individuals with a compatible clinical illness, where monkeypox is suspected should be tested.
Approval for monkeypox testing is not required, nor is it required to contact Public Health Ontario (PHO) Customer Service Centre prior to specimen submission.
Contact PHO Customer Service (416-235-6556/1-877-604-4567) or after hours the on-call Duty Officer (416-605-3113) if you wish to consult prior to sample collection and shipment.
Samples may include: nasopharyngeal, throat or lesion swabs, samples/scrapings of scabbed lesions.
Refer to PHO’s Monkeypox Virus Test Information Index for detailed information on sample collection and submission.
Transport Canada has issued Temporary Certificate TU 0886 for the transportation of monkeypox sample shipments by land (in a road vehicle, railway vehicle, vessel, between two points in Canada). The exemption does not apply to other modes of transportation. Specimens will need to comply with Transport Canada regulations.
As of June 2, 2022, clinical specimens from patients undergoing monkeypox testing have been temporarily reclassified as UN3373 Biological Substance, Category B for land transport. In addition to the routine category B requirement, the outer packaging must be marked, on a contrasting background, with “TU 0886”, “Temporary Certificate – TU 0886” or “Certificat Temporaire – TU 0886”. For full details on packaging and transporting, the temporary certificate can be downloaded by searching “TU 0886” at the Transport Canada website.
Primary health care providers with no access to a Transportation of Dangerous Goods (TDG) certified shipper and/or the special packaging must refer the patient to a location with such resources for specimen collection and transport. It is currently advised to refer patients to a nearby hospital with a laboratory capable of shipping Category B packages for specimen collection. It is also advised to call the hospital ahead to notify of the patient referral in order for the hospital to implement appropriate infection prevention and control measures immediately on the patient’s arrival.
PHO has developed the following IPAC Recommendations for Monkeypox in Health Care Settings (1st revision, May 2022):
Room Placement:
Hand hygiene as per the Four Moments of Hand Hygiene.
Personal Protective Equipment (PPE) for health care workers:
Duration: Additional Precautions are maintained until all scabs have fallen off and new skin is present.
Patient Transport: Have the patient wear clean clothes/gown, wash their hands, wear a medical mask and cover their lesions to the best extent possible for transport.
Laundry: Soiled laundry is to be managed in accordance with Routine Practices. Staff are to protect themselves from potential cross-infection from soiled linen by wearing appropriate PPE (gloves, gown, fit-tested and seal-checked N95 respirator and eye protection) when handling soiled linens. Staff are to clean their hands upon removal of PPE. Care should be taken in the management of soiled laundry to avoid shaking or handling in a manner that may cause dispersal of microorganisms.
Waste disposal: Containment and disposal of contaminated waste (e.g., dressings) in accordance with facility-specific/public health guidelines for infectious waste.
Environmental cleaning: Healthcare-grade cleaning and disinfecting agents, with a Drug Identification Number (DIN) are appropriate for cleaning and disinfection of environmental surfaces and shared equipment in the patient care environment. Follow the manufacturer’s recommendations for dilution and contact time.
Food Services: Food service items are to be managed in accordance with Routine Practices. Dishware and eating utensils are effectively decontaminated in commercial dishwashers with hot water and detergents. Reusable dishware and utensils may be used; disposable dishes are not required.
There is no specific treatment available for monkeypox. Most patients will recover from monkeypox without intervention. Some may require hospitalization and supportive care.
Some antivirals that have been developed for the treatment of smallpox may be effective, but they are not widely available at this time. In Canada, Tecovirimat (TPoxx®) is authorized by Health Canada under an extraordinary use indication for the treatment of human smallpox disease in adults and pediatric patients weighing at least 13 kg:
More information: Ministry of Health’s Interim Vaccine Guidance for Post-exposure Prophylaxis and How to Access Tecovirimat.
Vaccination after an exposure to monkeypox infection may prevent infection or may lessen severity in those who still go on to develop infection after receiving the vaccine as PEP. IMVAMUNE is a live-attenuated, non-replicating vaccine which is active against both monkeypox and smallpox.
More information:
Suspect and Probable Cases
Confirmed Case
Contact Management
More information can be found on Public Health Ontario’s Monkeypox Virus: Interim Case and Contact Management Guidance for Local Public Health Units.