Mpox and Other Orthopoxviruses

Suspected cases must be reported immediately by phone to the Thunder Bay District Health Unit at 625-5930 or toll-free 1-888-294-6630, ext. 5930 (Monday-Friday, 8:30am to 4:30pm). After hours and on weekends/holidays call Thunder Bay Answering Service at (807) 624-1280.

Reporting Obligations

Please complete the Ontario Monkeypox Investigation Tool for Clinicians.

The first page of the tool must be completed in full and reported to the TBDHU by fax: (807) 625-4822

To speak with a public health nurse about this tool: (807) 625-8318 or toll-free at 1-888-294—6630, ext. 8318.

Appendix 1: Case Definitions and Disease-Specific Information

Please see Appendix 1 of Ontario's Infectious Diseases Protocol for more information including case definitions.

Management of Cases and Contacts

Please see the Ontario document specific to the management of cases and contacts.

Epidemiology

Ontario

• See Public Health Ontario’s biweekly Enhanced Epidemiological Summary of Mpox in Ontario (January 1 to August 10) 

Canada

There has been an ongoing outbreak of clade II mpox in Canada since 2022. Some regions of Canada have continued to report cases of clade II mpox, including a recent uptick of cases in the Toronto area. Current reports suggest that clade II mpox is less severe than clade I.

In collaboration with provincial and territorial partners, the Public Health Agency of Canada (PHAC) has been monitoring for mpox virus through wastewater surveillance in Canada since July 2022 and has the ability to test for clade I and clade II. Mpox cases detected in provinces and territories are required to be reported to PHAC.

For more information, see the Government of Canada's website.

Global

• On August 14, 2024, the World Health Organization declared a Public Health Emergency of International Concern (PHEIC) due to the emergence and spread of a novel and more severe mpox strain (clade 1b) in several Central African countries as well as ongoing clade Ia and/or clade IIb mpox outbreaks in Central and West African countries.
• Clade Ib emerged in the Democratic Republic of Congo (DRC) in 2023 and appears to be spreading primarily through hetero-sexual networks. Although the vast majority (>95%) of clade Ib mpox cases have been reported in the DRC, additional cases have recently been detected in neighbouring countries that were previously non-endemic for mpox (Kenya, Uganda, Rwanda, and Burundi).
  • Close to 70% of all mpox cases in the DRC are children <15 years of age and involve clade Ia which can be spread through close contact (i.e., household transmission) and in some settings, zoonotic transmission.
• In addition, there remains ongoing transmission of mpox clades Ia and IIb in a number of countries in West and Central Africa, as well as South Africa.
• As of August 19, 2024, only one country outside of Africa has reported a travel-related mpox clade 1b case (Sweden).

Aetiologic Agent:

Please visit the government of Canada's website for more information.

Clinical Manifestation and Period of Communicability:

Please visit the government of Canada's website for more information and updated as new evidence becomes available about the clinical manifestations seen during the multi-country 2022 outbreak.

Modes of transmission:

Please visit the government of Canada's website for more information.

Provincial Summary

A provincial summary is available on the Public Health Ontario website.

Diagnosis & Laboratory Testing

Testing information can be found here: MPOX Virus Testing Information. 

Vaccination

Imvamune® vaccine is approved in Canada for Pre-Exposure Prophylaxis – (PrEP) and Post-Exposure Prophylaxis (PEP).

• MPOX Vaccine (Imvamune®) Guidance for Health Care Providers *updated June 2024
• MPOX Vaccine Information Sheet *update June 2024
• Imvamune® Vaccine Storage and Handling Guidance *updated June 2024

Local Vaccination Approach

TBDHU will continue to offer both pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).  

TBDHU will contact individuals who received a first dose and make a second dose of the vaccine available, in additional to continuing to provide doses to those who want to start the series. The completion of the required vaccine series should be encouraged.

Individuals are asked to call 807-625-5900 and ask to speak with the Vaccine Preventable Diseases program and request information an appointment.

TBDHU will work with health care providers to ensure PrEP is easily accessible in district communities. Anyone from these communities who qualifies for this clinic are welcome to receive the vaccine in Thunder Bay.

Pre-Exposure Vaccine Eligibility

Pre-exposure eligibility:

• 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:
  • Have or had a confirmed sexually transmitted infection 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., bath house, sex clubs) recently or may be planning to, or who work/volunteer in these settings
  • Have had anonymous sex (e.g., using hookup apps) recently or may be planning to, and/or are a sexual contact of an individual who engages in sex work.
• 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 those identified for PrEP eligibility in parts 1 or 2 above AND who are moderately to severely immunocompromised or pregnant may be at higher risk for severe illness from a MPOX infection. These individuals may be considered for PrEP and should contact their healthcare provider (or their local public health unit) for more information.

Mpox Vaccine Promotional Resources

• Downloadable Poster (PDF)
• Draft Social Media Posts
  • The mpox (formerly monkeypox) vaccine isn’t just a one-time thing. You need 2 doses to be fully protected. So if you still haven’t received your 2nd dose (or you’re eligible and want to get your 1st) call the Health Unit at 807-625-5900. https://www.tbdhu.com/mpox
• Downloadable Social Media Images Image 1 

Treatment

• MPOX Antiviral Guidance for Health Care Providers
• TPoxx^® Antiviral Information Sheet

Patient Information

• Mpox Vaccine information sheet (Ministry of Health) (French)

MPOX Self-Isolation Fact Sheet

Infection Prevention and Control (IPAC)Recommendations

The guidance provided in Infection Prevention and Control (IPAC) Recommendations for Monkeypox in Health Care Settings is applicable to all health care settings including hospitals and outpatient settings (e.g. primary care, sexual health clinics, and vaccine clinics).

Training/Webinars

Additional Resources