Mpox Virus

NOTE: Monkeypox is now referred to as Mpox.

What is Mpox?

Mpox is a rare disease caused by the mpox virus.

It is found mostly in areas of Africa but has been seen in other areas of the world. Recently, Mpox virus has been found in countries where it is not endemic (not usually found).

There is no proven treatment for mpox, although antiviral treatment is available for severe cases and there is also a vaccine (see below). Mpox usually goes away on its own.

NOTE: The Ontario outbreak was declared over on December 12, 2022. Ontario will continue to monitor the situation and will re-assess if numbers start to increase.

How do you get it?

Mpox typically does not spread easily between people. Person-to-person spread may occur through:

• sexual or intimate contact with an infected person
• contact with clothing or linens (such as bedding or towels) used by an infected person
• direct contact with mpox skin lesions or scabs
• respiratory transmission from an individual with mpox.

The virus enters the body through broken skin (even if not visible), the respiratory tract or the mucous membranes (eyes, nose or mouth).

Anyone who has had close, prolonged contact with someone who is infected with mpox or who has touched contaminated objects (clothing, bedding, towels, eating utensil and dishes) is at risk of becoming infected.

Symptoms

Mpox is usually a mild illness, with most people recovering on their own after a few weeks; however, some may have severe illness and need to be hospitalized. People typically develop symptoms five to 21 days after being exposed to the mpox virus. Symptoms occur in two stages and typically last from two to four weeks.

In stage one, symptoms may include:

• fever
• chills
• swollen lymph nodes
• headache
• muscle pain
• joint pain
• back pain
• exhaustion

In stage two of the illness, a rash develops - usually within one to three days (sometimes longer) after the fever starts. The rash often starts on the face or extremities, however it can affect other parts of the body, such as the hands, feet, mouth and genitals.

The rash can last between 14 and 21 days and changes through different stages before finally forming a scab which later falls off.

Vaccine - Imvamune®

• Imvamune® vaccine is approved in Canada for protection against mpox. It contains a weakened virus so you cannot get mpox from the vaccine.
• It can be used to protect those who are at high risk for an exposure BEFORE they are exposed (pre-exposure) or after being exposed (post-exposure).
• See the section below for more informatio on WHO IS ELIGIBLE for pre-exposure vaccine;  two doses, with at least 28 days between first and second doses.
• Read more about the vaccine by reviewing Ontario's information sheet.

Am I eligible to get the vaccine that protects me before I am exposed?

Based on Ontario Ministry of Health guidelines, you are eligible to receive the Imvamune® vaccine BEFORE you are exposed to mpox (pre-exposure vaccine) if you fall into any of the eligible groups listed below:

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: 

• Have more than one partner 
• Are in a relationship where at least one of the partners has other sexual partners 
• Have had a confirmed sexually transmitted infection within the last year 
• Have attended venues for sexual contact (e.g., bath houses, sex clubs) 
• Have had anonymous sex (e.g., 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 fomites potentially contaminated with mpox 

5. Individuals who engage in sex tourism (regardless of gender, sex assigned at birth, or sexual orientation). Sex tourism is travel for the specific purpose of having sex, typically with commercial sex workers. It differs from having casual sex during travel with fellow travelers or locals (Centers for Disease Control and Prevention, 2022). 

6. Individuals who anticipate experiencing (think they might experience any of the above scenarios.

NOTE - HOUSEHOLD CONTACTS

Household contacts of those identified above AND who are moderately to severely immunocompromised (see page 11/Appendix A of the Ontario Guidance for a list) OR who are pregnant may be at higher risk for severe illness from mpox infection and may be considered for pre-exposure vaccine. Those who meet this criteria should contact their health care provider (or TBDHU) for more information

How can I get the vaccine if I am eligible?

First dose:

• Contact TBDHU (625-5900 or toll-free 1-866-294-6630) to discuss options, including making an appointment for an upcoming clinic.

Second dose:

• It is STRONGLY recommended a second dose is received for improved protection.
• You are eligible to get a second dose when it has been at least 28 days after first dose. If it’s been more than 28 days since your first dose, you do not have to start again and it’s strongly recommended you finish this series of vaccines.

1. If you received a first dose through TBDHU or any other health unit in Ontario: contact TBDHU (625-5900 or toll-free 1-866-294-6630) to discuss options, including making an appointment for an upcoming clinic.
2. If you received a first dose outside of Ontario: contact TBDHU (625-5900 or toll-free 1-866-294-6630) to discuss options. Proof of the first dose is required and this can be reviewed with TBDHU staff. 

Treatment

• Tecovirmat (TPoxx®) is an antiviral medication that prevents the virus’ ability to multiply and therefore slows down its spread throughout the body. This allows your body to build up its defences to fight off the infection.
• Tecovirmat (TPoxx®) is currently being used for severe cases of mpox and with individuals at risk for severe disease.
• Learn more about  Tecovirmat (TPoxx®) by reviewing Ontario's information sheet.

For Further Information

Visit one of these resources:

• Mpox: What We Know | Gay Men’s Sexual Health Alliance
• Government of Canada
  • World Health Organization: Mpox fact sheet
• Government of Ontario
• Public Health Ontario - Mpox

To learn more about:

• Mpox, call the Infectious Disease Program: (807) 625-5900 or toll-free: 1-888-294-6630
• Mpox vaccine, call the Vaccine Preventable Diseases (VPD) Program: (807) 625-5900 or toll-free: 1-888-294-6630