Monkeypox now reportable to Medical Officer of Health as a newly designated Disease of Public Health Significance under provincial legislation

Advisory Alert

June 20, 2022

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To: Local Health System Partners

FOR IMMEDIATE ATTENTION

Updates to reporting requirements and guidance to support clinical and public health management of cases and contacts

On June 16, 2022, monkeypox was designated a Disease of Public Health Significance (DOPHS) as “Smallpox and other orthopoxviruses including monkeypox” under the Health Protection and Promotion Act (HPPA). Under this legislation, it has been designated as both a communicable disease and a virulent disease.

As monkeypox is now a DOPHS under the HPPA, the monkeypox Order issued by the Chief Medical Officer of Health on May 20, 2022, is no longer in effect. Persons required to report DOPHS and/or communicable diseases under the HPPA are now required to report monkeypox directly to the local Medical Officer of Health in accordance with routine reporting processes. Reporting requirements are noted below.

Case definitions and reporting requirements

The provincial surveillance case definitions for smallpox and other orthopoxviruses including monkeypox have been updated and are included within the attached guidance document (this document will be posted on the Ministry of Health website in the near future). Confirmed, probable, suspect cases and persons under investigation for smallpox and other orthopoxviruses including monkeypox must be reported. The following are highlights of the updated case definitions for monkeypox.

• Confirmed cases include those with virus detection through laboratory testing.
• Probable cases include those with clinical signs and symptoms consistent with monkeypox and epidemiological link (high-risk exposure [Public Health Ontario] to a case; link to a location or event where transmission is suspected/known to occur; or zoonotic exposure) pending laboratory results/with indeterminant result/in the absence of testing results. It also includes asymptomatic persons who have a positive screening test result and confirmatory test results are pending.
• Suspect cases are those where the virus has not been ruled out by testing and with unexplained acute rash and one or more other symptoms of fever, chills/sweats, lymphadenopathy, headache, myalgia, sore throat, cough, coryza, prostration or asthenia pending test results; OR those with unexplained acute genital, perianal or oral lesions.
• Persons under investigation include those with pending test results for monkeypox infection, but do not meet the confirmed, probable, or suspect case definitions.

Testing information

Who to test

Testing is recommended for individuals with a compatible clinical illness, where monkeypox is suspected. Approval for monkeypox testing is not required. Specimens may be obtained and collected in accordance with the Public Health Ontario Monkeypox Virus Test Information sheet (highlights below). Consult with PHO if you have any questions regarding testing eligibility, specimen collection or transportation.

Utilize the General Test Requisition ensuring to complete all fields. Refer to the Public Health Ontario (PHO) test webpage for information on appropriate test collection kits and containers.

Testing for herpesviruses (i.e., herpes simplex, varicella) may be ordered on the same specimens being tested for monkeypox and will be performed once monkeypox testing is completed. If tests other than herpesviruses are required submit additional specimens as the specimens submitted for monkeypox virus testing will not be routinely processed for additional tests besides herpesviruses. All tests requested on a patient being investigated for monkeypox will be put on hold until monkeypox virus testing is completed.

How to ship

Specimens for monkeypox testing must be shipped separately from other specimens in accordance with the information/criteria outlined on the Public Health Ontario Monkeypox Virus Test Information sheet.

Primary health care providers with no access to a Transportation of Dangerous Goods (TDG) certified shipper and/or appropriate packaging for Category B shipping (Government of Canada) must refer the patient to a location with such resources for specimen collection and transport.

Test frequency and turnaround time

Samples requesting monkeypox testing will be screened at PHO’s Toronto laboratory for Orthopoxvirus and screening results will be issued within 2 days upon receipt at PHO’s laboratory.

Orthopox negative and invalid results from PHO’s laboratory will be considered final, and no further testing will routinely occur on the submitted specimen.

Orthopox positive and indeterminate specimens currently will be reported as preliminary results and the specimen will be forwarded to the National Microbiology Laboratory (NML) in Winnipeg for confirmatory testing, including monkeypox virus specific PCR testing. Turnaround time at NML is approximately 2 calendar days from receipt at NML. It is anticipated that the PHO laboratory will soon be able to issue final reports on positive results and not require NML confirmation.

Further information on testing and requirements for specimen collection and submission is available on the Public Health Ontario website.

Treatment of cases

Recommendations for treatment of hospitalized severely ill cases were outlined in a previous Advisory Alert – Interim Guidance for Post-Exposure Prophylaxis and Treatment of Monkeypox.

Tecovirimat (TPoxx®) is available for use and must be requested by hospital clinicians through the Ministry of Health Emergency Operations Centre

EOCOperations.MOH@ontario.ca or by calling the Healthcare Provider Hotline at 1-866-212-2272.

Post-exposure prophylaxis of contacts for those at risk of infection

Imvamune® vaccine is available for post-exposure prophylaxis (PEP) of select adult contacts (18 years of age and older). It is recommended for those at high risk of exposure. It may be recommended for those at intermediate risk of exposure based on the public health unit’s assessment of risks and benefits. Clinicians who think they have a patient (i.e., a contact of a case) who might be recommended to receive PEP should contact Public Health Sudbury & Districts as soon as possible for risk exposure assessment. If required, PEP should be administered within 4 days of exposure, up to a maximum of 14 days after exposure. The vaccine is not indicated in the treatment of monkeypox infection.

Imvamune® is also available for pre-exposure prophylaxis (PrEP) in areas where confirmed cases have occurred. Vaccine used as PrEP is arranged by the local public health unit in consultation with the Ministry of Health.

Reporting process

Health care providers with a patient that meets the monkeypox case definitions must contact Public Health Sudbury & Districts immediately at 705.522.9200, extension 772 or toll-free 1.866.522.9200 during business hours, or after-hours at 705.688.4366. In addition please complete the first four pages of the monkeypox investigation tool (Public Health Ontario) and fax to Public Health Sudbury & Districts’ secure fax at 705.677.9618 so that prompt follow-up can be initiated.

Sincerely,

Original Signed By

Dr. Penny Sutcliffe
Medical Officer of Health and Chief Executive Officer

NOTE: All Advisory Alerts are found on our website.

Related information

Factsheet: Smallpox and other Orthopoxviruses including Monkeypox (Ontario Public Health Standards) (PDF, 2.77 MB)

Memorandum: Health Care Providers and Public Health Units RE: Monkeypox (Ministry of Health) (PDF, 52 KB)

This item was last modified on August 22, 2024