Reports of confirmed monkeypox in Canada

Advisory Alert

May 21, 2022

*Cette information est seulement disponible en anglais.

Updated May 25, 2022

Further information is available at Public Health Sudbury & Districts – Monkeypox and guidance for health care providers (phsd.ca).

Update – Effective May 24, 2022 – Please note the following regarding specimen collection:

There is no longer a need to consult with Public Health Ontario If you suspect a case of monkeypox illness prior to collection of specimens for microbiological examination. Prior to submission, however, please contact PHO laboratory at 1.877.604.4567 to advise them of the specimen and continue to utilize the PHO General Test Requisition and collect samples with a virus culture kit.

See Monkeypox Virus | Public Health Ontario.

To: Local Health System Partners

FOR IMMEDIATE ATTENTION

The Ministry of Health is closely monitoring the situation concerning monkeypox cases reported in Europe and the U.S, as well as two confirmed cases in Québec. There are no confirmed cases currently reported in Ontario. Please see memo (PDF) from the Chief Medical Officer of Health.

Monkeypox virus (MPXV) is an orthopoxvirus that causes a disease with symptoms similar to, but less severe than, smallpox. It is typically mild and self-limiting, however severe illness can occur.

Human infections caused by human to human transmission is historically rare, however, occurs primarily through person-to-person transmission via close contact with infected bodily fluids, respiratory droplets, direct contact with skin lesions or a patient’s items that have been contaminated with the infected person’s fluid or lesions.

Diagnosis and infection prevention and control (IPAC):

Please have an increased index of suspicion of monkeypox virus infection with individuals with the below compatible symptoms and consider the following infection control measures, especially with those with a travel history to affected countries and other risk factors.

Early epidemiology on recent cases shows that some cases have been clustered in males who are gay, bisexual, and men who have sex with men. Please do not limit concerns for the diagnosis to these individuals as anyone with close personal contact with a person with monkeypox virus infection could be at risk of disease. Continue to consider the following differential diagnoses, which may be hard to distinguish from monkeypox – including syphilis, herpes simplex virus (HSV), chancroid, varicella zoster, and other common infections.

Symptoms:

Monkeypox virus infection presents with a prodrome that includes fever, chills, headache, myalgias, lymphadenopathy, and fatigue, followed one to three days later by a progressively developing rash. The rash usually starts on the face and then spreads elsewhere to the body. Lesions can also develop on mucous membranes, in the mouth, on the tongue, and on the genitalia. The rash can last for 2-4 weeks and progress through the following stages from macules, to papules, to vesicles, and then to pustules, followed by umbilication, scabbing and desquamation. The rash is usually confined to the trunk but can spread to the palms and soles of the feet, occurring in a centrifugal distribution.
Lymphadenopathy is considered a key distinguishing feature of monkeypox.

IPAC measures:

In addition to routine practices, follow additional airborne/droplet/contact precautions for suspected or confirmed cases per Public Health Ontario Infection Prevention and Control (IPAC) recommendations for Monkeypox in Health Care Settings.

Specimen collection:

If you suspect a case of monkeypox illness, do not collect specimens for microbiological examination prior to consultation with Public Health Ontario (PHO). If testing is agreed to, PHO laboratory will provide the submitter with further direction about next steps. Contact PHO laboratory at 1.877.604.4567.

Utilize the PHO General Test Requisition and collect samples with a virus culture kit.

Samples requesting testing for MPXV will be forwarded to the National Microbiology Laboratory (NML) in Winnipeg. Samples will be tested by polymerase chain reaction (PCR) and where applicable by cell culture.

Monkeypox Virus | Public Health Ontario

Reporting criteria

Ontario’s Chief Medical Officer of Health has issued an order (PDF) under section 77.6 of the Health Protection and Promotion Act, requiring all physicians and registered nurses in the extended class, including Medical Officers of Health, person who operate a group practice that includes physicians and/or registered nurses in the extended class and to hospitals and regulated health professionals who practice within hospitals to provide information related to monkeypox virus.

Reports of any individual who meets the case definitions of monkeypox virus (as noted in Appendix A of the order) to Public Health Ontario (PHO) by completing the Monkeypox Investigation Tool (Appendix B of the order) and faxing via secure fax to 647.260.7603. PHO will notify the Medical Officer of Health of the public health unit in which the case or contact resides. The information shared is for the purpose of investigating, eliminating or reducing the risk of monkeypox, including conducting case and contact management.

Case and contact management:

The incubation period of MPXV is approximately 6 to 13 days, but can range from 5 to 21 days.^. The communicability of monkeypox illness is from onset of initial lesions (typically on the tongue/in the mouth), until all scabbed lesions have fallen off and new skin presents. Some individuals may be contagious during their prodrome, before the rash develops, when they have nonspecific symptoms such as fever, malaise, and headache. Most individuals recover in 2 to 4 weeks.

The treatment for monkeypox is mainly supportive. Ontario is working with the Public Health Agency of Canada (PHAC) to determine eligibility for vaccines and/or therapeutics.

Individuals who meet the probable case definition are advised to self-isolate at home. If being seen for clinical care, they are advised to wear a medical mask and cover their skin lesions while test results are pending. Confirmed cases are advised to self-isolate until lesions are resolved.

Contacts should self-monitor for symptoms for 21 days and seek medical care/testing if symptoms present. They do not need to quarantine as long as they are asymptomatic.

We will continue to share information on monkeypox illness as it is received. Please contact the communicable diseases program at 705.522.9200, ext. 772 or toll-free 1.866.522.9200 with any questions you may have.

Sincerely,

Original Signed By

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

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This item was last modified on May 25, 2022