Monkeypox

Monkeypox symptoms usually appear 6 to 13 days after being exposed to the virus, but can also range from 5 to 21 days. Infection usually has two phases:

1. A prodromal (early) illness that lasts between 1 to 5 days, including:
   • Fever
   • Headache
   • Muscle aches
   • Swollen lymph nodes
   • Backache
   • Chills
   • Exhaustion
   • Sore throat and/or cough
   • Runny nose
2. A skin rash that begins 1 to 5 days after fever. The rash often begins on the face and then spreads to other places on the body, including the palms of the hands, soles of the feet, and mouth. The rash turns into blisters that then scab over.

The monkeypox virus enters the body through breaks in the skin, or through the eyes, nose, and mouth.

The virus is spread by:

• Touching the sores, scabs, or body fluids of an infected person (including hugging, kissing, and sexual contact)
• Prolonged face-to-face contact with an infected person, such as an in person conversation
• Touching objects that are contaminated with the virus, such as clothing or bedding
• Being bit/scratched by an infected animal, touching wild game meat, or using products made from infected animals

Monkeypox is contagious when symptoms first appear and until all scabs from the sores have fallen off and new skin is present.

If you have symptoms of monkeypox, you should talk your health care provider right away to see if treatment is recommended. Most people do not need treatment for monkeypox, and symptoms will go away on their own within 2 to 4 weeks. For rare, severe cases of illness, the treatment used for smallpox may be used to treat monkeypox.

Anyone who has been exposed to a person infected with monkeypox should monitor themselves for symptoms for 21 days. A health care provider may give smallpox vaccine to those who have had a high risk exposure to monkeypox. Anyone with symptoms of monkeypox should isolate right away and contact a health care provider.

To reduce the risk of monkeypox infection:

• Practice good hand hygiene after contact with infected people or animals. This includes washing your hands with soap and water or using an alcohol-based hand rub.
• Use personal protective equipment (PPE) when caring for an infected person, including gloves, gown, eye protection, and respirator.
• Avoid contact with animals that could carry the virus (including animals that are sick or found dead in areas where there is monkeypox).
• Avoid direct contact with materials that have been in contact with an infected person or animal, such as bedding.

At this time, one dose of the monkeypox vaccine (Imvamune®) can be given to eligible persons as per the Ontario Ministry of Health guidelines. A single dose is expected to provide reasonable protection by 2-4 weeks following vaccination. A second dose produces slightly higher response and may provide longer-lasting protection. Monitor for changes to the Ontario Ministry of Health recommendations and eligibility and register for a second dose if you become eligible.

Imvamune® can be used to protect individuals before an exposure to the monkeypox virus (this is called Pre-Exposure Prophylaxis or PrEP) or to protect individuals after being exposed to the monkeypox virus (this is called Post-Exposure Prophylaxis or PEP).

Imvamune® vaccine eligibility for protection before an exposure to the monkeypox virus (PrEP)

Based on the Ontario Ministry of Health guidelines, trans- or cis-gender individuals who self-identify as belonging to the gay, bisexual and other men who have sex with men (gbMSM) community are eligible for pre-exposure prophylaxis if they meet one of the following criteria: 

• Have had two or more sexual partners within the past 21 days or may be planning to. 
• Have had anonymous/casual sex in the past 21 days or may be planning to. 
• Have received a diagnosis of bacterial sexually transmitted infection (STI) in the past two months. Examples of bacterial STIs are chlamydia, gonorrhea, and syphilis.  
• Have attended venues for sexual contact within the past 21 days, or may be planning to, or who work/volunteer in these settings. Examples of these settings include bath houses or sex clubs. 
• Engage in sex for work or may be planning to. Sexual contacts of these individuals are also eligible to receive the monkeypox vaccine. 

Imvamune® vaccine eligibility after being exposed to the monkeypox virus (PEP)

Based on the Ontario Ministry of Health guidelines, individuals who have been identified by their local public health unit as having a high or intermediate-risk exposure with someone who has the monkeypox virus are eligible to receive Imvamune®. These individuals will be contacted directly by their local public health unit.