Are media reports on monkeypox causing you concern? Do you need to be worried? Should you be taking precautions? Read on for everything you need to know about monkeypox in Canada as of June 2022.
Monkeypox is a virus that may be transmitted from animal to human, or person to person. It is endemic in West and Central Africa, meaning it is regularly found in these regions of the world. First discovered in a cohort of monkeys in 1958, then realized in humans in 1970 in the Democratic Republic of the Congo, monkeypox is a cousin of smallpox, the viral disease that in 1980 the World Health Organization (WHO) declared eradicated. Monkeypox is a double-stranded DNA virus, and as such it’s bigger and heavier than COVID-19 (a small RNA virus). Consequently, it’s less capable of spreading through the air.
Monkeypox symptoms include fever, muscle aches and pains, headache, and swollen lymph nodes, followed by a rash of raised lesions or pustules that develop into crusty scabs. The sores are usually localized to one area of the body, and can be inside the mouth, on the face or on genitals. Most monkeypox symptoms are self-limited and mild, which means patients are likely to recover on their own after two to four weeks.
Monkeypox is transmitted through close, prolonged skin-to-skin contact, or through direct contact with the respiratory secretions of an infectious person. It can be transmitted through droplets, contact with infectious lesions or bodily fluids, or by sharing contaminated materials like bedding that have been exposed to infectious rash or bodily fluids. Monkeypox transmission is not believed to be airborne, meaning that the infected particles do not travel through the air; to become infected, an individual needs to come into direct close contact with another infected person or their shared contaminated materials.
The incubation period for monkeypox is between five and 21 days, meaning it can take up to three weeks after exposure for symptoms to appear. A patient is, however, infectious to others from the onset of symptoms until all scabs have resolved. People who do not have monkeypox symptoms cannot spread the virus to others.
Since monkeypox is a self-limited disease, the illness typically resolves in two to four weeks with conservative management of fluids, pain medication and rest as required until the rash scabs and heals over. In the rare case of a severe infection, hospitalized patients could be offered Tecovirimat (brand name TPOXX), an oral medication approved by Health Canada which was previously used to treat smallpox.
Not everyone testing positive for monkeypox will require Tecovirimat; only in severe cases would it be administered, and only in a hospital setting. The medication must be specially requested from the Ministry of Health in cases of serious illness.
It’s important to remain cautiously aware of the situation. The health and safety measures already in place for COVID-19, such as physical distancing and frequent handwashing, are effective for monkeypox prevention too. So are preventive measures for sexually transmitted infections, such as condom use. One should avoid having direct close contact (hugging, kissing) with a person who is showing signs of a pox-like rash (see picture below). High-risk populations should take extra precautions. “High risk” in the case of monkeypox has been determined to include household members of an infected person, men who have sex with men (MSM), or anyone with multiple new sexual partners. As of June 17, 2022, 95% of Canadian cases have been discovered in the MSM community.
Health Canada is currently recommending Imvamune, a smallpox vaccine, to people who have had a high-risk exposure and are over 18 years old. Imvamune can only be administered within the first four days of exposure. Post-exposure prophylaxis, the administration of a vaccine shortly after a high risk exposure, is currently being offered to high-risk communities.
There is evidence that people who previously received the smallpox vaccine (generally those born before 1970) have some cross-protective immunity to monkeypox.
If you think you’ve been exposed to monkeypox, contact your doctor, local public health or sexual health unit. If you are high risk or exhibiting signs and symptoms of severe illness, go to your nearest emergency room to be assessed and tested. Based on your medical history and exposure risk, the emergency room physician may ask for special dispensation to get Imvamune if you’ve been exposed, or TPOXX if you require treatment for an acute severe infection that requires hospitalization.
Your primary physician, or a clinic like Medcan, can provide testing on-site, usually consisting of PCR-swab testing of any pox-like rash, bloodwork and urine testing.
Monkeypox is unlikely to be the next global pandemic as it is less transmissible and can be contained by close contact tracing and vaccination. As a double-stranded DNA virus, it is more stable compared to RNA viruses (such as the virus causing COVID-19), which tend to be more unstable and mutate more easily. In addition, monkeypox is not a new disease. There are known antivirals that can be used for treatment as well as an effective vaccine that could be made widely available if required.
Medcan’s Medical Advisory Services (MAS) physicians are monitoring the situation closely for any emerging threats of spread to the community and are aware of the options for Imvamune and Tecovirimat as treatment. Our doctors and nurses are being educated on what to look for in our patients, and we are rolling out education measures to our staff and patient population. The world health situation is evolving rapidly, and MAS will continue to stay up-to-date and prepared for each new development in real time.