Monkeypox: Know Facts to Play Your Roles & Responsibilities
Article by: Dr. M Kashyap, PDF, Ph.D
Disclaimer: “This blog has been prepared for general informational purposes only. They are not intended to and do not constitute any medical advice and do not contain any medical diagnoses, symptom assessments or medical opinions.”
Introduction
Monkeypox is a rare disease caused by the Monkeypox virus (MPXV), but less severe than, smallpox. This disease is typically transmitted from animals to humans. It causes mild and self-limiting flu-like symptoms such as fever, headache, swollen lymph nodes, and tiredness, followed by a rash and blisters on the skin with most people recovering within 2-4 weeks. It is usually spread by very close contact with someone who has the virus. Presently monkeypox has mostly spread among people who had close intimate/sexual contact with a person who has the virus. The virus also does not spread through casual contact.
It was found mostly in areas of Africa and limited cases had been identified in other countries but never in Canada. Since May 2022, there have been cases of monkeypox in several countries where the disease is not normally found, including Canada. The first monkeypox cases in Canada were reported on May 19, 2022, in Montreal. The Public Health Agency of Canada (PHAC) confirmed Ontario’s first case on May 26, 2022.
Facts & Figure
The most current information available is from Ontario’s integrated Public Health Information System (iPHIS) as of September 13, 2022.
• 656 confirmed cases of monkeypox in Ontario
• No deaths have been reported to date due to monkeypox
• The average age of confirmed cases is 36.5 years
• 651/656 (99.2%) confirmed cases are male and 5/656 (0.8%) are female
• 484/656 (73.8%) confirmed cases were reported by Toronto Public Health
• 19/656 (2.9%) of confirmed hospitalized cases, and 2/656 (0.3%) of confirmed ICU cases
• Most commonly reported symptoms include rash, oral/genital lesions, swollen lymph nodes, headache, fever, chills, myalgia, and fatigue.
Signs and Symptoms of Monkeypox
Clinical presentation resembles smallpox but is less severe. Symptoms can vary depending on different factors, including exposure characteristics, age, presence of conditions that alter immune response, previous immunity for smallpox and viral strain.
After exposure, it may be several days to a few weeks before you develop symptoms. Early signs of monkeypox include flu-like symptoms, including:
• Fever.
• Chills.
• Fatigue.
• Headache.
• Muscle aches.
• Swollen lymph nodes.
• Sores in mouth, vagina, or anus.
• Rash starts as flat, red bumps, which can be painful.
This uncommon presentation includes only a few lesions, no swollen lymph nodes, less fever, and other signs of illness.
Transmission of Monkeypox Infection
Most transmission of monkeypox in Canada has occurred between close contacts like intimate partners or household members or pets
• Human-to-human transmission occurs via
o direct contact with cutaneous or mucosal lesions
o intimate situations like cuddling, kissing or sex.
o respiratory droplets from prolonged face-to-face contact
o fomites, i.e. contaminated material such as linens or clothing
o contaminated materials like clothing, bedding, and other linens used by a person who is
infected or an infected animal
• Animal-to-Human transmission occurs via
o broken skin, like from bites or scratches
o direct contact with an infected animal’s blood, bodily fluids, or pox lesions (sores).
Testing and Diagnosis
Contact healthcare provider to get tested for monkeypox infection based on a combination of factors:
1. signs and symptoms
2. risk factors such as:
3. exposure to a case
4. travel history
Monkeypox is diagnosed by a healthcare provider, based on symptoms and a laboratory test. Confirmation of monkeypox virus infection is based on nucleic acid amplification testing (NAAT), using real-time or conventional polymerase chain reaction (PCR), for detection of unique sequences of viral DNA. PCR can be used alone or in combination with sequencing.
What to follow, if symptoms of Monkeypox are suspected or diagnosed
If anyone develops symptoms of monkeypox (including fever, headache, muscle aches, swollen lymph nodes, and/or rash or sores) person should contact a health care provider to get advice on testing and/or medical care.
Follow the recommendations below:
• Self-isolate at home if possible and avoid close contact with others, until receive information from local public health unit about when to end isolation. Stay in a separate room or area away from other people in the home and use a separate bathroom.
• Wear a medical mask.
• Cover any rashes or sores as best as possible when unable to avoid close contact with other people.
• People should not visit a person with monkeypox symptoms unless it is for an essential purpose.
• People with monkeypox symptoms should avoid contact with those at higher risk of severe illness including people who are pregnant or immunocompromised, and children under the age 12 years.
• Clean hands often with soap and water or an alcohol-based hand sanitizer, including after touching the rash or sores, clothing, or objects and surfaces that may have had contact with the rash or sores.
• Clean and disinfect contaminated surfaces (e.g., bathroom, if shared) after use with regular household cleaning/disinfectants according to the manufacturer’s instructions.
• Do not share dishes or utensils when eating; however, dishes/utensils can be used by others in the home if these are properly washed between uses either in a dishwasher or in a sink, using warm water and soap.
• Avoid direct contact with any laundry/linens that have touched the rash, bodily fluids, and scabs of the person with monkeypox symptoms. Handle laundry/linens with care and avoid shaking. Laundry can be cleaned in a washing machine with warm water and detergent.
• Get vaccinated for monkeypox if eligible
• Imvamune® vaccine is approved in Canada for protection against smallpox, monkeypox, and other orthopoxvirus-related illnesses. Imvamune® is not a treatment for monkeypox and must be given before you have symptoms of monkeypox.
• Currently, in Ontario, one dose of Imvamune® may be received as:
• Pre-Exposure Prophylaxis (PrEP), which means receiving the vaccine prior to any monkeypox exposure (for those who are likely to be exposed).
• Post-Exposure Prophylaxis (PEP), which means receiving the vaccine after potential exposure. The vaccine should ideally be given within 4 days but can be given up to 14 days after the last exposure.
Our roles and responsibility to reduce the infection rate
Although monkeypox is rare, there are things we should do to reduce chance of getting it and passing it on monkeypox.
Do’s
• Get vaccinated for monkeypox if eligible
• Use condoms and practice safe sex and have fewer sexual partners, particularly those who are
anonymous, even when they don't have symptoms
• Follow good hand hygiene. Wash your hands with soap and water or use an alcohol-based hand sanitizer.
• Clean and disinfect high touch surfaces (such as door handles and phones).
Don’ts
o Do not kiss, hug, cuddle or have sex with someone who has or may have monkeypox.
o Avoid skin-to-skin contact with monkeypox rashes or lesions.
o Avoid sharing objects such as toothbrushes, utensils, sex toys, or drug equipment.
o Avoid touching bedding and laundry that has been in contact with a person or animal that may have the virus.
o Avoid contact with sick or dead animals
If you are caring for someone who has monkeypox at home:
o Use personal protective equipment (PPE), including disposable gloves and a mask.
o Encourage the person to cover their rash and blisters (use bandages, wear a long sleeve shirt and long pants) and to wear a mask when you are close to them.
o Avoid skin-to-skin contact, including contact with blisters.
o Clean your hands with soap and water after each contact with the person.
Resource information
Public Health Ontario - Monkeypox | Public Health Ontario
Public Health Agency of Canada - Monkeypox: For health professionals - Canada.ca