Mpox (formerly known as monkeypox)

What is mpox?

Mpox is a disease caused by the monkeypox virus. It is a viral zoonotic disease, meaning that it can spread from animals to humans. It can also spread between people. Public Health Agencies around the world have reported cases of mpox since May 2022.

There are 2 known subtypes (clades) of mpox virus: clade I and clade II. Clade II is less severe than clade Ia, and clade IIb was responsible for the 2022 global outbreak.

The virus typically causes a flu-like illness that can cause a rash. Some people develop a rash (including oral, genital and/or perianal lesions) before or without fever and other symptoms. Some, but not all, may develop a more generalized rash.

What are the symptoms of mpox?

People usually develop symptoms 7 to 10 days after being exposed to the monkeypox virus. However, the time it takes to develop symptoms can range from 3 to 21 days after being exposed.

The rash can be painful and can affect any part of the body, such as the:

• face and mouth
• arms and legs
• hands and feet
• anus, rectum and genitals

The rash usually lasts between 2 to 4 weeks and eventually forms scabs that later fall off. The rash can be accompanied by general symptoms such as:

• fever
• chills
• headache
• exhaustion
• swollen lymph nodes
• back, joint and muscle pain

Sometimes people may not notice that they have a rash but may have a sore throat or rectal pain.

How can I get mpox?

Current evidence suggests that mpox spreads in 3 ways:

• From person-to-person
• From animals to humans
• Through direct contact with contaminated objects

How long is someone with mpox contagious?

People are contagious from the onset of first symptoms until the scabs have fallen off on their own and new intact skin has formed. This also includes the healing of all mucosal surfaces (mouth, throat, eyes, vagina and anorectal area).

A person infected with mpox can be contagious for up to 2 to 4 weeks.

What can happen if I get mpox?

Most people recover without treatment after a few weeks. Young children and immunocompromised individuals might be at increased risk of complications. If you have any concerns, please speak with your HCP.

What should I do if I have symptoms of mpox?

If you develop symptoms of mpox, you should contact a health care provider to get advice on testing and medical care. Tell them if you think you have had contact with a person with mpox. You should also follow the recommendations below:

• Self-isolate at home if possible and avoid close contact with others, unless it is for an essential purpose, until you receive information from your local public health unit. Stay in a separate room or area away from other people in the home and use a separate bathroom.
• Avoid contact with those at higher risk of severe illness including people who are pregnant, immunocompromised, and children under the age of 12 years.
• Wear a medical mask for source control when you are indoors with other people if safe and tolerated.
• Cover any rashes or sores (for example, long sleeves, long pants, bandages, medical mask, and/or gloves) as best as possible when you are unable to avoid close contact with other people.
• Clean your hands and the environment:
  • Clean your hands often with soap and water or an alcohol-based hand sanitizer
  • Clean and disinfect contaminated surfaces (such as the bathroom, if shared) after use with regular household cleaning products
  • Do not share dishes or utensils when eating, however, dishes and 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.
  • Have dedicated clothing, bed linens, and towels that are not shared with others.

How is mpox treated?

Treatment is generally not needed as most people will self-recover within 2 to 4 weeks. Treatment for mpox is mainly supportive and mainly includes:

• wound care
• pain control
• treating infections and other complications

If you are concerned, and want more information on treatment, please contact your health care provider.

Can I get vaccinated against mpox?

Imvamune® vaccine is approved in Canada for protection against mpox before getting exposed to the virus (pre-exposure vaccination) and after being exposed, but before developing symptoms (post-exposure vaccination).

Imvamune for both of these scenarios is most effective when received as two doses, four weeks apart. Booster doses are not recommended at this time.

Imvamune® vaccine for Pre-Exposure Vaccination

Visit the Ontario Ministry of Health (external link) to see who is eligible to get Imvamune® for pre-exposure vaccination
Consultation with your health care provider prior to immunization is encouraged if you are:

• under 18 years of age (note: Halton Region Public Health clinics are not currently offering vaccine for pre-exposure vaccination to anyone younger than 12 years of age)
• pregnant or breastfeeding
• severely immunocompromised
• have been diagnosed with atopic dermatitis
• had a previous allergic reaction to eggs or egg products, gentamicin, or ciprofloxacin
• have been diagnosed with myocarditis or pericarditis

Travel is not currently an indication for the Imvamune® vaccine unless you are an individual who meets Ontario’s current eligibility criteria. 

Imvamune® vaccine for Post-Exposure Vaccination

• Imvamune® vaccine for post-exposure vaccination requires an assessment of the risk of exposure by Halton Region Public Health.
• Post-exposure vaccination should be given within 4 days of exposure but can be given up to 14 days after last exposure.
• If you have been exposed to mpox, please contact Halton Region Public Health by calling 311 to find out if you are eligible for post-exposure vaccination.

How to get vaccinated

Eligible individuals can get vaccinated at:

• Halton Region Public Health Sexual Health Clinic, by appointment only. Appointments can be made by booking a vaccination appointment online; no OHIP card is required.
• Your Healthcare Provider’s Office. Your healthcare provider can assess your eligibility and order the vaccine for you.

Who can receive a second dose of the mpox vaccine?

Imvamune® is offered as a two-dose primary series, with at least 28 days between first and second doses for individuals eligible for pre-exposure and post-exposure vaccination.

Individuals who are household and/or sexual contacts of someone who meets pre-exposure vaccination eligibility AND are moderately to severely immunocompromised are also eligible to receive 2 doses of Imvamune® at least 28 days apart. For details of the definition of moderately to severely immunocompromised, please see Appendix A in the Mpox Vaccine (Imvamune®) Guidance for Health Care Providers.

Please note, individuals who are eligible for pre-exposure vaccination and post-exposure vaccination who previously received an older generation replicating smallpox vaccine can be vaccinated with 2 doses of Imvamune®.

Who should not receive the mpox vaccine?

Anyone who does not meet the current eligibility criteria outlined by the Ontario Ministry of Health's is not eligible to receive the mpox vaccine.

People with signs and symptoms of mpox infection should NOT receive the Imvamune mpox vaccine as it is not intended for the treatment of mpox. Please follow-up with your health care provider for further assessment.

People who have a confirmed allergy to a previous dose of Imvamune® or any of the vaccine ingredients should consult with an allergy specialist before getting the vaccine. Ingredients of the Imvamune® vaccine are:

• Tromethamine (trometamol, Tris)
• Sodium chloride
• Hydrochloric acid
• Bromobutyl rubber stopper

Imvamune® may also contain trace amounts of:

• Gentamicin
• Ciprofloxacin
• Egg cell DNA and protein
  • People with a confirmed allergy to eggs or egg products may receive Imvamune and will be asked to stay at the clinic for a 30 minute observation post-vaccination.
• Benzonase

I previously received the smallpox vaccination, does it offer any protection against mpox?

People who were vaccinated against smallpox are likely to have some protection against mpox infection. However, younger people are unlikely to have been vaccinated against smallpox because smallpox vaccination stopped in the 1970s after smallpox became the first human disease to be eradicated in 1980. Even though people who have been vaccinated against smallpox will have some protection against mpox, they also need to take precautions to protect themselves and others.

Please note, individuals who are eligible for pre-exposure vaccination and post-exposure vaccination who previously received an older generation replicating smallpox vaccine can be re-vaccinated.

What should I do if I am exposed to mpox?

If someone is exposed to a person with mpox, they should self-monitor for symptoms for 21 days after their last contact with that person. If symptoms develop, they should contact their health care provider.

Is mpox the same as smallpox or chickenpox?

No, mpox is not the same as chickenpox or smallpox. Mpox is caused by the monkeypox virus that belongs to the orthopoxvirus group. Smallpox is caused by the variola virus, which also belongs to the orthopoxvirus genus. Mpox presents as a milder version of smallpox, and causes lymph node swelling (lymphadenopathy), whereas smallpox does not. Chickenpox is caused by the varicella-zoster virus, which belongs to an entirely different virus group.

Who is at risk of getting mpox?

Anyone can get and spread mpox if they come into close contact with someone who has the virus, regardless of:

• sex
• race
• gender
• sexual orientation

Person-to-person transmission is currently happening in Canada. Most cases in Canada so far are in people who self-identify as gbMSM (gay, bisexual and other men who have sex with men), especially those with multiple sexual partners. However, it's important to stress that the risk of exposure to the monkeypox virus is not exclusive to any group or setting.

Having multiple sexual partners may increase your overall risk of infection.

How can I avoid getting mpox?

To help lower the risk of getting mpox avoid:

• close physical contact with someone who has mpox, including sexual contact
• sexual contact with someone who may have had a high-risk exposure to mpox
  For example, a sexual partner or household member of someone with mpox.
• contact with personal items or objects used by someone with mpox

You can also lower the risk by:

• getting vaccinated against mpox, if eligible
• having fewer sexual partners
• using barrier protection during sexual activity, including:
• condoms
• dental dams
• gloves
• clothing
• practicing regular hand hygiene
• cleaning and disinfecting high-touch surfaces and objects in the home, especially after having visitors

What animals can get mpox?

There are several types of animals that have been found to be susceptible to infection with mpox, including several species of rodents (e.g., rats, mice, hamsters, gerbils, squirrels, chipmunks, etc.), rabbits, hedgehogs, opossums, and non-human primates (e.g., monkeys). It is unknown which other species may be at risk of infection. Precautions should be taken to prevent exposure of any domestic or wild mammals to the virus.

Animals with mpox have been observed with clinical signs such as cough, fever, eye infections, lack of appetite, difficulty breathing, and rash. Veterinarians that suspect an animal has been infected with mpox should call the Ontario Ministry of Agriculture Food and Rural Affairs at 1-877-424-1300 to discuss the need for testing and/or management plans.

I have pets in my home. What precautions should I take if I have mpox or symptoms of mpox?

Although no cases of mpox have been reported in animals in Canada, cases should avoid contact with animals, including household pets, wildlife, poultry, and livestock.

Recommendations for symptomatic mpox cases:

• Cases should avoid close and/or prolonged unprotected contact (e.g., not wearing clothing or bandages covering lesions) with pets while infectious (e.g., petting, snuggling, kissing, sleeping with pets) without the use of risk mitigations measures.
  It is particularly important to prevent direct contact of pets with any unhealed skin lesions.
• Ask someone else in the home who is not sick with mpox to care for the pet, especially for rodents, rabbits, and non-human primates. For dogs that need to go outside periodically, keep them on leash and away from other animals.
• If no one else is available to care for the pet, the case should take precautions when providing care to the animal (see use of risk mitigation measures).

What if my pet becomes sick while I am isolating?

Recommendations for exposed animals who develop unexplained signs of a compatible viral illness within 21 days of having close contact with a case (e.g., fever, depression, not eating, respiratory signs, diarrhea, oral ulcers, skin lesions):

• Consult a veterinarian. Veterinarians seeking advice on MPXV testing or whether such testing is indicated in a particular case should contact OMAFA at 1-877-424-1300.
• Avoid unprotected contact with the pet, or any contact with anyone who is immunocompromised, pregnant, or children under 12 years of age.

I own or work with livestock or poultry, and I think I may have been exposed to mpox. What should I do?

Any person who may have been exposed to mpox should not work with livestock or poultry until they are advised by their health care provider or public health unit that they don’t pose any risk for transmission of the virus. Animal owners are responsible for providing basic care for their animals including food, water, and shelter. Livestock and poultry producers should always have a plan in place for others to provide care for their animals in case of emergencies, including the need to self-isolate due to illness.

If someone in the household is isolating from an exposure to mpox or has tested positive for mpox, how can we dispose of our household waste?

The risk to humans within the household who may directly handle contaminated domestic waste (e.g., gauze, wound dressings) generated within the home setting can be reduced through practices such as:

• performing regular hand hygiene, including after removing gloves used to handle waste,
• wearing gloves when handling waste,
• discarding contaminated items directly into a dedicated lined waste container,
• and not touching the outside of the waste container or other surfaces with contaminated gloves.

Any waste (i.e. bandages, gauze) that has come in contact with open sores or blood from an individual who is isolated from an exposure to mpox or has tested positive for mpox can be double bagged and placed in regular garbage. All other household waste can be disposed of in regular garbage.