Mpox

Mpox is a zoonosis, meaning an infection that can be passed from animals to humans. It can then be transmitted from one person to another, or from contaminated surfaces to people. In general, infected people heal by themselves within two to four weeks.

The main symptom of mpox is, first, a skin rash that appears 5 to 21 days after exposure. This rash lasts on average 14 to 28 days and goes through several stages: first redness, then lesions (small sores) and finally crusts, which eventually fall off by themselves. Often, the lesions are painful or cause severe itching.

In the case of the outbreak that began in May 2022, the skin rashes happened mainly around the penis, the anus and the mouth, but the rash can affect any part of the body, including:

• the face
• the arms and legs
• the feet
• the hands

Other symptoms that often come with the skin rash include:

• fever
• chills
• swollen lymph nodes
• headaches
• muscle aches or joint pain
• back pain
• exhaustion

At this time, a person is considered contagious from the onset of symptoms until their skin is fully healed (no more crusts).

Person-to-person transmission

Mpox is transmitted from one person to another:

• Through prolonged contact with the lesions or crusts of an infected person (skin or mucus membranes: eyes, mouth, throat, penis, vulva, anus or rectum).
• Through prolonged contact with the bodily fluids of an infected person (blood, saliva, sperm).

As such, transmission is more likely when:

• People have sexual and skin-to-skin contact including hugs, massages, kissing, blow jobs and rubbing together (frotting, dick2dick).
• Someone provides care to an infected person.
• People live in the same household (regular and prolonged contact with a person in a limited space).

We don’t yet know if a person who is infected but who’s not showing symptoms can transmit the virus.

Transmission from surfaces to people

Mpox can also be transmitted from a contaminated surface or object to a person. The objects in question can include:

• clothes
• bedding
• towels
• razors
• utensils
• needles
• sex toys, whether penetrative or not
• toothbrushes

The virus may also be transmitted through close contact with an infected person’s respiratory secretions (emitted when we talk, breathe, cough or sneeze). For this reason, as we explain in the list of measures to take, the recommendations include wearing a mask. However, data collection on this subject is still underway.

If you were in close contact with a person who has symptoms:

• Watch for the appearance of symptoms for three weeks (21 days) after contact with the symptomatic person.
• If you live with the symptomatic person, try to apply the following measures as best you can (we know it’s not always possible!):
  • Don’t sleep in the same bed.
  • Don’t share personal items (bedding, clothes or dishes, for example).
  • Limit your contacts.
  • Wear a mask when you’re around them.
  • Get vaccinated (post-exposure vaccination).

If you’re having symptoms typical of mpox:

• See a healthcare professional as soon as possible for evaluation and, if necessary, collection of biological samples. Before attending your appointment:
  • Warn them that you have symptoms
  • Wear a mask
  • Cover your lesions

If your medical examination determines that there’s a good chance you have mpox (probable case), or if the analysis of your samples confirms the infection beyond any doubt (confirmed case), there are many measures to follow, which can be anxiety-provoking for several reasons.

For support, don’t hesitate to reach out to a community organization, such as RÉZO if you live in Montréal. You can also look at our interactive map to find the organization closest to you.

Here are the measures to take:

• Cover your lesions at all times.
• Avoid touching your eyes or using contact lenses.
• Avoid contact with people who are vulnerable to infection, such as immunosuppressed people, pregnant people and young children.
• Avoid sexual contact.
• Wear a mask when you’re less than a metre away from a person for three hours or more.
• Avoid sharing all objects, whatever they may be.
• Avoid any situations where uncovered lesions could touch or be touched by other people as well as situations where lesions could touch surfaces or objects that other people may touch afterwards.
• Follow basic hygiene measures: wash your hands regularly and cover your nose and mouth when you sneeze or cough.
• Inform your sexual partners and anyone else you’ve had contact with since your first symptoms. This part can be stressful, and that’s normal! Portail VIH/sida du Québec offers a free, anonymous notification service that can help you.
• As a precaution, avoid contact with your pets (and any other animals around you); mpox may be transmittable from humans to animals.

You need to follow these measures until the crusts (the final phase of the lesions) fall off and you can see a layer of new skin or according to your doctor’s recommendations.

 

Studies from high-income countries show that people living with HIV who are taking treatment and have a strong immune system do not present more severe symptoms or symptoms that last longer than HIV-negative people.

However, people living with HIV who have a weakened immune system are at greater risk of complications. Various studies have shown that the vast majority of people hospitalized for severe complications have very weakened immune systems, often because they lack appropriate treatment for controlling HIV infection.

As such, the most important measures you can take to prevent any complications are:

• Get vaccinated against mpox.
• Get regularly tested for HIV.
  • In general, you need to make an appointment at a SIDEP, a specialized HIV clinic or an HIV community organization.
  • Consult the interactive map to find the HIV testing service closest to you.
  • Also find out more about PrEP—this could be the right prevention method for you!

As well, if you’re already living with HIV, it’s important to:

• Get vaccinated against mpox.
• Continue taking your HIV treatment as prescribed. If you don’t have access to effective treatment, contact an HIV community organization near you.

The vaccine is an excellent preventative method. In Canada, the Imvamune® vaccine has been authorized for use against mpox.

The success of the Québec vaccination campaign was made possible by 1) collaboration between the community sector, public health and private clinics, which were able to effectively reach gay and bisexual men and men who have sex with men, and 2) the response from the community, which heeded the call to get vaccinated. The vaccination campaign is still underway; you can make an appointment near you.

The vaccine can be given before or after exposure. For a complete vaccination, you need two doses of the vaccine, given at least four weeks apart.

Pre-exposure vaccination

Pre-exposure vaccination is strongly recommended for the following people, in the form of two doses given at least four weeks apart:

Post-exposure vaccination

Post-exposure vaccination is provided in the form of two doses given at least four weeks apart to people who, in the last 14 days, have had the following types of contact with a person who is infected AND symptomatic:

• Direct contact with skin (particularly with lesions, but not only) or bodily fluids.
• Direct contact with objects that the person has touched (bedding, clothing, toothbrush, sex toys, and so on).
• Interaction for three hours or more, within one metre, and without wearing a mask.

What should I do if I have symptoms when I come to get vaccinated?

If you have symptoms when you show up, you won’t be given the vaccine that day. Here’s what to do:

• See a healthcare professional so that they can examine you and take the necessary samples to detect (or not) the virus.
• If the samples analysis determines that you are not infected, wait until your symptoms have disappeared, then come back for the vaccine.
• If the samples analysis determines that you are infected, follow the steps outlined in the “Symptoms of mpox” section.
  • Once you’ve fully recovered, you’ll be considered adequately protected and won’t need to receive the vaccine.

Additional information

If you were vaccinated against smallpox as part of the vaccination campaign that ended in 1972 AND you’re at high risk of exposure to mpox, a single booster dose may be recommended for you. But this is a conversation you need to have with your health professional.

 

How do I get assessed?

If you have symptoms resembling those of mpox and would like to make an appointment for an evaluation, you can consult your local public health website (see list at bottom of page) to find the relevant information.

You can also contact Info-Santé 811 (by dialing 811) for advice and referral to an appropriate resource in your area.

Where can I get vaccinated?

Some clinics have walk-in hours, particularly in major cities. Visit the public health website for your area (see the list below) to find this information.

You can also make an appointment. To do this:

• Visit ClicSanté.
• Click on “Vaccination,” then on “Simian smallpox”, then on “Select this service.”
• Next, enter your postal code to find the vaccination clinic closest to you!

Information sources

• Public Health Agency of Canada (PHAC)
• Ministère de la Santé et des Services sociaux du Québec (MSSS)
• Direction régionale de santé publique de Montréal
• CATIE