mpox

mpox is a zoonosis, i.e. an infection transmitted from animals to humans. It can then be transmitted from human to human, or from contaminated surfaces to humans. It creates characteristic lesions on the skin. The infection generally heals on its own within 2 to 4 weeks.

mpox comes in two subtypes known as clades: clade I and clade II.

Clade II is the one detected in Canada and several other countries around the world in 2022. It leads to less severe infections and few or no deaths.

In 2024, there was an increase in mpox cases linked to clade I, especially in African countries. These cases present more severe manifestations of infection and a higher death rate.

As of September 2024, clade I has not yet been detected in Canada, but surveillance is being carried out following the World Health Organization’s (WHO) warning in August 2024 of the potential for international spread.

The characteristic symptom of mpox is a rash that appears 5 to 21 days after exposure. This rash lasts an average of 14 to 28 days, and evolves through various stages, which can be summarized as follows: first redness, then lesions (small sores) and finally scabs, which eventually fall off on their own. Often, lesions can be painful or very itchy. Photos of the lesions can be found on the Government of Canada website. They can help you better visualize the symptoms of mpox, so that you can get proper treatment if necessary.

The rash often appears first on the face and mouth, and can then spread to the whole body, including :

• anus
• genitals
• torso
• arms and legs
• feet
• hands

Other symptoms often appear before, during or after the rash:

• fever
• chills
• swollen glands
• sore throat
• headaches
• rectal pain
• muscle or joint pain
• gastrointestinal problems
• exhaustion

To date, mpox is considered contagious from the first symptoms until complete healing of the skin, including mucous membranes. Complete healing is defined by the fact that all scabs have fallen off on their own, and a new layer of intact skin has appeared.

Person-to-person transmission

mpox is transmitted from human to human:

• by direct contact with the lesions or scabs of a person with mpox (skin or mucous membranes: eyes, mouth, throat, penis, vulva, anus or rectum)
• by direct contact with the body fluids of a person with mpox (blood, saliva, semen).

Situations that could lead to transmission include:

• skin-to-skin and sexual contact, including hugging, massaging, kissing, oral sex or frotting
• living in the same household (regular contact with the person and his or her personal objects, in confined spaces)
• pregnancy (from the pregnant person to the fetus)
• caring for a person with mpox

It is not yet known whether a person with mpox, but no symptoms, can transmit the virus.

The virus can be transmitted by air (through breathing), but available data indicate that the role of this mode of transmission remains minimal. More research is needed on this subject, however, according to the Public Health Agency of Canada (PHAC).

Transmission from surfaces to people

mpox can also be transmitted by direct contact with a surface, fabric or object used by the person with mpox and which has not been disinfected. The objects in question may be:

• clothing
• bedding
• towels
• razors
• utensils
• needles
• sex toys, whether penetrating or not
• toothbrushes

Person-to-animal transmission

It is possible for mpox to be transmitted from humans to animals. If a person has mpox, it is therefore recommended that they avoid contact with their pets.

If you’ve been in close contact with someone with symptoms:

• Watch for symptoms for 3 weeks (21 days) after contact with the person with symptoms;
• If you live with the person with symptoms, try to apply these measures as much as possible (it’s normal for circumstances to make certain measures more difficult to apply):
  • Don’t sleep in the same bed
  • Don’t share personal items (bedding, clothes, dishes, etc.)
  • Limit physical contact
  • Wear a mask when in close proximity (less than one meter)
  • Get vaccinated (postexposure vaccine)

If you have symptoms compatible with mpox, consult a healthcare professional as soon as possible for an assessment and, if necessary, the taking of biological samples. Before showing up for your appointment:

• Tell them 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 may cause you anxiety for a number of reasons.

For support, don’t hesitate to contact a community organization, like RÉZO if you live in Montreal. You can also consult the interactive map to find the organization nearest you.

Here’s what you must do:

• Cover your lesions at all times
• Avoid touching your eyes and using contact lenses
• Avoid contact with people who are more vulnerable to infection, such as immunosuppressed people, pregnant people or young children.
• Avoid sexual contact
• Wear a mask when within one meter of another person (whether indoors or outdoors).
• Avoid sharing objects of any kind
• Avoid all situations where your uncovered lesions could touch or be touched by other people, and situations where your lesions could touch surfaces/objects that other people may subsequently touch
• 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 come into contact with since your first symptoms.
  • This part can be stressful, which is normal. The Portail VIH/sida du Québec offers a free, anonymous partner notification service that can help with this process. Health professionals can also help.
• As a precaution, avoid contact with your pets (or other animals around you): mpox could be transmitted from humans to animals.

You’ll need to follow these measures until the scabs (last phase of the lesions) fall off and a layer of new, intact skin is visible, or as recommended by your doctor.

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

Conversely, people living with HIV with weakened immune systems are at greater risk of complications. Various studies have shown that the vast majority of people hospitalized for severe complications had a very weakened immune system, often due to the absence of adequate treatment to control HIV infection.

So, if you’re living with HIV, the most important steps you can take to prevent any complications are:

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

If you are not living with HIV, it is recommended that you:

• Get vaccinated against mpox
• Have regular HIV screening tests
  • In general, you need to make an appointment with a SIDEP, a specialized HIV clinic or an HIV community organization.
  • Consult the interactive map to find the HIV testing service nearest you.
  • Find out more about PrEP: it could be the right HIV prevention method for you!

Vaccination is an excellent method of prevention. In Canada, the Imvamune® vaccine has been authorized for mpox vaccination.

The success of the vaccination campaign in Quebec was made possible by (1) the collaboration between the community, public health and private clinics, which were able to effectively reach gay, bisexual and men who have sex with men, and (2) the response of this community, which answered the call to be vaccinated.

The vaccination campaign is still underway: you can book an appointment near you right now, or consult your local public health department.

The vaccine can be administered both before and after exposure. For a complete vaccination, 2 doses are required, administered at least 4 weeks apart.

Pre-exposure vaccination

The pre-exposure vaccine is strongly recommended for the following people, with 2 doses separated by at least 4 weeks:

• men (cis and trans) who are gay, bisexual or who have relationships with men who meet at least one of these criteria:
  • have relationships with people other than an exclusive partner, or whose partner has relationships with other people
  • have relations in a place of sexual socialization (e.g. sauna)
  • have sexual contact involving the exchange of money, goods or services
• people who work in places where people socialize sexually (e.g. saunas)
• people who do sex work
• laboratory workers over 18 considered to be at high risk of exposure

Post-exposure vaccination

Postexposure vaccine is offered in 2 doses separated by a minimum of 4 weeks to people who, within the last 14 days, have had these types of contact with a person with mpox and symptoms:

• direct contact with skin (including but not limited to lesions) or body fluids
• direct contact with objects touched by the person (bedding, clothing, toothbrushes, sex toys, etc.)
• interaction at a distance of less than 1 meter and without a mask, whether indoors or outdoors

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

If you have symptoms when you come to get vaccinated, you will not be able to be vaccinated that day. Here’s what to do:

• Consult a health care professional so that he or she can examine you and, if necessary, take the samples required to detect (or not) the virus.
• If the examination or analysis of the samples determines that you do not have mpox, wait until your symptoms have disappeared, then present yourself again.
• If the examination or sample analysis determines that you do have mpox, follow the steps outlined in the section on what to do if you have symptoms.
  • Important: once you’ve fully recovered, you’ll be considered adequately protected and won’t need to receive the vaccine.

Additional information

If you received the smallpox vaccine as part of the vaccination campaign that ended in 1972, and are considered at high risk of exposure to mpox, a booster dose may be recommended, but this is a discussion you need to have with your healthcare professional.

How do I get assessed?

If you have symptoms similar to those of mpox and would like to make an appointment for an evaluation, you can consult your local public health website 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 periods, especially in larger cities. Check your local public health website for relevant information.

You can also make an appointment. To make an appointment:

• Go to the dedicated ClicSanté page
• Enter your postal code to find the vaccination clinic nearest you
• Reserve your time slot

• Public Health Agency of Canada (PHAC)
• Quebec Ministry of Health and Social Services (MSSS)
• Direction régionale de santé publique de Montréal (DRSP)
• CATIE
• Centers for Disease Control and Prevention (CDC)

Additional resources

• Community based research center (CBRC) website on mpox (including testimonials)
• RÉZO page on mpox (including testimonials)

In May 2022, several cases of mpox were confirmed across Canada. While Montreal was one of the most affected Canadian cities at the start of the outbreak, it was quickly brought under control. This was due to the swift action of the community, in partnership with public health and private clinics, and to the overwhelmingly positive response of the affected communities, particularly the gay community, to the targeted vaccination campaign.

Between May 30, 2022 and August 15, 2024, 46,984 doses of the vaccine were administered in Quebec.

However, the risk of contracting mpox remains a reality. Indeed, more than 40 cases were reported in Quebec between March and October 2024. The vaccination campaign is therefore still underway. People who have not yet been vaccinated are invited to get their two doses, and those who have only received one dose are encouraged to get the second.

While mpox can be contracted by anyone, the vast majority of cases detected in Canada involve gay, bisexual and men who have sex with men (cis and trans).

Fortunately, as mentioned in the previous sections, there are many effective preventive measures, and most cases of mpox heal on their own in 2 to 4 weeks.