Mpox (monkeypox)

Mpox is caused by the monkeypox virus (MPXV), an Orthopoxvirus related to vaccinia, cowpox, and variola (smallpox) viruses. It can cause a painful rash, enlarged lymph nodes, fever and other symptoms. Most people fully recover, but some get very sick.


November 2024 Update

On November 22, 2024, Manitoba Seniors and Long-Term Care confirmed its first case of clade Ib mpox, which is also the first case of clade Ib mpox in Canada. This travel-related case is linked to an ongoing outbreak of clade I mpox in central and eastern Africa. While clade I mpox had not been reported in Canada before, several travel-associated cases of subclade Ib have been recorded in other countries, including a recent instance in the United States.

On August 14, 2024, the WHO declared the ongoing mpox outbreak in Africa a Public Health Emergency of International Concern (PHEIC) due to the surge in cases and the spread of the new clade I variant to more countries across the continent.

Meanwhile, clade IIb MPXV continues to be detected in Canada; epidemiology updates are available from the Public Health Agency of Canada at Mpox (monkeypox) epidemiology update — Canada.ca.

Vaccination can help prevent infection. Read below to find out if you are eligible, where to get vaccinated and other ways to decrease your risk, especially if you are planning any travel.



MPXV is endemic, or found regularly, in various regions of Central and West Africa. Before the multi-country outbreak in 2022, mpox was considered a rare zoonotic disease (a disease that can be spread between animals and people). In 2022–2023 a global outbreak of mpox occurred, primarily spread through contact with infected people.

Mpox is spread by close contact, which includes touching, kissing, or sex. Most cases in Canada and globally have reported close or intimate contact with other people who had mpox. The overall risk to the general public is low.

Vaccination is available to help prevent mpox among people who are at greater risk of being exposed. For those at risk, it is important to receive 2 doses of the vaccine for the best protection. Vaccination is also available to those who have recently had high risk contact with someone who has mpox.

Public health authorities and clinicians in Canada, including Manitoba, are advised to be vigilant and consider mpox when patients present with an unusual, unexplained rash and other clinical signs consistent with mpox (e.g. fever, headache, and/or lymphadenopathy), particularly in individuals who may have been exposed and travelled to areas with increased mpox activity. Clinicians are encouraged to consult infectious disease specialists when assessing a suspected mpox case


Symptoms

Symptoms are typically flu-like, and can include:

  • fever,
  • headache,
  • muscle aches,
  • back aches,
  • chills,
  • exhaustion, and
  • swollen lymph nodes.

Several days after these symptoms appear, a rash may appear anywhere on the body, but is typically found on the face, palms of the hands and soles of the feet. The lesions progress through four stages (macular, papular, vesicular, to pustular) before scabbing over and resolving, over a period of two to three weeks. Close intimate contact during sex is known to be a risk factor, and the lesions may start and be localized to the sites of contact (e.g. genital lesions).

The severity of illness depends on the health of the infected individual, how they were exposed, and the strain of the infecting virus. There are two clades or strains. Clade II (the former West African strain), which had been identified in the global outbreak of 2022 (caused mostly by Clade IIb virus), typically causes milder illness than Clade I (the former Central African strain). In previous outbreaks, mpox infection has caused death in between 0 to 10 per cent of those infected, with the higher rate seen among those infected with Clade I.

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Transmission

Mpox does not generally spread easily between people. Current evidence suggests that mpox spreads in 3 ways:

  1. person to person :
    • direct contact with an infected person's lesions or scabs on the skin (even if not visible) or mucous membranes (e.g., eyes, nose, mouth)
    • contact with an infected person's body fluids such as blood, saliva, and semen
    • through respiratory particles, such as from talking, breathing, coughing, or sneezing (usually requires prolonged (hours) close face-to-face contact)
    • from an infected pregnant person to their developing fetus through the placenta
  2. contact with contaminated objects used by an infected person (i.e. clothing, bedding, towels, and other shared objects)
  3. animals to humans (i.e. via a bite or scratch or through meat preparation or consumption of undercooked meat)

A person may be infectious up to four days before the onset of symptoms and until all the skin lesions have resolved.

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Risk of Getting Mpox

Similar to other countries, the majority of cases in Canada to date are men who reported intimate sexual contact with other men. However, it's important to stress that the risk of exposure to mpox is not exclusive to any group or setting. Anyone can get infected and spread mpox if they come into close contact with someone who has the virus, regardless of:

  • sex
  • race
  • gender or
  • sexual orientation

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Diagnosis and Testing

Health care providers should discuss all suspected cases with an Infectious Disease Specialist to coordinate appropriate testing and management. The diagnosis is confirmed by PCR laboratory testing.

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Treatment

Most cases are self-limited, which means they don’t require treatment, and resolve within 2 to 4 weeks. It is unknown whether or not a person with severe mpox infection will benefit from treatment with antivirals, although their use may be considered on a case-by-case basis.

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Prevention

Mpox is currently being transmitted through close, sustained physical contact. This includes sexual contact.

Vaccination can protect people, but no vaccine is 100% effective. It is important to consider other ways to reduce your risk of exposure, whether or not you have been vaccinated. To protect yourself and prevent mpox:

  • be aware of any new or unexplained rash or lesion on you or your partner(s). In some cases, symptoms may be mild, and some people may not even know they have mpox;
  • avoid skin-to-skin or face-to-face contact with anyone who has symptoms. Especially avoid touching any rash;
  • stay home if you are sick, and encourage others to do the same;
  • consider minimizing the number of sexual partners that you have, recognizing the risk of mpox spread may be higher with anonymous sexual contact and/or multiple partners;
  • use barrier protection (e.g. condoms, dental dams), recognizing barrier protection alone may not prevent all exposures to mpox since the rash can occur on other parts of the body;
  • condoms also help prevent other sexually transmitted infections;
  • perform hand hygiene regularly (washing hands with soap and water for at least 15 seconds or using an alcohol-based hand sanitizer);
  • clean and disinfect objects and surfaces that have been touched regularly (e.g. door handles, phones, countertops, etc.) with standard household disinfectants;
  • don’t share personal items (e.g. towels, bedding, toothbrushes, sex toys, etc.) with others; and
  • get vaccinated if you’re eligible.

For more information: Safer Sex, Social Gatherings and Mpox (Centers for Disease Control and Prevention)

For more information on Mpox and Advice for Travellers (Government of Canada)

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Vaccination

Imvamune® is the name of the vaccine used to protect against mpox. Imvamune® is approved by Health Canada for use in adults who are assessed as being at high-risk for exposure to mpox.

Imvamune® can be used in two different ways:

  • exposure to mpox; this is called pre-exposure prophylaxis. By giving the vaccine before exposure to the virus, it can help protect against mpox;
  • After exposure to mpox and before you develop symptoms; this is called post-exposure prophylaxis. If the vaccine is given shortly after exposure to mpox, it may help prevent the disease or make it less severe.

More information on Imvamune® and vaccination can be found in the mpox vaccine factsheet. Manitobans can also contact their local public health office, Health Links – Info Santé (204-788-8200 or toll free at 1-888-315-9257), or their health care provider with questions about mpox vaccination.

Eligibility for pre-exposure prophylaxis

The following individuals are eligible for the mpox vaccine:

  • cisgender, transgender, or two-spirit people who self-identify as belonging to the gay, bisexual and other men who have sex with men (gbMSM) community and who meet at least one of the following criteria:
    • have received a diagnosis of a sexually transmitted infection in the past year;
    • have had two or more sexual partners in the past 90 days;
    • have attended locations for sexual contact (e.g. bath houses or sex clubs) or are planning to;
    • have had anonymous sex in the past 90 days (i.e. using apps, online sites, formal/informal gatherings) or are planning to;
    • engaged in sex work or plan to, as a worker or client; or
  • any sexual contacts of the individuals described above.
  • individuals who self-identify as sex workers, regardless of self-identified sex/gender
  • staff or volunteers in sex-on-premises venues where workers may have contact with objects or materials that may be contaminated with the mpox virus without the use of personal protective equipment
  • individuals who engage in sex tourism regardless of gender, sex assigned at birth, or sexual orientation
  • individuals who anticipate experiencing any of the above scenarios;
  • Laboratory personnel who have direct contact with replicating orthopoxviruses that pose a risk for human health (e.g., vaccinia or monkeypox viruses) and are at high risk of occupational exposures

It is recommended, individuals be provided with two doses of vaccine for pre-exposure prophylaxis administered 28 days apart. If it has been more than 28 days since you have received your first dose, you can still obtain your second dose. Two doses of vaccine represent a complete primary series of Imvamune® vaccine.

The vaccine is available in communities across the province. Preventive immunization for eligible people can be booked by contacting your local public health office, Monday to Friday 830-430. If you need help in identifying your local public health office, contact Health Links — Info Santé (204-788-8200 or toll free at 1-888-315-9257) for support.

Eligibility for post-exposure prophylaxis:

People are eligible if they have had high risk close contact with a confirmed or probable mpox case. Even if you have already received a dose of Imvamune® for pre-exposure prophylaxis, you may be eligible for a second dose as post-exposure prophylaxis.

If you are a close contact of a confirmed or probable mpox case, contact your local public health office or Health Links – Info Santé (204-788-8200 or toll free at 1-888-315-9257).

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Information for Mpox Cases

Individuals with symptoms of mpox should speak with their health care provider and avoid contact with others to help prevent the spread of this infection. For more information, please see the mpox case and contact management factsheet.

During their infectious period (from the start of their symptoms until their rash has resolved), individuals with mpox should:

  • Stay home and isolate in a separate area from other household members (e.g. private room for sleeping and washroom). If you do not have somewhere to isolate, you can discuss other options with public health;
  • Avoid directly touching other people, including through sexual contact. After being deemed no longer contagious, cases should wear a condom during any sexual activity for 12 weeks;
  • Avoid contact with those at higher risk of severe mpox illness including immunosuppressed people, pregnant women, and children under 12 years of age;
  • Avoid areas commonly used by others in the home, where possible. Surfaces/objects in common spaces that may be accessed by the case should be adequately cleaned and disinfected;
  • Wear a well-made, well-fitting medical mask (if sharing space with others);
  • Cover any lesions (e.g., long pants, sleeves, bandages);
  • Avoid sharing items or objects or exposing other people to clothes, towels, bedding, linens, or other materials used or worn by the infected person. Unless unable to do so, cases should be responsible for handling and laundering their own clothing, bedding, towels, etc. Cases should also be responsible for handling and washing their own utensils and dishes;
  • Practice proper hand hygiene (washing with soap and water for at least 15 seconds or using alcohol-based hand sanitizer) and using a tissue or your elbow to cover coughs and sneezes;
  • If breastfeeding, cases should seek advice from their healthcare provider;
  • Avoid contact with animals, including household pets as the virus can spread to animals;
  • Only leave isolation to access urgent medical care or for other similar emergencies;
  • Call ahead, if seeking health care, and let them know you have symptoms of mpox to avoid exposing other people. Wear a well-made, well-fitting medical mask and cover any lesions with clothing or bandages.
Information for Close Contacts of Mpox Cases

Public health will notify all close contacts and provide information on monitoring for symptoms including fever, chills, swollen lymph nodes, and skin rashes for 21 days after the last exposure to the infected person. Close contacts do not need to self-isolate (quarantine) if they do not have any symptoms. If symptoms develop, contacts should isolate at home and follow guidance for cases to prevent spread to others:

All contacts should:

  • Practice proper hand hygiene (washing with soap and water for at least 15 seconds or using alcohol-based hand sanitizer) and use a tissue or your elbow to cover coughs and sneezes. Consider wearing a well-fitting medical mask around others in enclosed indoor spaces;
  • Limit your contact with the person who is a suspected case if you live with them, avoid sleeping in the same bed, and wear a medical mask if sharing the same space;
  • Do not donate blood, cells, tissue, breast milk, semen, or organs during the 21 days after the last exposure;
  • Avoid all sexual contact during the monitoring period;
  • Avoid non-essential interactions in enclosed indoor settings with those at higher risk of severe mpox illness including congregate settings (e.g., personal care home, assisted living facilities, etc.), immunosuppressed people, pregnant women, and young children. If this is unavoidable, consider wearing a well-fitting medical mask in these settings. Consult occupational health at your workplace if you work in a high-risk setting such as a health care facility or a congregate setting (e.g., personal care home, assisted living facilities, etc.);
  • To prevent possible spread to animals, including pets, livestock, and wildlife, have someone else care for your animals. If this is not possible, wear a well-fitting medical mask and gloves when near the animals. Practice proper hand hygiene (washing with soap and water for at least 15 seconds or using alcohol-based hand sanitizer) before and after contact with the animal or items they have had contact with, and before putting on and after talking off gloves;
  • If symptoms develop, isolate at home, and follow guidance above to prevent spread to others. Notify public health or Health Links – Info Santé (204-788-8200 or toll-free at (1-888-315-9257)) of your symptoms. You should be assessed by your health care provider. Call ahead and let them know you have been exposed to mpox and have symptoms, to avoid exposing other people. Wear a well-made, well-fitting medical mask and cover any lesions.

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Manitoba Health Resources

For the Public

For Health Care Providers

Other Resources

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Communicable Disease Control (CDC)
 Public Health
Manitoba Health
4th Floor - 300 Carlton St.
Winnipeg MB  R3B 3M9  CANADA

Health Links – Info Santé
204-788-8200 or 1-888-315-9257