Mpox Information for Health Professionals

Mpox is a rare infectious disease caused by the monkeypox virus. It is typically found in parts of Central and West Africa, but cases of mpox have recently been found in many countries worldwide, including Canada.

The risk of infection is low for the general population. There are two types (clades) of mpox virus. The recent increase in mpox infections in the Democratic Republic of Congo and neighbouring African countries are clade I. This clade is more likely to cause severe infections and is not currently circulating in Canada. The rise in local mpox cases is clade II, which has caused infections in Canada since 2022.

York Region Public Health offers mpox vaccine appointments for people at higher risk of infection. Please help us promote these clinics to your eligible patients as listed in the Pre-exposure Vaccination section below.

Imvamune® is a two-dose vaccine. For full protection, everyone should get two doses 28 days apart.

For information about local mpox cases and related epidemiological information, go to Public Health Ontario

Person-to-person transmission usually occurs through direct contact with an infected individual’s lesions/scabs, bodily fluids, respiratory secretions, mucus membranes, and materials contaminated with the monkeypox virus (e.g., contaminated bedding, linens, towels, lesion dressings)

Mpox infection is typically mild and self-limiting. However, severe illness can occur in some individuals. Signs and symptoms typically include fever, headache, muscle aches, exhaustion and swollen lymph nodes, followed by a progressively developing rash one to three days later.

The incubation period (period from exposure to development of symptoms) is typically six to 13 days but can range from five to 21 days. Mpox is considered most infectious from the start of the first sores until scabs have fallen off and new skin is present. Some cases may be infectious during early symptoms (prodrome), such as fever, muscle, body aches and headache before the rash develops. Recent evidence suggests that some individuals may be contagious up to 4 days before the onset of symptoms.

When assessing your patients, please continue to consider the following differential diagnoses, which may be hard to distinguish from mpox – including syphilis, herpes simplex virus (HSV), chancroid, varicella zoster, hand, foot and mouth disease and other common infections. The Ministry of Health has developed a reference guide comparing mpox, chickenpox, and hand-foot-and-mouth disease. The Ministry of Health has also posted resources on its. Mpox resources for health care professionals

Visit the World Health Organization’s mpox outbreak page for updates on areas currently affected by monkeypox worldwide and visit the Public Health Agency of Canada’s Mpox page for Canadian update.

Reporting Information for Health Professionals

Mpox is a Disease of Public Health Significance (DOPHS) as “Smallpox and other Orthopoxviruses including Mpox” by the Ministry of Health under the Health Protection and Promotion Act (HPPA).

Health care providers have a duty to report DOPHS and/or communicable diseases and should also report any suspected mpox cases directly to York Region Public Health.

Contact York Region Public Health

For questions, issues or reports of any DOPHS, contact York Region Public Health’s Control of Infectious Disease team:

  • Email: @email
  • Telephone: 1-877-464-9675 ext. 73588 (Monday to Friday, 8:30 a.m. to 4:30 p.m.)
  • On-call Response Telephone: 905-953-6478 (after 4:30 p.m. and 24/7 on weekends and holidays)
  • Fax number: 905-898-5213

For more information, go the Diseases of Public Health Significance Reporting Form

Infection Prevention and Control (IPAC) Recommendations

Please refer to Public Health Ontario’s Infection Prevention and Control (IPAC) Recommendations for Mpox in Health Care Settings.

Cases with suspect, probable or confirmed mpox should be in a single-patient room with the door closed. An airborne infection isolation room is not necessary but may be used while ruling out other infectious diseases (e.g., varicella or measles as differential diagnoses).

Health care providers should use gloves, gown, eye protection and a fit-tested, seal-checked N95 respirator (or equivalent) if assessing or caring for a person with possible mpox infection.

Laboratory Testing

Approval for mpox testing is not required and any health care provider can test patients in their office. Individuals with compatible symptoms and mpox is suspected should be tested. Individuals tested for mpox should be advised to isolate at home until their results are reported and Public Health contacts them.

For patients that have a rash, the best specimen to submit is a skin lesion specimen. You can submit a maximum of three skin lesion specimens (virus culture collection kit order#: 390081).

If the patient does not have a rash, submit both a nasopharyngeal or throat swab (virus respiratory collection kit order#: 390082) and a blood sample for maximum test effectiveness.

NOTE: The outer packaging on all collected specimens must be marked, on a contrasting background, with "TU 0886".

Please refer to Public Health Ontario’s (PHO) Mpox Virus test information page for the most up-to-date information.

Please refer to PHO’s testing indications identified above for details on which samples to take, how to label them, and how to submit samples from a patient being investigated for mpox.

Additional questions regarding testing may be directed to PHO Laboratory Customer Service Centre at 416-235-6556/1-877-604-4567 during business hours, or after-hours 416-605-3113.

Vaccine Availability

Post-Exposure Vaccination

The provision of Imvamune® for post-exposure vaccination requires a risk assessment by York Region Public Health. It is offered to contacts who may have had a high or intermediate risk exposure to a mpox case. As part of our contact tracing and follow up, York Region Public Health will provide recommendations in conjunction with the contact’s health care provider regarding post-exposure vaccination and can help support administration of the vaccine.

Individuals who have been a confirmed case of mpox or are symptomatic are NOT recommended to receive the mpoxvaccine at this time.

Ministry of Health case and contact guidance is available at Recommendations for the management of cases and contacts of mpox in Ontario.

Pre-exposure Vaccination

York Region Public Health offers two doses of Imvamune® (with at least 28 days between the first and second dose) for individuals meeting the following provincial eligibility criteria for pre-exposure vaccination:

  1. Two-spirited, non-binary, transgender, cisgender, intersex or gender-queer individuals who self-identify as belonging to the gay, bisexual, pansexual and other men who have sex with men (gbMSM) community AND who meet at least one of the following:
    1. Have more than one partner
    2. Are in a relationship where at least one of the partners has other sexual partners
    3. Have had a confirmed sexually transmitted infection within the last year
    4. Have attended venues for sexual contact (e.g., bath houses, sex clubs)
    5. Have had anonymous sex recently (e.g., using hookup apps) recently 
  2. Sexual partners of individuals who meet the criteria above
  3. Sex workers (regardless of gender, sex assigned at birth, or sexual orientation) or who are a sexual contact of an individual who engages in sex work
  4. Staff or volunteers in sex-on-premises venues where workers may have contact with fomites potentially contaminated with mpox
  5. Individuals who engage in sex tourism (regardless of gender, sex assigned at birth, or sexual orientation)
  6. Individuals who anticipate experiencing any of the above scenarios

Household contacts of those identified for pre-exposure vaccination eligibility above AND are moderately to severely immunocompromised or who are pregnant may be at higher risk for severe illness from a mpox infection and may be considered for pre-exposure vaccine. These individuals should contact their health care provider for more information.

Each appointment is provided one-to-one in a private room.

Your eligible patients can book an appointment at an upcoming clinic by visiting york.ca/mpox or calling Access York at 1-877-464-9675. The website also provides information for the public on signs and symptoms and how to prevent mpox infection.

Special Populations

For detailed information on Imvamune® including the use in special populations, please see the Ministry of Health's Mpox Vaccine (Imvamune®) Guidance for Health Care Providers document.

Special populations include those with previous smallpox vaccine, those who have had mpox infection, research laboratory employees, moderately to severely immunocompromised individuals (defined in Appendix A of the guidance), those with allergy/hypersensitivity, pregnant and/or breastfeeding, children and youth and persons with atopic dermatitis.

Vaccine Frequently Asked Questions

Are individuals eligible to get a mpox vaccine if travelling soon?  

Imvamune® vaccine is not a routine travel immunization. Individuals may get vaccinated if they meet one of the eligibility requirements outlined above.

Can individuals with a history of previous smallpox vaccine get vaccinated?

Yes. Individuals eligible for Imvamune® as a pre-or post-exposure vaccination and who have previously received smallpox vaccination are still recommended to receive a two-dose series of Imvamune®.  

Can individuals with a previous mpox infection get vaccinated?

No. Individuals who have been a confirmed case of mpox are NOT recommended to receive the mpox vaccine.

What is the definition of moderately to severely immunocompromised?

Please see Appendix A of the Mpox Vaccine (Imvamune®) Guidance for Health Care Providers document for the full definition of moderately to severely immunocompromised.

Who can get a second dose of Imvamune®?

Imvamune® should be offered as a two-dose primary series for individuals currently eligible for pre-exposure vaccination and to individuals who received a post-exposure vaccination. The first and second dose should be at least 28 days apart.

Who requires a medical note to receive Imvamune®?

Given the scarcity of data on the effectiveness of vaccine in certain special populations, as well as the need for clinical assessment, we are asking that the following groups speak with their health care provider and provide a medical note (or for those under the first bullet, proof of prescription) to be immunized in our clinics.  These include:

  • Individuals that are immunocompromised and have a household or sexual partner that is in a pre-exposure vaccination eligible group can receive the vaccine with proof of their condition or medication (e.g., a note from their provider, a copy of their prescription or their eligible medication bottle)
  • Individuals who are severely immunocompromised
  • Individuals that are pregnant
  • Individuals that are less than 18 years of age

Can Imvamune® be co-administered with other vaccines?

Yes, Imvamune® can be given concurrently (i.e., same day) or at any time before or after other live or non-live vaccines.

How can I promote this vaccine in my clinic(s)?

Your eligible patients can book an appointment or find locations and walk-in times for upcoming York Region Public Health clinics by visiting york.ca/mpox or calling Access York at 1-877-464-9675. You may also print and post in your clinic(s) the general vaccine clinic flyer.

Treatment

In Canada, Tecovirimat (TPoxx®) is authorized by Health Canada for the treatment of human smallpox disease in adults and pediatric patients weighing at least 13 kg. The drug does not have an approved indication for the treatment of mpox in Canada. However, a licensed healthcare professional may use their clinical judgment to prescribe TPoxx® off-label for the treatment for severe mpox infections.

A limited supply is available in Ontario for patients who are severely ill/disabled due to mpox infection or at high risk for severe disease (e.g., immunocompromised, pediatric, pregnant, or patients with one or more complications). Detailed information on the use of TPoxx®, including eligibility criteria, is available in the Ministry of Health’s Mpox Antiviral Guidance for Health Care Providers.

Clinicians can request products by contacting the Ministry of Health Emergency Operations Centre at @email or by calling the Healthcare Provider Hotline at 1-866-212-2272.

General information on TPoxx® for patients is available in the Ministry of Health’s TPoxx® Information Sheet.

Past Communications from York Region Public Health

External Resources for Health Professionals