Mpox (Monkeypox)

Mpox spreads through close contact with an infected person, such as between people you live with or during intimate contact. Transmission happens through contact with body fluids, such as fluids from the mpox sores. More rarely, it can be passed on through contaminated clothing or bedding or respiratory droplets following prolonged face-to-face contact. It can also be spread through bites or scratches from infected animals.

Anyone can get mpox through close contact with a person who is infected. However, data from outbreaks which began in 2022 suggests most cases have occurred among people who self-identify as gay, bisexual and other men who report sexual or intimate contact with other men (gbMSM).

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 and body aches, and headache before the rash develops. Recent evidence suggests some individuals may be contagious up to four days before the onset of symptoms.

The incubation period, which is the time from when you’re exposed to the virus until symptoms develop, is typically six to 13 days but can range from five days to 21 days.

Common symptoms of mpox infection can include:

• Fever
• Headache
• Muscle or body aches
• Exhaustion
• Swollen lymph nodes
• New rash or sores (typically appear a few days after other symptoms, beginning on face, around genital areas and/or extremities)

These symptoms are common among many diseases – having these symptoms does not always mean you have mpox.

Mpox infection is usually mild and goes away on its own, with most people recovering in two to four weeks; however, more serious illness can happen in some individuals.

If you think you have mpox, you should isolate yourself and see a health care provider. To diagnose mpox, your health care provider will consider your symptoms, complete a lab test (e.g., a swab of your rash or throat or a blood test) and ask about other risk factors like exposure to someone with mpox.

Public Health will identify and directly notify contacts of mpox cases. People who have been in contact with someone infected with mpox should monitor themselves for symptoms for 21 days.

The most important way to prevent or lower your risk of mpox is to avoid close contact with people who are visibly sick, have a rash, or have been exposed to mpox.

Avoid direct contact with any materials, such as bedding or laundry, that have been in contact with someone with the virus.

Like other diseases that may spread through close contact, people can help lower their risk by practicing good hand and respiratory hygiene.

Standard household cleaning/disinfectants can be used to kill the virus.

Individuals at higher risk of infection are recommended to receive the mpox vaccine – review information on mpox vaccines and eligibility. 

Imvamune® is a two-dose vaccine, with at least 28 days between the first and second dose. Eligible Individuals should receive both doses of Imvamune® to be best protected. York Region Public Health offers mpox vaccine appointments for people who are considered to be at higher risk of exposure. Imvamune® vaccine will be provided at no cost to people that meet the following eligibility:

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 (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 with 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 who 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 a pre-exposure vaccine. Individuals who meet this criteria should speak to a health care provider about pre-exposure vaccination.

The mpox vaccine may be given to individuals who have had high-risk exposure to someone with mpox. The decision to receive post-exposure vaccination will be based on a risk assessment by Public Health in partnership with your health care provider. These individuals will be contacted directly by public health to receive vaccination. 

Decisions about the treatment of people with mpox are decided by the health care provider. In general, most people with mpox do not need treatment and symptoms get better on their own. A health care provider may consider ordering antivirals (TPoxx) directly from the Ministry of Health for people who are very sick from mpox.

Am I eligible to get vaccinated before I travel?

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

Should I be worried about the mpox outbreak in Central and East Africa?

There are two distinct subtypes of monkeypox virus (called clades): clade 1 and clade 2. The increase in mpox infections in Central and East Africa is a more severe strain of the mpox virus (clade 1) and is not circulating in Ontario or Canada. The modest rise in local mpox cases is related to a less severe mpox strain (clade 2) than the strain of mpox (clade 1) circulating in Africa right now.

Can I get the vaccine if I have symptoms?

No. The Imvamune® vaccine is not a form of treatment and should not be given if you have any signs or symptoms of infection. Anyone who experiences symptoms compatible with mpox should be assessed by a health care provider.

Can I get the vaccine if I recently had mpox?

No. At this time, individuals who have had a confirmed case of mpox are not recommended to receive the mpox vaccine.

Can I get a second dose?

Yes. Anyone that is eligible for a first dose should get a second dose with at least 28 days between the first and second doses.

Am I able to get vaccinated if I had the smallpox vaccine before?

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

Do I require a medical note from a health care provider to get vaccinated?

Please speak to your health care provider and bring a medical note (or for the last group, proof of prescription) to the vaccine clinic if you are:

• Severely immunocompromised
• Pregnant
• Under the age of 18
• Immunocompromised and have a household or sexual partner that is in one of the eligible groups for pre-exposure vaccination – you can receive the vaccine with proof of your condition or medication (bring either a note from your health care provider, a copy of your prescription or your medication bottle)

Can you get Imvamune® vaccine at the same time as 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.