The Monkeypox virus is circulating in Ontario and has mostly been reported among gay and bisexual men so far. However, the Monkeypox virus is not exclusive to any group or setting because anyone can get infected and spread Monkeypox if they come into close contact with someone who has the virus, regardless of sex, race, gender, or sexual orientation.

We have compiled information from public health authorities—including Toronto Public Health, Public Health Ontario, and the office of the Chief Medical Officer of Health—along with the most recent news reports and published scientific research. The information on this page is meant to help people in our community understand what’s going on, what to look for, and where to get care. We’re keeping an eye out for reliable sources and updating this information regularly.

What’s Monkeypox? 

It’s a virus that can cause a rash, lesions, or blisters, along with fever, swollen lymph nodes, muscle aches, and extreme tiredness. It has been transmitted from animals to humans and it is spread mostly by close and prolonged contact. It’s in the same family as smallpox, but Monkeypox is less contagious and has milder symptoms.  

It’s a rare viral disease but it not a new one with most cases reported in central and western African countries. As of September 06, in Ontario, there are 656 confirmed cases of monkeypox 484/656 (73.8%) confirmed cases were reported by Toronto Public Health. However, we are now seeing a sustained downward trend of infection in Canada.

Common Symptoms 

Symptoms typically show up within three to five days from exposure to the Monkeypox virus, but can take up to 21 days to show up (This is called the incubation period). Symptoms can include:  

• A rash or blisters in your mouth (like a canker sore), on your face, around your genitals, or around or in your butt 
• Swollen lymph nodes  
• Fever and chills  
• Muscle aches  
• Headaches  
• Exhaustion  

Until a person shows symptoms, they are typically not considered contagious but once a fever or lesions appear, individuals are highly contagious and should start isolation and avoid contact with many people.  

In the current outbreak, some people had a rash or blisters appear first before feeling tired and feverish. And in some cases, people didn’t have any noticeable symptoms, or the rash may be confined to only a few lesions or individuals may develop only one single lesion. If you suspect you have been exposed to someone who has Monkeypox, you can follow up with your local public health unit or your healthcare provider. Very serious symptoms are possible but are less common. Recently, between 3%-6% of cases have led to death.

Visit https://www.cdc.gov/poxvirus/monkeypox/resources/graphics.html for visual examples of Monkeypox rash

How does it get passed along?

It is transmitted by direct, close, and prolonged contact with an infected animal or person through skin-to-skin contact with lesions, blisters, rashes, and or any respiratory droplets from breathing, talking, coughing or sneezing. In addition, it can spread through contact with contaminated objects, fabrics and surfaces used by someone who has the virus, for example: linen, clothes, towels, etc.   

There are a lot of modes of transmission however, during the current outbreak in Canada, the spread has been driven mostly by extended skin-to-skin contact, sex, kissing, or very close talking. The chances of transmission are very low from contaminated objects or contact that is not prolonged or direct with lesions or blisters such as walking side by side or being in the same space as someone with Monkeypox. It is important to note that even when transmission is low, there is still a potential for you to get it so, wearing a mask and maintaining good hand hygiene and respiratory etiquette, would provide an extra layer of protection.

Can you get it from sex?  

Since one of the main modes of transmission is through Skin-to-skin contact with lesions, blisters, rashes, and or any respiratory droplets, you can get monkeypox from sexual contact. 

Is it an STI then? 

No, that doesn’t mean that you can only get it from sex. In places where this virus is endemic, transmission is very rarely linked to sexual contact.  

The vast majority of cases in Ontario are linked to intimate contact however, it’s possible that monkeypox may spread next in places where skin-to-skin contact or contact with bodily fluids is typically common, like spas, gyms, daycares, and health care facilities. If we label monkeypox an STI now, and both health care experts and the public come to know it as such, that understanding will follow the spread wherever it goes, ultimately making it harder to convince people to adopt appropriate safety measures. 

Testing

If you suspect that you have come in contact with someone with Monkeypox and start to develop symptoms and or rashes, contact your healthcare provider right away. If you don’t have one, the next best option are walk-in clinics or your local sexual health clinic. If that’s not an option, then you can call either your  local public health unit or the Sexual Health Infoline Ontario (SHILO).  

You should get tested as soon as possible. The most accurate monkeypox test is a swab of the fluid from bumps, blisters, sores or scabs. Throat and nose swabs, as well as a blood test are available but less accurate. A health care provider will decide which test is recommended and if your healthcare provider isn’t sure about it, share this guidance with them: publichealthontario.ca/en/Laboratory-Services/Test-Information-Index/Monkeypox-Virus.  

In the meantime, keep any lesions covered, wear a mask if you’re around and close to other people, and avoid close contact as much as you can until you get your test results back. It’s also a good idea to monitor and record your symptoms and any changes you develop. 

Please do not call or go to an emergency department for testing. Only go to the emergency department if you need emergency care. Toronto Public Health will contact and give guidance to people who test positive for monkeypox as well as known close contacts of someone who tests positive. 

For more information of testing for Monkeypox: https://www.publichealthontario.ca/en/Laboratory-Services/Test-Information-Index/Monkeypox-Virus 

What to do if you test positive for monkeypox?

Treatment and Care

It is a self-limited disease meaning that you will recover with time. The symptoms last from 2 to 4 weeks and a full recovery happens when all lesions and rashes resolved. Based on current data, very few folks have had severe complications or passed away in the current outbreak.

If you get monkeypox remember to rest and stay hydrated, take your medications (if needed) and wash your hands frequently and especially after caring for a lesion.

A diagnosis of monkeypox means isolating at home for an extended period (sometimes as long as a month) so taking care of our mental health is important as well. Fortunately, from our collective experience with COVID19 we have some experience doing this, so think of activities that got you through those times such as having video calls with friends or family, catching up with a book or taking on a new or old hobby.

Some online resources are listed on this post to help you navigate this infection if you tested positive for it. The following are a blog post about a first-hand account of what it’s like to have monkeypox along with some tips and a support group. IGotMpox.com (support group via Instagram)

For more on how to care for yourself while recovering from monkeypox, check out this graphic by the World Health Organization (WHO). 

Vaccine Information 

There’s no specific monkeypox vaccine, however Imvamune® vaccine is approved in Canada for protection against smallpox, monkeypox, and other orthopoxvirus related illness; it is 3rd generation smallpox vaccine. It has been found effective at preventing a monkeypox infection and serious symptoms. Even for people who were vaccinated with the smallpox vaccine as children, there is benefit in getting the newer vaccine if you meet the eligibility criteria. 

Getting the vaccine early to help prevent monkeypox is known as pre-exposure prophylaxis (PrEP). If you have close contact with someone with a confirmed case of monkeypox, but don’t have any symptoms, then getting the vaccine is known as post-exposure prophylaxis (PEP).  

Because it was developed for smallpox and not specifically for monkeypox, there is less research available than we’d like on some of these details. That said, we do know that the smallpox vaccine is safe. It is authorized for use in Canada in people 18 years and older and is delivered by injection into the arm. You can receive the vaccine regardless of when or whether you were vaccinated for COVID-19. After getting the vaccine, it takes two weeks to build protection. During these two weeks, consider reducing your number of close contacts, including sex partners. 

Vaccine Clinics

Getting vaccinated against monkeypox can help reduce your chances of getting it and reduce serious symptoms if you get it. Remember: vaccines don’t work like an on/off switch. It can take two weeks for your body to process and react to the vaccine after getting it. 

Toronto Vaccine Clinics 

Booked appointments are now available at all three City of Toronto immunization clinic locations. 

You can book your appointment through the Toronto Public Health Appointment Booking System.

For more information about the City of Toronto’s vaccine clinics, visit: https://www.toronto.ca/community-people/health-wellness-care/health-programs-advice/monkeypox/  

Note: Friends of Ruby is sharing this information to support our community and to promote vaccination for those of us who may benefit from it. We aren’t responsible for running any of the clinics, how many doses are available, or the individual experience of people at the various vaccine clinics that are set up across the province. 

The current eligibility criteria determined by the Ontario Ministry of Health are: 

For Pre-Exposure Prophylaxis (PrEP)  

1. Two-spirited, non-binary, transgender men and women or cis-gender individuals who self-identify or have sexual partners who self-identify as belonging to the gay, bisexual and other men who have sex with men (gbMSM) community AND at least one of the following: 
   • Diagnosed with a bacterial sexually transmitted infection (STI) in the past two months (e.g. chlamydia, gonorrhea, or syphilis); 
   • Recently had two or more sexual partners or may be planning to; 
   • Recently attended venues for sexual contact (e.g. bathhouses, sex clubs) or may be planning to, or who work/volunteer in these settings; 
   • Recently had anonymous/casual sex (e.g. using hook up apps) or may be planning to; 
   • A sexual contact of an individual who engages in sex work 
2. Anyone who engages in sex work or may be planning to. 
3. Household and/or sexual contacts of people who are eligible for PrEP – listed above in parts (1) or (2) – AND have a weak immune system or are pregnant. These individuals should contact a healthcare provider or Toronto Public Health for more information. 

For Post-Exposure Prophylaxis (PEP) 

• People who have a known exposure/close contact with someone with monkeypox can get the vaccine. 
• When the vaccine is used as PEP, it should be given within four days, but can be given up to 14 days after the last exposure 

For more information (references):  

https://www.health.gov.on.ca/en/pro/programs/emb/docs/Monkeypox_Imvamune_Guidance_HCP.pdf

https://www.who.int/news-room/fact-sheets/detail/monkeypox https://www.cdc.gov/poxvirus/monkeypox/index.html   

https://www.toronto.ca/community-people/health-wellness-care/health-programs-advice/monkeypox/?accordion=monkeypox-cases-in-toronto

https://www.health.gov.on.ca/en/pro/programs/emb/monkeypox.aspx

https://www.quebec.ca/en/health/health-issues/a-z/monkeypox

https://gmsh.ca/monkeypox/

https://www.canada.ca/en/public-health/services/diseases/monkeypox.html

https://www.publichealthontario.ca/-/media/Documents/M/2022/wwksf-multi-jurisdictional-monkeypox-outbreak-2022.pdf?sc_lang=en

https://www.journalofinfection.com/article/S0163-4453(22)00335-8/fulltext (Contains graphic images)  

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2168110/ https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html