'This is an unusual situation': Feds monitoring monkeypox cases in Canada

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Canada's Chief Public Health Officer Dr. Theresa Tam says the federal government is monitoring monkeypox cases and their chains of transmission after two cases were confirmed in this country.

Quebec's health ministry announced Thursday evening there are two confirmed cases of monkeypox in the province, while 20 other suspected cases are still under investigation.

Speaking at a press briefing on Friday, Tam said health authorities are also following up with a couple of possible contacts in British Columbia.

"There are samples under processing at the national microbiology lab as we speak, so we might expect to hear more confirmations in the upcoming hours and days," Tam said.

She added that officials don't yet know the extent to which monkeypox has spread in Canada, but it is under "active investigation."

"This is an unusual situation," she said.

A growing number of countries, including Canada, the U.S., Spain, Portugal, and the U.K, are reporting an unusual outbreak of monkeypox. What makes these cases notable is the disease is relatively rare and there are no clear links between some of the infections, raising concerns about community spread and undetected cases.

The World Health Organization says no source of infection for the outbreak has been confirmed.

First discovered in 1958, monkeypox is a rare disease caused by a virus that belongs to the same family as the one that causes smallpox. The disease was first found in colonies of monkeys used for research.

The disease has primarily been reported in central and western African countries, with the first case outside the continent reported in 2003 in the United States.

Due to the unexpected nature of the current outbreak, Tam said health officials in Canada and abroad are looking at whether there are any changes from what was previously known about the rare illness, including incubation period and method of transmission.

"It's unusual for the world to see this many cases reported in different countries outside of Africa and… we will let people know as soon as we get more information," Tam said, adding that the current impact on Canada is unclear.

However, Tam said anyone who thinks they may have had or been experiencing symptoms of monkeypox should seek advice from their health-care provider.

The virus is transmitted through contact with an infected animal, human or contaminated material. Transmission between people is thought to primarily occur through large respiratory droplets, which generally do not travel far and would require extended close contact. Transmission from an animal can happen through bites or scratches, contact with an animal’s blood or body fluids.

Monkeypox symptoms are similar to those for the smallpox, but generally milder. The first signs are fever, headache, muscle aches, backaches, chills, and exhaustion. One distinguishing feature specific to monkeypox is that an infection also causes lymphadenopathy – the swelling of the lymph nodes.

The "pox" develops after the onset of a fever and usually occurs between one to three days later, sometimes longer. A rash usually begins on the face and spreads to other parts of the body, developing into distinct, raised bumps that then become filled with fluid or pus.

However, Tam warned that milder cases can go undetected and worries there may be asymptomatic transmission in Canada.

"I think at the beginning of any outbreak, we should cast the net wide to try and understand the transmission routes," Tam said. "There's probably been some hidden chains of transmission that could have occurred for quite a number of weeks, given the sort of global situation that we're seeing right now, so we shouldn't rule out new things that we might learn as we go along."

Deputy Chief Public Health Officer Dr. Howard Njoo told reporters on Friday that while the overall risk of monkeypox to the general public is low, he said it is important to remember that everyone is susceptible.

"Some of the good practices that we've all learned with COVID-19 actually service us against a whole host of other diseases, including this one," Njoo said.

He reminded Canadians to practice good hand hygiene, wear a mask if they feel sick or have a cough, and physical distancing.

Njoo added that health officials will further monitor the outbreak and how to best prevent transmission, providing updates as necessary.

"We'll continue to examine and also develop guidance to help the health-care providers and others in terms of how to deal with this disease as it continues to evolve," he said.

There is no proven treatment for the virus infection, but the smallpox vaccine is known to also protect against monkeypox, with a greater than 85 per cent efficacy. Because the smallpox vaccine eradicated the disease, however, routine smallpox immunization for the general population ended in Canada in 1972.

Tam said there are discussions happening in Canada and abroad about reviewing smallpox vaccines and their efficacy in relation to monkeypox.

Earlier this month, the Public Health Agency of Canada placed an order for 500,000 vials of the smallpox vaccine Imvamune, which also gives protection against monkeypox. However, these doses won’t be delivered until April 2023.

Tam said Canada currently has a "limited supply" of this vaccine, but could not disclose the exact number due to "security reasons." Because of the limited supply, the vaccines are not available to the general public and are reserved for those determined to be at high risk for exposure.

With files from The Canadian Press and CTVNews.ca's Solarina Ho