Monkeypox cases up to 26; first case detected in Ontario: PHAC

There are now 26 confirmed cases of monkeypox in Canada, and the virus has been detected in a new province, according to an update from the Public Health Agency of Canada.

In Thursday’s update, PHAC stated that over the past week, it had confirmed 25 cases of monkeypox in Quebec.

Now, it has confirmed a case of monkeypox in Ontario as well, the first case in a province outside of Quebec.

“Our understanding of the virus is still evolving, but I want to emphasize this is a global response,” Dr. Howard Njoo, Deputy Chief Public Health Officer, said in the update.

Toronto Public Health stated Thursday that they have confirmed one case in Toronto, and are also investigating several suspected and probable cases.

“It is likely that additional cases will be reported in the coming days as the [National Microbiology Laboratory] is continuing to receive samples for confirmatory testing from multiple jurisdictions,” PHAC said in a written statement Thursday evening.

Monkeypox is a rare virus from the same family as smallpox, with symptoms including fever, muscle aches, skin rashes, swollen lymph nodes and headache, among others.

Canadians should be aware of the symptoms, Njoo said, and limit contact with others and seek medical attention particularly if they have an unexplained rash, one of the more recognizable symptoms.

The incubation period — the span of time between initial infection and seeing symptoms — for monkeypox is generally 6-13 days, but can range to as many as 21 days, according to PHAC.

Spread occurs through close contact with an infected individual, usually through contact with an infected person’s fluids, open sores or large “respiratory droplets”, Njoo said, as well as through shared contaminated objects.

He emphasized that although the risk to Canadians is currently low, anyone is capable of contracting this virus.

• Read more: Monkeypox isn't the new COVID: here's why

Because smallpox was eradicated in 1980, many people do not already have the smallpox vaccine, which provides some protection, which means the “whole Canadian population is susceptible to [monkeypox].”

“Contrary to recent media reports, this virus does not discriminate and is not limited to spread from sexual activity,” he said.

Because the virus spreads through close contact, this obviously includes sexual activity, Njoo said, but it’s important to note that sexual contact is far from the only way the disease is spread, and it can infect anyone — it’s not limited to one specific demographic.

“Anyone who is engaged in close contact with someone who is infected with monkeypox is certainly susceptible to infection,” Njoo said.

“At the present time, it appears to be circulating in specific communities."

Many of the current individuals who are infected with the virus are men who have sex with other men, who are believed to have contracted the virus through sexual contact with an infected individual.

Officials are working with community organizations to spread awareness to those who may be at an elevated risk currently, Njoo said.

He added that incorrectly viewing this virus as purely sexually transmitted, or a disease only affecting a certain group, can lead to stigmatization and “misunderstanding of risks, and negative health outcomes.”

PHAC stated that they are focusing on a “targeted approach to vaccination and treatment”, and do not believe a mass vaccination campaign is necessary.

They have already supplied Quebec with 1,000 doses of the smallpox vaccine Imvamune from Canada’s National Emergency Strategic Stockpile. Due to the similarity between the viruses, the smallpox vaccine can provide around 85 per cent efficacy in protecting recipients from monkeypox as well, according to the World Health Organization.

They’re also looking at the use of the antiviral Tecovirimat (TPOXX), an oral capsule designed to treat smallpox, which was approved by Health Canada last fall.

Monkeypox is endemic in animals in regions in Western Africa, and can sometimes transmit from animals to humans, often through a bite from an infected animal, with the first human case recorded in 1970.

While monkeypox has popped up in countries where it is not endemic before, the cases typically involved people who recently travelled from a country in Africa where the virus is endemic.

What is unusual right now is that officials in numerous countries that don’t usually deal with monkeypox are seeing cases where the patient has no travel history, Njoo said.

Prior to this month, monkeypox had never been detected in Canada.

He added that clinicians on the ground are seeing variety between cases — some patients have not presented with a rash on their face, the common location for this symptom, and instead have just had rashes around their genitals.

“They’re not all similar in how they’re presenting,” he said.

Co-operating with international partners will help Canadian officials keep track of the virus and whether it is evolving, he said.

Canada’s National Microbiology Laboratory is continuing to do testing on samples to track the spread and keep Canadians updated on risk level if the virus continues to progress.

“We will provide updates to the public as new emerging information becomes available,” Njoo said. 

More guidance on case identification and contact tracing, along with infection prevention, will be released shortly, PHAC stated.