Overview

Mpox (formerly known as monkeypox) is an infectious disease that is caused by the monkeypox virus. While most people get better quickly, some may become very sick.

The virus that causes mpox has two known subtypes, clade I and clade II.

The current subtype of mpox with cases in Ontario and Canada, clade II, is associated with less severe illness and deaths and primarily affects adults who identify as men who have sex with other men. To date, no cases of mpox clade I have been reported in Ontario or Canada. Per the August 2024 statement by the Government of Canada, the risk remains low in the country for clade I. Current testing in Ontario includes both clade I and II.

Although the risk for mpox is low, anyone who has had close physical contact with someone who has mpox or a contaminated surface or is concerned about symptoms they are experiencing should self-isolate and contact a health care provider.

For those at high-risk, vaccination is the best defense against Mpox and is shown to reduce severe outcomes including hospitalization. Learn more about the vaccine and who is eligible per high-risk criteria.

Key facts about mpox

Illness from mpox is usually mild and typically goes away on its own within 2 to 4 weeks. Severe cases are more common among newborns, children, pregnant people and people who are immunocompromised. You can reduce your risk of getting mpox by avoiding close contact with people who have confirmed mpox or people with symptoms that might be due to mpox infection.

Early symptoms of mpox may include:

  • rash
  • headache
  • fever
  • chills
  • sweats
  • swollen lymph nodes
  • muscle pain
  • fatigue
  • sore throat

Symptoms that usually appear 1 to 3 days later are:

  • rash or sores on the palms of the hands or on the soles of the feet
  • rash or sores inside the mouth
  • rash or sores on the genitals or inside or around the anus or rectum
  • pain or bleeding from the anus or rectum

How mpox is spread

Mpox can spread from person to person through:

  • direct close contact (skin-to-skin)
  • direct contact with skin lesions, scabs and bodily fluids, particularly through sexual contact
  • respiratory secretions (such as when a person coughs or sneezes)
  • contact with materials that have been contaminated with the virus (such as bedding, linens, towels, lesion dressings, needles, eating utensils, and dishes)

Mpox can also spread from someone who is pregnant to the fetus or from a parent to a child during or after birth.

If you have come in contact with a suspected or confirmed case of mpox

Monitor for signs and symptoms for 21 days from the day you may have been exposed to someone with mpox.

Local public health units will work to identify and notify close contacts of a person with mpox and may:

  • advise you to avoid non-essential interactions with people at higher risk of severe mpox illness (including people who are pregnant, immunocompromised, and children under the age of 12 years)
  • advise you to avoid sexual contact with others during the 21-day monitoring period to minimize the risk of onward transmission
  • advise you on whether Imvamune® vaccine may help prevent mpox infection or reduce the risk of severe illness 

What to do if you have symptoms of mpox

If you develop symptoms of mpox, you should contact a health care provider to get advice on testing and medical care. Tell them if you think you have had contact with a person with mpox. You should also follow the recommendations below:

  • Self-isolate at home if possible and avoid close contact with others, unless it is for an essential purpose, until you receive information from your local public health unit. Stay in a separate room or area away from other people in the home and use a separate bathroom.
  • Avoid contact with those at higher risk of severe illness including people who are pregnant, immunocompromised, and children under the age of 12 years.
  • If safe and tolerated, wear a medical mask for source control when you are indoors with other people.
  • Cover any rashes or sores (for example, long sleeves, long pants, bandages, medical mask, and/or gloves) as best as possible when you are unable to avoid close contact with other people.
  • Clean your hands and the environment:
    • Clean your hands often with soap and water or an alcohol-based hand sanitizer, including after touching the rash or sores, clothing, or objects and surfaces that may have had contact with the rash or sores.
    • Clean and disinfect contaminated surfaces (such as the bathroom, if shared) after use with regular household cleaning products and disinfectants according to the manufacturer’s instructions.
    • Discard contaminated items directly into a waste container and avoid touching the outside of the waste container or other surfaces. Hands should be cleaned immediately after handling the waste.
    • Do not share dishes or utensils when eating, however, dishes and utensils can be used by others in the home if these are properly washed between uses either in a dishwasher or in a sink using warm water and soap.
    • Have dedicated clothing, bed linens, and towels that are not shared with others. Handle laundry and linens with care and avoid shaking. Laundry can be cleaned in a washing machine with hot water and detergent.

If you’ve been tested for mpox

If you have been tested for mpox:

  • self-isolate at home until your test results are known, or per advice from health care provider or local public health unit. If your test results are negative, you can stop self-isolating

If you test positive:

  • continue to self-isolate at home until a staff person from your local public health unit contacts you to provide further information about mpox, including how to prevent spreading mpox to others and when you can end your self-isolation

If you need to seek medical care:

  • call a health care provider ahead of time to inform them of your health status, that you are being tested for mpox, and about any contact you had with a person with suspected or confirmed mpox
  • wear a medical mask when seeking medical care

Vaccination for mpox

Ontario provides the Imvamune® to help protect individuals at high risk of mpox exposure (pre-exposure vaccination).

It is also available to some individuals after exposure to the virus, based on a risk assessment (post exposure vaccination).

Please note, Imvamune® is not a treatment for mpox.

Pre-exposure vaccination:

Imvamune® should be administered:

  • before known exposure to the virus
  • as a two-dose series, with doses given 28 days apart. To ensure optimal protection, individuals should receive both doses.

Booster doses are not recommended at this time.

Who is eligible for pre-exposure vaccination

  • two-spirit, non-binary, transgender, cisgender, intersex, or gender-queer individuals who self-identify or have sexual partners who self-identify as belonging to the gay, bisexual, pansexual and other men who have sex with men (gbMSM) community and who meet one or more of the following:
    • had a confirmed sexually transmitted infection (STI) within the last year
    • have or are planning to have 2 or more sexual partners or are in a relationship where at least one of the partners may have other sexual partners
    • have attended venues for sexual contact (such as bathhouses, sex clubs) recently or may be planning to, or who work or volunteer in these settings
    • have had anonymous sex (such as using hookup apps) or may be planning to or are a sexual contact of an individual who engages in sex work
  • sexual partners of individuals who meet the criteria above
  • individuals who self-identify as engaging in sex work or are planning to, regardless of self-identified sex or gender
  • staff or volunteers in sex-on-premises venues where workers may have contact with items potentially contaminated with mpox
  • people who engage in sex tourism footnote 1  (regardless of gender, sex assigned at birth, or sexual orientation)
  • people who anticipate experiencing any of the above scenarios

Household and/or sexual contacts of those identified for pre-exposure vaccination eligibility above who are also moderately to severely immunocompromised, or pregnant may be at higher risk for severe illness from mpox infection and may be considered for pre-exposure vaccine. People who meet these criteria should contact a health care provider or their local public health unit for more information.

If you have previously received a vaccine against smallpox, it is recommended that you receive a 2-dose series of Imvamune® with a minimum interval of 28 days between doses.

Post-exposure vaccination:

Administered to people who have had a high-risk exposure to a probable or confirmed case of mpox, or within a setting where transmission is occurring.

  • The first dose should be offered ideally within 4 days (up to 14 days) from the date of the last exposure to individuals who are a high-risk contact of a confirmed or probable case of mpox.
  • The second dose should be offered at least 28 days after the first dose if mpox infection did not develop.

To ensure optimal protection, individuals should receive both doses.

Booster doses are not recommended at this time.

Who is eligible for post-exposure vaccination

Imvamune® given for post-exposure vaccination requires an assessment of the risk of exposure by a public health unit.

Research laboratory employees

Research laboratory employees working directly with replicating orthopoxviruses are eligible to receive two doses of Imvamune®, 28 days apart as post-exposure vaccination or pre-exposure vaccination if there is an ongoing risk of exposure.

Effectiveness:

  • Recent studies indicate that two doses of Imvamune® reduce the risk of mpox infection by up to 66-83%.
  • Those who have received at least one dose and become infected are expected to be less likely to experience severe symptoms or require hospitalization compared to those who are unvaccinated.

Tecovirmat (TPoxx®) for mpox

Symptoms usually go away on their own without the need for any treatment.

You can manage your symptoms by:

  • letting the rash dry or covering the rash with a moist dressing to protect the area, if needed
  • avoiding touching any sores in the mouth or eyes and if needed, mouth rinse or eye drops can be used (but products containing cortisone should be avoided)

For individuals who are severely ill due to mpox, there is an antiviral medication, Tecovirmat (TPoxx®), that your healthcare provider may recommend. There is a limited supply of TPoxx® available in Ontario and it is currently only being used for individuals who are severely ill/disabled due to mpox infection or at high risk for severe disease. If you think you have symptoms of mpox, contact your health care provide who will help determine what is best for you.

Caring for someone with mpox or with symptoms that may be due to mpox infection

If you need to provide care to someone with mpox symptoms or confirmed to have mpox, you should:

  • perform hand hygiene regularly, including after touching the rash or sores, before putting on and after removing gloves, or after handling clothing, linens, or environmental surfaces that may have come into contact with fluid from rash or sores
  • encourage the person to cover their rash and sores as best as they can (for example, wearing a long sleeve shirt and long pants)
  • if safe and tolerated, wear a medical mask and encourage the person to wear a medical mask when you are physically close to them
  • avoid skin-to-skin contact
  • if you provide care that may involve touching the rash and sores, wear a medical mask and use disposable gloves (these should be disposed of after you use them once)
  • avoid direct contact when handling contaminated laundry/linens (i.e., wear disposable gloves, disposable gowns or long sleeved clothing if gowns are not available)
  • not shake soiled laundry in a way that could disperse infectious particles
  • wash laundry in a standard washing machine with hot water and detergent is acceptable
  • clean and disinfect contaminated surfaces

Mpox in animals

Some animals can become infected with mpox and can spread it to people, including:

  • rodents (such as rats, mice, hamsters, gerbils, squirrels, chipmunks)
  • rabbits
  • hedgehogs
  • opossums
  • non-human primates (such as monkeys)

Limited research exists regarding susceptibility in other animal species; therefore precautions should be taken to prevent infected humans from exposing domestic and wild animals, including pets (such as cats, dogs, hamsters, gerbils), livestock and wildlife, to the virus.

Pets in your home

As the risk of infection in different animal species from humans is unclear, it is best to find someone else to take care of your pet until you are no longer infectious. If you have ongoing contact with an animal let your public health unit know.

Precautions to help reduce the risk of mpox transmission to your pets or to other people via your pets:

  • avoid close or prolonged contact with pets (such as touching, snuggling, kissing animals or having animals sleep in your bed) and their belongings
  • while infectious, keep your pets in the home, if possible. For dogs that need to go outside periodically, keep them on leash and avoid contact with other people and animals
  • while infectious, wear a well-fitting medical mask and gloves, cover all skin rashes or sores with clothing or bandages and perform hand hygiene measures as recommended to reduce the risk of transmission to other people, when interacting with animals, their food and supplies

If you have any questions about the health or care of your animals when you are exposed or infected with mpox, please contact your veterinarian.

If your pet becomes sick while you have mpox

Seek care from a veterinary telemedicine service to assess if the animal’s condition can be managed at home.

If your animal must be examined directly by a veterinarian or requires other procedures that cannot be reasonably delayed until your own infection is resolved, your veterinarian should be advised that your pet may have been exposed to mpox.

If you own or work with livestock or poultry and think you may have been exposed to mpox

As a precaution, any person who has, or may have been exposed to, mpox should not work with livestock or poultry until they are advised by a healthcare provider that they are no longer able to pass on the virus.

Animal owners are responsible for providing basic care for their animals including food, water and shelter. Livestock and poultry producers should always have a plan in place for others to provide care for their animals in case of emergencies, including the need to self-isolate due to illness or to avoid contact with animals if exposed.

Ministry of Health resources for the public

Document TitleDescription
Mpox Vaccine Information SheetInformation for patients and the public about the vaccine for mpox
Mpox Antiviral Information SheetInformation for patients and the public about treatment for mpox

Additional resources