UPDATED: MONKEYPOX VIRUS
Please note - this version of the May 31 Public Health Bulletin includes updated links to PHO resources. Please disregard the previous version.
As per the May 20, 2022 CMOH Order under section 77.6 of the Health Protection and Promotion Act requiring any individual who meets case definition (see Appendix A) must be reported to Public Health Ontario (PHO) within 1 business day.
Patients suspected of having monkeypox virus should be referred to the local hospital emergency department to be managed as per PHO infection prevention and control recommendations. This includes an airborne isolation room with negative pressure ventilation when available, or the patient can be placed in a single room with the door closed with dedicated toileting facility.
Reporting:
Attending clinicians are to report to PHO using the Ontario Monkey Pox Investigation Tool (updated May 27, 2022) and send the information via secure fax to PHO (647-260-7603). PHO will forward the case report form to the appropriate public health unit (PHU) for case and contact management.
- Changes to previous version include:
- Updates to symptom, complication, medical risk factor and intervention sections
- New behavioural and social risk factors added
- Period of interest for risk factors updated to 21 days and period of isolation for symptomatic cases is until scabs have fallen off and new skin present
Case definitions:
Confirmed
- Lab confirmation of infection:
- Detection of monkeypox virus DNA by polymerase chain reaction (PCR) from an appropriate clinical specimen, or
- Isolation of monkeypox culture from an appropriate clinical specimen
Probable
- A new onset rash in keeping with monkeypox illness, and
- At least one other acute sign or symptom of monkeypox illness, and
- Meets at least one of the following epidemiological criteria within 21 days of their symptoms onset:
- High-risk exposure to a probable or confirmed human case of monkeypox, or
- A history of travel to a region that has reported confirmed cases of monkeypox, or
- A relevant zoonotic exposure
Suspect
- A new onset rash in keeping with monkeypox illness, and
- At least one other acute sign or symptom of monkeypox illness, and
- An alternative diagnosis cannot fully explain the illness
Testing:
Individuals with compatible clinical and exposure history should be tested. Consult with PHO microbiologist prior to sample collection and shipment, contact PHO Customer Service (416-235-6556/1-877-604-4567) or after hours the on-call Duty Officer (416-605-3113). Separate specimens will be required if additional tests are requested. Refer to Public Health Ontario for specific details and instructions.
NEW: Post Exposure Prophylaxis for Monkeypox virus
The Ministry of Health (MOH) has released interim recommendations for treatment of severe monkeypox virus infection and guidance on the use of vaccine for post-exposure prophylaxis (PEP) of selected contacts of monkeypox virus.
Refer to Ontario Ministry of Health’s Q&A for the Interim Vaccine Guidance for Post-Exposure Prophylaxis and How to Access Tecovirimat
*The provision of Imavune vaccine for PEP must be assessed by public health units according to risk of exposure as per PHO Monkeypox Virus: Interim Case and Contact Guidance for Local Public Health Units and Recommendations for PEP according to risk of infection (Table1) from Q&A document. MOH
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