Hastings Prince Edward Public Health
Online Bulletin for Health Care Providers May 25, 2022 From:
Dr. Ethan Toumishey
Medical Officer of Health and CEO
Hastings Prince Edward Public Health | ALERT: MONKEYPOX VIRUS As of May 20, 2022 over 100 cases of monkeypox virus have been reported in numerous countries with two lab confirmed cases and 18 suspect cases in Quebec. Monkeypox virus is endemic in certain parts of Central and West Africa with previous sporadic cases in non-endemic countries linked to international travel. Early epidemiology of recent cases has shown a cluster in some males who identify as gay, bisexual, men who have sex with men (gbMSM) presenting with unusual rashes in mouth or genital regions; however, anyone with close personal contact with a person with monkeypox virus infection could be at risk. Hastings Prince Edward Public Health (HPEPH) is recommending health care providers be alert for symptoms consistent with monkeypox virus infection, especially in patients who have travelled or had close contact with a known case. Monkeypox virus should be considered in the differential diagnosis in persons with symptoms of syphilis, herpes simplex virus, chancroid, varicella zoster and other common infections. Please refer to the Chief Medical Officer of Health’s (CMOH) Memo providing an update on the current situation, along with new guidance and directives. Reporting: On May 20, 2022 the CMOH issued an order under section 77.6 of the Health Protection and Promotion Act requiring any individual who meets the case definition (see Appendix A) to be reported to Public Health Ontario (PHO) within 1 business day. -
If a person meets the case definition, the attending health care provider must complete the Ontario Monkeypox Investigation Tool in Appendix B and send via secure fax to Public Health Ontario (PHO) (647) 260-7603 -
PHO will share the information with local Public Health units for investigation and follow-up. Clinical Presentation: -
Typically begins as a progressively developing rash that starts on the face and then spreads elsewhere on the body including the palms of hands and feet. The rash can affect the mucous membranes in the mouth, tongue, and genitalia. The rash can last for 2-4 weeks and progresses through stages of macules, papules, vesicles, pustules and scabs. -
Other symptoms include fever, lymphadenopathy, chills/sweats, headache, back pain, sore throat, cough, coryza, malaise/listlessness, prostration/distress. Testing: consult with PHO microbiologist prior to sample collection and shipment. Separate specimens will be required if additional tests are requested. Follow PHO’s Testing Indications for Monkeypox Virus. Epidemiology: -
Primary mode of person-to-person transmission is via close contact with an infected person’s respiratory secretions, direct contact with their skin lesions or indirect contact with items that have been contaminated (bedding/clothing). -
Incubation period is average of 6-13 days (range 5-21 days). -
Communicable period may begin during the prodomal stage, before the rash develops with non-specific symptoms of fever, malaise and headache. Persons are communicable until all lesions resolve. IPAC Precautions: Personal Protective Equipment for Health Care Workers: -
Fit tested and seal checked N95 respirator (or equivalent); perform seal check after donning N95 respirator. -
Gloves, gown, eye protections (face shield or goggles). Case and Contact Management: -
Confirmed cases are to self-isolate until rash has resolved. -
Persons with symptoms and/or awaiting lab results should self-isolate at home until negative results or rash has resolved. If attending medical care, wear a medical mask and cover skin lesions. -
Close contacts of people with suspected or confirmed monkeypox virus should self-monitor for symptoms for 21 days after their last exposure. If symptoms develop, self isolate and seek medical care including testing. Treatment: -
Treatment is mainly supportive as currently there is no specific treatment for monkeypox virus. -
Prior vaccination against smallpox virus provides some cross-protection. Eligibility for vaccines and/or therapeutics is currently being reviewed with PHO and Public Health Agency of Canada. For more information: | Mental Health Toolkit for Health Care Workers Ontario Health’s Centre for Mental Health and Addictions Centre of Excellence is sharing information about supports available for health care workers whose mental wellness has been impacted by the pandemic. Ontario Health has created a digital toolkit to help raise awareness about some of these supports. The Digital Toolkit is available online, and posted on HPEPH’s Health Care Providers page. Health care providers are encouraged to use the resources available through this toolkit to: If you are looking to bring an additional mental wellness support to health care workers at your organization, the Canadian Mental Health Association, Ontario Division, has developed Your Health Space. This provides workshops for clinical, non-clinical, and management staff to assist in strengthening mental health in Ontario's health care settings. Please reach out to yourhealthspace@ontario.cmha.ca for more information. For more information, or if you have any questions, please contact MHACoE@ontariohealth.ca. | UPDATE on Severe Acute Hepatitis in Children Since October 2021 there have been at least 348 probable cases of acute hepatitis of unknown origin in children up to 16 years of age reported to the World Health Organization from 21 countries. On May 20, 2022 the Chief Medical Officer of Health issued a second memo with a revised order under the Health Protection and Promotion Act which requires public hospitals to report cases to Public Health Ontario. Revisions to the order include: Clinicians are being asked to be vigilant with infants and children up to 16 years of age presenting with signs and symptoms compatible with acute hepatitis, including new onset of jaundice (yellow skin and/or eyes) and discolouration of urine (dark) and/or feces (pale). Considering the appropriate clinical context, other symptoms that may be suggestive of hepatitis include pruritis, arthralgia/myalgia, fever, nausea, vomiting or abdominal pain, lethargy and or loss of appetite. Testing information is available online at Public Health Ontario. | Refugee Health The Ministry of Health is providing a toll-free, multi-lingual, Refugee HealthLine where they can connect with health care providers who deliver transitional health care and services, including primary care, specialist care, and mental health supports. Transitional care includes initial assessment(s), care, and/or referral(s) to other health services. For more information and/or to register as a Health Care Provider able to provide transitional health care: Additional Information for health care professionals working with immigrant and refugee children and youth is available online at Caring for Kids New to Canada. | Information on Evusheld for COVID-19 Prophylaxis -
Evusheld is indicated for pre-exposure prophylaxis of COVID-19 for certain populations who are immunocompromised and unlikely to mount an adequate immune response to vaccination or whom COVID-19 vaccination is not recommended. -
Review reference information for health care providers who may prescribe or administer Evusheld. -
Reference Ontario Health’s Patient Information Handout. | Highly Pathogenic H5N1 Avian Influenza The province of Ontario continues to work with local, and other provincial, federal and international authorities to monitor and respond to ongoing cases of highly pathogenic avian influenza (HPAI). HPAI H5N1 has been detected in Ontario in wild and commercial poultry across 11 health unit jurisdictions. There are 25 infected premises (IPs) in Ontario, with farm sizes ranging from small backyard flocks to large commercial operations. The majority of new sick bird calls to the Canadian Food Inspection Agency (CFIA) now are from small flocks (non-commercial, less than 300 birds). The spread of this virus has been primarily attributed to the migration of infected waterfowl. The risk to the public of catching the HPAI H5N1 virus from domestic poultry or products is very low and there is no need to change food consumption habits or travel plans. For additional information: -
Updated health information is on the Ministry of Health’s website. The Ministry has issued PPE recommendations to the poultry industry. -
Public Health Ontario Laboratories is testing exposed and symptomatic individuals for Influenza A, other respiratory viruses, and COVID-19. -
OMAFRA is holding weekly public webinars, on which MOH has participated as a panelist, for the poultry industry, small flock owners, bird enthusiasts, hunters, and indigenous communities. Webinar registration can be found here. -
The CWHC has just posted a blog about the finding of H5N1 in Ontario foxes. -
MOH Avian Influenza FAQ web page. | Educational Opportunities | Harm Reduction - Enhancing harm reduction education for service providers June 14, 1 pm to 2:30 pm
Register Online at CATIE Webinars In this webinar, CATIE will share their new Harm Reduction Fundamentals toolkit and how it can be used by frontline organizations, along with examples of how organizations are training their workers and community partners. They will also have a broader discussion around the role of education in capacity building for organizations that provide services for people who use drugs. | New and updated COVID-19 resources | Contact Information: To give us your comments: hart.sara@hpeph.ca To report communicable diseases:613-966-5500 x349 To report AEFI or DOPHS: Online / Fax: 613-966-1813 or CDCFAX1@hpeph.ca
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