Monkeypox Information for Health Professionals
York Region Public Health offers monkeypox vaccine clinics for people who may be at higher risk of infection. Please help us promote these clinics to your eligible patients as listed in the Pre-exposure Vaccination section below.
Monkeypox is a zoonotic viral illness endemic in certain areas of Central and West Africa. Since May 2022, a large number of Clade II (formerly known as the West African clade) monkeypox cases have been reported globally in non-endemic countries. Clade II consists of two subclades, IIa and IIb, with the latter referring mainly to the variants circulating in the current global outbreak.
As of August 30, 2022, 75% of confirmed cases in Ontario have been reported by Toronto Public Health. Most confirmed cases in Ontario to date have been among people who self-identify as gay, bisexual and other men who report sexual or intimate contact with other men (gbMSM), with the average age being 36.4 years old (range of less than 20 to 74 years). In Ontario and globally, the growth rate of cases in the outbreak appears to be declining. Ontario updates may be found in Public Health Ontario’s (PHO) epidemiological summary report posted on the PHO monkeypox webpage weekly.
Transmission occurs predominantly through close contact with an infected individual’s lesions or monkeypox sores, by sharing clothing, bedding or common items that have been contaminated with the virus (fomite transmission) and much less so, respiratory droplets.
Monkeypox infection is typically mild and self-limiting, however, severe illness can occur in some individuals. Signs and symptoms typically include fever, headache, muscle aches, exhaustion and swollen lymph nodes, followed one to three days later by a progressively developing rash. The rash usually begins on the face and then spreads to other parts of the body, including the hands, feet and genitals.
The incubation period (period from exposure to symptom development) is typically six to 13 days but can range from five to 21 days. Individuals are infectious from symptom onset until all scabs have fallen off and new skin is present.
When assessing your patients, please continue to consider the following differential diagnoses, which may be hard to distinguish from monkeypox – including syphilis, herpes simplex virus (HSV), chancroid, varicella zoster, hand, foot and mouth disease and other common infections. The Ministry of Health has developed a reference guide comparing monkeypox, chickenpox, and hand-foot-and-mouth disease. The Ministry of Health has also posted resources on its Monkeypox Virus page.
Visit the World Health Organization’s monkeypox outbreak page for updates on areas currently affected by monkeypox worldwide and visit the Public Health Agency of Canada’s Monkeypox page for Canadian update.
Reporting Information for Health Professionals
Effective June 16, 2022, monkeypox has been designated as a Disease of Public Health Significance (DOPHS) as “Smallpox and other Orthopoxviruses including Monkeypox” by the Ministry of Health under the Health Protection and Promotion Act (HPPA).
Health care providers with a duty to report DOPHS and/or communicable diseases are now required to report directly to York Region Public Health, as they would with other DOPHS.
Health care providers should report to York Region Public Health as soon as possible if you believe your patient has or may have monkeypox.
Contact York Region Public Health
For questions, issues or reports of any DOPHS, contact York Region Public Health’s Control of Infectious Disease team:
Telephone: 1-877-464-9675 ext. 73588 (Monday to Friday, 8:30 a.m. to 4:30 p.m.)
On-call Response Telephone: 905-953-6478 (after 4:30 p.m. and 24/7 on weekends and holidays)
Fax number: 905-898-5213
Diseases of Public Health Significance Reporting Form
Infection Prevention and Control (IPAC) Recommendations
For the most up-to-date Infection Prevention and Control (IPAC) recommendations, please refer to Public Health Ontario’s Infection Prevention and Control (IPAC) Recommendations for Monkeypox in Health Care Settings.
Cases with suspect, probable or confirmed monkeypox should be in a single-patient room with the door closed. An airborne infection isolation room is not necessary but may be used while ruling out other infectious diseases (e.g., varicella or measles as differential diagnoses).
Health care providers should use gloves, gown, eye protection and a fit-tested, seal-checked N95 respirator (or equivalent) if assessing or caring for a person with possible monkeypox infection.
Approval for monkeypox testing is not required and any health care provider can test patients in their office (e.g., if you already test for diseases such as syphilis, gonorrhea, etc.). Individuals with compatible symptoms and in whom monkeypox is suspected should be tested. Individuals who have been tested for monkeypox should be advised to isolate at home until their results are reported and Public Health contacts them.
For patients that have a rash, the best specimen to submit is a skin lesion specimen. You can submit a maximum of three skin lesion specimens (virus culture collection kit order#: 390081).
If the patient does not have a rash, submit both a nasopharyngeal or throat swab (virus respiratory collection kit order#: 390082) and a blood sample for maximum test effectiveness.
NOTE: The outer packaging on all collected specimens must be marked, on a contrasting background, with "TU 0886".
For the most up-to-date information regarding testing recommendations, please refer to Public Health Ontario’s (PHO) Monkeypox Virus test information page.
Please refer to PHO’s testing indications linked above for details on which samples to take, how to label them, and how to submit samples from a patient being investigated for monkeypox.
Additional questions regarding testing may be directed to PHO Laboratory Customer Service Centre at 416-235-6556/1-877-604-4567 during business hours, or after-hours 416-605-3113.
The provision of Imvamune® for post-exposure prophylaxis (PEP) requires a risk assessment by York Region Public Health and is offered to contacts who may have had a high or intermediate risk exposure to a monkeypox case. As part of our contact tracing and follow up, York Region Public Health will provide recommendations in conjunction with the contact’s health care provider regarding PEP, and can help support administration of the vaccine in many cases
Individuals who have been a confirmed case of monkeypox in the current outbreak are NOT recommended to receive the monkeypox vaccine at this time.
Ministry of Health case and contact guidance can be found in the document Recommendations for the management of cases and contacts of monkeypox in Ontario.
York Region Public Health offers no-cost monkeypox vaccine clinics for individuals meeting the following provincial eligibility criteria:
- Two-spirited, non-binary, trans- or cis-gender individuals who self-identify or have sexual partners who self-identify as belonging to the gay, bisexual and other men who have sex with men (gbMSM) community AND at least one of the following:
- Have received a diagnosis of bacterial sexually transmitted infection (STI) in the past 2 months (e.g., chlamydia, gonorrhea, syphilis)
- Have had two or more sexual partners recently or may be planning to
- Have attended venues for sexual contact recently, or may be planning to, or who work/volunteer in these settings (examples of these settings include bath houses or sex clubs)
- Have had anonymous sex (e.g., using hookup apps) recently or may be planning to
- Are a sexual contact of an individual who engages in sex work
- Any individual who engages in sex for work or may be planning to
Household and/or sexual contacts of those identified for PrEP eligibility in parts (a) and (b) above AND are moderately to severely immunocompromised or pregnant may be at higher risk for severe illness from a monkeypox infection. These individuals may be considered for PrEP and should contact their health care provider for more information.
Each appointment is provided one-to-one in a private room.
Your eligible patients can book an appointment at an upcoming clinic by visiting york.ca/monkeypox or by calling Access York at 1-877-464-9675. The website also provides information for the public on signs and symptoms and how to prevent monkeypox infection.
For detailed information on Imvamune® including the use in special populations, please see the Ministry of Health’s Monkeypox Vaccine (Imvamune®) Guidance for Health Care Providers document.
Special populations include those with previous smallpox vaccine, those who have had monkeypox infection, research laboratory employees, moderately to severely immunocompromised individuals (defined in Appendix A of the guidance), those with allergy/hypersensitivity, pregnant and/or breastfeeding, children and youth and persons with atopic dermatitis.
Vaccine Frequently Asked Questions
Can individuals with history of previous smallpox vaccine get vaccinated?
Yes. Individuals eligible for Imvamune® as PreP or PEP who previously received either an older generation replicating (live) smallpox vaccine or Imvamune® more than two years ago can be revaccinated with a single dose of Imvamune®.
Can individuals with a previous monkeypox infection get vaccinated?
No. Individuals who have been a confirmed case of monkeypox in the current outbreak are NOT recommended to receive the monkeypox vaccine at this time.
What is the definition of moderately to severely immunocompromised?
Please see Appendix A of the Monkeypox Vaccine (Imvamune®) Guidance for Health Care Providers document for the full definition of moderately to severely immunocompromised.
Who can get a second dose of Imvamune®?
Two doses given at least 28 days apart are only currently recommended for moderately to severely immunocompromised individuals.
Who requires a medical note to receive Imvamune®?
Given the scarcity of data on the effectiveness of vaccine in certain special populations, as well as the need for clinical assessment, we are asking that the following groups speak with their health care provider and provide a medical note (or for those under the first bullet, proof of prescription) to be immunized in our clinics. These include:
- People that are moderately to severely immunocompromised and wishing to receive a second dose; if these individuals have a prescription, they can present this to receive their second dose instead of contacting their health care provider
- Individuals who are severely immunocompromised and wishing to receive a first dose
- Individuals that are immunocompromised and have a household or sexual partner that is at high risk of infection
- Individuals that are pregnant
- Individuals that are less than 18 years of age
Can Imvamune® be co-administered with other vaccines?
It is recommended to not co-administer Imvamune® with other vaccines, and to reschedule any other vaccines until at least 14 days after administration of Imvamune® (including COVID-19 vaccine). The administration of Imvamune® as post-exposure prophylaxis should not be delayed in an individual who has recently received another vaccine.
How can I promote this vaccine in my clinic(s)?
Your eligible patients can book an appointment or find locations and walk-in times for upcoming York Region Public Health clinics by visiting york.ca/monkeypox or calling Access York at 1-877-464-9675. You may also print and post in your clinic(s) the general vaccine clinic flyer.
In Canada, Tecovirimat (TPoxx®) is authorized by Health Canada for the treatment of human smallpox disease in adults and pediatric patients weighing at least 13 kg. The drug does not have an approved indication for the treatment of monkeypox in Canada. However, a licensed healthcare professional may use their clinical judgment to prescribe TPoxx® off-label for the treatment for severe monkeypox infections.
A limited supply is available in Ontario for patients who are severely ill/disabled due to monkeypox infection or at high risk for severe disease (e.g., immunocompromised, pediatric, pregnant, or patients with one or more complications). Detailed information on the use of TPoxx®, including eligibility criteria, is available in the Ministry of Health’s Monkeypox Antiviral Guidance for Health Care Providers.
Clinicians can request product by contacting the Ministry of Health Emergency Operations Centre at @email or by calling the Healthcare Provider Hotline at 1-866-212-2272.
General information on TPoxx® for patients is available in the Ministry of Health’s TPoxx® Information Sheet.
Past Communications from York Region Public Health
- August 17, 2022 – Testing for Monkeypox and Other Differential Diagnoses
- July 7, 2022 – Monkeypox PrEP Clinics Available in York Region
- June 17, 2022 - Monkeypox Designated a Disease of Public Health Significance
- June 9, 2022 - Monkeypox Update – Including Interim Vaccine Guidance Q&A for Post-Exposure Prophylaxis
- May 27, 2022 - Supporting Material for Reported Monkeypox Cases
- May 20, 2022 - Confirmed Monkeypox Cases Identified in Quebec