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Monkeypox

Monkeypox is a rare disease that is caused by infection with monkeypox virus. Monkeypox virus belongs to the Orthopoxvirus genus which also includes variola virus (which causes smallpox), vaccinia virus (used in the smallpox vaccine), and cowpox virus.

Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name ‘monkeypox.’ The first human case of monkeypox was recorded in 1970 in the Democratic Republic of the Congo (DRC). Monkeypox is thought to originate in rodents in Central and West Africa, and it has repeatedly jumped to humans. Cases outside Africa are rare and have so far been traced to infected travelers or imported animals.

In May 2022, multiple cases of monkeypox were identified in several non-endemic countries. As of June 1, 2022, the WHO reported 550 cases of monkeypox from thirty non-endemic countries. Epidemiological investigations are ongoing. The vast majority of reported cases so far have no established travel links to an endemic area and have presented through primary care or sexual health services Studies are currently underway to further understand the epidemiology, sources of infection, and transmission patterns.  

The Public Health Agency of Canada is working with provincial and territorial public health partners to investigate cases of monkeypox in Canada. As of June 17, 2022, there have been 168 cases of monkeypox identified in Canada.

Jurisdictions in Canada with confirmed cases
Province or Territory Confirmed cases
British Columbia 2
Alberta 4
Ontario 45
Quebec 184
Total 235

Source: Public Health Agency of Canada


Transmission

Historically, there has been limited person-to-person transmission The primary mode of person-to person transmission has been through respiratory secretions and direct contact with skin lesions or a patient’s items that have been contaminated


Signs and Symptoms

According to the World Health Organization, all of the infected people in the U.K. contracted the West African clade of the virus, a version that tends to be mild and usually resolves without treatment. The infection begins with fever, headache, aching limbs and fatigue. Typically, after one to three days, a rash develops, along with blisters and pustules that resemble those caused by smallpox, which eventually crust over.

Monkeypox National Case Definition

Suspected case

A person of any age who presents with one or more of the following:

  1. An unexplained acute rash AND has at least one of the following signs or symptoms
    • Headache
    • Acute onset of fever (>38.5°C),
    • Lymphadenopathy (swollen lymph nodes)
    • Myalgia (muscle and body aches)
    • Back pain
    • Asthenia (profound weakness)
  2. An unexplained acute genital, perianal or oral lesion(s)

Probable case

A person of any age who presents with an unexplained acute rash or lesion(s)

AND

Has one or more of the following:

  1. Has an epidemiological link to a probable or confirmed monkeypox case in the 21 days before symptom onset, such as
    • face-to-face exposure, including health workers without appropriate personal protective equipment (PPE)
    • Direct physical contact, including sexual contact; or contact with contaminated materials such as clothing or bedding
  2. Reported travel history to or residence in a location where monkeypox is reported in the 21 days before symptom onset.

Confirmed case

A person who is laboratory confirmed for monkeypox virus by detection of unique sequences of viral DNA either by real-time polymerase chain reaction (PCR) and/or sequencing.

Source: Public Health Agency of Canada


Infection Prevention and Control

PPE used by healthcare personnel who enter the patient’s room should include:

  • Gown
  • Gloves
  • Eye protection (i.e., goggles or a face shield that covers the front and sides of the face)
  • NIOSH-approved N95 filtering facepiece or equivalent, or higher-level respirator

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