GUELPH – Since an international mpox outbreak in 2022, local public health officials have recommended people at higher-than-average risk of contracting the disease get vaccinated against it.
Mpox is an infectious disease caused by the monkeypox virus.
Symptoms can include a painful rash, swollen lymph nodes, high fever, headache, muscle ache, back pain and low energy, according to the World Health Organization (WHO).
While most people with mpox recover completely, some people get very sick and the disease can be fatal, WHO officials state.
Mpox is a less severe, “distant cousin to small pox,” Wellington-Dufferin-Guelph Public Health (WDGPH) associate medical officer of health Dr. Matthew Tenenbaum told the Advertiser.
“It’s similar in the sense that the way it causes illness is lesions or sores on a person’s body that typically have fluid in them – that fluid has the virus in it.”
Spread typically happens through contact with the sores, he said, but the virus can also spread through droplets in the air. He added mpox can cause sickness, pain and disability.
Severe complications can be caused by mpox skin lesions developing secondary bacterial infections such as necrotizing infections in which the skin or soft tissue dies, Tenenbaum added.
“Extensive mpox lesions can cause fluid shifts in the body that lead to severe dehydration or shock,” he said.
“Other complications of mpox can include severe pneumonia, encephalitis (brain infection), or sepsis (blood infection) that can lead to death.”
Overall though, Tenenbaum said, “we are not in a place where people need to be worried about mpox.”
There are no recorded mpox deaths in Canada to date, according to the Public Health Agency of Canada.
Between Jan. 1 and Aug. 12, 164 cases of mpox were reported to the agency.
Hospitalizations for mpox in Canada have been rare, Tenenbaum noted.
Worldwide, over 220 people have died of mpox, and there have been more than 100,000 laboratory confirmed cases between January 2022 and August 2024, according to the WHO.
Different strains
The mpox strain behind the recent outbreak in the Democratic Republic of the Congo and its bordering countries is known as clade I.
All recorded mpox cases in Canada so far have been clade II, which is “less severe and less lethal typically than clade I,” Tenenbaum said.
“Other countries are having cases in returning travellers from Africa,” Tenenbaum said, and he “wouldn’t be surprised if at some point we have someone who is a return traveller” test positive for clade I.
“Right now we are very much in monitoring mode,” he said, and “following what’s driving spread overseas [and] maintaining vigilance,” ready to update practices if the situation changes.
If clade I makes its way to this region, Tenenbaum feels “quite confident in practices we have to maintain that.”
In addition to the different strain, Tenenbaum attributes the mpox deaths internationally to lower immunization rates and health care systems’ ability to respond to outbreaks.
In Canada, one “tool we have in our tool box” for responding to mpox is Tecovirimat, or TPOXX, an anti-viral agent that people can receive in hospital, Tenenbaum said, but he notes TPOXX is rarely needed.
In Wellington, Guelph and Dufferin, Tenenbaum said mpox rates were highest in 2022, when the virus was newer to the community.
Immunization
“That’s when we rolled out our immunization campaign – since then there has been less activity,” he said.
There were six reported mpox cases in the region in 2022, none in 2023, and two so far this year, he said.
Global outbreaks have informed WDGPH’s mpox response, Tenenbaum noted.
“It seemed to be the case that people were developing sores in genital areas, and it appeared to be spreading from person to person in genital contact,” Tenenbaum said, describing the lesions as “more like an STI [sexually transmitted infection] than a fully body rash.”
That has informed mpox vaccine eligibility criteria.
WDGPH’s current focus in mpox management is encouraging people eligible for the vaccine to come forward for their first and second doses, Tenenbaum said, “to try to maximize protection for our community.”
Mpox vaccine eligibility includes gay, bisexual and pansexual individuals who have sex with men and who also have multiple partners, have a partner with multiple partners, have had an STI within the last year, have attended venues for sexual contact such as bathhouses or sex clubs, or have had recent anonymous sex.
It also includes sexual partners of people who meet the criteria above, sex workers and partners of sex workers, staff and volunteers at sex-on-premises venues, people engaged in sex tourism, and people who anticipate experiencing any of the above scenarios.
Household contacts of people eligible may also be eligible if they are immunocompromised or pregnant, and officials recommend they contact their health care providers or WDGPH for more information.
“Anyone eligible for the vaccine, it’s a good idea to come forward and get it,” Tenenbaum said, “because of what’s happening here and abroad.”
He noted the vaccine is “highly effective,” with an 80 to 90 per cent efficacy range after two doses. “Even if not perfect, it’s highly protective against more severe cases,” he added.
Locally, Tenenbaum said “the vast … majority of cases have been among those that have not gotten two doses.”
For more information about mpox and vaccine eligibility visit wdgpublichealth.ca.
To book vaccination or to inquire about eligibility call 1-800-265-7293 extension 7006.
