Question Period Note: Cases of Monkeypox in Canada

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• As of November 18, at 12:00 pm EDT, there have been 1,449 confirmed cases of Monkeypox in Canada (690 in Ontario, 525 in Quebec, 182 in British Columbia, 41 in Alberta, 6 in Saskatchewan, 2 in Yukon, 1 in Manitoba, 1 in Nova Scotia, and 1 in New Brunswick). The Public Health Agency of Canada’s National case counts are publicly updated weekly. Prior to the current international outbreak of Monkeypox, Canada has never had any confirmed cases of Monkeypox.
• Keeping people in Canada safe from threats to their health, and keeping our most vulnerable citizens safe and healthy is a top priority for the Government of Canada.
• Anyone can get infected with and spread Monkeypox if they come into close contact with someone who has the virus. People in Canada should be aware of the symptoms of Monkeypox and report any concerns to their health care provider. Additional information is available on Canada.ca.
• The Public Health Agency of Canada is actively working with public health partners to investigate reports of suspected cases of Monkeypox in Canada.
• The Public Health Agency of Canada has alerted public health authorities to work with health care providers to look for patients who have signs or symptoms consistent with Monkeypox, including whether they have reported travel or have specific risk factors for Monkeypox.
• The Public Health Agency of Canada’s National Microbiology Laboratory and jurisdictions that have the capacity are conducting testing to confirm or rule out a diagnosis of Monkeypox for suspected cases.
• The situation is evolving in Canada and internationally. The Public Health Agency of Canada will continue to work with the provinces and territories to assess the risks to people in Canada, respond to the evolving situation, and continue to provide updates to the public as new information becomes available.

If pressed on vaccines and treatments:
• On September 23, 2022, NACI provided updated guidance on the use of Imvamune® in the context of ongoing monkeypox outbreaks in Canada. Recommendations include pre-exposure vaccination for priority populations considered at highest risk, given current and projected epidemiology, as well as dose-sparing strategies for consideration if vaccine supply is constrained.
• To support the targeted public health response strategies of provinces and territories, the Public Health Agency of Canada is deploying vaccines and therapeutics from Canada’s National Emergency Strategic Stockpile.
• To date, Canada’s National Emergency Strategic Stockpile has deployed over 140,000 doses of vaccine and over 160 treatment courses of therapeutics.
• At this time, and in alignment with international expert assessments, including the World Health Organization, there is no need for the vaccine to be used for mass immunization.

If pressed on the risk to people in Canada:
• The Agency is continually assessing the possible risk of exposure to the Monkeypox virus in Canada. At this time, person-to-person transmission is occurring in Canada.
• Anyone can get infected with and spread Monkeypox if they come into close contact with someone who has the virus.
• People who develop symptoms of Monkeypox, such as a new rash accompanied by general symptoms should isolate at home and immediately contact their health care provider or local public health authority for advice on what to do.
• People can reduce their risk of becoming infected with or spreading the Monkeypox virus by:
o Staying home and limiting contact with others if they have symptoms, or as recommended by their health care provider;
o Avoiding close physical contact, including sexual contact, with someone who has Monkeypox or may have been exposed to the Monkeypox virus;
o Maintaining good hand hygiene and respiratory etiquette;
o Cleaning and disinfecting high-touch surfaces and objects in their home, especially after having visitors.
• Interim Monkeypox Infection Prevention and Control Guidance within healthcare settings was first released on May 27, 2022, and will continue to be updated as the evidence evolves.

If pressed on the National Microbiology Laboratory’s role in testing
• Testing for Monkeypox is primarily determined at the provincial and territorial level.
• British Columbia, Alberta, Ontario, and Quebec are performing their own diagnostic testing for cases of suspected Monkeypox virus infection.
• New Brunswick, Newfoundland, Manitoba, and Saskatchewan are in the early stages of performing their own diagnostic testing, with support from the National Microbiology Laboratory. All other Canadian samples of suspected Monkeypox virus infection are sent to the National Microbiology Laboratory for further laboratory analysis and confirmation.
• The National Microbiology Laboratory continues to work on increasing provincial and territorial capacity to test for cases of Monkeypox virus infection.
• Once a sample is received, the National Microbiology Laboratory strives to have results returned to the requestor within 24-48 hours.
• This is an evolving investigation in Canada and internationally. The National Microbiology Laboratory is performing whole genome sequencing, and enhanced fingerprint analysis, on Canadian samples of Monkeypox. This sequencing will help our experts understand the chains of transmission occurring in Canada. The Public Health Agency of Canada will continue to provide updates as new information becomes available.

Limited cases of travel-related Monkeypox were identified internationally prior to the current outbreak. As of November 24, 2022, there have been 80,859 confirmed cases and 55 deaths reported to the WHO across 110 countries, including Canada, with a high proportion of these cases reported from countries without previously documented Monkeypox transmission.
To date in Canada, confirmed cases have been identified in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick, Nova Scotia, and the Yukon.
Monkeypox is typically transmitted from animals to humans. However, human-to-human transmission can result from direct contact with their body fluids, respiratory droplets, or Monkeypox sores, or by sharing clothing, bedding or common items that have been contaminated with the infected person’s fluids or sores. Transmission via respiratory droplets usually requires prolonged face-to-face contact, which can put health care providers and household members of active cases at greater risk.
All provinces and territories with testing capacity follow the safety guidelines required to work with the Monkeypox virus from the Public Health Agency of Canada’s Centre for Biosecurity.

In June 2022, the National Microbiology Laboratory provided control material and proficiency test panels (which verify the quality of tests) for the Monkeypox virus to nine provincial partners. For some jurisdictions, this has eliminated the need to ship samples and has decreased turnaround times for testing.

Currently, there is no specific treatment approved for Monkeypox, however, it is often self-limiting and symptoms usually resolve spontaneously within 2 to 4 weeks.
Health Canada has authorized the vaccine Imvamune for active immunization against Monkeypox, smallpox and related Orthopox virus infections and diseases in adults 18 years of age and older determined to be at high risk for exposure. Imvamune is authorized under the Extraordinary Use New Drugs regulatory pathway, which permits the restricted sale of the product for emergency preparedness in Canada for use by federal, provincial and territorial, and municipal governments.
The Public Health Agency of Canada continues to support provincial public health authorities to manage this outbreak by coordinating national surveillance, providing guidance and medical countermeasures. The Public Health Agency of Canada will continue to monitor this evolving outbreak and work collaboratively with public health authorities to protect the health of Canadians.

• Monkeypox is a viral infection with a rash that may be painful and affect any part of the body, such as the mouth, genitals, face, and hands.
• On July 23, 2022, the WHO Director-General declared the escalating global Monkeypox outbreak a Public Health Emergency of International Concern.
• Following notification received from the United States Centers for Disease Control and Prevention about a U.S. traveler with Monkeypox who visited Montreal, Quebec in early May 2022, the Public Health Agency of Canada, in collaboration with public health authorities, launched activities to raise awareness and vigilance for Monkeypox.
• The first two cases of Monkeypox in Canada were reported on May 19, 2022, in Quebec.
• People usually develop symptoms 5 to 21 days after being exposed to the Monkeypox virus.
• Signs and symptoms of Monkeypox can typically include fever, and a rash that often appears within a few days after symptoms such as headache, muscle aches, exhaustion, and swollen lymph nodes.
• Current evidence suggests that Monkeypox spreads in 3 ways: from person to person, through direct contact with contaminated objects, and from animals to humans.
• Monkeypox is spread from person to person through: contact with lesions or scabs that may be found on the skin or mucosal surfaces of a person with Monkeypox; and direct contact with bodily fluids of a person with Monkeypox.
• The virus may also spread through respiratory particles from a person with Monkeypox, however, information is still being gathered on that mode of transmission.
• There are no well-established treatments for Monkeypox and limited data is available on the clinical effectiveness of specific treatments in humans.
• Some existing treatments for smallpox, such as TPOXX® (tecovirimat monohydrate capsules) may have a role to play in select instances. TPOXX® is an oral antiviral agent that is indicated for the treatment of human smallpox disease in adults and pediatric patients. TPOXX® does not have an approved Health Canada indication for monkeypox or other Orthopoxviruses.
• IMVAMUNE® is a licensed 3rd generation smallpox vaccine indicated for active immunization against smallpox, monkeypox and related Orthopoxvirus infection and disease in adults 18 years of age and older determined to be at high risk for exposure.