Commons signs and symptoms

• Fever
• Chills
• Headache
• Muscle aches
• Exhaustion
• Swollen lymph nodes
• New rash or lesions–(usually appears a few days after other symptoms on the face and the extremities.)

The incubation period (time between exposure/ infection and when symptoms begin) is typically six to 13 days, and can be up to 21 days.

If you think that you may have the signs and symptoms of monkeypox, and or are a close contact of someone who has confirmed monkeypox, please contact your health care provider for an assessment as soon as possible. Limit your contact with others and self-isolate.

Most transmission of monkeypox in Canada has occurred between close contacts like intimate partners or household members.

If you think you may have come in contact with someone who has symptoms of monkeypox, you should monitor yourself for symptoms for 21 days and contact Renfrew County and District Health Unit 613-732-3629 or 1-800-267-1097 for further assessment to see if post exposure prophylaxis, or vaccination, is recommended.

If no symptoms appear after 21 days, you can continue with normal activities. If symptoms develop, you should self-isolate immediately and contact your healthcare provider.

If you have been tested for monkeypox, it is important to self-isolate at home until you receive negative test results. Renfrew County and District Health Unit will follow up with you if your test result is positive and advise on next steps.

If you test positive for monkeypox you should self-isolate at home. This recovery period typically takes two to four weeks.

If you have been tested for monkeypox or are experiencing symptoms you should:

• Not attend work, school, or public areas
• Stay in a separate room or area away from other household members
• Use a separate bathroom if available, including using separate towels
• If unable to separate from household members you should
  • Wear a medical mask
  • Cover skin lesions as much as possible (e.g., long sleeves, long pants)
  • Maintain a physical distance of at least two meters from others
• Avoid sexual contact
• Avoid leaving the home unless seeking urgent medical care
• Avoid household visitor
• Avoid contact with those at higher risk of severe monkeypox illness including people who are immunosuppressed or pregnant, and/or children under 12 years of age
• Avoid contact with animals, including household pets as the virus can be spread to animals.
  • Keep your pets in the home and if possible, ask someone else in the home who is not sick to care for the pet.
  • Avoid close contact or prolonged contact with pets including touching, snuggling and kissing.
  • If having to care for the pet, you should wear a mask and wash hands with soap and water immediately before and after touching pets, their food, or supplies. If lesions are present on the hands, wear disposable gloves.

• Practice good hand hygiene. Wash your hands with soap and water or use an alcohol-based hand sanitizer.
• Do not kiss, hug, cuddle or have sex with someone who has or may have monkeypox.
• Avoid skin to skin contact with monkeypox rashes or lesions.
• Avoid sharing objects such as toothbrushes, utensils, sex toys or drug equipment.
• Clean and disinfect high touch surfaces (such as door handles and phones).
• Avoid touching bedding and laundry that has been in contact with a person or animal that may have the virus.
• Avoid contact with sick or dead animals
• Use personal protective equipment (PPE) when caring for someone at home who has the virus, including a medical mask and disposable gloves for direct contact with lesions.

Imvamune® is a vaccine that helps protect against monkeypox infection. Imvamune® is a live, non-replicating vaccine. The vaccine contains a very weakened form of a virus similar to the one that causes monkeypox and cannot make you sick. When a person is given the vaccine, the immune system will produce its own protection in the form of antibodies against the virus.

At this time, one dose of the monkeypox vaccine (Imvamune®) can be given to eligible persons as per the Ontario Ministry of Health guidelines. A single dose is expected to provide reasonable protection by 2-4 weeks following vaccination. A second dose produces slightly higher response and may provide longer-lasting protection. Monitor for changes to the Ontario Ministry of Health recommendations and eligibility.  If you become eligible for a second dose, please call 613-732-9436 or 1-833-773-0004.

Imvamune® can be used to protect individuals before an exposure to the monkeypox virus (this is called Pre-Exposure Prophylaxis or PrEP) or to protect individuals after being exposed to the monkeypox virus (this is called Post-Exposure Prophylaxis or PEP).

Imvamune® vaccine eligibility for protection before an exposure to the monkeypox virus.

For the purposes of Pre-Exposure Prophlaxis (PrEP):

a) Two-spirited, non-binary, trans- or cis- gender individuals who self-identify or have sexual partners who self-identify as belong 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 STI (i.e., chlamydia, gonorrhea, syphilis) in the past 2 months;
• Have had 2 or more sexual partners or may be planning to;
• Have attended venues for sexual contact (i.e., bath houses, sex clubs) or may be planning to, or who work/volunteer in these settings; or
• Have had anonymous sex (e.g., using hookup apps) or may be planning to; and/or
• Are a sexual contact of an individual who engages in sex work.

b) Any individual who engages in sex work or may be planning to.

c) Individuals who are immunocompromised and/or pregnant. These individuals may be at higher risk for severe illness from a monkeypox infection and they should contact their local public health unit for consideration of PrEP if they are at risk for contracting monkeypox.

Imvamune® vaccine eligibility after being exposed to the monkeypox virus

Based on the Ontario Ministry of Health guidelines, individuals who have been identified by their local public health unit as having a high or intermediate-risk exposure with someone who has the monkeypox virus are eligible to receive Imvamune®. These individuals will be contacted directly by their local public health unit.

Anyone who does not meet the current eligibility criteria outlined by the Ontario Ministry of Health is not eligible to receive the monkeypox vaccine.

People with signs and symptoms of Monkeypox infection should NOT receive the Imvamune monkeypox vaccine as it is not intended for the treatment of Monkeypox.

People who have a confirmed allergy to any of the vaccine ingredients or its container are not eligible for the monkeypox vaccine. Ingredients of the Imvamune® vaccine are:

• Tromethamine (trometamol, Tris)
• Sodium chloride
• Water for injection
• Hydrochloric acid
• Bromobutyl rubber stopper

Imvamune® may also contain trace amounts of:

• Gentamicin
• Ciprofloxacin
• Egg cell DNA and protein
• Benzonase

If you have an allergy to eggs, gentamicin or ciprofloxacin, or an antibiotic in the same class as gentamicin (aminoglycosides) or ciprofloxacin (quinolones), please call 613-732-9436 or 1-833-773-0004 for more information about eligibility for Imvamune®.

For Pre-Exposure Prophylaxis, it is currently recommended that people wait at least four weeks after receiving a live vaccine and at least two weeks after receiving an inactivated vaccine before receiving the monkeypox vaccine.

If you have been identified as a high-risk contact or an intermediate risk contact of a confirmed or probable case of monkeypox, you will be contacted by Renfrew County and District Health Unit directly and may be offered an appointment to receive the monkeypox vaccine for Post-Exposure Prophylaxis (PEP).

If you think you may be eligible to receive the monkeypox vaccine for Pre-Exposure Prophylaxis (PrEP), please call Renfrew County and District Health Unit Vaccine Intake Number at 613-732-9436 or 1-833-773-0004 for more information.

Side effects may develop in the few days after receiving the vaccine. Although most of these side effects are not serious to your health, they may make you feel unwell for a few days. The side effects should go away on their own.

Common side effects of Imvamune® include pain, swelling, redness and itchiness at the injection site where the needle was given. Applying a cool, damp cloth where the vaccine was given may help with pain and swelling.

Other common side effects can include fatigue, headache, body aches, nausea, loss of appetite, joint pain, chills and fever. If needed, pain or fever medication (such as acetaminophen or ibuprofen) may help.

People who have atopic dermatitis (eczema) may experience more side effects than others and may also experience a flare-up or worsening of their condition.

If you develop any serious signs or symptoms that could be an allergic reaction within four hours of being vaccinated, call 9-1-1 right away. Symptoms of an allergic reaction include:

• Swelling of the face, tongue or throat
• Difficulty breathing or wheezing
• Hives (bumps on the skin that are often very itchy)

You should also seek medical attention right away if you develop any symptoms that could be related to your heart such as chest pain or discomfort, shortness of breath, and a fast or irregular heartbeat.

If you have concerns about the symptoms you develop after receiving the vaccine, contact your healthcare provider. Any adverse events following vaccination should be reported to your local public health unit.

• Monkeypox: Outbreak update (Government of Canada)
• Monkeypox: Questions and answers (World Health Organization)
• About Monkeypox (USA Centers for Disease Control and Prevention)
• Monkeypox virus overview: including transmission and clinical signs / symptoms (Ontario Ministry of Health)
• Monkeypox detailed fact sheet: Provides an overview of the virus, transmission, epidemiology, clinical considerations including treatment, case and contact management, and prevention (World Health Organization)
• Monkeypox: What we know (Gay Men’s Sexual Health Alliance)