Mpox

Mpox is a disease caused by a virus in the family Poxviridae. It is closely related to the smallpox virus, which was declared eradicated by the World Health Organization (WHO) in 1980. In November 2022, the World Health Organization began using ‘mpox’ as the preferred term for monkeypox disease.

Health Canada states that mpox is usually a mild illness and that most people recover on their own after a few weeks.

The incubation period (time between infection and experiencing symptoms) for mpox is usually between 3 to 21 days (generally 7 to 10 days). Mpox illness often resolves by itself in 2 to 4 weeks.

Systemic symptoms typically occur about 0 to 5 days before the appearance of lesions. Signs and symptoms include:

• skin or mucosal lesions (mucosa is the soft tissue that lines the body's canals and organs in the digestive, respiratory, and reproductive systems)
• fever
• chills
• swollen lymph nodes
• headache
• sore throat
• muscle pain
• backache
• exhaustion 
• rectal pain
• gastrointestinal symptoms (e.g., vomiting, diarrhea)

Skin lesions may occur within 1 to 3 days of experiencing a fever, the individual develops skin eruptions (skin rash or lesions), usually on their face, hands, and feet. The rash may also appear on the mouth, eyes, and genitals. The rash lasts between 14 and 28 days and has different stages before finally forming a scab which falls off.

Most individuals recover without treatment. Newborn babies, children, and immunocompromised individuals are more at risk of severe disease and complications.

An individual with mpox can spread the disease while they have symptoms. A person is considered contagious from when the first symptoms appear until the scabs have fallen off on their own and the skin is healed.

The mpox virus can be spread through:

• bites or scratches from infected animals
• contact with products from infected animals (e.g., furs or skin) or eating undercooked meat from infected animals
• person to person after contact with sores, scabs, lesions, bodily fluids (e.g., blood, saliva, semen, or pus from lesions) or mucosal areas (e.g., eyes, mouth, throat, anus, rectum, genitals)
• living in the same household, such as contact with contaminated materials (e.g., bedsheets or clothes of a symptomatic person or by sharing personal objects used by an infected person such as razors, utensils, needles, etc.)
• providing care
• the placenta (mother to fetus)
• respiratory droplets (produced by coughing or sneezing from close contact with an infected person)

Mpox is typically found in central and western African countries. The cases discovered outside of these regions are believed to have been spread by infected travellers or animals.

On March 31, 2023, the total count of confirmed cases in Canada was 1,480.  The risk of infection is considered low for the general population.

People who closely interact with symptomatic individuals are at greater risk of infection. These persons include healthcare workers, people living in the same house, and sexual partners. Workers such as doctors, nurses, and laboratory workers are at risk when they:

• make physical contact with sick individuals, or shared surfaces or objects
• work with infected individuals in poorly ventilated enclosed spaces, especially when physically close and for extended durations
• handling animals or specimens that may carry the virus.

The most effective way to avoid contracting mpox is by limiting exposure to infected individuals. It is currently not known if asymptomatic people (those who do not show any symptoms) can spread the disease.  Infected individuals should be encouraged to:

• Self-isolate as long as they are experiencing symptoms
• Cover skin lesions if possible (e.g., with clothing or a light bandage)
• Maintain good hand hygiene and respiratory etiquette
• Avoid close physical contact (e.g.,  sexual activity, etc.)

Anyone who must be physically present with an infected individual (or materials the individual has been in contact with) should:

• use gloves and avoid direct contact with the skin lesions or secretions.
• wear an N95 or higher-level respirator, eye protection, and a gown (for healthcare personnel who must enter a patient’s room)
• frequently wash (with soap and water) or sanitize hands, especially after physically touching an infected individual or handling contaminated materials (e.g., clothes, towels, utensils, or objects that came in contact with their secretions)

Do not reuse contaminated personal protective equipment (PPE).

Clean and disinfect objects or surfaces touched by infected individuals.  Keep contaminated materials separate from clean objects and surfaces.

Immediately contact a healthcare provider if you have symptoms of mpox, particularly skin eruptions or swollen lymph nodes, or had contact with a known or suspected mpox case. Describe your symptoms and include how you may have been in contact (e.g., recent travel to a place where there was a mpox outbreak, close contact where there have been suspected infections, etc.). Healthcare providers can advise on your next steps.

If you have been diagnosed with mpox, self-isolate until all symptoms resolve. All scabs should have fallen off and healed before ending isolation.

Most individuals with mpox do not require specific medical treatment. Symptoms are usually mild and supportive treatment is usually sufficient. Healthcare providers can monitor and adjust treatment based on the severity of the infection.

More information is available from:

• Mpox (Monkeypox) – Government of Canada
• Mpox – World Health Organization (WHO)
• Mpox – Centers for Disease Control and Prevention (CDC)