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.

Mpox infection can appear similar to other infectious diseases, such as chickenpox, or several sexually transmitted infections (such as herpes or gonorrhea). This is why it’s important to consult a health care provider and be tested.

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

Most transmission of mpox 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 mpox, 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 mpox, 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 mpox you should self-isolate at home. This recovery period typically takes two to four weeks.

If you have been tested for mpox 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 mpox 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.

• Get vaccinated for mpox if eligible
• Use condoms
• Practice safe sex and having fewer sexual partners, particularly those who are anonymous, even when they don’t have symptoms
• 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 mpox
• Avoid skin to skin contact with mpox 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.

Ontario provides the Imvamune® vaccine for protection against mpox. Imvamune® should be given as a two-dose series, 28 days apart. Imvamune® is not a treatment for mpox and must be given before you have symptoms of mpox.
Imvamune® should be considered for the following:

• Pre-exposure vaccination — when Imvamune® is administered before known exposure to the virus
• Post-exposure vaccination — when Imvamune® is administered for individuals who have had a high-risk exposure to a probable or confirmed case of mpox, or within a setting where transmission is happening

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

Individuals who are eligible to get Imvamune® for pre-exposure vaccination

two-spirit, non-binary, transgender, cisgender, intersex, or gender-queer individuals who self-identify or have sexual partners who self-identify as belonging to the gay, bisexual, pansexual and other men who have sex with men (gbMSM) community and at least one of the following:

• had a confirmed sexually transmitted infection (STI) within the last year
• have or are planning to have 2 or more sexual partners or are in a relationship where at least one of the partners may have other sexual partners
• have attended venues for sexual contact (such as bathhouses, sex clubs) recently or may be planning to, or who work or volunteer in these settings
• have had anonymous sex (such as using hookup apps) or may be planning to or are a sexual contact of an individual who engages in sex work
• individuals who self-identify as engaging in sex work or are planning to, regardless of self-identified sex or gender
• Household and/or sexual contacts of those identified for pre-exposure vaccination eligibility in parts A and B above and who are moderately to severely immunocompromised or pregnant.

Individuals who are eligible to get Imvamune® for post-exposure vaccination

Imvamune® given for post-exposure vaccination requires an assessment of the risk of exposure by the public health unit. The first dose should be offered ideally within 4 days (up to 14 days) from the date of the last exposure to individuals who are a high-risk contact of a confirmed or probable case of mpox. The second dose should be offered at least 28 days after the first dose. Anyone who self-identifies as a high-risk contact of a confirmed or probable case of mpox should contact their local public health unit for further assessment to see if post-exposure vaccination would be recommended.

If you have previously received a vaccine against smallpox, this will give you some protection, but you will still need to receive 1 dose of Imvamune®. Individuals should ensure to receive both doses of Imvamune® to be best protected. Booster doses are not recommended at this time.

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

Individuals who have been a confirmed case of mpox since 2022, are NOT recommended to receive the mpox vaccine at this time; this is based on the limited utility of the vaccine given that these persons are expected to have natural immunity due to recent infection.

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

Individuals who have received two doses of Imvamune® in 2022 or later or not eligible for additional doses.

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

If you think you may be eligible to receive the mpox vaccine, 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.

Yes, Imvamune® is safe to receive. If you received another vaccination in the past 4 weeks, please let your health care provider know before getting Imvamune®. If you are less than 18 years of age, pregnant, breastfeeding, or are immunocompromised you should speak to your health care provider. Your health care provider will review the risks and benefits of receiving the mpox vaccine.

We know that vaccination is not a 100% guarantee of not being infected with the virus that causes mpox. A single dose is expected to provide reasonable protection by two to four weeks following vaccination. A second dose produces a slightly higher response and may provide longer-lasting protection. It takes around 14 days for your immune system to build up protective immunity to mpox. Waiting a full month after vaccination before resuming higher risk sexual contact, using condoms, staying home when having symptoms and having fewer sexual partners helps lower the risk of getting mpox.

• Mpox (monkeypox) : Outbreak update (Government of Canada)
• Mpox (monkeypox) : Questions and answers (World Health Organization)
• About Mpox (monkeypox) (USA Centers for Disease Control and Prevention)
• Mpox (monkeypox virus overview): including transmission and clinical signs / symptoms (Ontario Ministry of Health)
• Mpox(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)
• Mpox(monkeypox): What we know (Gay Men’s Sexual Health Alliance)