Monkeypox

How does it spread?

Monkeypox spreads in 3 ways:

1. From person-to-person through respiratory droplets or through close, physical contact with someone who has monkeypox (especially from contact with the rash, bodily fluids, or scabs).
2. By touching materials and objects (e.g. clothing, bedding, towels, eating utensils, and dishes) that may be contaminated.
3. From someone who is pregnant to the fetus, or from a parent to a child during or after birth.

 What are the symptoms?

Monkeypox is usually a mild illness, and most people recover on their own after a few weeks. People usually develop symptoms 5 to 21 days after being exposed to the monkeypox virus. Symptoms occur in 2 stages and typically last from 2 to 4 weeks.

In stage 1, symptoms may include:

• fever
• chills
• swollen lymph nodes
• headache
• muscle pain
• joint pain
• back pain
• exhaustion

In stage 2 of the illness, a rash develops - usually within 1 to 3 days (sometimes longer) after the fever starts. The rash often starts on the face or extremities however it can affect other parts of the body, such as the hands, feet, mouth, and genitals.

The rash usually lasts between 14 and 21 days and changes through different stages before finally forming a scab which later falls off.

You can be contagious and spread the virus 1 to 5 days before the rash develops. You can continue to be contagious until the scabs have fallen off on their own and the skin is healed.

Call a health care provider immediately if:

• you develop symptoms of monkeypox
• you have had contact with a known or suspect monkeypox case

What should I do if I’ve been to a venue where there was someone with suspected or confirmed monkeypox? 

What should I do if I’ve been in contact with someone who has monkeypox? 

• Advise you to avoid non-essential interactions with people at higher risk of severe monkeypox illness.
• Advise you on whether Imvamune vaccine may help prevent monkeypox infection or reduce the risk of severe illness.  

If you think you have been exposed to monkeypox, contact KFL&A Public Health to see if you may be eligible to receive the Imvamune vaccine. 

 What should I do if I develop symptoms of monkeypox?

• Self-isolate at home if possible and avoid close contact with others, until you receive information from your local public health unit about when to end isolation. Stay in a separate room or area away from other people in the home and use a separate bathroom.
• Wear a medical mask.
• Cover any rashes or sores as best as possible when you are unable to avoid close contact with other people.
• People should not visit a person with monkeypox symptoms unless it is for an essential purpose.
• People with monkeypox symptoms should avoid contact with those at higher risk of severe illness including people who are pregnant or immunocompromised, and children under age 12 years.

• Clean your hands often with soap and water or an alcohol-based hand sanitizer, including after touching the rash or sores, clothing, or objects and surfaces that may have had contact with the rash or sores.
• Clean and disinfect contaminated surfaces (e.g., bathroom, if shared) after use with regular household cleaning/disinfectants according to the manufacturer’s instructions.
• Do not share dishes or utensils when eating; however, dishes/utensils can be used by others in the home if these are properly washed between uses either in a dishwasher or in a sink, using warm water and soap.
• Avoid direct contact with any laundry/linens that have touched the rash, bodily fluids, and scabs of the person with monkeypox symptoms. Handle laundry/linens with care and avoid shaking. Laundry can be cleaned in a washing machine with warm water and detergent. 

How to self-isolate

Stay home

• Do not use public transportation, taxis, or rideshares.
• Do not go to work, school, or other public places.
• Reschedule non-essential medical appointments.
• Rely on friends and family to pick up groceries, prescriptions, and other supplies, or use delivery services for these items. Be sure to instruct delivery drivers to leave items on your doorstep for you to collect.

Don’t have visitors or visit others

• Do not have visitors or visit others during your self-isolation period.

Avoid contact with other household members and animals

• Minimize the amount of time any vulnerable family members or children are in shared spaces with you, such as kitchens or living rooms. 
• Avoid sexual contact
• Use a separate bathroom if available
• Clean and disinfect shared areas every time you use them. 
• Household members should wash their hands frequently.
• Avoid contact with animals, including pets, poultry and livestock.

Wash your hands

• Wash your hands often with soap and water for 20 seconds.
• Dry your hands with a paper towel, or with your own cloth towel that no one else shares.
• Use an alcohol-based hand sanitizer, if soap and water are not available.

Cover your rash

• Cover skin lesions as much as possible (e.g., bandages, long sleeves, long pants)

Cover your cough and sneezes

• Cover your mouth and nose with a tissue when you cough or sneeze.
• Cough or sneeze into your upper sleeve or elbow, not your hand.

Clean surfaces and avoid sharing objects

• Clean and disinfect surfaces with household cleaning products

Double bag waste

• Dispose of contaminated waste (e.g., gauze, tissues, wound dressings) in strong bags, double bagged and securely tied.
• Wash hands after handling waste

Wear a mask or face covering

• If you have to be in a room with other people, keep a distance of at least 2 metres (6 feet) and wear a mask

Handling soiled laundry and linens

• Avoid direct contact with contaminated laundry (i.e., wear disposable gloves)
• Do not shake soiled laundry
• Wash with warm water and your usual detergent

What do I do if I have been tested or test positive for monkeypox? 

If you’ve been tested for monkeypox, self-isolate at home until your test results are known. If your test results are negative, you can stop self-isolating. If you test positive, continue to self-isolate at home until a staff person from KFL&A Public Health contacts you to provide further information about when you can end your self-isolation.

If you need to seek medical care:

• Call a health care provider ahead of time to inform them of your health status, that you are being tested for monkeypox, and about any contact you had with a person with suspected or confirmed monkeypox. 

What is a close contact?

High risk

You had intimate or sexual contact with someone

You had direct contact with someone’s rash

You had direct contact with contaminated surfaces or objects (bedding, linens, towels, clothing, sex toys, needles etc.)

You live or care for someone in the same home

Intermediate risk

You had contact with someone’s intact skin

You sat next to someone without direct skin contact (e.g., riding in a car)

Low risk

You had a brief social interaction that did not involve direct contact

No risk

You passed someone quickly

You greeted someone and kept your distance

You made a delivery to someone who is self-isolating, but had no contact with them

If any risk of exposure is present, you should monitor for signs and symptoms of monkeypox for 21 days from your last exposure. If you develop any symptoms isolate and contact your healthcare provider as soon as possible.

What treatment is available for monkeypox? 

• Letting the rash dry or covering the rash with a moist dressing to protect the area, if needed.
• Avoiding touching any sores in the mouth or eyes. If needed, mouth rinse or eye drops can be used, but products containing cortisone should be avoided. 

How can I care for someone with monkeypox infection, or with symptoms that may be due to monkeypox infection? 

If you need to provide care to someone with monkeypox symptoms or confirmed to have monkeypox, you should:

• Encourage the person to cover their rash and sores as best as they can (e.g., wearing a long sleeve shirt and long pants).
• Wear a medical mask and encourage the person to wear a medical mask when you are physically close to them.
• Avoid skin-to-skin contact.
• If you provide direct care that may involve touching the rash and sores, wear a medical mask and use disposable gloves. 
• Clean your hands and the environment:
  • Clean your hands often with soap and water or an alcohol-based hand sanitizer, including after touching the rash or sores, clothing, or objects and surfaces that may have had contact with the rash or sores.
  • Clean and disinfect contaminated surfaces (e.g., bathroom, if shared) after use with regular household cleaning/disinfectants according to the manufacturer’s instructions.
  • Do not share dishes or utensils when eating; however, dishes/utensils can be used by others in the home if these are properly washed between uses either in a dishwasher or in a sink, using warm water and soap.
  • Avoid direct contact with any laundry/linens that have touched the rash, bodily fluids, and scabs of the person with monkeypox symptoms. Handle laundry/linens with care and avoid shaking. Laundry can be cleaned in a washing machine with warm water and detergent. 

What animals can get monkeypox?

There are several types of animals that have been found to be susceptible to infection with monkeypox, including several species of rodents (e.g., rats, mice, hamsters, gerbils, squirrels, chipmunks, etc.), rabbits, hedgehogs, opossums, and non-human primates (e.g., monkeys). It is unknown which other species may be at risk of infection. Precautions should be taken to prevent exposure of any domestic or wild mammals to the virus.

Animals with monkeypox have been observed with clinical signs such as cough, fever, eye infections, lack of appetite, difficulty breathing, and rash. Veterinarians that suspect an animal has been infected with monkeypox should call the Ontario Ministry of Agriculture Food and Rural Affairs at 1-877-424-1300 to discuss the need for testing or management plans. 

I have pets in my home. What precautions should I take if I have monkeypox or symptoms of monkeypox?

The risk of infection in different animal species is unclear, and because the monkeypox virus could be carried from one person to another on an animal's coat or feathers, it is best to find someone else to take care of your pet until you are out of isolation.

If you have or have recently been exposed to monkeypox and have been advised to self-isolate:

• Keep your pets in your home. If possible, ask someone else in your home who is not sick and who has not been exposed to care for your pets.
• Avoid close or prolonged contact with pets, for example, avoid direct contact, including touching, snuggling, and kissing animals, especially if you have unhealed sores on your face, hands, or arms.
• Take precautions when providing care for pets, for example, wear a mask when in the same room as your pet, especially if you have sores in your mouth or are coughing/sneezing. Wash your hands with soap and water or use an alcohol-based hand rub immediately before and after touching pets, their food, or supplies. 

What if my pet becomes sick while I am isolating? 

If your animal is in quarantine with you and becomes sick, it is preferred to first seek care from a veterinary telemedicine service, to assess if the animal’s condition can be managed at home.

If your pet must be examined directly by a veterinarian or requires other procedures that cannot be reasonably delayed until the end of the isolation period, your veterinarian should be advised that your pet may have been exposed to monkeypox.

Your veterinarian should then contact the Ontario Ministry of Agriculture Food and Rural Affairs at 1-877-424-1300 to ensure that they have proper infection control procedures in place and appropriate personal protective equipment prior to attending your pet at home (ideally) or at a veterinary clinic (if necessary).

I own or work with livestock or poultry, and I think I may have been exposed to monkeypox. What should I do? 

Any person who may have been exposed to monkeypox should not work with livestock or poultry until they are advised by their physician or public health unit that they don’t pose any risk for transmission of the virus.

Animal owners are responsible for providing basic care for their animals including food, water, and shelter. Livestock and poultry producers should always have a plan in place for others to provide care for their animals in case of emergencies, including the need to self-isolate due to illness.