As of July 29, there were 803 cases of monkeypox recorded here in Canada, with most of those cases, 726 of them, in Ontario and Quebec. The Bancroft Times speaks with Dr. Golden Gao, a medical consultant with Hastings Prince Edward Public Health about what people should know about Monkeypox here and abroad and whether they should be concerned with the rise in cases domestically and globally.
Monkeypox is endemic to central and west Africa, where it was first diagnosed in humans in 1970 in the Democratic Republic of the Congo. The first case outside Africa was found in the U.S. in 2003, and prior to the current worldwide outbreak, was reported sporadically in the years since in Israel, the U.K. and Singapore. The fatality rate from monkeypox, according to the WHO, is around three to six per cent.
The World Health Organization director general Tedros Adhanom Ghebreyesus declared the global monkeypox outbreak a public health emergency of international concern on July 23. This move helps initiate a coordinated international response and could free funding for nations worldwide to work together on sharing vaccines and treatments. At the press conference follow the International Health Regulations emergency committee regarding the multi-country outbreak of monkeypox, he said that the WHO’s assessment is that there’s a moderate risk globally, except in Europe where the risk is high. He also said there is a clear risk of further international spread of monkeypox.
“So, in short, we have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little, and which meets the criteria in the International Health Regulations. For all these reasons, I have decided that the global monkeypox outbreak represents a public health emergency of international concern,” he says.
The Public Health Agency of Canada issued their own statement following the WHO’s statement on July 23 to update their own response to the monkeypox outbreak, including working with the WHO and provincial and territorial public health partners. PHAC purchased $56 million worth of a non-replicating smallpox vaccine called Imvamune from Bavarian Nordic in June to use in the fight against monkeypox. Deliveries will begin in 2023.
The government of Canada announced on July 21 that it was funding community-based organizations in regions most impacted by monkeypox to reach at-risk populations with information on how to protect themselves and slow the spread of the virus. PHAC reminds Canadians that they can reduce their risk of contracting monkeypox or spreading it by doing the following; self isolating if you have symptoms, avoiding close physical contact (including sexual contact) with someone who is infected or may have been exposed to monkeypox, making sure you use a condom and have fewer or one sexual partner, washing and/or disinfecting hands regularly and adhering to good respiratory etiquette, cleaning and disinfecting high touch surfaces and objects in your home regularly. Regular updates are available at www.canada.ca/monkeypox.
Worldwide, the number of monkeypox cases as of Aug. 10 is 31,400 in more than 80 countries. With similar but less severe symptoms to smallpox (which vaccination campaigns eradicated in 1980), monkeypox is caused by a zoonotic (transferred from animals to humans) orthopoxvirus. Human to human transmission is limited and is usually more prevalent through contact with bodily fluids, lesions on skin or internal mucosal surfaces, respiratory droplets and contaminated objects.
Dr. Gao told Bancroft This Week that as of Aug. 12, there were no cases of monkeypox in Hastings Prince Edward, and that they’re continuing to work with provincial and federal health authorities to monitor the epidemiology (the study of how often diseases, like monkeypox, occur in different groups of people and why).
“We have teleconferences with the province on a weekly basis about the ongoing outbreak and we’re monitoring the development of the epidemiology. In addition, we’ve also secured doses of the vaccine [Imvamune] for individuals in our area who may require post exposure prophylaxis (getting the vaccine after possible exposure to prevent infection), for those who’ve been exposed to a confirmed case of monkeypox may qualify for a vaccine in that case,” he says.
As to how monkeypox has spread so much outside of Africa where it is endemic, Dr. Gao said that health authorities suspect it may be related to a mass gathering event that happened or it may have been transmitting slowly for longer than they’d suspected.
“Because it’s something that is transmitted through close intimate contact and it does have a relatively long incubation period [the number of days between exposure/infection and onset of symptoms] of possibly up to 21 days and also many people can have pretty mild symptoms so for those reasons it may have been for longer than we suspect, which could contribute to the current outbreak,” he says.
If cases do appear in Hastings Prince Edward, Dr. Gao explains that HPEPH has policies they’ve developed and that they’ve trained their nurses and staff in terms of handling cases and also managing their contacts and educating the contacts and following up with them.
“If we do see cases here and suspect there may be local transmission of monkeypox we would then not only offer the vaccine for post exposure prophylaxis but also consider offering it as a pre-exposure prophylaxis for individuals at higher risk of getting the disease. We’d consider offering the vaccine for prevention,” he says.
Dr. Gao says the most important advice he’d have for anyone concerned about any signs or symptoms of monkeypox like an inexplicable rash, fever, chills, headache and other flu-like symptoms, then he urges them to self isolate and seek help from their doctor or public health about those symptoms.
“And also, if you’re concerned about any contacts you may have had, especially close intimate contacts who may have monkeypox themselves, you can also seek help from public health,” he says. “Otherwise, for most individuals in the public, it should not be a huge concern primarily because it is something that generally is transmitted through close intimate contact, especially with infected people who have active lesions.”