As the World Health Organization declared a public emergency over the spread of mpox and its potential danger across the world, local public health officials say they've been concerned to see the virus spreading in the Toronto area.
"Although the risk for most of the general public is low, the fact that it is now spreading much quicker and further worldwide is very concerning," said Dr. Colin Lee, associate medical officer of health for the Simcoe Muskoka District Health Unit in an email.
On Aug. 14, the World Health Organization (WHO) director-general, Dr. Tedros Adhanon Ghebreyesus, announced the upsurge of mpox in Africa is a public health emergency of international concern.
The declaration was made following the advice of the International Health Regulations Emergency Committee of independent experts who reviewed data from WHO and from affected countries, including the Democratic Republic of Congo (DRC).
"The current upsurge of mpox in parts of Africa, along with the spread of a new sexually transmissible strain of the monkeypox virus, is an emergency, not only for Africa, but for the entire globe," stated the emergency committee chairperson, professor Dimie Ogoina, in a news release. "Mpox, originating in Africa, was neglected there, and later caused a global outbreak in 2022. It is time to act decisively to prevent history from repeating itself."
Mpox, which is caused by an orthopoxvirus, was first found in humans in 1970 in the DRC. It has stuck around and regularly occurs in Central and West African countries.
There has been one confirmed case of mpox in the Simcoe Muskoka District Health Unit's coverage area this year, which is the first case in the region since 2022. No cases have yet been linked to the newest strain: clade 1b.
While mpox is still relatively rare locally, that's no excuse to ignore the WHO declaration, according to Lee.
"The declaration means that internationally, federally, provincially and locally, we need to increase our existing efforts to prevent and control the spread of mpox," said Lee in the email. "Locally, testing and diagnosing persons with symptoms of potential mpox, contacting those who are in close contact with them, and immunization of persons at risk for acquiring the infection will be the cornerstones of our strategies."
So far this year, there have been 15,600 cases of mpox reported in the DRC and 537 deaths.
The new virus strain in the DRC, known as clade 1b, appears to be spreading mainly through sexual networks, according to the WHO. It's also been detected in countries neighbouring the DRC that have not reported mpox cases before, such as Burundi, Kenya, Rwanda and Uganda. The WHO says the case numbers are likely higher than reported.
"Several outbreaks of different clades of mpox have occurred in different countries, with different modes of transmission and different levels of risk," states a WHO news release.
In Simcoe-Muskoka, the risk of contracting mpox is low, according to Lee, but there are risk factors, and he encourages those who fit in high-risk groups to get the publicly funded mpox immunization.
"Mpox can be spread through touch contact with the virus," explained Lee. "At this time, the most common way to acquire and spread mpox is through close skin-to-skin and sexual contact."
Although mpox can infect everyone, said Lee, in Ontario it appears to be circulating mainly in the gay, bisexual and other men-who-have-sex-with-men populations.
"Given the increased spread worldwide, we may see more mpox transmission outside the current high-risk groups in Ontario in the future," said Lee. "Travellers to regions where there are outbreaks should be aware of the signs and symptoms of mpox."
He noted the reported cases from the DRC show 70 per cent of those infected and 85 per cent of those who have died from the disease are children younger than 15 years old.
There are a variety of symptoms that come with mpox (formerly known as monkeypox), but often they include a rash or sores on the palms of the hands, the soles of the feet, inside the mouth, on the genitals, or inside or around the anus or rectum. You can read more about the signs and symptoms of mpox on the Ontario Ministry of Health website here.
The Simcoe Muskoka District Health Unit offers pre-exposure vaccination against mpox for people in the high-risk categories. They include:
- Two-Spirit, non-binary, transgender, cisgender, intersex, or gender-queer individuals who self-identify as belonging to the gay, bisexual, pansexual and other men-who-have-sex-with-men (gbMSM) population and who meet one or more of the following:
- have more than one partner
- are in a relationship where at least one of the partners has other sexual partners
- have had a confirmed sexually transmitted infection within the last year
- have attended venues for sexual contact (for example, bath houses, sex clubs)
- have had anonymous sex recently (for example, using hookup apps)
- sexual partners of individuals who meet the criteria above
- sex workers (regardless of gender, sex assigned at birth, or sexual orientation) or who are a sexual contact of an individual who engages in sex work
- staff or volunteers in sex-on-premises venues where workers may have contact with surfaces or objects that may be contaminated with mpox
- individuals who engage in sex tourism (regardless of gender, sex assigned at birth, or sexual orientation)
- individuals who anticipate experiencing any of the above scenarios
- household contacts of those identified for pre-exposure vaccination eligibility above who are moderately to severely immunocompromised or who are pregnant may be at higher risk for severe illness from mpox infection and may be considered for pre-exposure vaccination
- research laboratory employees working directly with replicating orthopoxviruses
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.
People living in Simcoe-Muskoka who meet the above eligibility criteria can complete an online form and someone from public health will contact them to book a vaccination appointment, or they can contact Health Connection at 705-721-7520 for further assistance.
Globally, the WHO is also accelerating immunization by triggering the emergency use listing for mpox vaccines to get them to lower-income countries that haven't issued their own national regulatory approval, particularly those where there are outbreaks. The emergency use listing also empowers organizations like Gavi and UNICEF to get and distribute vaccines.
"On top of outbreaks of other mpox clades in DRC and other countries in Africa, it’s clear that a co-ordinated international response is needed to stop these outbreaks and save lives," said Ghebreyesus.
