Monkeypox cases spike in Canada – has the risk level changed in the country?

Since its unusual emergence in the West this spring, monkeypox has been a topic of discussion among Canadians as officials work to limit its spread.

On Wednesday, Canada reported a 59 per cent increase in monkeypox cases over the last week – mirroring a trend of rising cases reported across the globe.

Though cases are on the rise, the risk to the general population remains low – but that doesn’t mean Canadians shouldn’t be vigilant, health experts say.

“If you’re not part of that at-risk community for the moment, that doesn’t mean that you’re impervious to the virus. It just means that for the moment, it’s not something that should be preoccupying you or causing you to have anxiety,” said Dr. Don Vinh, an infectious diseases specialist at McGill University Health Centre.

“I would suggest that you allow the medical, scientific and public health communities to bear that burden of anxiety. We will implement the necessary steps to try to intervene either at the individual or community levels, but I don’t think that people need to panic or be anxious other than just being informed or educated.”

Canada now has 477 confirmed cases of monkeypox in the country since its emergence as part of the unusual global outbreak that started in May.

Between July 4 and 13, a total of 177 new cases have been confirmed in the country, representing a 59 per cent increase in case numbers during that time frame.

Quebec continues to have the major share of the viral disease, with 284 cases as of July 13, up from 211 cases last week.

But Ontario saw the biggest increase in cases of all the provinces, going to 156 cases from 77 cases as of July 4.

British Columbia also saw an increase in cases for the first time in weeks, with 29 confirmed cases compared with four previously. Alberta continues to have just eight cases confirmed, unchanged from the last update.

While confirmed cases factor into the increased tally, other reasons such as enhanced surveillance are also playing a part, said Dr. Sameer Elsayed, an infectious diseases specialist with Western University.

“There’s a greater awareness of the disease,” he said.

“More people are thinking about monkeypox when they’re seeing someone with a rash that might be compatible with monkeypox.”

Monkeypox, which causes flu-like symptoms and skin lesions, is transmitted to humans from animals caused by an orthopoxvirus, which is related to smallpox, according to the Public Health Agency of Canada.

Individuals can be infected through direct contact with an infected person or by shared contaminated objects, including bed linens or towels.

Around 60 countries in which monkeypox is not endemic have reported outbreaks of the disease, with confirmed cases now at 10,400. The disease mainly occurs in west and central Africa and only occasionally spreads elsewhere.

The World Health Organization announced Thursday that its emergency committee for monkeypox will reconvene on July 21 to look at trends in the outbreak and at how effective counter-measures taken against the virus have been.

The committee will also make recommendations for what countries and communities should do to tackle the outbreak, WHO director-general Tedros Adhanom Ghebreyesusi said during a briefing in Geneva on Tuesday.

“I don’t think it’s anything like COVID-19 in terms of hitting the panic button and saying we have a worldwide public health threat,” said Elsayed.

“We do have a public health concern.”

Last month, Canada’s National Advisory Committee on Immunization (NACI) recommended Canadians who are at high risk of contracting monkeypox — not just those who have been infected — get a vaccine.

Anyone with a high risk of exposure to a probable or confirmed case of monkeypox, or who has visited a setting where transmission of the virus is happening, should receive one dose of the Imvamune vaccine, NACI said.

NACI also said vaccines may be offered to those who are immunocompromised, pregnant or lactating, or children and youth, if they are at a higher risk of exposure.

Imvamune, normally used to treat smallpox, has been approved by Health Canada to treat monkeypox.

Ideally, those who have been exposed to this virus should receive their vaccine within four days of exposure, Canada’s chief health officer, Dr. Theresa Tam, said on June 10.

Quebec has been vaccinating close contacts of confirmed or suspected cases of monkeypox since late May, inoculating thousands since that time.

In Toronto, the city has been hosting community clinics offering the Imvamune vaccine to at-risk people. As of July 4, close to 6,000 at-risk people had received a shot since June 30.

Meanwhile, Vancouver Coastal Health is opening more monkeypox vaccine clinics, increasing access to those 18 and older who are transgender people or who belong to the LGBTQ2 community, and who meet additional high-risk criteria.

To date, officials have said mass vaccination for the general population is not needed. The unusual spread of monkeypox has been circulating primarily in men who have sex with men, but the characteristics of the virus don’t restrict it to one group, experts say. Ontario recorded its first case of monkeypox in a female on Thursday.

Those at risk can include those who have close contact with an infected person, be it health-care workers or family members, said Elsayed.

But with monkeypox spreading globally, other countries are also vaccinating at-risk groups, putting demand on supply and straining resources, said Vinh.

“We also have to remember that because there are limited supplies, we have to first focus on the most at-risk groups in the same way that we did when we had a limited supply of the COVID vaccine and we targeted the elderly,” he said.

“What we need to do is use the vaccine wisely.”

Elsayed agrees.

“With COVID, we’ve used kind of a throw-the-kitchen-sink approach where we hit COVID so hard, we’ve actually caused harm to our health-care system by ignoring other components of health. We have staff shortages. We have cancer diagnoses that are being delayed,” he said.

“Just target the highest-risk groups, which are men who have sex with men, health-care workers … maybe family members, those would be the people who I would vaccinate. I wouldn’t vaccinate the general population at all like we’re doing with COVID.”

Aside from vaccination, public health practices like distancing, handwashing and masking that Canadians learned for managing COVID-19 can also be applied to monkeypox, Elsayed added.

“The main thing is to provide education to people to say you should avoid contact with people who are potentially high risk, or people who might have symptoms that are compatible with monkeypox,” he said.

“A lot of it has to do with education – you can advise people about what to do, but you can’t control what people do.”

— with files from Teresa Wright.