Canadian health officials are urging those at risk of contracting monkeypox to get vaccinated after the World Health Organization (WHO) declared the outbreak a global health emergency over the weekend.
Dr. Theresa Tam, Canada’s chief public health officer, told reporters during a briefing on Wednesday that vaccine uptake has slowed in recent days among high risk groups. She did not provide specific data, other than to say that 27,000 of the 70,000 vaccine doses Ottawa provided to provinces and territories have been used to date.
“At this point, they still have enough supply and we will be able to provide more should they need it, but Canada and other countries do have limited supplies,” Tam said.
“What we need right now is actually those in the highest-risk groups, including gay and bisexual men who’ve had sex with other men, take up the vaccine in order to protect themselves and others. I know vaccination has plateaued in recent days, and maybe with a bit more effort, we can help this group access the vaccine we need.”
Tam’s plea came as Canada’s confirmed monkeypox case count hit 745 on July 26. The majority of the country’s cases have been found in Quebec and Ontario, which logged 346 and 326, respectively, as of July 26. British Columbia has 58 confirmed cases, Alberta has 12 and Saskatchewan and Yukon have two and one, respectively.
Ninety-nine per cent of cases in Canada are in men, with the median age being 36. The majority of those cases involved men who reported having close intimate sexual contact with other men. One confirmed case has been reported in a woman in Ontario.
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In Montreal, monkeypox cases appear to be peaking and summer tourism, coupled with a low vaccination rate could further trigger the virus to surge in the city, officials worry.
Dr. Geneviève Bergeron of Montreal public health said that getting an early start to vaccination was helpful in the efforts to control the disease, but the city “still has a lot of work to do” when it comes to promoting vaccination.
Only between a third and half of those eligible to be vaccinated have received a shot, she said. Demand for the vaccine has slowed, although there has been an uptick since the WHO declared the disease a global emergency.
“We’re concerned we might see an increase over the coming weeks because of travel and how connected we are with different countries, so we are being quite vigilant with the progress pattern that we see right now,” Bergeron said.
More than 18,000 monkeypox cases have been reported in 78 countries since its unusual emergence in the West this spring, WHO officials said on Wednesday. More than 70 per cent of cases have been found in Europe, and 25 per cent have been traced to the Americas.
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So far, five deaths have been linked to the outbreak and 10 per cent of cases have needed hospital admission. Roughly 98 per cent of cases have been among men who have sex with other men, WHO officials said, urging caution that the virus can spread to anyone as it’s not limited to one group.
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 PHAC.
Individuals can be infected through direct contact with an infected person or by shared contaminated objects, including bed linens or towels. The disease mainly occurs in west and central Africa and only occasionally spreads elsewhere.
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.
Right now, mass vaccination is not recommended, WHO officials said on Wednesday. Canadian health officials have said the overall risk to the general public remains low.
Currently, monkeypox vaccination involves one dose, which was “deemed to be a really important strategy, especially given limited supply,” Tam said. However, officials are monitoring data for any breakthrough infections follow inoculation to determine if the vaccinated should receive a second dose.
Right now, NACI recommends a second dose may be offered to an individual assessed as having a predictable ongoing risk of exposure.
“The product, the way that it’s authorized does permit a two-dose series with a 28-day interval, and I know under certain circumstances, certain individuals may be at very high risk of continuous exposure, that could be considered,” she said.
“But just stay tuned. We of course would have the National Advisory Committee on Immunization and other experts look at this question as we learn more. So I would say stay prepared for the potential to need that second dose, but there’ll be more communication writ large by public health should that be needed.”
While vaccination is expected to provide protection, a successful monkeypox outbreak response relies on many public health measures including targeted public health education and equipping people with the information they need to make informed choices, PHAC said on July 23.
To reduce the risk of becoming infected or spreading monkeypox, PHAC advises Canadians to stay home and limit contact with others if they have symptoms, which include fever, headache, fatigue and muscle aches.
Canadians can also stay protected by avoiding close physical contact, including sexual contact, with someone who is infected with or may have been exposed to the monkeypox virus, maintaining good hand hygiene and respiratory etiquette and cleaning and disinfecting high-touch surfaces and objects in your home, especially after having visitors.
“PHAC continues to work closely with international, provincial and territorial health partners to gather information on this evolving outbreak and to assess the possible risk of exposure of the monkeypox virus in Canada,” PHAC officials said in its July 23 statement.
“Canada will continue to work with the WHO and international partners to strengthen the global response to the current monkeypox outbreak.”
— with files from The Canadian Press
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