A total of 300 confirmed cases of monkeypox have been reported in Canada as of July 4, according to the Public Health Agency of Canada (PHAC). This total includes 211 cases in Quebec, 77 in Ontario, 8 in Alberta, and 4 in British Columbia.
“We continue to closely monitor the monkeypox situation in Canada and internationally,” said Theresa Tam, MBBS, Canada’s chief public health officer, at a news conference June 29.
In all, 5783 cases of monkeypox have been reported in 52 countries as of July 1, according to the US Centers for Disease Control and Prevention.
The Canadian federal government says it is working closely with the provinces to ensure that vaccinations to prevent the spread of monkeypox are being administered, particularly in high-risk groups. It also is working to ensure a steady supply of smallpox vaccine Imvamune.
Epidemiological indicators suggest that most cases of monkeypox in Canada are detected in men between ages 20-69 years, said Tam.
“In line with the international trends, the majority of cases in Canada to date reported intimate sexual contact with other men,” said Tam. “However, it is important to stress that the risk of exposure to monkeypox virus is not exclusive to any group or setting. Anyone, no matter their gender or sexual orientation, could get infected and spread the virus if they come into close contact with someone who has monkeypox or have direct contact with a personal or shared object, including towels or bed linens.”
Tam is in close contact with provincial and territorial chief medical officers of health to ensure that any cases of monkeypox occurring in Canada continue to be rapidly identified and managed, according to the PHAC.
In addition, the National Microbiology Laboratory is performing diagnostic testing for the virus that causes monkeypox. The laboratory is also conducting whole genome sequencing on Canadian samples of monkeypox to help understand the chains of transmission occurring in Canada. It is working with provincial and territorial public health laboratories to provide testing guidance and to increase testing capacity.
As with COVID-19, preventive measures like vaccination can curb the spread of monkeypox, said Tam.
She noted that Canada’s National Advisory Committee on Immunization (NACI) recommends that post-exposure prophylaxis (PEP) using a single dose of the Imvamune vaccine be offered to individuals with high-risk exposures to a probable or confirmed case of monkeypox or within a setting where transmission is happening.
“We’ve been having very close bilateral discussions with provinces in terms of the [vaccine] supply,” said Tam, noting that more than 7000 individuals have been vaccinated in Quebec and about 5000 have been vaccinated in Ontario.
“I do think that Canada, compared to other countries, has mobilized quite a bit of activation,” said Tam.
Is Testing Accessible?
But vaccine supply could be a concern, Darrell Tan MD, PhD, clinician–scientist in the division of infectious diseases at St. Michael’s Hospital and associate professor of Medicine at the University of Toronto, told Medscape Medical News. The vaccine has been stockpiled by the federal government in Canada, as smallpox and monkeypox have been considered potential bioterrorism threats.
“The total amount available is therefore not something that has been disclosed even to provincial health authorities who are organizing the vaccine rollout,” Tan added. “This is why the priority has been to focus implementation efforts among folks who are at greatest risk.”
Although the vaccine is available for pre- and post-exposure prophylaxis, a large proportion of exposed contacts could not be traced. “This is the reason for the rapid pivot to primarily a pre-exposure prophylaxis approach,” said Tan.
Zain Chagla, MD, infectious disease physician and associate professor at McMaster University in Hamilton, Ontario, suggested that the estimates of the number of cases in Canada may be low.
“Testing is not as accessible as it should be,” Chagla told Medscape Medical News. “There is probably an undercount of numbers in the context that people don’t recognize they have symptoms, or they are not accessing testing appropriately, or clinicians are deciding that testing is not needed for an individual.”
Anonymous activity occurs in some of the venues linked with transmission, which makes contact tracing a challenge, said Chagla.
He pointed out that the virus could take hold in shared, contained spaces like a shelter or a jail where there can be close, intimate contact and where hygiene practices may be suboptimal.
“It could cause chaos very quickly in that sense,” said Chagla. In addition to the community of men who have sex with men, there could be other networks of transmission, he added.
The federal government needs to scale up vaccination in higher-risk individuals at preemptive prophylaxis clinics outside major cities like Montreal and Toronto, but also in smaller cities and remote areas where individuals may not be able to access appropriate testing, said Chagla.
“It will be easier for someone to navigate the situation in downtown Toronto, compared to rural Alberta, where coming forth with monkeypox may stigmatize you off the bat,” said Chagla.
Another way that the federal government can be proactive is by offering financial support to individuals who develop monkeypox and must isolate as a result, said Chagla.
“The other thing that has been circulated to the federal government is that they can absolutely be involved in is the cost of isolation for people,” said Chagla. “This is a disease where people are being isolated for weeks on end. Financially, they can’t necessarily deal with that. And it’s probably a barrier for people to then present for care, recognizing that they might be in exile for a month or longer.”
The federal government “can make sure that people have easily accessible financial support should they need to isolate as part of their public health response,” explained Chagla. “A lot of people can’t take off work for a month. We should not disincentivize people for coming forward [with a suspected case].”
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