Mpox Bulletin

Last updated: July 4th, 2022

Over the last few months, our communities have heard a lot about outbreaks of a virus that we will be referring to as Mpox (monkeypox).    

To date, there have been 300 publicly reported cases of Mpox in Canada with the vast majority of cases being found in groups of gay, bi, queer men and men who have sex with men for any reason (including for work). 211 of the cases are in Quebec. There are also cases in Ontario (77), Alberta (8), and BC (4).

This bulletin is designed to provide you with the information we know and provide assurance that HIM is working with our healthcare partners on proactive responses as quickly as possible as the situation develops.   

In the meantime, we recommend that people in our communities:  

  • Be aware – and informed about the symptoms of Mpox virus infection, and how it’s transmitted.  
  • Watch for symptoms – including flu-like symptoms, new sores, or rashes on your body. 
  • Seek clinical care – if you have symptoms.  

In line with updates from the Public Health Agency of Canada (PHAC), BCCDC will post regular situation updates and case numbers on its website.


STOPPING THE STIGMA: 
If we have learned anything from the HIV epidemic and the COVID-19 Pandemic, it is that stigma causes damage in our communities and creates barriers to care. We witnessed the anti-Asian hate/racism that causes pain, suffering, and community division. In the early days of HIV misinformation and stigmatizing beliefs lead to many people not receiving the care they needed.

Stigma can be created by: 

  • Slut shaming or making false connections between “promiscuity” and Mpox.
  • Teasing friends about scars and marks on the body (e.g. ingrown hairs, bandaged cuts).  
  • Making homophobic comments about other people’s behaviours. 
  • Not supporting our friends who come into contact or are diagnosed with Mpox.  
  • Joking about Mpox in our social groups or on social media.  
  • Teasing friends about having Mpox.  
  • Making racist jokes or insinuations of any kind. 
  • Sharing or participating in racist discussions.  
  • Sharing misleading information via memes/articles etc.  

Stigma can show up as:  

  • Avoiding testing because of fear of what our peers will say.  
  • Avoiding isolating due to lack of community support or fear of repercussions.  
  • Avoiding seeking care.  
  • Feeling anxiety and fear.  
  • Feeling terrified about violent racist attacks.  
  • Feeling suicidal due to terror and fear.

FREQUENTLY ASKED QUESTIONS

What are the symptoms?

Symptoms for Mpox usually appear 1-2 weeks after transmission but can take anywhere from 5-21 days. Symptoms can last up to 2-4 weeks.

Flu-like symptoms (prodrome):

Infections may start with flu-like symptoms (called prodrome) including: 

– Fever and/ or chills, 
– Swollen lymph nodes, 
– Intense headaches, 
– Muscle aches, 
– Back pain, 
– Fatigue/exhaustion. 

Some people with Mpox may not experience these flu-like symptoms at all.

Rash and sores/blisters:

Mpox infections cause a skin rash and sores/blisters. For those who have the flu-like symptoms above, this can happen 1-5 days after those symptoms.

Classically, the Mpox rash can appear nearly anywhere on the body but the cases we’re seeing in Canada tend to be in the genitals (e.g., penis) or in and around the rectum and ass (known as perianal). These symptoms can be similar to STIs like herpes, so we may get Mpox confused for one of those STIs.

The rash and sores may start in one place and spread to other parts of the body. These sores often go through a specific pattern: they appear as a flat lesion, turn into a bump, then blister, ulcerate, crust over, and finally heal. 

Mpox is infectious from when a person’s symptoms first appear until the rash and sores crust over, are dry, and new skin is visible.

How does it spread?

Mpox can spread from one person to another through close contact with: 

1. Sores and blisters. 
2. Items like fabrics (e.g., bedding or towels), sex toys, and fetish gear that have Mpox virus on them. 
3. Respiratory secretions of people with Mpox, through deep kissing and other face-to-face contact over several hours.  

Mpox is not known to be transmitted through sex itself like syphilis, HIV, or other STIs. However, sexual activity often involves close contact, which is how Mpox is transmitted. For comparison, even things like wrestling can transmit Mpox from one person-to-another.

Although concerns about the theoretical risk of airborne spread have been raised, it has not been identified as a primary mode of transmission in the cases seen during the current international outbreak. 

How can I protect myself and my community?

Be alert to symptoms of Mpox in yourself and your partners. If you develop symptoms, visit your primary care provider or a clinic to get tested. Let your provider or the clinic know the reason for your visit ahead of time. 

If you have been exposed to someone while they were infectious with Mpox, you may develop symptoms anywhere from 5 to 14 days afterwards (but could be as long as 21 days).

If you develop symptoms, it’s important to do the following to ensure you don’t pass it on to others: 
– Wear a mask 
– Keep any sores or blisters covered as much as possible (e.g., long sleeves, long pants) 
– Avoid close contact, including sexual contact, with others until you get a negative test or are no longer infectious 
– Clean hands, objects, and surfaces that have been touched regularly 
– Stay home and self-isolate until you have a test result.  
– Stay away from people you live with if you can and do not share towels, clothing, or linens. 
– Consider adapting your sexual activities. You can do this by not having sex, reducing your number of partners, or having sex in ways that reduce skin-to-skin contact: virtual sex, masturbate together at a distance of at least 6 feet, avoid kissing, and wash your hands, fetish gear, sex toys and any fabrics after having sex (e.g., bedding, towels, clothing). 

If a close contact of yours gets Mpox, you may get a call from Public Health. That’s because under B.C.’s Public Health Act, Mpox is a reportable communicable disease. This means that Public Health must contact all reported possible and confirmed cases of Mpox and their close contacts, to provide information and arrange any needed testing.

People who are exposed to Mpox within the incubation period (5-21 days) may be offered the vaccine to protect them from serious illness and help prevent the spread of Mpox.

If you get a positive test result, think about when you first developed symptoms (remember they could be very mild), and of any people with whom you had close personal or sexual contact with, including hookups. Sharing this information with Public Health if you get an Mpox diagnosis will help stop the spread of Mpox. 

Public Health tracers are trained to be non-judgmental and just want to know your close contacts to help keep our communities safe. In B.C., Public Health is using vaccines to prevent serious illness in people who have been exposed, and to manage the spread of Mpox.    

Can monkeypox be treated?

Most people with Mpox have mild symptoms that go away after 2-4 weeks. Because symptoms are usually mild, they do not require any specific interventions. Treatment for Mpox is usually focused on managing symptoms (e.g., fever control, hydration support, treating any secondary infections).

In very rare cases of severe disease, or when lesions get in the way of mobility (e.g., when they’re in the mouth) Infectious Disease doctors may consider medications and hospitalization.  

Are there differences for people living with HIV?

As with other viral infections, Mpox infection can be more severe in people who are moderately or severely immunocompromised (e.g., people living with HIV who are not on treatment and have high viral loads or low CD4+ counts). People living with HIV who are on treatment, and have supressed viral loads, should not have more severe cases of Mpox.  

Young children (under 8 years) and people who are pregnant may also be at higher risk for severe disease. 

Is it true that some provinces are vaccinating lots of people?

Vaccination is taking place in all regions of Canada that have identified cases of Mpox.

Quebec has seen significant community spread of Mpox, and has the vast majority of cases in Canada. Most cases there are within in networks of GBQ men. Because they have so many cases, Quebec is offering the vaccine to certain people, including: 

– Individuals who have had skin-to-skin contract with a person with Mpox in the past 14 days.  
– GBQ men who have had sexual contact with 2 or more male partners in the past 14 days.  
– People who, in the past 14 days, have had contact with objects or bedding potentially contaminated with the virus that causes Mpox in a setting with sex on site (e.g., bathhouse employees). 

Can people get the vaccine in BC?

Currently in BC, people who are exposed to Mpox within the incubation period (5-21 days) may be offered the vaccine to protect them from serious illness and help prevent the spread of Mpox. For this to happen, it’s important to communicate openly with Public Health if we get a positive Mpox diagnosis about our close contacts. For every case, an assessment will determine if vaccination is appropriate for close contacts, and regional health authorities will ensure that all those who qualify for vaccine are given timely access.

The Imvamune Vaccine is becoming increasingly available for more members of our communities in certain health authority regions. HIM is working with health authorities across BC to support these efforts, including hosting Public Health for vaccine clinics as provincial supply become available. Planning is underway for more vaccine clinics in regions impacted by Mpox— please stay tuned for future vaccination opportunities.

To learn more about the vaccine please visit:

http://www.bccdc.ca/resource-gallery/Documents/Guidelines%20and%20Forms/Guidelines%20and%20Manuals/Epid/CD%20Manual/Chapter%202%20-%20Imms/Part4/Monkeypox-Vaccine-Client-Information.pdf

What happens next?

You can expect Public Health to monitor the situation and determine what interventions might be appropriate in consultation with the province’s Ministry of Health and Health Canada.  These may include more public awareness campaigns, or a broader vaccination program similar to what’s happening in places with community spread like Quebec. 

HIM will also monitor and continue to advocate for increase of support on behalf of our communities, be proactive in planning strategies in case community spread does occur (including vaccines), and make all efforts to communicate best practices back to our communities. 

To help prevent the spread of Mpox in our communities, it’s important that we cooperate with Public Health if we feel symptoms, receive an Mpox diagnosis, or get a call about being a close contact to someone with Mpox. Remember, people who are exposed to Mpox within the incubation period (5-21 days) may be offered the vaccine, meaning it’s important to cooperate quickly to keep ourselves and our communities safe.


WHAT HIM IS DOING

Clinical services

We are working with our health authority partners carefully and swiftly to plan ways that HIM’s Health Centres can meet the needs that may occur if we begin to see community spread of Mpox following relevant directives from Public Health.

The HIM on Davie and HIM on the Drive Health centres are still recommended services for those who know they have come into contact with someone who has tested positive for Mpox and/or has developed symptoms that look like Mpox. If you’re visiting us and have Mpox symptoms, please remember to wear a mask and try to keep any sores or blisters covered (e.g., long sleeves, long pants). 

HIM is working with Health Authority partners across BC to help connect eligible community members to vaccine (including hosting vaccine clinics as supply become available).

Advocacy

HIM has been in ongoing conversations with Public Health and health authority partners around messaging and strategies that are appropriate to our current Mpox situation, but also for creation of strategies in the event that we start seeing more cases in BC. Learning from and collaborating with our national partners, and especially in Montreal, we have gained valuable information about how we can help prevent and address Mpox, and stigma related to Mpox. 

HIM is working with our national alliance (Advance-Avancer) on coordinated advocacy efforts to the federal government to advocate for the mobilization of vaccinations.  

Along with over 60 organizations across Canada, HIM has signed onto two letters to the federal Minister of Health requesting that:  

– Emergency financial support should be made available to individuals with confirmed or suspected Mpox infection, including via waiver of the one-week waiting period for Employment Insurance benefits, to enable effective adherence with public health directives to self-isolate. This support must extend to anyone required to isolate because of Mpox infection, irrespective of proven employment status.

– Support should be made available to community-based and frontline service organizations for prompt rollout of wrap-around services to people with confirmed or suspected Mpox: these include the delivery of groceries, medications, and other essential needs, and temporary housing for those without adequate housing for self-isolation.

You can read those letters here: https://www.cbrc.net/emergency_supports_and_services_in_response_to_monkeypox_infection

Communication and harm prevention

HIM is working closely with health authority partners and BCCDC on messaging strategies and content. We are working to ensure our communities are aware of Mpox, but that messaging from Public Health doesn’t unnecessarily add to the stigma we often experience.  

We are also working with partners in our national alliance on coordinated communication efforts that reach our community members travelling to Pride celebrations across the country.

HIM has developed and is operationalizing communications and engagement strategies as we begin to see community spread of Mpox. These include education, but also connecting community members to vaccine who are eligible.


OTHER RESOURCES

HIM honours the xʷməθkwəy̓əm (Musqueam), Skwxwú7mesh (Squamish), and səlil̓ilw̓ətaʔɬ (Tsleil-Waututh) Nations, and the territories of many nations on the west coast of Turtle Island, on whose unceded and stolen land we live and work. As uninvited inhabitants, we acknowledge that this space is and always will be Indigenous land.

Newsletter Signup

Want to stay up-to-date with HIM happenings? Join our newsletter and get all the latest news and events from HIM! We won’t share your email with anyone and you can unsubscribe at any time.