With many Covid-related restrictions remaining in place, Canada is now introducing monkeypox-related ones. Last week, the country had elevated monkeypox to Level 2 status, which means travelers may be subject to “isolation,” i.e., mandatory quarantine. Canadian health authorities recommend anyone potentially exposed get a monkeypox vaccine.
The Public Health Agency of Canada (PHAC) has issued a level two travel health notice for monkeypox, which is one grade below a call to avoid non-essential travel.
Noting that clusters of monkeypox cases have been reported in several countries outside of areas in Central and West Africa where such cases are “normally found,” PHAC warned,
During your travel, you may be subject to procedures at your destination put in place to limit the spread of monkeypox, such as isolation, should you become infected. You may have limited access to timely and appropriate health care should you become ill, and may experience delays in returning home.
When traveling, Canadians are advised to use the following “precautions”:
- Delaying travel if infected or “having symptoms,” and self-isolating.
- “Practicing respiratory etiquette,” i.e., covering coughs and sneezes and wearing a mask.
- Being “particularly vigilant” when partying and attending mass gatherings while traveling.
- Washing hands frequently and avoiding close physical contact, including sexual contact, with individuals who are sick or “appear to be sick.” “Individuals engaging with new or multiple sexual partners should be particularly vigilant,” says the updated recommendation.
Those travelers who develop monkeypox-like symptoms during the flight should notify the flight attendant before they land or the border services officer as they enter the country. “They will notify a quarantine officer who can assess your symptoms,” says the agency.
Travelers are recommended to sign up with the Registration of Canadians Abroad service to stay connected with the government in case of an emergency abroad or at home.
In addition to travel precautions, the agency now recommends people who could have been exposed to the virus to vaccinate.
Last Friday, the National Advisory Committee on Immunization (NACI) came out with new guidelines saying anyone who was potentially exposed to the infection should receive at least one dose of the Imvamune® monkeypox vaccine for post-exposure prophylaxis.
“A single dose of the Imvamune® vaccine may be offered to people with high risk exposures (to be defined by PHAC) of a probable or confirmed case of monkeypox, or within a setting where transmission is happening,” says the interim guidance. Notably, there is no concrete definition of “people with high risk exposures” yet, which as of today leaves lots of room for medical discretion.
That dose should be given to patients “as soon as possible” following the suspected exposure, “but may be considered up to 14 days since last exposure.”
Confusingly, the shot should not be given to people “who have current monkeypox infection.”
The second dose may be offered to those who are at the risk of “continuous exposure.”
The recommendation suggests that the shots are associated with an elevated risk of heart issues such as myocarditis and pericarditis.
Lastly, the shots should not be mixed with mRNA Covid vaccines, and should be taken at least four weeks apart from Covid vaccines “if possible.” However, the administration of Imvamune® should be prioritized and should not be delayed even if a patient has recently been inoculated with a Covid shot, says the committee.
The guidance contains an overview of high-risk populations, which includes pregnant women and young children, in addition those who are immunocompromised.
It is noted that the evidence on the safety and efficacy of Imvamune® in pregnant women and young children is lacking, yet “there are no known safety signals and people in these populations may particularly benefit from receiving the vaccine.” The risk of myocarditis and pericarditis is “unknown” with the monkeypox shot, which is allowed to be used off-label in people younger than 18.
The Canadian province of Quebec, which has reported the most monkeypox cases to date (98), began offering the shots to “high-risk” people, primarily gay men. As of the latest media updates, over 500 Quebecers have been inoculated against the disease.
In Ontario, where nine cases have been reported, the first of several community-based vaccine clinics were also opened last week. According to CTV News Toronto, the first clinic was launched specifically for workers at Toronto bathhouses:
Run by Toronto Public Health (TPH) in partnership with Gay Men’s Sexual Health Alliance (GMSH) and other community organizations, the goal of this program is to offer protection to those who have had close contact with someone who has tested positive for monkeypox, those with high risk contacts, and those who have a higher risk of being exposed to the virus.
The local health authorities stress that while men having sex with other men are most at risk of monkeypox, “anyone, regardless of sexual orientation, can spread monkeypox.”
As of last Thursday, 1,622 people in Toronto had been vaccinated.
Canada’s chief health officer, Dr. Theresa Tam, said that while the supply of monkeypox shots is currently “limited,” the PHAC is working with vaccine manufacturers to “ensure a sufficient supply of the Imvamune vaccine moving forward.”
Canada first declared cases of monkeypox on May 19, and confirmed 112 cases as of June 10.
