Monkeypox information in the works for N.B. clinicians, citizens, says health official

New Brunswick has no confirmed cases of monkeypox and no new suspected cases, but Public Health is putting together some resources for clinicians and working on a public awareness campaign.

Dr. Jennifer Russell, the province's chief medical officer of health, says the province is developing a document for clinicians so they get the right information.

The Public Health Agency of Canada is working on something similar, she said, "looking at evidence and how is monkeypox different right now than what we would have seen in the past in terms of the spread in different countries, messaging around prevention and also detecting and testing."

Monkeypox is an orthopoxvirus that causes a disease with symptoms similar to, but less severe than smallpox, which was eradicated in 1980.

The virus has been identified in more than 50 new countries outside the countries in Africa where it is endemic.

A total of 375 cases have now been confirmed in Canada, mostly in Quebec and Ontario, according to the federal government's website. But officials expect that number to rise.

Canada's chief public health officer, Dr. Theresa Tam, said last month the Canadian cases are males between the ages of 20 and 63, and the majority of them had sexual contact with other men, but she stressed that the infection can spread to anyone who is exposed through close contact with an infected person or contaminated objects.

The World Health Organization said "sustained transmission" of monkeypox worldwide could see the virus begin to move into high-risk groups, such as pregnant people, immunocompromised people and children.

Welcome resource

The New Brunswick Medical Society welcomes any resources the province has to offer, said president Dr. Mark MacMillan.

"It's important to be updated by the experts," he said.

"This particular infection is not that common in Canada. So a lot of clinicians probably have never seen it. They most likely have heard of it because of the media, but they most likely have never seen a case in person.

"So it's important to be able to know where the resources are … for us to look into cases further if we suspect we have one."

MacMillan expects the material will cover some of the common symptoms, recommendations when a clinician suspects a case and what steps to follow for testing.

According to the Public Health Agency of Canada, monkeypox is usually a mild illness and most people recover on their own after a few weeks. But some people can become very sick and even die.

Symptoms usually develop five to 21 days after being exposed to the virus and occur in two stages.

During stage 1, symptoms may include:

• Fever.
• Chills.
• Swollen lymph nodes.
• Headache.
• Muscle pain.
• Joint pain.
• Back pain.
• Exhaustion.

During stage 2, a rash develops, usually one to three days after the fever. The rash often starts on the face or extremities, but can affect other parts of the body, such as the hands, feet, mouth and genitals.

The rash usually lasts 14 to 28 days and changes from flat reddened areas to raised bumps, to fluid-filled then pus-filled lesions, before it forms scabs that fall off.

People can be contagious from the onset of symptoms until the skin has healed, according to the website.

Although New Brunswick clinicians are "always concerned" when a new infection has been identified, "knowing our numbers in Canada are relatively low is reassuring," said MacMillan.

Monkeypox is "nowhere near as transmittable or virulent as SARS-CoV-2, which is a virus for COVID 19," he added.

Transmission not fully understood

The exact way the virus spreads is not completely known at this time, according to the Public Health Agency of Canada.

But it can be transmitted from person to person through contact with an infected person's: skin lesions, blood, body fluids or mucosal surfaces, such as eyes, mouth, throat and rectum, or contact with contaminated bedding, sheets, clothing, or other objects.

It can also be spread through sexual contact, providing care, or living in the same household as an infected person.

"It is thought that respiratory droplets may transmit monkeypox virus, but this is not well understood at this time," the federal website states.

The virus may also be transmitted during pregnancy to the fetus through the placenta.

Focus on prevention

New Brunswick Public Health is developing some messaging around prevention and risk, and its campaign will include social media efforts.

People should avoid skin-to-skin or face-to-face contact, including sexual contact with anyone who has monkeypox symptoms or is a known case.

They should also wash their hands frequently, wash objects and surfaces they touch regularly, and avoid sharing personal items, said Russell.

Anyone who has monkeypox symptoms should get assessed by a health-care provider, she said.

Russell said she had no update on the province's plan for monkeypox vaccines.

She previously confirmed New Brunswick would be requesting doses from the federal government, but did not say how many or who would get them.

Alberta is offering a single dose of the vaccine to close contacts of known cases. That includes sexual partners, people who share a home and health-care workers who provided care without the appropriate personal protective equipment.

Earlier this week, Hamilton held a pop-up monkeypox vaccine clinic focused on the LGBTQ community.

The city said any transgender, gay or bisexual man who is 18 and older is eligible so long as they:

• Are a contact of someone who recently tested positive for monkeypox.
• Have had two or more sexual partners within the past three weeks or may be planning to.
• Have been diagnosed with a chlamydia, gonorrhea or syphilis infection over the past two months.
• Have attended, worked or volunteered bath houses, sex clubs and other venues for sexual contact within the past three weeks.
• Have had anonymous or casual sex in the past three weeks.

The vaccine is ideally given within four days of exposure to the virus to prevent the disease. But it can be given within a two-week window to reduce symptoms.