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Cases of monkeypox in Canada have doubled since July 1 and vaccine supplies remain limited.

Monkeypox: Tracking the new global health emergency

Canada confirmed more than 680 cases of monkeypox across five provinces on the heels of the World Health Organization declaring the global outbreak an international health emergency.

Monkeypox stems from the same family of viruses that causes smallpox and spreads through respiratory droplets and close contact with infected people or contaminated materials such as bedding.

Common symptoms include fever, headache, swollen lymph nodes, and skin lesions that can cause intense pain. According to the WHO, roughly 3-6% of cases can be fatal, but this death rate is based on African data prior to 2022 that may under-represent milder cases. Most monkeypox virus infections resolve within a few weeks without treatment.

So far, 75 countries have reported more than 16,000 monkeypox cases and five deaths since May this year.

Canada has seen a doubling of confirmed monkeypox virus infections since July 1, and the Public Health Agency of Canada expects case counts to continue rising.

Ontario and Quebec are seeing the most confirmed cases, with 288 and 331, respectively. Ontario’s tally alone has jumped 20% in the past week.

Alberta, British Columbia, Saskatchewan, and the Yukon have also reported cases.

Who is most at risk of monkeypox?

Until very recently, monkeypox was seldom reported outside of central and west Africa, where the disease is endemic.

Research published in the New England Journal of Medicine revealed that 98% of monkeypox virus infections diagnosed in 16 countries between April and June occurred in men who have sex with men.

Concern about stigmatizing the LGBTQ community has complicated public health communication about monkeypox.

Some argue that generic messaging that emphasizes the risk to everyone may miss the people most at risk of infection. Others contend that focusing on men who have sex with men may backfire as infections spread beyond that community.

Notably, the United States has already reported two cases in children.

Canada announced it will provide $1 million to community organizations to raise awareness among gay and bisexual men and fight the stigma around monkeypox.

Limited vaccine supply to curb outbreaks

Smallpox vaccines have proven safe and effective against monkeypox. But in Canada, demand far exceeds supply, which could hinder efforts to control outbreaks.

Canada is drawing on its national emergency stockpile to supply targeted vaccination campaigns in higher-risk areas, including in Ontario and Quebec. So far, more than 13,000 people in those provinces have received vaccinations against monkeypox.

Public health units across Canada are recommending vaccination for close contacts of known cases and anyone who has an increased risk of exposure to monkeypox – although some advice stops short of specifying who is at increased risk.

Meanwhile, the federal government is “continuing discussions and contract negotiations” to obtain more doses from Bavarian Nordic, a Danish vaccine manufacturer.

Montreal is offering vaccination against monkeypox to all men who have sex with men and anyone who has been exposed, including tourists, and cases in the city appear to be hitting a plateau.

Some people are travelling to Montreal from other provinces and countries to get vaccinated. In one case, a Halifax man flew to Montreal after he was unable to access the shots in Nova Scotia and Newfoundland.

Given that monkeypox is still relatively contained and vaccine supplies are limited, some public health experts are calling on governments to prioritize vaccination for the close contacts of infected people.

Researchers and public health advocates say paid sick leave to help people isolate and more information about the virus could also help prevent infections.

Photo credit: kontekbrothers/iStock via Getty Images

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