Information for Community Physicians

Monkeypox

Monkeypox Testing | Infection Prevention & Control Measures | Sampling Guidance | Monkeypox Immunization

Last Updated: September 8, 2022

Monkeypox Testing

Testing is recommended for individuals of all genders, presenting with acute rash or ulcers with or without systemic symptoms (fever, headache, myalgia, arthralgia, back pain, or lymphadenopathy) AND in the last 21 days had one or more of the following risk factors:

  • Sexual contact with new, anonymous or multiple partner(s)
  • Sexual contact with a person(s) who had sexual contact with new, anonymous or multiple partner(s)
  • Significant contact with a person who had skin lesions such as macules, papules, pustules, vesicles, or ulcers with no known alternate cause
  • Contact with a known or probable case of monkeypox

This criteria should guide clinical decision-making regarding patients presenting to primary care providers, specific to monkeypox testing. It is also important to consider testing for common causes of acute rash including varicella zoster, herpes zoster, herpes simplex, syphilis, chancroid, lymphogranuloma venereum, and enteroviruses (e.g., hand-foot-and-mouth disease). Co-infection is also possible, and therefore Monkeypox testing should be considered in addition to testing for other pathogens in clients with atypical symptoms.

For individuals without the risk factors above, Monkeypox testing may be indicated once more common causes of acute rash have been ruled out. Consultation with the Virologist on Call is required.

Infection Prevention & Control Measures

If suspecting a patient with monkeypox (based on the above criteria):

Provide patient with a surgical / procedure mask and place them in a separate room with the door closed immediately upon arrival. Mask should be worn by patient for the duration of the appointment.

Person-to-person transmission primarily occurs via large respiratory droplets and/or direct contact with infective lesions or material. There is a theoretical risk of airborne transmission. However, there are other infections which spread by the airborne route that could have similar rash presentations as monkeypox.

  • If measles or varicella (specifically primary infection/chickenpox, disseminated shingles, or localized shingles in an immunocompromised individual) or other airborne infections are included in the differential diagnosis use Airborne Precautions with or without Contact / Contact and Droplet precautions as indicated.
    • Healthcare workers must use a fit tested N95 respirator.
    • After the patient leaves: Air clearance time (i.e. "settle time") required. The room should remain empty with the door closed for 2 hours and then use routine cleaning/disinfection protocols.
  • If measles or varicella or other airborne infections (i.e. other than Monkeypox) are NOT part of the differential diagnosis, then use Modified Respiratory Precautions.
  • Healthcare workers must use a fit tested N95 respirator.
  • After the patient leaves: Air clearance time not required. Routine Practices include cleaning and disinfection of surfaces, and appropriate linen handling, between patients. Do not shake linens when changing.

See IPC Algorithm for Suspect/Probable Monkeypox (MPX) in All Healthcare Settings for further information.

Sampling Guidance

Prior to the collection of any specimens for monkeypox testing, clinicians should consult with the Virologist-on-call (VOC) at the Provincial Laboratory. The VOC can be paged by calling 403-944-1200 (Calgary) or 780-407-8822 (Edmonton). Refer to this Bulletin for more information: Monkeypox virus (MPXV) testing (UPDATED from July 18, 2022).

Monkeypox Immunization

AHS continues to offer post-exposure prophylaxis to contacts with high exposure risk to a confirmed case of monkeypox. Immunization can be given ideally within 4 days of the last exposure, up to a maximum of 14 days after the last exposure. Contacts with high exposure risk include individuals with direct skin/mucosal contact with a confirmed monkeypox case while the case is infectious, their body fluids, secretions, skin lesions, contaminated objects or surfaces (e.g. clothing, bedding) without appropriate PPE.

Additionally, Albertans 18 and older, who self-identify as meeting the below outlined eligibility criteria, are now able to get the monkeypox vaccine, preventatively before an exposure. Any patient who meet this criteria should call 1-866-301-2668, to book an appointment for immunization.

Monkeypox vaccine is now available in nine cities across the province, including Calgary, Edmonton, Edson, Fort McMurray, Grande Prairie, Lethbridge, Medicine Hat, Red Deer and St. Paul.

Alberta residents 18 years and older who are now eligible for the monkeypox vaccine include:

  • Trans-, cis-gender or two-spirit individuals who self-identify as belonging to the gay, bisexual and other men who have sex with men (gbMSM) community and who meet at least one of the following criteria:
    • Have received a recent (i.e. in the last 6 months) diagnosis of STI
    • Are planning to have, or in the past 90 days had, sex outside of a mutually monogamous relationship
    • Have attended venues for sexual contact within the past 90 days (e.g. bath houses, sex clubs) or may be planning to, or who work/volunteer in these settings
  • Any sexual contacts of the individuals described above.
  • Staff and volunteers in a social setting or venue or event where sexual activities between men (individuals described above) may take place.