On Wednesday, Aug. 14, the World Health Organization (WHO) declared mpox (formerly known as monkeypox) a public health emergency of international concern for the second time in two years. Yesterday’s announcement follows an increase in mpox cases in the Democratic Republic of Congo (DRC) and neighbouring countries, as well as the emergence of the new clade Ib variant.

Many are worried that this is indicative of another global outbreak similar to COVID-19 — but there are some key differences between the two.

Here’s everything you need to know about mpox.

What is Mpox?

According to the WHO, Mpox is an infectious disease caused by the monkeypox virus. Two different clades exist: clade I (typically found in the DRC/Central Africa, with a mortality rate of up to 10% in Africa) and clade II (typically found in West Africa; this clad is associated with less severe outcomes, with a mortality rate of less than 1% in Africa). The outbreak in the DRC began with the spread of clade I.  But a new variant of concern has emerged — clade Ib (part of the clade I group), which appears to spread more easily through close contact (including sexual contact) compared to previous strains.  This variant has spread from Congo to neighbouring countries, which triggered the global public health emergency announcement from WHO.

In Canada, there have been no cases of clade I as of publication, but there has been an ongoing outbreak of clade II since 2022, particularly in the Toronto area. Cases in Toronto increased in late June and July this year following major events and festivals across the city. As of July 31, 93 cases have been confirmed for 2024 in Toronto compared to 21 confirmed cases reported for the same period last year, and there’s a higher concentration of cases in the downtown core.

How is Mpox transmitted? 

The Centers for Disease Control and Prevention note that both mpox clades can spread through direct contact with infected wild animals, especially small wild animals in West and Central Africa, where mpox is found naturally. Contact with infected animals includes touching their fluid or waste or getting bitten/scratched. It’s possible to get infected from

You’re less likely to get mpox from a pet, but close contact with an infected pet (like petting, cuddling, hugging, a pet licking you, and sharing sleeping spaces) can spread mpox to a person.

Transmission can also occur through contaminated materials (like contact with clothing, bedding, towels, fetish gear, sex toys, and other objects, fabrics, and surfaces that haven’t been disinfected after used by someone with mpox) or via close contact with a person with mpox, including intimate or sexual contact; skin-to-skin contact with an mpox rash or scab; contact via saliva, snot, mucus, bodily fluids or lesions around the anus, rectum, or vagina; touching the genitals; hugging, massaging, and kissing; and even via prolonged face-to-face interactions (such as talking or breathing).

Pregnant women with mpox can also pass the virus to the fetus during pregnancy or to the newborn during and after birth.

To date, there is no link between mpox and water in pools/hot tubs; the virus is typically killed in water at recommended chlorine levels recommended for disinfection.

What are the symptoms of mpox? 

Typically, fever, headaches/muscle aches, and a sore throat are the first symptoms of mpox. Signs also include painful skin rashes or pus-filled lesions — these rashes might first appear as flat sores. For some people, the rash forms on the face before spreading to the body, but these rashes could appear anywhere on the body, including the palms of hands, soles of feet; face, mouth, and throat; groin/genital/anus areas. Some patients develop one or a few skin rashes while others have hundreds or more.  People can also experience flu-like symptoms, enlarged lymph nodes, and lethargy.

Mpox symptoms usually appear within a week but can begin up to 3 weeks after exposure. Symptoms generally last for 2–4 weeks but could prolong for people with weakened immune systems.

How serious ism pox? Would I die if infected?

In African countries, mpox clades 1 and 2 have death rates ranging from 1% to 10%, but globally, the strain circulating is associated with a 1% or lower death rate. As of publication, no mpox-related deaths have been reported in Canada, with no reported cases of the new clade I mpox strain in the country. Still, those infected can get super sick.  The WHO states that the skin can become infected with bacteria, leading to abscesses or skin damage. Other complications include pneumonia, vision loss due to corneal infections, severe dehydration or malnutrition as a result of vomiting or diarrhea, sepsis, and inflammation.

Again, people with compromised immune systems are at a higher risk of serious illness and death.

What are the key differences between pox and COVID-19?

Experts have found that mpox doesn’t spread through the air like COVID-19. Also unlike COVID-19, mpox isn’t contagious until an infected person becomes symptomatic, so it should make it easier to isolate those who are infected and help prevent the spread.

What is the Canadian government doing to fight mpox?

The federal government has been monitoring for mpox virus through wastewater surveillance in Canada since July 2022 and they can test for clade I and clade II strains. The Government recently stated that although the risk of this strain to people in Canada remains low at this time, they are monitoring the mpox situation in the DRC/Africa.

Since April of this year, the government implemented a level two travel health notice for the DRC, recommending that travellers practice “enhanced health precautions”.

Also, Canada has secured a sufficient supply of mpox vaccines. Health Canada authorized the Imvamune vaccine for immunization against mpox, smallpox, and related orthopoxvirus infections and diseases. In May of this year, the National Advisory Committee on Immunization recommended a two-dose vaccination series for mpox among adults at a high risk of exposure. As of publication, vaccination of the general public isn’t recommended.

How do I prevent mpox? 

Many public health agencies agree that getting vaccinated is the best way to prevent further virus spread. Although the same vaccine used for smallpox is also used for mpox — even if you have already received a smallpox vaccine in the past, health officials recommend you still get vaccinated for mpox as you might not be protected. Again, at-risk individuals are encouraged to get vaccinated as of publication.

In Toronto, Toronto Public Health recommends two doses of the vaccine for at-risk individuals, with the second dose being taken 28 days after the first dose. For more information including eligibility requirements in Toronto, click here to visit the City’s mpox site and here to book an appointment.

What do I do if I have mpox?

If you are worried that you have mpox, notify your physician and local public health agency immediately. The WHO advises that you:

• Inform anyone who you have been close to recently.
• Stay at home until all scabs fall off and a new layer of skin forms. Avoid physical contact with others.
• Cover lesions and wear a mask when around other people

How is mpox treated? 

For those who have been in contact with the virus, research shows that when given the mpox vaccine early enough after exposure (within four days), it might lessen the severity of the disease (post-exposure prophylaxis).

Treatment plans typically include treating complications from mpox, and would likely involve wound care, pain control, and bacterial superinfections.

In the US, TPOXX (tecovirimat) is an antiviral medication that is still being tested in people with mpox to find out if it is safe and effective. As of publication, it’s available through the Study of Tecovirimat for Mpox (STOMP) clinical trial or CDC’s compassionate use program. According to the Government of Canada, as of publication, there is limited data on the clinical effectiveness of specific antiviral treatments for mpox, as these antivirals were first developed to treat smallpox. The government recommends that individuals speak to their health care providers for advice on mpox treatment.