Two cases of monkeypox have been confirmed in Quebec, the first such cases in the country, according to the Public Health Agency of Canada (PHAC).
The agency says it has alerted public health authorities around Canada to look for symptoms in patients, regardless of whether they’ve travelled.
“This is an evolving and ongoing investigation, both in Canada and around the world,” PHAC said in a statement on Thursday.
Earlier on Thursday, Montreal’s top public health official urged people not to panic as her department investigated 17 cases of suspected monkeypox in the greater Montreal region.
Dr. Mylène Drouin said there were 15 suspected cases on the island of Montreal, one on the South Shore and another north of Laval.
It’s not clear if the two cases confirmed by PHAC are among those 17.
“Most of our cases are not severe,” said Drouin.
Until now, monkeypox outbreaks have been limited mostly to central and western Africa, but in recent weeks, suspected cases have been identified in the U.S., U.K., Portugal and Spain.
Drouin said the first cases in Montreal were reported on May 12 by clinics specializing in sexually transmitted diseases. She said those cases are tied mostly to men aged 30 to 55 who have had sexual relations with other men.
The virus is not sexually transmitted, Drouin explained, but is mainly spread “by close contact and [respiratory] droplets.”
It is also spread by open sores, contact with bodily fluids, or by touching contaminated clothes or bedding.
“It’s not something that you can acquire when you [do your groceries] or on public transportation,” she said.
Drouin described those at risk of contracting the virus as “those in the same household and sexual partners.” She urged anyone with symptoms to consult a doctor.
The news conference came after Quebec’s Health Ministry said late Wednesday it had been notified of a person with a confirmed case of monkeypox who had travelled to the province.
The Massachusetts Department of Public Health confirmed a single case of monkeypox on Wednesday in a man who had recently travelled to Canada. Drouin said several of the cases in Montreal have been linked to the traveller who came from Boston.
Likened to a milder form of smallpox, monkeypox is a rare viral illness that typically begins with symptoms such as fever, headache, backache and fatigue — similar to symptoms of COVID-19 or the flu. But doctors say the most noticeable symptom is a rash or lesions on the skin.
“They’re very specific: they look like mini-volcanoes,” said Dr. Robert Pilarski, a family physician at Clinique Médicale La Licorne in Montreal, who has treated several recent suspected monkeypox patients.
Pilarski said the four patients he’s seen have presented with lesions around their genitals. He recommends anyone with flu-like symptoms and “eruptions on the skin” to isolate immediately.
The incubation period for monkeypox is between seven to 14 days, according to the doctor, but it can be as short as five days and as long as 21. A person is likely to be contagious one day before symptoms appear, he said.
According to the World Health Organization, there are two distinct clades, or strains, of the monkeypox virus — the Central African (Congo Basin) strain and the West African strain.
Pilarski said he’s seeing what appears to be a less-contagious strain of the virus, which is giving him hope that it will not be widespread.
“We [likely] have the western virus, which is less contagious. So I’m pretty much sure this is going to be a milder course of disease,” said Pilarski. “But we cannot eliminate the possibility of serious complications.”
While the U.S. Centers for Disease Control and Prevention (CDC) says infections with the Congo Basin strain can be fatal in as many as one in 10 people, infections with the West African strain can be fatal in about one in 100 people. Rates can be higher in people who have weakened immune systems.
Smallpox vaccine a potential option
Montreal public health officials don’t believe the virus will circulate in the community, since it’s not highly infectious, Drouin said.
She said all people with suspected cases are in isolation and have been asked to cover their skin lesions with bandages.
Asked about potential treatments for the illness, Drouin said there are no specific remedies available in Canada, “so it is painful, but mainly, the forms that we have right now are not severe forms of the illness.”
Dr. Geneviève Bergeron, Montreal’s medical officer responsible for health emergencies and infectious diseases, said there’s reason to believe people who received the smallpox vaccine as children may have a better chance at fighting off monkeypox.
However, routine immunization programs against smallpox ended in Canada in the early 1970s.
In the U.K., some health-care workers and people who have been in contact with cases have been offered a smallpox vaccine as protection.
Montreal health authorities said they don’t yet know how many people in the city received the smallpox vaccine as children, and a similar course of action to the U.K. won’t be taken just yet.
“First, we have to see if we have access to a vaccine, so it’s going to be a decision that is made at the provincial and federal level,” said Drouin.
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