Ontario’s top doctor issues order to doctors requiring reporting on possible monkeypox cases

Ontario’s top public health official issued an order to healthcare providers requiring them to report any possible or suspected cases of monkeypox to local authorities.

In a copy of the order, which was issued under section 77.6 of the Health Protection and Promotion Act, it states that health-care providers must provide Public Health Ontario with information on any patient that meets the “case definitions” of monkeypox.

The information will be used for investigative purposes, as well as conducting case and contact management.

The Ministry of Health confirmed to CTV News Toronto the order was issued on May 20, a day before the first suspected Ontario case was identified.

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On Saturday, Toronto Public Health (TPH) said there was an infection suspected in a man in his 40s who had recently been in contact with an individual who had travelled to Montreal.

The man is in stable condition and recovering in hospital, officials said. Anyone who attended the Axis Club (located at 722 College Street) on May 14 or Woody's bar (located at 467 Church Street) on either May 13 or May 14 may have been exposed and are being asked to self-monitor for symptoms.

Speaking with CP24 the following day, TPH associate medical officer of health Dr. Rita Shahin said monkeypox usually starts with a fever and a general feeling of being unwell—lymph nodes may be swollen and the patient can experience muscle aches.

“A couple of days later it can progress to a rash that starts first on the face. The lesions look a little bit like chickenpox. They start off with small red bumps and then fill with a clear fluid and then the rash will spread to the rest of the body.”

At the same time, Shahin said that monkeypox is not easily spread and usually requires prolonged face-to-face contact or skin-to-skin contact with the lesions.

“The risk is really low. It’s not easily spread like COVID, which is reassuring, but we’re asking anyone who may have been exposed to just be on the lookout for any unusual lesions that they may have.”

Anyone with symptoms is being asked to seek medical attention.

WHAT DOES A SUSPECTED CASE MEAN?

According to the section 77.6 order, a suspected case of monkeypox is defined as a new onset rash and at least one other acute sign or symptom of the illness. It also means that an alternative diagnosis cannot fully explain the patient’s ailments.

A “probable case” is being defined as a patient who meets the definition of a suspected case but also has a high-risk exposure to a probably or confirmed human case of monkeypox, has a history of travel to a region with a confirmed case or has a “relevant zoonotic exposure.”

A case becomes confirmed when there is a laboratory test conducted and monkeypox virus DNA is detected.

The incubation period can range between 5 and 21 days, officials say.

An internal memo sent to health-care providers and public health units along with the order, obtained by CTV News, the chief medical officer of health asks doctors to consider monkeypox as a diagnosis “in individuals presenting with signs and symptoms that may be compatible, especially with those with history of travel to affected countries or other risk factors.”

“Please do not limit concerns or suspicion for the diagnosis to men who report having sex with other men, as anyone with close personal contact with a person with monkeypox virus infection could be at risk for the disease,” Moore wrote. “I am urging all healthcare providers to be alert for patients presenting with symptoms that are consistent with monkeypox virus infection, especially if they have had travel or contact with a known case.”

The memo also says that close contacts of patients with suspected or confirmed monkeypox should self-monitor for symptoms for 21 days after exposure. If symptoms begin to occur, those individuals should seek care, get tested and self isolate.

The World Health Organization has confirmed 92 cases of monkeypox across the globe, along with up to 28 suspected cases, including up to 25 across Canada.