The type of mpox spreading rapidly through several African countries could arrive in Canada, where that strain hasn㽶Ƶֱt appeared before, Canadian experts say.
The detection of clade I mpox in Sweden in someone who had travelled to an affected African country is a 㽶Ƶֱharbinger㽶Ƶֱ of broader spread, said Dr. Fahad Razak, an internal medicine specialist and epidemiologist at St. Michael㽶Ƶֱs Hospital in Toronto.
The Public Health Agency of Sweden said Thursday it is the first case of clade I mpox to be diagnosed outside the African continent.
Razak said he wasn㽶Ƶֱt surprised to learn about the case.
㽶ƵֱIt was only a matter of time,㽶Ƶֱ he said in an interview. 㽶ƵֱCanada being a major port of travel globally 㽶Ƶֱ we㽶Ƶֱre one of the most travelled high-income countries in the world㽶Ƶֱ I think we should expect that cases will occur here.㽶Ƶֱ
The World Health Organization㽶Ƶֱs declaration on Wednesday that mpox is a public health emergency of international concern was partly based on the surge of clade I in Congo and its appearance in nearby Burundi, Kenya, Rwanda and Uganda 㽶Ƶֱ four countries that had not had mpox of any kind before.
Clade I mpox appears to be more transmissible and more severe than the clade II variant that caused an epidemic in Canada in 2022, Razak said.
Many of the cases of clade I mpox are children, he said.
The good news is that mpox may not spread as easily as COVID-19 did when it first arrived, so Canadian health agencies would likely have an easier time containing it, said Razak, who was the scientific director for Ontario㽶Ƶֱs COVID-19 Science Advisory Table.
㽶ƵֱIt is still a disease that seems largely to be transmitted through direct contact rather than airborne (transmission). And that means that control measures can work really well,㽶Ƶֱ he said.
The other good news, Razak said, is that there is a vaccine for mpox.
Dr. Allison McGeer, an infectious diseases specialist at Mount Sinai Hospital in Toronto, said we need to learn more about the epidemiology of clade I mpox before the sense of what to expect in Canada becomes clear.
McGeer noted that we didn㽶Ƶֱt get any Ebola cases in Canada during the west African outbreak about a decade ago.
If clade I mpox is mostly spreading in rural areas from animals and within households 㽶Ƶֱ and if there㽶Ƶֱs not a lot of travel happening in those settings 㽶Ƶֱ Canada may not see cases, or only a few of them, she said in an email on Thursday.
㽶Ƶֱ(But) if it has evolved to be more transmissible, we㽶Ƶֱll start to see travel-related cases,㽶Ƶֱ McGeer said.
On Wednesday, the Public Health Agency of Canada said there have been no cases of clade I mpox cases in this country.
㽶ƵֱPHAC is closely monitoring the increase in clade I mpox cases in the DRC (Congo) and neighbouring regions and liaising with partners and subject matter experts to update risk assessments, public health guidance and travel health advice as appropriate,㽶Ƶֱ the agency said in a statement.
Canada is able to test for both clade I and clade II mpox, it said.
The public health agency is monitoring an increase in clade II mpox cases in Toronto, it said, and encourages people who are eligible to get two doses of the mpox vaccine.
Clade II mpox spreads through 㽶Ƶֱclose/intimate or sexual contact with someone who has the virus or contact with surfaces/materials that may have the virus,㽶Ƶֱ according to the Toronto Public Health website.
Men who have sex with men are eligible for vaccination if they have or are planning to have two or more sexual partners, have attended venues for sexual contact, have had or are planning to have anonymous sex, are a sexual contact of someone who does sex work, or has had a confirmed sexually transmitted infection in the past year, the website says.
Anyone who does sex work, regardless of self-identified sex or gender, is eligible to receive the vaccine, the website says.
Household members or sexual contacts of those listed above who are immunocompromised or pregnant may also be eligible for mpox vaccination.
People who have had close contact with someone with mpox may be able to get a post-exposure vaccination. That should ideally be given within four days of exposure but can be administered up to 14 days after the last exposure, the website says.