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Canada needs to act quickly to control the monkeypox outbreak by expanding evidence, identifying cases quickly and resolving unanswered key questions about the source and spread of the virus before it takes root here and puts our health experts at risk public. to say.
There has been 112 confirmed cases in Canada so far, one in British Columbia, four in Alberta, nine in Ontario and 98 in Quebec, but officials said Friday that they expect that number to increase in the coming days and weeks as more results arrive.
“Our main goal is to contain the outbreak,” Canada’s director of public health, Dr. Theresa Tam, told a news conference on Friday.
“This means stopping transmission chains quickly to prevent the establishment of monkeypox in Canada and to protect public health and health care in Canada.”
Tam said all patients are men between the ages of 20 and 63, and most of them had sex with other men, but stressed that the infection can be spread to anyone who is exposed through contact. close to an infected or contaminated person. objects.
“We need to try to contain the current monkeypox outbreak,” said Jason Kindrachuk, an adjunct professor of viral pathogenesis at the University of Manitoba in Winnipeg and the Canadian Chair in Emerging Virus Research, which has studied monkeypox. .
“Especially when we are still facing a pandemic. Viruses and infectious diseases not only stop when a new one emerges, but become cumulative.”
Limited evidence may obscure the true spread
But due to limited surveillance in the general community and the time it takes to diagnose and send samples to the Winnipeg National Microbiology Laboratory for confirmation, Canada is likely to be weeks behind in identifying the true extent of the spread of monkeypox.
The World Health Organization (WHO) said this week that there are more than 1,000 cases of confirmed smallpox in 29 non-endemic countries around the world, but some researchers it is estimated that the actual number is over 1,500 and is growing rapidly.
“The sudden and unexpected appearance of monkeypox in several non-endemic countries suggests that there may have been undetected transmission for some time. How long? We don’t know,” the WHO Director-General said this week. , Tedros Adhanom Ghebreyesus. “The risk of monkeypox being established in non-endemic countries is real.”
TARGET | WHO urges countries to help stop the spread of monkeypox worldwide:
WHO urges nations to help stop the spread of monkeypox
The World Health Organization warns that the monkeypox virus could spread to non-endemic countries if they do not control the current outbreak.
Tedros said that while health officials are particularly concerned about the threat posed by monkeypox to vulnerable groups such as children and pregnant women, countries such as Canada may intensify before the virus spreads. set in our soil.
“This scenario can be prevented,” he said. “The WHO urges affected countries to do their utmost to identify all cases and contacts to control this outbreak and prevent its spread.”
Dr. Zain Chagla, an infectious disease physician at St. Joseph’s Healthcare Hamilton, an associate professor of medicine at McMaster University, said Canada should try to find as many cases of monkeypox as possible, especially when there are cases with no known travel links.
“This really suggests we’re just looking at the tip of the iceberg in terms of testing,” he told CBC News.
“You want to make sure that the evidence is very extensive until we are able to link the contacts more and more, and that we know where the cases are coming from more and more, because at the moment it doesn’t seem like it.”
When CBC News asked him if the Public Health Agency of Canada (PHAC) is conducting random tests in the general community to look for cases outside of those presented to doctors with symptoms, Tam said the agency leaves it in the hands of of doctors for now.
TARGET | Health officials are working to contain the monkeypox outbreak and raise awareness:
Quebec health officials are working to contain the monkey’s smallpox outbreak
Quebec health officials are working to contain the province’s monkeypox outbreak, as the focus is on keeping people safe during summer meetings.
“They’re on the lookout for rashes and of course the medical history of contacts, but they’re testing a lot of people who are actually giving negative to the monkey’s smallpox but positive to other things,” he said.
“This is a way to bring the network to the forefront of public health, and some of these people being tested have very minimal skin damage, but they are still being tested and we are finding other causes.”
Tam said PHAC is also analyzing wastewater and other surveillance systems to detect cases of smallpox and antibody levels in different populations, but did not provide specific details on when or if such initiatives would be launched to help make a follow-up of the spread.
“This is not like COVID, of course, it’s very difficult,” Tam said. “A lot of people have very different symptoms, but the rash is definitely a clue in this case.”
Vaccines are another important tool to prevent monkeypox from spreading uncontrollably in the community, and National Immunization Advisory Committee (NACI) now recommend a single dose of the Smallpox vaccine against smallpox for high risk exposures.
But while some provinces like Quebec have already begun to vaccinate close contacts through the so-called ring vaccination strategywith more than 1,600 doses administered so far, Canada has been with tight lips in his reserve of the vaccine nationwide.
“The affected provinces are currently implementing vaccination strategies based on their local epidemiology and [PHAC] “We are currently working with manufacturers to ensure a sufficient supply of vaccines in the future,” Tam said.
Unknown origins reveal the dangers of overflow
Genetic analysis has shown that the smallpox strain circulating in Canada is the same as that spreading internationally, but the origin of the outbreak in that country is still unknown.
“The spread will be slower than what we’ve seen with COVID, but I think obviously if we see cases that aren’t epidemiologically related, there’s a problem,” Chagla said.
“This is really suggestive that many of these people might be missing, could continue to transmit, and even if they think they have it, there may be barriers to accessing care.”
Tam added that there were no known “singular events” that triggered the explosion of cases in Quebec in particular, but that there may have been multiple outreach events that have driven the spread.
Canada has yet to see deaths or serious cases of monkeypox, but Kindrachuk said this does not “rule out the risk” of the virus in the future if it continues to move to different vulnerable areas, such as shelters for people without home, prisons and long-term care. facilities.
“When we have continuously accumulating infections, we know we have populations and demographics within populations that are at higher risk for serious illness,” he said. “It all depends on restraint.”
TARGET | 2 strains of monkeypox circulating around the world, say health officials:
Two different strains of monkeypox are circulating, U.S. health officials say
The U.S. Centers for Disease Control and Prevention has identified two different strains of the monkeypox virus in that country and says the virus may be circulating undetected.
Chagla said there could probably be a “little-known overflow” to other social media and high-risk close contact settings “where we could anticipate a very real risk of spreading in progress.”
“We saw it with COVID, where it went into some of those high-risk places and took off like wildfire, and so I think that’s the main concern,” he said.
“Let the monkey’s smallpox fly into a homeless shelter, or the monkey’s smallpox into a correctional facility can wreak havoc and make people who are already on the sidelines still pushed. more in that sense. “
Another major contagion risk expert they are monitoring is within the animal population because, unlike smallpox, which was eradicated by vaccination largely because it was limited to human hosts, monkeypox has the potential to be transmitted to animal depots.
“We don’t fully understand what the host of the repository is like or what other incidental guests are like,” Kindrachuk said, adding that this unanswered key question plays an important role in the long-term containment of monkeypox and possibility of becoming endemic here. .
“We certainly know that it can move in other animals. We saw it in 2003 in the midwestern United States, when it moved to prairie dogs. We know it has been found in rodents and other animals in Central Africa. western, “he said. . “It is likely that this network will now have to be launched beyond humans.”
Microphotography of a mucopurulent nasal discharge smear of a prairie dog infected with the monkeypox virus. Experts are monitoring a significant risk of infection in the animal population. (Centers for Disease Control and Prevention)
Dr Scott Weese, head of infection control at Ontario Veterinary College at the University of Guelph, said the creation of a new animal depot is a “general concern” that could lead to a prolonged and even spread. and a whole mutation of the virus.
“If we control people in Canada, it’s gone. It may come back, but it won’t stay,” he said. “If we introduce this into wildlife, we will find ourselves in a situation where there will be continued risk, as there is in endemic areas of Africa.”