Provincial Health Services Authority (PHSA) improves the health of British Columbians by seeking province-wide solutions to specialized health care needs in collaboration with BC health authorities and other partners.

Children, pregnant women and some immunocompromised individuals are considered at higher risk for severe disease. Recent cases in Canada and western countries have been described as mild. Since May 2022, no deaths have been reported in western countries.

Given the epidemiology of the cases confirmed thus far in Europe and North America, clinicians should be aware of the differential diagnosis as lesions associated with monkeypox can resemble several other infections, including:

For individuals who do not have skin lesions and are suspected to be in the first stage of illness (prodrome), oropharyngeal swabs, nasopharyngeal swabs, EDTA blood and urine can also be considered for testing; please discuss with a BCCDC Microbiologist on call  (604-661-7033) and/or your local hospital microbiologist before collecting and submitting these sample types.

For individuals who have passed the first and second clinical stages, and in whom monkeypox was suspected, urine should be considered for testing (serology is currently not available); please discuss with a BCCDC Microbiologist on call  (604-661-7033) and/or your local hospital microbiologist before collecting and submitting this sample type.

Collected specimens should be stored and shipped refrigerated. Monkeypox is a Risk Group 3 pathogen. Samples from suspect cases can be shipped by ground to laboratories as TDG Category B (temporary Transport Canada certificate) but need to be shipped as TDG Category A by air. 

Given that the differential includes HSV, VZV and enterovirus, frontline testing laboratories should consider testing for HSV, VZV and enterovirus on lesion material using Containment Level 2+ procedures. If testing for these is not available at the frontline laboratory, this should be indicated to the BCCDC PHL to perform testing. 

Refer to the Provincial Infection Control Network's infection prevention and control guidance for monkeypox, last updated August 8, 2022:B.C.'s interim infection prevention and control guidance for monkeypox in health care settings

Suspected cases should be instructed to limit their contact until results are obtained and practice frequent hand and respiratory hygiene. Lesions should be covered whenever possible, and contaminated objects should be manipulated by the case only.

Health Canada maintains a limited stockpile of monkeypox vaccine (Imvamune™) that is made available to BCCDC for use in the event of monkeypox cases. The National Advisory Committee on Immunization published recommendations for the use of Imvamune in the context of monkeypox outbreaks. In BC, regional public health authorities will identify contacts or any other high-risk group who is eligible and can benefit from the vaccine. 

If a patient suspected or confirmed to have monkeypox requires transportation, the patient must be provided with a medical mask and lesions must be covered (e.g., patient gown, sheet or dry dressing). The receiving department/facility and transporting personnel should be informed of the need for airborne, droplet and contact precautions.

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