Interim Guidance for Post-Exposure Prophylaxis and Treatment of Monkeypox

Advisory Alert

May 31, 2022

*Cette information est seulement disponible en anglais.

To: Local Health System Partners

FOR IMMEDIATE ATTENTION

Information on post-exposure management of select contacts and treatment of cases of monkeypox infection

Ontario continues to monitor for cases of monkeypox and is working collaboratively with partners to address health risk(s) that may be associated with the infection.

Given the rapidly evolving situation, summarized below are interim recommendations on the use of vaccination for post-exposure prophylaxis (PEP) of select contacts and information on how to access Tecovirimat (TPoxx®) for the treatment of severe infection.

Imvamune® for post-exposure prophylaxis

A live attenuated 3^rd generation replication deficient smallpox virus vaccine authorized by Health Canada in 2020 under the provision of the Extraordinary Use New Drug regulations is available for active immunization against smallpox, monkey pox and related orthopoxviral infection.

Indicated for adults 18 years of age and older who are high risk contacts of a probable or confirmed case monkeypox.
Requires a risk exposure assessment by public health.
May be offered to eligible contacts with intermediate exposure risk based on individual assessment.
To be administered within 4 days (preferentially) up to 14 days after exposure.

The vaccine is not indicated in the treatment of monkeypox infection.

Should you have a patient who might qualify for PEP after a high or intermediate risk exposure to monkeypox infection please contact Public Health Sudbury & Districts as noted below.

Tecovirimat (TPoxx®) for treatment of monkeypox infection

Tecovirimat is authorized by Health Canada under an extraordinary use indication for the treatment of human smallpox disease in adults and children weighing at least 13 kg. The drug is not approved for treatment of monkeypox in Canada however it may be used off-label by a licensed healthcare professional based on their clinical judgement and risk/benefit analysis to treat severe monkeypox infections.

Treatment course is three (200 mg each) capsules taken twice daily for 14 days.
Supply is limited to hospitalized severely ill patients.

Clinicians may request Tecovirimat for treatment of hospitalized cases by contacting the Ministry of Health Emergency Operations Centre by email EOCoperations.MOH@ontario.ca or by calling the Healthcare Provider Hotline at 1.866.212.2272.

Attached you will find the Ministry of Health Q&A for Monkeypox with further information on the interim recommendations for use, clinical indications for use, product specific details, and ordering information for Imvamune® (PEP in eligible contacts) and Tecovirimat (TPoxx®) (for treatment of severe illness in hospitalized patients). Further information will be shared with you as it becomes available. Information is also posted on our website at: www.phsd.ca.

To request an exposure risk assessment on an eligible patient for PEP or for further information on monkeypox please contact the Control of Infectious Disease Program at 1.705.522.9200, ext. 772 or toll-free 1.866.522.9200.

Sincerely,

Original Signed By

Dr. Penny Sutcliffe
Medical Officer of Health and Chief Executive Officer

NOTE: All Advisory Alerts are found on our website.

This item was last modified on May 31, 2022