Mpox: Advice for travellers

Original publication date: June 7, 2022

Updated: December 3, 2024

Current situation

Mpox (formerly monkeypox) is a viral infectious disease caused by monkeypox virus. There are two main subtypes of this virus, called clades: clade I and clade II.

There are currently outbreaks of clade I mpox, being driven by person to person spread, in the Democratic Republic of Congo (DRC), the Central African Republic, the Republic of Congo, Burundi, Rwanda, Kenya and Uganda. While clade I mpox is usually found in some countries in Central Africa, the current outbreaks are larger than expected, and new regions outside Central Africa are reporting cases for the first time. There have also been travel-associated cases reported in Europe, Asia and North America.

On August 14, 2024, the World Health Organization (WHO) announced that the rise  in cases in the DRC and other African countries is a public health emergency of international concern (PHEIC). The Public Health Agency of Canada is working with health partners around the world, as well as those in Canada, to actively monitor the situation.

Learn more:

Mpox IHR Emergency Committee 2024

About mpox

Clade I and clade II mpox is usually found in parts of Central and West Africa, where cases have been increasing in recent years. Current information suggests that infection with clade I monkeypox virus is more likely to cause severe illness and death  compared to clade II. Since 2022, clade II mpox has been reported in more than 100 countries around the world.

Symptoms

Mpox is a viral infection with a rash that may be painful. Most people recover without treatment after a few weeks.

In rare cases, people can become very sick and die.

People usually develop symptoms 7 to 10 days after being exposed to the monkeypox virus. However, the time it takes to develop symptoms can range from 3 to 21 days after being exposed.

The rash can be painful and could affect any part of the body, such as the:

• face and mouth
• arms and legs
• hands and feet
• anus, rectum and genitals

The rash usually lasts between 2 to 4 weeks and changes through different stages. It finally forms scabs that later fall off. The rash can be accompanied by general symptoms such as:

• fever
• chills
• headache
• exhaustion
• swollen lymph nodes
• back, joint and muscle pain

Sometimes people may not notice that they have a rash, but may have a sore throat or rectal pain.

People are contagious from the onset of first symptoms until the scabs have fallen off on their own and the skin is healed.

Treatment for symptomatic mpox mainly includes:

• wound care
• pain control
• treating bacterial superinfections and other complications

How mpox spreads

Mpox virus can spread in three ways:

• from person to person
• through contact with contaminated objects
• from infected animals to humans

Person to person

You can be exposed to mpox in different situations, such as during:

• sexual contact
  • including oral or non-penetrative contact
• close contact, including when:
  • providing care at home
  • living in the same household

Mpox can spread from person-to-person through contact with lesions or scabs of a person with mpox. These lesions or scabs may be found on the skin or mucosal surfaces, such as:

• genitals
• anus and rectum
• mouth and throat
• eyes

It can also spread through contact with bodily fluids of a person with mpox, such as:

• semen
• saliva
• blood

The virus may spread through respiratory particles, such as from:

• coughing or sneezing
• talking or breathing

However, based on the current evidence, the role respiratory particles play in transmission is unknown, but likely limited.

If you're pregnant, there's a chance you could pass on the virus to your fetus through the placenta.

Animal to human

Mpox can spread to people from an infected animal. In the wild, African rodents are thought to be the main carriers of the virus, however, other carriers include primates, such as monkeys.
Activities that may spread the virus from infected animals to people include:

• eating undercooked game meat
• hunting and processing animals for eating
• exposure to an animal’s body fluids, such as when cleaning up animal enclosures or areas where animals were processed
• touching or handling live or dead animals, especially if there were bites or scratches while handling

Learn more:

Mpox: Symptoms, getting tested, what to do if you have mpox or were exposed
Mpox: How it spreads, prevention and risks

Recommendations

Talk to a healthcare provider or visit a travel health clinic preferably at least 6 weeks before you travel to get personalized health advice.

You should delay your travel if you have any symptoms of mpox, or have been diagnosed with mpox.

You can help lower your risk of getting mpox by avoiding:

• close physical contact with someone who has mpox, including sexual contact
• sexual contact with someone who may have had a high-risk exposure to mpox
  • For example, a sexual partner or household member of someone with mpox.
• contact with personal items or objects used by someone with mpox

You can also lower your risk by:

• getting vaccinated against mpox, if eligible
• having fewer sexual partners
• using barrier protection during sexual activity, including:
  • condoms
  • dental dams
  • gloves
  • clothing
•    practising regular hand hygiene
  • Wash your hands frequently with soap and water for at least 20 seconds or use a hand sanitizer containing at least 60% alcohol.
  • If your hands look dirty, you should wash them with soap and water instead of using hand sanitizer.
  • It's a good idea to always keep hand sanitizer with you when you travel.

Vaccination for travellers

Currently, the mpox vaccine is not routinely recommended for travellers without known exposure to mpox, unless they:

• meet high risk criteria
• are a Canadian healthcare professional being deployed to support mpox clade I outbreaks (see Information for healthcare professionals section)

Before you travel, check with your local public health authority to see if you are eligible for the mpox vaccine. The vaccine requires at least 4 weeks between the two doses.

Learn more:

Vaccines for mpox high-risk criteria
Preventing the spread of mpox

Monitor your health

Be aware of the symptoms of mpox and talk and to a healthcare provider if you notice any new rash or lesions, even with no other symptoms.

• If you’ve been exposed, watch for symptoms, even those that may be mild and go unnoticed, for 21 days. Avoid taking medications that are known to lower fever, such as acetaminophen, ibuprofen and acetylsalicylic acid. They may mask an early symptom of mpox infection.
• If you develop mpox symptoms when you are travelling or after your return, you should immediately:
  • isolate away from others
  • contact a healthcare provider or local public health authority for advice on what to do
• If you have symptoms that could be due to mpox during the flight, tell the flight attendant before you land or the border services officer as you enter the country. They will notify a quarantine officer who can assess your symptoms.

Learn more: 

Mpox: If you have mpox
Mpox: If you've been exposed
If you become sick or injured while travelling outside Canada or after your return

Information for healthcare professionals

Mpox vaccination is recommended for Canadian healthcare professionals in advance of deployment to support mpox clade I outbreaks in countries where this THN is applied.

Healthcare professionals being deployed to these regions should receive 2 doses of Imvamune® administered at least 28 days apart, in advance of deployment, given the heightened mpox epidemiology in these regions and potential increased risk of exposure to the virus.

The mpox vaccine is not routinely recommended for travellers without known exposure to mpox unless they meet high-risk criteria. When providing recommendations to patients, healthcare professionals should consider a traveller's responsibility to prevent the introduction and spread of mpox internationally.

Learn more:

Mpox (monkeypox): For health professionals
National Advisory Committee on Immunization (NACI): Interim guidance on the use of Imvamune in the context of a routine immunization program

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