Mpox (monkeypox) : Advice for travellers

Original publication date: June 7, 2022

Updated: March 30, 2023

Note:

• On November 28, 2022, the World Health Organization began using ‘mpox’ as the preferred term for monkeypox disease. The Travel Health Notice has been updated to reflect this change.
• The list of countries that the Travel Health Notice is applied to has been updated.

Current situation

Clusters of mpox (monkeypox) cases have been reported in several countries internationally, outside of areas in Central and West Africa where cases are normally found. The occurrence of cases with no direct travel to those areas, or without established links to a traveller from those areas, is unusual.

In the current outbreak, the majority of cases to date are those who have reported close or intimate contact with a person who has mpox.

During your travel, you may be subject to procedures at your destination put in place to limit the spread of mpox, such as isolation, should you become infected. You may have limited access to timely and appropriate health care should you become ill, and may experience delays in returning home.

PHAC is working closely with international, provincial and territorial health partners to gather information on this evolving issue. Further investigations are underway to determine the likely source of infection and to limit further onward spread.

About mpox (monkeypox)

Mpox is a viral infection with a rash that may be painful. It is usually self-limited, meaning most people recover on their own after a few weeks. However, in some situations, people may become very sick and death may occur. It is regularly found in parts of Central and West Africa, where it has been re-emerging in recent years. Sporadic cases outside Central and West Africa have been known to occur, usually through infected travellers or transmission from imported animals.

Mpox virus can spread in three ways:

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

Mpox can spread from person to person through contact with an infected person’s:

• lesions or scabs that may be found on the skin or mucosal surfaces (such as eyes, mouth, throat, genitalia, rectum). These lesions may resemble chickenpox.
• blood or body fluids
• contaminated clothing or linens, such as bedding and towels, or by sharing personal objects used by an infected person (such as razors, utensils, needles, sex toys, toothbrushes)
• respiratory droplets (for example, from coughs and sneezes)
  • While respiratory droplets may transmit mpox virus, this is not well understood at this time.

The risk of transmission increases when coming into close contact with someone who is infected, such as:

• during sexual contact (including oral and non-penetrative sexual contact)
• when providing care
• when living in the same household

An infected pregnant person may also pass on the virus to their developing fetus.

In the current outbreak, the majority of cases to date are men who reported intimate sexual contact with other men. However, the risk of exposure to the virus is not exclusive to any group or setting.

Having multiple sexual partners may increase your overall risk of infection.

Symptoms of mpox can begin 5 to 21 days after exposure, and can include:

• fever
• chills
• swelling of the lymph nodes
• headache
• muscle pain
• joint pain
• back pain
• exhaustion
• onset of a rash or lesions

It is possible that a rash may be the only presenting symptom. The rash is similar in appearance to chickenpox or sexually transmitted infections (such as herpes or gonorrhea). It can be painful and could affect any part of the body, such as the mouth, genitals, perianal area, face, arms and legs, feet, and hands. The rash usually lasts between 14 and 28 days and changes through different stages before finally forming a scab, which later falls off.

Symptoms of mpox typically last from 2 to 4 weeks. Treatment is mainly supportive.

The Imvamune® vaccine is authorized for use against mpox infections in adults 18 years of age and older who are at high risk of exposure. The vaccine may be offered to people with high-risk exposures to a mpox case, or within a setting where transmission is happening. Contact your local public health authority to learn more.

Recommendations

Consult a health care professional or visit a travel health clinic at least 6 weeks before you travel.

You can reduce the risk of becoming infected with or spreading mpox by:

• staying home when you’re sick
  • delay your travel if you have any symptoms of mpox, or have been diagnosed with mpox
• avoiding close physical contact, including sexual contact, with people who have or may have mpox
• covering coughs and sneezes (for example by using the bend of your arm or a tissue or by wearing a well-fitting mask)
• washing your hands frequently with soap and water for at least 20 seconds
  • If soap and water are not available, use hand sanitizer containing at least 60% alcohol
• cleaning and disinfecting high-touch surfaces and objects

To further reduce your risk of becoming infected with and spreading mpox or sexually transmitted infections, it is recommended that you:

• use condoms
• practice safe sex
• limit your number of sexual partners, particularly those who are anonymous
  • this includes partners who are not showing symptoms of mpox

While travelling, be particularly vigilant if you are planning to attend gatherings or events that entail close, prolonged and frequent interactions among people, in particular sexual activity. Outbreaks of infectious diseases have been linked to travel abroad and social and mass gatherings.

 Monitor your health

Be aware of the symptoms of mpox and report any concerns, particularly a new rash or lesions with or without other symptoms, to a health care professional. Individuals engaging with new or multiple sexual partners should be particularly vigilant.

• If you’ve been exposed, watch for symptoms for 21 days and avoid taking medications that are known to lower fever, such as acetaminophen, ibuprofen and acetylsalicylic acid. They may mask an early symptom of mpox
• If you develop symptoms that could be due to mpox when you are travelling or after your return, isolate immediately and contact a health care professional or your local public health authority and avoid contact with others. Tell them where you have been travelling or living and follow their instructions.
• 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. Make sure you keep your mask (preferably a well-fitting medical mask) on at all times during the flight.

If you've been infected with the mpox virus, the local public health authority may require that you isolate to prevent further spread.

Information for health care professionals

 Mpox information for health professionals can be found on the Government of Canada’s Mpox: For health professionals website.

Registration of Canadians Abroad

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