Testing is recommended for individuals of all genders, presenting with acute rash or ulcers with or without systemic symptoms (fever, headache, myalgia, arthralgia, back pain, or lymphadenopathy) AND in the last 21 days had one or more of the following risk factors:

• Sexual contact with new, anonymous or multiple partner(s)
• Sexual contact with a person(s) who had sexual contact with new, anonymous or multiple partner(s)
• Significant contact with a person who had skin lesions such as macules, papules, pustules, vesicles, or ulcers with no known alternate cause
• Contact with a known or probable case of mpox
• Travel to an area where mpox transmission is ongoing, especially if patient reports attending gatherings that involve close, prolonged and frequent interactions, particularly those involving sexual activity.

This criteria should guide clinical decision-making regarding patients presenting to primary care providers, specific to mpox testing. It is also important to consider testing for common causes of acute rash including varicella zoster, herpes zoster, herpes simplex, syphilis, chancroid, lymphogranuloma venereum, and enteroviruses (e.g., hand-foot-and-mouth disease). Co-infection is also possible, and therefore mpox testing should be considered in addition to testing for other pathogens in clients with atypical symptoms.

For individuals without the risk factors above, mpox testing may be indicated once more common causes of acute rash have been ruled out. Consultation with the Virologist on Call is required.

If suspecting a patient with mpox (based on the above criteria):

Provide the patient with a surgical/procedure mask and place them in a separate room with the door closed immediately upon arrival. Mask should be worn by patient for the duration of the appointment.

Person-to-person transmission primarily occurs via large respiratory droplets and/or direct contact with infective lesions or material. There is a theoretical risk of airborne transmission. However, there are other infections which spread by the airborne route that could have similar rash presentations as mpox.

• If measles or varicella or other airborne infections are NOT part of the differential diagnosis, then use Contact and Droplet Precautions for suspected mpox infection.
  • Healthcare workers are to use a well-fitting surgical/procedure mask as part of Contact and Droplet Precautions. Use fit tested N95 respirator if aerosol-generating medical procedure required.
  • After the patient leaves: Air clearance time (i.e. "settle time") is not required.
• If measles or varicella (specifically primary infection/chickenpox, disseminated shingles, or localized shingles in an immunocompromised individual) or other airborne infections are included in the differential diagnosis then use Airborne Precautions in addition to Contact and Droplet Precautions.
  • Healthcare workers use a fit tested N95 respirator.
  • After the patient leaves: Air clearance time (i.e. "settle time") is required. The room should remain empty with the door closed for two hours and then use routine cleaning/disinfection protocols.
• For all patients: Use Routine Practices, including cleaning and disinfection of surfaces and appropriate linen handling, between patients. Do not shake linens when changing.

See the IPC Algorithm for Suspect/Probable Mpox in All Healthcare Settings for further information.

Prior to the collection of any specimens for mpox testing, clinicians should consult with the Virologist-on-call (VOC) at the Provincial Laboratory. The VOC can be paged by calling 403-944-1200 (Calgary) or 780-407-8822 (Edmonton). Refer to this Bulletin for more information: Mpox virus (MPXV) testing (UPDATED from July 18, 2022).

Pre Exposure

Additionally, Alberta residents who self-identify as meeting the below outlined eligibility criteria, are now able to get the mpox vaccine preventatively before an exposure. Two doses of vaccine at least 28 days apart are required for optimum protection. Any patient who meets this criteria should call 1-866-301-2668, to book an appointment for immunization.

Alberta residents who are eligible for the mpox vaccine include:

• Men who have sex with men (MSM) and who meet at least one of the following criteria:
  • Have more than one sexual partner
  • Are in a relationship where at least one of the partners has other sexual partners
  • Have had a confirmed sexually transmitted infection acquired in the last year
  • Have engaged in sexual contact in sex-on-premises venues
• Sexual partners of any of the above.
• Sex workers regardless of gender, sex assigned at birth, or sexual orientation.
• Staff or volunteers in sex-on-premises venues where workers may have contact with fomites potentially contaminated with mpox.
• Individuals who engage in sex tourism (regardless of gender, sex assigned at birth, or sexual orientation).
• Individuals who anticipate experiencing any of the above scenarios.
• Research laboratory employees working directly with replicating orthopoxviruses and who are at high risk of occupational exposure

Post Exposure

AHS continues to offer post-exposure prophylaxis to contacts with high exposure risk to a confirmed case of mpox. Immunization can be given ideally within 4 days of the exposure, up to a maximum of 14 days after the exposure. Contacts with high exposure risk include individuals with direct skin/mucosal contact with a confirmed mpox case while the case is infectious, their body fluids, secretions, skin lesions, contaminated objects or surfaces (e.g. clothing, bedding) without appropriate PPE.