Monkeypox cases in Montreal appear to have plateaued, but officials say they are concerned that rising infections in the U.S. and a low vaccination rate could help the disease rise again in the city
Dr. Geneviève Bergeron of Montreal Public Health says that while the situation in the city has stabilized in recent weeks, she fears the busy tourist and travel season could compromise efforts to contain the illness
“We’re concerned that we may see an increase over the next few weeks because of travel and how connected we are to different countries, so we’re very careful with the pattern of progress we’re seeing now,” he said in an interview Monday.
Last month, public health officials described Montreal as the epicenter of the monkeypox outbreak in North America and expanded vaccination against the disease to all men who have sex with men.
Bergeron said starting vaccination early was helpful in efforts to control the disease, but the city “still has a lot of work to do” when it comes to promoting vaccination.
He said only one-third to one-half of people eligible for vaccination have received a vaccine. Demand for the vaccine has slowed somewhat, he said, although there has been an increase since the World Health Organization declared the disease a global emergency on Saturday.
The provincial government has described the monkeypox outbreak in the province as “relatively contained,” with 331 cases last week and no hospitalizations. More than 13,000 people have been vaccinated.
Instead, the Public Health Agency of Canada says cases across the country have continued to rise, to a total of 681. “Since July 1, we’ve also seen cases double so far, the first case in a woman, and the first cases in Saskatchewan,” the agency wrote Saturday.
Bergeron said the city is working with different levels of government and with community organizations to raise awareness about monkeypox and promote vaccination. This includes pop-up notifications sent through dating apps, mobile vaccine clinics and enlisting the support of influencers, including a popular drag queen, to raise awareness.
Dr. Michael Libman, a specialist in infectious and tropical diseases at the McGill University Health Centre, said his impression is that monkeypox numbers in the city “are under control and maybe changing.”
He says that, for now, the disease is primarily transmitted among a small segment of the population — men who report sex with men — making it controllable as long as health officials act quickly. But he notes that anyone can contract monkeypox, which is spread through prolonged close contact through respiratory droplets, direct contact with skin lesions or body fluids, or through contaminated clothing or bedding.
If left unchecked, “it will inevitably reach other sexually active communities and eventually homes if we don’t get it under control,” he said.
Dr. Réjean Thomas, who works at the l’Actuel medical clinic in Montreal, said he is “very surprised” by the number of sexually active patients who are not vaccinated. He believes that public health messages may need to be strengthened to better reflect the seriousness of the situation, without being alarmist.
He believes that some people may have been inadvertently led to believe that the disease is “benign” simply because it is rarely fatal.
“But the cases we see are quite severe: large ulcers in the mouth, tongue, chin, genital organs,” he said. “People are suffering a lot.”
A study published last week in the New England Journal of Medicine that looked at more than 500 cases in 16 countries found that 98% of those infected were gay or bisexual, 75% were white and 41% had a previous HIV diagnosis . However, the study noted that while the current outbreak disproportionately affects men who have sex with men, monkeypox can affect anyone and heterosexual transmission was also reported.
Spread to other populations is “anticipated,” the study added.
Bergeron said the vaccine is available in Montreal for people who have had direct contact with someone who has smallpox or with potentially contaminated items or bedding. It is also available to men and members of the gay, bisexual and trans communities who have sex with at least one male partner in Montreal other than a single regular partner.
This report by The Canadian Press was first published on July 26, 2022.
— With archives of Frédéric Lacroix-Couture