2 monkeypox cases confirmed in Quebec the first in Canada

Two cases of monkeypoxhave been confirmed in Quebec, the first such cases in the country, according to the Public Health Agency of Canada (PHAC).

The agency says it has alerted public health authorities around Canada to look for symptoms in patients, regardless of whether they've travelled.

"This is an evolving and ongoing investigation, both in Canada and around the world," PHAC said in a statement on Thursday.

Earlier on Thursday,Montreal's top public healthofficial urged people not to panic as her departmentinvestigated17 cases ofsuspected monkeypoxin the greater Montreal region.

Dr. Mylne Drouinsaid there were 15 suspectedcases on the island of Montreal,one on the South Shore and another north of Laval.

It's not clear if the two cases confirmed by PHAC are among those 17.

"Most of our cases are not severe," said Drouin.

Until now, monkeypox outbreaks havebeen limited mostly to central and western Africa, but in recent weeks, suspected cases have been identified in the U.S., U.K., Portugal and Spain.

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Montrealers 'do not have to panic' over monkeypox: public health

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Drouin said the first cases in Montreal were reported on May 12 byclinics specializing in sexually transmitted diseases. She said those casesare tied mostly to men aged 30 to 55 who have had sexual relations with other men.

The virus is not sexually transmitted, Drouinexplained, but ismainly spread "by close contact and[respiratory] droplets."

It is also spread by open sores, contact with bodily fluids, or by touching contaminated clothes or bedding.

"It's not something that you can acquire when you[do your groceries] or on public transportation," she said.

Drouin described those at risk of contracting the virus as "those in the same household and sexual partners." Sheurged anyone with symptoms to consult a doctor.

The news conference came after Quebec's Health Ministrysaid late Wednesday it had beennotified of a person with a confirmed case of monkeypox who had travelled to the province.

TheMassachusetts Department of Public Healthconfirmed a single case of monkeypox on Wednesday in a man who had recently travelled to Canada.Drouinsaid several of the cases in Montreal have been linked to the traveller who came from Boston.

Cautious optimism

Likened to amilder form of smallpox, monkeypox is a rareviral illness that typically begins with symptoms such as fever, headache, backache and fatigue similar to symptoms of COVID-19 or the flu.But doctors say the most noticeable symptom is a rash or lesions on the skin.

"They're very specific: they look like mini-volcanoes," said Dr. Robert Pilarski, a family physician at Clinique Mdicale La Licorne in Montreal, who has treated several recent suspected monkeypox patients.

Pilarski said the four patients he's seen have presented with lesions around their genitals. He recommends anyone with flu-like symptoms and "eruptions on the skin" to isolate immediately.

The incubation period for monkeypox is between seven to 14 days, according to the doctor, but it can be as short as five days and as long as 21. A person is likely to be contagious one day before symptoms appear, he said.

According to the World Health Organization, there are two distinct clades, or strains,of the monkeypox virus the Central African (Congo Basin) strainand the West African strain.

Pilarski said he's seeing what appears to be a less-contagious strain of the virus,which is giving him hope that it will not be widespread.

"We[likely] have the western virus, which is less contagious. SoI'm pretty much sure this is going to be a milder course of disease," said Pilarski. "But we cannot eliminate the possibility of serious complications."

While the U.S. Centersfor Disease Control and Prevention (CDC) says infections with the Congo Basinstrain can be fatal in as many as one in 10 people, infectionswith the West African strain can be fatal in about one in 100 people. Rates can be higher in people who have weakened immune systems.

Smallpox vaccine a potential option

Montrealpublic health officials don'tbelieve the virus will circulate inthe community, sinceit's not highly infectious, Drouin said.

She said all people with suspected cases are in isolation and have been asked to cover their skin lesions with bandages.

Asked about potential treatments for the illness, Drouin said there are no specific remedies available in Canada, "so it ispainful, but mainly, the forms that we have right now are not severe forms of the illness."

Dr.Genevive Bergeron, Montreal's medical officer responsible for health emergencies and infectious diseases, said there's reason to believe people who received the smallpox vaccine as children may have a better chanceat fighting off monkeypox.

However, routine immunization programs against smallpox ended in Canada in the early 1970s.

In the U.K., some health-care workers and people who have been in contact with caseshave been offered a smallpox vaccine as protection.

Montreal health authorities said they don't yet know how many people in the city received the smallpox vaccine as children, and asimilar course of action to the U.K. won't be taken just yet.

"First, we have to see ifwe have access to a vaccine, so it's going to be a decision that is made at the provincial and federal level," said Drouin.