A report dissects the success of the DSP of Montreal against monkeypox

Ugo Giguere, The Canadian Press

MONTREAL — A new scientific publication, unveiled earlier this month in the journal « Annals of Internal Medicine », looks back on how public health managed to quickly put down, last summer in Montreal, the most serious outbreak of never seen in North America.

As of October 18, 2022, there had been 402 cases of monkeypox in the territory of Montreal, mostly in men who had sex with other men. It was strongly suspected that the transmission was linked to sexual contact.

In the scientific article entitled « Monkeypox in Montreal: Epidemiology, Phylogenomics, and Public Health Response to a Large North American Outbreak », researchers from McGill University attribute the success of the operation in particular to the rapid and sustained intervention of the Regional Public Health Department (DRSP) of Montreal with communities at risk, in particular by deploying an effective preventive vaccination campaign.

Dr. Sapha Barkati, microbiologist-infectiologist at the McGill University Health Center (MUHC), who coordinated the writing of this report, insists that this success is a team affair. Of particular note is the contribution of clinicians who reported and treated the cases, as well as the public health laboratory which facilitated rapid testing without having to rely on Canada’s national microbiology laboratory. The latter was still responsible for the sequencing of the positive samples.

Among the successes associated with the Montreal operation, we note that it is the first jurisdiction to have offered a free dose of the Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine as a preventive measure as early as June.

According to Dr. Barkati, the DRSP has played a pioneering role in adopting a vaccination strategy targeting not only Montrealers at risk, but also anyone who has close contact with these people, including tourists passing through The city.

She says that people who came to take part in the international AIDS conference last July took the opportunity to get vaccinated. Reports had also mentioned tourists from New York who were delighted to have access to a vaccine in a simpler and faster way than south of the border.

“It probably helped a lot,” admits the tropical disease specialist. « In public health approaches, it’s rarely a single element » that leads to success, she continues, but vaccination has certainly played a major role.

However, the community’s reaction to the vaccine supply should not be overlooked, as it is the demand that determines the effectiveness of a vaccination campaign.

As of October 18, 23,835 people had received at least one dose of MVA-BN. A significant number when the population at risk is estimated at 32,000 individuals.

Two waves were observed at the beginning of June and at the beginning of July during which peaks of 43 and 44 cases per week were reached. There was then a gradual decline until the virus virtually disappeared from the territory in October.

Monkeypox is a zoonosis-like viral disease endemic in the regions of central and western Africa. It is believed that the virus is transmitted by direct contact between people, but also by fomites and droplets. The disease can cause intense pain mainly through rashes that can spread all over the body.

First cases of monkeypox in Western countries began to emerge in May 2022, notably in the United Kingdom. The cases then spread, including in Canada.

The delay between the appearance of the epidemic in other Western countries and the outbreak in Montreal has given clinicians time to see things coming, believes Dr. Barkati.

Doctors were able to get information and be on the lookout to quickly report the appearance of the first cases.

If Montreal has been identified as the epicenter of the epidemic in North America, the prompt and effective mobilization of public health authorities was able to quickly stem the spread.

For Dr. Sapha Barkati, this demonstration of commitment, collaboration and creativity in responding to an epidemic is a lesson to be learned for experts here and a model to follow for health authorities elsewhere in the world.

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