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Ontario chief medical officer issues reporting order on monkeypox cases – CP24 Toronto's Breaking News



Ontario’s top public health official issued issued an order to healthcare providers requiring them to report any possible or suspected cases of monkeypox to local authorities.

In a copy of the order, which was issued under section 77.6 of the Health Protection and Promotion Act, it states that health-care providers must provide Public Health Ontario with information on any patient that meets the “case definitions” of monkeypox.

The information will be used for investigative purposes, as well as conducting case and contact management.

The Ministry of Health confirmed to CTV News Toronto the order was issued on May 20, a day before the first suspected Ontario case was identified.

On Saturday, Toronto Public Health (TPH) said there was an infection suspected in a man in his 40s who had recently been in contact with an individual who had travelled to Montreal.

The man is in stable condition and recovering in hospital, officials said. Anyone who attended the Axis Club (located at 722 College Street) on May 14 or Woody’s bar (located at 467 Church Street) on either May 13 or May 14 may have been exposed and are being asked to self-monitor for symptoms.

Speaking with CP24 the following day, TPH associate medical officer of health Dr. Rita Shahin said monkeypox usually starts with a fever and a general feeling of being unwell—lymph nodes may be swollen and the patient can experience muscle aches.

“A couple of days later it can progress to a rash that starts first on the face. The lesions look a little bit like chickenpox. They start off with small red bumps and then fill with a clear fluid and then the rash will spread to the rest of the body.”

At the same time, Shahin said that monkeypox is not easily spread and usually requires prolonged face-to-face contact or skin-to-skin contact with the lesions.

“The risk is really low. It’s not easily spread like COVID, which is reassuring, but we’re asking anyone who may have been exposed to just be on the lookout for any unusual lesions that they may have.”

Anyone with symptoms is being asked to seek medical attention.


According to the section 77.6 order, a suspected case of monkeypox is defined as a new onset rash and at least one other acute sign or symptom of the illness. It also means that an alternative diagnosis cannot fully explain the patient’s ailments.

A “probable case” is being defined as a patient who meets the definition of a suspected case but also has a high-risk exposure to a probably or confirmed human case of monkeypox, has a history of travel to a region with a confirmed case or has a “relevant zoonotic exposure.”

A case becomes confirmed when there is a laboratory test conducted and monkeypox virus DNA is detected.

The incubation period can range between 5 and 21 days, officials say.

An internal memo sent to health-care providers and public health units along with the order, obtained by CTV News, the chief medical officer of health asks doctors to consider monkeypox as a diagnosis “in individuals presenting with signs and symptoms that may be compatible, especially with those with history of travel to affected countries or other risk factors.”

“Please do not limit concerns or suspicion for the diagnosis to men who report having sex with other men, as anyone with close personal contact with a person with monkeypox virus infection could be at risk for the disease,” Moore wrote. “I am urging all healthcare providers to be alert for patients presenting with symptoms that are consistent with monkeypox virus infection, especially if they have had travel or contact with a known case.”

The memo also says that close contacts of patients with suspected or confirmed monkeypox should self-monitor for symptoms for 21 days after exposure. If symptoms begin to occur, those individuals should seek care, get tested and self isolate.

The World Health Organization has confirmed 92 cases of monkeypox across the globe, along with up to 28 suspected cases, including up to 25 across Canada.

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Westmount Mall to open COVID-19 vaccination clinic for month of July – CTV News London



A new COVID-19 vaccination clinic may soon open in a mall near you.

According to a press release issued by the Middlesex-London Health Unit (MLHU) on Tuesday, the latest mall-based COVID-19 vaccination clinic is set to open in southwest London in early July.

Westmount Shopping Centre will be the home of the newest vaccination clinic and is slated to open on July 7.

In the press release, the MLHU said due to the previous success of the clinics at CF Masonville Place and White Oaks Mall, “The opening of this latest COVID-19 vaccination clinic continues the Health Unit’s strategy of creating easy and convenient ways for area residents to have optimal protection against the virus.”

The clinic will operate out of a space beside the Bulk Barrel located near the mall’s entrance one location, off Viscount Road.

It will be open Thursdays, Fridays and Saturdays from 11:30 a.m. to 5:30 p.m. throughout the month of July. It will operate on a walk-in basis, and individuals can receive any dose they are currently eligible for.

Dr. Alex Summers, MLHU medical officer of health said that due to the summer weather and more people spending time outdoors, Londoners might not be thinking about COVID-19. But, he hopes the new clinic will change that for the better.

“Our clinic at Westmount Shopping Centre will allow people who have not received all the doses they are eligible for to get vaccinated. This will provide additional protection against the COVID-19 virus that continues to circulate in our community.”

Likewise, Amanda Smith, property administrator at Westmount Shopping Centre is optimistic at the upcoming partnership with the MLHU.

“Westmount Shopping Centre Management is pleased to be collaborating with the Middlesex-London Health Unit, as they offer these vaccination services to our Centre and our community,” she said.

A list of the MLHU’s COVID-19 vaccination clinics can be found on the health unit’s website

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Vitamin D supplement 'overdosing' is possible and harmful, warn doctors – Medical Xpress



Credit: Pixabay/CC0 Public Domain

‘Overdosing’ on vitamin D supplements is both possible and harmful, warn doctors in the journal BMJ Case Reports after they treated a man who needed hospital admission for his excessive vitamin D intake.

‘Hypervitaminosis D’, as the condition is formerly known, is on the rise and linked to a wide range of potentially serious health issues, they highlight.

The case concerns a middle-aged man who was referred to hospital by his family doctor after complaining of recurrent vomiting, nausea, , leg cramps, tinnitus (ringing in the ear), dry mouth, increased thirst, diarrhea, and weight loss (28 lbs or 12.7 kg).

These symptoms had been going on for nearly 3 months, and had started around 1 month after he began an intensive vitamin supplement regimen on the advice of a nutritional therapist.

The man had had various health issues, including tuberculosis, an inner ear tumor (left vestibular schwannoma), which had resulted in deafness in that ear, a build-up of fluid in the brain (hydrocephalus), bacterial meningitis, and chronic sinusitis.

He had been taking high doses of more than 20 over the counter supplements every day containing: vitamin D 50000 mg—the daily requirement is 600 mg or 400 IU; vitamin K2 100 mg (daily requirement 100–300 μg); vitamin C, vitamin B9 (folate) 1000 mg (daily requirement 400 μg); vitamin B2 (riboflavin), vitamin B6, omega-3 2000 mg twice daily (daily requirement 200–500 mg), plus several other vitamin, mineral, nutrient, and probiotic supplements.

Once symptoms developed, he stopped taking his daily cocktail, but his symptoms didn’t go away.

The results of blood tests ordered by his revealed that he had very high levels of calcium and slightly raised levels of magnesium. And his vitamin D level was 7 times over the level required for sufficiency.

The tests also indicated that his kidneys weren’t working properly (acute kidney injury). The results of various X-rays and scans to check for cancer were normal.

The man stayed in hospital for 8 days, during which time he was given intravenous fluids to flush out his system and treated with bisphosphonates—drugs that are normally used to strengthen bones or lower excessive levels of calcium in the blood.

Two months after discharge from hospital, his calcium level had returned to normal, but his vitamin D level was still abnormally high.

“Globally, there is a growing trend of hypervitaminosis D, a clinical condition characterized by elevated serum vitamin D3 levels,” with women, children and surgical patients most likely to be affected, write the authors.

Recommended vitamin D levels can be obtained from the diet (eg wild mushrooms, oily fish), from exposure to sunlight, and supplements.

“Given its slow turnover (half-life of approximately 2 months), during which vitamin D toxicity develops, symptoms can last for several weeks,” warn the authors.

The symptoms of hypervitaminosis D are many and varied, they point out, and are mostly caused by excess calcium in the blood. They include drowsiness, confusion, apathy, psychosis, depression, stupor, coma, anorexia, abdominal pain, vomiting, constipation, peptic ulcers, pancreatitis, , abnormal heart rhythm, and kidney abnormalities, including renal failure.

Other associated features, such as keratopathy (inflammatory eye disease), joint stiffness (arthralgia), and hearing loss or deafness, have also been reported, they add.

This is just one case, and while hypervitaminosis D is on the rise, it is still relatively uncommon, caution the authors.

Nevertheless, complementary therapy, including the use of dietary supplements, is popular, and people may not realize that it’s possible to overdose on D, or the potential consequences of doing so, they say.

“This case report further highlights the potential toxicity of supplements that are largely considered safe until taken in unsafe amounts or in unsafe combinations,” they conclude.

Explore further

Vitamin D supplements may offset bone loss caused by diabetes drug

More information:
Vitamin D intoxication and severe hypercalcaemia complicating nutritional supplements misuse, BMJ Case Reports (2022). DOI: 10.1136/bcr-2022-250553

Vitamin D supplement ‘overdosing’ is possible and harmful, warn doctors (2022, July 5)
retrieved 6 July 2022

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no
part may be reproduced without the written permission. The content is provided for information purposes only.

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Pharmacists in London, Ont., hope medication shortage is resolved before cold and flu season –



An Ontario-wide shortage of cold and flu medication has led to partially empty shelves in pharmacies in London. 

The Ontario Pharmacists Association told CBC News in April that drug stores were seeing an increase in people looking to treat symptoms of upper respiratory tract infections, due to COVID-19, influenza or the common cold, after mask mandates were lifted on March 21. 

Months later, pharmacists in London say the shortage has been further exacerbated by allergy season and ongoing supply chain issues.

“Demand is the same, but we hear patients are going from one pharmacy to the other looking for the product,” said Gamal Awad, owner of Guardian Wonderland Pharmacy. 

For the past month, wholesalers of over-the-counter medications for cold and flu have been unable to make their delivery dates. Pharmacies have lost out on sales, said Awad, while customers are scrambling for back-ordered items like cough syrup, Tylenol or Advil. 

At Guardian Wonderland Pharmacy in London, Ont., what little stock owner Gamal Awad has is pushed to the front of shelves. (Angela McInnes/CBC)

“The only thing we can ask our patients is to wait as we look back on our supplier website to see when those medications are going to be back online or when we can order them,” said Fadi Shatara, a pharmacist at Chapman’s Pharmacy.   

The shortage includes medication for children, said Shatara. He advises parents to refer to their doctors for alternatives if they’re unable to find what they need. 

Risk of transmission is low, for now

London’s medical officer of health, Dr. Alex Summers, said outdoor movement in summer generally brings a lower risk of respiratory illness transmission, even as COVID-19 restrictions have been lifted. 

However, the absence of those measures and return to indoor activity mean risk for cold, flu and COVID-19 will rise in the fall and winter months. 

“The more people gather indoors, the greater the risk of transmission. The less people are wearing masks, the greater the risk of transmission, the less people are vaccinated, the greater the risk of transmission,” he said. 

That leaves pharmacists like Shatara bracing for the changing seasons and hoping the medication shortage is resolved by then. 

“If it happens again, that’s going to be devastating, especially with the lack of medications,” he said. “Now, if that lasts until winter or fall, it’s going to have a huge impact on everyone.” 

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