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A monkeypox vaccination clinic in Montreal, on June 6.CHRISTINNE MUSCHI/Reuters

Once the epicentre of Canada’s monkeypox outbreak, Montreal has almost eradicated the virus on its territory, according to doctors in the city – but they warn it’s too early to declare victory.

Cases can still be imported by tourists and other visitors, they say, adding that it’s still unclear how long the vaccine will remain effective.

Doctors and members of the city’s LGTBQ community are crediting the quick launch of a vaccination campaign and collaboration between public health officials and community organizations for the success in controlling the disease.

Dr. Genevieve Bergeron, responsible for health emergencies and infectious disease at Montreal’s public health department, said she’s “cautiously optimistic.”

“We’ve definitely seen a large decrease in the last few weeks,” she said in a recent interview. “At this point, the latest cases that we have began their illness in late September.”

Dr. Rejean Thomas, the president of a clinic in Montreal’s Village district that specializes in sexually transmitted and blood-borne infections, said that early in the outbreak, his clinic – l’Actuel – was seeing almost a dozen people a day who thought they had the disease.

Now, he said in a recent interview, “we’re seeing almost no more cases; it has completely diminished, almost eradicated.”

In total, his clinic treated 125 people with monkeypox – more than a quarter of all the cases in Montreal since the first case was detected in the city May 12.

But Thomas said it remains unclear what the future holds; he said he recently saw a patient with monkeypox who had been vaccinated in July. “So that’s the big question: what will be the effectiveness of the vaccine – for how long.”

Bergeron said studies are ongoing about the length of the protection offered by Imvamune, a smallpox vaccine that was approved for use against the related monkeypox virus. The vaccine is offered to anyone who thinks they may have been exposed to the virus, as well as to those whose sexual contacts may put them at higher risk for the disease.

Public health officials are now encouraging people who got an initial dose of monkeypox vaccine to get a second shot, she said. “We know that one dose offers good protection, a second dose offers even better protection.”

Around 30,000 people have received one dose of a monkeypox vaccine in Quebec. Last week, the province’s public health director, Dr. Luc Boileau, said around 6,000 had received a second.

“The situation is going well,” Boileau told reporters, adding that one case had been detected in the province over the past two weeks.

But Quebec isn’t the only place where monkeypox cases are declining. In Ontario, where the trajectory of the disease has followed a similar pattern, the province’s chief medical officer of health said in mid-October he was “actively looking” at declaring the outbreak over.

The World Health Organization says the number of new monkeypox cases across several countries – including Canada, the United Kingdom and Italy – decreased by more than 50 per cent in the final week of October compared to the week prior. Several other countries, including France and the United States, have recorded smaller declines, but the number of new cases is still rising in other parts of Europe and in parts of Central and South America.

Bergeron said it’s not clear what’s driving the decline, but she said vaccination and seasonality could be playing a role.

“We’ve seen overall in Montreal a lower number of cases compared to other countries and other jurisdictions, so I think that the vaccination campaign did help,” she said.

Bergeron said public health officials knew there was a high risk of stigmatizing people and worked closely with the community to design the messaging around vaccination. If people were worried they would be judged or stigmatized for protecting themselves, that would be counterproductive, she said.

Christian Tanguay, the executive director of the Montreal LGBTQ+ Community Centre, said that while the experience at the vaccination clinic felt like getting a flu shot, he worried that people wouldn’t get vaccinated because they feared being stigmatized as having multiple partners.

Seeing three people he knows get the virus motivated him to get vaccinated quickly and to encourage others to do the same, he said.

Tanguay said the outbreak caused real fear and it came at a difficult time, when life was returning to normal after the COVID-19 pandemic and people wanted to be around each other again.

Alexandre Dumont Blais, the executive director of REZO, an organization that promotes sexual health among gay, bisexual and other men who have sex with men, said he thinks people in the LGBTQ community are confident that the outbreak is largely behind them, adding that the number of questions his group gets about the disease has declined significantly.

“We feel much better than a couple of months ago,” he said in a recent interview.