Monkeypox
Monkeypox Outbreak Status Report
Tuesday, June 17, 2003
Monkeypox Disease
Human monkeypox is a rare viral disease that primarily infects
animals, but may also be transmitted to humans. It occurs primarily in
the rain forest countries of central and west Africa. In humans, the
illness produces symptoms that include fever, cough, headache, drenching
sweats, chills, swollen lymph nodes and a vesicular/pustular rash
similar in appearance to that of smallpox. Limited person-to-person
spread of infection has been reported in disease-endemic areas in
Africa. There is no specific treatment for monkeypox, although the
Centers for Disease Control and Prevention (CDC) has recommended the
limited use of smallpox vaccine for close and intimate contacts to
infected animals or humans. Smallpox vaccine appears to confer immunity
to monkeypox. (For Wisconsin Division of Public
Health guidance on the use of smallpox vaccination with respect to
monkeypox, read: "Recommendations
for Smallpox Vaccine for Prevention of Monkeypox" -PDF, 1 page, 19kb)
The case fatality rate for monkeypox in Africa is between
1% and 10%, but this may not reflect the fatality rate expected in the
U.S. with our better level of nutrition, better general health status
and the availability of health care. This is the first known occurrence
of monkeypox in the western hemisphere.
2003 Outbreak
The first case presented to physicians at the Marshfield Clinic for
treatment of an infected bite from one of the prairie dogs. After ruling
out bacterial causes such as plague and tularemia (the most likely
suspects in infections from prairie dogs) they observed what they
believed to be orthopox virus by electron microscopy and sent specimens
to CDC who confirmed monkeypox virus.
All cases were believed to be connected to a shipment of prairie dogs
that were sold by a Milwaukee animal distributor to two pet shops in the
Milwaukee area and during a pet "swap meet" (pets for sale or
exchange) in northern Wisconsin. The Milwaukee animal distributor had
obtained prairie dogs and a Gambian giant rat that was ill at the time
from a northern Illinois animal distributor who also distributed animals
to other states. The Illinois distributor obtained the animals from a
distributor in Texas. The United States Department of Agriculture (USDA)
and CDC worked to trace the origin of the prairie dogs
and their exposure to other animals on their way to the Milwaukee
distributor.
Control Activities (2003)
On Thursday, June 5, the Department of Health and Family Services (DHFS)
issued a press release describing the connection between human illness
and exposure to prairie dogs, warning the public to avoid contact with
prairie dogs. The release described the symptoms of the illness and
advised anyone who had handled prairie dogs and developed symptoms to
see their physician and report their condition to the local or state
health department.
On Friday, June 6, DHFS issued an emergency order under chapter
254.51, prohibiting the importation, sale, display or other activity
that might result in human contact with prairie dogs acquired since
April 1, 2003. The prohibition also applied to any mammals that come
into contact with these prairie dogs. On June 12, DHFS issued a
revised order expanding the prohibition to include certain African
rodents connected to the investigation and to make the order consistent
with that from the USDA. For the DHFS Order, see the "Emergency
Order" page.
Local health departments and staff from the Division of Public Health
interviewed potential cases, identifying contacts to the
cases and to the prairie dogs from the shipment in question. These
individuals were instructed to monitor their health daily and report any
symptoms that developed in the 21 days following their exposure. If they
developed any symptoms they were told to isolate themselves and contact
their health care provider for further evaluation.
Employees from the Wisconsin Department of Agriculture, Trade and
Consumer Protection (DATCP) collected animal specimens, tracked animals
from the shipment in question to ensure compliance with the DHFS
emergency order and answered questions for veterinarians, pet dealers
and the general public.
The Wisconsin State Laboratory of Hygiene informed all laboratories in
Wisconsin about proper specimen handling and shipment. They were responsible for shipping specimens to CDC.
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