MONKEYPOX, HUMAN, PRAIRIE DOGS - USA (WISCONSIN, ILLINOIS, INDIANA)
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A ProMED-mail post
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International Society for Infectious Diseases
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Date: Sat, 07 Jun 2003 23:27:03 -0400
From: George Robertson <geo456@comcast.net>
Source: Associate Press [Edited]

Illness caused by pet prairie dogs is possibly monkeypox
-----------------------
MADISON, Wis. (AP) - A virus related to smallpox that has never been 
detected in the Western Hemisphere may be the cause of a mysterious 
disease spreading from pet prairie dogs to people across the upper 
Midwest, health officials said Saturday.

Dr. James Hughes, director of the National Center for Infectious 
Diseases at the Centers for Disease Control and Prevention, said a 
group of prairie dogs sold from a suburban Chicago pet distributor 
appears to be infected with the monkeypox virus, a member of the same 
viral family that causes smallpox but is not nearly as deadly.

Monkeypox has typically been found in West African rain forests, 
Hughes said. The death rate among infected humans has ranged from 1 
to 10 percent.

Hughes said although monkeypox is spread primarily through rodents in 
Africa, scientists haven't ruled out person-to-person transmission.

"We're in the very early stages of classifying this virus," Hughes 
said.  "We're not certain."

Since early May [2003] , 17 possible cases have been reported in 
Wisconsin in people as young as 4 and as old as 48. 2 possible cases 
have been reported in Illinois and one has been reported in Indiana, 
health officials from all 3 states said.

They appeared to have been exposed to prairie dogs - rodents whose 
popularity as pets has grown in recent years. They reported fever, 
coughs, rashes and swollen lymph nodes.

CDC and state health officials are still researching the disease with 
samples from the infected prairie dogs and humans, but the virus 
appears susceptible to the anti-viral drug Cidofovir, Hughes said. He 
isn't aware of any long-term aftereffects of monkeypox.

No one has died or become severely ill in the current outbreak, 
Hughes said.  But 4 people in Wisconsin had to be hospitalized at 
Froedtert Memorial Lutheran Hospital, hospital spokesman Mark 
McLaughlin said. 2 remained hospitalized in satisfactory condition 
Saturday.

Authorities don't believe bioterrorism was involved.  Investigators 
have traced the origin of the outbreak to a pet distributor in
Villa Park, Ill. That distributor had a giant Gambian rat, indigenous 
to African countries, that may have infected batches of prairie dogs, 
Hughes said.

SK Exotics, a South Milwaukee pet distributor, bought prairie dogs 
from the Villa Park distributor and imported them to Wisconsin.

2 pet stores, Hoffer TropicLife Pets in Milwaukee and Rainbow Pets in 
Shorewood, a Milwaukee suburb, bought some dogs from SK Exotics.

More prairie dogs from Villa Park found their way to northern 
Wisconsin through a Wausau swap meet, said Dr. Mark Wegner, chief of 
the Wisconsin Communicable Disease Epidemiology Section.

Wisconsin agriculture officials have taken several emergency steps 
since word of the outbreak broke earlier this week.

The state Department of Health and Family Services issued an 
emergency order Friday banning the sale, importation and display of 
prairie dogs.

Also Friday, acting state veterinarian Dr. Robert Ehlenfeldt imposed 
quarantines on SK Exotics, Hoffer TropicLife Pets, Rainbow Pets and 
the Dorchester home of Tammy Kautzer, who apparently sells animals to 
swap meets, Gilson said.

The quarantines prohibit movement of any prairie dogs or mammals that 
come in contact with them.

[One of the cases] said she got 2 female prairie dogs from SK Exotics 
on 5 May 2003.  Neither looked sick at first, she said, but one 
eventually began to look tired. [She] said she got sick in mid-May 
with blisters, coughing and a
101-degree fever. Hospital staff gave her aspirin, told her it was a 
viral infection and she went home, she said.

Meanwhile, state and federal investigators are still trying to track 
down animals sold from the Villa Park distributor. The source of the 
Gambian rat is still unknown, they said.

The World Health Organization has released facts about the disease:

   a. The disease has never before been reported in the Western Hemisphere.
   b. It is usually found in remote villages in Central and West Africa.
   c. Monkeypox is related to the virus that caused smallpox, and smallpox
vaccinations also gave protection against it.
   d. The death rate among those with monkeypox ranges from 1 to 10 
percent, with the highest rates among young children.
   e. The disease is usually transmitted to people from squirrels and 
primates through a bite or contact with the animal's blood.

--
George A. Robertson
<geo456@comcast.net>

[ProMED-mail also thanks the Humanitarian Resource Institute 
<news@humanitarian.net> that submitted a similar news story. - Mod. 
LM]

******
[2]
Date: 7 Jun 2003
From: ProMED-mail <promed@promedmail.org> & H. Larry Penning 
<hlpenning@yahoo.com>
Source: CDC press release
<http://www.cdc.gov/od/oc/media/pressrel/r030607.htm>


Public Health Investigation Uncovers First Outbreak of Human 
Monkeypox Infection in Western Hemisphere
------------------------------
Public health officials from the Centers for Disease Control and 
Prevention (CDC) and the states of Wisconsin, Illinois and Indiana 
have reported the first outbreak of human infections with a 
monkeypox-like virus to be documented in the Western Hemisphere. Thus 
far, 19 cases have been reported: 17 in Wisconsin, one in Northern 
Illinois, and one in Northern Indiana. All patients who have become 
ill reported direct or close contact with ill prairie dogs.

CDC is advising physicians, veterinarians, and the public to report 
instances of rash illness associated with exposure to prairie dogs, 
Gambian rats and other animals to local and state public health 
authorities. CDC also has issued interim recommendations for 
infection control calling for health care personnel attending 
hospitalized patients to follow standard precautions for guarding 
against airborne or contact illness. Veterinarians examining or 
treating sick rodents, rabbits and such exotic pets as prairie dogs 
and Gambian rats are advised to use personal protective equipment, 
including gloves, surgical mask or N-95 respirator, and gowns.

The prairie dogs were sold by a Milwaukee animal distributor in May 
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 obtained prairie dogs and a Gambian giant rat that 
was ill at the time from a northern Illinois animal distributor. 
Investigations are underway to trace the source of animals and the 
subsequent distribution of animals from the Illinois distributor. 
Preliminary information suggests that animals from this distributor 
may have been sold in several other states.

Human monkeypox is a rare, zoonotic, viral disease that occurs 
primarily in the rain forest countries of Central and West Africa. It 
is a member of the orthopox family of viruses. In humans, infection 
with monkeypox virus results in a rash illness similar to but less 
infectious than smallpox. Monkeypox in humans is not usually fatal. 
The incubation period is about 12 days. Animal species susceptible to 
monkeypox virus may include non-human primates, rabbits, and some 
rodents.

Scientists at the Marshfield Clinic in Marshfield, Wisconsin, 
recovered the first viral isolates from a patient and a prairie dog. 
Through examination with an electron microscope they demonstrated a 
poxvirus.

Physicians should consider monkeypox in persons with fever, cough, 
headache, myalgia, rash, or lymph node enlargement within 3 weeks 
after contact with prairie dogs or Gambian giant rats. Veterinarians 
examining sick exotic animal species, especially prairie dogs and 
Gambian giant rats, should consider the possibility of monkeypox. 
Veterinarians should also be alert to the development of illness in 
other animal species that may have been housed with ill prairie dogs 
or Gambian giant rats.

Local, state, and federal agencies and private institutions that have 
participated in this investigation to date have included the 
Marshfield Clinic and Marshfield Laboratories, Froedtert Hospital and 
Medical College of Wisconsin, the City of Milwaukee Health Department 
and at least 10 additional health departments in Wisconsin and 
Illinois, the Wisconsin Division of Public Health, Wisconsin 
Department of Agriculture Trade and Consumer Protection and Wisconsin 
State Laboratory of Hygiene, the Illinois Department of Public 
Health, the Illinois State Department of Agriculture, the Indiana 
State Department of Health, and the US Department of Agriculture.

<http://research.marshfieldclinic.org/crc/prairiedog.asp> (electron 
microscopy images)

For additional information about monkeypox, see 
<http://www.cdc.gov/ncidod/eid/vol7no3/hutinG1.htm>

--
ProMED-mail
<promed@promedmail.org>

[As mentioned in the above reports, this is the first identification 
of monkeypox in the Western Hemisphere.  In the article by Hutin YJF, 
Williams RJ, Malfait P, Pebody R. et al, Outbreak of Human Monkeypox, 
Democratic Republic of Congo, 1996 to 1997. EID Vol. 7, No. 3 May–Jun 
2001, (accessible at 
<http://www.cdc.gov/ncidod/eid/vol7no3/hutin.htm#Figure%201>), Table 
2  (Species of animals caught in the wild and monkeypox virus plaque 
reduction neutralization antibody assay results, Katako-Kombe Health 
Zone, 23-27 Feb, 1997) shows that 3 out of 19 (15.8 percent) Gambian 
rats (_Cricetomys emini_) tested had evidence of monkeypox infection. 
Given this, it would not be surprising to learn that the Gambian rat 
mentioned in the above articles was the source of the infection of 
the prairie dogs.  I wonder when and how it arrived on US shores, and 
if it was in the incubation period during transit... or if there has 
been an ongoing slow outbreak among these exotic animals for some 
time that is just coming to notice now that it is spilling over into 
the human population.

As per the newswire report, cases have occurred in individuals ages 4 
through 48.  It will be very interesting to see the real age 
distribution of these cases, to see if there is persistent immunity 
from earlier smallpox vaccination (pre-1972). It will also be of 
interest to know the smallpox vaccination status of the cases that 
occurred in individuals born before 1972 when smallpox vaccination 
was discontinued (a possible natural study on the duration of 
immunity from earlier smallpox vaccination in the USA).  The 
cessation of smallpox vaccination has been associated with an 
observed increase in monkeypox activity in central Africa (see EID 
article above and WHO fact sheet information below).

Monkeypox is a viral disease with a clinical presentation in humans 
similar to that seen in the past in smallpox patients. Monkeypox is 
seen as a sporadic disease in parts of Africa. The virus responsible 
for monkeypox is related to the virus that causes smallpox 
(orthopoxviruses). Vaccination against smallpox gave protection 
against monkeypox. Before the eradication of smallpox, vaccination 
was widely practised and protected against both diseases. However, 
children born after 1980 have not been vaccinated against smallpox 
and are likely to be more susceptible to monkeypox than older members 
of the population. The death rate from monkeypox is highest in young 
children, reaching about 10 percent.

Most cases occur in remote villages of Central and West Africa close 
to tropical rainforests where there is frequent contact with infected 
animals. Monkeypox is usually transmitted to humans from squirrels 
and primates through contact with the animal's blood or through a 
bite.

An outbreak of human monkeypox in the Democratic Republic of the 
Congo (DRC) in 1997 was associated with person-to-person 
transmission; a change from prior limited outbreaks.  Previous 
studies over a twenty-year period had shown that the rate of 
transmission of monkeypox within households was low, suggesting that 
the disease had a low potential for transmission from person to 
person. Outbreaks were generally self-limiting after one or two 
sequential transmissions.

The percentage of suspect cases from person-to-person transmission 
(78 percent) was higher in this outbreak than previously reported (30 
percent). This was associated with the clustering of cases in 
household compounds and prolonged chains of transmission from person 
to person;

The ending of vaccination programmes against smallpox in the late 
1970s has probably led to an increase in susceptibility to monkeypox 
and could explain the larger size of the most recent outbreak, the 
higher proportion of patients aged 15 and over, and the spread 
through many generations of transmission. (see WHO fact sheet at: 
<http://www.who.int/inf-fs/en/fact161.html>).

We await further information on this outbreak. - Mod.MPP]


[see also:
2002
-----
Monkeypox - Congo DR (Equateur) (07) 20021025.5638
Monkeypox - Congo DR (Equateur)      20020228.3654
Monkeypox - Congo DR (Equateur) (06)  20020410.3926
2001
----
Monkeypox, suspected - Congo DR (Equateur) (02)  20010927.2353
Monkeypox, suspected - Congo DR (Equateur): RFI      20010315.0523
2000
----
Monkeypox - Congo, Dem. Rep. (Mbuji-Mayi): 1999      20000428.0645
Monkeypox - Congo, Dem. Rep. (Mbuji-Mayi): comment      20000506.0691
1998
----
Monkeypox, new therapeutic agent      19980311.0470
1997
----
Monkeypox, threat to humans?      19970728.1585
Monkeypox - Congo, Dem.Rep.      19970928.2049
Monkeypox - Congo, Democratic Republic (09)  19971214.2481
Monkeypox - Zaire      19970321.0599
Monkeypox - Zaire (09) 19970426.0847
1996
----
Monkeypox - Zaire      19960903.1505
Monkeypox - Zaire (02)  19961030.1834]
............................lm/mpp/lm
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