Return to Vaccination News Home Page  __»   Right-click to "open in new window"

Subscribe to the Vaccination NewsLetter

View past & current Scandals (columns by Sandy Mintz)

Search This Site using keywords

Monkeypox outbreak: Swift action leads to identification of exotic virus

Public health officials say physicians should be alert to the infection's symptoms and ask patients about possible animal exposures.

By Victoria Stagg Elliott, AMNews staff. June 30, 2003.

The child had been treated with numerous rounds of antibiotics but was still feverish. She had several lesions on her body. Physicians at the Marshfield Clinic in Marshfield, Wis., were fairly sure her illness was linked to the bite from her pet prairie dog. But what was the infectious agent? Prime suspects such as tularemia, plague and anthrax had all been ruled out. And antibiotics weren't working.

"I had researched the pathogens carried by prairie dogs and did not find any viral transmission to humans," said John Melski, MD, a dermatologist and Marshfield's medical director of clinical informatics. He was part of the team that diagnosed this case.

With this article   Links   See related content

"I was perplexed, but I was convinced it was some kind of viral syndrome," Dr. Melski said.

This child ultimately became the first diagnosed case of monkeypox in a spate of infections that began last month. Her parents also were infected. It was the call from Marshfield Clinic to the local health department that eventually tipped off the Centers for Disease Control and Prevention to determine that there was outbreak of a pathogen previously unseen in the Western hemisphere.

This monkeypox index case has since been traced to a shipment of more than 800 various small mammals, including many prairie dogs, which contracted the infection from a sick Gambian giant rat. At press time, more than 50 human cases in four states had been diagnosed, and public health officials were still in the process of tracking the hundreds of animals that have been shipped across the country.

Keeping the lines open

Those same officials pointed to the incident as a perfect example of why close ties between physicians and public health are vital.

"The identification of monkeypox happened because private physicians contacted public health authorities when they detected something unusual," said Seth Foldy, MD, Milwaukee's commissioner of health, who has been investigating the outbreak. "And it's one more reminder that exotic infections are a few hours away by jet, so keep your eyes open out there."

Public health officials say this relationship is vital not just as a first alert system, but also to contain the virus long term. The nature of monkeypox is such that the swift medical and public health response will prevent it from making a permanent home here.

"It doesn't appear to be one of those diseases that is likely to cause consistent endemic disease patterns, but we're not taking any chances," said Herb Bostrom, director of the Bureau of Communicable Disease for the Wisconsin Division of Public Health.

The virus is primarily spread through animal-to-human contact. Human-to-human spread is unusual, but two cases are currently suspected. In its African home, it does not cause epidemics but flares up periodically and then returns to its animal hosts.

Public health officials are asking physicians to be alert to symptoms. Physicians may also want to question patients about animal exposures, just as travel-related questions help to detect potential exposure to severe acute respiratory syndrome. Patients who own exotic animals should also be advised that healthy pets should not cause concern. There are worries, though, that owners may release ill pets into the wild, thereby possibly contaminating native animal species.

"We don't know if it is a virus that can thrive in the wild in the United States," said Dr. Foldy. "[But] I'm not particularly anxious to find out."

Some physicians are reporting patient concerns -- especially from those who are immunocompromised.

"If they have some kind of fever or flu-like illness, they need to be evaluated," said Denise Weaver, MD, infection control officer for LaPorte (Ind.) Hospital, where one case was treated. "The most important thing we can do is take a good history. The nice thing about this outbreak is the information came out so fast. Patients are well-informed."

Patients may also ask their doctors about whether they should now have the smallpox vaccine. The father in the initial case experienced very mild symptoms, which was attributed in part to the fact that he had been vaccinated against smallpox as a child. The CDC has since recommended the vaccine for those who may have been exposed, although none of the public health departments that may be affected by this announcement are rushing to administer it.

"The lack of information on the benefits in this setting, given the apparent low risk of person-to-person transmission, and the known, however low, risk of vaccinia complications, would make us lean toward not being enthusiastic about recommending the vaccine, however close the contact with a suspected or confirmed case," said Eddy A. Bresnitz, MD, state epidemiologist and assistant commissioner for the New Jersey Dept. of Health and Senior Services.

Back to top.

 ADDITIONAL INFORMATION: 

Copyright 2003 American Medical Association. All rights reserved.
 

Return to Vaccination News Home Page  __»   Right-click to "open in new window"

DISCLAIMER:    All information, data, and material contained, presented, or provided here is for general information purposes only and is not to be construed as reflecting the knowledge or opinions of the publisher, and is not to be construed or intended as providing medical or legal advice.  The decision whether or not to vaccinate is an important and complex issue and should be made by you, and you alone, in consultation with your health care provider.