Monkeypox

Monkeypox
Classification and external resources
Human monkeypox lesions
ICD-10	B04
ICD-9	059.01

Monkeypox also known as cockpox is an exotic infectious disease caused by the monkeypox virus. The disease was first identified in laboratory monkeys, hence its name, but in its natural state it seems to infect rodents more often than primates. The disease is most prevalent in Central and West Africa, but an outbreak occurred also in the United States in 2003.^[1]

Human monkeypox is a zoonotic viral disease that occurs primarily in remote villages of Central and West Africa in proximity to tropical rainforests where there is more frequent contact with infected animals. Monkeypox is usually transmitted to humans from rodents, pets, and primates through contact with the animal's blood or through a bite. Human monkeypox can be difficult to distinguish clinically from smallpox (to which it is closely related) and chickenpox (to which it is not).^[2]

Epidemiology

In addition to monkeys, giant pouched rats (Cricetomys sp.), dormice (Graphiurus sp.) and African squirrels (Heliosciurus, Funisciurus) have all been implicated as reservoirs of the virus. The use of these animals as food may be an important source of transmission to humans.^{[citation needed]}

Monkeypox as a disease in humans was first associated with an illness in the Democratic Republic of the Congo (formerly Zaire), in the town of Basankusu, Equateur Province, in 1970.^[3] A second outbreak of human illness was identified in DRC/Zaire in 1996–1997. In 2003, a small outbreak of human monkeypox in the United States occurred among owners of pet prairie dogs.^[4] The outbreak originated from Villa Park IL, outside of Chicago, when a exotic animal dealer kept young prairie dogs in close proximity to an infected Gambian pouched rat (Cricetomys gambianus) recently imported from West Africa. Seventy-three people were reportedly infected, of which there were no fatalities.

A second African focus of infection has been discovered in Sudan. No infected patients died.^[5]

Monkeypox disease in animals

The symptoms of a sick animal include: listlessness, ocular and nasal discharges, coughing, hair loss sometimes accompanied by painful scabs, and pneumonia. Look for nodules similar to mosquito bites and inflammation of the lymph glands.

Monkeypox disease in humans

Symptoms and course

In humans, monkeypox is similar to smallpox, although it is often milder. Unlike smallpox, monkeypox [[It is assumed that vaccination against smallpox would provide protection against human monkeypox infection considering that they are closely related viruses and the vaccine protects animals from experimental lethal monkeypox challenge.^[6] This has not been conclusively demonstrated in humans because routine smallpox vaccination was discontinued following the apparent eradication of smallpox and due to safety concerns with the vaccine. Limited person-to-person spread of infection has been reported in disease-endemic areas in Africa. Case-fatality ratios in Africa have ranged from 1% to 10%.^[7]

Prevention and treatment

Currently, there is no proven, safe treatment for monkeypox. Smallpox vaccine has been reported to reduce the risk of monkeypox among previously vaccinated persons in Africa. The United States Centers for Disease Control and Prevention (CDC) recommends that persons investigating monkeypox outbreaks and involved in caring for infected individuals or animals should receive a smallpox vaccination to protect against monkeypox. Persons who have had close or intimate contact with individuals or animals confirmed to have monkeypox should also be vaccinated. The people who have been infected can be vaccinated up to 14 days after exposure. CDC does not recommend preexposure vaccination for unexposed veterinarians, veterinary staff, or animal control officers, unless such persons are involved in field investigations.

This film, produced by INCEF for distribution in communities prone to infection, describes the nature of the illness and how best to confront it.

2003 U.S. outbreak

Through June 18, 2003, there were 93 cases of monkeypox in the United States including Wisconsin (44 cases), Indiana (24), Illinois (19), Ohio (4), Kansas (1), Missouri (1), and New Jersey (1). Analysis of the first 53 cases showed that 50 had contact with prairie dogs that were purchased from Phil's Pocket Pets of Villa Park, Illinois.^[8] Electron microscopy and serologic studies were used to confirm that the disease was human monkeypox.

The onset of the illness among the patients in the United States began in early May 2003. Patients typically experienced a prodrome consisting of fever, headaches, myalgias, chills, and drenching sweats. Roughly one-third of patients had nonproductive cough. This prodromal phase was followed 1–10 days later by the development of a papular rash that typically progressed through stages of vesiculation, pustulation, umbilication, and crusting. In some patients, early lesions had become ulcerated. Rash distribution and lesions occurred on head, trunk, and extremities; many of the patients had initial and satellite lesions on palms, soles, and extremities. Rashes were generalized in some patients. After onset of the rash, patients generally manifested rash lesions in different stages. All patients reported direct or close contact with prairie dogs, most of which were sick. Illness in prairie dogs was frequently reported as beginning with a blepharoconjunctivitis, progressing to presence of nodular lesions in some cases. Some prairie dogs died from the illness, while others reportedly recovered.

See also

• Smallpox
• Zoonosis

References

1. ^ Bayer-Garner IB (2005). "Monkeypox virus: histologic, immunohistochemical and electron-microscopic findings". J. Cutan. Pathol. 32 (1): 28–34. doi:10.1111/j.0303-6987.2005.00254.x. PMID 15660652. 
2. ^ Jezek Z, Szczeniowski M, Paluku KM, Mutombo M, Grab B (1988). "Human monkeypox: confusion with chickenpox". Acta Trop. 45 (4): 297–307. PMID 2907258. 
3. ^ A human infection caused by monkeypox virus in Basankusu Territory, Democratic Republic of the Congo - I. D. Ladnyj, P. Ziegler, and E. Kima
4. ^ "What You Should Know About Monkeypox" (PDF). Fact Sheet. Centers for disease control and prevention. 2003-06-12. http://www.cdc.gov/ncidod/monkeypox/pdf/factsheet2.pdf. Retrieved 2008-03-21. 
5. ^ Damon IK, Roth CE, Chowdhary V (2006). "Discovery of monkeypox in Sudan". N. Engl. J. Med. 355 (9): 962–3. doi:10.1056/NEJMc060792. PMID 16943415. http://content.nejm.org/cgi/content/full/355/9/962. 
6. ^ Marriott KA, Parkinson CV, Morefield SI, Davenport R, Nichols R, Monath TP (2008). "Clonal vaccinia virus grown in cell culture fully protects monkeys from lethal monkeypox challenge". Vaccine 26 (4): 581–8. doi:10.1016/j.vaccine.2007.10.063. PMID 18077063. http://linkinghub.elsevier.com/retrieve/pii/S0264-410X(07)01257-1. 
7. ^ Hutin YJ, Williams RJ, Malfait P, et al. (2001). "Outbreak of human monkeypox, Democratic Republic of Congo, 1996 to 1997". Emerging Infect. Dis. 7 (3): 434–8. PMC 2631782. PMID 11384521. http://www.cdc.gov/ncidod/eid/vol7no3/hutin.htm. 
8. ^ Medscape Monkeypox Review

External links

• CDC - Monkeypox Fact Sheet
• CDC Questions and Answers About Monkeypox
• CDC - Human Monkeypox -- Kasai Oriental, Zaire, 1996-1997
• CDC - Outbreak of Human Monkeypox, Democratic Republic of Congo, 1996 to 1997
• CDC Preliminary Report: Multistate Outbreak of Monkeypox in Persons Exposed to Pet Prairie Dogs
• INCEF education project to reduce Monkeypox transmission
• National Library of Medicine - Monkeypox virus
• Virology.net Picturebook: Monkeypox