1/4. Monkeypox in the United States: an occupational health look at the first cases. Between May 15 and June 20, 2003, 71 suspected cases of monkeypox were investigated and 37 individuals in the United States developed laboratory confirmed monkeypox. These were the first cases of human monkeypox ever documented in the United States or in the Western Hemisphere. The disease was transmitted from small animals imported from africa to other animals, including prairie dogs sold as pets throughout the U.S. Midwest. Direct contact with the infected animals was the method of infection, and although human to human transmission was thought to have occurred, this was not confirmed by follow up testing. Because of the link with contact with a prairie dog, initial evaluation of the disease was focused toward diseases commonly associated with this animal (e.g., tularemia, plague). Laboratory findings at the Marshfield Clinic in Marshfield, wisconsin pointed to the presence of an orthopox. The CDC confirmed monkeypox was the infecting orthopox agent. occupational health nurses from the Marshfield Clinic had direct involvement in the identification and follow up of employees who had direct contact with the diagnosed patients. programs, such as a respiratory protection program initiated and carried out by Clinic occupational health nurses, were used to prevent employee exposure for Clinic staff. One Clinic employee was thought to potentially have monkeypox because of her direct contact with one of the patients. Four Clinic employees were vaccinated with vaccinia vaccine as a result of their contact with patients or lab specimens. quarantine of the potentially infected employee and her boyfriend uncovered issues that must be addressed if other infectious diseases requiring quarantine or isolation of individuals emerge or re-emerge. These include a system to compensate individuals in quarantine or isolation who do not have any other source of income. The issue of whether workers' compensation should cover an employee who is quarantined or isolated for a potential work related exposure to an infectious disease if no disease is actually diagnosed also needs to be explored. A better system of getting state or CDC laboratory results back to the local level, including the occupational health area of the generating facility, must be developed. This will be very important if diseases such as severe acute respiratory syndrome (SARS) or smallpox should re-emerge in the United States. occupational health nurses are an integral part of any infectious disease process occurring in the United States. The identification of monkeypox in the United States shows that any planning to detect, prevent, and treat diseases with the potential to affect the employee population must include occupational health nurse involvement. ( info) |
2/4. Monkeypox: a review of the history and emergence in the Western hemisphere. A mysterious disease was reported on May 24, 2003, when the wisconsin Division of public health (DPH) received notice of a 3-year-old girl who had been hospitalized in central wisconsin with cellulites and fever after being bitten by a prairie dog on May 13. The laboratory isolated a gram-negative bacillus, raising concerns that it might be tularemia or plague; ultimately, it was identified as an acinetobacter species and was considered to be a contaminant. Because no other such cases were reported at the time, the case was thought to be merely an isolated event. However, within two weeks, on June 2, 2003, evidence of a much wider scenario began to emerge. On that date, the wisconsin DPH received notice from the Marshfield Laboratory that the mother of the first patient had become ill on May 26 and that electron-microscopic evidence of a poxvirus was found in a skin lesion. On that same day, another report, this time from the Milwaukee Health Department, of a strange illness was received at the DPH and described the case of a meat inspector who resided in southeastern wisconsin and also was a distributor of exotic animals. By July 30, 2003, 72 confirmed or suspected cases of monkeypox had been reported in wisconsin, illinois, and indiana and represented a large outbreak. The peak in the onset of illness occurred between May 29 and June 9, 2003, and no further cases of illness have been reported in humans since June 22, 2003. Traceback investigations from the child and other patients followed the route of introduction of monkeypox into wisconsin to a distributor in illinois, who had received a shipment of exotic animals imported into the United States through texas from ghana, West africa. ( info) |
| BACKGROUND: The outbreak of monkeypox in the midwestern united states during June 2003 marks the first documented human infection in the Western Hemisphere. Consistent with those in outbreaks in africa, most cases in this outbreak were associated with febrile rash illness. We describe a cluster of monkeypox in a family with a spectrum of clinical illness, including encephalitis, and outline the laboratory confirmation of monkeypox. methods: Standardized patient information was collected by questionnaire and medical chart review; all cases described were laboratory confirmed. Laboratory methods included nucleic acid detection, viral culture, serologic testing, histopathologic evaluation, and immunohistochemical testing. RESULTS: Of 3 family members with monkeypox, 2 had rash illness only, and 1 required hospitalization for severe encephalitis. The family member with the mildest clinical course had previously received smallpox vaccination. Diagnostic testing by both polymerase chain reaction and culture revealed infectious monkeypox virus in skin lesions of all 3 patients; 2 patients had orthopoxvirus detected by immunohistochemistry in skin lesions. The patient with encephalitis had orthopoxvirus-reactive immunoglobulin m (IgM) in cerebrospinal fluid. All patients had detectable IgM responses to orthopoxvirus antigens. CONCLUSIONS: These 3 patients illustrate a spectrum of clinical illness with monkeypox despite a common source of exposure; manifestation and severity of illness may be affected by age and prior smallpox vaccination. We report that monkeypox, in addition to causing febrile rash illness, causes severe neurologic infection, and we discuss the use of novel laboratory tests for its diagnosis. ( info) |
4/4. Extensive lesions of monkeypox in a prairie dog (Cynomys sp). Monkeypox with extensive lesions was diagnosed in a prairie dog that was involved in a recent human outbreak of monkeypox in the midwestern united states. Gross lesions included oral ulcers, pulmonary consolidation, enlarged cervical and thoracic lymph nodes, and multifocal, small, white umbilicated plaques in the gastrointestinal wall. Microscopic lesions were extensive in the lungs and consisted of fibrinonecrotic bronchopneumonia with vasculitis and poorly defined eosinophilic intracytoplasmic inclusion bodies in cells thought to be alveolar epithelial cells, histiocytes, and fibroblasts. Multifocal necrotizing lesions, often accompanied by myxedema, were also present in most of the other examined organs. Aggregates of pox viral particles were observed within lesions by transmission electron microscopy. monkeypox virus infection was confirmed by real-time polymerase chain reaction and virus culture at the Centers for disease Control and Prevention. This report highlights the difficulties of rapid diagnosis of exotic or emerging diseases and further substantiates the prairie dog as an animal model of monkeypox. ( info) |