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Volume 12, Number 12—December 2006

Perspective

Qualitative Assessment of Risk for Monkeypox Associated with Domestic Trade in Certain Animal Species, United States

Susan M. Bernard*Comments to Author  and Steven A. Anderson*
Author affiliations: *US Food and Drug Administration, College Park, Maryland, USA

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Table 2

Variables considered in characterizing risk for human monkeypox cases and the degree of uncertainty associated with these variables

Variable Degree of uncertainty
Animal host and carrier species High—some, but not all, host species identified
Proportion of probable host or carrier species infected with virus High—need to assume absent data that all animals within known or probable carrier species are infected
Proportion of animals exposed during US 2003 outbreak infected with virus High—need to assume that all exposed animals are infected
Susceptibility of naive animals to infection High—but experience in United States and Africa suggests several species and orders can be infected with monkeypox virus
Latency in nonhuman species High
Duration of infection or infectiousness in nonhuman species High
Seasonality of disease High—some indication of peak monkeypox cases in humans in July and August in African outbreaks, which may be associated with human behavior rather than characteristics of virus or host animals
Incubation in nonhuman species High
Infection rates in exposed nonhuman species High
Proportion of infected animals (of different species) that shed virus High
Mode(s) of transmission across species and to humans High—but evidence of mucocutaneous and respiratory transmission pathways
Attack rates among humans exposed to infected animals High
Secondary attack rates among humans High—secondary attack rates seem to be increasing in monkeypox-endemic areas due to increasing susceptibility of exposed populations, and historical data indicating low risk for human transmission may be unreliable
Fatality rates in nonhuman species High

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