Skip directly to page options Skip directly to A-Z link
Volume 13, Number 9—September 2007
Research

Spectrum of Infection and Risk Factors for Human Monkeypox, United States, 2003

Mary G. Reynolds*Comments to Author , Whitni B. Davidson*, Aaron T. Curns*, Craig S. Conover†, Gregory Huhn*‡, Jeffrey P. Davis§, Mark Wegner§, Donita R. Croft§, Alexandra Newman*§, Nkolika N. Obiesie¶, Gail R. Hansen¶, Patrick L. Hays¶, Pamela Pontones#, Brad Beard#, Robert Teclaw#, James F. Howell#, Zachary Braden*, Robert C. Holman*, Kevin L. Karem*, and Inger K. Damon*
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Illinois Department of Public Health, Chicago, Illinois, USA; ‡Rush University, Chicago, Illinois, USA; §Wisconsin Department of Health and Family Services, Madison, Wisconsin, USA; ¶Kansas Department of Health and Environment, Topeka, Kansas, USA; #Indiana State Department of Health, Indianapolis, Indiana, USA;

Main Article

Table 2

Characteristics of monkeypox case-patients and controls selected from the population of persons exposed, monkeypox virus outbreak, United States, 2003

Characteristic Study classifications, no. (%)
Case-patients Case-patients infected but not diseased Controls
State
Illinois 8 (26.7) 1 (33.3) 8 (28.6)
Indiana 10 (33.3) 1 (33.3) 17 (60.7)
Kansas 1 (3.3) 0 0
Wisconsin 11 (36.7) 1 (33.3) 3 (10.7)
Age, y
<18 10 (33.3) 0 7 (25.0)
>18 20 (66.7) 3 (100) 21 (75.0)
History of smallpox vaccination
Yes 6 (20.0) 3 (100) 15 (53.6)
No
 24 (80.0)
 0
 13 (46.4)
Setting in which exposure occurred*
Home 18 (60.0) 1 (33.3) 17 (60.7)
Neighbor’s home 3 (10.0) 0 6 (21.4)
Pet store 2 (6.7) 1 (33.3) 1 (3.6)
Veterinary clinic 7 (23.3) 1 (33.3) 4 (14.3)
Exposure source†‡
Prairie dog (PD) 30 (100) 3 (100) 28 (100)
PD and African animal 1 (3.3) 1 (33.3) 2 (7.1)
PD and other animal 1 (3.3) 0 2 (7.1)
Only other animal
 0
 0
 0
Symptoms postexposure
Fever 28§ (93.3) 2 (66.7) 4 (14.3)
Rash 30 (100) 1 (33.3) 7 (25.0)
Lymphadenopathy 20 (66.7) 1 (33.3) 4 (14.3)
Mouth sores 8 (26.7) 0 1 (3.6)
Conjunctivitis 4 (13.3) 0 0
Cough
 17 (56.7)
 0
 2 (7.1)
Total 30 3 28

*Indicates principal setting for exposure.
†Reported exposures pertain to animals with laboratory-confirmed monkeypox infections (15) or ones that had lesion-producing illnesses plus prior exposure to a confirmed infected animal. African animals included dormice, giant Gambian rats, jerboas, hedgehogs, striped mice, and pygmy mice.
‡Includes all reported exposures; categories not mutually exclusive.
§Self-reported information for fever was indicated as unknown or was missing for 2 persons who had laboratory-confirmed monkeypox infections.

Main Article

References
  1. Ladnyj  ID, Ziegler  P, Kima  E. A human infection caused by monkeypox virus in Basankusu Territory, Democratic Republic of the Congo. Bull World Health Organ. 1972;46:593–7.PubMedGoogle Scholar
  2. von Magnus  P, Andersen  E, Petersen  K, Birch-Andersen  A. A pox-like disease in Cynomolgus monkeys. Acta Pathol Microbiol Scand. 1959;46:156–76.
  3. Centers for Disease Control and Prevention. Update: multistate outbreak of monkeypox—Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003. MMWR Morb Mortal Wkly Rep. 2003;52:642–6.PubMedGoogle Scholar
  4. Arita  I, Jezek  Z, Khodakevich  L, Ruti  K. Human monkeypox: a newly emerged orthopoxvirus zoonosis in the tropical rain forests of Africa. Am J Trop Med Hyg. 1985;34:781–9.PubMedGoogle Scholar
  5. Guarner  J, Johnson  BJ, Paddock  CD, Shieh  WJ, Goldsmith  CS, Reynolds  MG, Monkeypox transmission and pathogenesis in prairie dogs. Emerg Infect Dis. 2004;10:426–31.PubMedGoogle Scholar
  6. Khodakevich  L, Jezek  Z, Kinzanzka  K. Isolation of monkeypox virus from wild squirrel infected in nature. Lancet. 1986;1:98–9. DOIPubMedGoogle Scholar
  7. Mutombo  M, Arita  I, Jezek  Z. Human monkeypox transmitted by a chimpanzee in a tropical rain-forest area of Zaire. Lancet. 1983;1:735–7. DOIPubMedGoogle Scholar
  8. Reed  KD, Melski  JW, Graham  MB, Regnery  RL, Sotir  MJ, Wegner  MV, The detection of monkeypox in humans in the Western Hemisphere. N Engl J Med. 2004;350:342–50. DOIPubMedGoogle Scholar
  9. Fleischauer  AT, Kile  JC, Davidson  M, Fischer  M, Karem  KL, Teclaw  R, Evaluation of human-to-human transmission of monkeypox from infected patients to health care workers. Clin Infect Dis. 2005;40:689–94. DOIPubMedGoogle Scholar
  10. Reynolds  MG, Yorita  KL, Kuehnert  MJ, Davidson  WB, Huhn  GD, Holman  RC, Clinical manifestations of human monkeypox influenced by route of infection. J Infect Dis. 2006;194:773–80. DOIPubMedGoogle Scholar
  11. Likos  AM, Sammons  SA, Olson  VA, Frace  AM, Li  Y, Olsen-Rasmussen  M, A tale of two clades: monkeypox viruses. J Gen Virol. 2005;86:2661–72. DOIPubMedGoogle Scholar
  12. Karem  KL, Reynolds  M, Braden  Z, Lou  G, Bernard  N, Patton  J, Characterization of acute-phase humoral immunity to monkeypox: use of immunoglobulin M enzyme-linked immunosorbent assay for detection of monkeypox infection during the 2003 North American outbreak. Clin Diagn Lab Immunol. 2005;12:867–72.PubMedGoogle Scholar
  13. Olson  VA, Laue  T, Laker  MT, Babkin  IV, Drosten  C, Shchelkunov  SN, Real-time PCR system for detection of orthopoxviruses and simultaneous identification of smallpox virus. J Clin Microbiol. 2004;42:1940–6. DOIPubMedGoogle Scholar
  14. Centers for Disease Control and Prevention. Update: multistate outbreak of monkeypox—Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003. MMWR Morb Mortal Wkly Rep. 2003;52:561–4.PubMedGoogle Scholar
  15. Hutson  CL, Lee  KN, Abel  J, Carroll  DS, Montgomery  JM, Olson  VA, Monkeypox zoonotic associations: insights from laboratory evaluation of animals associated with the multi-state US outbreak. Am J Trop Med Hyg. 2007;76:757–68.PubMedGoogle Scholar
  16. Xiao  SY, Sbrana  E, Watts  DM, Siirin  M, da Rosa  AP, Tesh  RB. Experimental infection of prairie dogs with monkeypox virus. Emerg Infect Dis. 2005;11:539–45.PubMedGoogle Scholar
  17. Kleinbaum  DG, Klein  M. Logistic regression, a self-learning text, 2nd ed. New York: Springer-Verlag; 2002.
  18. Advisory Committee for Immunization Practices (ACIP). Smallpox vaccine. MMWR Morb Mortal Wkly Rep. 1980;29:417–20.
  19. Anderson  MG, Frenkel  LD, Homann  S, Guffey  J. A case of severe monkeypox virus disease in an American child: emerging infections and changing professional values. Pediatr Infect Dis J. 2003;22:1093–6. DOIPubMedGoogle Scholar
  20. Sejvar  JJ, Chowdary  Y, Schomogyi  M, Stevens  J, Patel  J, Karem  K, Human monkeypox infection: a family cluster in the midwestern United States. J Infect Dis. 2004;190:1833–40. DOIPubMedGoogle Scholar
  21. Jezek  Z, Marennikova  SS, Mutumbo  M, Nakano  JH, Paluku  KM, Szczeniowski  M. Human monkeypox: a study of 2,510 contacts of 214 patients. J Infect Dis. 1986;154:551–5.PubMedGoogle Scholar
  22. Jezek  Z, Nakano  JH, Arita  I, Mutombo  M, Szczeniowski  M, Dunn  C. Serological survey for human monkeypox infections in a selected population in Zaire. J Trop Med Hyg. 1987;90:31–8.PubMedGoogle Scholar
  23. Jezek  Z, Grab  B, Paluku  KM, Szczeniowski  MV. Human monkeypox: disease pattern, incidence and attack rates in a rural area of northern Zaire. Trop Geogr Med. 1988;40:73–83.PubMedGoogle Scholar
  24. Hammarlund  E, Lewis  MW, Carter  SV, Amanna  I, Hansen  SG, Strelow  LI, Multiple diagnostic techniques identify previously vaccinated individuals with protective immunity against monkeypox. Nat Med. 2005;11:1005–11.PubMedGoogle Scholar
  25. Huhn  GD, Bauer  AM, Yorita  K, Graham  MB, Sejvar  J, Likos  A, Clinical characteristics of human monkeypox, and risk factors for severe disease. Clin Infect Dis. 2005;41:1742–51. DOIPubMedGoogle Scholar
  26. Edghill-Smith  Y, Venzon  D, Karpova  T, McNally  J, Nacsa  J, Tsai  WP, Modeling a safer smallpox vaccination regimen, for human immunodeficiency virus type 1–infected patients, in immunocompromised macaques. J Infect Dis. 2003;188:1181–91. DOIPubMedGoogle Scholar
  27. Edghill-Smith  Y, Bray  M, Whitehouse  CA, Miller  D, Mucker  E, Manischewitz  J, Smallpox vaccine does not protect macaques with AIDS from a lethal monkeypox virus challenge. J Infect Dis. 2005;191:372–81. DOIPubMedGoogle Scholar

Main Article

Page created: July 01, 2010
Page updated: July 01, 2010
Page reviewed: July 01, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external