Volume 13, Number 9—September 2007
Research
Spectrum of Infection and Risk Factors for Human Monkeypox, United States, 2003
Table 3
Characteristic | Case-patients, no. (%) | Controls, no. (%) | OR (95% CI) | aOR (95% CI) |
---|---|---|---|---|
Smallpox vaccination | ||||
Yes | 6 (20.0) | 15 (53.6) | 0.2 (0.1–0.7) | |
No | 24 (80.0) | 13 (46.7) | ||
Age, y† | ||||
<18 | 10 (33.3) | 7 (25.0) | 1.5 (0.5–4.7) | 0.6 (0.2–2.4) |
>18 | 20 (66.7) | 21 (75.0) | ||
Sex | ||||
Female | 17 (56.7) | 16 (57.1) | 1.0 (0.3–2.8) | 0.9 (0.3–2.7) |
Male |
13 (43.3) |
12 (42.9) |
||
Type of exposure to prairie dog(s) | ||||
Animal as pet | ||||
Yes | 17 (56.7) | 9 (32.1) | 2.8 (0.9–8.1) | 2.4 (0.8–7.4) |
No | 13 (43.3) | 19 (67.9) | ||
Daily exposure while animal was ill | ||||
Yes | 23 (76.7) | 13 (46.4) | 3.8 (1.2–11.7) | 4.0 (1.2–13.4) |
No | 7 (23.3) | 15 (53.6) | ||
Touched rash or eye crusts | ||||
Yes | 18 (60.0) | 11 (39.3) | 2.3 (0.8–6.6) | 2.2 (0.7–6.7) |
No | 12 (40.0) | 17 (60.7) | ||
Scratched‡ | ||||
Yes | 9 (30.0) | 2 (7.1) | 5.6 (1.1–28.6) | 3.9 (0.7–21.1) |
No | 21 (70.0) | 26 (92.9) | ||
Cleaned cage/touched bedding | ||||
Yes | 14 (46.7) | 4 (14.3) | 5.3 (1.5–18.9) | 5.3 (1.4–20.7) |
No | 16 (53.3) | 24 (85.7) | ||
Proximity, no touching§ | ||||
Yes | 12 (40.0) | 7 (25.0) | 2.0 (0.6–6.2) | 2.0 (0.6–6.5) |
No | 18 (60.0) | 21 (75.0) | ||
Direct exposure¶ | ||||
Yes | 23 (76.7) | 13 (46.4) | 3.8 (1.2–11.7) | 4.0 (1.2–13.4) |
No | 7 (23.3) | 15 (53.6) |
*OR, odds ratio; CI, confidence interval; aOR, adjusted OR. The aORs and 95% CIs were adjusted for history of (>1) smallpox vaccination at any time during case-patient’s life.
†Routine immunization was stopped in the United States in 1972 (18), persons <33 years of age at the time of the outbreak were unlikely to have received prior smallpox vaccination.
‡Scratched with a break in the skin.
§Came within 6 feet of the prairie dog but never touched it.
¶Direct exposure to an infected animal included having touched the animal or having received a bite or scratch from it sufficient to break the skin.
References
- 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
- 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.
- 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
- 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
- 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
- Khodakevich L, Jezek Z, Kinzanzka K. Isolation of monkeypox virus from wild squirrel infected in nature. Lancet. 1986;1:98–9. DOIPubMedGoogle Scholar
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Kleinbaum DG, Klein M. Logistic regression, a self-learning text, 2nd ed. New York: Springer-Verlag; 2002.
- Advisory Committee for Immunization Practices (ACIP). Smallpox vaccine. MMWR Morb Mortal Wkly Rep. 1980;29:417–20.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
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