2003 Midwest monkeypox outbreak

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2003 Midwest monkeypox outbreak
Map of USA Midwest.svg
The outbreak included Wisconsin, Indiana, Illinois, Ohio, Kansas, and Missouri as well as an additional case in the eastern state of New Jersey.
Disease Monkeypox
Virus strain"West African clade" [1]
SourceAfrican rodents (Gambian pouched rat, dormice, rope squirrels) housed with prairie dogs
Location Midwestern United States
Index case May 15, 2003
Confirmed cases71
Recovered71
Deaths
0
Fatality rate0%

An outbreak of human monkeypox (now known as mpox) began in May 2003 in the United States. By July, a total of 71 cases were found in six Midwestern states including Wisconsin (39 cases), Indiana (16), Illinois (12), Kansas (1), Missouri (2), and Ohio (1). The cause of the outbreak was traced to three species of African rodents (Gambian pouched rat, dormice, rope squirrels) imported from Ghana on April 9, 2003, into the United States by an exotic animal importer in Texas. These were shipped from Texas to an Illinois distributor, who housed them with prairie dogs, which then became infected.

Contents

The outbreak marked the first time monkeypox infection appeared in the Western Hemisphere. No deaths were reported, and no human-to-human transmission was found. All cases involved direct contact with infected prairie dogs. Electron microscopy and testing by polymerase chain reaction and immunohistochemistry were used to confirm the causative agent was human monkeypox. [2] [3]

Timeline

In May, 2003, a three-year-old Wisconsin resident was bitten by a prairie dog purchased from a local pet store. [4] The child was hospitalized after developing fever of unknown origin (103 °F (39 °C)), swollen eyes, and a red vesicular skin rash. The child's parents also developed a rash, but no other symptoms. [5] Physicians immediately associated the symptoms with the animal bite and reported the case to the Milwaukee Health Department. Testing of both the child and the prairie dog confirmed the monkeypox virus as the causative agent. [6]

Between May 15, 2003, when the three-year-old index patient was first diagnosed through June 20, the date of the last patient with a laboratory-confirmed case of monkeypox, a total of 71 people ranging in age from 1 to 51 were infected. [3]

Source

Gambian pouched rat receiving food reward Food Reward.JPG
Gambian pouched rat receiving food reward

On April 9, 2003, a Texas importer received a shipment of 762 African rodents from Accra, Ghana, which included rope squirrels (Funiscuirus sp.), tree squirrels (Heliosciurus sp.), Gambian pouched rats (Cricetomys sp.), African brush-tailed porcupine (Atherurus sp.), dormice (Graphiurus sp.), and striped mice (Hybomys sp.). Of these 762 rodents, 584 (77%) were shipped to distributors in six US states: Texas (9), New Jersey (1), Iowa (1), Japan (1), Illinois (2), Minnesota (1) and Wisconsin (1). The remaining 178 (23%) rodents could not be traced due to lack of documentation. CDC laboratory testing of animals from this shipment confirmed monkeypox by PCR and virus isolation in one Gambian rat, three dormice, and two rope squirrels. [3]

Illinois distributor number one received Gambian rats and dormice and housed the rodents with 200 prairie dogs. This distributor shipped prairie dogs to pet stores in Wisconsin, Illinois, Indiana, Missouri, Kansas, South Carolina, and Michigan. No human cases of monkeypox were reported in Japan, Michigan, and South Carolina. Laboratory-confirmed cases occurred only in Kansas (1), Missouri (2), Indiana (16), Illinois (12), and Wisconsin (22). [3]

Of the 200 prairie dogs housed with the Gambian rats and dormice, 93 tested positive for monkeypox virus, including prairie dogs in pet stores in Wisconsin (42 cases), Indiana (24), Illinois (14), Kansas (1), Missouri (1), and one case in the eastern seaboard state of New Jersey. The Gambian rats and dormice housed with the prairie dogs at Illinois distributor number one tested positive for monkeypox virus. [3]

The most recent incidence of monkeypox prior to the Midwest outbreak occurred in the Democratic Republic of the Congo in 1996–1997, with a reported 88 cases. [7] No deaths occurred in the Midwest outbreak. This was attributed to the prompt medical care received and the standard of living in the United States, which includes soap, running water, washing machines, sterile dressing materials, and hospital use of universal precautions, including isolation, gown, mask, gloves, and handwashing. [8]

Transmission

No human-to-human transmission was found during this outbreak. All cases were found to be the direct result of contact with infected prairie dogs. [3]

Signs and symptoms

The onset of the illness among affected persons in the United States began in early May 2003. People typically experienced fever, headaches, muscle aches, chills, and nonproductive coughs, followed 1–10 days later by a generalized papular rash which developed first on the trunk, then limbs and head. The papules evolved through phases of vesiculation, pustulation, umbilication, and crusting. All persons reported direct or close contact with recently acquired prairie dogs. [9]

Treatment

As no direct antiviral treatment for monkeypox was known, only supportive care and prevention of secondary infection was recommended. [10]

Use of smallpox vaccine

In the Midwest outbreak, the CDC issued guidance on the use of smallpox vaccine, Cidofovir, and Vaccinia immune globulin. Thirty residents in six states received the smallpox vaccination. This included 28 adults and two children. Vaccine was given before exposure to seven persons (three veterinarians, two laboratory workers, and two health-care workers) and after exposure to 23 persons (10 health-care workers, seven household contacts, three laboratory workers, one public health veterinarian, one public health epidemiologist, and one work contact). Three (10%) reported rash within 2 weeks of vaccination. [3]

Further action

To prevent monkeypox virus from entering into the United States again, the Centers for Disease Control banned the importation of implicated African rodents. [3] The U.S. Food and Drug Administration issued orders banning the interstate shipment of prairie dogs and all African rodents. [11] The bans were later lifted in 2008. [12]

See also

Related Research Articles

<span class="mw-page-title-main">Mpox</span> Viral disease of humans and animals

Mpox is an infectious viral disease that can occur in humans and other animals. Symptoms include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes. The illness is usually mild, and most of infected individuals recover within a few weeks without treatment. The time from exposure to the onset of symptoms ranges from five to twenty-one days, and symptoms typically last from two to four weeks. However, cases may be severe, especially in children, pregnant women, or people with suppressed immune systems.

<i>Monkeypox virus</i> Species of double-stranded DNA virus

The monkeypox virus is a species of double-stranded DNA virus that causes mpox disease in humans and other mammals. It is a zoonotic virus belonging to the Orthopoxvirus genus, making it closely related to the variola, cowpox, and vaccinia viruses. MPV is oval, with a lipoprotein outer membrane. The genome is approximately 190 kb. Smallpox and monkeypox viruses are both orthopoxviruses, and the smallpox vaccine is effective against mpox if given within 3–5 years before the disease is contracted. Symptoms of mpox in humans include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes. The virus is transmissible between animals and humans by direct contact to the lesions or bodily fluids. The virus was given the name monkeypox virus after being isolated from monkeys, but most of the carriers of this virus are smaller mammals.

<span class="mw-page-title-main">2022–2023 mpox outbreak in the United Kingdom</span> Ongoing viral outbreak

The 2022–2023 mpox outbreak in the United Kingdom is part of the larger outbreak of human mpox caused by the West African clade (type) of the monkeypox virus. The United Kingdom was the first country, outside of the endemic African areas, to experience an outbreak. As of 22 July 2022, there were 2,208 confirmed cases in the United Kingdom, with 2,115 in England, 54 in Scotland, 24 in Wales, and 15 in Northern Ireland.

<span class="mw-page-title-main">2022–2023 mpox outbreak in the United States</span> Ongoing viral outbreak

The 2022–2023 mpox outbreak in the United States is part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. The United States was the fourth country outside of the African countries with endemic mpox, to experience an outbreak in 2022. The first case was documented in Boston, Massachusetts, on May 17, 2022. As of August 22, mpox has spread to all 50 states in the United States, as well as Washington, D.C., and Puerto Rico. The United States has the highest number of mpox cases in the world. California has the highest number of mpox cases in the United States.

<span class="mw-page-title-main">2022–2023 mpox outbreak in Canada</span> Ongoing viral outbreak

The 2022–2023 mpox outbreak in Canada is a part of the outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak started in Canada on May 19, 2022, with the country since then becoming one of the most affected in the Americas.

The 2022–2023 mpox outbreak in Portugal is part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. Portugal was the third country, outside of the African countries with endemic mpox, to experience an outbreak in 2022.

The 2022–2023 mpox outbreak in Italy is part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. Italy was the sixth country, outside of the African countries with endemic mpox, to experience an outbreak in 2022. The first case was documented in Rome, Italy, on May 19, 2022. As of August 5th, Italy has 505 cases.

The 2022 – 2023 mpox outbreak in France is part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. France had its first case on 20 May 2022.

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The 2022–2023 mpox outbreak in Australia is a part of the outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak reached Australia on 20 May 2022. By 28 October 2022 there were over 140 confirmed cases. The Chief Medical Officer of Australia stood down the country's Communicable Disease Incident of National Significance declaration on 25 November 2022.

The 2022–2023 mpox outbreak in Israel is a part of the ongoing outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak was first reported in Israel on 20 May 2022 when the Health Ministry announced a suspected case which was confirmed on 21 May 2022. One month later, on 21 June, the first locally transmitted case was reported.

The 2022–2023 mpox outbreak in Switzerland is a part of the outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak started in Switzerland on 19 May 2022, with the country since then becoming one of the most affected in Europe.

The 2022–2023 mpox outbreak in Austria is part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. Austria is the fifteenth country outside of Africa to experience an endemic mpox outbreak. The first case was reported in Vienna, Austria, on 22 May 2022. As of 2 December, Austria has confirmed a total of 327 cases.

<span class="mw-page-title-main">2022–2023 mpox outbreak in Mexico</span> Ongoing viral outbreak

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The 2022–2023 mpox outbreak in Brazil is a part of the ongoing outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak was first reported in Brazil on 9 June 2022 when a man in São Paulo was registered as the country's index case.

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<span class="mw-page-title-main">2022–2023 mpox outbreak in Chile</span> Ongoing viral outbreak

The 2022–2023 mpox outbreak in Chile is a part of the outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak reached Chile on 17 June 2022.

The 2022–2023 mpox outbreak in Ghana is a part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. As opposed to its West African neighbours, Ghana had no endemic presence of mpox, only experiencing it during the 2022 outbreak. The first 5 cases of mpox in Ghana was detected on June 8, 2022.

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References

  1. ↑ Osorio, J.E.; Yuill, T.M. (2008). "Zoonoses". Encyclopedia of Virology. pp. 485–495. doi:10.1016/B978-012374410-4.00536-7. ISBN   9780123744104. S2CID   214756407.
  2. ↑ "Medscape Monkeypox Review". Bcbsma.medscape.com. Retrieved 2013-03-22.
  3. 1 2 3 4 5 6 7 8 Centers for Disease Control and Prevention (CDC) (2003-07-11). "Update: multistate outbreak of monkeypox--Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003". MMWR. Morbidity and Mortality Weekly Report. 52 (27): 642–646. ISSN   0149-2195. PMID   12855947.Centers for Disease Control (CDC), Morbidity and Mortality Weekly Report. Atlanta, Georgia. (MMWR) July 11, 2003. (52) 27; 642-646.
  4. ↑ Spice, Linda (6 June 2003). "13 Sick After Prairie Dog Contact; Milwaukee Pet Store Employee, Two Others Remain Hospitalized". Milwaukee Journal Sentinel . Archived from the original on 9 October 2003. Retrieved 31 May 2022. Cited Here Archived 17 October 2020 at the Wayback Machine (PDF)
  5. ↑ Todd Richmond. Four Get Monkeypox Virus from Prairie Dogs." Associated Press. 6/11/2003.
  6. ↑ Ligon, B.Lee (2004). "Monkeypox: A review of the history and emergence in the Western hemisphere". Seminars in Pediatric Infectious Diseases. 15 (4). Elsevier BV: 280–287. doi:10.1053/j.spid.2004.09.001. ISSN   1045-1870. PMC   7129998 . PMID   15494953.
  7. ↑ Y.J.F. Hutin, R.J. Williams, P. Malfait, et al., Outbreak of Human Monkeypox, Democratic Republic of Congo, 1996-1997. Emerging Infectious Diseases, 7(3) May–June 2001.
  8. ↑ Todd Richmond. Four Get Monkeypox Virus from Prairie Dogs. Associated Press. June 11, 2003.
  9. ↑ Anderson MG, Frenkel LD, Homann S, and Guffey J. (2003), "A case of severe monkeypox virus disease in an American child: emerging infections and changing professional values"; Pediatr Infect Dis J ;22(12): 1093–1096; discussion 1096–1098.
  10. ↑ Rizk, John G.; Lippi, Giuseppe; Henry, Brandon M.; Forthal, Donald N.; Rizk, Youssef (2022). "Prevention and Treatment of Monkeypox". Drugs. 82 (9). Springer Science and Business Media LLC: 957–963. doi:10.1007/s40265-022-01742-y. ISSN   0012-6667. PMC   9244487 . PMID   35763248.
  11. ↑ "Bringing an Animal into U.S." CDC. 2019-02-19. Retrieved 2024-06-29.
  12. ↑ "Federal Register, Volume 73 Issue 174 (Monday, September 8, 2008)".
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