FW: Health Questions & Answers #41 ~ [Issue 0603-4]

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Health Questions & Answers #41 ~ [issue 0603-4]

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Questions and Answers About " Monkeypox "

What is monkeypox?

Monkeypox is a rare viral disease that occurs mainly in the rain

forest countries of central and west Africa. The disease was first

discovered in laboratory monkeys in 1958. Blood tests of animals in

Africa later found evidence of monkeypox infection in a number of

African rodents. The virus that causes monkeypox was recovered from

an African squirrel, which may be the natural host. Laboratory

studies showed that the virus also could infect mice, rats, and

rabbits. In 1970, monkeypox was reported in humans for the first

time. In June 2003, monkeypox was reported in prairie dogs and humans

in the United States.

What is the cause of monkeypox?

Monkeypox is caused by Monkeypox virus, which belongs to the

orthopoxvirus group of viruses. Other orthpoxviruses that cause

infections in humans include variola (smallpox), vaccinia (used for

smallpox vaccine), and cowpox viruses.

What are the clinical features of monkeypox?

In humans, monkeypox is similar to smallpox, although it is often

milder. Unlike smallpox, monkeypox causes lymph nodes to swell

(lymphadenopathy). The incubation period for monkeypox is about 12

days (range 7 to 17 days).The illness begins with fever, headache,

muscle aches, backache, swollen lymph nodes, a general feeling of

discomfort, and exhaustion. Within 1 to 3 days (sometimes longer)

after the appearance of fever, the patient develops a papular rash

(i.e., raised bumps), often first on the face but sometimes initially

on other parts of the body. The lesions usually develop through

several stages before crusting and falling off.

How long does monkeypox last?

The illness typically lasts for 2 to 4 weeks.

Is monkeypox fatal?

Studies of human monkeypox in rural central and west Africa - where

people live in remote areas and are medically underserved - have

reported case-fatality ratios of 1% to 10%.

How do people get monkeypox?

Monkeypox can spread to humans from an infected animal through an

animal bite or direct contact with the animal's lesions or body

fluids. The disease also can be spread from person to person,

although it is much less infectious than smallpox. The virus is

thought to be transmitted by respiratory droplets during direct and

prolonged face-to-face contact. In addition, it is possible monkeypox

can be spread by direct contact with body fluids of an infected

person or with virus-contaminated objects, such as bedding or clothing.

Is there a treatment or vaccine for monkeypox?

Currently, there is no proven, safe treatment for monkeypox. Smallpox

vaccine has been reported to reduce the risk of monkeypox among

previously vaccinated persons in Africa. The United States Centers

for Disease Control and Prevention (CDC) is recommending that persons

investigating monkeypox outbreaks and involved in caring for infected

individuals or animals should receive a smallpox vaccination to

protect against monkeypox. Persons who have had close or intimate

contact with individuals or animals confirmed to have monkeypox

should also be vaccinated. These persons can be vaccinated up to 14

days after exposure. CDC is not recommending preexposure vaccination

for unexposed veterinarians, veterinary staff, or animal control

officers, unless such persons are involved in field investigations.

Monkeypox in the United States

Where has human monkeypox been reported in the United States?

As of June 14, 2003, a total of 81 persons with suspected monkeypox

had been reported in Wisconsin (34), Illinois (19), Indiana (26), and

Ohio (2). Monkeypox had been confirmed by laboratory tests in nine

persons. At least 14 of the people with suspected monkeypox had been

hospitalized for their illness; there have been no deaths related to

the outbreak. The number of cases and states involved in the outbreak

will likely change as the investigation continues. For the monkeypox

case definition and other current information about the outbreak,

visit the CDC web site at: http://www.cdc.gov/ncidod/monkeypox/

How did these people become infected with monkeypox virus?

On the basis of preliminary investigations, it appears that most of

the patients became ill after having close contact with infected

prairie dogs that had been purchased as pets. Traceback

investigations have found a common distributor of exotic pets where

prairie dogs and Gambian giant rats were housed together in Illinois.

The Gambian rats were shipped to the United States from Ghana. The

shipment contained a large number of other small mammals that might

have been the actual source of monkeypox. In addition, the

possibility of human-to-human transmission in some cases cannot be

excluded at this time.

What evidence is there that monkeypox virus causes these illnesses?

The clinical features of the illness in U.S. patients - fever,

headache, muscle aches, and rash - are consistent with those of

monkeypox. There is also strong laboratory evidence of monkeypox.

Scientists at the Marshfield Clinic in Marshfield, Wisconsin,

recovered viral isolates from a patient and a prairie dog. Using an

electron microscope, they found that the virus had the size and

appearance of a poxvirus (see for electron microscopy images).

Laboratory tests at CDC - including several PCR-based assays,

serologic tests, electron microscopy, immunohistochemistry, and gene

sequencing - confirmed these results and showed that the virus is

Monkeypox virus.

Has monkeypox previously been reported in the United States?

No. Prior to the recent report of the disease in the United States,

community-acquired monkeypox had never been reported outside of Africa.

How was monkeypox introduced in the United States?

There is not enough information to determine with certainty how

monkeypox arrived in the United States. One hypothesis is that the

prairie dogs contracted the virus from infected dormice, rope

squirrels, or Gambian giant rats, which were housed in the same

animal-holding facility or pet shop as the prairie dogs. The Gambian

giant rats were likely imported into the United States from Africa.

Studies have shown that Gambian rats and other rodents in Africa have

evidence of monkeypox virus infection.

What should people do if they think they have been exposed to an

animal or person with monkeypox?

Persons who think they may have been exposed to a person or an animal

(e.g., pet prairie dog) with monkeypox should contact their health

care provider and their state or local health department.

Could I have monkeypox?

It appears that most people who are ill with monkeypox in the United

States got sick after close contact with infected prairie dogs that

had been purchased as pets. Some patients may have been infected

through contact with other infected animals, including a Gambian

giant rat (purchased as an exotic pet) and a rabbit. If you have not

had close contact with an exotic animal then the risk that you might

have monkeypox if very low.

What measures have been taken to control the outbreak?

The CDC and the public health departments in the affected states,

together with the US Department of Agriculture, the Food and Drug

Administration, and other agencies, are participating in a variety of

activities to prevent further spread of monkeypox and identify the

source of the outbreak.

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Please note: the information contained herein

has been compiled from various sources. The

above statements have not been evaluated by the

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