Monkeypox Prompts Voluntary Quarantine

Wisconsin residents who may have virus stay home

(HealthDay is the new name for HealthScoutNews.)

TUESDAY, June 10, 2003 (HealthDayNews) -- Twenty Wisconsin residents are under voluntary quarantine out of concern they may have monkeypox, state health officials say.

Four of those cases so far have been confirmed and one person is hospitalized with the illness. At least 17 others in Illinois and Indiana may also have human monkeypox, which is making its first appearance in the Western hemisphere.

Almost all of the victims have handled pet prairie dogs infected with monkeypox. One came into contact with a rabbit that had been infected by a sick prairie dog.

A spokesman for the U.S. Department of Agriculture said he couldn't confirm published reports that an exotic pet dealer in northern Illinois was the source of the outbreak. The spokesman, Jim Rogers, said that dealer is among several under investigation in Wisconsin, Illinois, Texas, and other states. Officials are investigating whether an infected Gambian giant pouched rat appears to have transmitted the virus to a batch of prairie dogs, which were then sent to stores and pet swaps across the country.

Kathy Harben, a spokeswoman for the U.S. Centers for Disease Control and Prevention, which is leading the investigation into the outbreak, said officials expect the number of cases to climb. So far, seven people have been hospitalized but none has died.

Monkeypox and smallpox belong to the orthopoxvirus family of microbes, and the smallpox vaccine protects against both infections. Since smallpox vaccinations were discontinued more than 20 years ago, younger people are more likely to contract monkeypox and are more vulnerable to serious illness.

First seen in 1970, human monkeypox causes a skin rash similar to that found with smallpox. It also leads to fever and swollen lymph glands. While none of the people in the latest outbreak has died, the death rate from the disease in Africa has reached as high as 10 percent, about one-third the fatality rate from smallpox.

The virus can be spread through bites and close contact with infected animals and people. However, no person-to-person transmission is thought to have occurred in the current outbreak, officials say.

The largest outbreak of monkeypox ever recorded occurred in the Democratic Republic of the Congo (formerly Zaire) in 1996 and 1997, when 511 people fell ill. Of those, 2 percent died. All were children under the age of 8, according to the World Health Organization.

Dr. Joel Breman, a monkeypox expert at the National Institutes of Health's Fogarty International Center in Bethesda, Md., said many of the victims in the Congo outbreak likely had chicken pox, bringing down the death rate.

It isn't clear why anyone in the United States hasn't died of monkeypox, he said.

"I think it's a combination of better, quicker, and more comprehensive medical care [in this country]," Breman said. "And then there's a high possibility that a lot of the patients here may have had just a few lesions on the hand, rather than the respiratory-acquired infection, which seems to spread into a more generalized reaction."

Breman is part of a hastily organized panel of experts who are helping the CDC draft guidelines for how health workers and the public should deal with the threat of monkeypox.

Dr. Mark Wegner, chief of communicable diseases for the Wisconsin Department of Health and Family Services in Madison, said the patients in his state are being asked to stay isolated from others until their rash scabs fall off, or until they go 10 days from falling ill without developing a rash.

Wisconsin officials first suspected a problem with prairie dogs on Memorial Day, when a person who'd been bitten by one fell ill, Wegner said. The initial concern was bubonic plague or tularemia -- also known as rabbit fever -- which are occasionally seen with the animals. Those diseases were ruled out, however, and when a second patient appeared on June 3, the investigation quickened.

Health officials briefly feared a potential outbreak of smallpox, but the CDC identified the virus as monkeypox last weekend.

Monkeypox has no treatment beyond steps to make patients more comfortable -- giving fluids, reducing fevers. "No one has had an illness that hasn't resolved on its own," Wegner said.

Last Friday, Wisconsin enacted an emergency measure banning the sale, display, or importation of prairie dogs. The state is also urging residents with sick animals to bring them to a veterinarian or animal shelter for euthanizing. Owners of healthy prairie dogs may keep them, Wegner said, though "it's not a practice that we condone. They're not native to Wisconsin. Introducing them to this habitat could be a dangerous thing."

The exotic pet market is a loosely regulated trade, covered in patches by various state and federal rules. It is legal, for example, to own an endangered tiger, as long as one has the proper permit, said Rogers, the spokesman for the USDA, which is helping the CDC track the affected animals.

The USDA regulates the sale of exotic pets, such as how they are held and fed in stores. "We have no authority over people's pets, but if someone is selling you one we have authority over the seller," Rogers said.

More information

Try the World Health Organization or the Centers for Disease Control and Prevention to learn more about monkeypox.

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