Wis. Family Quarantined for Monkeypox

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But that's just where Tammy Kautzer is biding her time with her husband and 3-year-old daughter, quarantined after suffering a bout with suspected monkeypox linked to the burrowing rodents.

"They said we can't leave until the scabs fall off the sores," said Kautzer, 28, of nearby Dorchester in central Wisconsin. "I only have a few more scabs to fall off. My daughter's are gone."

Health officials were working to contain the spread of the monkeypox virus, which is related to smallpox and apparently never before found in the Western Hemisphere.

The disease in humans is not usually fatal but causes rashes, fevers, chills and sores

In all, 33 cases of monkeypox are either suspected or have been confirmed in three Midwest states. In Wisconsin, 16 cases are suspected and three were confirmed; health officials have not identified who the confirmed cases are.

Thirteen cases are suspected in Indiana. And in Illinois, there are four suspected and one confirmed case.

Investigators say a shipment of prairie dogs likely was infected with the virus by a giant Gambian rat, which is indigenous to Africa, at a Chicago-area pet distributor, Phil's Pocket Pets. Federal and state health officials were trying to track down 115 customers - both individuals and pet stores - that bought animals since April 15 from the business.

The U.S. Centers for Disease Control and Prevention could not say how many people or animals may have come in contact with the virus.

The distributor, Phillip Moberley, said Monday that he voluntarily quarantined his home-based business and has destroyed 70 prairie dogs. A 24-year-old employee of Moberley's was Illinois' confirmed monkeypox case.

In Wisconsin, state officials had accounted for two-thirds of the 30 prairie dogs shipped to the state and issued two more quarantines barring people from moving mammals on their property to help stem the spread. Health officials also issued an emergency order banning the sale, importation and display of prairie dogs.

Eileen Whitmarsh, who fell ill after handling an infected prairie dog at her suburban Milwaukee pet store, said at first one of the animals just seemed fatigued. But then the symptoms spread to another prairie dog in the store.

"Nobody knew. Everybody thought, 'Oh, just a prairie dog not feeling well,'" Whitmarsh said.

Kautzer said she bought her two 6- to 8-week-old prairie dogs at a Mother's Day event in Wausau for $95 apiece. Two days later, the eyes of one crusted over and swelled up.

"I figured it had a cold," she said Monday in a telephone interview from her home. By then, she said, the animal had bitten her daughter on the finger.

Kautzer eventually took the animal to a veterinarian, who diagnosed a swollen lymph node. Then her daughter began running a 103-degree fever - and the prairie dog died May 20.

"I just threw it in the garbage. I didn't think nothing of it," Kautzer said.

That day, she took her daughter to a doctor and mentioned the bite. "That started a scare, especially since they found it had died," she said.

Health professionals had her retrieve the animal's body for testing.

By May 22, her daughter was admitted to a hospital; the child began feeling better by the fourth day. The quarantine of the Kautzer home and five-acre hobby farm was ordered last Friday.

The second prairie dog - named Chuckles - also got sick but is recovering and is being kept in a pet carrier, she said. Health officials will decide his fate.

"Why get rid of it because it caught something like we caught something? It is not its fault that it caught it from a rat," Kautzer said.

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Symptoms can be accompanied by diarrhea, swollen lymph nodes, a sore throat and mouth sores. In some cases, a victim may experience trouble breathing. Symptoms are at their worst for 3 to 7 days, after which the fever lessens and blisters begin to form crusts.

Monkeypox is a viral disease with a clinical presentation in humans similar to that seen in the past in smallpox patients. Smallpox no longer occurs, following its worldwide eradication in 1980, whereas monkeypox is still seen as a sporadic disease in parts of Africa.

The virus responsible for monkeypox is related to the virus that used to cause smallpox (both are orthopoxviruses). Vaccination against smallpox (no longer necessary) also gave protection against monkeypox. Before the eradication of smallpox, vaccination was widely practiced and protected against both diseases. However, children born after 1980 have not been vaccinated against smallpox and are likely to be more susceptible to monkeypox than older members of the population. The death rate from monkeypox is highest in young children, reaching about 10%.

Most cases occur in remote villages of Central and West Africa close to tropical rainforests where there is frequent contact with infected animals. Monkeypox is usually transmitted to humans from squirrels and primates through contact with the animal's blood or through a bite.

Following reports of ongoing cases of human monkeypox in the Democratic Republic of the Congo ("DRC", formerly Zaire) representing a new pattern of the disease, the Ministry of Health in DRC and the World Health Organization (WHO) organized two investigations in February and October 1997.

In the past, an outbreak of monkeypox in DRC would have been limited to the village and would not last long because it did not spread extensively after the first patients recovered. However, the present study indicates that monkeypox disease is changing its pattern of infection in humans. The outbreak had a much higher rate of person-to-person transmission than seen previously, and spread through many generations of transmission, thus maintaining the outbreak for more than a year.

Previous studies over a twenty-year period had shown that the rate of transmission of monkeypox within households was low, suggesting that the disease had a low potential for transmission from person to person. Outbreaks were generally self-limiting after one or two sequential transmissions. However, the two recent WHO studies have to-date shown that:

  • The outbreak in DRC presents the largest cluster of monkeypox cases - albeit with less severe clinical disease ever reported: 511 suspect cases were identified with onset of disease between February 1996 and October 1997; some of these suspect cases are thought to be chickenpox and laboratory confirmation studies are underway.

  • The proportion of suspect cases who were 16 years of age or older (21%) was higher than previously reported (8%). Young children had mostly been affected in previous outbreaks.

  • The percentage of suspect cases from person to person transmission (78%) was higher than previously reported (30%). This was associated with the clustering of cases in household compounds and prolonged chains of transmission from person to person.

  • Secondary attack rates among contacts of primary cases (those thought to be infected by animal contact) have been calculated, on a preliminary basis, at 8%, which is similar to secondary attack rates of 4-12% estimated in Zaire in the early 1980s.

  • The proportion of deaths (2%) was lower than previously reported (10%); all were aged under eight years and died within three weeks of disease onset.

The ending of vaccination programs against smallpox in the late 1970's has probably led to an increase in susceptibility to monkeypox and could explain the larger size of the most recent outbreak, the higher proportion of patients aged 15 and over, and the spread through many generations of transmission.

WHO is concerned that monkeypox could pose a public health problem in this region of DRC and therefore vigilance must be maintained by strengthening detection systems for monkeypox and completely investigating future outbreaks.

Further WHO studies are planned in the region to determine the need for additional risk-reduction measures.

In May 1996, the 49th World Health Assembly decided that the last remaining stock of smallpox virus held in two research centers in the Russian Federation and the United States of America should be destroyed as the last step in the complete and final global elimination of smallpox. It also decided that WHO would keep 500 000 doses of smallpox vaccine (which is also effective against monkeypox). The smallpox vaccine seed virus (vaccinia virus strain Lister Elstrea) will be maintained in the WHO Collaborating Centre on Smallpox Vaccine at the National Institute of Public Health and Environmental Protection in Bilthoven, Netherlands, so that new stocks of vaccine can be produced if needed.

Source: http://www.who.int/inf-fs/en/fact161.html

Pet Safety

Pet owners who suspect their animal may have an illness compatible with monkeypox should immediately isolate the animal from humans and other animals and contact their state or local health department. In most cases, evaluation by a veterinarian will be recommended. Owners should notify the veterinarian before transporting the animal to the clinic so that appropriate infection control precautions can be implemented prior to arrival.

Owners should consider wearing a mask and gloves when handling the animal. The animal’s bedding should be collected and bagged and brought with the animal to the veterinary clinic for disposal as medically regulated waste. Soiled bedding should not be disposed of as household trash. Following identification of an animal with suspect monkeypox in a household, any animals (including dogs and cats) who may have come in contact with the sick animal should be closely observed for signs of illness for a period of one month following the last date of exposure. Contaminated household surfaces should be cleaned and disinfected. Standard household cleaning/disinfectants may be used in accordance with manufacturer’s instructions.

Source: http://www.cdc.gov (Center for Disease Control Web site) contributed to this report.