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Interim Case Definition for Animal Cases of Monkeypox

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Clinically Compatible Illness

Rash (macular, papular, vesicular, or pustular; generalized or localized; discrete or confluent)
Other possible signs and symptoms:

• Conjunctivitis
• Coryza
• Cough
• Anorexia
• Lethargy

Epidemiological Criteria

• Originating from the shipment of rodents from Ghana to Texas on April 9, 2003 (i.e., Gambian giant rats, rope squirrels, tree squirrels, striped mice, brush-tailed porcupines, and dormice)
• Originating from a pet holding facility where wild or exotic mammalian pets¹ with suspect, probable, or confirmed monkeypox have been reported.
• Exposure² to a wild or exotic mammalian pet that has been diagnosed with suspect, probable, or confirmed monkeypox.
• Exposure² to a suspect, probable, or confirmed human case of monkeypox.

Laboratory Criteria

• Isolation of monkeypox virus in culture
• Demonstration of monkeypox virus DNA by polymerase chain reaction testing in a clinical specimen
• Demonstration of virus morphologically consistent with an orthopoxvirus by electron microscopy in the absence of exposure to another orthopoxvirus
• Demonstration of presence of orthopox virus in tissue using immunohistochemical testing methods in the absence of exposure to another orthopoxvirus.

Case Classification

Suspect Case

• Meets one of the epidemiologic criteria, AND
• Rash OR two or more other signs or symptoms

Probable Case

• Meets one of the epidemiologic criteria, AND
• Rash AND two or more other signs or symptoms

Confirmed Case

• Meets one of the epidemiologic criteria, AND
• Rash AND two or more other signs and symptoms, AND
• Meets one of the laboratory criteria

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¹ Wild or exotic mammalian pets include prairie dogs, Gambian giant rats, rope squirrels, tree squirrels, striped mice, and dormice. Exposure to other exotic or non-exotic mammalian pets will be considered on a case-by-case basis; assessment should include the likelihood of contact with a mammal with monkeypox and the compatibility of clinical illness with monkeypox.
² Exposure includes living in a household as a human or a wild or exotic mammalian pet with monkeypox, or originating from the same pet holding facility as a wild or exotic mammalian pet with monkeypox.

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