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Interim Guidance to State and Local Governments for the Removal of State- and Locally Imposed Quarantine Orders and the Euthanasia of Animals Affected by the Monkeypox Outbreak

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The Centers for Disease Control and Prevention (CDC) has been working closely with several state and local health departments and other partners to investigate cases of monkeypox virus infections among persons who had direct or close contact with ill prairie dogs. Exposures of interest to these ill animals occurred after April 15, 2003.

Monkeypox is a rare viral disease that typically occurs among animals and humans in central and west Africa. In humans, the illness produces a blister-like rash similar to that of smallpox. Time from contact with a sick animal to the beginning of fever in a person is usually about 12 days. During the current outbreak of monkeypox in the United States, most infected persons have had illness that was relatively mild to moderate in severity, and there have been no deaths. However, the disease can be severe, and in Africa about 1% to 10% of human cases are fatal. (For additional information about monkeypox, see this EID article.)

This document provides interim guidance for state and federal officials who have issued quarantine orders restricting the movement of animals that may have been exposed to monkeypox virus.

Background and Rationale for Recommendations

During the emergency response to monkeypox, CDC and the Food and Drug Administration issued a joint order banning the importation of African rodents and the sale and movement of involved animals). On November 4, 2003, the joint order was replaced by an interim final rule which maintains the bans on importation of African rodents and the sale, distribution, transport, and release into the environment as previously described. In addition, CDC recommended that states place quarantines or hold orders on 1) premises with infected animals (Infected Premises); 2) premises that received African rodents from a particular shipment (from Ghana to Texas on April 9, 2003) of imported animals that was identified during the traceback investigation (Premises Receiving Imported African Rodents); and 3) premises that received prairie dogs from a holding facility where wild or exotic mammalian pets with suspect, probable, or confirmed monkeypox have been reported.

Minimal data are available about the natural history of monkeypox in animals, and certain aspects of infection, such as the types of susceptible animal species, incubation period, and duration of infectiousness, are not known. Various rodent species are known to be susceptible, but all mammals are considered potentially susceptible. Currently, capacity for laboratory testing of animals is limited, and available assays are not able to prove that animals are not infectious.

These guidelines attempt to balance the prudent use of quarantine and euthanasia of exposed animals with the goal of preventing additional infections among humans and other animals, as well as preventing monkeypox from being maintained in a new wild animal reservoir.

Definitions

Infected premises are defined as commercial or residential premises that housed animals meeting the suspect, probable, or confirmed case definition for monkeypox.

Premises receiving imported African rodents are defined as commercial or residential premises that housed a rodent originating from the shipment of animals imported from Ghana to Texas on 4/9/03, and includes Tree squirrels (Heliosciurus sp.), Rope squirrels (Funisciurus sp.), Dormice (Graphiurus sp.), Gambian Giant Pouched Rats (Cricetomys sp.), Brush-tailed porcupines (Atherurus sp.), and Striped mice (Hybomys sp.).

Recommendations For Premises That Received Prairie Dogs Acquired From Infected Premises

Commercial and residential premises that have prairie dogs acquired from infected premises should be placed under quarantine until the following conditions are met:

• All prairie dogs on the premises have been euthanized.
• All other mammals remaining on the premises have completed a six-week quarantine following the last date of occupation by the aforementioned prairie dogs.

Recommendations For Premises That Received Rodents From The African Shipment

Premises Receiving Imported African Rodents should be placed under quarantine until the following conditions are met:

• All African rodents from the 4/9/03 shipment from Ghana on the premises have been euthanized.
• All prairie dogs on the premises that may have been exposed to African rodents have been euthanized.
• All other mammals remaining on the premises have completed a 6-week quarantine following the last date of occupation by the aforementioned African rodents and prairie dogs.

Recommendations for Other Infected Premises

Infected premises should be placed under quarantine until the following conditions are met:

• All animals meeting the suspect, probable, or confirmed case definition for monkeypox have been euthanized.
• All prairie dogs have been euthanized.
• Other mammals remaining on the premises have completed a 6-week quarantine following the last date of occupation by the aforementioned infected animals and prairie dogs.

Euthanasia and Disposal of Animals

Animals should be humanely euthanized. (See the AVMA guidelines on humane euthanasia for more information.) Carcasses should not be disposed of by burial in a landfill or backyard setting. CDC recommends incineration of carcasses. Animals associated with a human case should be tested for monkeypox. Necropsies should not be performed on animals with suspected monkeypox. Rather, whole carcasses should be double bagged and frozen. To obtain submission instructions before sending specimens to CDC, consult with the state epidemiologist and state health laboratory.

Cleaning of Premises after Removal of an Animal with Monkeypox

Contaminated surfaces should be cleaned and disinfected. Standard household cleaners or disinfectants may be used in accordance with the manufacturer's instructions. Do not dispose of the animal's bedding, cage, toys, or food and water bowls with the household trash or at a dump or landfill because this material may be potentially infectious; contact the state or local health department for instructions. Follow the laundry steps provided above when caring for a quarantined animal.

Recommendations for Follow-Up of Previously Quarantined Facilities

Close public health surveillance of morbidity and mortality of animals on the premises is required during the 6-week quarantine. Evidence of monkeypox based on clinical or laboratory findings results in automatic extension of quarantine. Following the end of the 6-week quarantine or depopulation, cleaning, and disinfection of the premises, trade in animals not covered by the Restrictions on African Rodents and Prairie Dogs interim final rule may resume at commercial facilities; the owners should keep records on all sales and transactions. Close state and federal surveillance of morbidity and mortality of animals on the premise is encouraged for at least 6-weeks after the quarantine is lifted and trade has resumed.

Additional Information

For more information, contact the state or local health department or the CDC Emergency Operations Center at 770-488-7100. Additional information and recommendations will be released as they become available. Updated information will be available at CDC's monkeypox Web site.

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