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In April, May, and June of 2003, 87 cases of monkeypox were reported in the states of Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin. Mildly ill in most cases, the majority of patients had direct contact with infected prairie dogs. The prairie dogs were purchased at the same wholesale pet store that had housed sick exotic African rodents. Common symptoms included rash, fever, and cough. The animal investigation traced the infection back to Gambian giant rats imported from Ghana where monkeypox is endemic. [MMWR. 7/11/03] Small, sporadic outbreaks of monkeypox have been reported in villages in the rainforests of central and west Africa. Squirrels and primates appear to be reservoirs. Humans develop disease after contact with infected animals or humans. Serial transmission in humans occurs, but does not usually go beyond secondary cases. The secondary attack rate is about 8%. The illness resembles smallpox or chickenpox, but lymphadenopathy is more prominent. Case fatality rate was estimated at 1-14% in children not vaccinated against smallpox. [CCDM, p. 494-5] Unlike smallpox, monkeypox causes lymphadenopathy (regional or generalized) in over 85% of unvaccinated patients. [Guerrant, p. 626] |
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