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Mysterious illness caused by pet prairie dogs is possibly monkeypox
http://abclocal.go.com/ktrk/news/60703_nat_monkeypox.html By The Associated Press
(6/07/03 - MADISON, WI) — A virus related to smallpox that has never been detected in the Western Hemisphere may be the cause of a mysterious disease spreading from pet prairie dogs to people across the upper Midwest, health officials said Saturday.
Dr. James Hughes, director of the National Center for Infectious Diseases at the Centers for Disease Control and Prevention, said a group of prairie dogs sold from a suburban Chicago pet distributor appears to be infected with the monkeypox virus, a member of the same viral family that causes smallpox but is not nearly as deadly.
Monkeypox has typically been found in West African rain forests, Hughes said. The death rate among infected humans has ranged from 1 percent to 10 percent.
Hughes said although monkeypox is spread primarily through rodents in Africa, scientists haven't ruled out person-to-person transmission.
"We're in the very early stages of classifying this virus," Hughes said. "We're not certain."
Since early May, 17 possible cases have been reported in Wisconsin in people as young as 4 and as old as 48. Two possible cases have been reported in Illinois and one has been reported in Indiana, health officials from all three states said.
They appeared to have been exposed to prairie dogs _ rodents whose popularity as pets has grown in recent years. They reported fever, coughs, rashes and swollen lymph nodes.
CDC and state health officials are still researching the disease with samples from the infected prairie dogs and humans, but the virus appears susceptible to the anti-viral drug Cidofovir, Hughes said. He isn't aware of any long-term aftereffects of monkeypox.
No one has died or become severely ill in the current outbreak, Hughes said. But four people in Wisconsin had to be hospitalized at Froedtert Memorial Lutheran Hospital, hospital spokesman Mark McLaughlin said. Two remained hospitalized in satisfactory condition Saturday.
Authorities don't believe bioterrorism was involved.
Investigators have traced the origin of the outbreak to a pet distributor in Villa Park, Ill. That distributor had a giant Gambian rat, indigenous to African countries, that may have infected batches of prairie dogs, Hughes said.
SK Exotics, a South Milwaukee pet distributor, bought prairie dogs from the Villa Park distributor and imported them to Wisconsin.
Two pet stores, Hoffer TropicLife Pets in Milwaukee and Rainbow Pets in Shorewood, a Milwaukee suburb, bought some dogs from SK Exotics.
More prairie dogs from Villa Park found their way to northern Wisconsin through a Wausau swap meet, said Dr. Mark Wegner, chief of the Wisconsin Communicable Disease Epidemiology Section.
Wisconsin agriculture officials have taken several emergency steps since word of the outbreak broke earlier this week.
The state Department of Health and Family Services issued an emergency order Friday banning the sale, importation and display of prairie dogs.
Also Friday, acting state veterinarian Dr. Robert Ehlenfeldt imposed quarantines on SK Exotics, Hoffer TropicLife Pets, Rainbow Pets and the Dorchester home of Tammy Kautzer, who apparently sells animals to swap meets, Gilson said.
The quarantines prohibit movement of any prairie dogs or mammals that come in contact with them.
"I wouldn't want to do it any other way than to follow the rules and find out exactly what's going on," said Eileen Whitmarsh, co-owner of Rainbow Pets.
Calls left at Kautzer's home and Hoffer TropicLife Pets were not returned. No listing could be found for SK Exotics.
Whitmarsh said she got two female prairie dogs from SK Exotics on May 5. Neither looked sick at first, she said, but one eventually began to look tired.
She said the store immediately quarantined them. SK Exotics took them back on May 12, she said.
Whitmarsh said she got sick in mid-May with blisters, coughing and a 101-degree fever. Hospital staff gave her aspirin, told her it was a viral infection and she went home, she said.
Whitmarsh said she didn't feel better and ended up going to West Allis Memorial Hospital five days later, where she was given antibiotics. She finally felt better around Memorial Day, she said.
Meanwhile, state and federal investigators are still trying to track down animals sold from the Villa Park distributor. The source of the Gambian rat is still unknown, they said.
Last Updated: Jun 7, 2003
From the New England Journal of Medicine
More than 20 years have passed since the last case of smallpox was confirmed and 18 years since the International Commission for the Certification of Smallpox Eradication of the World Health Organization (WHO) concluded that the global eradication of smallpox had been achieved.1,2 Now, new dilemmas confront the world. Could recent outbreaks of human monkeypox in the Democratic Republic of the Congo (known as Zaire from 1971 to 1997)3,4,5 represent the return of another form of smallpox?6 Could variola (smallpox) virus be used as a weapon of biologic terrorism? And what are the implications of the decision of the WHO to advise the destruction of all isolates of the smallpox virus in June 1999?7
Monkeypox in Humans
Recent reports of large outbreaks of possible cases of monkeypox in the Democratic Republic of the Congo have raised questions as to whether monkeypox could sustain itself as an infection transmitted from human to human, in the same way as smallpox.3,4,5 Smallpox vaccine protects against monkeypox, but no one is being immunized against smallpox anymore. Might monkeypox soon take over the ecologic niche left vacant by smallpox?6 The available data do not support this possibility.
The first case of human monkeypox was identified in 1970, and through 1979, 55 cases of monkeypox were confirmed by the WHO in forested areas of western and central Africa, of which 44 cases (80 percent) occurred in the Democratic Republic of the Congo.8,9,10 The clinical picture of monkeypox (Figure 1) resembles that of smallpox in Central Africa.
....Proponents of destruction argue that the genomes of reference strains have been cloned and sequenced,35,36,37 through cooperative efforts of American and Russian scientists.38,39,40,41,42 Moreover, monkeypox virus has proved a valuable surrogate for variola: its genomic DNA has more than 90 percent homology with that of variola virus. Monkeypox illness in humans and in macaques closely resembles smallpox in humans, and the disease can be prevented in animals by vaccination. In contrast, there is no satisfactory animal model of smallpox. Work with variola virus must be performed in a biosafety-level 4 laboratory, whereas studies with monkeypox require less stringent precautions. The views of developing countries where smallpox was formerly endemic must also be weighed, since they contributed the most money and human resources to the eradication of smallpox. These countries have advocated the destruction of variola-virus stocks.7
During 1995, scientists from the Department of Defense and the Department of Health and Human Services undertook to determine what, if any, studies involving the use of intact variola virus would be critical to public health and national security. It was decided that if a model of monkeypox infection in macaques proved unsatisfactory, studies would be warranted to find a technique to grow variola virus in a genetically or chemically altered mammalian host. The macaque monkeypox model indicated that studies of pathogenesis, the protective efficacy of vaccines, and the therapeutic potential of antiviral compounds could be conducted successfully (Jahrling P, U.S. Army Medical Research Institute for Infectious Diseases: personal communication).
....Conclusions Reports suggesting that monkeypox might replace smallpox as a serious epidemic threat are unsubstantiated, but the threat posed by the possible use of smallpox as a terrorist weapon is genuine. Because of the gravity of this threat, all known stocks of variola virus should be destroyed as soon as possible. The deliberate deployment of this virus must be discouraged by whatever means possible.
Poxvirus Dilemmas — Monkeypox, Smallpox, and Biologic Terrorism