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6/20/2003

Six States Report Possible Monkeypox Infections

Kate Traynor

The Centers for Disease Control and Prevention (CDC) is investigating 87 domestic cases of monkeypox virus infection, 20 of which have been confirmed by laboratory testing.

A week ago, four states had reported a total of 54 possible cases of monkeypox infection. Now six states—Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin—have monkeypox cases under investigation. No deaths have been reported among those infected with the virus, which is believed to have entered the country in infected rodents imported from Africa.

CDC last week recommended the limited use of Dryvax, the U.S.-licensed smallpox vaccine, for those at high risk for monkeypox disease. According to an interim guidance document (PDF) from CDC, data suggest that smallpox vaccination is at least 85 percent effective at preventing disease in people exposed to the monkeypox virus. Because this is not a labeled indication for Dryvax, the vaccine is administered under an investigational new drug (IND) protocol.

CDC Deputy Director David Fleming, who described the vaccination policy during a June 11 media telebriefing, said that targets for vaccination include health care workers who treat patients with monkeypox; family members and close contacts of persons infected with the virus; and people exposed to an animal harboring monkeypox virus.

Fleming said that CDC recommends vaccination for many target-group members for whom Dryvax would normally be contraindicated.

“We're recommending that vaccination occur in children, in pregnant women, in individuals who have a history of eczema,” Fleming said. He noted, however, that Dryvax should not be administered to people with an immune deficiency condition even if they are exposed to monkeypox.

CDC Director Julie L. Gerberding said during yesterday’s media telebriefing that about 20 people so far have received smallpox vaccine under the IND covering monkeypox and that additional vaccinees may not yet be part of the agency’s count.

State health departments control the distribution and administration of Dryvax, which was made available to them as early as January 2003 as part of the national smallpox emergency-preparedness program.

CDC’s interim guidance document also addresses the use of cidofovir and vaccinia immune globulin (VIG) for the prevention and treatment of monkeypox disease. According to the document, cidofovir should be used only in life-threatening cases of monkeypox. VIG has not been shown to be effective for the treatment of monkeypox disease. Neither agent is recommended for prophylactic use.

Gerberding named globalization as a driving force behind the emergence of monkeypox along with severe acute respiratory syndrome and West Nile virus in this country.

“All of this is part of a new normal of emerging infectious diseases,” Gerberding said. “It is a global community, and all of these [outbreaks] illustrate the tendency for a problem in one corner of the world to emerge as a problem in another corner of the world.”