VACCINATIONS URGED, PRAIRIE DOGS BANNED TO HALT MONKEYPOX
12 Jun 2003
Source: New York Times, June 12, 2003
Vaccinations Urged, Prairie Dogs Banned to Halt Monkeypox
By LAWRENCE K. ALTMAN
The federal government recommended smallpox vaccinations yesterday for all those exposed to monkeypox, including pregnant women and children. It also banned the sale and distribution of prairie dogs in the nation and prohibited the importation of all rodents from Africa.
The Centers for Disease Control and Prevention also issued a list of signs and symptoms to determine which patients had monkeypox and to help in the agency's investigation of this potentially fatal viral disease.
The actions seek to control the first outbreak of monkeypox in the Americas and to prevent importing it and other diseases endemic elsewhere in the world. Imported rodents are believed to have brought monkeypox to the United States from West and Central Africa, where it is endemic.
Yesterday, there were 54 cases of monkeypox under investigation in four states. Laboratory tests have confirmed monkeypox in nine of the cases. Of the 54, Indiana reported 23, Wisconsin 20, Illinois 10, and New Jersey 1. Ten patients have been hospitalized. But officials at the disease centers said they did not know how many had left the hospital.
Studies conducted in Africa have shown that smallpox vaccine is about 85 percent effective in preventing monkeypox. The disease centers said the vaccination was most effective during the first four days after exposure to an infected animal and to a lesser extent for as long as two weeks after exposure.
The vaccine is being recommended for pet owners, household members and friends who have had close contact with people or animals confirmed to have monkeypox, as well as for health workers investigating monkeypox outbreaks or involved in the care of infected people or animals.
Because the Food and Drug Administration has not approved the smallpox vaccine for monkeypox, the government is making it available under provisions for emergency use. The decision to use it will depend on discussions between patients, doctors and local health officials. All patients receiving the vaccine will be required to sign a form stating that they have been informed of the immunization's benefits and risks.
Monkeypox is fatal in up to 10 percent of cases, much lower than the 30 percent figure for smallpox before it was eradicated worldwide in 1980.
The government stopped routine smallpox vaccinations in 1970. The Bush administration began vaccinating health care workers this year in a program to protect against the introduction of the disease from a bioterrorist attack.
Because vaccinations under that program were a response to a theoretical threat, they excluded children, pregnant women and other categories of high-risk groups. But because infected animals have transmitted monkeypox to people in this country, "the risk-benefit ratio of the vaccine changes" and "we are recommending a somewhat more aggressive approach" to include broader groups, said Dr. David W. Fleming, deputy director of the Centers for Disease Control and Prevention.
"In this situation, where we are recommending smallpox vaccine for a very limited group of people who have had contact and therefore are at risk for monkeypox, we feel that the risk of disease is sufficient to make that recommendation for pregnant women and children as well," Dr. Fleming said.
Dr. Fleming said his agency did not know how many people would receive smallpox vaccinations to protect against monkeypox, in part because state and local health departments have not yet completed their investigations.
The vaccine will be administered by someone recently vaccinated in a health department.
Because the smallpox vaccine has been delivered to state health departments, Dr. Fleming said, the government is "confident that we can deliver it to affected individuals in time to do good."
The bans on the sale of prairie dogs and importing rodents from Africa took effect immediately and will remain in effect until health officials can determine the safety of lifting them.
Senators James M. Jeffords, independent of Vermont, and John Ensign, Republican of Nevada, yesterday called for an Environment and Public Works Committee hearing on regulations on importing exotic pets and their impact on public health.
The ban within the United States includes prairie dogs and six African rodent species implicated in the current monkeypox outbreak. They are: tree squirrels, rope squirrels, dormice, Gambian giant pouched rats, brush-tailed porcupines and striped mice.
The ban is on the sale of the animals and does not apply to people who want to take their sick animals to veterinarians and health officials. Animals with monkeypox may develop a rash, have problems breathing or runny noses and have red eyes.
Health officials have cautioned people not to release sick animals into the wild. The disease centers said it was recommending euthanizing sick animals after they had been checked by a veterinarian.
Federal health workers are tracking shipments of potentially infected animals to help prevent the spread of monkeypox and to reduce the chances of the disease's gaining a permanent foothold.
The disease centers included these signs and symptoms for monkeypox: a rash consisting of raised bumps and blisters spread over the body or confined to a small area; a fever of 99.3 degrees or higher; headache; backache; swollen lymph nodes; sore throat; cough; shortness of breath.
Monkeypox can spread from person to person, but is much less communicable than smallpox and diseases like chickenpox and measles. There are no such documented cases in the current outbreak, Dr. Fleming said, but it is possible that a few cases may have been transmitted that way.
Different members of a household have been exposed to a single sick animal but have become ill at different times, raising the possibility of person-to-person spread, Dr. Fleming said.