By NewsDesk  @infectiousdiseasenews

In a follow-up on the monkeypox case recently confirmed in Dallas, Texas, the World Health Organization (WHO) published a DON Tuesday with some additional details:

Monkeypox/CDC

On 17 July 2021, the IHR National Focal Point of the United States of America (USA) notified PAHO/WHO of an imported case of human monkeypox in Dallas, Texas, USA. The case-patient travelled from the USA to Lagos State, Nigeria on 25 June and also stayed in Ibadan, Oyo State, from 29 June to 3 July. He developed self-reported fever, vomiting and mild cough on 30 June, and a painful genital rash on 7 July. The case-patient returned to the USA, departing Lagos on 8 July and arriving on 9 July. He developed a facial rash on the next day. On 13 July, the patient attended a local hospital; fever was documented, and he was immediately placed under isolation.

Sample of a skin lesion was taken, and on 14 July, an Orthopoxvirus was confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) by Dallas County. On 15 July, the patient’s skin samples tested positive for the West African clade of monkeypoxvirus via RT-PCR conducted at the US Centers for Disease Control and Prevention (US CDC) Poxvirus and Rabies Branch Laboratory. The patient is currently hospitalized.

At this time, the source of infection for this case is unknown. Although monkeypox is considered a zoonotic disease, the wildlife reservoir has not been determined. During an outbreak of monkeypox in human in 2003 in the USA, exposure was traced to contact with pet prairie dogs that had been co-housed with monkeypoxvirus-infected African rodents, imported from Ghana. Contact with wild animals (including live animals, meat for consumption, and other products) are known potential risk factors in enzootic countries. Prolonged contact with an infected person can also result in person-to-person transmission.

An outbreak occurred in Nigeria from 2017 to 2019, with cases still being reported in 2021. In addition to Nigeria, outbreaks have also been reported in nine other countries in central and western Africa since 1970. In 2020, over 6200 suspected cases were reported in the Democratic Republic of the Congo. Sporadic outbreaks among humans have occurred in other countries such as Cameroon or the Central African Republic.

This is the first time that human monkeypox has been detected in a traveller to the USA, and the first case reported in the USA since the outbreak in 2003. Human monkeypox in travellers from Nigeria has been documented on seven previous occasions since 1978. The earliest documented travel-related case occurred in Benin in a patient who had contracted the infection in Oyo State, Nigeria. Since 2018, six cases have been reported and confirmed in non-endemic countries via travelers to Israel (2018), Singapore (2019), and the United Kingdom of Great Britain and Northern Ireland (two cases in 2018, one in 2019 and one in 2021). Lagos State and Oyo State in Nigeria continue to report and confirm sporadic cases. Additionally, cases have been reported in South Sudan which were likely imported from the Democratic Republic of the Congo.