Previously considered a rare zoonotic infection, human monkeypox has reemerged as a clinically serious disease after decades of quiescence. At the conclusion of the surveillance period, we did not detect disease transmission. Hospital-based public health officials contacted each HCW daily for 21 days (the duration of incubation period for monkeypox) and instructed them to measure their temperature twice a day and monitor any symptoms. No HCW met the criteria for high-risk exposure, and no doses of preventive smallpox vaccine were administered. Upon confirmation of the monkeypox diagnosis, we identified all healthcare workers (HCWs) involved in the case and classified 40 as contacts by CDC guidelines ( 8). CDC used viral culture and RT-PCR to confirm the diagnosis of monkeypox, further identifying the specimen as part of the West African clade, which has driven the outbreak in Nigeria since 2017. Additional specimens of the skin lesions were identified by the Maryland Department of Health as non‒variola orthopox by real-time reverse transcription PCR (RT-PCR) and the CDC Laboratory Response Network protocol. Hematoxylin and eosin stain original magnification ×4 in panel A, ×20 in panel B, and ×40 in panel C.īased on the travel history of the patient and histopathologic findings, we suspected monkeypox, likely acquired by human contact in the absence of any animal exposures. B, C) Higher magnification views showing dyskeratotic keratinocytes, neutrophil exocytosis, and intracytoplasmic inclusion bodies consistent with Guarnieri bodies in the epidermis. In the dermis, a diffuse mixed superficial dermal infiltrate was observed. A) Epidermal necrosis, reticular necrosis, and vesiculation. Imported monkeypox from international traveler, Maryland, USA, 2021. Within 24 hours of admission, no new lesions developed, and there was noticeable crusting of several existing vesicles. The patient was given intravenous acyclovir for empiric treatment of disseminated varicella zoster virus infection, admitted, and subjected to contact and airborne isolation precautions pending further evaluation.

A few 2–3-mm round erosions were noted on the oral mucosa, and an intact pustule was observed on the lower mucosal lip ( Figure 1). Some of these pustules had central umbilication and were present diffusely with acrofacial propensity, favoring the face, neck, and hands. He denied having associated symptoms, including fever, chills, or headache.Īt examination, we observed right cervical lymphadenopathy and numerous 2–4-mm pustules on an erythematous base. During his flight from Lagos, he noticed a burning sensation on his skin, followed by development of discrete vesicles on his forehead and nose, which spread to his arms, trunk, and inner thighs over several hours. While in Nigeria, he visited relatives, stayed in hotel lodging without travel to rural regions, and had no interactions with animals or animal carcasses. He had traveled on a flight from Lagos, Nigeria, and arrived in the United States the day he sought care. We describe a case of imported monkeypox in Maryland, USA, and the infection control measures used to prevent additional disease transmission.Ī 28-year-old man sought care for a diffuse vesicular rash that had developed over the preceding 24–48 hours. As case rates increase, determining effective public health interventions in preventing secondary spread of monkeypox is critical and a challenge that largely has yet to be confronted in the United States.

Before that case, the last confirmed monkeypox cases in the United States were in an outbreak involving 47 persons across 6 states those cases were associated with contact of prairie dogs infected by imported rats from Ghana ( 7). In the United States, a case was recently identified in Texas in a traveler returning from Nigeria ( 7). Outside Africa, cases of monkeypox remain rare, but are increasing 7 international cases have been diagnosed since 2018 ( 4– 6). Because of global health implications, in 2017 the World Health Organization and the US Centers for Disease Control and Prevention (CDC) conducted an informal consultation with infectious diseases experts and researchers in countries in Africa to assess the surveillance and outbreak response to monkeypox. Nigeria is in the midst of an ongoing monkeypox outbreak as of October 2021, a total of 502 cases and 8 deaths from this disease had been reported ( 3). More confirmed cases of monkeypox have been diagnosed since 2016 than in the previous 40 years ( 2).

Formerly a rare disease native to Africa, monkeypox is now endemic to countries in western and central Africa, which have faced a resurgence of monkeypox outbreaks over the past decade. Since the eradication of smallpox, monkeypox has assumed the role of the most prominent orthopoxvirus affecting human communities ( 1).

Monkeypox outbreak 2021