title: Spectrum of infection and risk factors for human monkeypox, United States, 2003.
abstract: For the 2003 monkeypox virus (MPXV) outbreak in the United States, interhuman transmission was not documented and all case-patients were near or handled MPXV-infected prairie dogs. We initiated a case-control study to evaluate risk factors for animal-to-human MPXV transmission. Participants completed a questionnaire requesting exposure, clinical, and demographic information. Serum samples were obtained for analysis of immunoglobulin G (IgG) and IgM to orthopoxvirus. When data were adjusted for smallpox vaccination, case-patients were more likely than controls to have had daily exposure to a sick animal (odds ratio [OR] 4.0, 95% confidence interval [CI] 1.2-13.4), cleaned cages and bedding of a sick animal (OR 5.3, 95% CI 1.4-20.7), or touched a sick animal (OR 4.0, 95% CI 1.2-13.4). These findings demonstrate that human MPXV infection is associated with handling of MPXV-infected animals and suggest that exposure to excretions and secretions of infected animals can result in infection.
authors.affiliation: Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. nzr6@cdc.gov
authors.forename: Mary G
authors.initials: MG
authors.lastname: Reynolds
authors.forename: Whitni B
authors.initials: WB
authors.lastname: Davidson
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Curns
authors.forename: Craig S
authors.initials: CS
authors.lastname: Conover
authors.forename: Gregory
authors.initials: G
authors.lastname: Huhn
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Davis
authors.forename: Mark
authors.initials: M
authors.lastname: Wegner
authors.forename: Donita R
authors.initials: DR
authors.lastname: Croft
authors.forename: Alexandra
authors.initials: A
authors.lastname: Newman
authors.forename: Nkolika N
authors.initials: NN
authors.lastname: Obiesie
authors.forename: Gail R
authors.initials: GR
authors.lastname: Hansen
authors.forename: Patrick L
authors.initials: PL
authors.lastname: Hays
authors.forename: Pamela
authors.initials: P
authors.lastname: Pontones
authors.forename: Brad
authors.initials: B
authors.lastname: Beard
authors.forename: Robert
authors.initials: R
authors.lastname: Teclaw
authors.forename: James F
authors.initials: JF
authors.lastname: Howell
authors.forename: Zachary
authors.initials: Z
authors.lastname: Braden
authors.forename: Robert C
authors.initials: RC
authors.lastname: Holman
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Karem
authors.forename: Inger K
authors.initials: IK
authors.lastname: Damon
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D016022:Case-Control Studies; D006801:Humans; D045908:Mpox, Monkeypox / Q000453:epidemiology*; D016017:Odds Ratio; D012307:Risk Factors; D012589:Sciuridae / Q000821:virology; D014481:United States / Q000453:epidemiology