Novel Orthopoxvirus Infection in an Alaska Resident.
Human infection by orthopoxviruses is being reported with increasing frequency, attributed in part to the cessation of smallpox vaccination and concomitant waning of population-level immunity. In July 2015, a female resident of interior Alaska presented to an urgent care clinic with a dermal lesion consistent with poxvirus infection. Laboratory testing of a virus isolated from the lesion confirmed infection by an Orthopoxvirus.
The virus isolate was characterized by using electron microscopy and nucleic acid sequencing. An epidemiologic investigation that included patient interviews, contact tracing, and serum testing, as well as environmental and small-mammal sampling, was conducted to identify the infection source and possible additional cases.
Neither signs of active infection nor evidence of recent prior infection were observed in any of the 4 patient contacts identified. The patient's infection source was not definitively identified. Potential routes of exposure included imported fomites from Azerbaijan via the patient's cohabiting partner or wild small mammals in or around the patient's residence. Phylogenetic analyses demonstrated that the virus represents a distinct and previously undescribed genetic lineage of Orthopoxvirus, which is most closely related to the Old World orthopoxviruses.
Investigation findings point to infection of the patient after exposure in or near Fairbanks. This conclusion raises questions about the geographic origins (Old World vs North American) of the genus Orthopoxvirus. Clinicians should remain vigilant for signs of poxvirus infection and alert public health officials when cases are suspected.
Alaska Division of Public Health, Section of Epidemiology, Anchorage.|Epidemic Intelligence Service, Division of Scientific Education and Professional Development.
Yuri P
YP
Springer
Epidemic Intelligence Service, Division of Scientific Education and Professional Development.|Poxvirus and Rabies Branch, and.
Christopher H
CH
Hsu
Tanana Valley Clinic.
Zachary R
ZR
Werle
University of Alaska Museum, and.
Link E
LE
Olson
Alaska Division of Public Health, Section of Epidemiology, Anchorage.
Michael P
MP
Cooper
Alaska Division of Public Health, Section of Epidemiology, Anchorage.
Louisa J
LJ
Castrodale
Alaska Division of Public Health, Section of Laboratories, Fairbanks.
Nisha
N
Fowler
Poxvirus and Rabies Branch, and.
Andrea M
AM
McCollum
Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Cynthia S
CS
Goldsmith
Poxvirus and Rabies Branch, and.
Ginny L
GL
Emerson
Poxvirus and Rabies Branch, and.
Kimberly
K
Wilkins
Poxvirus and Rabies Branch, and.
Jeffrey B
JB
Doty
Poxvirus and Rabies Branch, and.
Jillybeth
J
Burgado
Poxvirus and Rabies Branch, and.
JinXin
J
Gao
Poxvirus and Rabies Branch, and.
Nishi
N
Patel
Poxvirus and Rabies Branch, and.|Oak Ridge Institute for Science and Education, Tennessee.
Matthew R
MR
Mauldin
Poxvirus and Rabies Branch, and.
Mary G
MG
Reynolds
Poxvirus and Rabies Branch, and.
Panayampalli S
PS
Satheshkumar
Poxvirus and Rabies Branch, and.
Whitni
W
Davidson
Poxvirus and Rabies Branch, and.
Yu
Y
Li
Alaska Division of Public Health, Section of Epidemiology, Anchorage.
Joseph B
JB
McLaughlin
D000413:Alaska; D000818:Animals; D000914:Antibodies, Viral / Q000097:blood; D004279:DNA, Viral / Q000097:blood; D005260:Female; D050456:Fomites / Q000821:virology; D006801:Humans; D008322:Mammals / Q000821:virology; D008854:Microscopy, Electron; D008875:Middle Aged; D018155:Orthopoxvirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification* / Q000648:ultrastructure; D010802:Phylogeny; D011213:Poxviridae Infections / Q000175:diagnosis* / Q000821:virology*; D017422:Sequence Analysis, DNA; D012867:Skin / Q000473:pathology / Q000821:virology
D000914:Antibodies, Viral; D004279:DNA, Viral
Alaska; North America; Orthopoxvirus; lesion; phylogenetics.