For Immediate Release:
June 13, 2003

Contact:
Bryant McNally, JD, MPH
Director, Division of Environmental Health and Communicable Disease Prevention
Missouri Department of Health and Senior Services
930 Wildwood
PO BOX 570
Jefferson City, MO 65102-0570

Monkeypox Update and Guidance For Local Public Health Agencies

Introduction

The Missouri Department of Health and Senior Services is recommending that local public health agencies begin immediately to conduct active surveillance of pet shops, swap meets, exotic animal farms, and similar interests in order to identify the location and condition of prairie dogs, Gambian rats, and other rodents (and other mammals, if necessary) that may be infected with monkeypox virus as well as monitoring calls from concerned citizens.

This recommendation is made in an effort to prevent the introduction of monkeypox into the natural wildlife system of the western hemisphere. Such a release would carry unknown and potentially serious public health implications for the United States. In addition, the introduction of monkeypox virus would likely result in unpredictable economic and health impacts to humans, domesticated and wild animals.

Surveillance for monkeypox is authorized under RSMo192.020. In addition, monkeypox is a reportable condition under 19 CSR 20-20.020 as an illness, disease or condition of public health concern. The recently issued "Joint Order of the Centers for Disease Control and Prevention and the Food and Drug Administration, Department of Health and Human Services," which was issued June 11, 2003, places restrictions on the sale, transportation, and release to the wild of certain rodents and prairie dogs.

It should be noted that this active surveillance might lead to the quarantine or euthanizing of sick animals intended for sale or breeding. In addition, this active surveillance serves as an important educational tool for businesses and citizens with concerns and questions about a newly emerging disease. Most importantly, active surveillance for monkeypox virus infection in animals also may facilitate the early recognition or prevention of human disease.

Missouri public health agencies have specific authority under RSMo 322.140 to isolate, quarantine or test animals that may have possibly transmitted a zoonotic disease to a person. Guidance on implementing this section of the law is available by calling the Division of Environmental Health and Communicable Disease Prevention at (866) 628-9891.

Surveillance Activities

• Health officials' understanding about this disease increases daily. Refer frequently to the Centers for Disease Control and Prevention's Monkeypox web page for updates to guidelines and resources. The web address is: http://www.cdc.gov/ncidod/monkeypox/index.htm
  
• For specific, up-to-date information on signs and symptoms of infected animals, refer to the document "Monkeypox Infections in Animals: Interim Guidance for Persons Who Have Frequent Contact with Animals, Including Pet Owners, Pet Shop Employees, Animal Handlers, and Animal Control Officers."
• Provide a copy of the "Joint Order of the Centers for Disease Control and Prevention and the Food and Drug Administration, Department of Health and Human Services": http://www.cdc.gov/ncidod/monkeypox/pdf/embargo.pdf to the animal owner and instruct them on the prohibitions for sale, transport, or release of the animals covered in the Joint Order, and discuss the serious implications of the release of monkeypox to the environment. In addition, enlist their help in continued surveillance of the animals under their care. This order has the full force and effect of law.
• Document whether animals exhibit signs of sickness, obtaining the cooperation and observations of the owner when possible. Any animal that has come in contact with an animal known to have monkeypox should be placed under 30-day quarantine. Isolate animals that appear ill and contact a local veterinarian for evaluation.
• Continue active surveillance on a regular schedule, as resources permit. Instruct the animal owner to contact both the local public health agency and a veterinarian if an animal becomes ill.
• Report difficulties and suspected infections to the Regional Senior Epidemiologists using the Department of Health and Senior Services emergency reporting number at (800) 392-0272.
  

Pending Monkeypox Outbreak Issues

A number of critical issues on the containment of Monkeypox virus remain to be resolved at both state and federal levels. DHSS is employing the expertise of Department staff, CDC, Missouri Department of Agriculture and the Missouri Department of Conservation.

Please look for additional guidance as it is developed on:

• Angela Ford will be working with the five pre-event vaccination sites to implement smallpox vaccination for exposed health care workers, veterinarians, animal owners, and others, if necessary.
• Detailed instructions for obtaining and submitting pustule and blood specimen from suspected infected animals.