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Review
. 2021 Dec;32(4):528-536.
doi: 10.1016/j.wem.2021.08.003. Epub 2021 Sep 22.

The Disease Ecology, Epidemiology, Clinical Manifestations, Management, Prevention, and Control of Increasing Human Infections with Animal Orthopoxviruses

James H Diaz  1
Affiliations
Review

The Disease Ecology, Epidemiology, Clinical Manifestations, Management, Prevention, and Control of Increasing Human Infections with Animal Orthopoxviruses

James H Diaz. Wilderness Environ Med. 2021 Dec.

Abstract

Zoonotic orthopoxvirus outbreaks have occurred repeatedly worldwide, including monkeypox in Africa and the United States, cowpox in Europe, camelpox in the Middle East and India, buffalopox in India, vaccinia in South America, and novel emerging orthopoxvirus infections in the United States, Europe, Asia, and South America. Waning smallpox immunity may increase the potential for animal-to-human transmission followed by further community transmission person-to-person (as demonstrated by monkeypox and buffalopox outbreaks) and by contact with fomites (as demonstrated by camelpox, cowpox, and, possibly, Alaskapox). The objectives of this review are to describe the disease ecology, epidemiology, clinical manifestations, prevention, and control of human infections with animal orthopoxviruses and to discuss the association with diminished population herd immunity formerly induced by vaccinia vaccination against smallpox. Internet search engines were queried with key words, and case reports, case series, seroprevalence studies, and epidemiologic investigations were found for review.

Keywords: buffalopox; camelpox; cowpox; monkeypox; smallpox; vaccinia; variola; zoonoses.

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Figures

Figure 1
Figure 1
Cowpox lesions on a pet rat (Rattus norvegicus) and its owners during an outbreak in Germany in 2009. A, Pet rat with a cowpox lesion on its right forepaw. B, Cowpox lesions on the neck of a pet rat owner without previous vaccinia virus vaccination (VVV) for smallpox 13 d after direct contact with her cowpox-infected pet rat. Regional lymphadenopathy was also described. C, Milder, nearly asymptomatic lesions on the neck of the patient’s grandmother, who had a history of VVV for smallpox, 13 d after direct contact with the family’s pet rat.
Figure 2
Figure 2
Atypical cowpox virus infection in a smallpox-vaccinated patient in France in 2016. A, Profile appearance of the patient’s torso 1 mo after the initial traumatic injury. B, Appearance 9 mo after the initial trauma.
See this image and copyright information in PMC

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