2022•MMWR Morbidity and Mortality Weekly ReportOpen access
Monkeypox in a Traveler Returning from Nigeria — Dallas, Texas, July 2021
Agam K. Rao, Joann Schulte, Tai-Ho Chen, Christine M. Hughes, Whitni Davidson, Justin M. Neff, Mary Markarian, Kristin C. Delea, Suzanne Wada, Allison Moore Liddell, Shane Alexander, Brittany J. Sunshine, Philip C. C. Huang, Heidi Threadgill Honza, Araceli Rey, Benjamin P. Monroe, Jeffrey B. Doty, Bryan K. Christensen, Lisa J. Delaney, Joel Massey, Michelle A. Waltenburg, Caroline A. Schrodt, David T. Kuhar, Panayampalli Subbian Satheshkumar, Ashley V. Kondas, Yu Li, Kimberly Wilkins, Kylie M. Sage, Yon Yu, Patricia A. Yu, Amanda Feldpausch, Jennifer H. McQuiston, Inger K. Damon, Andrea M. McCollum, July 2021 Monkeypox Response Team, July 2021 Monkeypox Response Team, Asma’u Aminu-Alhaji, Lauren M. Andersen, Matthew J. Arduino, Nicolette C. Bestul, Megan Bias, Mary J. Choi, Crystal M. Gigante, Madison Harkey, Kate Hendricks, Yonette Hercules, Farah Husain, Oladipupo B. Ipadeola, Robynne Jungerman, Theodora Khan, Grishma A. Kharod, Amber Kunkel, Amanda MacGurn, Audrey M. Matheny, Timothy McCleod, Faisal Syed Minhaj, Jenna Mink, Clint N. Morgan, Yoshinori J. Nakazawa, Donovan Newton, Eddy Ortega, Lalita Priyamvada, Kay W. Radford, Joseph E. Rehfus, Muhammad Muhammad Saleh, Michael B. Townsend, Rita M. Traxler, Florence Whitehill, Xianfu Wu, Hui Zhao, Michelle Carruthers, Ivory Gomez, Samantha Groppell, Juan Jaramillo, Daniel Serinaldi, J.L. Serrano, Joey Stringer, Jenna R. Gettings, Jessica Pavlick, José David Retana, Shelley Stonecipher, Rachael Straver, Inger-Marie E. Vilcins, Leisha Diane Nolen
Abstract
Response TeamMonkeypox is a rare, sometimes life-threatening zoonotic infection that occurs in west and central Africa.It is caused by Monkeypox virus, an orthopoxvirus similar to Variola virus (the causative agent of smallpox) and Vaccinia virus (the live virus component of orthopoxvirus vaccines) and can spread to humans.After 39 years without detection of human disease in Nigeria, an outbreak involving 118 confirmed cases was identified during 2017-2018 (1); sporadic cases continue to occur.During September 2018-May 2021, six unrelated persons traveling from Nigeria received diagnoses of monkeypox in non-African countries: four in the United Kingdom and one each in Israel and Singapore.In July 2021, a man who traveled from Lagos, Nigeria, to Dallas, Texas, became the seventh traveler to a non-African country with diagnosed monkeypox.Among 194 monitored contacts, 144 (74%) were flight contacts.The patient received tecovirimat, an antiviral for treatment of orthopoxvirus infections, and his home required large-scale decontamination.Whole genome sequencing showed that the virus was consistent with a strain of Monkeypox virus known to circulate in Nigeria, but the specific source of the patient's infection was not identified.No epidemiologically linked cases were reported in Nigeria; no contact received postexposure prophylaxis (PEP) with the orthopoxvirus vaccine ACAM2000. FindingsOn July 13, 2021, an emergency department (ED) physician in Dallas evaluated an early middle-aged man* with a * Past medical history and identifying information withheld to protect patient confidentiality.2-week history of fever, cough, and fatigue, followed by onset of a diffuse rash.Less than 1 week earlier, the patient had been in Nigeria for a large social gathering.Because of the extensive pustular rash on his face, hospital staff members immediately placed the patient in an airborne isolation room, where he was managed with airborne and contact precautions plus eye protection.After reviewing CDC's Travelers' Health destination webpage for Nigeria, † the ED physician suspected monkeypox, and public health authorities were immediately notified.The following day, the Dallas County Health and † https://wwwnc.cdc.gov/travel/destinations/traveler/none/nigeria?s_cid%20 =%20ncezid-dgmq-travel-single-001 INSIDE 517 Cardiac Complications After SARS-CoV-2 Infection and mRNA COVID-19 Vaccination -PCORnet, United States, January 2021