First Deadly Alaskapox Case Reported

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Epidemiologists at the Alaska Department of Health have reported the first known fatal case of Alaskapox, a novel orthopox virus first identified in 2015. The deadly infection involved a man with an underlying health condition living on the Kenai Peninsula.

The man's infection is the state's seventh Alaskapox case and is the first located outside of the Fairbanks area, officials said in a February 9 epidemiologic bulletin. 

Alaska reported its most recent previous Alaskapox virus cases in 2021, involving a young girl and a middle-aged woman from the Fairbanks area. There were no links between the patients, but both had pets, including cats, and had spent time outside in the summer.

The elderly man's symptoms began in the middle of September 2023 with a red, tender papule in his right armpit. At the time, he was undergoing immunosuppressive therapy as part of cancer treatment. Over the next 6 weeks he sought care for the lesion, which worsened. In November he was hospitalized for cellulitis that limited movement of his arm.

He was transferred to a hospital in Anchorage, as pain and other symptoms worsened and clinicians noted four other lesions on different parts of his body. Lab tests were initially positive for cowpox, and follow-up testing at the state health lab was positive for generic orthopox virus.

A sample sent to the US Centers for Disease Control and Prevention (CDC) was consistent with Alaskapox virus, but genetic sequencing suggested it was distinct from samples from earlier cases that had been reported from Fairbanks.

Following treatment with tecovirimat (Tpoxx), intravenous vaccinia immunoglobulin, and oral brincidofovir, his arm symptoms initially improved, but during the man's time in a long-term care facility, his condition deteriorated and he experienced delayed wound healing, kidney failure, and respiratory failure. He died at the end of January.

Investigators found that he had no recent travel history or contact with people who did. The man had cared for a stray cat at his home that regularly hunted small animals. The cat frequently scratched the man, which included a notable scratch in his right armpit in the month before his symptoms began. 

The man reported no other contact with small animals, but had gardened in his backyard through September 2023. Blood and mucosal samples collected from the cat were negative on antibody orthopox testing at the CDC.

Officials said the man's immunocompromised status probably contributed to his disease severity.

 

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Alaskapox virus is an orthopoxvirus that was first identified in a patient in Fairbanks, Alaska, in 2015. Orthopoxviruses are known infect mammals, including humans, and can lead to the development of skin lesions. Since 2015, six additional cases of Alaskapox virus have been reported in Alaska, five of which were in persons living in the Fairbanks North Star Borough and one person was living in the Kenai Peninsula Borough.

Current evidence indicates that Alaskapox virus primarily occurs in small mammals. The virus has been most commonly identified in red-backed voles and shrews, based on small mammal sampling in the Fairbanks North Star Borough. However, it is likely that the virus is more widespread in Alaska's small mammal populations, and infections in humans may have occurred in other patients but were not diagnosed. Domestic pets (cats and dogs) may also play a role in spreading the virus.

To date, no human-to-human transmission of Alaskapox virus has been documented. However, since certain orthopoxviruses can be transmitted through direct contact with skin lesions, we recommend that people with skin lesions possibly caused by Alaskapox keep the affected area covered with a bandage.

The Northern Red-Backed Vole, found throughout Alaska, is one species that has shown evidence of having Alaskapox virus. 

Symptoms of Alaskapox have included one or more skin lesions (bumps or pustules) and other symptoms like swollen lymph nodes and joint and/or muscle pain. Immunocompromised people might be at increased risk for more severe illness.

Healthcare providers who suspect Alaskapox virus infection and have not identified an alternative diagnosis should contact the 

 

https://www.cidrap.umn.edu/orthopoxvirus/alaska-reports-fatal-alaskapox-case

https://health.alaska.gov/dph/Epi/id/Pages/Alaskapox.aspx

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[Guest]

 

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