What is Alaskan smallpox? New infection puts this virus in the spotlight

In mid-September 2023, an elderly resident of the Kenai Peninsula, south of Anchorage, Alaska, who was undergoing drug treatment for cancer and suffered from immunosuppression, He noticed a painful red papule in his right armpit.

Naturally, the shock was terrible, and he decided to immediately consult a doctor. Over the next six weeks, he visited the primary health care center and the local emergency department several times for clinical evaluation of the injury.

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The case was confusing and possible contamination was difficult to determine. Old man did not respond to antibiotic treatment. A needle biopsy revealed no evidence of malignancy or bacterial infection. Medical workers were confused. Days pass the patient experienced fatigue and increasing hardness. The pain in my right armpit and right shoulder was getting worse.

On November 17, the prognosis worsened and he was hospitalized. The main reason was extensive progression of presumed infectious cellulitis which affected the range of motion of his right arm. There was no time to lose, and the patient was transferred to Anchorage and transferred to a hospital with more resources and resources.

Patient in Anchorage intense burning pain of neuropathic type appears

. The biopsy site in the right armpit has not healed and copious serous fluid is secreted. There was extensive muscle inflammation affecting the right armpit and shoulder muscles. There were also four of them smaller, smallpox-like lesions, in diffuse places throughout the body. What’s happened?

After an extensive battery of laboratory tests, the sample was sent to the Centers for Disease Control and Prevention (CDC). proved the presence of Alaskan smallpox virus (ASVV).. That is, orthopoxvirus, discovered in 2015 in Alaska, in the Fairbanks area, which until that time Only seven cases of human infection have been reported. All of them were observed in residents of the Fairbanks area and were accompanied by mild, spontaneous illnesses consisting of localized rash and lymphadenopathy.

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After the possible pathogen was identified, the elderly man became the eighth case of AKPV infection and received specific treatment, which consisted of intravenous tecovirimate, intravenous immunoglobulin, and oral brincidofovir.

After a week of therapy, the patient’s condition began to improve. Unfortunately, this was not enough. Despite intensive medical care, after some time the patient developed delayed wound healing, malnutrition, acute renal failure and respiratory failure. Died at the end of January 2024.. In the second week of February 2024, health department officials confirmed that the death was due to the Alaska smallpox virus.

Its reservoir can be shrews and voles.

There are currently more than 10,000 types of viruses described, and we know that about 270 of them infect humans. Some of these viruses have been known for centuries, others have emerged recently.

Actually, Viruses account for about two-thirds of all new human pathogens.. These new viruses vary greatly in importance, from the rare and mild disease caused by the Menangle virus to the devastating public health impact caused by the coronavirus SARS-CoV-2.

Of the known viruses that infect humans, about 80% occur naturally in non-human bodies of water, mainly in mammals and birds and, to a lesser extent, in arthropods and other wild animals. It is assumed that zoonotic infectious agents, e.g. Those transmitted from animals to humans account for about 60% of human pathogens.

known and up to 75% of new human pathogens.

Unfortunately, insufficient knowledge about wild animals They may contain thousands of unknown types of viruses, and this is a great inconvenience since many of them can be pathogenic to humans.

Kodiak Island, home of North America’s largest bears.

The evidence currently available indicates that Alaska smallpox virus is present in several species of small mammals.among which stand out are shrews and red-backed voles (Kletriomys rutilus), which can act as a reservoir.

That’s why, We are faced with a new zoonosis. Although available evidence suggests that the public health impact of Alaska poxvirus is limited, it is likely to be widespread among small mammal populations in Alaska, and other infections may have occurred in humans but have not been diagnosed.

In addition to Alaskan smallpox virus, some other orthopoxviruses have recently been described, such as Achmeta virus or Abatino virus. highlight the possibility of unknown members of this genus with zoonotic potential.

There are currently no human-to-human transmissions of the Alaska smallpox virus. However, since some orthopoxviruses They can be transmitted through direct contact with skin lesions.People with wounds that may have been caused by Alaska smallpox are advised to apply a bandage to the affected area.

Poxviruses infect a wide range of hosts, including insects, birds, reptiles and mammals. Among the poxviruses there is the genus Orthopoxvirus. It includes several viruses of great medical importance. these include variola virus (VARV), the causative agent of human smallpox, and vaccinia virus (VACV), which was used in the smallpox eradication campaign.

Monkeypox family

Other orthopoxviruses with zoonotic potential, such as MPox virus (commonly known as monkeypox virus) and vaccinia virus, are increasingly reported as a cause of human disease.

In fact, the mpox outbreak, which emerged in May 2022 and is still ongoing, has caused more than 93,000 cases and 177 deaths. This situation may have contributed to discontinuation of routine vaccination against eradicated human smallpox

as this vaccine induced a degree of immunity in the population against other orthopoxviruses.

In addition to those mentioned, there are many other pathogenic mammalian orthopoxviruses. Examples include, but are not limited to, ectromelia mousepox virus, camelpox virus, raccoonpox virus, gerbilpox virus, cowpox virus, skunkpox virus, or certain sublineages of the cowpox virus such as rabbitpox virus and buffalopox virus.

The wide host range, wide geographic distribution, and continued global emergence of zoonotic viruses, including emerging orthopoxviruses, poses a global health threat requiring close monitoring and take appropriate preventive measures.

In this situation, the most sensible thing to do is to take an urgent approach One health and recognize that we cannot care for human health without also caring for the health of animals and the environment.

Raul Rivas Gonzalez, professor of microbiology. Member of the Spanish Society of Microbiologists., University of Salamanca

This article was originally published on The Conversation. Read the original.