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Centers for Disease Control and Prevention
1600 Clifton Rd.
Atlanta, GA 30333
USA
(404) 639-3311 |
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The previous
case definition (published June 17, 2003) has been updated as follows:
- Exclusion
criteria have been revised
- Suspect,
probable, and confirmed case classifications have been edited
Clinical
Criteria
Rash (macular,
papular, vesicular, or pustular; generalized or localized; discrete or
confluent)
Fever (subjective
or measured temperature of >99.3° F [> 37.4°
C])
Other signs
and symptoms
- Chills
and/or sweats
- Headache
- Backache
- Lymphadenopathy
- Sore throat
- Cough
- Shortness
of breath
Epidemiologic
Criteria
- Exposure1
to an exotic or wild mammalian pet2 obtained
on or after April 15, 2003, with clinical signs of illness (e.g., conjunctivitis,
respiratory symptoms, and/or rash)
- Exposure1
to an exotic or wild mammalian pet2 with
or without clinical signs of illness that has been in contact with either
a mammalian pet3 or a human with monkeypox
- Exposure4
to a suspect, probable, or confirmed human case of monkeypox
Laboratory
Criteria
- Isolation
of monkeypox virus in culture
- Demonstration
of monkeypox virus DNA by polymerase chain reaction testing of a clinical
specimen
- Demonstration
of virus morphologically consistent with an orthopoxvirus by electron
microscopy in the absence of exposure to another orthopoxvirus
- Demonstration
of presence of orthopoxvirus in tissue using immunohistochemical testing
methods in the absence of exposure to another orthopoxvirus.
Case
Classification
Suspect Case
- Meets
one of the epidemiologic criteria
AND
- Fever
or unexplained rash AND two or more other signs or symptoms with onset
of first sign or symptom <21 days after last exposure meeting
epidemiologic criteria
Probable
Case
• Meets
one of the epidemiologic criteria
AND
- Fever
AND vesicular-pustular rash with onset of first sign or symptom <21
days after last exposure meeting epidemiologic criteria
Confirmed
Case
- Meets
one of the laboratory criteria
Exclusion
Criteria
A case may be excluded as a suspect or probable monkeypox case if:
- An alternative
diagnosis can fully explain the illness5
OR
- The case
was reported on the basis of primary or secondary exposure to an exotic
or wild mammalian pet or a human (see epidemiologic
criteria) subsequently determined not to have monkeypox, provided
other possible epidemiologic exposure criteria are not present OR
- A case
without a rash does not develop a rash within 10 days of onset of clinical
symptoms consistent with monkeypox6.
- The case
is determined to be negative for non-variola generic orthopoxvirus by
polymerase chain reaction testing of a well sampled rash lesion by the
approved Laboratory Response Network (LRN) protocol.
_______________
| 1 |
Includes
living in a household, petting or handling, or visiting a pet holding
facility (e.g., pet store, veterinary clinic, pet distributor) |
| 2 |
Includes
prairie dogs, Gambian giant rats, and rope squirrels. Exposure to
other exotic or non-exotic mammalian pets will be considered on a
case-by-case basis; assessment should include the likelihood of contact
with a mammal with monkeypox and the compatibility of clinical illness
with monkeypox |
| 3 |
Includes
living in a household, or originating from the same pet holding facility
as another animal with monkeypox |
| 4 |
Includes
skin-to-skin or face-to-face contact |
| 5 |
Factors
that might be considered in assigning alternate diagnoses include
the strength of the epidemiologic exposure criteria for monkeypox,
the specificity of the diagnostic test, and the compatibility of the
clinical presentation and course of illness for the alternative diagnosis. |
| 6 |
If
possible, obtain convalescent-phase serum specimen from these patients.
See specimen collection guidelines
for details on collecting serum for convalescence evaluation. |
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