First Known Death Reported From the Rare Virus

Alaskapox is a type of orthopoxvirus found mainly in small mammals, according to state officials. No human-to-human transmission of Alaskapox virus has been documented, according to state officials, although they still recommend keeping skin lesions caused by the virus covered.

Symptoms of Alaskapox include:

• one or more skin lesions
• swollen lymph nodes
• joint and/or muscle pain

“We know, at this time, that infections are rare and usually not severe,” said Dr. Jay Varma, executive vice president and chief medical officer at SIGA Technologies, a pharmaceutical company focused on providing solutions for the health security market.

SIGA Technologies manufactures TPOXX, an antiviral to treat smallpox disease.

He highlighted that more research is needed on Alaskapox virus to understand how common it is in animals, the environment, and people, and how best to prevent and treat it.

“The more important lesson for the public is to recognize that new infectious diseases are emerging and spreading faster than ever,” he told Healthline.

In the most recent Alaskapox case, the man’s symptoms began in September 2023 as a tender red papule, or lesion, in his right armpit. At the time, he was undergoing medical treatment for cancer that also suppressed his immune system.

Over the next 6 weeks, he visited his primary care doctor and the emergency department several times, and was prescribed several rounds of antibiotics. A biopsy of the lesion revealed no signs of cancer or a bacterial infection.

In spite of the antibiotic therapy, the man developed fatigue and pain in the right armpit and shoulder. He was hospitalized in November with a worsening infection that limited the movement of his arm.

He was later transferred to a hospital in Anchorage with increased pain and other symptoms. Four smaller lesions were found on other areas of his body.

A laboratory test initially indicated that the lesion was positive for cowpox virus. However, additional testing ruled out cowpox, mpox, and vaccinia viruses, but not Alaskapox virus.

A sample sent to the Centers for Disease Control and Prevention (CDC) identified the infection as due to Alaskapox virus, one that is distinct from samples collected from previous cases in Fairbanks.

The man was treated with:

About 1 week into treatment, the man’s symptoms initially improved. However, during his time in long-term care, his condition worsened, and he experienced delayed wound healing, malnutrition, acute kidney failure and respiratory failure. He died at the end of January.

According to state health officials, Alaskapox virus has been most commonly identified in red-backed voles and shrews. However, the virus may be more widespread in small mammal populations, and undiagnosed infections may have occurred in people, they said.

In the Feb. 9 bulletin, officials report that the man lived alone in a forested area, and indicated he had not traveled recently or come in close contact with anyone who had recently traveled, was sick or had similar lesions.

The man also reported caring for a stray cat that hunted small mammals and frequently scratched him. About one month prior to the appearance of his rash, the man had a significant cat scratch near his right armpit.

The man reported no other recent contact with small mammals but said he gardened in his backyard through September 2023. Blood and mucosal swab samples from the cat sent to the CDC were negative on antibody and orthopoxvirus testing.

The route of transmission “remains unclear,” officials said in the bulletin, adding that “the patient’s immunocompromised status likely contributed to illness severity.”

The most recent previous Alaskapox cases in Alaska occurred in 2021, a young child and a middle-aged woman. The two were unrelated, but both had spent time outside in the summer.

Neither had known direct contact with small mammals or their feces, but dogs and at least one cat were present in both households, with the cats hunting small mammals.

“While the number of recorded cases [of Alaskapox] is low, this recent incident highlights that orthopoxviruses continue to be a potential threat to human health,” SIGA Technologies, the manufacturer of TPOXX, said in a statement.

In addition to being approved for the treatment of smallpox in the United States, TPOXX is approved for smallpox, monkeypox, and cowpox in the European Union and United Kingdom.

Varma suggests you consider talking to a healthcare provider if you develop a new skin lesion that you are concerned about, especially if you also have swollen lymph nodes, fever or other new symptoms, and have had recent close contact with wildlife.

Alaska state officials also recommend that people follow CDC guidelines for staying safe around wildlife, including:

• Wash your hands with soap and running water after coming into contact with wild animals or their feces, or after spending time outdoors or in places where wild animals might have been (such as attics, cabins, gardens or sheds).
• Keep your distance from wildlife, don’t pet or feed wildlife, and don’t touch or pick up dead animals with your bare hands.
• Before spending time outdoors, learn about its wildlife, such as biting insects, spiders and venomous snakes, and diseases that wildlife may be carrying.
• Keep pets safe around wildlife, including keeping them on a leash in unfenced areas, and not letting them interact with wild animals or eat dead wild animals.

Alaska state health officials report that an older man with immunosuppression resulting from medical cancer treatment died as a result of an infection due to Alaskapox virus.

The first case of Alaskapox occurred in the state in 2015. Since then, six other cases have occurred. The most recent case is the first death. The virus is closely related to the monkeypox virus.

The virus is found mainly in small mammals such as voles and shrews, and may spread to people through direct contact with wild animals or their feces, or through domestic pets that have come into contact with the animals