Top 5 Takeaways

1. First U.S. Case Since 2017 Outbreak: In July 2021, a U.S. resident returning from Nigeria was diagnosed with Monkeypox, marking the first travel-associated case in the U.S. since the 2017 outbreak in Nigeria.
2. Extensive Public Health Response: The investigation involved identifying and monitoring 223 contacts, disinfecting potentially contaminated surfaces, and ensuring no secondary cases occurred.
3. Importance of Early Detection: Prompt clinical suspicion, reporting to public health authorities, and appropriate infection control measures were critical in managing the case.
4. Challenges in Contact Tracing: Difficulties included reaching non-U.S. residents and those with inaccurate contact information, as well as categorizing exposure risks accurately.
5. Preventive Measures and Recommendations: The case highlighted the need for awareness of Monkeypox risks, early clinical suspicion, and preparedness for potential future cases in the U.S.

Original Article Author and Citation

Corresponding Author

Agam Rao, akrao@cdc.gov

Suggested Citation

Rao AK, Schulte J, Chen T, et al. Monkeypox in a Traveler Returning from Nigeria — Dallas, Texas, July 2021. MMWR Morb Mortal Wkly Rep 2022;71:509–516. DOI: http://dx.doi.org/10.15585/mmwr.mm7114a1

Summary

In July 2021, a U.S. resident returning from Nigeria was diagnosed with Monkeypox, marking the first travel-associated case in the U.S. since the 2017 outbreak in Nigeria. The patient exhibited symptoms such as fever, cough, fatigue, and a diffuse rash. The public health response involved identifying and monitoring 223 contacts, disinfecting potentially contaminated surfaces, and ensuring no secondary cases occurred. The patient received tecovirimat treatment and underwent a 32-day hospitalization. The case underscored the importance of early clinical suspicion, prompt reporting, and awareness of Monkeypox transmission risks.

Methods

The investigation included reviewing orthopoxvirus information, categorizing exposures based on risk levels, and utilizing airport video surveillance, patient interviews, and flight seating assignments to identify contacts. Notifications were issued to the public, clinicians, and public health officials. Disinfection protocols were followed for potentially contaminated surfaces. A CDC call center was established to coordinate daily monitoring and provide clinical consultations.

Discussion

This case highlighted the challenges of managing a travel-associated Monkeypox case, including contact tracing difficulties and the need for a cautious approach due to limited data on Monkeypox virus epidemiology. The use of masks during the COVID-19 pandemic reduced the risk of transmission. The case emphasized the importance of early clinical suspicion, appropriate infection control measures, and preparedness for future cases. Understanding exposure risks and ensuring timely decontamination of surfaces were critical actions taken.

Conclusion

The case of Monkeypox in a traveler returning from Nigeria underscored the need for continued vigilance and preparedness for potential future cases in the U.S. Early clinical suspicion, prompt reporting, and awareness of high-risk exposures are crucial for effective public health response. The case also highlighted the importance of understanding Monkeypox transmission risks and ensuring timely decontamination of potentially contaminated surfaces.

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