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A Case of Monkeypox in a Returned Traveler

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On June 30, 2021, five days after having arrived in Nigeria, where he stayed only in urban centers, a man had onset of cough, fever, diarrhea, and vomiting. Then, on July 8, he developed a purulent skin eruption. ( See Figure 1. ) The following day, he flew to Dallas, with a brief stopover in Atlanta, followed by a ride-share to his home. On July 13, he was driven to the hospital by a friend after worsening of the rash, which had become visible on his face.

The man was immediately placed into airborne isolation and managed with contact isolation and eye protection. The emergency department doctor reviewed the information for Nigeria at the Centers for Disease Control and Prevention (CDC) Traveler’s Health website, which led him to suspect monkeypox and to immediately notify public health authorities. The diagnosis of monkeypox was confirmed the following day, and subsequent testing identified the virus as belonging to the West African clade. The patient was treated with tecovirimat and was discharged after 32 days, at which time monkeypox virus deoxyribonucleic acid (DNA) could no longer be detected in residual skin lesions.

Figure 1: Time Line of Patient Activities and Potential Exposures to Monkeypox Virus from Patient’s Arrival in Lagos, Nigeria to Completion of Monitoring for the Last Exposed Known Contact — Dallas, Texas, June–September 2021

ED: emergency department

Source: Rao AK, Schulte J, Chen TH, et al. Monkeypox in a traveler returning from Nigeria — Dallas, Texas, July 2021. MMWR Morb Mortal Wkly Rep 2022;71:509-516.

Potential exposures of others were determined by patient report, flight seating arrangements, and airport video surveillance. Public notifications were made. It was determined that the labels of disinfectants used on planes between flights indicated that they inactivated monkeypox virus. Multiple relevant surfaces, including those in the patient’s...