Genetically distinct Alaskapox in a new location: How many more exist?

Since the first case of Alaskapox, an infection caused by a novel orthopoxvirus, was identified in a person living near Fairbanks, Alaska, in 2015, all six known cases have lived in the Fairbanks region, were immunocompetent and did not require hospitalization. In contrast, the first known fatal case, reported Feb. 9 in the State of Alaska Epidemiology Bulletin, was an elderly immunocompromised man who lived several hundred miles south of Fairbanks in the Kenai Peninsula of Alaska and required hospitalization before his death in January with renal and pulmonary failure.

“We were able to sequence the virus from this patient’s case, and it did show that there was a distinction between this case and the clusters of cases that we were able to sequence from Fairbanks,” Julia Rogers, PhD, MPH, an epidemiologist with the Centers for Disease Control and Prevention who is assigned to the Alaska Department of Health, told CNN.

After the first patient in 2015, the origin of the infection due to this novel Old World orthopoxvirus was not determined. A second patient was diagnosed in August 2020 by the same clinician in Fairbanks as in 2015. Afterwards, testing of a larger number of animals resulted in viable virus being isolated from at least one red-backed vole and one shrew. In addition, 20/385 (5%) animals across two species were positive for Alaskapox virus by PCR as reported on April 25, 2023, at the CDC EIS Conference (see abstracts, page 50) by Katherine Newell, PhD, MPH, and colleagues at CDC and in Alaska.

Given the extensive geographic range of the northern red-backed vole across Alaska as well as parts of Canada, Russia, China and Scandinavia, it will not be surprising if even more genetically distinct Alaskapox viruses are found in patients and animal species elsewhere in Alaska and other nations. Active epidemiologic surveillance and testing for susceptibility to antiviral drugs and vaccines available for mpox and smallpox in the U.S. Strategic National Stockpile are warranted.