In July, a young child in the Fairbanks area showed up at an urgent care clinic with a “pox-like” mark on the inside of her left elbow, along with other symptoms including a mild fever and pain.
Three weeks later, the mark — which at first resembled an insect bite — had gone away, as had her other symptoms.
In August, an unrelated Fairbanks-area woman sought medical care for a similar lesion on her right thigh accompanied by joint pain. After three weeks, she had mostly recovered too.
According to a report recently issued by the Alaska Division of Public Health, both patients were later diagnosed with the third and fourth known cases of a recently discovered species of double-stranded-DNA virus called “Alaskapox,” which comes from the same genus as smallpox, monkeypox and cowpox.
The first two cases of Alaskapox were identified in 2020 and 2015, when two Fairbanks-area residents developed similar lesions on their arms.
The discovery of two more cases suggests that the virus may be more common than initially thought, said Eric Mooring, an epidemiologist and Centers for Disease Control and Prevention assignee to the Alaska Section of Epidemiology who is investigating the case.
“We do think that it’s good for people to be aware of this, especially health care providers,” said Mooring, a lieutenant in the U.S. Public Health Service Commissioned Corps. “But in terms of how concerned people should be, we don’t think it should be a major source of worry.”
That’s because all four known cases of Alaskapox have been relatively mild, meaning they did not involve hospitalizations or aggressive medical treatment. Symptoms resolved on their own after a few weeks. Evidence of human-to-human transmission is also nonexistent, which is an encouraging sign, Mooring said.
“These are continuing to be isolated cases that don’t have any known connection to each other — and certainly we always ask if household members or other contacts have had similar illness, and none have,” Mooring said.
While Alaskapox belongs to the same genus as smallpox, the two appear to share few traits.
Unlike Alaskapox, smallpox is highly contagious and involves multiple lesions across the body. Alaskapox has so far involved a single, localized lesion in each known case. Smallpox — which was essentially eradicated worldwide by 1980 — was linked to significant mortality and hospitalization rates over thousands of years.
In contrast, “we haven’t identified anyone who was hospitalized much less died from Alaskapox,” Mooring said.
The discovery of a new viral disease in humans is relatively rare: Alaskapox is only the third orthopoxvirus discovered in the last decade.
How Alaskapox is contracted, whether it poses a serious health risk and how long it has been around still remain a mystery. But according to Mooring and the newest report, some patterns have begun to emerge.
The two most recent cases involved people with no travel history and no links to previous cases — and all four cases have involved people living in low-density housing in forested areas where small mammals roam.
The running hypothesis is that small animals played some role in transmission, which appears highly likely at this point, Mooring said. Research done in October 2020 turned up some evidence of the virus in small mammals in the area, including voles, shrews and squirrels.
What’s yet to be determined is which small mammals were most likely involved in transmission to humans, and how that transmission occurred.
Three of four people diagnosed owned cats, which can “serve as intermediate hosts for another orthopoxvirus, cowpox virus, and can transmit the virus to humans,” the report noted — but Mooring said the role cats may or not play in transmission is yet to be determined.
That discovery plus the newest cases have made researchers “more and more confident that this virus lives in this state, and probably has for quite some time,” Mooring said, though it is difficult to put a timeline on it. He said it was possible that Alaskapox has been around a long time and is only now being discovered.
Mooring encouraged Alaskans to not handle wild animals and to avoid areas with animal droppings, try to keep wild animals from entering their homes and wash their hands regularly. Anyone with an Alaskapox-like lesion should cover it with a bandage and see a medical provider, he added.