The United States has recorded its first death from Alaskan smallpox, a newly discovered new virus.

In Alaska, the first death associated with the newly discovered Alaskapox virus (Alaskan smallpox) has been identified, reports CNN.

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Since Alaskapox was identified in 2015, there have been seven cases of the virus, according to the state Department of Health. The last one was found in an elderly man who died last month.

“This is the first case of severe Alaskapox infection resulting in hospitalization and death,” the department said in a statement.

Officials noted that the man had a weakened immune system due to cancer treatment. This probably contributed to the severity of his illness.

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Experts say the disease is often mild. People rarely become infected. The virus is primarily found in small mammal populations throughout Alaska.

“Six out of seven cases were mild. The patient did not even require any supportive care from the health care provider,” said Dr. Joe McLaughlin, chief of Alaska's Division of Epidemiology.

However, little is known about the virus, including how it spreads from animals to humans and how long it has been around, McLaughlin said.

What is Alaskapox

Alaskapox was recently discovered. McLaughlin says the virus is endemic in small mammal populations in Alaska. It regularly infects red-backed voles and shrews, as well as other rodents such as red squirrels.

It belongs to the genus Orthopoxviruses, which includes its more famous “relatives” - smallpox and MPox (monkeypox). They often infect mammals and cause skin lesions.

McLaughlin notes that Alaskapox is an “old world” virus typically found in Africa, Asia and Europe.

“It is quite possible that this virus has been present in Alaska for hundreds, if not thousands, of years,” he suggested.

However, the discovery of more Alaskapox cases does not mean the virus has become more prevalent in the state's small mammal population in recent years.

“What has changed is the awareness among doctors and the general public that the Alaskapox virus exists,” McLaughlin said. “It is quite possible that the cases occurred before 2015, they were just subclinical or slightly clinical. They just weren't diagnosed."

Geography of the virus

It's not yet clear how long the virus has been circulating in the state, with infections occurring through contact with animals, said Dr. Julia Rogers, an epidemiologist with the Epidemic Intelligence Service.
“These people contracted it as a result of some contact with an animal,” she noted.

The first case of Alaskapox was identified in July 2015 in a woman living near Fairbanks in central Alaska, according to the state health department. Since then, five more cases have been reported in the Fairbanks area.

The most recent one, which resulted in the first known smallpox death in Alaska, was the first to be discovered outside of Fairbanks. It happened about 800 miles south of the Kenai Peninsula, officials said.

That is, Alaskapox is more geographically widespread than previously thought.

“We were able to determine the amino acid sequence of the virus from this patient's case. It really showed that there was a difference between this case and the clusters of cases that we were able to study in Fairbanks,” Rogers explained.

However, she clarifies, the recent discovery is likely due to geographic differences in the virus and is not the result of it being “brought in from the Fairbanks area.”

None of the seven people diagnosed with Alaskapox had recently traveled out of the state or country, experts said. And not a single case of the disease has been identified outside of Alaska.

Possible spread through pets

Rogers says more sampling of affected animal populations is needed to fully understand how the virus spreads from animals to humans. But contact with small mammals and the pets that come into contact with them may play a role.

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Health officials say the man who died lived in a heavily wooded area and cared for a stray cat that preyed on small mammals.

“A stray cat would come into his house from time to time and he would play with it. She often scratched the man,” McLaughlin said.

The Alaska Department of Public Health says scratches from the cat in this case are a "possible source" of infection.

“This is consistent with data patterns from other old world orthopoxviruses,” McLaughlin said. “Trauma to the skin usually leads to transmission of infection from pet to person.”

Alaskapox symptoms and treatment

With the exception of the latest case, all Alaskapox patients had mild illness that went away on its own within a few weeks, according to the state health department.

Symptoms usually include one or more skin lesions that at first glance look like a spider bite, McLaughlin said. Enlarged lymph nodes are also possible, as well as muscle pain and fever.

“If there are any series or isolated symptoms that meet this case definition, and you do not have any other known cause or known medical condition that contributes to these symptoms, then you should definitely contact your doctor. He will do additional evaluation and some tests,” Rogers advised.

Health officials say symptoms may be more severe in people with weakened immune systems. The man who died from Alaskapox had slow wound healing, malnutrition, and acute renal and respiratory failure.

Antiviral therapy and immunoglobulin treatment can be prescribed, McLaughlin said.

Experts note that although some orthopoxviruses can be transmitted from person to person through direct contact with skin lesions, there is no evidence that a person with Alaskapox can transmit the virus to someone else.

“People outside of Alaska should not worry,” McLaughlin said. “Alaska residents just need to know that this is an infection that they can get.”

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