Veterinary Guidance for Monkeypox

Zoonotic transmission

The exact vectors of monkeypox virus (MPXV) in endemic areas are unknown, but it is believed that small mammals, such as rope and sun squirrels, giant-pouched rats, African dormice, anteaters, hedgehogs, prairie dogs, squirrels, and shrews may carry the virus in parts of West and Central Africa.

Small mammals can be asymptomatic carriers, while infected non-human primates are typically symptomatic.

Infected animals can potentially spread monkeypox to people or other animals including companion animals, livestock or production animals, zoo animals, and wild animals (captive and free ranging, as well as household pests like mice and rats).The most common route for transmission of monkeypox from infected animals to people is direct contact with the infectious rash, scabs, crusts or fluids from sores, saliva, or infected bodily fluids, including respiratory secretions. Exposure often occurs from hunting, trapping, and processing infected animals or their body parts and fluids.

People with monkeypox could possibly spread the virus to pets through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food. However, no pets or other animals were confirmed to have gotten monkeypox from human transmission during the global clade II monkeypox outbreak that began in 2022.

Case definition in animals

Epidemiologic criteria

• The animal had close contact with a probable or confirmed human or animal monkeypox case within the past 21 days
  • Close contact includes petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food

Clinical criteria

• Rash or poxvirus-like lesions, which may be:
  • Macular, papular, vesicular, or pustular
  • Generalized or localized

Other possible clinical signs:

• Conjunctivitis with or without ocular secretion
• Coryza (crusty nose) and/or nasal secretions
• Cough
• Loss of appetite
• Lethargy
• Labored breathing
• Bloating
• Fever

Case classification

Suspect Case

• An animal that meets the epidemiologic criteria AND has a rash, or two or more clinical signs
• Wild mammals that meet the clinical criteria

Probable Case

• An animal that meets the epidemiologic criteria AND presence of anti-orthopoxvirus antibodies*, OR
• An animal with presence of monkeypox virus DNA by polymerase chain reaction

Confirmed Case

• An animal with isolation of monkeypox in culture from a clinical specimen AND presence of monkeypox DNA by polymerase chain reaction (PCR) testing or DNA sequencing, OR
• An animal with presence of monkeypox DNA by PCR or DNA sequencing AND presence of anti-orthopoxvirus antibodies*, OR
• An animal with evidence of orthopoxvirus in pox lesions or other tissues by immunohistochemistry OR electron microscopy testing methods, AND presence of monkeypox DNA by PCR or DNA sequencing

*There is a lack of data regarding the timing of anti-orthopoxvirus IgG antibody production in most animal species. However, it is generally thought to be detectable between 2-4 weeks post-exposure and remains detectable for months or years.

Testing animals for monkeypox

Test animals for monkeypox if they meet the suspect case definition (i.e., epidemiological link and clinical signs).

Prevent transmission in veterinary settings

Animals with suspected or known monkeypox exposure within the past 21 days, should not be allowed to enter through the waiting area of a veterinary clinic or hospital, nor should they be taken to a common treatment room. All treatment and diagnostics should be performed in a private examination room away from people and other animals. Limit the number of staff allowed in the exam room and that come in contact with this animal. After each use, clean and disinfect the examination room and any patient care areas where the animal may have been.

When examining and caring for animals with suspected or known MPXV infections, veterinarians and staff should use the following precautions:

Personal protective equipment (PPE)

• In accordance with veterinary standard precautions, wear a gown and gloves for all contact with the sick animal and contaminated surfaces and practice appropriate hand hygiene.
• Use eye protection (e.g., tight-fitting goggles or face shield) if splash or spray of body fluids is likely.
• Use a NIOSH-approved particulate respirator equipped with N95 filters or higher when entering the exam room.
• Employers must comply with OSHA's standards on PPE (29 CFR 1910.132), Respiratory Protection (29 CFR 1910.134), and other requirements, including those established by state plans, whenever such requirements apply.

Handling contaminated material

Follow your local health department guidelines for waste disposal, but in general:

• Use a dedicated, lined trash can for all potentially contaminated waste. An exception is animal waste, which, along with disposable rodent/small mammal bedding, can be flushed down the toilet if appropriate for the species and your plumbing system.
• Seal disposable rodent/small mammal bedding and other waste that cannot be flushed down the toilet in puncture-resistant plastic bags and dispose of the bags as recommended by your local health department.
• Do not dispose of waste outdoors or in landfills, as this could expose wild animals and household pests like mice and rats to MPXV.
• Clean and disinfect potentially infectious non-disposable items.
• Do not dispose of potential infectious items or materials in clinic trash or in landfills without previous disinfection. See waste disposal recommendations above.
• Do not shake or handle soiled laundry and bedding (including disposable rodent bedding) in a manner that may disperse infectious particles.

Environmental cleaning

• Disinfect bedding, enclosures, food dishes, and any other items in direct contact with infected animals following disinfection guidance for home and other non-healthcare settings.
• Perform standard cleaning and disinfection procedures using an EPA-registered hospital-grade disinfectant with an emerging viral pathogen claim.
• Products with Emerging Viral Pathogens claims may be found on EPA's List Q. Follow the manufacturer's directions for concentration, contact time, and care and handling.

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