There is an increasing global incidence of human infection with orthopoxviruses, thought to partly be due to the cessation of smallpox vaccination and waning of population-level immunity. The authors describe the case in July 2015 of a female resident of Alaska who presented to an urgent care clinic with a dermal lesion consistent with poxvirus infection. Laboratory testing confirmed that the viral cause was an orthopoxvirus. Neither signs of active infection nor evidence of recent prior infection were seen in any of the patient’s four contacts. The patient’s infection source was not definitively identified. Potential routes of exposure included imported fomites from Azerbaijan via the patient’s cohabiting partner or from wild small mammals in or around the patient’s residence. Phylogenetic analyses found that the virus was from a distinct and previously undescribed genetic lineage of Orthopoxvirus, most closely related to Old World orthopoxviruses. Therefore orthopoxviruses continue to pose an infection risk and their exact geographic origins (Old World vs. North American) are still not clear.
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