A Man Has Died From Alaskapox. Here’s What We Know About the Virus

Alaska’s health department reports that the first person in the state has died from a recently discovered virus called Alaskapox.

The elderly man—who was immunocompromised due to cancer treatments—first noticed an unusual lesion in his right armpit last September, according to Alaska health officials who spoke to TIME about the case. He was prescribed antibiotics at his local emergency room on the Kenai Peninsula, but after multiple visits and a worsening, painful infection, he was transferred to a hospital in Anchorage.

The patient tested positive for orthopoxvirus, but extensive testing ruled out cowpox, mpox, and chickenpox, which are members of the same viral family. Doctors sent a sample to the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, where scientists confirmed the presence of Alaskapox.

After initially improving, the man's health declined, and he eventually experienced renal and respiratory failure.

What is Alaskapox?

Alaskapox was first reported in a man in the Fairbanks region in 2015. Six additional cases have since been reported, all in residents of the same area—one in 2020, two in 2021, one in 2022, and two in 2023 (including the latest case). All of the patients before the most recent one had relatively mild symptoms of rashes and swollen lymph nodes and recovered without treatment. Infectious disease experts tested small mammals in the region and found four species—including voles, flying squirrels, and other rodents—were infected with the virus, and were likely the reservoir for infecting people.

The latest case is "the first case of serious Alaskapox infection seen in Alaska, the first case that involved somebody who was immunocompromised, the first case that required hospitalization, the first case that ultimately resulted in death, and the first case to occur outside of the Fairbanks area," says Dr. Joseph McLaughlin, staff physician in the Alaska Department of Health and the state epidemiologist.

How Alaskapox might spread

The man in the fatal case lived alone in the Kenai Peninsula and reported taking in a stray cat that scratched him several times, including near the right underarm. The cat tested negative for Alaskapox virus, but McLaughlin says that it's possible that cats and dogs who hunt small mammals could remain uninfected but retain the virus on their claws, potentially transmitting it when they scratch people. "We are very interested in studying the role of domestic pets as potential intermediate vectors in transmitting the virus from rodents to humans," he says.

Alaska health authorities believe the man’s weakened immune system might have contributed to his severe case. The virus from this latest case is also genetically different from previously identified Alaskapox viruses, which isn't surprising since orthopox viruses change as they circulate among animal reservoirs. So far, "there is no evidence to make us believe that this strain would have increased virulence or transmissibility," says Dr. Julia Rogers, an epidemic intelligence officer with the CDC assigned to the Alaska division of public health. "That can't be ascertained without additional cases and investigations."

What's concerning for public health experts is the fact that his case occurred about 500 miles outside the region where previous infections had been reported, suggesting that the virus is more widespread in mammal populations than previously thought. The Alaska Department of Health, the CDC, and the University of Alaska have collaborated to trap and test small rodents in the Fairbanks area for Alaskapox to determine where the virus is circulating, and now those plans will expand to include testing animals down to the Kenai Peninsula. "Right now the most pressing question is how widely distributed this virus is in small mammals throughout Alaska, and perhaps even beyond the state," says McLaughlin. If Alaskapox has spread beyond Alaska, it's most likely that animals in neighboring areas such as the Yukon and Russia could also be carrying the virus.

Though human-to-human transmission of Alaskapox hasn't been recorded, other viruses in this family can spread this way. Therefore, health officials warn that people infected with Alaskapox or who have suspected infections should avoid touching them and get tested as soon as possible. In some cases, people such as healthcare workers who are immunocompromised and who might have been exposed can be vaccinated with the vaccine for mpox, Jynneos, to minimize the severity of infection.

It's not clear yet how widespread the Alaskapox virus is, but McLaughlin says it's likely been circulating among animals for a long time, and that health officials have only recently detected it as people have become infected. "Alaskapox remains a rare disease, and we don't have any evidence to indicate that the incidence is increasing over time," he says. Even so, health officials urge people with unexplained lesions and rashes to report them immediately to their doctors, who can then determine if additional testing at public health labs is needed to identify the virus.