First fatal case of Alaskapox claims life of Kenai Peninsula man

An elderly man on the Kenai Peninsula has died from Alaskapox, making him the first person to be killed by the viral disease that was identified only nine years ago, state health officials reported on Friday.

Aside from being the first fatal human case, it is the documented first human infection outside of the Fairbanks area, indicating that the virus, which is known to be harbored by small mammals, has spread beyond the wildlife populations in that Interior community.

The patient, who had an immune system that was compromised because of treatment for cancer, first reported signs of the infection in September when a tender lesion appeared in his armpit area, according to a bulletin issued by the state Division of Public Health’s epidemiology section. The infection worsened, and after six weeks of emergency-care visits, he was hospitalized locally. As the situation deteriorated and his arm movement became impaired, he was transferred to an Anchorage hospital. There, numerous tests were needed to identify the infection, the bulletin said.

Even with treatment, the patient suffered renal failure, respiratory failure, malnutrition and other problems, the bulletin said. He died in late January, the bulletin said.

Related to more dangerous diseases

Alaskapox is a disease caused by a virus in what’s known as the orthopox group. It is related to more dangerous viruses that cause monkeypox and smallpox. Like the other orthopox viruses, the virus causing Alaskapox is maintained in and spread by populations of small mammals. Voles, which live nearly everywhere in Alaska, have been found to be especially prominent carriers.

The first case of a human Alaskapox infection was detected in 2015 in the Fairbanks area. The next case emerged in 2020; there were two more in 2021, one in 2022 and one last year, according to state officials. The Kenai Peninsula case is the seventh to be identified.

A common thread in the prior cases, all involving Fairbanks-area patients, was the wooded nature of their homes. Another thread was contact with household pets – cats or dogs – that appeared to have mingled with small mammals.

Until last month’s death, the documented effects of Alaskapox infections in people were fairly mild, with symptoms such as rashes, fevers and fatigue, said Julia Rogers, a state epidemiologist who coauthored the bulletin released Friday.

“All 6 prior cases were identified in an outpatient setting and involved mild illnesses that were largely resolved within a few weeks without hospitalization. None of these patients had significant prior medical history, including immunocompromising conditions,” Rogers said by email.

Like the Fairbanks patients, the Kenai Peninsula patient lived in a forested area, the epidemiology bulletin said. He could have had at least indirect contact with small mammals in the wild, as he reported caring for a stray cat that might have been hunting those mammals, the bulletin said.

Alaskapox, like the monkeypox to which it is related, is among a vast number of zoonotic diseases, which are diseases that can spread between animal species, including humans. Such diseases demonstrate the link between human and wildlife health.

Yet to be determined is how long Alaskapox has been in the environment. But signs are emerging that it has been circulating in populations of small mammals for decades

In the past, Rogers said, research into wildlife diseases focused on large mammals, not small animals like voles.

But in 2015, after the first Alaskapox case was identified, researchers tested a few rodents near the patient’s home but did not find any that were infected with the virus, Rogers said. Wider testing of small mammals that were trapped in the Fairbanks area after the 2020 case emerged did show the first evidence of the infection in those animals, she said.

New evidence

Link Olson, curator of mammals at the University of Alaska Museum of the North, said on Friday that tests have now discovered the virus in a 25-year-old vole specimen in the museum’s collection.

“We know this is not a last-10years-thing,” he said.

Scientists at the museum, in cooperation with the state epidemiology section and other organizations, have now started a testing program using its vast collection of Alaska animal specimens, he said. Later on, when the weather allows it, there will be more field work to trap small mammals in the wild, he said.

There is a good chance that Alaskapox will be found in animal populations well beyond the state’s borders and even beyond North America, Olson said.

“I fully expect that this will be detected across the boreal forest,” he said.

Biologist calls for more preventive approach to disease research

Falk Huettmann, a University of Alaska Fairbanks biologist who studies wildlife diseases and the environmental factors that shape them, also said he believes that Alaskapox has been circulating in the wild for years – and that there may have been serious human infections in the past that went undetected.

Understanding how Alaskapox may be spreading among small mammals is “a big topic because we have so many of them,” and thus difficult, he said.

There are also structural obstacles to better understanding, he said. “I think that it’s a mixture between having enough resources being overwhelmed and facing a new disease but also being caught in a very oldfashioned perspective of diseases,” he said.

Policy responses tend to be reactive, especially when there are serious or “spectacular” cases, Huettmann said. But preparation for disease spread is lacking, he said. There should be more information sharing from hospitals and health care providers, locally and regionally focused monitoring to help identify hot spots of higher risks, and lab experiment work to identify genetics of different strains and create models for different disease-spread scenarios, he said.

The role of small mammals in

Alaska’s ecosystems in general and the spread of disease in particular is often overlooked, said Huettmann, who recently published a book about squirrels.

But they are big players. Tiny animals like mice spread hantavirus, for example, as do rats, which are invasive in Alaska. On the larger side of the small-mammal spectrum are squirrels, known to spread bubonic plague, which was known as the Black Death when it killed 25 million people in Europe in the 14th century.

It makes sense that Alaskans would be exposed to a zoonotic disease like Alaskapox, Huettmann said, notably in Fairbanks, where there is a long tradition of outdoor lifestyles that include activities like biking, mushing, trapping and use of rustic cabins.

What should change, he said, is a different tradition, “the idea that the past dictates the future,” he said.

Alaskapox, now shown to be potentially fatal, is an example of evolving diseases that demand a more open-minded approach to research, he said.

“I totally appreciate that that’s a new case, that people are surprised. But then, if you know the reality of diseases and the history of diseases, we shouldn’t be surprised,” he said. “Everything is possible by now.”