Animal-to-human (zoonotic) transmission can occur from direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals. In Africa, evidence of monkeypox virus infection has been found in many animals including rope squirrels, tree squirrels, Gambian poached rats, dormice, different species of monkeys and others.  In July 2003, there were 71 cases of monkeypox reported   The cases came from several states: Wisconsin had 39 cases; Indiana, 16; Illinois, 12; Missouri, 2; Kansas, 1; and Ohio, 1.  Eating inadequately cooked meat and other animal products of infected animals is a possible risk factor. People living in or near forested areas may have indirect or low-level exposure to infected animals.  Investigators determined that a shipment of animals from Ghana, imported to Texas in April 2003, introduced monkeypox virus into the United States. By June 2003, at least 30 people received the smallpox vaccine, including 28 adults and two children. The vaccine was given pre-exposure to some and postexposure to othe  No serious adverse events were reported following smallpox vaccination.   On May 7, the UK Health Security Agency confirmed a case of monkeypox in a patient who had traveled from Nigeria to the United Kingdom.  As of May 20, the UKHSA has detected 20 cases of monkeypox since May 6.  Scientists at the Centers for Disease Control and Prevention (CDC) are collaborating with the Massachusetts Department of Public Health to investigate a situation in which a U.S. resident tested positive for monkeypox on May 18 after returning to the U.S. from Canada.  CDC is also tracking multiple clusters of monkeypox that have been reported in early- to mid-May in several countries that don’t normally report monkeypox, including in Europe and North America.  U.S. monkeypox cases are very rare. Monkeypox does not occur naturally in the United States, but cases have happened that were associated with international travel or importing animals from areas where the disease is more common.”

Center for Disease Control and Prevention (CDC)