For Public Health Veterinarians and Animal Health Officials

Mpox Transmission between Animals and People

Infected animals can potentially spread mpox 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 such as mice and rats). We don’t know for sure if pets like dogs and cats can be infected with mpox, but it is possible. The most common route for transmission of mpox 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.

People with mpox could possibly spread the virus to pets through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food. No pets or other animals were confirmed to have mpox during the 2022-2023 global mpox outbreak. People who are immunocompromised, pregnant, have young children present in the home (children < 1 year of age), or with a history of atopic dermatitis or eczema, should not care for animals that potentially exposed to mpox.

Case Definition in Animals

Epidemiologic Criteria

• The animal had close contact with a probable or confirmed human or animal mpox 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 mpox virus DNA by polymerase chain reaction

Confirmed Case

• An animal with isolation of mpox in culture from a clinical specimen AND presence of mpox DNA by polymerase chain reaction (PCR) testing or DNA sequencing, OR
• An animal with presence of mpox 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 mpox 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.

Preventing Transmission in the Veterinary Clinical Setting

Animals with suspected or known mpox 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 mpox virus infections, veterinarians and staff should use the following precautions:

Personal Protective Equipment (PPE)

• In accordance with veterinary standard precautions [783 KB, 27 pages], 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 of 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 the mpox virus.
• 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.

• For guidelines on handling soiled and contaminated linens, see Infection Prevention and Control of Mpox in Healthcare Settings. Soiled laundry and bedding (including disposable rodent bedding) should not be shaken or otherwise handled in a manner that may disperse infectious particles.

Environmental Cleaning

• Bedding, enclosures, food dishes, and any other items in direct contact with infected animals must be properly disinfected 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.

Testing Animals for Mpox

Animals should be tested for mpox if they meet the suspect case definition (i.e., epi link and clinical signs).

Sample Collection

• While collecting samples from animals with suspected cases, follow precautions, including:
  • Hand hygiene before and after sample collection
  • Use of personal protective equipment (PPE): a disposable gown, gloves, eye protection (safety glasses, goggles, or face shield), and a NIOSH-approved particulate respirator equipped with N95 filters or higher
• Acceptable clinical samples from animals and how to collect them:
  • Lesion (rash) material is required for animals with an active rash. This may include a swab of the lesion surface, swab of lesion fluid, or lesion crust.
  • If no rash is present, oral, nasal, and anal swabs are acceptable.
  • Use polyester swabs with a thin plastic, wood, or aluminum shaft; avoid using cotton swabs if possible.
  • Whole blood collected in a tube with EDTA is acceptable.
  • Serum should be separated from whole blood (preferably in a serum separator tube) within 2 hours after blood collection and then transferred to a sterile tube for submission.
• If lesions are present, more than one lesion should be sampled, preferably from different locations on the body and/or from lesions with differing appearances.
  • Vigorously swab the lesion to ensure adequate DNA is collected.
  • Wet lesions under the fur can be identified by clumping of hair (moist or dry).
• Take pictures of the lesions as diagnostic tools.
• If samples need to be tested from a dead or euthanized animal, email CDC at the address below for additional information.

Sample Storage and Shipping

• Swabs can be stored in VTM or UTM (300ul) or in a dry tube.
• Lesion crusts should be sent in a dry tube.
• Swabs can be stored in O-ring sealed 2 mL screw-cap tubes or other gasketed sterile container.
• Use one storage container per sample; do not store multiple swabs or samples in a single container.
• Samples should be stored refrigerated or frozen within an hour of collection if possible.
• Ship samples with enough ice packs or dry ice to ensure they arrive cold (dry ice is preferred).
• Packages must be accompanied with a list of contents on shipper letterhead.
  • Ensure there is no human personal identifiable information (PII) included.
• Samples should be packaged and shipped as UN 3373 Biological Substance Category B guidelines (see U.S. Department of Transportation’s (DOT) Transporting Infectious Substances Safely [3 MB, 24 pages]).

Sample Submission

• Prior to sample submission, email onehealth@cdc.gov to request testing and to receive global file accessioning template (GFAT).
• Send samples as detailed above to:
  • US Centers for Disease Control and Prevention
    STAT LAB: ATTN POX (unit 47) One Health
    1600 Clifton Rd NE
    Mailstop G-12
    Atlanta, GA 30333