In 2003, the monkeypox virus was identified in the United States, the first time the disease was seen outside of Africa. The virus was introduced into the United States through a shipment of animals, including sick prairie dogs eventually sold as pets, and some individuals who had contact with the pets became ill. The primary route of transmission is through close contact with, bite or scratch, from an infected animal. Symptoms include fever (higher than 99.3 °F or higher than 37.4 °C), headache, backache, muscular pain or tenderness, and a papular rash.

1. Oropharyngeal, scab lesion, or blood specimen can be used.

2. An oropharyngeal specimen can be obtained by swabbing or brushing the posterior tonsillar tissue. The swab should then be placed into a 2-mL screw-capped tube.

3. For a scab lesion, cleanse site with an alcohol wipe. Using either a scalpel or sterile 26-gauge needle, remove the top of the vesicle or pustule. Place specimen in a 2-mL sterile screw-capped plastic tube. Also, the base of the vesicle or pustule should be scraped with a swab or wooden end of an applicator stick and smeared onto a glass microscope slide.

4. For a serum sample, obtain 7–10 mL of venous blood in a marble-topped or yellow-topped serum separator tube, centrifuge, and collect the serum.

5. For a whole blood sample, obtain 3–5 mL of venous blood in a purple-topped tube and mix with anticoagulant.

6. Label specimens with the patient’s name, date, and test(s) ordered, and place specimens in a biohazard bag.

7. Assays for the monkeypox virus include immunohistochemical testing methods, polymerase chain reaction (PCR) for DNA, or morphologic identification by electron microscopy.