Borealpox: A Rare but Emerging Orthopoxvirus.

Abstract

Borealpox, formerly known as Alaskapox, is a novel zoonotic orthopoxvirus with a limited but concerning emergence in Alaska, part of the boreal ecosystem. To date, only 7 human cases have been confirmed, with transmission likely occurring from small wild mammals via intermediary domestic animals such as cats. While the illness is typically mild, it can lead to severe complications including death in immunocompromised patients. This case highlights the diagnostic and clinical challenges associated with orthopoxvirus infections in high-risk populations. Management is primarily supportive, with antiviral and immunoglobulin therapy reserved for severe presentations. Emergency clinicians, including advanced practice clinicians, should be familiar with the clinical manifestations, diagnostic approaches, and emerging treatment strategies for borealpox as cases are expected to increase. Early recognition, appropriate reporting, and interdisciplinary collaboration are essential to optimizing outcomes, particularly in vulnerable populations.