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A health care worker in Wisconsin is suspected of having monkeypox in what would be the first known transmission of the viral disease between humans in this country, a Wisconsin state health official said yesterday. In issuing a definition of a case of monkeypox on Wednesday, the C.D.C. included these signs and symptoms: a rash consisting of raised bumps and pus-filled blisters spread over the body or confined to a small area, a fever of 99.3 degrees or higher, headache, backache, swollen lymph nodes, sore throat, cough and shortness of breath. In an interview this week in his office at the Bloomberg School of Public Health at Johns Hopkins University, Dr. D. A. Henderson, who led the program to eradicate smallpox worldwide, cited a study in Africa in which 209 people with monkeypox transmitted the disease to 47 people in the second generation of cases. The 47 transmitted monkeypox to 11 people in the third generation. The 11 transmitted the disease to 3 people in the fourth generation. One person was infected in the fifth generation before the outbreak died out

There were 54 cases of monkeypox under investigation in four states Wednesday. Tests have confirmed monkeypox in nine of them. Of the 54, Indiana reported 23, Wisconsin 20, Illinois 10, and New Jersey one. Ten patients have been hospitalized, but officials at the disease center said they did not know how many had left the hospital. Studies conducted in Africa have shown that smallpox vaccine is about 85 percent effective in preventing monkeypox. The disease center said it was most effective within four days after the first exposure to an infected animal, and somewhat less effective for as long as two weeks after first exposure

The actions seek to control the first outbreak of monkeypox in the Americas and to prevent importing it and other diseases endemic elsewhere in the world. Imported rodents are believed to have brought monkeypox to the United States from West and Central Africa, where it is endemic. The vaccine is being recommended for pet owners, household members and friends who have had close contact with people or animals confirmed to have monkeypox, as well as for health workers investigating monkeypox outbreaks or involved in the care of infected people or animals. Because vaccinations under that program were a response to a theoretical threat, they excluded children, pregnant women and other categories of high-risk groups. But because infected animals have transmitted monkeypox to people in this country, ''the risk-benefit ratio of the vaccine changes'' and ''we are recommending a somewhat more aggressive approach'' to include broader groups, said Dr. David W. Fleming, deputy director of the Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention is expected to make the vaccinations available as an option to highly selected groups like health workers who care for patients with monkeypox, people who have been exposed to animals sick with monkeypox, veterinarians who care for animals suspected of having it and scientists investigating monkeypox. Discussions focused on the benefits and risks of smallpox vaccine for monkeypox, a viral disease that can be fatal in 10 percent of human cases. The death rate for smallpox was about 30 percent. Smallpox vaccination can also be fatal. Studies from the 1960's, when smallpox vaccinations were routine, found that for every million people older than 1 year old who were vaccinated, 1 or 2 died, 9 suffered from brain infection and more than 100 developed eczema vaccinatum, a severe illness and skin rash that can leave deep scars and can occasionally be life-threatening

Everyone known to be infected, officials said, had been in contact with a pet prairie dog or other animal that had been with a pet prairie dog. They suspect a shipment of prairie dogs, sold in several states by a distributor, Phil's Pocket Pets, near Chicago, might have been infected by a pet Gambian giant pouched rat, native to Central or West Africa. Prairie dogs, which have become popular as exotic pets, are furry, sociable creatures that are often chestnut colored and about the size of a small cat or gopher

Everyone known to be infected, officials said, had contact with a pet prairie dog or some other animal that had contact with a pet prairie dog. They suspect a shipment of prairie dogs, sold in several states by a pet distributor, Phil's Pocket Pets, near Chicago, may have been infected by a pet Gambian giant pouched rat, which comes from Central or West Africa. At Rainbow Pets in Shorewood, Patricia Simmons, an owner, scrubbed the animal tanks with bleach this afternoon. No small mammals, prairie dogs or otherwise, were for sale. For seven days in mid-May, prairie dogs had played in a display near the front counter, until Eileen Whitmarsh, the other owner, got sick with a fever, swollen glands, blisterlike pimples and a pounding sensation in her chest that felt as if it were being compressed from the front and back. [Steve Kautzer] and Tammy Kautzer and their daughter, [Schyan], of Dorchester, Wis., are suspected of having contracted monkeypox. The future of Chuckles, their prairie dog, is in the hands of the health authorities. (Mike Roemer for The New York Times)

Several patients in the American outbreak work for veterinarians or pet stores that sold prairie dogs and Gambian rats. No patients have died and four have been hospitalized. Laboratory tests performed at the diseases center in Atlanta on Sunday confirmed that the patients had been infected with the monkeypox virus, which belongs to the same Orthopox family that includes the viruses that cause smallpox and chickenpox. By quickly identifying the animals that can be infected with monkeypox, health officials hope to eliminate them before the disease becomes endemic in this country and in the Americas, [Stephen M. Ostroff] said. For this and other reasons, CDC advised people not to release live animals suspected of being infected with monkeypox into the wild. The agency also advised hospital workers caring for suspected monkeypox patients to follow standard infection control measures, including the gloves, gowns and N-95 masks that have been used to protect against SARS. The agency also advised veterinarians to take the same precautions in caring for sick prairie dogs, Gambian rats, other rodents and rabbits

The sudden appearance of monkeypox in the United States is a surprise. Precisely how monkeypox reached the United States is unknown. Dr. Stephen Ostroff, a CDC official, said that the federal agency was investigating a number of theories, including an imported case in a traveler from West Africa or a sick animal. Dr. Kurt Reed, an infectious disease pathologist who runs the microbiology lab and the clinical research center at Marshfield Clinic, a large research facility in central Wisconsin, said his lab was the first to isolate the virus, after a 4-year-old girl who had been bitten by her new pet prairie dog came in with an infected finger in mid-May. That really raised the suspicion that this was an old-world virus that had made its way into the United States, Reed said. Prairie dogs, and Gambian rats, are part of a wide array of exotic animals feeding a growing niche pet market, though some animal-rights activists oppose their domestication. Prairie dogs, members of the squirrel family that are found in the Rocky Mountain west, are believed to have a sophisticated communication system. The rats, which grow to the size of small cats, eat pet food mixes as well as fruits, vegetables and cooked meats. They are intelligent, social and can be very gentle if handled from an early age, one enthusiast, Jazmyn Concolor, posted on the Web site www.altpet.net, adding that one rat sleeps with, and does not chew to death, a stuffed toy lion. They are not pets for everyone, requiring patience and understanding of their habits

Wisconsin reported 18 cases (15 suspected and 3 confirmed); Illinois reported four (one confirmed); and Indiana reported a single case. The patients ranged in age from 4 to 48 and became ill from May 15 to June 3. All had had direct or close contact with ill prairie dogs, which have become a fad in the exotic-pet market and which might have caught monkeypox from another species, possibly Gambian giant pouched rats; the rats are imported as pets from West or Central Africa, where the disease has long occurred. Monkeypox in Africa is carried mainly by squirrels but named after monkeys because it often kills them. Several patients in the American outbreak work for veterinarians or pet stores that sold prairie dogs and Gambian rats. No patients have died and four have been hospitalized. Laboratory tests performed at the disease centers in Atlanta yesterday confirmed that the patients had been infected with the monkeypox virus, which belongs to the same orthopox family that includes the virus that causes smallpox. The disease agency said that the prairie dogs were sold by a Milwaukee animal distributor in May to two pet shops in the Milwaukee area and during a pet ''swap meet'' in northern Wisconsin. The Milwaukee animal distributor obtained prairie dogs and a Gambian giant rat, which was ill at the time, from a northern Illinois animal distributor. Investigations are under way to trace the source of the animals and to find out where they went, Centers for Disease Control officials said

The prairie dogs might have caught monkeypox from another species, possibly Gambian giant pouched rats, which are imported as pets from West or Central Africa, where the disease has long occurred. Laboratory tests performed at the CDC in Atlanta on Sunday confirmed that the patients had been infected with the monkeypox virus, which belongs to the same orthopox family that includes the viruses that cause smallpox and chickenpox. The CDC issued a health alert about monkeypox Saturday night, partly out of concern that doctors who had treated the cases had initially mistaken some for smallpox and chickenpox, said Dr. Stephen Ostroff, a CDC epidemiologist