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COWPOX, RODENTS, HUMAN (06): EUROPE, BACKGROUND
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A ProMED-mail post
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International Society for Infectious Diseases
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Date: 11 Feb 2009
Source: ECDC Risk Assessment Roundtable [edited]
<http://ecdc.europa.eu/en/files/pdf/Health_topics/RA_Cowpox_updated.pdf>
Cowpox in Germany and France related to rodent pets
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Public health issue: Risk of further sporadic cases in the human population.
Consulted experts:
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Andreas Jansen, Robert Koch Institute, Germany
Andreas Nitsche, Robert Koch Institute, Germany
Isabelle Capek, Institut National de Veille sanitaire
Remi Charrel, Universite Marseille
Helene Callon, Direction Generale Alimentation Paris
Francois Albina, CIRAD Montpellier, France
Risk of infection spread person-to-person: None.
Risk for Europe: Possible spread of the disease through pet animal
trade with sporadic transmission to humans.
Disease background information:
-------------------------------
Cowpox is a viral disease circulating among rodent population that
appears to be indigenous in Europe. Cowpox virus can be transmitted
also to domestic animals such as cats or pet rats (1,3). It has also
been described in various zoo animals. Animals get sick and may die
of the disease (6). Sporadic human cases of cowpox are reported in
Europe, mostly linked to infected animal handling mostly rodents, and
cats. [Note: references are available at the source URL mentioned above.]
The virus belongs to the _Orthopoxvirus_ genus which comprises 7
other distinct virus species (e.g., Vaccinia, Monkeypox) plus the
eradicated Variola (smallpox) virus. Rodents such as voles or
lemmings are animal hosts of Cowpox in Europe. Recent studies in
eastern France have found antibodies to Cowpoxvirus in 66 (41.8
percent) of 158 voles (2).
Human infection is the results of direct contact with an infected
animal. Infection is through a break of the skin, and this determines
the location of the primary lesion, mostly reported in fingers or
hands. Large amounts of virus are found in lungs of infected animals.
The disease is self-limitating in immuno-competent human hosts
(localized lesion) but it can be severe, even fatal in
immuno-compromised patients (4,5). The incubation period usually
varies from 7 to 12 days but can be longer. There is no evidence of
human to human transmission (7). There is no approved treatment;
however a promising therapeutic option is cidofovir, but this
virostatic drug is not approved for the treatment of cowpox. Recent
cases in Europe were mostly reported in children and young adults (6,7).
Event background information
----------------------------
On 20 Jan 2009 Germany reported a total of 18 cases of human cowpox
infections: 6 cases in Bavaria and 12 cases in North Rhine-Westphalia
(no date range) (Early Warning and Response System (ERWS) selective
exchange). The message was posted following a query by the
Netherlands (14 Jan 2009) about possible connection between a suspect
case (thereafter confirmed as negative and discarded) of cowpox in
the Netherland in an area close to the German border and the
situation of cowpox in Germany.
On 16 Jan 2009, 3 cases of ulcero-necrotic lesions were reported in
Northern France among young girls who bought pet rats in a shop
(EWRS, 5 Feb 2009). On 9 Feb 2009, 12 cases have been identified in
France including 5 confirmed cases (11 cases in northern France and 1
case in Central region). Confirmation is pending for 6 cases. The
mean age was 15 (6 to 30 years) with onset of symptoms from 29 Dec
2008 to 24 Jan 2009 (8).
Sequence data of an amplified fragment from several Cowpoxvirus human
isolates from Germany and France were identical suggesting a
potential common source of infection (German Consultant Laboratory
for Poxviruses, Berlin and Unite des Virus Emergents, Marseille).
Veterinary Health Authorities in France and Germany were able to
trace back some of the pet rats from France and from North
Rhine-Westphalia to the same rat breeder in the Czech Republic.
Further investigations by the Veterinary Health Authorities are being
conducted to check any link associated with the cases in Bavaria and
the other cases in France.
The Czech Public Health Authorities have informed (EWRS, 5 Fen 2009)
that investigations are being conducted around the potential common
source and the potential threat for Public Health. The results of the
investigations will be communicated to EWRS.
Comments
--------
Cowpox infection is a notifiable disease in France (all
_Orthopoxvirus_ infections) and in Germany.
The sequence data analysis of Cowpox isolates from several cowpox
cases in Germany in 2008 and recent cowpox cases in France and the
trace back investigations of the pet rats to which the cases were
exposed, suggested a common source of infection related to
international trade of pet rats by a Czech rat breeder.
Other human cases still are under investigation.
Conclusions
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- All recent cases are reported in children or young adults.
- In the current event, pet rats were involved and potential links
with a common origin have been reported in 2 countries.
- Further investigations are conducted by the Veterinary Authorities
to identify the origin of contamination of the different human cases
and to trace possible connections with animal trades.
- The possible risk for the occurrence of spread of human cowpox
infections related to pet rats in other Member States should be
evaluated when the results of the veterinary investigations in the
Czech Republic are available.
--
Communicated by:
Castleview Pedigree English Longhorns
Sabine Zentis
Gut Laach
52385 Nideggen
<CVLonghorns@aol.com>
[The sequencing data demonstrates unequivocally the common source of
the outbreak virus. The question of the taxonomic identity of the
rodent carrier remains to be confirmed. - Mod.CP]
[Since it appears that there are only 2 cowpox sequences in Genbank,
which differ widely, doesn't the taxonomic identity of the *virus*
still remain to be confirmed -- cowpox vs. monkeypox? And since they
apparently haven't sequenced an isolate from an implicated rodent,
isn't the whole source question only circumstantial? Nowhere is it
stated that ALL the cases were from pet rat owners, although this
seems likely.
This is a nearly 4-week-old report. Given that it says "The results of the
investigations will be communicated to EWRS," we would really like to
know what they are, as soon as they become available. - Mod.JW]
[see also:
Cowpox, rodents, human (05): Europe, monkeypox? 20090305.0912
Cowpox, rodents, human (04): Europe 20090304.0890
Cowpox, rodents, human (03): Czech Republic, NOT 20090303.0870
Cowpox, rodents, human (02): France 20090226.0809
Cowpox, rodents, human - Germany, France ex Czech Rep. 20090225.0786
2007
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Cowpox, human - Germany (02): comment 20070420.1299
Cowpox, human - Germany 20070419.1286
2003
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Monkeypox, human, prairie dogs - USA (06) 20030612.1450]
....................cp/jw/ejp/jw
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