Concomitant Human Infections with 2 Cowpox Virus Strains in Related Cases, France, 2011

Corinne Ducournau, Audrey Ferrier-Rembert, Olivier Ferraris, Aurélie Joffre, Anne-Laure Favier, Olivier Flusin, Dieter Van Cauteren, Kaci Kecir, Brigitte Auburtin, Serge Védy, Maël Bessaud, and Christophe N. Peyrefitte

Author affiliations: French Army Biomedical Research Institut, Grenoble and Lyon, France (C. Ducournau, A. Ferrier-Rembert, O. Ferraris, A. Joffre, A.-L. Favier, O. Flusin, C.N. Peyrefitte); National Reference Center for Orthopoxviruses, Grenoble (C. Ducournau, O. Ferraris, C.N. Peyrefitte); French Institute for Public Health Surveillance, Lyon (D. Van Cauteren); Regional Hospital of Epinal, Epinal, France (K. Kecir, B. Auburtin); Legouest Military Hospital, Metz, France (S. Védy); UMR190 Aix Marseille University EHESP French School of Public Health, Marseille, France (M. Bessaud)

Abstract

We investigated 4 related human cases of cowpox virus infection reported in France during 2011. Three patients were infected by the same strain, probably transmitted by imported pet rats, and the fourth patient was infected by another strain. The 2 strains were genetically related to viruses previously isolated from humans with cowpox infection in Europe.

The Study

Figure 1

Thumbnail of Cowpox virus infection in 4 persons in France. The case-patients were infected in 2011 by virus transmitted from infected pet rats. A) Cutaneous lesion on patient 1. B) Cytopathic effects observed on Vero cell monolayers with isolate CEPAD332. Scale bar represents 500 μm. C) Cytopathic effects observed on Vero cell monolayers with isolate CEPAD335. Scale bar represents 500 μm. D) Negative-staining electron microscopy image of isolate CEPAD332. Scale bar represents 100 nm. E) Negativ

Figure 1. . Cowpox virus infection in 4 persons in France. The case-patients were infected in 2011 by virus transmitted from infected pet rats. A) Cutaneous lesion on patient 1. B) Cytopathic effects...

On September 12, 2011, an 8-year-old girl (patient 1) was admitted to the regional hospital of Epinal, France, for a cutaneous lesion on the lateral part of her neck that had evolved to a necro-ulcerative rash (Figure 1, panel A). Her sister (patient 2, age unknown) had similar cutaneous lesions. The family had purchased 4 rats (Rattus norvegicus) from a pet shop on August 19, 2011. The rats had been imported from a breeding facility in the Czech Republic by a local pet dealer. Locomotor disorders developed in 1 rat, and it died 4 days after the purchase. Two other rats became ill during the following weeks: the first, displaying symptoms of coryza, was examined by a veterinarian on September 5; the second was examined by the same veterinarian on September 12 for a vestibular syndrome that evolved to severe respiratory failure and then death on September 15. The fourth rat died without visible signs of disease. No biologic samples were collected.
Patient 3 was the 26-year-old female veterinarian who examined the sick rats. She kept their corpses in her office for a few days before destroying them. On September 20, she displayed cutaneous lesions similar to those of patients 1 and 2; samples of her lesions were collected 3 days later.