title: Investigation of the first laboratory-acquired human cowpox virus infection in the United States.
abstract: BACKGROUND
  Cowpox virus is an Orthopoxvirus that can cause infections in humans and a variety of animals. Infections occur in Eurasia; infections in humans and animals have not been reported in the United States. This report describes the occurrence of the first known human case of laboratory-acquired cowpox virus infection in the United States and the ensuing investigation.
  
  
  METHODS
  The patient and laboratory personnel were interviewed, and laboratory activities were reviewed. Real-time polymerase chain reaction (PCR) and serologic assays were used to test the patient's specimens. PCR assays were used to test specimens obtained during the investigation.
  
  
  RESULTS
  A specimen from the patient's lesion tested positive for cowpox virus DNA. Genome sequencing revealed a recombinant region consistent with a strain of cowpox virus stored in the research laboratory's freezer. Cowpox virus contamination was detected in 6 additional laboratory stocks of viruses. Orthopoxvirus DNA was present in 3 of 20 environmental swabs taken from laboratory surfaces.
  
  
  CONCLUSIONS
  The handling of contaminated reagents or contact with contaminated surfaces was likely the mode of transmission. Delays in recognition and diagnosis of this infection in a laboratory researcher underscore the importance of a thorough patient history-including occupational information-and laboratory testing in facilitating a prompt investigation and application of control and remediation measures.
authors.affiliation: Poxvirus Team, Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. amccollum@cdc.gov
authors.forename: Andrea M
authors.initials: AM
authors.lastname: McCollum
authors.forename: Connie
authors.initials: C
authors.lastname: Austin
authors.forename: John
authors.initials: J
authors.lastname: Nawrocki
authors.forename: Julia
authors.initials: J
authors.lastname: Howland
authors.forename: Julie
authors.initials: J
authors.lastname: Pryde
authors.forename: Awais
authors.initials: A
authors.lastname: Vaid
authors.forename: David
authors.initials: D
authors.lastname: Holmes
authors.forename: M Ryan
authors.initials: MR
authors.lastname: Weil
authors.forename: Yu
authors.initials: Y
authors.lastname: Li
authors.forename: Kimberly
authors.initials: K
authors.lastname: Wilkins
authors.forename: Hui
authors.initials: H
authors.lastname: Zhao
authors.forename: Scott K
authors.initials: SK
authors.lastname: Smith
authors.forename: Kevin
authors.initials: K
authors.lastname: Karem
authors.forename: Mary G
authors.initials: MG
authors.lastname: Reynolds
authors.forename: Inger K
authors.initials: IK
authors.lastname: Damon
mesh_terms: D015605:Cowpox / Q000453:epidemiology / Q000635:transmission / Q000821:virology*; D015608:Cowpox virus / Q000235:genetics / Q000302:isolation & purification*; D059018:DNA Contamination; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D007757:Laboratory Infection / Q000453:epidemiology / Q000635:transmission / Q000821:virology*; D059232:Laboratory Personnel; D014481:United States / Q000453:epidemiology
chemical_list: D004279:DNA, Viral