An Investigation of a Cluster of Parapoxvirus Cases in Missouri, Feb-May 2006: Epidemiologic, Clinical and Molecular Aspects.
In the spring of 2006, four human cases of parapoxvirus infections in Missouri residents were reported to the Centers for Disease Control and Prevention (CDC), two of which were initially diagnosed as cutaneous anthrax. This investigation was conducted to determine the level of recognition of zoonotic parapoxvirus infections and prevention measures, the degree to which veterinarians may be consulted on human infections and what forces were behind this perceived increase in reported infections. Interviews were conducted and clinical and environmental sampling was performed. Swab and scab specimens were analyzed by real-time polymerase chain reaction (PCR), whereas serum specimens were evaluated for parapoxvirus antibodies. Three case patients were found to have fed ill juvenile animals without using gloves. Forty-six percent of veterinarians reported having been consulted regarding suspected human orf infections. Orf virus DNA was detected from five of 25 asymptomatic sheep. Analysis of extracellular envelope gene sequences indicated that sheep and goat isolates clustered in a species-preferential fashion. Parapoxvirus infections are common in Missouri ruminants and their handlers. Infected persons often do not seek medical care; some may seek advice from veterinarians rather than physicians. The initial perception of increased incidence in Missouri may have arisen from a reporting artifact stemming from heightened concern about anthrax. Asymptomatic parapoxvirus infections in livestock may be common and further investigation warranted.
Poxvirus and Rabies Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. erlederman@yahoo.com.|Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. erlederman@yahoo.com.
Edith R
ER
Lederman
Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. tao_minmin@yahoo.com.
Min
M
Tao
Poxvirus and Rabies Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. nzr6@cdc.gov.
Mary G
MG
Reynolds
Poxvirus and Rabies Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. lay4@cdc.gov.
Yu
Y
Li
Poxvirus and Rabies Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. cgz9@cdc.gov.
Hui
H
Zhao
Poxvirus and Rabies Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. sks5@cdc.gov.
Scott K
SK
Smith
Lincoln County Health Department, Troy, MO 63379, USA. sitlel@lchdmo.org.
Lisa
L
Sitler
Office of the Director, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. fnj2@cdc.gov.
Dana L
DL
Haberling
Poxvirus and Rabies Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. wfd6@cdc.gov.
Whitni
W
Davidson
Poxvirus and Rabies Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. zuu6@cdc.gov.
Christina
C
Hutson
Poxvirus and Rabies Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. dtt4@cdc.gov.
Ginny
G
Emerson
Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond, CA 94804, USA. david.schnurr@cdph.ca.gov.
David
D
Schnurr
Poxvirus and Rabies Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. russellregnery@mac.com.
Russell
R
Regnery
Missouri Department of Health and Senior Services, Jefferson City, MO 65102, USA. baopingzhu@yahoo.com.
Bao-Ping
BP
Zhu
Missouri Department of Health and Senior Services, Jefferson City, MO 65102, USA. howard.pue@dhss.mo.gov.
Howard
H
Pue
Poxvirus and Rabies Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. iad7@cdc.gov.
Inger K
IK
Damon
diagnostics; occupational exposure; orf virus; parapoxvirus; pseudocowpox virus; transmission