Fatal Cowpox Virus Infection in Human Fetus, France, 2017.

Audrey Ferrier,Sandrine Henard,Gaelle Frenois-Veyrat,Olivier Ferraris,Isabelle Drouet,Estelle Mosca,Evelyne Schvoerer,Laetitia Boutin,Christophe Peyrefitte,Hawa Timera,Fanny Jarjaval

doi:10.3201/eid2710.204818

Abstract

Cowpox virus (CPXV) has an animal reservoir and is typically transmitted to humans by contact with infected animals. In 2017, CPXV infection of a pregnant woman in France led to the death of her fetus. Fetal death after maternal orthopoxvirus (smallpox) vaccination has been reported; however, this patient had not been vaccinated. Investigation of the patient’s domestic animals failed to demonstrate prevalence of CPXV infection among them. The patient’s diagnosis was confirmed by identifying CPXV DNA in all fetal and maternal biopsy samples and infectious CPXV in biopsy but not plasma samples. This case of fetal death highlights the risk for complications of orthopoxvirus infection during pregnancy. Among orthopoxviruses, fetal infection has been reported for variola virus and vaccinia virus; our findings suggest that CPXV poses the same threats for infection complications as vaccinia virus.

Highlights

Cowpox virus (CPXV) has an animal reservoir and is typically transmitted to humans by contact with infected animals
Vero cells inoculated with each sample showed the typical cytopathic effect resulting from orthopoxvirus infection after 5 days of incubation at 37°C
CPXV represents a potential risk to human health, especially after the success of the worldwide smallpox vaccination campaign in 1979 and the subsequent cessation of vaccination

Summary

Introduction

Cowpox virus (CPXV) has an animal reservoir and is typically transmitted to humans by contact with infected animals. The patient’s diagnosis was confirmed by identifying CPXV DNA in all fetal and maternal biopsy samples and infectious CPXV in biopsy but not plasma samples This case of fetal death highlights the risk for complications of orthopoxvirus infection during pregnancy. CPXV is assumed to be the causative agent of cowpox, mainly associated with lesions on the udders of dairy cows and the hands of dairy workers. This zoonotic disease has a broad range of hosts [1], so spillover infections to accidental hosts (e.g., rats, cats, cattle, horses, llamas, zoo animals, and humans) are reported regularly; case numbers in Europe are increasing [2]. We describe a fatal case of CPXV infection in a human fetus

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