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J. Med. Microbiol. - Vol. 45 (1996), 157-158 0 1996 The Pathological Society of Great Britain and Ireland ED IT0 R IA L cowpox On 14 May 1796, Edward Jenner inoculated James Phipps, an 8-year-old boy, with cowpox material obtained from a lesion on a local dairy maid, Sarah Nelmes. Two months later, Phipps was inoculated with smallpox lesion material but did not develop smallpox. Although earlier accounts of cowpox, and even vaccination, exist, it was Jenner’s Inquiry, of 1798 [l], together with his Further Observations [2] published the following year, that contained the first thorough descriptions of bovine and human cowpox. These reports formed the basis for our understanding of the natural history of cowpox for much of the following two centuries, and only since the mid1970s has this traditional view of cowpox, as an endemic disease of cattle, been challenged. pox virus has not been isolated from any rodent species in Western Europe, bank and field voles and woodmice are susceptible to very low doses of virus by skin and oronasal inoculation, and bank voles are resistant to infectious ectromelia, the other main Orthopoxvirus of rodents (unpublished observations). Experimentally infected voles and woodmice develop little obvious clinical disease, and the mechanisms of transmission in wild and captive populations of the reservoir hosts are being studied currently. Antibody studies in the UK, where cowpox is the only reported Orthopoxvirus, are relatively easy to interpret, but in central Europe, where other, antigenically similar, orthopoxviruses may circulate [151, identification of the responsible virus can be difficult. Cowpox virus has been isolated only in Europe and some contiguous regions of Western Asia [3]. Clinical bovine infection is rare [4, 51: the prevalence of Orthopoxvirus antibody in British cattle is only 0.7% [6], and we are not aware of any virologically confirmed bovine cases in the UK since 1976. Furthermore, human infections can only rarely be traced to contact with cattle, infected or otherwise [4,7]. In contrast, pseudocowpox (also known as milker’s nodule or paravaccinia), caused by a Parapoxvirus very closely related to orf virus of sheep, is endemic world-wide in cattle, and human infection is an occupational disease of farm workers [S]. Felids are also susceptible to cowpox. Clinical infection is most frequently diagnosed in the domestic cat [16, 171, but several outbreaks have also occurred in other cat species held in European zoological collections [18]. Affected domestic cats often have a history of a single original lesion, sometimes described as a bite-like wound, on the head or a forelimb, but widespread secondary skin lesions resulting from a cell-associated viraemia have usually developed by the time that the cat is presented for veterinary attention [ 161. During the viraemic period, large amounts of virus can also be isolated from the lungs and turbinates of infected cats, although clinical respiratory disease is rare. Most affected domestic cats come from rural areas, are known to hunt rodents, and are seen in the autumn: all features consistent with transmission from a rodent host while hunting. Cat-tocat transmission can occur, but is rare, and serological surveys confirm that cats are not a reservoir host of cowpox. Over the last 20 years, evidence has accumulated that the reservoir hosts of cowpox virus are wild rodents, with infection endemic in different species in different areas of its geographic range. In Turkmenia, ground squirrels (Citellus fulvus) and giant gerbils (Rhombomys opimus) appear to be the reservoir hosts, based on serology and virus isolation [9, 101. In Eastern Europe, virus has also been isolated from root voles (Microtus oeconomus) [ll], while in the UK and western continental Europe, Orthopoxvirus antibody has been detected in bank voles (Clethrionomys glareolus), field voles (Microtus agrestis) and woodmice (Apodemus sylvaticus) [ 12- 141. Although cow- Correspondence should be sent to: Dr M. Bennett, Department of Veterinary Clinical Science and Animal Husbandry, University of Liverpool, PO Box 147, Liverpool L69 3BX. One or two cases of human cowpox are reported each year in the UK, and there is only a low prevalence of Orthopoxvirus antibody, even though smallpox vaccination might be expected to cause ‘false’ positive results. The clinical and epidemiological features have recently been reviewed [7]. There is usually a single lesion at the site of inoculation, most often on a hand or on the face. Multiple inoculations sometimes occur, and immunocompromised patients may exhibit more widespread lesions. Most affected individuals are systemically ill, and around one-third are admitted to Downloaded from www.microbiologyresearch.org by IP: 88.99.165.207 On: Sun, 14 May 2017 06:26:34 158 EDITORIAL hospital. Rare fatal cases have been described [19]. Over half of all recent cases have been traced to contact with an infected cat [7], but the virus is probably not very infectious to man, and cat-to-man transmission can be readily avoided by basic hygienic precautions. Like feline cowpox, the human disease is most frequently seen in the autumn, probably reflecting the incidence of feline cases and the size and activity of rodent populations. Immunisation with smallpox vaccine is unlikely to protect against infection and the development of a primary lesion, but may prevent the development of more severe cowpox [20]. Thus, the decline in Orthopoxvirus immunity after the cessation of smallpox vaccination is unlikely to affect the incidence of human cowpox. Cowpox has also been described in various zoo animals including elephants, rhinoceroses, anteaters, okapis and white rats [3, 101. One case in a pet dog has been described [17]. Serological surveys of foxes (Vulpes vulpes) in the UK, and some Benelux countries have revealed no evidence of infection in foxes [14], but surveys in central Europe have detected a low prevalence of relatively low titre antibody [21]. These differences may reflect the different assays used, or variation in the host ranges of virus strains. Experimentally, foxes are susceptible to skin inoculation only with very high doses of a British strain of cowpox virus [22], but little work has been done to compare the host range and virulence of geographically distinct cowpox viruses. A Russian isolate appeared to be much more pathogenic for domestic cats than British isolates [23], and cowpox viruses are known to differ in both biological properties (such as ceiling temperature of growth, haemagglutinin production and heat inactivation) and restriction maps. Isolates from the extremes of the geographic range (i.e., British and Turkmenian strains) show the greatest variation. The largest variety of strains in any one area is found in central Europe, suggesting a central European origin for cowpox virus. Cowpox virus is not the only Orthopoxvirus with a rodent reservoir. Monkeypox is endemic in squirrels (Funisciurus spp. and Heliosciurus spp.) in West and Central Africa [24]; in the western USA an Orthopoxvirus circulates in wild voles (Microtus californicus) [25]. Uncharacterised poxviruses occur in other rodents, and the reservoir hosts of several orthopoxviruses, for example buffalopox [26], are unknown. Thus cowpox, as well as being of interest in its own right, may provide a useful, and accessible, model for understanding the epidemiology of other orthopoxviruses, some of which, like cowpox, are zoonotic. M. BENNETT and D. BAXBY* Departments of Veteiinary Clinical Science and Animal Husbandry and Medical Microbiology and Genitourinary Medicine, University of Liverpool, PO Box 147, Liverpool L69 3BX References 1. Jenner E. An inquiry into the causes and effects of the variolae vaccinae, a disease discovered in some of the western countries of England, particularly Gloucestershire, and known by the name of the cowpox. London, Sampson Low. 1798. 2. Jenner E. Further observations on the variolae vaccinae or cowpox. London, Sampson Low. 1799. 3. Baxby D, Bennett M. Cowpox virus. In: Webster RG, Granoff A (eds) Encyclopedia of virology, vol 1. London, Academic Press. 1994: 261-267. 4. Baxby D. Is cowpox misnamed? A review of 10 human cases. BMJ 1977; 1: 1379-1381. 5 . Gibbs EPJ, Johnson RH, Collings DF. Cowpox in a dairy herd in the United Kingdom. Vet Rec 1973; 92: 56-64. 6. Baxby D, Osborne AD. Antibodies in natural bovine cowpox. J Hyg 1979; 83: 425448. 7. Baxby D, Bennett M, Getty B. Human cowpox 1969-93; a review based on 54 cases.‘Br J Dermatol 1994; 131: 598407. 8. Baxby D, Bennett M. Poxvirus zoonoses. J Med Microbiol 1996 (in press). 9. Marennikova SS. Field and experimental studies of poxvirus infections in rodents. Bull World Health Organ 1979; 57: 461464. 10. Marennikova SS, Shelukhina EA, Efremova El! New outlook on the biology of cowpox virus. Acta Virol 1984; 57: 437444. 11. Lvov SD, Gromashevskyi VL, Marennikova S S et al. Poxvirus isolation from Microtus oeconomus Pal. 1776 in Colsky peninsula. Vopr Virus01 1988; 1: 92-94. 12. Kaplan C, Healing TD, Evans N, Healing L, Prior A. Evidence of infection by viruses in small British field rodents. J Hyg 1980; 84: 285-294. 13. Crouch AC, Baxby D, McCracken CM, Gaskell RM, Bennett M. Serological evidence for the reservoir hosts of cowpox virus in British wildlife. Epidemiol Znfect 1995; 115: 185-191. 14. Boulanger D, Crouch A, Brochier B et al. Serological survey of Orthopoxvirus infection in wild mammals in Belgium and assessment of the risk of hybridisation between recombinant vaccinia virus and wild orthopoxviruses in the field. Vet Rec 1996 (in press). 15. Mahnel H, Holejsovsky J, Bartak P, Czerny C-P. [Congenital ‘ectromelia’ in fir-bearing animals caused by Orthopoxvirus muris.] Kongenitale ‘Ektromelie’ bei Pelztieren durch Orthopoxvirus muris. Tierarztl Prax 1993; 21: 469-172. 16. Bennett M, Gaskell CJ, Baxby D, Gaskell RM, Kelly DF, Naidoo J. Feline cowpox viruses infection. J Small Anim Pract 1990; 31: 167-173. 17. Bomhard D, von Pfleghaar S, Mahnel H. Zur Epidemiologie, Klinik, Pathologie und Virologie der Katzen-Pocken-Infektion. Kleintierpraxis 1992; 37: 2 19-230. 18. Baxby D, Ashton DG, Jones DM, Thomsett LR. An outbreak of cowpox in captive cheetahs: virological and epidemiological studies. J Hyg 1982; 89: 365-372. 19. Czerny C-P, Eis-Hubinger AM, Mayr A, Schnewies KE, Pfeiff B. Animal poxviruses transmitted from cat to man: current event with lethal end. Zentralbl Veterinarmed 1991; 38: 421431. 20. Baxby D. Indications for smallpox vaccination: policies still differ. Vaccine 1993; 11: 395-396. 21. Henning K, Czerny C-P, Meyer H, Muller T, Kramer M. A seroepidemiological survey for orthopox virus in the red fox (Vulpes vulpes). Vet Microbiol 1995; 43: 251-259. 22. Boulanger D, Brochier B, Crouch A et al. Comparison of the susceptibility of the red fox (Vulpes vulpes) to vaccinia rabies recombinant virus and to cowpox virus. Vaccine 1995; 13: 215-219. 23. Zhukova OA, Tsanava SA, Marennikova SS. Experimental infection of domestic cats by cowpox virus. Acta Virol 1992; 36: 329-331. 24. Khodakevich L, Jezek Z, Kinzanzka K. Isolation of monkeypox virus from wild squirrel infected in nature. Lancet 1986; 1: 98-99. 25. Regnery DC. Isolation and partial characterization of an Orthopoxvirus from a California vole (Microtus calijornicus). Arch Virol 1986; 94: 159-162. 26. Dumbell K, Richardson M. Virological investigations of specimens from buffaloes affected by buffalopox in Maharashtra State, India, between 1985 and 1987. Arch Virol 1993; 128: 257-267. Downloaded from www.microbiologyresearch.org by IP: 88.99.165.207 On: Sun, 14 May 2017 06:26:34