A longitudinal study of an endemic disease in its wildlife reservoir: cowpox and wild rodents

Cowpox is an orthopoxvirus infection endemic in European wild rodents, but with a wide host range including human beings. In this longitudinal study we examined cowpox in two wild rodent species, bank voles Clethrionomys glareolus and wood mice Apodemus sylvaticus, to investigate the dynamics of a virus in its wild reservoir host. Trapping was carried out at 4-weekly intervals over 3 years and each animal caught was uniquely identified, blood sampled and tested for antibodies to cowpox. Antibody prevalence was higher in bank voles than in wood mice and seroconversion varied seasonally, with peaks in autumn. Infection was most common in males of both species but no clear association with age was demonstrated. This study provides a model for studying other zoonotic infections that derive from wild mammals since other approaches, such as one-off samples, will fail to detect the variation in infection and thus, risk to human health, demonstrated here.

Transmission dynamics of a zoonotic pathogen within and between wildlife host species

The transmission dynamics of the cowpox virus infection have been quantified in two mixed populations of bank voles (Clethrionomys glareolus) and wood mice (Apodemus sylvaticus), through analyses of detailed time-series of the numbers of susceptible, infectious and newly infected individuals. The cowpox virus is a zoonosis which circulates in these rodent hosts and has been shown to have an adverse effect on reproductive output. The transmission dynamics within species is best described as frequency dependent rather than density dependent, contrary to the 'mass action' assumption of most previous studies, both theoretical and empirical. Estimation of a transmission coefficient for each species in each population also allows annual and seasonal variations in transmission dynamics to be investigated through an analysis of regression residuals. Transmission between host species is found to be negligible despite their close cohabitation. The consequences of this for the combining ability of hosts as zoonotic reservoirs, and for apparent competition between hosts, are discussed.

Cowpox: reservoir hosts and geographic range

It is generally accepted that the reservoir hosts of cowpox virus are wild rodents, although direct evidence for this is lacking for much of the virus's geographic range. Here, through a combination of serology and PCR, we demonstrate conclusively that the main hosts in Great Britain are bank voles, wood mice and short-tailed field voles. However, we also suggest that wood mice may not be able to maintain infection alone, explaining the absence of cowpox from Ireland where voles are generally not found. Infection in wild rodents varies seasonally, and this variation probably underlies the marked seasonal incidence of infection in accidental hosts such as humans and domestic cats.

Edward Jenner's Inquiry; a bicentenary analysis

Edward Jenner's famous Inquiry was published 200 years ago. Probably few now know on what evidence he based his claims but most will be aware that they initiated controversy which to some extent still continues. This paper briefly reviews the Inquiry, analysing its merits and faults. Jenner's claims were based on slender experimental evidence and some of the information presented was incomplete and misleading. However Jenner's role in the introduction of vaccination was seminal and others could only test and extend his ideas. His reputation as the initial promoter of vaccination is justified.

Cowpox: a re-evaluation of the risks of human cowpox based on new epidemiological information

Human cowpox is a rare but relatively severe infection of interest because of its links with Edward Jenner and the introduction of smallpox vaccine and, more recently, because of re-evaluation of the epidemiology of the infection. This indicates that cowpox is not enzootic in cattle, relegates the cow to a minor role, and emphasizes the importance of feline cowpox as a source of human infection and of wildlife as virus reservoirs. The evidence available suggests that the virus is of low infectivity for humans and should not become an increasing problem despite the cessation of smallpox vaccination and increasing numbers of immunocompromised individuals.

The effect of cowpox virus infection on fecundity in bank voles and wood mice

Although epidemic infectious diseases are a recognized cause of changes in host population dynamics, there is little direct evidence for the effect of endemic infections on populations. Cowpox virus is an orthopoxvirus which is endemic in bank voles (Clethrionomys glareolus), wood mice (Apodemus sylvaticus) and field voles (Microtus agrestis) in Great Britain. It does not cause obvious signs of disease nor does it affect survival, but in this study we demonstrate experimentally that it can reduce the fecundity of bank voles and wood mice by increasing the time to first litter by 20-30 days. The pathogenic mechanisms causing this effect are at present not known, but this finding suggests that natural subclinical infection could have a considerable effect on the dynamics of wild populations.

Cowpox in British voles and mice

Serosurveys indicate that bank voles, field voles and woodmice are probably reservoir hosts of cowpox virus in western Europe, although virus has not yet been isolated from these species. In this study, bank voles, field voles, woodmice and laboratory mice were shown to be susceptible to combined intradermal and subcutaneous inoculation with 3-20 plaque-forming units (pfu) of cowpox virus. Bank and field voles, but not laboratory mice, were also susceptible to combined oral and nasal inoculation with 50 pfu. Few clinical signs were seen and virus was generally recovered only from inoculation sites. Bank voles were not susceptible to injection of ectromelia virus (5000 pfu) into the skin (as described above). These results provide information on which further pathogenesis and transmission studies can be based, and support the view that the orthopoxvirus antibody detected in British wild voles and woodmice indicates infection with cowpox virus. However, further investigation of the pathogenesis of cowpox in these species is needed to understand better the epidemiology of the disease.

The Jenner bicentenary: the introduction and early distribution of smallpox vaccine

This review describes the background to Jenner's first vaccination, his later work, and the dissemination of information about vaccination and the vaccine itself. Although based on relatively slender evidence, Jenner's theories were basically sound and he merits the credit given him. Given the circumstances, particularly the slow speed of travel and the lack of information about the duration of immunity, vaccination became established very quickly in many countries.

Should smallpox virus be destroyed? The relevance of the origins of vaccinia virus

The fate of surviving stocks of smallpox virus is still uncertain, and it is important that arguments in favour of retention or destruction should present balanced evidence. This article balances the view, probably incorrect and possibly alarmist presented earlier in this Journal by Peter Razzell, that vaccinia and cowpox viruses were derived from smallpox virus. The generally accepted alternative view that all three viruses are independent species and that smallpox virus could not emerge through simple mutation of the other two is presented, together with appropriate literature citations.

Serological survey for orthopoxvirus infection of wild mammals in areas where a recombinant rabies virus is used to vaccinate foxes

Several fox vaccination campaigns against rabies have been undertaken in Belgium by using a vaccinia-rabies recombinant virus distributed in baits in the field. However, foxes and other wild animals that may ingest the baits could be infected at the same time by another orthopoxvirus, such as cowpox virus, which circulates in wildlife. Recombination between the two viruses could therefore occur. A serological survey for antibodies to orthopoxvirus, and particularly to cowpox virus, was undertaken in foxes and in several other wild species. Antibodies were detected only in two rodent species, in 16 of 25 bank voles (64 per cent) and in two of 29 woodmice (7 per cent). The risk of virus recombination in wildlife can therefore be considered to be extremely low.

Serological evidence for the reservoir hosts of cowpox virus in British wildlife

The reservoir host of cowpox virus in Western Europe is not known, but epidemiological evidence from human and feline infections indicates that the virus is probably endemic in small wild rodents. Therefore, serum and tissue samples were collected from a variety of wild British mammals and some birds, and tested for evidence of Orthopoxvirus infection. Antibody reacting with cowpox virus was detected in 9/44 (20%) bank voles (Clethrionomys glareolus), 8/24 (33%) field voles (Microtus agrestis), 17/86 (20%) wood mice (Apodemus sylvaticus) and 1/44 house mice (Mus musculus), but in no other animal species tested. Although virus was not isolated from any animal, this serological survey, together with other evidence, suggests that bank and field voles and wood mice are the main reservoir hosts of cowpox virus in Great Britain.

Comparison of the susceptibility of the red fox (Vulpes vulpes) to a vaccinia-rabies recombinant virus and to cowpox virus

Sylvatic rabies can be efficiently controlled by vaccination of foxes with a vaccinia-rabies recombinant virus. However, the risk of recombination between the engineered vaccine virus and other orthopoxviruses endemic in wildlife, such as cowpox virus, still needs to be investigated. In this study, foxes inoculated orally and intradermally with cowpox virus were found to be not very susceptible to cowpox virus, which was isolated from only the oropharynx and tonsils, at low titre and for only five days after inoculation. Thus the risk of recombination between these viruses in foxes is very low.

Human cowpox 1969-93: a review based on 54 cases

This survey of the clinical and epidemiological features of human cowpox, a rare but relatively severe zoonotic infection, is based on 54 cases, many unpublished, which we have studied since 1969. Patients present with painful, haemorrhagic pustules or black eschars, usually on the hand or face, accompanied by oedema, erythema, lymphadenopathy, and systemic involvement. Severe, occasionally fatal, cases occur in eczematous and immunosuppressed individuals, although cowpox has not yet been reported in anyone infected with the human immunodeficiency virus. Variations in the clinical features are described, and the differential clinical diagnosis of cowpox, parapox, herpes virus, and anthrax infections is discussed. The role of the laboratory in diagnosis is described, and the value of electron microscopy in providing rapid confirmation is emphasized. Care in taking a detailed history will assist in the initial clinical diagnosis, and a history of contact with domestic cats, particularly during July-October, is important. The possible influence of smallpox vaccination on the incidence and severity is discussed and discounted.

Cowpox can mimic anthrax

We report a patient suffering from cowpox infection, in whom the clinical features mimicked those of anthrax. The infection may have been acquired as a result of contact with a rodent.

Indications for smallpox vaccination: policies still differ

The need for vaccination of those handling vaccinia and other related orthopoxviruses is still uncertain, with UK and US authorities adopting different policies. The former revised an earlier decision and now no longer recommend vaccination; the latter confirmed earlier decisions to recommend vaccination. These policies are reviewed in the light of evidence on the safety and efficacy of smallpox vaccine.

Characterization of orthopoxviruses isolated from feline infections in Britain

The biological properties and genomes of orthopoxviruses isolated from cats in Britain were compared with strains of cowpox virus isolated from cows and their handlers. All the isolates tested produced haemorrhagic pocks and A-type inclusions on the CAM, but did not produce pocks above 40 degrees C. Thus the feline isolates behaved as typical strains of cowpox virus. Differences were found in the heat resistance of the virions and in the character of the A-type inclusion which did not correlate with the host from which the viruses were isolated. Analysis of the genomes with a variety of restriction endonucleases showed very close relationship between all the isolates and also failed to separate feline isolates from cowpox virus. However again minor differences, which may prove to be of epidemiological value were detected. We conclude that the orthopoxvirus currently isolated from domestic cats in Britain is cowpox virus and that there is no evidence that a feline variant or subspecies circulates in Britain.

Potential use of non-replicating vectors as recombinant vaccines

Avipoxviruses, members of the Poxvirus family, are naturally restricted in that productive replication takes place only in avian species. Recent work has described the construction of Avipox recombinants using fowlpox and canarypox viruses. Preparation of recombinant fowlpox viruses which express immunogens from avian pathogens and successful vaccination of poultry have been reported. Recombinant fowlpox and canarypox viruses which express immunogens from mammalian pathogens have also been described and have been demonstrated to provide protective immunity on inoculation in non-avian species. This is a surprising result. Such non-replicating expression vectors provide the possibility of developing safe, effective vaccines which combine the advantages of killed and live vaccines.

Studies on poxvirus infection in cats

The development of clinical disease and the pathogenesis of cowpox were studied in domestic cats inoculated by a variety of routes. Intradermal titration in two cats demonstrated that as little as five pfu of cowpox virus caused a primary skin lesion. Intradermal inoculation of greater than or equal to 10(5) pfu cowpox virus resulted in severe systemic disease. Large amounts of virus (greater than or equal to 10(3) pfu/g) were isolated from skin lesions and the turbinates of cats killed at eight and 11 days post-inoculation (dpi). Lesser amounts of virus (congruent to 10(2) pfu/g) were isolated from lymphoid tissues and the lung, and small amounts of virus were isolated from various other tissues. A white cell-associated viraemia was detected from 5 dpi onwards. Skin scarification with 10(3) or 50 pfu cowpox virus enabled reproduction of the naturally-acquired disease. Cat-to-cat transmission was demonstrated from cats inoculated by skin scarification, but caused only subclinical infection in sentinel cats. Oronasal inoculation resulted in transient coryza and milder generalized disease than skin inoculation, and no transmission to sentinel cats. Preliminary investigations showed vaccinia virus (Lister strain) to be of low infectivity in cats while inoculation of ectromelia virus (Mill Hill strain) did not cause any clinical signs.

Recognition and laboratory characteristics of an atypical oocyst of Cryptosporidium

Feces from some patients with clinically unremarkable cryptosporidiosis contained an unusual variety of oocyst not previously recognized. These atypical oocysts were shown by electron microscopy to have a distinctive three-layered outer coat and, by immunofluorescence with a monoclonal antiserum, to lack an antigen present on the surface of typical oocysts. In contrast to typical oocysts, the atypical variety is very fragile and quickly collapses when suspended in solutions of high osmotic pressure or in lipid solvents. Atypical oocysts cannot be stained by methods used to stain typical oocysts, but their appearance in sucrose-phenol is characteristic. Their stability in this solution, though much less than that of typical oocysts, is sufficient for them to be recognized and for cases to be diagnosed by microscopy. Patients who excreted atypical oocysts never excreted the typical variety. General findings in patients who excreted atypical oocysts were no different from those who excreted typical oocysts.

Human poxvirus infection after the eradication of smallpox

There occurred during the planning and publication of this review: the twentieth anniversary of the start of the intensified WHO Smallpox Eradication Campaign and the tenth anniversary of the last endemic case of smallpox; debate about the fate of smallpox virus and possibly its irrevocable destruction; claims that mass smallpox vaccination campaigns may have helped the spread of AIDS in Africa; publication of the definitive account of Smallpox and its Eradication (Fenner et al. 1988), and the closure of the WHO Smallpox Eradication Unit (SEU). It is therefore perhaps an appropriate moment to assess the current status of human poxvirus infections and their epidemiology; this review concentrates on those viruses antigenically related to smallpox (i.e. orthopoxviruses).

Ecology of orthopoxviruses and use of recombinant vaccinia vaccines

Little is known of the ways in which orthopoxviruses are maintained in nature, and the role of wild-life reservoirs requires further investigation. This lack of information is important in view of proposals to use as vaccines recombinant vaccinia viruses which carry genes for other immunising antigens. The possibility that such strains may become established in nature, as vaccinia may have in Indian buffaloes, and/or undergo genetic hybridisation with existing orthopoxviruses should be considered.

Cryptosporidium as a cause of gastro-enteritis in Sudanese children

Stool samples from 83 Sudanese children with gastro-enteritis were examined using a safranin-methylene blue stain. Five children (6.1%) were excreting cryptosporidium oocysts but no other potential enteropathogens. The clinical features of anorexia, vomiting and pyrexia and the profuse green watery offensive stool were similar to those reported previously. All of the children were dehydrated. None of 37 children studied who did not have gastro-enteritis was excreting oocysts.

Poxvirus infection in the domestic cat: some clinical and epidemiological observations

The clinical findings from 30 cases of feline poxvirus infection in the UK are reviewed and some epidemiological observations described and discussed. In most cases the clinical signs consisted of skin lesions only, although systemic signs were also occasionally seen. Over half the cats had a history of a single recent lesion, assumed to be primary, on the head, neck or a forelimb. Twenty-nine of 30 cats developed more widespread secondary skin lesions. Cat-to-cat transmission was apparently rare. More cases were recognised in the autumn than at other times of the year. The possibility of a wild mammal reservoir of infection is discussed.