Cowpox brighton virus Agent Information Sheet

Boston University
Research Occupational Health Program (ROHP)
617-358-7647

Agent

Cowpox brighton virus was the first virus to be used as a vaccine against smallpox. It is an orthopoxvirus related to smallpox and vaccinia.

Disease/Infection

Cowpox brighton virus is the causative agent of bovine vaccinia. It causes rare occupational infections in humans and outside laboratory settings and can be acquired by contact with infected cows.

Pathogenicity

Laboratory-acquired poxvirus infections of most concern are from the orthopoxviruses that infect humans: variola virus (causes smallpox; human-specific), monkeypox virus (causes smallpox-like disease), cowpox brighton virus (causes skin pustule, generalized rash), and vaccinia virus (causes skin pustule, systemic illness). There have been 18 significant reported vaccinia laboratory infections and 2 reported infections of laboratory workers with recombinant vaccinia virus over the past 30 years.

• Special Populations at Risk
  Complications are serious for those with eczema or who are immunocompromised.

Biosafety Information

Risk Group/BSL
Risk Group 2
Biosafety level 2

Modes of Transmission

Host Range/Reservoir

Humans and dairy cows

Symptoms
Accidental cowpox inoculation usually leads to a single painful skin pustule at the site of entry. However, multiple lesions maybe caused if there are multiple inoculation or if virus is spread to other parts of the body through autoinoculation (i.e. touching other sites after touching infected lesion). Skin lesions are similar to those seen in primary vaccinia virus vaccination. The site becomes papular and then develops into a vesicle in 4-5 days, eventually progressing to a pustular stage before forming a hard black crust. Local rash and edema can occur in later stages as can systemic influenza like symptoms. Most cases recover in 6 to 8 weeks.

Incubation Period
Incubation period is generally 9-10 days.

Viability
Susceptible to 1% sodium hypochlorite, 2% glutaraldehyde, formaldehyde. Physically, heat-labile antigen destroyed at 60° C, heat-stable antigen withstands 100° C (both may be present in infected tissue).

Survival Outside Host
Lyophilized vaccinia virus maintains potency for 18 months at 4-6° C, may be stable when dried onto inanimate surfaces.

Information for Lab Workers

Laboratory PPE

Personal protective equipment includes but is not limited to gowns with tight wrists and ties in back, disposable gloves, combination safety glass and mask or a face shield. Facilities for washing and changing clothing after work should be available.

Containment

Research should be conducted using Biosafety Level 2 practices, equipment, and facility design. Gloves and gowns should be worn when handling infected laboratory animals and when there is the likelihood of direct skin contact with infectious materials. Animal studies may be performed at ABSL-3. BSL-2 practices, containment equipment, and facilities are recommended for activities using clinical materials and diagnostic quantities of infectious cultures.

In Case of Exposure/Disease

• For injuries in the lab which are major medical emergencies (heart attacks, seizures, etc…). 
  • Medical Campus: call or have a coworker call the Control Center at 617-414–4144.
  • Charles River Campus: call or have a coworker call campus security at 617-353-2121.
    You will be referred to or transported to the appropriate health care location by the emergency response team.
• For lab exposures (needle sticks, bite, cut, scratch, splash, etc…) involving animals or infectious agents, or for unexplained symptoms or illness call the ROHP 24/7 hour number (1-617-358-ROHP (7647); or, 8-ROHP (7647) if calling from an on-campus location) to be connected with the BU Research Occupational Health Program (ROHP) medical officer. ROHP will refer you to the appropriate health care location.
• Under any of these scenarios, always inform the physician of your work in the laboratory and the agent(s) that you work with.
• Provide the wallet-size agent ID card to the physician.

Vaccination

Vaccinia immunization is cross protective against other orthopoxvirus infections, including variola.

Advisory Committee on Immunization Practices (ACIP) recommends smallpox vaccination at least every 10 years for laboratory workers who handle cultures or animals infected with nonhighly attenuated VACV or other orthopoxviruses (e.g., monkeypox, cowpox, or variola). Vaccinia vaccination is not recommended for laboratory workers working with highly attenuated poxvirus strains as these strains either are unable to replicate or replicate poorly in mammalian host cells and, therefore, do not create productive infections in healthy persons.

The vaccinia vaccination is contraindicated for those individuals who are immunocompromised, are pregnant, or have cardiac disease, or eczema.

Information for First Responders/Medical Personnel

Public Health Issues

Although human-to-human transmission of cowpox has never been reported, lesions could potentially be contagious. Contact precautions and careful hand hygiene should be employed by healthcare workers when caring for a human case of cowpox.

Diagnosis/Surveillance

Clinical history and presentation may aid in diagnosis. Electron microscopy of vesicle fluid or scab extracts is the most rapid and useful technique to aid in diagnosis. PCR testing on biopsy material can also be performed.

First Aid/Post Exposure Prophylaxis

Perform one of the following actions:

If vaccinia vaccine is administered within 3 days after exposure to orthopox virus, it may prevent disease, or decrease the severity of disease and risk of death.

Treatment

Human cowpox is generally a self-limited illness. Vaccinia immune globulin and cidofovir may be of value in treating severe diseases.

References

Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th Edition. US Government Printing Office, Washington, 2007.

Control of Communicable Diseases Manual. David L. Heymann. Washington DC, USA: American Public Health Association Press, 19th edition 2008

McCollum AM, Austin C, Nawrocki J, Howland J, Pryde J, Vaid A, Holmes D, Weil MR, Li Y, Wilkins K, Zhao H, Smith SK, Karem K, Reynolds MG, Damon IK. Investigation of the first laboratory-acquired human cowpox virus infection in the United States. J Infect Dis. 2012 Jul 1;206(1):63-8.

Public Health Agency of Canada, Pathogen Safety Data Sheet, Vaccinia virus, http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/vaccinia-virus-eng.php

Wharton, M., et al. (2003). “Recommendations for using smallpox vaccine in a pre-event vaccination program. Supplemental recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC).” MMWR Recomm Rep 52(RR-7): 1-16.

Revised: 11/4/15