Despite the fact that research group members were drawn from a wide variety of disciplinary backgrounds and professional duties, we were able to easily come to an agreement on what the literature had to say, the key themes from the focus groups, and the areas that needed attention and further research. The literature was clear that failure to implement appropriate barrier precautions and hand hygiene was responsible for most nosocomial transmission. It was also striking that the concerns identified as highest priority in the focus groups of frontline workers matched well with what the interdisciplinary multistakeholder group has concluded were scientific gaps.
As such, there was a strong consensus that attention to understanding why there was a failure to implement appropriate precautions, and how best to promote compliance in future, is an important topic for study. Taking into account the evidence from the literature review and the priorities identified through the focus group analysis, the following areas for further research were identified.
Although many studies have shown that workplace safety climate is an important determinant of worker safety, no studies have evaluated interventions on how to improve the safety climate in healthcare institutions. If effective interventions could be designed, this would likely result in improvements in worker health and safety well beyond reducing infectious disease transmission, because workplace culture appears to be an important determinant of many occupational injuries and illnesses.
The SENIC studies from the s and s provided a good understanding of the human resources needed in healthcare institutions to reduce the incidence of nosocomial infections. However, similar studies have not been conducted in health-care institutions to assess occupational health and safety needs. This has, in part, led to wide variations in the staffing levels of occupational physicians, occupational health nurses, ergonomists, hygienists, and other occupational health staff in healthcare facilities, which in turn has led to variations in the scope of occupational health programming.
Research is urgently needed to provide policymakers with evidence as to what programs and staff are needed to provide effective occupational health programs to protect workers from preventable illness and injury. Such research would provide evidence for the development of provincial and national standards for occupational health in healthcare.
Both occupational health and infection control rely on training programs to transfer knowledge to frontline HCWs. However, some studies have shown that training achieves short-term changes in behavior, at best, and requires ongoing feedback to sustain these changes.
The authors noted that other techniques, including inservice education sessions, computer-assisted learning, as well as provision of education and group feedback by researchers also failed to show long-term effectiveness.
More research needs to be conducted to determine the best training techniques to ensure that workers learn what they need to know to protect themselves and apply this knowledge on a daily basis. Fit-testing appears to have an important educational benefit in ensuring that workers properly use N respirators; however, the relative role of the fit-test versus the fit-check and the frequency of monitoring compliance with either requires further evaluation.
Healthcare institutions communicate with their staff to transfer important safety-related information to workers on a daily basis. However, the best mechanisms to provide communication to frontline workers to ensure that new information is incorporated into their daily work practice have not been clearly identified. Finally, the organization of the workplace in healthcare in Canada has undergone dramatic changes in recent years resulting in reduced staffing levels, increased acuity of patients in the hospital, increased casualization, and increased out-sourcing of basic services.
Research is needed to understand whether and how these changes have affected of worker health and safety. Before SARS, aerosol-generating procedures such as nebulizer therapy and suctioning of respiratory secretions were not thought to pose health risks to HCWs except when caring for patients with tuberculosis.
However, it is clear that these procedures very much facilitated the spread of the virus in healthcare settings. Although it was well understood that patients could produce infectious respiratory droplets by coughing or sneezing, they appeared to travel only short distances and remain aloft for very short periods of time.
This question is key because it addresses the issue of the hierarchy of exposure controls. Although it is quite possible that HCWs may not be threatened by SARS ever again, it is likely that a pandemic strain of influenza could produce similar or worse effects if these issues are not addressed. Much attention during SARS outbreaks was also focused on the potential for transmission through fomites to HCWs, in particular the potential for contaminated PPE and environmental surfaces to transmit disease.
However, there are few studies that have examined whether respiratory tract pathogens can survive on barrier equipment and clothing and transmit disease. This has implications for environmental decontamination, reuse of barriers versus the use of disposals, and the potential importance of autoinoculation through contaminated PPE.
As well, there have been few studies that have assessed the relative importance of the transocular route as a means of transmission of disease by respiratory tract pathogens. Eye protection is now being recommended for droplet-spread organisms, but the effectiveness of this protection in decreasing the risk of acquiring disease remains to be tested.
The SARS epidemics highlighted the risks associated with airborne infectious particles. Research is required to determine the changes to the physical environments in hospitals that can most effectively reduce these risks. Potential engineering controls include changes to temperature, air exchange, and relative humidity to maximize particle fall out or decrease viability of organisms contained in respiratory droplets. Equipment design needs to be reexamined with a critical eye to minimizing the generation and dispersal of infectious aerosols during respiratory therapy eg, continuous positive airway pressure devices, nebulizer therapy, ventilator aerosols.
Following directly from the basic science research noted here, research is also needed on the effectiveness of decreasing aerosols at the source. Recommendations have been made to nurse patients with SARS in negative-pressure rooms. However, the added benefit of a negative pressure atmosphere over physical isolation and adequate ventilation throughout hospitals has not been established and should be researched thoroughly.
More research is also needed regarding the effectiveness of facial protection against bioaerosols. In conjunction with more research on the importance of transocular transmission of respiratory tract pathogens, answers to this question will clarify the relative importance of full facial protection, versus eye protection, versus nose and mouth protection.
Compiling this report available at www. This has already served as a tool to direct future research and to develop evidence-based practice in the interim. Specifically, the team, with the assistance of a grant from the Canadian Institutes of Health Research CIHR , is now conducting further research into measures to improve safety climate and specifically provide greater protection from respiratory pathogens. The team is also designing a study to better characterize aerosolization and characteristics of droplet spreads.
Meanwhile, by September , we completed 23 train-the-trainer sessions across the province, and, through our CIHR grant, we will have an opportunity to study the effectiveness of this training. This experience illustrates the value of an interdisciplinary multi-stakeholder approach to developing evidence-based policy in important areas in occupational health.
Yassi is supported by a chair from the Canada Research Council. National Center for Biotechnology Information , U. J Occup Environ Med. Author manuscript; available in PMC May Author information Copyright and License information Disclaimer.
Copyright notice. The publisher's final edited version of this article is available at J Occup Environ Med. See other articles in PMC that cite the published article. Abstract Objective To identify priorities for further research in protecting healthcare workers HCWs from severe acute respiratory syndrome SARS and other respiratory pathogens by summarizing the basic science of infectious bioaerosols and the efficacy of facial protective equipment; the organizational, environmental, and individual factors that influence the success of infection control and occupational health programs; and factors identified by HCWs as important.
Method An extensive literature review was conducted and 15 focus groups held, mostly with frontline HCWs in Toronto. Results Highest priority was given to organizational factors that create a climate of safety.
Conclusions Further research is warranted to improve safety climate in health care and, specifically, to provide greater protection against respiratory pathogens. Results Key Findings Basic Science and Efficacy of Facial Protective Equipment Bioaerosols are formed as combinations of exhaled respiratory gases, respiratory droplets, and microorganisms.
Open in a separate window. Organizational Factors Organizational factors refer to determinants of workplace safety, which range from very broad issues such as workplace culture and safety climate to specific policies and procedures such as the availability of training programs.
Environmental Factors Environmental factors such as the use of negative pressure rooms and making available specific PPE such as N respirators have been seen as the key to preventing the spread of tuberculosis in healthcare institutions. Focus Groups Over HCWs who participated in focus groups spent the greatest amount of time discussing organizational factors, as discussed in depth elsewhere.
Training and Communication Training in infection control was also discussed at length. Environmental Factors and Personal Protective Equipment Focus group participants discussed fittesting at length, but the value of it was not universally accepted, because different institutions used different methods and workers often saw these inconsistencies as sources of concern for the whole process. Discussion Despite the fact that research group members were drawn from a wide variety of disciplinary backgrounds and professional duties, we were able to easily come to an agreement on what the literature had to say, the key themes from the focus groups, and the areas that needed attention and further research.
Priority 1: Improving Workplace Health and Safety Through Organizational Factors Although many studies have shown that workplace safety climate is an important determinant of worker safety, no studies have evaluated interventions on how to improve the safety climate in healthcare institutions. Conclusion and Next Steps Compiling this report available at www. References 1.
A collaborative evidence-based approach to making healthcare a healthier place to work. Hosp Q. Job stress in healthcare workers: highlights from the National Population Health Survey.
Healthcare Providers. Toronto: Canadian Institute for Health Information; The wellness program for medical faculty at the University of Ottawa: a work in progress. Hospital ventilation and risk for tuberculosis infection in Canadian health care workers.
Ann Intern Med. Tuberculosis infection among health care workers in Montreal. Severe acute respiratory syndrome—guidelines were drawn up collaboratively to protect healthcare workers in British Columbia.
Protecting healthcare workers from SARS and other respiratory pathogens: a critical review of the infection control literature. Am J Infect Control. Healthcare worker perceptions of occupational health and infection control practices related to severe acute respiratory syndrome.
J Occ Org Pyschol. Duguid JP. The size and the duration of air carriage of respiratory droplets and droplet-nuclei. J Hyg. For example, while the United States Centers for Disease Control and Prevention recommends autoclaving a form of sterilizing or incinerating waste, the latter is effectively prohibited in California and banned in at least seven other states.
Moreover, there are basic unresolved questions about whether EBOV-infected human waste may enter sanitary sewer systems: the USCDC says that it can, but other sources say the waste must first be sterilized.
All effluent should be disinfected prior to disposal into a municipal sewer system or septic tank by adding disinfectant prior to use of using chemical toilets. This level of precaution should continue for 6 weeks of convalescence or until the patient is virologically negative. A bioweapon consists of two parts, a weaponized agent and a delivery mechanism. Bioweapon manufacture and use has three distinct phases, agent production , agent stabilization , and agent dissemination.
The first two involve selecting a pathogen and obtaining a starter culture, which is then mass-produced and stabilized. At this point, the bioweapon consists of a liquid suspension in our example, of EBOV and a chemical stabilizer. A canister holding the liquid suspension is then placed in a disseminating device e. A biohazardous weapon in many important ways is much simpler, and in its simplicity, a much more threatening device. The most rudimentary form of EBOV biohazardous weapon would use liquid [19] fluids medical waste acquired from an EVD patient and disseminate it by means of a sprayer to aerosolize the waste.
While practical considerations might argue against using explosive munitions to disperse EBOV-contaminated waste—explosives generate heat that may render a biological agent inactive—the shock effect of a known detonation in an urban area might well have all the disruptive effect a malefactor intended. As stated earlier, biohazardous weapons share many characteristics of improvised nuclear and radiological devices, especially the latter since biohazardous and radiological materials are fairly easy to come by for a determined malefactor and simple to weaponize.
This might well carry over to consideration of how a malefactor would deploy these weapons, since all are far most effective when detonated or in the case of a biohazardous weapon, dispersed in a contained environment such as a large building, for the common objective is to disperse the material in question as an aerosol rather than rely on the destructive kinetic effect, which is of secondary interest.
Beyond the socially, politically and economically disruptive effects of dispersing EBOV-contaminated medical waste, there is a question whether aerosolized EBOV presents a meaningful health risk to an exposed human population.
This is not strictly so, however, in the case of intentional direct aerosol exposure of the sort intended from the use of an EBOV biohazardous weapon or bioweapon. At the very least, the potential exists for aerosol transmission, given that virus is detected in bodily secretions, the pulmonary alveolar interstitial cells, and within lung spaces. An earlier peer-reviewed study [24] established the potential of aerogenic infection of EBOV.
It is important here to distinguish two different points: a the potential for aerogenic infection of EBOV through aerosol transmission; and b the probability that aerogenic infection is a significant infection pathway during human EVD outbreaks.
With particular attention to the question of weaponizing EBOV in one form or another, and accepting the first condition—that aerogenic EBOV infection is possible—what factors might affect why it has not been observed to be a significant pathway during human EVD outbreaks in Africa?
Two factors—ambient temperature and relative humidity—are of particular interest since elevated levels in each have long been shown to reduce the aerosol stability of viruses. When scientists controlled these levels:. Ebola virus sensitivity to the high temperatures and humidity…in southern Sudan and northern Zaire may have been a factor limiting aerosol transmission of Ebola virus in the African epidemics.
However, this concern must be couched with an understanding of the paucity of data concerning that potential. Without data there can be little understanding of the level of threat that filoviruses present. In the context of considering the malevolent dispersion of biohazardous material, it has been understood for some time that small-particle aerosols present a far greater danger than large droplets:.
If air containing such droplets is inspired, they are largely trapped in the turbinates or impinge on the posterior pharynx. They will remain dispersed in the air and circulate as airborne particles for long distances without settling.
If inspired, they will penetrate deep into the lung, and Brownian motion, sedimentation, and turbulence will result in retention of about half of them in the lower respiratory passages or alveolae.
These particles are not efficiently filtered from air by ordinary surgical masks and therefore enhanced respiratory protection must be used. There are two important factors to weigh in assessing the issues raised here: first, whether EBOV is stable in small-particle aerosols; and second, whether this mode of spread is observed clinically.
The answer to both questions is yes, with an important caveat regarding incidence:. Indeed, during the — epizootic of the Reston subtype of Ebola, there was circumstantial evidence of airborne spread of the virus, and supporting observations included suggestive epidemiology in patterns of spread within rooms and between rooms in the quarantine facility, high concentrations of virus in nasal and oropharyngeal secretions, and ultrastructural visualization of abundant virus particles in alveoli.
However, this is far from saying that Ebola viruses are transmitted in the clinical setting by small-particle aerosols generated from an index patient.
Indeed patients without any direct exposure to a known EHF case were carefully sought but uncommonly found. The conclusion is that if this mode of spread occurred, it was very minor. This might explain the seeming disconnect between on the one hand, scientific data indicating EBOV transmission can occur by means of small-particle aerosol; and on the other hand, public statements by governmental officials and other that the risk of secondary human-to-human transmission by this mode is unlikely.
It is the former, however, that has bearing in the context of a theorized biological or biohazardous weapon. With the aid of negative staining of clinical samples, electron microscopy permits rapid morphological differentiation of viruses of the OPV genus from other pathogens such as PPV and herpes viruses, but also bacteria such as Bacillus anthracis, which can cause comparable lesions such as pustules, vesicles, or crusts on the skin and therefore permits a differential diagnosis fig.
Electron microscopy diagnostics is therefore suitable for rapid primary diagnostics permitting a first morphological characterisation of pathogens diagnostics of the open view [ 93 , 94 ]. Both genera show characteristic surface structures fig. A differentiation of species within the OPV genus is not possible by electron microscopy, since all OPV show the same morphological characteristics [ 81 , 93 , 95 ]. An OPV infection can be diagnosed with the aid of serological test methods. The detection of OPV-specific IgM is an indication of acute OPV infection which can be further confirmed by a second serum drawn after an interval of 10—14 days [ 75 , 81 ].
The immune response against different OPV species cannot up to now be differentiated routinely due to the fact that the antigens are closely related within the genus. Differentiation is possible to a limited extent by complex and time-consuming pre-adsorption procedures performed on sera with antigen preparations of different OPV species and subsequent examination for reactivity in ELISA or immunofluorescence tests [ 96 , 97 ].
Differentiation of neutralising antibodies against different OPV species is not possible due to the close antigenic relationship. However, the neutralisation test — using VACV as target virus in the plaque reduction test — is used to follow up the immune response after a vaccination and to determine the immune status, i. The detection of OPV antigens, for example in clinical samples such as pustules, vesicles, and crusts , is possible by means of antigen capture ELISA in some specialised laboratories [ 75 , 81 ].
Kitamoto and co-workers [ 98 ] used monoclonal antibodies in the immunoblot for the detection of OPV antigens. Antigen detection tests are less sensitive than PCR and, in addition, do not permit differentiation of the OPV species.
OPV can be cultured in suitable cell cultures generally monkey cells or human cells from clinical samples of infected humans. After starting the culture, a differentiation of the virus species can be performed by PCR, and phylogenetic characterisation of the isolates can be carried out by sequence analysis [ 80 , 81 ]. Polymerase chain reaction PCR methods have proved to be particularly suitable for the identification and differentiation of OPV species and for differential diagnostics of Poxviridae e.
PCR tests in combination with restriction fragment length analysis permitted differentiation of OPV [ 99 ]. In recent years, various groups have published real-time PCR methods which permit an identification of OPV and differentiation of the species [reviewed in 80, 81]. Because of the high hazard represented by human pox for the human population, special requirements are requested for specificity and sensitivity of the diagnostic methods.
According to the present state of the art, OPV species are differentiated using suitable nucleic acid detection methods including phylogenetic analysis.
The close genetic relation of OPV requires a particularly careful validation of the detection methods. Real-time PCR on the one hand permits quantification of viral genomes; on the other hand, using suitable probes, melting curve analyses can be carried out, permitting a differentiation between OPV species or, in the case of suspected VARV genomes in clinical and environmental samples, excluding or confirming this virus [ 80 , 81 , , ].
In principle, it is recommended to investigate several genome regions by the molecular detection methods and to perform phylogenetic analysis following sequencing of particular genome regions in order to achieve reliable classification of the viruses.
The isolation of poxvirus in clinical samples can be useful for molecular epidemiology or forensic investigations. However, for the assessment of the risk of infection by contaminated environmental samples, isolation is requested to prove the presence of infectious virus [ ].
In the case of symptoms on the skin pointing to a poxvirus infection, the suspected diagnosis OPV infections like cowpox, monkeypox, parapox, molluscum contagiosum, cutaneous anthrax, mycoses, Bartonella henselae can be verified by means of virological or microbiological and molecular methods. Molecular detection methods PCR, real-time PCR are used in specialised laboratories to an increasing extent in diagnostics and differential diagnostics [ 81 ].
There are no reliable data on the seroprevalence of OPV in Germany, neither in humans nor in the animal population [ , ]. Compulsory smallpox vaccinations were discontinued in the Federal Republic of Germany in , and in the German Democratic Republic in In Germany, in recent years people have been vaccinated with VACV Lister-Elstree, but only to a very limited extent in vaccination studies.
In Germany and other countries, infections with MOCV as a rule occur in children and immunosuppressed individuals. Studies on the prevalence of PPV have so far not been performed. These guidelines do not lay down any specific exclusion criteria for smallpox infections, since human pox are considered as eradicated.
Other poxvirus infections manifest themselves as local skin lesions, are accompanied by fever and malaise, and would be captured through the usual exclusion criteria for blood donors. In conformity with the data on the epidemiology of OPV infections in Germany, donor testing is regarded as not necessary. Neither donor-nor recipient-specific information is available in Germany on the prevalence and incidence of OPV infections.
Because vaccinations against smallpox became compulsory in the Deutsche Reich German Empire in and was continued up to Federal Republic and German Democratic Republic , it can be assumed that the majority of individuals for whom these compulsory vaccinations applied still have residual antibodies against OPV. The portion of the population that acquired an immune response to cowpox or catpox virus or other OPVs after compulsory vaccination has so far not been sufficiently studied.
No data are available on the serostatus of the recipients of blood and blood products in Germany. Studies in various countries showed that people who had been vaccinated before the vaccination was discontinued after the eradication of human pox partly revealed antibodies against VACV. An infection with human poxvirus, however, generally took a mild course in these people. It is currently discussed to what extent people who in former times received a vaccination are still protected against OPV infections [ , , ].
Up to now, no reports are available on infections with OPV or other human pathogenic poxviruses by transfusions. A prophylactic vaccination against OPV is possible today, too, using the previously authorised VACV vaccines as well as those currently being developed. Because of the considerable adverse reactions, no vaccinations have been performed in Germany, unlike the USA, where certain populations army members, members of the health service, etc.
It remains to be seen, when and to what extent new vaccines on the basis of further attenuated VACV, such as MVA or the Japanese vaccine strain LC16m8 which are considered as vaccines of the third generation, will replace vaccines used for the eradication or vaccines of the second generation.
It must be noted that LC16m8 was licensed as vaccine in Japan. The extent to which MVA or derivatives of MVA will be licensed for prophylactic vaccination of humans also remains to be seen [ 39 , 42 , ]. New data from various animal models allow to conclude that an effective protection against OPV infections can be achieved by MVA immunisation and may even be effective following exposure with pathogenic OPV [ , ].
The efforts to develop new chemotherapeuticals were increased especially with regard to potential bioterrorist attacks with VARV. However, due to the fact that it has to be administered i. Hexadecyloxypropylcidofovir CMX , a derivative of cidofovir, is bioavailable after oral administration.
ST is a small molecule compound which specifically interacts with an OPV envelope protein F13L protein and is thus able to inhibit the exit of OPV from infected cells [ ]. In animal experiments, the treatment with ST even proved to be effective after the manifestation of clinical symptoms [ ]. In addition, experimental systems were able to show that the vaccination with concomitant administration of ST induced a cellular and a humoral immune response so that the mice were protected against a challenge with pathogenic VACV [ ].
ST was used successfully for the treatment of a month-old infant who had been infected with VACV by his vaccinated father and developed severe eczema vaccinatum [ ]. Passive immunisation with immunoglobulin preparations vaccinia IgG; VIG has so far been recommended only in the case of an occurrence of vaccination-associated complications. However, VIG products are available only to a very limited extent world-wide. No reports are available on the transmission of OPV by blood or blood products.
Because of the inactivation or removal of OPV during the manufacture of plasma products, there is no risk of transmission by these products. No transmissions by cellular blood products have so far been reported. It can be assumed that the potential risk of a transmission in the viraemic phase is largely reduced for leucocyte-depleted cellular blood products, since CPXV and MPXV circulate in the blood in a cell-associated manner. So far, there are no studies on the OPV load of the starting material.
Studies on healthy VACV-immunised individuals show that VACV can be detected neither in the plasma nor associated with cells after vaccination with live virus. In patients with severe clinical symptoms after vaccination with VACV, virus could be detected in the cells, but not in plasma.
The second viraemic phase leads to infection of skin and mucosae as well as other organs via the blood. Concerning the infection with VARV, infectious viruses could be detected in the blood of infected individuals [ ].
A systemic infection following an infection with other OPV, however, is not regularly observed. Efforts to detect MPXV in the blood of infected individuals are not always successful, and viraemia probably depends on the severity of the disease [ 47 , ]. Investigations on the dissemination of VACV following immunisation in the blood is discussed controversially [ 5 , 36 , ]. In some studies, viraemia was detected by PCR up to 21 days following an immunisation [ 3 ]. Other authors did not succeed in detecting VACV DNA in the blood, or did so only in isolated cases, and even then, only in a short time interval after the vaccination [ 36 , , ].
Infectious virus could not be detected in these investigations. It must therefore be assumed that viral DNA exists only cell-bound. In cases where the vaccination showed considerable adverse effects, viraemia could usually be detected by PCR [ , ]. Nitsche and co-workers [ ] have recently been able to show that virus DNA can be detected in blood also in CPXV infections and that the genome detection is possible only in the cellular fraction of the blood.
Since according to the current state of knowledge OPV occur cell-bound in the blood also in the viraemic phase, an examination of cell-containing materials for OPV genome by NAT would be possible [ , , ].
As far as the manufacture of plasma products is concerned, ways of inactivation or removal generally are simpler for enveloped, lipid-containing viruses than for non-enveloped viruses.
For filtration methods virus filter, nanofilter , it can be assumed that these remove OPV effectively due to the size of virus particles. Examinations of the removal and inactivation of OPV in blood products were performed within model studies on the virus safety of blood products. Various methods were evaluated by Remington and co-workers [ ] in extensive studies on virus safety of plasma products. In stabilised alpha1-proteinase inhibitor products 0. In inactivation experiments using 0.
It could be shown in various experiments that poxviruses could be effectively removed from plasma products by filtration [ , ]. In conclusion, various elimination and inactivation methods are available for the production of OPV-safe plasma products.
A risk of transmission of OPV by plasma products is therefore not recognisable. The effectiveness of inactivation methods developed for plasma and cellular blood products e. Since, according to the current state of knowledge, OPV in blood is cell-bound, it must be assumed that leucocyte depletion leads to a considerable reduction of the risk of the transmission of OPV.
Thus, OPV genomes could be found in the cell-containing fraction of the blood up to 3 weeks after the onset of clinical symptoms. In contrast to VARV infections, however, no infectious virus could be isolated from blood. In principle, viraemic blood donations can be detected by using NAT methods. Infections with MPXV in humans have been observed. In the past few years, an increasing number of infections with CPXV in humans has been observed in Germany, which partly took courses with serious clinical symptoms.
The genetic differences observed in the CPXV isolates and the different clinical courses give rise to the assumption that CPXV can be to a variable extent pathogenic in humans. Studies in molecular biology may provide information on previously unknown OPV variants displaying a modified pathological potential. However, infections with OPV currently do not present a recognisable risk for the blood donation system in Germany.
If a vaccination against OPV should become necessary, a deferral of 4 weeks after immunisation with live vaccine should be sufficient. National Center for Biotechnology Information , U.
Journal List Transfus Med Hemother v. Transfus Med Hemother. Published online Nov Georg Pauli , Dr. Reinhard Burger , Prof. Christian Drosten , Dr. Margarethe Heiden , Prof. Martin Hildebrandt , Prof. Bernd Jansen , Dr. Thomas Montag-Lessing , Dr. Ruth Offergeld , Prof. Uwe Schlenkrich , Dr. Volkmar Schottstedt , Dr. Johanna Strobel , Dr. Hannelore Willkommen , and Prof.
Author information Article notes Copyright and License information Disclaimer. Received Jul 7; Accepted Jul Karger GmbH, Freiburg. This article has been cited by other articles in PMC. Table 1 Family Poxviridae. Subfamily Genus Chordopoxvirinae orthopoxvirus OPV avipoxvirus capripoxvirus leporipoxvirus suipoxvirus molluscipoxvirus MOCV yatapoxvirus other non-classified chordopoxviruses Entomopoxvirinae alpha-entomopoxvirus beta-entomopoxvirus gamma-entomopoxvirus other non-classified entomopoxviruses.
Open in a separate window. Racoonpox racoon broad? Infections with camelpox virus in humans, however, have not been observed [ ]. Table 3 Other chor-dopox viruses that can infect humans. Genus Species Clinical sign Host Parapox virus orfvirus Orf; ecthyma contagiosum sheep, goat, wild ruminant pseudo cowpox virus Melker's nodule cattle parapox in cattle stomatitis papulosa virus of the cattle local infections cattle seal parapox virus SPPV local infections seal reindeer parapox virus local infections reindeer Molluscipoxvirus molluscum contagiosum virus non-malignant tumours human Yatapoxvirus yaba monkey tumour virus yaba monkey tumour monkey tanapoxvirus tanapox monkey rodent.
Cowpox Infections Cowpox Virus, CPXV Infections of humans in most cases occur via skin lesions or by direct contact with infectious tissue or secretions from cats or infected rats [ 26 , 27 , 28 , 29 ]. Vaccinea Virus VACV were used by the WHO [ 4 , 34 ] as vaccination viruses as human smallpox prophylaxis world-wide and during the eradication campaign up to the time of eradication of human smallpox.
Diseases Caused by Other Poxvirus Species As a rule, infections with other poxviruses are of benign outcome, and clinical symptoms remain limited to the infection site. VACV-Like Viruses These viruses present a health problem, especially in India and Brazil, not only in agriculture, but also for people who come into close contact with buffaloes and dairy cows.
Electron Microscopy With the aid of negative staining of clinical samples, electron microscopy permits rapid morphological differentiation of viruses of the OPV genus from other pathogens such as PPV and herpes viruses, but also bacteria such as Bacillus anthracis, which can cause comparable lesions such as pustules, vesicles, or crusts on the skin and therefore permits a differential diagnosis fig.
Serology An OPV infection can be diagnosed with the aid of serological test methods. Antigen Detection The detection of OPV antigens, for example in clinical samples such as pustules, vesicles, and crusts , is possible by means of antigen capture ELISA in some specialised laboratories [ 75 , 81 ]. Cell Culture OPV can be cultured in suitable cell cultures generally monkey cells or human cells from clinical samples of infected humans.
Chemotherapy The efforts to develop new chemotherapeuticals were increased especially with regard to potential bioterrorist attacks with VARV. Passive Immunisation Passive immunisation with immunoglobulin preparations vaccinia IgG; VIG has so far been recommended only in the case of an occurrence of vaccination-associated complications.
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