Sheep-to-Human Transmission of Orf Virus during Eid al-Adha Religious Practices, France

Antoine Nougairede¹

, Christelle Fossati¹, Nicolas Salez, Stephan Cohen-Bacrie, Laetitia Ninove, Fabrice Michel, Samer Aboukais, Mathias Buttner, Christine Zandotti, Xavier de Lamballerie, and Remi N. Charrel

Author affiliations: Author affiliations: Aix-Marseille University, Marseille, France (A. Nougairede, N. Salez, L. Ninove, X. de Lamballerie, R.N. Charrel); Assistance Publique–Hopitaux de Marseille, Marseille (A. Nougairede, L. Ninove, C. Zandotti, X. de Lamballerie, R.N. Charrel); Hôpital Paul Desbief, Marseille (C. Fossati); AlphaBio Laboratory, Marseille (S. Cohen-Bacrie); Service Santé, Protection Animales et Environnement, Marseille (F. Michel); Regional Office of the French Institute for Public Health Surveillance (Institut de Veille Sanitaire), Marseille (S. Aboukais); Bavarian Health and Food Safety Authority, Oberschleißheim, Germany (M. Buttner)

Abstract

Five persons in France were infected with Orf virus after skin wounds were exposed to infected sheep tissues during Eid al-Adha, the Muslim Feast of Sacrifice. Infections were confirmed by electron microscopy, PCR, and sequence analysis. Prevention and control of this underdiagnosed disease can be achieved by educating physicians, slaughterhouse workers, and persons participating in Eid al-Adha.

Orf virus (genus Parapoxvirus, family Poxviridae) is endemic to most countries. The virus primarily causes contagious ecthyma in wild and domestic ruminants, mostly sheep and goats (1). Human infections caused by occupational and household exposures have been described (2–5); they most commonly cause lesions on the hands (1,3,6). We report Orf virus infection in 5 humans who had household exposure to the virus.

The Cases

Figure 1

Thumbnail of Orf virus infection in 5 persons who butchered or prepared lambs as part of a religious practice for Eid al-Adha (the Muslim Feast of Sacrifice), Marseille, France, 2011. Cutaneous lesions on hands of case-patient 3 (A, B) and case-patient 5 (C) are shown. Negative-staining electron microscopy of samples from case-patient 3 (D) and case-patient 5 (E, F) show ovoid particles (≈250 nm long, 150 nm wide) with a crisscross appearance; the size and appearance of these particles are highl

Figure 1. . Orf virus infection in 5 persons who butchered or prepared lambs as part of a religious practice for Eid al-Adha (the Muslim Feast of Sacrifice), Marseille, France, 2011. Cutaneous lesions...

Case-patient 1, a 51-year-old woman, was examined on November 28, 2011, by a surgeon (CF) for an 8-mm lesion without local complications on her left thumb. Case-patient 2, the 33-year-old niece of case-patient 1, was hospitalized on November 29 for surgical excision of a phlegmonous lesion on the fifth finger of her left hand; she also had a fever and a lesion without local complications on the second finger of the same hand. The surgery was performed by CF, the same surgeon who examined case-patient 1. By chance, case-patient 3, the 38-year-old brother of case-patient 2, met CF on November 29 while visiting his sister in the hospital; he asked CF if she would examine lesions on his left hand. Clinical examination revealed 2 lesions (1 each on the thumb and third finger) without local complications (Figure 1, panels A and B). The man reported having fever and malaise 1 day before the examination.
While examining case-patient 3, CF became aware that case-patients 1–3 were members of the same family and that they had butchered or handled several lambs on November 6, 2011, in preparation for Eid al-Adha (also called Eid al-Kabir), the Muslim Feast of Sacrifice. Using a smartphone, CF photographed the lesions on case-patient 3 and transmitted the photographs to 2 infectious disease specialists. The specialists indicated that the lesions appeared to be typical of parapoxvirus infection. CF interviewed case-patients 1–3 again, and they reported having knife wounds after preparing lambs for the religious feast and seeing lesions on the gums and tongue of 1 lamb. Swab (Virocult; Medical Wire and Equipment Co. Ltd., Corsham, United Kingdom) specimens were obtained from lesions on case-patients 1 and 3 and sent, along with a surgical skin biopsy specimen from case-patient 2, to the virology laboratory at Public Assistance–Hospitals of Marseille, Marseille, France.
Case-patient 4, a 64-year-old woman, sought medical care on December 9 for an ulcerovegetative lesion on the third finger of her left hand; the lesion was on the internal face of the interphalangeal joint, and phlegmon and cellulitis were present. The patient reported that she had injured herself with a kitchen knife on November 6 while butchering lamb meat for Eid al-Adha. Ten days later, she noticed vesicular lesions at the injury site; a pustule complicated by superinfection subsequently developed. The lesion was surgically excised on December 12, and skin biopsy samples were sent to the virology laboratory at Public Assistance–Hospitals of Marseille.
Case-patient 5, a 42-year-old woman, sought medical care on December 14 for a painful 2-cm papulonodular lesion on her right wrist (Figure 1, panel C). She recalled being injured on November 6 with a knife used to cut off the head of a lamb that was being prepared for Eid al-Adha. The lesion was surgically excised, and a sample was sent to the virology laboratory at Public Assistance–Hospitals of Marseille.