First Human Infection Case of Monkey B Virus Identified
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What is Monkey B Virus? Monkey B virus infection is extremely rare, but it can lead to severe brain damage or death if you do not get treatment immediately.
People typically get infected with B virus if they are bitten or scratched by an infected macaque monkey, or have contact with the monkey’s eyes, nose, or mouth.
Monkey B virus (BV), initially isolated in 1932, is currently designated as Macacine alphaherpesvirus 1 by the International Committee on Taxonomy of Viruses. BV is an alphaherpesvirus enzootic in macaques of the genus Macaca, normally transmitted horizontally via direct contact and exchange of bodily secretions, just like herpes simplex virus (HSV) in humans.
BV is not evident in its natural macaque hosts, but about 60 additional cases of pathogenic zoonotic BV infection have occurred sporadically and the fatality rate of zoonotic BV infections is 70%–80%. Although the risk for secondary transmission appears to be minimal, only one case of human-to-human transmission of herpes B virus has previously been documented.
According to the US CDC "Since B virus was identified in 1932, only 50 people have been documented to have infections; 21 of them died. Most of these people got infected after they were bitten or scratched by a monkey, or when tissue or fluids from a monkey got on their broken skin, such as by needle stick or cut. In 1997, a researcher died from B virus infection after bodily fluid from an infected monkey splashed into her eye."
Zoonotic BV infections have mainly involved primate veterinarians, animal care personnel, or laboratory researchers in North America. However, there were no fatal or even clinically evident BV infections in China before 2021.
This report is the first human infection case with BV identified in China. The victim is a veterinary surgeon (53 years old, male) who worked in an institute specialized in nonhuman primate breeding and experimental research in Beijing.
He dissected two dead monkeys on March 4 and 6, 2021 and experienced nausea and vomiting followed by fever with neurological symptoms one month later. As a result, the patient visited doctor in several hospitals but eventually died on May 27.
On April 17, cerebrospinal fluid (CSF) was collected from this patient for next generation sequencing (NGS), 285 reads obtained suggesting possible alphaherpesvirus infection.
To further identify the etiological agent, several specimens (including CSF, blister fluid, blood, nasal swab, and oropharyngeal swab) were collected from this patient and 2 close contacts (1 doctor, 47 years old, male; 1 nurse, 25 years old, female), then sent to National Institute for Viral Disease Control and Prevention (IVDC) of China CDC on April 19.
Four sets of real-time polymerase chain reaction (rtPCR) were performed to detect BV, varicella zoster virus (VZV), monkeypox virus and orthopoxvirus.
For BV detection, the forward primer was 5′-TGGCCTACTACCGCGTGG-3′, the reverse primer was 5′-TGGTACGTGTGGGAGTAGCG-3′; and the TaqMan probe was 5′-FAM-CCGCCCTCTCCGAGCACGTG-TAMRA-3′.
The rtPCR results showed that only BV genome was detected as positive (Cycle of threshold: 34) in the CSF specimen of the patient, while BV negative in other specimens from the patient and all specimens from close contacts; Moreover, all tests were negative for VZV, monkeypox virus, and orthopoxvirus. This result confirmed the first human infection case with BV in China.
This case was identified by NGS and rtPCR in China, 2021. It implies that BV in monkeys might pose a potential zoonotic threat to the occupational workers.
It is necessary to eliminate BV during the development of specific pathogen-free rhesus colonies and to strengthen surveillance in laboratory macaques and occupational workers in China.
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