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China CDC Weekly

Notes from the Field

First Infection Case of Monkey B Identified in China, 2021

Wenling Wang1,&; Wenjie Qi2,&; Jingyuan Liu3,&; Haijun Du4,&; Li Zhao1; Yang Zheng5; Guoxing Wang2; Yang Pan5; Baoying Huang1; Zhaomin Feng5; Daitao Zhang5; Peng Yang5; Jun Han4,#; Quanyi Wang5,#; Wenjie Tan1,#

Monkey (BV), initially isolated in 1932, is polymerase chain reaction (rtPCR) were performed to currently designated as Macacine alphaherpesvirus 1 by detect BV (3), (VZV) (4), the International Committee on Taxonomy of virus and (5). For BV (1). BV is an alphaherpesvirus enzootic in of detection, the forward primer was 5′-TGGCCTACTA the genus Macaca, normally transmitted horizontally CCGCGTGG-3′, the reverse primer was 5′-TGGTA via direct contact and exchange of bodily secretions, CGTGTGGGAGTAGCG-3′; and the TaqMan probe just like virus (HSV) in . BV is was 5′-FAM-CCGCCCTCTCCGAGCACGTG-TAM not evident in its natural hosts, but about 60 RA-3′. The rtPCR results showed that only BV additional cases of pathogenic zoonotic BV infection was detected as positive (Cycle of threshold: have occurred sporadically and the fatality rate of 34) in the CSF specimen of the patient, while BV zoonotic BV infections is 70%–80%. Although the risk negative in other specimens from the patient and all for secondary transmission appears to be minimal, one specimens from close contacts; moreover, all tests were case of human-to-human transmission of herpes B negative for VZV, , and virus has previously been documented (2). Zoonotic orthopoxvirus (Figure 1). This result confirmed the BV infections have mainly involved first human infection case with BV in China. veterinarians, care personnel, or laboratory The first human infection case with BV was researchers in North America. However, there were no identified by NGS and rtPCR in China, 2021. This fatal or even clinically evident BV infections in China implied that BV in monkeys might pose a potential before 2021. Here, we reported the first human zoonotic threat to the occupational workers. It is infection case with BV identified in China. necessary to eliminate BV during the development of This case of BV occurred in a veterinary surgeon (53 specific pathogen-free rhesus colonies and to years old, male) who worked in an institute specialized strengthen surveillance in laboratory macaques and in nonhuman primate breeding and experimental occupational workers in China. research in Beijing. He dissected two dead monkeys on Conflicts of interest: No conflicts of interest. March 4 and 6, 2021 and experienced nausea and Funding: The National Key Research and vomiting followed by fever with neurological Development Program of China (2016YFD0500301) symptoms one month later. As a result, the patient and Viral Center of National Pathogen Resource visited doctor in several hospitals but eventually died Center, China CDC (NPRC-32). on May 27. doi: 10.46234/ccdcw2021.154 On April 17, cerebrospinal fluid (CSF) was collected # Corresponding authors: Jun Han, [email protected]; Quanyi from this patient for next generation sequencing Wang, [email protected]; Wenjie Tan, [email protected]. (NGS), 285 reads obtained suggesting possible 1 Key Laboratory of Biosafety, National Health and Family Planning alphaherpesvirus infection. To further identify the Commission, National Institute for Control and etiological agent, several specimens (including CSF, Prevention, China CDC, Beijing, China; 2 Beijing Friendship Hospital, blister fluid, blood, airway aspirates, nasal swab, throat Capital Medical University, Beijing, China; 3 Intensive Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China; swab, and plasma) were collected from this patient and 4 Viral Center of National Pathogen Resource Center, China CDC, 2 close contacts (1 doctor, 47 years old, male; 1 nurse, Beijing, China; 5 Beijing Center for Disease Prevention and Control, 25 years old, female), then sent to National Institute Beijing, China. & Joint first authors. for Viral Disease Control and Prevention (IVDC) of China CDC on April 19. Four sets of real-time Submitted: June 29, 2021; Accepted: June 30, 2021

632 CCDC Weekly / Vol. 3 / No. 29 Chinese Center for Disease Control and Prevention China CDC Weekly

A B

10 10 CSF Threshold Threshold 1 1 Fluorescence (465−510) Fluorescence (618−660)

2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 Cycles Cycles C D

10 10 Threshold Threshold 1 1 Fluorescence (465−510) Fluorescence (465−510)

2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 Cycles Cycles

FIGURE 1. Identification of the first human infection case with monkey B virus by rtPCR. (A) The rtPCR test result for BV; (B) The rtPCR test result for VZV; (C) The rtPCR test result for monkeypox virus; (D) The rtPCR test result for orthopoxvirus. Note: For (A)–(D), rtPCR detections targeting to various virus in the 11 specimens collected from the patient (CSF, blister fluid, blood, airway aspirates, nasal swab) and 2 close contacts (throat swab, blister fluid and plasma). Each line represents a specimen, red lines represent positive controls or positive specimens, and green lines represent negative specimens. Abbrevations: CSF=cerebrospinal fluid, rtPCR=real-time polymerase chain reaction, BV=B virus, VZV=varicella zoster virus.

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