Human infection with a zoonotic orthopoxvirus in the country of Georgia

N Engl J Med. 2015 Mar 26;372(13):1223-30. doi: 10.1056/NEJMoa1407647.


During 2013, cutaneous lesions developed in two men in the country of Georgia after they were exposed to ill cows. The men had never received vaccination against smallpox. Tests of lesion material with the use of a quantitative real-time polymerase-chain-reaction assay for non-variola virus orthopoxviruses were positive, and DNA sequence analysis implicated a novel orthopoxvirus species. During the ensuing epidemiologic investigation, no additional human cases were identified. However, serologic evidence of exposure to an orthopoxvirus was detected in cows in the patients' herd and in captured rodents and shrews. A third case of human infection that occurred in 2010 was diagnosed retrospectively during testing of archived specimens that were originally submitted for tests to detect anthrax. Orthopoxvirus infection should be considered in persons in whom cutaneous lesions develop after contact with animals.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Animals
  • Antibodies, Viral / blood
  • Cattle
  • Cattle Diseases / transmission*
  • DNA, Viral / analysis
  • Female
  • Georgia
  • Humans
  • Male
  • Mammary Glands, Animal / virology
  • Middle Aged
  • Orthopoxvirus / genetics
  • Orthopoxvirus / isolation & purification*
  • Phylogeny
  • Poxviridae Infections / transmission*
  • Poxviridae Infections / virology
  • Rodentia / virology
  • Shrews / virology
  • Smallpox Vaccine
  • Young Adult
  • Zoonoses / transmission*
  • Zoonoses / virology


  • Antibodies, Viral
  • DNA, Viral
  • Smallpox Vaccine