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LYMPHOCYTIC CHORIOMENINGITIS VIRUS

PATHOGEN SAFETY DATA SHEET - INFECTIOUS SUBSTANCES

SECTION I - INFECTIOUS AGENT

NAME: Lymphocytic choriomeningitis virus^{Footnote 1}.

SYNONYM OR CROSS REFERENCE: LCMV^{Footnote 2-}^{Footnote 13}, LCM^{Footnote 14-}^{Footnote 18}, benign (or serous) lymphocytic meningitis^{Footnote 14}, and Armstrong’s disease^{Footnote 15}.

CHARACTERISTICS: As member of the family Arenaviridae, genus Arenavirus^{Footnote 9,}^{Footnote 15}, LCMV is an enveloped, round, oval, or pleomorphic virion, measuring roughly 110 nm to 130 nm in diameter with a bipartite single-stranded RNA genome^{Footnote 6,}^{Footnote 15}. The virion interior contains granules resembling grains of sand, which are characteristic of the family Arenaviridae, while the surface has hollow golf-club shaped projections^{Footnote 15}.

SECTION II - HAZARD IDENTIFICATION

PATHOGENICITY/TOXICITY: Acquired LCM (Postnatal): LCMV infection in immunocompetent adults may be asymptomatic (nearly one third of all infections^{Footnote 2,}^{Footnote 8} or limited to a non-specific, self-limited viral syndrome with symptoms such as fever, cough, malaise, myalgia, headache, photophobia, nausea, vomiting, adenopathy, and sore throat^{Footnote 2,}^{Footnote 8,}^{Footnote 9,}^{Footnote 15,}^{Footnote 19}. The illness can progress to include meningitis or meningoencephalitis^{Footnote 6,}^{Footnote 8,}^{Footnote 14}, and other less common neurologic symptoms such as paralysis, sensorineural hearing loss^{Footnote 2,}^{Footnote 6,}^{Footnote 8}, and Guillain-Barré type syndrome^{Footnote 8}. Uncommon non-neurologic manifestations of illness include pancreatitis^{Footnote 2}, orchitis^{Footnote 2,}^{Footnote 8}, arthritis, pericarditis, parotitis^{Footnote 8} pneumonitis, and rash^{Footnote 2}. Acquired LCMV infection is usually non-fatal, with a mortality rate of less than 1%, and recovery from even severe disease occurs without sequelae in most cases^{Footnote 5,}^{Footnote 6,}^{Footnote 14}.

Congenital LCM: LCMV infection can produce a spectrum of pathologic effects, from minimal to severe, depending on the developmental stage of the foetus at the time of infection^{Footnote 12}. In some cases, infection may result in abortion^{Footnote 2,}^{Footnote 9}, hydrocephalus, chorioretinitis, and/or mental retardation of the infant^{Footnote 6}. The mortality rate of infants diagnosed with congenital LCMV is approximately 35%^{Footnote 16}. Among survivors of congenital LCMV infection, two thirds have long-term neurologic abnormalities, including microcephaly, mental retardation, cerebral palsy, seizures, and visual impairment^{Footnote 2,}^{Footnote 8,}^{Footnote 16}.

Transplantation associated LCM: Recently LCMV infection has been identified in individuals who received solid organ transplants from donors who died of apparent non-infectious aetiologies^{Footnote 7,}^{Footnote 20}. These cases were uniformly fatal with the exception of one recipient who underwent ribavirin treatment when LCMV infection was suspected.

EPIDEMIOLOGY: The first identified Arenavirus, LCMV was isolated in 1933 from a woman thought to have St. Louis encephalitis^{Footnote 1}. Unlike other Arenaviruses, which have limited geographic distribution, LCMV is found in Europe, the Americas, and Asia, primarily in areas where mice co-habitate with humans^{Footnote 15}. The largest outbreak occurred between 1973 and 1974 in the United States with 181 cases and no deaths^{Footnote 19}. Other recognised outbreaks have been recorded in Germany and France^{Footnote 9}. The number of acquired LCM cases is underestimated since most cases are mild or asymptomatic and such individuals rarely seek medical attention^{Footnote 12}. Greater awareness and improved methods of detection may be contributing to increased prevalence^{Footnote 6}. Approximately 5% of humans show evidence of previous infection with LCMV ⁽⁵⁾. Congenital LCM was first recognised in 1955, and since then there have been 54 reported cases worldwide^{Footnote 3,}^{Footnote 6,}^{Footnote 21}, 63% of them since 1993^{Footnote 6}. It is not known whether the actual number of cases is significantly higher than this since only the most severe cases are reported^{Footnote 13}, and congenital LCM can produce a spectrum of pathological effects from minimal to severe^{Footnote 12}.

HOST RANGE: Humans^{Footnote 2-}^{Footnote 4,}^{Footnote 6,}^{Footnote 8,}^{Footnote 9,}^{Footnote 12-}^{Footnote 17}, mice^{Footnote 2,}^{Footnote 3,}^{Footnote 6,}^{Footnote 14,}^{Footnote 15,}, hamsters^{Footnote 3,}^{Footnote 4,}^{Footnote 15,}^{Footnote 17,}^{Footnote 18}, guinea pigs, rats, monkeys, dogs, rabbits, and chickens^{Footnote 17}.

INFECTIOUS DOSE: Unknown.

MODE OF TRANSMISSION: Mice infected in utero asymptomatically shed LCMV in their faeces, urine, saliva, breast milk, and semen^{Footnote 2,}^{Footnote 3,}^{Footnote 8,}^{Footnote 14,}^{Footnote 15}, and transmit the virus to humans (and other rodents, such as hamsters) by direct contact^{Footnote 2,}^{Footnote 3}, through damaged skin^{Footnote 14} or mucous membranes^{Footnote 14,}^{Footnote 15}, inhalation of aerosolised virus^{Footnote 2,}^{Footnote 3,}^{Footnote 8,}^{Footnote 14}, ingestion of virus contaminated food^{Footnote 8,}^{Footnote 9.}^{Footnote 14,}^{Footnote 15} or dust^{Footnote 9,}^{Footnote 14}, through rodent bites^{Footnote 8,}^{Footnote 15}, or by contact with infected fomites^{Footnote 2,}^{Footnote 14}. Transmission is also possible through organ transplantation from LCMV infected donors^{Footnote 4,}^{Footnote 7}, and vertically from an infected mother to her foetus^{Footnote 3}.

INCUBATION PERIOD: Approximately 8 to 13 days^{Footnote 9,}^{Footnote 14} and 15 to 21 days before any meningeal symptoms appear^{Footnote 14,}^{Footnote 15}.

COMMUNICABILITY: No evidence of human-to-human transmission^{Footnote 14}, with the exception of vertical transmission from an infected mother to her foetus during pregnancy^{Footnote 3}, and through solid organ transplantation from infected donors^{Footnote 4,}^{Footnote 7}.

SECTION III - DISSEMINATION

RESERVOIR: Primarily the house mouse (Mus. musculus)^{Footnote 2,}^{Footnote 5,}^{Footnote 14-}^{Footnote 16}, but the Syrian hamster is also a possibility^{Footnote 17}.

ZOONOSIS: Yes, LCMV is spread mainly through contact with contaminated rodent secretions/excretions^{Footnote 2,}^{Footnote 5,}^{Footnote 14,}^{Footnote 15,}^{Footnote 18}.

VECTORS: LCMV has been isolated from fleas, Culicoides flies, several species of Aedes mosquitoes, ticks and cockroaches, but it is deemed unlikely that arthropods play a role in LCMV transmission^{Footnote 15}.

SECTION IV – STABILITY AND VIABILITY

DRUG SUSCEPTIBILITY: Ribavirin has been shown to inactivate arenaviruses in vitro and may improve symptoms under clinical conditions^{Footnote 5,}^{Footnote 7,}^{Footnote 21}.

SUSCEPTIBILITY TO DISINFECTANTS: Bleach (sodium hypochlorite) or other common household disinfectants will inactivate LCMV^{Footnote 11}.

PHYSICAL INACTIVATION: LCMV is inactivated by UV light^{Footnote 10} and heat (55°C for at least 20 minutes)^{Footnote 1}.

SURVIVAL OUTSIDE HOST: Unless it is preserved at -80°C, LCMV is quickly inactivated outside its host^{Footnote 9}. LCMV will retain its infectivity for at least 206 days if stored in 50% glycerine and 0.85% saline at 4-10°C^{Footnote 1}.

SECTION V - FIRST AID / MEDICAL

SURVEILLANCE: Monitor for symptoms. Diagnosis is confirmed by serology, ELISA^{Footnote 2-}^{Footnote 4,}^{Footnote 8,}^{Footnote 9,}^{Footnote 15}, RT-PCR^{Footnote 3,}^{Footnote 4}^{Footnote 15}, Western blot^{Footnote 9,}^{Footnote 15}, immunohistochemical staining^{Footnote 4,}^{Footnote 17}, neutralisation assay^{Footnote 17}, immunofluorescent antibody test^{Footnote 8,}^{Footnote 9}, and viral culture from blood or cerebrospinal fluid^{Footnote 4,}^{Footnote 9}. The widely available complement fixation test, however, is deemed to be insensitive and its use is no longer recommended^{Footnote 6,}^{Footnote 8}.

Note: All diagnostic methods are not necessarily available in all countries.

FIRST AID/TREATMENT: Treatment is symptomatic and generally supportive^{Footnote 12,}^{Footnote 15}. Ribavirin is effective in vitro, and may be effective for treatment of LCM^{Footnote 5,}^{Footnote 7,}^{Footnote 21}.

IMMUNIZATION: None^{Footnote 14}.

PROPHYLAXIS: None.

SECTION VI - LABORATORY HAZARD

LABORATORY-ACQUIRED INFECTIONS: LCMV infection is a well known occupational risk for those working with rodents, especially hamsters and mice. 76 cases were reported up until 1978^{Footnote 22}, including 3 outbreaks between 1973 and 1975 among laboratory workers who had handled hamsters that had tumour grafts containing LCMV^{Footnote 18,}^{Footnote 19}. Further cases have occurred since then, notably in an outbreak associated with nude mice, in which 9% of 82 animal care workers were found to be seropositive for LCMV^{Footnote 23}.

SOURCES/SPECIMENS: Blood^{Footnote 1,}^{Footnote 14,}^{Footnote 18}, cerebrospinal fluid^{Footnote 1,}^{Footnote 8,}^{Footnote 14,}^{Footnote 18}, urine^{Footnote 1,}^{Footnote 17,}^{Footnote 18}, transplantable tumours^{Footnote 15,}^{Footnote 18}, secretions of the nasopharynx^{Footnote 8,}^{Footnote 14,}^{Footnote 15,}^{Footnote 18}, faeces^{Footnote 8,}^{Footnote 14,}^{Footnote 15}, and infected tissues from animals and humans^{Footnote 5}.

PRIMARY HAZARDS: Aerosols^{Footnote 5}, and direct contact of mucous membranes with virus^{Footnote 14,}^{Footnote 15}.

SPECIAL HAZARDS: Transplantable tumour lines represent a potential hazard^{Footnote 14,}^{Footnote 15}.

SECTION VII - EXPOSURE CONTROLS / PERSONAL PROTECTION

RISK GROUP CLASSIFICATION: Risk Group 3^{Footnote 24}. This risk group applies to the species as a whole, and may not be representative of all strains and clonal isolates.

CONTAINMENT REQUIREMENTS: Containment Level 3 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures. These containment levels apply to the species as a whole, and may not be representative of all strains and clonal isolates.

PROTECTIVE CLOTHING: Personnel entering the laboratory should remove street clothing and jewellery, and change into dedicated laboratory clothing and shoes, or don full coverage protective clothing (i.e., completely covering all street clothing). Additional protection may be worn over laboratory clothing when infectious materials are directly handled, such as solid-front gowns with tight fitting wrists, gloves, and respiratory protection. Eye protection must be used where there is a known or potential risk of exposure to splashes^{Footnote 25}.

OTHER PRECAUTIONS: All activities with infectious material should be conducted in a biological safety cabinet (BSC) or other appropriate primary containment device in combination with personal protective equipment. Centrifugation of infected materials must be carried out in closed containers placed in sealed safety cups, or in rotors that are loaded or unloaded in a biological safety cabinet. The use of needles, syringes, and other sharp objects should be strictly limited. Open wounds, cuts, scratches, and grazes should be covered with waterproof dressings. Additional precautions should be considered with work involving animals or large scale activities^{Footnote 25}.

SECTION VIII - HANDLING AND STORAGE

SPILLS: Allow aerosols to settle and, wear protective clothing, gently cover spill with paper towels and apply an appropriate disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean up.

DISPOSAL: Decontaminate all materials for disposal by steam sterilisation, chemical disinfection, and/or incineration.

STORAGE: In sealed containers that are appropriately labelled.

SECTION IX - REGULATORY AND OTHER INFORMATION

REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.

UPDATED: September 2011

PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada.

Although the information, opinions and recommendations contained in this Pathogen Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.

Public Health Agency of Canada, 2011

Canada

REFERENCES:

Footnote 1: Armstrong, C., & Lillie, R. D. (1934). Experimental lymphocytic choriomeningitis of monkeys and mice produced by a virus encountered in studies of the 1933 St. Louis encephalitis epidemic. Pub. Health Rep., 49, 1019-1027.
Footnote 2: Barton, L. L., & Mets, M. B. (2001). Congenital lymphocytic choriomeningitis virus infection: Decade of rediscovery. Clinical Infectious Diseases, 33(3), 370-374.
Footnote 3: Barton, L. L., Mets, M. B., & Beauchamp, C. L. (2002). Lymphocytic choriomeningitis virus: emerging fetal teratogen. American Journal of Obstetrics and Gynecology, 187(6), 1715-1716.
Footnote 4: Center for Disease Control and Prevention. (2005). Lymphocytic Choriomeningitis Virus Infection in Organ Transplant Recipients-Massachusetts, Rhode Island. MMWR, 54, 537.
Footnote 5: Peters, C. J. (2006). Lymphocytic choriomeningitis virus - An old enemy up to new tricks. New England Journal of Medicine, 354(21), 2208-2211.
Footnote 6: Jamieson, D. J., Kourtis, A. P., Bell, M., & Rasmussen, S. A. (2006). Lymphocytic choriomeningitis virus: An emerging obstetric pathogen? American Journal of Obstetrics and Gynecology, 194(6), 1532-1536.
Footnote 7: Fischer, S. A., Graham, M. B., Kuehnert, M. J., Kotton, C. N., Srinivasan, A., Marty, F. M., Comer, J. A., Guarner, J., Paddock, C. D., DeMeo, D. L., Shieh, W. -., Erickson, B. R., Bandy, U., DeMaria Jr., A., Davis, J. P., Delmonico, F. L., Pavlin, B., Likos, A., Vincent, M. J., Sealy, T. K., Goldsmith, C. S., Jernigan, D. B., Rollin, P. E., Packard, M. M., Patel, M., Rowland, C., Helfand, R. F., Nichol, S. T., Fishman, J. A., Ksiazek, T., & Zaki, S. R. (2006). Transmission of lymphocytic choriomeningitis virus by organ transplantation. New England Journal of Medicine, 354(21), 2235-2249.
Footnote 8: Barton, L. L., & Mets, M. B. (1999). Lymphocytic choriomeningitis virus: pediatric pathogen and fetal teratogen. The Pediatric Infectious Disease Journal, 18(6), 540-541.
Footnote 9: Rousseau, M. C., Saron, M. F., Brouqui, P., & Bourgeade, A. (1997). Lymphocytic choriomeningitis virus in southern France: Four case reports and a review of the literature. European Journal of Epidemiology, 13(7), 817-823.
Footnote 10: Gairin, J. E., Joly, E., & Oldstone, M. B. A. (1991). Persistent infection with lymphocytic choriomeningitis virus enhances expression of MHC class I glycoprotein on cultured mouse brain endothelial cells. Journal of Immunology, 146(11), 3953-3957.
Footnote 11: Centers for Disease Control and Prevention. (2005). Update: Interim Guidance for Minimizing Risk for Human Lymphocytic Choriomeningitis Virus Associated with Pet Rodents. MMWR, 54, 799.
Footnote 12: Bonthius, D. J., Wright, R., Tseng, B., Barton, L., Marco, E., Karacay, B., & Larsen, P. D. (2007). Congenital lymphocytic choriomeningitis virus infection: Spectrum of disease. Annals of Neurology, 62(4), 347-355.
Footnote 13: Bonthius, D. J., & Perlman, S. (2007). Congenital viral infections of the brain: Lessons learned from lymphocytic choriomeningitis virus in the neonatal rat. PLoS Pathogens, 3(11), 1541-1550.
Footnote 14: Control of Communicable Diseases Manual: An Official Report of the American Public Health Association. (2004). In D. L. Heymann (Ed.), (18th ed., pp. pp. 321-322). Washington, D.C.: American Public Health Association.
Footnote 15: Acha, P. N., & Szyfres, B. (2003). In Pan American Health Organization (Ed.), Zoonoses and Communicable Diseases Common to Man and Animals (3rd ed.). Washington DC: PAHO HQ library.
Footnote 16: Wright, R., Johnson, D., Neumann, M., Ksiazek, T. G., Rollin, P., Keech, R. V., Bonthius, D. J., Hitchon, P., Grose, C. F., Bell, W. E., & Bale Jr., J. F. (1997). Congenital lymphocytic choriomeningitis virus syndrome: a disease that mimics congenital toxoplasmosis or Cytomegalovirus infection. Pediatrics, 100(1)
Footnote 17: Parker, J. C., Igel, H. J., Reynolds, R. K., Lewis, A. M., & Rowe, W. P. (1967). Lymphocytic choriomeningitis virus infection in foetal, newborn, and young adult Syrian hamsters. Infection and Immunity, 13(3), 967-981.
Footnote 18: Bowen, G. S., Calisher, C. H., & Winkler, W. G. (1975). Laboratory studies of a lymphocytic choriomeningitis virus outbreak in man and laboratory animals. American Journal of Epidemiology, 102(3), 233-240.
Footnote 19: Gregg, M. B. (1975). Recent outbreaks of lymphocytic choriomeningitis in the United States of America. Bulletin of the World Health Organization, 52(4-5 6), 549-553.
Footnote 20: Paddock, C., Ksiazek, T., Comer, J. A., Rollin, P. N., S., & Shieh, W. J. (2005). Pathology of fatal lymphocytic choriomeningitis virus infection in multiple organ transplant recipients from a common donor. Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc, 18, 263A-264A.
Footnote 21: Greenhow, T. L., & Weintrub, P. S. (2003). Neonate with hydrocephalus. Pediatric Infectious Disease Journal, 22(12), 1099+1111-1112.
Footnote 22: Collins, C. H., & Kennedy, D. A. (1999). laboratory acquired infections. Laboratory-Acquired Infections: History, Incidence, Causes and Prevention. . . (4th Edn ed., pp. 1-37 27) Buttersworth, London, UK.
Footnote 23: Dykewicz, C. A., Dato, V. M., Fisher-Hoch, S. P., Howarth, M. V., Perez-Oronoz, G. I., Ostroff, S. M., Gary Jr., H., Schonberger, L. B., & McCormick, J. B. (1992). Lymphocytic choriomeningitis outbreak associated with nude mice in a research institute. Journal of the American Medical Association, 267(10), 1349-1353.
Footnote 24: Human Pathogens and Toxins Act. S.C. 2009, c. 24. Government of Canada, Second Session, Fortieth Parliament, 57-58 Elizabeth II, 2009, (2009).
Footnote 25: Public Health Agency of Canada. (2004). In Best M., Graham M. L., Leitner R., Ouellette M. and Ugwu K. (Eds.), Laboratory Biosafety Guidelines (3rd ed.). Canada: Public Health Agency of Canada.

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