Alkhumra virus
Pathogen Safety Data Sheets: Infectious Substances – Alkhumra virus
SECTION I – INFECTIOUS AGENT
Name: Alkhumra virus
Agent type: Virus
Family: Flaviviridae
Genus: Flavivirus
Species: Kyasanur Forest disease virus
Subspecies/strain/clonal isolate: Alkhumra virus
Synonym or cross–reference: Alkhumra virus (ALKV), Alkhumra hemorrhagic fever virus 1 2, Alkhurma’ virus 3 4.
Characteristics
ALKV is closely related to Kyasanur Forest disease virus 1 2. ALKV is a single-stranded, positive-sense RNA virus. Its genome is approximately 10.5 kb in length 1. ALKV has icosahedral symmetry, is surrounded by a lipid envelope, and measures approximately 40 nm in diameter 5.
Section II – Hazard identification
Pathogenicity and toxicity
ALKV is the causative agent of Alkhumra hemorrhagic fever 6 7. ALKV infections can be subclinical in some individuals 8. Symptomatic individuals may experience influenza-like symptoms including fever (96-100%), malaise (59-86%), anorexia (62%), or nausea (60%) 9 10. Hemorrhagic manifestations have been reported in 26-55% of patients 9. Neurological manifestations are less common and include confusion (3-25%), hallucination (4.3%), neck rigidity (1-9%), and convulsion (2-5%) 9 11. Disease is biphasic in 3% of symptomatic cases 7. In these cases, the initial fever persists for 9 to 10 days, followed by a symptom-free period for 2 to 3 days, and a second febrile period for 2 days 7. Complications including encephalitis have been reported in 12-20% of cases 7 9. Overall case fatality rate is approximately 1% 7, while one outbreak had a mortality rate of 25% 6.
Epidemiology
ALKV is endemic in Saudi Arabia, since being discovered in 1995, with outbreaks occurring sporadically 7 10 12. Since 2009, approximately 38-93 new cases of Alkhumra hemorrhagic fever are reported in Saudi Arabia every year 10 11. Recently travel-related cases, and cases in the surrounding geographic areas have become more prevalent 1 13.
Predisposing factors include individuals who handle, or work closely with, raw meat or blood from infected animals. This includes abattoir workers, butchers, and shepherds 12 14.
Host range
Natural host(s): Humans, sheep 15, camels 1, goats 11.
Other host(s): Mice have been experimentally infected with ALKV 16.
Infectious dose: Unknown.
Incubation period: Approximately 3 to 8 days 6.
Communicability
No evidence of human-to-human transmission. ALKV can be transmitted via bites from infected ticks and direct contact with blood or raw meat from infected animals 7 12 15. Although other flaviviruses can be transmitted to humans via consumption of raw milk products 17 18, there is currently insufficient evidence to support this transmission pathway for ALKV 8 19.
Section III – Dissemination
Reservoir
Potential reservoirs include goats, sheep, and camels 20.
Zoonosis
ALKV can be transmitted to humans from infected livestock via direct contact with blood or raw meat from infected animals 12 15.
Vectors
ALKV is transmitted to mammalian hosts via tick bites. ALKV has been found in soft tick Ornithodoros savignyi 21, and hard ticks Hyalomma dromedarii and Amblyomma lepidum 19 22.
Section IV – Stability and viability
Drug susceptibility/resistance
An adenosine analog (NITD008), 6-Azauridine, 2′-C-methylcytidine, and interferon alpha 2a inhibited ALKV replication in vitro 23 24. Perylenyltriazoles, an aglycon analogue of the antibiotic teicoplanin (LCTA-949), and Arbidol (Umifenovir), a broad-spectrum antiviral drug approved in China and Russia for influenza treatment, showed antiviral activity against other flaviviruses in vitro 25 26 27.
Susceptibility to disinfectants
Ethanol (70%) effectively inactivates ALKV 1. Other members of the Flavivirus genus are inactivated by iodine-based disinfectants (1%), hypochlorite (1%), paraformaldehyde, and glutaraldehyde (2%) 28 29.
Physical inactivation
ALKV is inactivated by heat treatment at 60 °C for 3 minutes and 56 °C for 30 minutes 30. Flaviviruses can be inactivated by UV radiation and extreme pH, (pH ≥ 9) 28 29.
Survival outside host
No literature currently provides information on survival of ALKV outside host. Other tick-borne flaviviruses are stable in milk for 72 hours at refrigeration temperature but are not detectable after 48 hours at room temperature 31.
Section V – First aid/medical
Surveillance
Diagnosis is accomplished through the monitoring of clinical symptoms. ALKV can be detected in blood using reverse transcriptase PCR 8 32. ELISA can be used to detect ALKV antibodies in blood, but cross-reaction with other flaviviruses (e.g., dengue, yellow fever, West Nile) can be problematic 8 14.
Note: The specific recommendations for surveillance in the laboratory should come from the medical surveillance program, which is based on a local risk assessment of the pathogens and activities being undertaken, as well as an overarching risk assessment of the biosafety program as a whole. More information on medical surveillance is available in the Canadian Biosafety Handbook (CBH).
First aid/treatment
There is no available antiviral treatment for Alkhumra hemorrhagic fever; treatment includes supportive care to manage symptoms 14 28.
Note: The specific recommendations for first aid/treatment in the laboratory should come from the post-exposure response plan, which is developed as part of the medical surveillance program. More information on the post-exposure response plan can be found in the CBH.
Immunization
No vaccine is currently available.
Note: More information on the medical surveillance program can be found in the CBH, and by consulting the Canadian Immunization Guide.
Prophylaxis
None.
Note: More information on prophylaxis as part of the medical surveillance program can be found in the CBH.
Section VI – Laboratory hazard
Laboratory-acquired infections
None have been reported to date.
Note: Please consult the Canadian Biosafety Standard (CBS) and CBH for additional details on requirements for reporting exposure incidents. A Canadian biosafety guideline describing notification and reporting procedures is also available.
Sources/specimens
Blood/serum and biopsy specimens can be sources of ALKV.
Primary hazards
Exposure of mucous membranes or wounded skin to infectious material, and bites/scratches of an infected animal are the primary hazards associated with ALKV exposure.
Special hazards
None.
Section VII – Exposure controls/personal protection
Risk group classification
Alkhumra virus is a Risk Group (RG) 4 human pathogen and a RG 4 animal pathogen 33 34.
Containment requirements
Containment Level 4 facilities, equipment, and operational practices outlined in the CBS for work involving infectious or potentially infectious materials, animals, or cultures.
Protective clothing
The applicable Containment Level 4 requirements for personal protective equipment and clothing outlined in the CBS to be followed. The use of a positive-pressure suit or use of a Class III biological safety cabinet (BSC) line is required for all work with RG4 pathogens.
Note: A local risk assessment will identify the appropriate hand, foot, head, body, eye/face, and respiratory protection, and the personal protective equipment requirements for the containment zone must be documented.
Other precautions
All activities involving open vessels of infectious material are to be performed in a certified biological safety cabinet (BSC) or other appropriate primary containment device. Centrifugation of infected materials must be carried out in closed containers placed in sealed safety cups, or in rotors that are unloaded in a biological safety cabinet. The integrity of positive pressure suits must be routinely checked for leaks. The use of needles, syringes, and other sharp objects to be strictly limited. Open wounds, cuts, scratches, and grazes are to be covered with waterproof dressings. Additional precautions must be considered with work involving animal activities.
Section VIII – Handling and storage
Spills
The spill area to be evacuated and secured. Aerosols must be allowed to settle for a minimum of 30 minutes. Spills of potentially contaminated material to be covered with absorbent paper-based material (e.g., paper towels), liberally covered with an effective disinfectant (e.g., 1% sodium hypochlorite), and left to soak for an appropriate amount of time (e.g., 10 minutes) before being wiped up. Following the removal of the initial material, the disinfection process is to be repeated. Individuals performing this task must wear PPE, including particulate respirators (e.g., N95 or higher). Disposable gloves, impermeable gowns and protective eye wear are to be removed immediately after completion of the process, placed in an autoclave bag, and decontaminated prior to disposal (CBH).
Disposal
All materials/substances that have come in contact with the infectious agent must be completely decontaminated before they are removed from the containment zone. This can be achieved by using decontamination technologies and processes that have been demonstrated to be effective against the infectious material, such as chemical disinfectants, autoclaving, irradiation, incineration, an effluent treatment system, or gaseous decontamination (CBH).
Storage
The applicable Containment Level 4 requirements for storage outlined in the CBS are to be followed. Pathogens, toxins, and other regulated materials to be stored inside the containment zone.
Inventory of Risk Group 4 (RG4) pathogens in long-term storage to be maintained and to include:
- specific identification of the pathogens, toxins, and other regulated materials; and
- a means to allow for the detection of a missing or stolen sample in a timely manner.
Section IX – Regulatory and other information
Canadian regulatory information
Controlled activities with ALKV require a Human Pathogens and Toxins Licence, issued by the Public Health Agency of Canada. ALKV is a non-indigenous animal pathogen in Canada; therefore, importation of ALKV requires an import permit, issued by the Canadian Food Inspection Agency.
The following is a non-exhaustive list of applicable designations, regulation, or legislation:
- Human Pathogen and Toxins Act and Human Pathogens and Toxins Regulations
- Health of Animals Act and Health of Animals Regulations
- Transportation of Dangerous Goods Regulations
Last file update: October, 2019
Prepared by: Centre for Biosecurity, Public Health Agency of Canada.
Disclaimer
The scientific information, opinions, and recommendations contained in this Pathogen Safety Data Sheet have been developed based on or compiled from trusted sources available at the time of publication. Newly discovered hazards are frequent and this information may not be completely up to date. The Government of Canada accepts no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information.
Persons in Canada are responsible for complying with the relevant laws, including regulations, guidelines and standards applicable to the import, transport, and use of pathogens in Canada set by relevant regulatory authorities, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment and Climate Change Canada, and Transport Canada. The risk classification and related regulatory requirements referenced in this Pathogen Safety Data Sheet, such as those found in the Canadian Biosafety Standard, may be incomplete and are specific to the Canadian context. Other jurisdictions will have their own requirements.
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