Zoonotic Infection with Pigeon Paramyxovirus Type 1 linked to Fatal Pneumonia

The characteristics and risk factors of pigeon paramyxovirus type 1 (PPMV-1) infection in humans are poorly known. We performed virological, pathological and epidemiological analyses of a Dutch case, and compared the results with those of a US case. Both infections occurred in transplant patients under immunosuppressive therapy and caused fatal respiratory failure. Both virus isolates clustered with avian paramyxovirus type 1 (APMV-1) genotype VIb/1, which has pigeons and doves as reservoir. Experimentally inoculated pigeons became infected and transmitted the virus to naïve pigeons. Likely route of transmission to both patients was direct or indirect contact with infected pigeons or doves. Given the large populations of feral pigeons with endemic PPMV-1 infection in cities, increasing urbanisation and a higher proportion of immunocompromised individuals, the risk of severe human PPMV-1 infections may increase. We recommend to test for APMV-1, including PPMV-1, in respiratory disease cases where common respiratory pathogens cannot be identified.