1
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Fan Y, Hou Y, Li Q, Dian Z, Wang B, Xia X. RNA virus diversity in rodents. Arch Microbiol 2023; 206:9. [PMID: 38038743 DOI: 10.1007/s00203-023-03732-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023]
Abstract
Many zoonotic disease emergencies are associated with RNA viruses in rodents that substantially impact public health. With the widespread application of meta-genomics and meta-transcriptomics for virus discovery over the last decade, viral sequences deposited in public databases have expanded rapidly, and the number of novel viruses discovered in rodents has increased. As important reservoirs of zoonotic viruses, rodents have attracted increasing attention for the risk of potential spillover of rodent-borne viruses. However, knowledge of rodent viral diversity and the major factors contributing to the risk of zoonotic epidemic outbreaks remains limited. Therefore, this study analyzes the diversity and composition of rodent RNA viruses using virus records from the Database of Rodent-associated Viruses (DRodVir/ZOVER), which covers the published literatures and records in GenBank database, reviews the main rodent RNA virus-induced human infectious diseases, and discusses potential challenges in this field.
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Affiliation(s)
- Yayu Fan
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, 650500, People's Republic of China
| | - Yutong Hou
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, 650500, People's Republic of China
| | - Qian Li
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, 650500, People's Republic of China
| | - Ziqin Dian
- Department of Clinical Laboratory, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, People's Republic of China
| | - Binghui Wang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, 650500, People's Republic of China.
| | - Xueshan Xia
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, 650500, People's Republic of China.
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2
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Züst R, Ackermann-Gäumann R, Liechti N, Siegrist D, Ryter S, Portmann J, Lenz N, Beuret C, Koller R, Staehelin C, Kuenzli AB, Marschall J, Rothenberger S, Engler O. Presence and Persistence of Andes Virus RNA in Human Semen. Viruses 2023; 15:2266. [PMID: 38005942 PMCID: PMC10675069 DOI: 10.3390/v15112266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
When infecting humans, Andes orthohantavirus (ANDV) may cause a severe disease called hantavirus cardiopulmonary syndrome (HCPS). Following non-specific symptoms, the infection may progress to a syndrome of hemorrhagic fever combined with hyper-acute cardiopulmonary failure. The case fatality rate ranges between 25-40%, depending on the outbreak. In this study, we present the follow-up of a male patient who recovered from HCPS six years ago. We demonstrate that the ANDV genome persists within the reproductive tract for at least 71 months. Genome sequence analysis early and late after infection reveals a low number of mutations (two single nucleotide variants and one deletion), suggesting limited replication activity. We can exclude the integration of the viral genome into the host genome, since the treatment of the specimen with RNAse led to a loss of signal. We demonstrate a long-lasting, strong neutralizing antibody response using pseudovirions expressing the ANDV glycoprotein. Taken together, our results show that ANDV has the potential for sexual transmission.
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Affiliation(s)
- Roland Züst
- Spiez Laboratory, Swiss Federal Office for Civil Protection, 3700 Spiez, Switzerland (O.E.)
| | | | - Nicole Liechti
- Spiez Laboratory, Swiss Federal Office for Civil Protection, 3700 Spiez, Switzerland (O.E.)
| | - Denise Siegrist
- Spiez Laboratory, Swiss Federal Office for Civil Protection, 3700 Spiez, Switzerland (O.E.)
| | - Sarah Ryter
- Spiez Laboratory, Swiss Federal Office for Civil Protection, 3700 Spiez, Switzerland (O.E.)
| | - Jasmine Portmann
- Spiez Laboratory, Swiss Federal Office for Civil Protection, 3700 Spiez, Switzerland (O.E.)
| | - Nicole Lenz
- Food Microbial Systems, Risk Assessment and Mitigation Group, Agroscope, 3097 Bern, Switzerland
| | - Christian Beuret
- Spiez Laboratory, Swiss Federal Office for Civil Protection, 3700 Spiez, Switzerland (O.E.)
| | - Roger Koller
- Institute for Infectious Diseases, University of Bern, 3001 Bern, Switzerland
| | - Cornelia Staehelin
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Andrea B. Kuenzli
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Sylvia Rothenberger
- Spiez Laboratory, Swiss Federal Office for Civil Protection, 3700 Spiez, Switzerland (O.E.)
- Institute of Microbiology, University Hospital Center and University of Lausanne, 1005 Lausanne, Switzerland
| | - Olivier Engler
- Spiez Laboratory, Swiss Federal Office for Civil Protection, 3700 Spiez, Switzerland (O.E.)
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3
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Maia RM, Fernandes J, de Mattos LHBV, Camacho LAB, Caetano KAA, dos Santos Carneiro MA, de Oliveira Santos F, Teles SA, de Lemos ERS, de Oliveira RC. Seroprevalence of Hantavirus among Manual Cane Cutters and Epidemiological Aspects of HPS in Central Brazil. Viruses 2023; 15:2238. [PMID: 38005915 PMCID: PMC10674252 DOI: 10.3390/v15112238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 11/26/2023] Open
Abstract
Hantavirus pulmonary syndrome (HPS) is a rodent-borne zoonotic disease that is endemic throughout the Americas. Agricultural activities increase exposure to wild rodents, especially for sugarcane cutters. We carried out a survey of the epidemiological aspects of HPS and investigated the prevalence of hantavirus infection in the sugarcane cutter population from different localities in the Brazilian Midwest region. We conducted a retrospective study of all confirmed HPS cases in the state of Goiás reported to the National HPS surveillance system between 2007 and 2017, along with a seroepidemiological study in a population of sugarcane cutters working in Goiás state in 2016, using the anti-hantavirus (Andes) ELISA IgG. A total of 634 serum samples from cane cutters were tested for hantavirus antibodies, with 44 (6.9%) being IgG-reactive according to ELISA. The destination of garbage was the only statistically significant variable (p = 0.03) related to the detection of hantavirus IgG (p < 0.05). We described the epidemiological profile of reported hantavirus cases in Goiás-a highly endemic area for HPS, and where the seroepidemiological study was conducted. Our results increase our knowledge about hantavirus infections in Brazil and highlight the vulnerability of sugarcane cutters to a highly lethal disease that, to date, has no specific treatment or vaccination.
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Affiliation(s)
- Renata Malachini Maia
- Hantaviruses and Rickettsiosis Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Rio de Janeiro 21040-360, Brazil; (J.F.); (L.H.B.V.d.M.); (E.R.S.d.L.)
| | - Jorlan Fernandes
- Hantaviruses and Rickettsiosis Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Rio de Janeiro 21040-360, Brazil; (J.F.); (L.H.B.V.d.M.); (E.R.S.d.L.)
| | | | | | | | | | - Fernando de Oliveira Santos
- Biology and Parasitology of Wild Mammals Reservoirs Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Rio de Janeiro 21041-210, Brazil;
| | - Sheila Araujo Teles
- Faculty of Nursing, Federal University of Goiás, Goiânia 74605-080, Brazil; (K.A.A.C.); (S.A.T.)
| | - Elba Regina Sampaio de Lemos
- Hantaviruses and Rickettsiosis Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Rio de Janeiro 21040-360, Brazil; (J.F.); (L.H.B.V.d.M.); (E.R.S.d.L.)
| | - Renata Carvalho de Oliveira
- Hantaviruses and Rickettsiosis Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Rio de Janeiro 21040-360, Brazil; (J.F.); (L.H.B.V.d.M.); (E.R.S.d.L.)
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4
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Riesle-Sbarbaro SA, Kirchoff N, Hansen-Kant K, Stern A, Kurth A, Prescott JB. Human-to-Human Transmission of Andes Virus Modeled in Syrian Hamsters. Emerg Infect Dis 2023; 29:2159-2163. [PMID: 37735788 PMCID: PMC10521624 DOI: 10.3201/eid2910.230544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
Several occurrences of human-to-human transmission of Andes virus, an etiological agent of hantavirus cardiopulmonary syndrome, are documented. Syrian hamsters consistently model human hantavirus cardiopulmonary syndrome, yet neither transmission nor shedding has been investigated. We demonstrate horizontal virus transmission and show that Andes virus is shed efficiently from both inoculated and contact-infected hamsters.
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Vial PA, Ferrés M, Vial C, Klingström J, Ahlm C, López R, Le Corre N, Mertz GJ. Hantavirus in humans: a review of clinical aspects and management. THE LANCET. INFECTIOUS DISEASES 2023; 23:e371-e382. [PMID: 37105214 DOI: 10.1016/s1473-3099(23)00128-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 04/29/2023]
Abstract
Hantavirus infections are part of the broad group of viral haemorrhagic fevers. They are also recognised as a distinct model of an emergent zoonotic infection with a global distribution. Many factors influence their epidemiology and transmission, such as climate, environment, social development, ecology of rodent hosts, and human behaviour in endemic regions. Transmission to humans occurs by exposure to infected rodents in endemic areas; however, Andes hantavirus is unique in that it can be transmitted from person to person. As hantaviruses target endothelial cells, they can affect diverse organ systems; increased vascular permeability is central to pathogenesis. The main clinical syndromes associated with hantaviruses are haemorrhagic fever with renal syndrome (HFRS), which is endemic in Europe and Asia, and hantavirus cardiopulmonary syndrome (HCPS), which is endemic in the Americas. HCPS and HFRS are separate clinical entities, but they share several features and have many overlapping symptoms, signs, and pathogenic alterations. For HCPS in particular, clinical outcomes are highly associated with early clinical suspicion, access to rapid diagnostic testing or algorithms for presumptive diagnosis, and prompt transfer to a facility with critical care units. No specific effective antiviral treatment is available.
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Affiliation(s)
- Pablo A Vial
- Programa Hantavirus y Zoonosis, Instituto de Ciencias e Innovación en Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Departamento de Pediatría Clínica Alemana de Santiago, Santiago, Chile.
| | - Marcela Ferrés
- Department of Pediatric Infectious Disease and Immunology, Infectious Disease and Molecular Virology Laboratory, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia Vial
- Programa Hantavirus y Zoonosis, Instituto de Ciencias e Innovación en Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Jonas Klingström
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Clas Ahlm
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - René López
- Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Departamento de Paciente Crítico Clínica Alemana, Santiago, Chile
| | - Nicole Le Corre
- Department of Pediatric Infectious Disease and Immunology, Infectious Disease and Molecular Virology Laboratory, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gregory J Mertz
- Department of Internal Medicine, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, USA
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Nnamani EI, Spruill-Harrell B, Williams EP, Taylor MK, Owen RD, Jonsson CB. Deep Sequencing to Reveal Phylo-Geographic Relationships of Juquitiba Virus in Paraguay. Viruses 2023; 15:1798. [PMID: 37766205 PMCID: PMC10537311 DOI: 10.3390/v15091798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Several hantaviruses result in zoonotic infections of significant public health concern, causing hemorrhagic fever with renal syndrome (HFRS) or hantavirus cardiopulmonary syndrome (HCPS) in the Old and New World, respectively. Given a 35% case fatality rate, disease-causing New World hantaviruses require a greater understanding of their biology, genetic diversity, and geographical distribution. Juquitiba hantaviruses have been identified in Oligoryzomys nigripes in Brazil, Paraguay, and Uruguay. Brazil has reported the most HCPS cases associated with this virus. We used a multiplexed, amplicon-based PCR strategy to screen and deep-sequence the virus harbored within lung tissues collected from Oligoryzomys species during rodent field collections in southern (Itapúa) and western (Boquerón) Paraguay. No Juquitiba-like hantaviruses were identified in Boquerón. Herein, we report the full-length S and M segments of the Juquitiba hantaviruses identified in Paraguay from O. nigripes. We also report the phylogenetic relationships of the Juquitiba hantaviruses in rodents collected from Itapúa with those previously collected in Canindeyú. We showed, using the TN93 nucleotide substitution model, the coalescent (constant-size) population tree model, and Bayesian inference implemented in the Bayesian evolutionary analysis by sampling trees (BEAST) framework, that the Juquitiba virus lineage in Itapúa is distinct from that in Canindeyú. Our spatiotemporal analysis showed significantly different time to the most recent ancestor (TMRA) estimates between the M and S segments, but a common geographic origin. Our estimates suggest the additional geographic diversity of the Juquitiba virus within the Interior Atlantic Forest and highlight the need for more extensive sampling across this biome.
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Affiliation(s)
- Evans Ifebuche Nnamani
- Department of Microbiology, Immunology, and Biochemistry, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (E.I.N.); (B.S.-H.); (E.P.W.); (M.K.T.)
| | - Briana Spruill-Harrell
- Department of Microbiology, Immunology, and Biochemistry, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (E.I.N.); (B.S.-H.); (E.P.W.); (M.K.T.)
| | - Evan Peter Williams
- Department of Microbiology, Immunology, and Biochemistry, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (E.I.N.); (B.S.-H.); (E.P.W.); (M.K.T.)
| | - Mariah K. Taylor
- Department of Microbiology, Immunology, and Biochemistry, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (E.I.N.); (B.S.-H.); (E.P.W.); (M.K.T.)
| | - Robert D. Owen
- Centro Para El Desarrollo de Investigación Científica, Asunción C.P. 1255, Paraguay;
| | - Colleen B. Jonsson
- Department of Microbiology, Immunology, and Biochemistry, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (E.I.N.); (B.S.-H.); (E.P.W.); (M.K.T.)
- Regional Biocontainment Laboratory, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Institute for the Study of Host-Pathogen Systems, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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7
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Armién B, Muñoz C, Cedeño H, Salazar JR, Salinas TP, González P, Trujillo J, Sánchez D, Mariñas J, Hernández A, Cruz H, Villarreal LY, Grimaldo E, González S, Nuñez H, Hesse S, Rivera F, Edwards G, Chong R, Mendoza O, Meza M, Herrera M, Kant R, Esquivel R, Estripeaut D, Serracín D, Denis B, Robles E, Mendoza Y, Gonzalez G, Tulloch F, Pascale JM, Dunnum JL, Cook JA, Armién AG, Gracia F, Guerrero GA, de Mosca I. Hantavirus in Panama: Twenty Years of Epidemiological Surveillance Experience. Viruses 2023; 15:1395. [PMID: 37376694 DOI: 10.3390/v15061395] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Twenty years have passed since the emergence of hantavirus zoonosis in Panama at the beginning of this millennium. We provide an overview of epidemiological surveillance of hantavirus disease (hantavirus pulmonary syndrome and hantavirus fever) during the period 1999-2019 by including all reported and confirmed cases according to the case definition established by the health authority. Our findings reveal that hantavirus disease is a low-frequency disease, affecting primarily young people, with a relatively low case-fatality rate compared to other hantaviruses in the Americas (e.g., ANDV and SNV). It presents an annual variation with peaks every 4-5 years and an interannual variation influenced by agricultural activities. Hantavirus disease is endemic in about 27% of Panama, which corresponds to agroecological conditions that favor the population dynamics of the rodent host, Oligoryzomys costaricensis and the virus (Choclo orthohantavirus) responsible for hantavirus disease. However, this does not rule out the existence of other endemic areas to be characterized. Undoubtedly, decentralization of the laboratory test and dissemination of evidence-based surveillance guidelines and regulations have standardized and improved diagnosis, notification at the level of the primary care system, and management in intensive care units nationwide.
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Affiliation(s)
- Blas Armién
- Department of Research in Emerging and Zoonotic Infectious Diseases, Gorgas Memorial Institute of Health Studies, Panama City 0816-02593, Panama
- Sistema Nacional de Investigación (SNI), Secretaria Nacional de Ciencia y Tecnología (SENACYT), Panama City 0816-02852, Panama
| | - Carlos Muñoz
- Department of Epidemiology, Health Region of Los Santos, Ministry of Health, Las Tablas, Los Santos 0816-06812, Panama
| | - Hector Cedeño
- National Department of Epidemiology, Ministry of Health, Panama City 0816-06812, Panama
| | - Jacqueline R Salazar
- Department of Research in Emerging and Zoonotic Infectious Diseases, Gorgas Memorial Institute of Health Studies, Panama City 0816-02593, Panama
| | - Tybbyssay P Salinas
- Department of Research in Emerging and Zoonotic Infectious Diseases, Gorgas Memorial Institute of Health Studies, Panama City 0816-02593, Panama
| | - Publio González
- Department of Research in Emerging and Zoonotic Infectious Diseases, Gorgas Memorial Institute of Health Studies, Panama City 0816-02593, Panama
| | - José Trujillo
- Hospital Gustavo Nelson Collado, Caja de Seguro Social, Chitre, Herrera 0816-06808, Panama
| | - Deyanira Sánchez
- Hospital Rural de Tonosí, Ministerio de Salud, Tonosi, Los Santos 0816-06812, Panama
| | - Jamileth Mariñas
- Hospital Rural de Tonosí, Ministerio de Salud, Tonosi, Los Santos 0816-06812, Panama
| | - Ayvar Hernández
- Hospital Rural de Tonosí, Ministerio de Salud, Tonosi, Los Santos 0816-06812, Panama
| | - Harmodio Cruz
- Hospital Rural de Tonosí, Ministerio de Salud, Tonosi, Los Santos 0816-06812, Panama
| | | | - Elba Grimaldo
- Hospital Joaquín Pablo Franco Sayas, Ministry of Health, Las Tablas, Los Santos 0816-06812, Panama
| | - Samuel González
- Hospital Gustavo Nelson Collado, Caja de Seguro Social, Chitre, Herrera 0816-06808, Panama
| | - Heydy Nuñez
- Hospital Ezequiel Abadía, Caja de Seguro Social, Soná, Veraguas 0816-06808, Panama
- Department of Epidemiology, Caja de Seguro Social, Santiago, Veraguas 0816-06808, Panama
| | - Susana Hesse
- Hospital Dr. Luis Chicho Fábrega, Ministry of Health, Santiago, Veraguas 0816-06812, Panama
| | - Fernando Rivera
- Hospital Dr. Luis Chicho Fábrega, Ministry of Health, Santiago, Veraguas 0816-06812, Panama
| | - George Edwards
- Hospital Dr. Luis Chicho Fábrega, Ministry of Health, Santiago, Veraguas 0816-06812, Panama
| | - Ricardo Chong
- Department of Epidemiology, Health Region of Veraguas, Ministry of Health, Santiago, Veraguas 0816-06812, Panama
| | - Ovidio Mendoza
- Department of Epidemiology, Health Region of Veraguas, Ministry of Health, Santiago, Veraguas 0816-06812, Panama
| | - Martín Meza
- Department of Epidemiology, Health Region of Herrera, Ministry of Health, Chitre, Herrera 0816-06812, Panama
| | - Milagro Herrera
- Hospital Regional Rafael Estevez, Caja de Seguro Social, Aguadulce, Coclé 0816-06808, Panama
| | - Rudick Kant
- Department of Epidemiology of the Caja de Seguro Social, Panama City 0816-06808, Panama
| | - Raul Esquivel
- Hospital del Niño José Renal Esquivel, Panama City 0816-00383, Panama
| | - Dora Estripeaut
- Sistema Nacional de Investigación (SNI), Secretaria Nacional de Ciencia y Tecnología (SENACYT), Panama City 0816-02852, Panama
- Hospital del Niño José Renal Esquivel, Panama City 0816-00383, Panama
| | - Demetrio Serracín
- Department of Research in Emerging and Zoonotic Infectious Diseases, Gorgas Memorial Institute of Health Studies, Panama City 0816-02593, Panama
| | - Bernardino Denis
- Department of Research in Emerging and Zoonotic Infectious Diseases, Gorgas Memorial Institute of Health Studies, Panama City 0816-02593, Panama
| | - Esthefani Robles
- Department of Research in Emerging and Zoonotic Infectious Diseases, Gorgas Memorial Institute of Health Studies, Panama City 0816-02593, Panama
| | - Yaxelis Mendoza
- Sistema Nacional de Investigación (SNI), Secretaria Nacional de Ciencia y Tecnología (SENACYT), Panama City 0816-02852, Panama
- Department of Genomics and Proteomics, Gorgas Memorial Institute of Health Studies, Panama City 0816-02593, Panama
| | - Gloria Gonzalez
- Department of Genomics and Proteomics, Gorgas Memorial Institute of Health Studies, Panama City 0816-02593, Panama
| | | | - Juan Miguel Pascale
- Department of Genomics and Proteomics, Gorgas Memorial Institute of Health Studies, Panama City 0816-02593, Panama
| | - Jonathan L Dunnum
- Department of Biology and Museum of Southwestern Biology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Joseph A Cook
- Department of Biology and Museum of Southwestern Biology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Anibal G Armién
- California Animal Health & Food Safety Laboratory System (CAHFS), School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | | | | | - Itza de Mosca
- National Department of Epidemiology, Ministry of Health, Panama City 0816-06812, Panama
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8
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Dospital C, Arancibia-Avila P, Araneda-Flores J. Epidemiological profile of Hantavirus in the Ñuble region period 2002-2018, Chile. BRAZ J BIOL 2023; 84:e269097. [PMID: 37222376 DOI: 10.1590/1519-6984.269097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/21/2023] [Indexed: 05/25/2023] Open
Abstract
Hantavirus infection is an endemic zoonosis in Chile, with an average lethality of around 36%. The highest lethality (60%) was recorded in 1997. Prevention strategies have been applied since then. Early diagnosis and technologies, such as the use of ECMO (Extracorporeal Membrane Oxygenation) and Hantavirus immune plasma, have contributed to increasing the survival of people due to this disease at the national level. In the newly created Region of Ñuble in Chile, the incidence and lethality of Hantavirus cases are unknown; therefore, the objective of this research is to describe the epidemiological profile of Hantavirus cases in the Region of Ñuble, Chile from 2002 to 2018. This knowledge contributes to substantiating and justifies the need to invest in technology and reinforce interventions related to the early diagnosis and prevention of this disease in the region. Cases reported in the Ñuble region during the period 2002-2018, extracted from the Epidemiological Survey of Environmental Research of Hantavirus cases of the Ministry of Health of Chile, were analyzed retrospectively. The epidemiological profile of the Ñuble region is very similar to the national one in terms of characterizing the individual suffering from the disease. The most affected population is young men, residents in rural areas, and mainly from a low socioeconomic segment. The regional profile of Hantavirus cases makes it possible to identify three communes with the highest number of cases: El Carmen, Coihueco, and San Carlos. A political-administrative response is expected to focus on and optimize strategies and resources to reduce the incidence and lethality of this pathology in the Ñuble region.
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Affiliation(s)
- C Dospital
- Ministerio de Salud, Secretaria Regional Ministerial - SEREMI, Chillán, Diguillín Chile
- Universidad del Bío-Bío, Facultad de Ciencias de la Salud, Chillán, Chile
| | - P Arancibia-Avila
- Universidad del Bío-Bío, Facultad de Ciencias, Departamento de Ciencias Básicas, Chillán, Chile
| | - J Araneda-Flores
- Universidad del Bío-Bío, Facultad de Ciencias de la Salud, Departamento de Nutrición y Salud Pública, Programa Magister Salud Pública, Chillán, Chile
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9
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Omoga DCA, Tchouassi DP, Venter M, Ogola EO, Rotich G, Muthoni JN, Ondifu DO, Torto B, Junglen S, Sang R. Divergent Hantavirus in Somali Shrews ( Crocidura somalica) in the Semi-Arid North Rift, Kenya. Pathogens 2023; 12:pathogens12050685. [PMID: 37242355 DOI: 10.3390/pathogens12050685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/21/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Hantaviruses are zoonotic rodent-borne viruses that are known to infect humans and cause various symptoms of disease, including hemorrhagic fever with renal and cardiopulmonary syndromes. They have a segmented single-stranded, enveloped, negative-sense RNA genome and are widely distributed. This study aimed to investigate the circulation of rodent-borne hantaviruses in peridomestic rodents and shrews in two semi-arid ecologies within the Kenyan Rift Valley. The small mammals were trapped using baited folding Sherman traps set within and around houses, then they were sedated and euthanatized through cervical dislocation before collecting blood and tissue samples (liver, kidney, spleen, and lungs). Tissue samples were screened with pan-hantavirus PCR primers, targeting the large genome segment (L) encoding the RNA-dependent RNA polymerase (RdRp). Eleven of the small mammals captured were shrews (11/489, 2.5%) and 478 (97.5%) were rodents. A cytochrome b gene-based genetic assay for shrew identification confirmed the eleven shrews sampled to be Crocidura somalica. Hantavirus RNA was detected in three (3/11, 27%) shrews from Baringo County. The sequences showed 93-97% nucleotide and 96-99% amino acid identities among each other, as well as 74-76% nucleotide and 79-83% amino acid identities to other shrew-borne hantaviruses, such as Tanganya virus (TNGV). The detected viruses formed a monophyletic clade with shrew-borne hantaviruses from other parts of Africa. To our knowledge, this constitutes the first report published on the circulation of hantaviruses in shrews in Kenya.
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Affiliation(s)
- Dorcus C A Omoga
- International Centre of Insect Physiology and Ecology, Nairobi P.O. Box 30772-00100, Kenya
- Zoonotic arbo and Respiratory Virus Research Program, Centre for Viral Zoonoses, Department of Medical Virology, Faculty of Health, University of Pretoria, Gezina 0031, South Africa
| | - David P Tchouassi
- International Centre of Insect Physiology and Ecology, Nairobi P.O. Box 30772-00100, Kenya
| | - Marietjie Venter
- Zoonotic arbo and Respiratory Virus Research Program, Centre for Viral Zoonoses, Department of Medical Virology, Faculty of Health, University of Pretoria, Gezina 0031, South Africa
| | - Edwin O Ogola
- International Centre of Insect Physiology and Ecology, Nairobi P.O. Box 30772-00100, Kenya
| | - Gilbert Rotich
- International Centre of Insect Physiology and Ecology, Nairobi P.O. Box 30772-00100, Kenya
| | - Joseph N Muthoni
- International Centre of Insect Physiology and Ecology, Nairobi P.O. Box 30772-00100, Kenya
| | - Dickens O Ondifu
- International Centre of Insect Physiology and Ecology, Nairobi P.O. Box 30772-00100, Kenya
| | - Baldwyn Torto
- International Centre of Insect Physiology and Ecology, Nairobi P.O. Box 30772-00100, Kenya
| | - Sandra Junglen
- Institute of Virology, Charité Universitätsmedizin Berlin, Corporate Member of Free University Berlin, Humboldt-University Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Rosemary Sang
- International Centre of Insect Physiology and Ecology, Nairobi P.O. Box 30772-00100, Kenya
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10
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Vadell MV, Fischer CG, Codesido M, Carbajo A, Bilenca D, Gómez Villafañe IE. Modelling relative abundance of Oligoryzomys flavescens, an Orthohantavirus reservoir, in an endemic hantavirus pulmonary syndrome zone. Zoonoses Public Health 2023; 70:13-21. [PMID: 36031760 DOI: 10.1111/zph.12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 01/07/2023]
Abstract
Hantavirus pulmonary syndrome (HPS) is a zoonotic emerging infectious disease caused by New World orthohantaviruses (family Hantaviridae) hosted by rodents of the family Cricetidae. In Argentina, one of its main hosts is the sigmodontine rodent Oligoryzomys flavescens, a widely distributed mouse of the Pampas, Delta and Espinal ecoregions of central-east Argentina. Because the abundance of the reservoir and its proportion in the rodent community affects both virus prevalence and human exposure risk, its estimation throughout its known geographical distribution is of key importance for the design of public health strategies to prevent HPS. The aim of this study was therefore to model the relative abundance of O. flavescens in most of the Pampas ecoregion within Buenos Aires Province, Argentina, where hantavirus pulmonary syndrome is endemic. To do this we used owl-pellet samples collected between 2006 and 2008 from 51 sites distributed throughout most of Buenos Aires province. Mammalian prey in each pellet was identified to the lowest possible taxonomic level by examination of the skulls, dentaries and molars. We modelled the frequency of O. flavescens found in each sample as a function of climatic, environmental, and topographic data of each site. The two best models were applied to a Geo referential Information System to build maps of estimated frequency (as a proxy of relative abundance) within Buenos Aires province. Estimated relative abundance of O. flavescens in Buenos Aires province was significantly associated with annual mean temperature, annual precipitation and presence of freshwater bodies, and varied among sub-regions, with the Inland and Rolling Pampas being the regions with highest frequencies. Knowing in which areas O. flavescens abundance is expected to be higher can be used to concentrate limited sanitary efforts in those areas that are most needed in order to reduce transmission and increase detection.
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Affiliation(s)
- María Victoria Vadell
- Instituto Nacional de Medicina Tropical (INMeT) - ANLIS "Dr. Carlos G Malbrán", Puerto Iguazú, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Carlos González Fischer
- Facultad de Ciencias Exactas y Naturales, Instituto de Ecología, Genética y Evolución de Buenos Aires (CONICET-UBA), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Mariano Codesido
- Facultad de Ciencias Exactas y Naturales, Instituto de Ecología, Genética y Evolución de Buenos Aires (CONICET-UBA), Universidad de Buenos Aires, Buenos Aires, Argentina
- Departamento de Biodiversidad y Biología Experimental, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Aníbal Carbajo
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Instituto de Investigación e Ingeniería Ambiental, Universidad Nacional de San Martín, Buenos Aires, Argentina
| | - David Bilenca
- Facultad de Ciencias Exactas y Naturales, Instituto de Ecología, Genética y Evolución de Buenos Aires (CONICET-UBA), Universidad de Buenos Aires, Buenos Aires, Argentina
- Departamento de Biodiversidad y Biología Experimental, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Isabel E Gómez Villafañe
- Facultad de Ciencias Exactas y Naturales, Instituto de Ecología, Genética y Evolución de Buenos Aires (CONICET-UBA), Universidad de Buenos Aires, Buenos Aires, Argentina
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11
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Contreras F, Andreo V, Hechem V, Polop J, Provensal MC. Colilargo’s occupancy and the role of native and exotic plants in hantavirus expansion and transmission risk. MAMMAL RES 2023. [DOI: 10.1007/s13364-023-00671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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12
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Trends and focuses of hantavirus researches: a global bibliometric analysis and visualization from 1980 to 2020. Arch Public Health 2022; 80:218. [PMID: 36182906 PMCID: PMC9526533 DOI: 10.1186/s13690-022-00973-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Abstract
Background There have been worldwide changes in the researches on hantaviruses in the past several decades. Nevertheless, there are few bibliometric analysis studies this field. We aim to evaluate and visualize the research focuses and trends of this field using a bibliometric analysis way to help understand the developmet and future hotspots of this field. Material and methods Publications related to hantavirus studies were culled from the Web of Science Core Collection to generate trend analysis. The articles and reviews were re-extracted and Countries, institutions, authors, references and keywords in this field were visually analyzed by using VOSviewer and CiteSpace. Results A total of 4408 studies were included and the number of publications regarding hantaviruses significantly increased yearly. Three thousand seven hundred sixteen research articles and reviews were retrieved to generate bibliometric analysis. These studies mainly come from 125 countries led by USA and China and 3312 institutions led by the University of Helsinki. Twelve thousand five hundred twenty nine authors were identified and Vaheri A were the most influential author. Journal of Virology was the journal with the most studies and citations. After analysis, Hemorrhagic fever with renal syndrome, Hantavirus cardiopulmonary syndrome, nephropathia epidemica and related genotypes, clinical symptoms and rodents were the most common keywords and developing areas. Conclusion Research on hantavirus is flourishing. Cooperation among different countries and institutions in this field must be strengthened in the future. The ecology and clinical symptoms of new genotypes, the vaccine development and factors that affect host population distribution and density are current and developing areas of study.
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13
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Koehler FC, Di Cristanziano V, Späth MR, Hoyer-Allo KJR, Wanken M, Müller RU, Burst V. OUP accepted manuscript. Clin Kidney J 2022; 15:1231-1252. [PMID: 35756741 PMCID: PMC9217627 DOI: 10.1093/ckj/sfac008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Indexed: 01/18/2023] Open
Abstract
Hantavirus-induced diseases are emerging zoonoses with endemic appearances and frequent outbreaks in different parts of the world. In humans, hantaviral pathology is characterized by the disruption of the endothelial cell barrier followed by increased capillary permeability, thrombocytopenia due to platelet activation/depletion and an overactive immune response. Genetic vulnerability due to certain human leukocyte antigen haplotypes is associated with disease severity. Typically, two different hantavirus-caused clinical syndromes have been reported: hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). The primarily affected vascular beds differ in these two entities: renal medullary capillaries in HFRS caused by Old World hantaviruses and pulmonary capillaries in HCPS caused by New World hantaviruses. Disease severity in HFRS ranges from mild, e.g. Puumala virus-associated nephropathia epidemica, to moderate, e.g. Hantaan or Dobrava virus infections. HCPS leads to a severe acute respiratory distress syndrome with high mortality rates. Due to novel insights into organ tropism, hantavirus-associated pathophysiology and overlapping clinical features, HFRS and HCPS are believed to be interconnected syndromes frequently involving the kidneys. As there are no specific antiviral treatments or vaccines approved in Europe or the USA, only preventive measures and public awareness may minimize the risk of hantavirus infection. Treatment remains primarily supportive and, depending on disease severity, more invasive measures (e.g., renal replacement therapy, mechanical ventilation and extracorporeal membrane oxygenation) are needed.
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Affiliation(s)
- Felix C Koehler
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Veronica Di Cristanziano
- Institute of Virology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Martin R Späth
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - K Johanna R Hoyer-Allo
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Manuel Wanken
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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14
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Delayed viral clearance despite high number of activated T cells during the acute phase in Argentinean patients with hantavirus pulmonary syndrome. EBioMedicine 2022; 75:103765. [PMID: 34986457 PMCID: PMC8743200 DOI: 10.1016/j.ebiom.2021.103765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/08/2021] [Accepted: 12/03/2021] [Indexed: 01/16/2023] Open
Abstract
Background The hallmarks of HPS are increase of vascular permeability and endothelial dysfunction. Although an exacerbated immune response is thought to be implicated in pathogenesis, clear evidence is still elusive. As orthohantaviruses are not cytopathic CD8+ T cells are believed to be the central players involved in pathogenesis. Methods Serum and blood samples from Argentinean HPS patients were collected from 2014 to 2019. Routine white blood cell analyses, quantification and characterization of T-cell phenotypic profile, viral load, neutralizing antibody response and quantification of inflammatory mediators were performed. Findings High numbers of activated CD4+ and CD8+ T cells were found in all HPS cases independently of disease severity. We found increased levels of some proinflammatory mediators during the acute phase of illness. Nonetheless, viral RNA remained high, showing a delay in clearance from blood up to late convalescence, when titers of neutralizing antibodies reached a high level. Interpretation The high activated phenotypic profile of T cells seems to be unable to resolve infection during the acute and early convalescent phases, and it was not associated with the severity of the disease. Thus, at least part of the activated T cells could be induced by the dysregulated inflammatory response in an unspecific manner. Viral clearance seems to have been more related to high titers of neutralizing antibodies than to the T-cell response. Funding This work was supported mainly by the Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) “Dr. Carlos Malbrán”. Further details of fundings sources is included in the appendix.
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15
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Douglas KO, Payne K, Sabino-Santos G, Agard J. Influence of Climatic Factors on Human Hantavirus Infections in Latin America and the Caribbean: A Systematic Review. Pathogens 2021; 11:pathogens11010015. [PMID: 35055965 PMCID: PMC8778283 DOI: 10.3390/pathogens11010015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND With the current climate change crisis and its influence on infectious disease transmission there is an increased desire to understand its impact on infectious diseases globally. Hantaviruses are found worldwide, causing infectious diseases such as haemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS)/hantavirus pulmonary syndrome (HPS) in tropical regions such as Latin America and the Caribbean (LAC). These regions are inherently vulnerable to climate change impacts, infectious disease outbreaks and natural disasters. Hantaviruses are zoonotic viruses present in multiple rodent hosts resident in Neotropical ecosystems within LAC and are involved in hantavirus transmission. METHODS We conducted a systematic review to assess the association of climatic factors with human hantavirus infections in the LAC region. Literature searches were conducted on MEDLINE and Web of Science databases for published studies according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) criteria. The inclusion criteria included at least eight human hantavirus cases, at least one climatic factor and study from > 1 LAC geographical location. RESULTS In total, 383 papers were identified within the search criteria, but 13 studies met the inclusion criteria ranging from Brazil, Chile, Argentina, Bolivia and Panama in Latin America and a single study from Barbados in the Caribbean. Multiple mathematical models were utilized in the selected studies with varying power to generate robust risk and case estimates of human hantavirus infections linked to climatic factors. Strong evidence of hantavirus disease association with precipitation and habitat type factors were observed, but mixed evidence was observed for temperature and humidity. CONCLUSIONS The interaction of climate and hantavirus diseases in LAC is likely complex due to the unknown identity of all vertebrate host reservoirs, circulation of multiple hantavirus strains, agricultural practices, climatic changes and challenged public health systems. There is an increasing need for more detailed systematic research on the influence of climate and other co-related social, abiotic, and biotic factors on infectious diseases in LAC to understand the complexity of vector-borne disease transmission in the Neotropics.
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Affiliation(s)
- Kirk Osmond Douglas
- Centre for Biosecurity Studies, Cave Hill Campus, The University of the West Indies, Cave Hill, St. Michael BB11000, Barbados
- Correspondence:
| | - Karl Payne
- Centre for Resource Management and Environmental Studies, Cave Hill Campus, The University of the West Indies, Cave Hill, St. Michael BB11000, Barbados;
| | - Gilberto Sabino-Santos
- School of Public Health and Tropical Medicine, Tulane University, 1324 Tulane Ave Suite 517, New Orleans, LA 70112, USA;
- Centre for Virology Research, Ribeirao Preto Medical School, University of Sao Paulo, 3900 Av. Bandeirantes, Ribeirao Preto 14049-900, SP, Brazil
| | - John Agard
- Department of Life Sciences, The University of the West Indies, St. Augustine 999183, Trinidad and Tobago;
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16
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Riquelme R. Hantavirus. Semin Respir Crit Care Med 2021; 42:822-827. [PMID: 34918323 DOI: 10.1055/s-0041-1733803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hantaviruses are tri-segmented lipid-enveloped RNA viruses belonging to the Bunyaviridae family. Human infection corresponds to a zoonosis associated with two different clinical syndromes: hemorrhagic fever with renal syndrome that occurs in Asia and Europe and hantavirus cardiopulmonary syndrome (HCPS) that occurs in the North America, Central America and South America. The major pathogenic mechanisms in HCPS include (1) direct microvascular endothelial injury leading to increased capillary permeability and the development of noncardiogenic pulmonary edema and acute respiratory distress syndrome, and (2) exaggerated host immune response leading to secondary organ damage. The incubation period for this disease is quite long (6-39 days, median: 18 days); however, rapid progression to respiratory failure and shock can occur highlighting the importance of high index of clinical suspicion. Management revolves around high-quality supportive care. Various management and preventative strategies are currently being explored and warrant further examination to improve the overall outlook following infection with hantavirus.
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Affiliation(s)
- Raúl Riquelme
- Puerto Montt Hospital, San Sebastian University, Puerto Montt, Chile
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17
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Koehler FC, Blomberg L, Brehm TT, Büttner S, Cornely OA, Degen O, Di Cristanziano V, Dolff S, Eberwein L, Hoxha E, Hoyer-Allo KJR, Rudolf S, Späth MR, Wanken M, Müller RU, Burst V. Development and design of the Hantavirus registry - HantaReg - for epidemiological studies, outbreaks and clinical studies on hantavirus disease. Clin Kidney J 2021; 14:2365-2370. [PMID: 34754431 PMCID: PMC8573013 DOI: 10.1093/ckj/sfab053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background Frequent outbreaks around the globe and endemic appearance in different parts of the world emphasize the substantial risk of hantavirus diseases. Increasing incidence rates, trends of changing distribution of hantavirus species and new insights into clinical courses of hantavirus diseases call for multinational surveillance. Furthermore, evidence-based guidelines for the management of hantavirus diseases and scoring systems, which allow stratification of patients into risk categories, are lacking. Methods Hantavirus registry (HantaReg) is a novel registry platform facilitating multinational research of hantavirus-caused diseases, such as haemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). HantaReg provides an electronic case report form and uses the General Data Protection Regulation compliant platform clinicalsurveys.net, which can be accessed from any internet browser in the world. Having a modular structure, the registry platform is designed to display or hide questions and items according to the documented case (e.g. patient with HFRS versus HCPS) to facilitate fast, but standardized, data entry. Information categories documented in HantaReg are demographics, pre-existing diseases, clinical presentation, diagnostic and therapeutic approaches, as well as outcome. Conclusions HantaReg is a novel, ready-to-use platform for clinical and epidemiological studies on hantavirus diseases and facilitates the documentation of the disease course associated with hantavirus infections. HantaReg is expected to promote international collaboration and contributes to improving patient care through the analysis of diagnostic and treatment pathways for hantavirus diseases, providing evidence for robust treatment recommendations. Moreover, HantaReg enables the development of prognosis-indicating scoring systems for patients with hantavirus disease.
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Affiliation(s)
- Felix C Koehler
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Linda Blomberg
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thomas Theo Brehm
- I. Department of Internal Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Büttner
- Department I of Internal Medicine, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Olaf Degen
- I. Department of Internal Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Veronica Di Cristanziano
- Institute of Virology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, University Hospital Essen, Essen, Germany
| | - Lukas Eberwein
- 4th Department of Internal Medicine, Klinikum Leverkusen gGmbH, Leverkusen, Germany
| | - Elion Hoxha
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Johanna R Hoyer-Allo
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sarah Rudolf
- Department of Nephrology, Medical Clinic III, University Hospital Frankfurt, Frankfurt, Germany
| | - Martin R Späth
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Manuel Wanken
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Volker Burst
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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18
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Novel infection of pericytes by Andes virus enhances endothelial cell permeability. Virus Res 2021; 306:198584. [PMID: 34624404 DOI: 10.1016/j.virusres.2021.198584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/07/2021] [Accepted: 09/26/2021] [Indexed: 11/22/2022]
Abstract
Andes Virus (ANDV) non-lytically infects pulmonary microvascular endothelial cells (PMECs) causing a severe capillary leak syndrome termed Hantavirus Pulmonary Syndrome (HPS). Basolaterally, PMECs are in contact with pericytes which play critical roles in regulating PMEC permeability and immune cell recruitment. We discovered that ANDV persistently infects primary human vascular pericytes for up to 9 days, and that PMEC monolayer permeability was increased by supernatants from ANDV-infected pericytes. Pericyte-directed PMEC permeability was consistent with the high-level secretion of the permeability factor VEGF (vascular endothelial growth factor) elicited by ANDV-infected pericytes. These findings suggest that ANDV infection of pericytes augments PMEC permeability and reveal a novel mechanism of pericyte-directed vascular barrier dysfunction that contributes to HPS and provides new therapeutic targets.
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19
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Spruill-Harrell B, Pérez-Umphrey A, Valdivieso-Torres L, Cao X, Owen RD, Jonsson CB. Impact of Predator Exclusion and Habitat on Seroprevalence of New World Orthohantavirus Harbored by Two Sympatric Rodents within the Interior Atlantic Forest. Viruses 2021; 13:1963. [PMID: 34696393 PMCID: PMC8538774 DOI: 10.3390/v13101963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/19/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022] Open
Abstract
Understanding how perturbations to trophic interactions influence virus-host dynamics is essential in the face of ongoing biodiversity loss and the continued emergence of RNA viruses and their associated zoonoses. Herein, we investigated the role of predator exclusion on rodent communities and the seroprevalence of hantaviruses within the Reserva Natural del Bosque Mbaracayú (RNBM), which is a protected area of the Interior Atlantic Forest (IAF). In the IAF, two sympatric rodent reservoirs, Akodon montensis and Oligoryzomys nigripes, harbor Jaborá and Juquitiba hantavirus (JABV, JUQV), respectively. In this study, we employed two complementary methods for predator exclusion: comprehensive fencing and trapping/removal. The goal of exclusion was to preclude the influence of predation on small mammals on the sampling grids and thereby potentially reduce rodent mortality. Following baseline sampling on three grid pairs with different habitats, we closed the grids and began predator removal. By sampling three habitat types, we controlled for habitat-specific effects, which is important for hantavirus-reservoir dynamics in neotropical ecosystems. Our six-month predator exclusion experiment revealed that the exclusion of terrestrial mammalian predators had little influence on the rodent community or the population dynamics of A. montensis and O. nigripes. Instead, fluctuations in species diversity and species abundances were influenced by sampling session and forest degradation. These results suggest that seasonality and landscape composition play dominant roles in the prevalence of hantaviruses in rodent reservoirs in the IAF ecosystem.
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Affiliation(s)
- Briana Spruill-Harrell
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Anna Pérez-Umphrey
- School of Renewable Natural Resources, Louisiana State University and AgCenter, 227 RNR Building, Baton Rouge, LA 70803, USA;
| | | | - Xueyuan Cao
- Department of Nursing-Acute/Tert Care, University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Robert D. Owen
- Centro para el Desarrollo de la Investigación Científica, Asunción C.P. 1371, Paraguay;
- Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Colleen B. Jonsson
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN 38163, USA;
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20
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Williamson BN, Prescott J, Garrido JL, Alvarez RA, Feldmann H, Barría MI. Therapeutic Efficacy of Human Monoclonal Antibodies against Andes Virus Infection in Syrian Hamsters. Emerg Infect Dis 2021; 27:2707-2710. [PMID: 34545791 PMCID: PMC8462347 DOI: 10.3201/eid2710.210735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Andes virus, an orthohantavirus endemic to South America, causes severe hantavirus cardiopulmonary syndrome associated with human-to-human transmission. No approved treatments or vaccines against this virus are available. We show that a combined treatment with 2 monoclonal antibodies protected Syrian hamsters when administered at midstage or late-stage disease.
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21
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Vera-Otarola J, Castillo-Vargas E, Angulo J, Barriga FM, Batlle E, Lopez-Lastra M. The viral nucleocapsid protein and the human RNA-binding protein Mex3A promote translation of the Andes orthohantavirus small mRNA. PLoS Pathog 2021; 17:e1009931. [PMID: 34547046 PMCID: PMC8454973 DOI: 10.1371/journal.ppat.1009931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
The capped Small segment mRNA (SmRNA) of the Andes orthohantavirus (ANDV) lacks a poly(A) tail. In this study, we characterize the mechanism driving ANDV-SmRNA translation. Results show that the ANDV-nucleocapsid protein (ANDV-N) promotes in vitro translation from capped mRNAs without replacing eukaryotic initiation factor (eIF) 4G. Using an RNA affinity chromatography approach followed by mass spectrometry, we identify the human RNA chaperone Mex3A (hMex3A) as a SmRNA-3’UTR binding protein. Results show that hMex3A enhances SmRNA translation in a 3’UTR dependent manner, either alone or when co-expressed with the ANDV-N. The ANDV-N and hMex3A proteins do not interact in cells, but both proteins interact with eIF4G. The hMex3A–eIF4G interaction showed to be independent of ANDV-infection or ANDV-N expression. Together, our observations suggest that translation of the ANDV SmRNA is enhanced by a 5’-3’ end interaction, mediated by both viral and cellular proteins. Andes orthohantavirus (ANDV) is endemic in Argentina and Chile and is the primary etiological agent of hantavirus cardiopulmonary syndrome (HCPS) in South America. ANDV is unique among other members of the Hantaviridae family of viruses because of its ability to spread from person to person. The molecular mechanisms driving ANDV protein synthesis remain poorly understood. A previous report showed that translation of the Small segment mRNA (SmRNA) of ANDV relied on both the 5’cap and the 3’untranslated region (UTR) of the SmRNA. In this new study, we further characterize the mechanism by which the 5’ and 3’end of the SmRNA interact to assure viral protein synthesis. We establish that the viral nucleocapsid protein N and the cellular protein hMex3A participate in the process. These observations indicated that both viral and cellular proteins regulate viral gene expression during ANDV infection by enabling the viral mRNA to establish a non-covalent 5’-3’end interaction.
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Affiliation(s)
- Jorge Vera-Otarola
- Laboratorio de Virología Molecular, Instituto Milenio de Inmunología e Inmunoterapia, Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, Centro de Investigaciones Médicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Unidad de Virología Aplicada, Dirección de Investigación y Doctorados de la Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Estefania Castillo-Vargas
- Laboratorio de Virología Molecular, Instituto Milenio de Inmunología e Inmunoterapia, Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, Centro de Investigaciones Médicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Facultad de Odontología, Universidad Finis Terrae, Santiago, Chile
| | - Jenniffer Angulo
- Laboratorio de Virología Molecular, Instituto Milenio de Inmunología e Inmunoterapia, Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, Centro de Investigaciones Médicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco M. Barriga
- Institute for Research in Biomedicine (IRB Barcelona). The Barcelona Institute of Science and Technology. Barcelona, Spain
| | - Eduard Batlle
- Institute for Research in Biomedicine (IRB Barcelona). The Barcelona Institute of Science and Technology. Barcelona, Spain
- ICREA, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Barcelona, Spain
| | - Marcelo Lopez-Lastra
- Laboratorio de Virología Molecular, Instituto Milenio de Inmunología e Inmunoterapia, Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, Centro de Investigaciones Médicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- * E-mail:
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22
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Toledo J, Haby MM, Reveiz L, Sosa Leon L, Angerami R, Aldighieri S. Evidence for human-to-human transmission of hantavirus: a systematic review. J Infect Dis 2021; 226:1362-1371. [PMID: 34515290 PMCID: PMC9574657 DOI: 10.1093/infdis/jiab461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background Hantavirus is known to be transmitted from rodents to humans. However, some reports from Argentina and Chile have claimed that the hantavirus strain Andes virus (ANDV) can cause human-to-human transmission of the disease. The aim of this systematic review was to assess the evidence for human-to-human transmission of hantavirus. Methods We searched PubMed (inception to 28 February 2021), Cochrane Central, Embase, LILACS and SciELO (inception to 3 July 2020), and other sources. We included studies that assessed whether interpersonal contact with a person with laboratory-confirmed hantavirus infection led to human-to-human transmission. Two reviewers conducted screening, selection, data extraction, and risk of bias assessment. Results Twenty-two studies met the inclusion criteria. Meta-analysis was not possible due to heterogeneity. With the exception of 1 prospective cohort study of ANDV in Chile with serious risk of bias, evidence from comparative studies (strongest level of evidence available) does not support human-to-human transmission of hantavirus infection. Noncomparative studies with a critical risk of bias suggest that human-to-human transmission of ANDV may be possible. Conclusions The balance of the evidence does not support the claim of human-to-human transmission of ANDV. Well-designed cohort and case-control studies that control for co-exposure to rodents are needed to inform public health recommendations.
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Affiliation(s)
- Joao Toledo
- Department of Health Emergencies, Pan American Health Organization, Washington, District of Columbia, USA
| | - Michelle M Haby
- Correspondence: Michelle M. Haby, PhD, Departamento de Ciencias Químico Biológicas, Universidad de Sonora, Blvd. Luis Encinas y Rosales S/N, Col. Centro Hermosillo, Sonora 83000, Mexico ()
| | - Ludovic Reveiz
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, Washington, District of Columbia, USA
| | | | - Rodrigo Angerami
- Hospital Epidemiology Section, Hospital of Clinics, State University of Campinas, Campinas, São Paulo, Brazil
| | - Sylvain Aldighieri
- Hospital Epidemiology Section, Hospital of Clinics, State University of Campinas, Campinas, São Paulo, Brazil
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23
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Binding of the Andes Virus Nucleocapsid Protein to RhoGDI Induces the Release and Activation of the Permeability Factor RhoA. J Virol 2021; 95:e0039621. [PMID: 34133221 DOI: 10.1128/jvi.00396-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Andes virus (ANDV) nonlytically infects pulmonary microvascular endothelial cells (PMECs), causing acute pulmonary edema termed hantavirus pulmonary syndrome (HPS). In HPS patients, virtually every PMEC is infected; however, the mechanism by which ANDV induces vascular permeability and edema remains to be resolved. The ANDV nucleocapsid (N) protein activates the GTPase RhoA in primary human PMECs, causing VE-cadherin internalization from adherens junctions and PMEC permeability. We found that ANDV N protein failed to bind RhoA but coprecipitates RhoGDI (Rho GDP dissociation inhibitor), the primary RhoA repressor that normally sequesters RhoA in an inactive state. ANDV N protein selectively binds the RhoGDI C terminus (residues 69 to 204) but fails to form ternary complexes with RhoA or inhibit RhoA binding to the RhoGDI N terminus (residues 1 to 69). However, we found that ANDV N protein uniquely inhibits RhoA binding to an S34D phosphomimetic RhoGDI mutant. Hypoxia and vascular endothelial growth factor (VEGF) increase RhoA-induced PMEC permeability by directing protein kinase Cα (PKCα) phosphorylation of S34 on RhoGDI. Collectively, ANDV N protein alone activates RhoA by sequestering and reducing RhoGDI available to suppress RhoA. In response to hypoxia and VEGF-activated PKCα, ANDV N protein additionally directs the release of RhoA from S34-phosphorylated RhoGDI, synergistically activating RhoA and PMEC permeability. These findings reveal a fundamental edemagenic mechanism that permits ANDV to amplify PMEC permeability in hypoxic HPS patients. Our results rationalize therapeutically targeting PKCα and opposing protein kinase A (PKA) pathways that control RhoGDI phosphorylation as a means of resolving ANDV-induced capillary permeability, edema, and HPS. IMPORTANCE HPS-causing hantaviruses infect pulmonary endothelial cells (ECs), causing vascular leakage, pulmonary edema, and a 35% fatal acute respiratory distress syndrome (ARDS). Hantaviruses do not lyse or disrupt the endothelium but dysregulate normal EC barrier functions and increase hypoxia-directed permeability. Our findings reveal a novel underlying mechanism of EC permeability resulting from ANDV N protein binding to RhoGDI, a regulatory protein that normally maintains edemagenic RhoA in an inactive state and inhibits EC permeability. ANDV N sequesters RhoGDI and enhances the release of RhoA from S34-phosphorylated RhoGDI. These findings indicate that ANDV N induces the release of RhoA from PKC-phosphorylated RhoGDI, synergistically enhancing hypoxia-directed RhoA activation and PMEC permeability. Our data suggest inhibiting PKC and activating PKA phosphorylation of RhoGDI as mechanisms of inhibiting ANDV-directed EC permeability and therapeutically restricting edema in HPS patients. These findings may be broadly applicable to other causes of ARDS.
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24
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Meier K, Thorkelsson SR, Quemin ERJ, Rosenthal M. Hantavirus Replication Cycle-An Updated Structural Virology Perspective. Viruses 2021; 13:1561. [PMID: 34452426 PMCID: PMC8402763 DOI: 10.3390/v13081561] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
Hantaviruses infect a wide range of hosts including insectivores and rodents and can also cause zoonotic infections in humans, which can lead to severe disease with possible fatal outcomes. Hantavirus outbreaks are usually linked to the population dynamics of the host animals and their habitats being in close proximity to humans, which is becoming increasingly important in a globalized world. Currently there is neither an approved vaccine nor a specific and effective antiviral treatment available for use in humans. Hantaviruses belong to the order Bunyavirales with a tri-segmented negative-sense RNA genome. They encode only five viral proteins and replicate and transcribe their genome in the cytoplasm of infected cells. However, many details of the viral amplification cycle are still unknown. In recent years, structural biology methods such as cryo-electron tomography, cryo-electron microscopy, and crystallography have contributed essentially to our understanding of virus entry by membrane fusion as well as genome encapsidation by the nucleoprotein. In this review, we provide an update on the hantavirus replication cycle with a special focus on structural virology aspects.
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Affiliation(s)
- Kristina Meier
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany;
| | - Sigurdur R. Thorkelsson
- Centre for Structural Systems Biology, Leibniz Institute for Experimental Virology, University of Hamburg, 22607 Hamburg, Germany;
| | - Emmanuelle R. J. Quemin
- Centre for Structural Systems Biology, Leibniz Institute for Experimental Virology, University of Hamburg, 22607 Hamburg, Germany;
| | - Maria Rosenthal
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany;
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 22525 Hamburg, Germany
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25
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Common Themes in Zoonotic Spillover and Disease Emergence: Lessons Learned from Bat- and Rodent-Borne RNA Viruses. Viruses 2021; 13:v13081509. [PMID: 34452374 PMCID: PMC8402684 DOI: 10.3390/v13081509] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 12/18/2022] Open
Abstract
Rodents (order Rodentia), followed by bats (order Chiroptera), comprise the largest percentage of living mammals on earth. Thus, it is not surprising that these two orders account for many of the reservoirs of the zoonotic RNA viruses discovered to date. The spillover of these viruses from wildlife to human do not typically result in pandemics but rather geographically confined outbreaks of human infection and disease. While limited geographically, these viruses cause thousands of cases of human disease each year. In this review, we focus on three questions regarding zoonotic viruses that originate in bats and rodents. First, what biological strategies have evolved that allow RNA viruses to reside in bats and rodents? Second, what are the environmental and ecological causes that drive viral spillover? Third, how does virus spillover occur from bats and rodents to humans?
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26
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Lupuşoru G, Lupuşoru M, Ailincăi I, Bernea L, Berechet A, Spătaru R, Ismail G. Hanta hemorrhagic fever with renal syndrome: A pathology in whose diagnosis kidney biopsy plays a major role (Review). Exp Ther Med 2021; 22:984. [PMID: 34345266 PMCID: PMC8311249 DOI: 10.3892/etm.2021.10416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/14/2021] [Indexed: 11/05/2022] Open
Abstract
Hantavirus infection belongs to a group of zoonoses rare in the Balkan Peninsula, causing two major syndromes, depending on the viral serotype involved: Hemorrhagic fever with renal syndrome (HFRS) also known as endemic nephropathy and cardiopulmonary syndrome (CPS). Because there is no specific treatment or vaccine for this condition approved in the USA or Europe, the key to minimizing the risk of adverse progression to chronic kidney disease, secondary hypertension or even death is primarily the recognition and early diagnosis of this condition with prompt therapeutic intervention. The aim of this study was to review the literature data on the epidemiology, pathogenesis and management of this disease and to identify several aspects related to the difficulties encountered in diagnosing this pathology, taking into consideration that the disease is not endemic in this geographical area.
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Affiliation(s)
- Gabriela Lupuşoru
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Uronephrology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mircea Lupuşoru
- Department of Physiology I, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ioana Ailincăi
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Lavinia Bernea
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Andreea Berechet
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Radu Spătaru
- Department of Pediatric Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Gener Ismail
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Uronephrology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
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27
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Dieterle ME, Solà-Riera C, Ye C, Goodfellow SM, Mittler E, Kasikci E, Bradfute SB, Klingström J, Jangra RK, Chandran K. Genetic depletion studies inform receptor usage by virulent hantaviruses in human endothelial cells. eLife 2021; 10:e69708. [PMID: 34232859 PMCID: PMC8263056 DOI: 10.7554/elife.69708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Hantaviruses are RNA viruses with known epidemic threat and potential for emergence. Several rodent-borne hantaviruses cause zoonoses accompanied by severe illness and death. However, assessments of zoonotic risk and the development of countermeasures are challenged by our limited knowledge of the molecular mechanisms of hantavirus infection, including the identities of cell entry receptors and their roles in influencing viral host range and virulence. Despite the long-standing presumption that β3/β1-containing integrins are the major hantavirus entry receptors, rigorous genetic loss-of-function evidence supporting their requirement, and that of decay-accelerating factor (DAF), is lacking. Here, we used CRISPR/Cas9 engineering to knockout candidate hantavirus receptors, singly and in combination, in a human endothelial cell line that recapitulates the properties of primary microvascular endothelial cells, the major targets of viral infection in humans. The loss of β3 integrin, β1 integrin, and/or DAF had little or no effect on entry by a large panel of hantaviruses. By contrast, loss of protocadherin-1, a recently identified entry receptor for some hantaviruses, substantially reduced hantavirus entry and infection. We conclude that major host molecules necessary for endothelial cell entry by PCDH1-independent hantaviruses remain to be discovered.
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Affiliation(s)
- Maria Eugenia Dieterle
- Department of Microbiology and Immunology, Albert Einstein College of MedicineBronxUnited States
| | - Carles Solà-Riera
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska InstitutetStockholmSweden
| | - Chunyan Ye
- University of New Mexico Health Science Center, Center for Global Health, Department of Internal MedicineAlbuquerqueUnited States
| | - Samuel M Goodfellow
- University of New Mexico Health Science Center, Center for Global Health, Department of Internal MedicineAlbuquerqueUnited States
| | - Eva Mittler
- Department of Microbiology and Immunology, Albert Einstein College of MedicineBronxUnited States
| | - Ezgi Kasikci
- Department of Microbiology and Immunology, Albert Einstein College of MedicineBronxUnited States
| | - Steven B Bradfute
- University of New Mexico Health Science Center, Center for Global Health, Department of Internal MedicineAlbuquerqueUnited States
| | - Jonas Klingström
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska InstitutetStockholmSweden
| | - Rohit K Jangra
- Department of Microbiology and Immunology, Albert Einstein College of MedicineBronxUnited States
| | - Kartik Chandran
- Department of Microbiology and Immunology, Albert Einstein College of MedicineBronxUnited States
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28
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Saavedra F, Díaz FE, Retamal‐Díaz A, Covián C, González PA, Kalergis AM. Immune response during hantavirus diseases: implications for immunotherapies and vaccine design. Immunology 2021; 163:262-277. [PMID: 33638192 PMCID: PMC8207335 DOI: 10.1111/imm.13322] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/05/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022] Open
Abstract
Orthohantaviruses, previously named hantaviruses, cause two emerging zoonotic diseases: haemorrhagic fever with renal syndrome (HFRS) in Eurasia and hantavirus cardiopulmonary syndrome (HCPS) in the Americas. Overall, over 200 000 cases are registered every year worldwide, with a fatality rate ranging between 0·1% and 15% for HFRS and between 20% and 40% for HCPS. No specific treatment or vaccines have been approved by the U.S. Food and Drug Administration (FDA) to treat or prevent hantavirus-caused syndromes. Currently, little is known about the mechanisms at the basis of hantavirus-induced disease. However, it has been hypothesized that an excessive inflammatory response plays an essential role in the course of the disease. Furthermore, the contributions of the cellular immune response to either viral clearance or pathology have not been fully elucidated. This article discusses recent findings relative to the immune responses elicited to hantaviruses in subjects suffering HFRS or HCPS, highlighting the similarities and differences between these two clinical diseases. Also, we summarize the most recent data about the cellular immune response that could be important for designing new vaccines to prevent this global public health problem.
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Affiliation(s)
- Farides Saavedra
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
| | - Fabián E. Díaz
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
| | - Angello Retamal‐Díaz
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
| | - Camila Covián
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
| | - Pablo A. González
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
- Millennium Institute on Immunology and ImmunotherapyDepartamento de EndocrinologíaFacultad de MedicinaEscuela de MedicinaPontificia Universidad Católica de ChileSantiagoChile
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29
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Alonso DO, Pérez-Sautu U, Bellomo CM, Prieto K, Iglesias A, Coelho R, Periolo N, Domenech I, Talmon G, Hansen R, Palacios G, Martinez VP. Person-to-Person Transmission of Andes Virus in Hantavirus Pulmonary Syndrome, Argentina, 2014. Emerg Infect Dis 2021; 26:756-759. [PMID: 32186494 PMCID: PMC7101103 DOI: 10.3201/eid2604.190799] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Andes virus is unique among hantaviruses because it can be transmitted from person to person. This mechanism was previously supported by epidemiologic data and genetic evidence based only on partial sequences. We used full-length virus sequencing to confirm person-to-person transmission of this virus in a cluster of 3 cases in Argentina in 2014.
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30
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Mayor J, Engler O, Rothenberger S. Antiviral Efficacy of Ribavirin and Favipiravir against Hantaan Virus. Microorganisms 2021; 9:microorganisms9061306. [PMID: 34203936 PMCID: PMC8232603 DOI: 10.3390/microorganisms9061306] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
Ecological changes, population movements and increasing urbanization promote the expansion of hantaviruses, placing humans at high risk of virus transmission and consequent diseases. The currently limited therapeutic options make the development of antiviral strategies an urgent need. Ribavirin is the only antiviral used currently to treat hemorrhagic fever with renal syndrome (HFRS) caused by Hantaan virus (HTNV), even though severe side effects are associated with this drug. We therefore investigated the antiviral activity of favipiravir, a new antiviral agent against RNA viruses. Both ribavirin and favipiravir demonstrated similar potent antiviral activity on HTNV infection. When combined, the efficacy of ribavirin is enhanced through the addition of low dose favipiravir, highlighting the possibility to provide better treatment than is currently available.
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Affiliation(s)
- Jennifer Mayor
- Institute of Microbiology, University Hospital Center and University of Lausanne, CH-1011 Lausanne, Switzerland;
- Spiez Laboratory, Federal Office for Civil Protection, CH-3700 Spiez, Switzerland;
| | - Olivier Engler
- Spiez Laboratory, Federal Office for Civil Protection, CH-3700 Spiez, Switzerland;
| | - Sylvia Rothenberger
- Institute of Microbiology, University Hospital Center and University of Lausanne, CH-1011 Lausanne, Switzerland;
- Spiez Laboratory, Federal Office for Civil Protection, CH-3700 Spiez, Switzerland;
- Correspondence: ; Tel.: +41-213145103
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31
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Lee L, Samardzic K, Wallach M, Frumkin LR, Mochly-Rosen D. Immunoglobulin Y for Potential Diagnostic and Therapeutic Applications in Infectious Diseases. Front Immunol 2021; 12:696003. [PMID: 34177963 PMCID: PMC8220206 DOI: 10.3389/fimmu.2021.696003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/26/2021] [Indexed: 01/14/2023] Open
Abstract
Antiviral, antibacterial, and antiparasitic drugs and vaccines are essential to maintaining the health of humans and animals. Yet, their production can be slow and expensive, and efficacy lost once pathogens mount resistance. Chicken immunoglobulin Y (IgY) is a highly conserved homolog of human immunoglobulin G (IgG) that has shown benefits and a favorable safety profile, primarily in animal models of human infectious diseases. IgY is fast-acting, easy to produce, and low cost. IgY antibodies can readily be generated in large quantities with minimal environmental harm or infrastructure investment by using egg-laying hens. We summarize a variety of IgY uses, focusing on their potential for the detection, prevention, and treatment of human and animal infections.
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Affiliation(s)
- Lucia Lee
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA, United States
| | - Kate Samardzic
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael Wallach
- School of Life Sciences, University of Technology, Sydney, NSW, Australia
| | | | - Daria Mochly-Rosen
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA, United States
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32
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Douglas KO, Samuels TA, Iheozor-Ejiofor R, Vapalahti O, Sironen T, Gittens-St. Hilaire M. Serological Evidence of Human Orthohantavirus Infections in Barbados, 2008 to 2016. Pathogens 2021; 10:pathogens10050571. [PMID: 34066699 PMCID: PMC8151097 DOI: 10.3390/pathogens10050571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 02/08/2023] Open
Abstract
Background: Hantavirus pulmonary syndrome (HPS) is well-known in South and North America; however, not enough data exist for the Caribbean. The first report of clinical orthohantavirus infection was obtained in Barbados, but no other evidence of clinical orthohantavirus infections among adults in the Caribbean has been documented. Methods: Using enzyme linked immunosorbent assay (ELISA) tests followed by confirmatory testing with immunofluorescent assays (IFA), immunochromatographic (ICG) tests, and pseudotype focus reduction neutralization tests (pFRNT), we retrospectively and prospectively detected orthohantavirus-specific antibodies among patients with febrile illness in Barbados. Results: The orthohantavirus prevalence rate varied from 5.8 to 102.6 cases per 100,000 persons among febrile patients who sought medical attention annually between 2008 and 2016. Two major orthohantavirus epidemics occurred in Barbados during 2010 and 2016. Peak orthohantavis infections were observed observed during the rainy season (August) and prevalence rates were significantly higher in females than males and in patients from urban parishes than rural parishes. Conclusions: Orthohantavirus infections are still occurring in Barbados and in some patients along with multiple pathogen infections (CHIKV, ZIKV, DENV and Leptospira). Orthohantavirus infections are more prevalent during periods of high rainfall (rainy season) with peak transmission in August; females are more likely to be infected than males and infections are more likely among patients from urban rather than rural parishes in Barbados.
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Affiliation(s)
- Kirk Osmond Douglas
- Centre for Biosecurity Studies, University of the West Indies, Cave Hill, St. Michael BB11000, Barbados
- Correspondence: ; Tel.: +1-(246)-417-7468
| | - Thelma Alafia Samuels
- Epidemiology Research Unit, Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Mona, Kingston 7, Jamaica;
| | - Rommel Iheozor-Ejiofor
- Department of Virology, Faculty of Medicine, Medicum, University of Helsinki, Haartmaninkatu 3, 00290 Helsinki, Finland; (R.I.-E.); (O.V.); (T.S.)
| | - Olli Vapalahti
- Department of Virology, Faculty of Medicine, Medicum, University of Helsinki, Haartmaninkatu 3, 00290 Helsinki, Finland; (R.I.-E.); (O.V.); (T.S.)
| | - Tarja Sironen
- Department of Virology, Faculty of Medicine, Medicum, University of Helsinki, Haartmaninkatu 3, 00290 Helsinki, Finland; (R.I.-E.); (O.V.); (T.S.)
| | - Marquita Gittens-St. Hilaire
- Best-dos Santos Public Health Laboratory, Enmore #6, Lower Collymore Rock, St. Michael BB11155, Barbados;
- Faculty of Medical Sciences, University of the West Indies, Cave Hill, St. Michael BB11000, Barbados
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Kim WK, No JS, Lee D, Jung J, Park H, Yi Y, Kim JA, Lee SH, Kim Y, Park S, Cho S, Lee GY, Song DH, Gu SH, Park K, Kim HC, Wiley MR, Chain PSG, Jeong ST, Klein TA, Palacios G, Song JW. Active Targeted Surveillance to Identify Sites of Emergence of Hantavirus. Clin Infect Dis 2021; 70:464-473. [PMID: 30891596 DOI: 10.1093/cid/ciz234] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/19/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Endemic outbreaks of hantaviruses pose a critical public health threat worldwide. Hantaan orthohantavirus (HTNV) causes hemorrhagic fever with renal syndrome (HFRS) in humans. Using comparative genomic analyses of partial and nearly complete sequences of HTNV from humans and rodents, we were able to localize, with limitations, the putative infection locations for HFRS patients. Partial sequences might not reflect precise phylogenetic positions over the whole-genome sequences; finer granularity of rodent sampling reflects more precisely the circulation of strains. METHODS Five HFRS specimens were collected. Epidemiological surveys were conducted with the patients during hospitalization. We conducted active surveillance at suspected HFRS outbreak areas. We performed multiplex polymerase chain reaction-based next-generation sequencing to obtain the genomic sequence of HTNV from patients and rodents. The phylogeny of human- and rodent-derived HTNV was generated using the maximum likelihood method. For phylogeographic analyses, the tracing of HTNV genomes from HFRS patients was defined on the bases of epidemiological interviews, phylogenetic patterns of the viruses, and geographic locations of HTNV-positive rodents. RESULTS The phylogeographic analyses demonstrated genetic clusters of HTNV strains from clinical specimens, with HTNV circulating in rodents at suspected sites of patient infections. CONCLUSIONS This study demonstrates a major shift in molecular epidemiological surveillance of HTNV. Active targeted surveillance was performed at sites of suspected infections, allowing the high-resolution phylogeographic analysis to reveal the site of emergence of HTNV. We posit that this novel approach will make it possible to identify infectious sources, perform disease risk assessment, and implement preparedness against vector-borne viruses.
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Affiliation(s)
- Won-Keun Kim
- Department of Microbiology, College of Medicine, Korea University, Seoul
| | - Jin Sun No
- Department of Microbiology, College of Medicine, Korea University, Seoul
| | - Daesang Lee
- 4th Research and Development Institute, Agency for Defense Development, Daejeon
| | | | | | | | - Jeong-Ah Kim
- Department of Microbiology, College of Medicine, Korea University, Seoul
| | - Seung-Ho Lee
- Department of Microbiology, College of Medicine, Korea University, Seoul
| | - Yujin Kim
- Armed Forces Medical Center, Seongnam
| | - Sunhye Park
- 4th Research and Development Institute, Agency for Defense Development, Daejeon
| | - Seungchan Cho
- Department of Microbiology, College of Medicine, Korea University, Seoul
| | - Geum-Young Lee
- Department of Microbiology, College of Medicine, Korea University, Seoul
| | - Dong Hyun Song
- 4th Research and Development Institute, Agency for Defense Development, Daejeon
| | - Se Hun Gu
- 4th Research and Development Institute, Agency for Defense Development, Daejeon
| | - Kkothanahreum Park
- Department of Microbiology, College of Medicine, Korea University, Seoul
| | | | - Michael R Wiley
- Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Maryland
| | | | - Seong Tae Jeong
- 4th Research and Development Institute, Agency for Defense Development, Daejeon
| | | | - Gustavo Palacios
- Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Maryland
| | - Jin-Won Song
- Department of Microbiology, College of Medicine, Korea University, Seoul
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Perret C, Le Corre N, Castro-Rodriguez JA. Emergent Pneumonia in Children. Front Pediatr 2021; 9:676296. [PMID: 34222146 PMCID: PMC8247473 DOI: 10.3389/fped.2021.676296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/21/2021] [Indexed: 12/11/2022] Open
Abstract
In recent decades there have been multiple pathogens, viruses and bacteria, which have emerged as causal agents of pneumonia affecting adults, albeit less frequently, to children. For the purposes of this article we have classified emerging pathogens as follows: True emerging, to pathogens identified for the very first time affecting human population (SARS-CoV-1, SARS-CoV-2, MERS-CoV, avian influenza, and hantavirus); Re-emerging, to known pathogens which circulation was controlled once, but they have reappeared (measles, tuberculosis, antimicrobial resistant bacteria such as CA-MRSA, Mycoplasma pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and new serotypes of post-vaccine pneumococcal); and finally, those that we have called old known with new presentations, including common pathogens that, in particular condition, have changed their form of presentation (rhinovirus, and non-SARS coronavirus). We will review for each of them their epidemiology, forms of presentation, therapy, and prognosis in children compared to the adult with the aim of being able to recognize them to establish appropriate therapy, prognostics, and effective control measures.
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Affiliation(s)
- Cecilia Perret
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicole Le Corre
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jose A Castro-Rodriguez
- Department of Pediatric Pulmonology and Cardiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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35
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Martínez VP, Di Paola N, Alonso DO, Pérez-Sautu U, Bellomo CM, Iglesias AA, Coelho RM, López B, Periolo N, Larson PA, Nagle ER, Chitty JA, Pratt CB, Díaz J, Cisterna D, Campos J, Sharma H, Dighero-Kemp B, Biondo E, Lewis L, Anselmo C, Olivera CP, Pontoriero F, Lavarra E, Kuhn JH, Strella T, Edelstein A, Burgos MI, Kaler M, Rubinstein A, Kugelman JR, Sanchez-Lockhart M, Perandones C, Palacios G. "Super-Spreaders" and Person-to-Person Transmission of Andes Virus in Argentina. N Engl J Med 2020; 383:2230-2241. [PMID: 33264545 DOI: 10.1056/nejmoa2009040] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND From November 2018 through February 2019, person-to-person transmission of Andes virus (ANDV) hantavirus pulmonary syndrome occurred in Chubut Province, Argentina, and resulted in 34 confirmed infections and 11 deaths. Understanding the genomic, epidemiologic, and clinical characteristics of person-to-person transmission of ANDV is crucial to designing effective interventions. METHODS Clinical and epidemiologic information was obtained by means of patient report and from public health centers. Serologic testing, contact-tracing, and next-generation sequencing were used to identify ANDV infection as the cause of this outbreak of hantavirus pulmonary syndrome and to reconstruct person-to-person transmission events. RESULTS After a single introduction of ANDV from a rodent reservoir into the human population, transmission was driven by 3 symptomatic persons who attended crowded social events. After 18 cases were confirmed, public health officials enforced isolation of persons with confirmed cases and self-quarantine of possible contacts; these measures most likely curtailed further spread. The median reproductive number (the number of secondary cases caused by an infected person during the infectious period) was 2.12 before the control measures were enforced and decreased to 0.96 after the measures were implemented. Full genome sequencing of the ANDV strain involved in this outbreak was performed with specimens from 27 patients and showed that the strain that was present (Epuyén/18-19) was similar to the causative strain (Epilink/96) in the first known person-to-person transmission of hantavirus pulmonary syndrome caused by ANDV, which occurred in El Bolsón, Argentina, in 1996. Clinical investigations involving patients with ANDV hantavirus pulmonary syndrome in this outbreak revealed that patients with a high viral load and liver injury were more likely than other patients to spread infection. Disease severity, genomic diversity, age, and time spent in the hospital had no clear association with secondary transmission. CONCLUSIONS Among patients with ANDV hantavirus pulmonary syndrome, high viral titers in combination with attendance at massive social gatherings or extensive contact among persons were associated with a higher likelihood of transmission. (Funded by the Ministerio de Salud y Desarrollo Social de la Nación Argentina and others.).
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Affiliation(s)
- Valeria P Martínez
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Nicholas Di Paola
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Daniel O Alonso
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Unai Pérez-Sautu
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Carla M Bellomo
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Ayelén A Iglesias
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Rocio M Coelho
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Beatriz López
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Natalia Periolo
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Peter A Larson
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Elyse R Nagle
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Joseph A Chitty
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Catherine B Pratt
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Jorge Díaz
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Daniel Cisterna
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Josefina Campos
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Heema Sharma
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Bonnie Dighero-Kemp
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Emiliano Biondo
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Lorena Lewis
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Constanza Anselmo
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Camila P Olivera
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Fernanda Pontoriero
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Enzo Lavarra
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Jens H Kuhn
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Teresa Strella
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Alexis Edelstein
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Miriam I Burgos
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Mario Kaler
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Adolfo Rubinstein
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Jeffrey R Kugelman
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Mariano Sanchez-Lockhart
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Claudia Perandones
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Gustavo Palacios
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
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Ferro I, Bellomo CM, López W, Coelho R, Alonso D, Bruno A, Córdoba FE, Martinez VP. Hantavirus pulmonary syndrome outbreaks associated with climate variability in Northwestern Argentina, 1997-2017. PLoS Negl Trop Dis 2020; 14:e0008786. [PMID: 33253144 PMCID: PMC7728390 DOI: 10.1371/journal.pntd.0008786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 12/10/2020] [Accepted: 09/09/2020] [Indexed: 01/10/2023] Open
Abstract
Background Rodent-borne hantaviruses (genus Orthohantavirus) are the etiologic agents causing two human diseases: hemorrhagic fever with renal syndrome (HFRS) in Euroasia; and hantavirus pulmonary syndrome (HPS) in North and South America. In South America fatality rates of HPS can reach up to 35%–50%. The transmission of pathogenic hantaviruses to humans occurs mainly via inhalation of aerosolized excreta from infected rodents. Thus, the epidemiology of HPS is necessarily linked to the ecology of their rodent hosts and the contact with a human, which in turn may be influenced by climatic variability. Here we examined the relationship between climatic variables and hantavirus transmission aim to develop an early warning system of potential hantavirus outbreaks based on ecologically relevant climatic factors. Methodology and main findings We compiled reported HPS cases in northwestern Argentina during the 1997–2017 period and divided our data into biannual, quarterly, and bimestrial time periods to allow annual and shorter time delays to be observed. To evaluate the relationship of hantavirus transmission with mean temperature and precipitation we used dynamic regression analysis. We found a significant association between HPS incidence and lagged rainfall and temperature with a delay of 2 to 6 months. For the biannual and quarterly models, hantavirus transmission was positively associated with lagged rainfall and temperature; whereas the bimestrial models indicate a direct relationship with the rainfall but inverse for temperature in the second lagged period. Conclusions/Significance This work demonstrates that climate variability plays a significant role in the transmission of hantavirus in northwestern Argentina. The model developed in this study provides a basis for the forecast of potential HPS outbreaks based on climatic parameters. Our findings are valuable for the development of public health policies and prevention strategies to mitigate possible outbreaks. Nonetheless, a surveillance program on rodent population dynamics would lead to a more accurate forecast of HPS outbreaks. Hantavirus pulmonary syndrome (HPS) is a Pan-American emerging disease with a high mortality rate caused by a rodent-borne virus. In Argentina, almost half of the HPS infections occur in the northwestern endemic region. Most of the reported cases (75%) developed severe respiratory insufficiency, of which 30% required mechanical ventilation and 15% with a fatal outcome. In this study area, nearly half of the population is below the poverty line, particularly in rural areas, where most infections occur. Since there are no vaccines currently available nor specific therapeutic treatments, prevention of hantavirus infection involves mainly environmental management practices and educational campaigns. Our results provide a framework for the planning and implementation of early public health prevention campaigns based on the significant relationship between hantavirus outbreaks and delayed climatic variables.
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Affiliation(s)
- Ignacio Ferro
- Instituto de Ecorregiones Andinas—Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)—Universidad Nacional de Jujuy (UNJu), San Salvador de Jujuy, Argentina
- * E-mail:
| | - Carla M. Bellomo
- Instituto Nacional de Enfermedades Infecciosas (INEI), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) “Dr. C. G. Malbrán”, Buenos Aires, Argentina
| | - Walter López
- Instituto de Investigaciones de Enfermedades Tropicales, Oran, Salta, Argentina
| | - Rocío Coelho
- Instituto Nacional de Enfermedades Infecciosas (INEI), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) “Dr. C. G. Malbrán”, Buenos Aires, Argentina
| | - Daniel Alonso
- Instituto Nacional de Enfermedades Infecciosas (INEI), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) “Dr. C. G. Malbrán”, Buenos Aires, Argentina
| | | | - Francisco E. Córdoba
- Instituto de Ecorregiones Andinas—Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)—Universidad Nacional de Jujuy (UNJu), San Salvador de Jujuy, Argentina
| | - Valeria P. Martinez
- Instituto Nacional de Enfermedades Infecciosas (INEI), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) “Dr. C. G. Malbrán”, Buenos Aires, Argentina
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Vial C, Whitaker A, Wilhelm J, Ovalle J, Perez R, Valdivieso F, Ferres M, Martinez-Valdebenito C, Eisenhauer P, Mertz GJ, Hooper JW, Botten JW, Vial PA. Comparison of VSV Pseudovirus and Focus Reduction Neutralization Assays for Measurement of Anti- Andes orthohantavirus Neutralizing Antibodies in Patient Samples. Front Cell Infect Microbiol 2020; 10:444. [PMID: 33042854 PMCID: PMC7527604 DOI: 10.3389/fcimb.2020.00444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/20/2020] [Indexed: 12/24/2022] Open
Abstract
Andes orthohantavirus (ANDV) is the etiologic agent of hantavirus cardiopulmonary syndrome (HCPS), which has a case fatality rate around 35%, with no effective treatment or vaccine available. ANDV neutralizing antibody (NAb) measurements are important for the evaluation of the immune response following infection, vaccination, or passive administration of investigational monoclonal or polyclonal antibodies. The standard assay for NAb measurement is a focus reduction neutralization test (FRNT) featuring live ANDV and must be completed under biosafety level (BSL)-3 conditions. In this study, we compared neutralization assays featuring infectious ANDV or vesicular stomatitis virus (VSV) pseudovirions decorated with ANDV glycoproteins for their ability to measure anti-ANDV NAbs from patient samples. Our studies demonstrate that VSV pseudovirions effectively measure NAb from clinical samples and have greater sensitivity compared to FRNT with live ANDV. Importantly, the pseudovirus assay requires less labor and sample materials and can be conducted at BSL-2.
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Affiliation(s)
- Cecilia Vial
- Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Programa Hantavirus, Instituto de Ciencias e Innovación en Medicina, Santiago, Chile
| | - Annalis Whitaker
- Division of Immunobiology, Department of Medicine, University of Vermont, Burlington, VT, United States
- Cellular, Molecular and Biomedical Sciences Graduate Program, University of Vermont, Burlington, VT, United States
| | - Jan Wilhelm
- Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Programa Hantavirus, Instituto de Ciencias e Innovación en Medicina, Santiago, Chile
- Clínica Alemana de Santiago, Santiago, Chile
| | - Jimena Ovalle
- Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Programa Hantavirus, Instituto de Ciencias e Innovación en Medicina, Santiago, Chile
| | - Ruth Perez
- Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Programa Hantavirus, Instituto de Ciencias e Innovación en Medicina, Santiago, Chile
| | | | - Marcela Ferres
- Laboratorio de Infectología y Virología Molecular, Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, Facultad de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Constanza Martinez-Valdebenito
- Laboratorio de Infectología y Virología Molecular, Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, Facultad de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Philip Eisenhauer
- Division of Immunobiology, Department of Medicine, University of Vermont, Burlington, VT, United States
| | - Gregory J. Mertz
- Division of Infectious Diseases, Department of Internal Medicine University of New Mexico, Albuquerque, NM, United States
| | - Jay W. Hooper
- Molecular Virology Branch, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, United States
| | - Jason W. Botten
- Division of Immunobiology, Department of Medicine, University of Vermont, Burlington, VT, United States
- Department of Microbiology and Molecular Genetics, University of Vermont, Burlington, VT, United States
| | - Pablo A. Vial
- Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Programa Hantavirus, Instituto de Ciencias e Innovación en Medicina, Santiago, Chile
- Clínica Alemana de Santiago, Santiago, Chile
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Serris A, Stass R, Bignon EA, Muena NA, Manuguerra JC, Jangra RK, Li S, Chandran K, Tischler ND, Huiskonen JT, Rey FA, Guardado-Calvo P. The Hantavirus Surface Glycoprotein Lattice and Its Fusion Control Mechanism. Cell 2020; 183:442-456.e16. [PMID: 32937107 DOI: 10.1016/j.cell.2020.08.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/31/2020] [Accepted: 08/13/2020] [Indexed: 12/20/2022]
Abstract
Hantaviruses are rodent-borne viruses causing serious zoonotic outbreaks worldwide for which no treatment is available. Hantavirus particles are pleomorphic and display a characteristic square surface lattice. The envelope glycoproteins Gn and Gc form heterodimers that further assemble into tetrameric spikes, the lattice building blocks. The glycoproteins, which are the sole targets of neutralizing antibodies, drive virus entry via receptor-mediated endocytosis and endosomal membrane fusion. Here we describe the high-resolution X-ray structures of the heterodimer of Gc and the Gn head and of the homotetrameric Gn base. Docking them into an 11.4-Å-resolution cryoelectron tomography map of the hantavirus surface accounted for the complete extramembrane portion of the viral glycoprotein shell and allowed a detailed description of the surface organization of these pleomorphic virions. Our results, which further revealed a built-in mechanism controlling Gc membrane insertion for fusion, pave the way for immunogen design to protect against pathogenic hantaviruses.
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Affiliation(s)
- Alexandra Serris
- Institut Pasteur, Structural Virology Unit, and CNRS UMR 3569, Paris, France
| | - Robert Stass
- Division of Structural Biology, Wellcome Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Eduardo A Bignon
- Fundación Ciencia & Vida, Molecular Virology Laboratory, Santiago, Chile; Universidad San Sebastián, Santiago, Chile
| | - Nicolás A Muena
- Fundación Ciencia & Vida, Molecular Virology Laboratory, Santiago, Chile
| | - Jean-Claude Manuguerra
- Institut Pasteur, Unité Environnement et Risques Infectieux, Cellule d'Intervention Biologique d'Urgence (CIBU), Paris, France
| | - Rohit K Jangra
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, NY, USA
| | - Sai Li
- Division of Structural Biology, Wellcome Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK; School of Life Sciences, Tsinghua University, Beijing 100084, China
| | - Kartik Chandran
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, NY, USA
| | - Nicole D Tischler
- Fundación Ciencia & Vida, Molecular Virology Laboratory, Santiago, Chile; Universidad San Sebastián, Santiago, Chile
| | - Juha T Huiskonen
- Division of Structural Biology, Wellcome Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK; Helsinki Institute of Life Science HiLIFE, Viikinkaari 1, 00014 University of Helsinki, Finland; Molecular and Integrative Biosciences Research Program, Faculty of Biological and Environmental Sciences, Viikinkaari 1, 00014 University of Helsinki, Finland
| | - Felix A Rey
- Institut Pasteur, Structural Virology Unit, and CNRS UMR 3569, Paris, France.
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Noack D, Goeijenbier M, Reusken CBEM, Koopmans MPG, Rockx BHG. Orthohantavirus Pathogenesis and Cell Tropism. Front Cell Infect Microbiol 2020; 10:399. [PMID: 32903721 PMCID: PMC7438779 DOI: 10.3389/fcimb.2020.00399] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/29/2020] [Indexed: 12/20/2022] Open
Abstract
Orthohantaviruses are zoonotic viruses that are naturally maintained by persistent infection in specific reservoir species. Although these viruses mainly circulate among rodents worldwide, spill-over infection to humans occurs. Orthohantavirus infection in humans can result in two distinct clinical outcomes: hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). While both syndromes develop following respiratory transmission and are associated with multi-organ failure and high mortality rates, little is known about the mechanisms that result in these distinct clinical outcomes. Therefore, it is important to identify which cell types and tissues play a role in the differential development of pathogenesis in humans. Here, we review current knowledge on cell tropism and its role in pathogenesis during orthohantavirus infection in humans and reservoir rodents. Orthohantaviruses predominantly infect microvascular endothelial cells (ECs) of a variety of organs (lungs, heart, kidney, liver, and spleen) in humans. However, in this review we demonstrate that other cell types (e.g., macrophages, dendritic cells, and tubular epithelium) are infected as well and may play a role in the early steps in pathogenesis. A key driver for pathogenesis is increased vascular permeability, which can be direct effect of viral infection in ECs or result of an imbalanced immune response in an attempt to clear the virus. Future studies should focus on the role of identifying how infection of organ-specific endothelial cells as well as other cell types contribute to pathogenesis.
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Affiliation(s)
- Danny Noack
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marco Goeijenbier
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Chantal B E M Reusken
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, Netherlands.,Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Marion P G Koopmans
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Barry H G Rockx
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, Netherlands
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The Andes Orthohantavirus NSs Protein Antagonizes the Type I Interferon Response by Inhibiting MAVS Signaling. J Virol 2020; 94:JVI.00454-20. [PMID: 32321811 DOI: 10.1128/jvi.00454-20] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/10/2020] [Indexed: 12/11/2022] Open
Abstract
The small messenger RNA (SmRNA) of the Andes orthohantavirus (ANDV), a rodent-borne member of the Hantaviridae family of viruses of the Bunyavirales order, encodes a multifunctional nucleocapsid (N) protein and for a nonstructural (NSs) protein of unknown function. We have previously shown the expression of the ANDV-NSs, but only in infected cell cultures. In this study, we extend our early findings by confirming the expression of the ANDV-NSs protein in the lungs of experimentally infected golden Syrian hamsters. Next, we show, using a virus-free system, that the ANDV-NSs protein antagonizes the type I interferon (IFN) induction pathway by suppressing signals downstream of the melanoma differentiation-associated protein 5 (MDA5) and the retinoic acid-inducible gene 1 (RIG-I) and upstream of TBK1. Consistent with this observation, the ANDV-NSs protein antagonized mitochondrial antiviral-signaling protein (MAVS)-induced IFN-β, NF-κB, IFN-regulatory factor 3 (IRF3), and IFN-sensitive response element (ISRE) promoter activity. Results demonstrate that ANDV-NSs binds to MAVS in cells without disrupting the MAVS-TBK-1 interaction. However, in the presence of the ANDV-NSs ubiquitination of MAVS is reduced. In summary, this study provides evidence showing that the ANDV-NSs protein acts as an antagonist of the cellular innate immune system by suppressing MAVS downstream signaling by a yet not fully understand mechanism. Our findings reveal new insights into the molecular regulation of the hosts' innate immune response by the Andes orthohantavirus.IMPORTANCE Andes orthohantavirus (ANDV) is endemic in Argentina and Chile and is the primary etiological agent of hantavirus cardiopulmonary syndrome (HCPS) in South America. ANDV is distinguished from other hantaviruses by its unique ability to spread from person to person. In a previous report, we identified a novel ANDV protein, ANDV-NSs. Until now, ANDV-NSs had no known function. In this new study, we established that ANDV-NSs acts as an antagonist of cellular innate immunity, the first line of defense against invading pathogens, hindering the cellular antiviral response during infection. This study provides novel insights into the mechanisms used by ANDV to establish its infection.
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Mull N, Jackson R, Sironen T, Forbes KM. Ecology of Neglected Rodent-Borne American Orthohantaviruses. Pathogens 2020; 9:E325. [PMID: 32357540 PMCID: PMC7281597 DOI: 10.3390/pathogens9050325] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/31/2022] Open
Abstract
The number of documented American orthohantaviruses has increased significantly over recent decades, but most fundamental research has remained focused on just two of them: Andes virus (ANDV) and Sin Nombre virus (SNV). The majority of American orthohantaviruses are known to cause disease in humans, and most of these pathogenic strains were not described prior to human cases, indicating the importance of understanding all members of the virus clade. In this review, we summarize information on the ecology of under-studied rodent-borne American orthohantaviruses to form general conclusions and highlight important gaps in knowledge. Information regarding the presence and genetic diversity of many orthohantaviruses throughout the distributional range of their hosts is minimal and would significantly benefit from virus isolations to indicate a reservoir role. Additionally, few studies have investigated the mechanisms underlying transmission routes and factors affecting the environmental persistence of orthohantaviruses, limiting our understanding of factors driving prevalence fluctuations. As landscapes continue to change, host ranges and human exposure to orthohantaviruses likely will as well. Research on the ecology of neglected orthohantaviruses is necessary for understanding both current and future threats to human health.
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Affiliation(s)
- Nathaniel Mull
- Department of Biological Sciences, University of Arkansas, Fayetteville, AR 72701, USA; (R.J.); (K.M.F.)
| | - Reilly Jackson
- Department of Biological Sciences, University of Arkansas, Fayetteville, AR 72701, USA; (R.J.); (K.M.F.)
| | - Tarja Sironen
- Department of Virology, University of Helsinki, 00290 Helsinki, Finland;
- Department of Veterinary Biosciences, University of Helsinki, 00790 Helsinki, Finland
| | - Kristian M. Forbes
- Department of Biological Sciences, University of Arkansas, Fayetteville, AR 72701, USA; (R.J.); (K.M.F.)
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Meeting report: Eleventh International Conference on Hantaviruses. Antiviral Res 2020; 176:104733. [PMID: 32068071 DOI: 10.1016/j.antiviral.2020.104733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/01/2020] [Indexed: 12/24/2022]
Abstract
The 2019 11th International Conference on Hantaviruses (ICH 2019) was organized by the International Society for Hantaviruses (ISH), and held on September 1-4, 2019, at the Irish College, in Leuven, Belgium. These ICHs have been held every three years since 1989. ICH 2019 was attended by 158 participants from 33 countries. The current report summarizes research presented on all aspects of hantavirology: ecology; pathogenesis and immune responses; virus phylogeny, replication and morphogenesis; epidemiology; vaccines, therapeutics and prevention; and clinical aspects and diagnosis.
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Solà-Riera C, García M, Ljunggren HG, Klingström J. Hantavirus inhibits apoptosis by preventing mitochondrial membrane potential loss through up-regulation of the pro-survival factor BCL-2. PLoS Pathog 2020; 16:e1008297. [PMID: 32032391 PMCID: PMC7032725 DOI: 10.1371/journal.ppat.1008297] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 02/20/2020] [Accepted: 12/30/2019] [Indexed: 12/12/2022] Open
Abstract
Hantaviruses, zoonotic RNA viruses belonging to the order Bunyavirales, cause two severe acute diseases in humans, hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). Hantavirus-infected patients show strong cytotoxic lymphocyte responses and hyperinflammation; however, infected cells remain mostly intact. Hantaviruses were recently shown to inhibit apoptosis in infected cells. By inhibiting granzyme B- and TRAIL-mediated apoptosis, hantaviruses specifically and efficiently inhibit cytotoxic lymphocyte-mediated killing of infected cells. Hantaviruses also strongly inhibit apoptosis triggered intrinsically; i.e., initiated through intracellular activation pathways different from those used by cytotoxic lymphocytes. However, insights into the latter mechanisms are currently largely unknown. Here, we dissected the mechanism behind how hantavirus infection, represented by the HFRS-causing Hantaan virus and the HPS-causing Andes virus, results in resistance to staurosporine-induced apoptosis. Less active caspase-8 and caspase-9, and consequently less active caspase-3, was observed in infected compared to uninfected staurosporine-exposed cells. While staurosporine-exposed uninfected cells showed massive release of pro-apoptotic cytochrome C into the cytosol, this was not observed in infected cells. Further, hantaviruses prevented activation of BAX and mitochondrial outer membrane permeabilization (MOMP). In parallel, a significant increase in levels of the pro-survival factor BCL-2 was observed in hantavirus-infected cells. Importantly, direct inhibition of BCL-2 by the inhibitor ABT-737, as well as silencing of BCL-2 by siRNA, resulted in apoptosis in staurosporine-exposed hantavirus-infected cells. Overall, we here provide a tentative mechanism by which hantaviruses protect infected cells from intrinsic apoptosis at the mitochondrial level by inducing an increased expression of the pro-survival factor BCL-2, thereby preventing MOMPs and subsequent activation of caspases. The variety of mechanisms used by hantaviruses to ensure survival of infected cells likely contribute to the persistent infection in natural hosts and may play a role in immunopathogenesis of HFRS and HPS in humans. Hantaviruses cause two severe, often fatal, diseases in humans: hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS; also called hantavirus cardiopulmonary syndrome (HCPS)). Two hallmarks of human hantavirus infection are robust immune cell activation and hyperinflammation. Despite these strong immune responses, hantavirus-infected cells do not succumb to cell death in patients. Recent studies have shown that hantaviruses hamper cytotoxic lymphocyte-mediated killing, by inhibiting cytotoxic granule-dependent induction of apoptosis and TRAIL-mediated apoptosis, as well as inhibiting intrinsic apoptosis. However, mechanisms behind hantavirus induced inhibition of intrinsic apoptosis have not been described. Here, we show that hantavirus infection leads to increased production of the anti-apoptotic protein BCL-2, hampering the permeabilization of mitochondria and thereby blocking downstream signaling and activation of caspases. Treatment of infected cells with a BCL-2 inhibitor, as well as silencing of BCL-2 with siRNA, both reverted the anti-apoptotic effect. Taken together, this study reveals new insights into the interactions between hantaviruses and infected cells and demonstrates novel mechanisms by which hantaviruses inhibit apoptosis by hampering the permeabilization of mitochondria.
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Affiliation(s)
- Carles Solà-Riera
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- * E-mail:
| | - Marina García
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Hans-Gustaf Ljunggren
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Klingström
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Maroli M, Crosignani B, Piña CI, Coelho R, Martínez VP, Gómez Villafañe IE. New data about home range and movements of Oligoryzomys flavescens (Rodentia: Cricetidae) help to understand the spread and transmission of Andes virus that causes Hantavirus Pulmonary Syndrome. Zoonoses Public Health 2020; 67:308-317. [PMID: 32034891 DOI: 10.1111/zph.12690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/08/2020] [Accepted: 01/14/2020] [Indexed: 01/16/2023]
Abstract
Hantavirus pulmonary syndrome is an emerging infectious disease caused by viruses of the genus Orthohantavirus. The rodent Oligoryzomys flavescens is distributed along four countries of South America. In Argentina, O. flavescens acts as a reservoir of three genotypes of ANDV orthohantavirus. The aims of this work were to estimate home range size and movements-with spool-and-line and radiotelemetry-of infected and non-infected O. flavescens in order to understand the spread and transmission of the virus. O. flavescens use a wide area to satisfice its requirements, reaching a home range of 1.82 ha during spring. Orthohantavirus infection did not change the behaviour of individuals. We observed a great overlapping in the home range of infected and non-infected individuals resulting in a high probability of virus dispersion on rodent population. These results show that human health risks could be high on island environments and knowledge about the movement ecology of O. flavescens provides useful information on prevention.
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Affiliation(s)
- Malena Maroli
- Centro de Investigación Científica y de Transferencia Tecnológica a la Producción, Diamante, Argentina.,Facultad de Ciencia y Tecnología, Universidad Autónoma de Entre Ríos, Entre Ríos, Argentina
| | - Belén Crosignani
- Departamento de Ecología, Genética y Evolución, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carlos I Piña
- Centro de Investigación Científica y de Transferencia Tecnológica a la Producción, Diamante, Argentina.,Facultad de Ciencia y Tecnología, Universidad Autónoma de Entre Ríos, Entre Ríos, Argentina
| | - Rocío Coelho
- Instituto Nacional de Enfermedades Infecciosas, Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán, Buenos Aires, Argentina
| | - Valeria P Martínez
- Instituto Nacional de Enfermedades Infecciosas, Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán, Buenos Aires, Argentina
| | - Isabel Elisa Gómez Villafañe
- Facultad de Ciencias Exactas y Naturales, Instituto de Ecología, Genética y Evolución (CONICET-UBA), Universidad de Buenos Aires, Buenos Aires, Argentina
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Pizarro E, Navarrete M, Mendez C, Zaror L, Mansilla C, Tapia M, Carrasco C, Salazar P, Murua R, Padula P, Otth C, Rodríguez EM. Immunocytochemical and Ultrastructural Evidence Supporting That Andes Hantavirus (ANDV) Is Transmitted Person-to-Person Through the Respiratory and/or Salivary Pathways. Front Microbiol 2020; 10:2992. [PMID: 31998273 PMCID: PMC6965362 DOI: 10.3389/fmicb.2019.02992] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/10/2019] [Indexed: 01/07/2023] Open
Abstract
In South America Andes hantavirus (ANDV) is hosted by the rodent Oligoryzomys longicaudatus (also known as pygmy rice rat). In humans, ANDV causes Hantavirus Pulmonary Syndrome (HPS), with a fatality rate of about 40%. Epidemiologic and molecular evidence has shown that ANDV can be transmitted from person to person. Sin Nombre hantavirus, occurring in North America, and ANDV are genetically related, and both cause HPS with similar clinical evolution and mortality rate. However, only ANDV is transmitted from person to person. A recent hantavirus outbreak in a small village in Southern Argentine, with 29 HPS cases and 11 deaths has brought to mind that person-to-person transmission continues to be a public health emergency. The present investigation was aimed to understand how does ANDV actually spread between persons. Tissue samples of lung and salivary glands from infected Oligoryzomys longicaudatus and lethal cases of human HPS were investigated by bright field immunocytochemistry, multichannel immunofluorescence, and transmission electron microscopy. The findings are consistent with ANDV infection and replication in the lung alveolar epithelium and macrophages, and in the secretory cells of the submandibular salivary glands. In the lung of infected Oligoryzomys longicaudatus and human cases HPS, the bulk of immunoreactive hantavirus antigens was localized in epithelial cells of the alveolar walls and macrophages. The ultrastructural study supports that in the lung of HPS patients the virus replicates in the alveolar epithelial cells with virus particles being discharged into the alveolar lumen. Virus-like particles were seen within vacuoles of the lung macrophages. Considering that these macrophages can reach the conductive segments of the airways, their expectoration becomes a deadly bullet for ANDV transmission. In the submandibular glands of infected rodents and HPS cases, ANDV antigens were in capillary endothelium, the secretory cells and filling the lumen of the excretory pathway. It is proposed that in patients with HPS caused by ANDV the alveolar epithelium and macrophages would be the gate for the airway spreading of the virus, while the salivary glands are a target for virus replication and an exit pathway through saliva.
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Affiliation(s)
- Enrique Pizarro
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Maritza Navarrete
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.,Instituto de Microbiología Clínica, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.,Unidad Microbiología Clínica, Hospital Base Valdivia, Servicio de Salud Valdivia, Valdivia, Chile
| | - Carolina Mendez
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.,Instituto de Microbiología Clínica, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Luis Zaror
- Instituto de Microbiología Clínica, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Carlos Mansilla
- Unidad de Anatomía Patológica, Servicio de Salud Aysén, Hospital Regional de Coyhaique, Aysén, Chile
| | - Mauricio Tapia
- Unidad de Anatomía Patológica, Servicio de Salud Aysén, Hospital Regional de Coyhaique, Aysén, Chile
| | - Cristian Carrasco
- Subdepartamento Anatomía Patológica Hospital Base Valdivia Servicio de Salud Valdivia, Valdivia, Chile
| | - Paula Salazar
- Instituto de Microbiología Clínica, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Roberto Murua
- Instituto de Ecología y Evolución, Facultad de Ciencias, Universidad Austral de Chile, Valdivia, Chile
| | - Paula Padula
- Servicio Biología Molecular, Departamento de Virología, Instituto Nacional de Enfermedades Infecciosas, ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Carola Otth
- Instituto de Microbiología Clínica, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Esteban Martin Rodríguez
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
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Logue J, Crozier I, Jahrling PB, Kuhn JH. Post-exposure prophylactic vaccine candidates for the treatment of human Risk Group 4 pathogen infections. Expert Rev Vaccines 2020; 19:85-103. [PMID: 31937163 PMCID: PMC7011290 DOI: 10.1080/14760584.2020.1713756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/07/2020] [Indexed: 12/30/2022]
Abstract
Introduction: The development of therapeutics and vaccines to combat Risk Group 4 pathogens, which are associated with high case-fatality rates, is a high priority. Postexposure prophylactic vaccines have the potential to bridge classical therapeutic and vaccine applications, but little progress has been reported to date.Areas covered: This review provides an overview of postexposure prophylactic vaccine candidates against Risk Group 4 pathogens.Expert opinion: A few candidate postexposure prophylactic vaccines protect experimental animals infected with a few Risk Group 4 pathogens, such as filoviruses or hantaviruses, but the efficacy of candidate vaccines has not been similarly reported for most other high-consequence pathogens. A major drawback for the further development of existing candidates is the lack of understanding of their mechanisms of action, knowledge of which could help to identify focused paths forward in vaccine development and licensure. These drawbacks to further development ultimately slow progress toward postexposure prophylactic vaccine licensure.
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Affiliation(s)
- James Logue
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | - Ian Crozier
- Integrated Research Facility at Fort Detrick, Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA
| | - Peter B Jahrling
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
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Possibility of nosocomial person-to-person transmission of hemorrhagic fever with renal syndrome. Infect Control Hosp Epidemiol 2019; 40:1329-1331. [DOI: 10.1017/ice.2019.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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López R, Pérez-Araos R, Salazar Á, Ulloa AL, Vial C, Vial PA, Graf J. Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution. Viruses 2019; 11:v11100900. [PMID: 31569646 PMCID: PMC6832621 DOI: 10.3390/v11100900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 01/08/2023] Open
Abstract
Hantavirus cardiopulmonary syndrome (HCPS) is characterized by capillary leak, pulmonary edema (PE), and shock, which leads to death in up to 40% of patients. Treatment is supportive, including mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO). Hemodynamic monitoring is critical to titrate therapy and to decide ECMO support. Transpulmonary thermodilution (TPTD) provides hemodynamic and PE data that have not been systematically used to understand HCPS pathophysiology. We identified 11 HCPS patients monitored with TPTD: eight on MV, three required ECMO. We analyzed 133 measurements to describe the hemodynamic pattern and its association with PE. The main findings were reduced stroke volume, global ejection fraction (GEF), and preload parameters associated with increased extravascular lung water and pulmonary vascular permeability compatible with hypovolemia, myocardial dysfunction, and increased permeability PE. Lung water correlated positively with heart rate (HR, r = 0.20) and negatively with mean arterial pressure (r = −0.27) and GEF (r = −0.36), suggesting that PE is linked to hemodynamic impairment. Pulmonary vascular permeability correlated positively with HR (r = 0.31) and negatively with cardiac index (r = −0.49), end-diastolic volume (r = −0.48), and GEF (r = −0.40), suggesting that capillary leak contributes to hypovolemia and systolic dysfunction. In conclusion, TPTD data suggest that in HCPS patients, increased permeability leads to PE, hypovolemia, and circulatory impairment.
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Affiliation(s)
- René López
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago 7650567, Chile.
- Escuela de Medicina. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile.
| | - Rodrigo Pérez-Araos
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago 7650567, Chile.
- Escuela de Kinesiología. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile.
| | - Álvaro Salazar
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago 7650567, Chile.
| | - Ana L Ulloa
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago 7650567, Chile.
| | - Cecilia Vial
- Programa Hantavirus, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7590943, Chile.
| | - Pablo A Vial
- Escuela de Medicina. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile.
- Programa Hantavirus, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7590943, Chile.
- Departamento de Pediatría, Clínica Alemana de Santiago, Santiago 7650567, Chile.
| | - Jerónimo Graf
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago 7650567, Chile.
- Escuela de Medicina. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile.
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Schönrich G, Raftery MJ. Dendritic Cells (DCs) as "Fire Accelerants" of Hantaviral Pathogenesis. Viruses 2019; 11:v11090849. [PMID: 31540199 PMCID: PMC6783833 DOI: 10.3390/v11090849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 01/20/2023] Open
Abstract
Hantaviruses are widespread zoonotic pathogens found around the globe. Depending on their geographical location, hantaviruses can cause two human syndromes, haemorrhagic fever with renal syndrome (HFRS) or hantavirus pulmonary syndrome (HPS). HPS and HFRS have many commonalities amongst which excessive activation of immune cells is a prominent feature. Hantaviruses replicate in endothelial cells (ECs), the major battlefield of hantavirus-induced pathogenesis, without causing cytopathic effects. This indicates that a misdirected response of human immune cells to hantaviruses is causing damage. As dendritic cells (DCs) orchestrate antiviral immune responses, they are in the focus of research analysing hantavirus-induced immunopathogenesis. In this review, we discuss the interplay between hantaviruses and DCs and the immunological consequences thereof.
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Affiliation(s)
- Günther Schönrich
- Institute of Virology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany.
| | - Martin J Raftery
- Institute of Virology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
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Torres-Pérez F, Palma RE, Boric-Bargetto D, Vial C, Ferrés M, Vial PA, Martínez-Valdebenito C, Pavletic C, Parra A, Marquet PA, Mertz GJ. A 19 Year Analysis of Small Mammals Associated with Human Hantavirus Cases in Chile. Viruses 2019; 11:v11090848. [PMID: 31547341 PMCID: PMC6784195 DOI: 10.3390/v11090848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 12/13/2022] Open
Abstract
Small mammals present in areas where hantavirus cardiopulmonary syndrome (HCPS) cases had occurred in central and southern Chile were captured and analyzed to evaluate the abundance of rodents and seroprevalence rates of antibodies to Andes orthohantavirus (ANDV). Sampling areas ranged from the Coquimbo to Aysén regions (30–45° S approx.) regions. Ninety-two sites in peridomestic and countryside areas were evaluated in 19 years of sampling. An antibody against ANDV was detected by strip immunoassay in 58 of 1847 specimens captured using Sherman traps. Of the eleven species of rodents sampled, Abrothrix olivacea, Oligoryzomys longicaudatus and Abrothrix hirta were the most frequently trapped. O. longicaudatus had the highest seropositivity rate, and by logistic regression analysis, O. longicaudatus of at least 60 g had 80% or higher probability to be seropositive. Sex, age and wounds were significantly related to seropositivity only for O. longicaudatus. Across administrative regions, the highest seropositivity was found in the El Maule region (34.8–36.2° S), and the highest number of HCPS cases was registered in the Aysén region. Our results highlight the importance of long term and geographically extended studies, particularly for highly fluctuating pathogens and their reservoirs, to understand the implications of the dynamics and transmission of zoonotic diseases in human populations.
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Affiliation(s)
- Fernando Torres-Pérez
- Instituto de Biología, Pontificia Universidad Católica de Valparaíso, Valparaíso 2373223, Chile.
| | - R Eduardo Palma
- Laboratorio de Biología Evolutiva, Departamento de Ecología, Pontificia Universidad Católica de Chile; Santiago 8331150, Chile.
| | - Dusan Boric-Bargetto
- Instituto de Biología, Pontificia Universidad Católica de Valparaíso, Valparaíso 2373223, Chile.
| | - Cecilia Vial
- Programa Hantavirus, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago 7610658, Chile.
| | - Marcela Ferrés
- Laboratorio de Infectología y Virología Molecular, Red Salud UC-Christus, Departamento de Enfermedades Infecciosas e Inmunología Pediátricas, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.
| | - Pablo A Vial
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago 7610658, Chile.
| | - Constanza Martínez-Valdebenito
- Laboratorio de Infectología y Virología Molecular, Red Salud UC-Christus, Departamento de Enfermedades Infecciosas e Inmunología Pediátricas, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.
| | - Carlos Pavletic
- Oficina de Zoonosis y Control de Vectores, División de Políticas Publicas Saludables y Promoción, Subsecretaría de Salud Pública, Ministerio de Salud, Santiago 8320064, Chile.
| | - Alonso Parra
- Oficina de Zoonosis y Control de Vectores, División de Políticas Publicas Saludables y Promoción, Subsecretaría de Salud Pública, Ministerio de Salud, Santiago 8320064, Chile.
| | - Pablo A Marquet
- Departamento de Ecología, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile.
| | - Gregory J Mertz
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque 87131, New Mexico.
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