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Ulrich RG, Drewes S, Haring V, Panajotov J, Pfeffer M, Rubbenstroth D, Dreesman J, Beer M, Dobler G, Knauf S, Johne R, Böhmer MM. [Viral zoonoses in Germany: a One Health perspective]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:599-616. [PMID: 37261460 PMCID: PMC10233563 DOI: 10.1007/s00103-023-03709-0] [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: 02/15/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023]
Abstract
The COVID-19 pandemic and the increasing occurrence of monkeypox (mpox) diseases outside Africa have illustrated the vulnerability of populations to zoonotic pathogens. In addition, other viral zoonotic pathogens have gained importance in recent years.This review article addresses six notifiable viral zoonotic pathogens as examples to highlight the need for the One Health approach in order to understand the epidemiology of the diseases and to derive recommendations for action by the public health service. The importance of environmental factors, reservoirs, and vectors is emphasized, the diseases in livestock and wildlife are analyzed, and the occurrence and frequency of diseases in the population are described. The pathogens selected here differ in their reservoirs and the role of vectors for transmission, the impact of infections on farm animals, and the disease patterns observed in humans. In addition to zoonotic pathogens that have been known in Germany for a long time or were introduced recently, pathogens whose zoonotic potential has only lately been shown are also considered.For the pathogens discussed here, there are still large knowledge gaps regarding the transmission routes. Future One Health-based studies must contribute to the further elucidation of their transmission routes and the development of prevention measures. The holistic approach does not necessarily include a focus on viral pathogens/diseases, but also includes the question of the interaction of viral, bacterial, and other pathogens, including antibiotic resistance and host microbiomes.
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Affiliation(s)
- Rainer G Ulrich
- Institut für neue und neuartige Tierseuchenerreger, Friedrich-Loeffler-Institut, Bundesforschungsinstitut für Tiergesundheit, Südufer 10, 17493, Greifswald-Insel Riems, Deutschland.
| | - Stephan Drewes
- Institut für neue und neuartige Tierseuchenerreger, Friedrich-Loeffler-Institut, Bundesforschungsinstitut für Tiergesundheit, Südufer 10, 17493, Greifswald-Insel Riems, Deutschland
| | - Viola Haring
- Institut für neue und neuartige Tierseuchenerreger, Friedrich-Loeffler-Institut, Bundesforschungsinstitut für Tiergesundheit, Südufer 10, 17493, Greifswald-Insel Riems, Deutschland
| | - Jessica Panajotov
- Fachgruppe Viren in Lebensmitteln, Bundesinstitut für Risikobewertung, Berlin, Deutschland
| | - Martin Pfeffer
- Institut für Tierhygiene und Öffentliches Veterinärwesen, Universität Leipzig, Leipzig, Deutschland
| | - Dennis Rubbenstroth
- Institut für Virusdiagnostik, Friedrich-Loeffler-Institut, Bundesforschungsinstitut für Tiergesundheit, Greifswald-Insel Riems, Deutschland
| | | | - Martin Beer
- Institut für Virusdiagnostik, Friedrich-Loeffler-Institut, Bundesforschungsinstitut für Tiergesundheit, Greifswald-Insel Riems, Deutschland
| | - Gerhard Dobler
- Abteilung Virologie und Rickettsiologie, Institut für Mikrobiologie der Bundeswehr, München, Deutschland
| | - Sascha Knauf
- Institut für Internationale Tiergesundheit/One Health, Friedrich-Loeffler-Institut, Bundesforschungsinstitut für Tiergesundheit, Greifswald-Insel Riems, Deutschland
| | - Reimar Johne
- Fachgruppe Viren in Lebensmitteln, Bundesinstitut für Risikobewertung, Berlin, Deutschland
| | - Merle M Böhmer
- Landesinstitut Gesundheit II - Task Force Infektiologie, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), München, Deutschland
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto-von-Guericke Universität, Magdeburg, Deutschland
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Pet Rats as the Likely Reservoir for Human Seoul Orthohantavirus Infection. Viruses 2023; 15:v15020467. [PMID: 36851681 PMCID: PMC9962845 DOI: 10.3390/v15020467] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
Seoul orthohantavirus (SEOV) is a rat-associated zoonotic pathogen with an almost worldwide distribution. In 2019, the first autochthonous human case of SEOV-induced hemorrhagic fever with renal syndrome was reported in Germany, and a pet rat was identified as the source of the zoonotic infection. To further investigate the SEOV reservoir, additional rats from the patient and another owner, all of which were purchased from the same vendor, were tested. SEOV RNA and anti-SEOV antibodies were found in both of the patient's rats and in two of the three rats belonging to the other owner. The complete coding sequences of the small (S), medium (M), and large (L) segments obtained from one rat per owner exhibited a high sequence similarity to SEOV strains of breeder rat or human origin from the Netherlands, France, the USA, and Great Britain. Serological screening of 490 rats from breeding facilities and 563 wild rats from Germany (2007-2020) as well as 594 wild rats from the Netherlands (2013-2021) revealed 1 and 6 seropositive individuals, respectively. However, SEOV RNA was not detected in any of these animals. Increased surveillance of pet, breeder, and wild rats is needed to identify the origin of the SEOV strain in Europe and to develop measures to prevent transmission to the human population.
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Hofmann J, Kramer S, Herrlinger KR, Jeske K, Kuhns M, Weiss S, Ulrich RG, Krüger DH. Tula Virus as Causative Agent of Hantavirus Disease in Immunocompetent Person, Germany. Emerg Infect Dis 2021; 27:1234-1237. [PMID: 33754997 PMCID: PMC8007307 DOI: 10.3201/eid2704.203996] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report molecular evidence of Tula virus infection in an immunocompetent patient from Germany who had typical signs of hantavirus disease. Accumulating evidence indicates that Tula virus infection, although often considered nonpathogenic, represents a threat to human health.
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Reil D, Rosenfeld UM, Imholt C, Schmidt S, Ulrich RG, Eccard JA, Jacob J. Puumala hantavirus infections in bank vole populations: host and virus dynamics in Central Europe. BMC Ecol 2017; 17:9. [PMID: 28245831 PMCID: PMC5331674 DOI: 10.1186/s12898-017-0118-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 02/08/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In Europe, bank voles (Myodes glareolus) are widely distributed and can transmit Puumala virus (PUUV) to humans, which causes a mild to moderate form of haemorrhagic fever with renal syndrome, called nephropathia epidemica. Uncovering the link between host and virus dynamics can help to prevent human PUUV infections in the future. Bank voles were live trapped three times a year in 2010-2013 in three woodland plots in each of four regions in Germany. Bank vole population density was estimated and blood samples collected to detect PUUV specific antibodies. RESULTS We demonstrated that fluctuation of PUUV seroprevalence is dependent not only on multi-annual but also on seasonal dynamics of rodent host abundance. Moreover, PUUV infection might affect host fitness, because seropositive individuals survived better from spring to summer than uninfected bank voles. Individual space use was independent of PUUV infections. CONCLUSIONS Our study provides robust estimations of relevant patterns and processes of the dynamics of PUUV and its rodent host in Central Europe, which are highly important for the future development of predictive models for human hantavirus infection risk.
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Affiliation(s)
- Daniela Reil
- Institute for Plant Protection in Horticulture and Forests, Vertebrate Research, Julius Kühn-Institute, Toppheideweg 88, 48161 Muenster, Germany
- Institute of Biochemistry and Biology, Animal Ecology, University of Potsdam, Maulbeerallee 1, 14469 Potsdam, Germany
| | - Ulrike M. Rosenfeld
- Institute for Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Südufer 10, 17493 Greifswald-Insel Riems, Germany
| | - Christian Imholt
- Institute for Plant Protection in Horticulture and Forests, Vertebrate Research, Julius Kühn-Institute, Toppheideweg 88, 48161 Muenster, Germany
| | - Sabrina Schmidt
- Institute for Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Südufer 10, 17493 Greifswald-Insel Riems, Germany
| | - Rainer G. Ulrich
- Institute for Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Südufer 10, 17493 Greifswald-Insel Riems, Germany
| | - Jana A. Eccard
- Institute of Biochemistry and Biology, Animal Ecology, University of Potsdam, Maulbeerallee 1, 14469 Potsdam, Germany
| | - Jens Jacob
- Institute for Plant Protection in Horticulture and Forests, Vertebrate Research, Julius Kühn-Institute, Toppheideweg 88, 48161 Muenster, Germany
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Drewes S, Turni H, Rosenfeld UM, Obiegala A, Straková P, Imholt C, Glatthaar E, Dressel K, Pfeffer M, Jacob J, Wagner-Wiening C, Ulrich RG. Reservoir-Driven Heterogeneous Distribution of Recorded Human Puumala virus Cases in South-West Germany. Zoonoses Public Health 2016; 64:381-390. [PMID: 27918151 DOI: 10.1111/zph.12319] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Indexed: 01/19/2023]
Abstract
Endemic regions for Puumala virus (PUUV) are located in the most affected federal state Baden-Wuerttemberg, South-West Germany, where high numbers of notified human hantavirus disease cases have been occurring for a long time. The distribution of human cases in Baden-Wuerttemberg is, however, heterogeneous, with a high number of cases recorded during 2012 in four districts (H districts) but a low number or even no cases recorded in four other districts (L districts). Bank vole monitoring during 2012, following a beech (Fagus sylvatica) mast year, resulted in the trapping of 499 bank voles, the host of PUUV. Analyses indicated PUUV prevalences of 7-50% (serological) and 1.8-27.5% (molecular) in seven of eight districts, but an absence of PUUV in one L district. The PUUV prevalence differed significantly between bank voles in H and L districts. In the following year 2013, 161 bank voles were trapped, with reduced bank vole abundance in almost all investigated districts except one. In 2013, no PUUV infections were detected in voles from seven of eight districts. In conclusion, the linear modelling approach indicated that the heterogeneous distribution of human PUUV cases in South-West Germany was caused by different factors including the abundance of PUUV RNA-positive bank voles, as well as by the interaction of beech mast and the proportional coverage of beech and oak (Quercus spec.) forest per district. These results can aid developing local public health risk management measures and early warning models.
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Affiliation(s)
- S Drewes
- Friedrich-Loeffler-Institut, Institute for Novel and Emerging Infectious Diseases, Greifswald - Insel Riems, Germany
| | - H Turni
- Stauss & Turni Gutachterbüro, Tübingen, Germany
| | - U M Rosenfeld
- Friedrich-Loeffler-Institut, Institute for Novel and Emerging Infectious Diseases, Greifswald - Insel Riems, Germany
| | - A Obiegala
- Veterinärmedizinische Fakultät, Institut für Tierhygiene und Öffentliches Veterinärwesen, University Leipzig, Leipzig, Germany
| | - P Straková
- Friedrich-Loeffler-Institut, Institute for Novel and Emerging Infectious Diseases, Greifswald - Insel Riems, Germany.,Institute of Vertebrate Biology v.v.i., Academy of Sciences, Masaryk University, Brno, Czech Republic.,Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - C Imholt
- Julius Kühn-Institute, Federal Research Centre for Cultivated Plants, Institute for Plant Protection in Horticulture and Forests, Vertebrate Research, Münster, Germany
| | - E Glatthaar
- Forstzoologisches Institut, Arbeitsbereich Wildtierökologie und Wildtiermanagement, Universität Freiburg, Freiburg, Germany
| | - K Dressel
- sine-Institut gGmbH, Munich, Germany
| | - M Pfeffer
- Veterinärmedizinische Fakultät, Institut für Tierhygiene und Öffentliches Veterinärwesen, University Leipzig, Leipzig, Germany
| | - J Jacob
- Julius Kühn-Institute, Federal Research Centre for Cultivated Plants, Institute for Plant Protection in Horticulture and Forests, Vertebrate Research, Münster, Germany
| | - C Wagner-Wiening
- Landesgesundheitsamt Baden-Württemberg, Referat 95 - Epidemiologie und Gesundheitsberichterstattung, Sachgebietsleitung: Infektionsepidemiologische Meldesysteme (SG4), Stuttgart, Germany
| | - R G Ulrich
- Friedrich-Loeffler-Institut, Institute for Novel and Emerging Infectious Diseases, Greifswald - Insel Riems, Germany
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Wichtige, durch Vektoren übertragene Infektionskrankheiten beim Menschen in Deutschland. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57:557-67. [DOI: 10.1007/s00103-013-1925-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Faber M, Wollny T, Schlegel M, Wanka KM, Thiel J, Frank C, Rimek D, Ulrich RG, Stark K. Puumala virus outbreak in Western Thuringia, Germany, 2010: epidemiology and strain identification. Zoonoses Public Health 2013; 60:549-54. [PMID: 23398736 DOI: 10.1111/zph.12037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Indexed: 11/30/2022]
Abstract
In 2010, the highest annual number of human Puumala virus (PUUV) infections was reported in Germany since hantavirus surveillance started in 2001. The increase in annual case numbers was especially marked in western Thuringia. We combined results of case-based hantavirus surveillance in humans and serological and molecular investigations in the rodent reservoir to describe the epidemiological situation and to identify the putative outbreak strain. A 5-fold increase in notified hantavirus cases compared to the previous annual maximum was observed in western Thuringia in 2010. Disease incidence varied tremendously within a small geographical area with case patients' places of residence clustering around beech-dominated broad leaf forest patches. Investigations in the rodent reservoir revealed a novel Puumala virus (PUUV) subtype, which is clearly distinct from strains collected in other PUUV endemic regions of Germany. It can be assumed that in regions in western Thuringia where hantavirus cases occurred in 2010 or previous outbreak years, PUUV has been present in the environment for a long time. Further studies are needed to elucidate the population dynamics and hantavirus prevalence of the rodent reservoir and driving ecological factors.
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Affiliation(s)
- M Faber
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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[Systemic hantavirus-infection in a comatose HIV patient]. Wien Med Wochenschr 2013; 163:32-6. [PMID: 23341221 PMCID: PMC7100073 DOI: 10.1007/s10354-012-0143-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 09/19/2012] [Indexed: 12/04/2022]
Abstract
Klinik Ein 40 jähriger, desorientierter, HIV- und Hepatitis B positiver Patient wurde mit 40,3°C vorstellig. Es lag eine Sinustachykardie (160/min) mit arterieller Hypotonie (70/60 mmHg) vor. Untersuchungen Erhöhte Entzündungsparameter, Retentionsparameter, sowie Proteinurie, Thrombopenie. CD4+ T-Helferzahl: 320/µl (32 %), HIV RNA: < 40 Kopien/ml, Hepatitis B DNA: 20800 Kopien/ml. Hantavirus-Serologie (Immunfluoreszenz-Antikörper-Test): 1:2048; Serotyp Puumala. Verlauf Es wurde eine leitliniengerechte Sepsistherapie und Antibiose mit Piperacillin und Tazobactam eingeleitet. Bei respiratorischer Insuffizienz bei Acute Respiratory Distress Syndrome (ARDS ) mit bipulmonalem Infiltrat erfolgte die Intubation. Bei akutem intrarenalem Nierenversagen bei Aufnahme bestand keine Indikation zur Dialysebehandlung. Bei paralleler HIV Erkrankung und Hepatitis B wurde eine antiretrovirale Therapie begonnen. Bei Fieber, konjunktivalen und petechialen Einblutungen sowie subkutanen Einblutungen und Nierenversagen wurde eine Hantavirus-Infektion (Serotyp Puumala) festgestellt. Schlussfolgerung Anhand dieses Fallberichtes zeigt sich der potentiell fulminante Verlauf der Puumala Infektion. Dies ist untypisch für diese oft blande verlaufende Infektionskrankheit.
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Adesiyun A, Dookeran S, Stewart-Johnson A, Rahaman S, Bissessar S, Thompson N. Serological evidence of hantavirus infection in farm and abattoir workers in Trinidad--a preliminary study. J Agromedicine 2011; 16:194-9. [PMID: 21728870 DOI: 10.1080/1059924x.2011.581534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hantaviruses are established causative agents of hemorrhagic fevers and renal diseases amongst other clinical manifestations in humans, with most diagnosis based on serological assays. The disease, which is rodent-borne, has been reported in numerous countries worldwide but information about the disease is scanty in the Caribbean. The objective of this investigation is to determine the frequency of exposure to hantaviruses in a selected apparently healthy human population associated with abattoirs and livestock farms in Trinidad using a hantavirus immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA). Of a total of 236 individuals tested, 27 (11.4%) were seropositive for hantavirus infection. Amongst abattoir workers the frequency of infection was 9.4% (6 of 64) compared with seropositivity rate of 12.4% (18 of 145) and 11.1% (3 of 27) amongst livestock farm workers and office workers and other individuals with minimal animal contact respectively. The differences were, however, not statistically significant (p > .05; χ(2) test). Age, gender, and race did not significantly affect the infection rate by hantavirus in the workers studied. This is considered the first documented evidence of hantavirus infection in Trinidad and Tobago. It is imperative for local physicians to consider hantavirus as a differential diagnosis in patients with hemorrhagic fever and renal diseases, since there may be a number of undiagnosed cases of hantavirus disease in the human population in the country.
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Affiliation(s)
- Abiodun Adesiyun
- School of Veterinary Medicine, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago.
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Cytokine expression during early and late phase of acute Puumala hantavirus infection. BMC Immunol 2011; 12:65. [PMID: 22085404 PMCID: PMC3259039 DOI: 10.1186/1471-2172-12-65] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 11/16/2011] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hantaviruses of the family Bunyaviridae are emerging zoonotic pathogens which cause hemorrhagic fever with renal syndrome (HFRS) in the Old World and hantavirus pulmonary syndrome (HPS) in the New World. An immune-mediated pathogenesis is discussed for both syndromes. The aim of our study was to investigate cytokine expression during the course of acute Puumala hantavirus infection. RESULTS We retrospectively studied 64 patients hospitalised with acute Puumala hantavirus infection in 2010 during a hantavirus epidemic in Germany. Hantavirus infection was confirmed by positive anti-hantavirus IgG/IgM. Cytokine expression of IL-2, IL-5, IL-6, IL-8, IL-10, IFN-γ, TNF-α and TGF-β1 was analysed by ELISA during the early and late phase of acute hantavirus infection (average 6 and 12 days after onset of symptoms, respectively). A detailed description of the demographic and clinical presentation of severe hantavirus infection requiring hospitalization during the 2010 hantavirus epidemic in Germany is given. Acute hantavirus infection was characterized by significantly elevated levels of IL-2, IL-6, IL-8, TGF-β1 and TNF-α in both early and late phase compared to healthy controls. From early to late phase of disease, IL-6, IL-10 and TNF-α significantly decreased whereas TGF-β1 levels increased. Disease severity characterized by elevated creatinine and low platelet counts was correlated with high pro-inflammatory IL-6 and TNF-α but low immunosuppressive TGF-β1 levels and vice versa . CONCLUSION High expression of cytokines activating T-lymphocytes, monocytes and macrophages in the early phase of disease supports the hypothesis of an immune-mediated pathogenesis. In the late phase of disease, immunosuppressive TGF-β1 level increase significantly. We suggest that delayed induction of a protective immune mechanism to downregulate a massive early pro-inflammatory immune response might contribute to the pathologies characteristic of human hantavirus infection.
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Mertens M, Hofmann J, Petraityte-Burneikiene R, Ziller M, Sasnauskas K, Friedrich R, Niederstrasser O, Krüger DH, Groschup MH, Petri E, Werdermann S, Ulrich RG. Seroprevalence study in forestry workers of a non-endemic region in eastern Germany reveals infections by Tula and Dobrava-Belgrade hantaviruses. Med Microbiol Immunol 2011; 200:263-8. [PMID: 21611907 DOI: 10.1007/s00430-011-0203-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Indexed: 10/18/2022]
Abstract
Highly endemic and outbreak regions for human hantavirus infections are located in the southern, southeastern, and western parts of Germany. The dominant hantavirus is the bank vole transmitted Puumala virus (PUUV). In the eastern part of Germany, previous investigations revealed Tula virus (TULV) and Dobrava-Belgrade virus (DOBV) infections in the respective rodent reservoirs. Here, we describe a seroprevalence study in forestry workers from Brandenburg, eastern Germany, using IgG ELISA and immunoblot tests based on recombinant TULV, DOBV, and PUUV antigens. Out of the 563 sera tested, 499 from male and 64 from female workers, we found 41 out of the 499 (8.2%) sera from men (mean age 47 years) and 10 out of 64 (15.6%) from the women (mean age 48 years) anti-hantavirus-positive. The majority of the 51 seropositive samples reacted exclusively in the TULV (n=22) and DOBV tests (n=17). Focus reduction neutralization assay investigations on selected sera confirmed the presence of TULV- and DOBV-specific antibodies in the forestry workers. These investigations demonstrated a potential health threat for forestry workers and also the average population in non-endemic geographical regions where TULV and DOBV are circulating in the corresponding reservoir hosts. The infections in this region might be frequently overlooked due to their unspecific and mild symptoms.
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Affiliation(s)
- Marc Mertens
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, OIE Collaborating Centre for Zoonoses in Europe, Südufer 10, 17493 Greifswald-Insel Riems, Germany
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Mertens M, Kindler E, Emmerich P, Esser J, Wagner-Wiening C, Wölfel R, Petraityte-Burneikiene R, Schmidt-Chanasit J, Zvirbliene A, Groschup MH, Dobler G, Pfeffer M, Heckel G, Ulrich RG, Essbauer SS. Phylogenetic analysis of Puumala virus subtype Bavaria, characterization and diagnostic use of its recombinant nucleocapsid protein. Virus Genes 2011; 43:177-91. [PMID: 21598005 DOI: 10.1007/s11262-011-0620-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 05/05/2011] [Indexed: 10/18/2022]
Abstract
Puumala virus (PUUV) is the predominant hantavirus species in Germany causing large numbers of mild to moderate cases of haemorrhagic fever with renal syndrome (HFRS). During an outbreak in South-East Germany in 2004 a novel PUUV subtype designated Bavaria was identified as the causative agent of HFRS in humans [1]. Here we present a molecular characterization of this PUUV strain by investigating novel partial and almost entire nucleocapsid (N) protein-encoding small (S-) segment sequences and partial medium (M-) segment sequences from bank voles (Myodes glareolus) trapped in Lower Bavaria during 2004 and 2005. Phylogenetic analyses confirmed their classification as subtype Bavaria, which is further subdivided into four geographical clusters. The entire N protein, harbouring an amino-terminal hexahistidine tag, of the Bavarian strain was produced in yeast Saccharomyces cerevisiae and showed a slightly different reactivity with N-specific monoclonal antibodies, compared to the yeast-expressed N protein of the PUUV strain Vranica/Hällnäs. Endpoint titration of human sera from different parts of Germany and from Finland revealed only very slight differences in the diagnostic value of the different recombinant proteins. Based on the novel N antigen indirect and monoclonal antibody capture IgG-ELISAs were established. By using serum panels from Germany and Finland their validation demonstrated a high sensitivity and specificity. In summary, our investigations demonstrated the Bavarian PUUV strain to be genetically divergent from other PUUV strains and the potential of its N protein for diagnostic applications.
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Affiliation(s)
- Marc Mertens
- Institute for Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, 17493 Greifswald-Insel Riems, Germany
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Denecke B, Bigalke B, Haap M, Overkamp D, Lehnert H, Haas CS. Hantavirus infection: a neglected diagnosis in thrombocytopenia and fever? Mayo Clin Proc 2010; 85:1016-20. [PMID: 21037045 PMCID: PMC2966365 DOI: 10.4065/mcp.2009.0040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Thrombocytopenia, fever, and acute renal failure are characteristic features of nephropathia epidemica, the predominant hantavirus infection in Europe. However, clinical presentation and blood cell counts may point to other disorders, such as a hematologic disease, particularly when impairment of renal function is not evident. This differential diagnosis often results in further extensive and unnecessary testing. We describe 3 patients with hantavirus infection with no renal failure, in whom a hematologic disorder was initially suspected. Serologic testing of hantavirus finally unraveled the mystery, and outcome of the patients was excellent. It is conceivable that similar cases often remain undiagnosed. Thus, testing for hantavirus should always be considered in cases of thrombocytopenia and fever of unknown origin, especially in areas endemic for the infection.
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Affiliation(s)
| | | | | | | | | | - Christian S. Haas
- Individual reprints of this article are not available. Address correspondence to Christian S. Haas, MD, University Hospital Schleswig-Holstein, Campus Luebeck, Department of Medicine I, Ratzeburger Allee 160, 23538 Luebeck, Germany ()
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Mertens M, Essbauer SS, Rang A, Schröder J, Splettstoesser WD, Kretzschmar C, Krüger DH, Groschup MH, Mätz-Rensing K, Ulrich RG. Non-human primates in outdoor enclosures: risk for infection with rodent-borne hantaviruses. Vet Microbiol 2010; 147:420-5. [PMID: 20727685 DOI: 10.1016/j.vetmic.2010.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 07/13/2010] [Accepted: 07/16/2010] [Indexed: 02/03/2023]
Abstract
Different species of non-human primates have been exploited as animal disease models for human hantavirus infections. To study the potential risk of natural hantavirus infection of non-human primates, we investigated serum samples from non-human primates of three species living in outdoor enclosures of the German Primate Center (GPC), Göttingen, located in a hantavirus endemic region of central Germany. For that purpose we used serological assays based on recombinant antigens of the bank vole (Myodes glareolus) transmitted Puumala virus (PUUV) and the common and field vole (Microtus arvalis, Microtus agrestis) associated Tula virus (TULV) which are both broadly geographically distributed in Germany. In 24 out of 251 (9.6%) monkey sera collected in 2006 PUUV- and/or TULV-reactive immunoglobulin G (IgG) antibodies were detected. Investigation of follow-up sera from 13 animals confirmed for two animals a seroconversion due to hantavirus exposure at the GPC. To prove the origin of the infection, wild rodents from the surrounding regions were analyzed by hantavirus-specific reverse transcriptase-PCR analysis. In 6 of the 73 investigated bank voles and 3 of the 19 investigated Microtus spp. PUUV- and TULV-specific nucleic acid sequences, respectively, were detected. In conclusion, our investigations demonstrate for the first time natural infections of non-human primates in outdoor enclosures in Germany. These findings highlight the importance of hantavirus surveillance in those primate housings and corresponding preventive measures against wild rodents, particularly in hantavirus endemic regions.
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Affiliation(s)
- M Mertens
- Friedrich-Loeffler-Institut, Institute for Novel and Emerging Infectious Diseases, Greifswald-Insel Riems, Germany
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Braun N, Haap M, Overkamp D, Kimmel M, Alscher MD, Lehnert H, Haas CS. Characterization and outcome following Puumala virus infection: a retrospective analysis of 75 cases. Nephrol Dial Transplant 2010; 25:2997-3003. [PMID: 20223893 DOI: 10.1093/ndt/gfq118] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Infection with the Puumala virus (PUUV), which belongs to the Hantavirus family, is a common but often neglected cause of acute kidney injury (AKI) in endemic areas of Europe. The objective of the present study was to systematically analyse clinical presentation and renal outcomes following PUUV infection. METHODS In a retrospective study, we analysed data from 75 patients who were admitted to two large hospitals in Germany over an 8-year period and who tested positive for PUUV infection. Clinical and laboratory data were collected from patient files; creatinine levels before admission and during follow-up were obtained from phone calls. RESULTS Patients were between 16 and 82 years old (average +/- SD, 40.4 +/- 13.4) with a male to female ratio of 2.5:1. They showed a wide variety of clinical presentations with renal failure being the cause of admission in only 50%. AKI developed in 95% of patients who showed maximum creatinine levels of 4.3 +/- 0.3 mg/dl. Four patients required temporary dialysis, and one patient died from pulmonary complications. Thrombocytopaenia (137 +/- 11 x 10(3)/microl) was present in almost all cases, and elevated levels of lactate dehydrogenase (LDH) and C-reactive protein (CRP) were observed in 57 and 100% of patients, respectively. Urinalysis revealed mild to nephrotic proteinuria in 85%, which was often associated with haemoglobinuria. All patients showed full recovery of renal function and return to pre-existing normal serum creatinine levels. CONCLUSION In a majority of cases, PUUV infection results in thrombocytopenic AKI. Fever is a requirement for diagnosis, while elevated LDH and CRP values are also frequently observed. Overall, early renal outcomes were excellent.
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Affiliation(s)
- Niko Braun
- Department of Internal Medicine IV, Division of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
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Abstract
To examine the host association of Tula virus (TULV), a hantavirus present in large parts of Europe, we investigated a total of 791 rodents representing 469 Microtus arvalis and 322 Microtus agrestis animals from northeast, northwest, and southeast Germany, including geographical regions with sympatric occurrence of both vole species, for the presence of TULV infections. Based on serological investigation, reverse transcriptase PCR, and subsequent sequence analysis of partial small (S) and medium (M) segments, we herein show that TULV is carried not only by its commonly known host M. arvalis but also frequently by M. agrestis in different regions of Germany for a prolonged time period. At one trapping site, TULV was exclusively detected in M. agrestis, suggesting an isolated transmission cycle in this rodent reservoir separate from spillover infections of TULV-carrying M. arvalis. Phylogenetic analysis of the S and M segment sequences demonstrated geographical clustering of the TULV sequences irrespective of the host, M. arvalis or M. agrestis. The novel TULV lineages from northeast, northwest, and southeast Germany described here are clearly separated from each other and from other German, European, or Asian lineages, suggesting their stable geographical localization and fast sequence evolution. In conclusion, these results demonstrate that TULV represents a promiscuous hantavirus with a large panel of susceptible hosts. In addition, this may suggest an alternative evolution mode, other than a strict coevolution, for this virus in its Microtus hosts, which should be proven in further large-scale investigations on sympatric Microtus hosts.
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A serosurvey reveals Bosnia and Herzegovina as a Europe's hotspot in hantavirus seroprevalence. Epidemiol Infect 2009; 138:1185-93. [DOI: 10.1017/s0950268809991348] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
SUMMARYThe extent of hantavirus seroprevalence in the healthy population from Bosnia and Herzegovina has not yet been investigated; therefore, the aim of this study was to assess the hantavirus seroprevalence in the population from different regions of Bosnia and Herzegovina and in different risk groups. The serosurvey included 1331 subjects from endemic and non-endemic regions in Bosnia and Herzegovina. All sera samples were examined using IgG ELISA, and Western blot (Bunyavirus IgG) tests. Hantavirus seroprevalence was 7·4% in the endemic region and 2·4% in the non-endemic region (P<0·05). Former soldiers from the endemic region had significantly the highest seroprevalence (16·1%) compared to the general population from the endemic region (6·2%), the occupational risk group from the non-endemic region (5·6%) and the general population from the non-endemic region (0·8%) (P<0·01). No difference in hantavirus seroprevalence between gender or age groups was observed. Hantavirus seroprevalence in different populations in Bosnia and Herzegovina was found to be highest compared to other central European countries.
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Abstract
In Baden-Wuerttemberg, a federal state in south-west Germany, a large outbreak of 1089 laboratory-confirmed human Puumala virus (PUUV) infections occurred in 2007. We conducted a survey to describe the disease burden and a case-control study to identify risk factors for acquiring PUUV. Case-patients were interviewed about clinical outcome and both case-patients and randomly recruited controls were interviewed about exposure. We calculated matched odds ratios (mOR) using a conditional logistic regression model. Multivariable analysis of 191 matched case-control pairs showed that case-patients were more likely than controls to have seen small rodents/their droppings (mOR 1.9, 95% CI 1.2-3.0), cleaned utility rooms (mOR 1.8, 95% CI 1.0-3.4) and visited forest shelters (mOR 3.9, 95% CI 1.1-14.3). Two thirds of case-patients required hospitalization. During PUUV epidemics rodent control measures and use of protective equipment should be considered in utility rooms and shelters.
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Ulrich RG, Heckel G, Pelz HJ, Wieler LH, Nordhoff M, Dobler G, Freise J, Matuschka FR, Jacob J, Schmidt-Chanasit J, Gerstengarbe FW, Jäkel T, Süss J, Ehlers B, Nitsche A, Kallies R, Johne R, Günther S, Henning K, Grunow R, Wenk M, Maul LC, Hunfeld KP, Wölfel R, Schares G, Scholz HC, Brockmann SO, Pfeffer M, Essbauer SS. Nagetiere und Nagetierassoziierte Krankheitserreger. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2009; 52:352-69. [DOI: 10.1007/s00103-009-0798-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Seroepidemiological study in a Puumala virus outbreak area in South-East Germany. Med Microbiol Immunol 2009; 198:83-91. [PMID: 19148676 DOI: 10.1007/s00430-009-0106-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Indexed: 10/21/2022]
Abstract
Puumala virus (PUUV) is the cause of the majority of haemorrhagic fever with renal syndrome cases in Germany. In 2004, a nephropathia epidemica outbreak was recorded in Lower Bavaria, South-East Germany. For a seroepidemiological study in this region including the resident population at four locations (n = 178) and soldiers from one location (n = 208) indirect immunoglobulin M (IgM) and immunoglobulin G (IgG) enzyme-linked immunosorbent assays (ELISAs) and immunoblot tests based on a yeast-expressed PUUV nucleocapsid protein were established. The validation using human serum panels originating from Germany revealed a diagnostic sensitivity and specificity of 98/100% for the IgM ELISA, 99/99% for the IgG ELISA, 99/100% for the IgM immunoblot test and 100/96% for the IgG immunoblot test. Using the novel IgG assays as well as a commercial IgG ELISA and an immunofluorescence assay for the resident population an average prevalence of 6.7% (12 of 178) with a range of 0% (0 of 21) to 11.9% (7 of 59) was observed. Positive serological results were equally distributed between males and females with an average age of 63 for males and 52 for females. The seroprevalence in the soldier group was found to be about 1% with one positive male of 203 (age 46 years) and one positive female of five (age 47 years). In conclusion, the PUUV seroprevalence in the residents of the outbreak region in Lower Bavaria was found to be up to fivefold higher than the average hantavirus seroprevalence of the German population.
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Piechotowski I, Brockmann SO, Schwarz C, Winter CH, Ranft U, Pfaff G. Emergence of hantavirus in South Germany: rodents, climate and human infections. Parasitol Res 2008; 103 Suppl 1:S131-7. [PMID: 19030895 DOI: 10.1007/s00436-008-1055-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 05/26/2008] [Indexed: 11/30/2022]
Abstract
Human hantavirus (serotype Puumala) infections are prevalent throughout Europe. The bank vole is the main reservoir of the Puumala virus (PUUV). Between 2001 and 2006, the annual incidences in Germany ranged from 0.1 to 0.5 per 100,000 inhabitants. About half of the cases were reported from the state of Baden-Württemberg (BW) in southwest Germany. In 2007, 1,089 PUUV infections were reported from BW. This reflects an incidence of 10.1:100,000, which is more than 11 times higher than the mean incidence of the previous 6 years. Spatial analysis highlights incidences up to 90:100,000 in the most affected district. The winter season 2006/2007 showed an all time high in reported mean temperature. The previous summer and autumn led to a beech mast year, resulting in favourable feed conditions for bank voles in the winter season 2006/2007. The causes of the observed increase in PUUV infections in 2007 cannot be restricted to known cycles in the bank vole population. Favourable feed conditions, a mild winter and an early onset of spring may have influenced bank vole population size as well as human exposure to infectious rodent excretions. Further epidemiologic studies are necessary to better understand the interaction between environmental factors, occurrence of Puumala virus in bank voles and the risk for human disease.
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Affiliation(s)
- Isolde Piechotowski
- Baden-Württemberg State Health Office (Landesgesundheitsamt Baden-Württemberg), District of Stuttgart Government, Stuttgart, Germany
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Network "Rodent-borne pathogens" in Germany: longitudinal studies on the geographical distribution and prevalence of hantavirus infections. Parasitol Res 2008; 103 Suppl 1:S121-9. [PMID: 19030894 DOI: 10.1007/s00436-008-1054-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 05/26/2008] [Indexed: 12/29/2022]
Abstract
Hantavirus infections are known in Germany since the 1980s. While the overall antibody prevalence against hantaviruses in the general human population was estimated to be about 1-2%, an average of 100-200 clinical cases are recorded annually. In the years 2005 and 2007 in particular, a large increase of the number of human hantavirus infections in Germany was observed. The most affected regions were located in the federal states of Baden-Wuerttemberg, Bavaria, North Rhine Westphalia, and Lower Saxony. In contrast to the well-documented situation in humans, the knowledge of the geographical distribution and frequency of hantavirus infections in their rodent reservoirs as well as any changes thereof was very limited. Hence, the network "Rodent-borne pathogens" was established in Germany allowing synergistic investigations of the rodent population dynamics, the prevalence and evolution of hantaviruses and other rodent-associated pathogens as well as their underlying mechanisms in order to understand their impact on the frequency of human infections. A monitoring of hantaviruses in rodents from endemic regions (Baden-Wuerttemberg, Bavaria, North Rhine Westphalia, Lower Saxony) and regions with a low number of human cases (Mecklenburg Western-Pomerania, Brandenburg, Saxony, Saxony-Anhalt) was initiated. Within outbreak regions, a high prevalence of Puumala virus (PUUV) was detected in bank voles. Initial longitudinal studies in North Rhine Westphalia (city of Cologne), Bavaria (Lower Bavaria), and Lower Saxony (rural region close to Osnabrück) demonstrated a continuing presence of PUUV in the bank vole populations. These longitudinal studies will allow conclusions about the evolution of hantaviruses and other rodent-borne pathogens and changes in their distribution, which can be used for a risk assessment of human infections. This may become very important in order to evaluate changes in the epidemiology of rodent-borne pathogens in the light of expected global climate changes in the future.
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Unterer Respirationstrakt. KLINISCHE INFEKTIOLOGIE 2008. [PMCID: PMC7152301 DOI: 10.1016/b978-343721741-8.50016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Meier M, Helmchen U, Fricke L, Ulrich R, Schütt M. Acute hantavirus infection or renal transplant rejection. Transpl Infect Dis 2007; 9:225-8. [PMID: 17692069 DOI: 10.1111/j.1399-3062.2006.00193.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hantaviruses belong to the so-called emerging pathogens that are transmitted to humans by infected rodents and their excreta. In Central Europe, hantavirus infections usually occur in a mild to moderate form of hemorrhagic fever with renal syndrome. In contrast to the mostly benign or even asymptomatic course of hantavirus infections in previously healthy individuals, the acute hantavirus infection in kidney transplant recipients represents an exceptional situation regarding diagnosis and therapy. We describe the case of a 44-year-old kidney transplant recipient with acute renal transplant failure associated with acute hantavirus infection.
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Affiliation(s)
- M Meier
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany.
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Abstract
Emerging viral infections are becoming a serious problem in Europe in the recent years. This is particularly true for severe acute respiratory syndrome (SARS), West Nile virus (WNV) disease, Toscana virus (TOSV) disease, and potentially for avian influenza virus (H5N1). In contrast, emergence or re-emergence of severe viral infections, including tick borne encephalitis virus, and viral haemorrhagic fever caused by Hantavirus and dengue virus have been frequently reported in several European countries. Laboratory diagnosis of these viral infections based on viral isolation or detection by immune electron microscopy, immunoassay and polymerase chain reaction (PCR) has dramatically improved in the recent years, and SARS represents a good example of a diagnostic approach to emerging viral infections. Finally, old and new promising agents are in the pipeline of pharmaceutical companies to treat emerging viral infections. However only prevention based on large epidemiological studies, and research and development of new vaccines may be able to control and eventually eradicate these deadly viral infections.
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Affiliation(s)
- Agostino Pugliese
- Department of Medical and Surgical Sciences, Section of Clinical Microbiology of Turin University, Amedeo di Savoia Hospital, Turin, Italy.
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Essbauer S, Schmidt J, Conraths FJ, Friedrich R, Koch J, Hautmann W, Pfeffer M, Wölfel R, Finke J, Dobler G, Ulrich R. A new Puumala hantavirus subtype in rodents associated with an outbreak of Nephropathia epidemica in South-East Germany in 2004. Epidemiol Infect 2006; 134:1333-44. [PMID: 16650330 PMCID: PMC2870504 DOI: 10.1017/s0950268806006170] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2006] [Indexed: 11/07/2022] Open
Abstract
A micro-epidemic of hantavirus infections occurred in Lower Bavaria, South-East Germany, starting in April 2004. While only three cases were registered from 2001 to 2003, a dramatically increased number of clinically apparent human hantavirus infections (n=38) was observed in 2004, plus seven additional cases by June 2005. To determine the reservoir responsible for the infections, a total of 43 rodents were trapped in Lower Bavaria. Serological and genetic investigations revealed that Puumala virus (PUUV) is dominant in the local population of bank voles. Partial PUUV S segment nucleotide sequences originating from bank voles at four different trapping sites in Lower Bavaria showed a low divergence (up to 3.1%). This is contrasted by a nucleotide sequence divergence of 14-16% to PUUV strains detected in Belgium, France, Slovakia or North-Western Germany. PUUV sequences from bank voles in Lower Bavaria represent a new PUUV subtype which seems to be responsible for the observed increase of human hantavirus infections in 2004-2005.
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Affiliation(s)
- S Essbauer
- Bundeswehr Institute of Microbiology, Munich, Germany.
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