Seroprevalence of West Nile Virus in Iran

Medically Significant Vector-Borne Viral Diseases in Iran

Vector-borne viral diseases (VBVDs) continue to pose a considerable public health risk to animals and humans globally. Vectors have integral roles in autochthonous circulation and dissemination of VBVDs worldwide. The interplay of agricultural activities, population expansion, urbanization, host/pathogen evolution, and climate change, all contribute to the continual flux in shaping the epidemiology of VBVDs. In recent decades, VBVDs, once endemic to particular countries, have expanded into new regions such as Iran and its neighbors, increasing the risk of outbreaks and other public health concerns. Both Iran and its neighboring countries are known to host a number of VBVDs that are endemic to these countries or newly circulating. The proximity of Iran to countries hosting regional diseases, along with increased global socioeconomic activities, e.g., international trade and travel, potentially increases the risk for introduction of new VBVDs into Iran. In this review, we examined the epidemiology of numerous VBVDs circulating in Iran, such as Chikungunya virus, Dengue virus, Sindbis virus, West Nile virus, Crimean-Congo hemorrhagic fever virus, Sandfly-borne phleboviruses, and Hantavirus, in relation to their vectors, specifically mosquitoes, ticks, sandflies, and rodents. In addition, we discussed the interplay of factors, e.g., urbanization and climate change on VBVD dissemination patterns and the consequent public health risks in Iran, highlighting the importance of a One Health approach to further surveil and to evolve mitigation strategies.

"Acute Bilateral Neuroretinitis and Panuveitis in A Patient with Coronavirus Disease 2019: A Case Report"- Few Comments

During the Coronavirus Disease 2019 (COVID-19) pandemic, we have witnessed increase in number of reports of a known uveitic entity being associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Causal relation is yet to be proven for many reports. Perhaps, occurrence of a previously known region-specific endemic disease or closely resembling manifestations of a known disease in a non-endemic region during the COVID-19 pandemic might suggest a causal relationship. Epidemic retinitis (ER) or post fever retinitis is such condition with geographic variation. Occurrence of ER or ER-like manifestations in a non-endemic country during the pandemic should instigate further studies to consider SARS-CoV-2 as a causative organism.

Species Variety of the Calf and Human-Attracted Mosquitoes in Southwest Iran

Background:

Any mosquito control methods requires precise information about population dynamics, variety, biology and mosquito habitat. This research assessed Culicid mosquitoes’ attraction to a human host and a calf to better understand their behavior.

Methods:

Adult mosquitoes were sampled in 22 weeks in southwestern Iran’s Nur Ali Village from May to October 2015. The mosquitoes were drawn to the person and calf as bait, while the unbaited trap was also used. A substantial statistical difference between attracted mosquitoes to the hosts was determined in the T-test.

Results:

Within 22 weeks, 29821 mosquitoes were captured. Only 9% were collected from the human baited net trap, 89.1% from the calf baited net trap, and 1.9% from the unbaited net trap. The number of collected female mosquitoes was statistically significantly higher using the calf baited net trap of the total mosquitoes, 916 were randomly identified at the species level by local identification keys. Of these, 63 were Anopheles stephensi (human: 16%, calf: 75% and unbaited: 9%), 83 An. pulcherrimus (human: 27%, calf: 60% and unbaited: 13%), 118 Aedes caspius (human: 24%, calf: 69% and unbaited: 7%), 493 Culex tritaeniorhynchus (human: 52%, calf: 37% and unbaited: 11%), 153 Cx. quinquefasciatus (human: 44%, calf: 47% and unbaited: 9%), and 6 Cx. theileri (human: 33%, calf: 50% and unbaited: 17%).

Conclusion:

The obtained results here provide useful insights into the mosquito population and the possibility of using this information as an essential part of integrated vector management regarding the reemergence of malaria or other mosquito-borne.

The seroepidemiology and risk factors of West Nile virus infection in blood donors of Fars province, southwest of Iran

Aim: To evaluate the frequency of West Nile virus (WNV) in blood donors of the blood transfusion center of Fars province, Iran. Materials & methods: A total of 337 participants referred for blood donation to Fars blood centers were included. The presence of anti-WNV antibodies was analyzed using the WNV IgG ELISA kit. Results: Out of all participants, 76 (22.6%) were positive for anti-WNV IgG antibodies. Our results also showed that the frequency of WNV was associated with the age, educational level, job and city of residency of participants (p < 0.05). Conclusion: The results indicated the high frequency of WNV seropositivity among blood donors in southwest Iran. Accordingly, there is an urgent need to establish an integrated surveillance system for monitoring WNV infection in Iran.

Evidence of West Nile Virus Circulation in Lebanon

West Nile virus (WNV) has never been reported from Lebanon. Yet, this country is located on the flyway of migratory birds in the Middle East region. Serological screening was conducted to assess the potential circulation of this virus. Human, horse, and chicken sera were collected from the Bekaa and North districts. Specific IgG and IgY were first screened by ELISA. Then, positive samples were confirmed by plaque reduction neutralization test (PRNT). Besides this, adult mosquitoes were collected and tested for the presence of WNV RNA using conventional RT-PCR. Sera screening revealed a seroprevalence rate reaching 1.86% among humans and 2.47% among horses. Cross-reactions revealed by ELISA suggested the circulation of flaviviruses other than WNV. None of the tested mosquitoes was positive for WNV. The observed results constitute strong evidence of local exposure of the Lebanese population to this virus and the first report of equine WNV in Lebanon.

Vector-borne diseases in Iran: epidemiology and key challenges

Vector-borne diseases have become a global health concern in recent decades as a result of global warming, globalization, growth in international trade and travel, use of insecticide and drug resistance. This review study addressed the key vector-borne diseases and their current status in Iran to emphasize the requirements for further research on vector-borne diseases. The dispersion patterns of these diseases differ in various regions. Some of them such as Crimean-Congo hemorrhagic fever, and Q fever are distributed all across Iran, whereas some others such as plague, leishmaniasis, tularemia, and malaria are restricted to specific areas. The high prevalence of vectors throughout the country necessitates enhancing the monitoring and surveillance of emerging and reemerging vector-borne diseases and their potential vectors.

Autochthonous Transmission of West Nile Virus by a New Vector in Iran, Vector-Host Interaction Modeling and Virulence Gene Determinants

Using molecular techniques and bioinformatics tools, we studied the vector-host interactions and the molecular epidemiology of West Nile virus (WNV) in western Iran. Mosquitoes were collected during 2017 and 2018. DNA typing assays were used to study vector-host interactions. Mosquitoes were screened by RT-PCR for the genomes of five virus families. WNV-positive samples were fully sequenced and evolutionary tree and molecular architecture were constructed by Geneious software and SWISS-MODEL workspace, respectively. A total of 5028 mosquito specimens were collected and identified. The most prevalent species was Culex (Cx.) pipiens complex (57.3%). Analysis of the blood-feeding preferences of blood-fed mosquitoes revealed six mammalian and one bird species as hosts. One mosquito pool containing non-blood-fed Cx. theileri and one blood-fed Culex pipiens pipiens (Cpp.) biotype pipiens were positive for WNV. A phylogram indicated that the obtained WNV sequences belonged to lineage 2, subclade 2 g. Several amino acid substitutions suspected as virulence markers were observed in the Iranian WNV strains. The three-dimensional structural homology model of the E-protein identified hot spot domains known to facilitate virus invasion and neurotropism. The recent detection of WNV lineage 2 in mosquitoes from several regions of Iran in consecutive years suggests that the virus is established in the country.

Serosurvey of West Nile virus in horses and detection of West Nile virus antigen in mosquitoes in Kaduna State, Nigeria

West Nile virus (WNV) causes a mosquito-borne zoonotic disease of public health importance. The aim of this study was to determine the state of WNV infection in horses and detect the virus antigen in mosquitoes trapped in stables in Kaduna State Nigeria. The study was carried out in Kaduna State, Nigeria, and 368 horses were screened for the presence of antibodies against WNV using an IgG competitive enzyme-linked immunosorbent assay. Of the 368 samples tested, 331 (89.9%) were positive for WNV antibodies. Mosquitoes from the stables were tested for WNV antigen using a VectorTest kit, and of the 31 pools of adult mosquitoes tested, only 5 (16.1%) pools tested positive for WNV antigen. This finding showed that WNV infection has occurred in horses and that there is evidence of circulation of the virus by mosquitoes in Kaduna State, Nigeria.

Serological evidence of West Nile virus infection among birds and horses in some geographical locations of Iran

Recent expansion of arboviruses such as West Nile (WNV), Usutu (USUV), and tick‐borne encephalitis (TBEV) over their natural range of distribution needs strengthening their surveillance. As common viral vertebrate hosts, birds and horses deserve special attention with routine serological surveillance. Here, we estimated the seroprevalence of WNV, USUV and TBEV in 160 migrating/resident birds and 60 horses sampled in Mazandaran, Golestan, North Khorasan, Kordestan provinces and Golestan province of Iran respectively. ELISA results showed that of 220 collected samples, 32 samples (14.54%), including 22 birds and 10 horses, were positive. Microsphere immunoassay results showed that 16.7% (10/60) of horse blood samples collected in Golestan province were seropositive against WNV (7; 11.7%), Flavivirus (2; 3.3%) and seropositive for USUV or WNV (1; 1.7%). Furthermore, micro virus neutralization tests revealed that four of seven ELISA‐positive bird blood samples were seropositive against WNV: two Egyptian vultures, and one long‐legged buzzard collected in Golestan province as well as a golden eagle collected in North Khorasan province. No evidence of seropositivity with TBEV was observed in collected samples. We showed that WNV, responsible for neuroinvasive infection in vertebrates, is circulating among birds and horses in Iran, recommending a sustained surveillance of viral infections in animals, and anticipating future infections in humans.

Morphological and molecular identification of Culicidae mosquitoes (Diptera: Culicidae) in Lorestan province, Western Iran

Culicidae mosquitoes are main vectors of arboviruses that cause arboviral diseases in humans. Studies on fauna, ecology, biology, resting behaviors of Culicidae mosquitoes are important and greatly impacts the control of arboviral diseases that are transmitted by vectors. The aim of the present study was to determine fauna of mosquitoes (Diptera: Culicidae) based on morphological and molecular (genomic) identification and their habitats in Lorestan province, Western Iran. Meanwhile mosquito samples were examined for arbovirus infection.

Culicidae mosquitoes were caught in 2015 and 2016 from human homes, animal dwellings, storehouses and pit shelters in Lorestan province, Western Iran, using an oral aspirator (hand catch), total catch, human and animal bait and light trap methods. The samples were identified on the genus and species. Six species of Culex and eight species of Anopheles were caught. One complex species (Cx. pipiens complex) and a hybrid between Cx. pipiens pipiens biotype pipiens and Cx. pipiens pipiens biotype molestus were identified. Among all of the trapped mosquitoes (4211), 94.68% were from genus Culex mosquitoes (3987), which indicate that this genus is the dominant in Lorestan province, Western Iran. Anopheles comprised of 201 individuals out of the total catch. Arboviruses were not detected in these samples.

Seroprevalence Study on West Nile Virus (WNV) Infection, a Hidden Viral Disease in Fars Province, Southern Iran

Background:

West Nile Virus, a mosquito-borne flavivirus, causes a variety of symptoms in human, from asymptomatic infection to neuroinvasive disease. Several studies have been conducted on the seroprevalence of WNV infection in different areas from Iran. This study was performed to find the presence of antiviral antibodies in human serum among some high risk population and awareness of health care staff about symptom of the WNV infection.

Methods:

Study performed in five geographical districts based on high population of immigrant and domestic birds and prevalence of the antiviral antibodies in horses which was reported previously. Totally 150 human blood samples were collected during 2018. The samples collected from patients referred to the clinics. The ELISA method used to detect IgG and IgM antibody against WNV. Logistic regression models used to analyze the effect of sex, age, keeping birds and urban/rural residence on the risk of infection. The awareness of health care staff about symptom of infection surveyed.

Results:

From all blood donors, 41 samples (27.33%) showed positive to IgG antibody. From which 56.10% were males and remaining females. None of the mentioned factors had a significant relationship. Health care staff had less attention to the infection.

Conclusion:

Although the prevalence of antibodies was relatively high, due to the similarity to other viral diseases, health care staff had less attention to the disease. The study showed that people in these areas have been exposed to the virus. Further research activities are recommended for control of this arbovirus.

Detection of arboviruses in mosquitoes: Evidence of circulation of chikungunya virus in Iran

Mosquitoes are vectors of viruses affecting animal and human health. In Iran, the prevalence of mosquito-borne viruses remains poorly investigated. Once infected, mosquito females remain infected for all their life making virus detections possible at early steps before infections are reported in vertebrate hosts. In this study, we used a recently developed high-throughput chip based on the BioMark Dynamic arrays system capable of detecting 37 arboviruses in a single experiment. A total of 1,212 mosquitoes collected in Mazandaran, North-Khorasan, and Fars provinces of Iran were analyzed. Eighteen species were identified, belonging to five genera; the most prevalent species were Anopheles maculipennis s.l. (42.41%), Culex pipiens (19.39%), An. superpictus (11.72%), and Cx. tritaeniorhynchus (10.64%). We detected chikungunya virus (CHIKV) of the Asian genotype in six mosquito pools collected in North Khorasan and Mazandaran provinces. To our knowledge, this is the first report of mosquitoes infected with CHIKV in Iran. Our high-throughput screening method can be proposed as a novel epidemiological surveillance tool to identify circulating arboviruses and to support preparedness to an epidemic in animals and humans.

Seropositivity of Chikungunya and West Nile Viruses in Iranian Children in 2018

Background: Several surveys have been conducted on the seroprevalence of viral infections caused by Chikungunya and West Nile viruses in humans. However, there is a paucity of studies on the seroprevalence and spread of these viruses in children. Objectives: We aimed to investigate the seropositivity of IgG antibodies against Chikungunya and West Nile viruses in a group of Iranian children aged one month to 14 years. Methods: A cross-sectional study was performed on blood samples collected from children aged one month to 14 years in Tehran who attended the outpatient clinics of a children’s hospital from March to December 2018. The serum IgG levels against Chikungunya and West Nile viruses were assessed using the ELISA technique. Results: Of 180 serum samples assessed for positivity, four (three from boys and one from girls) had positive IgG for Chikungunya and 11 (seven from boys and four from girls) had positive IgG for West Nile, causing overall seropositivity of 2.2% and 6.1% for Chikungunya and West Nile infections, respectively. Moreover, Chikungunya and West Nile viruses showed no significant association between seropositivity and sex. High seropositivity was observed predominantly in the age groups of below two years and over 10 years in Chikungunya and West Nile infections, respectively. However, the difference was not significant (P-value > 0.05). In the age group of one month to two years, all cases with positive IgG were less than six-month-old. Conclusions: The results of the seroprevalence of Chikungunya and West Nile viruses among children in Tehran showed the prevalence of these viral infections in this region. Therefore, these infections should be considered in the differential diagnosis for children with clinical symptoms of viral diseases.

High Transmission Potential of West Nile Virus Lineage 1 for Cx. pipiens s.l. of Iran

: Vector competence is an important parameter in evaluating whether a species plays a role in transmission of an arbovirus. Although the protocols are similar, interpretation of results is unique given the specific interactions that exist between a mosquito population and a viral genotype. Here, we assessed the infection (IR), dissemination (DR), and transmission (TR) rates of Cx. pipiens s.l., collected from Iran, for West Nile virus (WNV) lineage 1a. We showed that Cx. pipiens s.l. mosquitoes in Iran were susceptible to WNV with IR up to 89.7%, 93.6%, and 83.9% at 7, 14, and 21 days post-infection (dpi) respectively. In addition, DR and TR reached respectively 92.3% and 75.0% at 21 dpi, and the number of viral particles delivered with saliva reached up to 1.33 × 105 particles. Therefore, an unexpected high risk of WNV dissemination in the region where Cx. pipiens s.l. mosquitoes are well established should be considered carefully and surveillance measures implemented accordingly.

Seroprevalence, risk factors and spatial distribution of West Nile virus in Jordan

Background

This is the first countrywide study of the seroprevalence, risk factors and spatial distribution of West Nile virus (WNV) in Jordan.

Methods

A cross-sectional sample of 801 participants was administered a comprehensive questionnaire survey and tested for WNV immunoglobulin G antibodies.

Results

The point seroprevalence rate for WNV infection was 8.61% (95% confidence interval 6.8 to 10.8). Multivariate regression analysis demonstrated that sex, age, climate, income and drinking water source were significantly associated with seropositivity (p≤0.05). Males had 1.73 greater odds of infection compared with females. Compared with 15 to 29-year-olds, adults 30-49 y old and adults ≥50 y old had 2.0 and 3.1 greater odds of infection, respectively. Individuals living in the Jordan Valley and Badia had 22.2 and 7.2 times greater odds of infection, respectively, compared with individuals living in the highlands. Households with an income of <US$750/month had 1.8 greater odds of infection compared with those with higher household incomes. Individuals using spring lakes as a drinking water source had 5.1 greater odds of infection than people who used water from any other source.

Conclusions

This study demonstrates that WNV is circulating in Jordan and should be considered as a differential diagnosis in medical cases presenting with nervous system symptoms, especially for older populations living in the Jordan Valley and Badia areas.

Ecological Niche Modeling of West Nile Virus Vector in Northwest of Iran

OBJECTIVES

West Nile virus (WNV) is a microorganism and the leading cause of the spread of fatal diseases in horses, birds, and humans. The etiologic agent of West Nile fever belongs to the genus Flavivirus that is transmitted by Culex mosquitoes in Iran and throughout the world. We aimed to evaluate the distribution of WNV vectors in northwest of Iran ecological niche modeling.

METHODS

This cross-sectional study was conducted in Ardabil province in one year, from January to December with the samples captured from May to November 2017. Forty-five locations from all 10 counties of the province were selected randomly to determine the seasonal activity of mosquitoes. Larval collection was carried out twice a month. MaxEnt version 3.3, ArcMap 10.3 software, jackknife, and crew methods were used to determine the impact of climatic change and environmental factors on the distribution of mosquito species.

RESULTS

A total of 2000 larva were collected, 1789 (89.5%) of which were Culex larvae. Seven species of Culex genus were identified, including Culex pipiens, Cx. modestus, Cx. theileri, Cx. hortensis, Cx. perexiguus, Cx. tritaeniorhynchus, and Cx. mimeticus. Two important ecological niche areas were identified in the north and south of the province. The annual temperature and rainfall in the cold seasons were the most important factors affecting the distribution of Culex species larva. Cx. pipiens was identified as the main vector of WNV vectors with high frequency in Ardabil province.

CONCLUSIONS

Two large areas were found as the ecological niches of larvae of these species. It is recommended that additional investigations be carried out on infection in adult female Cx. pipiens and its hosts in these areas.

A detailed review of the mosquitoes (Diptera: Culicidae) of Iran and their medical and veterinary importance

Mosquitoes (Diptera: Culicidae) are the most significant arthropods of medical importance because of the burden of diseases, such as malaria, encephalitis and filariasis, which are caused by pathogens and parasites they transmit to humans. In 2007, the most recently published checklist of Iranian mosquitoes included 64 species representing seven genera. Public databases were searched to the end of August 2018 for publications concerning the diseases in Iran caused by mosquito-borne pathogens. Pertinent information was extracted and analyzed, and the checklist of Iranian mosquitoes was updated. Six arboviral diseases, two bacterial diseases, four helminthic diseases and two protozoal diseases occur in Iran. The agents of these diseases are biologically or mechanically known or assumed to be transmitted by mosquitoes. The updated checklist of Iranian mosquitoes includes 69 species representing seven or 11 genera depending on the generic classification of aedines. There is no published information about the role of mosquitoes in the transmission of the causal agents of avian malaria, avian pox, bovine ephemeral fever, dengue fever, Rift Valley fever, Sindbis fever, Deraiophoronema evansi infection, lymphatic filariasis, anthrax and tularemia in Iran. There is just one imported case of lymphatic filariasis, which is not endemic in the country. It seems arthropods do not play an important role in the epidemiology of anthrax and ixodid ticks are the main vectors of the tularemia bacterium. In view of the recent finding of only a few adults and larvae of Aedes albopictus in southeastern Iran and the absence of Ae. aegypti, it is not possible to infer the indigenous transmission of the dengue fever virus in Iran. Considering the importance of mosquito-borne diseases in the country, it is necessary to improve vector and vector-borne disease surveillance in order to apply the best integrated vector management interventions as a part of the One Health concept.

Epidemiology of West Nile Virus in the Eastern Mediterranean region: A systematic review

Background

West Nile Virus (WNV), a member of the genus Flavivirus, is one of the most widely distributed arboviruses in the world. Despite some evidence for circulation of WNV in countries summarized by the World Health Organization as the Eastern Mediterrian Regional Office (EMRO), comprehensive knowledge about its epidemiology remains largely unknown. This study aims to provide a concise review of the published literature on WNV infections in the Eastern Mediterranean Regional Office of WHO (EMRO).

Methodology/principal findings

A systematic review of WNV prevalence studies on humans, animals and vectors in the EMRO region was performed by searching: Web of Science, Science Direct, Scopus, PubMed, Embase and Google Scholar. Finally, 77 citations were included, comprising 35 seroprevalence studies on general population (24460 individuals), 15 prevalence studies among patients (3439 individuals), 22 seroprevalence studies among animals (10309 animals), and 9 studies on vectors (184242 vector species). Of the 22 countries in this region, five had no data on WNV infection among different populations. These countries include Kuwait, Bahrain, Oman, Syria and Somalia. On the other hand, among countries with available data, WNV-specific antibodies were detected in the general population of all investigated countries including Djibouti (0.3–60%), Egypt (1–61%), Iran (0–30%), Iraq (11.6–15.1%), Jordan (8%), Lebanon (0.5–1%), Libya (2.3%), Morocco (0–18.8%), Pakistan (0.6–65.0%), Sudan (2.2–47%), and Tunisia (4.3–31.1%). WNV RNA were also detected in patient populations of Iran (1.2%), Pakistan (33.3%), and Tunisia (5.3% –15.9%). WNV-specific antibodies were also detected in a wide range of animal species. The highest seropositivity rate was observed among equids (100% in Morocco) and dogs (96% in Morocco). The highest seroprevalence among birds was seen in Tunisia (23%). In addition, WNV infection was detected in mosquitoes (Culex, and Aedes) and ticks (Argas reflexus hermanni). The primary vector of WNV (Culex pipiens s.l.) was detected in Djibouti, Egypt, Iran and Tunisia, and in mosquitoes of all these countries, WNV was demonstrated.

Conclusions

This first systematic regional assessment of WNV prevalence provides evidence to support the circulation of WNV in the EMRO region as nearly all studies showed evidence of WNV infection in human as well as animal/vector populations. These findings highlight the need for continued prevention and control strategies and the collection of epidemiologic data for WNV epidemic status, especially in countries that lack reliable surveillance systems.

West Nile Virus (WNV) is a mosquito-borne Flavivirus belonging to the Flaviviridae family, which is endemic in a vast geographical area, including the EMRO region. However, the epidemiology of WNV in the EMRO region remains poorly understood. To address this gap, we performed a systematic review on WNV prevalence studies conducted on human populations, animals and vectors across Eastern Mediterranean countries. Our review indicated the infection of most investigated human, animal and vector populations with WNV; however, the paucity of epidemiological data underline the need for integrated surveillance programs as well as continued deployment of prevention and control strategies.

Widespread circulation of West Nile virus, but not Zika virus in southern Iran

West Nile virus (WNV) and Zika virus (ZIKV) are mosquito-borne viral infections. Over the past few decades, WNV has been associated with several outbreaks involving high numbers of neuroinvasive diseases among humans. The recent re-emergence of ZIKV has been associated with congenital malformation and also with Guillain-Barre syndrome in adults. The geographic range of arthropod-borne viruses has been rapidly increasing in recent years. The objectives of this study were to determine the presence of IgG specific antibodies and the genome of WNV and ZIKV in human samples, as well as WNV and ZIKV genomes in wild-caught mosquitoes in urban and rural areas of the Hormozgan province, in southern Iran. A total of 494 serum samples were tested for the presence of WNV and ZIKV IgG antibodies using ELISA assays. One hundred and two (20.6%) samples were reactive for WNV IgG antibodies. All serum samples were negative for ZIKV IgG antibodies. Using the multivariable logistic analysis, age (45+ vs. 1-25; OR = 3.4, 95% C.I.: 1.8-6.3), occupation (mostly outdoor vs. mostly indoor; OR = 2.4, 95% C.I.: 1.1-5.2), and skin type(type I/II vs. type III/IV and type V/VI; OR = 4.3, 95% C.I.: 1.7-10.8 and OR = 2.7, 95% C.I.: 1.3-5.5 respectively, skin types based on Fitzpatrick scale) showed significant association with WNV seroreactivity. We collected 2,015 mosquitoes in 136 pools belonging to 5 genera and 14 species. Three pools of Culex pipiens complex were positive for WNV RNA using real-time reverse transcription polymerase chain reaction (rtRT-PCR). ZIKV RNA was not detected in any of the pools. All WNV ELISA reactive serum samples were negative for WNV RNA. In conclusion, we provided evidence of the establishment of WNV in southern Iran and no proof of ZIKV in serum samples or in mosquito vectors. The establishment of an organized arbovirus surveillance system and active case finding strategies seems to be necessary.

Kobinger G, Moosa-Kazemi SH. DNA barcodes corroborating identification of mosquito species and multiplex real-time PCR differentiating Culex pipiens complex and Culex torrentium in Iran

Identifying mosquito species is a fundamental step in risk assessment and implementation of preventative strategies. Moreover, Culex pipiens is the most widespread mosquito vector in several regions of Iran and is the main vector for transmission of West Nile virus (WNV). Mosquitoes were collected at 14 sites in northern regions of Iran in 2015 and 2016. A subset of mosquito specimens was selected for identification confirmation using a DNA-barcoding technique. Construction of a phylogenetic tree showed clustering of mosquito sequences into three main genera: Aedes, Anopheles and Culex with individuals of a single species clustered closely together, regardless of where and when they were collected. Cx. pipiens complex and Cx. torrentium were identified and differentiated using multiplex real-time PCR targeting the gene locus for acetylcholinesterase 2 (ace2) to discriminate between Cx. pipiens pipiens and Cx. torrentium. The CQ11 microsatellite locus was used for discrimination between Cpp. biotypes. The predominant mosquito species in investigated regions were Cx. pipiens pipiens biotype pipiens, but we also detected Culex pipiens pipiens biotype molestus and hybrids of the two pipiens biotypes, as well as Cx. torrentium. The results of this study represent the first certain evidence of the presence of Cx. pipiens pipiens biotype molestus and hybrids between pipiens and molestus forms, and Cx. torrentium in Iran through a molecular identification approach. This report of a potentially important bridge vector for WNV might have key influence in the risk projections for WNV in Iran.

Dengue Fever as an Emerging Infection in Southeast Iran

Dengue fever (DF) is a mosquito-borne acute viral disease presenting with hemorrhagic manifestations in severe cases. Southeast Iran is in close proximity to Pakistan, an endemic country for DF. This cross-sectional study was conducted in the Sistan and Baluchestan province in the southeast of Iran to investigate possibility of DF (immunoglobulin M [IgM], immunoglobulin G [IgG], and nonstructural protein 1 [NS1] antigen tests) in 60 clinically suspected patients (April 2013 to August 2015). NS1 protein was detected in 5% (N = 3), at least one of the antibodies (IgM and/ or IgG) was detected in 11% (N = 7) of the samples. Five patients identified as of acutely infected. There was a simultaneous presence of NS1 protein and IgG or IgM antibodies in 4% (N = 2) of patients. Previous studies show establishment of potential vectors in this area. These evidences support the hypothesis that DF can be a health concern in Southeast Iran with potential future outbreaks.

Human West Nile Virus Disease Outbreak in Pakistan, 2015-2016

Like most of the world, Pakistan has seen an increase in mosquito-transmitted diseases in recent years. The magnitude and distribution of these diseases are poorly understood as Pakistan does not have a nation-wide system for reporting disease. A cross-sectional study to determine which flaviviruses were causing of arboviral disease in Pakistan was instituted. West Nile virus (WNV) is a cause of seasonal fever with neurotropic findings in countries that share borders with Pakistan. Here, we describe the active and persistent circulation of WNV in humans in the southern region of Pakistan. This is the first report of WNV causing neurological disease in human patients in this country. Of 997 enrolled patients presenting with clinical features suggestive of arboviral disease, 105 were positive for WNV IgM antibodies, and 71 of these patients possessed WNV-specific neutralizing antibodies. Cross-reactivity of WNV IgM antibodies with Japanese encephalitis virus (JEV) occurred in 75 of these 105 patients. WNV co-infections with Dengue viruses were not a contributing factor for the severity of disease. Nor did prior exposure to dengue virus contribute to incidence of neurological involvement in WNV-infected patients. Patients with WNV infections were more likely to present with altered mental status, seizures, and reduced Glasgow Coma scores when compared with JEV-infected patients. Human WNV cases and vector numbers exhibited a temporal correlation with climate.

Seroprevalence survey of arboviruses in workers from Tuscany, Italy

Background:

Arthropod-borne viruses (Arbovirus) play an important role among emerging and re-emerging infectious diseases and in the spreading of infections in new geographic areas. Although some arboviral infections may be asymptomatic or mild flu-like illnesses, many occur as severe forms of meningitis and meningoencephalitis.

Objectives:

To assess whether arboviral infections may be associated with occupational risk, in a population of agricultural and forestry workers potentially at high risk for arthropods bite and sting.

Methods:

A seroprevalence survey for arboviruses belonging to the genera Flaviviruses (West Nile, Tick-borne encephalitis and Usutu viruses) and Phlebovirus (Toscana virus) was carried out in Grosseto province (Tuscany, Italy). One hundred and one serum samples of occupationally exposed workers and 100 serum samples of not exposed workers were analyzed using commercial and home-made serological assays. Serological data were obtained in 2012 and analyzed according to demographic characteristics, recollection of insect-bites, and time spent in outdoor activities.

Results:

A total seropositivity of 10% (21/201) was observed for Toscana virus. No difference in seroprevalence for Toscana virus was observed among the exposed (10/101) versus the not exposed (11/100) workers. No seropositivity for West Nile, Usutu and Tick-borne encephalitis viruses was detected.

Conclusions:

Although circulation of Toscana virus is recognized in the study area, our results did not reveal a higher risk for workers exposed to arthropods bite and sting. Health surveillance programs remain useful to monitor the potential emergence of arboviruses.

Co-circulation of Crimean-Congo Hemorrhagic Fever virus strains Asia 1 and 2 between the border of Iran and Pakistan

Crimean-Congo Hemorrhagic Fever (CCHF) is a tick-borne viral disease that is transmitted by numerous species of ticks, which serve both as a reservoir and vector of CCHF virus (CCHFV). Molecular and serological tests were undertaken on hard ticks (Ixodidae spp.) and samples from livestock were collected in 2015 from Chabahar County in Southeast Iran. Using RT-PCR, the ticks were tested for the presence of CCHFV. In addition, seven livestock were serologically tested for the presence of IgG antibodies using an ELISA test. IgG antibodies against CCHFV were detected in one of 7 of the livestock that were tested. In total, 49 ticks including five species: Rhipicephalus sanguineus, Hyalomma anatolicum, Hy. asiaticum, Hy. dromedarii and Hy. marginatum with a prevalence of 46.9%, 32.7%, 4.1%, 4.1% and 2.1% respectively were identified. CCHFV was detected in three ticks among 49 collected ticks. The ticks infected with CCHFV belonged to the genus Hyalomma and Rhipicephalus. Phylogenetic analysis demonstrated that two sequences clustered in clade IV (Asia-1) and one sequence was located within clade IV (Asia-2). Most of the animal and human CCHF cases of the country are reported from Sistan and Baluchistan provinces. Regular monitoring programs in the tick population and livestock are needed in the future.

The Presence and Seroprevalence of Arthropod-Borne Viruses in Nasiriyah Governorate, Southern Iraq: A Cross-Sectional Study

The knowledge on the presence and seroprevalence of arboviruses in Iraq is fragmental. To assess the exposure of the population to arbovirus infections in southern Iraq, we conducted a serological screening of the most common arbovirus groups using immunofluorescence, hemagglutination inhibition and neutralization tests. Serum samples of 399 adult volunteers were collected in Nasiriyah, Iraq. Antibodies were detected against West Nile virus (WNV) (11.6%), sandfly-borne Sicilian virus serocomplex (18.2%), sandfly-borne Naples virus serocomplex (7.8%), Sindbis virus (1.5%), chikungunya virus (0.5%), and Tahyna virus (2.0%). The results suggest that WNV and sandfly-borne phlebovirus infections are common in southern Iraq, and these viruses should be considered as potential causative agents in patients with febrile disease and/or neurological manifestations.

Genetic variants associated with susceptibility of Ashkenazi Jews to West Nile virus infection

The epidemiology of West Nile virus (WNV) in Israel is different from other neighbouring countries in the Middle East where disease burden has been minimal. We analysed a cohort of Ashkenazi Jewish patients with symptomatic WNV infection (n = 39), and WNV-negative controls (n = 61), for nine genetic variants that has been suggested to be associated with susceptibility to WNV. Two single nucleotide polymorphisms were significantly more frequent in WNV-infected than non-infected individuals, rs7280422 (MX1) [odds ratio (OR) 4·05, 95% confidence interval (CI) 2·04-8·03, P < 0·001] and rs3213545 (OASL) (OR 1·85, 95% CI 1·03-3·3, P = 0·03). Genetic polymorphism may play a significant role in susceptibility to WNV infection in Ashkenazi Jews.