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da Conceição PJP, de Carvalho LR, de Godoy BLV, Nogueira ML, Terzian ACB, de Godoy MF, Calmon MF, Bittar C, Rahal P. Detection of DENV-2 and ZIKV coinfection in southeastern Brazil by serum and urine testing. Med Microbiol Immunol 2023:10.1007/s00430-023-00762-z. [PMID: 37029306 DOI: 10.1007/s00430-023-00762-z] [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: 09/13/2022] [Accepted: 03/28/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE Aedes aegypti mosquito-borne diseases have a significant impact on public health in Brazil. In this study, we investigated the presence of the Zika virus (ZIKV) and dengue virus (DENV) in serum and urine samples from symptomatic participants who attended an Emergency Care Unit located in a city in the northwestern region of São Paulo between February 2018 and April 2019. METHODS Serum and urine samples were collected from participants suspected of having arbovirus infection. After the extraction of viral RNA, viral detection was performed by real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) (One-Step RT-qPCR). RESULTS A total of 305 participants participated in this study. A total of 283 blood and 270 urine samples were collected. Of 305 patients, 36.4% (111/305) were positive for ZIKV, 43.3% (132/305) for DENV2, and 0.3% (1/305) for DENV1. Coinfection with ZIKV/DENV2 was observed in 13.1% of participants. If only serum samples were used, ZIKV detection would have decreased to 23.3% (71/305). Of all the participants included in the study, only one was suspected of having ZIKV infection based on clinical diagnosis, and the remaining participants were suspected of having DENV. CONCLUSION By testing serum and urine samples, we increased the detection of both viruses and detected considerable levels of ZIKV and DENV-2 coinfection when compared to other studies. Additionally, we detected an unnoticed ZIKV outbreak in the city. These findings highlight the importance of the molecular diagnosis of arboviruses to aid public health surveillance and management strategies.
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Affiliation(s)
| | | | - Bianca Lara Venâncio de Godoy
- Department of Molecular Biology, Medical School of São José do Rio Preto-FAMERP, São José do Rio Preto, São Paulo, Brazil
| | - Mauricio Lacerda Nogueira
- Department of Dermatological, Infectious and Parasitic Diseases, Medical School of São José do Rio Preto-FAMERP, São José do Rio Preto, São Paulo, Brazil
| | - Ana Carolina Bernardes Terzian
- Department of Dermatological, Infectious and Parasitic Diseases, Medical School of São José do Rio Preto-FAMERP, São José do Rio Preto, São Paulo, Brazil
| | - Moacir Fernandes de Godoy
- Department of Cardiology and Cardiovascular Surgery, Medical School of São José do Rio Preto-FAMERP, São José do Rio Preto, São Paulo, Brazil
| | - Marília Freitas Calmon
- Department of Biology, São Paulo State University-UNESP, São José do Rio Preto, São Paulo, Brazil
| | - Cintia Bittar
- Department of Biology, São Paulo State University-UNESP, São José do Rio Preto, São Paulo, Brazil.
- Laboratory of Molecular Immunology-The Rockefeller University, New York, NY, USA.
| | - Paula Rahal
- Department of Biology, São Paulo State University-UNESP, São José do Rio Preto, São Paulo, Brazil
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Blitvich BJ, Magalhaes T, Laredo-Tiscareño SV, Foy BD. Sexual Transmission of Arboviruses: A Systematic Review. Viruses 2020; 12:v12090933. [PMID: 32854298 PMCID: PMC7552039 DOI: 10.3390/v12090933] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/20/2020] [Accepted: 08/22/2020] [Indexed: 12/15/2022] Open
Abstract
Arthropod-borne viruses (arboviruses) are primarily maintained in nature in transmission cycles between hematophagous arthropods and vertebrate hosts, but an increasing number of arboviruses have been isolated from or indirectly detected in the urogenital tract and sexual secretions of their vertebrate hosts, indicating that further investigation on the possibility of sexual transmission of these viruses is warranted. The most widely recognized sexually-transmitted arbovirus is Zika virus but other arboviruses, including Crimean-Congo hemorrhagic fever virus and dengue virus, might also be transmitted, albeit occasionally, by this route. This review summarizes our current understanding on the ability of arboviruses to be sexually transmitted. We discuss the sexual transmission of arboviruses between humans and between vertebrate animals, but not arthropod vectors. Every taxonomic group known to contain arboviruses (Asfarviridae, Bunyavirales, Flaviviridae, Orthomyxoviridae, Reoviridae, Rhabdoviridae and Togaviridae) is covered.
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Affiliation(s)
- Bradley J. Blitvich
- Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA;
- Correspondence: ; Tel.: +1-515-294-9861; Fax: +1-515-294-8500
| | - Tereza Magalhaes
- Arthropod-Borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523, USA; (T.M.); (B.D.F.)
| | - S. Viridiana Laredo-Tiscareño
- Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA;
| | - Brian D. Foy
- Arthropod-Borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523, USA; (T.M.); (B.D.F.)
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Grobusch MP, van der Fluit KS, Stijnis C, De Pijper CA, Hanscheid T, Gautret P, Schlagenhauf P, Goorhuis A. Can dengue virus be sexually transmitted? Travel Med Infect Dis 2020; 38:101753. [PMID: 32473313 DOI: 10.1016/j.tmaid.2020.101753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 11/15/2022]
Abstract
It has been well documented that Zika virus (ZIKV) can be sexually transmitted. Dengue virus (DENV) shows many similarities with ZIKV; both belong to the genus Flavivirus and share the same main vector route of transmission. Moreover, they share overall architectural features on a molecular level, with a highly similar structure and distinctive insertions, deletions and mutations of their respective E proteins, and it has been suggested that they use a common pathophysiological pathway. In view of similarities with other sexually transmissible viruses, the question arises as to whether DENV could also be sexually transmissible. Limited animal model data do not suggest otherwise. The presence of dengue virus in - and human-to-human, non-vector transmission from - various bodily fluids other than semen or vaginal secretions has been documented anecdotally. Several anecdotal reports described prolonged presence of DENV in semen, urine and vaginal secretions. In 2019, two cases of likely sexual transmission were reported from Spain and South Korea, respectively. We discuss the evidence for and against a relevant DENV sexual transmission potential, highlight controversies and propose a future research agenda on this issue.
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Affiliation(s)
- Martin P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centres, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam, the Netherlands; Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.
| | - Karin S van der Fluit
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centres, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam, the Netherlands
| | - Cornelis Stijnis
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centres, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam, the Netherlands
| | - Cornelis A De Pijper
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centres, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam, the Netherlands
| | - Thomas Hanscheid
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Instituto de Microbiologia, Faculdade de Medicina, Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-028, Lisboa, Portugal
| | - Philippe Gautret
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers' Health, Department of Public and Global Health, Institute for Epidemiology, Biostatistics and Prevention, Zürich, Switzerland
| | - Abraham Goorhuis
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centres, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam, the Netherlands
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Iannetta M, Di Caro A, Nicastri E, Vairo F, Masanja H, Kobinger G, Mirazimi A, Ntoumi F, Zumla A, Ippolito G. Viral Hemorrhagic Fevers Other than Ebola and Lassa. Infect Dis Clin North Am 2020; 33:977-1002. [PMID: 31668201 DOI: 10.1016/j.idc.2019.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Viral hemorrhagic fevers represent a group of diseases caused by enveloped RNA viruses. The epidemiology is broadly variable, ranging from geographically localized to more diffuse infections. Viral hemorrhagic fevers are classified as category A bioweapon agents by the Centers for Disease Control and Prevention. Viral hemorrhagic fevers are severe febrile illnesses with hemorrhagic phenomena. Laboratory diagnosis takes place in highly specialized reference laboratories. Treatment is essentially supportive. In this article, we focus the attention on yellow fever and viral hemorrhagic fevers other than Ebola and Lassa virus diseases that have been described elsewhere in this issue.
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Affiliation(s)
- Marco Iannetta
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense 292, Rome 00149, Italy
| | - Antonino Di Caro
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense 292, Rome 00149, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense 292, Rome 00149, Italy
| | - Francesco Vairo
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense 292, Rome 00149, Italy
| | - Honorati Masanja
- Ifakara Health Institute, Ifakara Health Research and Development Centre, Kiko Avenue, Plot N 463, Mikocheni, Dar es Salaam, Tanzania
| | - Gary Kobinger
- Centre de Recherche en Infectiologie, Centre Hospitalier Universitaire de Québec, Université Laval, 2325 Rue de l'Université, Quebec City, Quebec G1V 0A6, Canada
| | - Ali Mirazimi
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Alfred Nobels Alle 8 Plan 7, Stockholm 14183, Sweden
| | - Francine Ntoumi
- Université Marien NGouabi, Fondation Congolaise pour la Recherche Médicale (FCRM), Villa D6, Campus OMS//AFRO Djoué, Brazzaville, Congo; Institute for Tropical Medicine, University of Tübingen, Germany
| | - Alimuddin Zumla
- Center for Clinical Microbiology, University College London, Royal Free Campus 2nd Floor, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense 292, Rome 00149, Italy.
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Wei KC, Wei WJ, Liu YS, Yen LC, Chang TH. Assessment of Prolonged Dengue Virus Infection in Dermal Fibroblasts and Hair-Follicle Dermal Papilla Cells. Viruses 2020; 12:v12030267. [PMID: 32121148 PMCID: PMC7150742 DOI: 10.3390/v12030267] [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: 11/21/2019] [Revised: 02/19/2020] [Accepted: 02/26/2020] [Indexed: 11/16/2022] Open
Abstract
Dengue virus (DENV)-mediated hair loss is one of the post-dengue fatigue syndromes and its pathophysiology remains unknown. Whether long-term or persistent infection with DENV in the scalp results in hair loss is unclear. In this study, we cultured human dermal fibroblasts (WS1 cells) and primary human hair-follicle dermal papilla cells (HFDPCs) in the long term with DENV-2 infection. The production of virion, the expression of inflammatory and anti-virus genes, and their signaling transduction activity in the infected cells were analyzed. DENV-2 NS3 protein and DENV-2 5′ UTR RNA were detected in fibroblasts and HFDPCs that were subjected to long-term infection with DENV-2 for 33 days. A significant amount of DENV-2 virion was produced by both WS1 cells and HFDPCs in the first two days of acute infection. The virion was also detected in WS1 cells that were infected in the long term, but HFDPCs failed to produce DENV-2 after long-term culture. Type I and type III interferons, and inflammatory cytokines were highly expressed in the acute phase of DENV infection in HFPDC and WS1 cells. However, in the long-term cultured cells, modest levels of anti-viral protein genes were expressed and we observed reduced signaling activity, which was correlated with the level of virus production changes. Long-term infection of DENV-2 downregulated the expression of hair growth regulatory factors, such as Rip1, Wnt1, and Wnt4. This in vitro study shows that the long-term infection with DENV-2 in dermal fibroblasts and dermal papilla cells may be involved with the prolonged-DENV-infection-mediated hair loss of post-dengue fatigue syndrome. However, direct evidence for viral replication in the human hair of a dengue victim or animal infection model is required.
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Affiliation(s)
- Kai-Che Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan; (K.-C.W.); (W.-J.W.)
- Faculty of Yuh-Ing Junior College of Health Care and Management, Kaohsiung 80776, Taiwan
- National Yang Ming University, Taipei 11211, Taiwan
| | - Wan-Ju Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan; (K.-C.W.); (W.-J.W.)
| | - Yi-Shan Liu
- Department of Dermatology, E-Da Hospital, I-Shou University, Kaohsiung 84001, Taiwan;
- Graduate Institute of Science Education and Environmental Education, National Kaohsiung Normal University, Kaohsiung 82446, Taiwan
| | - Li-Chen Yen
- Department and Graduate Institute of Microbiology and Immunology, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Tsung-Hsien Chang
- Department and Graduate Institute of Microbiology and Immunology, National Defense Medical Center, Taipei 11490, Taiwan;
- Correspondence:
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Wilder-Smith A. Can dengue virus be sexually transmitted? J Travel Med 2019; 26:5259064. [PMID: 30590715 DOI: 10.1093/jtm/tay157] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 12/16/2018] [Accepted: 12/19/2018] [Indexed: 11/13/2022]
Abstract
Can dengue virus be sexually transmitted? A literature review revealed one probable case of female-to-male transmission. Even if dengue PCR can occasionally be found in semen or vaginal secretions, reports on sexual transmission are extremely rare. Sexual transmission of DENV has no public health significance.
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Affiliation(s)
- Annelies Wilder-Smith
- London School of Hygiene and Tropical Medicine, London, UK.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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Abstract
Mortality from severe dengue is low, but the economic and resource burden on health services remains substantial in endemic settings. Unfortunately, progress towards development of effective therapeutics has been slow, despite notable advances in the understanding of disease pathogenesis and considerable investment in antiviral drug discovery. For decades antibody-dependent enhancement has been the prevalent model to explain dengue pathogenesis, but it was only recently demonstrated in vivo and in clinical studies. At present, the current mainstay of management for most symptomatic dengue patients remains careful observation and prompt but judicious use of intravenous hydration therapy for those with substantial vascular leakage. Various new promising technologies for diagnosis of dengue are currently in the pipeline. New sample-in, answer-out nucleic acid amplification technologies for point-of-care use are being developed to improve performance over current technologies, with the potential to test for multiple pathogens using a single specimen. The search for biomarkers that reliably predict development of severe dengue among symptomatic individuals is also a major focus of current research efforts. The first dengue vaccine was licensed in 2015 but its performance depends on serostatus. There is an urgent need to identify correlates of both vaccine protection and disease enhancement. A crucial assessment of vector control tools should guide a research agenda for determining the most effective interventions, and how to best combine state-of-the-art vector control with vaccination.
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Affiliation(s)
- Annelies Wilder-Smith
- London School of Hygiene & Tropical Medicine, London, UK; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
| | - Eng-Eong Ooi
- Duke-National University of Singapore Medical School, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Olaf Horstick
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Bridget Wills
- Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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8
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Affiliation(s)
- Changhwan Lee
- a Clinical Medical Experts Organization Hospital , Hwaseong , Korea
| | - Hyungmin Lee
- b Korea Centers for Disease Control and Prevention , Cheongju , Korea
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Paz-Bailey G, Rosenberg ES, Doyle K, Munoz-Jordan J, Santiago GA, Klein L, Perez-Padilla J, Medina FA, Waterman SH, Gubern CG, Alvarado LI, Sharp TM. Persistence of Zika Virus in Body Fluids - Final Report. N Engl J Med 2018; 379:1234-1243. [PMID: 28195756 PMCID: PMC5831142 DOI: 10.1056/nejmoa1613108] [Citation(s) in RCA: 300] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND To estimate the frequency and duration of detectable Zika virus (ZIKV) RNA in human body fluids, we prospectively assessed a cohort of newly infected participants in Puerto Rico. METHODS We evaluated samples obtained from 150 participants (including 55 men) in whom ZIKV RNA was detected on reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay in urine or blood in an enhanced arboviral clinical surveillance site. We collected serum, urine, saliva, semen, and vaginal secretions weekly for the first month and then at 2, 4, and 6 months. All specimens were tested by means of RT-PCR, and serum was tested with the use of anti-ZIKV IgM enzyme-linked immunosorbent assay. Among the participants with ZIKV RNA in any specimen at week 4, biweekly collection continued until all specimens tested negative. We used parametric Weibull regression models to estimate the time until the loss of ZIKV RNA detection in each body fluid and reported the findings in medians and 95th percentiles. RESULTS The medians and 95th percentiles for the time until the loss of ZIKV RNA detection were 14 days (95% confidence interval [CI], 11 to 17) and 54 days (95% CI, 43 to 64), respectively, in serum; 8 days (95% CI, 6 to 10) and 39 days (95% CI, 31 to 47) in urine; and 34 days (95% CI, 28 to 41) and 81 days (95% CI, 64 to 98) in semen. Few participants had detectable ZIKV RNA in saliva or vaginal secretions. CONCLUSIONS The prolonged time until ZIKV RNA clearance in serum in this study may have implications for the diagnosis and prevention of ZIKV infection. Current sexual-prevention guidelines recommend that men use condoms or abstain from sex for 6 months after ZIKV exposure; in 95% of the men in this study, ZIKV RNA was cleared from semen after about 3 months. (Funded by the Centers for Disease Control and Prevention.).
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Affiliation(s)
- Gabriela Paz-Bailey
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Eli S Rosenberg
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Kate Doyle
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Jorge Munoz-Jordan
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Gilberto A Santiago
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Liore Klein
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Janice Perez-Padilla
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Freddy A Medina
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Stephen H Waterman
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Carlos Garcia Gubern
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Luisa I Alvarado
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Tyler M Sharp
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
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10
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Counotte MJ, Kim CR, Wang J, Bernstein K, Deal CD, Broutet NJN, Low N. Sexual transmission of Zika virus and other flaviviruses: A living systematic review. PLoS Med 2018; 15:e1002611. [PMID: 30040845 PMCID: PMC6057622 DOI: 10.1371/journal.pmed.1002611] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/14/2018] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Health authorities in the United States and Europe reported an increasing number of travel-associated episodes of sexual transmission of Zika virus (ZIKV) following the 2015-2017 ZIKV outbreak. This, and other scientific evidence, suggests that ZIKV is sexually transmissible in addition to having its primary mosquito-borne route. The objective of this systematic review and evidence synthesis was to clarify the epidemiology of sexually transmitted ZIKV. METHODS AND FINDINGS We performed a living (i.e., continually updated) systematic review of evidence published up to 15 April 2018 about sexual transmission of ZIKV and other arthropod-borne flaviviruses in humans and other animals. We defined 7 key elements of ZIKV sexual transmission for which we extracted data: (1) rectal and vaginal susceptibility to infection, (2) incubation period following sexual transmission, (3) serial interval between the onset of symptoms in a primary and secondary infected individuals, (4) duration of infectiousness, (5) reproduction number, (6) probability of transmission per sex act, and (7) transmission rate. We identified 1,227 unique publications and included 128, of which 77 presented data on humans and 51 presented data on animals. Laboratory experiments confirm that rectal and vaginal mucosae are susceptible to infection with ZIKV and that the testis serves as a reservoir for the virus in animal models. Sexual transmission was reported in 36 human couples: 34/36 of these involved male-to-female sexual transmission. The median serial symptom onset interval in 15 couples was 12 days (interquartile range: 10-14.5); the maximum was 44 days. We found evidence from 2 prospective cohorts that ZIKV RNA is present in human semen with a median duration of 34 days (95% CI: 28-41 days) and 35 days (no CI given) (low certainty of evidence, according to GRADE). Aggregated data about detection of ZIKV RNA from 37 case reports and case series indicate a median duration of detection of ZIKV of 40 days (95% CI: 30-49 days) and maximum duration of 370 days in semen. In human vaginal fluid, median duration was 14 days (95% CI: 7-20 days) and maximum duration was 37 days (very low certainty). Infectious virus in human semen was detected for a median duration of 12 days (95% CI: 1-21 days) and maximum of 69 days. Modelling studies indicate that the reproduction number is below 1 (very low certainty). Evidence was lacking to estimate the incubation period or the transmission rate. Evidence on sexual transmission of other flaviviruses was scarce. The certainty of the evidence is limited because of uncontrolled residual bias. CONCLUSIONS The living systematic review and sexual transmission framework allowed us to assess evidence about the risk of sexual transmission of ZIKV. ZIKV is more likely transmitted from men to women than from women to men. For other flaviviruses, evidence of sexual transmissibility is still absent. Taking into account all available data about the duration of detection of ZIKV in culture and from the serial interval, our findings suggest that the infectious period for sexual transmission of ZIKV is shorter than estimates from the earliest post-outbreak studies, which were based on reverse transcription PCR alone.
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Affiliation(s)
| | - Caron Rahn Kim
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Jingying Wang
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Kyle Bernstein
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Carolyn D. Deal
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | | | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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11
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Lalle E, Colavita F, Iannetta M, Gebremeskel Teklè S, Carletti F, Scorzolini L, Bordi L, Vincenti D, Castilletti C, Ippolito G, Capobianchi MR, Nicastri E. Prolonged detection of dengue virus RNA in the semen of a man returning from Thailand to Italy, January 2018. Euro Surveill 2018; 23:18-00197. [PMID: 29741153 PMCID: PMC6053624 DOI: 10.2807/1560-7917.es.2018.23.18.18-00197] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This study reports the presence of dengue virus RNA in longitudinally collected semen samples of a previously healthy Caucasian man, returning to Italy from Thailand with primary dengue fever, up to 37 days post-symptom onset, when viraemia and viruria were undetectable. This finding, coupled with the evidence of dengue virus negative-strand RNA, an indirect marker of ongoing viral replication, in the cellular fraction of semen, indicates a need to further investigate possible sexual transmission.
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Affiliation(s)
- Eleonora Lalle
- National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, IRCCS, Rome, Italy,These authors contributed equally to this work
| | - Francesca Colavita
- National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, IRCCS, Rome, Italy,These authors contributed equally to this work
| | - Marco Iannetta
- National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, IRCCS, Rome, Italy
| | | | - Fabrizio Carletti
- National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, IRCCS, Rome, Italy
| | - Laura Scorzolini
- National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, IRCCS, Rome, Italy
| | - Licia Bordi
- National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, IRCCS, Rome, Italy
| | - Donatella Vincenti
- National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, IRCCS, Rome, Italy
| | - Concetta Castilletti
- National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, IRCCS, Rome, Italy
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, IRCCS, Rome, Italy
| | | | - Emanuele Nicastri
- National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, IRCCS, Rome, Italy
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12
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Mohr EL, Block LN, Newman CM, Stewart LM, Koenig M, Semler M, Breitbach ME, Teixeira LBC, Zeng X, Weiler AM, Barry GL, Thoong TH, Wiepz GJ, Dudley DM, Simmons HA, Mejia A, Morgan TK, Salamat MS, Kohn S, Antony KM, Aliota MT, Mohns MS, Hayes JM, Schultz-Darken N, Schotzko ML, Peterson E, Capuano S, Osorio JE, O’Connor SL, Friedrich TC, O’Connor DH, Golos TG. Ocular and uteroplacental pathology in a macaque pregnancy with congenital Zika virus infection. PLoS One 2018; 13:e0190617. [PMID: 29381706 PMCID: PMC5790226 DOI: 10.1371/journal.pone.0190617] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/18/2017] [Indexed: 12/03/2022] Open
Abstract
Congenital Zika virus (ZIKV) infection impacts fetal development and pregnancy outcomes. We infected a pregnant rhesus macaque with a Puerto Rican ZIKV isolate in the first trimester. The pregnancy was complicated by preterm premature rupture of membranes (PPROM), intraamniotic bacterial infection and fetal demise 49 days post infection (gestational day 95). Significant pathology at the maternal-fetal interface included acute chorioamnionitis, placental infarcts, and leukocytoclastic vasculitis of the myometrial radial arteries. ZIKV RNA was disseminated throughout fetal tissues and maternal immune system tissues at necropsy, as assessed by quantitative RT-PCR for viral RNA. Replicating ZIKV was identified in fetal tissues, maternal uterus, and maternal spleen by fluorescent in situ hybridization for viral replication intermediates. Fetal ocular pathology included a choroidal coloboma, suspected anterior segment dysgenesis, and a dysplastic retina. This is the first report of ocular pathology and prolonged viral replication in both maternal and fetal tissues following congenital ZIKV infection in a rhesus macaque. PPROM followed by fetal demise and severe pathology of the visual system have not been described in macaque congenital ZIKV infection previously. While this case of ZIKV infection during pregnancy was complicated by bacterial infection with PPROM, the role of ZIKV on this outcome cannot be precisely defined, and further nonhuman primate studies will determine if increased risk for PPROM or other adverse pregnancy outcomes are associated with congenital ZIKV infection.
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Affiliation(s)
- Emma L. Mohr
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail: (ELM); (TGG)
| | - Lindsey N. Block
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Christina M. Newman
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Laurel M. Stewart
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Michelle Koenig
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Matthew Semler
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Meghan E. Breitbach
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Leandro B. C. Teixeira
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Xiankun Zeng
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, United States of America
| | - Andrea M. Weiler
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Gabrielle L. Barry
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Troy H. Thoong
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Gregory J. Wiepz
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Dawn M. Dudley
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Heather A. Simmons
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Andres Mejia
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Terry K. Morgan
- Departments of Pathology and Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - M. Shahriar Salamat
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Sarah Kohn
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Kathleen M. Antony
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Matthew T. Aliota
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Mariel S. Mohns
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Jennifer M. Hayes
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Nancy Schultz-Darken
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Michele L. Schotzko
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Eric Peterson
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Saverio Capuano
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Jorge E. Osorio
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Shelby L. O’Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Thomas C. Friedrich
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - David H. O’Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Thaddeus G. Golos
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail: (ELM); (TGG)
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13
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Molton JS, Low I, Choy MMJ, Aw PPK, Hibberd ML, Tambyah PA, Wilder-Smith A. Dengue virus not detected in human semen. J Travel Med 2018; 25:4965004. [PMID: 29672710 DOI: 10.1093/jtm/tay023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/12/2018] [Indexed: 11/14/2022]
Abstract
Zika and Ebola viruses can persist in semen and pose a risk for sexual transmission. To determine if dengue virus, another flavivirus, is similarly detectable in semen, we performed dengue PCR on semen in five patients with acute dengue virus infection. All five tested negative, suggesting that dengue does not pose a risk for sexual transmission.
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Affiliation(s)
- James S Molton
- University Medicine Cluster, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Isaac Low
- University Medicine Cluster, National University Health System, Singapore
| | - Milly Ming Ju Choy
- GIS Efficient Rapid Microbial Sequencing Platform, A*STAR Genome Institute of Singapore, Singapore
| | - Pauline Poh Kim Aw
- GIS Efficient Rapid Microbial Sequencing Platform, A*STAR Genome Institute of Singapore, Singapore
| | - Martin L Hibberd
- GIS Efficient Rapid Microbial Sequencing Platform, A*STAR Genome Institute of Singapore, Singapore
| | - Paul A Tambyah
- University Medicine Cluster, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Annelies Wilder-Smith
- Travellers' Health & Vaccination Clinic, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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