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Kasule S, Fernholz E, Grant L, Kole A, Grys TE, Kaleta E, Theel ES, Pritt B, Graf EH. Whole-Blood PCR Preferred for Timely Diagnosis of Neuroinvasive West Nile Virus Infections: Lessons From the 2021 Arizona Outbreak. Open Forum Infect Dis 2024; 11:ofae188. [PMID: 38680608 PMCID: PMC11055396 DOI: 10.1093/ofid/ofae188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Indexed: 05/01/2024] Open
Abstract
Background In 2021, the state of Arizona experienced the largest focal outbreak of West Nile virus (WNV) in US history. Timely and accurate diagnostic testing remains a challenge for WNV due to transient viremia and limited immunoassay specificity. Recent studies have identified whole blood (WB) and urine as more sensitive specimen types for the detection of WNV RNA. Methods We evaluated ordering practices, test performance, and patient characteristics of probable and confirmed cases. In total, we identified 190 probable and proven cases, including 127 patients (66.8%) with neuroinvasive disease. Results Among all cases, only 29.5% had WNV polymerase chain reaction (PCR) testing ordered on WB, of which 80.3% resulted as positive, including 7 cases in which WNV serologic testing was negative and 5 cases for which serologic testing was not ordered. In comparison, only 23.7% of cases that had cerebrospinal fluid (CSF) PCR ordered had a positive result, including 3 cases that were negative by PCR on WB. In contrast, WNV PCR on WB detected 12 neuroinvasive cases that were CSF PCR negative. WNV PCR testing in urine was only ordered on 2 patients, both of whom were positive. Crossing cycle threshold (Ct) values were not significantly different between WB and CSF specimen types, nor was there a correlation between Ct value and days from symptom onset at the time of sample collection; all specimen types and time points had Ct values, with 98% above 30. WB was positive by WNV PCR in several patients for >7 days (range, 7-25 days) after symptom onset, as was the CSF PCR. Conclusions Taken together, these findings indicate that WNV PCR testing on WB may be the best initial test for timely diagnosis of WNV infection, irrespective of clinical manifestation; however, if negative in patients with suspected neuroinvasive disease, WNV PCR testing on CSF should be ordered.
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Affiliation(s)
- Sabirah Kasule
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
- Division of Infectious Disease, Department of Internal Medicine, BronxCare Health System, Bronx, New York, USA
| | - Emily Fernholz
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Leah Grant
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Amy Kole
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Thomas E Grys
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona, USA
| | - Erin Kaleta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona, USA
| | - Elitza S Theel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bobbi Pritt
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Erin H Graf
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona, USA
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Sivadasan A, Cortel-LeBlanc MA, Cortel-LeBlanc A, Katzberg H. Peripheral nervous system and neuromuscular disorders in the emergency department: A review. Acad Emerg Med 2024; 31:386-397. [PMID: 38419365 DOI: 10.1111/acem.14861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Acute presentations and emergencies in neuromuscular disorders (NMDs) often challenge clinical acumen. The objective of this review is to refine the reader's approach to history taking, clinical localization and early diagnosis, as well as emergency management of neuromuscular emergencies. METHODS An extensive literature search was performed to identify relevant studies. We prioritized meta-analysis, systematic reviews, and position statements where possible to inform any recommendations. SUMMARY The spectrum of clinical presentations and etiologies ranges from neurotoxic envenomation or infection to autoimmune disease such as Guillain-Barré Syndrome (GBS) and myasthenia gravis (MG). Delayed diagnosis is not uncommon when presentations occur "de novo," respiratory failure is dominant or isolated, or in the case of atypical scenarios such as GBS variants, severe autonomic dysfunction, or rhabdomyolysis. Diseases of the central nervous system, systemic and musculoskeletal disorders can mimic presentations in neuromuscular disorders. CONCLUSIONS Fortunately, early diagnosis and management can improve prognosis. This article provides a comprehensive review of acute presentations in neuromuscular disorders relevant for the emergency physician.
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Affiliation(s)
- Ajith Sivadasan
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Miguel A Cortel-LeBlanc
- Department of Emergency Medicine, Queensway Carleton Hospital, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- 360 Concussion Care, Ottawa, Ontario, Canada
| | - Achelle Cortel-LeBlanc
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- 360 Concussion Care, Ottawa, Ontario, Canada
- Division of Neurology, Department of Medicine, Queensway Carleton Hospital, Ottawa, Ontario, Canada
| | - Hans Katzberg
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Pavesi A, Tiecco G, Rossi L, Sforza A, Ciccarone A, Compostella F, Lovatti S, Tomasoni LR, Castelli F, Quiros-Roldan E. Inflammatory Response Associated with West Nile Neuroinvasive Disease: A Systematic Review. Viruses 2024; 16:383. [PMID: 38543749 PMCID: PMC10976239 DOI: 10.3390/v16030383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND West Nile virus (WNV) infection is a seasonal arbovirosis with the potential to cause severe neurological disease. Outcomes of the infection from WNV depend on viral factors (e.g., lineage) and host-intrinsic factors (e.g., age, sex, immunocompromising conditions). Immunity is essential to control the infection but may also prove detrimental to the host. Indeed, the persistence of high levels of pro-inflammatory cytokines and chemokines is associated with the development of blood-brain barrier (BBB) damage. Due to the importance of the inflammatory processes in the development of West Nile neuroinvasive disease (WNND), we reviewed the available literature on the subject. METHODS According to the 2020 updated PRISMA guidelines, all peer-reviewed articles regarding the inflammatory response associated with WNND were included. RESULTS One hundred and thirty-six articles were included in the data analysis and sorted into three groups (in vitro on-cell cultures, in vivo in animals, and in humans). The main cytokines found to be increased during WNND were IL-6 and TNF-α. We highlighted the generally small quantity and heterogeneity of information about the inflammatory patterns associated with WNND. CONCLUSIONS Further studies are needed to understand the pathogenesis of WNND and to investigate the extent and the way the host inflammatory response either helps in controlling the infection or in worsening the outcomes. This might prove useful both for the development of target therapies and for the development of molecular markers allowing early identification of patients displaying an inflammatory response that puts them at a higher risk of developing neuroinvasive disease and who might thus benefit from early antiviral therapies.
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Affiliation(s)
- Alessandro Pavesi
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (A.P.); (G.T.); (L.R.); (A.S.); (A.C.); (F.C.); (S.L.); (F.C.)
| | - Giorgio Tiecco
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (A.P.); (G.T.); (L.R.); (A.S.); (A.C.); (F.C.); (S.L.); (F.C.)
| | - Luca Rossi
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (A.P.); (G.T.); (L.R.); (A.S.); (A.C.); (F.C.); (S.L.); (F.C.)
| | - Anita Sforza
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (A.P.); (G.T.); (L.R.); (A.S.); (A.C.); (F.C.); (S.L.); (F.C.)
| | - Andrea Ciccarone
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (A.P.); (G.T.); (L.R.); (A.S.); (A.C.); (F.C.); (S.L.); (F.C.)
| | - Federico Compostella
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (A.P.); (G.T.); (L.R.); (A.S.); (A.C.); (F.C.); (S.L.); (F.C.)
| | - Sofia Lovatti
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (A.P.); (G.T.); (L.R.); (A.S.); (A.C.); (F.C.); (S.L.); (F.C.)
| | - Lina Rachele Tomasoni
- Unit of Infectious and Tropical Diseases, ASST Spedali Civili di Brescia, 25123 Brescia, Italy;
| | - Francesco Castelli
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (A.P.); (G.T.); (L.R.); (A.S.); (A.C.); (F.C.); (S.L.); (F.C.)
| | - Eugenia Quiros-Roldan
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (A.P.); (G.T.); (L.R.); (A.S.); (A.C.); (F.C.); (S.L.); (F.C.)
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Holcomb KM, Staples JE, Nett RJ, Beard CB, Petersen LR, Benjamin SG, Green BW, Jones H, Johansson MA. Multi-Model Prediction of West Nile Virus Neuroinvasive Disease With Machine Learning for Identification of Important Regional Climatic Drivers. GEOHEALTH 2023; 7:e2023GH000906. [PMID: 38023388 PMCID: PMC10654557 DOI: 10.1029/2023gh000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/15/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023]
Abstract
West Nile virus (WNV) is the leading cause of mosquito-borne illness in the continental United States (CONUS). Spatial heterogeneity in historical incidence, environmental factors, and complex ecology make prediction of spatiotemporal variation in WNV transmission challenging. Machine learning provides promising tools for identification of important variables in such situations. To predict annual WNV neuroinvasive disease (WNND) cases in CONUS (2015-2021), we fitted 10 probabilistic models with variation in complexity from naïve to machine learning algorithm and an ensemble. We made predictions in each of nine climate regions on a hexagonal grid and evaluated each model's predictive accuracy. Using the machine learning models (random forest and neural network), we identified the relative importance and variation in ranking of predictors (historical WNND cases, climate anomalies, human demographics, and land use) across regions. We found that historical WNND cases and population density were among the most important factors while anomalies in temperature and precipitation often had relatively low importance. While the relative performance of each model varied across climatic regions, the magnitude of difference between models was small. All models except the naïve model had non-significant differences in performance relative to the baseline model (negative binomial model fit per hexagon). No model, including the ensemble or more complex machine learning models, outperformed models based on historical case counts on the hexagon or region level; these models are good forecasting benchmarks. Further work is needed to assess if predictive capacity can be improved beyond that of these historical baselines.
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Affiliation(s)
- Karen M. Holcomb
- Global Systems LaboratoryNational Oceanic and Atmospheric AdministrationBoulderCOUSA
- Now at Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionFort CollinsCOUSA
| | - J. Erin Staples
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionFort CollinsCOUSA
| | - Randall J. Nett
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionFort CollinsCOUSA
| | - Charles B. Beard
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionFort CollinsCOUSA
| | - Lyle R. Petersen
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionFort CollinsCOUSA
| | - Stanley G. Benjamin
- Global Systems LaboratoryNational Oceanic and Atmospheric AdministrationBoulderCOUSA
- Cooperative Institute for Research in Environmental SciencesUniversity of Colorado BoulderBoulderCOUSA
| | - Benjamin W. Green
- Global Systems LaboratoryNational Oceanic and Atmospheric AdministrationBoulderCOUSA
- Cooperative Institute for Research in Environmental SciencesUniversity of Colorado BoulderBoulderCOUSA
| | - Hunter Jones
- Climate Prediction OfficeNational Oceanic and Atmospheric AdministrationSilver SpringMDUSA
| | - Michael A. Johansson
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPRUSA
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5
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Gervais A, Rovida F, Avanzini MA, Croce S, Marchal A, Lin SC, Ferrari A, Thorball CW, Constant O, Le Voyer T, Philippot Q, Rosain J, Angelini M, Pérez Lorenzo M, Bizien L, Achille C, Trespidi F, Burdino E, Cassaniti I, Lilleri D, Fornara C, Sammartino JC, Cereda D, Marrocu C, Piralla A, Valsecchi C, Ricagno S, Cogo P, Neth O, Marín-Cruz I, Pacenti M, Sinigaglia A, Trevisan M, Volpe A, Marzollo A, Conti F, Lazzarotto T, Pession A, Viale P, Fellay J, Ghirardello S, Aubart M, Ghisetti V, Aiuti A, Jouanguy E, Bastard P, Percivalle E, Baldanti F, Puel A, MacDonald MR, Rice CM, Rossini G, Murray KO, Simonin Y, Nagy A, Barzon L, Abel L, Diamond MS, Cobat A, Zhang SY, Casanova JL, Borghesi A. Autoantibodies neutralizing type I IFNs underlie West Nile virus encephalitis in ∼40% of patients. J Exp Med 2023; 220:e20230661. [PMID: 37347462 PMCID: PMC10287549 DOI: 10.1084/jem.20230661] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/23/2023] Open
Abstract
Mosquito-borne West Nile virus (WNV) infection is benign in most individuals but can cause encephalitis in <1% of infected individuals. We show that ∼35% of patients hospitalized for WNV disease (WNVD) in six independent cohorts from the EU and USA carry auto-Abs neutralizing IFN-α and/or -ω. The prevalence of these antibodies is highest in patients with encephalitis (∼40%), and that in individuals with silent WNV infection is as low as that in the general population. The odds ratios for WNVD in individuals with these auto-Abs relative to those without them in the general population range from 19.0 (95% CI 15.0-24.0, P value <10-15) for auto-Abs neutralizing only 100 pg/ml IFN-α and/or IFN-ω to 127.4 (CI 87.1-186.4, P value <10-15) for auto-Abs neutralizing both IFN-α and IFN-ω at a concentration of 10 ng/ml. These antibodies block the protective effect of IFN-α in Vero cells infected with WNV in vitro. Auto-Abs neutralizing IFN-α and/or IFN-ω underlie ∼40% of cases of WNV encephalitis.
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Affiliation(s)
- Adrian Gervais
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Francesca Rovida
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Microbiology and Virology Unit, San Matteo Research Hospital, Pavia, Italy
| | - Maria Antonietta Avanzini
- Laboratory of Pediatric Hemato-Oncology and Bone Marrow Transplantation, San Matteo Research Hospital, Pavia, Italy
| | - Stefania Croce
- UOSD Cell Factory, San Matteo Research Hospital, Pavia, Italy
| | - Astrid Marchal
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Shih-Ching Lin
- Departments of Medicine, Molecular Microbiology, Pathology and Immunology, and The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO, USA
| | - Alessandro Ferrari
- Microbiology and Virology Unit, San Matteo Research Hospital, Pavia, Italy
| | - Christian W. Thorball
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- School of Life Sciences, Swiss Federal Institute of Technology, Lausanne, Switzerland
| | - Orianne Constant
- Pathogenesis and Control of Chronic and Emerging Infections, University of Montpellier, INSERM, EFS, Montpellier, France
| | - Tom Le Voyer
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Quentin Philippot
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Jérémie Rosain
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
- Study Center for Primary Immunodeficiencies, Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Micol Angelini
- Neonatal Intensive Care Unit, San Matteo Research Hospital, Pavia, Italy
| | - Malena Pérez Lorenzo
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Necker Hospital for Sick Children, Paris, France
| | - Lucy Bizien
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Cristian Achille
- Neonatal Intensive Care Unit, San Matteo Research Hospital, Pavia, Italy
| | - Francesca Trespidi
- Neonatal Intensive Care Unit, San Matteo Research Hospital, Pavia, Italy
| | - Elisa Burdino
- Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Irene Cassaniti
- Microbiology and Virology Unit, San Matteo Research Hospital, Pavia, Italy
| | - Daniele Lilleri
- Microbiology and Virology Unit, San Matteo Research Hospital, Pavia, Italy
| | - Chiara Fornara
- Microbiology and Virology Unit, San Matteo Research Hospital, Pavia, Italy
| | | | | | - Chiara Marrocu
- Department of Biomedical Sciences for Health, Postgraduate School of Public Health, University of Milan, Milan, Italy
| | - Antonio Piralla
- Microbiology and Virology Unit, San Matteo Research Hospital, Pavia, Italy
| | - Chiara Valsecchi
- Laboratory of Pediatric Hemato-Oncology and Bone Marrow Transplantation, San Matteo Research Hospital, Pavia, Italy
| | - Stefano Ricagno
- Department of Biosciences, University of Milan, Milan, Italy
- Institute of Molecular and Translational Cardiology, San Donato Hospital, Milan, Italy
| | - Paola Cogo
- Department of Medicine (DAME), Division of Pediatrics, University of Udine, Udine, Italy
| | - Olaf Neth
- Inborn Errors of Immunity Laboratory, Biomedicine Institute in Seville (IBiS), University of Seville/CSIC, “Red de Investigación Translacional en Infectología Pediátrica”, Seville, Spain
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - Inés Marín-Cruz
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - Monia Pacenti
- Microbiology and Virology Unit, Padova University Hospital, Padova, Italy
| | | | - Marta Trevisan
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Andrea Volpe
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Antonio Marzollo
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Padova University Hospital, Padova, Italy
| | - Francesca Conti
- Pediatric Unit, University Hospital of Bologna, Bologna, Italy
| | - Tiziana Lazzarotto
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Section of Microbiology, University of Bologna, Bologna, Italy
| | - Andrea Pession
- Pediatric Unit, University Hospital of Bologna, Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, University Hospital of Bologna, Bologna, Italy
| | - Jacques Fellay
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- School of Life Sciences, Swiss Federal Institute of Technology, Lausanne, Switzerland
| | | | - Mélodie Aubart
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
- Pediatric Neurology Department, Necker-Enfants-Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Valeria Ghisetti
- Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Alessandro Aiuti
- Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Emmanuelle Jouanguy
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Paul Bastard
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
- Pediatric Hematology-Immunology and Rheumatology Unit, Necker Hospital for Sick Children, Assistante Publique-Hôpitaux de Paris, Paris, France
| | - Elena Percivalle
- Microbiology and Virology Unit, San Matteo Research Hospital, Pavia, Italy
| | - Fausto Baldanti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Microbiology and Virology Unit, San Matteo Research Hospital, Pavia, Italy
| | - Anne Puel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Margaret R. MacDonald
- Laboratory of Virology and Infectious Disease, The Rockefeller University, New York, NY, USA
| | - Charles M. Rice
- Laboratory of Virology and Infectious Disease, The Rockefeller University, New York, NY, USA
| | - Giada Rossini
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Kristy O. Murray
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Center for Human Immunobiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - Yannick Simonin
- Pathogenesis and Control of Chronic and Emerging Infections, University of Montpellier, INSERM, EFS, Montpellier, France
| | - Anna Nagy
- National Reference Laboratory for Viral Zoonoses, National Public Health Center, Budapest, Hungary
| | - Luisa Barzon
- Microbiology and Virology Unit, Padova University Hospital, Padova, Italy
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Laurent Abel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Michael S. Diamond
- Departments of Medicine, Molecular Microbiology, Pathology and Immunology, and The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO, USA
| | - Aurélie Cobat
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Shen-Ying Zhang
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
- Howard Hughes Medical Institute, New York, NY, USA
- Department of Pediatrics, Necker Hospital for Sick Children, Paris, France
| | - Alessandro Borghesi
- School of Life Sciences, Swiss Federal Institute of Technology, Lausanne, Switzerland
- Neonatal Intensive Care Unit, San Matteo Research Hospital, Pavia, Italy
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6
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Hills SL, Netravathi M, Solomon T. Japanese Encephalitis among Adults: A Review. Am J Trop Med Hyg 2023; 108:860-864. [PMID: 37037440 PMCID: PMC10160886 DOI: 10.4269/ajtmh.23-0036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/18/2023] [Indexed: 04/12/2023] Open
Abstract
Japanese encephalitis (JE) is becoming an increasingly important issue among adults. The reasons for this are multifactorial. During the past decades, new areas of Japanese encephalitis virus (JEV) transmission have occurred in several locations, most notably in a markedly expanded area of Australia during 2021-2022. When JEV enters new areas, cases in adults frequently occur. This is unlike the typical pattern in endemic areas where the burden of disease is in children because most adults are protected through natural immunity following earlier exposure to the virus. Even in endemic areas, JEV has become relatively more important in adults because improved JE control through childhood immunization programs has resulted in a substantial decrease in pediatric JE cases and thus more prominence of adult JE cases. Finally, increases in tourism to JE risk areas have resulted in more exposure of adult travelers, who are usually non-immune, to infection in JE risk areas. In this review we describe the increasing importance of JE in adults in some areas and then consider the comparative clinical presentation and severity of illness among children and adults.
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Affiliation(s)
- Susan L. Hills
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - M. Netravathi
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Tom Solomon
- The Pandemic Institute and The National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
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7
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Jackson EE, Janitz AE, Carabin H. A Method to Create Directed Acyclic Graphs from Cycles of Transmission of Zoonotic and Vector-Borne Infectious Agents. Vector Borne Zoonotic Dis 2023; 23:129-135. [PMID: 36847355 PMCID: PMC11074630 DOI: 10.1089/vbz.2022.0040] [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] [Indexed: 03/01/2023] Open
Abstract
Background: The life cycles of zoonotic and vector-borne diseases can be complex. This complexity makes it challenging to identify factors that confound the association between an exposure of interest and infection in one of the susceptible hosts. In epidemiology, directed acyclic graphs (DAGs) can be used to visualize the relationships between exposures and outcomes and also to identify which factors confound the association between exposure and the outcome of interest. However, DAGs can only be used in situations where no cycle exists in the causal relationships being represented. This is problematic for infectious agents that cycle between hosts. Zoonoses and vector-borne diseases pose additional challenges with DAG construction since multiple required or optional hosts of different species may be part of the cycle. Methods: We review the existing examples of DAGs created for nonzoonotic infectious agents. We then demonstrate how to cut the transmission cycle to create DAGs where infection of a specific host species is the outcome of interest. We adapt our method to create DAGs using examples of transmission and host characteristics common to many zoonotic and vector-borne infectious agents. Results: We demonstrate our method using the transmission cycle of West Nile virus to create a simple transmission DAG that lacks a cycle. Conclusions: Using our work, investigators can create DAGs to help identify confounders of the relationships between modifiable risk factors and infection. Ultimately, a better understanding and control of confounding in measuring the impact of such risk factors can be used to inform health policy, guide public health and animal health interventions, and uncover gaps needing further research attention.
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Affiliation(s)
- Ellen E. Jackson
- Département de pathologie et microbiologie, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal and Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Université de Montréal, Saint-Hyacinthe, Québec, Canada
- Centre de recherche en infectiologie porcine et avicole (CRIPA), Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Amanda E. Janitz
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Hélène Carabin
- Département de pathologie et microbiologie, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal and Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Université de Montréal, Saint-Hyacinthe, Québec, Canada
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, Montréal, Québec, Canada
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8
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Ronca SE, Gunter SM, Kairis RB, Lino A, Romero J, Pautler RG, Nimmo A, Murray KO. A Potential Role for Substance P in West Nile Virus Neuropathogenesis. Viruses 2022; 14:v14091961. [PMID: 36146768 PMCID: PMC9503494 DOI: 10.3390/v14091961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Of individuals who develop West Nile neuroinvasive disease (WNND), ~10% will die and >40% will develop long-term complications. Current treatment recommendations solely focus on supportive care; therefore, we urgently need to identify novel and effective therapeutic options. We observed a correlation between substance P (SP), a key player in neuroinflammation, and its receptor Neurokinin-1 (NK1R). Our study in a wild-type BL6 mouse model found that SP is upregulated in the brain during infection, which correlated with neuroinvasion and damage to the blood−brain barrier. Blocking the SP/NK1R interaction beginning at disease onset modestly improved survival and prolonged time to death in a small pilot study. Although SP is significantly increased in the brain of untreated WNND mice when compared to mock-infected animals, levels of WNV are unchanged, indicating that SP likely does not play a role in viral replication but may mediate the immune response to infection. Additional studies are necessary to define if SP plays a mechanistic role or if it represents other mechanistic pathways.
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Affiliation(s)
- Shannon E. Ronca
- Division of Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
- Correspondence: (S.E.R.); (K.O.M.)
| | - Sarah M. Gunter
- Division of Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
| | - Rebecca Berry Kairis
- Division of Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
| | - Allison Lino
- Division of Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
| | - Jonathan Romero
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Robia G. Pautler
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Alan Nimmo
- Centre for Molecular Therapeutics and College of Medicine and Dentistry, James Cook University, Cairns, QLD 4878, Australia
| | - Kristy O. Murray
- Division of Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
- Correspondence: (S.E.R.); (K.O.M.)
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9
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Erickson TA, Ronca SE, Gunter SM, Brown EL, Hasbun R, Murray KO. Zoonotic Disease Testing Practices in Pediatric Patients with Meningitis and Encephalitis in a Subtropical Region. Pathogens 2022; 11:pathogens11050501. [PMID: 35631022 PMCID: PMC9145480 DOI: 10.3390/pathogens11050501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
Emerging vector-borne and zoonotic pathogens can cause neuroinvasive disease in children; utilization of appropriate diagnostic testing can be low, hindering diagnosis and clinical management of these cases. We must understand factors that influence healthcare providers’ decisions to order diagnostic testing. We reviewed medical charts for pediatric meningitis and encephalitis patients (90 days–18 years) between 2010 and 2017 and analyzed variables associated with testing for known neuroinvasive zoonotic pathogens in the southern United States: West Nile virus (WNV), Bartonella spp., and Rickettsia spp. Among 620 cases of meningitis and encephalitis, ~1/3 (n = 209, 34%) were tested for WNV. Fewer cases were tested for Bartonella (n = 77, 12%) and Rickettsia (n = 47, 8%). Among those tested, 14 (7%) WNV, 7 (9%) Bartonella, and 6 (13%) Rickettsia cases were identified. Factors predicting testing were similar between all agents: clinical presentation of encephalitis, focal neurologic symptoms, new onset seizure, and decreased Glasgow Coma Scale on admission. Cases with a history of arthropod contact were more likely to be tested; however, we did not see an increase in testing during the summer season, when vector exposure typically increases. While our test utilization was higher than that reported in other studies, improvement is needed to identify zoonotic causes of neuroinvasive diseases.
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Affiliation(s)
- Timothy A. Erickson
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Center for Human Immunobiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA; (T.A.E.); (S.M.G.)
- School of Public Health, University of Texas Health Science Center, Houston, TX 77030, USA;
| | - Shannon E. Ronca
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Center for Human Immunobiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA; (T.A.E.); (S.M.G.)
- Correspondence: (S.E.R.); (K.O.M.); Tel.: +1-832-824-7595 (S.E.R.)
| | - Sarah M. Gunter
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Center for Human Immunobiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA; (T.A.E.); (S.M.G.)
| | - Eric L. Brown
- School of Public Health, University of Texas Health Science Center, Houston, TX 77030, USA;
| | - Rodrigo Hasbun
- McGovern Medical School, University of Texas, Houston, TX 77030, USA;
| | - Kristy O. Murray
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Center for Human Immunobiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA; (T.A.E.); (S.M.G.)
- Correspondence: (S.E.R.); (K.O.M.); Tel.: +1-832-824-7595 (S.E.R.)
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10
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Caldwell M, Boruah AP, Thakur KT. Acute neurologic emerging flaviviruses. Ther Adv Infect Dis 2022; 9:20499361221102664. [PMID: 35719177 PMCID: PMC9198421 DOI: 10.1177/20499361221102664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/30/2022] [Indexed: 11/24/2022] Open
Abstract
The COVID-19 pandemic has shed light on the challenges we face as a global society in preventing and containing emerging and re-emerging pathogens. Multiple intersecting factors, including environmental changes, host immunological factors, and pathogen dynamics, are intimately connected to the emergence and re-emergence of communicable diseases. There is a large and expanding list of communicable diseases that can cause neurological damage, either through direct or indirect routes. Novel pathogens of neurotropic potential have been identified through advanced diagnostic techniques, including metagenomic next-generation sequencing, but there are also known pathogens which have expanded their geographic distribution to infect non-immune individuals. Factors including population growth, climate change, the increase in animal and human interface, and an increase in international travel and trade are contributing to the expansion of emerging and re-emerging pathogens. Challenges exist around antimicrobial misuse giving rise to antimicrobial-resistant infectious neurotropic organisms and increased susceptibility to infection related to the expanded use of immunomodulatory treatments. In this article, we will review key concepts around emerging and re-emerging pathogens and discuss factors associated with neurotropism and neuroinvasion. We highlight several neurotropic pathogens of interest, including West Nile virus (WNV), Zika Virus, Japanese Encephalitis Virus (JEV), and Tick-Borne Encephalitis Virus (TBEV). We emphasize neuroinfectious diseases which impact the central nervous system (CNS) and focus on flaviviruses, a group of vector-borne pathogens that have expanded globally in recent years and have proven capable of widespread outbreak.
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Affiliation(s)
- Marissa Caldwell
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Abhilasha P Boruah
- Department of Neurology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital (CUIMC/NYP), New York, NY, USA
| | - Kiran T Thakur
- Division of Critical Care and Hospitalist Neurology, Department of Neurology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital (CUIMC/NYP), 177 Fort Washington Avenue, Milstein Hospital, 8GS-300, New York, NY 10032, USA
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11
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Humphreys JM, Young KI, Cohnstaedt LW, Hanley KA, Peters DPC. Vector Surveillance, Host Species Richness, and Demographic Factors as West Nile Disease Risk Indicators. Viruses 2021; 13:934. [PMID: 34070039 PMCID: PMC8267946 DOI: 10.3390/v13050934] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 02/06/2023] Open
Abstract
West Nile virus (WNV) is the most common arthropod-borne virus (arbovirus) in the United States (US) and is the leading cause of viral encephalitis in the country. The virus has affected tens of thousands of US persons total since its 1999 North America introduction, with thousands of new infections reported annually. Approximately 1% of humans infected with WNV acquire neuroinvasive West Nile Disease (WND) with severe encephalitis and risk of death. Research describing WNV ecology is needed to improve public health surveillance, monitoring, and risk assessment. We applied Bayesian joint-spatiotemporal modeling to assess the association of vector surveillance data, host species richness, and a variety of other environmental and socioeconomic disease risk factors with neuroinvasive WND throughout the conterminous US. Our research revealed that an aging human population was the strongest disease indicator, but climatic and vector-host biotic interactions were also significant in determining risk of neuroinvasive WND. Our analysis also identified a geographic region of disproportionately high neuroinvasive WND disease risk that parallels the Continental Divide, and extends southward from the US-Canada border in the states of Montana, North Dakota, and Wisconsin to the US-Mexico border in western Texas. Our results aid in unraveling complex WNV ecology and can be applied to prioritize disease surveillance locations and risk assessment.
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Affiliation(s)
- John M. Humphreys
- Pest Management Research Unit, Agricultural Research Service, US Department of Agriculture, Sidney, MT 59270, USA
| | - Katherine I. Young
- Jornada Experimental Range Unit, Agricultural Research Service, US Department of Agriculture, Las Cruces, NM 88003, USA; (K.I.Y.); (D.P.C.P.)
- Arthropod-Borne Animal Disease Research Unit, Agricultural Research Service, US Department of Agriculture, Manhattan, KS 66502, USA;
| | - Lee W. Cohnstaedt
- Department of Biology, New Mexico State University, Las Cruces, NM 88003, USA;
| | - Kathryn A. Hanley
- Arthropod-Borne Animal Disease Research Unit, Agricultural Research Service, US Department of Agriculture, Manhattan, KS 66502, USA;
| | - Debra P. C. Peters
- Jornada Experimental Range Unit, Agricultural Research Service, US Department of Agriculture, Las Cruces, NM 88003, USA; (K.I.Y.); (D.P.C.P.)
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12
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Ronca SE, Ruff JC, Murray KO. A 20-year historical review of West Nile virus since its initial emergence in North America: Has West Nile virus become a neglected tropical disease? PLoS Negl Trop Dis 2021; 15:e0009190. [PMID: 33956816 PMCID: PMC8101735 DOI: 10.1371/journal.pntd.0009190] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
After the unexpected arrival of West Nile virus (WNV) in the United States in 1999, the mosquito-borne virus quickly spread throughout North America. Over the past 20 years, WNV has become endemic, with sporadic epizootics. Concerns about the economic impact of infection in horses lead to the licensure of an equine vaccine as early as 2005, but few advances regarding human vaccines or treatments have since been made. There is a high level of virus transmission in hot/humid, subtropical climates, and high morbidity that may disproportionately affect vulnerable populations including the homeless, elderly, and those with underlying health conditions. Although WNV continues to cause significant morbidity and mortality at great cost, funding and research have declined in recent years. These factors, combined with neglect by policy makers and amenability of control measures, indicate that WNV has become a neglected tropical disease.
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Affiliation(s)
- Shannon E. Ronca
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, United States of America
- William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas, United States of America
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jeanne C. Ruff
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, United States of America
- William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas, United States of America
| | - Kristy O. Murray
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, United States of America
- William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas, United States of America
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail:
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13
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Garzon Jimenez RC, Lieshout-Krikke RW, Janssen MP. West Nile virus and blood transfusion safety: A European perspective. Vox Sang 2021; 116:1094-1101. [PMID: 33900632 DOI: 10.1111/vox.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/28/2021] [Accepted: 04/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES There is a growing concern for the transmission of arboviral infections by blood transfusion in Europe. However, no assessment of the risk of transmission through all European blood supplies has been reported. Risk regulations at a European level should take differences in local transmission risk and the risk of transmission by travelling donors into consideration. MATERIALS AND METHODS A risk model and publicly available tool were developed to calculate the risk of transmission by all European blood supplies for arboviral outbreaks within Europe. Data on individual European blood supplies from Council of Europe reports and inter-European travel data from EUROSTAT were used to populate this model. RESULTS Each neuroinvasive case of WNV reported in Europe will on average result in 0·43 (95%CI: 0·32-0·55) infected blood product by locally infected donors and 0·010 (95%CI: 0·006-0·015) infected products by travelling donors. On basis of the 1373 neuroinvasive human WNV cases reported in the outbreak of 2018, it is estimated that without safety interventions this outbreak would have resulted in 708 (95%CI: 523-922) infected components derived from resident donors. Noncompliance to European regulations, which requires donor deferral or testing of donors who visited WNV-infected areas, would have resulted in 7.4 (95%CI: 4·7-11·1) infected blood components derived from infectious travelling donors exposed in outbreak areas throughout Europe. CONCLUSION The risk of WNV transmission by a local outbreak is on average 113 times (95%CI: 95-139), so two orders of magnitude higher than the risk of transmission by travelling donors in Europe.
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Affiliation(s)
- Rossana C Garzon Jimenez
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
| | - Ryanne W Lieshout-Krikke
- Medical Affairs, Corporate Staff, Sanquin, Amsterdam, The Netherlands.,Emerging Infectious Diseases - Monitor Working Group, European Blood Alliance, Amsterdam, The Netherlands
| | - Mart P Janssen
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
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14
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Vlaskamp DR, Thijsen SF, Reimerink J, Hilkens P, Bouvy WH, Bantjes SE, Vlaminckx BJ, Zaaijer H, van den Kerkhof HH, Raven SF, Reusken CB. First autochthonous human West Nile virus infections in the Netherlands, July to August 2020. ACTA ACUST UNITED AC 2021; 25. [PMID: 33213687 PMCID: PMC7678035 DOI: 10.2807/1560-7917.es.2020.25.46.2001904] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
In October 2020, the first case of autochthonous West Nile virus neuroinvasive disease was diagnosed in the Netherlands with a presumed infection in the last week of August. Investigations revealed five more cases of local West Nile virus (WNV) infection. The cases resided in a region where WNV was detected in a bird and mosquitoes in August 2020. Molecular analysis was successful for two cases and identified the presence of WNV lineage 2.
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Affiliation(s)
- Danique Rm Vlaskamp
- These authors contributed equally.,Department of Neurology, St. Antonius hospital, Nieuwegein, the Netherlands
| | - Steven Ft Thijsen
- Department of Medical Microbiology and Immunology, Diakonessenhuis Hospital, Utrecht, the Netherlands.,These authors contributed equally
| | - Johan Reimerink
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,These authors contributed equally
| | - Pieter Hilkens
- Department of Neurology, St. Antonius hospital, Nieuwegein, the Netherlands
| | - Willem H Bouvy
- Department of Neurology, Diakonessenhuis Hospital, Utrecht, the Netherlands
| | - Sabine E Bantjes
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Bart Jm Vlaminckx
- Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Hans Zaaijer
- Sanquin Blood Supply Foundation and Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Hans Htc van den Kerkhof
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Stijn Fh Raven
- Department of Infectious Diseases, Public Health Service region Utrecht, Utrecht, the Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,These authors contributed equally
| | - Chantal Bem Reusken
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,These authors contributed equally
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15
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Biggerstaff BJ. Estimation of time-dependent arbovirus infection risk in blood and tissue donations. STATISTICAL COMMUNICATIONS IN INFECTIOUS DISEASES 2020; 12:10.1515/scid-2020-0001. [PMID: 38618187 PMCID: PMC11010585 DOI: 10.1515/scid-2020-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
West Nile virus (WNV) outbreaks raise the concern of WNV infection in donated blood and blood products destined for transfusion. We describe methods we developed to estimate time-dependent risk of WNV infection in donated blood, including improvements not previously detailed. The methods are then extended for use in estimation of the risk of WNV infection in donated cadaveric tissues by introducing stratification and stratum-specific weighting to address novel aspects of this application. Data from the WNV outbreak in Colorado in 2003 are used to estimate risk for donated cardiac tissue.
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Affiliation(s)
- Brad J. Biggerstaff
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado, USA
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16
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Snyder RE, Feiszli T, Foss L, Messenger S, Fang Y, Barker CM, Reisen WK, Vugia DJ, Padgett KA, Kramer VL. West Nile virus in California, 2003-2018: A persistent threat. PLoS Negl Trop Dis 2020; 14:e0008841. [PMID: 33206634 PMCID: PMC7710070 DOI: 10.1371/journal.pntd.0008841] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 12/02/2020] [Accepted: 09/24/2020] [Indexed: 02/06/2023] Open
Abstract
The California Arbovirus Surveillance Program was initiated over 50 years ago to track endemic encephalitides and was enhanced in 2000 to include West Nile virus (WNV) infections in humans, mosquitoes, sentinel chickens, dead birds and horses. This comprehensive statewide program is a function of strong partnerships among the California Department of Public Health (CDPH), the University of California, and local vector control and public health agencies. This manuscript summarizes WNV surveillance data in California since WNV was first detected in 2003 in southern California. From 2003 through 2018, 6,909 human cases of WNV disease, inclusive of 326 deaths, were reported to CDPH, as well as 730 asymptomatic WNV infections identified during screening of blood and organ donors. Of these, 4,073 (59.0%) were reported as West Nile neuroinvasive disease. California's WNV disease burden comprised 15% of all cases that were reported to the U.S. Centers for Disease Control and Prevention during this time, more than any other state. Additionally, 1,299 equine WNV cases were identified, along with detections of WNV in 23,322 dead birds, 31,695 mosquito pools, and 7,340 sentinel chickens. Annual enzootic detection of WNV typically preceded detection in humans and prompted enhanced intervention to reduce the risk of WNV transmission. Peak WNV activity occurred from July through October in the Central Valley and southern California. Less than five percent of WNV activity occurred in other regions of the state or outside of this time. WNV continues to be a major threat to public and wild avian health in California, particularly in southern California and the Central Valley during summer and early fall months. Local and state public health partners must continue statewide human and mosquito surveillance and facilitate effective mosquito control and bite prevention measures.
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Affiliation(s)
- Robert E. Snyder
- California Department of Public Health, Vector-Borne Disease Section, Richmond and Sacramento, California, United States of America
| | - Tina Feiszli
- California Department of Public Health, Vector-Borne Disease Section, Richmond and Sacramento, California, United States of America
| | - Leslie Foss
- California Department of Public Health, Vector-Borne Disease Section, Richmond and Sacramento, California, United States of America
| | - Sharon Messenger
- California Department of Public Health, Division of Communicable Disease Control, Richmond, California, United States of America
| | - Ying Fang
- Department of Pathology, Microbiology & Immunology, School of Veterinary Medicine, University of California, Davis, California, United States of America
| | - Christopher M. Barker
- Department of Pathology, Microbiology & Immunology, School of Veterinary Medicine, University of California, Davis, California, United States of America
| | - William K. Reisen
- Department of Pathology, Microbiology & Immunology, School of Veterinary Medicine, University of California, Davis, California, United States of America
| | - Duc J. Vugia
- California Department of Public Health, Division of Communicable Disease Control, Richmond, California, United States of America
| | - Kerry A. Padgett
- California Department of Public Health, Vector-Borne Disease Section, Richmond and Sacramento, California, United States of America
| | - Vicki L. Kramer
- California Department of Public Health, Vector-Borne Disease Section, Richmond and Sacramento, California, United States of America
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17
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Daios S, Polychronopoulos G, Pilalas D, Nakou I, Tegos T, Kanellos I, Vagropoulos I, Savopoulos C, Kaiafa G. West Nile neuroinvasive disease: Could ESR/CRP ratio be a screening biomarker? J Med Virol 2020; 92:925-926. [DOI: 10.1002/jmv.25979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Stylianos Daios
- Internal Medicine DepartmentGeneral Hospital of Serres Serres Greece
| | - George Polychronopoulos
- First Propedeutic Department of Internal Medicine, Medical School, AHEPA University HospitalAristotle University of Thessaloniki Thessaloniki Greece
| | - Dimitrios Pilalas
- First Propedeutic Department of Internal Medicine, Medical School, AHEPA University HospitalAristotle University of Thessaloniki Thessaloniki Greece
| | - Ifigeneia Nakou
- Internal Medicine DepartmentGeneral Hospital of Serres Serres Greece
| | - Thomas Tegos
- First Neurology Department, Medical School, AHEPA University HospitalAristotle University of Thessaloniki Thessaloniki Greece
| | - Ilias Kanellos
- First Propedeutic Department of Internal Medicine, Medical School, AHEPA University HospitalAristotle University of Thessaloniki Thessaloniki Greece
| | | | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, AHEPA University HospitalAristotle University of Thessaloniki Thessaloniki Greece
| | - Georgia Kaiafa
- First Propedeutic Department of Internal Medicine, Medical School, AHEPA University HospitalAristotle University of Thessaloniki Thessaloniki Greece
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18
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Kala AK, Atkinson SF, Tiwari C. Exploring the socio-economic and environmental components of infectious diseases using multivariate geovisualization: West Nile Virus. PeerJ 2020; 8:e9577. [PMID: 33194330 PMCID: PMC7391972 DOI: 10.7717/peerj.9577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/29/2020] [Indexed: 11/20/2022] Open
Abstract
Background This study postulates that underlying environmental conditions and a susceptible population's socio-economic status should be explored simultaneously to adequately understand a vector borne disease infection risk. Here we focus on West Nile Virus (WNV), a mosquito borne pathogen, as a case study for spatial data visualization of environmental characteristics of a vector's habitat alongside human demographic composition for understanding potential public health risks of infectious disease. Multiple efforts have attempted to predict WNV environmental risk, while others have documented factors related to human vulnerability to the disease. However, analytical modeling that combines the two is difficult due to the number of potential explanatory variables, varying spatial resolutions of available data, and differing research questions that drove the initial data collection. We propose that the use of geovisualization may provide a glimpse into the large number of potential variables influencing the disease and help distill them into a smaller number that might reveal hidden and unknown patterns. This geovisual look at the data might then guide development of analytical models that can combine environmental and socio-economic data. Methods Geovisualization was used to integrate an environmental model of the disease vector's habitat alongside human risk factors derived from socio-economic variables. County level WNV incidence rates from California, USA, were used to define a geographically constrained study area where environmental and socio-economic data were extracted from 1,133 census tracts. A previously developed mosquito habitat model that was significantly related to WNV infected dead birds was used to describe the environmental components of the study area. Self-organizing maps found 49 clusters, each of which contained census tracts that were more similar to each other in terms of WNV environmental and socio-economic data. Parallel coordinate plots permitted visualization of each cluster's data, uncovering patterns that allowed final census tract mapping exposing complex spatial patterns contained within the clusters. Results Our results suggest that simultaneously visualizing environmental and socio-economic data supports a fuller understanding of the underlying spatial processes for risks to vector-borne disease. Unexpected patterns were revealed in our study that would be useful for developing future multilevel analytical models. For example, when the cluster that contained census tracts with the highest median age was examined, it was determined that those census tracts only contained moderate mosquito habitat risk. Likewise, the cluster that contained census tracts with the highest mosquito habitat risk had populations with moderate median age. Finally, the cluster that contained census tracts with the highest WNV human incidence rates had unexpectedly low mosquito habitat risk.
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Affiliation(s)
- Abhishek K Kala
- Advanced Environmental Research Institute, University of North Texas, Denton, TX, USA.,Department of Biological Sciences, University of North Texas, Denton, TX, USA
| | - Samuel F Atkinson
- Advanced Environmental Research Institute, University of North Texas, Denton, TX, USA.,Department of Biological Sciences, University of North Texas, Denton, TX, USA
| | - Chetan Tiwari
- Advanced Environmental Research Institute, University of North Texas, Denton, TX, USA.,Department of Geography and the Environment, University of North Texas, Denton, TX, USA
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19
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Ouhoummane N, Tchouaket E, Lowe AM, Fortin A, Kairy D, Vibien A, Kovitz-Lensch J, Tannenbaum TN, Milord F. Economic Burden of West Nile Virus Disease, Quebec, Canada, 2012-2013. Emerg Infect Dis 2020; 25:1943-1950. [PMID: 31538563 PMCID: PMC6759276 DOI: 10.3201/eid2510.181608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The economic burden of West Nile virus (WNV) infection is not known for Canada. We sought to describe the direct and indirect costs of WNV infection in the province of Quebec, Canada, up to 2 years after onset of signs and symptoms. We conducted a retrospective cohort study that included WNV cases reported during 2012 and 2013. For 90 persons infected with WNV, persons with encephalitis accounted for the largest proportion of total cost: a median cost of $21,332 per patient compared with $8,124 for West Nile meningitis (p = 0.0004) and $192 for West Nile fever (p<0.0001). When results were extrapolated to all reported WNV patients, the estimated total cost for 124 symptomatic cases was ≈$1.7 million for 2012 and that for 31 symptomatic cases was ≈$430,000 for 2013. Our study provides information for the government to make informed decisions regarding public health policies and infectious diseases prevention and control programs.
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20
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Shing E, Wang J, Nelder MP, Parpia C, Gubbay JB, Loeb M, Kristjanson E, Marchand-Austin A, Moore S, Russell C, Sider D, Sander B. The direct healthcare costs attributable to West Nile virus illness in Ontario, Canada: a population-based cohort study using laboratory and health administrative data. BMC Infect Dis 2019; 19:1059. [PMID: 31847823 PMCID: PMC6918579 DOI: 10.1186/s12879-019-4596-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/24/2019] [Indexed: 11/27/2022] Open
Abstract
Background West Nile virus (WNV) is a mosquito-borne flavivirus, first detected in the Western Hemisphere in 1999 and spread across North America over the next decade. Though endemic in the most populous areas of North America, few studies have estimated the healthcare costs associated with WNV. The objective of this study was to determine direct healthcare costs attributable to WNV illness in Ontario, Canada. Methods We conducted a cost-of-illness study on incident laboratory confirmed and probable WNV infected subjects identified from the provincial laboratory database from Jan 1, 2002 through Dec 31, 2012. Infected subjects were linked to health administrative data and matched to uninfected subjects. We used phase-of-care methods to calculate costs for 3 phases of illness: acute infection, continuing care, and final care prior to death. Mean 10-day attributable costs were reported in 2014 Canadian dollars, per capita. Sensitivity analysis was conducted to test the impact of WNV neurologic syndromes on healthcare costs. Results One thousand five hundred fifty-one laboratory confirmed and probable WNV infected subjects were ascertained; 1540 (99.3%) were matched to uninfected subjects. Mean age of WNV infected subjects was 49.1 ± 18.4 years, 50.5% were female. Mean costs attributable to WNV were $1177 (95% CI: $1001, $1352) for acute infection, $180 (95% CI: $122, $238) for continuing care, $11,614 (95% CI: $5916, $17,313) for final care - acute death, and $3199 (95% CI: $1770, $4627) for final care - late death. Expected 1-year costs were $13,648, adjusted for survival. Three hundred seventeen infected subjects were diagnosed with at least one neurologic syndrome and greatest healthcare costs in acute infection were associated with encephalitis ($4710, 95% CI: $3770, $5650). Conclusions WNV is associated with increased healthcare resource utilization across all phases of care. High-quality studies are needed to understand the health system impact of vector-borne diseases and evaluate the cost effectiveness of novel WNV interventions.
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Affiliation(s)
- Emily Shing
- Public Health Ontario, Toronto, Ontario, Canada.
| | - John Wang
- Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | | | | | - Mark Loeb
- Department of Pathology and Molecular Medicine; Department of Health Research, Evidence, and Impact; Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Doug Sider
- Public Health Ontario, Toronto, Ontario, Canada
| | - Beate Sander
- Public Health Ontario, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
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21
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Karaba AH, Blair PW, Martin K, Saheed MO, Carroll KC, Borowitz MJ. The Effects of a Systemwide Diagnostic Stewardship Change on West Nile Virus Disease Ordering Practices. Open Forum Infect Dis 2019; 6:ofz488. [PMID: 32128331 PMCID: PMC7047944 DOI: 10.1093/ofid/ofz488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/13/2019] [Indexed: 11/23/2022] Open
Abstract
We report that removing the clinically insensitive West Nile virus CSF nucleic acid amplification test (NAAT) from the electronic health record (EHR) test. This diagnostic stewardship intervention decreased costs and may have improved diagnostic yield.
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Affiliation(s)
- Andrew H Karaba
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul W Blair
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Kevin Martin
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mustapha O Saheed
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen C Carroll
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Borowitz
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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22
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Prediction of unfavorable outcomes in West Nile virus neuroinvasive infection - Result of a multinational ID-IRI study. J Clin Virol 2019; 122:104213. [PMID: 31778945 DOI: 10.1016/j.jcv.2019.104213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/31/2019] [Accepted: 11/07/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND WNV causes 1.4% of all central nervous system infections and is the most common cause of epidemic neuro-invasive disease in humans. OBJECTIVES Our main objective was to investigate retrospectively West Nile virus neuroinvasive disease (WNND) cases hospitalized during 2010-2017 and identified factors that can influence prognosis. STUDY DESIGN We documented the demographic, epidemiologic, clinical and laboratory data of WNND and identified factors that can influence prognosis. The data were recruited through Infectious Diseases International Research Initiative (ID-IRI), which serves as a network for clinical researches. RESULTS We investigated 165 patients with WNND in 10 countries from three continents. 27 patients died and the mortality rate was 16.4%. In an univariate analysis age, congestive heart failure, neoplasm and ischemic heart disease (p < 0.001), neuropsychiatric disorders (p = 0.011), chronic hepatitis (p = 0.024) and hypertension (p = 0.043) were risk factors for death. Fatal evolution was also correlated with ICU addmission, disorientation, speech disorders, change in consciousnes, coma, a low Glasgow coma score, obtundation, confusion (p < 0.001), history of syncope (p = 0.002) and history of unconsciousness (p = 0.037). In a binomial logistic regresssion analysis only age and coma remained independent prediction factors for death. We created an equation that was calculated according to age, co-morbidities and clinical manifestations that may be used to establish the prognosis of WNND patients. CONCLUSIONS WNND remain an important factor for morbidity and mortality worldwide, evolution to death or survival with sequelae are not rare. Our study creates an equation that may be used in the future to establish the prognosis of WNND patients.
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23
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Petersen LR. Epidemiology of West Nile Virus in the United States: Implications for Arbovirology and Public Health. JOURNAL OF MEDICAL ENTOMOLOGY 2019; 56:1456-1462. [PMID: 31549728 DOI: 10.1093/jme/tjz085] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Indexed: 06/10/2023]
Abstract
Since West Nile virus (WNV) emerged in the United States in 1999, 22,999 neuroinvasive disease cases in humans were reported through 2017. These cases have arisen from an estimated seven million human infections. Population incidence is geographically heterogeneous and is highest in the West and Midwest. Upwards of 2% of the population in some jurisdictions may become infected during outbreaks. Before universal screening of the United States blood supply, this high infection incidence and that approximately 75% of those infected remain asymptomatic translated into a considerable risk of WNV transfusion transmission despite the short duration of viremia following infection. Universal blood donor screening has nearly eliminated the risk of WNV transfusion transmission, but at enormous cost. WNV transmission via transplanted organs carries extremely high morbidity and mortality. Improved vector surveillance and timely and effective response to surveillance data can reduce the impact of WNV and should remain public health priorities.
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Affiliation(s)
- Lyle R Petersen
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 3156 Rampart Road, Fort Collins, CO
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24
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McGuckin Wuertz K, Treuting PM, Hemann EA, Esser-Nobis K, Snyder AG, Graham JB, Daniels BP, Wilkins C, Snyder JM, Voss KM, Oberst A, Lund J, Gale M. STING is required for host defense against neuropathological West Nile virus infection. PLoS Pathog 2019; 15:e1007899. [PMID: 31415679 DOI: 10.1371/journal.ppat.1007899] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/07/2019] [Indexed: 12/13/2022] Open
Abstract
West Nile Virus (WNV), an emerging and re-emerging RNA virus, is the leading source of arboviral encephalitic morbidity and mortality in the United States. WNV infections are acutely controlled by innate immunity in peripheral tissues outside of the central nervous system (CNS) but WNV can evade the actions of interferon (IFN) to facilitate CNS invasion, causing encephalitis, encephalomyelitis, and death. Recent studies indicate that STimulator of INterferon Gene (STING), canonically known for initiating a type I IFN production and innate immune response to cytosolic DNA, is required for host defense against neurotropic RNA viruses. We evaluated the role of STING in host defense to control WNV infection and pathology in a murine model of infection. When challenged with WNV, STING knock out (-/-) mice displayed increased morbidity and mortality compared to wild type (WT) mice. Virologic analysis and assessment of STING activation revealed that STING signaling was not required for control of WNV in the spleen nor was WNV sufficient to mediate canonical STING activation in vitro. However, STING-/- mice exhibited a clear trend of increased viral load and virus dissemination in the CNS. We found that STING-/- mice exhibited increased and prolonged neurological signs compared to WT mice. Pathological examination revealed increased lesions, mononuclear cellular infiltration and neuronal death in the CNS of STING-/- mice, with sustained pathology after viral clearance. We found that STING was required in bone marrow derived macrophages for early control of WNV replication and innate immune activation. In vivo, STING-/- mice developed an aberrant T cell response in both the spleen and brain during WNV infection that linked with increased and sustained CNS pathology compared to WT mice. Our findings demonstrate that STING plays a critical role in immune programming for the control of neurotropic WNV infection and CNS disease.
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Affiliation(s)
- Kathryn McGuckin Wuertz
- Department of Global Health, University of Washington, Seattle, WA, United States of America.,Department of Immunology, University of Washington, Seattle, WA, United States of America.,Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States of America.,Department of Defense; United States Army Medical Department, San Antonio, TX, United States of America
| | - Piper M Treuting
- Department of Comparative Medicine, University of Washington, Seattle, WA, United States of America
| | - Emily A Hemann
- Department of Immunology, University of Washington, Seattle, WA, United States of America.,Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States of America
| | - Katharina Esser-Nobis
- Department of Immunology, University of Washington, Seattle, WA, United States of America.,Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States of America
| | - Annelise G Snyder
- Department of Immunology, University of Washington, Seattle, WA, United States of America.,Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States of America
| | - Jessica B Graham
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Brian P Daniels
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, United States of America
| | - Courtney Wilkins
- Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States of America
| | - Jessica M Snyder
- Department of Comparative Medicine, University of Washington, Seattle, WA, United States of America
| | - Kathleen M Voss
- Department of Immunology, University of Washington, Seattle, WA, United States of America.,Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States of America
| | - Andrew Oberst
- Department of Immunology, University of Washington, Seattle, WA, United States of America.,Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States of America
| | - Jennifer Lund
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Michael Gale
- Department of Global Health, University of Washington, Seattle, WA, United States of America.,Department of Immunology, University of Washington, Seattle, WA, United States of America.,Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States of America
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25
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Ronca SE, Murray KO, Nolan MS. Cumulative Incidence of West Nile Virus Infection, Continental United States, 1999-2016. Emerg Infect Dis 2019; 25:325-327. [PMID: 30666940 PMCID: PMC6346444 DOI: 10.3201/eid2502.180765] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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
Using reported case data from ArboNET and previous seroprevalence data stratified by age and sex, we conservatively estimate that ≈7 million persons in the United States have been infected with West Nile virus since its introduction in 1999. Our data support the need for public health interventions and improved surveillance.
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26
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West Nile Virus and Usutu Virus Co-Circulation in Europe: Epidemiology and Implications. Microorganisms 2019; 7:microorganisms7070184. [PMID: 31248051 PMCID: PMC6680635 DOI: 10.3390/microorganisms7070184] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/20/2019] [Accepted: 06/25/2019] [Indexed: 01/01/2023] Open
Abstract
West Nile virus (WNV) and Usutu virus (USUV) are neurotropic mosquito-borne flaviviruses that may infect humans. Although WNV is much more widespread and plays a much larger role in human health, the two viruses are characterized by similar envelope antigens, clinical manifestations, and present overlapping in terms of geographic range of transmission, host, and vector species. This review highlights some of the most relevant aspects of WNV and USUV human infections in Europe, and the possible implications of their co-circulation.
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27
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Picinich C, Madden LK, Brendle K. Activation to Arrival: Transition and Handoff from Emergency Medical Services to Emergency Departments. Nurs Clin North Am 2019; 54:313-323. [PMID: 31331619 DOI: 10.1016/j.cnur.2019.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The burden of neurologic disease in the United States continues to increase due to a growing older population, increased life expectancy, and improved mortality after cancer and cardiac disease. Emergency medical services (EMS) providers are responding to more patients with stroke, traumatic neurologic injury, neuromuscular weakness, seizure, and spontaneous cardiac arrest. Efficient prehospital care and triage to facilities with specialized services improve outcomes. Effective handoff from EMS to an emergency department ensures continuity of care and patient safety. Although advancements in prehospital cardiopulmonary resuscitation have increased rates of return to spontaneous circulation, a large proportion of patients sustain neurologic injury.
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Affiliation(s)
- Christine Picinich
- Department of Neurological Surgery, UC Davis Health, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA.
| | - Lori Kennedy Madden
- Center for Nursing Science, UC Davis Health, 2315 Stockton Boulevard, Sacramento, CA 95817, USA
| | - Kellie Brendle
- Heart and Vascular Services, UC Davis Health, 2315 Stockton Boulevard, Sacramento, CA 95817, USA
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28
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Latif A, Kapoor V, Simmons E, Parekh J, Andukuri V. West Nile virus encephalitis in a young immunocompetent female in Omaha Nebraska. Intractable Rare Dis Res 2019; 8:48-51. [PMID: 30881858 PMCID: PMC6409123 DOI: 10.5582/irdr.2018.01108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
One of the most common cause of arbovirus encephalitis in the United States of America (USA) is West Nile virus (WNV). In immunocompetent hosts, 70-80% of infected individuals have subclinical disease. However, in less than 1% of people infected by WNV it can become fulminant neuroinvasive disease associated with neurological morbidity. Herein, we discuss a case of neuroinvasive WNV disease with non-specific symptoms in an immunocompetent young female in Omaha. Our patient survived the acute phase of WNV encephalitis but has extended recovery to daily functioning. We also reviewed literature on WNV cases in immunocompetent individuals and to the best of our knowledge only 3 cases have been reported to date. The difference between reported cases and our case is her younger age, bilateral upper and lower extremity paralysis, 30 day hospitalization with significant morbidity leading to a prolonged stay at rehabilitation facility with residual cognitive and gross motor impairment. Usually WNV is not considered a differential in immunocompetent individuals which leads to delay in diagnosis, management and therefore increases mortality and morbidity. Therefore purpose of our case report is to raise awareness of atypical presentations of WNV infection in immunocompetent individuals in non-endemic area to emphasize the importance of early diagnosis and management.
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Affiliation(s)
- Azka Latif
- CHI Health, Creighton University, Omaha, NE, USA
- Address correspondence to:Dr. Azka Latif, CHI Health, Creighton University, 7500 Mercy Road, Omaha, NE 68124, USA. E-mail:
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29
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Therapeutic Modulation of Virus-Induced Oxidative Stress via the Nrf2-Dependent Antioxidative Pathway. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:6208067. [PMID: 30515256 PMCID: PMC6234444 DOI: 10.1155/2018/6208067] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/24/2018] [Indexed: 12/17/2022]
Abstract
Virus-induced oxidative stress plays a critical role in the viral life cycle as well as the pathogenesis of viral diseases. In response to reactive oxygen species (ROS) generation by a virus, a host cell activates an antioxidative defense system for its own protection. Particularly, a nuclear factor erythroid 2p45-related factor 2 (Nrf2) pathway works in a front-line for cytoprotection and detoxification. Recently, a series of studies suggested that a group of clinically relevant viruses have the capacity for positive and negative regulations of the Nrf2 pathway. This virus-induced modulation of the host antioxidative response turned out to be a crucial determinant for the progression of several viral diseases. In this review, virus-specific examples of positive and negative modulations of the Nrf2 pathway will be summarized first. Then a number of successful genetic and pharmacological manipulations of the Nrf2 pathway for suppression of the viral replication and the pathogenesis-associated oxidative damage will be discussed later. Understanding of the interplay between virus-induced oxidative stress and antioxidative host response will aid in the discovery of potential antiviral supplements for better management of viral diseases.
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30
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Sheppard DP, Woods SP, Hasbun R, Salazar L, Nolan MS, Murray KO. Does intra-individual neurocognitive variability relate to neuroinvasive disease and quality of life in West Nile Virus? J Neurovirol 2018; 24:506-513. [PMID: 29696579 DOI: 10.1007/s13365-018-0641-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/08/2018] [Accepted: 04/10/2018] [Indexed: 11/29/2022]
Abstract
West Nile Virus (WNV) can be a neuroinvasive pathogen that may produce persistent mild-to-moderate neurocognitive impairments in some infected persons. Intra-individual variability (IIV) is an index of a person's performance across a neuropsychological test or battery, which is an indicator of neurocognitive control and integrity of prefrontal systems. The present study examined possible associations of IIV to neurological health and well-being in WNV infection. Participants included 84 adults with a range of clinical WNV disease (31 West Nile Encephalitis, 16 West Nile Meningitis, 37 West Nile Fever) who completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). IIV was operationalized as covariance of variation (CoV), or the intra-individual standard deviation across 5 age-adjusted RBANS standard scores divided by the mean of standard scores. Participants were assessed for health-related quality of life (QoL) using the RAND 36-item short form health survey (SF-36). Analyses revealed that the West Nile Encephalitis group had higher neurocognitive CoV compared to the West Nile Fever group, and this difference was associated with a medium effect size (Cohen's d = .52). Mixed linear models controlling for estimated IQ, activities of daily living, depression, neuroinvasive disease groups, and fatigue showed that higher RBANS CoV was associated with lower physical, but not mental health QoL. In persons with WNV infection, there is a modest association between elevations in IIV and encephalitis, and even subtle disruptions in neuropsychological functioning show relationships with important self-reported functioning as measured by physical health quality of life. Future studies should examine whether IIV predicts long-term health outcomes (e.g., mortality) in individuals infected with WNV.
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Affiliation(s)
- David P Sheppard
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Rodrigo Hasbun
- Department of Internal Medicine, University of Texas Health Science Center in Houston, School of Medicine, Houston, TX, USA
| | - Lucrecia Salazar
- Department of Internal Medicine, University of Texas Health Science Center in Houston, School of Medicine, Houston, TX, USA
| | - Melissa S Nolan
- Baylor College of Medicine, Department of Pediatrics, Section of Pediatric Tropical Medicine, National School of Tropical Medicine, Houston, TX, USA
| | - Kristy O Murray
- Baylor College of Medicine, Department of Pediatrics, Section of Pediatric Tropical Medicine, National School of Tropical Medicine, Houston, TX, USA
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31
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Martinez D, Murray KO, Reyna M, Arafat RR, Gorena R, Shah UA, Debboun M. West Nile Virus Outbreak in Houston and Harris County, Texas, USA, 2014. Emerg Infect Dis 2018; 23:1372-1376. [PMID: 28726615 PMCID: PMC5547786 DOI: 10.3201/eid2308.170384] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Since 2002, West Nile virus (WNV) has been detected every year in Houston and the surrounding Harris County, Texas. In 2014, the largest WNV outbreak to date occurred, comprising 139 cases and causing 2 deaths. Additionally, 1,286 WNV-positive mosquito pools were confirmed, the most reported in a single mosquito season.
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Abstract
We aimed to describe the clinical characteristics of West Nile patients reported in Québec in 2012 and 2013 and to document physical, mental and functional status 24 months after symptom onset according to illness severity. The cases were recruited by a public health professional. Data were collected from public health files, medical records and two standardised phone questionnaires: the Short Form-36 and the Instrumental Activities of Daily Living. In all, 92 persons participated in the study (25 had West Nile fever (WNF), 18 had meningitis and 49 had encephalitis). Encephalitis participants were older, had more underlying medical conditions, more neurological symptoms, worse hospital course and higher lethality than meningitis or WNF participants. Nearly half of the surviving hospitalised encephalitis patients required extra support upon discharge. At 24-month follow-up, encephalitis and meningitis patients had a lower score in two domains of the mental component: mental health and social functioning (P = 0.0025 and 0.0297, respectively) compared with the norms based on age- and sex-matched Canadians. Physical status was not affected by West Nile virus (WNV) infection. In addition, 5/36 (15%) of encephalitis, 1/17 (6%) of meningitis and 1/23 (5%) of WNF participants had new functional limitations 24 months after symptom onset. In summary, mental and functional sequelae in encephalitis patients are likely to represent a source of long-term morbidity. Preventive measures should target patients at higher risk of severe illness after WNV infection.
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El-Jawahri AR, Schaefer PW, El Khoury JB, Martinez-Lage M. Case 5-2018: A 63-Year-Old Man with Confusion after Stem-Cell Transplantation. N Engl J Med 2018; 378:659-669. [PMID: 29443669 DOI: 10.1056/nejmcpc1707556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Areej R El-Jawahri
- From the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Massachusetts General Hospital, and the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Harvard Medical School - both in Boston
| | - Pamela W Schaefer
- From the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Massachusetts General Hospital, and the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Harvard Medical School - both in Boston
| | - Joseph B El Khoury
- From the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Massachusetts General Hospital, and the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Harvard Medical School - both in Boston
| | - Maria Martinez-Lage
- From the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Massachusetts General Hospital, and the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Harvard Medical School - both in Boston
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Burakoff A, Lehman J, Fischer M, Staples JE, Lindsey NP. West Nile Virus and Other Nationally Notifiable Arboviral Diseases - United States, 2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:13-17. [PMID: 29324725 PMCID: PMC5769797 DOI: 10.15585/mmwr.mm6701a3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Arthropod-borne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes and ticks. West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease in the continental United States (1,2). Other arboviruses, including La Crosse, Powassan, Jamestown Canyon, St. Louis encephalitis, and eastern equine encephalitis viruses, cause sporadic cases of disease and occasional outbreaks. This report summarizes surveillance data reported to CDC for 2016 for nationally notifiable arboviruses. It excludes dengue, chikungunya, and Zika viruses, as these are primarily nondomestic viruses typically acquired through travel. Forty-seven states and the District of Columbia (DC) reported 2,240 cases of domestic arboviral disease, including 2,150 (96%) WNV disease cases. Of the WNV disease cases, 1,310 (61%) were classified as neuroinvasive disease (e.g., meningitis, encephalitis, acute flaccid paralysis), for a national incidence of 0.41 cases per 100,000 population. After WNV, the most frequently reported arboviruses were La Crosse (35 cases), Powassan (22), and Jamestown Canyon (15) viruses. Because arboviral diseases continue to cause serious illness, maintaining surveillance is important to direct prevention activities.
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Nayak R. Practical approach to the patient with acute neuromuscular weakness. World J Clin Cases 2017; 5:270-279. [PMID: 28798922 PMCID: PMC5535318 DOI: 10.12998/wjcc.v5.i7.270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/12/2017] [Accepted: 05/15/2017] [Indexed: 02/05/2023] Open
Abstract
Acute neuromuscular paralysis (ANMP) is a clinical syndrome characterized by rapid onset muscle weakness progressing to maximum severity within several days to weeks (less than 4 wk). Bulbar and respiratory muscle weakness may or may not be present. It is a common neurological emergency which requires immediate and careful investigations to determine the etiology because accurate diagnosis has significant impact on therapy and prognosis. Respiratory failure caused by neuromuscular weakness is considered as more critical than lung disease because its development may be insidious or subtle until sudden decompensation leads to life threatening hypoxia. Also, the arterial blood gas finding of severe hypoxemia, hypercapnia, and acidosis may not be apparent until respiratory failure is profound. Hence, the requirement for respiratory assistance should also be intensively and promptly investigated in all patients with neuromuscular disease. The disorder is classified based on the site of defect in motor unit pathway, i.e., anterior horn cells, nerve root, peripheral nerve, neuromuscular junction or muscle. Identification of the cause is primarily based on a good medical history and detailed clinical examination supplemented with neurophysiologic investigations and sometimes few specific laboratory tests. Medical history and neurological examination should be focused on the onset, progression, pattern and severity of muscle weakness as well as cranial nerves testing and tests for autonomic dysfunction. Associated non neurological features like fever, rash or other skin lesions etc. should also be noted. Globally, Guillain-Barré syndrome is the most frequent cause of ANMP and accounts for the majority of cases of respiratory muscles weakness associated with neuromuscular disorders. Newly acquired neuromuscular weakness in intensive care unit patients consist of critical illness polyneuropathy, critical illness myopathy and drug induced neuromuscular weakness which may arise as a consequence of sepsis, multi-organ failure, and exposure to certain medications like intravenous corticosteroids and neuromuscular blocking agents.
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Shankar MB, Staples JE, Meltzer MI, Fischer M. Cost effectiveness of a targeted age-based West Nile virus vaccination program. Vaccine 2017; 35:3143-3151. [PMID: 28456529 DOI: 10.1016/j.vaccine.2016.11.078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND West Nile virus (WNV) is the leading cause of domestically-acquired arboviral disease in the United States. Several WNV vaccines are in various stages of development. We estimate the cost-effectiveness of WNV vaccination programs targeting groups at increased risk for severe WNV disease. METHODS We used a mathematical model to estimate costs and health outcomes of vaccination with WNV vaccine compared to no vaccination among seven cohorts, spaced at 10year intervals from ages 10 to 70years, each followed until 90-years-old. U.S. surveillance data were used to estimate WNV neuroinvasive disease incidence. Data for WNV seroprevalence, acute and long-term care costs of WNV disease patients, quality-adjusted life-years (QALYs), and vaccine characteristics were obtained from published reports. We assumed vaccine efficacy to either last lifelong or for 10years with booster doses given every 10years. RESULTS There was a statistically significant difference in cost-effectiveness ratios across cohorts in both models and all outcomes assessed (Kruskal-Wallis test p<0.0001). The 60-year-cohort had a mean cost per neuroinvasive disease case prevented of $664,000 and disability averted of $1,421,000 in lifelong model and $882,000 and $1,887,000, respectively in 10-year immunity model; these costs were statistically significantly lower than costs for other cohorts (p<0.0001). Vaccinating 70-year-olds had the lowest cost per death averted in both models at around $4.7 million (95%CI $2-$8 million). Cost per disease case averted was lowest among 40- and 50-year-old cohorts and cost per QALY saved lowest among 60-year cohorts in lifelong immunity model. The models were most sensitive to disease incidence, vaccine cost, and proportion of persons developing disease among infected. CONCLUSIONS Age-based WNV vaccination program targeting those at higher risk for severe disease is more cost-effective than universal vaccination. Annual variation in WNV disease incidence, QALY weights, and vaccine costs impact the cost effectiveness ratios.
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Affiliation(s)
- Manjunath B Shankar
- Division for Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS C-18, Atlanta, GA 30329, USA.
| | - J Erin Staples
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 3156 Rampart Road, Fort Collins, CO 80521, USA.
| | - Martin I Meltzer
- Division for Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS C-18, Atlanta, GA 30329, USA.
| | - Marc Fischer
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 3156 Rampart Road, Fort Collins, CO 80521, USA.
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Delage G, Dubuc S, Grégoire Y, Lowe AM, Bernier F, Germain M. Determining the rate of underrecognition of West Nile virus neurologic disease in the province of Quebec in 2012. Transfusion 2017; 57:1294-1298. [PMID: 28301049 DOI: 10.1111/trf.14081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 01/09/2017] [Accepted: 01/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND During a major outbreak of West Nile virus (WNV) infection in the province of Quebec in 2012, public health authorities (PHAs) suspected underrecognition of West Nile neurologic disease (WNND). With data on acute infections detected in blood donors, an estimate of the degree of underrecognition was produced. STUDY DESIGN AND METHODS All 2012 donors were tested for WNV infection with the use of reverse transcription-polymerase chain reaction (RT-PCR). With the number of cases detected, the number of donors tested, our estimate of the duration of viremia, an estimate of the population at risk, and the ratio of WNND to total cases, an expected number of WNND cases was calculated. A Monte Carlo simulation was used to estimate the range of several of these variables. RESULTS Seventeen RT-PCR-positive donors were found among 52,309 donations tested. In the base case, the total number of cases was 16,095 and the expected number of WNND cases was 115. In the Monte Carlo simulation, the mean number of expected WNND cases was 136, and the median was 129. Since only 85 cases were reported to PHAs, it is estimated that between 26 and 37.5% of cases occurring in the province went undetected. CONCLUSION The observation that close to one-third of cases of WNND went undetected because of the omission of appropriate laboratory testing indicates the need for improvement in the investigation of acute neurologic syndrome of suspected infectious etiology in Québec.
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Affiliation(s)
| | | | | | - Anne-Marie Lowe
- Institut National de Santé Publique du Québec, Montréal, Québec, Canada
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Basu M, Courtney SC, Brinton MA. Arsenite-induced stress granule formation is inhibited by elevated levels of reduced glutathione in West Nile virus-infected cells. PLoS Pathog 2017; 13:e1006240. [PMID: 28241074 PMCID: PMC5344523 DOI: 10.1371/journal.ppat.1006240] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/09/2017] [Accepted: 02/14/2017] [Indexed: 12/30/2022] Open
Abstract
Oxidative stress activates the cellular kinase HRI, which then phosphorylates eIF2α, resulting in stalled translation initiation and the formation of stress granules (SGs). SG assembly redirects cellular translation to stress response mRNAs and inhibits cap-dependent viral RNA translation. Flavivirus infections were previously reported to induce oxidative stress in infected cells but flavivirus-infected cells paradoxically develop resistance to arsenite (Ars)-induced SG formation with time after infection. This resistance was previously postulated to be due to sequestration of the SG protein Caprin1 by Japanese encephalitis virus capsid protein. However, Caprin1 did not co-localize with West Nile virus (WNV) capsid protein in infected cells. Other stressors induced SGs with equal efficiency in mock- and WNV-infected cells indicating the intrinsic ability of cells to assemble SGs was not disabled. Induction of both reactive oxygen species (ROS) and the antioxidant response was detected at early times after WNV-infection. The transcription factors, Nrf2 and ATF4, which activate antioxidant genes, were upregulated and translocated to the nucleus. Knockdown of Nrf2, ATF4 or apoptosis-inducing factor (AIF), a mitochondrial protein involved in regenerating intracellular reduced glutathione (GSH) levels, with siRNA or treatment of cells with buthionine sulphoximine, which induces oxidative stress by inhibiting GSH synthesis, decreased intracellular GSH levels and increased the number of SG-positive, infected cells. Mitochondria were protected from Ars-induced damage by WNV infection until late times in the infection cycle. The results indicate that the increase in virus-induced ROS levels is counterbalanced by a virus-induced antioxidant response that is sufficient to also overcome the increase in ROS induced by Ars treatment and prevent Ars-induced SG assembly and mitochondrial damage. The virus-induced alterations in the cellular redox status appear to provide benefits for the virus during its lifecycle.
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Affiliation(s)
- Mausumi Basu
- Department of Biology, Georgia State University, Atlanta, GA, United States of America
| | - Sean C. Courtney
- Department of Biology, Georgia State University, Atlanta, GA, United States of America
| | - Margo A. Brinton
- Department of Biology, Georgia State University, Atlanta, GA, United States of America
- * E-mail:
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No evidence of West Nile virus infection among Polish patients with encephalitis. Cent Eur J Immunol 2017; 41:383-385. [PMID: 28450801 PMCID: PMC5382883 DOI: 10.5114/ceji.2016.65137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/26/2016] [Indexed: 11/17/2022] Open
Abstract
West Nile virus (WNV) infection usually causes mild febrile illness, but in a small proportion of patients it can lead to encephalitis. Epidemiological studies of WNV indicate fast spread of infection worldwide and in Europe, but there have been no comprehensive studies of WNV infection among encephalitis patients in Poland. Here we present the results of WNV RNA and anti-WNV testing in serum and cerebrospinal fluid (CSF) samples in 80 patients with the clinical diagnosis of viral encephalitis. WNV RNA was not detected in any of the analyzed samples. Anti-WNV IgG and IgM were not present in CSF in any of the investigated patients, but anti-WNV IgM were unexpectedly detected in serum of 14 subjects. The latter represented false positive results are probably related to cross reactivity of antibodies. Although there was no evidence of WNV infection in any of our patients, epidemiological situation in the neighbouring countries warrants vigilance and appropriate measures, including introduction of specific diagnostic tools into clinical practice, seem necessary.
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Krow-Lucal E, Lindsey NP, Lehman J, Fischer M, Staples JE. West Nile Virus and Other Nationally Notifiable Arboviral Diseases - United States, 2015. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 66:51-55. [PMID: 28103209 PMCID: PMC5657660 DOI: 10.15585/mmwr.mm6602a3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sarri CA, Markantoni M, Stamatis C, Papa A, Tsakris A, Pervanidou D, Baka A, Politis C, Billinis C, Hadjichristodoulou C, Mamuris Z. Genetic Contribution of MHC Class II Genes in Susceptibility to West Nile Virus Infection. PLoS One 2016; 11:e0165952. [PMID: 27812212 PMCID: PMC5094746 DOI: 10.1371/journal.pone.0165952] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/20/2016] [Indexed: 11/19/2022] Open
Abstract
WNV is a zoonotic neurotropic flavivirus that has recently emerged globally as a significant cause of viral encephalitis. The last five years, 624 incidents of WNV infection have been reported in Greece. The risk for severe WNV disease increases among immunosuppressed individuals implying thus the contribution of the MHC locus to the control of WNV infection. In order to investigate a possible association of MHC class II genes, especially HLA-DPA1, HLA-DQA1, HLA-DRB1, we examined 105 WNV patients, including 68 cases with neuroinvasive disease and 37 cases with mild clinical phenotype, collected during the period from 2010 to2013, and 100 control individuals selected form the Greek population. Typing was performed for exon 2 for all three genes. DQA1*01:01 was considered to be "protective" against WNV infection (25.4% vs 40.1%, P = 0.004) while DQA1*01:02 was associated with increased susceptibility (48.0% vs 32.1%, P = 0.003). Protection against neuroinvasion was associated with the presence of DRB1*11:02 (4.99% vs 0.0%, P = 0.018). DRB1*16:02 was also absent from the control cohort (P = 0.016). Three additional population control groups were used in order to validate our results. No statistically significant association with the disease was found for HLA-DPA alleles. The results of the present study provide some evidence that MHC class II is involved in the response to WNV infection, outlining infection "susceptibility" and "CNS-high-risk" candidates. Furthermore, three new alleles were identified while the frequency of all alleles in the study was compared with worldwide data. The characterization of the MHC locus could help to estimate the risk for severe WNV cases in a country.
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Affiliation(s)
- Constantina A. Sarri
- Laboratory of Genetics, Comparative and Evolutionary Biology, Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece
| | - Maria Markantoni
- Laboratory of Genetics, Comparative and Evolutionary Biology, Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece
| | - Costas Stamatis
- Laboratory of Genetics, Comparative and Evolutionary Biology, Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece
| | - Anna Papa
- Arboviruses Reference Laboratory, 1st Microbiological Laboratory, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Tsakris
- Laboratory of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Danai Pervanidou
- Hellenic Centre for Disease Control and Prevention (HCDCP), Attika, Greece
| | - Agoritsa Baka
- Hellenic Centre for Disease Control and Prevention (HCDCP), Attika, Greece
| | | | - Charalambos Billinis
- Laboratory of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Thessaly, Karditsa, Greece
| | | | - Zissis Mamuris
- Laboratory of Genetics, Comparative and Evolutionary Biology, Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece
- * E-mail:
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Taylor TJ, Diaz F, Colgrove RC, Bernard KA, DeLuca NA, Whelan SPJ, Knipe DM. Production of immunogenic West Nile virus-like particles using a herpes simplex virus 1 recombinant vector. Virology 2016; 496:186-193. [PMID: 27336950 DOI: 10.1016/j.virol.2016.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 11/18/2022]
Abstract
West Nile virus (WNV) is a flavivirus that swept rapidly across North America in 1999, declined in prevalence, and then resurged in 2012. To date, no vaccine is available to prevent infection in the human population. Herpes simplex virus (HSV) replication-defective vaccine vectors induce a durable immunity characterized by strong antibody and CD8(+) T cell responses even in HSV-immune animals. In this study, a WNV protein expression cassette was optimized for virus-like particle (VLP) production in transfection studies, and the cassette was recombined into an HSV-1 d106-WNV virus vector, which produced extracellular VLPs, as confirmed by immunoelectron microscopy. Immunization of mice with the d106-WNV recombinant vector elicited a specific anti-WNV IgG response. This study highlights the flavivirus coding sequences needed for efficient assembly of virus-like particles. This information will facilitate generation of additional vaccine vectors against other flaviviruses including the recently emerged Zika virus.
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Affiliation(s)
- Travis J Taylor
- Department of Microbiology and Immunobiology, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, United States
| | - Fernando Diaz
- Department of Microbiology and Immunobiology, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, United States
| | - Robert C Colgrove
- Department of Microbiology and Immunobiology, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, United States
| | - Kristen A Bernard
- Wadsworth Center, New York State Department of Health, P.O Box 509, Albany, NY 12201, United States
| | - Neal A DeLuca
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, 523 Bridgeside Point II, 450 Technology Drive, Pittsburgh, PA 15261, United States
| | - Sean P J Whelan
- Department of Microbiology and Immunobiology, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, United States
| | - David M Knipe
- Department of Microbiology and Immunobiology, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, United States.
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Kaidarova Z, Bravo MD, Kamel HT, Custer BS, Busch MP, Lanteri MC. Blood group A and D negativity are associated with symptomatic West Nile virus infection. Transfusion 2016; 56:1699-706. [PMID: 27189860 DOI: 10.1111/trf.13622] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND West Nile virus (WNV) infection is mostly asymptomatic (AS) but 20% of subjects report WNV fever and 1% of patients experience neurologic diseases with higher rates in elderly and immunosuppressed persons. With no treatment and no vaccine to prevent the development of symptomatic (S) infections, it is essential to understand prognostic factors influencing S disease outcome. Host genetic background has been linked to the development of WNV neuroinvasive disease. This study investigates the association between the ABO and D blood group status and WNV disease outcome. STUDY DESIGN AND METHODS The distribution of blood groups was investigated within a cohort of 374 WNV+ blood donors including 244 AS and 130 S WNV+ blood donors. Logistic regression analyses were used to examine associations between A, B, O, and D blood groups and WNV clinical disease outcome. RESULTS S WNV+ donors exhibited increased frequencies of blood group A (S 47.6%, AS 36.8%, p = 0.04; odds ratio [OR], 1.56; 95% confidence interval [CI], 1.01-2.40) and D- individuals (S 21.5%, AS 13.1%, p = 0.03; OR, 1.82; 95% CI, 1.04-3.18). CONCLUSION The findings suggest a genetic susceptibility placing blood group A and D- individuals at risk for the development of S disease outcome after WNV infection.
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Affiliation(s)
| | | | | | - Brian S Custer
- Blood Systems Research Institute, San Francisco, California.,Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California
| | - Michael P Busch
- Blood Systems Research Institute, San Francisco, California.,Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California
| | - Marion C Lanteri
- Blood Systems Research Institute, San Francisco, California.,Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California
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Genetic Variability of West Nile Virus in U.S. Blood Donors from the 2012 Epidemic Season. PLoS Negl Trop Dis 2016; 10:e0004717. [PMID: 27182734 PMCID: PMC4868353 DOI: 10.1371/journal.pntd.0004717] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/27/2016] [Indexed: 12/26/2022] Open
Abstract
West Nile virus (WNV) is an arbovirus maintained in nature in a bird-mosquito enzootic cycle which can also infect other vertebrates including humans. WNV is now endemic in the United States (U.S.), causing yearly outbreaks that have resulted in an estimated total of 4-5 million human infections. Over 41,700 cases of West Nile disease, including 18,810 neuroinvasive cases and 1,765 deaths, were reported to the CDC between 1999 and 2014. In 2012, the second largest West Nile outbreak in the U.S. was reported, which caused 5,674 cases and 286 deaths. WNV continues to evolve, and three major WNV lineage I genotypes (NY99, WN02, and SW/WN03) have been described in the U.S. since introduction of the virus in 1999. We report here the WNV sequences obtained from 19 human samples acquired during the 2012 U.S. outbreak and our examination of the evolutionary dynamics in WNV isolates sequenced from 1999-2012. Maximum-likelihood and Bayesian methods were used to perform the phylogenetic analyses. Selection pressure analyses were performed with the HyPhy package using the Datamonkey web-server. Using different codon-based and branch-site selection models, we detected a number of codons subjected to positive pressure in WNV genes. Thirteen of the 19 completely sequenced isolates from 10 U.S. states were genetically similar, sharing up to 55 nucleotide mutations and 4 amino acid substitutions when compared with the prototype isolate WN-NY99. Overall, these analyses showed that following a brief contraction in 2008-2009, WNV genetic divergence in the U.S. continued to increase in 2012, and that closely related variants were found across a broad geographic range of the U.S., coincident with the second-largest WNV outbreak in U.S.
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Hamer GL. Heterogeneity of Mosquito (Diptera: Culicidae) Control Community Size, Research Productivity, and Arboviral Diseases Across the United States. JOURNAL OF MEDICAL ENTOMOLOGY 2016; 53:485-495. [PMID: 27026158 DOI: 10.1093/jme/tjw020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 02/19/2016] [Indexed: 06/05/2023]
Abstract
Multiple factors lead to extensive variation in mosquito and mosquito-borne virus control programs throughout the United States. This variation is related to differences in budgets, number of personnel, operational activities targeting nuisance or vector species, integration of Geographical Information Systems, and the degree of research and development to improve management interventions through collaboration with academic institutions. To highlight this heterogeneity, the current study evaluates associations among the size of a mosquito control community, the research productivity, and the mosquito-borne virus human disease burden among states within the continental United States. I used the attendance at state mosquito and vector control meetings as a proxy for the size of the mosquito control community in each state. To judge research productivity, I used all peer-reviewed publications on mosquitoes and mosquito-borne viruses using data originating in each state over a 5- and 20-yr period. Total neuroinvasive human disease cases caused by mosquito-borne viruses were aggregated for each state. These data were compared directly and after adjusting for differences in human population size for each state. Results revealed that mean meeting attendance was positively correlated with the number of publications in each state, but not after correcting for the size of the population in each state. Additionally, human disease cases were positively correlated with the number of publications in each state. Finally, mean meeting attendance and human disease cases were only marginally positively associated, and no correlation existed after correcting for human population size. These analyses indicated that the mosquito control community size, research productivity, and mosquito-borne viral human disease burden varied greatly among states. The mechanisms resulting in this variation were discussed and the consequences of this variation are important given the constantly changing environment due to invasive mosquito species and arboviruses, urbanization, immigration, global travel, and climate change.
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Affiliation(s)
- Gabriel L Hamer
- Department of Entomology, Texas A&M University, 2475 TAMU, College Station, TX 77843
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Busch MP, Sabino EC, Brambilla D, Lopes ME, Capuani L, Chowdhury D, McClure C, Linnen JM, Prince H, Simmons G, Lee TH, Kleinman S, Custer B. Duration of Dengue Viremia in Blood Donors and Relationships Between Donor Viremia, Infection Incidence and Clinical Case Reports During a Large Epidemic. J Infect Dis 2016; 214:49-54. [PMID: 27302934 DOI: 10.1093/infdis/jiw122] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 03/22/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Dengue viruses (DENV-1-4) pose a transfusion-transmission risk. This study estimated the dengue RNA detection period in asymptomatic blood donors and relationships between donor viremia and dengue incidence during a large epidemic. METHODS Donor samples from the 2012 dengue transmission season in Rio de Janeiro, Brazil, were tested for DENV RNA by a transcription-mediated amplification (TMA) assay, with DENV types and viral loads determined by polymerase chain reaction. Samples collected during the first and last weeks of enrollment were tested for DENV immunoglobulin (Ig) G and IgM to estimate incidence during the study period, which was analyzed relative to nucleic acid amplification technology (NAT) yield to estimate the duration of NAT-detectable viremia and compared with reported clinical dengue cases in Rio. RESULTS Samples from 16 241 donations were tested; 87 (0.54%) were confirmed as DENV-4 RNA positive. Dengue IgM-positive/IgG-positive reactivity increased from 2.8% to 8.8%, indicating a 6.2% incidence (95% confidence interval [CI], 3.2%-9.1%) during the study period. Based on these data, we estimated a 9.1-day period (95% CI, 4.4-13.9 days) of RNA detectable with TMA. With 100 475 reported cases of clinical dengue, 1 RNA-positive donation was identified per 800 DENV cases. CONCLUSIONS These parameters allow projections of dengue incidence from donor NAT yield data and vice versa, and suggest that viremic donations will be rare relative to clinical disease cases.
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Affiliation(s)
- Michael P Busch
- Blood Systems Research Institute Department of Laboratory Medicine, University of California, San Francisco
| | - Ester C Sabino
- Department of Infectious Diseases and Institute of Tropical Medicine, University of Sao Paulo
| | | | | | - Ligia Capuani
- Department of Infectious Diseases and Institute of Tropical Medicine, University of Sao Paulo
| | | | | | | | - Harry Prince
- Focus Diagnostics, San Juan Capistrano, California
| | - Graham Simmons
- Blood Systems Research Institute Department of Laboratory Medicine, University of California, San Francisco
| | | | | | - Brian Custer
- Blood Systems Research Institute Department of Laboratory Medicine, University of California, San Francisco
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Incidence of West Nile virus infection in the Dallas–Fort Worth metropolitan area during the 2012 epidemic. Epidemiol Infect 2016; 145:2536-2544. [DOI: 10.1017/s0950268816000042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYThe 2012 West Nile virus (WNV) epidemic was the largest since 2003 and the North Texas region was the most heavily impacted. We conducted a serosurvey of blood donors from four counties in the Dallas–Fort Worth area to characterize the epidemic. Blood donor specimens collected in November 2012 were tested for WNV-specific antibodies. Donors positive for WNV-specific IgG, IgM, and neutralizing antibodies were considered to have been infected in 2012. This number was adjusted using a multi-step process that accounted for timing of IgM seroreversion determined from previous longitudinal studies of WNV-infected donors. Of 4971 donations screened, 139 (2·8%) were confirmed WNV IgG positive, and 69 (1·4%) had IgM indicating infection in 2012. After adjusting for timing of sampling and potential seroreversion, we estimated that 1·8% [95% confidence interval (CI) 1·5–2·2] of the adult population in the Dallas–Fort Worth area were infected during 2012. The resulting overall estimate for the ratio of infections to reported WNV neuroinvasive disease (WNND) cases was 238:1 (95% CI 192–290), with significantly increased risk of WNND in older age groups. These findings were very similar to previous estimates of infections per WNND case, indicating no change in virulence as WNV evolved into an endemic infection in the United States.
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James EA, Gates TJ, LaFond RE, Yamamoto S, Ni C, Mai D, Gersuk VH, O’Brien K, Nguyen QA, Zeitner B, Lanteri MC, Norris PJ, Chaussabel D, Malhotra U, Kwok WW. Neuroinvasive West Nile Infection Elicits Elevated and Atypically Polarized T Cell Responses That Promote a Pathogenic Outcome. PLoS Pathog 2016; 12:e1005375. [PMID: 26795118 PMCID: PMC4721872 DOI: 10.1371/journal.ppat.1005375] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 12/09/2015] [Indexed: 11/18/2022] Open
Abstract
Most West Nile virus (WNV) infections are asymptomatic, but some lead to neuroinvasive disease with symptoms ranging from disorientation to paralysis and death. Evidence from animal models suggests that neuroinvasive infections may arise as a consequence of impaired immune protection. However, other data suggest that neurologic symptoms may arise as a consequence of immune mediated damage. We demonstrate that elevated immune responses are present in neuroinvasive disease by directly characterizing WNV-specific T cells in subjects with laboratory documented infections using human histocompatibility leukocyte antigen (HLA) class II tetramers. Subjects with neuroinvasive infections had higher overall numbers of WNV-specific T cells than those with asymptomatic infections. Independent of this, we also observed age related increases in WNV-specific T cell responses. Further analysis revealed that WNV-specific T cell responses included a population of atypically polarized CXCR3+CCR4+CCR6- T cells, whose presence was highly correlated with neuroinvasive disease. Moreover, a higher proportion of WNV-specific T cells in these subjects co-produced interferon-γ and interleukin 4 than those from asymptomatic subjects. More globally, subjects with neuroinvasive infections had reduced numbers of CD4+FoxP3+ Tregs that were CTLA4 positive and exhibited a distinct upregulated transcript profile that was absent in subjects with asymptomatic infections. Thus, subjects with neuroinvasive WNV infections exhibited elevated, dysregulated, and atypically polarized responses, suggesting that immune mediated damage may indeed contribute to pathogenic outcomes.
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Affiliation(s)
- Eddie A. James
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Theresa J. Gates
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Rebecca E. LaFond
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Shinobu Yamamoto
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Chester Ni
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Duy Mai
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Vivian H. Gersuk
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Kimberly O’Brien
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Quynh-Anh Nguyen
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Brad Zeitner
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Marion C. Lanteri
- Blood Systems Research Institute, San Francisco, California, United States of America
| | - Philip J. Norris
- Blood Systems Research Institute, San Francisco, California, United States of America
- Departments of Laboratory Medicine and Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Damien Chaussabel
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Uma Malhotra
- Virginia Mason Medical Center, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - William W. Kwok
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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Cervantes DT, Chen S, Sutor LJ, Stonecipher S, Janoski N, Wright DJ, Busch MP. West Nile virus infection incidence based on donated blood samples and neuroinvasive disease reports, Northern Texas, USA, 2012. Emerg Infect Dis 2015; 21:681-3. [PMID: 25812045 PMCID: PMC4378495 DOI: 10.3201/eid2104.141178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
During the 2012 outbreak of West Nile virus in the United States, approximately one third of the cases were in Texas. Of those, about half occurred in northern Texas. Models based on infected blood donors and persons with neuroinvasive disease showed, respectively, that ≈0.72% and 1.98% of persons in northern Texas became infected.
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Shah S, Fite LP, Lane N, Parekh P. Purpura fulminans associated with acute West Nile virus encephalitis. J Clin Virol 2015; 75:1-4. [PMID: 26686320 DOI: 10.1016/j.jcv.2015.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 11/17/2015] [Accepted: 11/26/2015] [Indexed: 12/01/2022]
Abstract
Purpura fulminans is a progressive thrombotic disorder that presents with widespread purpura due to deficiency or dysfunction of protein C or protein S. Lesions present as well-demarcated erythematous macules that progress to irregular areas of hemorrhagic necrosis.West Nile virus is a member of the Flaviviridae family transmitted to humans through the bite of various mosquito species. It manifests as West Nile fever in 25% of those infected and less commonly as neuroinvasive disease. An African American man in his fortiespresented with altered mental status and was noted to have evidence of disseminated intravascular coagulation according to his lab data. He then developed dusky skin discoloration and systemic flaccid bullae with desquamation. Biopsy was consistent with purpura fulminans and the patient eventually developed symmetric peripheral gangrene, requiring amputations of all four extremities. Infectious work up revealed positive testing for IgM and IgG antibodies in serum and cerebrospinal fluid leading to the diagnosis of acute West Nile Virus encephalitis. We present this case to describe the rarely reported association of purpura fulminans with West Nile Virus infection.
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Affiliation(s)
- Sheevam Shah
- Texas A&M Health Science Center College of Medicine, Temple, TX, United States
| | - Laura Paul Fite
- Department of Dermatology, Scott & White Memorial Hospital, Temple, TX, United States.
| | - Natalie Lane
- Department of Dermatology, Scott & White Memorial Hospital, Temple, TX, United States
| | - Palak Parekh
- Department of Dermatology, Scott & White Memorial Hospital, Temple, TX, United States
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