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Qi F, Yan Y, Lv Q, Liu M, Liu M, Li F, Deng R, Liang X, Li S, Mou G, Bao L. IL-37 possesses both anti-inflammatory and antiviral effects against Middle East respiratory syndrome coronavirus infection. Animal Model Exp Med 2024. [PMID: 38803038 DOI: 10.1002/ame2.12435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/05/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The aim was to elucidate the function of IL-37 in middle east respiratory syndrome coronavirus (MERS-CoV) infection, thereby providing a novel therapeutic strategy for managing the clinical treatment of inflammatory response caused by respiratory virus infection. METHODS We investigated the development of MERS by infecting hDPP4 mice with hCoV-EMC (107 TCID50 [50% tissue culture infectious dose]) intranasally. We infected A549 cells with MERS-CoV, which concurrently interfered with IL-37, detecting the viral titer, viral load, and cytokine expression at certain points postinfection. Meanwhile, we administered IL-37 (12.5 μg/kg) intravenously to hDPP4 mice 2 h after MERS-CoV-2 infection and collected the serum and lungs 5 days after infection to investigate the efficacy of IL-37 in MERS-CoV infection. RESULTS The viral titer of MERS-CoV-infected A549 cells interfering with IL-37 was significantly reduced by 4.7-fold, and the viral load of MERS-CoV-infected hDPP4 mice was decreased by 59-fold in lung tissue. Furthermore, the administration of IL-37 suppressed inflammatory cytokine and chemokine (monocyte chemoattractant protein 1, interferon-γ, and IL-17A) expression and ameliorated the infiltration of inflammatory cells in hDPP4 mice. CONCLUSION IL-37 exhibits protective properties in severe pneumonia induced by MERS-CoV infection. This effect is achieved through attenuation of lung viral load, suppression of inflammatory cytokine secretion, reduction in inflammatory cell infiltration, and mitigation of pulmonary injury.
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Affiliation(s)
- Feifei Qi
- Beijing Key Laboratory for Animal Models of Emerging and Reemerging Infectious Diseases, NHC Key Laboratory of Comparative Medicine, Institute of Laboratory Animal Science, CAMS & PUMC, Beijing, China
- National Center of Technology Innovation for Animal Model, Beijing, China
| | - Yiwei Yan
- Beijing Key Laboratory for Animal Models of Emerging and Reemerging Infectious Diseases, NHC Key Laboratory of Comparative Medicine, Institute of Laboratory Animal Science, CAMS & PUMC, Beijing, China
| | - Qi Lv
- Beijing Key Laboratory for Animal Models of Emerging and Reemerging Infectious Diseases, NHC Key Laboratory of Comparative Medicine, Institute of Laboratory Animal Science, CAMS & PUMC, Beijing, China
- National Center of Technology Innovation for Animal Model, Beijing, China
| | - Mingya Liu
- Beijing Key Laboratory for Animal Models of Emerging and Reemerging Infectious Diseases, NHC Key Laboratory of Comparative Medicine, Institute of Laboratory Animal Science, CAMS & PUMC, Beijing, China
| | - Ming Liu
- Beijing Key Laboratory for Animal Models of Emerging and Reemerging Infectious Diseases, NHC Key Laboratory of Comparative Medicine, Institute of Laboratory Animal Science, CAMS & PUMC, Beijing, China
| | - Fengdi Li
- Beijing Key Laboratory for Animal Models of Emerging and Reemerging Infectious Diseases, NHC Key Laboratory of Comparative Medicine, Institute of Laboratory Animal Science, CAMS & PUMC, Beijing, China
- National Center of Technology Innovation for Animal Model, Beijing, China
| | - Ran Deng
- Beijing Key Laboratory for Animal Models of Emerging and Reemerging Infectious Diseases, NHC Key Laboratory of Comparative Medicine, Institute of Laboratory Animal Science, CAMS & PUMC, Beijing, China
- National Center of Technology Innovation for Animal Model, Beijing, China
| | - Xujian Liang
- Beijing Key Laboratory for Animal Models of Emerging and Reemerging Infectious Diseases, NHC Key Laboratory of Comparative Medicine, Institute of Laboratory Animal Science, CAMS & PUMC, Beijing, China
- National Center of Technology Innovation for Animal Model, Beijing, China
| | - Shuyue Li
- Beijing Key Laboratory for Animal Models of Emerging and Reemerging Infectious Diseases, NHC Key Laboratory of Comparative Medicine, Institute of Laboratory Animal Science, CAMS & PUMC, Beijing, China
| | - Guocui Mou
- Beijing Key Laboratory for Animal Models of Emerging and Reemerging Infectious Diseases, NHC Key Laboratory of Comparative Medicine, Institute of Laboratory Animal Science, CAMS & PUMC, Beijing, China
| | - Linlin Bao
- Beijing Key Laboratory for Animal Models of Emerging and Reemerging Infectious Diseases, NHC Key Laboratory of Comparative Medicine, Institute of Laboratory Animal Science, CAMS & PUMC, Beijing, China
- National Center of Technology Innovation for Animal Model, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
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2
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Capriotti N, Amorós Morales LC, de Sousa E, Juncal L, Pidre ML, Traverso L, López MF, Ferelli ML, Lavorato G, Lillo C, Vazquez Robaina O, Mele N, Vericat C, Schilardi P, Cabrera AF, Stewart S, Fonticelli MH, Mendoza Zéliz P, Ons S, Romanowski V, Rodríguez Torres C. Silica-coated magnetic particles for efficient RNA extraction for SARS-CoV-2 detection. Heliyon 2024; 10:e25377. [PMID: 38322940 PMCID: PMC10844049 DOI: 10.1016/j.heliyon.2024.e25377] [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: 03/28/2023] [Revised: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 02/08/2024] Open
Abstract
Molecular diagnostic methods to detect and quantify viral RNA in clinical samples rely on the purification of the genetic material prior to reverse transcription polymerase chain reaction (qRT-PCR). Due to the large number of samples processed in clinical laboratories, automation has become a necessity in order to increase method processivity and maximize throughput per unit of time. An attractive option for isolating viral RNA is based on the magnetic solid phase separation procedure (MSPS) using magnetic microparticles. This method offers the advantage over other alternative methods of making it possible to automate the process. In this study, we report the results of the MSPS method based on magnetic microparticles obtained by a simple synthesis process, to purify RNA from oro- and nasopharyngeal swab samples of patients suspected of COVID-19 provided by three diagnostic laboratories located in the Buenos Aires Province, Argentina. Magnetite nanoparticles of Fe3O4 (MNPs) were synthesized by the coprecipitation method and then coated with silica (SiO2) produced by hydrolysis of tetraethyl orthosilicate (TEOS). After preliminary tests on samples from the A549 human lung cell line and swabs, an extraction protocol was developed. The quantity and purity of the RNA obtained were determined by gel electrophoresis, spectrophotometry, and qRT-PCR. Tests on samples from naso- and oropharyngeal swabs were performed in order to validate the method for RNA purification in high-throughput SARS-CoV-2 diagnosis by qRT-PCR. The method was compared to the spin columns method and the automated method using commercial magnetic particles. The results show that the method developed is efficient for RNA extraction from nasal and oropharyngeal swab samples, and also comparable to other extraction methods in terms of sensitivity for SARS-CoV-2 detection. Of note, this procedure and reagents developed locally were intended to overcome the shortage of imported diagnostic supplies as the sudden spread of COVID-19 required unexpected quantities of nucleic acid isolation and diagnostic kits worldwide.
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Affiliation(s)
- Natalia Capriotti
- Laboratorio de Neurobiología de Insectos (LNI), Centro Regional de Estudios Genómicos, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CENEXA, CONICET, La Plata, Buenos Aires, Argentina
| | - Leslie C. Amorós Morales
- Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata-CONICET, La Plata, Argentina
| | - Elisa de Sousa
- IFLP-CCT-La Plata-CONICET and Departamento de Física, Facultad de Ciencias Exactas, C. C. 67, Universidad Nacional de La Plata, 1900, La Plata, Argentina
| | - Luciana Juncal
- IFLP-CCT-La Plata-CONICET and Departamento de Física, Facultad de Ciencias Exactas, C. C. 67, Universidad Nacional de La Plata, 1900, La Plata, Argentina
| | - Matias Luis Pidre
- Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata-CONICET, La Plata, Argentina
| | - Lucila Traverso
- Laboratorio de Neurobiología de Insectos (LNI), Centro Regional de Estudios Genómicos, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CENEXA, CONICET, La Plata, Buenos Aires, Argentina
| | - Maria Florencia López
- Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata-CONICET, La Plata, Argentina
| | - Maria Leticia Ferelli
- Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata-CONICET, La Plata, Argentina
| | - Gabriel Lavorato
- Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas (INIFTA), Facultad de Ciencias Exactas, Universidad Nacional de La Plata - CONICET, 1900, La Plata, Buenos Aires, Argentina
| | - Cristian Lillo
- Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas (INIFTA), Facultad de Ciencias Exactas, Universidad Nacional de La Plata - CONICET, 1900, La Plata, Buenos Aires, Argentina
| | - Odin Vazquez Robaina
- IFLP-CCT-La Plata-CONICET and Departamento de Física, Facultad de Ciencias Exactas, C. C. 67, Universidad Nacional de La Plata, 1900, La Plata, Argentina
| | - Nicolas Mele
- IFLP-CCT-La Plata-CONICET and Departamento de Física, Facultad de Ciencias Exactas, C. C. 67, Universidad Nacional de La Plata, 1900, La Plata, Argentina
| | - Carolina Vericat
- Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas (INIFTA), Facultad de Ciencias Exactas, Universidad Nacional de La Plata - CONICET, 1900, La Plata, Buenos Aires, Argentina
| | - Patricia Schilardi
- Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas (INIFTA), Facultad de Ciencias Exactas, Universidad Nacional de La Plata - CONICET, 1900, La Plata, Buenos Aires, Argentina
| | - Alejandra Fabiana Cabrera
- IFLP-CCT-La Plata-CONICET and Departamento de Física, Facultad de Ciencias Exactas, C. C. 67, Universidad Nacional de La Plata, 1900, La Plata, Argentina
| | - Silvana Stewart
- IFLP-CCT-La Plata-CONICET and Departamento de Física, Facultad de Ciencias Exactas, C. C. 67, Universidad Nacional de La Plata, 1900, La Plata, Argentina
| | - Mariano H. Fonticelli
- Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas (INIFTA), Facultad de Ciencias Exactas, Universidad Nacional de La Plata - CONICET, 1900, La Plata, Buenos Aires, Argentina
| | - Pedro Mendoza Zéliz
- IFLP-CCT-La Plata-CONICET and Departamento de Física, Facultad de Ciencias Exactas, C. C. 67, Universidad Nacional de La Plata, 1900, La Plata, Argentina
| | - Sheila Ons
- Laboratorio de Neurobiología de Insectos (LNI), Centro Regional de Estudios Genómicos, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CENEXA, CONICET, La Plata, Buenos Aires, Argentina
| | - Victor Romanowski
- Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata-CONICET, La Plata, Argentina
| | - Claudia Rodríguez Torres
- IFLP-CCT-La Plata-CONICET and Departamento de Física, Facultad de Ciencias Exactas, C. C. 67, Universidad Nacional de La Plata, 1900, La Plata, Argentina
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Viral agents (2nd section). Transfusion 2024; 64 Suppl 1:S19-S207. [PMID: 38394038 DOI: 10.1111/trf.17630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/02/2023] [Indexed: 02/25/2024]
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4
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Luu B, McCoy-Hass V, Kadiu T, Ngo V, Kadiu S, Lien J. Severe Acute Respiratory Syndrome Associated Infections. PHYSICIAN ASSISTANT CLINICS 2023; 8:495-530. [PMID: 37197227 PMCID: PMC10015106 DOI: 10.1016/j.cpha.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Viral infections are some of the most common sources of respiratory illness in pediatric and adult populations worldwide. Influenza and coronaviruses are viral pathogens that could lead to severe respiratory illness and death. More recently, respiratory illness from coronaviruses, accounts for more than 1 million deaths in the United States alone. This article will explore the epidemiology, pathogenesis, diagnosis, treatment, and prevention of severe acute respiratory syndrome caused by coronavirus-2, and Middle Eastern respiratory syndrome.
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Affiliation(s)
- Brent Luu
- UC Davis Betty Irene Moore School of Nursing, 2450 48th Street, Sacramento, CA 95817, USA
| | - Virginia McCoy-Hass
- UC Davis Betty Irene Moore School of Nursing, 2450 48th Street, Sacramento, CA 95817, USA
| | - Teuta Kadiu
- UC Davis Betty Irene Moore School of Nursing, 2450 48th Street, Sacramento, CA 95817, USA
| | - Victoria Ngo
- UC Davis Betty Irene Moore School of Nursing, 2450 48th Street, Sacramento, CA 95817, USA
| | - Sara Kadiu
- Partners Pharmacy, 181 Cedar Hill Road Suite 1610, Marlborough, MA 01752, USA
| | - Jeffrey Lien
- Walgreens, 227 Shoreline Highway, Mill Valley, CA 94941, USA
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5
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Mohammadi S, Tabatabaei Yazdi SM, Balagholi S, Saremi S, Dabbaghi R, Ferdowsi S, Eshghi P. Assessment of Standard Operating Procedures (SOPs) Preparing Hygienic Condition in the Blood Donation Centers during the Outbreak of COVID-19. Int J Hematol Oncol Stem Cell Res 2023; 17:167-176. [PMID: 37817974 PMCID: PMC10560646 DOI: 10.18502/ijhoscr.v17i3.13306] [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: 05/13/2021] [Accepted: 05/01/2022] [Indexed: 10/12/2023] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) outbreak has led to an alteration in hygienic conditions. In this situation, improving standard operating procedures (SOPs) in blood donation centers is critical. The purpose of this study was the assessment of SOPs in the blood donation centers during the outbreak of COVID-19 by regular blood donors as external audits. Materials and Methods: Regular donors were selected as external inspectors in 31 provinces of Iran. The questionnaire containing 10 closed questions was provided to assess the hygienic SOPs of blood transfusion centers in the prevention of COVID-19 transmission. Comparison and evaluation of questionnaires were conducted by assigning an importance coefficient (IC) score to each question. Results: Assessment of SOPs in blood donation departments by regular donors in 31 provinces of Iran showed that 18 centers (58.1%) received IC scores >10(Strong performance), seven centers (22.6%) received the range of IC scores between7-10(acceptable performance), and six centers (19.4%) received IC scores <7(poor performance). The difference in IC scores between provinces was not statistically significant. Conclusion: This study confirms that the assessment of blood donation centers through regular blood donor inspection is a reliable method to identify the strengths and weaknesses of blood transfusion center services and ultimately leads to corrective intervention and improvement of hygienic SOPs to prevent COVID-19 transmission.
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Affiliation(s)
- Saeed Mohammadi
- Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
- Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sahar Balagholi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Saeid Saremi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Rasul Dabbaghi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Shirin Ferdowsi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Peyman Eshghi
- Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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6
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Engineering potent live attenuated coronavirus vaccines by targeted inactivation of the immune evasive viral deubiquitinase. Nat Commun 2023; 14:1141. [PMID: 36854765 PMCID: PMC9973250 DOI: 10.1038/s41467-023-36754-z] [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: 08/02/2022] [Accepted: 02/16/2023] [Indexed: 03/02/2023] Open
Abstract
Coronaviruses express a papain-like protease (PLpro) that is required for replicase polyprotein maturation and also serves as a deubiquitinating enzyme (DUB). In this study, using a Middle East respiratory syndrome virus (MERS-CoV) PLpro modified virus in which the DUB is selectively inactivated, we show that the PLpro DUB is an important MERS-CoV interferon antagonist and virulence factor. Although the DUB-negative rMERS-CoVMA replicates robustly in the lungs of human dipeptidyl peptidase 4 knock-in (hDPP4 KI) mice, it does not cause clinical symptoms. Interestingly, a single intranasal vaccination with DUB-negative rMERS-CoVMA induces strong and sustained neutralizing antibody responses and sterilizing immunity after a lethal wt virus challenge. The survival of naïve animals also significantly increases when sera from animals vaccinated with the DUB-negative rMERS-CoVMA are passively transferred, prior to receiving a lethal virus dose. These data demonstrate that DUB-negative coronaviruses could be the basis of effective modified live attenuated vaccines.
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7
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Mesquita JR, Barradas P, Gomes da Silva P, Ferreira AS, Silva E, Matas IM, Thomson G, Amorim I, Duarte R, Gomes HC, Monteiro Á, Nascimento MSJ. SARS-CoV-2 and blood donations in Portugal, June-July 2020. J Med Virol 2022; 94:42-43. [PMID: 34546586 PMCID: PMC8661584 DOI: 10.1002/jmv.27353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/02/2021] [Accepted: 09/18/2021] [Indexed: 11/11/2022]
Affiliation(s)
- João R. Mesquita
- EPI UnitInstituto de Saúde Pública da Universidade do Porto (ISPUP)PortoPortugal
- Department of Veterinary Clinics, Instituto de Ciências Biomédicas Abel Salazar (ICBAS)Universidade do PortoPortoPortugal
| | - Patrícia Barradas
- EPI UnitInstituto de Saúde Pública da Universidade do Porto (ISPUP)PortoPortugal
| | - Priscilla Gomes da Silva
- EPI UnitInstituto de Saúde Pública da Universidade do Porto (ISPUP)PortoPortugal
- Department of Veterinary Clinics, Instituto de Ciências Biomédicas Abel Salazar (ICBAS)Universidade do PortoPortoPortugal
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of EngineeringUniversity of PortoPortoPortugal
| | - Ana Sofia Ferreira
- EPI UnitInstituto de Saúde Pública da Universidade do Porto (ISPUP)PortoPortugal
| | - Eliane Silva
- Department of Veterinary Clinics, Instituto de Ciências Biomédicas Abel Salazar (ICBAS)Universidade do PortoPortoPortugal
| | - Isabel M. Matas
- Department of Veterinary Clinics, Instituto de Ciências Biomédicas Abel Salazar (ICBAS)Universidade do PortoPortoPortugal
- Centro de Investigação em Biodiversidade e Recursos Genéticos (CIBIO/InBIO)Universidade do PortoPortoPortugal
| | - Gertrude Thomson
- Department of Veterinary Clinics, Instituto de Ciências Biomédicas Abel Salazar (ICBAS)Universidade do PortoPortoPortugal
- Centro de Investigação em Biodiversidade e Recursos Genéticos (CIBIO/InBIO)Universidade do PortoPortoPortugal
| | - Irina Amorim
- Department of Veterinary Clinics, Instituto de Ciências Biomédicas Abel Salazar (ICBAS)Universidade do PortoPortoPortugal
| | - Raquel Duarte
- EPI UnitInstituto de Saúde Pública da Universidade do Porto (ISPUP)PortoPortugal
- Serviço de Sangue e Medicina TransfusionalCentro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E)Vila Nova de GaiaPortugal
| | - Helena Cruz Gomes
- Serviço de Sangue e Medicina TransfusionalCentro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E)Vila Nova de GaiaPortugal
| | - Álvaro Monteiro
- Serviço de Sangue e Medicina TransfusionalCentro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E)Vila Nova de GaiaPortugal
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Brunet-Ratnasingham E, Anand SP, Gantner P, Dyachenko A, Moquin-Beaudry G, Brassard N, Beaudoin-Bussières G, Pagliuzza A, Gasser R, Benlarbi M, Point F, Prévost J, Laumaea A, Niessl J, Nayrac M, Sannier G, Orban C, Messier-Peet M, Butler-Laporte G, Morrison DR, Zhou S, Nakanishi T, Boutin M, Descôteaux-Dinelle J, Gendron-Lepage G, Goyette G, Bourassa C, Medjahed H, Laurent L, Rébillard RM, Richard J, Dubé M, Fromentin R, Arbour N, Prat A, Larochelle C, Durand M, Richards JB, Chassé M, Tétreault M, Chomont N, Finzi A, Kaufmann DE. Integrated immunovirological profiling validates plasma SARS-CoV-2 RNA as an early predictor of COVID-19 mortality. SCIENCE ADVANCES 2021; 7:eabj5629. [PMID: 34826237 PMCID: PMC8626074 DOI: 10.1126/sciadv.abj5629] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Despite advances in COVID-19 management, identifying patients evolving toward death remains challenging. To identify early predictors of mortality within 60 days of symptom onset (DSO), we performed immunovirological assessments on plasma from 279 individuals. On samples collected at DSO11 in a discovery cohort, high severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral RNA (vRNA), low receptor binding domain–specific immunoglobulin G and antibody-dependent cellular cytotoxicity, and elevated cytokines and tissue injury markers were strongly associated with mortality, including in patients on mechanical ventilation. A three-variable model of vRNA, with predefined adjustment by age and sex, robustly identified patients with fatal outcome (adjusted hazard ratio for log-transformed vRNA = 3.5). This model remained robust in independent validation and confirmation cohorts. Since plasma vRNA’s predictive accuracy was maintained at earlier time points, its quantitation can help us understand disease heterogeneity and identify patients who may benefit from new therapies.
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Affiliation(s)
- Elsa Brunet-Ratnasingham
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Sai Priya Anand
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Microbiology and Immunology, McGill University, Montréal, QC, Canada
| | - Pierre Gantner
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Alina Dyachenko
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Gaël Moquin-Beaudry
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montréal, QC, Canada
| | - Nathalie Brassard
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Guillaume Beaudoin-Bussières
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Amélie Pagliuzza
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Romain Gasser
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Mehdi Benlarbi
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Floriane Point
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Jérémie Prévost
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Annemarie Laumaea
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Julia Niessl
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Manon Nayrac
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Gérémy Sannier
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Catherine Orban
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
- Centre hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Marc Messier-Peet
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Centre hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Guillaume Butler-Laporte
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - David R. Morrison
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Sirui Zhou
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Tomoko Nakanishi
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Kyoto-McGill International Collaborative School in Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, 102-0083 Tokyo, Japan
| | - Marianne Boutin
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Jade Descôteaux-Dinelle
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Gabrielle Gendron-Lepage
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Guillaume Goyette
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Catherine Bourassa
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Halima Medjahed
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Laetitia Laurent
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Rose-Marie Rébillard
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montréal, QC, Canada
| | - Jonathan Richard
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Mathieu Dubé
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Rémi Fromentin
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Nathalie Arbour
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montréal, QC, Canada
| | - Alexandre Prat
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montréal, QC, Canada
| | - Catherine Larochelle
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montréal, QC, Canada
| | - Madeleine Durand
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Centre hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - J. Brent Richards
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Department of Twin Research, King’s College London, London, UK
| | - Michaël Chassé
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Centre hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Martine Tétreault
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montréal, QC, Canada
| | - Nicolas Chomont
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
- Corresponding author. (N.C.); (A.F.); (D.E.K.)
| | - Andrés Finzi
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
- Department of Microbiology and Immunology, McGill University, Montréal, QC, Canada
- Corresponding author. (N.C.); (A.F.); (D.E.K.)
| | - Daniel E. Kaufmann
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
- Centre hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
- Département de Médecine, Université de Montréal, Montréal, QC, Canada
- Corresponding author. (N.C.); (A.F.); (D.E.K.)
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9
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A Pilot Study on Presence of SARS-CoV-2-RNA in Iranian Blood Donors. Jundishapur J Microbiol 2021. [DOI: 10.5812/jjm.117424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: With the rapidly increasing incidence of the novel coronavirus disease 2019 (COVID-19) and the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in plasma, blood supply safety has become a main concern. Objectives: Due to some reports on the detection of RNAemia in SARS-CoV-2-infected blood donors, this study examined the presence of SARS-CoV-2 RNA in asymptomatic blood donors. Methods: In this cross-sectional study, about 400 blood donors from the Tehran Blood Transfusion Center with negative results for viral serological markers of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) were included in the study. Moreover, all samples were tested for anti-SARS-CoV-2 ELISA (IgG) to detect antibodies against SARS-CoV-2. The Presence of SARS-CoV-2 RNA in blood donors was identified by targeting RNA-dependent, RNA polymerase (RdRp), and N (nucleocapsid protein) genes using Real-Time PCR. Furthermore, the RNase P gene was used as an internal control. Results: The SARS-CoV-2 ELISA test showed that 60 (15%) of blood donors had antibodies against SARS-CoV-2 nucleocapsid protein, and 340 (85%) of the participants have not been exposed to the virus. The cycle threshold (Ct) for positive control in the RT-PCR test for nucleocapsid (N) and RdRP SARS-CoV-2 genes was < 40 (CT = 20.37). Moreover, internal control (RNase P gene) in all samples had Ct < 40. The presence of SARS-CoV-2 RNA was detected in the blood sample of none of the blood donors. In this regard, there has been no report of SARS-CoV-2 transmission to blood recipients yet. Conclusions: The blood-borne transmission of SARS-CoV-2 seems to be highly unlikely, and coronavirus RNA screening is unnecessary among blood donors. Preventive measures should be adopted to reduce the theoretical risk of transmitting SARS-CoV-2 by the blood from asymptomatic COVID-19 cases.
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10
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Mishra C, Meena S, Meena JK, Tiwari S, Mathur P. Detection of three pandemic causing coronaviruses from non-respiratory samples: systematic review and meta-analysis. Sci Rep 2021; 11:16131. [PMID: 34373501 PMCID: PMC8352881 DOI: 10.1038/s41598-021-95329-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/30/2021] [Indexed: 12/12/2022] Open
Abstract
SARS-CoV-2 has posed an unprecedented challenge to the world. Pandemics have been caused previously by viruses of this family like Middle East Respiratory Corona Virus (MERS CoV), Severe Acute Respiratory Syndrome Corona Virus (SARS CoV). Although these viruses are primarily respiratory viruses, but they have been isolated from non-respiratory samples as well. Presently, the detection rate of SARS-CoV-2 RNA from different clinical specimens using Real Time Reverse Transcriptase Polymerized Chain Reaction (qRT-PCR) after onset of symptoms is not yet well established. Therefore, the aim of this systematic review was to establish the profile of detecting SARS-CoV-2, MERS CoV, SARS CoV from different types of clinical specimens other than the respiratory using a standard diagnostic test (qRT-PCR). A total of 3429 non-respiratory specimens were recorded: SARS CoV (total sample-802), MERS CoV (total sample-155), SARS CoV-2 (total sample-2347). Out of all the samples studied high positive rate was seen for saliva with 96.7% (14/14; 95% CI 87.6-100.0%) for SARS CoV and 57.5% (58/250; 95% CI - 1.2 to 116.2%) for SARS CoV-2, while low detection rate in urine samples for SARS CoV-2 with 2.2% (8/318; 95% CI 0.6-3.7%) and 9.6% (12/61; 95% CI - 0.9 to 20.1%) for SARS CoV but there was relatively higher positivity in urine samples for MERS CoV with detection rate of 32.4% (2/38; 95% CI - 37.3 to 102.1%). In Stool sample positivity was 54.9% (396/779; 95% CI 41.0-68.8%), 45.2% (180/430; 95% CI 28.1-62.3%) and 34.7% (4/38; 95% CI - 29.5 to 98.9%) for SARS CoV-2, MERS CoV, and SARS CoV, respectively. In blood sample the positivity was 33.3% (7/21; 95% CI 13.2-53.5%), 23.7% (42/277; 95% CI 10.5-36.9%) and 2.5% (2/81; 95% CI 0.00-5.8%) for MERS CoV, SARS CoV-2 and SARS CoV respectively. SARS-CoV-2 along with previous two pandemic causing viruses from this family, were highly detected stool and saliva. A low positive rate was recorded in blood samples. Viruses were also detected in fluids along with unusual samples like semen and vaginal secretions thus highlighting unique pathogenic potential of SARS-CoV-2.
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Affiliation(s)
- Chandan Mishra
- Department of Laboratory Medicine, All India Institute of Medical Sciences, Delhi, India
| | - Suneeta Meena
- Department of Laboratory Medicine, All India Institute of Medical Sciences, Delhi, India.
| | - Jitendra Kumar Meena
- Preventive Oncology, NCI Jhajjar, All India Institute of Medical Sciences, Delhi, India
| | - Suman Tiwari
- Department of Anaesthesia and Intensive Care, VMMC and Safdarjung Hospital, Delhi, India
| | - Purva Mathur
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, Delhi, India
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11
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Mawalla WF, Njiro BJ, Bwire GM, Nasser A, Sunguya B. No evidence of SARS-CoV-2 transmission through transfusion of human blood products: A systematic review. ACTA ACUST UNITED AC 2021; 2:601-606. [PMID: 34518827 PMCID: PMC8426699 DOI: 10.1002/jha2.263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 01/24/2023]
Abstract
The presence of viral nucleic material in the circulation poses a theoretical risk of transmission through transfusion. However, little is known about the possibility of the actual transmission through transfusion or transplantation of blood products. A PROSPERO registered systematic review pooled evidence from PubMed/MEDLINE, Google Scholar and CINAHL. The search included studies on severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) transmission through human blood products. In total 537 studies were extracted, and only eight articles (1.5%) were eligible for the final analysis. A total of 14 patients received blood products from coronavirus disease‐2019 (COVID‐19) virus‐positive donors, and six (42.9%) tested negative for COVID‐19 RT‐PCR for up to 14 days post‐transfusion/transplantation. There were no documented clinical details on the COVID‐19 test for eight (57.1%) blood products recipients. Of the eight patients, none of them developed any COVID‐19‐related symptoms. In conclusion, there is limited evidence of transfusion transmission of SARS‐CoV‐2 via human blood products. Consolidation of further evidence, as it emerges, is warranted.
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Affiliation(s)
- William Frank Mawalla
- School of Medicine Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | - Belinda J Njiro
- School of Public Health and Social Services Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | - George M Bwire
- School of Pharmacy Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | - Ahlam Nasser
- School of Medicine Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | - Bruno Sunguya
- School of Public Health and Social Services Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
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12
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Miki S, Sasaki H, Horiuchi H, Miyata N, Yoshimura Y, Miyazaki K, Matsumura T, Takahashi Y, Suzuki T, Matano T, Kawana-Tachikawa A, Tachikawa N. On-admission SARS-CoV-2 RNAemia as a single potent predictive marker of critical condition development and mortality in COVID-19. PLoS One 2021; 16:e0254640. [PMID: 34255796 PMCID: PMC8277033 DOI: 10.1371/journal.pone.0254640] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/01/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study aimed to clarify how SARS-CoV-2 RNAemia is related to COVID-19 critical condition development and mortality in comparison with other predictive markers and scoring systems. METHODS This is a retrospective cohort study conducted at Yokohama Municipal Citizen's Hospital and National Institute of Infectious Diseases. We recruited adult patients with COVID-19 admitted between March 2020 and January 2021. We compared RNAemia with clinical status on admission including scoring systems such as the 4C Mortality, CURB-65, and A-DROP, as well as the Ct value of the nasopharyngeal PCR, in predicting COVID-19 mortality and critical condition development. RESULTS Of the 92 recruited patients (median age, 58; interquartile range, 45-71 years), 14 (14.9%) had RNAemia. These patients had an older age (median, 68 years vs. 55.5 years; p = 0.011), higher values of lactated dehydrogenase (median, 381 U/L vs. 256.5 U/L, p < 0.001), C-reactive protein (median, 10.9 mg/dL vs. 3.8 mg/dL; p < 0.001), D-dimer (median, 2.07 μg/mL vs. 1.28 μg/mL; p = 0.015), lower values of lymphocyte (median, 802/μL vs. 1007/μL, p = 0.025) and Ct of the nasopharyngeal PCR assay (median, 20.59 vs. 25.54; p = 0.021) than those without RNAemia. Univariate analysis showed RNAemia was associated with mortality (odds ratio [OR], 18.75; 95% confidence interval [CI], 3.92-89.76; area under the receiver operating characteristic curve [AUC], 0.7851; p = 0.002) and critical condition (OR, 72.00; 95% CI, 12.98-399.29; AUC, 0.8198; p < 0.001). Plus, multivariate analysis also revealed the association of RNAemia with critical condition (adjusted OR, 125.71; 95% CI, 11.47-1377.32; p < 0.001). CONCLUSION On-admission SARS-CoV-2 RNAemia is a potent predictive marker of COVID-19 critical condition and mortality. The adjusted OR for critical condition was as high as 125.71.
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Affiliation(s)
- Shoji Miki
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hiroaki Sasaki
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
| | - Hiroshi Horiuchi
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
| | - Nobuyuki Miyata
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
| | - Yukihiro Yoshimura
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
| | - Kazuhito Miyazaki
- Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
| | - Takayuki Matsumura
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yoshimasa Takahashi
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tadaki Suzuki
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tetsuro Matano
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
- Department of AIDS Vaccine Development, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Ai Kawana-Tachikawa
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
- Department of AIDS Vaccine Development, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Natsuo Tachikawa
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
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13
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Balagholi S, Maghsudlu M, Amini-Kafiabad S, Nazemi AM, Sotoudeh Anvari M. COVID-19 related callback in blood donors; Outcomes in blood donors and patients. Transfus Apher Sci 2021; 60:103129. [PMID: 33879420 PMCID: PMC8019242 DOI: 10.1016/j.transci.2021.103129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/14/2021] [Accepted: 03/25/2021] [Indexed: 11/29/2022]
Abstract
Call back as a procedure to report post donation symptoms or illness by donors has been established since 2009 in Iranian Blood Transfusion Organization (IBTO). During the first phase of COVID-19 outbreak, all blood donors were requested to report any respiratory infection symptoms after donation. The study investigated the callback data of COVID-19 in Tehran Blood Center during the first 3 months of the outbreak in Iran. The purpose of this study was to estimate the frequency of post donation COVID-19 related call back reports and determine its implications for blood donors and patients. A telephone interview was conducted with donors who had reported COVID-19 symptoms. Some questions were asked to evaluate donor's health at the time of blood donation. The donors categorized into three groups: laboratory-confirmed, suspected, and COVID-19 irrelevant based on their answers. In cases that the blood component obtained from a laboratory-confirmed donor had been released, the hospital was notified and asked to follow up the recipient for COVID-19. The results showed 30 donors (0.08 %) had callback related to COVID-19 and 76.63 % of the obtained component was disposed. The results also showed that only one donor had a laboratory-confirmed result with the RBC unit processed from her whole blood released for transfusion. The RBC unit recipient did not show any signs or symptoms of infection during a 46-day follow-up. Concluded that callback system was effective to remove most of the components obtained from the donors who reported to be COVID-19 suspected or confirmed. Moreover, the result did not support virus transmission through blood transfusion.
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Affiliation(s)
- Sahar Balagholi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Mahtab Maghsudlu
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.
| | - Sedigheh Amini-Kafiabad
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Amir Masoud Nazemi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Maryam Sotoudeh Anvari
- Pathology Department, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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14
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Armaly Z, Kinaneh S, Skorecki K. Renal Manifestations of Covid-19: Physiology and Pathophysiology. J Clin Med 2021; 10:1216. [PMID: 33804075 PMCID: PMC8000200 DOI: 10.3390/jcm10061216] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023] Open
Abstract
Corona virus disease 2019 (COVID-19) imposes a serious public health pandemic affecting the whole world, as it is spreading exponentially. Besides its high infectivity, SARS-CoV-2 causes multiple serious derangements, where the most prominent is severe acute respiratory syndrome as well as multiple organ dysfunction including heart and kidney injury. While the deleterious impact of SARS-CoV-2 on pulmonary and cardiac systems have attracted remarkable attention, the adverse effects of this virus on the renal system is still underestimated. Kidney susceptibility to SARS-CoV-2 infection is determined by the presence of angiotensin-converting enzyme 2 (ACE2) receptor which is used as port of the viral entry into targeted cells, tissue tropism, pathogenicity and subsequent viral replication. The SARS-CoV-2 cellular entry receptor, ACE2, is widely expressed in proximal epithelial cells, vascular endothelial and smooth muscle cells and podocytes, where it supports kidney integrity and function via the enzymatic production of Angiotensin 1-7 (Ang 1-7), which exerts vasodilatory, anti-inflammatory, antifibrotic and diuretic/natriuretic actions via activation of the Mas receptor axis. Loss of this activity constitutes the potential basis for the renal damage that occurs in COVID-19 patients. Indeed, several studies in a small sample of COVID-19 patients revealed relatively high incidence of acute kidney injury (AKI) among them. Although SARS-CoV-1 -induced AKI was attributed to multiorgan failure and cytokine release syndrome, as the virus was not detectable in the renal tissue of infected patients, SARS-CoV-2 antigens were detected in kidney tubules, suggesting that SARS-CoV-2 infects the human kidney directly, and eventually induces AKI characterized with high morbidity and mortality. The mechanisms underlying this phenomenon are largely unknown. However, the fact that ACE2 plays a crucial role against renal injury, the deprivation of the kidney of this advantageous enzyme, along with local viral replication, probably plays a central role. The current review focuses on the critical role of ACE2 in renal physiology, its involvement in the development of kidney injury during SARS-CoV-2 infection, renal manifestations and therapeutic options. The latter includes exogenous administration of Ang (1-7) as an appealing option, given the high incidence of AKI in this ACE2-depleted disorder, and the benefits of ACE2/Ang1-7 including vasodilation, diuresis, natriuresis, attenuation of inflammation, oxidative stress, cell proliferation, apoptosis and coagulation.
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Affiliation(s)
- Zaher Armaly
- Department of Nephrology, Nazareth Hospital, EMMS, Nazareth 16100, Israel;
- The Bar-Ilan University Azrieli Faculty of Medicine, Safed 1311502, Israel;
| | - Safa Kinaneh
- Department of Nephrology, Nazareth Hospital, EMMS, Nazareth 16100, Israel;
| | - Karl Skorecki
- The Bar-Ilan University Azrieli Faculty of Medicine, Safed 1311502, Israel;
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15
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Mattioli IA, Hassan A, Oliveira ON, Crespilho FN. On the Challenges for the Diagnosis of SARS-CoV-2 Based on a Review of Current Methodologies. ACS Sens 2020; 5:3655-3677. [PMID: 33267587 PMCID: PMC7724986 DOI: 10.1021/acssensors.0c01382] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022]
Abstract
Diagnosis of COVID-19 has been challenging owing to the need for mass testing and for combining distinct types of detection to cover the different stages of the infection. In this review, we have surveyed the most used methodologies for diagnosis of COVID-19, which can be basically categorized into genetic-material detection and immunoassays. Detection of genetic material with real-time polymerase chain reaction (RT-PCR) and similar techniques has been achieved with high accuracy, but these methods are expensive and require time-consuming protocols which are not widely available, especially in less developed countries. Immunoassays for detecting a few antibodies, on the other hand, have been used for rapid, less expensive tests, but their accuracy in diagnosing infected individuals has been limited. We have therefore discussed the strengths and limitations of all of these methodologies, particularly in light of the required combination of tests owing to the long incubation periods. We identified the bottlenecks that prevented mass testing in many countries, and proposed strategies for further action, which are mostly associated with materials science and chemistry. Of special relevance are the methodologies which can be integrated into point-of-care (POC) devices and the use of artificial intelligence that do not require products from a well-developed biotech industry.
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Affiliation(s)
- Isabela A. Mattioli
- São Carlos Institute of
Chemistry, University of São Paulo,
São Carlos 13560-970, São Paulo,
Brazil
| | - Ayaz Hassan
- São Carlos Institute of
Chemistry, University of São Paulo,
São Carlos 13560-970, São Paulo,
Brazil
| | - Osvaldo N. Oliveira
- São Carlos Institute of
Physics, University of São Paulo,
São Carlos 13560-590, São Paulo,
Brazil
| | - Frank N. Crespilho
- São Carlos Institute of
Chemistry, University of São Paulo,
São Carlos 13560-970, São Paulo,
Brazil
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16
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Kumar A, Faiq MA, Pareek V, Raza K, Narayan RK, Prasoon P, Kumar P, Kulandhasamy M, Kumari C, Kant K, Singh HN, Qadri R, Pandey SN, Kumar S. Relevance of SARS-CoV-2 related factors ACE2 and TMPRSS2 expressions in gastrointestinal tissue with pathogenesis of digestive symptoms, diabetes-associated mortality, and disease recurrence in COVID-19 patients. Med Hypotheses 2020; 144:110271. [PMID: 33254575 PMCID: PMC7487155 DOI: 10.1016/j.mehy.2020.110271] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/21/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023]
Abstract
COVID-19 is caused by a new strain of coronavirus called SARS-coronavirus-2 (SARS-CoV-2), which is a positive sense single strand RNA virus. In humans, it binds to angiotensin converting enzyme 2 (ACE2) with the help a structural protein on its surface called the S-spike. Further, cleavage of the viral spike protein (S) by the proteases like transmembrane serine protease 2 (TMPRSS2) or Cathepsin L (CTSL) is essential to effectuate host cell membrane fusion and virus infectivity. COVID-19 poses intriguing issues with imperative relevance to clinicians. The pathogenesis of GI symptoms, diabetes-associated mortality, and disease recurrence in COVID-19 are of particular relevance because they cannot be sufficiently explained from the existing knowledge of the viral diseases. Tissue specific variations of SARS-CoV-2 cell entry related receptors expression in healthy individuals can help in understanding the pathophysiological basis the aforementioned collection of symptoms. ACE2 mediated dysregulation of sodium dependent glucose transporter (SGLT1 or SLC5A1) in the intestinal epithelium also links it to the pathogenesis of diabetes mellitus which can be a possible reason for the associated mortality in COVID-19 patients with diabetes. High expression of ACE2 in mucosal cells of the intestine and GB make these organs potential sites for the virus entry and replication. Continued replication of the virus at these ACE2 enriched sites may be a basis for the disease recurrence reported in some, thought to be cured, patients. Based on the human tissue specific distribution of SARS-CoV-2 cell entry factors ACE2 and TMPRSS2 and other supportive evidence from the literature, we hypothesize that SARS-CoV-2 host cell entry receptor-ACE2 based mechanism in GI tissue may be involved in COVID-19 (i) in the pathogenesis of digestive symptoms, (ii) in increased diabetic complications, (iii) in disease recurrence.
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Affiliation(s)
- Ashutosh Kumar
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India; Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Patna, India.
| | - Muneeb A Faiq
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India; New York University (NYU) Langone Health Center, NYU Robert I Grossman School of Medicine, New York, NY, USA
| | - Vikas Pareek
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India; National Brain Research Center, Manesar, Haryana, India
| | - Khursheed Raza
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India; Department of Anatomy, All India Institute of Medical Sciences, Deoghar, India
| | - Ravi K Narayan
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India; Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Pranav Prasoon
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India; Pittsburgh Center for Pain Research, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Pavan Kumar
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India; Department of Pediatrics, Medical University of South Carolina, Charleston, USA
| | - Maheswari Kulandhasamy
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India; Department of Biochemistry, Maulana Azad Medical College (MAMC), New Delhi, India
| | - Chiman Kumari
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India; Department of Anatomy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kamla Kant
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India; Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bathinda, India
| | - Himanshu N Singh
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India; TAGC-INSERM, U1090, Aix Marseille University, Marseille, France
| | - Rizwana Qadri
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India; Neuro-oncology Laboratory, Rockefeller University, New York, NY, USA
| | - Sada N Pandey
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India; Department of Zoology, Banaras Hindu University (BHU), Varanasi, India
| | - Santosh Kumar
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India; Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, USA
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Feldman C, Anderson R. Brief review: Cardiac complications and platelet activation in COVID-19 infection. Afr J Thorac Crit Care Med 2020; 26:10.7196/AJTCCM.2020.v26i3.107. [PMID: 34235425 PMCID: PMC7433708 DOI: 10.7196/ajtccm.2020.v26i3.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 12/19/2022] Open
Abstract
COVID-19 pneumonia, much like that of bacterial and viral community-acquired pneumonia before it, is accompanied by a high rate of cardio- and cerebrovascular events that are associated with an increased risk of complications and a greater mortality. Although the mechanisms underlying the pathogenesis of these adverse events are not entirely clear and may be multifactorial, platelets appear to have a prominent aetiologic role and this, together with an overview of the clinical evidence, forms the basis of this short review.
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Affiliation(s)
- C Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - R Anderson
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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18
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Treatment for Severe Coronavirus Disease 2019 With the Seraph-100 Microbind Affinity Blood Filter. Crit Care Explor 2020; 2:e0180. [PMID: 32766569 DOI: 10.1097/cce.0000000000000180] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
To determine whether Seraph-100 (Exthera Medical Corporation, Martinez, CA) treatment provides clinical benefit for severe coronavirus disease 2019 cases that require mechanical ventilation and vasopressor support. Data Sources The first two patients in the United States treated with the novel Seraph-100 device. These cases were reviewed by the Food and Drug Administration prior to granting an emergency use authorization for treatment of coronavirus disease 2019. Study Selection Case series. Data Extraction Vasopressor dose, mean arterial pressure, temperature, interleukin-6, C-reactive protein, and other biomarker levels were documented both before and after Seraph-100 treatments. Data Synthesis Vasopressor dose, temperature, interleukin-6, and C-reactive protein levels declined after Seraph-100 treatments. Severe acute respiratory syndrome coronavirus 2 viremia was confirmed in the one patient tested and cleared by the completion of treatments. Conclusions Seraph-100 use may improve hemodynamic stability in coronavirus disease 2019 cases requiring mechanical ventilation and vasopressor support. These findings warrant future study of a larger cohort with the addition of mortality and total hospital day outcomes.
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Affiliation(s)
- Raymond M Johnson
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine New Haven, CT, USA
| | - Joseph M Vinetz
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine New Haven, CT, USA
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20
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Molecular Evolution and Structural Mapping of N-Terminal Domain in Spike Gene of Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Viruses 2020; 12:v12050502. [PMID: 32370153 PMCID: PMC7290774 DOI: 10.3390/v12050502] [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: 03/12/2020] [Revised: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 01/10/2023] Open
Abstract
The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a lethal zoonotic pathogen circulating in the Arabian Peninsula since 2012. There is no vaccine for MERS and anti-viral treatment is generally not applicable. We investigated the evolution of the MERS-CoV spike gene sequences and changes in viral loads over time from patients in Saudi Arabia from 2105-2017. All the MERS-CoV strains belonged to lineage 5, and showed high sequence homology (99.9%) to 2017 strains. Recombination analysis showed a potential recombination event in study strains from patients in Saudi Arabia. The spike gene showed eight amino acid substitutions, especially between the A1 and B5 lineage, and contained positively selected codon 1020. We also determined that the viral loads were significantly (p < 0.001) higher in fatal cases, and virus shedding was prolonged in some fatal cases beyond 21 days. The viral concentration peaked during the first week of illness, and the lower respiratory specimens had higher levels of MERS-CoV RNA. The presence of the diversifying selection and the topologies with the structural mapping of residues under purifying selection suggested that codon 1020 might have a role in the evolution of spike gene during the divergence of different lineages. This study will im-prove our understanding of the evolution of MERS-CoV, and also highlights the need for enhanced surveillance in humans and dromedaries. The presence of amino acid changes at the N-terminal domain and structural mapping of residues under positive selection at heptad repeat 1 provides better insight into the adaptive evolution of the spike gene and might have a potential role in virus-host tropism and pathogenesis.
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21
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Yan Y, Chang L, Wang L. Laboratory testing of SARS-CoV, MERS-CoV, and SARS-CoV-2 (2019-nCoV): Current status, challenges, and countermeasures. Rev Med Virol 2020; 30:e2106. [PMID: 32302058 PMCID: PMC7235496 DOI: 10.1002/rmv.2106] [Citation(s) in RCA: 188] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 01/08/2023]
Abstract
Emerging and reemerging infectious diseases are global public concerns. With the outbreak of unknown pneumonia in Wuhan, China in December 2019, a new coronavirus, SARS-CoV-2 has been attracting tremendous attention. Rapid and accurate laboratory testing of SARS-CoV-2 is essential for early discovery, early reporting, early quarantine, early treatment, and cutting off epidemic transmission. The genome structure, transmission, and pathogenesis of SARS-CoV-2 are basically similar to SARS-CoV and MERS-CoV, the other two beta-CoVs of medical importance. During the SARS-CoV and MERS-CoV epidemics, a variety of molecular and serological diagnostic assays were established and should be referred to for SARS-CoV-2. In this review, by summarizing the articles and guidelines about specimen collection, nucleic acid tests (NAT) and serological tests for SARS-CoV, MERS-CoV, and SARS-CoV-2, several suggestions are put forward to improve the laboratory testing of SARS-CoV-2. In summary, for NAT: collecting stool and blood samples at later periods of illness to improve the positive rate if lower respiratory tract specimens are unavailable; increasing template volume to raise the sensitivity of detection; putting samples in reagents containing guanidine salt to inactivate virus as well as protect RNA; setting proper positive, negative and inhibition controls to ensure high-quality results; simultaneously amplifying human RNase P gene to avoid false-negative results. For antibody test, diverse assays targeting different antigens, and collecting paired samples are needed.
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Affiliation(s)
- Ying Yan
- National Center for Clinical Laboratories, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
- Beijing Engineering Research Center of Laboratory MedicineBeijing HospitalBeijingChina
| | - Le Chang
- National Center for Clinical Laboratories, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
- Beijing Engineering Research Center of Laboratory MedicineBeijing HospitalBeijingChina
| | - Lunan Wang
- National Center for Clinical Laboratories, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
- Beijing Engineering Research Center of Laboratory MedicineBeijing HospitalBeijingChina
- Graduate School, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
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22
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Kwon SY, Kim EJ, Jung YS, Jang JS, Cho NS. Post-donation COVID-19 identification in blood donors. Vox Sang 2020; 115:601-602. [PMID: 32240537 DOI: 10.1111/vox.12925] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 12/28/2022]
Affiliation(s)
- So-Yong Kwon
- Blood Services Headquarters, Korean Red Cross, Wonju, Korea
| | - Eun-Jin Kim
- Daegu-Kyoungbook Blood Center, Korean Red Cross, Daegu, Korea
| | - Yu Soek Jung
- Blood Services Headquarters, Korean Red Cross, Wonju, Korea
| | - Jin Sung Jang
- Blood Services Headquarters, Korean Red Cross, Wonju, Korea
| | - Nam-Sun Cho
- Blood Services Headquarters, Korean Red Cross, Wonju, Korea
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23
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Hidalgo J, Woc-Colburn L. Influenza, Measles, SARS, MERS, and Smallpox. HIGHLY INFECTIOUS DISEASES IN CRITICAL CARE 2020. [PMCID: PMC7120728 DOI: 10.1007/978-3-030-33803-9_5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Influenza, measles, SARS, MERS, and smallpox illnesses are caused by highly infectious viral pathogens that induce critical illness. These biologically diverse viruses enter and replicate within host cells triggering viral- and host-mediated damage that results in pneumonia and multiorgan failure in severe cases. Early case identification and strict infection control limit healthcare transmission. Vaccination allowed smallpox eradication and limits global measles and seasonal influenza mortality. While SARS-coronavirus (CoV) is no longer circulating, MERS-CoV and zoonotic influenza viruses, with pandemic potential, remain persistent threats. Supportive critical care is the mainstay of treatment for severe disease due to these viral infections.
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Affiliation(s)
- Jorge Hidalgo
- Division of Critical Care, Karl Heusner Memorial Hospital, Belize City, Belize
| | - Laila Woc-Colburn
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX USA
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24
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Al-Abdely HM, Midgley CM, Alkhamis AM, Abedi GR, Lu X, Binder AM, Alanazi KH, Tamin A, Banjar WM, Lester S, Abdalla O, Dahl RM, Mohammed M, Trivedi S, Algarni HS, Sakthivel SK, Algwizani A, Bafaqeeh F, Alzahrani A, Alsharef AA, Alhakeem RF, Jokhdar HAA, Ghazal SS, Thornburg NJ, Erdman DD, Assiri AM, Watson JT, Gerber SI. Middle East Respiratory Syndrome Coronavirus Infection Dynamics and Antibody Responses among Clinically Diverse Patients, Saudi Arabia. Emerg Infect Dis 2019; 25:753-766. [PMID: 30882305 PMCID: PMC6433025 DOI: 10.3201/eid2504.181595] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) shedding and antibody responses are not fully understood, particularly in relation to underlying medical conditions, clinical manifestations, and mortality. We enrolled MERS-CoV–positive patients at a hospital in Saudi Arabia and periodically collected specimens from multiple sites for real-time reverse transcription PCR and serologic testing. We conducted interviews and chart abstractions to collect clinical, epidemiologic, and laboratory information. We found that diabetes mellitus among survivors was associated with prolonged MERS-CoV RNA detection in the respiratory tract. Among case-patients who died, development of robust neutralizing serum antibody responses during the second and third week of illness was not sufficient for patient recovery or virus clearance. Fever and cough among mildly ill patients typically aligned with RNA detection in the upper respiratory tract; RNA levels peaked during the first week of illness. These findings should be considered in the development of infection control policies, vaccines, and antibody therapeutics.
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25
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Focus on Middle East respiratory syndrome coronavirus (MERS-CoV). Med Mal Infect 2019; 50:243-251. [PMID: 31727466 PMCID: PMC7125975 DOI: 10.1016/j.medmal.2019.10.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/22/2018] [Accepted: 10/08/2019] [Indexed: 01/13/2023]
Abstract
MERS-CoV was first detected in June 2012 in Saudi Arabia. On October 16, 2018, 2260 cases and 803 related deaths had been reported in 27 countries. Although this emerging virus seems unlikely to become endemic in humans, it is still present and has not disappeared rapidly in less than 2 years like the SARS coronavirus. In this review, we discuss the main findings about the origin, emergence and virological characteristics of this virus, as well as preventive measures, the typical clinical picture, and currently available therapeutic options.
Since the first case of human infection by the Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia in June 2012, more than 2260 cases of confirmed MERS-CoV infection and 803 related deaths have been reported since the 16th of October 2018. The vast majority of these cases (71%) were reported in Saudi Arabia but the epidemic has now spread to 27 countries and has not ceased 6 years later, unlike SARS-CoV that disappeared a little less than 2 years after emerging. Due to the high fatality rate observed in MERS-CoV infected patients (36%), much effort has been put into understanding the origin and pathophysiology of this novel coronavirus to prevent it from becoming endemic in humans. This review focuses in particular on the origin, epidemiology and clinical manifestations of MERS-CoV, as well as the diagnosis and treatment of infected patients. The experience gained over recent years on how to manage the different risks related to this kind of epidemic will be key to being prepared for future outbreaks of communicable disease.
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26
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Hashem AM, Hassan AM, Tolah AM, Alsaadi MA, Abunada Q, Damanhouri GA, El-Kafrawy SA, Picard-Maureau M, Azhar EI, Hindawi SI. Amotosalen and ultraviolet A light efficiently inactivate MERS-coronavirus in human platelet concentrates. Transfus Med 2019; 29:434-441. [PMID: 31696565 PMCID: PMC7169717 DOI: 10.1111/tme.12638] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 12/12/2022]
Abstract
Objective This study aimed to assess the efficacy of the INTERCEPT™ Blood System [amotosalen/ultraviolet A (UVA) light] to reduce the risk of Middle East respiratory syndrome‐Coronavirus (MERS‐CoV) transmission by human platelet concentrates. Background Since 2012, more than 2425 MERS‐CoV human cases have been reported in 27 countries. The infection causes acute respiratory disease, which was responsible for 838 deaths in these countries, mainly in Saudi Arabia. Viral genomic RNA was detected in whole blood, serum and plasma of infected patients, raising concerns of the safety of blood supplies, especially in endemic areas. Methods Four apheresis platelet units in 100% plasma were inoculated with a clinical MERS‐CoV isolate. Spiked units were then treated with amotosalen/UVA to inactivate MERS‐CoV. Infectious and genomic viral titres were quantified by plaque assay and quantitative real‐time reverse transcription polymerase chain reaction (RT‐qPCR). Inactivated samples were successively passaged thrice on Vero E6 cells to exclude the presence of residual replication‐competent viral particles in inactivated platelets. Results Complete inactivation of MERS‐CoV in spiked platelet units was achieved by treatment with Amotosalen/UVA light with a mean log reduction of 4·48 ± 0·3. Passaging of the inactivated samples in Vero E6 showed no viral replication even after nine days of incubation and three passages. Viral genomic RNA titration in inactivated samples showed titres comparable to those in pre‐treatment samples. Conclusion Amotosalen and UVA light treatment of MERS‐CoV‐spiked platelet concentrates efficiently and completely inactivated MERS‐CoV infectivity (>4 logs), suggesting that such treatment could minimise the risk of transfusion‐related MERS‐CoV transmission.
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Affiliation(s)
- A M Hashem
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - A M Hassan
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - A M Tolah
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - M A Alsaadi
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Q Abunada
- Cerus Europe B.V, Amersfoort, The Netherlands
| | - G A Damanhouri
- Department of Hematology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - S A El-Kafrawy
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - E I Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - S I Hindawi
- Department of Hematology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Bradley BT, Bryan A. Emerging respiratory infections: The infectious disease pathology of SARS, MERS, pandemic influenza, and Legionella. Semin Diagn Pathol 2019; 36:152-159. [PMID: 31054790 PMCID: PMC7125557 DOI: 10.1053/j.semdp.2019.04.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Lower respiratory infections remain one of the top global causes of death and the emergence of new diseases continues to be a concern. In the first two decades of the 21st century, we have born witness to the emergence of newly recognized coronaviruses that have rapidly spread around the globe, including severe acute respiratory syndrome virus (SARS) and Middle Eastern respiratory syndrome virus (MERS). We have also experienced the emergence of a novel H1N1 pandemic influenza strain in 2009 that caused substantial morbidity and mortality around the world and has transitioned into a seasonal strain. Although we perhaps most frequently think of viruses when discussing emerging respiratory infections, bacteria have not been left out of the mix, as we have witnessed an increase in the number of infections from Legionella spp. since the organisms' initial discovery in 1976. Here, we explore the basic epidemiology, clinical presentation, histopathology, and clinical laboratory diagnosis of these four pathogens and emphasize themes in humans' evolving relationship with our natural environment that have contributed to the infectious burden. Histology alone is rarely diagnostic for these infections, but has been crucial to bettering our understanding of these diseases. Together, we rely on the diagnostic acumen of pathologists to identify the clinicopathologic features that raise the suspicion of these diseases and lead to the early control of the spread in our populations.
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Affiliation(s)
- Benjamin T Bradley
- University of Washington, Department of Laboratory Medicine, Box 357110, 1959 NE Pacific Street, NW120, Seattle, WA 98195-7110, United States
| | - Andrew Bryan
- University of Washington, Department of Laboratory Medicine, Box 357110, 1959 NE Pacific Street, NW120, Seattle, WA 98195-7110, United States.
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28
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Niedrig M, Patel P, El Wahed AA, Schädler R, Yactayo S. Find the right sample: A study on the versatility of saliva and urine samples for the diagnosis of emerging viruses. BMC Infect Dis 2018; 18:707. [PMID: 30594124 PMCID: PMC6311079 DOI: 10.1186/s12879-018-3611-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/10/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The emergence of different viral infections during the last decades like dengue, West Nile, SARS, chikungunya, MERS-CoV, Ebola, Zika and Yellow Fever raised some questions on quickness and reliability of laboratory diagnostic tests for verification of suspected cases. Since sampling of blood requires medically trained personal and comprises some risks for the patient as well as for the health care personal, the sampling by non-invasive methods (e.g. saliva and/ or urine) might be a very valuable alternative for investigating a diseased patient. MAIN BODY To analyse the usefulness of alternative non-invasive samples for the diagnosis of emerging infectious viral diseases, a literature search was performed on PubMed for alternative sampling for these viral infections. In total, 711 papers of potential relevance were found, of which we have included 128 in this review. CONCLUSIONS Considering the experience using non-invasive sampling for the diagnostic of emerging viral diseases, it seems important to perform an investigation using alternative samples for routine diagnostics. Moreover, during an outbreak situation, evaluation of appropriate sampling and further processing for laboratory analysis on various diagnostic platforms are very crucial. This will help to achieve optimal diagnostic results for a good and reliable case identification.
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Affiliation(s)
| | | | - Ahmed Abd El Wahed
- Division of Microbiology and Animal Hygiene, University of Goettingen, Goettingen, Germany
| | | | - Sergio Yactayo
- Control of Epidemic Diseases (CED), World Health Organization, Geneva, Switzerland
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29
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Practical Guidance for Clinical Microbiology Laboratories: Viruses Causing Acute Respiratory Tract Infections. Clin Microbiol Rev 2018; 32:32/1/e00042-18. [PMID: 30541871 DOI: 10.1128/cmr.00042-18] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Respiratory viral infections are associated with a wide range of acute syndromes and infectious disease processes in children and adults worldwide. Many viruses are implicated in these infections, and these viruses are spread largely via respiratory means between humans but also occasionally from animals to humans. This article is an American Society for Microbiology (ASM)-sponsored Practical Guidance for Clinical Microbiology (PGCM) document identifying best practices for diagnosis and characterization of viruses that cause acute respiratory infections and replaces the most recent prior version of the ASM-sponsored Cumitech 21 document, Laboratory Diagnosis of Viral Respiratory Disease, published in 1986. The scope of the original document was quite broad, with an emphasis on clinical diagnosis of a wide variety of infectious agents and laboratory focus on antigen detection and viral culture. The new PGCM document is designed to be used by laboratorians in a wide variety of diagnostic and public health microbiology/virology laboratory settings worldwide. The article provides guidance to a rapidly changing field of diagnostics and outlines the epidemiology and clinical impact of acute respiratory viral infections, including preferred methods of specimen collection and current methods for diagnosis and characterization of viral pathogens causing acute respiratory tract infections. Compared to the case in 1986, molecular techniques are now the preferred diagnostic approaches for the detection of acute respiratory viruses, and they allow for automation, high-throughput workflows, and near-patient testing. These changes require quality assurance programs to prevent laboratory contamination as well as strong preanalytical screening approaches to utilize laboratory resources appropriately. Appropriate guidance from laboratorians to stakeholders will allow for appropriate specimen collection, as well as correct test ordering that will quickly identify highly transmissible emerging pathogens.
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A spike-modified Middle East respiratory syndrome coronavirus (MERS-CoV) infectious clone elicits mild respiratory disease in infected rhesus macaques. Sci Rep 2018; 8:10727. [PMID: 30013082 PMCID: PMC6048037 DOI: 10.1038/s41598-018-28900-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 07/02/2018] [Indexed: 12/22/2022] Open
Abstract
The recurrence of new human cases of Middle East respiratory syndrome coronavirus (MERS-CoV) underscores the need for effective therapeutic countermeasures. Nonhuman primate models are considered the gold standard for preclinical evaluation of therapeutic countermeasures. However, MERS-CoV-induced severe respiratory disease in humans is associated with high viral loads in the lower respiratory tract, which may be difficult to achieve in nonhuman primate models. Considering this limitation, we wanted to ascertain the effectiveness of using a MERS-CoV infectious clone (icMERS-0) previously shown to replicate to higher titers than the wild-type EMC 2012 strain. We observed respiratory disease resulting from exposure to the icMERS-0 strain as measured by CT in rhesus monkeys with concomitant detection of virus antigen by immunohistochemistry. Overall, respiratory disease was mild and transient, resolving by day 30 post-infection. Although pulmonary disease was mild, these results demonstrate for the first time the utility of CT imaging to measure disease elicited by a MERS-CoV infectious clone system in nonhuman primate models.
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31
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Koch B, Schult-Dietrich P, Büttner S, Dilmaghani B, Lohmann D, Baer PC, Dietrich U, Geiger H. Lectin Affinity Plasmapheresis for Middle East Respiratory Syndrome-Coronavirus and Marburg Virus Glycoprotein Elimination. Blood Purif 2018; 46:126-133. [PMID: 29698959 DOI: 10.1159/000487224] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/29/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND/AIMS Middle East respiratory syndrome coronavirus (MERS-CoV) and Marburg virus (MARV) are among the World Health Organization's top 8 emerging pathogens. Both zoonoses share nonspecific early symptoms, a high lethality rate, and a reduced number of specific treatment options. Therefore, we evaluated extracorporeal virus and glycoprotein (GP) elimination by lectin affinity plasmapheresis (LAP). METHODS For both MERS-CoV (pseudovirus) as well as MARV (GPs), 4 LAP devices (Mini Hemopurifiers, Aethlon Medical, San Diego, CA, USA) and 4 negative controls were tested. Samples were collected every 30 min and analyzed for reduction in virus infectivity by a flow cytometry-based infectivity assay (MERS-CoV) and in soluble GP content (MARV) by an immunoassay. RESULTS The experiments show a time-dependent clearance of MERS-CoV of up to 80% within 3 h (pseudovirus). Up to 70% of MARV-soluble GPs were eliminated at the same time. Substantial saturation of the binding resins was detected within the first treatment hour. CONCLUSION MERS-CoV (pseudovirus) and MARV soluble GPs are eliminated by LAP in vitro. Considering the high lethality and missing established treatment options, LAP should be evaluated in vivo. Especially early initiation, continuous therapy, and timed cartridge exchanges could be of importance.
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Affiliation(s)
- Benjamin Koch
- Goethe University Hospital, Med. III, Division of Nephrology, Dialysis and Transplantation, Frankfurt, Germany
| | | | - Stefan Büttner
- Goethe University Hospital, Med. III, Division of Nephrology, Dialysis and Transplantation, Frankfurt, Germany
| | - Bijan Dilmaghani
- Goethe University Hospital, Med. III, Division of Nephrology, Dialysis and Transplantation, Frankfurt, Germany
| | - Dario Lohmann
- Goethe University Hospital, Med. III, Division of Nephrology, Dialysis and Transplantation, Frankfurt, Germany
| | - Patrick C Baer
- Goethe University Hospital, Med. III, Division of Nephrology, Dialysis and Transplantation, Frankfurt, Germany
| | - Ursula Dietrich
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt, Germany
| | - Helmut Geiger
- Goethe University Hospital, Med. III, Division of Nephrology, Dialysis and Transplantation, Frankfurt, Germany
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32
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Oh MD, Park WB, Park SW, Choe PG, Bang JH, Song KH, Kim ES, Kim HB, Kim NJ. Middle East respiratory syndrome: what we learned from the 2015 outbreak in the Republic of Korea. Korean J Intern Med 2018; 33:233-246. [PMID: 29506344 PMCID: PMC5840604 DOI: 10.3904/kjim.2018.031] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/13/2018] [Indexed: 02/07/2023] Open
Abstract
Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first isolated from a patient with severe pneumonia in 2012. The 2015 Korea outbreak of MERSCoV involved 186 cases, including 38 fatalities. A total of 83% of transmission events were due to five superspreaders, and 44% of the 186 MERS cases were the patients who had been exposed in nosocomial transmission at 16 hospitals. The epidemic lasted for 2 months and the government quarantined 16,993 individuals for 14 days to control the outbreak. This outbreak provides a unique opportunity to fill the gap in our knowledge of MERS-CoV infection. Therefore, in this paper, we review the literature on epidemiology, virology, clinical features, and prevention of MERS-CoV, which were acquired from the 2015 Korea outbreak of MERSCoV.
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Affiliation(s)
- Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Hindawi SI, Hashem AM, Damanhouri GA, El-Kafrawy SA, Tolah AM, Hassan AM, Azhar EI. Inactivation of Middle East respiratory syndrome-coronavirus in human plasma using amotosalen and ultraviolet A light. Transfusion 2017; 58:52-59. [PMID: 29239484 PMCID: PMC7169686 DOI: 10.1111/trf.14422] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/11/2017] [Accepted: 07/18/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Middle East respiratory syndrome‐coronavirus (MERS‐CoV) is a novel zoonotic pathogen. Although the potential for MERS‐CoV transmission through blood transfusion is not clear, MERS‐CoV was recognized as a pathogen of concern for the safety of the blood supply especially after its detection in whole blood, serum, and plasma of infected individuals. Here we investigated the efficacy of amotosalen and ultraviolet A light (UVA) to inactivate MERS‐CoV in fresh‐frozen plasma (FFP). STUDY DESIGN AND METHODS Pooled FFP units were spiked with a recent clinical MERS‐CoV isolate. Infectious and genomic viral titers were determined in plasma before and after inactivation with amotosalen/UVA treatment by plaque assay and reverse transcription–quantitative polymerase chain reaction, respectively. In addition, residual replicating or live virus after inactivation was examined by passaging in the permissive Vero E6 cells. RESULTS The mean MERS‐CoV infectious titer in pretreatment samples was 4.67 ± 0.25 log plaque‐forming units (pfu)/mL, which was reduced to undetectable levels after inactivation with amotosalen/UVA demonstrating a mean log reduction of more than 4.67 ± 0.25 pfu/mL. Furthermore, inoculation of inactivated plasma on Vero E6 cells did not result in any cytopathic effect (CPE) even after 7 days of incubation and three consecutive passages, nor the detection of MERS RNA compared to pretreatment samples which showed complete CPE within 2 to 3 days postinoculation and log viral RNA titer ranging from 9.48 to 10.22 copies/mL in all three passages. CONCLUSION Our data show that amotosalen/UVA treatment is a potent and effective way to inactivate MERS‐CoV infectious particles in FFP to undetectable levels and to minimize the risk of any possible transfusion‐related MERS‐CoV transmission.
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Affiliation(s)
- Salwa I Hindawi
- Blood Transfusion Services, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Anwar M Hashem
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghazi A Damanhouri
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sherif A El-Kafrawy
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Clinical Pathology Department, National Liver Institute, Menoufiya University, Shebin El-Kom, Egypt
| | - Ahmed M Tolah
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed M Hassan
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Esam I Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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34
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Maslow JN. Vaccines for emerging infectious diseases: Lessons from MERS coronavirus and Zika virus. Hum Vaccin Immunother 2017; 13:2918-2930. [PMID: 28846484 PMCID: PMC5718785 DOI: 10.1080/21645515.2017.1358325] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The past decade and a half has been characterized by numerous emerging infectious diseases. With each new threat, there has been a call for rapid vaccine development. Pathogens such as the Middle East Respiratory Syndrome coronavirus (MERS-CoV) and the Zika virus represent either new viral entities or viruses emergent in new geographic locales and characterized by novel complications. Both serve as paradigms for the global spread that can accompany new pathogens. In this paper, we review the epidemiology and pathogenesis of MERS-CoV and Zika virus with respect to vaccine development. The challenges in vaccine development and the approach to clinical trial design to test vaccine candidates for disease entities with a changing epidemiology are discussed.
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35
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Evaluation of a Real-Time Reverse Transcription-PCR (RT-PCR) Assay for Detection of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Clinical Samples from an Outbreak in South Korea in 2015. J Clin Microbiol 2017; 55:2554-2555. [PMID: 28566313 DOI: 10.1128/jcm.00667-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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36
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Mouse-adapted MERS coronavirus causes lethal lung disease in human DPP4 knockin mice. Proc Natl Acad Sci U S A 2017; 114:E3119-E3128. [PMID: 28348219 DOI: 10.1073/pnas.1619109114] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The Middle East respiratory syndrome (MERS) emerged in Saudi Arabia in 2012, caused by a zoonotically transmitted coronavirus (CoV). Over 1,900 cases have been reported to date, with ∼36% fatality rate. Lack of autopsies from MERS cases has hindered understanding of MERS-CoV pathogenesis. A small animal model that develops progressive pulmonary manifestations when infected with MERS-CoV would advance the field. As mice are restricted to infection at the level of DPP4, the MERS-CoV receptor, we generated mice with humanized exons 10-12 of the mouse Dpp4 locus. Upon inoculation with MERS-CoV, human DPP4 knockin (KI) mice supported virus replication in the lungs, but developed no illness. After 30 serial passages through the lungs of KI mice, a mouse-adapted virus emerged (MERSMA) that grew in lungs to over 100 times higher titers than the starting virus. A plaque-purified MERSMA clone caused weight loss and fatal infection. Virus antigen was observed in airway epithelia, pneumocytes, and macrophages. Pathologic findings included diffuse alveolar damage with pulmonary edema and hyaline membrane formation associated with accumulation of activated inflammatory monocyte-macrophages and neutrophils in the lungs. Relative to the parental MERS-CoV, MERSMA viruses contained 13-22 mutations, including several within the spike (S) glycoprotein gene. S-protein mutations sensitized viruses to entry-activating serine proteases and conferred more rapid entry kinetics. Recombinant MERSMA bearing mutant S proteins were more virulent than the parental virus in hDPP4 KI mice. The hDPP4 KI mouse and the MERSMA provide tools to investigate disease causes and develop new therapies.
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37
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Chan JFW, Sridhar S, Yip CCY, Lau SKP, Woo PCY. The role of laboratory diagnostics in emerging viral infections: the example of the Middle East respiratory syndrome epidemic. J Microbiol 2017; 55:172-182. [PMID: 28243939 PMCID: PMC7090747 DOI: 10.1007/s12275-017-7026-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 02/09/2017] [Indexed: 02/07/2023]
Abstract
Rapidly emerging infectious disease outbreaks place a great strain on laboratories to develop and implement sensitive and specific diagnostic tests for patient management and infection control in a timely manner. Furthermore, laboratories also play a role in real-time zoonotic, environmental, and epidemiological investigations to identify the ultimate source of the epidemic, facilitating measures to eventually control the outbreak. Each assay modality has unique pros and cons; therefore, incorporation of a battery of tests using traditional culture-based, molecular and serological diagnostics into diagnostic algorithms is often required. As such, laboratories face challenges in assay development, test evaluation, and subsequent quality assurance. In this review, we describe the different testing modalities available for the ongoing Middle East respiratory syndrome (MERS) epidemic including cell culture, nucleic acid amplification, antigen detection, and antibody detection assays. Applications of such tests in both acute clinical and epidemiological investigation settings are highlighted. Using the MERS epidemic as an example, we illustrate the various challenges faced by laboratories in test development and implementation in the setting of a rapidly emerging infectious disease. Future directions in the diagnosis of MERS and other emerging infectious disease investigations are also highlighted.
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Affiliation(s)
- Jasper F W Chan
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, P. R. China
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, P. R. China
- Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, P. R. China
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, P. R. China
| | - Siddharth Sridhar
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, P. R. China
| | - Cyril C Y Yip
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, P. R. China
| | - Susanna K P Lau
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, P. R. China
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, P. R. China
- Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, P. R. China
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, P. R. China
| | - Patrick C Y Woo
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, P. R. China.
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, P. R. China.
- Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, P. R. China.
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, P. R. China.
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Nam HS, Park JW, Ki M, Yeon MY, Kim J, Kim SW. High fatality rates and associated factors in two hospital outbreaks of MERS in Daejeon, the Republic of Korea. Int J Infect Dis 2017; 58:37-42. [PMID: 28223175 PMCID: PMC7110480 DOI: 10.1016/j.ijid.2017.02.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To explore the epidemiological and clinical factors predictive of the case fatality rate (CFR) of Middle East respiratory syndrome-coronavirus (MERS-CoV) infection in an outbreak in Daejeon, the Republic of Korea. METHODS We reviewed the outbreak investigation reports and medical records of 1 index case and 25 additional MERS cases in hospitals A (14 cases) and B (11 cases), and conducted an in-depth interview with the index case. RESULTS The CFR in hospital B was higher than that in hospital A (63.6% vs. 28.6%, respectively). Higher MERS-CoV exposure conditions were also found in hospital B, including aggravated pneumonia in the index case and nebulizer use in a six-bed admission room. The host factors associated with high CFR were pre-existing pneumonia, smoking history, an incubation period of less than 5 days, leukocytosis, abnormal renal function at diagnosis, and respiratory symptoms such as sputum and dyspnea. CONCLUSIONS The conditions surrounding MERS-CoV exposure and the underlying poor pulmonary function due to a smoking history or pre-existing pneumonia may explain the high CFR in hospital B. The clinical features described above may enable prediction of the prognosis of MERS cases.
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Affiliation(s)
- Hae-Sung Nam
- Department of Preventive Medicine and Public Health, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
| | - Jung Wan Park
- Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Cheongju, Republic of Korea
| | - Moran Ki
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Mi-Yeon Yeon
- Department of Preventive Medicine and Public Health, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Jin Kim
- Department of Nursing, Graduate School, Chungnam National University, Daejeon, Republic of Korea
| | - Seung Woo Kim
- Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Cheongju, Republic of Korea
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Arabi YM, Balkhy HH, Hayden FG, Bouchama A, Luke T, Baillie JK, Al-Omari A, Hajeer AH, Senga M, Denison MR, Nguyen-Van-Tam JS, Shindo N, Bermingham A, Chappell JD, Van Kerkhove MD, Fowler RA. Middle East Respiratory Syndrome. N Engl J Med 2017; 376:584-594. [PMID: 28177862 PMCID: PMC5362064 DOI: 10.1056/nejmsr1408795] [Citation(s) in RCA: 394] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Between September 2012 and January 20, 2017, the World Health Organization (WHO) received reports from 27 countries of 1879 laboratory-confirmed cases in humans of the Middle East respiratory syndrome (MERS) caused by infection with the MERS coronavirus (MERS-CoV) and at least 659 related deaths. Cases of MERS-CoV infection continue to occur, including sporadic zoonotic infections in humans across the Arabian Peninsula, occasional importations and associated clusters in other regions, and outbreaks of nonsustained human-to-human transmission in health care settings. Dromedary camels are considered to be the most likely source of animal-to-human transmission. MERS-CoV enters host cells after binding the dipeptidyl peptidase 4 (DPP-4) receptor and the carcinoembryonic antigen–related cell-adhesion molecule 5 (CEACAM5) cofactor ligand, and it replicates efficiently in the human respiratory epithelium. Illness begins after an incubation period of 2 to 14 days and frequently results in hypoxemic respiratory failure and the need for multiorgan support. However, asymptomatic and mild cases also occur. Real-time reverse-transcription–polymerase-chain-reaction (RT-PCR) testing of respiratory secretions is the mainstay for diagnosis, and samples from the lower respiratory tract have the greatest yield among seriously ill patients. There is no antiviral therapy of proven efficacy, and thus treatment remains largely supportive; potential vaccines are at an early developmental stage. There are multiple gaps in knowledge regarding the evolution and transmission of the virus, disease pathogenesis, treatment, and prospects for a vaccine. The ongoing occurrence of MERS in humans and the associated high mortality call for a continued collaborative approach toward gaining a better understanding of the infection both in humans and in animals. MERS-CoV was first identified in September 2012 in a patient from Saudi Arabia who had hypoxemic respiratory failure and multiorgan illness. Subsequent cases have included infections in humans across the Arabian Peninsula, occasional importations and associated clusters in other regions, and outbreaks of nonsustained human-to-human transmission in health care settings (Fig. 1).
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Affiliation(s)
- Yaseen M Arabi
- From the Departments of Intensive Care (Y.M.A., A. Bouchama), Infection Prevention and Control (H.H.B.), and Pathology and Laboratory (A.H.H.), King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (Y.M.A., H.H.B., A. Bouchama, A.H.H.), the Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals (A.A.-O.), and Alfaisal University (A.A.-O.) - all in Riyadh, Saudi Arabia; the Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.); the Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD (T.L.); the Roslin Institute, University of Edinburgh, and Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh (J.K.B.), the Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham (J.S.N.-V.-T.), and the Virus Reference Laboratory, Public Health England, London (A. Bermingham) - all in the United Kingdom; the Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva (M.S., N.S., R.A.F.); the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville (M.R.D., J.D.C.); the Center for Global Health, Institut Pasteur, Paris (M.D.V.K.); and the Institute of Health Policy Management and Evaluation, University of Toronto, and the Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre - both in Toronto (R.A.F.)
| | - Hanan H Balkhy
- From the Departments of Intensive Care (Y.M.A., A. Bouchama), Infection Prevention and Control (H.H.B.), and Pathology and Laboratory (A.H.H.), King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (Y.M.A., H.H.B., A. Bouchama, A.H.H.), the Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals (A.A.-O.), and Alfaisal University (A.A.-O.) - all in Riyadh, Saudi Arabia; the Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.); the Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD (T.L.); the Roslin Institute, University of Edinburgh, and Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh (J.K.B.), the Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham (J.S.N.-V.-T.), and the Virus Reference Laboratory, Public Health England, London (A. Bermingham) - all in the United Kingdom; the Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva (M.S., N.S., R.A.F.); the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville (M.R.D., J.D.C.); the Center for Global Health, Institut Pasteur, Paris (M.D.V.K.); and the Institute of Health Policy Management and Evaluation, University of Toronto, and the Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre - both in Toronto (R.A.F.)
| | - Frederick G Hayden
- From the Departments of Intensive Care (Y.M.A., A. Bouchama), Infection Prevention and Control (H.H.B.), and Pathology and Laboratory (A.H.H.), King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (Y.M.A., H.H.B., A. Bouchama, A.H.H.), the Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals (A.A.-O.), and Alfaisal University (A.A.-O.) - all in Riyadh, Saudi Arabia; the Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.); the Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD (T.L.); the Roslin Institute, University of Edinburgh, and Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh (J.K.B.), the Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham (J.S.N.-V.-T.), and the Virus Reference Laboratory, Public Health England, London (A. Bermingham) - all in the United Kingdom; the Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva (M.S., N.S., R.A.F.); the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville (M.R.D., J.D.C.); the Center for Global Health, Institut Pasteur, Paris (M.D.V.K.); and the Institute of Health Policy Management and Evaluation, University of Toronto, and the Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre - both in Toronto (R.A.F.)
| | - Abderrezak Bouchama
- From the Departments of Intensive Care (Y.M.A., A. Bouchama), Infection Prevention and Control (H.H.B.), and Pathology and Laboratory (A.H.H.), King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (Y.M.A., H.H.B., A. Bouchama, A.H.H.), the Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals (A.A.-O.), and Alfaisal University (A.A.-O.) - all in Riyadh, Saudi Arabia; the Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.); the Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD (T.L.); the Roslin Institute, University of Edinburgh, and Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh (J.K.B.), the Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham (J.S.N.-V.-T.), and the Virus Reference Laboratory, Public Health England, London (A. Bermingham) - all in the United Kingdom; the Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva (M.S., N.S., R.A.F.); the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville (M.R.D., J.D.C.); the Center for Global Health, Institut Pasteur, Paris (M.D.V.K.); and the Institute of Health Policy Management and Evaluation, University of Toronto, and the Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre - both in Toronto (R.A.F.)
| | - Thomas Luke
- From the Departments of Intensive Care (Y.M.A., A. Bouchama), Infection Prevention and Control (H.H.B.), and Pathology and Laboratory (A.H.H.), King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (Y.M.A., H.H.B., A. Bouchama, A.H.H.), the Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals (A.A.-O.), and Alfaisal University (A.A.-O.) - all in Riyadh, Saudi Arabia; the Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.); the Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD (T.L.); the Roslin Institute, University of Edinburgh, and Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh (J.K.B.), the Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham (J.S.N.-V.-T.), and the Virus Reference Laboratory, Public Health England, London (A. Bermingham) - all in the United Kingdom; the Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva (M.S., N.S., R.A.F.); the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville (M.R.D., J.D.C.); the Center for Global Health, Institut Pasteur, Paris (M.D.V.K.); and the Institute of Health Policy Management and Evaluation, University of Toronto, and the Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre - both in Toronto (R.A.F.)
| | - J Kenneth Baillie
- From the Departments of Intensive Care (Y.M.A., A. Bouchama), Infection Prevention and Control (H.H.B.), and Pathology and Laboratory (A.H.H.), King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (Y.M.A., H.H.B., A. Bouchama, A.H.H.), the Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals (A.A.-O.), and Alfaisal University (A.A.-O.) - all in Riyadh, Saudi Arabia; the Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.); the Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD (T.L.); the Roslin Institute, University of Edinburgh, and Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh (J.K.B.), the Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham (J.S.N.-V.-T.), and the Virus Reference Laboratory, Public Health England, London (A. Bermingham) - all in the United Kingdom; the Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva (M.S., N.S., R.A.F.); the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville (M.R.D., J.D.C.); the Center for Global Health, Institut Pasteur, Paris (M.D.V.K.); and the Institute of Health Policy Management and Evaluation, University of Toronto, and the Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre - both in Toronto (R.A.F.)
| | - Awad Al-Omari
- From the Departments of Intensive Care (Y.M.A., A. Bouchama), Infection Prevention and Control (H.H.B.), and Pathology and Laboratory (A.H.H.), King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (Y.M.A., H.H.B., A. Bouchama, A.H.H.), the Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals (A.A.-O.), and Alfaisal University (A.A.-O.) - all in Riyadh, Saudi Arabia; the Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.); the Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD (T.L.); the Roslin Institute, University of Edinburgh, and Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh (J.K.B.), the Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham (J.S.N.-V.-T.), and the Virus Reference Laboratory, Public Health England, London (A. Bermingham) - all in the United Kingdom; the Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva (M.S., N.S., R.A.F.); the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville (M.R.D., J.D.C.); the Center for Global Health, Institut Pasteur, Paris (M.D.V.K.); and the Institute of Health Policy Management and Evaluation, University of Toronto, and the Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre - both in Toronto (R.A.F.)
| | - Ali H Hajeer
- From the Departments of Intensive Care (Y.M.A., A. Bouchama), Infection Prevention and Control (H.H.B.), and Pathology and Laboratory (A.H.H.), King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (Y.M.A., H.H.B., A. Bouchama, A.H.H.), the Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals (A.A.-O.), and Alfaisal University (A.A.-O.) - all in Riyadh, Saudi Arabia; the Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.); the Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD (T.L.); the Roslin Institute, University of Edinburgh, and Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh (J.K.B.), the Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham (J.S.N.-V.-T.), and the Virus Reference Laboratory, Public Health England, London (A. Bermingham) - all in the United Kingdom; the Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva (M.S., N.S., R.A.F.); the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville (M.R.D., J.D.C.); the Center for Global Health, Institut Pasteur, Paris (M.D.V.K.); and the Institute of Health Policy Management and Evaluation, University of Toronto, and the Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre - both in Toronto (R.A.F.)
| | - Mikiko Senga
- From the Departments of Intensive Care (Y.M.A., A. Bouchama), Infection Prevention and Control (H.H.B.), and Pathology and Laboratory (A.H.H.), King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (Y.M.A., H.H.B., A. Bouchama, A.H.H.), the Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals (A.A.-O.), and Alfaisal University (A.A.-O.) - all in Riyadh, Saudi Arabia; the Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.); the Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD (T.L.); the Roslin Institute, University of Edinburgh, and Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh (J.K.B.), the Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham (J.S.N.-V.-T.), and the Virus Reference Laboratory, Public Health England, London (A. Bermingham) - all in the United Kingdom; the Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva (M.S., N.S., R.A.F.); the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville (M.R.D., J.D.C.); the Center for Global Health, Institut Pasteur, Paris (M.D.V.K.); and the Institute of Health Policy Management and Evaluation, University of Toronto, and the Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre - both in Toronto (R.A.F.)
| | - Mark R Denison
- From the Departments of Intensive Care (Y.M.A., A. Bouchama), Infection Prevention and Control (H.H.B.), and Pathology and Laboratory (A.H.H.), King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (Y.M.A., H.H.B., A. Bouchama, A.H.H.), the Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals (A.A.-O.), and Alfaisal University (A.A.-O.) - all in Riyadh, Saudi Arabia; the Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.); the Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD (T.L.); the Roslin Institute, University of Edinburgh, and Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh (J.K.B.), the Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham (J.S.N.-V.-T.), and the Virus Reference Laboratory, Public Health England, London (A. Bermingham) - all in the United Kingdom; the Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva (M.S., N.S., R.A.F.); the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville (M.R.D., J.D.C.); the Center for Global Health, Institut Pasteur, Paris (M.D.V.K.); and the Institute of Health Policy Management and Evaluation, University of Toronto, and the Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre - both in Toronto (R.A.F.)
| | - Jonathan S Nguyen-Van-Tam
- From the Departments of Intensive Care (Y.M.A., A. Bouchama), Infection Prevention and Control (H.H.B.), and Pathology and Laboratory (A.H.H.), King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (Y.M.A., H.H.B., A. Bouchama, A.H.H.), the Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals (A.A.-O.), and Alfaisal University (A.A.-O.) - all in Riyadh, Saudi Arabia; the Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.); the Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD (T.L.); the Roslin Institute, University of Edinburgh, and Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh (J.K.B.), the Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham (J.S.N.-V.-T.), and the Virus Reference Laboratory, Public Health England, London (A. Bermingham) - all in the United Kingdom; the Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva (M.S., N.S., R.A.F.); the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville (M.R.D., J.D.C.); the Center for Global Health, Institut Pasteur, Paris (M.D.V.K.); and the Institute of Health Policy Management and Evaluation, University of Toronto, and the Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre - both in Toronto (R.A.F.)
| | - Nahoko Shindo
- From the Departments of Intensive Care (Y.M.A., A. Bouchama), Infection Prevention and Control (H.H.B.), and Pathology and Laboratory (A.H.H.), King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (Y.M.A., H.H.B., A. Bouchama, A.H.H.), the Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals (A.A.-O.), and Alfaisal University (A.A.-O.) - all in Riyadh, Saudi Arabia; the Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.); the Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD (T.L.); the Roslin Institute, University of Edinburgh, and Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh (J.K.B.), the Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham (J.S.N.-V.-T.), and the Virus Reference Laboratory, Public Health England, London (A. Bermingham) - all in the United Kingdom; the Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva (M.S., N.S., R.A.F.); the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville (M.R.D., J.D.C.); the Center for Global Health, Institut Pasteur, Paris (M.D.V.K.); and the Institute of Health Policy Management and Evaluation, University of Toronto, and the Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre - both in Toronto (R.A.F.)
| | - Alison Bermingham
- From the Departments of Intensive Care (Y.M.A., A. Bouchama), Infection Prevention and Control (H.H.B.), and Pathology and Laboratory (A.H.H.), King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (Y.M.A., H.H.B., A. Bouchama, A.H.H.), the Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals (A.A.-O.), and Alfaisal University (A.A.-O.) - all in Riyadh, Saudi Arabia; the Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.); the Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD (T.L.); the Roslin Institute, University of Edinburgh, and Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh (J.K.B.), the Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham (J.S.N.-V.-T.), and the Virus Reference Laboratory, Public Health England, London (A. Bermingham) - all in the United Kingdom; the Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva (M.S., N.S., R.A.F.); the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville (M.R.D., J.D.C.); the Center for Global Health, Institut Pasteur, Paris (M.D.V.K.); and the Institute of Health Policy Management and Evaluation, University of Toronto, and the Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre - both in Toronto (R.A.F.)
| | - James D Chappell
- From the Departments of Intensive Care (Y.M.A., A. Bouchama), Infection Prevention and Control (H.H.B.), and Pathology and Laboratory (A.H.H.), King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (Y.M.A., H.H.B., A. Bouchama, A.H.H.), the Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals (A.A.-O.), and Alfaisal University (A.A.-O.) - all in Riyadh, Saudi Arabia; the Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.); the Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD (T.L.); the Roslin Institute, University of Edinburgh, and Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh (J.K.B.), the Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham (J.S.N.-V.-T.), and the Virus Reference Laboratory, Public Health England, London (A. Bermingham) - all in the United Kingdom; the Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva (M.S., N.S., R.A.F.); the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville (M.R.D., J.D.C.); the Center for Global Health, Institut Pasteur, Paris (M.D.V.K.); and the Institute of Health Policy Management and Evaluation, University of Toronto, and the Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre - both in Toronto (R.A.F.)
| | - Maria D Van Kerkhove
- From the Departments of Intensive Care (Y.M.A., A. Bouchama), Infection Prevention and Control (H.H.B.), and Pathology and Laboratory (A.H.H.), King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (Y.M.A., H.H.B., A. Bouchama, A.H.H.), the Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals (A.A.-O.), and Alfaisal University (A.A.-O.) - all in Riyadh, Saudi Arabia; the Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.); the Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD (T.L.); the Roslin Institute, University of Edinburgh, and Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh (J.K.B.), the Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham (J.S.N.-V.-T.), and the Virus Reference Laboratory, Public Health England, London (A. Bermingham) - all in the United Kingdom; the Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva (M.S., N.S., R.A.F.); the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville (M.R.D., J.D.C.); the Center for Global Health, Institut Pasteur, Paris (M.D.V.K.); and the Institute of Health Policy Management and Evaluation, University of Toronto, and the Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre - both in Toronto (R.A.F.)
| | - Robert A Fowler
- From the Departments of Intensive Care (Y.M.A., A. Bouchama), Infection Prevention and Control (H.H.B.), and Pathology and Laboratory (A.H.H.), King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (Y.M.A., H.H.B., A. Bouchama, A.H.H.), the Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals (A.A.-O.), and Alfaisal University (A.A.-O.) - all in Riyadh, Saudi Arabia; the Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.); the Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD (T.L.); the Roslin Institute, University of Edinburgh, and Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh (J.K.B.), the Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham (J.S.N.-V.-T.), and the Virus Reference Laboratory, Public Health England, London (A. Bermingham) - all in the United Kingdom; the Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva (M.S., N.S., R.A.F.); the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville (M.R.D., J.D.C.); the Center for Global Health, Institut Pasteur, Paris (M.D.V.K.); and the Institute of Health Policy Management and Evaluation, University of Toronto, and the Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre - both in Toronto (R.A.F.)
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