Lassa and Crimean-Congo Hemorrhagic Fever Viruses, Mali

A survey of the tick-borne disease Crimean-Congo hemorrhagic fever in southern Algeria: First serological evidence in the dromedary camel population

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral zoonosis caused by a Nairovirus, Crimean-Congo hemorrhagic fever virus (CCHFV). Despite its wide geographical distribution, the epidemiology of CCHF in northern Africa is incompletely understood and its occurrence in Algeria is virtually unknown. The present survey aimed to determine the prevalence of CCHF antibodies and to identify the potential risk factors associated with CCHFV seropositivity among the one-humped camel (Camelus dromedarius) in southern Algeria. A total of 269 camels selected randomly from slaughterhouses in three wilayas were employed in the study. Sera sampled were tested for the presence of CCHFV-specific IgG antibodies using enzyme-linked immunosorbent assay (ELISA). CCHFV seropositivity was recorded in 255 out of 269 camels accounting for a prevalence rate of 94.8% (95%CI = 92.14-97.45). The seroprevalence by origin was determined to be 97% (193/199) in imported camels and 86% (49/57) in local ones (p > 0.25). Tick presence (OR = 12.35, 95%CI = 1.41-107.43, p < 0.05) was recorded as the only potential risk factor for contracting CCHFV. This study shows for the first time that camels are exposed to CCHFV in Algeria with a significantly high seroprevalence. It also underlines the need for further research to investigate the broader extent of circulating CCHFV in the country, whether in humans, animals, or ticks.

Large-Scale Serological Survey of Crimean-Congo Hemorrhagic Fever Virus and Rift Valley Fever Virus in Small Ruminants in Senegal

Crimean-Congo hemorrhagic fever (CCHF) and Rift Valley fever (RVF) are among the list of emerging zoonotic diseases that require special attention and priority. RVF is one of the six priority diseases selected by the Senegalese government. Repeated epidemic episodes and sporadic cases of CCHF and RVF in Senegal motivated this study, involving a national cross-sectional serological survey to assess the distribution of the two diseases in this country throughout the small ruminant population. A total of 2127 sera from small ruminants (goat and sheep) were collected in all regions of Senegal. The overall seroprevalence of CCHF and RVF was 14.1% (IC 95%: 12.5-15.5) and 4.4% (95% CI: 3.5-5.3), respectively. The regions of Saint-Louis (38.4%; 95% CI: 30.4-46.2), Kolda (28.3%; 95% CI: 20.9-35.7), Tambacounda (22.2%; 95% CI: 15.8-28.6) and Kédougou (20.9%; 95% CI: 14.4-27.4) were the most affected areas. The risk factors identified during this study show that the age, species and sex of the animals are key factors in determining exposure to these two viruses. This study confirms the active circulation of CCHF in Senegal and provides important and consistent data that can be used to improve the surveillance strategy of a two-in-one health approach to zoonoses.

Detection of Crimean-Congo hemorrhagic fever virus antibodies in cattle in Kenedougou and Mouhoun provinces in Burkina Faso

Background

Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic disease caused by an Orthonairovirus of the Nairoviridae family transmitted by tick bites and also contact with infected blood, tissues, or body fluids. Until now, fewer studies have been conducted on animals in Burkina Faso.

Aim

This study was conducted to investigate the seroprevalence and risk factors of CCHF in two provinces of Burkina Faso.

Methods

Serum samples were collected from 371 bovine animals. In addition, questionnaire surveys were performed with cattle breeders. The double-antigen sandwich enzyme-linked immunosorbent assay test was used to determine the presence of antibodies against the CCHF virus in serum samples.

Results

The results showed an overall prevalence of 72.2% [95% confidence interval (CI): 67.6%-76.7%)]. Within the 74 herds included in the study, a herd prevalence of 96% (95% CI: 91.4%-100%) was obtained. The prevalence was significantly higher in Mouhoun province (80%, 95% CI: 74%-86%) compared to Kénédougou province (65.6%, 95% CI: 59.1%-72.2%). Multivariable regression analysis showed that females were more likely to be infected (OR = 1.99, 95% CI: 1.1-3.6, p = 0.023) than males. In addition, cross-breed animals (OR = 6.42, 95% CI: 1.71-24.14, p = 0.006) were more likely to be infected compared to local-bred animals. This study revealed the presence of antibodies of the CCHF virus in cattle in the study area, indicating the need to implement control measures in the veterinary sector.

Conclusion

Despite the importance of CCHF in public health, no study has been implemented regarding this condition in animals in Burkina Faso. This study described evidence of cattle exposure to the virus in Burkina Faso.

Seroprevalence of Crimean-Congo hemorrhagic fever virus among people living with HIV in Brazzaville, Congo and among blood donors in Bamako, Mali

Crimean-Congo hemorrhagic fever virus (CCHFV) is the causative agent of Crimean-Congo hemorrhagic fever (CCHF), a highly contagious and potentially fatal emerging disease. We assessed CCHFV seroprevalence by conducting a serological survey of two cohorts from Brazzaville, Congo and Bamako, Mali. We retrospectively screened 581 sera samples, including 352 from monitoring centers for people living with HIV (PLWH) in Brazzaville and 229 provided by the Blood Transfusion Center at Gabriel Touré Hospital in Bamako. An ELISA kit (ID Screen® CCHF Double Antigen Multi-species, Innovative Diagnostics) was used to detect total anti-CCHFV antibodies in serum. CCHFV seroprevalence was 0.6% in the PLWH cohort in Brazzaville, all in a peri‑urban area near livestock/agriculture, and 1.75% in a cohort of blood donors in Bamako, half living in a peri‑urban area near livestock/agriculture and the others performing risk-exposure activities, such as working as a butcher or with frequent rural travels. PLWH from Brazzaville were mostly female, older, and more highly educated, with a tertiary sector activity and living in an urban biotope without livestock/agricultural activities in the surroundings, in contrast to the blood donors of Bamako, who were younger and more likely to live in peri‑urban/rural areas with livestock/agricultural activities in the surroundings. Despite a low CCHFV seroprevalence, our study indicates human contact with CCHFV in sub-urban areas of the capital cities of Congo and Mali associated with previously described CCHFV risk factors.

Serological evidence and factors associated with Crimean-Congo haemorrhagic fever in sheep in Burkina Faso

BACKGROUND

Crimean-Congo haemorrhagic fever (CCHF) is caused by an orthonairovirus transmitted by bites from infected ticks or by direct contact with blood or tissues of infected ticks, viraemic patients or viraemic livestock.

OBJECTIVE

It was implemented to access the seropositivity and associated factors with CCHF in sheep in two provinces in Burkina Faso.

METHODS

Three hundred and sixty-four sheep sera have been taken from 73 herds in four municipalities and two provinces. The double-antigen sandwich ELISA test was used to test for antibodies against CCHF virus (CCHFV). Data have also been collected using questionnaire to assess factors associated with CCHF seropositivity.

RESULTS

Fifty-four (54 out to 364 sheep were seropositive given an overall seropositivity of 14.8% (95% confidence interval [CI]: 10.9%-19.8%) with an adjusted seropositivity of 13.1%. The study showed that 15.6% (95% CI: 10.2-21.0) and 14.1% (95% CI: 9.2-19.1) of sheep in the provinces of Mouhoun and Kénédougou, respectively, had antibodies against CCHFV. The highest seropositivity was found in Dédougou municipality (24.4%). The study showed that sheep from the municipalities of Dédougou (AOR = 8.4; 95% CI: 2.2-31.8), N'dorola (AOR = 14.7; 95% CI: 3.8-56.8), Sindou (AOR = 4.9; 95% CI: 1.2-20.7), sheep aged between 27 and 36 months (AOR = 6.4; 95% CI: 2.3-17.3) and sheep with ticks (AOR = 24.8; 95% CI: 7.7-80.1) were more likely to be seropositive to CCHF.

CONCLUSIONS

The study revealed that sheep in Burkina Faso experienced contacts with CCHFV and suggests the importance of implementing control action in the country.

Tick-Borne Diseases of Humans and Animals in West Africa

Ticks are a significant group of arthropod vectors that transmit a large variety of pathogens responsible for human and animal diseases worldwide. Ticks are the second biggest transmitters of vector-borne diseases, behind mosquitoes. However, in West Africa, there is often only limited knowledge of tick-borne diseases. With the scarcity of appropriate diagnostic services, the prevalence of tick-borne diseases is generally underestimated in humans. In this review, we provide an update on tick-borne pathogens reported in people, animals and ticks in West Africa by microscopic, immunological and molecular methods. A systematic search was conducted in PubMed and Google Scholar. The selection criteria included all studies conducted in West Africa reporting the presence of Rickettsia, Borrelia, Anaplasma, Ehrlichia, Bartonella, Coxiella burnetii, Theileria, Babesia, Hepatozoon and Crimean-Congo haemorrhagic fever viruses in humans, animals or ticks. Our intention is to raise awareness of tick-borne diseases amongst human and animal health workers in West Africa, and also physicians working with tourists who have travelled to the region.

Crimean-Congo Hemorrhagic Fever, Mauritania

The distribution of Crimean-Congo hemorrhagic fever (CCHF), a tickborne arboviral disease, is not well known in West Africa. We report 2 recent human cases of CCHF with infectious syndrome and severe bleeding in Mauritania. CCHF was diagnosed by ELISA and real time reverse transcription PCR. No secondary CCHF cases were found.

Geographical Distribution of Ticks Ixodidae in Côte d'Ivoire: Potential Reservoir of the Crimean-Congo Hemorrhagic Fever Virus

Background: Ticks and tick-borne diseases are a major issue. These recent years, tick-borne diseases have attracted much attention because of their increasing incidence and the significant damage that they cause to livestock and human health. The objective was to identify the different species of ticks found in cattle and to determine the prevalence of Crimean-Congo hemorrhagic fever virus (CCHFV) in these different areas. Methods: The study was conducted in five regions of Côte d'Ivoire belonging to different geographic areas. The ticks were collected from cattle. The identification of ticks was done with a binocular microscope using the identification keys. The detection of CCHFV was done by RT-PCR using specific primers and probes. Findings: Of the ticks sampled, 4088 (96.9%) were adults. Of the genera Amblyomma, Hyalomma, and Rhipicephalus. The genus Rhipicephalus had the highest number with 54.3% of the collected ticks embodied in five species. It is followed by the genus Amblyomma with 43.7% and represented by only one species. The genus Hyalomma represented by seven species was obtained in a low proportion of 2.1%. The predominant species identified was Rhipicephalus (Boophilus) microplus with (48.7%), followed by the species Amblyomma variegatum (43.7%), and the other species <2%. In this study, CCHFV was detected in ticks belonging to the three genera identified. All-inclusive, 16 ticks (0.37%) out of 4219 collected from cattle tested positive for CCHFV. The species tested positive for CCHFV are A. variegatum, Hyalomma impressum, Rhipicephalus (Boophilus) geigyi, R. (B.) microplus, and Rhipicephalus sanguineus. All 16 ticks positive for CCHFV are adults and were obtained from the Korogho (11 ticks) and Bouaflé (5 ticks) regions. Conclusion: Three genera of ticks, Amblyomma, Hyalomma, and Rhipicephalus and 13 species infesting cattle were identified during this study. Eleven ticks were positive for CCHFV in Korhogo and five in Bouaflé. The genus mainly infested was A. Variegatum.

Epidemiology of Crimean-Congo Hemorrhagic Fever (CCHF) in Africa-Underestimated for Decades

Crimean-Congo hemorrhagic fever (CCHF) is endemic in Africa, but the epidemiology remains to be defined. Using a broad database search, we reviewed the literature to better define CCHF evidence in Africa. We used a One Health approach to define the impact of CCHF by reviewing case reports, human and animal serology, and records of CCHF virus (CCHFV) isolations (1956-mid-2020). In addition, published and unpublished collection data were used to estimate the geographic distribution of Hyalomma ticks and infection vectors. We implemented a previously proposed classification scheme for organizing countries into five categories by the level of evidence. From January 1, 1956 to July 25, 2020, 494 CCHF cases (115 lethal) were reported in Africa. Since 2000, nine countries (Kenya, Mali, Mozambique, Nigeria, Senegal, Sierra Leone, South Sudan, Sudan, and Tunisia) have reported their first CCHF cases. Nineteen countries reported CCHF cases and were assigned level 1 or level 2 based on maturity of their surveillance system. Thirty countries with evidence of CCHFV circulation in the absence of CCHF cases were assigned level 3 or level 4. Twelve countries for which no data were available were assigned level 5. The goal of this review is to inform international organizations, local governments, and healthcare professionals about shortcomings in CCHF surveillance in Africa to assist in a movement toward strengthening policy to improve CCHF surveillance.

The niche of One Health approaches in Lassa fever surveillance and control

Lassa fever (LF), a zoonotic illness, represents a public health burden in West African countries where the Lassa virus (LASV) circulates among rodents. Human exposure hinges significantly on LASV ecology, which is in turn shaped by various parameters such as weather seasonality and even virus and rodent-host genetics. Furthermore, human behaviour, despite playing a key role in the zoonotic nature of the disease, critically affects either the spread or control of human-to-human transmission. Previous estimations on LF burden date from the 80s and it is unclear how the population expansion and the improvement on diagnostics and surveillance methods have affected such predictions. Although recent data have contributed to the awareness of epidemics, the real impact of LF in West African communities will only be possible with the intensification of interdisciplinary efforts in research and public health approaches. This review discusses the causes and consequences of LF from a One Health perspective, and how the application of this concept can improve the surveillance and control of this disease in West Africa.

Epidemiology of Lassa Fever

Lassa fever (LF) is a lethal hemorrhagic disease primarily concentrated in the tropical savannah regions of Nigeria and the Mano River Union countries of Sierra Leone, Liberia, and Guinea. Endemic hotspots within these countries have had recurrent exposure to Lassa virus (LASV) via continual spillover from the host reservoir Mastomys natalensis. Increased trade and travel throughout the region have spread the virus to previously unexposed countries, including Ghana, Benin, Mali, and Côte d'Ivoire. In the absence of effective treatment or vaccines to LASV, preventative measures against Lassa fever rely heavily on reducing or eliminating rodent exposure, increasing the knowledge base surrounding the virus and disease in communities, and diminishing the stigmas faced by Lassa fever survivors.

Molecular Detection of Microorganisms Associated with Small Mammals and Their Ectoparasites in Mali

Small mammals are the natural reservoirs for many zoonotic pathogens. Using molecular tools, we assessed the prevalence of bacteria and protozoans in small mammals and their ectoparasites in Faladjè, Bougouni, and Bamoko, Mali. A total of 130 small mammals belonging to 10 different species were captured, of which 74 (56.9%) were infested by ectoparasites, including Laelaps echidnina, Xenopsylla cheopis, Amblyomma variegatum, Rhipicephalus sanguineus sensu lato, and Haemaphysalis spp. nymphs. DNA of Bartonella was found in 14/75 (18.7%), 6/48 (12.5%), and 3/7 (42.8%) small mammals from Faladjè, Bougouni, and Bamako, respectively. In Faladjè, Bartonella DNA was detected in 31/68 (45.6%) of L. echidnina and 14/22 (63.6%) of X. cheopis. In Bougouni, it was found in 2/26 (7.7%) of L. echidnina and 10/42 (23.8%) of X. cheopis. The sequences of Bartonella obtained from small mammals were close to those of Bartonella mastomydis, Bartonella elizabethae, and uncultured Bartonella spp. In Faladjè, Coxiella burnetii DNA was detected in 64.4% (29/45) of Haemaphysalis spp. ticks, 4.5% (2/44) of Mastomys erythroleucus, 12.5% (1/8) of Praomys daltoni, and 1.5% (1/68) of L. echidnina. We found DNA of Wolbachia in X. cheopis from Faladjè and DNA of Rickettsia africae and Ehrlichia ruminantium in Am. variegatum from Bougouni. The results of our study show that several small mammal species harbor and may serve as potential reservoirs of Bartonella spp., likely to play a major role in the maintenance, circulation, and potential transmission of bacteria in Mali. The pathogenicity of these bacteria for humans or animals remains to be demonstrated.

Systematic review and meta-analysis of the epidemiology of Lassa virus in humans, rodents and other mammals in sub-Saharan Africa

Accurate data on the Lassa virus (LASV) human case fatality rate (CFR) and the prevalence of LASV in humans, rodents and other mammals are needed for better planning of actions that will ultimately reduce the burden of LASV infection in sub-Saharan Africa. In this systematic review with meta-analysis, we searched PubMed, Scopus, Africa Journal Online, and African Index Medicus from 1969 to 2020 to obtain studies that reported enough data to calculate LASV infection CFR or prevalence. Study selection, data extraction, and risk of bias assessment were conducted independently. We extracted all measures of current, recent, and past infections with LASV. Prevalence and CFR estimates were pooled using a random-effect meta-analysis. Factors associated with CFR, prevalence, and sources of between-study heterogeneity were determined using subgroup and metaregression analyses. This review was registered with PROSPERO, CRD42020166465. We initially identified 1,399 records and finally retained 109 reports that contributed to 291 prevalence records from 25 countries. The overall CFR was 29.7% (22.3-37.5) in humans. Pooled prevalence of LASV infection was 8.7% (95% confidence interval: 6.8-10.8) in humans, 3.2% (1.9-4.6) in rodents, and 0.7% (0.0-2.3) in other mammals. Subgroup and metaregression analyses revealed a substantial statistical heterogeneity explained by higher prevalence in tissue organs, in case-control, in hospital outbreak, and surveys, in retrospective studies, in urban and hospital setting, in hospitalized patients, and in West African countries. This study suggests that LASV infections is an important cause of death in humans and that LASV are common in humans, rodents and other mammals in sub-Saharan Africa. These estimates highlight disparities between sub-regions, and population risk profiles. Western Africa, and specific key populations were identified as having higher LASV CFR and prevalence, hence, deserving more attention for cost-effective preventive interventions.

Lassa Virus Genetics

In a pattern repeated across a range of ecological niches, arenaviruses have evolved a compact four-gene genome to orchestrate a complex life cycle in a narrow range of susceptible hosts. A number of mammalian arenaviruses cross-infect humans, often causing a life-threatening viral hemorrhagic fever. Among this group of geographically bound zoonoses, Lassa virus has evolved a unique niche that leads to significant and sustained human morbidity and mortality. As a biosafety level 4 pathogen, direct study of the pathogenesis of Lassa virus is limited by the sparse availability, high operating costs, and technical restrictions of the high-level biocontainment laboratories required for safe experimentation. In this chapter, we introduce the relationship between genome structure and the life cycle of Lassa virus and outline reverse genetic approaches used to probe and describe functional elements of the Lassa virus genome. We then review the tools used to obtain viral genomic sequences used for phylogeny and molecular diagnostics, before shifting to a population perspective to assess the contributions of phylogenetic analysis in understanding the evolution and ecology of Lassa virus in West Africa. We finally consider the future outlook and clinical applications for genetic study of Lassa virus.