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Pathela P, Townsend MB, Kopping EJ, Tang J, Navarra T, Priyamvada L, Carson WC, Panayampalli SS, Fowler RC, Kyaw N, Hughes S, Jamison K. Serological Evidence of Mpox Virus Infection During Peak Mpox Transmission in New York City, July to August 2022. J Infect Dis 2024:jiae181. [PMID: 38736232 DOI: 10.1093/infdis/jiae181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND The extent to which infections may have been undetected in an epicenter of the 2022 mpox outbreak is unknown. METHODS A serosurvey (July and August 2022) assessed the seroprevalence and correlates of mpox infection among a diverse sample of asymptomatic patients with no prior mpox diagnoses and no known histories of smallpox or mpox vaccination. We present seropositivity stratified by participant characteristics collected via survey. RESULTS Two-thirds of 419 participants were cismen (281 of 419), of whom 59.1% (166 of 281) reported sex with men (MSM). The sample also included 109 ciswomen and 28 transgender/gender nonconforming/nonbinary individuals. Overall seroprevalence was 6.4% (95% confidence interval [CI], 4.1%-8.8%); 3.7% among ciswomen (95% CI, 1.0%-9.1%), 7.0% among cismen with only ciswomen partners (95% CI, 2.0%-11.9%), and 7.8% among MSM (95% CI, 3.7%-11.9%). There was little variation in seroprevalence by race/ethnicity, age group, HIV status, or number of recent sex partners. No participants who reported close contact with mpox cases were seropositive. Among participants without recent mpox-like symptoms, 6.3% were seropositive (95% CI, 3.6%-9.0%). CONCLUSIONS Approximately 1 in 15 vaccine-naive people in our study had antibodies to mpox during the height of the NYC outbreak, indicating the presence of asymptomatic infections that could contribute to ongoing transmission.
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Affiliation(s)
- Preeti Pathela
- Bureau of Hepatitis, HIV, and STI, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Michael B Townsend
- Multinational Mpox Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Erik J Kopping
- Bureau of the Public Health Laboratory, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Jennifer Tang
- Bureau of Hepatitis, HIV, and STI, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Terese Navarra
- Multinational Mpox Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lalita Priyamvada
- Multinational Mpox Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William C Carson
- Multinational Mpox Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Randal C Fowler
- Bureau of the Public Health Laboratory, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Nang Kyaw
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Bureau of Healthcare and Community Readiness, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Scott Hughes
- Bureau of the Public Health Laboratory, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Kelly Jamison
- Bureau of Hepatitis, HIV, and STI, New York City Department of Health and Mental Hygiene, Queens, New York, USA
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Emery JC, Russell TW, Liu Y, Hellewell J, Pearson CAB, Knight GM, Eggo RM, Kucharski AJ, Funk S, Flasche S, Houben RMGJ. The contribution of asymptomatic SARS-CoV-2 infections to transmission on the Diamond Princess cruise ship. eLife 2020; 9:e58699. [PMID: 32831176 PMCID: PMC7527238 DOI: 10.7554/elife.58699] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/23/2020] [Indexed: 01/01/2023] Open
Abstract
A key unknown for SARS-CoV-2 is how asymptomatic infections contribute to transmission. We used a transmission model with asymptomatic and presymptomatic states, calibrated to data on disease onset and test frequency from the Diamond Princess cruise ship outbreak, to quantify the contribution of asymptomatic infections to transmission. The model estimated that 74% (70-78%, 95% posterior interval) of infections proceeded asymptomatically. Despite intense testing, 53% (51-56%) of infections remained undetected, most of them asymptomatic. Asymptomatic individuals were the source for 69% (20-85%) of all infections. The data did not allow identification of the infectiousness of asymptomatic infections, however low ranges (0-25%) required a net reproduction number for individuals progressing through presymptomatic and symptomatic stages of at least 15. Asymptomatic SARS-CoV-2 infections may contribute substantially to transmission. Control measures, and models projecting their potential impact, need to look beyond the symptomatic cases if they are to understand and address ongoing transmission.
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Affiliation(s)
- Jon C Emery
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Timothy W Russell
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Yang Liu
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Joel Hellewell
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Carl AB Pearson
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Gwenan M Knight
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Rosalind M Eggo
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Adam J Kucharski
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Sebastian Funk
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Stefan Flasche
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Rein MGJ Houben
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUnited Kingdom
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Grant R, Malik MR, Elkholy A, Van Kerkhove MD. A Review of Asymptomatic and Subclinical Middle East Respiratory Syndrome Coronavirus Infections. Epidemiol Rev 2020; 41:69-81. [PMID: 31781765 PMCID: PMC7108493 DOI: 10.1093/epirev/mxz009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/02/2019] [Accepted: 09/09/2019] [Indexed: 12/14/2022] Open
Abstract
The epidemiology of Middle East respiratory syndrome coronavirus (MERS-CoV) since 2012 has been largely characterized by recurrent zoonotic spillover from dromedary camels followed by limited human-to-human transmission, predominantly in health-care settings. The full extent of infection of MERS-CoV is not clear, nor is the extent and/or role of asymptomatic infections in transmission. We conducted a review of molecular and serological investigations through PubMed and EMBASE from September 2012 to November 15, 2018, to measure subclinical or asymptomatic MERS-CoV infection within and outside of health-care settings. We performed retrospective analysis of laboratory-confirmed MERS-CoV infections reported to the World Health Organization to November 27, 2018, to summarize what is known about asymptomatic infections identified through national surveillance systems. We identified 23 studies reporting evidence of MERS-CoV infection outside of health-care settings, mainly of camel workers, with seroprevalence ranges of 0%–67% depending on the study location. We identified 20 studies in health-care settings of health-care worker (HCW) and family contacts, of which 11 documented molecular evidence of MERS-CoV infection among asymptomatic contacts. Since 2012, 298 laboratory-confirmed cases were reported as asymptomatic to the World Health Organization, 164 of whom were HCWs. The potential to transmit MERS-CoV to others has been demonstrated in viral-shedding studies of asymptomatic MERS infections. Our results highlight the possibility for onward transmission of MERS-CoV from asymptomatic individuals. Screening of HCW contacts of patients with confirmed MERS-CoV is currently recommended, but systematic screening of non-HCW contacts outside of health-care facilities should be encouraged.
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Affiliation(s)
| | | | | | - Maria D Van Kerkhove
- Correspondence to Maria D. Van Kerkhove, PhD, Department of Infectious Hazards Management, Health Emergencies Program, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland (e-mail: )
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Wang C, Pors SE, Christensen JP, Bojesen AM, Thøfner I. Comparison and assessment of necropsy lesions in end-of-lay laying hens from different housing systems in Denmark. Poult Sci 2019; 99:119-128. [PMID: 32416793 PMCID: PMC7587857 DOI: 10.3382/ps/pez569] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 09/23/2019] [Indexed: 12/31/2022] Open
Abstract
Apperantly healthy laying hens at the end of production (60 to 91 wk) were investigated for the occurrence of pathology and bacterial infections. In total, 7,477 hens from 15 flocks representing the following production systems: Enriched cages, barn housed layers, and organic/free range layers were necropsied. Indications of bacterial infection were investigated by bacteriological cultivation. The overall prevalence of lesions was 16.60%, including lesions of both infectious and non-infectious origin. The most prevalent lesions were bursitis presternalis (6.65%), reproductive tract lesions (e.g., salpingitis and/or peritonitis and/or oophoritis) (3.50%), serosal scarification (e.g., fibrotic adhesive peritonitis) 1.55%, and neoplasm 1.73%. Significant differences were observed between different production systems and/or flocks in the prevalence of reproductive tract lesions, bursitis presternalis, serosal scarification, skin infections, juvenile hens, and traumas/fractures. No significant difference was observed between different production systems in the prevalence of neoplasia, infection of septicemic etiology, and pododermatitis. In total, 3.4% of the hens were out of lay, with significantly higher rate in organic flocks. Infections of the reproductive tract were the most prevalent lesions with bacterial etiology in all productions systems. In total, 40% of the hens with lesions associated to the oviduct were out of lay and significant difference between production systems were observed. Escherichia coli was the most commonly isolated bacteria and in 90% of the cases they were isolated from the reproductive tract lesions. The second most prevalent bacteria was Gallibacteruim anatis. Significant difference in the prevalence of E. coli positive hens was observed between production systems (P < 0.05). In conclusion, the prevalence of reproductive tract lesions in apparently healthy end-of-lay laying was higher than indicated in previous reports. These findings support the previous suggestions that E. coli and G. anatis are the major pathogens causing reproductive tract lesions.
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Affiliation(s)
- Chong Wang
- Faculty of Health and Medical Science, Department of Veterinary and Animal Sciences, University of Copenhagen, DK-1870 Frederiksberg C, Denmark
| | - Susanne Elisabeth Pors
- Faculty of Health and Medical Science, Department of Veterinary and Animal Sciences, University of Copenhagen, DK-1870 Frederiksberg C, Denmark
| | - Jens Peter Christensen
- Faculty of Health and Medical Science, Department of Veterinary and Animal Sciences, University of Copenhagen, DK-1870 Frederiksberg C, Denmark
| | - Anders Miki Bojesen
- Faculty of Health and Medical Science, Department of Veterinary and Animal Sciences, University of Copenhagen, DK-1870 Frederiksberg C, Denmark
| | - Ida Thøfner
- Faculty of Health and Medical Science, Department of Veterinary and Animal Sciences, University of Copenhagen, DK-1870 Frederiksberg C, Denmark.
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Majumdar M, Singh MP, Goyal K, Chawla Y, Ratho RK. Detailed investigation of ongoing subclinical hepatitis E virus infections; occurring in outbreak settings of North India. Liver Int 2015; 35:826-33. [PMID: 24750588 DOI: 10.1111/liv.12568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 04/17/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Every year globally WHO reports 20 million Hepatitis E virus (HEV) infections. The disease occurs as sporadic cases or focused outbreaks and has potentials to cause massive epidemics. The reservoir of HEV during inter-epidemic period is not well characterized. The sporadic cases usually lack history of contact with clinically overt HEV patients. In the present context we evaluated the occurrence of subclinical HEV as a possible reservoir in endemic region. METHODS Blood samples were collected from 67 apparently healthy individuals and 10 acute viral hepatitis (AVH) patients during two HEV outbreaks in North India. The serum samples were tested for anti-HEV IgM, IgG, HEV-IgG avidity index, HEV viral load and conventional-PCR followed by sequencing and phylogenetic analysis. RESULTS A total of 14 (20.89%) apparently healthy individuals showed the presence of anti-HEV IgM and IgG. Of 14 based on HEV-IgG avidity index, 9 (64.28%) had secondary-exposure, 4 (28.57%) had primary exposure, while one patient had intermediate avidity. Subclinical subjects with primary exposure had significantly higher anti-HEV IgM index as compared to secondary-exposure (P = 0.0028). Viral load in clinically jaundiced patients was significantly higher as compared to subclinical subjects (P < 0.0001). Phylogenetic analysis showed HEV sequences retrieved from subclinical individuals clustered along with AVH patients, suggesting matched source. The significantly low viral load in subclinical subjects hints towards the dose dependency for progression of clinical manifestation. CONCLUSION We document subclinical HEV with low level viremia occurs during outbreak settings and goes un-noticed, which helps maintaining the virus in nature possibly leading to its endemicity.
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Affiliation(s)
- Manasi Majumdar
- Department of Virology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India
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