Chasing notifiable avian influenza in domestic poultry: a case report of low-pathogenic avian influenza h5 viruses in two Belgian holdings

In December 2008, bird species in two geographically distant holdings were found positive for H5 viruses following the annual Avian influenza serological screening in Belgium. The virological tests performed identified in one holding a low-pathogenic avian influenza (LPAI) virus subtype H5N2, and a H5 LPAI virus was identified by real-time PCR and direct sequencing at the second holding. The first farm was an outdoor mixed holding housing ornamental birds and poultry (n = 6000) and the second a free-range geese breeding farm (n = 1500). No clinical signs or mortalities were reported. Control measures defined by Council Directive 2005/94/EC were followed, including notification to the European Commission via the Animal Disease Notification System and to the World Organization for Animal Health, and poultry were killed, while ornamental bird species were quarantined. Partial sequencing of the H5N2 virus haemagglutinin and neuraminidase N2 gene sequences revealed a close homology to some recent LPAI isolates identified from wild birds in Germany and Italy and from wild birds in Eurasia and Africa, respectively. It is noteworthy that, these two holdings were already H5 positive based on HI test results carried out during the previous serological screening; however, no virus was detected at that time. To have a better understanding of the potential 'silent' circulation of the H5N2 isolate in the field, experimental infections of chickens and turkeys were performed. The low excretion detected might in part explain viral persistence not associated with spread between gallinaceous birds in the same holding, indicating that the H5N2 LPAI isolate was not fully adapted to these two poultry species. Our results highlighted limitations to only using serological screening for the early detection of LPAI in an 'at-risk farm', suggesting that virological and serological monitoring tests be applied simultaneously as a means of testing animals in 'at-risk farms'.

Molecular epidemiological analysis of the transboundary transmission of 2003 highly pathogenic avian influenza H7N7 outbreaks between the Netherlands and Belgium

The 2003 outbreak of Highly pathogenic avian influenza (HPAI) A(H7N7) in the Netherlands, Belgium and Germany resulted in significant genetic diversification that proved informative for tracing transmission events. Building on previous investigations on the Dutch outbreak, we focused on the potential transnational transmissions between the Netherlands and Belgium. Although no clear epidemiological links could be identified from the tracing data, the transmission network based on concatenated HA-NA-PB2 sequences supports at least three independent introductions from the Netherlands to Belgium and suggests one possible introduction form Belgium back to the Netherlands. Two introductions in the Belgian province of Limburg occurred from nearby farms in the Dutch province of Limburg. One introduction resulted in three secondary infected farms, while a second introduction did not cause secondary infections. The third introduction into Belgium occurred in the north of the Antwerp province, very close to the national border, and originated from the North of the Dutch province Brabant (long distance transmission, >65 km). The virus spread to two additional Belgian farms, one of which may be the source of a secondarily infected farm in the Netherlands. One infected turkey farm in the province of Antwerp (Westmalle) was geographically close to the latter introduction, but genetically clustered with the first introduction event in the Limburg province. Epidemiological tracing data could neither confirm nor exclude whether this outbreak was a result from long distance contacts within Belgium or whether this farm presented a fourth independent transboundary introduction. These multiple transnational transmissions of HPAI in spite of reinforced biosecurity measures and trade restrictions illustrate the importance of international cooperation, legislation and standardization of tools to combat transboundary diseases.

Establishment of the first international repository for transfusion-relevant bacteria reference strains: ISBT working party transfusion-transmitted infectious diseases (WP-TTID), subgroup on bacteria

BACKGROUND

Bacterial contamination of platelet concentrates (PCs) still remains a significant problem in transfusion with potential important clinical consequences, including death. The International Society of Blood Transfusion Working Party on Transfusion-Transmitted Infectious Diseases, Subgroup on Bacteria, organised an international study on Transfusion-Relevant Bacteria References to be used as a tool for development, validation and comparison of both bacterial screening and pathogen reduction methods.

MATERIAL AND METHODS

Four Bacteria References (Staphylococcus epidermidis PEI-B-06, Streptococcus pyogenes PEI-B-20, Klebsiella pneumoniae PEI-B-08 and Escherichia coli PEI-B-19) were selected regarding their ability to proliferate to high counts in PCs and distributed anonymised to 14 laboratories in 10 countries for identification, enumeration and bacterial proliferation in PCs after low spiking (0·3 and 0·03 CFU/ml), to simulate contamination occurring during blood donation.

RESULTS

Bacteria References were correctly identified in 98% of all 52 identifications. S. pyogenes and E. coli grew in PCs in 11 out of 12 laboratories, and K. pneumoniae and S. epidermidis replicated in all participating laboratories. The results of bacterial counts were very consistent between laboratories: the 95% confidence intervals were for S. epidermidis: 1·19-1·32 × 10(7) CFU/ml, S. pyogenes: 0·58-0·69 × 10(7) CFU/ml, K. pneumoniae: 18·71-20·26 × 10(7) CFU/ml and E. coli: 1·78-2·10 × 10(7) CFU/ml.

CONCLUSION

The study was undertaken as a proof of principle with the aim to demonstrate (i) the quality, stability and suitability of the bacterial strains for low-titre spiking of blood components, (ii) the property of donor-independent proliferation in PCs, and (iii) their suitability for worldwide shipping of deep frozen, blinded pathogenic bacteria. These aims were successfully fulfilled. The WHO Expert Committee Biological Standardisation has approved the adoption of these four bacteria strains as the first Repository for Transfusion-Relevant Bacteria Reference Strains and, additionally, endorsed as a project the addition of six further bacteria strain preparations suitable for control of platelet contamination as the next step of enlargement of the repository.

Flow cytometric differentiation of avian leukocytes and analysis of their intracellular cytokine expression

A flow cytometric method for the identification of chicken blood leukocyte subpopulations and thrombocytes was developed. An anti-chicken CD45 phycoerythrin-labelled antibody was used to separate leukocytes from red blood cell nuclei. Leukocytes and thrombocytes were identified using a combination of their CD45-positivity and their typical side scatter properties. The identity of the CD45-positive cells was confirmed by sorting the subpopulations and subsequent light microscopic evaluation. In these differentiated cell populations, intracellular expression analysis of the proinflammatory cytokines interleukin-1beta and interleukin-6 was subsequently optimized on whole blood after in vitro stimulation with lipopolysaccharide from Escherichia coli strain O127:B8.

Prime-boost vaccination with a fowlpox vector and an inactivated avian influenza vaccine is highly immunogenic in Pekin ducks challenged with Asian H5N1 HPAI

The efficacy of different vaccination schedules was evaluated in 17-day-old Pekin ducks using an experimental inactivated whole virus vaccine based on the H5N9 A/chicken/Italy/22A/98 isolate (H5N9-It) and/or a fowlpox recombinant (vFP-H5) expressing a synthetic HA gene from an Asian H5N1 isolate (A/chicken/Indonesia/7/2003). Full protection against clinical signs and shedding was induced by the different vaccination schemes. However, the broadest antibody response and the lowest antibody increase after challenge were observed in the group of ducks whose immune system was primed with the fowlpox vectored vaccine and boosted with the inactivated vaccine, suggesting that this prime-boost strategy induced optimal immunity against H5N1 and minimal viral replication after challenge in ducks. In addition, this prime-boost vaccination scheme was shown to be immunogenic in 1-day-old ducklings.

Important research questions in allergy and related diseases: nonallergic rhinitis: a GA2LEN paper

Nonallergic rhinitis (NAR) can be defined as a chronic nasal inflammation which is not caused by systemic IgE-dependent mechanisms. It is common and probably affects far more than 200 million people worldwide. Both children and adults are affected. However, its exact prevalence is unknown and its phenotypes need to be evaluated using appropriate methods to better understand its pathophysiology, diagnosis and management. It is important to differentiate between infectious rhinitis, allergic/NAR and chronic rhinosinusitis, as management differs for each of these cases. Characterization of the phenotype, mechanisms and management of NAR represents one of the major unmet needs in allergic and nonallergic diseases. Studies on children and adults are required in order to appreciate the prevalence, phenotype, severity and co-morbidities of NAR. These studies should compare allergic and NAR and consider different age group populations including elderly subjects. Mechanistic studies should be carried out to better understand the disease(s) and risk factors and to guide towards an improved diagnosis and therapy. These studies need to take the heterogeneity of NAR into account. It is likely that neuronal mechanisms, T cells, innate immunity and possibly auto-immune responses all play a role in NAR and may also contribute to the symptoms of allergic rhinitis.

Lung dendritic cells: targets for therapy in allergic disease

Dendritic cells (DCs) are crucial in determining the functional outcome of allergen encounter in the lung. Antigen presentation by myeloid DCs leads to Th2 sensitization typical of allergic disease, whereas antigen presentation by plasmacytoid DCs serves to dampen inflammation. It is increasingly clear that DCs have an antigen presenting function beyond sensitization. DCs therefore constitute a novel target for the development of antiallergic therapy aimed at the origin of the inflammatory cascade. A careful study of DC biology and of the receptors expressed by lung DCs has provided a framework for the discovery of novel antiallergic compounds.

Efficacy of an Inactivated and a Fowlpox-Vectored Vaccine in Muscovy Ducks Against an Asian H5N1 Highly Pathogenic Avian Influenza Viral Challenge

The efficacy of an inactivated vaccine containing the Eurasian isolate A/chicken/Italy/22A/98 H5N9 (H5N9-It) was compared with that of the fowlpox-vectored TROVACTM-AIV H5 (rFP-AIV-H5) vaccine against an H5N1 highly pathogenic avian influenza challenge. Five-week-old Muscovy ducks were vaccinated with either H5N9-It (0.5 ml) or rFP-AIV-H5 (5 log10 50% tissue culture infectious dose (TCID50)/dose), followed by a boost at 7 wk of age with the same vaccine (1.0 ml of H5N9-It or 5 log10 TCID50/dose rFP-AIV-H5), and a challenge at 9 wk of age with 10(7) egg infectious dose (lethality 50%) of A/crested eagle/ Belgium/01/2004 (H5N1). All unvaccinated challenged birds showed severe nervous signs (loss of balance, torticollis) starting 7 days postinfection (dpi). None of the vaccinated ducks showed these nervous signs. Shedding was measured in oropharyngeal and cloacal swabs, sampled from 3 to 19 dpi by titration in chicken embryo fibroblasts and by real-time reverse transcription-polymerase chain reaction. Virus shedding was significantly higher in oropharyngeal compared to cloacal swabs. Both vaccines reduced the percentage of positive swabs and the viral load in the swabs, but the reduction was higher with the H5N9-It vaccine. The inactivated vaccine induced hemagglutination inhibition (HI) titers (5.4 log2) that were boosted after the second administration (7.5 log2). rFP-AIV-H5-induced HI titers were lower (3 log2 only after the second administration), most probably because the fowlpox vector does not replicate in ducks. Altogether, these results indicate that significant protection from clinical signs and reduction in virus shedding may be achieved in ducks with conventional inactivated or fowlpox-vectored vaccine as compared with nonvaccinated challenged control birds.

A Universal Avian Endogenous Real-Time Reverse Transcriptase–Polymerase Chain Reaction Control and Its Application to Avian Influenza Diagnosis and Quantification

Real-time reverse transcriptase-polymerase chain reaction (RRT-PCR) is becoming an established first-line diagnostic assay as well as a precise quantification tool for avian influenza virus detection. However, there remain some limitations. First, we show that the sensitivity of RRT-PCR influenza detection can be 10- to 100-fold inhibited in oropharyngeal and cloacal swabs. Adding 0.5 U of heat-activated Taq DNA polymerase successfully reverses PCR inhibition. Second, an excellent strategy for detecting false negative samples is the coamplification of an internal control from each sample. We developed a universal avian endogenous internal control (bird beta-actin) and apply it to influenza A diagnosis. Moreover, this internal control proves useful as a normalizer control for virus quantification, because beta-actin gene expression does not change in infected vs. uninfected ducks. A combined panel of wild bird cloacal swabs, wild bird tissue samples, experimental duck swabs, and experimental duck and chicken tissue samples was used to validate the endogenous control. The application of an endogenous internal control proves an excellent strategy both for avoiding false negative diagnostic results and for standardizing virus quantification studies.

Development of an M2e-Specific Enzyme-Linked Immunosorbent Assay for Differentiating Infected from Vaccinated Animals

Vaccination programs for the control of avian influenza (AI) in birds have restrictions because of some limited efficacy and the difficulty of discriminating between vaccinated and virus-infected poultry. We studied M2e, the highly conserved external domain of the influenza A M2 protein, as a potential differential diagnostic marker for influenza virus infection. The M2 protein is an integral membrane protein, scarcely present on virus particles, but abundantly expressed on virus-infected cells. M2e-specific enzyme-linked immunosorbent assays (ELISAs) for different avian influenza strains were developed by coating the peptides corresponding to the first 18 amino acids, without the first methionine, of the universal human consensus M2e sequence and the specific M2e sequence of two highly pathogenic AI (HPAI) strains, H7N7 and H5N1. Using the M2e ELISAs, M2e-specific antibodies were observed in chickens and ducks experimentally infected with H7 or H5 HPAI, respectively, that correlated well with hemagglutination inhibition (HI) antibodies. Conversely, sera from chicken and ducks inoculated with inactivated AI vaccines were positive for HI test but negative for the M2e ELISAs. Moreover, ducks inoculated with inactivated vaccine and challenged with a HPAI H5N1 seroconverted for antibodies to the M2e peptide, with significantly different levels from those measured between the vaccinated and infected groups. These results indicate the potential benefit of a simple and specific M2e ELISA in the assessment of the efficacy of vaccination as well as for diagnostic and survey applications.

Oxygen saturation measured in vivo in bronchial tumors during bronchoscopy in patients with lung cancer using differential path length spectroscopy (DPS) correlates with survival, stage of the disease, and expression of HIF1a

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Background: Tumor hypoxia is known to correlate with poor prognosis in solid cancers. In bronchial tumors direct determination of oxygen saturation is not possible and therefore indirect measures like hypoxia related proteins as HIF1a have been studied. We studied the prognostic significance on patient survival and tumor stage of microvascular oxygen saturation (StO2) measured in vivo in bronchial tumors using optical spectroscopy and compared this to HIF1a expression in bronchial biopsies. Methods: DPS is a non-invasive real-time measurement of hypoxia related parameters such as microvascular blood oxygenation (StO2) which can be used during bronchoscopy (Bard Am J Respir Crit Care Med 2005). Endobronchial tumors (12 squamous cell carcinomas, 5 adenocarcinomas, 15 large cell undifferentiated and 6 small cell carcinomas), were measured in 38 patients. In a subgroup of patients HIF1a expression was related to StO2 using linear regression analysis. Results: StO2 of bronchial tumors was predictive for patient survival. Patients with an endobronchial tumor and a saturation lower than the median value of 52% had a significant shorter overall survival than patients with a better saturated tumor. The StO2 was also related to the stage of the disease. StO2 was significantly lower in case of advanced lung tumors (stage III & IV, StO2= 44.7 ± 24.7%) in comparison with localized lung tumors (stage I&II, StO2 = 73.3 ± 12.4) (p<0.05). StO2 correlated to HIF1a expression levels (r = −0.65). Conclusions: StO2 using DPS correlates with HIF1a expression, is related to tumor stage and is a prognositc factor. This opens a new field for study of therapeutic agents in lung cancer and may also be important in the staging of lung cancer.

No significant financial relationships to disclose.

Turkey and chicken interferon-gamma, which share high sequence identity, are biologically cross-reactive

Turkey and chicken interferon-gamma (IFN-gamma) share high identity (96.3% and 97% at the nucleotide and amino acid level, respectively). As such, we predicted that they would be functionally cross-reactive. To test this hypothesis, we produced recombinant turkey and chicken IFN-gamma, and compared their biological properties. Recombinant turkey and chicken IFN-gamma both induce HD11 cells (a chicken macrophage cell line) and LSTC-IAH30 cells (ALV-J-transformed turkey macrophages) to produce nitric oxide (NO), as measured in an avian IFN-gamma bioassay. Polyclonal and monoclonal antibodies, capable of neutralising the effect of chicken IFN-gamma on HD11 cells, were also shown to inhibit the activity of turkey IFN-gamma on these cells. The antibody neutralisation effect on both turkey and chicken IFN-gamma was shown by a significant reduction in NO production by HD11 cells when the neutralising antibodies were present in the bioassay. FACS analysis showed that HD11 and LSTC-IAH30 cells share some cell surface markers.

Tuberculosis DNA vaccine encoding Ag85A is immunogenic and protective when administered by intramuscular needle injection but not by epidermal gene gun bombardment

Immunogenicity and protective efficacy of a DNA vaccine encoding Ag85A from Mycobacterium tuberculosis were compared in BALB/c and C57BL (B6 and B10) mice immunized by intramuscular (i.m.) needle injection or epidermal gene gun (gg) bombardment. In BALB/c mice, gg immunization could induce elevated antibody and cytotoxic T lymphocyte responses with plasmid doses 50-fold lower than those required for i.m. immunization. Interleukin-2 (IL-2) and gamma interferon (IFN-gamma) secretion, however, was much lower in gg-immunized than in i.m.-immunized BALB/c mice. On the other hand, C57BL mice reacted only very weakly to gg immunization, whereas elevated Ag85A-specific antibody, IL-2, and IFN-gamma responses (significantly higher than in BALB/c mice) were detected following vaccination by the i.m. route. Antibody isotypes were indicative of Th2 activation following gg injection of BALB/c and of Th1 activation following i.m. injection of C57BL mice. Finally, C57BL but not BALB/c mice were protected by i.m. Ag85A DNA immunization against intravenous M. tuberculosis challenge, as measured by reduced numbers of CFU in spleen and lungs, compared to animals vaccinated with control DNA. Gene gun immunization was not effective in either BALB/c or C57BL mice. These results indicate that i.m. DNA vaccination is the method of choice for the induction of protective Th1 type immune responses with the Ag85A tuberculosis DNA vaccine.