Zika virus emergence in mosquitoes in southeastern Senegal, 2011

BACKGROUND

Zika virus (ZIKV; genus Flavivirus, family Flaviviridae) is maintained in a zoonotic cycle between arboreal Aedes spp. mosquitoes and nonhuman primates in African and Asian forests. Spillover into humans has been documented in both regions and the virus is currently responsible for a large outbreak in French Polynesia. ZIKV amplifications are frequent in southeastern Senegal but little is known about their seasonal and spatial dynamics. The aim of this paper is to describe the spatio-temporal patterns of the 2011 ZIKV amplification in southeastern Senegal.

METHODOLOGY/FINDINGS

Mosquitoes were collected monthly from April to December 2011 except during July. Each evening from 18:00 to 21:00 hrs landing collections were performed by teams of 3 persons working simultaneously in forest (canopy and ground), savannah, agriculture, village (indoor and outdoor) and barren land cover sites. Mosquitoes were tested for virus infection by virus isolation and RT-PCR. ZIKV was detected in 31 of the 1,700 mosquito pools (11,247 mosquitoes) tested: Ae. furcifer (5), Ae. luteocephalus (5), Ae. africanus (5), Ae. vittatus (3), Ae. taylori, Ae. dalzieli, Ae. hirsutus and Ae. metallicus (2 each) and Ae. aegypti, Ae. unilinaetus, Ma. uniformis, Cx. perfuscus and An. coustani (1 pool each) collected in June (3), September (10), October (11), November (6) and December (1). ZIKV was detected from mosquitoes collected in all land cover classes except indoor locations within villages. The virus was detected in only one of the ten villages investigated.

CONCLUSIONS/SIGNIFICANCE

This ZIKV amplification was widespread in the Kédougou area, involved several mosquito species as probable vectors, and encompassed all investigated land cover classes except indoor locations within villages. Aedes furcifer males and Aedes vittatus were found infected within a village, thus these species are probably involved in the transmission of Zika virus to humans in this environment.

Reemergence of Rift Valley fever, Mauritania, 2010

A Rift Valley fever (RVF) outbreak in humans and animals occurred in Mauritania in 2010. Thirty cases of RVF in humans and 3 deaths were identified. RVFV isolates were recovered from humans, camels, sheep, goats, and Culex antennatus mosquitoes. Phylogenetic analysis of isolates indicated a virus origin from western Africa.

Oral susceptibility of Aedes aegypti (Diptera: Culicidae) from Senegal for dengue serotypes 1 and 3 viruses

OBJECTIVE

To investigate the potential for domestic and wild populations of Aedes aegypti from Dakar and Kedougou to develop a disseminated infection after exposure to DENV-3 and DENV-1.

METHODS

We have exposed sylvatic and urban population of Ae. aegypti from Senegal to bloomeals containing dengue serotype 1 and 3. At different incubation period, individual mosquito legs/wings and bodies were tested for virus presence using real time RT-PCR to estimate the infection and dissemination rates.

RESULTS

The data indicated low susceptibility to DENV-3 (infection: 2.4-15.2%, and dissemination rates: 0-8.3%) and higher susceptibility to DENV-1 (infection and dissemination rates up to 50%).

CONCLUSION

Aedes aegypti from Senegal seem able to develop a disseminated infection of DENV-1 and DENV-3. Further studies are needed to test their ability to transmit the two serotypes.

Vector competence of Aedes aegypti and Aedes vittatus (Diptera: Culicidae) from Senegal and Cape Verde archipelago for West African lineages of chikungunya virus

To assess the risk of emergence of chikungunya virus (CHIKV) in West Africa, vector competence of wild-type, urban, and non-urban Aedes aegypti and Ae. vittatus from Senegal and Cape Verde for CHIKV was investigated. Mosquitoes were fed orally with CHIKV isolates from mosquitoes (ArD30237), bats (CS13-288), and humans (HD180738). After 5, 10, and 15 days of incubation following an infectious blood meal, presence of CHIKV RNA was determined in bodies, legs/wings, and saliva using real-time reverse transcription-polymerase chain reaction. Aedes vittatus showed high susceptibility (50-100%) and early dissemination and transmission of all CHIKV strains tested. Aedes aegypti exhibited infection rates ranging from 0% to 50%. Aedes aegypti from Cape Verde and Kedougou, but not those from Dakar, showed the potential to transmit CHIKV in saliva. Analysis of biology and competence showed relatively high infective survival rates for Ae. vittatus and Ae. aegypti from Cape Verde, suggesting their efficient vector capacity in West Africa.

Yellow fever risk assessment in the Central African Republic

BACKGROUND

Starting in 2008, the Central African Republic (CAR) experienced an unprecedented number of reported yellow fever (YF) cases. A risk assessment of YF virus (YFV) activity was conducted to estimate potential disease risk and vaccine needs.

METHODS

A multistage cluster sampling design was used to sample humans, non-human primates, and mosquitoes in distinct ecologic zones. Humans and non-human primates were tested for YFV-specific antibodies; mosquitoes were tested for YFV RNA.

RESULTS

Overall, 13.3% (125/938) of humans were found to have naturally-acquired YFV antibodies. Antibody levels were higher in zones in the southern and south central regions of CAR. All sampled non-human primates (n=56) were known YFV reservoirs; one tested positive for YFV antibodies. Several known YF vectors were identified including Aedes africanus, Ae. aegypti, Ae. luteocephalus, and Ae. simpsoni. Several more urban locations were found to have elevated Breateau and Container indices for Ae. aegypti.

CONCLUSIONS

A country-wide assessment of YF risk found YFV to be endemic in CAR. The potential for future YF cases and outbreaks, however, varied by ecologic zone. Improved vaccination coverage through mass campaign and childhood immunization was recommended to mitigate the YF risk.

Patterns of a sylvatic yellow fever virus amplification in southeastern Senegal, 2010

During the wet season of 2010, yellow fever virus (YFV) was detected in field-collected mosquitoes in the Kédougou region in southeastern Senegal. During this outbreak, we studied the association of the abundance of YFV-infected mosquitoes and land cover features to try and understand the dynamics of YFV transmission within the region. In total, 41,234 mosquito females were collected and tested for virus infection in 5,152 pools. YFV was detected in 67 pools; species including Aedes furcifer (52.2% of the infected pools), Ae. luteocephalus (31.3% of the infected pools), Ae. taylori (6.0% of the infected pools) and six other species (10.4% of the infected pools) captured in September (13.4%), October (70.1%), and November (16.4%). Spatially, YFV was detected from mosquitoes collected in all land cover classes but mainly, forest canopies (49.2%). Human infection is likely mediated by Ae. furcifer, the only species found infected with YFV within villages. Villages containing YFV-infected mosquitoes were significantly closer to large forests (> 2 ha) than villages in which no infected mosquitoes were detected.

Development of a Usutu virus specific real-time reverse transcription PCR assay based on sequenced strains from Africa and Europe

Usutu virus (USUV) has been isolated in several African and European countries mainly from mosquitoes and birds. However, previous benign and two recent severe cases of human infections point out the need of a tool for the identification of USUV in human samples. A published real-time reverse transcription (RT) PCR assay for the detection of USUV in human blood or cerebrospinal fluid does not take into account the genetic variability of USUV in different geographic regions. Therefore, this article presents a quantitative real-time RT-PCR assay based on sequences from Europe and Africa. Primers and probe were designed in conserved regions among USUV strains that differed from closely related flaviviruses. The specificity of the assay was investigated by testing 16 other flaviviruses circulating in Africa. The sensitivity was determined by testing serial dilutions of virus and RNA standard. Intra- and inter-assay coefficients of variation were evaluated by 10 reactions in a same and in different assays, respectively. The assay provides high analytical specificity for USUV and detection limits of 1.2pfu/reaction for virus dilutions in L-15 medium or human serum and 60 copies/reaction for the RNA standard. The assay needs to be evaluated in a clinical context and integrated in standard diagnosis of flaviviral diseases.

Bloodfeeding patterns of sylvatic arbovirus vectors in southeastern Senegal

BACKGROUND

Dengue (DENV), yellow fever (YFV) and chikungunya (CHIKV) viruses circulate in sylvatic, enzootic transmission cycles in southeastern Senegal, but understanding of the vector-host interactions involved is limited.

METHODS

The vertebrate hosts of several potential mosquito vectors of the three viruses were identified by PCR amplification and sequencing portions of the cytochrome b gene from bloodmeals of mosquitoes collected in Kedougou, Senegal, June 2010-January 2011.

RESULTS

We identified the sources of 65 bloodmeals of 82 engorged mosquitoes. Aedes taylori was the only species that fed on monkeys (Chlorocebus sabaeus and Papio papio). The majority of the avian-derived bloodmeals were from the Western Plantain-eater (Crinifer piscator).

CONCLUSION

These findings corroborate the importance of Ae. taylori and African monkeys in the sylvatic cycles of YFV, DENV and CHIKV and suggest the possible involvement of other vertebrates.

Yellow Fever outbreak in Darfur, Sudan in October 2012; the initial outbreak investigation report

INTRODUCTION

Sudan is subject to repeated outbreaks, including Viral Hemorrhagic Fever (VHF), which is considered to be a very serious illness. Yellow Fever (YF) outbreaks in Sudan have been reported from the 1940s through 2005. In 2012, a new outbreak of YF occurred in the Darfur region.

OBJECTIVE

To identify the potential for an outbreak, to diagnose the disease and to be able to recognize its cause among the initial reported cases.

METHODOLOGY

>This is a descriptive and investigative field study that applies standard communicable disease outbreak investigation steps. The study involved clinical, serological, entomological and environmental surveys.

RESULTS

The field investigation confirmed the outbreak and identified its cause to be YF.

CONCLUSION

National surveillance systems should be strong enough to detect VHFs in a timely manner. Local health facilities should be prepared to promptly treat the initial cases because the case fatality ratios (CFRs) are usually very high among the index cases.

Clarifying Bunyamwera virus riddles of the past

Pyrosequencing data and phylogenetic analysis for the full genome of Ilesha virus, Ngari virus and Calovo virus are described clarifying their much discussed relationship within the species Bunyamwera virus of the genus Orthobunyavirus of the Bunyaviridae.

Development of one-step quantitative reverse transcription PCR for the rapid detection of flaviviruses

Background

The genus Flavivirus includes several pathogenic agents that cause severe illness in humans. Re-emergence of West Nile virus in Europe and continuous spread of certain flaviviruses such as dengue, yellow fever and Japanese encephalitis viruses represent a global danger to public health. Therefore, a rapid and accurate molecular method is required for diagnostics and epidemiological surveillance of flaviviruses.

Methods

A Pan-Flavi quantitative RT-PCR assay using a Locked-Nucleic Acid probe targeting the flavivirus NS5 gene was developed and optimized to detect a wide range of flaviviruses simultaneously. The specificity and sensitivity of the Pan-Flavi assay were tested using RNA of different flaviviruses and non-flaviviruses. Furthermore, the assay was compared directly to flavivirus species-specific assays for the ability to detect flaviviruses sensitively.

Results

Two degenerate primers and one Locked-Nucleic Acids probe were designed to amplify most of the flaviviruses. To increase the specificity and fluorescence signal of the Pan-Flavi assay for detection of yellow fever virus and dengue virus 4, additional primers and probes were included. Viral RNA of thirty different flaviviruses was detected, verifying the broad range specificity. The testing of this assay was successful, using standard plasmid and RNA dilutions of yellow fever virus vaccine strain, dengue virus 1 and tick-borne encephalitis virus, with a sensitivity limit of 10–100 genome copies/reaction. Also comparatively good results were achieved for detecting different flaviviruses by the Pan-Flavi assay when compared to the flavivirus species-specific assays.

Conclusion

The assay is rapid, broad-range flavivirus-specific and highly sensitive making it a valuable tool for rapid detection of flaviviruses in livestock samples, epidemiological studies or as useful complement to single flavivirus-specific assays for clinical diagnosis.

Full-length genome sequence of Ntaya virus

Presentation of pyrosequencing data and phylogenetic analysis for the full genome of Ntaya virus, type virus of the Ntaya virus group of the Flaviviridae isolated in Cameroon in 1966.

Larval ecology of mosquitoes in sylvatic arbovirus foci in southeastern Senegal

Background

Although adult mosquito vectors of sylvatic arbovirus [yellow fever (YFV), dengue-2 (DENV-2) and chikungunya (CHIKV)] have been studied for the past 40 years in southeastern Senegal, data are still lacking on the ecology of larval mosquitoes in this area. In this study, we investigated the larval habitats of mosquitoes and characterized their seasonal and spatial dynamics in arbovirus foci.

Methods

We searched for wet microhabitats, classified in 9 categories, in five land cover classes (agriculture, forest, savannah, barren and village) from June, 2010 to January, 2011. Mosquito immatures were sampled monthly in up to 30 microhabitats of each category per land cover and bred until adult stage for determination.

Results

No wet microhabitats were found in the agricultural sites; in the remaining land covers immature stages of 35 mosquito species in 7 genera were sampled from 9 microhabitats (tree holes, fresh fruit husks, decaying fruit husks, puddles, bamboo holes, discarded containers, tires, rock holes and storage containers). The most abundant species was Aedes aegypti formosus, representing 30.2% of the collections, followed by 12 species, representing each more than 1% of the total, among them the arbovirus vectors Ae. vittatus (7.9%), Ae. luteocephalus (5.7%), Ae. taylori (5.0%), and Ae. furcifer (1.3%). Aedes aegypti, Cx. nebulosus, Cx. perfuscus, Cx. tritaeniorhynchus, Er. chrysogster and Ae. vittatus were the only common species collected from all land covers. Aedes furcifer and Ae. taylori were collected in fresh fruit husks and tree holes. Species richness and dominance varied significantly in land covers and microhabitats. Positive associations were found mainly between Ae. furcifer, Ae. taylori and Ae. luteocephalus. A high proportion of potential enzootic vectors that are not anthropophilic were found in the larval mosquito fauna.

Conclusions

In southeastern Senegal, Ae. furcifer and Ae. taylori larvae showed a more limited distribution among both land cover and microhabitat types than the other common species. Uniquely among vector species, Ae. aegypti formosus larvae occurred at the highest frequency in villages. Finally, a high proportion of the potential non-anthropophilic vectors were represented in the larval mosquito fauna, suggesting the existence of unidentified sylvatic arbovirus cycles in southeastern Senegal.

Synchrony of sylvatic dengue isolations: a multi-host, multi-vector SIR model of dengue virus transmission in Senegal

Isolations of sylvatic dengue-2 virus from mosquitoes, humans and non-human primates in Senegal show synchronized multi-annual dynamics over the past 50 years. Host demography has been shown to directly affect the period between epidemics in other pathogen systems, therefore, one might expect unsynchronized multi-annual cycles occurring in hosts with dramatically different birth rates and life spans. However, in Senegal, we observe a single synchronized eight-year cycle across all vector species, suggesting synchronized dynamics in all vertebrate hosts. In the current study, we aim to explore two specific hypotheses: 1) primates with different demographics will experience outbreaks of dengue at different periodicities when observed as isolated systems, and that coupling of these subsystems through mosquito biting will act to synchronize incidence; and 2) the eight-year periodicity of isolations observed across multiple primate species is the result of long-term cycling in population immunity in the host populations. To test these hypotheses, we develop a multi-host, multi-vector Susceptible, Infected, Removed (SIR) model to explore the effects of coupling multiple host-vector systems of dengue virus transmission through cross-species biting rates. We find that under small amounts of coupling, incidence in the host species synchronize. Long-period multi-annual dynamics are observed only when prevalence in troughs reaches vanishingly small levels (), suggesting that these dynamics are inconsistent with sustained transmission in this setting, but are consistent with local dengue virus extinctions followed by reintroductions. Inclusion of a constant introduction of infectious individuals into the system causes the multi-annual periods to shrink, while the effects of coupling remain the same. Inclusion of a stochastic rate of introduction allows for multi-annual periods at a cost of reduced synchrony. Thus, we conclude that the eight-year period separating amplifications of dengue may be explained by cycling in immunity with stochastic introductions.

Dengue virus has been isolated from mosquitoes, non-human primates and humans in Senegalese jungles for the past 50 years. This sylvatic cycle shows unique transmission dynamics that are unexpected given previous theory and observation: First, the isolations appear to be synchronized across several host and vector species each with different natural histories of infection. Second, the periodicity of the isolations (time between outbreaks) is approximately eight years, much longer than the one or two year period observed in human endemic settings (e.g., Thailand, Brazil). In this paper we develop a multi-host, multi-vector differential equation model to test hypotheses that are potentially consistent with these observations. We find that coupling of separate primate-mosquito pairs through mosquito biting induces synchrony that is robust over a wide range of parameters. We also find that the eight year cycle is not robust to the inclusion of a constant introduction of infection, but is to a stochastic rate of introduction, and thus may be due to cycling of immunity among primates with long-period stochastic introductions. An accurate and thorough understanding of the sylvatic cycle of dengue may allow prediction of epidemics and lessen its impact on humans living in surrounding areas. This knowledge is especially important given the potential for these primate species to act as reservoirs for dengue in post-vaccination scenarios.

Re-emergence of Rift Valley fever virus in Barkedji (Senegal, West Africa) in 2002-2003: identification of new vectors and epidemiological implications

The Rift Valley fever virus (RVFV) is a threat that must not be neglected, as the consequences of RVFV are dramatic, both for human and animal health. This virus is a zoonotic virus that already has demonstrated a real capacity for re-emerging after long periods of silence, as observed in Barkedji (Senegal, West Africa) in 2002. In this article we present the 2nd emergence in Barkedji after the 1st manifestation in 1993, and for the 1st time the circulation of RVFV during 2 consecutive years among mosquito populations in Senegal. As part of the entomological surveillance program undertaken since 1990 to detect circulation of the RVFV in Barkedji, 108,336 mosquitoes belonging to 34 species and 5 genera were collected in 2002-2003. Aedes vexans and Culex poicilipes, previously known to be vectors of RVFV in Senegal, comprised 88.7% of the total collection. In 2002, Ae. vexans was the most abundant mosquito, followed by Cx. poicilipes; the opposite situation was observed in 2003. In 2002, 29 and 10 RVFV isolates were obtained from Cx. poicilipes (minimum infection rate [MIR] = 0.13%) and Ae. vexans (MIR = 0.02%) pools, respectively and the MIR for the 2 species were significantly different (chi2 = 34.65; df = 1, P < 0.001). In 2003, 7 RVFV strains were isolated from Cx. poicilipes (3, MIR = 0.03), Mansonia africana (2, MIR = 0.08), Ae. fowleri (1), and Ma. uniformis (1, MIR = 0.05). The 3 latter species were found to be associated with RVFV for the 1st time in Senegal. A significant decrease in MIR was observed from 2002 to 2003 (chi2 6.28; df = 1, P = 0.01) for Cx. poicilipes, the only species involved in the transmission during the 2 sampling years.

Vector competence of Culex neavei (Diptera: Culicidae) for Usutu virus

Usutu virus (USUV), a flavivirus belonging to the Japanese encephalitis serocomplex, was isolated for the first time from a Culex neavei mosquito in 1959 in South Africa. Despite multiple isolations of USUV from Cx. neavei in Africa, its vector competence remains unproven. Therefore, we infected Cx. neavei orally with the USUV reference strain and used reverse transcription-polymerase chain reaction and an indirect immunofluorescence assay to detect virus in bodies, legs, wings, and saliva of mosquitoes. We demonstrated the susceptibility of Cx. neavei mosquitoes for the USUV reference strain, its potential to be transmitted, and infection, dissemination, and transmission rates of 90.9%, 40.0%, and 81.3%, respectively. Also, we showed that infection rates are dependent on the virus titer of the blood meal. Given the bionomics of Cx. neavei, its role as enzootic vector for USUV in Africa in a mosquito-bird transmission cycle or as bridge vector for USUV transmission to humans is discussed.

Landscape ecology of sylvatic chikungunya virus and mosquito vectors in southeastern Senegal

The risk of human infection with sylvatic chikungunya (CHIKV) virus was assessed in a focus of sylvatic arbovirus circulation in Senegal by investigating distribution and abundance of anthropophilic Aedes mosquitoes, as well as the abundance and distribution of CHIKV in these mosquitoes. A 1650 km(2) area was classified into five land cover classes: forest, barren, savanna, agriculture and village. A total of 39,799 mosquitoes was sampled from all classes using human landing collections between June 2009 and January 2010. Mosquito diversity was extremely high, and overall vector abundance peaked at the start of the rainy season. CHIKV was detected in 42 mosquito pools. Our data suggest that Aedes furcifer, which occurred abundantly in all land cover classes and landed frequently on humans in villages outside of houses, is probably the major bridge vector responsible for the spillover of sylvatic CHIKV to humans.

First international external quality assessment study on molecular and serological methods for yellow fever diagnosis

OBJECTIVE

We describe an external quality assurance (EQA) study designed to assess the efficiency and accurateness of molecular and serological methods used by expert laboratories performing YF diagnosis.

STUDY DESIGN

For molecular diagnosis evaluation, a panel was prepared of 14 human plasma samples containing specific RNA of different YFV strains (YFV-17D, YFV South American strain [Brazil], YFV IvoryC1999 strain), and specificity samples containing other flaviviruses and negative controls. For the serological panel, 13 human plasma samples with anti-YFV-specific antibodies against different strains of YFV (YFV-17D strain, YFV IvoryC1999 strain, and YFV Brazilian strain), as well as specificity and negative controls, were included.

RESULTS

Thirty-six laboratories from Europe, the Americas, Middle East, and Africa participated in these EQA activities. Only 16% of the analyses reported met all evaluation criteria with optimal performance. Serial dilutions of YFV-17D showed that in general the methodologies reported provided a suitable sensitivity. Failures were mainly due to the inability to detect wild-type strains or the presence of false positives. Performance in the serological diagnosis varied, mainly depending on the methodology used. Anti-YFV IgM detection was not performed in 16% of the reports using IIF or ELISA techniques, although it is preferable for the diagnosis of YFV acute infections. A good sensitivity profile was achieved in general; however, in the detection of IgM antibodies a lack of sensitivity of anti-YFV antibodies against the vaccine strain 17D was observed, and of the anti-YFV IgG antibodies against a West African strain. Neutralization assays showed a very good performance; however, the unexpected presence of false positives underlined the need of improving the running protocols.

CONCLUSION

This EQA provides information on each laboratory's efficacy of RT-PCR and serological YFV diagnosis techniques. The results indicate the need for improving serological and molecular diagnosis techniques and provide a follow-up of the diagnostic profiles.

Quantitative analysis of particles, genomes and infectious particles in supernatants of haemorrhagic fever virus cell cultures

Information on the replication of viral haemorrhagic fever viruses is not readily available and has never been analysed in a comparative approach. Here, we compared the cell culture growth characteristics of haemorrhagic fever viruses (HFV), of the Arenaviridae, Filoviridae, Bunyaviridae, and Flavivridae virus families by performing quantitative analysis of cell culture supernatants by (i) electron microscopy for the quantification of virus particles, (ii) quantitative real time PCR for the quantification of genomes, and (iii) determination of focus forming units by coating fluorescent antibodies to infected cell monolayers for the quantification of virus infectivity.

The comparative analysis revealed that filovirus and RVFV replication results in a surplus of genomes but varying degrees of packaging efficiency and infectious particles. More efficient replication and packaging was observed for Lassa virus, and Dengue virus resulting in a better yield of infectious particles while, YFV turned out to be most efficient with only 4 particles inducing one FFU. For Crimean-Congo haemorrhagic fever virus (CCHFV) a surplus of empty shells was observed with only one in 24 particles equipped with a genome. The complete particles turned out to be extraordinarily infectious.

Evaluation of the efficiency of bird-baited traps for sampling potential West Nile fever mosquito vectors (Diptera: Culicidae) in Senegal

The efficiency of bird-baited traps and collection heights for sampling potential West Nile mosquito vectors was studied during the 2006 rainy season (between September 27 and November 26) in Barkedji area situated in the sahelian area of Senegal (West Africa). Each night, two traps were set on the ground-level and two on the canopylevel (approximately 3 m) each containing either a chicken or a pigeon, the traps being rotated the following nights. A total of 1,030 mosquitoes were collected using 66 traps-nights. Culex species were predominant and represented 92.2% of the fauna of which 63% belonged to Cx. neavei group Theobald whereas 23.8% were Cx poicilipes (Theobald). The species of the Cx. neavei group were mainly collected by the pigeon-baited trap at canopy while Cx. poicilipes was captured similarly by pigeons and chickens placed at the canopy and ground. The implication of these results in West Nile vectors surveillance is discussed.

[Two cases of Crimean-Congo haemorrhagic fever (CCHF) in two tourists in Senegal in 2004]

Two cases of Crimean-Congo haemorrhagic fever (CCHF) occurred in two French tourists during their visit in Senegal in November 2004. Febrile and hemorrhagic syndrome with ulorrhagia, petechiae, haematemesis, haematomas associated with biological signs of disseminated intramuscular coagulation were observed. For the first case who had a medical evacuation to France before diagnosis, Crimean-Congo virus infection was revealed by laboratory tests performed by the National Reference Center for Hemorrhagic Fevers (NRCHF, Institut Pasteur, Lyon) and secondly by the Centre de Référence OMS sur la Recherche des Arbovirus et des virus des Fièvres Hémorragiques (CRORA) in the Dakar Pasteur Institute (DPI). The second case diagnosed by the CRORA died after clinical deterioration with liver failure and severe haemorrhages. Healthcare workers and family members who had contact with tissue or blood from patients were followed up after the putative exposure either in France or in Senegal.

Evolutionary history and dynamics of dog rabies virus in western and central Africa

The burden of rabies in Africa is estimated at 24,000 human deaths year(-1), almost all of which result from infection with dog rabies viruses (RABV). To investigate the evolutionary dynamics of RABV in western and central Africa, 92 isolates sampled from 27 African countries over 29 years were collected and sequenced. This revealed that RABV currently circulating in dogs in this region fell into a single lineage designated 'Africa 2'. A detailed analysis of the phylogeographical structure of this Africa 2 lineage revealed strong population subdivision at the country level, with only limited movement of virus among localities, including a possible east-to-west spread across Africa. In addition, Bayesian coalescent analysis suggested that the Africa 2 lineage was introduced into this region of Africa only recently (probably <200 years ago), in accordance with the timescale of expanding European colonial influence and urbanization, and then spread relatively slowly, perhaps occupying the entire region in a 100 year period.