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Fonzo M, Bertoncello C, Tudor L, Miccolis L, Serpentino M, Petta D, Amoruso I, Baldovin T, Trevisan A. Do we protect ourselves against West Nile Virus? A systematic review on knowledge, attitudes, and practices and their determinants. J Infect Public Health 2024; 17:868-880. [PMID: 38555655 DOI: 10.1016/j.jiph.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND West Nile virus (WNV) is a mosquito-borne flavivirus. In humans, 80% of infections are asymptomatic, while approximately 20% experience influenza-like symptoms. Fewer than 1% develop the neuroinvasive form which can lead to encephalitis, meningitis, acute flaccid paralysis, and even death. The global spread of the virus to areas where it was not previously present has become a growing concern. Since the 2000 s, there have been numerous outbreaks affecting local and travelling populations worldwide. Given the lack of a vaccine, preventative measures are primarily focused on surveillance, vector control, and the use of personal protective behaviours (PPBs). The importance of PPBs is central to public health recommendations. However, translating these messages into coherent action by the public can prove challenging, as the uptake of such measures is inevitably influenced by socio-economic factors, awareness, knowledge, and risk perception. METHODS A PRISMA-based systematic research was conducted on EMBASE, PubMed/MEDLINE, and Web of Science databases. PROSPERO registration number CRD42023459714. Quality of studies included in the final stage was evaluated using the Critical Appraisal Checklist for Cross-Sectional Study (CEBMa). RESULTS 2963 articles were screened, and 17 studies were included in the final round. Out of these, six were deemed of high quality, ten were of medium quality, and one was of low quality. In almost all studies considered, both awareness and knowledge of WNV transmission were above 90%, while concern about WNV ranged from 50% to 80%. Concern about the safety of repellents, either with or without DEET, ranged from 27% to 70%. The percentage of people actually using repellents ranged from 30% to 75%, with the lowest usage reported among individuals over 60 years old (29%) and pregnant women (33%), and the highest among students aged 9-11 (75%). Concern for West Nile Virus (WNV) was consistently linked to an increase in taking preventative measures, including the use of repellents, by two to four times across studies. The school-based intervention was effective in increasing the practice of removing standing water (AOR=4.6; 2.7-8.0) and wearing long clothing (AOR=2.4; 95%CI: 1.3-4.3), but did not have a significant impact on the use of repellents. CONCLUSIONS The present systematic review provides an overview of the knowledge, attitudes, and practices (KAP) of WNV and their determinants. While concern about West Nile Virus (WNV) and its effects can be a significant motivator, it is important to promote evidence-based personal protective behaviours (PPBs) to counter unwarranted fears. For example, the use of repellents among the most vulnerable age groups. Given the geographical expansion of WNV, it is necessary to target the entire population preventively, including those who are difficult to reach and areas not yet endemic. The findings of this investigation could have significant implications for public health and support well-informed and effective communication strategies and interventions.
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Affiliation(s)
- Marco Fonzo
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Bertoncello
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy.
| | - Liliana Tudor
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Liana Miccolis
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Michele Serpentino
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Daniele Petta
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Irene Amoruso
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Tatjana Baldovin
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Andrea Trevisan
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Oberlin AM, Wylie BJ. Vector-borne disease, climate change and perinatal health. Semin Perinatol 2023; 47:151841. [PMID: 37852894 DOI: 10.1016/j.semperi.2023.151841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Vector-borne diseases (VBDs) are caused by infectious pathogens that spread from an infected human or animal reservoir to an uninfected human via a vector (mosquito, tick, rodent, others) and remain an important cause of morbidity and mortality worldwide. Pregnant individuals and their fetuses are especially at risk, as certain pathogens, such as Zika virus, have specific implications in pregnancy and for neonatal health. Global climate change is affecting the incidence and geographic spread of many VBDs. Thus, it is important for clinicians in the fields of obstetrics/gynecology and newborn medicine, regardless of geographic location, to familiarize themselves with a basic understanding of these conditions and how climate change is altering their distributions. In this chapter, we review the incidence, clinical presentation, implications during pregnancy and intersection with climate change for four of the most important VBDs in pregnancy: malaria, Zika, dengue and Chagas disease. Although not exhaustive of all VBDs, a more extensive table is included for reference, and our discussion provides a helpful framework for understanding other vector-borne pathogens and perinatal health.
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Affiliation(s)
- Austin M Oberlin
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States
| | - Blair J Wylie
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States; Founding Director, The Collaborative for Women's Environmental Health at Columbia University, United States.
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Watanabe S, Vasudevan SG. Clinical and experimental evidence for transplacental vertical transmission of flaviviruses. Antiviral Res 2023; 210:105512. [PMID: 36572192 DOI: 10.1016/j.antiviral.2022.105512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
The Zika virus (ZIKV) epidemic outbreak in Americas in 2016 attracted global attention because of the association of the virus infection with severe birth defects such as microcephaly, mediated through transplacental virus transmission during pregnancy. Less well-known, but also reported is the increasing evidence that prenatal vertical transmission can be caused by other flaviviruses such as dengue virus (DENV). Currently, the mechanism(s) that cause the vertical transmission of flaviviruses is understudied. Here we review the published reports of clinical evidence of intrauterine transmission of ZIKV and other flaviviruses. We also discuss the animal models for flavivirus infection during pregnancy that have been developed to study the mechanisms underlying the transplacental transmission of flaviviruses in order to develop potential countermeasures for its prevention.
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Affiliation(s)
- Satoru Watanabe
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road, 169857, Singapore.
| | - Subhash G Vasudevan
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road, 169857, Singapore
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4
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Ginige S, Flower R, Viennet E. Neonatal Outcomes From Arboviruses in the Perinatal Period: A State-of-the-Art Review. Pediatrics 2021; 147:peds.2020-009720. [PMID: 33737375 DOI: 10.1542/peds.2020-009720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/24/2022] Open
Abstract
Since the 2016 Zika outbreak and the understanding of the teratogenic effect of this infection, there has been a newfound interest in arbovirus infections and their effects on pregnancy, resulting in numerous publications in the last 5 years. However, limited literature focuses on arbovirus infection in different stages of pregnancy and their effect on the neonate. There is currently no consensus management of perinatal acquisition of arboviruses, and current evidence is largely anecdotal observational reports. Teratogens can have different effects on the developing fetus depending on the time of infection, so infections during pregnancy should be analyzed by trimester. A better understanding of arbovirus infection in the perinatal period is required to assist obstetric, neonatal, and pediatric clinicians in making decisions about the management of mother and neonate. Our objective was to assess the evidence of adverse neonatal outcomes for several arboviral infections when contracted during the perinatal period to guide clinicians in managing these patients. There are 8 arboviruses for which neonatal outcomes from maternal acquisition in the perinatal period have been reported, with the most data for dengue and Chikungunya virus infections. The evidence reviewed in this article supports the adoption of preventive strategies to avoid ticks and mosquitoes close to the date of delivery. For the other arbovirus infections, further community-based cohort studies during outbreaks are required to evaluate whether these infections have a similar teratogenic impact.
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Aguilar Ticona JP, Nery N, Ladines-Lim JB, Gambrah C, Sacramento G, de Paula Freitas B, Bouzon J, Oliveira-Filho J, Borja A, Adhikarla H, Montoya M, Chin A, Wunder EA, Ballalai V, Vieira C, Belfort R, P. Almeida AR, Reis MG, Harris E, Ko AI, Costa F. Developmental outcomes in children exposed to Zika virus in utero from a Brazilian urban slum cohort study. PLoS Negl Trop Dis 2021; 15:e0009162. [PMID: 33544730 PMCID: PMC7891708 DOI: 10.1371/journal.pntd.0009162] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/18/2021] [Accepted: 01/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background The prevalence of developmental alterations associated with in-utero Zika virus (ZIKV) exposure in children is not well understood. Furthermore, estimation of the Population Attributable Fraction (PAF) of developmental alterations attributed to ZIKV has not been performed due to lack of population-based cohorts with data on symptomatic and asymptomatic ZIKV exposures and an appropriate control group. The aim of this study was to characterize neurodevelopmental outcomes of children at 11 to 32 months of age with intrauterine ZIKV exposure and estimate the PAF of alterations secondary to ZIKV exposure. Methodology/Principal findings We performed a cohort of biannual community-based prospective serosurveys in a slum community in Salvador, Brazil. We recruited women participating in our cohort, with a documented pregnancy from January 2015 to December 2016 and children born to those mothers. Children were classified as ZIKV exposed in utero (born from women with ZIKV seroconversion during pregnancy) or unexposed (born from women without ZIKV seroconversion or that seroconverted before/after pregnancy) by using an IgG monoclonal antibody blockade-of-binding (BoB). We interviewed mothers and performed anthropometric, audiometric, ophthalmological, neurologic, and neurodevelopmental evaluations of their children at 11 to 32 months of age. Among the 655 women participating in the cohort, 66 (10%) were pregnant during the study period. 46 (70%) of them completed follow-up, of whom ZIKV seroconversion occurred before, during, and after pregnancy in 25 (54%), 13 (28%), and 1 (2%), respectively. The rest of women, 7 (21.2%), did not present ZIKV seroconversion. At 11 to 32 months of life, the 13 ZIKV-exposed children had increased risk of mild cognitive delay (RR 5.1; 95%CI 1.1–24.4) compared with the 33 children unexposed, with a PAF of 53.5%. Exposed children also had increased risk of altered auditory behavior (RR 6.0; 95%CI 1.3–26.9), with a PAF of 59.5%. Conclusions A significant proportion of children exposed in utero to ZIKV developed mild cognitive delay and auditory behavioral abnormalities even in the absence of gross birth defects such as microcephaly and other neurodevelopmental domains. Furthermore, our findings suggest that over half of these abnormalities could be attributed to intrauterine ZIKV exposure. ZIKV is a neurotropic virus associated with congenital abnormalities that have been grouped under congenital Zika syndrome (CZS), the most prominent being microcephaly. Recent studies have uncovered a spectrum of other abnormalities. However, what remains unclear is the Population Attributable Fraction (PAF) of developmental alterations attributable to ZIKV intrauterine exposure in children (> one year of life). In this population-based cohort study, we found that children (without microcephaly) exposed in utero to ZIKV have an increased incidence of mild cognitive delay and auditory behavior abnormalities, with over half of these events attributable to intrauterine exposure. The results of this study suggest that more than half of alterations found in the population study can be attributed to intrauterine ZIKV exposure, thus demonstrating the importance of monitoring apparently healthy children born during the epidemic, even to asymptomatic mothers. Health services should implement early interventions to limit the morbidity of congenital ZIKV infection.
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Affiliation(s)
| | - Nivison Nery
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
| | - Joseph B. Ladines-Lim
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Claudia Gambrah
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Gielson Sacramento
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
| | - Bruno de Paula Freitas
- Hospital Geral Roberto Santos (HGRS), Salvador, Brazil
- Faculdade de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Jamary Oliveira-Filho
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pòs-Graduação em Ciencias da Saude (PPgCS) Universidade Federal da Bahia, Salvador, Brazil
| | - Ana Borja
- Departamento de Fonoaudiologia. Instituto de Ciências da Saúde. Universidade Federal da Bahia, Salvador, Brazil
| | - Haritha Adhikarla
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Magelda Montoya
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America
| | - Athena Chin
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America
| | - Elsio A. Wunder
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | - Carina Vieira
- Hospital Geral Roberto Santos (HGRS), Salvador, Brazil
| | - Rubens Belfort
- Faculdade de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Mitermayer G. Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America
| | - Albert I. Ko
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail: (AIK); (FC)
| | - Federico Costa
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail: (AIK); (FC)
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Suzukawa AA, Zanluca C, Jorge NAN, de Noronha L, Koishi AC, de Paula CBV, Rebutini PZ, Nagashima S, Hansel-Frose AFF, Parreira VSC, Bordignon J, MacDonald MR, Rice CM, Passetti F, Duarte Dos Santos CN. Downregulation of IGF2 expression in third trimester placental tissues from Zika virus infected women in Brazil. J Infect 2020; 81:766-775. [PMID: 32987099 DOI: 10.1016/j.jinf.2020.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Screening for genes differentially expressed in placental tissues, aiming to identify transcriptional signatures that may be involved in ZIKV congenital pathogenesis. METHODS Transcriptome data from placental tissues of pregnant women naturally infected with Zika virus during the third trimester were compared to those from women who tested negative for Zika infection. The findings were validated using both a cell culture model and an immunohistochemistry/morphological analysis of naturally infected placental tissues. RESULTS Transcriptome analysis revealed that Zika virus infection induces downregulation of insulin-like growth factor II (IGF2) gene, an essential factor for fetal development. The Caco-2 cell culture model that constitutively expresses IGF2 was used for the transcriptome validation. Asiatic and African Zika virus strains infection caused downregulated IGF2 gene expression in Caco-2 cells, whereas other flaviviruses, such as dengue serotype 1, West Nile and wild-type yellow fever viruses, had no effect on this gene expression. Immunohistochemical assays on decidual tissues corroborated our transcriptome analysis, showing that IGF2 is reduced in the decidua of Zika virus-infected women. CONCLUSIONS Our results draw attention to IGF2 modulation in uterine tissues, and this finding is expected to support future studies on strategies to ameliorate the harmful effects of Zika virus infection during pregnancy.
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Affiliation(s)
- Andréia A Suzukawa
- Laboratório de Virologia Molecular, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba, PR, Brazil
| | - Camila Zanluca
- Laboratório de Virologia Molecular, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba, PR, Brazil
| | - Natasha A N Jorge
- Bioinformatics Group, Department of Computer Science, and Interdisciplinary Center for Bioinformatics, D-04107 Leipzig, Germany
| | - Lucia de Noronha
- Laboratório de Patologia Experimental, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Andrea C Koishi
- Laboratório de Virologia Molecular, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba, PR, Brazil
| | - Caroline B V de Paula
- Laboratório de Patologia Experimental, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Patrícia Z Rebutini
- Laboratório de Patologia Experimental, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Seigo Nagashima
- Laboratório de Patologia Experimental, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Aruana F F Hansel-Frose
- Laboratório de Regulação da Expressão Gênica, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba, PR, Brazil
| | - Vinícius S C Parreira
- Laboratório de Regulação da Expressão Gênica, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba, PR, Brazil
| | - Juliano Bordignon
- Laboratório de Virologia Molecular, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba, PR, Brazil
| | - Margaret R MacDonald
- Laboratory of Virology and Infectious Disease, The Rockefeller University, New York, NY 10065, USA
| | - Charles M Rice
- Laboratory of Virology and Infectious Disease, The Rockefeller University, New York, NY 10065, USA
| | - Fabio Passetti
- Laboratório de Regulação da Expressão Gênica, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba, PR, Brazil.
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Teixeira FME, Pietrobon AJ, Oliveira LDM, Oliveira LMDS, Sato MN. Maternal-Fetal Interplay in Zika Virus Infection and Adverse Perinatal Outcomes. Front Immunol 2020; 11:175. [PMID: 32117303 PMCID: PMC7033814 DOI: 10.3389/fimmu.2020.00175] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/22/2020] [Indexed: 12/26/2022] Open
Abstract
During pregnancy, the organization of complex tolerance mechanisms occurs to assure non-rejection of the semiallogeneic fetus. Pregnancy is a period of vulnerability to some viral infections, mainly during the first and second trimesters, that may cause congenital damage to the fetus. Recently, Zika virus (ZIKV) infection has gained great notoriety due to the occurrence of congenital ZIKV syndrome, characterized by fetal microcephaly, which results from the ability of ZIKV to infect placental cells and neural precursors in the fetus. Importantly, in addition to the congenital effects, studies have shown that perinatal ZIKV infection causes a number of disorders, including maculopapular rash, conjunctivitis, and arthralgia. In this paper, we contextualize the immunological aspects involved in the maternal-fetal interface and vulnerability to ZIKV infection, especially the alterations resulting in perinatal outcomes. This highlights the need to develop protective maternal vaccine strategies or interventions that are capable of preventing fetal or even neonatal infection.
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Affiliation(s)
- Franciane Mouradian Emidio Teixeira
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil.,Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Anna Julia Pietrobon
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil.,Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Luana de Mendonça Oliveira
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil.,Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Luanda Mara da Silva Oliveira
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Maria Notomi Sato
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil.,Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Castro-Jorge LAD, Siconelli MJL, Ribeiro BDS, Moraes FMD, Moraes JBD, Agostinho MR, Klein TM, Floriano VG, Fonseca BALD. West Nile virus infections are here! Are we prepared to face another flavivirus epidemic? Rev Soc Bras Med Trop 2019; 52:e20190089. [PMID: 30942263 DOI: 10.1590/0037-8682-0089-2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 02/26/2019] [Indexed: 01/29/2023] Open
Abstract
Emerging arthropod-borne viruses (arboviruses), such as chikungunya and Zika viruses, are a major threat to public health in countries like Brazil where biodiversity is high and medical care is sometimes precarious. West Nile fever is a disease caused by the West Nile Virus (WNV), an RNA virus belonging to the Flaviviridae family. It is transmitted by infected mosquitoes to numerous animals like birds, reptiles and mammals, including human and non-human primates. In the last decade, the number of reported cases of WNV infection in humans and animals has increased in the Americas. Circulation of WNV in forests and rural areas in Brazil has been detected based on serological surveys and, in 2014, the first case of West Nile fever was confirmed in a patient from Piauí State. In 2018, the virus was isolated for the first time from a horse from a rural area in the state of Espírito Santo presenting with a neurological disorder; this raises the possibility that other cases of WNV encephalitis may have occurred without clinical recognition and without laboratory diagnosis by specific assays. The imminent WNV outbreak poses a challenge for Brazilian clinicians and researchers. In this review, we summarize the basic biological and ecological characteristics of this virus and the clinical presentation and treatment of febrile illnesses caused by WNV. We also discuss the epidemiological aspects, prophylaxis of WNV infections, and monitoring strategies that could be applied in the possibility of a WNV outbreak in Brazil.
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Affiliation(s)
- Luiza Antunes de Castro-Jorge
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Márcio Junio Lima Siconelli
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Beatriz Dos Santos Ribeiro
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Flávia Masson de Moraes
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Jonathan Ballico de Moraes
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Mayara Rovariz Agostinho
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Taline Monteiro Klein
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Vitor Gonçalves Floriano
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Herring R, Desai N, Parnes M, Jarjour I. Pediatric West Nile Virus-Associated Neuroinvasive Disease: A Review of the Literature. Pediatr Neurol 2019; 92:16-25. [PMID: 30611518 DOI: 10.1016/j.pediatrneurol.2018.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 07/10/2018] [Accepted: 07/15/2018] [Indexed: 10/27/2022]
Abstract
Over the past two decades, West Nile virus has become the most common arbovirus in North America, leading to several outbreaks and infecting thousands of people. Mosquitos help transmit the virus in the majority of cases, but transmission occurs via blood transfusions, organ transplantation, and possibly pregnancy and breastfeeding. While most infected patients experience mild to no symptoms, thousands of West Nile virus-associated neuroinvasive cases have been reported in the United States, with over 700 cases occurring in children from 2003 to 2016. Neuroinvasive disease presents as meningitis, encephalitis, or acute flaccid paralysis, and carries a high likelihood of poor outcome, including severe neurological disability or death. To date, no pharmacologic treatment has proven effective. Therapeutic clinical trials have not been successfully completed due to the sporadic nature of viral outbreaks and resultant poor study enrollment. Although older age and chronic disease are risk factors for neuroinvasive West Nile virus disease in adults, the specific factors that influence the risk in pediatric populations have not been fully elucidated. This review summarizes the most recent literature regarding West Nile virus-associated neuroinvasive disease, especially as it pertains to the pediatric population. Moreover, the review describes the epidemiology, clinical, laboratory, and radiographic findings, and outlines the various therapies that have been trialed and potential future research directions.
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Affiliation(s)
- Rachelle Herring
- Section of Child Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
| | - Nilesh Desai
- Section of Neuroradiology, Department of Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Mered Parnes
- Section of Child Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Imad Jarjour
- Section of Child Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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Abstract
Congenital and perinatal infections represent major causes of permanent disability among children worldwide. Linked together by the acronym TORCH, denoting Toxoplasma gondii, rubella virus, cytomegalovirus, and herpes virus, congenital infections can result from only a modest number of human pathogens that cross the placenta and infect the fetus. Although congenital rubella syndrome has been eliminated in the Americas by immunization, several pathogens discussed in this chapter cannot currently be prevented by vaccines or effectively treated with the available antimicrobial drugs. Due to the immaturity of the immune system, newborn infants are at risk for postnatally acquired infections with certain viruses and several bacteria. This chapter summarizes the epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prevention of selected pathogens that can damage the developing nervous system. As emphasized by the persisting challenges of preventing congenital cytomegalovirus infection and the emergence of severe brain damage associated with congenital Zika syndrome, these pathogens remain important causes of cerebral palsy, epilepsy, and intellectual disability.
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11
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Ward MJ, Alger J, Berrueta M, Bock H, Buekens P, Cafferata ML, Ciganda A, García J, García K, Lopez W, Lorenzana I, Parham L, Wesson DM. Zika Virus and the World Health Organization Criteria for Determining Recent Infection Using Plaque Reduction Neutralization Testing. Am J Trop Med Hyg 2018; 99:780-782. [PMID: 29943723 DOI: 10.4269/ajtmh.18-0237] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The recent Zika virus (ZIKV) epidemic swept across Latin America and the Caribbean, where dengue virus (DENV) is endemic. The antigenic similarities of these closely related flaviviruses left researchers and clinicians with challenges to interpret serological tests. Thirty-six women attending a prenatal clinic in Honduras and with positive DENV IgM enzyme-linked immunoabsorbent assays (ELISAs) were screened with a ZIKV immunoglobulin M ELISA, reverse transcription polymerase chain reaction for ZIKV and DENV 1-4, and plaque reduction neutralization tests (PRNTs) for ZIKV and DENV-2. Plaque reduction neutralization test results were interpreted using the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) criteria. Using the WHO criteria of a PRNT90 titer ≥ 20 and a 4-fold difference between ZIKV and DENV titers, we determined that 69.4% of samples had a recent ZIKV infection, compared with 5.6% using CDC criteria. The interpretation of ZIKV PRNTs in a DENV-endemic region is highly dependent on the choice of interpretation criteria.
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Affiliation(s)
- Matthew J Ward
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jackeline Alger
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal (IAV), Tegucigalpa, Honduras.,Departamento de Laboratorio Clínico, Hospital Escuela Universitario, Tegucigalpa, Honduras
| | - Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Harry Bock
- Región Sanitaria Metropolitana del Distrito Central, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Alvaro Ciganda
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Jorge García
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal (IAV), Tegucigalpa, Honduras.,Departamento de Laboratorio Clínico, Hospital Escuela Universitario, Tegucigalpa, Honduras
| | - Kimberly García
- Instituto de Investigaciones en Microbiología, Centro de Investigaciones Genéticas (CIG), Escuela de Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Wendy Lopez
- Departamento de Laboratorio Clínico, Hospital Escuela Universitario, Tegucigalpa, Honduras
| | - Ivette Lorenzana
- Instituto de Investigaciones en Microbiología, Centro de Investigaciones Genéticas (CIG), Escuela de Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Leda Parham
- Instituto de Investigaciones en Microbiología, Centro de Investigaciones Genéticas (CIG), Escuela de Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Dawn M Wesson
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
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12
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Rasmussen SA, Meaney-Delman DM, Petersen LR, Jamieson DJ. Studying the effects of emerging infections on the fetus: Experience with West Nile and Zika viruses. Birth Defects Res 2018; 109:363-371. [PMID: 28398684 PMCID: PMC7161891 DOI: 10.1002/bdr2.1006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 12/14/2022]
Abstract
Emerging infections have the potential to produce adverse effects on the pregnant woman or her fetus; however, studying these effects is often challenging. We review our experiences with investigating the prenatal effects of two mosquito‐borne infections that emerged in the past 2 decades, West Nile virus (WNV) and Zika virus. Concerns regarding teratogenicity were raised about both viruses; Zika virus has been confirmed to be teratogenic, while WNV appears not to increase the risk for adverse outcomes, although teratogenicity has not been excluded. Study designs used to examine the effects of both viruses include case reports and series, pregnancy registries, and cohort studies. Case–control studies and birth defects surveillance systems are being used to study the effects during pregnancy of Zika virus, but not the effects of WNV, because a specific phenotype was observed among infants with congenital Zika infection, but not among infants with congenital WNV infection. Experimental data that demonstrated that Zika virus was neurotropic have also been useful because they provided biologic plausibility for Zika virus's teratogenic effects: these findings were consistent with observations in congenitally infected infants. Challenges encountered with studies to evaluate the effects of these infections include the broad range of possible adverse outcomes, the inability to include all infected pregnant women in studies because many infections are asymptomatic, and the difficulty with interpretation of diagnostic testing of infants (WNV and Zika) and pregnant women (Zika). This review might be helpful to guide future studies of the effects of emerging infections during pregnancy. Birth Defects Research 109:363–371, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | - Lyle R Petersen
- Centers for Disease Control and Prevention, Atlanta, Georgia
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13
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Abstract
Congenital Zika syndrome is a set of congenital anomalies associated with Zika virus infection during pregnancy. We present the unique case of a neonate born to a suspected Zika virus-positive mother that developed an embolic stroke and medication-resistant seizures. This report may impact the evolving definition of congenital Zika syndrome.
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14
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Kakooza-Mwesige A, Mohammed AH, Kristensson K, Juliano SL, Lutwama JJ. Emerging Viral Infections in Sub-Saharan Africa and the Developing Nervous System: A Mini Review. Front Neurol 2018. [PMID: 29527187 PMCID: PMC5829034 DOI: 10.3389/fneur.2018.00082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The global public health concern is heightened over the increasing number of emerging viruses, i.e., newly discovered or previously known that have expanded into new geographical zones. These viruses challenge the health-care systems in sub-Saharan Africa (SSA) countries from which several of them have originated and been transmitted by insects worldwide. Some of these viruses are neuroinvasive, but have been relatively neglected by neuroscientists. They may provide experiments by nature to give a time window for exposure to a new virus within sizeable, previously non-infected human populations, which, for instance, enables studies on potential long-term or late-onset effects on the developing nervous system. Here, we briefly summarize studies on the developing brain by West Nile, Zika, and Chikungunya viruses, which are mosquito-borne and have spread worldwide out of SSA. They can all be neuroinvasive, but their effects vary from malformations caused by prenatal infections to cognitive disturbances following perinatal or later infections. We also highlight Ebola virus, which can leave surviving children with psychiatric disturbances and cause persistent infections in the non-human primate brain. Greater awareness within the neuroscience community is needed to emphasize the menace evoked by these emerging viruses to the developing brain. In particular, frontline neuroscience research should include neuropediatric follow-up studies in the field on long-term or late-onset cognitive and behavior disturbances or neuropsychiatric disorders. Studies on pathogenetic mechanisms for viral-induced perturbations of brain maturation should be extended to the vulnerable periods when neurocircuit formations are at peaks during infancy and early childhood.
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Affiliation(s)
- Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences and Mulago Hospital, Kampala, Uganda
| | | | | | - Sharon L Juliano
- Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Julius J Lutwama
- Arbovirology Laboratory, Uganda Virus Research Institute, Entebbe, Uganda
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15
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Platt DJ, Smith AM, Arora N, Diamond MS, Coyne CB, Miner JJ. Zika virus-related neurotropic flaviviruses infect human placental explants and cause fetal demise in mice. Sci Transl Med 2018; 10:eaao7090. [PMID: 29386359 PMCID: PMC6136894 DOI: 10.1126/scitranslmed.aao7090] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/20/2017] [Accepted: 12/12/2017] [Indexed: 12/16/2022]
Abstract
Although Zika virus (ZIKV) infection in pregnant women can cause placental damage, intrauterine growth restriction, microcephaly, and fetal demise, these disease manifestations only became apparent in the context of a large epidemic in the Americas. We hypothesized that ZIKV is not unique among arboviruses in its ability to cause congenital infection. To evaluate this, we tested the capacity of four emerging arboviruses [West Nile virus (WNV), Powassan virus (POWV), chikungunya virus (CHIKV), and Mayaro virus (MAYV)] from related (flavivirus) and unrelated (alphavirus) genera to infect the placenta and fetus in immunocompetent, wild-type mice. Although all four viruses caused placental infection, only infection with the neurotropic flaviviruses (WNV and POWV) resulted in fetal demise. WNV and POWV also replicated efficiently in second-trimester human maternal (decidua) and fetal (chorionic villi and fetal membrane) explants, whereas CHIKV and MAYV replicated less efficiently. In mice, RNA in situ hybridization and histopathological analysis revealed that WNV infected the placenta and fetal central nervous system, causing injury to the developing brain. In comparison, CHIKV and MAYV did not cause substantive placental or fetal damage despite evidence of vertical transmission. On the basis of the susceptibility of human maternal and fetal tissue explants and pathogenesis experiments in immunocompetent mice, other emerging neurotropic flaviviruses may share with ZIKV the capacity for transplacental transmission, as well as subsequent infection and injury to the developing fetus.
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Affiliation(s)
- Derek J Platt
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Amber M Smith
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Nitin Arora
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Center for Microbial Pathogenesis, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA 15224, USA
| | - Michael S Diamond
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
- The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Carolyn B Coyne
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Center for Microbial Pathogenesis, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA 15224, USA
| | - Jonathan J Miner
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
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16
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Charlier C, Beaudoin MC, Couderc T, Lortholary O, Lecuit M. Arboviruses and pregnancy: maternal, fetal, and neonatal effects. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 1:134-146. [PMID: 30169203 DOI: 10.1016/s2352-4642(17)30021-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/27/2017] [Accepted: 06/27/2017] [Indexed: 12/19/2022]
Abstract
Arboviruses are an expanding public health threat, with pregnant women facing unique complications from arbovirus infections. These infections, such as dengue and Crimean-Congo haemorrhagic fever, can be more severe in pregnant women than in the general population. Vertical transmission is reported for many arboviruses and can severely affect pregnancy outcome. Indeed, arboviruses-particularly flaviviruses and alphaviruses-are associated with increased risks of fetal loss and premature birth. Arboviruses can be teratogenic, as is the case for Zika virus and Venezuelan equine encephalitis virus. Finally, intrapartum transmission can result in severe neonatal infections, as is true for chikungunya virus. Although the global burden of arboviruses is well recognised, few studies have provided data on arbovirus infection specifically in the context of maternal and child health. Epidemiological and clinical studies are therefore needed to better assess the burden of arbovirus infections during pregnancy and to improve the prevention and clinical management of these viral infections. In this Review, we analyse the information available and identify gaps in knowledge that require further assessment.
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Affiliation(s)
- Caroline Charlier
- Institut Pasteur, Biology of Infection Unit, Paris, France; Inserm U1117, Paris, France; Paris-Descartes University, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Marie-Claude Beaudoin
- Paris-Descartes University, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France; Division of Medical Microbiology and Infectious Diseases, Laval University and CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Thérèse Couderc
- Institut Pasteur, Biology of Infection Unit, Paris, France; Inserm U1117, Paris, France
| | - Olivier Lortholary
- Paris-Descartes University, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Lecuit
- Institut Pasteur, Biology of Infection Unit, Paris, France; Inserm U1117, Paris, France; Paris-Descartes University, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France.
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