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Yuen NKY, Bielefeldt-Ohmann H, Coyle MP, Henning J. Exposure dynamics of Ross River virus in horses - Horses as potential sentinels (a One Health approach). Epidemiol Infect 2024; 152:e67. [PMID: 38606586 PMCID: PMC11062785 DOI: 10.1017/s0950268824000554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/06/2024] [Accepted: 03/24/2024] [Indexed: 04/13/2024] Open
Abstract
Ross River virus (RRV), the most medically and economically important arbovirus in Australia, has been the most prevalent arbovirus infections in humans for many years. Infected humans and horses often suffer similar clinical symptoms. We conducted a prospective longitudinal study over a 3.5-year period to investigate the exposure dynamics of RRV in three foal cohorts (n = 32) born in a subtropical region of South East Queensland, Australia, between 2020 and 2022. RRV-specific seroconversion was detected in 56% (n = 18) of foals with a median time to seroconversion, after waning of maternal antibodies, of 429 days (95% CI: 294-582). The median age at seroconversion was 69 weeks (95% CI: 53-57). Seroconversion events were only detected between December and March (Southern Hemisphere summer) over the entire study period. Cox proportion hazards regression analyses revealed that seroconversions were significantly (p < 0.05) associated with air temperature in the month of seroconversion. Time-lags in meteorological variables were not significantly (p > 0.05) associated with seroconversion, except for relative humidity (p = 0.036 at 2-month time-lag). This is in contrast to research results of RRV infection in humans, which peaked between March and May (Autumn) and with a 0-3 month time-lag for various meteorological risk factors. Therefore, horses may be suitable sentinels for monitoring active arbovirus circulation and could be used for early arbovirus outbreak detection in human populations.
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Affiliation(s)
- Nicholas K. Y. Yuen
- School of Veterinary Science, Faculty of Science, The University of Queensland, Gatton, Queensland, Australia
| | - Helle Bielefeldt-Ohmann
- School of Chemistry and Molecular Biosciences, Faculty of Science, The University of Queensland, St Lucia, Queensland, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, Queensland, Australia
| | - Mitchell P. Coyle
- Equine Unit, Office of the Director Gatton Campus, Faculty of Science, The University of Queensland, Gatton, Queensland, Australia
| | - Joerg Henning
- School of Veterinary Science, Faculty of Science, The University of Queensland, Gatton, Queensland, Australia
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2
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Damtew YT, Tong M, Varghese BM, Hansen A, Liu J, Dear K, Zhang Y, Morgan G, Driscoll T, Capon T, Bi P. Associations between temperature and Ross river virus infection: A systematic review and meta-analysis of epidemiological evidence. Acta Trop 2022; 231:106454. [PMID: 35405101 DOI: 10.1016/j.actatropica.2022.106454] [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: 02/09/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/01/2022]
Abstract
Ross River virus (RRV) infection is one of the emerging and prevalent arboviral diseases in Australia and the Pacific Islands. Although many studies have been conducted to establish the relationship between temperature and RRV infection, there has been no comprehensive review of the association so far. In this study, we performed a systematic review and meta-analysis to assess the effect of temperature on RRV transmission. We searched PubMed, Scopus, Embase, and Web of Science with additional lateral searches from references. The quality and strength of evidence from the included studies were evaluated following the Navigation Guide framework. We have qualitatively synthesized the evidence and conducted a meta-analysis to pool the relative risks (RRs) of RRV infection per 1 °C increase in temperature. Subgroup analyses were performed by climate zones, temperature metrics, and lag periods. A total of 17 studies met the inclusion criteria, of which six were included in the meta-analysis The meta-analysis revealed that the overall RR for the association between temperature and the risk of RRV infection was 1.09 (95% confidence interval (CI): 1.02, 1.17). Subgroup analyses by climate zones showed an increase in RRV infection per 1 °C increase in temperature in humid subtropical and cold semi-arid climate zones. The overall quality of evidence was "moderate" and we rated the strength of evidence to be "limited", warranting additional evidence to reduce uncertainty. The results showed that the risk of RRV infection is positively associated with temperature. However, the risk varies across different climate zones, temperature metrics and lag periods. These findings indicate that future studies on the association between temperature and RRV infection should consider local and regional climate, socio-demographic, and environmental factors to explore vulnerability at local and regional levels.
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3
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Choutka J, Jansari V, Hornig M, Iwasaki A. Unexplained post-acute infection syndromes. Nat Med 2022; 28:911-923. [PMID: 35585196 DOI: 10.1038/s41591-022-01810-6] [Citation(s) in RCA: 203] [Impact Index Per Article: 101.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/01/2022] [Indexed: 02/06/2023]
Abstract
SARS-CoV-2 is not unique in its ability to cause post-acute sequelae; certain acute infections have long been associated with an unexplained chronic disability in a minority of patients. These post-acute infection syndromes (PAISs) represent a substantial healthcare burden, but there is a lack of understanding of the underlying mechanisms, representing a significant blind spot in the field of medicine. The relatively similar symptom profiles of individual PAISs, irrespective of the infectious agent, as well as the overlap of clinical features with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), suggest the potential involvement of a common etiopathogenesis. In this Review, we summarize what is known about unexplained PAISs, provide context for post-acute sequelae of SARS-CoV-2 infection (PASC), and delineate the need for basic biomedical research into the underlying mechanisms behind this group of enigmatic chronic illnesses.
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Affiliation(s)
- Jan Choutka
- Department of Chemistry of Natural Compounds, University of Chemistry and Technology, Prague, Czech Republic.
| | - Viraj Jansari
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Mady Hornig
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA. .,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA. .,Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, CT, USA. .,Howard Hughes Medical Institute, Chevy Chase, MD, USA.
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4
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Doran C, Elsinga J, Fokkema A, Berenschot K, Gerstenbluth I, Duits A, Lourents N, Halabi Y, Burgerhof J, Bailey A, Tami A. Long-term Chikungunya sequelae and quality of life 2.5 years post-acute disease in a prospective cohort in Curaçao. PLoS Negl Trop Dis 2022; 16:e0010142. [PMID: 35231033 PMCID: PMC8887759 DOI: 10.1371/journal.pntd.0010142] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Little is known about the persistence and impact of non-rheumatic symptoms after acute chikungunya disease. We have studied the clinical presentation and long-term impact of rheumatic and non-rheumatic symptoms on health related quality of life (QoL) 2.5 years after disease onset. Additionally, the validity of the Curaçao Long-Term Chikungunya Sequelae (CLTCS) score in classifying disease severity over time was evaluated. Methodology/Principal findings This prospective cohort study followed 248 chikungunya patients. Symptoms and SF-36 QoL were evaluated during baseline and follow-up at 2.5 years using questionnaires. Chikungunya disease status was classified using the CLTCS-score. At 2.5 years after disease onset patients were classified as being recovered (43%), mildly (35%) or highly (22%) affected. In comparison to mildly affected, highly affected patients reported the highest prevalence of ongoing rheumatic and non-rheumatic/psychological symptoms, with increased prevalence of arthralgia in the lower extremities (p = .01) and fatigue (p = .049) over time, and higher pain intensity (p < .001). Compared to mildly affected, being highly affected was associated with weakness in the lower extremities (OR: 1.90; CI: 1.29–2.80, p = .001) and worsened physical and mental QoL impairment. Conclusions Patients are both physically and psychologically affected by rheumatic and non-rheumatic symptoms of long-term chikungunya disease. The CLTCS-score is an easy to use instrument for classifying long-term chikungunya disease severity and impact and can facilitate health care providers in identifying highly affected patients who are prone to develop severe QoL impairment. Highly affected patients are recommended to be treated in a multidisciplinary setting to improve physical and psychological functioning, and QoL. Chikungunya disease manifestation is characterized by a sudden onset of non-rheumatic flu-like symptoms and debilitating rheumatic symptoms in the acute phase. Little is known about the persistence of non-rheumatic symptoms after acute disease. In this prospective cohort study we investigated the clinical manifestations and persistence of baseline rheumatic and non-rheumatic/psychological symptoms and their impact on health related quality of life (QoL) 2.5 years after disease onset. Moreover, we investigated the performance of the classification instrument the Curaçao Long-Term Chikungunya Sequelae (CLTCS) score in classifying chikungunya disease severity over time. We found that 57% of the patients were still affected 2.5 years after disease onset. An increase of mainly recurrent rheumatic and non-rheumatic/psychological symptoms including fatigue, insomnia, sombreness, and loss of vitality were reported, with a significantly higher symptom recurrence and pain intensity reported by highly affected patients. In addition, QoL assessment indicates that the disease burden impaired the physiological well-being of these patients. We also showed that the CLTCS-score can be used to easily identify highly affected patients. This study demonstrates that disease severity increases non-rheumatic symptoms and subsequent physiological impairments and suggests a multidisciplinary treatment approach to treat the psychological effects of long-term chikungunya disease.
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Affiliation(s)
- Churnalisa Doran
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, The Netherlands
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
- * E-mail:
| | - Jelte Elsinga
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Ante Fokkema
- University of Groningen, Groningen, The Netherlands
| | | | - Izzy Gerstenbluth
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
- Department of Epidemiology and Research, Medical and Public Health Service Curaçao, Willemstad, Curaçao
| | - Ashley Duits
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
- Red Cross Blood Bank Foundation, Willemstad, Curaçao
| | - Norediz Lourents
- Department of Epidemiology and Research, Medical and Public Health Service Curaçao, Willemstad, Curaçao
| | - Yaskara Halabi
- Department of Epidemiology and Research, Medical and Public Health Service Curaçao, Willemstad, Curaçao
| | - Johannes Burgerhof
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Ajay Bailey
- Department of Human Geography and Spatial Planning, University of Utrecht, Utrecht, The Netherlands
| | - Adriana Tami
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, The Netherlands
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Ross River Virus Infection: A Cross-Disciplinary Review with a Veterinary Perspective. Pathogens 2021; 10:pathogens10030357. [PMID: 33802851 PMCID: PMC8002670 DOI: 10.3390/pathogens10030357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 02/06/2023] Open
Abstract
Ross River virus (RRV) has recently been suggested to be a potential emerging infectious disease worldwide. RRV infection remains the most common human arboviral disease in Australia, with a yearly estimated economic cost of $4.3 billion. Infection in humans and horses can cause chronic, long-term debilitating arthritogenic illnesses. However, current knowledge of immunopathogenesis remains to be elucidated and is mainly inferred from a murine model that only partially resembles clinical signs and pathology in human and horses. The epidemiology of RRV transmission is complex and multifactorial and is further complicated by climate change, making predictive models difficult to design. Establishing an equine model for RRV may allow better characterization of RRV disease pathogenesis and immunology in humans and horses, and could potentially be used for other infectious diseases. While there are no approved therapeutics or registered vaccines to treat or prevent RRV infection, clinical trials of various potential drugs and vaccines are currently underway. In the future, the RRV disease dynamic is likely to shift into temperate areas of Australia with longer active months of infection. Here, we (1) review the current knowledge of RRV infection, epidemiology, diagnostics, and therapeutics in both humans and horses; (2) identify and discuss major research gaps that warrant further research.
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Zaid A, Burt FJ, Liu X, Poo YS, Zandi K, Suhrbier A, Weaver SC, Texeira MM, Mahalingam S. Arthritogenic alphaviruses: epidemiological and clinical perspective on emerging arboviruses. THE LANCET. INFECTIOUS DISEASES 2020; 21:e123-e133. [PMID: 33160445 DOI: 10.1016/s1473-3099(20)30491-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Abstract
Mosquito-borne viruses, or arboviruses, have been part of the infectious disease landscape for centuries, and are often, but not exclusively, endemic to equatorial and subtropical regions of the world. The past two decades saw the re-emergence of arthritogenic alphaviruses, a genus of arboviruses that includes several members that cause severe arthritic disease. Recent outbreaks further highlight the substantial public health burden caused by these viruses. Arthritogenic alphaviruses are often reported in the context of focused outbreaks in specific regions (eg, Caribbean, southeast Asia, and Indian Ocean) and cause debilitating acute disease that can extend to chronic manifestations for years after infection. These viruses are classified among several antigenic complexes, span a range of hosts and mosquito vectors, and can be distributed along specific geographical locations. In this Review, we highlight key features of alphaviruses that are known to cause arthritic disease in humans and outline the present findings pertaining to classification, immunogenicity, pathogenesis, and experimental approaches aimed at limiting disease manifestations. Although the most prominent alphavirus outbreaks in the past 15 years featured chikungunya virus, and a large body of work has been dedicated to understanding chikungunya disease mechanisms, this Review will instead focus on other arthritogenic alphaviruses that have been identified globally and provide a comprehensive appraisal of present and future research directions.
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Affiliation(s)
- Ali Zaid
- Emerging Viruses, Inflammation, and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Felicity J Burt
- Division of Virology, National Health Laboratory Services, Bloemfontein, South Africa; Division of Virology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Xiang Liu
- Emerging Viruses, Inflammation, and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Yee Suan Poo
- Emerging Viruses, Inflammation, and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Keivan Zandi
- Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Andreas Suhrbier
- Inflammation Biology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Scott C Weaver
- Department of Microbiology and Immunology and Institute for Human Infections and Immunity, The University of Texas Medical Branch, Galveston, TX, USA
| | - Mauro M Texeira
- Department of Biochemistry and Immunology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Suresh Mahalingam
- Emerging Viruses, Inflammation, and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
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Murphy AK, Clennon JA, Vazquez-Prokopec G, Jansen CC, Frentiu FD, Hafner LM, Hu W, Devine GJ. Spatial and temporal patterns of Ross River virus in south east Queensland, Australia: identification of hot spots at the rural-urban interface. BMC Infect Dis 2020; 20:722. [PMID: 33008314 PMCID: PMC7530966 DOI: 10.1186/s12879-020-05411-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 09/10/2020] [Indexed: 12/02/2022] Open
Abstract
Background Ross River virus (RRV) is responsible for the most common vector-borne disease of humans reported in Australia. The virus circulates in enzootic cycles between multiple species of mosquitoes, wildlife reservoir hosts and humans. Public health concern about RRV is increasing due to rising incidence rates in Australian urban centres, along with increased circulation in Pacific Island countries. Australia experienced its largest recorded outbreak of 9544 cases in 2015, with the majority reported from south east Queensland (SEQ). This study examined potential links between disease patterns and transmission pathways of RRV. Methods The spatial and temporal distribution of notified RRV cases, and associated epidemiological features in SEQ, were analysed for the period 2001–2016. This included fine-scale analysis of disease patterns across the suburbs of the capital city of Brisbane, and those of 8 adjacent Local Government Areas, and host spot analyses to identify locations with significantly high incidence. Results The mean annual incidence rate for the region was 41/100,000 with a consistent seasonal peak in cases between February and May. The highest RRV incidence was in adults aged from 30 to 64 years (mean incidence rate: 59/100,000), and females had higher incidence rates than males (mean incidence rates: 44/100,000 and 34/100,000, respectively). Spatial patterns of disease were heterogeneous between years, and there was a wide distribution of disease across both urban and rural areas of SEQ. Overall, the highest incidence rates were reported from predominantly rural suburbs to the north of Brisbane City, with significant hot spots located in peri-urban suburbs where residential, agricultural and conserved natural land use types intersect. Conclusions Although RRV is endemic across all of SEQ, transmission is most concentrated in areas where urban and peri-urban environments intersect. The drivers of RRV transmission across rural-urban landscapes should be prioritised for further investigation, including identification of specific vectors and hosts that mediate human spillover.
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Affiliation(s)
- Amanda K Murphy
- Mosquito Control Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia. .,School of Biomedical Sciences, Faculty of Health, and Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
| | - Julie A Clennon
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, USA
| | | | - Cassie C Jansen
- Communicable Diseases Branch, Queensland Health, Herston, Australia
| | - Francesca D Frentiu
- School of Biomedical Sciences, Faculty of Health, and Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Louise M Hafner
- School of Biomedical Sciences, Faculty of Health, and Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Wenbiao Hu
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Gregor J Devine
- Mosquito Control Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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Fox JM, Huang L, Tahan S, Powell LA, Crowe JE, Wang D, Diamond MS. A cross-reactive antibody protects against Ross River virus musculoskeletal disease despite rapid neutralization escape in mice. PLoS Pathog 2020; 16:e1008743. [PMID: 32760128 PMCID: PMC7433899 DOI: 10.1371/journal.ppat.1008743] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/18/2020] [Accepted: 06/25/2020] [Indexed: 01/01/2023] Open
Abstract
Arthritogenic alphaviruses cause debilitating musculoskeletal disease and historically have circulated in distinct regions. With the global spread of chikungunya virus (CHIKV), there now is more geographic overlap, which could result in heterologous immunity affecting natural infection or vaccination. Here, we evaluated the capacity of a cross-reactive anti-CHIKV monoclonal antibody (CHK-265) to protect against disease caused by the distantly related alphavirus, Ross River virus (RRV). Although CHK-265 only moderately neutralizes RRV infection in cell culture, it limited clinical disease in mice independently of Fc effector function activity. Despite this protective phenotype, RRV escaped from CHK-265 neutralization in vivo, with resistant variants retaining pathogenic potential. Near the inoculation site, CHK-265 reduced viral burden in a type I interferon signaling-dependent manner and limited immune cell infiltration into musculoskeletal tissue. In a parallel set of experiments, purified human CHIKV immune IgG also weakly neutralized RRV, yet when transferred to mice, resulted in improved clinical outcome during RRV infection despite the emergence of resistant viruses. Overall, this study suggests that weakly cross-neutralizing antibodies can protect against heterologous alphavirus disease, even if neutralization escape occurs, through an early viral control program that tempers inflammation. The induction of broadly neutralizing antibodies is a goal of many antiviral vaccine programs. In this study, we show that cross-reactive monoclonal and polyclonal antibodies developed after CHIKV infection or immunization with relatively weak cross-neutralizing activity can protect against RRV-induced musculoskeletal disease in mice. Even though RRV rapidly escaped from neutralization, antibody therapy reduced inflammation in musculoskeletal tissues and decreased viral burden near the site of infection in a manner that required type I interferon signaling. These studies in mice show that broadly reactive antibodies with limited neutralizing activity still can confer protection against heterologous alphaviruses.
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Affiliation(s)
- Julie M. Fox
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Ling Huang
- MacroGenics, Rockville, Maryland, United States of America
| | - Stephen Tahan
- Department of Molecular Microbiology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Laura A. Powell
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - James E. Crowe
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Vaccine Center and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - David Wang
- Department of Molecular Microbiology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Michael S. Diamond
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, United States of America
- Department of Molecular Microbiology, Washington University in St. Louis, St. Louis, Missouri, United States of America
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, Missouri, United States of America
- * E-mail:
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Arboviruses and Muscle Disorders: From Disease to Cell Biology. Viruses 2020; 12:v12060616. [PMID: 32516914 PMCID: PMC7354517 DOI: 10.3390/v12060616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 12/23/2022] Open
Abstract
Infections due to arboviruses (arthropod-borne viruses) have dramatically increased worldwide during the last few years. In humans, symptoms associated with acute infection of most arboviruses are often described as "dengue-like syndrome", including fever, rash, conjunctivitis, arthralgia, and muscular symptoms such as myalgia, myositis, or rhabdomyolysis. In some cases, muscular symptoms may persist over months, especially following flavivirus and alphavirus infections. However, in humans the cellular targets of infection in muscle have been rarely identified. Animal models provide insights to elucidate pathological mechanisms through studying viral tropism, viral-induced inflammation, or potential viral persistence in the muscle compartment. The tropism of arboviruses for muscle cells as well as the viral-induced cytopathic effect and cellular alterations can be confirmed in vitro using cellular models. This review describes the link between muscle alterations and arbovirus infection, and the underlying mechanisms.
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Levi LI, Vignuzzi M. Arthritogenic Alphaviruses: A Worldwide Emerging Threat? Microorganisms 2019; 7:microorganisms7050133. [PMID: 31091828 PMCID: PMC6560413 DOI: 10.3390/microorganisms7050133] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 12/20/2022] Open
Abstract
Arthritogenic alphaviruses are responsible for a dengue-like syndrome associated with severe debilitating polyarthralgia that can persist for months or years and impact life quality. Chikungunya virus is the most well-known member of this family since it was responsible for two worldwide epidemics with millions of cases in the last 15 years. However, other arthritogenic alphaviruses that are as of yet restrained to specific territories are the cause of neglected tropical diseases: O'nyong'nyong virus in Sub-Saharan Africa, Mayaro virus in Latin America, and Ross River virus in Australia and the Pacific island countries and territories. This review evaluates their emerging potential in light of the current knowledge for each of them and in comparison to chikungunya virus.
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Affiliation(s)
- Laura I Levi
- Populations Virales et Pathogenèse, Institut Pasteur, CNRS UMR 3569, 75015 Paris, France.
- Ecole doctorale BioSPC, Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France.
| | - Marco Vignuzzi
- Populations Virales et Pathogenèse, Institut Pasteur, CNRS UMR 3569, 75015 Paris, France.
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Stephenson EB, Peel AJ, Reid SA, Jansen CC, McCallum H. The non-human reservoirs of Ross River virus: a systematic review of the evidence. Parasit Vectors 2018; 11:188. [PMID: 29554936 PMCID: PMC5859426 DOI: 10.1186/s13071-018-2733-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/20/2018] [Indexed: 11/10/2022] Open
Abstract
Understanding the non-human reservoirs of zoonotic pathogens is critical for effective disease control, but identifying the relative contributions of the various reservoirs of multi-host pathogens is challenging. For Ross River virus (RRV), knowledge of the transmission dynamics, in particular the role of non-human species, is important. In Australia, RRV accounts for the highest number of human mosquito-borne virus infections. The long held dogma that marsupials are better reservoirs than placental mammals, which are better reservoirs than birds, deserves critical review. We present a review of 50 years of evidence on non-human reservoirs of RRV, which includes experimental infection studies, virus isolation studies and serosurveys. We find that whilst marsupials are competent reservoirs of RRV, there is potential for placental mammals and birds to contribute to transmission dynamics. However, the role of these animals as reservoirs of RRV remains unclear due to fragmented evidence and sampling bias. Future investigations of RRV reservoirs should focus on quantifying complex transmission dynamics across environments.
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Affiliation(s)
- Eloise B Stephenson
- Environmental Futures Research Institute, Griffith University, Brisbane, Queensland, 4111, Australia.
| | - Alison J Peel
- Environmental Futures Research Institute, Griffith University, Brisbane, Queensland, 4111, Australia
| | - Simon A Reid
- The University of Queensland, School of Public Health, Herston, Brisbane, Queensland, 4006, Australia
| | - Cassie C Jansen
- Metro North Public Health Unit, Metro North Hospital and Health Service, Windsor, Brisbane, Queensland, 4030, Australia.,Communicable Diseases Branch, Department of Health, Queensland Government, Herston, Brisbane, Queensland, 4006, Australia
| | - Hamish McCallum
- Environmental Futures Research Institute, Griffith University, Brisbane, Queensland, 4111, Australia
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12
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Liu X, Tharmarajah K, Taylor A. Ross River virus disease clinical presentation, pathogenesis and current therapeutic strategies. Microbes Infect 2017; 19:496-504. [PMID: 28754345 DOI: 10.1016/j.micinf.2017.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/13/2017] [Indexed: 12/13/2022]
Abstract
Ross River virus (RRV) is an arthitogenic alphavirus capable of causing outbreaks of debilitating musculoskeletal inflammatory disease in humans. RRV is the most common mosquito-borne disease in Australia, with outbreaks of RRV generally occurring during seasonal wet and warm conditions. Patients with Ross River virus disease (RRVD) typically present with fever, polyarthralgia, myalgia and a maculopapular erythematous rash. Treatment of the disease is usually palliative with no licensed vaccines or antiviral therapies currently available. In an effort to better inform therapeutic design, much progress has been made to understand the pathogenesis of RRVD. Progress has been largely driven by clinical evaluations supported by research using established murine models of RRVD, able to accurately replicate human disease. In this review we describe RRVD pathogenesis and the role of the host immune response, with particular focus on insights from studying animal models. We also discuss prospects for effective vaccines, preclinical development of therapeutic strategies and raise important questions for future RRV research.
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Affiliation(s)
- Xiang Liu
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, 4222, Queensland, Australia
| | - Kothila Tharmarajah
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, 4222, Queensland, Australia
| | - Adam Taylor
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, 4222, Queensland, Australia.
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Clinical Presentation, Progression, and Management of Five Cases of Ross River Virus Infection in Performance Horses Located in Southeast Queensland: A Longitudinal Case Series. J Equine Vet Sci 2017. [DOI: 10.1016/j.jevs.2016.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mejía CR, López-Vélez R. Tropical arthritogenic alphaviruses. ACTA ACUST UNITED AC 2017; 14:97-105. [PMID: 28365217 DOI: 10.1016/j.reuma.2017.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 01/16/2017] [Accepted: 01/19/2017] [Indexed: 10/19/2022]
Abstract
Tropical alphaviruses have special tropism for bone and joint tissue. Patients can develop chronic rheumatic disorders similar to rheumatoid arthritis and ankylosing spondylitis. The prototype is Chikungunya virus, although other lesser known viruses in our environment such as Sindbis, Ross River, Mayaro, O'nyong nyong and Barmah Forest viruses have the potential to be sped through vectors and cause chronic rheumatic disease. International population movements have increased the numbers of patients diagnosed with these tropical viruses in areas in which they are not endemic. Since they can leave persistent symptoms and affect the quality of life of the patients, it is important that we be aware of them. Changes in ecosystems have favored the expansion of competent mosquitoes, making fears of local transmission in southern Europe a reality. The objective of this review is to provide a clinical approach to the different arthritogenic tropical alphaviruses, especially those in which chronic rheumatic disease is more frequent.
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Affiliation(s)
- Carla-Ruth Mejía
- Unidad de Referencia Nacional para Enfermedades Tropicales, Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Rogelio López-Vélez
- Unidad de Referencia Nacional para Enfermedades Tropicales, Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España.
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Nagpal K, Agarwal P, Kumar A, Reddi R. Chikungunya infection presenting as mild encephalitis with a reversible lesion in the splenium: a case report. J Neurovirol 2017; 23:501-503. [PMID: 28105556 DOI: 10.1007/s13365-017-0515-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/23/2016] [Accepted: 01/10/2017] [Indexed: 12/14/2022]
Abstract
Chikungunya fever is an Aedes mosquito-transmitted infection caused by chikungunya virus, an RNA virus in the family Togaviridae. The disease is characteristically manifested as fever, arthralgia, and/or rash. Various neurological manifestations like meningoencephalitis, myelitis, and myeloneuropathy have been mentioned in various reports. We present a rare case of chikungunya fever presenting with mild encephalitis with a reversible lesion of the splenium (MERS), which showed complete clinical and radiological recovery.
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Affiliation(s)
- Kadam Nagpal
- Department of Neurology, Max Superspeciality Hospital, Saket, New Delhi, India.
| | - Puneet Agarwal
- Department of Neurology, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Amit Kumar
- Department of Radiodiagnosis, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Rajashekhar Reddi
- Department of Neurology, Max Superspeciality Hospital, Saket, New Delhi, India
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Lwande OW, Obanda V, Bucht G, Mosomtai G, Otieno V, Ahlm C, Evander M. Global emergence of Alphaviruses that cause arthritis in humans. Infect Ecol Epidemiol 2015; 5:29853. [PMID: 26689654 PMCID: PMC4685977 DOI: 10.3402/iee.v5.29853] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 11/20/2022] Open
Abstract
Arthropod-borne viruses (arboviruses) may cause severe emerging and re-emerging infectious diseases, which pose a significant threat to human and animal health in the world today. These infectious diseases range from mild febrile illnesses, arthritis, and encephalitis to haemorrhagic fevers. It is postulated that certain environmental factors, vector competence, and host susceptibility have a major impact on the ecology of arboviral diseases. Presently, there is a great interest in the emergence of Alphaviruses because these viruses, including Chikungunya virus, O'nyong'nyong virus, Sindbis virus, Ross River virus, and Mayaro virus, have caused outbreaks in Africa, Asia, Australia, Europe, and America. Some of these viruses are more common in the tropics, whereas others are also found in temperate regions, but the actual factors driving Alphavirus emergence and re-emergence remain unresolved. Furthermore, little is known about the transmission dynamics, pathophysiology, genetic diversity, and evolution of circulating viral strains. In addition, the clinical presentation of Alphaviruses may be similar to other diseases such as dengue, malaria, and typhoid, hence leading to misdiagnosis. However, the typical presence of arthritis may distinguish between Alphaviruses and other differential diagnoses. The absence of validated diagnostic kits for Alphaviruses makes even routine surveillance less feasible. For that purpose, this review describes the occurrence, genetic diversity, clinical characteristics, and the mechanisms involving Alphaviruses causing arthritis in humans. This information may serve as a basis for better awareness and detection of Alphavirus-caused diseases during outbreaks and in establishing appropriate prevention and control measures.
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Affiliation(s)
| | - Vincent Obanda
- Veterinary Services Department, Kenya Wildlife Service, Nairobi, Kenya
| | - Göran Bucht
- Swedish Defence Research Agency, CBRN Defence and Security, Umeå, Sweden
| | - Gladys Mosomtai
- Earth Observation Unit, International Centre of Insect Physiology and Ecology, Nairobi, Kenya
| | - Viola Otieno
- IGAD Climate Prediction and Application Centre (ICPAC), Nairobi, Kenya
| | - Clas Ahlm
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
| | - Magnus Evander
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden
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Claflin SB, Webb CE. Ross River Virus: Many Vectors and Unusual Hosts Make for an Unpredictable Pathogen. PLoS Pathog 2015; 11:e1005070. [PMID: 26335937 PMCID: PMC4559463 DOI: 10.1371/journal.ppat.1005070] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Suzi B. Claflin
- Department of Entomology, Cornell University, Ithaca, New York, United States of America
| | - Cameron E. Webb
- Department of Medical Entomology, University of Sydney and Pathology West—ICPMR Westmead, Westmead Hospital, Westmead, New South Wales, Australia
- * E-mail:
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Dhama K, Kapoor S, Pawaiya RVS, Chakraborty S, Tiwari R, Verma AK. Ross River Virus (RRV) infection in horses and humans: a review. Pak J Biol Sci 2015; 17:768-79. [PMID: 26035950 DOI: 10.3923/pjbs.2014.768.779] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A fascinating and important arbovirus is Ross River Virus (RRV) which is endemic and epizootic in nature in certain parts of the world. RRV is a member of the genus Alphavirus within the Semliki Forest complex of the family Togaviridae, which also includes the Getah virus. The virus is responsible for causing disease both in humans as well as horses. Mosquito species (Aedes camptorhynchus and Aedes vigilax; Culex annulirostris) are the most important vector for this virus. In places of low temperature as well as low rainfall or where there is lack of habitat of mosquito there is also limitation in the transmission of the virus. Such probability is higher especially in temperate regions bordering endemic regions having sub-tropical climate. There is involvement of articular as well as non-articular cells in the replication of RRV. Levels of pro-inflammatory factors viz., tumor necrosis factor-alpha (TNF-α); interferon-gamma (IFN-γ); and macrophage chemo-attractant protein-1 (MAC-1) during disease pathogenesis have been found to be reduced. Reverse transcription-polymerase chain reaction (RT-PCR) is the most advanced molecular diagnostic tool along with epitope-blocking enzyme-linked immunosorbent assay (ELISA) for detecting RRV infection. Treatment for RRV infection is only supportive. Vaccination is not a fruitful approach. Precise data collection will help the researchers to understand the RRV disease dynamics and thereby designing effective prevention and control strategy. Advances in diagnosis, vaccine development and emerging/novel therapeutic regimens need to be explored to their full potential to tackle RRV infection and the disease it causes.
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TOCHITANI K, SHIMIZU T, SHINOHARA K, TSUCHIDO Y, MOI ML, TAKASAKI T. The First Case Report of Ross River Virus Disease in a Japanese Patient who Returned from Australia. ACTA ACUST UNITED AC 2014; 88:155-9. [DOI: 10.11150/kansenshogakuzasshi.88.155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | - Koh SHINOHARA
- Department of Infectious Diseases, Kyoto City Hospital
| | | | - Meng Ling MOI
- Department of Virology 1, National Institute of Infectious Diseases
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Gérardin P, Fianu A, Michault A, Mussard C, Boussaïd K, Rollot O, Grivard P, Kassab S, Bouquillard E, Borgherini G, Gaüzère BA, Malvy D, Bréart G, Favier F. Predictors of Chikungunya rheumatism: a prognostic survey ancillary to the TELECHIK cohort study. Arthritis Res Ther 2013; 15:R9. [PMID: 23302155 PMCID: PMC3672753 DOI: 10.1186/ar4137] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 01/04/2013] [Indexed: 05/03/2023] Open
Abstract
Introduction Long-lasting relapsing or lingering rheumatic musculoskeletal pain (RMSP) is the hallmark of Chikungunya virus (CHIKV) rheumatism (CHIK-R). Little is known on their prognostic factors. The aim of this prognostic study was to search the determinants of lingering or relapsing RMSP indicative of CHIK-R. Methods Three hundred and forty-six infected adults (age ≥ 15 years) having declared RMSP at disease onset were extracted from the TELECHIK cohort study, Reunion island, and analyzed using a multinomial logistic regression model. We also searched for the predictors of CHIKV-specific IgG titres, assessed at the time of a serosurvey, using multiple linear regression analysis. Results Of these, 111 (32.1%) reported relapsing RMSP, 150 (43.3%) lingering RMSP, and 85 (24.6%) had fully recovered (reference group) on average two years after acute infection. In the final model controlling for gender, the determinants of relapsing RMSP were the age 45-59 years (adjusted OR: 2.9, 95% CI: 1.0, 8.6) or greater or equal than 60 years (adjusted OR: 10.4, 95% CI: 3.5, 31.1), severe rheumatic involvement (fever, at least six joints plus four other symptoms) at presentation (adjusted OR: 3.6, 95% CI: 1.5, 8.2), and CHIKV-specific IgG titres (adjusted OR: 3.2, 95% CI: 1.8, 5.5, per one unit increase). Prognostic factors for lingering RMSP were age 45-59 years (adjusted OR: 6.4, 95% CI: 1.8, 22.1) or greater or equal than 60 years (adjusted OR: 22.3, 95% CI: 6.3, 78.1), severe initial rheumatic involvement (adjusted OR: 5.5, 95% CI: 2.2, 13.8) and CHIKV-specific IgG titres (adjusted OR: 6.2, 95% CI: 2.8, 13.2, per one unit increase). CHIKV specific IgG titres were positively correlated with age, female gender and the severity of initial rheumatic symptoms. Conclusions Our data support the roles of age, severity at presentation and CHIKV specific IgG titres for predicting CHIK-R. By identifying the prognostic value of the humoral immune response of the host, this work also suggest a significant contribution of the adaptive immune response to the physiopathology of CHIK-R and should help to reconsider the paradigm of this chronic infection primarily shifted towards the involvement of the innate immune response.
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Stoermer KA, Burrack A, Oko L, Montgomery SA, Borst LB, Gill RG, Morrison TE. Genetic ablation of arginase 1 in macrophages and neutrophils enhances clearance of an arthritogenic alphavirus. THE JOURNAL OF IMMUNOLOGY 2012; 189:4047-59. [PMID: 22972923 DOI: 10.4049/jimmunol.1201240] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chikungunya virus (CHIKV) and Ross River virus (RRV) cause a debilitating, and often chronic, musculoskeletal inflammatory disease in humans. Macrophages constitute the major inflammatory infiltrates in musculoskeletal tissues during these infections. However, the precise macrophage effector functions that affect the pathogenesis of arthritogenic alphaviruses have not been defined. We hypothesized that the severe damage to musculoskeletal tissues observed in RRV- or CHIKV-infected mice would promote a wound-healing response characterized by M2-like macrophages. Indeed, we found that RRV- and CHIKV-induced musculoskeletal inflammatory lesions, and macrophages present in these lesions, have a unique gene-expression pattern characterized by high expression of arginase 1 and Ym1/Chi3l3 in the absence of FIZZ1/Relmα that is consistent with an M2-like activation phenotype. Strikingly, mice specifically deleted for arginase 1 in neutrophils and macrophages had dramatically reduced viral loads and improved pathology in musculoskeletal tissues at late times post-RRV infection. These findings indicate that arthritogenic alphavirus infection drives a unique myeloid cell activation program in inflamed musculoskeletal tissues that inhibits virus clearance and impedes disease resolution in an arginase 1-dependent manner.
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Affiliation(s)
- Kristina A Stoermer
- Department of Immunology, University of Colorado School of Medicine, Aurora, CO 80045, USA
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Lau C, Weinstein P, Slaney D. Imported cases of Ross River virus disease in New Zealand – A travel medicine perspective. Travel Med Infect Dis 2012; 10:129-34. [DOI: 10.1016/j.tmaid.2012.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 04/05/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
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Cramer JP, Kastenbauer U, Löscher T, Emmerich P, Schmidt-Chanasit J, Burchard GD, von Sonnenburg F. Polyarthritis in two travellers returning from Australia. J Clin Virol 2012; 52:1-3. [PMID: 21641275 DOI: 10.1016/j.jcv.2011.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 05/04/2011] [Indexed: 11/17/2022]
Affiliation(s)
- J P Cramer
- University Medical Center Hamburg-Eppendorf, I. Department of Internal Medicine, Section Tropical Medicine, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany.
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Gérardin P, Fianu A, Malvy D, Mussard C, Boussaïd K, Rollot O, Michault A, Gaüzere BA, Bréart G, Favier F. Perceived morbidity and community burden after a Chikungunya outbreak: the TELECHIK survey, a population-based cohort study. BMC Med 2011; 9:5. [PMID: 21235760 PMCID: PMC3029216 DOI: 10.1186/1741-7015-9-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 01/14/2011] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Persistent disabilities are key manifestations of Chikungunya virus (CHIKV) infection, especially incapacitating polyarthralgia and fatigue. So far, little is known about their impact on health status. The present study aimed at describing the burden of CHIKV prolonged or late-onset symptoms on the self-perceived health of La Réunion islanders. METHODS At 18 months after an outbreak of Chikungunya virus, we implemented the TELECHIK survey; a retrospective cohort study conducted on a random sample of the representative SEROCHIK population-based survey. A total of 1,094 subjects sampled for CHIKV-specific IgG antibodies in the setting of La Réunion island in the Indian Ocean, between August 2006 and October 2006, were interviewed about current symptoms divided into musculoskeletal/rheumatic, fatigue, cerebral, sensorineural, digestive and dermatological categories. RESULTS At the time of interview, 43% of seropositive (CHIK+) subjects reported musculoskeletal pain (vs 17% of seronegative (CHIK-) subjects, P < 0.001), 54% fatigue (vs 46%, P = 0.04), 75% cerebral disorders (vs 57%, P < 0.001), 49% sensorineural impairments (vs 37%, P = 0.001), 18% digestive complaints (vs 15%, P = 0.21), and 36% skin involvement (vs 34%, P = 0.20) on average 2 years after infection (range: 15-34 months). After controlling for confounders such as age, gender, body mass index or major comorbidities in different Poisson regression models, 33% of joint pains were attributable to CHIKV, 10% of cerebral disorders and 7.5% of sensorineural impairments, while Chikungunya did not enhance fatigue states, digestive and skin disorders. CONCLUSIONS On average, 2 years after infection 43% to 75% of infected people reported prolonged or late-onset symptoms highly attributable to CHIKV. These manifestations carry a significant burden in the community in the fields of rheumatology, neurology and sensorineural health.
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Affiliation(s)
- Patrick Gérardin
- Centre for Clinical Investigation-Clinical Epidemiology (CIC-EC) of La Réunion (INSERM/CHR/URMLR), Saint Pierre, La Réunion, France.
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Soumahoro MK, Gérardin P, Boëlle PY, Perrau J, Fianu A, Pouchot J, Malvy D, Flahault A, Favier F, Hanslik T. Impact of Chikungunya virus infection on health status and quality of life: a retrospective cohort study. PLoS One 2009; 4:e7800. [PMID: 19911058 PMCID: PMC2771894 DOI: 10.1371/journal.pone.0007800] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 10/12/2009] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Persistent symptoms, mainly joint and muscular pain and depression, have been reported several months after Chikungunya virus (CHIKV) infection. Their frequency and their impact on quality of life have not been compared with those of an unexposed population. In the present study, we aimed to describe the frequency of prolonged clinical manifestations of CHIKV infection and to measure the impact on quality of life and health care consumption in comparison with that of an unexposed population, more than one year after infection. METHODOLOGY/PRINCIPAL FINDINGS In a retrospective cohort study, 199 subjects who had serologically confirmed CHIKV infection (CHIK+) were compared with 199 sero-negative subjects (CHIK-) matched for age, gender and area of residence in La Réunion Island. Following an average time of 17 months from the acute phase of infection, participants were interviewed by telephone about current symptoms, medical consumption during the last 12 months and quality of life assessed by the 12-items Short-Form Health Survey (SF-12) scale. At the time of study, 112 (56%) CHIK+ persons reported they were fully recovered. CHIK+ complained more frequently than CHIK- of arthralgia (relative risk = 1.9; 95% confidence interval: 1.6-2.2), myalgia (1.9; 1.5-2.3), fatigue (2.3; 1.8-3), depression (2.5; 1.5-4.1) and hair loss (3.8; 1.9-7.6). There was no significant difference between CHIK+ and CHIK- subjects regarding medical consumption in the past year. The mean (SD) score of the SF-12 Physical Component Summary was 46.4 (10.8) in CHIK+ versus 49.1 (9.3) in CHIK- (p = 0.04). There was no significant difference between the two groups for the Mental Component Summary. CONCLUSIONS/SIGNIFICANCE More than one year following the acute phase of infection, CHIK+ subjects reported more disabilities than those who were CHIK-. These persistent disabilities, however, have no significant influence on medical consumption, and the impact on quality of life is moderate.
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Affiliation(s)
- Man-Koumba Soumahoro
- Université Pierre et Marie Curie, Unité Mixte de Recherche en Santé 707, Paris, France.
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Affiliation(s)
- Iqbal Hossain
- Department of Medicine, National University of Singapore, Yong Loo Lin School of Medicine, Singapore
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Tappe D, Schmidt-Chanasit J, Ries A, Ziegler U, Müller A, Stich A. Ross River virus infection in a traveller returning from northern Australia. Med Microbiol Immunol 2009; 198:271-3. [DOI: 10.1007/s00430-009-0122-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Indexed: 11/28/2022]
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Climate variability and Ross River virus infections in Riverland, South Australia, 1992-2004. Epidemiol Infect 2009; 137:1486-93. [PMID: 19296873 DOI: 10.1017/s0950268809002441] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Ross River virus (RRV) infection is the most common notifiable vector-borne disease in Australia, with around 6000 cases annually. This study aimed to examine the relationship between climate variability and notified RRV infections in the Riverland region of South Australia in order to set up an early warning system for the disease in temperate-climate regions. Notified data of RRV infections were collected by the South Australian Department of Health. Climatic variables and monthly river flow were provided by the Australian Bureau of Meteorology and South Australian Department of Water, Land and Biodiversity Conservation over the period 1992-2004. Spearman correlation and time-series-adjusted Poisson regression analysis were performed. The results indicate that increases in monthly mean minimum and maximum temperatures, monthly total rainfall, monthly mean Southern Oscillation Index and monthly flow in the Murray River increase the likelihood, but an increase in monthly mean relative humidity decreases the likelihood, of disease transmission in the region, with different time-lag effects. This study demonstrates that a useful early warning system can be developed for local regions based on the statistical analysis of readily available climate data. These early warning systems can be utilized by local public health authorities to develop disease prevention and control activities.
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Post-epidemic Chikungunya disease on Reunion Island: course of rheumatic manifestations and associated factors over a 15-month period. PLoS Negl Trop Dis 2009; 3:e389. [PMID: 19274071 PMCID: PMC2647734 DOI: 10.1371/journal.pntd.0000389] [Citation(s) in RCA: 245] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 02/05/2009] [Indexed: 11/19/2022] Open
Abstract
Although the acute manifestations of Chikungunya virus (CHIKV) illness are well-documented, few data exist about the long-term rheumatic outcomes of CHIKV-infected patients. We undertook between June and September 2006 a retrospective cohort study aimed at assessing the course of late rheumatic manifestations and investigating potential risk factors associated with the persistence of these rheumatic manifestations over 15 months. 147 participants (>16 yrs) with laboratory-confirmed CHIKV disease diagnosed between March 1 and June 30, 2005, were identified through a surveillance database and interviewed by telephone. At the 15-month-period evaluation after diagnosis, 84 of 147 participants (57%) self-reported rheumatic symptoms. Of these 84 patients, 53 (63%) reported permanent trouble while 31 (37%) had recurrent symptoms. Age ≥45 years (OR = 3.9, 95% CI 1.7–9.7), severe initial joint pain (OR = 4.8, 95% CI 1.9–12.1), and presence of underlying osteoarthritis comorbidity (OR = 2.9, 95% CI 1.1–7.4) were predictors of nonrecovery. Our findings suggest that long-term CHIKV rheumatic manifestations seem to be a frequent underlying post-epidemic condition. Three independent risk factors that may aid in early recognition of patients with the highest risk of presenting prolonged CHIKV illness were identified. Such findings may be particularly useful in the development of future prevention and care strategies for this emerging virus infection. Transmitted by day-biting mosquitoes, Chikungunya virus (CHIKV), causing febrile illness and joint pain, is widespread in Africa and Asia. Recent outbreaks in the Indian Ocean islands, its rapid expansion across continents, and its unusual clinical acute pattern have shed light on and brought awareness of this re-emerging virus. However, late rheumatic manifestations of this infection remain poorly examined. Thus, we have evaluated over a 15-month period the evolution and assessed potential risk factors of CHIKV-related rheumatic manifestations in a cohort of Reunion Island residents infected with CHIKV during the initial phase of the epidemic in 2005. Eligible adult patients were identified through a surveillance database. We found that rheumatic symptoms lasted for at least 15 months in 57% of the participants. Of these, 63% reported permanent trouble while 37% had recurrent symptoms. Factors such as age ≥45 years, severe initial joint pain, and presence of underlying osteoarthritis comorbidity were associated with nonrecovery over the 15-month period. Our findings suggest that long-term CHIKV rheumatic manifestations seem to be a hidden, frequent, post-epidemic condition. These findings should be considered in the development of preventive measures.
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Tong S, Dale P, Nicholls N, Mackenzie JS, Wolff R, McMichael AJ. Climate variability, social and environmental factors, and ross river virus transmission: research development and future research needs. ENVIRONMENTAL HEALTH PERSPECTIVES 2008; 116:1591-1597. [PMID: 19079707 PMCID: PMC2599750 DOI: 10.1289/ehp.11680] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 07/23/2008] [Indexed: 05/27/2023]
Abstract
BACKGROUND Arbovirus diseases have emerged as a global public health concern. However, the impact of climatic, social, and environmental variability on the transmission of arbovirus diseases remains to be determined. OBJECTIVE Our goal for this study was to provide an overview of research development and future research directions about the interrelationship between climate variability, social and environmental factors, and the transmission of Ross River virus (RRV), the most common and widespread arbovirus disease in Australia. METHODS We conducted a systematic literature search on climatic, social, and environmental factors and RRV disease. Potentially relevant studies were identified from a series of electronic searches. RESULTS The body of evidence revealed that the transmission cycles of RRV disease appear to be sensitive to climate and tidal variability. Rainfall, temperature, and high tides were among major determinants of the transmission of RRV disease at the macro level. However, the nature and magnitude of the interrelationship between climate variability, mosquito density, and the transmission of RRV disease varied with geographic area and socioenvironmental condition. Projected anthropogenic global climatic change may result in an increase in RRV infections, and the key determinants of RRV transmission we have identified here may be useful in the development of an early warning system. CONCLUSIONS The analysis indicates that there is a complex relationship between climate variability, social and environmental factors, and RRV transmission. Different strategies may be needed for the control and prevention of RRV disease at different levels. These research findings could be used as an additional tool to support decision making in disease control/surveillance and risk management.
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Affiliation(s)
- Shilu Tong
- School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia.
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Jacups SP, Whelan PI, Currie BJ. Ross River virus and Barmah Forest virus infections: a review of history, ecology, and predictive models, with implications for tropical northern Australia. Vector Borne Zoonotic Dis 2008; 8:283-97. [PMID: 18279007 DOI: 10.1089/vbz.2007.0152] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of the present article is to present a review of the Ross River virus (RRV) and Barmah Forest virus (BFV) literature in relation to potential implications for future disease in tropical northern Australia. Ross River virus infection is the most common and most widespread arboviral disease in Australia, with an average of 4,800 national notifications annually. Of recent concern is the sudden rise in BFV infections; the 2005-2006 summer marked the largest BFV epidemic on record in Australia, with 1,895 notifications. Although not life-threatening, infection with either virus can cause arthritis, myalgia, and fatigue for 6 months or longer, resulting in substantial morbidity and economic impact. The geographic distribution of mosquito species and their seasonal activity is determined in large part by temperature and rainfall. Predictive models can be useful tools in providing early warning systems for epidemics of RRV and BFV infection. Various models have been developed to predict RRV outbreaks, but these appear to be mostly only regionally valid, being dependent on local ecological factors. Difficulties have arisen in developing useful models for the tropical northern parts of Australia, and to date no models have been developed for the Northern Territory. Only one model has been developed for predicting BFV infections using climate and tide variables. It is predicted that the exacerbation of current greenhouse conditions will result in longer periods of high mosquito activity in the tropical regions where RRV and BFV are already common. In addition, the endemic locations may expand further within temperate regions, and epidemics may become more frequent in those areas. Further development of predictive models should benefit public health planning by providing early warning systems of RRV and BFV infection outbreaks in different geographical locations.
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Affiliation(s)
- Susan P Jacups
- School for Environmental Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Kurkela S, Helve T, Vaheri A, Vapalahti O. Arthritis and arthralgia three years after Sindbis virus infection: clinical follow-up of a cohort of 49 patients. ACTA ACUST UNITED AC 2008; 40:167-73. [PMID: 17852949 DOI: 10.1080/00365540701586996] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sindbis virus (SINV) emerges as large human outbreaks in northern Europe every 7 years. Similar to many other alphaviruses, SINV is a mosquito-borne causative agent of a rash-arthritis. Previous reports suggest that in many alphavirus infections joint symptoms might persist for years. A prospective cohort of 49 patients was physically examined 3 y after verified acute SINV infection to reveal persistent joint symptoms. We carefully searched for a temporal association between the infection and current symptoms, and took into account other medical conditions. Sera were collected and analysed with enzyme immunoassays. Arthritis (swelling and tenderness on physical examination) was diagnosed in 4.1% (2/49) of the patients. Tenderness on palpation or in movement of a joint was found in 14.3% of the patients in the rheumatological examination, and an additional 10.2% complained of persisting arthralgia at the interview. Thus, 24.5% of the patients had joint manifestations attributable to the infection 3 y earlier. A positive IgM antibody response persisted in 3/49 of the patients; both patients with arthritis were in this group. As one-quarter of the patients were symptomatic 3 y after infection, it seems that persistent symptoms of SINV infection have considerable public health implications in areas with high seroprevalence.
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Affiliation(s)
- Satu Kurkela
- Department of Virology, Haartman Institute, Faculty of Medicine, University of Helsinki, Finland.
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Schuffenecker I, Iteman I, Michault A, Murri S, Frangeul L, Vaney MC, Lavenir R, Pardigon N, Reynes JM, Pettinelli F, Biscornet L, Diancourt L, Michel S, Duquerroy S, Guigon G, Frenkiel MP, Bréhin AC, Cubito N, Desprès P, Kunst F, Rey FA, Zeller H, Brisse S. Genome microevolution of chikungunya viruses causing the Indian Ocean outbreak. PLoS Med 2006; 3:e263. [PMID: 16700631 PMCID: PMC1463904 DOI: 10.1371/journal.pmed.0030263] [Citation(s) in RCA: 800] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Accepted: 04/25/2006] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A chikungunya virus outbreak of unprecedented magnitude is currently ongoing in Indian Ocean territories. In Réunion Island, this alphavirus has already infected about one-third of the human population. The main clinical symptom of the disease is a painful and invalidating poly-arthralgia. Besides the arthralgic form, 123 patients with a confirmed chikungunya infection have developed severe clinical signs, i.e., neurological signs or fulminant hepatitis. METHODS AND FINDINGS We report the nearly complete genome sequence of six selected viral isolates (isolated from five sera and one cerebrospinal fluid), along with partial sequences of glycoprotein E1 from a total of 127 patients from Réunion, Seychelles, Mauritius, Madagascar, and Mayotte islands. Our results indicate that the outbreak was initiated by a strain related to East-African isolates, from which viral variants have evolved following a traceable microevolution history. Unique molecular features of the outbreak isolates were identified. Notably, in the region coding for the non-structural proteins, ten amino acid changes were found, four of which were located in alphavirus-conserved positions of nsP2 (which contains helicase, protease, and RNA triphosphatase activities) and of the polymerase nsP4. The sole isolate obtained from the cerebrospinal fluid showed unique changes in nsP1 (T301I), nsP2 (Y642N), and nsP3 (E460 deletion), not obtained from isolates from sera. In the structural proteins region, two noteworthy changes (A226V and D284E) were observed in the membrane fusion glycoprotein E1. Homology 3D modelling allowed mapping of these two changes to regions that are important for membrane fusion and virion assembly. Change E1-A226V was absent in the initial strains but was observed in >90% of subsequent viral sequences from Réunion, denoting evolutionary success possibly due to adaptation to the mosquito vector. CONCLUSIONS The unique molecular features of the analyzed Indian Ocean isolates of chikungunya virus demonstrate their high evolutionary potential and suggest possible clues for understanding the atypical magnitude and virulence of this outbreak.
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Affiliation(s)
- Isabelle Schuffenecker
- 1Centre National de Référence des Arbovirus, Institut Pasteur, Lyon, France
- * To whom correspondence should be addressed. E-mail:
(IS); E-mail:
(SB)
| | - Isabelle Iteman
- 2Plate-forme Génotypage des Pathogènes et Santé Publique (PF8), Institut Pasteur, Paris, France
| | - Alain Michault
- 3Laboratoire de Microbiologie, Hôpital St Pierre, St Pierre, Ile de la Réunion, France
| | - Séverine Murri
- 1Centre National de Référence des Arbovirus, Institut Pasteur, Lyon, France
| | - Lionel Frangeul
- 4Plate-forme Intégration et Analyse Génomique, Institut Pasteur, Paris, France
| | - Marie-Christine Vaney
- 5Unité de Virologie Structurale, Institut Pasteur, Paris, France
- 6Centre National de la Recherche Scientifique/Institut National de la Recherche Agronomique UMR 2472/1157, Paris, France
| | - Rachel Lavenir
- 2Plate-forme Génotypage des Pathogènes et Santé Publique (PF8), Institut Pasteur, Paris, France
| | - Nathalie Pardigon
- 7Unité des Interactions Moléculaires Flavivirus-Hôtes, Institut Pasteur, Paris, France
| | | | - François Pettinelli
- 9Laboratoire de Biologie Médicale, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte, France
| | - Leon Biscornet
- 10Disease Surveillance and Sexually Transmitted Infections Unit, Seychelles Public Health Laboratory, Ministry of Health and Social Services, Victoria, Mahe, Seychelles
| | - Laure Diancourt
- 2Plate-forme Génotypage des Pathogènes et Santé Publique (PF8), Institut Pasteur, Paris, France
| | - Stéphanie Michel
- 1Centre National de Référence des Arbovirus, Institut Pasteur, Lyon, France
| | - Stéphane Duquerroy
- 5Unité de Virologie Structurale, Institut Pasteur, Paris, France
- 6Centre National de la Recherche Scientifique/Institut National de la Recherche Agronomique UMR 2472/1157, Paris, France
- 11Université Paris, XI-Orsay, Paris, France
| | - Ghislaine Guigon
- 2Plate-forme Génotypage des Pathogènes et Santé Publique (PF8), Institut Pasteur, Paris, France
| | | | - Anne-Claire Bréhin
- 7Unité des Interactions Moléculaires Flavivirus-Hôtes, Institut Pasteur, Paris, France
| | - Nadège Cubito
- 1Centre National de Référence des Arbovirus, Institut Pasteur, Lyon, France
| | - Philippe Desprès
- 7Unité des Interactions Moléculaires Flavivirus-Hôtes, Institut Pasteur, Paris, France
| | - Frank Kunst
- 12Unité de Génomique des Microorganismes Pathogènes and Centre National de la Recherche Scientifique URA 2171, Institut Pasteur, Paris, France
| | - Félix A Rey
- 5Unité de Virologie Structurale, Institut Pasteur, Paris, France
- 13Centre National de la Recherche Scientifique URA 1930, Paris, France
| | - Hervé Zeller
- 1Centre National de Référence des Arbovirus, Institut Pasteur, Lyon, France
| | - Sylvain Brisse
- 2Plate-forme Génotypage des Pathogènes et Santé Publique (PF8), Institut Pasteur, Paris, France
- * To whom correspondence should be addressed. E-mail:
(IS); E-mail:
(SB)
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Rulli NE, Suhrbier A, Hueston L, Heise MT, Tupanceska D, Zaid A, Wilmes A, Gilmore K, Lidbury BA, Mahalingam S. Ross River virus: Molecular and cellular aspects of disease pathogenesis. Pharmacol Ther 2005; 107:329-42. [PMID: 15923040 DOI: 10.1016/j.pharmthera.2005.03.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2005] [Indexed: 11/16/2022]
Abstract
Ross River virus (RRV) is a mosquito-borne alphavirus indigenous to Australia and the Western Pacific region and is responsible for several thousand cases of human RRV disease (RRVD) per annum. The disease primarily involves polyarthritis/arthralgia, with many patients also presenting with rash, myalgia, fever, and/or lethargy. The symptoms can be debilitating at onset, but they usually resolve within 3-6 months. Recent insights into the RRV-host relationship, associated pathology, and molecular biology of infection have generated a number of potential avenues for improved treatment. Although vaccine development has been proposed, the small market size and potential for antibody-dependent enhancement (ADE) of disease make this approach unattractive. Recent insights into the molecular basis of RRV-ADE and the virus's ability to manipulate host inflammatory and immune responses create potential new opportunities for therapeutic invention. Such interventions should overcome virus-induced dysregulation of protective host responses to promote viral clearance and/or ameliorate inflammatory immunopathology.
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Affiliation(s)
- Nestor E Rulli
- School of Health Sciences, University of Canberra, Kirinari Street, Canberra ACT 2601, Australia
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Sellner LN, Coelen RJ, Mackenzie JS. Detection of Ross River virus in clinical samples using a nested reverse transcription-polymerase chain reaction. ACTA ACUST UNITED AC 2005; 4:257-67. [PMID: 15566846 DOI: 10.1016/0928-0197(95)00009-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/1994] [Revised: 02/14/1995] [Accepted: 02/21/1995] [Indexed: 10/18/2022]
Abstract
BACKGROUND Ross River virus (RRV) is a mosquito borne alphavirus that has been found in Australia, Papua New Guinea and the Pacific Islands. It is aetiological agent of epidemic polyarthritis, a debilitating illness whose symptoms are arthritis, arthralgia, lethargy, rash and fever which may persist for weeks or months. Diagnosis is made on a serological basis, but in many cases is presumptive rather than definite. OBJECTIVES To apply the polymerase chain reaction (PCR) to detection of RRV in human sera to assess its suitability for application in disease diagnosis. STUDY DESIGN Sensitivity of the nested RT-PCR assay was determined by detection of virus of known titre diluted in uninfected serum. Clinical serum samples from patients serologically diagnosed of having RRV infection were tested by nested RT-PCR to assess its diagnostic value. RESULTS Sensitivity of the nested RT-PCR assay was determined to be detection of 0.01 PFU of virus stock in 100 mul serum. Clinical samples tested showed that 10 of 26 (38%) serum samples with low or negative (non-diagnostic) virus-specific antibody titres were PCR-positive, whereas all 22 specimens with high antibody titres were PCR-negative. PCR positivity was unaffected by repeated freezing and thawing of samples. CONCLUSIONS While PCR cannot replace serology as a means of RRV diagnosis, it may be useful in conjunction with serological testing, particularly for forming definitive diagnoses in those samples with low (inconclusive) antibody titres. It is faster and more sensitive than virus isolation by tissue culture, and could also prove useful in investigations of disease pathogenesis.
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Affiliation(s)
- L N Sellner
- Department of Microbiology, University of Western Australia, OEII Medical Centre, Verdun Street, Nedlands, 6009 Western Australia, Australia.
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Abstract
Amongst the arthritis-causing arboviruses, i.e. those spread by insects, the alphavirus group is of special interest. These viruses occasionally cause vast outbreaks, such as O'nyong-nyong in Africa in 1959. In Fennoscandia, Sindbis-related Ockelbo, Pogosta, or Karelian fever viruses have been found to cause significant morbidity. The major symptoms in addition to joint inflammation are fever, fatigue, headache and rash. The joint symptoms may persist for weeks, even months. The diagnosis is based on the clinical picture and serology. The causative viruses are closely related but not identical. It appears that at least in Finland the Pogosta disease is more common than thought, and the symptoms may often be overlooked. Several factors related to the viruses, their hosts, and global environmental changes may affect the spread of these viruses. All over the world arbovirus-caused diseases have increased, because of global changes.
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Affiliation(s)
- M Laine
- Keuruu Health Center, Keuruu, Finland.
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Kelly-Hope LA, Purdie DM, Kay BH. Ross River virus disease in Australia, 1886-1998, with analysis of risk factors associated with outbreaks. JOURNAL OF MEDICAL ENTOMOLOGY 2004; 41:133-150. [PMID: 15061271 DOI: 10.1603/0022-2585-41.2.133] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Ross River virus (RR) is a mosquito-borne arbovirus responsible for outbreaks of polyarthritic disease throughout Australia. To better understand human and environmental factors driving such events, 57 historical reports on RR outbreaks between 1896 and 1998 were examined collectively. The magnitude, regularity, seasonality, and locality of outbreaks were found to be wide ranging; however, analysis of climatic and tidal data highlighted that environmental conditions act differently in tropical, arid, and temperate regions. Overall, rainfall seems to be the single most important risk factor, with over 90% of major outbreak locations receiving higher than average rainfall in preceding months. Many temperatures were close to average, particularly in tropical populations; however, in arid regions, below average maximum temperatures predominated, and in southeast temperate regions, above average minimum temperatures predominated. High spring tides preceded coastal outbreaks, both in the presence and absence of rainfall, and the relationship between rainfall and the Southern Oscillation Index and La Niña episodes suggest they may be useful predictive tools, but only in southeast temperate regions. Such heterogeneity predisposing outbreaks supports the notion that there are different RR epidemiologies throughout Australia but also suggests that generic parameters for the prediction and control of outbreaks are of limited use at a local level.
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Affiliation(s)
- Louise A Kelly-Hope
- Infectious Diseases and Immunology Division, Queensland Institute of Medical Research and The University of Queensland, Australian Centre for International and Tropical Health and Nutrition, Post Office Royal Brisbane Hospital, Qld 4029, Australia
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Harley D, Bossingham D, Purdie DM, Pandeya N, Sleigh AC. Ross River virus disease in tropical Queensland: evolution of rheumatic manifestations in an inception cohort followed for six months. Med J Aust 2002; 177:352-5. [PMID: 12358576 DOI: 10.5694/j.1326-5377.2002.tb04836.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2001] [Accepted: 06/06/2002] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the natural history of rheumatic manifestations of Ross River virus (RRV) disease. DESIGN Prospective longitudinal clinical review. SETTING North Queensland local government areas of Cairns, Douglas, Mareeba and Atherton during January to May 1998. PARTICIPANTS General practice patients diagnosed with RRV disease on the basis of symptoms and a positive RRV IgM result. MAIN OUTCOME MEASURES Rheumatic symptoms and signs assessed as soon as possible after disease onset and on two subsequent occasions (up to 6.5 months after onset). RESULTS 57 patients were recruited, 47 of whom were reviewed three times (at means of 1.1, 2.4 and 3.6 months after disease onset). Results are reported for these 47: 46 (98%) complained of joint pain at first review, with the ankles, wrists, fingers, knees and metacarpophalangeal joints (II-IV) most commonly involved. Prevalence of joint pain decreased progressively on second and third reviews, both overall (92% and 68% of patients, respectively), and in the five joints most commonly affected. The prevalence of other common rheumatic symptoms and signs, and use of non-steroidal anti-inflammatory drugs, also progressively declined over the three reviews. CONCLUSIONS Earlier studies may have overestimated the prevalence and duration of symptoms in RRV disease. Progressive resolution over 3-6 months appears usual.
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Affiliation(s)
- David Harley
- Developmental Disability Unit, School of Population Health, University of Queensland, Mater Hospital, Raymond Terrace, South Brisbane, QLD 4101, Australia.
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Mylonas AD, Brown AM, Carthew TL, McGrath B, Purdie DM, Pandeya N, Vecchio PC, Collins LG, Gardner ID, de Looze FJ, Reymond EJ, Suhrbier A. Natural history of Ross River virus-induced epidemic polyarthritis. Med J Aust 2002; 177:356-60. [PMID: 12358577 DOI: 10.5694/j.1326-5377.2002.tb04837.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2002] [Accepted: 05/22/2002] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the natural history, treatment and cost of Ross River virus-induced epidemic polyarthritis (RRV disease). DESIGN Questionnaire-based longitudinal prospective study. PARTICIPANTS AND SETTING Patients in the greater Brisbane area, Queensland, diagnosed with RRV disease by their general practitioners based on clinical symptoms and paired serological tests between November 1997 and April 1999. MAIN OUTCOME MEASURES Scores on two validated quality-of-life questionnaires (Clinical Health Assessment Questionnaire and Medical Outcomes Study Short Form 36) were obtained soon after diagnosis and one, two, three, six and 12 months thereafter. Scores were compared between patients diagnosed with RRV disease alone and those with RRV disease plus other conditions. RESULTS 67 patients were enrolled. Most patients with RRV disease alone had severe acute symptoms, but followed a consistent path to recovery within three to six months. Other conditions, often chronic rheumatic diseases or depression, were identified in half the cohort; their quality-of-life scores suggested stable chronic illness between six and 12 months after diagnosis. Non-steroidal anti-inflammatory drugs (NSAIDs) were taken by 58% of patients (average use, 7.6 weeks; range, 2-22 weeks). Time off work averaged 1.9 days, and direct cost to the community was estimated as 1018 Australian dollars per patient. CONCLUSIONS Symptom duration and frequency of long-term symptoms may have been overestimated by previous studies of RRV disease. Disease persisting six to 12 months after RRV diagnosis was largely attributable to other conditions, highlighting the need to seek other diagnoses in RRV patients with persistent symptoms.
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Affiliation(s)
- Andrea D Mylonas
- Australian Centre for International Health and Nutrition, Queensland Institute of Medical Research, Post Office, Royal Brisbane Hospital, Brisbane, QLD 4029, Australia
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Abstract
Ross River virus is the most common mosquito-borne pathogen in Australia, and approximately 5000 human cases are reported annually. The infection is not fatal, but there is considerable morbidity associated with a debilitating polyarthritis that is the major symptom. The virus is annually active in most regions of Australia, but exists as strains that vary in virulence. Native macropods are thought to be the natural vertebrate hosts, although horses and humans may be involved during epidemic activity, and vertical transmission of the virus occurs in mosquitoes. Different mosquito species are involved as vectors in various regions and in different seasonal and environmental conditions. In coastal areas the saltmarsh mosquitoes Aedes camptorhynchus and Ae. vigilax are the most important vectors in southern and northern regions, respectively, whereas in inland areas Culex annulirostris is the most important vector, although various Aedes species can be involved depending on region and conditions, and the epidemiology of the disease and vector control imperatives vary with circumstance concomitantly.
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Affiliation(s)
- Richard C Russell
- Department of Medical Entomology, University of Sydney, ICPMR, Westmead Hospital, Westmead, NSW 2145, Australia.
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Harley D, Sleigh A, Ritchie S. Ross River virus transmission, infection, and disease: a cross-disciplinary review. Clin Microbiol Rev 2001; 14:909-32, table of contents. [PMID: 11585790 PMCID: PMC89008 DOI: 10.1128/cmr.14.4.909-932.2001] [Citation(s) in RCA: 280] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Ross River virus (RRV) is a fascinating, important arbovirus that is endemic and enzootic in Australia and Papua New Guinea and was epidemic in the South Pacific in 1979 and 1980. Infection with RRV may cause disease in humans, typically presenting as peripheral polyarthralgia or arthritis, sometimes with fever and rash. RRV disease notifications in Australia average 5,000 per year. The first well-described outbreak occurred in 1928. During World War II there were more outbreaks, and the name epidemic polyarthritis was applied. During a 1956 outbreak, epidemic polyarthritis was linked serologically to a group A arbovirus (Alphavirus). The virus was subsequently isolated from Aedes vigilax mosquitoes in 1963 and then from epidemic polyarthritis patients. We review the literature on the evolutionary biology of RRV, immune response to infection, pathogenesis, serologic diagnosis, disease manifestations, the extraordinary variety of vertebrate hosts, mosquito vectors, and transmission cycles, antibody prevalence, epidemiology of asymptomatic and symptomatic human infection, infection risks, and public health impact. RRV arthritis is due to joint infection, and treatment is currently based on empirical anti-inflammatory regimens. Further research on pathogenesis may improve understanding of the natural history of this disease and lead to new treatment strategies. The burden of morbidity is considerable, and the virus could spread to other countries. To justify and design preventive programs, we need accurate data on economic costs and better understanding of transmission and behavioral and environmental risks.
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Affiliation(s)
- D Harley
- Australian Centre for International and Tropical Health and Nutrition, Medical School, University of Queensland, Brisbane 4006, Queensland, Australia
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Abstract
Mosquito-borne arboviruses are an important public health issue in Australia. The alphaviruses Ross River and Barmah Forest virus are widespread and active annually, and cause debilitating polyarthritis. The flaviviruses Murray Valley encephalitis, Kunjin and Japanese encephalitis virus are restricted in distribution and activity but may cause life-threatening illness, and dengue viruses are active in some areas.
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Affiliation(s)
- R C Russell
- Department of Medical Entomology, University of Sydney, Institute of Clinical Pathology and Medical Research, Westmead Hospital, NSW 2145, Westmead, Australia.
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Flexman JP, Smith DW, Mackenzie JS, Fraser JR, Bass SP, Hueston L, Lindsay MD, Cunningham AL. A comparison of the diseases caused by Ross River virus and Barmah Forest virus. Med J Aust 1998; 169:159-63. [PMID: 9734514 DOI: 10.5694/j.1326-5377.1998.tb116019.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Barmah Forest virus (BFV) and Ross River virus (RRV) are mosquito-borne viruses with similar vectors and environmental requirements. They cause diseases characterised by arthralgia, arthritis and myalgia, often accompanied by fever and rash. Arthritis is more common and more prominent in RRV disease and rash is more common and florid with BFV infection, although the diseases cannot be reliably distinguished by their clinical symptoms. Diagnosis is based on serological tests and a definite diagnosis of recent infection requires the demonstration of rising titres of IgG. Arthralgia, myalgia and lethargy may continue for at least six months in up to half of patients with RRV, but in only about 10% of patients with BFV. Both diseases are managed symptomatically.
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Russell RC. Mosquito-borne arboviruses in Australia: the current scene and implications of climate change for human health. Int J Parasitol 1998; 28:955-69. [PMID: 9673874 DOI: 10.1016/s0020-7519(98)00053-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Of the mosquito-borne arboviruses, the encephalitic Murray Valley encephalitis and Kunjin viruses are a major public health concern, but the arthritides Ross River and Barmah Forest viruses are more important in a public health sense, being responsible for a far greater number of infections. Reported cases of Ross River totalled approximately 30,000 during 1991-1996; there have been several widely separated outbreaks of Barmah Forest in recent years and case reports are increasing annually. Surveillance programmes have increased our understanding of the geographic regions, climatic conditions and vector factors associated with viruses. Virus activity is widespread but is often localised, is driven primarily by mosquito abundance and various species are involved; host factors are involved also, but are not well understood. Typically, mosquito populations are governed by availability of habitat and environmental conditions. Models of climate change predict increases in rainfall, tides and temperature for parts of Australia, and such changes have the potential to increase the risk of arbovirus transmission by increasing the distribution and abundance of vectors, and duration of mosquito and arbovirus seasons. However, the amplitude of climate change is uncertain and the ecology of arbovirus transmission is complex. It is likely that some areas will have increases in arbovirus activity and human infection with predicted climate change, but risk of increased transmission will vary with locality, vector, host and human factors.
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Beard JR, Trent M, Sam GA, Delpech VC. Self-reported morbidity of Barmah Forest virus infection on the north coast of New South Wales. Med J Aust 1997; 167:525-8. [PMID: 9397039 DOI: 10.5694/j.1326-5377.1997.tb138872.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To describe the clinical features and disability associated with Barmah Forest virus (BFV) infection. DESIGN Retrospective postal survey. SETTING North Coast Public Health Unit, Lismore, New South Wales, January to October 1995. SUBJECTS All 84 subjects notified by mandatory laboratory reporting as positive for BFV IgM by enzyme-linked immunosorbent assay. OUTCOME MEASURES Demographic information, self-reported symptoms, disability and treatment. RESULTS Response rate was 77%. Peak incidence was in the 30-50 years age group, with almost identical numbers of men and women affected. The most common symptoms were lethargy (89%), joint pain (82%) and rash (68%). These were also generally the first symptoms to appear. Thirty of 54 respondents (56%) reported time off work and 27 of 53 (51%) reported illness lasting more than six months. Those who had a rash were significantly more likely to have recovered by the time of the survey than those who had no rash (odds ratio, 10.3; 95% confidence interval, 1.8-76.6). No treatment led to more than slight relief of symptoms. CONCLUSION Symptoms of BFV infection appear similar to those of the better-known Ross River virus infection, and clinicians should consider both in patients with symptoms of arboviral disease. The wide distribution and long duration of illness make BFV a potentially significant cause of morbidity in Australia. A possible association between the presence of a rash and improved prognosis needs further investigation.
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Affiliation(s)
- J R Beard
- Northern Rivers Institute of Health and Research, Lismore, NSW.
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Westley-Wise VJ, Beard JR, Sladden TJ, Dunn TM, Simpson J. Ross River virus infection on the North Coast of New South Wales. Aust N Z J Public Health 1996; 20:87-92. [PMID: 8799074 DOI: 10.1111/j.1467-842x.1996.tb01343.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A retrospective follow-up survey was undertaken of residents of the North Coast of New South Wales infected with Ross River virus in 1992. The aims of the study were to describe the epidemiology and acute symptomatology of Ross River virus infection, its natural history during the first 12 months of infection, and its effects on those infected. Questionnaires were distributed to both cases and their medical practitioners. Of 129 people infected, aged between six and 85 years, 81 (63 per cent) were male and 48 (37 per cent) were female. The peak age-specific incidence was in the age group 50 to 59 years. The most common symptoms were arthralgia (95 per cent) and tiredness (91 per cent). Over 60 per cent took time off work. At 12 months follow-up, over 50 per cent reported persistent arthralgia, 35 per cent reported persistent tiredness and 15 per cent were still unable to carry out their normal activities. The median duration of symptoms was in the range 7 to 12 months, and of incapacity was in the range five weeks to three months. There were some differences from previous reports of Ross River virus outbreaks, in the incidence of major symptoms and the duration of illness and incapacity. These are likely to be at least partly due to inconsistent measurement methods. In this study, there were systematic differences between medical practitioners' and patients' estimates of periods of incapacity. Previous estimates of the direct economic costs and indirect human costs of infection based on data obtained from medical practitioners, although alarming, are almost certainly underestimates.
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49
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Abstract
The two most common mosquito-borne viruses associated with epidemic polyarthritis and polyarticular disease are Ross River and Barmah Forest viruses, accounting for about 90% and 10%, respectively, of serologically confirmed cases. Occasional cases of polyarticular disease in Australia have been associated with infection by other mosquito-borne arboviruses, but the role of these viruses in human disease remains to be confirmed.
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Affiliation(s)
- J S Mackenzie
- Department of Microbiology, University of Queensland, Brisbane.
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50
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Mackenzie JS, Lindsay MD, Coelen RJ, Broom AK, Hall RA, Smith DW. Arboviruses causing human disease in the Australasian zoogeographic region. Arch Virol 1994; 136:447-67. [PMID: 8031248 DOI: 10.1007/bf01321074] [Citation(s) in RCA: 194] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Over 65 arboviruses have been reported from countries in the Australasian zoogeographic region, but only a few have been implicated in human disease. These include the flaviviruses Murray Valley encephalitis (MVE), Kunjin (KUN), Kokobera (KOK), and dengue, particularly types 1 and 2; the alphaviruses Ross River (RR), Barmah Forest (BF), and Sindbis (SIN); and the bunyaviruses, Gan Gan and Trubanaman. In this paper recent epidemiological and clinical results pertaining to these viruses are reviewed, with major emphasis on MVE and RR viruses. The extensive early studies of Australian arboviruses have been reviewed by Doherty [49, 50], and their ecology and vectors more recently by Kay and Standfast [87]. In addition, the biology of MVE and KUN [113] and RR [87, 114] viruses have been the subjects of more detailed reviews. The Australasian zoogeographic region is defined as countries east of the Wallace and Weber lines, two hypothetical lines in the Indo-Australian archipelago where the fauna of the Australasian and Oriental regions meet. Seroepidemiological studies of human arboviral infections have suggested that the Japanese encephalitis flavivirus and the chikungunya alphavirus occur only in the Oriental region, whereas the related MVE and RR viruses, respectively, are restricted to the Australasian region [85, 148]. Serological results from Wallacea, the zone between the Wallace and Weber lines, are not so clear-cut [85]. This review is therefore restricted to countries east of Wallacea, specifically New Guinea and Australia.
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Affiliation(s)
- J S Mackenzie
- Department of Microbiology, University of Western Australia, QU II Medical Centre, Nedlands
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