1
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Stein SR, Platt AP, Teague HL, Anthony SM, Reeder RJ, Cooper K, Byrum R, Drawbaugh DJ, Liu DX, Burdette TL, Hadley K, Barr B, Warner S, Rodriguez-Hernandez F, Johnson C, Stanek P, Hischak J, Kendall H, Huzella LM, Strich JR, Herbert R, St. Claire M, Vannella KM, Holbrook MR, Chertow DS. Clinical and Immunologic Correlates of Vasodilatory Shock Among Ebola Virus-Infected Nonhuman Primates in a Critical Care Model. J Infect Dis 2023; 228:S635-S647. [PMID: 37652048 PMCID: PMC10651209 DOI: 10.1093/infdis/jiad374] [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: 05/19/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Existing models of Ebola virus infection have not fully characterized the pathophysiology of shock in connection with daily virologic, clinical, and immunologic parameters. We implemented a nonhuman primate critical care model to investigate these associations. METHODS Two rhesus macaques received a target dose of 1000 plaque-forming units of Ebola virus intramuscularly with supportive care initiated on day 3. High-dimensional spectral cytometry was used to phenotype neutrophils and peripheral blood mononuclear cells daily. RESULTS We observed progressive vasodilatory shock with preserved cardiac function following viremia onset on day 5. Multiorgan dysfunction began on day 6 coincident with the nadir of circulating neutrophils. Consumptive coagulopathy and anemia occurred on days 7 to 8 along with irreversible shock, followed by death. The monocyte repertoire began shifting on day 4 with a decline in classical and expansion of double-negative monocytes. A selective loss of CXCR3-positive B and T cells, expansion of naive B cells, and activation of natural killer cells followed viremia onset. CONCLUSIONS Our model allows for high-fidelity characterization of the pathophysiology of acute Ebola virus infection with host innate and adaptive immune responses, which may advance host-targeted therapy design and evaluation for use after the onset of multiorgan failure.
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Affiliation(s)
- Sydney R Stein
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center
- Critical Care Medicine Branch, National Heart, Lung, and Blood Institute
| | - Andrew P Platt
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center
- Critical Care Medicine Branch, National Heart, Lung, and Blood Institute
| | - Heather L Teague
- Critical Care Medicine Branch, National Heart, Lung, and Blood Institute
- Pathogenesis and Therapeutics Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda
| | - Scott M Anthony
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick
| | - Rebecca J Reeder
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick
| | - Kurt Cooper
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick
| | - Russell Byrum
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick
| | - David J Drawbaugh
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick
| | - David X Liu
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick
| | - Tracey L Burdette
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick
| | - Kyra Hadley
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick
| | - Bobbi Barr
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick
| | - Seth Warner
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center
- Critical Care Medicine Branch, National Heart, Lung, and Blood Institute
- Pathogenesis and Therapeutics Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda
| | - Francisco Rodriguez-Hernandez
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick
| | - Cristal Johnson
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick
| | - Phil Stanek
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick
| | - Joseph Hischak
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick
| | - Heather Kendall
- Experimental Primate Virology Section, Comparative Medicine Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Poolesville, Maryland, USA
| | - Louis M Huzella
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick
| | - Jeffrey R Strich
- Critical Care Medicine Branch, National Heart, Lung, and Blood Institute
- Pathogenesis and Therapeutics Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda
| | - Richard Herbert
- Experimental Primate Virology Section, Comparative Medicine Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Poolesville, Maryland, USA
| | - Marisa St. Claire
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick
| | - Kevin M Vannella
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center
- Critical Care Medicine Branch, National Heart, Lung, and Blood Institute
| | - Michael R Holbrook
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick
| | - Daniel S Chertow
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center
- Critical Care Medicine Branch, National Heart, Lung, and Blood Institute
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2
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Bozzay JD, Walker PF, Atwood RE, DeSpain RW, Parker WJ, Chertow DS, Mares JA, Leonhardt CL, Elster EA, Bradley MJ. Development, refinement, and characterization of a nonhuman primate critical care environment. PLoS One 2023; 18:e0281548. [PMID: 36930612 PMCID: PMC10022766 DOI: 10.1371/journal.pone.0281548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 01/17/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Systemic inflammatory response remains a poorly understood cause of morbidity and mortality after traumatic injury. Recent nonhuman primate (NHP) trauma models have been used to characterize the systemic response to trauma, but none have incorporated a critical care phase without the use of general anesthesia. We describe the development of a prolonged critical care environment with sedation and ventilation support, and also report corresponding NHP biologic and inflammatory markers. METHODS Eight adult male rhesus macaques underwent ventilation with sedation for 48-96 hours in a critical care setting. Three of these NHPs underwent "sham" procedures as part of trauma control model development. Blood counts, chemistries, coagulation studies, and cytokines/chemokines were collected throughout the study, and histopathologic analysis was conducted at necropsy. RESULTS Eight NHPs were intentionally survived and extubated. Three NHPs were euthanized at 72-96 hours without extubation. Transaminitis occurred over the duration of ventilation, but renal function, acid-base status, and hematologic profile remained stable. Chemokine and cytokine analysis were notable for baseline fold-change for Il-6 and Il-1ra (9.7 and 42.7, respectively) that subsequently downtrended throughout the experiment unless clinical respiratory compromise was observed. CONCLUSIONS A NHP critical care environment with ventilation support is feasible but requires robust resources. The inflammatory profile of NHPs is not profoundly altered by sedation and mechanical ventilation. NHPs are susceptible to the pulmonary effects of short-term ventilation and demonstrate a similar bioprofile response to ventilator-induced pulmonary pathology. This work has implications for further development of a prolonged care NHP model.
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Affiliation(s)
- Joseph D. Bozzay
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland, United States of America
- * E-mail:
| | - Patrick F. Walker
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland, United States of America
| | - Rex E. Atwood
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland, United States of America
| | - Robert W. DeSpain
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland, United States of America
| | - William J. Parker
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland, United States of America
| | - Daniel S. Chertow
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - John A. Mares
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland, United States of America
| | - Crystal L. Leonhardt
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland, United States of America
| | - Eric A. Elster
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Matthew J. Bradley
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland, United States of America
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3
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Blair PW, Kortepeter MG, Downey LG, Madar CS, Downs IL, Martins KA, Rossi F, Williams JA, Madar A, Schellhase CW, Bearss JJ, Zeng X, Bavari S, Soloveva V, Wells JB, Stuthman KS, Garza NL, Vantongeren SA, Donnelly GC, Steffens J, Kalapaca J, Wiseman P, Henry J, Marko S, Chappell M, Lugo-Roman L, Ramos-Rivera E, Hofer C, Blue E, Moore J, Fiallos J, Wetzel D, Pratt WD, Unangst T, Miller A, Sola JJ, Reisler RB, Cardile AP. Intensive Care Unit-Like Care of Nonhuman Primates with Ebola Virus Disease. J Infect Dis 2021; 224:632-642. [PMID: 33367826 PMCID: PMC8366444 DOI: 10.1093/infdis/jiaa781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/18/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Ebola virus disease (EVD) supportive care strategies are largely guided by retrospective observational research. This study investigated the effect of EVD supportive care algorithms on duration of survival in a controlled nonhuman primate (NHP) model. METHODS Fourteen rhesus macaques were challenged intramuscularly with a target dose of Ebola virus (1000 plaque-forming units; Kikwit). NHPs were allocated to intensive care unit (ICU)-like algorithms (n = 7), intravenous fluids plus levofloxacin (n = 2), or a control group (n = 5). The primary outcome measure was duration of survival, and secondary outcomes included changes in clinical laboratory values. RESULTS Duration of survival was not significantly different between the pooled ICU-like algorithm and control groups (8.2 vs 6.9 days of survival; hazard ratio; 0.50; P = .25). Norepinephrine was effective in transiently maintaining baseline blood pressure. NHPs treated with ICU-like algorithms had delayed onset of liver and kidney injury. CONCLUSIONS While an obvious survival difference was not observed with ICU-like care, clinical observations from this model may aid in EVD supportive care NHP model refinement.
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Affiliation(s)
- Paul W Blair
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation, Bethesda, Maryland, USA
| | | | - Lydia G Downey
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | | | - Isaac L Downs
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Karen A Martins
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Franco Rossi
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Janice A Williams
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Annie Madar
- Tripler Army Medical Center, Honolulu, Hawaii, USA
| | | | - Jeremy J Bearss
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Xiankun Zeng
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Sina Bavari
- Edge BioInnovation Consulting and Management, Frederick, Maryland, USA
| | - Veronica Soloveva
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Jay B Wells
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Kelly S Stuthman
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Nicole L Garza
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Sean A Vantongeren
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Ginger C Donnelly
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Jesse Steffens
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Jennifer Kalapaca
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Perry Wiseman
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Joseph Henry
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Shannon Marko
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Mark Chappell
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Luis Lugo-Roman
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Elliot Ramos-Rivera
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Christian Hofer
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Eugene Blue
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Joshua Moore
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Jimmy Fiallos
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Darrel Wetzel
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - William D Pratt
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Tami Unangst
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Adele Miller
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - James J Sola
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Ronald B Reisler
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
| | - Anthony P Cardile
- Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA
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5
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Poliquin G, Funk D, Jones S, Tran K, Ranadheera C, Hagan M, Tierney K, Grolla A, Dhaliwal A, Bello A, Leung A, Nakamura C, Kobasa D, Falzarano D, Garnett L, Bovendo HF, Feldmann H, Kesselman M, Hansen G, Gren J, Risi G, Biondi M, Mortimer T, Racine T, Deschambault Y, Aminian S, Edmonds J, Sourette R, Allan M, Rondeau L, Hadder S, Press C, DeGraff C, Kucas S, Cook BWM, Hancock BJ, Kumar A, Soni R, Schantz D, McKitrick J, Warner B, Griffin BD, Qiu X, Kobinger GP, Safronetz D, Stein D, Cutts T, Kenny J, Soule G, Kozak R, Theriault S, Menec L, Vendramelli R, Higgins S, Liu G, Rahim NM, Kasloff S, Sloan A, He S, Tailor N, Gray M, Strong JE. Impact of intensive care unit supportive care on the physiology of Ebola virus disease in a universally lethal non-human primate model. Intensive Care Med Exp 2019; 7:54. [PMID: 31520194 PMCID: PMC6744539 DOI: 10.1186/s40635-019-0268-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/28/2019] [Indexed: 11/26/2022] Open
Abstract
Background There are currently limited data for the use of specific antiviral therapies for the treatment of Ebola virus disease (EVD). While there is anecdotal evidence that supportive care may be effective, there is a paucity of direct experimental data to demonstrate a role for supportive care in EVD. We studied the impact of ICU-level supportive care interventions including fluid resuscitation, vasoactive medications, blood transfusion, hydrocortisone, and ventilator support on the pathophysiology of EVD in rhesus macaques infected with a universally lethal dose of Ebola virus strain Makona C07. Methods Four NHPs were infected with a universally lethal dose Ebola virus strain Makona, in accordance with the gold standard lethal Ebola NHP challenge model. Following infection, the following therapeutic interventions were employed: continuous bedside supportive care, ventilator support, judicious fluid resuscitation, vasoactive medications, blood transfusion, and hydrocortisone as needed to treat cardiovascular compromise. A range of physiological parameters were continuously monitored to gage any response to the interventions. Results All four NHPs developed EVD and demonstrated a similar clinical course. All animals reached a terminal endpoint, which occurred at an average time of 166.5 ± 14.8 h post-infection. Fluid administration may have temporarily blunted a rise in lactate, but the effect was short lived. Vasoactive medications resulted in short-lived improvements in mean arterial pressure. Blood transfusion and hydrocortisone did not appear to have a significant positive impact on the course of the disease. Conclusions The model employed for this study is reflective of an intramuscular infection in humans (e.g., needle stick) and is highly lethal to NHPs. Using this model, we found that the animals developed progressive severe organ dysfunction and profound shock preceding death. While the overall impact of supportive care on the observed pathophysiology was limited, we did observe some time-dependent positive responses. Since this model is highly lethal, it does not reflect the full spectrum of human EVD. Our findings support the need for continued development of animal models that replicate the spectrum of human disease as well as ongoing development of anti-Ebola therapies to complement supportive care. Electronic supplementary material The online version of this article (10.1186/s40635-019-0268-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Guillaume Poliquin
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada.,Department of Pediatrics & Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Infectious Diseases and Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Duane Funk
- Department of Anaesthesia and Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shane Jones
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Kaylie Tran
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Charlene Ranadheera
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Mable Hagan
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada.,Department of Infectious Diseases and Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kevin Tierney
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Allen Grolla
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | | | - Alexander Bello
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Anders Leung
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Cory Nakamura
- National Centre for Foreign Animal Disease, Canadian Food Inspection Agency, Winnipeg, Manitoba, Canada
| | - Darwyn Kobasa
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada.,Department of Infectious Diseases and Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Darryl Falzarano
- Vaccine and Infectious Disease Organization-International Vaccine Centre, University of Saskatchewan, Saskatoon, Canada
| | - Lauren Garnett
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Hugues Fausther Bovendo
- Centre de Recherche en Infectiologie, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Canada
| | - Heinz Feldmann
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, USA
| | - Murray Kesselman
- Department of Pediatrics & Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gregory Hansen
- Faculty of Critical Care, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Jason Gren
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - George Risi
- Infectious Disease Specialists, P.C., Missoula, MT, USA
| | - Mia Biondi
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada.,Child & Women's Health Programme, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Todd Mortimer
- Child & Women's Health Programme, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Trina Racine
- Department of Infectious Diseases and Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Centre de Recherche en Infectiologie, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Canada
| | - Yvon Deschambault
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Sam Aminian
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Jocelyn Edmonds
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Ray Sourette
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Mark Allan
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Lauren Rondeau
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Sharron Hadder
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Christy Press
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Christine DeGraff
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Stephanie Kucas
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Bradley W M Cook
- Cytophage Technologies, Inc., St. Boniface Hospital, Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - B J Hancock
- Department of Pediatrics & Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Surgery, Division of Pediatric Surgery, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anand Kumar
- Department of Infectious Diseases and Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Reeni Soni
- Department of Pediatrics & Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Darryl Schantz
- Department of Pediatrics & Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jarrid McKitrick
- Regional Pharmacy, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Bryce Warner
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Bryan D Griffin
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Xiangguo Qiu
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada.,Department of Infectious Diseases and Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gary P Kobinger
- Department of Infectious Diseases and Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Centre de Recherche en Infectiologie, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Canada
| | - Dave Safronetz
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Derek Stein
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada.,Department of Infectious Diseases and Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Todd Cutts
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - James Kenny
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Geoff Soule
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Robert Kozak
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Steven Theriault
- Cytophage Technologies, Inc., St. Boniface Hospital, Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Liam Menec
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Robert Vendramelli
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Sean Higgins
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Guodong Liu
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Niaz Md Rahim
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Samantha Kasloff
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Angela Sloan
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Shihua He
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Nikesh Tailor
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Michael Gray
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - James E Strong
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada. .,Department of Pediatrics & Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. .,Department of Infectious Diseases and Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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