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Stephens PR, Sundaram M, Ferreira S, Gottdenker N, Nipa KF, Schatz AM, Schmidt JP, Drake JM. Drivers of African Filovirus (Ebola and Marburg) Outbreaks. Vector Borne Zoonotic Dis 2022; 22:478-490. [PMID: 36084314 PMCID: PMC9508452 DOI: 10.1089/vbz.2022.0020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Outbreaks of African filoviruses often have high mortality, including more than 11,000 deaths among 28,562 cases during the West Africa Ebola outbreak of 2014-2016. Numerous studies have investigated the factors that contributed to individual filovirus outbreaks, but there has been little quantitative synthesis of this work. In addition, the ways in which the typical causes of filovirus outbreaks differ from other zoonoses remain poorly described. In this study, we quantify factors associated with 45 outbreaks of African filoviruses (ebolaviruses and Marburg virus) using a rubric of 48 candidate causal drivers. For filovirus outbreaks, we reviewed >700 peer-reviewed and gray literature sources and developed a list of the factors reported to contribute to each outbreak (i.e., a "driver profile" for each outbreak). We compare and contrast the profiles of filovirus outbreaks to 200 background outbreaks, randomly selected from a global database of 4463 outbreaks of bacterial and viral zoonotic diseases. We also test whether the quantitative patterns that we observed were robust to the influences of six covariates, country-level factors such as gross domestic product, population density, and latitude that have been shown to bias global outbreak data. We find that, regardless of whether covariates are included or excluded from models, the driver profile of filovirus outbreaks differs from that of background outbreaks. Socioeconomic factors such as trade and travel, wild game consumption, failures of medical procedures, and deficiencies in human health infrastructure were more frequently reported in filovirus outbreaks than in the comparison group. Based on our results, we also present a review of drivers reported in at least 10% of filovirus outbreaks, with examples of each provided.
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Affiliation(s)
- Patrick R. Stephens
- Department of Integrative Biology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Mekala Sundaram
- Department of Integrative Biology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Susana Ferreira
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Department of Agricultural and Applied Economics, University of Georgia, Athens, Georgia, USA
| | - Nicole Gottdenker
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Department of Agricultural and Applied Economics, University of Georgia, Athens, Georgia, USA
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
- Odum School of Ecology, University of Georgia, Athens, Georgia, USA
| | - Kaniz Fatema Nipa
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Odum School of Ecology, University of Georgia, Athens, Georgia, USA
| | - Annakate M. Schatz
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Odum School of Ecology, University of Georgia, Athens, Georgia, USA
| | - John Paul Schmidt
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Odum School of Ecology, University of Georgia, Athens, Georgia, USA
| | - John M. Drake
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Odum School of Ecology, University of Georgia, Athens, Georgia, USA
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2
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Pathogen Dose in Animal Models of Hemorrhagic Fever Virus Infections and the Potential Impact on Studies of the Immune Response. Pathogens 2021; 10:pathogens10030275. [PMID: 33804381 PMCID: PMC7999429 DOI: 10.3390/pathogens10030275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/24/2022] Open
Abstract
Viral hemorrhagic fever viruses come from a wide range of virus families and are a significant cause of morbidity and mortality worldwide each year. Animal models of infection with a number of these viruses have contributed to our knowledge of their pathogenesis and have been crucial for the development of therapeutics and vaccines that have been approved for human use. Most of these models use artificially high doses of virus, ensuring lethality in pre-clinical drug development studies. However, this can have a significant effect on the immune response generated. Here I discuss how the dose of antigen or pathogen is a critical determinant of immune responses and suggest that the current study of viruses in animal models should take this into account when developing and studying animal models of disease. This can have implications for determination of immune correlates of protection against disease as well as informing relevant vaccination and therapeutic strategies.
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3
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Jia YF, Jian Z, Gao YT. Current status and future prospect of management of biosafety laboratories for emerging infectious diseases. Shijie Huaren Xiaohua Zazhi 2020; 28:1059-1067. [DOI: 10.11569/wcjd.v28.i21.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In recent years, there have been several outbreaks of infectious diseases around the world, including severe acute respiratory syndrome, Ebola virus disease, Middle East respiratory syndrome, and corona virus disease 2019. Experience suggests that the detection and research of emergent infectious diseases play a crucial role in the process of responding to the epidemic, which also brings great challenges to biosafety laboratories. In the face of unknown biological risk factors, the non-standard biosafety protection measures have a serious impact on the life safety of laboratory staff and the research of infectious diseases, which stresses the necessity of safety protection in biosafety laboratories. This article will briefly review the current status and future prospect of management of biosafety laboratories both in China and other countries in terms of safety protection measures during new sudden infectious disease incidents.
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Affiliation(s)
- Yan-Fang Jia
- Tianjin Medical University Third Center Clinical College, Tianjin 300170, China
| | - Zheng Jian
- Department of Clinical Laboratory Medicine, Tianjin First Central Hospital, Tianjin 300192, China
| | - Ying-Tang Gao
- Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China
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4
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Bhattacharya S, Dhar S, Banerjee A, Ray S. Detailed Molecular Biochemistry for Novel Therapeutic Design Against Nipah and Hendra Virus: A Systematic Review. Curr Mol Pharmacol 2019; 13:108-125. [PMID: 31657692 DOI: 10.2174/1874467212666191023123732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/13/2019] [Accepted: 10/15/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Nipah virus (NiV) and Hendra virus (HeV) of genus Henipavirus are the deadliest zoonotic viruses, which cause severe respiratory ailments and fatal encephalitis in humans and other susceptible animals. The fatality rate for these infections had been alarmingly high with no approved treatment available to date. Viral attachment and fusion with host cell membrane is essential for viral entry and is the most essential event of viral infection. Viral attachment is mediated by interaction of Henipavirus attachment glycoprotein (G) with the host cell receptor: Ephrin B2/B3, while viral fusion and endocytosis are mediated by the combined action of both viral glycoprotein (G) and fusion protein (F). CONCLUSION This review highlights the mechanism of viral attachment, fusion and also explains the basic mechanism and pathobiology of this infection in humans. The drugs and therapeutics used either experimentally or clinically against NiV and HeV infection have been documented and classified in detail. Some amino acid residues essential for the functionality of G and F proteins were also emphasized. Therapeutic designing to target and block these residues can serve as a promising approach in future drug development against NiV and HeV.
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Affiliation(s)
| | - Shreyeshi Dhar
- Amity Institute of Biotechnology, Amity University, Kolkata, India
| | - Arundhati Banerjee
- Department of Biochemistry and Biophysics, University of Kalyani, Kalyani, Nadia, India
| | - Sujay Ray
- Amity Institute of Biotechnology, Amity University, Kolkata, India
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Nosocomial Transmission of Emerging Viruses via Aerosol-Generating Medical Procedures. Viruses 2019; 11:v11100940. [PMID: 31614743 PMCID: PMC6832307 DOI: 10.3390/v11100940] [Citation(s) in RCA: 188] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 12/14/2022] Open
Abstract
Recent nosocomial transmission events of emerging and re-emerging viruses, including Ebola virus, Middle East respiratory syndrome coronavirus, Nipah virus, and Crimean–Congo hemorrhagic fever orthonairovirus, have highlighted the risk of nosocomial transmission of emerging viruses in health-care settings. In particular, concerns and precautions have increased regarding the use of aerosol-generating medical procedures when treating patients with such viral infections. In spite of increasing associations between aerosol-generating medical procedures and the nosocomial transmission of viruses, we still have a poor understanding of the risks of specific procedures and viruses. In order to identify which aerosol-generating medical procedures and emerging viruses pose a high risk to health-care workers, we explore the mechanisms of aerosol-generating medical procedures, as well as the transmission pathways and characteristics of highly pathogenic viruses associated with nosocomial transmission. We then propose how research, both in clinical and experimental settings, could advance current infection control guidelines.
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Yang B, Schaefer A, Wang YY, McCallen J, Lee P, Newby JM, Arora H, Kumar PA, Zeitlin L, Whaley KJ, McKinley SA, Fischer WA, Harit D, Lai SK. ZMapp Reinforces the Airway Mucosal Barrier Against Ebola Virus. J Infect Dis 2019; 218:901-910. [PMID: 29688496 DOI: 10.1093/infdis/jiy230] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/19/2018] [Indexed: 11/15/2022] Open
Abstract
Filoviruses, including Ebola, have the potential to be transmitted via virus-laden droplets deposited onto mucus membranes. Protecting against such emerging pathogens will require understanding how they may transmit at mucosal surfaces and developing strategies to reinforce the airway mucus barrier. Here, we prepared Ebola pseudovirus (with Zaire strain glycoproteins) and used high-resolution multiple-particle tracking to track the motions of hundreds of individual pseudoviruses in fresh and undiluted human airway mucus isolated from extubated endotracheal tubes. We found that Ebola pseudovirus readily penetrates human airway mucus. Addition of ZMapp, a cocktail of Ebola-binding immunoglobulin G antibodies, effectively reduced mobility of Ebola pseudovirus in the same mucus secretions. Topical delivery of ZMapp to the mouse airways also facilitated rapid elimination of Ebola pseudovirus. Our work demonstrates that antibodies can immobilize virions in airway mucus and reduce access to the airway epithelium, highlighting topical delivery of pathogen-specific antibodies to the lungs as a potential prophylactic or therapeutic approach against emerging viruses or biowarfare agents.
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Affiliation(s)
- Bing Yang
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Alison Schaefer
- University of North Carolina/North Carolina State University Joint Department of Biomedical Engineering, Chapel Hill, North Carolina
| | - Ying-Ying Wang
- Department of Biophysics, Johns Hopkins University, Baltimore, Maryland
| | - Justin McCallen
- University of North Carolina/North Carolina State University Joint Department of Biomedical Engineering, Chapel Hill, North Carolina
| | - Phoebe Lee
- University of North Carolina/North Carolina State University Joint Department of Biomedical Engineering, Chapel Hill, North Carolina
| | - Jay M Newby
- Department of Mathematics and Applied Physical Sciences, Chapel Hill, North Carolina
| | - Harendra Arora
- Department of Anesthesiology, School of Medicine, Chapel Hill, North Carolina
| | - Priya A Kumar
- Department of Anesthesiology, School of Medicine, Chapel Hill, North Carolina
| | | | | | - Scott A McKinley
- Mathematics Department, Tulane University, New Orleans, Louisiana
| | - William A Fischer
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Chapel Hill, North Carolina
| | - Dimple Harit
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Samuel K Lai
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, Chapel Hill, North Carolina.,University of North Carolina/North Carolina State University Joint Department of Biomedical Engineering, Chapel Hill, North Carolina.,Department of Microbiology & Immunology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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7
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Application of next generation sequencing technology on contamination monitoring in microbiology laboratory. BIOSAFETY AND HEALTH 2019; 1:25-31. [PMID: 32501441 PMCID: PMC7148601 DOI: 10.1016/j.bsheal.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/07/2019] [Accepted: 02/21/2019] [Indexed: 12/25/2022] Open
Abstract
The surveillance and prevention of pathogenic microbiological contamination are the most important tasks of biosafety management in the lab. There is an urgent need to establish an effective and unbiased method to evaluate and monitor such contamination. This study aims to investigate the utility of next generation sequencing (NGS) method to detect possible contamination in the microbiology laboratory. Environmental samples were taken at multiple sites at the lab including the inner site of centrifuge rotor, the bench used for molecular biological tests, the benches of biosafety cabinets used for viral culture, clinical sample pre-treatment and nucleic acids extraction, by scrubbing the sites using sterile flocked swabs. The extracted total nucleic acids were used to construct the libraries for deep sequencing according to the protocol of Ion Torrent platform. At least 1G raw data was obtained for each sample. The reads of viruses and bacteria accounted for 0.01 ± 0.02%, and 77.76 ± 12.53% of total reads respectively. The viral sequences were likely to be derived from gene amplification products, the nucleic acids contaminated in fetal bovine serum. Reads from environmental microorganisms were also identified. Our results suggested that NGS method was capable of monitoring the nucleic acids contaminations from different sources in the lab, demonstrating its promising utility in monitoring and assessing the risk of potential laboratory contamination. The risk of contamination from reagents, remnant DNA and environment should be considered in data analysis and results interpretation.
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Abstract
Ebola virus (EBOV) has been responsible for sporadic outbreaks in Central Africa since 1976 and has the potential of causing social disruption and public panic as illustrated by the 2013-2016 epidemic in West Africa. Transmission of EBOV has been described to occur via contact with infected bodily fluids, supported by data indicating that infectious EBOV could be cultured from blood, semen, saliva, urine, and breast milk. Parameters influencing transmission of EBOV are, however, largely undefined in part due to the lack of an established animal model to study mechanisms of pathogen spread. Here, we investigated EBOV transmissibility in male and female ferrets. After intranasal challenge, an infected animal was placed in direct contact with a naive ferret and in contact with another naive ferret (separated from the infected animal by a metal mesh) that served as the indirect-contact animal. All challenged animals, male direct contacts, and one male indirect contact developed disease and died. The remaining animals were not viremic and remained asymptomatic but developed EBOV-glycoprotein IgM and/or IgG specific antibodies-indicative of virus transmission. EBOV transmission via indirect contact was frequently observed in this model but resulted in less-severe disease compared to direct contact. Interestingly, these observations are consistent with the detection of specific antibodies in humans living in areas of EBOV endemicity.IMPORTANCE Our knowledge regarding transmission of EBOV between individuals is vague and is mostly limited to spreading via direct contact with infectious bodily fluids. Studying transmission parameters such as dose and route of infection is nearly impossible in naturally acquired cases-hence the requirement for a laboratory animal model. Here, we show as a proof of concept that ferrets can be used to study EBOV transmission. We also show that transmission in the absence of direct contact is frequent, as all animals with indirect contact with the infected ferrets had detectable antibodies to the virus, and one succumbed to infection. Our report provides a new small-animal model for studying EBOV transmission that does not require adaptation of the virus, providing insight into virus transmission among humans during epidemics.
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Abstract
The family Filoviridae, which includes the genera Marburgvirus and Ebolavirus, contains some of the most pathogenic viruses in humans and non-human primates (NHPs), causing severe hemorrhagic fevers with high fatality rates. Small animal models against filoviruses using mice, guinea pigs, hamsters, and ferrets have been developed with the goal of screening candidate vaccines and antivirals, before testing in the gold standard NHP models. In this review, we summarize the different animal models used to understand filovirus pathogenesis, and discuss the advantages and disadvantages of each model with respect to filovirus disease research.
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Affiliation(s)
- Vinayakumar Siragam
- Special Pathogens Program, Public Health Agency of Canada, Winnipeg, Manitoba R3E 3R2, Canada.,Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba R3E 0J9, Canada
| | - Gary Wong
- Special Pathogens Program, Public Health Agency of Canada, Winnipeg, Manitoba R3E 3R2, Canada.,Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba R3E 0J9, Canada.,Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Shenzhen Guangzhou 518020, China.,Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
| | - Xiang-Guo Qiu
- Special Pathogens Program, Public Health Agency of Canada, Winnipeg, Manitoba R3E 3R2, Canada. .,Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba R3E 0J9, Canada
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10
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Spengler JR, Bente DA, Bray M, Burt F, Hewson R, Korukluoglu G, Mirazimi A, Weber F, Papa A. Second International Conference on Crimean-Congo Hemorrhagic Fever. Antiviral Res 2018; 150:137-147. [PMID: 29199036 PMCID: PMC6497152 DOI: 10.1016/j.antiviral.2017.11.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 12/27/2022]
Abstract
The Second International Conference on Crimean-Congo Hemorrhagic Fever (CCHF) was held in Thessaloniki, Greece, from September 10-13, 2017, and brought together international public health professionals, clinicians, ecologists, and basic laboratory researchers. Nearly 100 participants, representing 24 countries and the World Health Organization (WHO), were in attendance. Meeting sessions covered the epidemiology of CCHF in humans; ticks and virus-tick interactions; wild and domestic animal hosts; molecular virology; taxonomic classification; pathogenesis and animal models; clinical aspects and diagnosis; clinical management and clinical trials; and disease prevention in humans. The concluding session focused on recent WHO recommendations for public health measures and future research. This report summarizes lectures by the invited speakers and highlights advances in the field.
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Affiliation(s)
- Jessica R Spengler
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dennis A Bente
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, TX, USA; Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Felicity Burt
- Division of Virology, National Health Laboratory Service Universitas and Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Roger Hewson
- National Infection Service, Public Health England, Porton Down, Salisbury, United Kingdom
| | - Gülay Korukluoglu
- Public Health Institution of Turkey, National Virology Reference Laboratory, Ankara, Turkey
| | - Ali Mirazimi
- Department for Clinical Microbiology, LabMed, Karolinska Institute in Stockholm, Sweden; Public Health Agency of Sweden, Sweden; National Veterinary Institute, Sweden
| | | | - Anna Papa
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Spengler JR, Kelly Keating M, McElroy AK, Zivcec M, Coleman-McCray JD, Harmon JR, Bollweg BC, Goldsmith CS, Bergeron É, Keck JG, Zaki SR, Nichol ST, Spiropoulou CF. Crimean-Congo Hemorrhagic Fever in Humanized Mice Reveals Glial Cells as Primary Targets of Neurological Infection. J Infect Dis 2017; 216:1386-1397. [PMID: 28482001 PMCID: PMC5853341 DOI: 10.1093/infdis/jix215] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 05/02/2017] [Indexed: 12/21/2022] Open
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral hemorrhagic disease seen exclusively in humans. Central nervous system (CNS) infection and neurological involvement have also been reported in CCHF. In the current study, we inoculated NSG-SGM3 mice engrafted with human hematopoietic CD34+ stem cells with low-passage CCHF virus strains isolated from human patients. In humanized mice, lethal disease develops, characterized by histopathological change in the liver and brain. To date, targets of neurological infection and disease have not been investigated in CCHF. CNS disease in humanized mice was characterized by gliosis, meningitis, and meningoencephalitis, and glial cells were identified as principal targets of infection. Humanized mice represent a novel lethal model for studies of CCHF countermeasures, and CCHF-associated CNS disease. Our data suggest a role for astrocyte dysfunction in neurological disease and identify key regions of infection in the CNS for future investigations of CCHF.
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Affiliation(s)
- Jessica R Spengler
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M Kelly Keating
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anita K McElroy
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Pediatric Infectious Diseases, Emory University, Atlanta, Georgia
| | - Marko Zivcec
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - JoAnn D Coleman-McCray
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica R Harmon
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brigid C Bollweg
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cynthia S Goldsmith
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Éric Bergeron
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James G Keck
- In Vivo Services, The Jackson Laboratory, Sacramento, California
| | - Sherif R Zaki
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stuart T Nichol
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christina F Spiropoulou
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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Singh RK, Dhama K, Malik YS, Ramakrishnan MA, Karthik K, Khandia R, Tiwari R, Munjal A, Saminathan M, Sachan S, Desingu PA, Kattoor JJ, Iqbal HMN, Joshi SK. Ebola virus - epidemiology, diagnosis, and control: threat to humans, lessons learnt, and preparedness plans - an update on its 40 year's journey. Vet Q 2017; 37:98-135. [PMID: 28317453 DOI: 10.1080/01652176.2017.1309474] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Ebola virus (EBOV) is an extremely contagious pathogen and causes lethal hemorrhagic fever disease in man and animals. The recently occurred Ebola virus disease (EVD) outbreaks in the West African countries have categorized it as an international health concern. For the virus maintenance and transmission, the non-human primates and reservoir hosts like fruit bats have played a vital role. For curbing the disease timely, we need effective therapeutics/prophylactics, however, in the absence of any approved vaccine, timely diagnosis and monitoring of EBOV remains of utmost importance. The technologically advanced vaccines like a viral-vectored vaccine, DNA vaccine and virus-like particles are underway for testing against EBOV. In the absence of any effective control measure, the adaptation of high standards of biosecurity measures, strict sanitary and hygienic practices, strengthening of surveillance and monitoring systems, imposing appropriate quarantine checks and vigilance on trade, transport, and movement of visitors from EVD endemic countries remains the answer of choice for tackling the EBOV spread. Herein, we converse with the current scenario of EBOV giving due emphasis on animal and veterinary perspectives along with advances in diagnosis and control strategies to be adopted, lessons learned from the recent outbreaks and the global preparedness plans. To retrieve the evolutionary information, we have analyzed a total of 56 genome sequences of various EBOV species submitted between 1976 and 2016 in public databases.
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Affiliation(s)
- Raj Kumar Singh
- a ICAR-Indian Veterinary Research Institute , Bareilly , India
| | - Kuldeep Dhama
- b Division of Pathology, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | - Yashpal Singh Malik
- c Division of Biological Standardization, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | | | - Kumaragurubaran Karthik
- e Divison of Bacteriology and Mycology, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | - Rekha Khandia
- f Department of Biochemistry and Genetics , Barkatullah University , Bhopal , India
| | - Ruchi Tiwari
- g Department of Veterinary Microbiology and Immunology , College of Veterinary Sciences, Deen Dayal Upadhayay Pashu Chikitsa Vigyan Vishwavidyalay Evum Go-Anusandhan Sansthan (DUVASU) , Mathura , India
| | - Ashok Munjal
- f Department of Biochemistry and Genetics , Barkatullah University , Bhopal , India
| | - Mani Saminathan
- b Division of Pathology, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | - Swati Sachan
- h Immunology Section, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | | | - Jobin Jose Kattoor
- c Division of Biological Standardization, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | - Hafiz M N Iqbal
- i School of Engineering and Science, Tecnologico de Monterrey , Monterrey , Mexico
| | - Sunil Kumar Joshi
- j Cellular Immunology Lab , Frank Reidy Research Center for Bioelectrics , School of Medical Diagnostics & Translational Sciences, Old Dominion University , Norfolk , VA , USA
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St Claire MC, Ragland DR, Bollinger L, Jahrling PB. Animal Models of Ebolavirus Infection. Comp Med 2017; 67:253-262. [PMID: 28662754 PMCID: PMC5482517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/29/2016] [Accepted: 01/26/2017] [Indexed: 06/07/2023]
Abstract
Ebola virus is a highly pathogenic member of the family Filoviridae that causes a severe hemorrhagic disease in humans and NHP. The 2013-2016 West African outbreak has increased interest in the development and refinement of animal models of Ebola virus disease. These models are used to test countermeasures and vaccines, gain scientific insights into the mechanisms of disease progression and transmission, and study key correlates of immunology. Ebola virus is classified as a BSL4 pathogen and Category A agent, for which the United States government requires preparedness in case of bioterrorism. Rodents, such as Syrian golden hamsters (Mesocricetus auratus), mice (Mus musculus), and guinea pigs (Cavia porcellus), are the most common research species. However, NHP, especially macaques, are favored for Ebola virus disease research due to similarities with humans regarding the pathogenesis, clinical presentation, laboratory findings, and causes of fatality. To satisfy the regulatory requirements for approval of countermeasures against high-consequence pathogens, the FDA instituted the Animal Rule, which permits efficacy studies in animal models in place of human clinical data when such studies are not feasible or ethical. This review provides a comprehensive summary of various animal models and their use in Ebola virus disease research.
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Affiliation(s)
- Marisa C St Claire
- Integrated Research Facility, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland;,
| | - Dan R Ragland
- Integrated Research Facility, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Laura Bollinger
- Integrated Research Facility, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Peter B Jahrling
- Integrated Research Facility, Division of Clinical Research, Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
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14
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Lin K, Marr LC. Aerosolization of Ebola Virus Surrogates in Wastewater Systems. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:2669-2675. [PMID: 28125778 DOI: 10.1021/acs.est.6b04846] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Recent studies have shown that Ebola virus can persist in wastewater. We evaluated the potential for Ebola virus surrogates to be aerosolized from three types of wastewater systems: toilets, a lab-scale model of an aeration basin, and a lab-scale model of converging sewer pipes. We measured the aerosol size distribution generated by each system, spiked Ebola virus surrogates (MS2 and Phi6) into each system, and determined the emission rate of viruses into the air. The number of aerosols released ranged from 105 to 107 per flush from the toilets or per minute from the lab-scale models, and the total volume of aerosols generated by these systems was ∼10-9 to 10-7 mL per flush or per minute in all cases. MS2 and Phi6, spiked into toilets at an initial concentration of 107 plaque-forming units per milliliter (PFU mL-1), were not detected in air after flushing. Airborne concentrations of MS2 and Phi6 were ∼20 PFU L-1 and ∼0.1 PFU L-1, respectively, in the chambers enclosing the aeration basin and sewer models. The corresponding emission rates of MS2 and Phi6 were 547 PFU min-1 and 3.8 PFU min-1, respectively, for the aeration basin and 79 PFU min-1 and 0.3 PFU min-1 for the sewer pipes.
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Affiliation(s)
- Kaisen Lin
- Department of Civil and Environmental Engineering, Virginia Tech , 418 Durham Hall, Blacksburg, Virginia 24061, United States
| | - Linsey C Marr
- Department of Civil and Environmental Engineering, Virginia Tech , 418 Durham Hall, Blacksburg, Virginia 24061, United States
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Landon P, Wood S, Bower K, Heil R, Van Slyke M, Dabisch P, Weaver P, Fitch JP. Performance Characteristics of a Primary Containment System for Large Animals in Animal Biosafety Level 4. APPLIED BIOSAFETY 2017. [DOI: 10.1177/1535676016683172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Paul Landon
- National Biodefense Analysis and Countermeasures Center, Frederick, MD, USA
| | - Stewart Wood
- National Biodefense Analysis and Countermeasures Center, Frederick, MD, USA
| | - Kristin Bower
- National Biodefense Analysis and Countermeasures Center, Frederick, MD, USA
| | - Ryan Heil
- National Biodefense Analysis and Countermeasures Center, Frederick, MD, USA
| | - Mike Van Slyke
- National Biodefense Analysis and Countermeasures Center, Frederick, MD, USA
| | - Paul Dabisch
- National Biodefense Analysis and Countermeasures Center, Frederick, MD, USA
| | - Patrick Weaver
- National Biodefense Analysis and Countermeasures Center, Frederick, MD, USA
| | - J. Pat Fitch
- National Biodefense Analysis and Countermeasures Center, Frederick, MD, USA
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16
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Vetter P, Fischer WA, Schibler M, Jacobs M, Bausch DG, Kaiser L. Ebola Virus Shedding and Transmission: Review of Current Evidence. J Infect Dis 2016; 214:S177-S184. [PMID: 27443613 PMCID: PMC6283352 DOI: 10.1093/infdis/jiw254] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The magnitude of the 2013-2016 Ebola virus disease outbreak in West Africa was unprecedented, with >28 500 reported cases and >11 000 deaths. Understanding the key elements of Ebola virus transmission is necessary to implement adequate infection prevention and control measures to protect healthcare workers and halt transmission in the community. METHODS We performed an extensive PubMed literature review encompassing the period from discovery of Ebola virus, in 1976, until 1 June 2016 to evaluate the evidence on modes of Ebola virus shedding and transmission. FINDINGS Ebola virus has been isolated by cell culture from blood, saliva, urine, aqueous humor, semen, and breast milk from infected or convalescent patients. Ebola virus RNA has been noted in the following body fluids days or months after onset of illness: saliva (22 days), conjunctiva/tears (28 days), stool (29 days), vaginal fluid (33 days), sweat (44 days), urine (64 days), amniotic fluid (38 days), aqueous humor (101 days), cerebrospinal fluid (9 months), breast milk (16 months [preliminary data]), and semen (18 months). Nevertheless, the only documented cases of secondary transmission from recovered patients have been through sexual transmission. We did not find strong evidence supporting respiratory or fomite-associated transmission.
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Affiliation(s)
- Pauline Vetter
- Division of Infectious Diseases, Geneva University Hospitals
- Laboratory of Virology and Swiss Reference Center for Emerging Viral Diseases
| | - William A. Fischer
- Division of Pulmonary and Critical Care Medicine, University of North Carolina–Chapel Hill School of Medicine
| | - Manuel Schibler
- Division of Infectious Diseases, Geneva University Hospitals
- Laboratory of Virology and Swiss Reference Center for Emerging Viral Diseases
- University of Geneva Medical School, Switzerland
| | - Michael Jacobs
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, United Kingdom
| | - Daniel G. Bausch
- Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Laurent Kaiser
- Division of Infectious Diseases, Geneva University Hospitals
- Laboratory of Virology and Swiss Reference Center for Emerging Viral Diseases
- University of Geneva Medical School, Switzerland
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17
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Bryan A, Cook L, Atienza EE, Kuypers J, Cent A, Baird GS, Coombs RW, Jerome KR, Wener MH, Butler-Wu SM. Bloodborne Viral Pathogen Contamination in the Era of Laboratory Automation. Clin Chem 2016; 62:973-81. [DOI: 10.1373/clinchem.2016.255349] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/07/2016] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
The CDC states that laboratory testing for persons under investigation for Ebola virus disease can be safely performed using automated laboratory instruments by adhering to bloodborne pathogen practices. We therefore sought to investigate the levels of viral contamination of a total laboratory automation (TLA) system to guide risk mitigation strategies for handling infectious agents.
METHODS
Environmental swabs followed by PCR for hepatitis B (HBV) and hepatitis C (HCV) viruses were taken from a chemistry TLA system during routine clinical use and after running a small number of high-titer HCV samples. Control experiments were performed to ensure the recovery of DNA and RNA viruses by swabs from a representative nonporous surface.
RESULTS
Of 79 baseline swabs for nucleic acids performed on the TLA system, 10 were positive for HBV and 8 for HCV. Viral nucleic acid was consistently detected from swabs taken from the distal inside surface of the decapper discharge chute, with areas adjacent to the decapper instrument and the centrifuge rotor also positive for HBV or HCV nucleic acid. Contamination was occasionally detected on exposed surfaces in areas without protective barriers between samples and personnel. After running known HCV-positive samples, at least one additional site of contamination was detected on an exposed area of the line.
CONCLUSIONS
A low level of viral contamination of automated clinical laboratory equipment occurs in clinical use. Given the risks associated with highly infectious agents, there is a need for risk-mitigation procedures when handling all samples.
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Affiliation(s)
| | | | | | | | - Anne Cent
- Department of Laboratory Medicine and
| | | | - Robert W Coombs
- Department of Laboratory Medicine and
- Department of Medicine, University of Washington, Seattle, WA
| | - Keith R Jerome
- Department of Laboratory Medicine and
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mark H Wener
- Department of Laboratory Medicine and
- Department of Medicine, University of Washington, Seattle, WA
| | - Susan M Butler-Wu
- Department of Pathology and Laboratory Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Mekibib B, Ariën KK. Aerosol Transmission of Filoviruses. Viruses 2016; 8:v8050148. [PMID: 27223296 PMCID: PMC4885103 DOI: 10.3390/v8050148] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 05/18/2016] [Accepted: 05/20/2016] [Indexed: 12/30/2022] Open
Abstract
Filoviruses have become a worldwide public health concern because of their potential for introductions into non-endemic countries through international travel and the international transport of infected animals or animal products. Since it was first identified in 1976, in the Democratic Republic of Congo (formerly Zaire) and Sudan, the 2013–2015 western African Ebola virus disease (EVD) outbreak is the largest, both by number of cases and geographical extension, and deadliest, recorded so far in medical history. The source of ebolaviruses for human index case(s) in most outbreaks is presumptively associated with handling of bush meat or contact with fruit bats. Transmission among humans occurs easily when a person comes in contact with contaminated body fluids of patients, but our understanding of other transmission routes is still fragmentary. This review deals with the controversial issue of aerosol transmission of filoviruses.
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Affiliation(s)
- Berhanu Mekibib
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp B-2000, Belgium.
- School of Veterinary Medicine, College of Natural and Computational Sciences, Hawassa University, P.O. Box 05, Hawassa, Ethiopia.
| | - Kevin K Ariën
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp B-2000, Belgium.
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Huang Q, Fu WL, You JP, Mao Q. Laboratory diagnosis of Ebola virus disease and corresponding biosafety considerations in the China Ebola Treatment Center. Crit Rev Clin Lab Sci 2016; 53:326-40. [PMID: 26952811 DOI: 10.3109/10408363.2016.1160866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Ebola virus disease (EVD), caused by Ebola virus (EBOV), is a potent acute infectious disease with a high case-fatality rate. Etiological and serological EBOV detection methods, including techniques that involve the detection of the viral genome, virus-specific antigens and anti-virus antibodies, are standard laboratory diagnostic tests that facilitate confirmation or exclusion of EBOV infection. In addition, routine blood tests, liver and kidney function tests, electrolytes and coagulation tests and other diagnostic examinations are important for the clinical diagnosis and treatment of EVD. Because of the viral load in body fluids and secretions from EVD patients, all body fluids are highly contagious. As a result, biosafety control measures during the collection, transport and testing of clinical specimens obtained from individuals scheduled to undergo EBOV infection testing (including suspected, probable and confirmed cases) are crucial. This report has been generated following extensive work experience in the China Ebola Treatment Center (ETC) in Liberia and incorporates important information pertaining to relevant diagnostic standards, clinical significance, operational procedures, safety controls and other issues related to laboratory testing of EVD. Relevant opinions and suggestions are presented in this report to provide contextual awareness associated with the development of standards and/or guidelines related to EVD laboratory testing.
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Affiliation(s)
- Qing Huang
- a Department of Laboratory Medicine , Southwest Hospital, the Third Military Medical University , Chongqing , People's Republic of China .,b Medical Contingent of the Chinese PLA to Liberia , Chongqing, People's Republic of China , and
| | - Wei-Ling Fu
- a Department of Laboratory Medicine , Southwest Hospital, the Third Military Medical University , Chongqing , People's Republic of China
| | - Jian-Ping You
- b Medical Contingent of the Chinese PLA to Liberia , Chongqing, People's Republic of China , and.,c Department of Infectious Diseases , Southwest Hospital, the Third Military Medical University , Chongqing , People's Republic of China
| | - Qing Mao
- b Medical Contingent of the Chinese PLA to Liberia , Chongqing, People's Republic of China , and.,c Department of Infectious Diseases , Southwest Hospital, the Third Military Medical University , Chongqing , People's Republic of China
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20
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Petti S, Messano GA, Vingolo EM, Marsella LT, Scully C. The face of Ebola: changing frequency of haemorrhage in the West African compared with Eastern-Central African outbreaks. BMC Infect Dis 2015; 15:564. [PMID: 26653293 PMCID: PMC4676861 DOI: 10.1186/s12879-015-1302-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 12/01/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The West-African (WA) Zaire Ebolavirus disease (EVD) outbreak was characterized by an exceptionally high number of cases and deaths as compared with the Eastern-Central African (ECA) outbreaks. Despite the Zaire Ebolavirus being the most lethal for humans, case-fatality rate, close to 80 % in ECA outbreaks, almost halved to 47 % in Guinea-Liberia-Sierra Leone (WA). Such an improvement was due to the remarkable implementation of international humanitarian aids. Some studies also suggested that the long human-to-human transmission cycle occurred in WA, gave rise to human adaptation and consequent immune escape. Haemorrhage, the main feature in seriously infected EVD patients, is due to the immune system that triggers the infected endothelial cells which expose the spike-like glycoprotein (GP) of the virion on their surface. If the human adaptation hypothesis holds true, the proportion of EVD patients with haemorrhage in the WA outbreak should be lower than in the ECA outbreaks due to immune escape. Therefore, the aim of this meta-analysis was to compare the relative frequencies of three typical haemorrhagic symptoms (conjunctival -CB, nasal -NB, gingival -GB- bleedings) in the ECA and WA outbreaks. METHODS Literature searches were performed through PubMed and Scopus using generic keywords; surveys including at least ten patients reporting CB, NB, GB relative frequencies were extracted and split into ECA and WA. The meta-analytical methods chosen were based on the levels of between-study heterogeneity and publication bias. Pooled CB, NB, GB relative frequencies in ECA and WA were estimated and compared. Subgroup analysis including only studies on Zaire Ebolavirus also was performed. RESULTS Fifteen studies (10 ECA, 5 WA) were located with 4,867 (CB), 3,859 (NB), 4,278 (GB) EVD patients overall. GB pooled relative frequency was 45.3 % (95 % confidence interval -95 CI, 34.7-56.1 %) and 18.0 % (95 CI, 6.0-34.5 %), in ECA and WA; NB was 10.6 % (95 CI, 5.7-16.8 %) and 1.3 % (1.0-1.8 %); GB was 24.2 % (95 CI, 11.9-39.2 %) and 1.9 % (95 CI, 1.4-2.4 %). Subgroup analysis confirmed these results. CONCLUSIONS During the WA outbreak the relative frequency of GB decreased by two thirds, while NB and GB almost disappeared, suggesting that the Zaire Ebolavirus human adaptation hypothesis is plausible.
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Affiliation(s)
- Stefano Petti
- Department of Public Health and Infectious Diseases, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Giuseppe Alessio Messano
- Department of Public Health and Infectious Diseases, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Enzo Maria Vingolo
- Ophthalmology Department, Sapienza University, Viale del Policlinico 155, 00186, Rome, Italy.
| | - Luigi Tonino Marsella
- Department of Biomedicine and Prevention, Tor Vergata University, Viale Oxford 81, 00133, Rome, Italy.
| | - Crispian Scully
- University College London, Gower Street WC1E 6BT, London, UK.
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Abstract
Ebola virus, the virus responsible for Ebola virus disease, has spawned several epidemics during the past 38 years. In 2014, an Ebola epidemic spread from Africa to other continents, becoming a pandemic. The virus's relatively unique structure, its infectivity and lethality, the difficulty in stopping its spread, and the lack of an effective treatment captured the world's attention. This article provides a brief review of the known history of Ebola virus disease, its etiology, epidemiology, and pathophysiology and a review of the limited information on managing patients with Ebola virus disease.
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Abstract
The current Ebola virus outbreak has highlighted the uncertainties surrounding many aspects of Ebola virus virology, including routes of transmission. The scientific community played a leading role during the outbreak—potentially, the largest of its kind—as many of the questions surrounding ebolaviruses have only been interrogated in the laboratory. Scientists provided an invaluable resource for clinicians, public health officials, policy makers, and the lay public in understanding the progress of Ebola virus disease and the continuing outbreak. Not all of the scientific communication, however, was accurate or effective. There were multiple instances of published articles during the height of the outbreak containing potentially misleading scientific language that spurred media overreaction and potentially jeopardized preparedness and policy decisions at critical points. Here, we use articles declaring the potential for airborne transmission of Ebola virus as a case study in the inaccurate reporting of basic science, and we provide recommendations for improving the communication about unknown aspects of disease during public health crises. Basic scientific research is now considered an integral component of the fight against emerging infectious diseases like Ebola virus. The recent Ebola outbreak, however, demonstrates how the ineffective communication of basic science can stoke public panic more than it provides helpful tools to responders; basic science trades in probabilities and uncertainty, while public communication tends to favor more categorical claims. Here, we discuss the ethics of communicating scientific results, using, as a case study, the recent controversy over whether basic life sciences research demonstrates that Ebola could become transmissible via airborne respiratory droplet nuclei—popularly known as a virus becoming “airborne.” We show how the science does not demonstrate this possibility, despite claims made in the popular and scientific press. We then recommend that uncertain scientific results in the context of public health crises ought to be communicated with humility, an emphasis on what is unknown, and a clear outline of the kinds of evidence that would give proof to controversial claims.
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Affiliation(s)
- Andy Kilianski
- BioDefense Branch, BioSciences Division, Edgewood Chemical Biological Center, Aberdeen Proving Ground, Maryland, United States of America
- * E-mail: (AK); (NGE)
| | - Nicholas G. Evans
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail: (AK); (NGE)
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Ocular Manifestations of Ebola Virus Disease: An Ophthalmologist's Guide to Prevent Infection and Panic. BIOMED RESEARCH INTERNATIONAL 2015; 2015:487073. [PMID: 26557674 PMCID: PMC4628748 DOI: 10.1155/2015/487073] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/11/2015] [Indexed: 11/27/2022]
Abstract
Ebola virus disease (EVD—formerly known as Ebola hemorrhagic fever) is a severe hemorrhagic fever caused by lipid-enveloped, nonsegmented, negative-stranded RNA viruses belonging to the genus Ebolavirus. Case fatality rates may reach up to 76% of infected individuals, making this infection a deadly health problem in the sub-Saharan population. At the moment, there are still no indications on ophthalmological clinical signs and security suggestions for healthcare professionals (doctors and nurses or cooperative persons). This paper provides a short but complete guide to reduce infection risks.
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Mohammed HM. Ebola virus disease: Effects of respiratory protection on healthcare workers. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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25
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Ebola virus disease in nonendemic countries. J Formos Med Assoc 2015; 114:384-98. [PMID: 25882189 PMCID: PMC7135111 DOI: 10.1016/j.jfma.2015.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/22/2015] [Accepted: 01/24/2015] [Indexed: 12/20/2022] Open
Abstract
The 2014 West African outbreak of Ebola virus disease was unprecedented in its scale and has resulted in transmissions outside endemic countries. Clinicians in nonendemic countries will most likely face the disease in returning travelers, either among healthcare workers, expatriates, or visiting friends and relatives. Clinical suspicion for the disease must be heightened for travelers or contacts presenting with compatible clinical syndromes, and strict infection control measures must be promptly implemented to minimize the risk of secondary transmission within healthcare settings or in the community. We present a concise review on human filoviral disease with an emphasis on issues that are pertinent to clinicians practicing in nonendemic countries.
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26
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Osterholm MT, Moore KA, Kelley NS, Brosseau LM, Wong G, Murphy FA, Peters CJ, LeDuc JW, Russell PK, Van Herp M, Kapetshi J, Muyembe JJT, Ilunga BK, Strong JE, Grolla A, Wolz A, Kargbo B, Kargbo DK, Sanders DA, Kobinger GP. Transmission of Ebola viruses: what we know and what we do not know. mBio 2015; 6:e00137. [PMID: 25698835 PMCID: PMC4358015 DOI: 10.1128/mbio.00137-15] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Available evidence demonstrates that direct patient contact and contact with infectious body fluids are the primary modes for Ebola virus transmission, but this is based on a limited number of studies. Key areas requiring further study include (i) the role of aerosol transmission (either via large droplets or small particles in the vicinity of source patients), (ii) the role of environmental contamination and fomite transmission, (iii) the degree to which minimally or mildly ill persons transmit infection, (iv) how long clinically relevant infectiousness persists, (v) the role that "superspreading events" may play in driving transmission dynamics, (vi) whether strain differences or repeated serial passage in outbreak settings can impact virus transmission, and (vii) what role sylvatic or domestic animals could play in outbreak propagation, particularly during major epidemics such as the 2013-2015 West Africa situation. In this review, we address what we know and what we do not know about Ebola virus transmission. We also hypothesize that Ebola viruses have the potential to be respiratory pathogens with primary respiratory spread.
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Affiliation(s)
- Michael T Osterholm
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kristine A Moore
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nicholas S Kelley
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lisa M Brosseau
- Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Gary Wong
- National Laboratory for Zoonotic Diseases and Special Pathogens, Public Health Agency of Canada, Winnipeg, Canada
| | - Frederick A Murphy
- The Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Clarence J Peters
- The Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - James W LeDuc
- The Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Michel Van Herp
- Medical Department Unit, Médecins sans Frontières, Brussels, Belgium
| | - Jimmy Kapetshi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | | | - James E Strong
- National Laboratory for Zoonotic Diseases and Special Pathogens, Public Health Agency of Canada, Winnipeg, Canada
| | - Allen Grolla
- National Laboratory for Zoonotic Diseases and Special Pathogens, Public Health Agency of Canada, Winnipeg, Canada
| | - Anja Wolz
- Medical Department Unit, Médecins sans Frontières, Brussels, Belgium
| | - Brima Kargbo
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - David K Kargbo
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - David Avram Sanders
- Department of Biological Sciences, Purdue University, Lafayette, Indiana, USA
| | - Gary P Kobinger
- National Laboratory for Zoonotic Diseases and Special Pathogens, Public Health Agency of Canada, Winnipeg, Canada
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27
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Martines RB, Ng DL, Greer PW, Rollin PE, Zaki SR. Tissue and cellular tropism, pathology and pathogenesis of Ebola and Marburg viruses. J Pathol 2015; 235:153-74. [PMID: 25297522 DOI: 10.1002/path.4456] [Citation(s) in RCA: 203] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 09/30/2014] [Accepted: 10/01/2014] [Indexed: 12/19/2022]
Abstract
Ebola viruses and Marburg viruses include some of the most virulent and fatal pathogens known to humans. These viruses cause severe haemorrhagic fevers, with case fatality rates in the range 25-90%. The diagnosis of filovirus using formalin-fixed tissues from fatal cases poses a significant challenge. The most characteristic histopathological findings are seen in the liver; however, the findings overlap with many other viral and non-viral haemorrhagic diseases. The need to distinguish filovirus infections from other haemorrhagic fevers, particularly in areas with multiple endemic viral haemorrhagic agents, is of paramount importance. In this review we discuss the current state of knowledge of filovirus infections and their pathogenesis, including histopathological findings, epidemiology, modes of transmission and filovirus entry and spread within host organisms. The pathogenesis of filovirus infections is complex and involves activation of the mononuclear phagocytic system, with release of pro-inflammatory cytokines, chemokines and growth factors, endothelial dysfunction, alterations of the innate and adaptive immune systems, direct organ and endothelial damage from unrestricted viral replication late in infection, and coagulopathy. Although our understanding of the pathogenesis of filovirus infections has rapidly increased in the past few years, many questions remain unanswered.
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Affiliation(s)
- Roosecelis Brasil Martines
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Judson S, Prescott J, Munster V. Understanding ebola virus transmission. Viruses 2015; 7:511-21. [PMID: 25654239 PMCID: PMC4353901 DOI: 10.3390/v7020511] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 01/21/2015] [Accepted: 01/29/2015] [Indexed: 12/01/2022] Open
Abstract
An unprecedented number of Ebola virus infections among healthcare workers and patients have raised questions about our understanding of Ebola virus transmission. Here, we explore different routes of Ebola virus transmission between people, summarizing the known epidemiological and experimental data. From this data, we expose important gaps in Ebola virus research pertinent to outbreak situations. We further propose experiments and methods of data collection that will enable scientists to fill these voids in our knowledge about the transmission of Ebola virus.
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Affiliation(s)
- Seth Judson
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840, USA.
| | - Joseph Prescott
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840, USA.
| | - Vincent Munster
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840, USA.
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29
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Del Rio C, Guarner J. Ebola: Implications and Perspectives. TRANSACTIONS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION 2015; 126:93-112. [PMID: 26330663 PMCID: PMC4530678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The 2014 Ebola virus disease outbreak in West Africa has been the largest in recorded history. During this Ebola epidemic, the media has focused much attention to the magnitude of the problem in West Africa but has also overplayed the potential for an Ebola virus pandemic as patients have been transported for treatment to the United States and Europe causing panic and paranoia in the population. Knowledge of the epidemiology, pathogenesis, clinical presentation, treatment, and prevention of this infection will allow a better understanding of the disease and decrease irrational fear of spread.
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30
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Katz LM, Tobian AAR. Ebola virus disease, transmission risk to laboratory personnel, and pretransfusion testing. Transfusion 2014; 54:3247-51. [PMID: 25403825 DOI: 10.1111/trf.12913] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 09/13/2014] [Accepted: 09/16/2014] [Indexed: 11/28/2022]
Abstract
As Ebola virus has infected thousands of individuals in West Africa, there is growing concern about the appropriate response of hospitals in developed nations caring for patients and handling laboratory specimens for patients suspected of Ebola virus disease (EVD). Guidelines for caring for EVD patients are proliferating rapidly from national and state public health authorities, professional societies, and individual hospitals. It is no surprise that they differ from one another, and some very conservative recommendations call for suspension of routine laboratory testing, including pretransfusion testing. EVD is transmitted by direct contact with blood, secretions, organs, and other body fluids and not by airborne routes. Based on experimental and observational data, the US Centers for Disease Control and Prevention (CDC) recommends that clinicians follow contact and droplet precautions. Laboratory personnel are required to follow the blood-borne pathogen standard, especially the use of appropriate barriers consisting of gloves, gown, goggles, mask to cover nose and mouth, and plexiglass shield, where splashes of potentially infectious materials may be generated. Their recommendations are permissive of clinically appropriate laboratory testing, including pretransfusion testing, using barrier isolation precautions. Most individuals with suspected EVD will have a fever of another etiology, such as Plasmodium falciparum malaria. We believe that forgoing all routine pretransfusion laboratory testing may result in a greater increase in poor clinical outcomes than any diminution in the risks to laboratory personnel will justify. It is imperative for all laboratory directors, working with institutional infection control and safety personnel, to evaluate their hospital policies for potentially infectious patients and provide a safe environment for their patients and employees.
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Affiliation(s)
- Louis M Katz
- America's Blood Centers, Washington, DC; Internal Medicine, Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City, IA
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Respiratory protection for healthcare workers treating Ebola virus disease (EVD): are facemasks sufficient to meet occupational health and safety obligations? Int J Nurs Stud 2014; 51:1421-6. [PMID: 25218265 PMCID: PMC7126049 DOI: 10.1016/j.ijnurstu.2014.09.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Affiliation(s)
- Jose M Martin-Moreno
- Department of Preventive Medicine and Public Health, University of Valencia, 46010 Valencia, Spain.
| | - Gilberto Llinás
- Department of Preventive Medicine and Public Health, University of Valencia, 46010 Valencia, Spain
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