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Brüssow H. Avian influenza virus cross-infections as test case for pandemic preparedness: From epidemiological hazard models to sequence-based early viral warning systems. Microb Biotechnol 2024; 17:e14389. [PMID: 38227348 PMCID: PMC10832514 DOI: 10.1111/1751-7915.14389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/17/2023] [Accepted: 12/06/2023] [Indexed: 01/17/2024] Open
Abstract
Pandemic preparedness starts with an early warning system of viruses with a pandemic potential. Based on information collected in a multitude of surveys, hazard models were developed identifying influenza viruses presenting a pandemic threat. Scores are attributed for 10 viral traits by expert panels which identified avian influenza viruses (AIV) belonging to subtypes H7N9 and H5N1 as representing the greatest pandemic risk. In 2013, more than 100 human cases infected with AIV H7N9 were observed in China. Case fatality rate (CFR) was high (27%), but the human-to-human transmission rate was low and by serological evidence H7N9 did not spread widely. Nevertheless, until 2019 more than 1500 H7N9 patients were identified characterized by a high CFR of 39%. Serology demonstrated that mild infections with H7N9 were widespread. In 2003, more than 400 people experienced AIV H7N7 cross-infection causing mainly conjunctivitis during a large poultry epidemic in The Netherlands. Between 1996 and 2019, a total of 881 human infections with avian H5N1 viruses were documented showing a CFR of 52%. Outbreaks were centred on South East Asia and showed close associations with epizootics in poultry. Mutations predisposing to human cross-infections were identified in the haemagglutinin (HA) and the RNA polymerase subunit PB2 of human H7N9 isolates. Human H5N1 isolates showed mutations in the receptor binding domain of HA and transmission in mammals could be obtained by as few as four additional aa changes introduced experimentally. Researchers have defined viral point mutations in HA, PB2 and the nucleoprotein NP that allowed AIV to cross the species barrier to mammals with respect to receptor recognition, RNA replication and escape from innate immunity respectively. Based on this insight a sequence-based early warning system for AIV preadapted to human transmission could be envisioned. Mink farms and live poultry markets are prime targets for such sequencing efforts.
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Affiliation(s)
- Harald Brüssow
- Division of Animal and Human Health Engineering, Department of BiosystemsKU LeuvenLeuvenBelgium
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Mehrbod P, Eybpoosh S, Farahmand B, Fotouhi F, Khanzadeh Alishahi M. Association of the host genetic factors, hypercholesterolemia and diabetes with mild influenza in an Iranian population. Virol J 2021; 18:64. [PMID: 33766078 PMCID: PMC7993858 DOI: 10.1186/s12985-021-01486-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/02/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Variation in host genetic factors may result in variation in the host immune response to the infection. Some chronic diseases may also affect individuals' susceptibility to infectious diseases. The aim of this study was to evaluate the association of the host genetic factors mostly involved in inflammation, as well as hypercholesterolemia and diabetes with mild flu in an Iranian population. METHODS In this cross-sectional study, nasopharyngeal swab samples were collected from 93 patients referred to primary care centers of Markazi, Semnan, and Zanjan provinces (central Iran) due to flu-like symptoms between March 2015 and December 2018. Of these, PCR test identified 49 influenza A/H1N1 and 44 flu-negative individuals. Twelve single-nucleotide polymorphisms (SNPs) in RPAIN, FCGR2A, MBL-2, CD55, C1QBP, IL-10, TNF-α and an unknown gene were genotyped using iPLEX GOLD SNP genotyping analysis. Hypercholesterolemia and diabetes status was determined based on the physician diagnosis. Association of the host genetic variants, hypercholesterolemia and diabetes with mild A/H1N1 flu was assessed with univariable and multivariable logistic regression analysis as implemented in Stata software (v.14). Statistical tests were considered as significant at 0.05 levels. RESULTS Frequency of diabetes and hypercholesterolemia, as well as participants mean age was significantly higher in the flu-negative rather than the flu-positive group. Of 12 SNPs, nine did not show any significant association with mild flu in our study (rs1801274, rs1800451, rs2564978, rs361525, rs1800450, rs1800871, rs1800872, rs1800896, rs1800629). Possessing G vs. A allele in two SNPs (rs3786054 and rs8070740) was associated with a threefold increase in the chance of mild flu when compared to flu-negative patients (95% CI: 1.1, 22.0). Possessing C allele (vs. A) in the rs9856661 locus also increased the chance of mild flu up to 2 folds (95% CI: 1.0, 10.0). CONCLUSION The results showed that possessing the G allele in either rs3786054 or rs8070740 loci in C1QBP and RPAIN genes, respectively, increased the risk of H1N1 infection up to 3.3 folds, regardless of the patient's age, BMI, diabetes, and hypercholesterolemia. Complementary functional genomic studies would shed more light on the underlying mechanism of human immunity associated with these genetic markers. The identified genetic factors may have the same role in susceptibility to similar respiratory infections with RNA viruses, like SARS, MERS and COVID-19. Future genetic association studies targeting these RNA viruses, especially COVID-19 is recommended. Studies on other ethnic groups would also shed light on possible ethnic variations in genetic susceptibility to respiratory RNA viruses. Trial registry IR.PII.REC.1399.063.
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Affiliation(s)
- Parvaneh Mehrbod
- Influenza and Respiratory Viruses Department, Pasteur Institute of Iran, Tehran, Iran
| | - Sana Eybpoosh
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
| | - Behrokh Farahmand
- Influenza and Respiratory Viruses Department, Pasteur Institute of Iran, Tehran, Iran
| | - Fatemeh Fotouhi
- Influenza and Respiratory Viruses Department, Pasteur Institute of Iran, Tehran, Iran
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Chen X, Wang W, Wang Y, Lai S, Yang J, Cowling BJ, Horby PW, Uyeki TM, Yu H. Serological evidence of human infections with highly pathogenic avian influenza A(H5N1) virus: a systematic review and meta-analysis. BMC Med 2020; 18:377. [PMID: 33261599 PMCID: PMC7709391 DOI: 10.1186/s12916-020-01836-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/02/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Highly pathogenic avian influenza A(H5N1) virus poses a global public health threat given severe and fatal zoonotic infections since 1997 and ongoing A(H5N1) virus circulation among poultry in several countries. A comprehensive assessment of the seroprevalence of A(H5N1) virus antibodies remains a gap and limits understanding of the true risk of A(H5N1) virus infection. METHODS We conducted a systematic review and meta-analysis of published serosurveys to assess the risk of subclinical and clinically mild A(H5N1) virus infections. We assessed A(H5N1) virus antibody titers and changes in titers among populations with variable exposures to different A(H5N1) viruses. RESULTS Across studies using the World Health Organization-recommended seropositive definition, the point estimates of the seroprevalence of A(H5N1) virus-specific antibodies were higher in poultry-exposed populations (range 0-0.6%) and persons exposed to both human A(H5N1) cases and infected birds (range 0.4-1.8%) than in close contacts of A(H5N1) cases or the general population (none to very low frequencies). Seroprevalence was higher in persons exposed to A(H5N1) clade 0 virus (1.9%, range 0.7-3.2%) than in participants exposed to other clades of A(H5N1) virus (range 0-0.5%) (p < 0.05). Seroprevalence was higher in poultry-exposed populations (range 0-1.9%) if such studies utilized antigenically similar A(H5N1) virus antigens in assays to A(H5N1) viruses circulating among poultry. CONCLUSIONS These low seroprevalences suggest that subclinical and clinically mild human A(H5N1) virus infections are uncommon. Standardized serological survey and laboratory methods are needed to fully understand the extent and risk of human A(H5N1) virus infections.
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Affiliation(s)
- Xinhua Chen
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
| | - Wei Wang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
| | - Yan Wang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
| | - Shengjie Lai
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, SO17 1BJ, UK
| | - Juan Yang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Peter W Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China.
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Boyce AM, Garibaldi BT. Genomics and High-Consequence Infectious Diseases: A Scoping Review of Emerging Science and Potential Ethical Issues. Health Secur 2019; 17:62-68. [PMID: 30724614 DOI: 10.1089/hs.2018.0108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Host genomic research on high-consequence infectious diseases is a growing area, but the ethical, legal, and social implications of such findings related to potential applications of the research have not yet been identified. While there is a robust ethical debate about the ethical, legal, and social implications of research during an emergency, there has been less consideration of issues facing research conducted outside of the scope of emergency response. Addressing the implications of research at an early stage (anticipatory ethics) helps define the issue space, facilitates preparedness, and promotes ethically and socially responsible practices. To lay the groundwork for more comprehensive anticipatory ethics work, this article provides a preliminary assessment of the state of the field with a scoping review of host genomic research on a subset of high-consequence infectious diseases of relevance to high-level isolation units, focusing on its ethically relevant features and identifying several ethical, legal, and social implications raised by the literature. We discuss the challenges of genomic studies of low-frequency, high-risk events and applications of the science, including identifying targets to guide the development of new therapeutics, improving vaccine development, finding biomarkers to predict disease outcome, and guiding decisions about repurposing existing drugs and genetic screening. Some ethical, legal, and social implications identified in the literature included the rise of systems biology and paradigm shifts in medical countermeasure development; controversies over repurposing of existing drugs; genetic privacy and discrimination; and benefit-sharing and global inequity as part of the broader ecosystem surrounding high-level isolation units. Future anticipatory ethics work should forecast the science and its applications; identify a more comprehensive list of ethical, legal, and social implications; and facilitate evaluation by multiple stakeholders to inform the integration of ethical concerns into high-level isolation unit policy and practice.
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Affiliation(s)
- Angie M Boyce
- Angie M. Boyce, PhD, is Research Scholar and Associate Faculty, Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
| | - Brian T Garibaldi
- Brian T. Garibaldi, MD, MEHP, is Director, Johns Hopkins Biocontainment Unit, and Associate Professor, Medicine and Physiology, Johns Hopkins University School of Medicine, Baltimore, MD
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Cook AR, Zhao X, Chen MIC, Finkelstein EA. Public preferences for interventions to prevent emerging infectious disease threats: a discrete choice experiment. BMJ Open 2018; 8:e017355. [PMID: 29453294 PMCID: PMC5857709 DOI: 10.1136/bmjopen-2017-017355] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE When faced with an emergent epidemic with high mortality and morbidity potential, policy makers must decide what public health interventions to deploy at different stages of the outbreak. However, almost nothing is known about how the public view these interventions or how they trade off risks (of disease) with inconvenience (of interventions). In this paper, we aim to understand public perceptions on pandemic interventions, as well as to identify if there are any distinct respondent preference classes. DESIGN A discrete choice experiment. SETTING This study was fielded in Singapore between November 2012 and February 2013. PARTICIPANTS A random sample of 500 Singapore residents aged 21 and over, including 271 women and 229 men, was analysed. OUTCOME MEASURES Demographic information was collected from each participant. Participants were also shown a series of pairs of alternatives, each combining interventions and morbidity, mortality and cost outcomes and declared a preference for one combination. A random utility model was developed to determine the individual's preference for interventions and a hierarchical cluster analysis was performed to identify distinct respondent preference classes. RESULTS On average, participants preferred more intense interventions, and preferred scenarios with fewer deaths and lower tax. The number of infections did not significantly influence respondents' responses. We identified two broad classes of respondents: those who were mortality averse and those who were expenditure averse. Education was found to be a predictor of group membership. CONCLUSION Overall, there was considerable support for government interventions to prevent or mitigate outbreaks of emerging infectious diseases, including those that greatly restricted individual liberties, as long as the restrictions showed a reasonable chance of reducing the adverse health effects of the outbreak.
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Affiliation(s)
- Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Program in Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore
- Communicable Disease Centre, Tan Tock Seng Hospital, Singapore
- Department of Statistics and Applied Probability, National University of Singapore, Singapore
| | - Xiahong Zhao
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Mark I C Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Communicable Disease Centre, Tan Tock Seng Hospital, Singapore
| | - Eric A Finkelstein
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Program in Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore
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de Jong W, Rusli M, Bhoelan S, Rohde S, Rantam FA, Noeryoto PA, Hadi U, Gorp ECMV, Goeijenbier M. Endemic and emerging acute virus infections in Indonesia: an overview of the past decade and implications for the future. Crit Rev Microbiol 2018; 44:487-503. [PMID: 29451044 DOI: 10.1080/1040841x.2018.1438986] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Being the largest archipelago country in the world, with a tropical climate and a unique flora and fauna, Indonesia habitats one of the most diverse biome in the world. These characteristics make Indonesia a popular travel destination, with tourism numbers increasing yearly. These characteristics also facilitate the transmission of zoonosis and provide ideal living and breading circumstances for arthropods, known vectors for viral diseases. A review of the past 10 years of literature, reports of the Ministry of Health, Republic of Indonesia and ProMED-mail shows a significant increase in dengue infection incidence. Furthermore, chikungunya, Japanese encephalitis and rabies are proven to be endemic in Indonesia. The combination of cohort studies, governmental data and ProMED-mail reveals an integrated overview for those working in travel medicine and public health, focusing on both endemic and emerging acute virus infections. This review summarizes the epidemiology of acute virus infections in Indonesia, including outbreak reports, as well as public health response measurements and their potential or efficacy. Knowledge about human behaviour, animal reservoirs, climate factors, environment and their role in emerging virus infection are discussed. We aim to support public health authorities and health care policy makers in a One Health approach.
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Affiliation(s)
- Wesley de Jong
- a Department of Viroscience , Erasmus MC , Rotterdam , the Netherlands
| | - Musofa Rusli
- b Department of Internal Medicine, Division of Tropical & Infectious Disease, Faculty of Medicine , Airlangga University , Surabaya , Indonesia
| | - Soerajja Bhoelan
- c Department of Internal medicine , Havenziekenhuis Institute for Tropical Medicine , Rotterdam , the Netherlands
| | - Sofie Rohde
- a Department of Viroscience , Erasmus MC , Rotterdam , the Netherlands
| | - Fedik A Rantam
- d Institute of Tropical Disease, Airlangga University , Surabaya , Indonesia
| | - Purwati A Noeryoto
- b Department of Internal Medicine, Division of Tropical & Infectious Disease, Faculty of Medicine , Airlangga University , Surabaya , Indonesia
| | - Usman Hadi
- b Department of Internal Medicine, Division of Tropical & Infectious Disease, Faculty of Medicine , Airlangga University , Surabaya , Indonesia
| | - Eric C M van Gorp
- a Department of Viroscience , Erasmus MC , Rotterdam , the Netherlands
| | - Marco Goeijenbier
- a Department of Viroscience , Erasmus MC , Rotterdam , the Netherlands.,c Department of Internal medicine , Havenziekenhuis Institute for Tropical Medicine , Rotterdam , the Netherlands
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Havers FP, Campbell AP, Uyeki TM, Fry AM. Commentary: A Historical Review of Centers for Disease Control and Prevention Antiviral Treatment and Postexposure Chemoprophylaxis Guidance for Human Infections With Novel Influenza A Viruses Associated With Severe Human Disease. J Infect Dis 2017; 216:S575-S580. [PMID: 28934460 DOI: 10.1093/infdis/jix065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Human infections with novel influenza A viruses are of global public health concern, and antiviral medications have a potentially important role in treatment and prevention of human illness. Initial guidance was developed by the U.S. Centers for Disease Control and Prevention after the emergence of human infections with avian influenza A(H5N1) and has evolved over time, with identification of influenza A(H7N9) virus infections in humans, as well as detection of avian influenza viruses in birds in the United States. This commentary describes the historical context and current guidance for the use of influenza antiviral medications for treatment and post-exposure chemoprophylaxis of human infections with novel influenza A viruses associated with severe human illness, or with the potential to cause severe human disease, and provides the scientific rationale behind current recommendations.
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Affiliation(s)
- Fiona P Havers
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela P Campbell
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Timothy M Uyeki
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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Root ED, Agustian D, Kartasasmita C, Uyeki TM, Simões EAF. Demographic and ecological risk factors for human influenza A virus infections in rural Indonesia. Influenza Other Respir Viruses 2017; 11:425-433. [PMID: 28715152 PMCID: PMC5596523 DOI: 10.1111/irv.12468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 11/26/2022] Open
Abstract
Background Indonesia has the world's highest reported mortality for human infections with highly pathogenic avian influenza (HPAI) A(H5N1) virus. Indonesia is an agriculturally driven country where human‐animal mixing is common and provides a unique environment for zoonotic influenza A virus transmission. Objectives To identify potential demographic and ecological risk factors for human infection with seasonal influenza A viruses in rural Indonesia, a population‐based study was conducted in Cileunyi and Soreang subdistricts near Bandung in western Java from 2008 to 2011. Methods Passive influenza surveillance with RT‐PCR confirmation of influenza A viral RNA in respiratory specimens was utilized for case ascertainment. A population census and mapping were utilized for population data collection. The presence of influenza A(H3N2) and A(H1N1)pdm09 virus infections in a household was modeled using Generalized Estimating Equations. Results Each additional child aged <5 years in a household increased the odds of H3N2 approximately 5 times (OR=4.59, 95%CI: 3.30‐6.24) and H1N1pdm09 by 3.5 times (OR=3.53, 95%CI: 2.51‐4.96). In addition, the presence of 16‐30 birds in the house was associated with an increased odds of H3N2 (OR=5.08, 95%CI: 2.00‐12.92) and H1N1pdm09 (OR=12.51 95%CI: 6.23‐25.13). Conclusion Our findings suggest an increase in influenza A virus infections in rural Indonesian households with young children and poultry.
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Affiliation(s)
| | - Dwi Agustian
- Faculty of Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
| | - Cissy Kartasasmita
- Faculty of Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Eric A F Simões
- University of Colorado School of Medicine, Aurora, CO, USA.,Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
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Wu Z, Sha J, Yu Z, Zhao N, Cheng W, Chan TC, Amer S, Zhang Z, Liu S. Epidemiological and virological differences in human clustered and sporadic infections with avian influenza A H7N9. Int J Infect Dis 2016; 49:9-17. [PMID: 27235087 DOI: 10.1016/j.ijid.2016.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/16/2016] [Accepted: 05/18/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Previous research has suggested that avian influenza A H7N9 has a greater potential pandemic risk than influenza A H5N1. This research investigated the difference in human clustered and sporadic cases of H7N9 virus and estimated the relative risk of clustered infections. METHODS Comparative epidemiology and virology studies were performed among 72 sporadic confirmed cases, 17 family clusters (FCs) caused by human-to-human transmission, and eight live bird market clusters (LCs) caused by co-exposure to the poultry environment. RESULTS The case fatality of FCs, LCs and sporadic cases (36%, 26%, and 29%, respectively) did not differ among the three groups (p>0.05). The average age (36 years, 60 years, and 58 years), co-morbidities (31%, 60%, and 54%), exposure to birds (72%, 100%, and 83%), and H7N9-positive rate (20%, 64%, and 35%) in FCs, LCs, and sporadic cases, respectively, differed significantly (p<0.05). These higher risks were associated with increased mortality. There was no difference between primary and secondary cases in LCs (p>0.05). However, exposure to a person with confirmed avian influenza A H7N9 (primary 12% vs. secondary 95%), history of visiting a live bird market (100% vs. 59%), multiple exposures (live bird exposure and human-to-human transmission history) (12% vs. 55%), and median days from onset to antiviral treatment (6 days vs. 3 days) differed significantly between primary and secondary cases in FCs (p<0.05). Mild cases were found in 6% of primary cases vs. 32% of secondary cases in FCs (p<0.05). Twenty-five isolates from the three groups showed 99.1-99.9% homology and increased human adaptation. CONCLUSIONS There was no statistical difference in the case fatality rate and limited transmission between FCs and LCs. However, the severity of the primary cases in FCs was much higher than that of the secondary cases due to the older age and greater underlying disease of the latter patients.
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Affiliation(s)
- Zuqun Wu
- Department of Respiratory Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianping Sha
- Department of Endocrinology, The 421 Hospital of the Chinese People's Liberation Army, Guangzhou, China
| | - Zhao Yu
- Department of Infectious Diseases and Key Lab of Vaccine against Hemorrhagic Fever with Renal Syndrome, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Na Zhao
- National Research Centre for Wildlife-Borne Diseases, Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
| | - Wei Cheng
- Department of Infectious Diseases and Key Lab of Vaccine against Hemorrhagic Fever with Renal Syndrome, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Ta-Chien Chan
- Research Centre for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
| | - Said Amer
- Department of Zoology, Faculty of Science, Kafr El Sheikh University, Kafr El Sheikh, Egypt
| | - Zhiruo Zhang
- School of Public Health, Shanghai Jiaotong University School of Medicine, 227 Chongqing South Road, Shanghai 200025, China.
| | - Shelan Liu
- Department of Infectious Diseases and Key Lab of Vaccine against Hemorrhagic Fever with Renal Syndrome, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang Province, China.
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Liu S, Sha J, Yu Z, Hu Y, Chan TC, Wang X, Pan H, Cheng W, Mao S, Zhang RJ, Chen E. Avian influenza virus in pregnancy. Rev Med Virol 2016; 26:268-84. [PMID: 27187752 DOI: 10.1002/rmv.1884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/19/2016] [Accepted: 03/29/2016] [Indexed: 12/19/2022]
Abstract
The unprecedented epizootic of avian influenza viruses, such as H5N1, H5N6, H7N1 and H10N8, has continued to cause disease in humans in recent years. In 2013, another novel influenza A (H7N9) virus emerged in China, and 30% of those patients died. Pregnant women are particularly susceptible to avian influenza and are more likely to develop severe complications and to die, especially when infection occurs in the middle and late trimesters. Viremia is believed to occur infrequently, and thus vertical transmission induced by avian influenza appears to be rare. However, avian influenza increases the risk of adverse pregnancy outcomes, including spontaneous abortion, preterm birth and fatal distress. This review summarises 39 cases of pregnant women and their fetuses from different countries dating back to 1997, including 11, 15 and 13 infections with H7N9, H5N1 and the 2009 pandemic influenza (H1N1), respectively. We analysed the epidemic features, following the geographical, population and pregnancy trimester distributions; underlying diseases; exposure history; medical timelines; human-to-human transmission; pathogenicity and vertical transmission; antivirus treatments; maternal severity and mortality and pregnancy outcome. The common experiences reported in different countries and areas suggest that early identification and treatment are imperative. In the future, vigilant virologic and epidemiologic surveillance systems should be developed to monitor avian influenza viruses during pregnancy. Furthermore, extensive study on the immune mechanisms should be conducted, as this will guide safe, rational immunomodulatory treatment among this high-risk population. Most importantly, we should develop a universal avian influenza virus vaccine to prevent outbreaks of the different subtypes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Shelan Liu
- Department of Infectious Diseases, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Jianping Sha
- Department of Endocrinology, The 421 Hospital of Chinese People's Liberation Army, Guangzhou, China
| | - Zhao Yu
- Department of Infectious Diseases, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Yan Hu
- Department of Endocrinology, The 421 Hospital of Chinese People's Liberation Army, Guangzhou, China
| | - Ta-Chien Chan
- Centre for Geographic Information Science, Research Centre for Humanities and Social Science, Academia Sinica, Taipei, Taiwan
| | - Xiaoxiao Wang
- Department of Infectious Diseases, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Hao Pan
- Department of Infectious Diseases, Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, China
| | - Wei Cheng
- Department of Infectious Diseases, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Shenghua Mao
- Department of Infectious Diseases, Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, China
| | - Run Ju Zhang
- Department of Reproductive Endocrinology, Key Laboratory of Reproductive Genetics, Ministry of Education, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Enfu Chen
- Department of Infectious Diseases, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
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Kirunda H, Kabi F, Muwereza N, Kabuuka T, Kerfua SD, Kasaija PD, Byarugaba DK, Wabwire-Mangen F. Seroprevalence and Risk Factors for Exposure of Free-Range Poultry to Avian Influenza Viruses in Important Bird Areas in Uganda. Avian Dis 2015; 59:64-70. [PMID: 26292536 DOI: 10.1637/10874-052714-reg] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Avian influenza (AI) viruses cause disease in domestic and wild bird species. Although these viruses have been reported to occur in poultry in Uganda, risk factors for their introduction and spread were largely unknown. We investigated the seroprevalence and risk factors for exposure of free-range poultry to AI viruses in Important Bird Areas (IBAs) in the country. A structured questionnaire was administered to 664 respondents, and 1342 sera were collected from poultry. Sera were analyzed for antibody titers against AI using competitive ELISA. AI antibody prevalence was 7.6% (95% confidence interval [CI]: 6.2-9.0) in the Lake Victoria Basin, 8.4% (95% CI: 7.0-9.8) in the southwestern region, and none (0/432) in the Kyoga region. High proportions of risky practices were observed among respondent farmers. Significant predictors for exposure of poultry to AI viruses were the source of restocking poultry, method of disposal of inedible parts of slaughtered poultry, and waterfowl visits to a nearby body of water. In addition, visits by waterbirds to a nearby body of water during October-December were more associated with exposure to AI viruses (odds ratio = 3.6; 95% CI: 1.42-9.23) compared with January-March visits'. These results suggested the existence of several risk factors for exposure of free-range to AI viruses in IBAs in Uganda.
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12
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Abstract
Emerflu is an inactivated, split-virion pandemic preparedness vaccine, containing 30 μg of hemagglutinin (HA) and 600 μg of aluminum hydroxide adjuvant. It is administered in two doses, 3 weeks apart. Only moderate immunogenicity was evident from clinical studies with the vaccine in adults, and HA antibody responses were below the criteria established by the EMA and US FDA for licensure. With the exception of Australia, the vaccine remains unlicensed. Further clinical development appears to have been suspended, and newer adjuvants such as MF59 and AS03 have since demonstrated safety and superior immunogenicity with lower HA doses. Emerflu is symbolic of the failure of aluminum salts as an adjuvant for influenza vaccines. Reasons for this failure are unclear, and may reflect problems with the adjuvant-antigen complex or interference in the immune response by heterosubtypic immunity.
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Affiliation(s)
- Barnaby E Young
- Communicable Diseases Centre, Institute of Infectious Diseases and Epidemiology, Communicable Diseases Centre, 144 Moulmein Road, Singapore, Singapore
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13
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Qin Y, Horby PW, Tsang TK, Chen E, Gao L, Ou J, Nguyen TH, Duong TN, Gasimov V, Feng L, Wu P, Jiang H, Ren X, Peng Z, Li S, Li M, Zheng J, Liu S, Hu S, Hong R, Farrar JJ, Leung GM, Gao GF, Cowling BJ, Yu H. Differences in the Epidemiology of Human Cases of Avian Influenza A(H7N9) and A(H5N1) Viruses Infection. Clin Infect Dis 2015; 61:563-71. [PMID: 25940354 DOI: 10.1093/cid/civ345] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/21/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The pandemic potential of avian influenza viruses A(H5N1) and A(H7N9) remains an unresolved but critically important question. METHODS We compared the characteristics of sporadic and clustered cases of human H5N1 and H7N9 infection, estimated the relative risk of infection in blood-related contacts, and the reproduction number (R). RESULTS We assembled and analyzed data on 720 H5N1 cases and 460 H7N9 cases up to 2 November 2014. The severity and average age of sporadic/index cases of H7N9 was greater than secondary cases (71% requiring intensive care unit admission vs 33%, P = .007; median age 59 years vs 31, P < .001). We observed no significant differences in the age and severity between sporadic/index and secondary H5N1 cases. The upper limit of the 95% confidence interval (CI) for R was 0.12 for H5N1 and 0.27 for H7N9. A higher proportion of H5N1 infections occurred in clusters (20%) compared to H7N9 (8%). The relative risk of infection in blood-related contacts of cases compared to unrelated contacts was 8.96 for H5N1 (95% CI, 1.30, 61.86) and 0.80 for H7N9 (95% CI, .32, 1.97). CONCLUSIONS The results are consistent with an ascertainment bias towards severe and older cases for sporadic H7N9 but not for H5N1. The lack of evidence for ascertainment bias in sporadic H5N1 cases, the more pronounced clustering of cases, and the higher risk of infection in blood-related contacts, support the hypothesis that susceptibility to H5N1 may be limited and familial. This analysis suggests the potential pandemic risk may be greater for H7N9 than H5N1.
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Affiliation(s)
- Ying Qin
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peter W Horby
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom Singapore Infectious Disease Initiative
| | - Tim K Tsang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Enfu Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou
| | - Lidong Gao
- Hunan Provincial Center for Disease Control and Prevention, Changsha
| | - Jianming Ou
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | | | - Tran Nhu Duong
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Luzhao Feng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Hui Jiang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiang Ren
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhibin Peng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sa Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ming Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiandong Zheng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shelan Liu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou
| | - Shixiong Hu
- Hunan Provincial Center for Disease Control and Prevention, Changsha
| | - Rongtao Hong
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Jeremy J Farrar
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom Singapore Infectious Disease Initiative ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, United Kingdom
| | - Gabriel M Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - George F Gao
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences Office of Director-General, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Hongjie Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
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14
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Emerging and Reemerging Infectious Disease Threats. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7151803 DOI: 10.1016/b978-1-4557-4801-3.00014-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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15
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Morens DM, Taubenberger JK. How low is the risk of influenza A(H5N1) infection? J Infect Dis 2014; 211:1364-6. [PMID: 25355943 PMCID: PMC7574601 DOI: 10.1093/infdis/jiu530] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 09/18/2014] [Indexed: 12/17/2022] Open
Affiliation(s)
- David M Morens
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jeffery K Taubenberger
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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16
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Family clusters of avian influenza A H7N9 virus infection in Guangdong Province, China. J Clin Microbiol 2014; 53:22-8. [PMID: 25339399 DOI: 10.1128/jcm.02322-14] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Since its first identification, the epizootic avian influenza A H7N9 virus has continued to cause infections in China. Two waves were observed during this outbreak. No cases were reported from Guangdong Province during the first wave, but this province became one of the prime outbreak sites during the second wave. In order to identify the transmission potential of this continuously evolving infectious virus, our research group monitored all clusters of H7N9 infections during the second wave of the epidemic in Guangdong Province. Epidemiological, clinical, and virological data on these patients were collected and analyzed. Three family clusters including six cases of H7N9 infection were recorded. The virus caused severe disease in two adult patients but only mild symptoms for all four pediatric patients. All patients reported direct poultry or poultry market exposure history. Relevant environment samples collected according to their reported exposures tested H7N9 positive. Virus isolates from patients in the same cluster shared high sequence similarities. In conclusion, although continually evolving, the currently circulating H7N9 viruses in Guangdong Province have not yet demonstrated the capacity for efficient and sustained person-to-person transmission.
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17
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Xiao XC, Li KB, Chen ZQ, Di B, Yang ZC, Yuan J, Luo HB, Ye SL, Liu H, Lu JY, Nie Z, Tang XP, Wang M, Zheng BJ. Transmission of avian influenza A(H7N9) virus from father to child: a report of limited person-to-person transmission, Guangzhou, China, January 2014. ACTA ACUST UNITED AC 2014; 19. [PMID: 24993555 DOI: 10.2807/1560-7917.es2014.19.25.20837] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We investigated a possible person-to-person transmission within a family cluster of two confirmed influenza A(H7N9) patients in Guangzhou, China. The index case, a man in his late twenties, worked in a wet market that was confirmed to be contaminated by the influenza A(H7N9) virus. He developed a consistent fever and severe pneumonia after 4 January 2014. In contrast, the second case, his five-year-old child, who only developed a mild disease 10 days after disease onset of the index case, did not have any contact with poultry and birds but had unprotected and very close contact with the index case. The sequences of the haemagglutinin (HA) genes of the virus stains isolated from the two cases were 100% identical. These findings strongly suggest that the second case might have acquired the infection via transmission of the virus from the sick father. Fortunately, all 40 close contacts, including the other four family members who also had unprotected and very close contact with the cases, did not acquire influenza A(H7N9) virus infection, indicating that the person-to-person transmissibility of the virus remained limited. Our finding underlines the importance of carefully, thoroughly and punctually following-up close contacts of influenza A(H7N9) cases to allow detection of any secondary cases, as these may constitute an early warning signal of the virus's increasing ability to transmit from person-to-person.
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Affiliation(s)
- X C Xiao
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
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18
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Bao S, Zhou X, Zhang L, Zhou J, To KKW, Wang B, Wang L, Zhang X, Song YQ. Prioritizing genes responsible for host resistance to influenza using network approaches. BMC Genomics 2013; 14:816. [PMID: 24261899 PMCID: PMC4046670 DOI: 10.1186/1471-2164-14-816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 11/06/2013] [Indexed: 01/17/2023] Open
Abstract
Background The genetic make-up of humans and other mammals (such as mice) affects their resistance to influenza virus infection. Considering the complexity and moral issues associated with experiments on human subjects, we have only acquired partial knowledge regarding the underlying molecular mechanisms. Although influenza resistance in inbred mice has been mapped to several quantitative trait loci (QTLs), which have greatly narrowed down the search for host resistance genes, only few underlying genes have been identified. Results To prioritize a list of promising candidates for future functional investigation, we applied network-based approaches to leverage the information of known resistance genes and the expression profiles contrasting susceptible and resistant mouse strains. The significance of top-ranked genes was supported by different lines of evidence from independent genetic associations, QTL studies, RNA interference (RNAi) screenings, and gene expression analysis. Further data mining on the prioritized genes revealed the functions of two pathways mediated by tumor necrosis factor (TNF): apoptosis and TNF receptor-2 signaling pathways. We suggested that the delicate balance between TNF’s pro-survival and apoptotic effects may affect hosts’ conditions after influenza virus infection. Conclusions This study considerably cuts down the list of candidate genes responsible for host resistance to influenza and proposed novel pathways and mechanisms. Our study also demonstrated the efficacy of network-based methods in prioritizing genes for complex traits. Electronic supplementary material The online version of this article (doi:10.1186/1471-2164-14-816) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | - You-Qiang Song
- Department of Biochemistry, The University of Hong Kong, Hong Kong, China.
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19
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Watanabe A. [Diagnosis, treatment and prevention of infectious diseases. Topics: I. Countermeasures against epidemic infectious diseases; 2. High pathogenic avian influenza, including A (H7N9) infection]. ACTA ACUST UNITED AC 2013; 102:2808-15. [PMID: 24450116 DOI: 10.2169/naika.102.2808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Akira Watanabe
- Research Division for Development of Anti-Infective Agents, Institute of Development, Aging and Cancer, Tohoku University, Japan
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20
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Lin TY, Brass AL. Host genetic determinants of influenza pathogenicity. Curr Opin Virol 2013; 3:531-6. [PMID: 23933004 DOI: 10.1016/j.coviro.2013.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/16/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
Abstract
Despite effective vaccines, influenza remains a major global health threat due to the morbidity and mortality caused by seasonal epidemics, as well as the 2009 pandemic. Also of profound concern are the rare but potentially catastrophic transmissions of avian influenza to humans, highlighted by a recent H7N9 influenza outbreak. Murine and human studies reveal that the clinical course of influenza is the result of a combination of both host and viral genetic determinants. While viral pathogenicity has long been the subject of intensive efforts, research to elucidate host genetic determinants, particularly human, is now in the ascendant, and the goal of this review is to highlight these recent insights.
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Affiliation(s)
- Tsai-Yu Lin
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA 01655, United States
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21
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Affiliation(s)
- David M. Morens
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
- Correspondence: David M. Morens, MD, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bldg 31, Rm 7A-03, 31 Center Dr, Bethesda, MD 20892 ()
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22
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Abstract
Two studies of H5N1 avian influenza viruses that had been genetically engineered to render them transmissible between ferrets have proved highly controversial. Divergent opinions exist about the importance of these studies of influenza transmission and about potential 'dual use' research implications. No consensus has developed yet about how to balance these concerns. After not recommending immediate full publication of earlier, less complete versions of the studies, the United States National Science Advisory Board for Biosecurity subsequently recommended full publication of more complete manuscripts; however, controversy about this and similar research remains.
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23
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Horby P, Nguyen NY, Dunstan SJ, Baillie JK. The role of host genetics in susceptibility to influenza: a systematic review. PLoS One 2012; 7:e33180. [PMID: 22438897 PMCID: PMC3305291 DOI: 10.1371/journal.pone.0033180] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 02/06/2012] [Indexed: 12/24/2022] Open
Abstract
Background The World Health Organization has identified studies of the role of host genetics on susceptibility to severe influenza as a priority. A systematic review was conducted to summarize the current state of evidence on the role of host genetics in susceptibility to influenza (PROSPERO registration number: CRD42011001380). Methods and Findings PubMed, Web of Science, the Cochrane Library, and OpenSIGLE were searched using a pre-defined strategy for all entries up to the date of the search. Two reviewers independently screened the title and abstract of 1,371 unique articles, and 72 full text publications were selected for inclusion. Mouse models clearly demonstrate that host genetics plays a critical role in susceptibility to a range of human and avian influenza viruses. The Mx genes encoding interferon inducible proteins are the best studied but their relevance to susceptibility in humans is unknown. Although the MxA gene should be considered a candidate gene for further study in humans, over 100 other candidate genes have been proposed. There are however no data associating any of these candidate genes to susceptibility in humans, with the only published study in humans being under-powered. One genealogy study presents moderate evidence of a heritable component to the risk of influenza-associated death, and while the marked familial aggregation of H5N1 cases is suggestive of host genetic factors, this remains unproven. Conclusion The fundamental question “Is susceptibility to severe influenza in humans heritable?” remains unanswered. Not because of a lack of genotyping or analytic tools, nor because of insufficient severe influenza cases, but because of the absence of a coordinated effort to define and assemble cohorts of cases. The recent pandemic and the ongoing epizootic of H5N1 both represent rapidly closing windows of opportunity to increase understanding of the pathogenesis of severe influenza through multi-national host genetic studies.
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Affiliation(s)
- Peter Horby
- Oxford University Clinical Research Unit-Wellcome Trust Major Overseas Programme, Hanoi, Vietnam.
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24
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Aditama TY, Samaan G, Kusriastuti R, Sampurno OD, Purba W, Misriyah, Santoso H, Bratasena A, Maruf A, Sariwati E, Setiawaty V, Glass K, Lokuge K, Kelly PM, Kandun IN. Avian influenza H5N1 transmission in households, Indonesia. PLoS One 2012; 7:e29971. [PMID: 22238686 PMCID: PMC3251608 DOI: 10.1371/journal.pone.0029971] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 12/09/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Disease transmission patterns are needed to inform public health interventions, but remain largely unknown for avian influenza H5N1 virus infections. A recent study on the 139 outbreaks detected in Indonesia between 2005 and 2009 found that the type of exposure to sources of H5N1 virus for both the index case and their household members impacted the risk of additional cases in the household. This study describes the disease transmission patterns in those outbreak households. METHODOLOGY/PRINCIPAL FINDINGS We compared cases (n = 177) and contacts (n = 496) in the 113 sporadic and 26 cluster outbreaks detected between July 2005 and July 2009 to estimate attack rates and disease intervals. We used final size household models to fit transmission parameters to data on household size, cases and blood-related household contacts to assess the relative contribution of zoonotic and human-to-human transmission of the virus, as well as the reproduction number for human virus transmission. The overall household attack rate was 18.3% and secondary attack rate was 5.5%. Secondary attack rate remained stable as household size increased. The mean interval between onset of subsequent cases in outbreaks was 5.6 days. The transmission model found that human transmission was very rare, with a reproduction number between 0.1 and 0.25, and the upper confidence bounds below 0.4. Transmission model fit was best when the denominator population was restricted to blood-related household contacts of index cases. CONCLUSIONS/SIGNIFICANCE The study only found strong support for human transmission of the virus when a single large cluster was included in the transmission model. The reproduction number was well below the threshold for sustained transmission. This study provides baseline information on the transmission dynamics for the current zoonotic virus and can be used to detect and define signatures of a virus with increasing capacity for human-to-human transmission.
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Affiliation(s)
- Tjandra Y. Aditama
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Gina Samaan
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rita Kusriastuti
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Ondri Dwi Sampurno
- National Institute of Health Research and Development, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Wilfried Purba
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Misriyah
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Hari Santoso
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Arie Bratasena
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Anas Maruf
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Elvieda Sariwati
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Vivi Setiawaty
- National Institute of Health Research and Development, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Kathryn Glass
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kamalini Lokuge
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Paul M. Kelly
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
- Population Health Division, Australian Capital Territory Government Health Directorate, Canberra, Australian Capital Territory, Australia
| | - I. Nyoman Kandun
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
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