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Hill V, Koch RT, Bialosuknia SM, Ngo K, Zink SD, Koetzner CA, Maffei JG, Dupuis AP, Backenson PB, Oliver J, Bransfield AB, Misencik MJ, Petruff TA, Shepard JJ, Warren JL, Gill MS, Baele G, Vogels CBF, Gallagher G, Burns P, Hentoff A, Smole S, Brown C, Osborne M, Kramer LD, Armstrong PM, Ciota AT, Grubaugh ND. Dynamics of eastern equine encephalitis virus during the 2019 outbreak in the Northeast United States. Curr Biol 2023; 33:2515-2527.e6. [PMID: 37295427 PMCID: PMC10316540 DOI: 10.1016/j.cub.2023.05.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/04/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023]
Abstract
Eastern equine encephalitis virus (EEEV) causes a rare but severe disease in horses and humans and is maintained in an enzootic transmission cycle between songbirds and Culiseta melanura mosquitoes. In 2019, the largest EEEV outbreak in the United States for more than 50 years occurred, centered in the Northeast. To explore the dynamics of the outbreak, we sequenced 80 isolates of EEEV and combined them with existing genomic data. We found that, similar to previous years, cases were driven by multiple independent but short-lived virus introductions into the Northeast from Florida. Once in the Northeast, we found that Massachusetts was important for regional spread. We found no evidence of any changes in viral, human, or bird factors which would explain the increase in cases in 2019, although the ecology of EEEV is complex and further data is required to explore these in more detail. By using detailed mosquito surveillance data collected by Massachusetts and Connecticut, however, we found that the abundance of Cs. melanura was exceptionally high in 2019, as was the EEEV infection rate. We employed these mosquito data to build a negative binomial regression model and applied it to estimate early season risks of human or horse cases. We found that the month of first detection of EEEV in mosquito surveillance data and vector index (abundance multiplied by infection rate) were predictive of cases later in the season. We therefore highlight the importance of mosquito surveillance programs as an integral part of public health and disease control.
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Affiliation(s)
- Verity Hill
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA.
| | - Robert T Koch
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Sean M Bialosuknia
- The Arbovirus Laboratory, New York State Department of Health, Wadsworth Center, Slingerlands, NY 12159, USA
| | - Kiet Ngo
- The Arbovirus Laboratory, New York State Department of Health, Wadsworth Center, Slingerlands, NY 12159, USA
| | - Steven D Zink
- The Arbovirus Laboratory, New York State Department of Health, Wadsworth Center, Slingerlands, NY 12159, USA
| | - Cheri A Koetzner
- The Arbovirus Laboratory, New York State Department of Health, Wadsworth Center, Slingerlands, NY 12159, USA
| | - Joseph G Maffei
- The Arbovirus Laboratory, New York State Department of Health, Wadsworth Center, Slingerlands, NY 12159, USA
| | - Alan P Dupuis
- The Arbovirus Laboratory, New York State Department of Health, Wadsworth Center, Slingerlands, NY 12159, USA
| | - P Bryon Backenson
- New York State Department of Health, Bureau of Communicable Disease Control, Albany, NY 12237, USA
| | - JoAnne Oliver
- New York State Department of Health, Bureau of Communicable Disease Control, Syracuse, NY 13202, USA; Division of Environmental and Renewable Resources, State University of New York at Morrisville - School of Agriculture, Business and Technology, Morrisville, NY 13408, USA
| | - Angela B Bransfield
- Center for Vector Biology and Zoonotic Diseases, Department of Entomology, The Connecticut Agricultural Experiment Station, New Haven, CT 06511, USA
| | - Michael J Misencik
- Center for Vector Biology and Zoonotic Diseases, Department of Entomology, The Connecticut Agricultural Experiment Station, New Haven, CT 06511, USA
| | - Tanya A Petruff
- Center for Vector Biology and Zoonotic Diseases, Department of Entomology, The Connecticut Agricultural Experiment Station, New Haven, CT 06511, USA
| | - John J Shepard
- Center for Vector Biology and Zoonotic Diseases, Department of Entomology, The Connecticut Agricultural Experiment Station, New Haven, CT 06511, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, USA; Public Health Modeling Unit, Yale School of Public Health, New Haven, CT 06510, USA
| | - Mandev S Gill
- Department of Statistics, University of Georgia, Athens, GA 30602, USA
| | - Guy Baele
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven BE-3000, Belgium
| | - Chantal B F Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Glen Gallagher
- Massachusetts Department of Public Health, Boston, MA 02108, USA; Rhode Island State Health Laboratory, Rhode Island Department of Health, Providence, RI 02904, USA
| | - Paul Burns
- Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - Aaron Hentoff
- Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - Sandra Smole
- Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - Catherine Brown
- Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - Matthew Osborne
- Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - Laura D Kramer
- The Arbovirus Laboratory, New York State Department of Health, Wadsworth Center, Slingerlands, NY 12159, USA; Department of Biomedical Sciences, State University of New York at Albany School of Public Health, Albany, NY 12237, USA
| | - Philip M Armstrong
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA; Division of Environmental and Renewable Resources, State University of New York at Morrisville - School of Agriculture, Business and Technology, Morrisville, NY 13408, USA.
| | - Alexander T Ciota
- The Arbovirus Laboratory, New York State Department of Health, Wadsworth Center, Slingerlands, NY 12159, USA; Department of Biomedical Sciences, State University of New York at Albany School of Public Health, Albany, NY 12237, USA.
| | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA; Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, USA; Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA.
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Ladzinski AT, Tai A, Rumschlag MT, Smith CS, Mehta A, Boapimp P, Edewaard EJ, Douce RW, Morgan LF, Wang MS, Fisher-Hubbard AO, Cummings MJ, Jagger BW. Clinical Characteristics of the 2019 Eastern Equine Encephalitis Outbreak in Michigan. Open Forum Infect Dis 2023; 10:ofad206. [PMID: 37180595 PMCID: PMC10173547 DOI: 10.1093/ofid/ofad206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/17/2023] [Indexed: 05/16/2023] Open
Abstract
Background Eastern equine encephalitis virus is a mosquito-borne alphavirus responsible for unpredictable outbreaks of severe neurologic disease in animals and humans. While most human infections are asymptomatic or clinically nonspecific, a minority of patients develops encephalitic disease, a devastating illness with a mortality rate of ≥30%. No treatments are known to be effective. Eastern equine encephalitis virus infection is rare in the United States, with an annual average nationwide incidence of 7 cases between 2009 and 2018. However, in 2019, 38 cases were confirmed nationwide, including 10 in Michigan. Methods Data from 8 cases identified by a regional network of physicians in southwest Michigan were abstracted from clinical records. Clinical imaging and histopathology were aggregated and reviewed. Results Patients were predominantly older adults (median age, 64 years), and all were male. Results of initial arboviral cerebrospinal fluid serology were frequently negative, and diagnosis was not made until a median of 24.5 days (range, 13-38 days) after presentation, despite prompt lumbar punctures in all patients. Imaging findings were dynamic and heterogeneous, with abnormalities of the thalamus and/or basal ganglia, and prominent pons and midbrain abnormalities were displayed in 1 patient. Six patients died, 1 survived the acute illness with severe neurologic sequelae, and 1 recovered with mild sequelae. A limited postmortem examination revealed diffuse meningoencephalitis, neuronophagia, and focal vascular necrosis. Conclusions Eastern equine encephalitis is a frequently fatal condition whose diagnosis is often delayed, and for which no effective treatments are known. Improved diagnostics are needed to facilitate patient care and encourage the development of treatments.
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Affiliation(s)
- Adam T Ladzinski
- Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MichiganUSA
| | - Aisha Tai
- Department of Internal Medicine, Corewell Health Lakeland, St Joseph, Michigan, USA
| | - Matthew T Rumschlag
- Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MichiganUSA
| | - Christopher S Smith
- Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MichiganUSA
| | - Aditya Mehta
- Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MichiganUSA
| | - Pimpawan Boapimp
- Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MichiganUSA
| | - Eric J Edewaard
- Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MichiganUSA
| | - Richard W Douce
- Department of Internal Medicine, Corewell Health Lakeland, St Joseph, Michigan, USA
| | - Larry F Morgan
- Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MichiganUSA
- Neuroscience Center, Bronson Methodist Hospital, Kalamazoo, MichiganUSA
| | - Michael S Wang
- Department of Internal Medicine, Corewell Health Lakeland, St Joseph, Michigan, USA
| | - Amanda O Fisher-Hubbard
- Department of Pathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MichiganUSA
| | - Matthew J Cummings
- Department of Neuroradiology, Premier Radiology, Kalamazoo, Michigan, USA
- Department of Radiology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MichiganUSA
| | - Brett W Jagger
- Correspondence: Brett W. Jagger, MD, PhD, Division of Infectious Diseases, Allergy and Immunology, Edward A. Doisy Research Center, 8th Floor, 1100 S Grand Blvd, St Louis, MO 63104 (); Current affiliation: Department of Internal Medicine, Saint Louis University, St Louis, Missouri
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3
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Hill V, Koch RT, Bialosuknia SM, Ngo K, Zink SD, Koetzner CA, Maffei JG, Dupuis AP, Backenson PB, Oliver J, Bransfield AB, Misencik MJ, Petruff TA, Shepard JJ, Warren JL, Gill MS, Baele G, Vogels CBF, Gallagher G, Burns P, Hentoff A, Smole S, Brown C, Osborne M, Kramer LD, Armstrong PM, Ciota AT, Grubaugh ND. Dynamics of Eastern equine encephalitis virus during the 2019 outbreak in the Northeast United States. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.06.23286851. [PMID: 36945576 PMCID: PMC10029029 DOI: 10.1101/2023.03.06.23286851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Eastern equine encephalitis virus (EEEV) causes a rare but severe disease in horses and humans, and is maintained in an enzootic transmission cycle between songbirds and Culiseta melanura mosquitoes. In 2019, the largest EEEV outbreak in the United States for more than 50 years occurred, centered in the Northeast. To explore the dynamics of the outbreak, we sequenced 80 isolates of EEEV and combined them with existing genomic data. We found that, like previous years, cases were driven by frequent short-lived virus introductions into the Northeast from Florida. Once in the Northeast, we found that Massachusetts was important for regional spread. We found no evidence of any changes in viral, human, or bird factors which would explain the increase in cases in 2019. By using detailed mosquito surveillance data collected by Massachusetts and Connecticut, however, we found that the abundance of Cs. melanura was exceptionally high in 2019, as was the EEEV infection rate. We employed these mosquito data to build a negative binomial regression model and applied it to estimate early season risks of human or horse cases. We found that the month of first detection of EEEV in mosquito surveillance data and vector index (abundance multiplied by infection rate) were predictive of cases later in the season. We therefore highlight the importance of mosquito surveillance programs as an integral part of public health and disease control.
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