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Sann S, Kleinewietfeld M, Cantaert T. Balancing functions of regulatory T cells in mosquito-borne viral infections. Emerg Microbes Infect 2024; 13:2304061. [PMID: 38192073 PMCID: PMC10812859 DOI: 10.1080/22221751.2024.2304061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/07/2024] [Indexed: 01/10/2024]
Abstract
Mosquito-borne viral infections are on the rise worldwide and can lead to severe symptoms such as haemorrhage, encephalitis, arthritis or microcephaly. A protective immune response following mosquito-borne viral infections requires the generation of a controlled and balanced immune response leading to viral clearance without immunopathology. Here, regulatory T cells play a central role in restoring immune homeostasis. In current review, we aim to provide an overview and summary of the phenotypes of FOXP3+ Tregs in various mosquito-borne arboviral disease, their association with disease severity and their functional characteristics. Furthermore, we discuss the role of cytokines and Tregs in the immunopathogenesis of mosquito-borne infections. Lastly, we discuss possible novel lines of research which could provide additional insight into the role of Tregs in mosquito-borne viral infections in order to develop novel therapeutic approaches or vaccination strategies.
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Affiliation(s)
- Sotheary Sann
- Immunology Unit, Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh, Cambodia
- Department of Immunology, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Markus Kleinewietfeld
- Department of Immunology, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- VIB Laboratory of Translational Immunomodulation, VIB Center for Inflammation Research (IRC), Hasselt University, Diepenbeek, Belgium
| | - Tineke Cantaert
- Immunology Unit, Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh, Cambodia
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2
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Zarate-Sanchez E, George SC, Moya ML, Robertson C. Vascular dysfunction in hemorrhagic viral fevers: opportunities for organotypic modeling. Biofabrication 2024; 16:032008. [PMID: 38749416 PMCID: PMC11151171 DOI: 10.1088/1758-5090/ad4c0b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/25/2024] [Accepted: 05/15/2024] [Indexed: 06/06/2024]
Abstract
The hemorrhagic fever viruses (HFVs) cause severe or fatal infections in humans. Named after their common symptom hemorrhage, these viruses induce significant vascular dysfunction by affecting endothelial cells, altering immunity, and disrupting the clotting system. Despite advances in treatments, such as cytokine blocking therapies, disease modifying treatment for this class of pathogen remains elusive. Improved understanding of the pathogenesis of these infections could provide new avenues to treatment. While animal models and traditional 2D cell cultures have contributed insight into the mechanisms by which these pathogens affect the vasculature, these models fall short in replicatingin vivohuman vascular dynamics. The emergence of microphysiological systems (MPSs) offers promising avenues for modeling these complex interactions. These MPS or 'organ-on-chip' models present opportunities to better mimic human vascular responses and thus aid in treatment development. In this review, we explore the impact of HFV on the vasculature by causing endothelial dysfunction, blood clotting irregularities, and immune dysregulation. We highlight how existing MPS have elucidated features of HFV pathogenesis as well as discuss existing knowledge gaps and the challenges in modeling these interactions using MPS. Understanding the intricate mechanisms of vascular dysfunction caused by HFV is crucial in developing therapies not only for these infections, but also for other vasculotropic conditions like sepsis.
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Affiliation(s)
- Evelyn Zarate-Sanchez
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, United States of America
| | - Steven C George
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, United States of America
| | - Monica L Moya
- Materials Engineering Division, Lawrence Livermore National Laboratory, Livermore, CA, United States of America
| | - Claire Robertson
- Materials Engineering Division, Lawrence Livermore National Laboratory, Livermore, CA, United States of America
- UC Davis Comprehensive Cancer Center, Davis, CA, United States of America
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3
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da Rocha MM, Codeço CT, da Silva CMFP. Spatiotemporal Evolution of the Yellow Fever Epidemic in Southeast Brazil from 2016 to 2019. Vector Borne Zoonotic Dis 2024. [PMID: 38813663 DOI: 10.1089/vbz.2024.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
Background: Yellow fever (YF) is a zoonotic disease transmitted by mosquitoes among humans and nonhuman primates. Although urban YF is eradicated, the sylvatic YF has reemerged in some areas of Brazil in the twenty-first century. From 2016 to 2019, a sylvatic YF epidemic occurred in Southeast Brazil, where it had been eradicated in the 1940s. Methods: This study's objective was to describe the epidemic in the states of the Southeast region, based on descriptive, cluster, and mobility analyses. Results: Both the descriptive and cluster analyses showed that the YF cases spread from the state of Minas Gerais southward, causing peaks in cases during the summer months. None of the state capitals was included in the clusters, but the connectivity between the municipalities in Greater Metropolitan São Paulo highlighted potential paths of spread. Despite differences in sociodemographic profiles between the Southeast and North of Brazil (the latter region considered endemic), the epidemiological profile was similar, except for patients' occupation, which was not related to rural work in the Southeast. Conclusion: The results contributed to our understanding of the paths by which YF spread across Southeast Brazil and the epidemiological profile in an area that had gone decades without autochthonous cases.
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Gonçalves AP, Almeida LT, de Rezende IM, Fradico JRB, Pereira LS, Ramalho DB, Pascoal Xavier MA, Calzavara Silva CE, Monath TP, LaBeaud AD, Drumond BP, Campi-Azevedo AC, Martins-Filho OA, Teixeira-Carvalho A, Alves PA. Evaluation of humoral immune response after yellow fever infection: an observational study on patients from the 2017-2018 sylvatic outbreak in Brazil. Microbiol Spectr 2024; 12:e0370323. [PMID: 38511952 PMCID: PMC11064539 DOI: 10.1128/spectrum.03703-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
Between 2016 and 2018, Brazil experienced major sylvatic yellow fever (YF) outbreaks that caused hundreds of casualties, with Minas Gerais (MG) being the most affected state. These outbreaks provided a unique opportunity to assess the immune response triggered by the wild-type (WT) yellow fever virus (YFV) in humans. The plaque reduction neutralization test (PRNT) is currently the standard method to assess the humoral immune response to YFV by measuring neutralizing antibodies (nAbs). The present study aimed to evaluate the humoral immune response of patients from the 2017-2018 sylvatic YF outbreak in MG with different disease outcomes by using PRNTs with a WT YFV strain, isolated from the 2017-2018 outbreak, and a vaccine YFV strain. Samples from naturally infected YF patients were tested, in comparison with healthy vaccinees. Results showed that both groups presented different levels of nAb against the WT and vaccine strains, and the levels of neutralization against the strains varied homotypically and heterotypically. Results based on the geometric mean titers (GMTs) suggest that the humoral immune response after a natural infection of YFV can reach higher levels than that induced by vaccination (GMT of patients against WT YFV compared to GMT of vaccinees, P < 0.0001). These findings suggest that the humoral immune responses triggered by the vaccine and WT strains of YFV are different, possibly due to genetic and antigenic differences between these viruses. Therefore, current means of assessing the immune response in naturally infected YF individuals and immunological surveillance methods in areas with intense viral circulation may need to be updated.IMPORTANCEYellow fever is a deadly febrile disease caused by the YFV. Despite the existence of effective vaccines, this disease still represents a public health concern worldwide. Much is known about the immune response against the vaccine strains of the YFV, but recent studies have shown that it differs from that induced by WT strains. The extent of this difference and the mechanisms behind it are still unclear. Thus, studies aimed to better understand the immune response against this virus are relevant and necessary. The present study evaluated levels of neutralizing antibodies of yellow fever patients from recent outbreaks in Brazil, in comparison with healthy vaccinees, using plaque reduction neutralization tests with WT and vaccine YFV strains. Results showed that the humoral immune response in naturally infected patients was higher than that induced by vaccination, thus providing new insights into the immune response triggered against these viruses.
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Affiliation(s)
| | - Letícia Trindade Almeida
- Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ-Minas), Belo Horizonte, Minas Gerais, Brazil
| | - Izabela Maurício de Rezende
- Department of Pediatrics, Infectious Disease Division, Stanford University School of Medicine, Stanford, California, USA
| | | | - Leonardo Soares Pereira
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital Eduardo de Menezes (HEM), Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazil
| | - Dario Brock Ramalho
- Hospital Eduardo de Menezes (HEM), Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazil
| | - Marcelo Antônio Pascoal Xavier
- Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ-Minas), Belo Horizonte, Minas Gerais, Brazil
- Departamento de Anatomia Patológica e Medicina Legal, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Angelle Desiree LaBeaud
- Department of Pediatrics, Infectious Disease Division, Stanford University School of Medicine, Stanford, California, USA
| | - Betania Paiva Drumond
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Andréa Teixeira-Carvalho
- Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ-Minas), Belo Horizonte, Minas Gerais, Brazil
| | - Pedro Augusto Alves
- Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ-Minas), Belo Horizonte, Minas Gerais, Brazil
| | - Grupo de Estudos de Pesquisa e Resposta em Febre Amarela do Estado de Minas Gerais
- Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ-Minas), Belo Horizonte, Minas Gerais, Brazil
- Department of Pediatrics, Infectious Disease Division, Stanford University School of Medicine, Stanford, California, USA
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital Eduardo de Menezes (HEM), Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazil
- Departamento de Anatomia Patológica e Medicina Legal, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Crozet BioPharma LLC, Lexington, Massachusetts, USA
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Lu HZ, Xie YZ, Gao C, Wang Y, Liu TT, Wu XZ, Dai F, Wang DQ, Deng SQ. Diabetes mellitus as a risk factor for severe dengue fever and West Nile fever: A meta-analysis. PLoS Negl Trop Dis 2024; 18:e0012217. [PMID: 38820529 PMCID: PMC11168630 DOI: 10.1371/journal.pntd.0012217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/12/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Dengue fever (DF) and West Nile fever (WNF) have become endemic worldwide in the last two decades. Studies suggest that individuals with diabetes mellitus (DM) are at a higher risk of developing severe complications from these diseases. Identifying the factors associated with a severe clinical presentation is crucial, as prompt treatment is essential to prevent complications and fatalities. This article aims to summarize and assess the published evidence regarding the link between DM and the risk of severe clinical manifestations in cases of DF and WNF. METHODOLOGY/PRINCIPAL FINDINGS A systematic search was conducted using the PubMed and Web of Science databases. 27 studies (19 on DF, 8 on WNF) involving 342,873 laboratory-confirmed patients were included in the analysis. The analysis showed that a diagnosis of DM was associated with an increased risk for severe clinical presentations of both DF (OR 3.39; 95% CI: 2.46, 4.68) and WNF (OR 2.89; 95% CI: 1.89, 4.41). DM also significantly increased the risk of death from both diseases (DF: OR 1.95; 95% CI: 1.09, 3.52; WNF: OR 1.74; 95% CI: 1.40, 2.17). CONCLUSIONS/SIGNIFICANCE This study provides strong evidence supporting the association between DM and an increased risk of severe clinical manifestations in cases of DF and WNF. Diabetic individuals in DF or WNF endemic areas should be closely monitored when presenting with febrile symptoms due to their higher susceptibility to severe disease. Early detection and appropriate management strategies are crucial in reducing the morbidity and mortality rates associated with DF and WNF in diabetic patients. Tailored care and targeted public health interventions are needed to address this at-risk population. Further research is required to understand the underlying mechanisms and develop effective preventive and therapeutic approaches.
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Affiliation(s)
- Hong-Zheng Lu
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, the Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui China
| | - Yu-Zhuang Xie
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, the Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Chen Gao
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, the Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui China
| | - Ying Wang
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
| | - Ting-Ting Liu
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
| | - Xing-Zhe Wu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fang Dai
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Duo-Quan Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Health Commission Key Laboratory of Parasite and Vector Biology; WHO Collaborating Center for Tropical Diseases; National Center for International Research on Tropical Diseases, Shanghai, China
| | - Sheng-Qun Deng
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, the Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
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6
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Giugni FR, Aiello VD, Faria CS, Pour SZ, Cunha MDP, Giugni MV, Pinesi HT, Ledesma FL, Morais CE, Ho YL, Sztajnbok J, de Morais Fernezlian S, Ferraz da Silva LF, Mauad T, Ferreira Alves VA, Hilário do Nascimento Saldiva P, Antonangelo L, Dolhnikoff M, Duarte-Neto AN. Understanding yellow fever-associated myocardial injury: an autopsy study. EBioMedicine 2023; 96:104810. [PMID: 37757571 PMCID: PMC10550587 DOI: 10.1016/j.ebiom.2023.104810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Yellow fever (YF) is a viral hemorrhagic fever, endemic in parts of South America and Africa. There is scarce evidence about the pathogenesis of the myocardial injury. The objective of this study is to evaluate the cardiac pathology in fatal cases of YF. METHODS This retrospective autopsy study included cases from the São Paulo (Brazil) epidemic of 2017-2019. We reviewed medical records and performed cardiac tissue histopathological evaluation, electron microscopy, immunohistochemical assays, RT-qPCR for YF virus (YFV)-RNA, and proteomics analysis on inflammatory and endothelial biomarkers. FINDINGS Seventy-three confirmed YF cases with a median age of 48 (34-60) years were included. We observed myocardial fibrosis in 68 (93.2%) patients; cardiomyocyte hypertrophy in 68 (93.2%); endothelial alterations in 67 (91.8%); fiber necrosis in 50 (68.5%); viral myocarditis in 9 (12.3%); and secondary myocarditis in 5 (6.8%). Four out of five patients with 17DD vaccine-associated viscerotropic disease presented with myocarditis. The cardiac conduction system showed edema, hemorrhages and endothelial fibrinoid necrosis. Immunohistochemistry detected CD68-positive inflammatory interstitial cells and YFV antigens in endothelial and inflammatory cells. YFV-RNA was detected positive in 95.7% of the cardiac samples. The proteomics analysis demonstrated that YF patients had higher levels of multiple inflammatory and endothelial biomarkers in comparison to cardiovascular controls, and higher levels of interferon gamma-induced protein 10 (IP-10) in comparison to sepsis (p = 0.01) and cardiovascular controls (p < 0.001) in Dunn test. INTERPRETATION Myocardial injury is frequent in severe YF, due to multifactorial mechanisms, including direct YFV-mediated damage, endothelial cell injury, and inflammatory response, with a possible prominent role for IP-10. FUNDING This study was funded by Fundação de Amparo à Pesquisa do Estado de São Paulo, Bill and Melinda Gates Foundation, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.
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Affiliation(s)
- Fernando Rabioglio Giugni
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vera Demarchi Aiello
- Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Caroline Silverio Faria
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Shahab Zaki Pour
- Laboratório de Evolução Molecular e Bioinformática, Instituto de Ciências Biomédicas, Universidade de São Paulo, SP, Brazil
| | - Marielton Dos Passos Cunha
- Laboratório de Evolução Molecular e Bioinformática, Instituto de Ciências Biomédicas, Universidade de São Paulo, SP, Brazil
| | - Melina Valdo Giugni
- Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Henrique Trombini Pinesi
- Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Felipe Lourenço Ledesma
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carolina Esteves Morais
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Yeh-Li Ho
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Serviço de Verificação de Óbitos da Capital (SVOC), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Leila Antonangelo
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Kimathi D, Juan-Giner A, Orindi B, Grantz KH, Bob NS, Cheruiyot S, Hamaluba M, Kamau N, Fall G, Dia M, Mosobo M, Moki F, Kiogora K, Chirro O, Thiong'o A, Mwendwa J, Guantai A, Karanja HK, Gitonga J, Mugo D, Ramko K, Faye O, Sanders EJ, Grais RF, Bejon P, Warimwe GM. Immunogenicity and safety of fractional doses of 17D-213 yellow fever vaccine in HIV-infected people in Kenya (YEFE): a randomised, double-blind, non-inferiority substudy of a phase 4 trial. THE LANCET. INFECTIOUS DISEASES 2023; 23:974-982. [PMID: 37127045 PMCID: PMC10371873 DOI: 10.1016/s1473-3099(23)00114-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Evidence indicates that fractional doses of yellow fever vaccine are safe and sufficiently immunogenic for use during yellow fever outbreaks. However, there are no data on the generalisability of this observation to populations living with HIV. Therefore, we aimed to evaluate the immunogenicity of fractional and standard doses of yellow fever vaccine in HIV-positive adults. METHODS We conducted a randomised, double-blind, non-inferiority substudy in Kilifi, coastal Kenya to compare the immunogenicity and safety of a fractional dose (one-fifth of the standard dose) versus the standard dose of 17D-213 yellow fever vaccine among HIV-positive volunteers. HIV-positive participants aged 18-59 years, with baseline CD4+ T-cell count of at least 200 cells per mL, and who were not pregnant, had no previous history of yellow fever vaccination or infection, and had no contraindication for yellow fever vaccination were recruited from the community. Participants were randomly assigned 1:1 in blocks (variable block sizes) to either a fractional dose or a standard dose of the 17D-213 yellow fever vaccine. Vaccines were administered subcutaneously by an unblinded nurse and pharmacist; all other study personnel were blinded to the vaccine allocation. The primary outcome of the study was the proportion of participants who seroconverted by the plaque reduction neutralisation test (PRNT50) 28 days after vaccination for the fractional dose versus the standard dose in the per-protocol population. Secondary outcomes were assessment of adverse events and immunogenicity during the 1-year follow-up period. Participants were considered to have seroconverted if the post-vaccination antibody titre was at least 4 times greater than the pre-vaccination titre. We set a non-inferiority margin of not less than a 17% decrease in seroconversion in the fractional dose compared with the standard dose. This study is registered with ClinicalTrials.gov, NCT02991495. FINDINGS Between Jan 29, 2019, and May 17, 2019, 303 participants were screened, and 250 participants were included and vaccinated; 126 participants were assigned to the fractional dose and 124 to the standard dose. 28 days after vaccination, 112 (96%, 95% CI 90-99) of 117 participants in the fractional dose group and 115 (98%, 94-100) of 117 in the standard dose group seroconverted by PRNT50. The difference in seroconversion between the fractional dose and the standard dose was -3% (95% CI -7 to 2). Fractional dosing therefore met the non-inferiority criterion, and non-inferiority was maintained for 1 year. The most common adverse events were headache (n=31 [12%]), fatigue (n=23 [9%]), myalgia (n=23 [9%]), and cough (n=14 [6%]). Reported adverse events were either mild (182 [97%] of 187 adverse events) or moderate (5 [3%]) and were self-limiting. INTERPRETATION Fractional doses of the 17D-213 yellow fever vaccine were sufficiently immunogenic and safe demonstrating non-inferiority to the standard vaccine dose in HIV-infected individuals with CD4+ T cell counts of at least 200 cells per mL. These results provide confidence that fractional dose recommendations are applicable to populations with high HIV prevalence. FUNDING Wellcome Trust, Médecins Sans Frontières Foundation, and the UK Department for International Development.
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Affiliation(s)
- Derick Kimathi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | | | - Benedict Orindi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kyra H Grantz
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Stanley Cheruiyot
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mainga Hamaluba
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - Naomi Kamau
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Moses Mosobo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Felix Moki
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kenneth Kiogora
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Oscar Chirro
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Alexander Thiong'o
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Jane Mwendwa
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Andrew Guantai
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Henry K Karanja
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - John Gitonga
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Daisy Mugo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kelly Ramko
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Eduard J Sanders
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | | | - Philip Bejon
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - George M Warimwe
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK.
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8
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Franco MB, Jardim LL, de Carvalho BN, Basques F, Ribeiro DD, Pereira LS, Rezende SM. Deficiency of coagulation factors is associated with the bleeding diathesis of severe yellow fever. Ann Hematol 2023; 102:1939-1949. [PMID: 37226021 DOI: 10.1007/s00277-023-05262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 05/03/2023] [Indexed: 05/26/2023]
Abstract
Yellow fever (YF) is an acute tropical infectious disease caused by an arbovirus and can manifest as a classic hemorrhagic fever. The mechanism of the bleeding diathesis in YF is not well understood. We assessed clinical and laboratory data (including a panel of coagulation tests) from 46 patients with moderate (M) and severe (S) YF admitted to a local hospital between January 2018 and April 2018. Among 46 patients, 34 had SYF of whom 12 (35%) patients died. A total of 21 (45%) patients developed some type of bleeding manifestation and 15 (32%) presented severe bleeding. Patients with SYF had more severe thrombocytopenia (p = 0.001); prolonged activated partial thromboplastin time (aPTT) and thrombin time (TT) (p = 0.03 and p = 0.005, respectively); reduced plasma levels of coagulation factor (F) II (p < 0.01), FIX (p = 0.01), and FX (p = 0.04); and D-dimer levels almost 10 times higher (p < 0.01) when compared with patients with MYF. Patients who died had more bleeding (p = 0.03), more major bleeding (p = 0.03), prolonged international normalized ratio (INR) and aPTT (p = 0.003 and p = 0.002, respectively), as well as lower activity of FII (p = 0.02), FV (p = 0.001), FVII (p = 0.005), FIX (p = 0.01), and protein C (p = 0.01) than the ones who survived. FVIII levels were either normal or increased in all patients studied. Our results suggest that the bleeding diathesis of SYF is associated with the deficiency of coagulation factors produced by the liver. Prolonged INR and aPTT and reduced FII, FV, FVII, FIX, and protein C were associated with death.
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Affiliation(s)
- Mariana Brandão Franco
- Faculty of Medicine, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190, Room 255, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Leticia Lemos Jardim
- Faculty of Medicine, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190, Room 255, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | | | - Fernando Basques
- Hemocentro de Belo Horizonte, Fundação HEMOMINAS, Belo Horizonte, Minas Gerais, Brazil
| | - Daniel Dias Ribeiro
- Hematology Unit, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Leonardo Soares Pereira
- Hospital Eduardo de Menezes, Fundação Hospitalar Do Estado de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Suely Meireles Rezende
- Faculty of Medicine, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190, Room 255, Belo Horizonte, Minas Gerais, 30130-100, Brazil.
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9
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Rodríguez CS, Charó N, Tatti S, Gómez RM, D’Atri LP, Schattner M. Regulation of megakaryo/thrombopoiesis by endosomal toll-like receptor 7 and 8 activation of CD34 + cells in a viral infection model. Res Pract Thromb Haemost 2023; 7:100184. [PMID: 37538496 PMCID: PMC10394566 DOI: 10.1016/j.rpth.2023.100184] [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: 03/13/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 08/05/2023] Open
Abstract
Background CD34+ cells, megakaryocytes (MKs), and platelets express toll-like receptors (TLRs) that enable these cells to amplify the host innate immune response. However, the role of TLR7/TLR8 activation in megakaryopoiesis has not yet been investigated. Objectives We evaluated the effect of coxsackievirus B3 (CVB3) and synthetic TLR7/TLR8 agonists on the development of human MKs and production of platelets. Methods CD34+ cells from human umbilical cord were inoculated with CVB3 or stimulated with synthetic TLR7/TLR8 agonists and then cultured in the presence of thrombopoietin. Results CD34+ cells, MK progenitor cells, and mature MKs expressed TLR7 and TLR8, and exposure to CVB3 resulted in productive infection, as determined by the presence of viral infectious particles in culture supernatants. Cell expansion, differentiation into MKs, MK maturation, and platelet biogenesis were significantly reduced in CD34+-infected cultures. The reduction in MK growth was not due to an alteration in cellular proliferation but was accompanied by an increase in cellular apoptosis and pyroptosis. Impairment of MK generation and maturation of viable cells were also associated with decreased expression of transcription factors involved in these processes. These effects were completely abrogated by TLR7 but not TLR8 antagonists and mimicked by TLR7 but not TLR8 agonists. CVB3 infection of CD34+ cells increased the immunophenotype of MKs characterized as CD148+/CD48+ or CD41+/CD53+ cells. Conclusion These data suggest a novel role of TLR7 in megakaryo/thrombopoiesis that may contribute to a better understanding of the molecular basis underlying thrombocytopenia and the immunologic role of MKs in viral infection processes.
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Affiliation(s)
- Camila Sofía Rodríguez
- Laboratory of Experimental Thrombosis and Immunobiology of Inflammation, IMEX-CONICET-National Academy of Medicine, Buenos Aires, Argentina
| | - Nancy Charó
- Laboratory of Experimental Thrombosis and Immunobiology of Inflammation, IMEX-CONICET-National Academy of Medicine, Buenos Aires, Argentina
| | | | - Ricardo Martín Gómez
- Laboratory of Animal Viruses, Institute of Biotechnology and Molecular Biology, UNLP-CONICET, La Plata, Argentina
| | - Lina Paola D’Atri
- Laboratory of Experimental Thrombosis and Immunobiology of Inflammation, IMEX-CONICET-National Academy of Medicine, Buenos Aires, Argentina
| | - Mirta Schattner
- Laboratory of Experimental Thrombosis and Immunobiology of Inflammation, IMEX-CONICET-National Academy of Medicine, Buenos Aires, Argentina
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10
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Schaumburg F, Grobusch MP. Reply to comments by Kling et al. On ‘new recommendation on yellow fever booster vaccination in Germany’ by Schaumburg et al. Travel Med Infect Dis 2023; 52:102562. [PMID: 36967050 DOI: 10.1016/j.tmaid.2023.102562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/02/2023] [Indexed: 03/31/2023]
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11
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Frassetto FP, Rosemberg S. Neuropathology of yellow fever autopsy cases. Trop Dis Travel Med Vaccines 2023; 9:1. [PMID: 36707912 PMCID: PMC9883951 DOI: 10.1186/s40794-022-00187-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 12/14/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Yellow fever is a viral hemorrhagic fever caused by yellow fever virus, a mosquito-borne flavivirus. Despite an effective vaccine, major outbreaks continue to occur around the world. Even though it is not a proven neurotropic virus, neurological symptoms in more severe clinical forms are frequent. The understanding of this apparent paradox is still rarely addressed in literature. METHODS The brains of thirty-eight patients with yellow fever confirmed by RT-PCR, who underwent autopsy, were analyzed morphologically to identify and characterize neuropathological changes. The data were compared with brains collected from individuals without the disease, as a control group. Both cases and controls were subdivided according to the presence or absence of co-concurrent septic shock, to exclude changes of the sepsis associated encephalopathy. To verify possible morphological differences between the yellow fever cases groups, between the control groups, and between the cases and the controls, we applied the statistical tests Fisher's exact test and chi-square, with p values < 0.05 considered statistically significant. RESULTS All cases and controls presented, at least focally, neuropathological changes, which included edema, meningeal and parenchymal inflammatory infiltrate and hemorrhages, and perivascular inflammatory infiltrate. We did not find an unequivocal aspect of encephalitis. The only parameter that, after statistical analysis, can be attributed to yellow fever was the perivascular inflammatory infiltrate. CONCLUSIONS The neuropathological findings are sufficient to justify the multiple clinical neurologic disturbances detected in the YF cases. Since most of the parameters evaluated did not show statistically significant difference between cases and controls, an explanation for most of the neuropathological findings may be the vascular changes, consequent to shock induced endotheliopathy, associated with stimulation of the immune system inherent to systemic infectious processes. The statistical difference obtained in yellow fever cases regarding perivascular infiltrate can be can be explained by the immune activation inherent to the condition.
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Affiliation(s)
- Fernando Pereira Frassetto
- grid.11899.380000 0004 1937 0722Department of Pathology, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP Brazil ,grid.261331.40000 0001 2285 7943Present Address: Department of Radiation Oncology, Ohio State University, OH Columbus, United States of America
| | - Sergio Rosemberg
- grid.11899.380000 0004 1937 0722Department of Pathology, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP Brazil
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12
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Kling K, Domingo C, Bogdan C, Duffy S, Harder T, Howick J, Kleijnen J, McDermott K, Wichmann O, Wilder-Smith A, Wolff R. Duration of Protection After Vaccination Against Yellow Fever: A Systematic Review and Meta-Analysis. Clin Infect Dis 2022; 75:2266-2274. [PMID: 35856638 PMCID: PMC9761887 DOI: 10.1093/cid/ciac580] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/30/2022] [Accepted: 07/13/2022] [Indexed: 01/19/2023] Open
Abstract
The duration of protection after a single dose of yellow fever vaccine is a matter of debate. To summarize the current knowledge, we performed a systematic literature review and meta-analysis. Studies on the duration of protection after 1 and ≥2 vaccine doses were reviewed. Data were stratified by time since vaccination. In our meta-analysis, we used random-effects models. We identified 36 studies from 20 countries, comprising more than 17 000 participants aged 6 months to 85 years. Among healthy adults and children, pooled seroprotection rates after single vaccination dose were close to 100% by 3 months and remained high in adults for 5 to 10 years. In children vaccinated before age 2 years, the seroprotection rate was 52% within 5 years after primary vaccination. For immunodeficient persons, data indicate relevant waning. The extent of waning of seroprotection after yellow fever vaccination depends on age and immune status at primary vaccination.
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Affiliation(s)
- Kerstin Kling
- Immunization Unit, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Cristina Domingo
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Christian Bogdan
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich Alexander Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Steven Duffy
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | - Thomas Harder
- Immunization Unit, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Jeremy Howick
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | | | - Ole Wichmann
- Immunization Unit, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Annelies Wilder-Smith
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Robert Wolff
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
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13
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Avelino-Silva VI, Thomazella MV, Marmorato MP, Correia CA, Dias JZC, Maestri A, Cerqueira NB, Moreira CHV, Buccheri R, Félix AC, Zanella LGFABE, Costa PR, Kallás EG. Viral Kinetics in Sylvatic Yellow Fever Cases. J Infect Dis 2022; 227:1097-1103. [PMID: 36316804 DOI: 10.1093/infdis/jiac435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/27/2022] Open
Abstract
Abstract
Background
Yellow fever is a mosquito-borne zoonotic disease caused by yellow fever virus (YFV). Between 2017 and 2019, more than 504 human cases and 176 deaths were confirmed in the outskirts of São Paulo city. Throughout this outbreak, studies suggested a potential association between YFV viremia and mortality.
Methods
Viral ribonucleic acid was measured using reverse-transcription quantitative polymerase chain reaction in plasma samples collected at up to 5 time points, between 3 and 120 days after symptoms onset.
Results
Eighty-four patients with confirmed YFV infection were included. Most were males, median age was 42, and 30 (36%) died. Deceased patients were older than survivors (P = .003) and had a higher viremia across all time points (P = .0006). Mean values of viremia had a positive, statistically significant correlation with peak values of neutrophils, indirect bilirubin, aspartate transaminase, international normalized ratio, and creatinine. Finally, a Cox proportional hazards model adjusted for age and laboratory variables showed that viremia is independently associated with death, with a mean 1.84-fold increase (84%) in the hazard of death (P < .001) for each unit increase in mean log10 viremia.
Conclusions
Our results raise the importance of monitoring YFV viremia and suggest a potential benefit of antiviral drugs or neutralizing monoclonal antibodies early in the course of this infection to improve disease outcomes.
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Affiliation(s)
- Vivian I Avelino-Silva
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 05403-000 , Brazil
| | - Mateus Vailant Thomazella
- Medical Investigation Laboratory 60 (LIM-60), Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 1246-903 , Brazil
| | - Mariana Prado Marmorato
- Medical Investigation Laboratory 60 (LIM-60), Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 1246-903 , Brazil
| | - Carolina A Correia
- Medical Investigation Laboratory 60 (LIM-60), Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 1246-903 , Brazil
| | - Juliana Z C Dias
- Medical Investigation Laboratory 60 (LIM-60), Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 1246-903 , Brazil
| | - Alvino Maestri
- Medical Investigation Laboratory 60 (LIM-60), Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 1246-903 , Brazil
| | - Natalia B Cerqueira
- Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo , SP, 05403-000 , Brazil
| | - Carlos H V Moreira
- Institute of Infectology “Emilio Ribas” , São Paulo, SP, 01246-900 , Brazil
- Institute of Tropical Medicine, Universidade de São Paulo , São Paulo, SP, 05403-000 , Brazil
| | - Renata Buccheri
- Institute of Infectology “Emilio Ribas” , São Paulo, SP, 01246-900 , Brazil
| | - Alvina C Félix
- Institute of Tropical Medicine, Universidade de São Paulo , São Paulo, SP, 05403-000 , Brazil
| | - Luiz G F A B E Zanella
- Medical Investigation Laboratory 60 (LIM-60), Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 1246-903 , Brazil
| | - Priscilla R Costa
- Medical Investigation Laboratory 60 (LIM-60), Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 1246-903 , Brazil
| | - Esper G Kallás
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 05403-000 , Brazil
- Medical Investigation Laboratory 60 (LIM-60), Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 1246-903 , Brazil
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14
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Tuells J, Henao-Martínez AF, Franco-Paredes C. The Perennial Threat of Yellow Fever. Arch Med Res 2022; 53:649-657. [DOI: 10.1016/j.arcmed.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/13/2022] [Indexed: 11/24/2022]
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15
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Continuous Circulation of Yellow Fever among Rural Populations in the Central African Republic. Viruses 2022; 14:v14092014. [PMID: 36146820 PMCID: PMC9503741 DOI: 10.3390/v14092014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Yellow fever remains a public-health threat in remote regions of Africa. Here, we report the identification and genetic characterisation of one yellow-fever case observed during the investigation of a cluster of nine suspected haemorrhagic fever cases in a village in the Central African Republic. Samples were tested using real-time RT-PCR targeting the main African haemorrhagic fever viruses. Following negative results, we attempted virus isolation on VERO E6 cells and new-born mice and rescreened the samples using rRT-PCR. The whole viral genome was sequenced using an Illumina NovaSeq 6000 sequencer. Yellow-fever virus (YFV) was isolated from one woman who reported farming activities in a forest setting several days before disease onset. Phylogenetic analysis shows that this strain belongs to the East–Central African YFV genotype, with an estimated emergence some 63 years ago. Finally, five unique amino-acid changes are present in the capsid, envelop, NS1A, NS3, and NS4B proteins. More efforts are required to control yellow-fever re-emergence in resource-limited settings.
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16
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Ma J, Yakass MB, Jansen S, Malengier-Devlies B, Van Looveren D, Sanchez-Felipe L, Vercruysse T, Weynand B, Javarappa MPA, Quaye O, Matthys P, Roskams T, Neyts J, Thibaut HJ, Dallmeier K. Live-attenuated YF17D-vectored COVID-19 vaccine protects from lethal yellow fever virus infection in mouse and hamster models. EBioMedicine 2022; 83:104240. [PMID: 36041265 PMCID: PMC9419561 DOI: 10.1016/j.ebiom.2022.104240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/29/2022] [Accepted: 08/10/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The live-attenuated yellow fever vaccine YF17D holds great promise as alternative viral vector vaccine platform, showcased by our previously presented potent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine candidate YF-S0. Besides protection from SARS-CoV-2, YF-S0 also induced strong yellow fever virus (YFV)-specific immunity, suggestive for full dual activity. A vaccine concomitantly protecting from SARS-CoV-2 and YFV would be of great benefit for those living in YFV-endemic areas with limited access to current SARS-CoV-2 vaccines. However, for broader applicability, pre-existing vector immunity should not impact the potency of such YF17D-vectored vaccines. METHODS The immunogenicity and efficacy of YF-S0 against YFV and SARS-CoV-2 in the presence of strong pre-existing YFV immunity were evaluated in mouse and hamster challenge models. FINDINGS Here, we show that a single dose of YF-S0 is sufficient to induce strong humoral and cellular immunity against YFV as well as SARS-CoV-2 in mice and hamsters; resulting in full protection from vigorous YFV challenge in either model; in mice against lethal intracranial YF17D challenge, and in hamsters against viscerotropic infection and liver disease following challenge with highly pathogenic hamster-adapted YFV-Asibi strain. Importantly, strong pre-existing immunity against the YF17D vector did not interfere with subsequent YF-S0 vaccination in mice or hamsters; nor with protection conferred against SARS-CoV-2 strain B1.1.7 (Alpha variant) infection in hamsters. INTERPRETATION Our findings warrant the development of YF-S0 as dual SARS-CoV-2 and YFV vaccine. Contrary to other viral vaccine platforms, use of YF17D does not suffer from pre-existing vector immunity. FUNDING Stated in the acknowledgments.
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Affiliation(s)
- Ji Ma
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology, Molecular Vaccinology and Vaccine Discovery, Leuven, Belgium,Global Virus Network (GVN), Baltimore, MD, USA
| | - Michael Bright Yakass
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology, Molecular Vaccinology and Vaccine Discovery, Leuven, Belgium,Global Virus Network (GVN), Baltimore, MD, USA,West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana
| | - Sander Jansen
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology, Molecular Vaccinology and Vaccine Discovery, Leuven, Belgium,Global Virus Network (GVN), Baltimore, MD, USA
| | - Bert Malengier-Devlies
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Immunity and Inflammation Research Group, Immunobiology Unit, KU Leuven, Leuven, Belgium
| | - Dominique Van Looveren
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology, Molecular Vaccinology and Vaccine Discovery, Leuven, Belgium,Global Virus Network (GVN), Baltimore, MD, USA,KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, Translational Platform Virology and Chemotherapy, Leuven, Belgium
| | - Lorena Sanchez-Felipe
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology, Molecular Vaccinology and Vaccine Discovery, Leuven, Belgium,Global Virus Network (GVN), Baltimore, MD, USA
| | - Thomas Vercruysse
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology, Molecular Vaccinology and Vaccine Discovery, Leuven, Belgium,Global Virus Network (GVN), Baltimore, MD, USA,KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, Translational Platform Virology and Chemotherapy, Leuven, Belgium
| | - Birgit Weynand
- KU Leuven Department of Imaging and Pathology, Translational Cell and Tissue Research, Leuven, Belgium
| | - Mahadesh Prasad Arkalagud Javarappa
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology, Molecular Vaccinology and Vaccine Discovery, Leuven, Belgium,Global Virus Network (GVN), Baltimore, MD, USA
| | - Osbourne Quaye
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology, Molecular Vaccinology and Vaccine Discovery, Leuven, Belgium,Global Virus Network (GVN), Baltimore, MD, USA,West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana
| | - Patrick Matthys
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Immunity and Inflammation Research Group, Immunobiology Unit, KU Leuven, Leuven, Belgium
| | - Tania Roskams
- KU Leuven Department of Imaging and Pathology, Translational Cell and Tissue Research, Leuven, Belgium
| | - Johan Neyts
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology, Molecular Vaccinology and Vaccine Discovery, Leuven, Belgium,Global Virus Network (GVN), Baltimore, MD, USA
| | - Hendrik Jan Thibaut
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology, Molecular Vaccinology and Vaccine Discovery, Leuven, Belgium,Global Virus Network (GVN), Baltimore, MD, USA,KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, Translational Platform Virology and Chemotherapy, Leuven, Belgium
| | - Kai Dallmeier
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology, Molecular Vaccinology and Vaccine Discovery, Leuven, Belgium,Global Virus Network (GVN), Baltimore, MD, USA,Corresponding author.
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17
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Gabiane G, Yen P, Failloux A. Aedes mosquitoes in the emerging threat of urban yellow fever transmission. Rev Med Virol 2022; 32:e2333. [PMID: 35124859 PMCID: PMC9541788 DOI: 10.1002/rmv.2333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/05/2022] [Accepted: 01/18/2022] [Indexed: 01/04/2023]
Abstract
This last decade has seen a resurgence of yellow fever (YF) in historical endemic regions and repeated attempts of YF introduction in YF‐free countries such as the Asia‐Pacific region and the Caribbean. Infected travellers are the main entry routes in these regions where competent mosquito vectors proliferate in appropriate environmental conditions. With the discovery of the 17D vaccine, it was thought that YF would be eradicated. Unfortunately, it was not the case and, contrary to dengue, chikungunya and Zika, factors that cotribute to YF transmission remain under investigation. Today, all the signals are red and it is very likely that YF will be the next pandemic in the YF‐free regions where millions of people are immunologically naïve. Unlike COVID‐19, YF is associated with a high case‐fatality rate and a high number of deaths are expected. This review gives an overview of global YF situation, including the non‐endemic Asia‐Pacific region and the Caribbean where Aedes aegypti is abundantly distributed, and also proposes different hypotheses on why YF outbreaks have not yet occurred despite high records of travellers importing YF into these regions and what role Aedes mosquitoes play in the emergence of urban YF.
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Affiliation(s)
- Gaelle Gabiane
- Institut Pasteur Université de Paris, Unit of Arboviruses and Insect Vectors Paris France
- Université des Antilles, Campus de Schoelcher Schoelcher Martinique
| | - Pei‐Shi Yen
- Institut Pasteur Université de Paris, Unit of Arboviruses and Insect Vectors Paris France
| | - Anna‐Bella Failloux
- Institut Pasteur Université de Paris, Unit of Arboviruses and Insect Vectors Paris France
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18
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Gehrke F, Cardoso Gois K, da Costa Alves Aguiar Reis B, Zorello Laporta G, Affonso Fonseca FL. Dengue 2 serotype and yellow fever coinfection. Access Microbiol 2022; 3:000300. [PMID: 35024560 PMCID: PMC8749146 DOI: 10.1099/acmi.0.000300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/31/2021] [Indexed: 01/02/2023] Open
Abstract
Case Presentation Arboviruses primarily consist of RNA, which favours greater genetic plasticity, with a higher frequency of mutations that allow the virus to adapt to different hosts. The initial symptomatology is nonspecific, in that the patient can present fever, myalgia, arthralgia, rash and headache. This makes a clinical diagnosis using laboratory tests difficult and time-consuming. In Brazil, the main arboviruses involved in epidemics belong to the family Flaviviridae. The patient in this case is from the municipality of São Bernardo do Campo, an area endemic for arboviruses. He presented symptoms of fever, myalgia and headache. Results The multiplex assay for arboviruses detected genetic material from the dengue 2 and yellow fever viruses. Conclusion This result confirms the importance of molecular tests showing high sensitivity and specificity that can assist clinical diagnosis, particularly in endemic areas during periods of outbreak for other arboviruses, like the epidemiological picture in Brazil in 2018, when significant co-circulation of dengue virus and yellow fever virus occurred. The presence of co-circulating arboviruses increases the chance of coinfection and demonstrates the importance of differential diagnosis.
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Affiliation(s)
- Flávia Gehrke
- Programa de Pós Graduação em Ciências da Saúde, Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo, Brazil.,Patologia, Centro Universitário FMABC, Santo André, São Paulo, Brazil.,Programa de Pós Graduação em Ciências da Saúde, Centro Universitário FMABC, São Paulo, Santo André, Brazil.,Present address: Programa de Pós Graduação em Ciências da Saúde, Centro Universitário FMABC, São Paulo, Santo André, Brazil
| | - Katharyna Cardoso Gois
- Programa de Pós Graduação em Ciências da Saúde, Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo, Brazil
| | | | - Gabriel Zorello Laporta
- Programa de Pós Graduação em Ciências da Saúde, Centro Universitário FMABC, São Paulo, Santo André, Brazil
| | - Fernando Luiz Affonso Fonseca
- Programa de Pós Graduação em Ciências da Saúde, Centro Universitário FMABC, São Paulo, Santo André, Brazil.,Laboratório de Análises Clínicas, FMABC-Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil.,Departamento de Ciências Farmacêuticas, Universidade Federal de São Paulo (UNIFESP), Diadema, São Paulo, Brazil
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19
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Yellow Fever in Transplantation. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00761-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Servadio JL, Muñoz-Zanzi C, Convertino M. Estimating case fatality risk of severe Yellow Fever cases: systematic literature review and meta-analysis. BMC Infect Dis 2021; 21:819. [PMID: 34399718 PMCID: PMC8365934 DOI: 10.1186/s12879-021-06535-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Case fatality risk (CFR), commonly referred to as a case fatality ratio or rate, represents the probability of a disease case being fatal. It is often estimated for various diseases through analysis of surveillance data, case reports, or record examinations. Reported CFR values for Yellow Fever vary, offering wide ranges. Estimates have not been found through systematic literature review, which has been used to estimate CFR of other diseases. This study aims to estimate the case fatality risk of severe Yellow Fever cases through a systematic literature review and meta-analysis. METHODS A search strategy was implemented in PubMed and Ovid Medline in June 2019 and updated in March 2021, seeking reported severe case counts, defined by fever and either jaundice or hemorrhaging, and the number of those that were fatal. The searches yielded 1,133 studies, and title/abstract review followed by full text review produced 14 articles reporting 32 proportions of fatal cases, 26 of which were suitable for meta-analysis. Four studies with one proportion each were added to include clinical case data from the recent outbreak in Brazil. Data were analyzed through an intercept-only logistic meta-regression with random effects for study. Values of the I2 statistic measured heterogeneity across studies. RESULTS The estimated CFR was 39 % (95 % CI: 31 %, 47 %). Stratifying by continent showed that South America observed a higher CFR than Africa, though fewer studies reported estimates for South America. No difference was seen between studies reporting surveillance data and studies investigating outbreaks, and no difference was seen among different symptom definitions. High heterogeneity was observed across studies. CONCLUSIONS Approximately 39 % of severe Yellow Fever cases are estimated to be fatal. This study provides the first systematic literature review to estimate the CFR of Yellow Fever, which can provide insight into outbreak preparedness and estimating underreporting.
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Affiliation(s)
- Joseph L Servadio
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, 55401, MN, USA.
| | - Claudia Muñoz-Zanzi
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, 55401, MN, USA
| | - Matteo Convertino
- Nexus Group and Gi-CORE, Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Hokkaido, Japan
- Institute of Environment and Ecology, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
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21
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Sikdar A, Gupta R, Boura E. Reviewing Antiviral Research Against Viruses Causing Human Diseases - A Structure Guided Approach. Curr Mol Pharmacol 2021; 15:306-337. [PMID: 34348638 DOI: 10.2174/1874467214666210804152836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 11/22/2022]
Abstract
The littlest of all the pathogens, viruses have continuously been the foremost strange microorganisms to consider. Viral Infections can cause extreme sicknesses as archived by the HIV/AIDS widespread or the later Ebola or Zika episodes. Apprehensive framework distortions are too regularly watched results of numerous viral contaminations. Besides, numerous infections are oncoviruses, which can trigger different sorts of cancer. Nearly every year a modern infection species rises debilitating the world populace with an annihilating episode. Subsequently, the need of creating antivirals to combat such rising infections. In any case, from the innovation of to begin with antiviral medicate Idoxuridine in 1962 to the revelation of Baloxavir marboxil (Xofluza) that was FDA-approved in 2018, the hone of creating antivirals has changed significantly. In this article, different auxiliary science strategies have been described that can be referral for therapeutics innovation.
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Affiliation(s)
- Arunima Sikdar
- Department of Hematology and Oncology, School of Medicine, The University of Tennessee Health Science Center, 920 Madison Ave, P.O.Box-38103, Memphis, Tennessee. United States
| | - Rupali Gupta
- Department of Neurology, Duke University Medical Center, Durham, North Carolina. United States
| | - Evzen Boura
- Department of Molecular Biology and Biochemistry, Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Flemingovo namesti 542/2, P.O. Box:16000, Prague. Czech Republic
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22
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Neves YCS, de Castro-Lima VAC, Solla DJF, Ogata VSDM, Pereira FL, Araujo JM, Nastri ACS, Ho YL, Chammas MC. Staging liver fibrosis after severe yellow fever with ultrasound elastography in Brazil: A six-month follow-up study. PLoS Negl Trop Dis 2021; 15:e0009594. [PMID: 34283826 PMCID: PMC8323872 DOI: 10.1371/journal.pntd.0009594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/30/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Yellow fever (YF) is a hemorrhagic disease caused by an arbovirus endemic in South America, with recent outbreaks in the last years. Severe cases exhibit fulminant hepatitis, but there are no studies regarding its late-term effects on liver parenchyma. Thus, the aim of this study was to determine the frequency and grade of liver fibrosis in patients who recovered from severe YF and to point out potential predictors of this outcome. METHODOLOGY/PRINCIPAL FINDINGS We followed-up 18 patients who survived severe YF during a recent outbreak (January-April 2018) in Brazil using ultrasound (US) with shear-wave elastography (SWE) at 6 months after symptoms onset. No patient had previous history of liver disease. Median liver stiffness (LS) was 5.3 (4.6-6.4) kPa. 2 (11.1%) patients were classified as Metavir F2, 1 (8.3%) as F3 and 1 (8.3%) as F4; these two last patients had features of cardiogenic liver congestion on Doppler analysis. Age and cardiac failure were associated with increased LS (p = 0.036 and p = 0.024, respectively). SAPS-3 at ICU admission showed a tendency of association with significant fibrosis (≥ F2; p = 0.053). 7 patients used sofosbuvir in a research protocol, of which none showed liver fibrosis (p = 0.119). CONCLUSIONS/SIGNIFICANCE We found a low frequency of liver fibrosis in severe YF survivors. US with SWE may have a role in the follow up of patients of age and / or with comorbidities after hospital discharge in severe YF, a rare but reemergent disease.
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Affiliation(s)
- Yuri Costa Sarno Neves
- Radiology Institute, Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | | | - Davi Jorge Fontoura Solla
- Department of Neurology, Division of Neurosurgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Vivian Simone de Medeiros Ogata
- Radiology Institute, Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Fernando Linhares Pereira
- Radiology Institute, Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Jordana Machado Araujo
- Department and Division of Infectious and Parasitic Diseases, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Ana Catharina Seixas Nastri
- Department and Division of Infectious and Parasitic Diseases, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Yeh-Li Ho
- Department and Division of Infectious and Parasitic Diseases, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Maria Cristina Chammas
- Radiology Institute, Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
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23
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Cracknell Daniels B, Gaythorpe K, Imai N, Dorigatti I. Yellow fever in Asia-a risk analysis. J Travel Med 2021; 28:taab015. [PMID: 33506250 PMCID: PMC8045179 DOI: 10.1093/jtm/taab015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is concern about the risk of yellow fever (YF) establishment in Asia, owing to rising numbers of urban outbreaks in endemic countries and globalisation. Following an outbreak in Angola in 2016, YF cases were introduced into China. Prior to this, YF had never been recorded in Asia, despite climatic suitability and the presence of mosquitoes. An outbreak in Asia could result in widespread fatalities and huge economic impact. Therefore, quantifying the potential risk of YF outbreaks in Asia is a public health priority. METHODS Using international flight data and YF incidence estimates from 2016, we quantified the risk of YF introduction via air travel into Asia. In locations with evidence of a competent mosquito population, the potential for autochthonous YF transmission was estimated using a temperature-dependent model of the reproduction number and a branching process model assuming a negative binomial distribution. RESULTS In total, 25 cities across Asia were estimated to be at risk of receiving at least one YF viraemic traveller during 2016. At their average temperatures, we estimated the probability of autochthonous transmission to be <50% in all cities, which was primarily due to the limited number of estimated introductions that year. CONCLUSION Despite the rise in air travel, we found low support for travel patterns between YF endemic countries and Asia resulting in autochthonous transmission during 2016. This supports the historic absence of YF in Asia and suggests it could be due to a limited number of introductions in previous years. Future increases in travel volumes or YF incidence can increase the number of introductions and the risk of autochthonous transmission. Given the high proportion of asymptomatic or mild infections and the challenges of YF surveillance, our model can be used to estimate the introduction and outbreak risk and can provide useful information to surveillance systems.
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Affiliation(s)
- Bethan Cracknell Daniels
- MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London
| | - Katy Gaythorpe
- MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London
| | - Natsuko Imai
- MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London
| | - Ilaria Dorigatti
- MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London
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24
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Koehl B, Aupiais C, Schinckel N, Mornand P, Odièvre MH, Niakate A, Brousse V, Ithier G, Missud F, Holvoet L, Benkerrou M, Sorge F, Faye A. Tolerance and humoral immune response to the yellow fever vaccine in sickle cell disease children treated with hydroxyurea: a multicentre prospective study. J Travel Med 2021; 28:6129658. [PMID: 33550421 DOI: 10.1093/jtm/taab013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/11/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) children are frequent travellers to countries where yellow fever (YF) is endemic, but there are no data regarding the safety and immunogenicity of the vaccine in such children treated with hydroxyurea (HU). The main objective of this study was to compare the tolerance and immune response to YF vaccination in SCD children treated or not with HU. METHOD SCD children < 18 years attending the international travel clinics of three large paediatric centres and requiring a first YF vaccination were included in a prospective study. Adverse events were collected 2 weeks after vaccination. YF vaccine antibody titres were measured ~6 months after vaccination. RESULTS Among the 52 SCD children vaccinated against YF, 17 (33%) were treated with HU. Only mild adverse events, mainly fever and local reaction, were observed in the HU group with a similar frequency in the non-HU group (57 and 35%, respectively, P = 0.30). YF antibody titres were measured in 15/17 patients in the HU group and 23/35 patients in the non-HU group after a median of 6.0 months (3.5-8.5) following vaccination. The geometric mean of YF antibody titre was similar in both groups. A protective antibody level was observed in 85% of the children in the HU group vs 100% in the non-HU group (P = 0.14), suggesting a lower effectiveness of the vaccine in patients on HU similarly to what has been described in patients on immune suppressive therapy for other vaccines. CONCLUSION YF vaccination seems to be safe and efficient in SCD children treated with HU. Considering the potential risk of severe complications in cases of YF while travelling in Africa for those patients, the benefit-to-risk ratio argues for YF vaccination in all SCD children. Control of a protective antibody titre may also be useful to ascertain an adequate response in those treated with HU.
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Affiliation(s)
- Berengere Koehl
- Department of Haematology, Reference Centre of Sickle Cell Disease, Hôpital Robert Debré, APHP, 48 Bd Sérurier, Paris 75019, France.,Université de Paris, 48 Bld Serurier, 75019, Paris, France.,INSERM UMRS 1134, BIGR, 6 rue Alexandre Cabanel, 75015, Paris, France
| | - Camille Aupiais
- INSERM UMRS 1123, ECEVE, 10 avenue de Verdun 75010, Paris, France.,Department of Paediatrics Emergency, Jean Verdier Hospital, APHP, Bondy, France
| | - Nelly Schinckel
- Department of General Paediatrics and Infectious Diseases, Robert Debré Hospital, APHP, Paris, France
| | - Pierre Mornand
- Department of General Paediatrics, Centre for Sickle Cell Disease, Trousseau Hospital, APHP, Sorbonne Université, Paris, France
| | - Marie-Hélène Odièvre
- INSERM UMRS 1134, BIGR, 6 rue Alexandre Cabanel, 75015, Paris, France.,Department of General Paediatrics, Centre for Sickle Cell Disease, Trousseau Hospital, APHP, Sorbonne Université, Paris, France
| | - Assa Niakate
- Department of General Paediatrics, Centre for Sickle Cell Disease, Trousseau Hospital, APHP, Sorbonne Université, Paris, France
| | - Valentine Brousse
- INSERM UMRS 1134, BIGR, 6 rue Alexandre Cabanel, 75015, Paris, France.,Department of General Paediatrics, Necker-Enfants malades hospital, APHP, 149 rue de Sevres, 75015, Paris, France
| | - Ghislaine Ithier
- Department of Haematology, Reference Centre of Sickle Cell Disease, Hôpital Robert Debré, APHP, 48 Bd Sérurier, Paris 75019, France
| | - Florence Missud
- Department of Haematology, Reference Centre of Sickle Cell Disease, Hôpital Robert Debré, APHP, 48 Bd Sérurier, Paris 75019, France
| | - Laurent Holvoet
- Department of Haematology, Reference Centre of Sickle Cell Disease, Hôpital Robert Debré, APHP, 48 Bd Sérurier, Paris 75019, France
| | - Malika Benkerrou
- Department of Haematology, Reference Centre of Sickle Cell Disease, Hôpital Robert Debré, APHP, 48 Bd Sérurier, Paris 75019, France.,INSERM UMRS 1123, ECEVE, 10 avenue de Verdun 75010, Paris, France
| | - Frederic Sorge
- Department of Haematology, Reference Centre of Sickle Cell Disease, Hôpital Robert Debré, APHP, 48 Bd Sérurier, Paris 75019, France
| | - Albert Faye
- Université de Paris, 48 Bld Serurier, 75019, Paris, France.,INSERM UMRS 1123, ECEVE, 10 avenue de Verdun 75010, Paris, France.,Department of General Paediatrics and Infectious Diseases, Robert Debré Hospital, APHP, Paris, France
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25
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Ultrasound Findings and Laboratory Predictors of Early Mortality in Patients With Severe Yellow Fever. AJR Am J Roentgenol 2021; 216:1392-1399. [PMID: 33703928 DOI: 10.2214/ajr.20.23455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE. Yellow fever is a hemorrhagic disease caused by an arbovirus endemic in South America; outbreaks have occurred in recent years. The purpose of this study was to describe abdominal ultrasound findings in patients with severe yellow fever and correlate them with clinical and laboratory data. MATERIALS AND METHODS. A retrospective cohort study was performed between January and April 2018. The subjects were patients admitted to an ICU with polymerase chain reaction-confirmed yellow fever. Bedside sonography was performed within 48 hours of admission. Images were independently analyzed by two board-certified radiologists. Laboratory test samples were collected within 12 hours of image acquisition. Multivariable logistic regression analysis was performed to identify 30-day mortality predictors; p < .05 was considered statistically significant. RESULTS. Forty-six patients (40 [87%] men, six [13%] women; mean age, 47.5 ± 15.2 years) were evaluated with bedside sonography. Laboratory tests showed high serum levels of aspartate aminotransferase (5319 U/L), total bilirubin (6.2 mg/dL), and creati-nine (4.3 mg/dL). Twenty-six (56.5%) patients died within 30 days of admission (median time to death, 5 days [interquartile range, 2-9 days]). The most frequent ultrasound findings were gallbladder wall thickening (80.4%), increased renal cortex echogenicity (71.7%), increased liver parenchyma echogenicity (65.2%), perirenal fluid (52.2%), and ascites (30.4%). Increased renal echogenicity was associated with 30-day mortality (84.6% versus 55.0%; p = .046) and was an independent predictor of this outcome after multivariate analysis (odds ratio, 10.89; p = .048). CONCLUSION. Reproducible abdominal ultrasound findings in patients with severe yellow fever may be associated with severity of disease and prognosis among patients treated in the ICU.
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26
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McEntire CRS, Song KW, McInnis RP, Rhee JY, Young M, Williams E, Wibecan LL, Nolan N, Nagy AM, Gluckstein J, Mukerji SS, Mateen FJ. Neurologic Manifestations of the World Health Organization's List of Pandemic and Epidemic Diseases. Front Neurol 2021; 12:634827. [PMID: 33692745 PMCID: PMC7937722 DOI: 10.3389/fneur.2021.634827] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/25/2021] [Indexed: 01/02/2023] Open
Abstract
The World Health Organization (WHO) monitors the spread of diseases globally and maintains a list of diseases with epidemic or pandemic potential. Currently listed diseases include Chikungunya, cholera, Crimean-Congo hemorrhagic fever, Ebola virus disease, Hendra virus infection, influenza, Lassa fever, Marburg virus disease, Neisseria meningitis, MERS-CoV, monkeypox, Nipah virus infection, novel coronavirus (COVID-19), plague, Rift Valley fever, SARS, smallpox, tularemia, yellow fever, and Zika virus disease. The associated pathogens are increasingly important on the global stage. The majority of these diseases have neurological manifestations. Those with less frequent neurological manifestations may also have important consequences. This is highlighted now in particular through the ongoing COVID-19 pandemic and reinforces that pathogens with the potential to spread rapidly and widely, in spite of concerted global efforts, may affect the nervous system. We searched the scientific literature, dating from 1934 to August 2020, to compile data on the cause, epidemiology, clinical presentation, neuroimaging features, and treatment of each of the diseases of epidemic or pandemic potential as viewed through a neurologist's lens. We included articles with an abstract or full text in English in this topical and scoping review. Diseases with epidemic and pandemic potential can be spread directly from human to human, animal to human, via mosquitoes or other insects, or via environmental contamination. Manifestations include central neurologic conditions (meningitis, encephalitis, intraparenchymal hemorrhage, seizures), peripheral and cranial nerve syndromes (sensory neuropathy, sensorineural hearing loss, ophthalmoplegia), post-infectious syndromes (acute inflammatory polyneuropathy), and congenital syndromes (fetal microcephaly), among others. Some diseases have not been well-characterized from a neurological standpoint, but all have at least scattered case reports of neurological features. Some of the diseases have curative treatments available while in other cases, supportive care remains the only management option. Regardless of the pathogen, prompt, and aggressive measures to control the spread of these agents are the most important factors in lowering the overall morbidity and mortality they can cause.
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Affiliation(s)
- Caleb R. S. McEntire
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Kun-Wei Song
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Robert P. McInnis
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - John Y. Rhee
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Michael Young
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Erika Williams
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Leah L. Wibecan
- Massachusetts General Hospital (MGH)-Brigham Pediatric Neurology Residency Program, Boston, MA, United States
| | - Neal Nolan
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Amanda M. Nagy
- Massachusetts General Hospital (MGH)-Brigham Pediatric Neurology Residency Program, Boston, MA, United States
| | - Jeffrey Gluckstein
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Shibani S. Mukerji
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Farrah J. Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
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27
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Raadsen M, Du Toit J, Langerak T, van Bussel B, van Gorp E, Goeijenbier M. Thrombocytopenia in Virus Infections. J Clin Med 2021; 10:jcm10040877. [PMID: 33672766 PMCID: PMC7924611 DOI: 10.3390/jcm10040877] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
Thrombocytopenia, which signifies a low platelet count usually below 150 × 109/L, is a common finding following or during many viral infections. In clinical medicine, mild thrombocytopenia, combined with lymphopenia in a patient with signs and symptoms of an infectious disease, raises the suspicion of a viral infection. This phenomenon is classically attributed to platelet consumption due to inflammation-induced coagulation, sequestration from the circulation by phagocytosis and hypersplenism, and impaired platelet production due to defective megakaryopoiesis or cytokine-induced myelosuppression. All these mechanisms, while plausible and supported by substantial evidence, regard platelets as passive bystanders during viral infection. However, platelets are increasingly recognized as active players in the (antiviral) immune response and have been shown to interact with cells of the innate and adaptive immune system as well as directly with viruses. These findings can be of interest both for understanding the pathogenesis of viral infectious diseases and predicting outcome. In this review, we will summarize and discuss the literature currently available on various mechanisms within the relationship between thrombocytopenia and virus infections.
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Affiliation(s)
- Matthijs Raadsen
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
| | - Justin Du Toit
- Department of Haematology, Wits University Donald Gordon Medical Centre Johannesburg, Johannesburg 2041, South Africa;
| | - Thomas Langerak
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
| | - Bas van Bussel
- Department of Intensive Care Medicine, Maastricht University Medical Center Plus, 6229 HX Maastricht, The Netherlands;
- Care and Public Health Research Institute (CAPHRI), Maastricht University, 6229 GT Maastricht, The Netherlands
| | - Eric van Gorp
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
- Department of Internal Medicine, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Marco Goeijenbier
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
- Department of Internal Medicine, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands
- Correspondence:
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28
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Wilder-Smith A. COVID-19 in comparison with other emerging viral diseases: risk of geographic spread via travel. Trop Dis Travel Med Vaccines 2021; 7:3. [PMID: 33517914 PMCID: PMC7847598 DOI: 10.1186/s40794-020-00129-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/26/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic poses a major global health threat. The rapid spread was facilitated by air travel although rigorous travel bans and lockdowns were able to slow down the spread. How does COVID-19 compare with other emerging viral diseases of the past two decades? RECENT FINDINGS Viral outbreaks differ in many ways, such as the individuals most at risk e.g. pregnant women for Zika and the elderly for COVID-19, their vectors of transmission, their fatality rate, and their transmissibility often measured as basic reproduction number. The risk of geographic spread via air travel differs significantly between emerging infectious diseases. COVID-19 is not associated with the highest case fatality rate compared with other emerging viral diseases such as SARS and Ebola, but the combination of a high reproduction number, superspreading events and a globally immunologically naïve population has led to the highest global number of deaths in the past 20 decade compared to any other pandemic.
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Affiliation(s)
- A Wilder-Smith
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
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29
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Wilder-Smith A. End of year editorial: hot topics in travel medicine. J Travel Med 2020; 27:5991847. [PMID: 33225360 PMCID: PMC7717345 DOI: 10.1093/jtm/taaa215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/09/2023]
Abstract
COVID-19 will reshape travel medicine, in particular in relation to business travellers and the use of digital technologies. Although the hot topic in travel medicine was the COVID-19 pandemic, travel-associated measles, yellow fever and rabies deserve some special attention.
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Affiliation(s)
- Annelies Wilder-Smith
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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30
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Wilder-Smith A, Osman S. Public health emergencies of international concern: a historic overview. J Travel Med 2020; 27:6025447. [PMID: 33284964 PMCID: PMC7798963 DOI: 10.1093/jtm/taaa227] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 12/19/2022]
Abstract
RATIONALE The International Health Regulations (IHR) have been the governing framework for global health security since 2007. Declaring public health emergencies of international concern (PHEIC) is a cornerstone of the IHR. Here we review how PHEIC are formally declared, the diseases for which such declarations have been made from 2007 to 2020 and justifications for such declarations. KEY FINDINGS Six events were declared PHEIC between 2007 and 2020: the 2009 H1N1 influenza pandemic, Ebola (West African outbreak 2013-2015, outbreak in Democratic Republic of Congo 2018-2020), poliomyelitis (2014 to present), Zika (2016) and COVID-19 (2020 to present). Poliomyelitis is the longest PHEIC. Zika was the first PHEIC for an arboviral disease. For several other emerging diseases a PHEIC was not declared despite the fact that the public health impact of the event was considered serious and associated with potential for international spread. RECOMMENDATIONS The binary nature of a PHEIC declaration is often not helpful for events where a tiered or graded approach is needed. The strength of PHEIC declarations is the ability to rapidly mobilize international coordination, streamline funding and accelerate the advancement of the development of vaccines, therapeutics and diagnostics under emergency use authorization. The ultimate purpose of such declaration is to catalyse timely evidence-based action, to limit the public health and societal impacts of emerging and re-emerging disease risks while preventing unwarranted travel and trade restrictions.
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Affiliation(s)
- Annelies Wilder-Smith
- Global Health and Epidemiology, University of Umea, 901 87 Umea, Sweden.,Heidelberg Institute of Global Health, University of Heidelberg, Im Neuenheimer Feld 365, 6900 Heidelberg, Germany
| | - Sarah Osman
- Global Health and Epidemiology, University of Umea, 901 87 Umea, Sweden
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Leong WY. COVID-19's impact on travel medicine surpasses that of all other emerging viral diseases. J Travel Med 2020; 27:6007545. [PMID: 33247591 PMCID: PMC7798941 DOI: 10.1093/jtm/taaa221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
COVID-19 has devastated economies, led to widespread lockdowns and an extent of travel restrictions that the world has not seen for decades.
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Affiliation(s)
- Wei-Yee Leong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Osman S, Preet R. Dengue, chikungunya and Zika in GeoSentinel surveillance of international travellers: a literature review from 1995 to 2020. J Travel Med 2020; 27:6007546. [PMID: 33258476 DOI: 10.1093/jtm/taaa222] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION GeoSentinel is a global surveillance network of travel medicine providers seeing ill-returned travellers. Much of our knowledge on health problems and infectious encountered by international travellers has evolved as a result of GeoSentinel surveillance, providing geographic and temporal trends in morbidity among travellers while contributing to improved pre-travel advice. We set out to synthesize epidemiological information, clinical manifestations and time trends for dengue, chikungunya and Zika in travellers as captured by GeoSentinel. METHODS We conducted a systematic literature search in PubMed on international travellers who presented with dengue, chikungunya or Zika virus infections to GeoSentinel sites around the world from 1995 until 2020. RESULTS Of 107 GeoSentinel publications, 42 articles were related to dengue, chikungunya and/or Zika. The final analyses and synthesis of and results presented here are based on the findings from 27 original articles covering the three arboviral diseases. CONCLUSIONS Dengue is the most frequent arboviral disease encountered in travellers presenting to GeoSentinel sites, with increasing trends over the past two decades. In Southeast Asia, annual proportionate morbidity increased from 50 dengue cases per 1000 ill returned travellers in non-epidemic years to an average of 159 cases per 1000 travellers during epidemic years. The highest number of travellers with chikungunya virus infections was reported during the chikungunya outbreak in the Americas and the Caribbean in the years 2013-16. Zika was first reported by GeoSentinel already in 2012, but notifications peaked in the years 2016-17 reflecting the public health emergency in the Americas at the time.
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Affiliation(s)
- S Osman
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, 90185, Sweden
| | - R Preet
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, 90185, Sweden
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Bailey AL, Kang LI, de Assis Barros D'Elia Zanella LGF, Silveira CGT, Ho YL, Foquet L, Bial G, McCune BT, Duarte-Neto AN, Thomas A, Raué HP, Byrnes K, Kallas EG, Slifka MK, Diamond MS. Consumptive coagulopathy of severe yellow fever occurs independently of hepatocellular tropism and massive hepatic injury. Proc Natl Acad Sci U S A 2020; 117:32648-32656. [PMID: 33268494 PMCID: PMC7768776 DOI: 10.1073/pnas.2014096117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Yellow fever (YF) is a mosquito-transmitted viral disease that causes tens of thousands of deaths each year despite the long-standing deployment of an effective vaccine. In its most severe form, YF manifests as a hemorrhagic fever that causes severe damage to visceral organs. Although coagulopathy is a defining feature of severe YF in humans, the mechanism by which it develops remains uncertain. Hepatocytes are a major target of yellow fever virus (YFV) infection, and the coagulopathy in severe YF has long been attributed to massive hepatocyte infection and destruction that results in a defect in clotting factor synthesis. However, when we analyzed blood from Brazilian patients with severe YF, we found high concentrations of plasma D-dimer, a fibrin split product, suggestive of a concurrent consumptive process. To define the relationship between coagulopathy and hepatocellular tropism, we compared infection and disease in Fah-/-, Rag2-/-, and Il2rɣ-/- mice engrafted with human hepatocytes (hFRG mice) and rhesus macaques using a highly pathogenic African YFV strain. YFV infection of macaques and hFRG mice caused substantial hepatocyte infection, liver damage, and coagulopathy as defined by virological, clinical, and pathological criteria. However, only macaques developed a consumptive coagulopathy whereas YFV-infected hFRG mice did not. Thus, infection of cell types other than hepatocytes likely contributes to the consumptive coagulopathy associated with severe YF in primates and humans. These findings expand our understanding of viral hemorrhagic disease and associated coagulopathy and suggest directions for clinical management of severe YF cases.
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Affiliation(s)
- Adam L Bailey
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110;
| | - Liang-I Kang
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110
| | | | - Cássia G T Silveira
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, Sao Paulo, Brazil 01246 903
| | - Yeh-Li Ho
- Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, Sao Paulo, Brazil 01246 903
| | | | - Greg Bial
- Yecuris Corporation, Tualatin, OR 97062
| | - Broc T McCune
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Amaro Nunes Duarte-Neto
- Department of Pathology, Clinical Hospital, School of Medicine, University of São Paulo, Sao Paulo, Brazil 01246 903
| | - Archana Thomas
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006
| | - Hans-Peter Raué
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006
| | - Kathleen Byrnes
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110
| | - Esper G Kallas
- Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, Sao Paulo, Brazil 01246 903
| | - Mark K Slifka
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006
| | - Michael S Diamond
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110;
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110
- The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO 63110
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Lataillade LDGD, Vazeille M, Obadia T, Madec Y, Mousson L, Kamgang B, Chen CH, Failloux AB, Yen PS. Risk of yellow fever virus transmission in the Asia-Pacific region. Nat Commun 2020; 11:5801. [PMID: 33199712 PMCID: PMC7669885 DOI: 10.1038/s41467-020-19625-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
Historically endemic to Sub-Saharan Africa and South America, yellow fever is absent from the Asia-Pacific region. Yellow fever virus (YFV) is mainly transmitted by the anthropophilic Aedes mosquitoes whose distribution encompasses a large belt of tropical and sub tropical regions. Increasing exchanges between Africa and Asia have caused imported YFV incidents in non-endemic areas, which are threatening Asia with a new viral emergence. Here, using experimental infections of field-collected mosquitoes, we show that Asian-Pacific Aedes mosquitoes are competent vectors for YFV. We observe that Aedes aegypti populations from Singapore, Taiwan, Thailand, and New Caledonia are capable of transmitting YFV 14 days after oral infections, with a number of viral particles excreted from saliva reaching up to 23,000 viral particles. These findings represent the most comprehensive assessment of vector competence and show that Ae. aegypti mosquitoes from the Asia-Pacific region are highly competent to YFV, corroborating that vector populations are seemingly not a brake to the emergence of yellow fever in the region. Yellow fever is absent from the Asia/Pacific region, despite presence of the mosquito vector. Here, the authors demonstrate that mosquitoes collected from field sites across the region are capable of transmitting yellow fever virus, indicating that vector competence is not a barrier to disease spread.
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Affiliation(s)
| | - Marie Vazeille
- Arboviruses and Insect Vectors Unit, Institut Pasteur, Paris, France
| | - Thomas Obadia
- Bioinformatics and Biostatistics Hub, Institut Pasteur, USR 3756, CNRS, Paris, France.,Malaria Unit: Parasites and Hosts, Institut Pasteur, Paris, France
| | - Yoann Madec
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France
| | - Laurence Mousson
- Arboviruses and Insect Vectors Unit, Institut Pasteur, Paris, France
| | - Basile Kamgang
- Department of Medical Entomology, Centre for Research in Infectious Diseases, Yaoundé, Cameroon
| | - Chun-Hong Chen
- National Health Research Institutes, Institute of Infectious Diseases and Vaccinology, Miaoli, Taiwan
| | | | - Pei-Shi Yen
- Arboviruses and Insect Vectors Unit, Institut Pasteur, Paris, France.
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35
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Abstract
Teaser Our review found the average reproductive number R0 for yellow fever to be 4.81 with a median of 4.21.
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Affiliation(s)
- Ying Liu
- School of International Business, Xiamen University Tan Kah Kee College, Zhangzhou 363105, China
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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36
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Lecomte E, Laureys G, Verbeke F, Domingo Carrasco C, Van Esbroeck M, Huits R. A clinician's perspective on yellow fever vaccine-associated neurotropic disease. J Travel Med 2020; 27:taaa172. [PMID: 32965473 PMCID: PMC7649383 DOI: 10.1093/jtm/taaa172] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 01/13/2023]
Abstract
Yellow fever (YF) causes high fever, liver dysfunction, renal failure, hypercoagulopathy and platelet dysfunction and can lead to shock and death with a case-fatality ratio of 20-50%. YF vaccination results in long-lasting protective immunity. Serious adverse events (SAEs), such as YF vaccine-associated neurotropic disease (YEL-AND) are rare. We present a case of a 56-year-old Caucasian man with fever, headache, cognitive problems at the emergency department. He received a primary YF vaccination 4 weeks prior to symptom onset. Cerebrospinal fluid tested positive (POS) for YF virus by reverse transcriptase polymerase chain reaction and confirmed diagnosis of YEL-AND. The patient recovered with symptomatic treatment. We reviewed published clinical reports on YEL-AND indexed for MEDLINE. We identified and analyzed 53 case reports. Forty-five patients were male and eight were female. Twenty-nine cases met criteria for definite YEL-AND and twenty-four for suspected YEL-AND according to YF Vaccine Safety Working Group. We applied the Brighton Collaboration diagnostic criteria to assess the diagnostic accuracy of the clinical diagnoses and found meningoencephalitis in 38 reported YEL-AND cases, Guillain Barré Syndrome (GBS) in seven, Acute Disseminated Encephalomyelitis (ADEM) in six and myelitis in five. Thirty-five patients recovered or improved; however, not all cases had a complete follow-up. The prognosis of YEL-AND presenting with GBS, ADEM or myelitis was poor. Fourteen patients received therapy (corticosteroids, intravenous immunoglobulins and/or plasmapheresis). In conclusion, YF vaccine-associated neurotropic disease is a very rare but SAE after YF vaccination. We described a case of YEL-AND and propose a standardized clinical workup of this condition based on a review of the literature. Centralized registration of complications of YF vaccination is encouraged.
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Affiliation(s)
- Elien Lecomte
- Department of Neurology, University Hospital of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Guy Laureys
- Department of Neurology, University Hospital of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Frederick Verbeke
- Department of Clinical Biology, University Hospital of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Cristina Domingo Carrasco
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses- ZBS-1, Robert Koch Institute, Seestraβe 10, 13353, Berlin, Germany
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Kronenburgstraat 43, 2000 Antwerp, Belgium
| | - Ralph Huits
- Department of Clinical Sciences, Institute of Tropical Medicine, Kronenburgstraat 43, 2000 Antwerp, Belgium
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37
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Bifani AM, Ong EZ, de Alwis R. Vaccination and Therapeutics: Responding to the Changing Epidemiology of Yellow Fever. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2020; 12:398-409. [PMID: 33173445 PMCID: PMC7644428 DOI: 10.1007/s40506-020-00237-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 12/24/2022]
Abstract
At the turn of the nineteenth century, yellow fever (YF) was considered the most dangerous infectious disease with high case fatality. Subsequent, mass vaccination campaigns coupled with widespread elimination of the YF mosquito vector significantly decreased YF cases and reduced outbreaks to the tropical and subtropical forested regions of Africa and South America. However, recent (2016) large outbreaks in Angola, Democratic Republic of Congo (DRC), and South-Eastern Brazil, where previously had been demarcated as low-risk regions, have highlighted the possibility of a rapidly changing epidemiology and the potential re-emergence of yellow fever virus (YFV). Furthermore, the first-ever importation of YFV into Asia has highlighted the potential fear of YFV emerging as a global threat. In this review, we describe the changing epidemiology of YF outbreaks, and highlight the use of public health policies, therapeutics, and vaccination as tools to help eliminate future YFV outbreaks.
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Affiliation(s)
- Amanda Makha Bifani
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Eugenia Z. Ong
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
- Viral Research and Experimental Medicine Centre @ SingHealth Duke-NUS (VIREMiCS), Singapore, Singapore
| | - Ruklanthi de Alwis
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
- Viral Research and Experimental Medicine Centre @ SingHealth Duke-NUS (VIREMiCS), Singapore, Singapore
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38
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de Oliveira Figueiredo P, Stoffella-Dutra AG, Barbosa Costa G, Silva de Oliveira J, Dourado Amaral C, Duarte Santos J, Soares Rocha KL, Araújo Júnior JP, Lacerda Nogueira M, Zazá Borges MA, Pereira Paglia A, Desiree LaBeaud A, Santos Abrahão J, Geessien Kroon E, Bretas de Oliveira D, Paiva Drumond B, de Souza Trindade G. Re-Emergence of Yellow Fever in Brazil during 2016-2019: Challenges, Lessons Learned, and Perspectives. Viruses 2020; 12:E1233. [PMID: 33143114 PMCID: PMC7692154 DOI: 10.3390/v12111233] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 12/15/2022] Open
Abstract
Yellow fever (YF) is a re-emerging viral zoonosis caused by the Yellow Fever virus (YFV), affecting humans and non-human primates (NHP). YF is endemic in South America and Africa, being considered a burden for public health worldwide despite the availability of an effective vaccine. Acute infectious disease can progress to severe hemorrhagic conditions and has high rates of morbidity and mortality in endemic countries. In 2016, Brazil started experiencing one of the most significant YF epidemics in its history, with lots of deaths being reported in regions that were previously considered free of the disease. Here, we reviewed the historical aspects of YF in Brazil, the epidemiology of the disease, the challenges that remain in Brazil's public health context, the main lessons learned from the recent outbreaks, and our perspective for facing future YF epidemics.
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Affiliation(s)
- Poliana de Oliveira Figueiredo
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (P.d.O.F.); (J.S.d.O.); (C.D.A.); (J.S.A.); (E.G.K.); (B.P.D.)
| | - Ana Gabriella Stoffella-Dutra
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (P.d.O.F.); (J.S.d.O.); (C.D.A.); (J.S.A.); (E.G.K.); (B.P.D.)
| | - Galileu Barbosa Costa
- Laboratório de Patologia e Biologia Molecular, Instituto Gonçalo Moniz, Oswaldo Cruz Foundation, Rua Waldemar Falcão, 121, Candeal, Salvador Bahia 40296-710, Brazil
| | - Jaqueline Silva de Oliveira
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (P.d.O.F.); (J.S.d.O.); (C.D.A.); (J.S.A.); (E.G.K.); (B.P.D.)
| | - Carolina Dourado Amaral
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (P.d.O.F.); (J.S.d.O.); (C.D.A.); (J.S.A.); (E.G.K.); (B.P.D.)
| | - Juliane Duarte Santos
- Centro Integrado de Pesquisa em Saúde, Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri Campus JK, Diamantina, Minas Gerais, Rodovia MGT 367, Km 583, nº 5.000 Alto da Jacuba 39100-000, Brazil; (J.D.S.); (K.L.S.R.); (D.B.d.O.)
| | - Kamila Lorene Soares Rocha
- Centro Integrado de Pesquisa em Saúde, Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri Campus JK, Diamantina, Minas Gerais, Rodovia MGT 367, Km 583, nº 5.000 Alto da Jacuba 39100-000, Brazil; (J.D.S.); (K.L.S.R.); (D.B.d.O.)
| | - João Pessoa Araújo Júnior
- Departamento de Microbiologia e Imunologia, Institute of Biotechnology, Universidade Estadual Paulista Júlio de Mesquita Filho, Rio Claro, São Paulo Avenida 24A, 1515, Bela Vista 13506-900, Brazil;
| | - Maurício Lacerda Nogueira
- Laboratório de Pesquisas em Virologia, Departamento de Doenças Infecciosas e Parasitárias, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo 15090-000, Brazil;
| | - Magno Augusto Zazá Borges
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros, Montes Claros, Minas Gerais, Avenida Prof. Rui Braga, s/n, Vila Mauriceia 39408-354, Brazil;
| | - Adriano Pereira Paglia
- Laboratório de Ecologia e Conservação, Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil;
| | - Angelle Desiree LaBeaud
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, 300 Pasteur Dr Rm G312 MC 5208, Stanford, CA 94305, USA;
| | - Jônatas Santos Abrahão
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (P.d.O.F.); (J.S.d.O.); (C.D.A.); (J.S.A.); (E.G.K.); (B.P.D.)
| | - Erna Geessien Kroon
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (P.d.O.F.); (J.S.d.O.); (C.D.A.); (J.S.A.); (E.G.K.); (B.P.D.)
| | - Danilo Bretas de Oliveira
- Centro Integrado de Pesquisa em Saúde, Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri Campus JK, Diamantina, Minas Gerais, Rodovia MGT 367, Km 583, nº 5.000 Alto da Jacuba 39100-000, Brazil; (J.D.S.); (K.L.S.R.); (D.B.d.O.)
| | - Betânia Paiva Drumond
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (P.d.O.F.); (J.S.d.O.); (C.D.A.); (J.S.A.); (E.G.K.); (B.P.D.)
| | - Giliane de Souza Trindade
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (P.d.O.F.); (J.S.d.O.); (C.D.A.); (J.S.A.); (E.G.K.); (B.P.D.)
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Hall C, Khodr ZG, Chang RN, Bukowinski AT, Gumbs GR, Conlin AMS. Safety of yellow fever vaccination in pregnancy: findings from a cohort of active duty US military women. J Travel Med 2020; 27:5896042. [PMID: 32830852 DOI: 10.1093/jtm/taaa138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/06/2020] [Accepted: 08/20/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Yellow fever (YF) is a rare viral disease that can be prevented through receipt of a live attenuated vaccine. In the US military, service members must receive the YF vaccine before assignment to endemic areas, putting active duty service women at heightened risk for inadvertent exposure during preconception or pregnancy. Few studies have investigated the safety of YF vaccination in pregnancy to date, and none in a military population. METHODS Department of Defense Birth and Infant Health Research program data were used to identify pregnancies and infants among active duty US military women, 2003-2014. Multivariable regression models estimated associations with YF vaccine exposure during preconception/pregnancy and adverse outcomes (e.g. spontaneous abortion, birth defects). Sensitivity analyses were performed that excluded pregnancies exposed to other live vaccines. For analyses of birth defects only, a secondary sensitivity analysis was performed that excluded infants diagnosed with chromosomal anomalies. RESULTS Of the 196 802 pregnancies and 160 706 singleton infants identified, 1347 (0.7%) and 1132 (0.7%), respectively, were exposed to the YF vaccine. No increased risks for adverse pregnancy or infant outcomes were observed in the main analysis. In sensitivity analyses that excluded pregnancies exposed to other live vaccines, preconception YF vaccine exposure was associated with birth defects [adjusted risk ratio (aRR) = 1.71, 95% confidence interval (CI) = 1.08-2.73]; this association was attenuated when further excluding infants with chromosomal anomalies (aRR = 1.59, 95% CI = 0.97-2.62). CONCLUSIONS Overall, YF vaccine exposure did not appear to be associated with most adverse outcomes among this population of pregnant military women. A tenuous association between preconception YF vaccine exposure and birth defects was observed in sensitivity analyses, which may warrant further investigation.
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Affiliation(s)
- Clinton Hall
- Leidos, Inc., 140 Sylvester Road, San Diego, CA, USA.,Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, USA
| | - Zeina G Khodr
- Leidos, Inc., 140 Sylvester Road, San Diego, CA, USA.,Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, USA
| | - Richard N Chang
- Leidos, Inc., 140 Sylvester Road, San Diego, CA, USA.,Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, USA
| | - Anna T Bukowinski
- Leidos, Inc., 140 Sylvester Road, San Diego, CA, USA.,Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, USA
| | - Gia R Gumbs
- Leidos, Inc., 140 Sylvester Road, San Diego, CA, USA.,Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, USA
| | - Ava Marie S Conlin
- Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, USA
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40
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Bühler S, Jaeger VK, Eperon G, Furrer H, Fux CA, Jansen S, Neumayr A, Rochat L, Schmid S, Schmidt-Chanasit J, Staehelin C, de Visser AW, Visser LG, Niedrig M, Hatz C. Safety and immunogenicity of a primary yellow fever vaccination under low-dose methotrexate therapy-a prospective multi-centre pilot study1. J Travel Med 2020; 27:5878835. [PMID: 32729905 DOI: 10.1093/jtm/taaa126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/17/2020] [Accepted: 07/24/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND More people on immunosuppression live in or wish to travel to yellow fever virus (YFV)-endemic areas. Data on the safety and immunogenicity of yellow fever vaccination (YFVV) during immunosuppression are scarce. The aim of this study was to compare the safety and immunogenicity of a primary YFVV between travellers on methotrexate and controls. METHODS We conducted a prospective multi-centre controlled observational study from 2015 to 2017 in six Swiss travel clinics. 15 adults (nine with rheumatic diseases, five with dermatologic conditions and one with a gastroenterological disease) on low-dose methotrexate (≤20 mg/week) requiring a primary YFVV and 15 age and sex-matched controls received a YFVV. Solicited/unsolicited adverse reactions were recorded, YFV-RNA was measured in serum samples on Days 3, 7, 10, 14, 28 and neutralizing antibodies on Days 0, 7, 10, 14, 28. RESULTS Patients´ and controls' median ages were 53 and 52 years; 9 patients and 10 controls were female. 43% of patients and 33% of controls showed local side effects (P = 0.71); 86% of patients and 66% of controls reported systemic reactions (P = 0.39). YFV-RNA was detected in patients and controls on Day 3-10 post-vaccination and was never of clinical significance. Slightly more patients developed YFV-RNAaemia (Day 3: n = 5 vs n = 2, Day 7: n = 9 vs n = 7, Day 10: n = 3 vs n = 2, all P > 0.39). No serious reactions occurred. On Day 10, a minority of vaccinees was seroprotected (patients: n = 2, controls: n = 6). On Day 28, all vaccinees were seroprotected. CONCLUSIONS First-time YFVV was safe and immunogenic in travellers on low-dose methotrexate. Larger studies are needed to confirm these promising results.
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Affiliation(s)
- Silja Bühler
- Department of Public Health and Global Health/Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany.,Division of Hygiene and Infectious Diseases, Institute of Hygiene and Environment, Marckmannstrasse 129a, 20539 Hamburg, Germany
| | - Veronika Katharina Jaeger
- Department of Rheumatology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.,Department of Clinical Epidemiology, Institute of Epidemiology and Social Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Gilles Eperon
- Division of Tropical and Humanitarian Medicine, Department of Primary Care, Geneva University Hospitals (HUG), Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Christoph A Fux
- Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Stephanie Jansen
- Department of Arbovirology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany
| | - Andreas Neumayr
- Department of Medicine, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland.,University of Basel, Socinstrasse 57, 4051 Basel, Switzerland
| | - Laurence Rochat
- Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital Lausanne, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Sabine Schmid
- Department of Public Health and Global Health/Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Jonas Schmidt-Chanasit
- Department of Arbovirology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany.,Faculty of Mathematics, Informatics and Natural Sciences, University of Hamburg, Bundesstraße 55, 20146 Hamburg, Germany
| | - Cornelia Staehelin
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Adriëtte W de Visser
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Leonardus G Visser
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Matthias Niedrig
- Robert Koch Institute (RKI), Seestraße 10, 13353 Berlin, Germany
| | - Christoph Hatz
- Department of Public Health and Global Health/Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.,Department of Medicine, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland.,University of Basel, Socinstrasse 57, 4051 Basel, Switzerland.,Department of Infectious Diseases and Hospital Hygiene, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
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Vaccination and Therapeutics: Responding to the Changing Epidemiology of Yellow Fever. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2020; 12:349-360. [PMID: 32837338 PMCID: PMC7351566 DOI: 10.1007/s40506-020-00232-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Purpose of Review At the turn of the nineteenth century, yellow fever (YF) was considered the most dangerous infectious disease with high case fatality. Subsequent, mass vaccination campaigns coupled with widespread elimination of the YF mosquito vector significantly decreased YF cases and reduced outbreaks to the tropical and subtropical forested regions of Africa and South America. Recent Findings However, recent (2016) large outbreaks in Angola, Democratic Republic of Congo (DRC), and South-Eastern Brazil, where previously had been demarcated as low-risk regions, have highlighted the possibility of a rapidly changing epidemiology and the potential re-emergence of yellow fever virus (YFV). Furthermore, the first-ever importation of YFV into Asia has highlighted the potential fear of YFV emerging as a global threat. Summary In this review, we describe the changing epidemiology of YF outbreaks and highlight the use of public health policies, therapeutics, and vaccination as tools to help eliminate future YFV outbreaks.
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42
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Staples JE, Barrett ADT, Wilder-Smith A, Hombach J. Review of data and knowledge gaps regarding yellow fever vaccine-induced immunity and duration of protection. NPJ Vaccines 2020; 5:54. [PMID: 32655896 PMCID: PMC7338446 DOI: 10.1038/s41541-020-0205-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/29/2020] [Indexed: 12/13/2022] Open
Abstract
Yellow fever (YF) virus is a mosquito-borne flavivirus found in Sub-Saharan Africa and tropical South America. The virus causes YF, a viral hemorrhagic fever, which can be prevented by a live-attenuated vaccine, strain 17D. Despite the vaccine being very successful at decreasing disease risk, YF is considered a re-emerging disease due to the increased numbers of cases in the last 30 years. Until 2014, the vaccine was recommended to be administered with boosters every 10 years, but in 2014 the World Health Organization recommended removal of booster doses for all except special populations. This recommendation has been questioned and there have been reports of waning antibody titers in adults over time and more recently in pediatric populations. Clearly, the potential of waning antibody titers is a very important issue that needs to be carefully evaluated. In this Perspective, we review what is known about the correlate of protection for full-dose YF vaccine, current information on waning antibody titers, and gaps in knowledge. Overall, fundamental questions exist on the durability of protective immunity induced by YF vaccine, but interpretation of studies is complicated by the use of different assays and different cut-offs to measure seroprotective immunity, and differing results among certain endemic versus non-endemic populations. Notwithstanding the above, there are few well-characterized reports of vaccine failures, which one would expect to observe potentially more with the re-emergence of a severe disease. Overall, there is a need to improve YF disease surveillance, increase primary vaccination coverage rates in at-risk populations, and expand our understanding of the mechanism of protection of YF vaccine.
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Affiliation(s)
- J. Erin Staples
- Arboviral Diseases Branch, U.S. Centers for Disease Control and Prevention, Fort Collins, CO USA
| | - Alan D. T. Barrett
- Department of Pathology and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX USA
| | - Annelies Wilder-Smith
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
- London School of Hygiene and Tropical Medicine, London, UK
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43
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Casadio L, Nastri AC, Malta FM, Araujo J, Silva JB, Salomao J, Yamashiro J, Salles AP, Gouvea MG, Kanamura C, Lima FR, Tanigawa RY, Melo ES, Lima R, Terrabuio D, Cançado E, Ho YL, Sabino EC, Pinho JR, Carrilho FJ, Alves VA, Levin AS. Late-Onset Relapsing Hepatitis Associated with Yellow Fever. N Engl J Med 2020; 382:2059-2061. [PMID: 32433844 DOI: 10.1056/nejmc1913036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Roque Lima
- Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Yeh-Li Ho
- Universidade de São Paulo, São Paulo, Brazil
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Reno E, Quan NG, Franco-Paredes C, Chastain DB, Chauhan L, Rodriguez-Morales AJ, Henao-Martínez AF. Prevention of yellow fever in travellers: an update. THE LANCET. INFECTIOUS DISEASES 2020; 20:e129-e137. [PMID: 32386609 DOI: 10.1016/s1473-3099(20)30170-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 12/20/2022]
Abstract
For centuries, yellow fever virus infection generated substantial fear among explorers, tourist travellers, workers, military personnel, and others entering areas of transmission. Currently, there is transmission only in some areas of tropical South America and sub-Saharan Africa. When symptomatic, yellow fever infection causes severe liver dysfunction and coagulopathy with elevated mortality rates. Since there is no effective treatment, vaccination against yellow fever, available since 1937, represents an important preventive intervention in endemic areas. Every year, an increasing number of individuals are travelling to yellow fever endemic areas, many of whom have complex medical conditions. Travel health practitioners should do individualised assessments of the risks and benefits of yellow fever vaccination to identify potential contraindications. The most relevant contraindications include a history of thymoma or thymus dysfunction, AIDS, and individuals receiving immunosuppressive drugs including biological therapies or chemotherapy. We briefly review strategies to prevent yellow fever infection in travellers with the use of yellow fever vaccination and the use of personal protection measures to avoid mosquito bites.
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Affiliation(s)
- Elaine Reno
- Department of Emergency Medicine, University of Colorado Denver, School of Medicine, Aurora, CO, USA
| | - Nicolas G Quan
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, School of Medicine, Aurora, CO, USA
| | - Carlos Franco-Paredes
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, School of Medicine, Aurora, CO, USA; Instituto Nacional de Salud, Hospital Infantil de México, Federico Gómez, Mexico City, Mexico
| | - Daniel B Chastain
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, USA
| | - Lakshmi Chauhan
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, School of Medicine, Aurora, CO, USA
| | - Alfonso J Rodriguez-Morales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia; Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia.
| | - Andrés F Henao-Martínez
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, School of Medicine, Aurora, CO, USA
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Cunha MS, Faria NR, Caleiro GS, Candido DS, Hill SC, Claro IM, da Costa AC, Nogueira JS, Maeda AY, da Silva FG, de Souza RP, Spinola R, Tubaki RM, de Menezes RMT, Abade L, Mucci LF, Timenetsky MDCST, Sabino E. Genomic evidence of yellow fever virus in Aedes scapularis, southeastern Brazil, 2016. Acta Trop 2020; 205:105390. [PMID: 32044285 DOI: 10.1016/j.actatropica.2020.105390] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 02/04/2023]
Abstract
The southeastern region of Brazil has recently experienced the largest yellow fever disease outbreak in decades. Since July 2016 epizootic events were reported in São Paulo state's north region, where 787 Culicidae were captured as part of public health surveillance efforts and tested using real-time quantitative PCR. One Aedes scapularis pool collected in November 2016 in an agriculture area in Urupês city tested positive for YFV-RNA. Using a validated multiplex PCR approach we were able to recover a complete virus genome sequence from this pool. Phylogenetic analysis of the novel strain and publicly available data indicates that the belongs to the South American genotype 1 clade circulating in Sao Paulo state and is basal to the recent outbreak clade in southeast Brazil. Our findings highlight the need of additional studies, including vector competence studies, to disentangle the role of Aedes scapularis in yellow fever transmission in the Americas.
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Affiliation(s)
| | | | - Giovana Santos Caleiro
- Adolfo Lutz Institute, São Paulo, SP, Brazil; Institute of Tropical Medicine, University of São Paulo, SP, Brazil
| | | | - Sarah C Hill
- Department of Zoology, University of Oxford, United Kingdom
| | | | | | | | | | | | | | - Roberta Spinola
- Centro de Vigilância Epidemiológica "Prof. Alexandre Vranjac", São Paulo, SP, Brazil
| | - Rosa Maria Tubaki
- Superintendence for Control of Endemic Diseases, São Paulo, SP, Brazil
| | | | - Leandro Abade
- Department of Zoology, University of Oxford, United Kingdom
| | - Luís Filipe Mucci
- Superintendence for Control of Endemic Diseases, Taubaté, SP, Brazil
| | | | - Esther Sabino
- Institute of Tropical Medicine, University of São Paulo, SP, Brazil
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Silva NIO, Sacchetto L, de Rezende IM, Trindade GDS, LaBeaud AD, de Thoisy B, Drumond BP. Recent sylvatic yellow fever virus transmission in Brazil: the news from an old disease. Virol J 2020; 17:9. [PMID: 31973727 PMCID: PMC6979359 DOI: 10.1186/s12985-019-1277-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/27/2019] [Indexed: 12/11/2022] Open
Abstract
Yellow fever (YF) is an acute viral disease, affecting humans and non-human primates (NHP), caused by the yellow fever virus (YFV). Despite the existence of a safe vaccine, YF continues to cause morbidity and mortality in thousands of people in Africa and South America. Since 2016, massive YF outbreaks have taken place in Brazil, reaching YF-free zones, causing thousands of deaths of humans and NHP. Here we reviewed the main epidemiological aspects, new clinical findings in humans, and issues regarding YFV infection in vectors and NHP in Brazil. The 2016-2019 YF epidemics have been considered the most significant outbreaks of the last 70 years in the country, and the number of human cases was 2.8 times higher than total cases in the previous 36 years. A new YFV lineage was associated with the recent outbreaks, with persistent circulation in Southeast Brazil until 2019. Due to the high number of infected patients, it was possible to evaluate severity and death predictors and new clinical features of YF. Haemagogus janthinomys and Haemagogus leucocelaenus were considered the primary vectors during the outbreaks, and no human case suggested the occurrence of the urban transmission cycle. YFV was detected in a variety of NHP specimens presenting viscerotropic disease, similar to that described experimentally. Further studies regarding NHP sensitivity to YFV, YF pathogenesis, and the duration of the immune response in NHP could contribute to YF surveillance, control, and future strategies for NHP conservation.
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Affiliation(s)
- Natalia Ingrid Oliveira Silva
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lívia Sacchetto
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Izabela Maurício de Rezende
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Giliane de Souza Trindade
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Angelle Desiree LaBeaud
- Division of Infectious Disease, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Benoit de Thoisy
- Laboratoire des Interactions Virus-Hôtes, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | - Betânia Paiva Drumond
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Osório FMF, Cançado GGL, Nardelli MJ, Vidigal PVT, Xavier MAP, Clemente WT. Hepatitis Relapse after Yellow Fever Infection: Is There Another Wave? Rev Soc Bras Med Trop 2020; 53:e20200152. [PMID: 32578715 PMCID: PMC7310355 DOI: 10.1590/0037-8682-0152-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/27/2020] [Indexed: 11/21/2022] Open
Abstract
During the yellow fever (YF) outbreak in Brazil, many cases of fulminant hepatitis were seen, although mild to moderate hepatitis was mostly observed with complete recovery. This report presents a case of late-onset hepatitis due to YF relapse. The patient sought medical attention after jaundice recurrence 40 days after the first YF hepatitis episode. This case highlights the importance of patient follow-up after the complete resolution of YF symptoms and discharge.
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48
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Disease Resurgence, Production Capability Issues and Safety Concerns in the Context of an Aging Population: Is There a Need for a New Yellow Fever Vaccine? Vaccines (Basel) 2019; 7:vaccines7040179. [PMID: 31717289 PMCID: PMC6963298 DOI: 10.3390/vaccines7040179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 12/19/2022] Open
Abstract
Yellow fever is a potentially fatal, mosquito-borne viral disease that appears to be experiencing a resurgence in endemic areas in Africa and South America and spreading to non-endemic areas despite an effective vaccine. This trend has increased the level of concern about the disease and the potential for importation to areas in Asia with ecological conditions that can sustain yellow fever virus transmission. In this article, we provide a broad overview of yellow fever burden of disease, natural history, treatment, vaccine, prevention and control initiatives, and vaccine and therapeutic agent development efforts.
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49
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50
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Kallas EG, Wilder-Smith A. Managing severe yellow fever in the intensive care: lessons learnt from Brazil. J Travel Med 2019; 26:5513107. [PMID: 31180486 PMCID: PMC6621914 DOI: 10.1093/jtm/taz043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/13/2022]
Affiliation(s)
- E G Kallas
- Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paolo, Brazil
| | - A Wilder-Smith
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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