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Zhong D, Wahaab A, Zheng J, Zhang J, Ma Z, Wei J. Development of Colloidal Gold-Based Immunochromatographic Strips for Rapid Detection and Surveillance of Japanese Encephalitis Virus in Dogs across Shanghai, China. Viruses 2024; 16:258. [PMID: 38400034 PMCID: PMC10892515 DOI: 10.3390/v16020258] [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: 12/15/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Japanese encephalitis virus (JEV) causes acute encephalitis in humans and is of major public health concern in most Asian regions. Dogs are suitable sentinels for assessing the risk of JEV infection in humans. A neutralization test (NT) or an enzyme-linked immunosorbent assay (ELISA) is used for the serological detection of JEV in dogs; however, these tests have several limitations, and, thus, a more convenient and reliable alternative test is needed. In this study, a colloidal gold immunochromatographic strip (ICS), using a purified recombinant EDIII protein, was established for the serological survey of JEV infection in dogs. The results show that the ICSs could specifically detect JEV antibodies within 10 min without cross-reactions with antibodies against other canine viruses. The test strips could detect anti-JEV in serum with dilution up to 640 times, showing high sensitivity. The coincidence rate with the NT test was higher than 96.6%. Among 586 serum samples from dogs in Shanghai examined using the ICS test, 179 (29.98%) were found to be positive for JEV antibodies, and the high seropositivity of JEV in dogs in China was significantly correlated with the season and living environment. In summary, we developed an accurate and economical ICS for the rapid detection of anti-JEV in dog serum samples with great potential for the surveillance of JEV in dogs.
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Affiliation(s)
- Dengke Zhong
- Shanghai Vocational College of Agriculture and Forestry, Shanghai 201600, China;
| | - Abdul Wahaab
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Shanghai 200241, China; (A.W.); (J.Z.); (J.Z.); (Z.M.)
- Department of Entomology, Center for Infectious Disease Dynamics and The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16801, USA
| | - Jiayang Zheng
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Shanghai 200241, China; (A.W.); (J.Z.); (J.Z.); (Z.M.)
| | - Junjie Zhang
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Shanghai 200241, China; (A.W.); (J.Z.); (J.Z.); (Z.M.)
| | - Zhiyong Ma
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Shanghai 200241, China; (A.W.); (J.Z.); (J.Z.); (Z.M.)
| | - Jianchao Wei
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Shanghai 200241, China; (A.W.); (J.Z.); (J.Z.); (Z.M.)
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Sabir AJ, Le NPK, Singh PP, Karniychuk U. Endogenous ZAP affects Zika virus RNA interactome. RNA Biol 2024; 21:1-10. [PMID: 39183472 PMCID: PMC11352719 DOI: 10.1080/15476286.2024.2388911] [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] [Revised: 07/15/2024] [Accepted: 07/30/2024] [Indexed: 08/27/2024] Open
Abstract
One of the most recent advances in the analysis of viral RNA-cellular protein interactions is the Comprehensive Identification of RNA-binding Proteins by Mass Spectrometry (ChIRP-MS). Here, we used ChIRP-MS in mock-infected and Zika-infected wild-type cells and cells knockout for the zinc finger CCCH-type antiviral protein 1 (ZAP). We characterized 'ZAP-independent' and 'ZAP-dependent' cellular protein interactomes associated with flavivirus RNA and found that ZAP affects cellular proteins associated with Zika virus RNA. The ZAP-dependent interactome identified with ChIRP-MS provides potential ZAP co-factors for antiviral activity against Zika virus and possibly other viruses. Identifying the full spectrum of ZAP co-factors and mechanisms of how they act will be critical to understanding the ZAP antiviral system and may contribute to the development of antivirals.
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Affiliation(s)
- Ahmad Jawad Sabir
- Department of Microbiology and Immunology, College of Medicine, University of Illinois, Chicago, IL, USA
| | - Nguyen Phuong Khanh Le
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Prince Pal Singh
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Uladzimir Karniychuk
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
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Alisjahbana DH, Nurmawati S, Milanti M, Djauhari H, Ledermann JP, Antonjaya U, Dewi YP, Johar E, Wiyatno A, Sriyani IY, Alisjahbana B, Safari D, Myint KSA, Powers AM, Hakim DDL. Central nervous system infection in a pediatric population in West Java. PLoS Negl Trop Dis 2023; 17:e0011769. [PMID: 38011279 PMCID: PMC10703213 DOI: 10.1371/journal.pntd.0011769] [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: 10/16/2022] [Revised: 12/07/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023] Open
Abstract
Central nervous system (CNS) viral infections are critical causes of morbidity and mortality in children; however, comprehensive data on etiology is lacking in developing countries such as Indonesia. To study the etiology of CNS infections in a pediatric population, 50 children admitted to two hospitals in Bandung, West Java, during 2017-2018 were enrolled in a CNS infection study. Cerebrospinal fluid and serum specimens were tested using molecular, serological, and virus isolation platforms for a number of viral and bacteriological agents. Causal pathogens were identified in 10 out of 50 (20%) and included cytomegalovirus (n = 4), Streptococcus pneumoniae (n = 2), tuberculosis (n = 2), Salmonella serotype Typhi (n = 1) and dengue virus (n = 1). Our study highlights the importance of using a wide range of molecular and serological detection methods to identify CNS pathogens, as well as the challenges of establishing the etiology of CNS infections in pediatric populations of countries with limited laboratory capacity.
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Affiliation(s)
- Dewi H. Alisjahbana
- Department of Child Health, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Syndi Nurmawati
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Mia Milanti
- Department of Child Health, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Hofiya Djauhari
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Jeremy P. Ledermann
- Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Ungke Antonjaya
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Yora Permata Dewi
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Edison Johar
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Ageng Wiyatno
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Ida Yus Sriyani
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Bachti Alisjahbana
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Dodi Safari
- Eijkman Research Center for Molecular Biology, National Research and Innovation Agency, Jakarta, Indonesia
| | - Khin Saw Aye Myint
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Ann M. Powers
- Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Dzulfikar DL Hakim
- Department of Child Health, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Brindle HE, Bastos LS, Christley R, Contamin L, Dang LH, Anh DD, French N, Griffiths M, Nadjm B, van Doorn HR, Thai PQ, Duong TN, Choisy M. The spatio-temporal distribution of acute encephalitis syndrome and its association with climate and landcover in Vietnam. BMC Infect Dis 2023; 23:403. [PMID: 37312047 PMCID: PMC10262680 DOI: 10.1186/s12879-023-08300-1] [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: 01/22/2023] [Accepted: 05/03/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Acute encephalitis syndrome (AES) differs in its spatio-temporal distribution in Vietnam with the highest incidence seen during the summer months in the northern provinces. AES has multiple aetiologies, and the cause remains unknown in many cases. While vector-borne disease such as Japanese encephalitis and dengue virus and non-vector-borne diseases such as influenza and enterovirus show evidence of seasonality, associations with climate variables and the spatio-temporal distribution in Vietnam differs between these. The aim of this study was therefore to understand the spatio-temporal distribution of, and risk factors for AES in Vietnam to help hypothesise the aetiology. METHODS The number of monthly cases per province for AES, meningitis and diseases including dengue fever; influenza-like-illness (ILI); hand, foot, and mouth disease (HFMD); and Streptococcus suis were obtained from the General Department for Preventive Medicine (GDPM) from 1998-2016. Covariates including climate, normalized difference vegetation index (NDVI), elevation, the number of pigs, socio-demographics, JEV vaccination coverage and the number of hospitals were also collected. Spatio-temporal multivariable mixed-effects negative binomial Bayesian models with an outcome of the number of cases of AES, a combination of the covariates and harmonic terms to determine the magnitude of seasonality were developed. RESULTS The national monthly incidence of AES declined by 63.3% over the study period. However, incidence increased in some provinces, particularly in the Northwest region. In northern Vietnam, the incidence peaked in the summer months in contrast to the southern provinces where incidence remained relatively constant throughout the year. The incidence of meningitis, ILI and S. suis infection; temperature, relative humidity with no lag, NDVI at a lag of one month, and the number of pigs per 100,000 population were positively associated with the number of cases of AES in all models in which these covariates were included. CONCLUSIONS The positive correlation of AES with temperature and humidity suggest that a number of cases may be due to vector-borne diseases, suggesting a need to focus on vaccination campaigns. However, further surveillance and research are recommended to investigate other possible aetiologies such as S. suis or Orientia tsutsugamushi.
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Affiliation(s)
- Hannah E Brindle
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
- Oxford University Clinical Research Unit, Hanoi City, Vietnam.
| | - Leonardo S Bastos
- Scientific Computing Programme, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Robert Christley
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Lucie Contamin
- Institut de Recherche Pour Le Développement, Hanoi, Vietnam
| | - Le Hai Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Neil French
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Michael Griffiths
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Behzad Nadjm
- Oxford University Clinical Research Unit, Hanoi City, Vietnam
- MRC Unit The Gambia at the London, School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Pham Quang Thai
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
- School Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Tran Nhu Duong
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Marc Choisy
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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Mote AB, Mehta D, Kumar MS, Gupta M, Hussain M, Patel SM, Gandham RK, Dhanze H. Genotypic characterization of Japanese encephalitis virus circulating in swine population of India: Genotype-III still in dominance. Virus Genes 2023; 59:67-78. [PMID: 36357764 DOI: 10.1007/s11262-022-01953-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/29/2022] [Indexed: 11/12/2022]
Abstract
Swine is considered as a suitable sentinel to predict Japanese encephalitis virus (JEV) outbreaks in humans. The present study was undertaken to determine the circulating genotypes of JEV in swine population of India. A total of 702 swine serum samples from four states of western, northern, northern-temperate, and north-eastern zones of India were screened by real-time RT-PCR targeting envelope gene of JEV, which showed positivity of 35.33%. The viral copy number ranged from 3 copies to 6.3 × 104 copies/reaction. Subsequently, the capsid/prM structural gene region of JEV positive samples was amplified by nested RT-PCR, sequenced, and genetically characterized. The phylogenetic analysis of the partial sequences of the capsid gene of 42 JEV positive samples showed that they all belonged to genotype-III (G-III) of JEV. Notably, JEV positive swine samples showed high nucleotide identity with human isolates from China and Nepal which explains the probable spillover of infection between neighboring countries probably by migratory birds. The novel mutations were observed in JEV positive sample B8 at C54 position (Phe → Ser), and JEV positive sample K50 at C62 (Thr → Ala) and C65 (Leu → Pro) positions which were absent from other JEV isolates reported till now. The mutation at the C66 position (Leu → Ser) observed in live attenuated vaccine SA14-14-2 strain was not found in JEV positive samples of our study. The detection of the G-III JE virus from climatically diverse states of India reinforces the need to continue the ongoing human vaccination program in India by extending vaccine coverage in temperate states.
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Affiliation(s)
- Akash Balasaheb Mote
- Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, India
| | - Deepa Mehta
- Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, India
| | - M Suman Kumar
- Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, India
| | - Megha Gupta
- Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, India
| | - Mir Hussain
- Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, India
| | - Sagar M Patel
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, India
| | - Ravi Kumar Gandham
- Division of Animal Biotechnology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, India
| | - Himani Dhanze
- Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, India.
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Modelling Japanese encephalitis virus transmission dynamics and human exposure in a Cambodian rural multi-host system. PLoS Negl Trop Dis 2022; 16:e0010572. [PMID: 35816555 PMCID: PMC9302853 DOI: 10.1371/journal.pntd.0010572] [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: 05/12/2021] [Revised: 07/21/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022] Open
Abstract
Japanese encephalitis (JE) is a vector-borne zoonosis and the leading cause of human viral encephalitis in Asia. Its transmission cycle is usually described as involving wild birds as reservoirs and pigs as amplifying hosts. JE is endemic in Cambodia, where it circulates in areas with low pig densities (<70 pigs per km2), and could be maintained in a multi-host system composed of pigs, but also poultry as competent hosts, and dogs, cattle and humans as non-competent hosts. We used a mathematical model representing Japanese encephalitis virus (JEV) transmission in a traditional Cambodian village that we calibrated with field data collected in 3 districts of Kandal province, Cambodia. First, R0 calculations allowed us to assess the capacity of the epidemiological system to be invaded by JEV and sustain virus transmission in villages in the 3 districts, and we predicted human exposure at the epidemiological equilibrium, based on simulations. Changes in spatial density of livestock, in agricultural practices, and epizootics (e.g., African swine fever), can profoundly alter the composition of host communities, which could affect JEV transmission and its impact on human health. In a second step, we then used the model to analyse how host community composition affected R0 and the predicted human exposure. Lastly, we evaluated the potential use of dog JE seroprevalence as an indicator of human exposure to JEV. In the modeled villages, the calculated R0 ranged from 1.07 to 1.38. Once the equilibrium reached, predicted annual probability of human exposure ranged from 9% to 47%, and predicted average age at infection was low, between 2 and 11 years old, highlighting the risk of severe forms of JEV infection and the need to intensify child immunization. According to the model, increasing the proportion of competent hosts induced a decrease in age at infection. The simulations also showed that JEV could invade a multi-host system with no pigs, reinforcing the assumption of poultry acting as reservoirs. Finally, the annual human exposure probability appeared linearly correlated with dog seroprevalence, suggesting that in our specific study area, dog seroprevalence would be a good proxy for human exposure. Japanese encephalitis virus (JEV) is endemic in Cambodia and remains the most common cause of acute viral encephalitis, particularly in children and adolescents. The traditionally described cycle of JEV, involving wild birds as reservoirs, pigs as amplifying hosts and Culex mosquitoes as vectors is questioned, with increasing evidence of a more complex multi-host system involved in areas where densities of pigs are low. In Cambodia, the infection could be maintained in a multi-host system consisting of pigs and poultry as competent hosts, and dogs, cattle and humans as non-competent hosts. We defined a compartmental dynamic model of JEV transmission in a multi-host system representing a rural Cambodian village, to predict human exposure to JEV in the studied area, and to analyse how host community composition may affect human exposure and R0 value. Our theoretical approach showed that variations of the composition of the multi-host system may have an impact on human exposure to JEV, and thus on the disease burden in humans, especially in young children. Besides children vaccination in JEV endemic areas, a proper evaluation of the impact on human health is needed to target prevention actions and reduce JEV burden in Cambodia.
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Pommier JD, Gorman C, Crabol Y, Bleakley K, Sothy H, Santy K, Tran HTT, Nguyen LV, Bunnakea E, Hlaing CS, Aye AMM, Cappelle J, Herrant M, Piola P, Rosset B, Chevalier V, Tarantola A, Channa M, Honnorat J, Pinto AL, Rattanavong S, Vongsouvath M, Mayxay M, Phangmanixay S, Phongsavath K, Tin OS, Kyaw LL, Tin HH, Linn K, Tran TMH, Pérot P, Thuy NTT, Hien N, Phan PH, Buchy P, Dussart P, Laurent D, Eloit M, Dubot-Pérès A, Lortholary O, de Lamballerie X, Newton PN, Lecuit M. Childhood encephalitis in the Greater Mekong region (the SouthEast Asia Encephalitis Project): a multicentre prospective study. Lancet Glob Health 2022; 10:e989-e1002. [PMID: 35714649 PMCID: PMC9210261 DOI: 10.1016/s2214-109x(22)00174-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Encephalitis is a worldwide public health issue, with a substantially high burden among children in southeast Asia. We aimed to determine the causes of encephalitis in children admitted to hospitals across the Greater Mekong region by implementing a comprehensive state-of-the-art diagnostic procedure harmonised across all centres, and identifying clinical characteristics related to patients' conditions. METHODS In this multicentre, observational, prospective study of childhood encephalitis, four referral hospitals in Cambodia, Vietnam, Laos, and Myanmar recruited children (aged 28 days to 16 years) who presented with altered mental status lasting more than 24 h and two of the following minor criteria: fever (within the 72 h before or after presentation), one or more generalised or partial seizures (excluding febrile seizures), a new-onset focal neurological deficit, cerebrospinal fluid (CSF) white blood cell count of 5 per mL or higher, or brain imaging (CT or MRI) suggestive of lesions of encephalitis. Comprehensive diagnostic procedures were harmonised across all centres, with first-line testing was done on samples taken at inclusion and results delivered within 24 h of inclusion for main treatable causes of disease and second-line testing was done thereafter for mostly non-treatable causes. An independent expert medical panel reviewed the charts and attribution of causes of all the included children. Using multivariate analyses, we assessed risk factors associated with unfavourable outcomes (ie, severe neurological sequelae and death) at discharge using data from baseline and day 2 after inclusion. This study is registered with ClinicalTrials.gov, NCT04089436, and is now complete. FINDINGS Between July 28, 2014, and Dec 31, 2017, 664 children with encephalitis were enrolled. Median age was 4·3 years (1·8-8·8), 295 (44%) children were female, and 369 (56%) were male. A confirmed or probable cause of encephalitis was identified in 425 (64%) patients: 216 (33%) of 664 cases were due to Japanese encephalitis virus, 27 (4%) were due to dengue virus, 26 (4%) were due to influenza virus, 24 (4%) were due to herpes simplex virus 1, 18 (3%) were due to Mycobacterium tuberculosis, 17 (3%) were due to Streptococcus pneumoniae, 17 (3%) were due to enterovirus A71, 74 (9%) were due to other pathogens, and six (1%) were due to autoimmune encephalitis. Diagnosis was made within 24 h of admission to hospital for 83 (13%) of 664 children. 119 (18%) children had treatable conditions and 276 (42%) had conditions that could have been preventable by vaccination. At time of discharge, 153 (23%) of 664 children had severe neurological sequelae and 83 (13%) had died. In multivariate analyses, risk factors for unfavourable outcome were diagnosis of M tuberculosis infection upon admission (odds ratio 3·23 [95% CI 1·04-10·03]), coma on day 2 (2·90 [1·78-4·72]), supplementary oxygen requirement (1·89 [1·25-2·86]), and more than 1 week duration between symptom onset and admission to hospital (3·03 [1·68-5·48]). At 1 year after inclusion, of 432 children who were discharged alive from hospital with follow-up data, 24 (5%) had died, 129 (30%) had neurological sequelae, and 279 (65%) had completely recovered. INTERPRETATION In southeast Asia, most causes of childhood encephalitis are either preventable or treatable, with Japanese encephalitis virus being the most common cause. We provide crucial information that could guide public health policy to improve diagnostic, vaccination, and early therapeutic guidelines on childhood encephalitis in the Greater Mekong region. FUNDING Institut Pasteur, Institut Pasteur International Network, Fondation Merieux, Aviesan Sud, INSERM, Wellcome Trust, Institut de Recherche pour le Développement (IRD), and Fondation Total.
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Affiliation(s)
- Jean David Pommier
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; Institut Pasteur, Biology of Infection Unit, Paris, France; Inserm U1117, Paris, France; Intensive Care Department, University Hospital of Guadeloupe, Guadeloupe, France
| | - Chris Gorman
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Yoann Crabol
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Kevin Bleakley
- Université Paris-Saclay, CNRS, Inria, Laboratoire de Mathématiques d'Orsay, Orsay, France
| | - Heng Sothy
- Kantha Bopha IV Children's Hospital, Phnom Penh, Cambodia
| | - Ky Santy
- Kantha Bopha IV Children's Hospital, Phnom Penh, Cambodia
| | | | | | - Em Bunnakea
- Kantha Bopha IV Children's Hospital, Phnom Penh, Cambodia
| | | | | | - Julien Cappelle
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; French Agricultural Research Centre for International Development (CIRAD), Montpellier, France
| | - Magali Herrant
- International Department, Institut Pasteur, Paris, France
| | - Patrice Piola
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Bruno Rosset
- French Agricultural Research Centre for International Development (CIRAD), Montpellier, France
| | - Veronique Chevalier
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; French Agricultural Research Centre for International Development (CIRAD), Montpellier, France
| | - Arnaud Tarantola
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Mey Channa
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Jerome Honnorat
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoi mmune Encephalitis, Hospices Civils de Lyon, Synatac Team, NeuroMyoGene Institute, Inserm U1217/CNRS UMR5310, Université de Lyon, Lyon, France
| | - Anne Laure Pinto
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoi mmune Encephalitis, Hospices Civils de Lyon, Synatac Team, NeuroMyoGene Institute, Inserm U1217/CNRS UMR5310, Université de Lyon, Lyon, France
| | - Sayaphet Rattanavong
- Lao-Oxford-Mahosot Hospital, Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital, Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital, Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Unité des Virus Émergents, Marseille, France
| | | | | | | | | | | | - Kyaw Linn
- Yangon Children's Hospital, Yangon, Myanmar
| | | | - Philippe Pérot
- Laboratory for Pathogen Discovery, Institut Pasteur, Paris, France
| | | | - Nguyen Hien
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Philippe Buchy
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Denis Laurent
- Kantha Bopha IV Children's Hospital, Phnom Penh, Cambodia
| | - Marc Eloit
- Laboratory for Pathogen Discovery, Institut Pasteur, Paris, France; Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Audrey Dubot-Pérès
- Lao-Oxford-Mahosot Hospital, Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Unité des Virus Émergents, Marseille, France; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - Olivier Lortholary
- Université Paris Cité, Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut Pasteur, CNRS, Molecular Mycology Unit, National Reference Center for Mycoses and Antifungals, UMR 2000, Paris, France
| | | | - Paul N Newton
- Lao-Oxford-Mahosot Hospital, Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - Marc Lecuit
- Institut Pasteur, Biology of Infection Unit, Paris, France; Inserm U1117, Paris, France; Université Paris Cité, Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Chapagain S, Pal Singh P, Le K, Safronetz D, Wood H, Karniychuk U. Japanese encephalitis virus persists in the human reproductive epithelium and porcine reproductive tissues. PLoS Negl Trop Dis 2022; 16:e0010656. [PMID: 35905074 PMCID: PMC9337681 DOI: 10.1371/journal.pntd.0010656] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Abstract
Japanese encephalitis virus (JEV) is the emerging and geographically expanding flavivirus and the major causative agent of encephalitis in humans in Asia. There are risks of JEV introduction into the Americas given a large population of amplifying hosts-pigs and wild boars, and insect vectors-Culex mosquitoes. There are emerging concerns about vector-free ways of flavivirus transmission, for example sexual and transplacental Zika virus transmissions, which may change flavivirus epidemiology and expand the geographical range to territories with no insect vectors. It is unknown whether JEV has tropism in the female lower reproductive tract and the potential for sexual transmission in humans. While clinical outcomes of transplacental JEV infection are described in humans and pigs, cellular targets and tissue tropism in the upper reproductive tract are also unknown. Here, we studied JEV infection phenotypes and host transcriptional responses in human reproductive epithelial cells. We found that JEV caused persistent infection and cytopathology in the vaginal epithelium, endometrial epithelium, and trophoblast. Human vaginal epithelial cells infected with JEV had altered transcriptional responses associated with inflammation and disruption of epithelial barrier function. Also, using pigs-the native amplifying host for JEV, we confirmed JEV tropism in the female lower and upper reproductive tracts. We discovered that JEV persists in the vaginal mucosa for at least 28 days and pigs shed the virus in vaginal secretions. We also found JEV persistence in the endometrium and placenta with transplacental and fetal infections. Altogether, we discovered that JEV targets the vaginal epithelium and has the potential for sexual transmission in humans. We also contributed to a better understanding of JEV pathogenesis during transplacental infection. Further studies are needed to better understand the interactions of JEV with reproductive tissues, how persistent infection affects female reproductive functions, and the risks for non-vector transmission.
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Affiliation(s)
- Subash Chapagain
- Vaccine and Infectious Disease Organization (VIDO), University of Saskatchewan, Saskatoon, Canada
- Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Prince Pal Singh
- Vaccine and Infectious Disease Organization (VIDO), University of Saskatchewan, Saskatoon, Canada
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Khanh Le
- Vaccine and Infectious Disease Organization (VIDO), University of Saskatchewan, Saskatoon, Canada
| | - David Safronetz
- The National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Heidi Wood
- The National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Uladzimir Karniychuk
- Vaccine and Infectious Disease Organization (VIDO), University of Saskatchewan, Saskatoon, Canada
- Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
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Mulvey P, Duong V, Boyer S, Burgess G, Williams DT, Dussart P, Horwood PF. The Ecology and Evolution of Japanese Encephalitis Virus. Pathogens 2021; 10:1534. [PMID: 34959489 PMCID: PMC8704921 DOI: 10.3390/pathogens10121534] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Japanese encephalitis virus (JEV) is a mosquito-borne flavivirus mainly spread by Culex mosquitoes that currently has a geographic distribution across most of Southeast Asia and the Western Pacific. Infection with JEV can cause Japanese encephalitis (JE), a severe disease with a high mortality rate, which also results in ongoing sequalae in many survivors. The natural reservoir of JEV is ardeid wading birds, such as egrets and herons, but pigs commonly play an important role as an amplifying host during outbreaks in human populations. Other domestic animals and wildlife have been detected as hosts for JEV, but their role in the ecology and epidemiology of JEV is uncertain. Safe and effective JEV vaccines are available, but unfortunately, their use remains low in most endemic countries where they are most needed. Increased surveillance and diagnosis of JE is required as climate change and social disruption are likely to facilitate further geographical expansion of Culex vectors and JE risk areas.
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Affiliation(s)
- Peter Mulvey
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia;
| | - Veasna Duong
- Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh 12201, Cambodia; (V.D.); (S.B.); (P.D.)
| | - Sebastien Boyer
- Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh 12201, Cambodia; (V.D.); (S.B.); (P.D.)
| | - Graham Burgess
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia;
| | - David T. Williams
- Australian Centre for Disease Preparedness, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Geelong 3220, Australia;
| | - Philippe Dussart
- Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh 12201, Cambodia; (V.D.); (S.B.); (P.D.)
| | - Paul F. Horwood
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia;
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia;
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Long-Term Neurological Sequelae and Disease Burden of Japanese Encephalitis in Gansu Province, China. Ann Glob Health 2021; 87:103. [PMID: 34722167 PMCID: PMC8533657 DOI: 10.5334/aogh.3343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background and objects: The study aimed to evaluate the long-term neurological sequelae and the disease burden of JE in Gansu, China. Methods: JE patients were included as study population from 2005–2011 in Gansu, and a follow-up survey was conducted in 2007–2014. Pair-matched healthy individuals were selected as controls. All subjects underwent a neurological examination and intelligence quotient (IQ) and memory quotient (MQ) assessments. Then, the disability-adjusted life years (DALYs), and direct and indirect medical expenses were systematic assessed. Results: Forty-four point seven percent of the JE patients had objective neurological deficits, compared with 2.4% of controls. Subnormal intelligence was found in 21.2% of JE subjects, compared with 1.2% control who exhibited a mildly reduced IQ. Abnormal MQ scores were noted in 56.3% JE subjects, compared with only 12.7% controls. Prevalence of each sequelae caused by JE were significantly higher in adults than in younger subjects. Furthermore, median DALY lost due to JE was 9.2 per subject. Median economic cost of JE was approximately $2776.6 per subject and significantly higher in adults than in younger subjects. Findings and Conclusions: JE patients suffered from severe neurological sequelae and high disease burden, resulting in a significant downstream burden for both the patients (especially adults) and the healthcare system.
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11
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Deng X, Yan R, Li ZQ, Tang XW, Zhou Y, He H. Economic and disease burden of Japanese encephalitis in Zhejiang Province, 2013-2018. PLoS Negl Trop Dis 2021; 15:e0009505. [PMID: 34153039 PMCID: PMC8248708 DOI: 10.1371/journal.pntd.0009505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 07/01/2021] [Accepted: 05/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Japanese encephalitis (JE) is a mosquito-borne disease and associated with high mortality and disability rate among symptomatic cases. In the absence of local data, this study estimated the economic burden and the disability-adjusted life years (DALYs) due to JE in Zhejiang Province, China during 2013-2018, to increase disease awareness and provide evidence for effective health policy. METHODOLOGY/PRINCIPLE FINDINGS We merged multiple data sources, including National Notifiable Disease Registry System (NNDRS), patient interviews and medical records from corresponding hospitals for JE cases which occurred during 2013-2018 in Zhejiang Province. Direct costs were extracted from hospitals' billing systems and patient interviews. Indirect costs and disease burden were calculated based on questionnaire survey from patient interviews and follow-up assessment by general practitioners. Given under-reporting, an expansion factor (EF) was applied to extrapolate the JE burden to the provincial level. The total economic burden of JE during 2013-2018 was estimated at US $12.01 million with an EF = 3. Of this, $8.32 million was due to direct economic cost and $3.69 million to indirect cost. The disease burden of JE was 42.75 DALYs per million population (28.44 YLD, 14.28 YLL) according to the 1990 Global Burden of Disease (GBD 1990) methodology and 80.01 DALYs (53.67YLD, 26.34YLL) according to the GBD 2010 methodology. Sensitivity analysis demonstrated that the overall economic burden varied from US$ 1.73-36.42 million. The greatest variation was due to the prognosis of illness (-85.57%-203.17%), followed by occupation (-34.07%-134.12%) and age (-72.97%-47.69%). CONCLUSIONS/SIGNIFICANCE JE imposes a heavy burden for families and society in Zhejiang Province. This study provides comprehensive empirical estimates of JE burden to increase awareness and strengthen knowledge of the public. These data may support provincial level public health decision making for prevention and control of JE. Ongoing surveillance for acute meningitis and encephalitis syndrome (AEMS) in sentinel hospitals, is needed to further refine estimates of JE burden.
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Affiliation(s)
- Xuan Deng
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People’s Republic of China
| | - Rui Yan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People’s Republic of China
| | - Zi-qiao Li
- Xiamen University, Xiamen, People’s Republic of China
| | - Xue-wen Tang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People’s Republic of China
| | - Yang Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People’s Republic of China
| | - Hanqing He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People’s Republic of China
- * E-mail:
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Chow C, Dehority W. Long-Term Outcomes in Children Surviving Tropical Arboviral Encephalitis: A Systematic Review. J Trop Pediatr 2021; 67:6295672. [PMID: 34109400 DOI: 10.1093/tropej/fmab028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Survivors of childhood encephalitis often suffer from physical and neurocognitive sequelae, particularly in tropical, resource-limited areas with a large burden of arboviral, neurotropic pathogens and limited resources with which to address chronic morbidities. Research into overall and pathogen-specific outcomes following childhood encephalitis may help identify risk factors for poor outcomes, quantify the burden of sequelae, assist with resource allocation and help focus rehabilitative efforts. However, such research is limited. To this end, we systematically reviewed the literature on this topic to identify gaps in knowledge worthy of future investigation. METHODS A search of PubMed, Web of Knowledge and the Cochrane databases was performed 10 January through 20 February 2020, using 17 search terms for sequelae and 14 for tropical, arboviral pathogens. Eligible reports demonstrated post-discharge follow-up of ≥3 months and assessment of clinical outcome in a child with an arboviral encephalitis ≤18 years of age at diagnosis. RESULTS Of 1513 articles, 35 were eligible, comprising 693 children. Japanese encephalitis accounted for 18 articles and 93.2% of all subjects (646 total). Sequelae were documented in ∼60% of subjects overall and in those with Japanese encephalitis. For non-Japanese encephalitis virus encephalitides (47 children), sequelae were found in 78.1%. No studies utilized comprehensive neurocognitive testing or assessed the efficacy of rehabilitative efforts. Only nine studies reported data from ≥1 follow-up visit. CONCLUSION Investigation into long-term outcomes following tropical childhood encephalitis is limited, particularly for neurocognitive sequelae, serial assessments over time and the effect of rehabilitative measures. LAY SUMMARY Encephalitis, an infection of the brain, is frequently caused by arboviruses (viruses spread via the bite of infected arthropods, such as mosquitoes) in tropical locales. Following infection, surviving children may be plagued with severe physical and cognitive deficits. Unfortunately, research into the type of deficits, their frequency and their responsiveness to rehabilitative efforts is lacking. We identified and reviewed 35 studies describing outcomes in children recovering from tropical, arboviral encephalitis at least 3 months following hospital discharge. Poor outcomes were common and found in up to 60% of children. Long-term and serial follow-up visits were rare, as was the use of comprehensive neurocognitive testing. No studies assessed the efficacy of rehabilitative measures. Further study into these areas is recommended.
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Affiliation(s)
- Christal Chow
- Division of Infectious Diseases, Department of Pediatrics, The University of New Mexico School of Medicine, Albuquerque, NM 87131-0001, USA
| | - Walter Dehority
- Division of Critical Care, Department of Pediatrics, The University of New Mexico School of Medicine, Albuquerque, NM 87131-0001, USA
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Pradhan N, Rath A, Panda BB, Mohanty I, Somalkar NM, Hazra RK. Implementation of molecular method in routine malaria diagnosis and entomological studies. J Vector Borne Dis 2020; 57:314-324. [PMID: 34856711 DOI: 10.4103/0972-9062.313973] [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: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES Molecular methods for malaria vector species and parasite identification have received great attention in recent years. Accurate and precise identification of the target species has direct medical and practical implications, such as in malaria diagnosis and vector dynamics study. Translation of molecular techniques will help in evaluation of epidemiological and entomological profile of malaria even in highly inaccessible areas where there is lack of an expert microscopist or entomologist. METHODS In the present study, we have developed a simple yet accurate molecular tool for malaria diagnosis as well as for malaria vector studies. We have standardized, simplified and improvised the DNA isolation (using Chelex; a cationic exchanger), its storage and multiplex PCR for parasite detection from dried blood spot (DBS) filter paper as well as malaria vector identification and infection status study. RESULTS The chelex-PCR based molecular method was highly sensitive (sensitivity >90%) and specific (specificity >80%) for parasite detection as well as vector species identification. This method has proven readily adaptable for use in the clinical diagnostic/research laboratory for epidemiological investigation and vector dynamics study that can challenge the conventional gold standard approach such as microscopy/ morphological methods not only in response to accuracy but also in relation to cost, time and technical expertise. INTERPRETATION & CONCLUSION Transfer of this molecular technology from laboratory to field condition is highly essential for its availability to the common public rather than being restricted to only academic research. This can be achieved by implementation of the technology in terms of conducting mass training and awareness programs in various resource-limited endemic zones for the purpose of malaria elimination.
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Affiliation(s)
- Nitika Pradhan
- KIIT School of Biotechnology, KIIT University; Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Animesha Rath
- KIIT School of Biotechnology, KIIT University; Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | - Ipsita Mohanty
- Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Nilam M Somalkar
- Regional Office for Health and Family Welfare, Bhubaneswar, Odisha, India
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Ladreyt H, Auerswald H, Tum S, Ken S, Heng L, In S, Lay S, Top C, Ly S, Duong V, Dussart P, Durand B, Chevalier V. Comparison of Japanese Encephalitis Force of Infection in Pigs, Poultry and Dogs in Cambodian Villages. Pathogens 2020; 9:pathogens9090719. [PMID: 32882890 PMCID: PMC7558861 DOI: 10.3390/pathogens9090719] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 12/22/2022] Open
Abstract
Japanese encephalitis virus (JEV) is the main cause of human viral encephalitis in Asia, with a mortality rate reaching 30%, mostly affecting children. The traditionally described cycle involving wild birds as reservoirs, pigs as amplifying hosts and Culex mosquitoes as vectors is questioned, with increasing evidence of a more complex multi-host system involved in areas where densities of pigs are low, such as in Cambodia. In 2018, we examined pigs, chickens, ducks and dogs from Kandal province, Cambodia, for antibody response against JEV by hemagglutination inhibition and virus neutralization assays. Forces of infection (FOI) for flaviviruses and JEV were estimated per species and per unit of body surface area (BSA). JEV seroprevalence reached 31% (95% CI: 23-41%) in pigs, 1% (95% CI: 0.1-3%) in chickens, 12% (95% CI: 7-19%) in ducks and 35% (95% CI: 28-42%) in dogs. Pigs were most likely to be infected (FOI: 0.09 per month), but the FOI was higher in ducks than in pigs for a given BSA (ratio of 0.13). Dogs had a lower FOI than ducks but a higher FOI than chickens (0.01 per month). For a given BSA, dogs were less likely to be infected than pigs (ratio of 1.9). In Cambodia, the virus may be circulating between multiple hosts. Dogs live in close contact with humans, and estimating their exposure to JEV infection could be a relevant indicator of the risk for humans to get infected, which is poorly known due to underdiagnosis. Understanding the JEV cycle and developing tools to quantify the exposure of humans is essential to adapt and support control measures for this vaccine-preventable disease.
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Affiliation(s)
- Héléna Ladreyt
- Epidemiology Unit, Laboratory for Animal Health, French Agency for Food, Environmental and Occupational Health and Safety (ANSES), University Paris-Est, 14 rue Pierre et Marie Curie, 94700 Maisons-Alfort, France; (H.L.); (B.D.)
- International Center of Research in Agriculture for Development (CIRAD), UMR ASTRE, F-34090 Montpellier, France
| | - Heidi Auerswald
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, 5 Monivong Boulevard, P.O Box. 983, Phnom Penh 12201, Cambodia; (H.A.); (S.K.); (L.H.); (S.I.); (C.T.); (V.D.); (P.D.)
| | - Sothyra Tum
- National Animal Health and Production Research Institute, General Directorate for Animal Health and Production, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh 12201, Cambodia;
| | - Sreymom Ken
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, 5 Monivong Boulevard, P.O Box. 983, Phnom Penh 12201, Cambodia; (H.A.); (S.K.); (L.H.); (S.I.); (C.T.); (V.D.); (P.D.)
| | - Leangyi Heng
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, 5 Monivong Boulevard, P.O Box. 983, Phnom Penh 12201, Cambodia; (H.A.); (S.K.); (L.H.); (S.I.); (C.T.); (V.D.); (P.D.)
| | - Saraden In
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, 5 Monivong Boulevard, P.O Box. 983, Phnom Penh 12201, Cambodia; (H.A.); (S.K.); (L.H.); (S.I.); (C.T.); (V.D.); (P.D.)
| | - Sokchea Lay
- Immunology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, 5 Monivong Boulevard, P.O Box. 983, Phnom Penh 12201, Cambodia;
| | - Chakriyouth Top
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, 5 Monivong Boulevard, P.O Box. 983, Phnom Penh 12201, Cambodia; (H.A.); (S.K.); (L.H.); (S.I.); (C.T.); (V.D.); (P.D.)
| | - Sowath Ly
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, 5 Monivong Boulevard, PO Box 983, Phnom Penh 12201, Cambodia;
| | - Veasna Duong
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, 5 Monivong Boulevard, P.O Box. 983, Phnom Penh 12201, Cambodia; (H.A.); (S.K.); (L.H.); (S.I.); (C.T.); (V.D.); (P.D.)
| | - Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, 5 Monivong Boulevard, P.O Box. 983, Phnom Penh 12201, Cambodia; (H.A.); (S.K.); (L.H.); (S.I.); (C.T.); (V.D.); (P.D.)
| | - Benoit Durand
- Epidemiology Unit, Laboratory for Animal Health, French Agency for Food, Environmental and Occupational Health and Safety (ANSES), University Paris-Est, 14 rue Pierre et Marie Curie, 94700 Maisons-Alfort, France; (H.L.); (B.D.)
| | - Véronique Chevalier
- International Center of Research in Agriculture for Development (CIRAD), UMR ASTRE, F-34090 Montpellier, France
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, 5 Monivong Boulevard, PO Box 983, Phnom Penh 12201, Cambodia;
- International Center of Research in Agriculture for Development (CIRAD), UMR ASTRE, Phnom Penh 12201, Cambodia
- Correspondence:
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Rattanavong S, Dubot-Pérès A, Mayxay M, Vongsouvath M, Lee SJ, Cappelle J, Newton PN, Parker DM. Spatial epidemiology of Japanese encephalitis virus and other infections of the central nervous system infections in Lao PDR (2003-2011): A retrospective analysis. PLoS Negl Trop Dis 2020; 14:e0008333. [PMID: 32453806 PMCID: PMC7274481 DOI: 10.1371/journal.pntd.0008333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 06/05/2020] [Accepted: 04/28/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Central nervous system (CNS) infections are important contributors to morbidity and mortality and the causative agents for ~50% patients are never identified. The causative agents of some CNS infections have distinct spatial and temporal patterns. METHODOLOGY/PRINCIPAL FINDINGS Here we present the results of a spatial epidemiological and ecological analysis of CNS infections in Lao PDR (2003-2011). The data came from hospitalizations for suspected CNS infection at Mahosot Hospital in Vientiane. Out of 1,065 patients, 450 were assigned a confirmed diagnosis. While many communities in Lao PDR are in rural and remote locations, most patients in these data came from villages along major roads. Japanese encephalitis virus ((JEV); n = 94) and Cryptococcus spp. (n = 70) were the most common infections. JEV infections peaked in the rainy season and JEV patients came from villages with higher surface flooding during the same month as admission. JEV infections were spatially dispersed throughout rural areas and were most common in children. Cryptococcus spp. infections clustered near Vientiane (an urban area) and among adults. CONCLUSIONS/SIGNIFICANCE The spatial and temporal patterns identified in this analysis are related to complex environmental, social, and geographic factors. For example, JEV infected patients came from locations with environmental conditions (surface water) that are suitable to support larger mosquito vector populations. Most patients in these data came from villages that are near major roads; likely the result of geographic and financial access to healthcare and also indicating that CNS diseases are underestimated in the region (especially from more remote areas). As Lao PDR is undergoing major developmental and environmental changes, the space-time distributions of the causative agents of CNS infection will also likely change. There is a major need for increased diagnostic abilities; increased access to healthcare, especially for rural populations; and for increased surveillance throughout the nation.
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Affiliation(s)
- Sayaphet Rattanavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Audrey Dubot-Pérès
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom
- Unité des Virus Émergents (UVE: Aix-Marseille Univ–IRD 190 –Inserm 1207 –IHU Méditerranée Infection), Marseille, France
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Sue J. Lee
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Julien Cappelle
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- CIRAD, UMR ASTRE, F-34398, Montpellier, France
- UMR ASTRE, CIRAD, INRA, Montpellier University, Montpellier, France
- UMR EpiA, INRA, VetAgro Sup, Marcy l’Etoile, France
| | - Paul N. Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Daniel M. Parker
- Department of Population Health and Disease Prevention, University of California, Irvine, United States of America
- Department of Epidemiology, School of Medicine, University of California, Irvine, United States of America
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Mao X, Zhou H. The spatiotemporal distribution of Japanese Encephalitis cases in Yunnan Province, China, from 2007 to 2017. PLoS One 2020; 15:e0231661. [PMID: 32287313 PMCID: PMC7156086 DOI: 10.1371/journal.pone.0231661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/27/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Japanese encephalitis (JE) is a vector-borne disease with a high prevalence in Yunnan Province, China. However, there has been a lack of a JE epidemic systematic analysis, which is urgently needed to guide control and prevention efforts. METHODS This study explored and described the spatiotemporal distribution of JE cases observed among two different age groups in Yunnan Province from 2007 to 2017. The epidemiological features and spatial features were analyzed according to basic statistics, ArcGIS software (version 9.3; ESRI, Redlands, CA) and SPSS software (version 20; IBM Corp., Armonk, New York). RESULTS Overall, the whole province had a high incidence of JE. The annual incidence rates in 2007 and 2017 were 1.668/100,000 and 0.158/100,000, respectively. The annual mortality was under 0.095/100,000 for these years. Although the whole province was in danger of JE, the Diqing autonomous prefecture and the Lijiang autonomous prefecture had no JE cases recorded for over 10 years. The JE cases were reported by hospitals located in 60 counties of 14 municipalities. The top ten areas with the most JE cases were Kunming City, Zhaotong City, Jinghong City, Wenshan City, Mangshi City, Pu'er City, Baoshan City, Dali City, Chuxiong City, and Gejiu City. The incidence declined smoothly, with a peak occurring from June to September, which accounted for 96.1% of the total cases. Children whose age was equal or less than 10 years old (LEQ10) still maintained a high frequency of JEV infection, and a large number of cases were reported in August, despite the Expanded Program on Immunization (EPI), which was established in April 2008. There was no difference in the quantity of cases between the two groups (t = -0.411, P>0.05); additionally, the number of JE cases among patients LEQ10 were significantly greater than those among patients older than 10 years (GTR10). Further analysis using local indicators of spatial association (LISA) revealed that the distribution of JE exhibited a high-high cluster characteristic (Z = 2.06, P<0.05), which showed that Jinghong City, Guangnan County, Yanshan County, Funing County, and Mengzi City were hot spots for the JE epidemic. CONCLUSIONS Although the EPI was established in 2008 and the incidence of JE declined smoothly in Yunnan Province, there was no difference in the number of cases between the two age groups, which reveals that the EPI has been conducted with a low level success. In the context of limited vaccine supply capacity, we should strengthen the implementation of the children's immunization program before strengthening other immunization programs.
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Affiliation(s)
- Xianghua Mao
- Yunnan Provincial Center of Arbovirus Research, Pu’er, Yunnan, China
- Yunnan Institute of Parasitic Diseases, Pu’er, Yunnan, China
| | - Hongning Zhou
- Yunnan Institute of Parasitic Diseases, Pu’er, Yunnan, China
- * E-mail:
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Postels DG, Soldatos A, LaRovere KL. Outcomes measures in children after acute central nervous system infections and malaria. Curr Opin Pediatr 2019; 31:756-762. [PMID: 31693584 DOI: 10.1097/mop.0000000000000823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW Acute central nervous system (CNS) infections in children result in significant mortality and neurologic morbidity worldwide. This article summarizes the recent pediatric literature published on outcomes measures used after acute infectious meningitis, encephalitis, and cerebral malaria, and highlights ongoing research efforts to standardize outcomes measurements. Search terms were geared toward functional, cognitive, behavioral, and other outcome assessments. RECENT FINDINGS Recent data suggest that, depending on microbiological cause, there are differences in currently used outcome measures following acute CNS infections. Outcomes assessments include a variety of formal psychological tests (structured interviews and neuropsychological tests of cognitive and motor functioning) and dichotomized or ordinal scales. Standardization of outcome measures, however, is lacking. Global efforts to standardize outcomes that encompass both the child and family are ongoing. SUMMARY Centers worldwide can track and measure a variety of cognitive, behavioral, and functional outcomes after acute CNS infections. Standardized documentation and coding of clinically important outcomes is needed. Further research to evaluate effective practices using acute adjunctive and rehabilitation therapies will be aided by outcome measure standardization.
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Affiliation(s)
- Douglas G Postels
- Department of Neurology, Children's National Health System, Washington, District of Columbia
| | - Ariane Soldatos
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Kerri L LaRovere
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
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Dubot-Pérès A, Mayxay M, Phetsouvanh R, Lee SJ, Rattanavong S, Vongsouvath M, Davong V, Chansamouth V, Phommasone K, Moore C, Dittrich S, Lattana O, Sirisouk J, Phoumin P, Panyanivong P, Sengduangphachanh A, Sibounheuang B, Chanthongthip A, Simmalavong M, Sengdatka D, Seubsanith A, Keoluangkot V, Phimmasone P, Sisout K, Detleuxay K, Luangxay K, Phouangsouvanh I, Craig SB, Tulsiani SM, Burns MA, Dance DAB, Blacksell SD, de Lamballerie X, Newton PN. Management of Central Nervous System Infections, Vientiane, Laos, 2003-2011. Emerg Infect Dis 2019; 25:898-910. [PMID: 31002063 PMCID: PMC6478220 DOI: 10.3201/eid2505.180914] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
During 2003–2011, we recruited 1,065 patients of all ages admitted to Mahosot Hospital (Vientiane, Laos) with suspected central nervous system (CNS) infection. Etiologies were laboratory confirmed for 42.3% of patients, who mostly had infections with emerging pathogens: viruses in 16.2% (mainly Japanese encephalitis virus [8.8%]); bacteria in 16.4% (including Orientia tsutsugamushi [2.9%], Leptospira spp. [2.3%], and Rickettsia spp. [2.3%]); and Cryptococcus spp. fungi in 6.6%. We observed no significant differences in distribution of clinical encephalitis and meningitis by bacterial or viral etiology. However, patients with bacterial CNS infection were more likely to have a history of diabetes than others. Death (26.3%) was associated with low Glasgow Coma Scale score, and the mortality rate was higher for patients with bacterial than viral infections. No clinical or laboratory variables could guide antibiotic selection. We conclude that high-dependency units and first-line treatment with ceftriaxone and doxycycline for suspected CNS infections could improve patient survival in Laos.
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Lee HS, Thanh TL, Ly NK, Nguyen-Viet H, Thakur KK, Grace D. Seroprevalence of leptospirosis and Japanese encephalitis in swine in ten provinces of Vietnam. PLoS One 2019; 14:e0214701. [PMID: 31369564 PMCID: PMC6675114 DOI: 10.1371/journal.pone.0214701] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 07/18/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Leptospirosis is an important zoonotic disease with a global distribution, affecting a wide range of mammalian animals and humans. Japanese encephalitis (JE) virus is the major vector-borne zoonotic disease in the Asia-Pacific region. The main objective of this study was to evaluate the seroprevalence of serovar-specific Leptospira and JE in swine from 10 provinces in Vietnam. METHODS Samples were initially collected for swine influenza surveillance from March to April 2017 at large-scale farms (with at least 50 sows and/or 250 fattening pigs) with pigs that tested positive for influenza in the previous surveillance period (2015-16). FINDINGS A total of 2,000 sera samples were analyzed from 10 provinces. Overall, the seroprevalence of leptospirosis was 21.05% (95% CI: 19.28-22.90) using a cut-off titer of ≥ 1:100. The apparent prevalence of JE was 73.45% (95% CI: 71.46-75.37) while the true prevalence was slightly higher (74.46%, 95% credible interval: 73.73-86.41). We found a relatively high presence of leptospirosis and JE in pigs kept on large farms. Prevalence was comparable with other studies suggesting opportunistic testing of samples collected for other surveillance purposes can be a valuable tool to better understand and prevent the potential transmission of these zoonotic diseases from pigs to people in Vietnam. CONCLUSION Our study provides evidence to veterinarians and animal health professionals for evidence-based practice such as diagnosis, vaccination and zoonotic control. Further investigation into the possible role of different domestic animals, wildlife species or environmental factors is needed to identify the potential risk factors and transmission routes in Vietnam.
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Affiliation(s)
- Hu Suk Lee
- International Livestock Research Institute, Hanoi, Vietnam
| | - To Long Thanh
- National Center for Veterinary Diagnosis, 15/78 Duong Giai Phong-Phuong Mai Dong Da Hanoi, Hanoi, Vietnam
| | - Nguyen Khanh Ly
- National Center for Veterinary Diagnosis, 15/78 Duong Giai Phong-Phuong Mai Dong Da Hanoi, Hanoi, Vietnam
| | | | - Krishna K Thakur
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - Delia Grace
- International Livestock Research Institute, Nairobi, Kenya
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20
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Ly S, Fortas C, Duong V, Benmarhnia T, Sakuntabhai A, Paul R, Huy R, Sorn S, Nguon K, Chan S, Kimsan S, Ong S, Kim KS, Buoy S, Voeung L, Dussart P, Buchy P, Tarantola A. Asymptomatic Dengue Virus Infections, Cambodia, 2012-2013. Emerg Infect Dis 2019; 25:1354-1362. [PMID: 31211672 PMCID: PMC6590774 DOI: 10.3201/eid2507.181794] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
We investigated dengue virus (DENV) and asymptomatic DENV infections in rural villages of Kampong Cham Province, Cambodia, during 2012 and 2013. We conducted perifocal investigations in and around households for 149 DENV index cases identified through hospital and village surveillance. We tested participants 0.5-30 years of age by using nonstructural 1 rapid tests and confirmed DENV infections using quantitative reverse transcription PCR or nonstructural 1-capture ELISA. We used multivariable Poisson regressions to explore links between participants' DENV infection status and household characteristics. Of 7,960 study participants, 346 (4.4%) were infected with DENV, among whom 302 (87.3%) were <15 years of age and 225 (65.0%) were <9 years of age. We identified 26 (7.5%) participants with strictly asymptomatic DENV infection at diagnosis and during follow-up. We linked symptomatic DENV infection status to familial relationships with index cases. During the 2-year study, we saw fewer asymptomatic DENV infections than expected based on the literature.
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Affiliation(s)
| | | | - Veasna Duong
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Tarik Benmarhnia
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Anavaj Sakuntabhai
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Richard Paul
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Rekol Huy
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Sopheak Sorn
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Kunthy Nguon
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Siam Chan
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Souv Kimsan
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Sivuth Ong
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Kim Srorn Kim
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Sowathy Buoy
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Lim Voeung
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Philippe Dussart
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
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Samy AM, Alkishe AA, Thomas SM, Wang L, Zhang W. Mapping the potential distributions of etiological agent, vectors, and reservoirs of Japanese Encephalitis in Asia and Australia. Acta Trop 2018; 188:108-117. [PMID: 30118701 DOI: 10.1016/j.actatropica.2018.08.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/11/2018] [Accepted: 08/12/2018] [Indexed: 12/15/2022]
Abstract
Japanese encephalitis virus (JEV) is a substantial cause of viral encephalitis, morbidity, and mortality in South-East Asia and the Western Pacific. World Health Organization recognized Japanese Encephalitis (JE) as a public health priority in demands to initiate active vaccination programs. Recently, the geographic distribution of JEV has apparently expanded into other areas in the Pacific islands and northern Australia; however, major gaps exist in knowledge in regard to its current distribution. Here, we mapped the potential distribution of mosquito vectors of JEV (Culex tritaeniorhynchus, Cx. pseudovishnui, Cx. vishnui, Cx. fuscocephala, Cx. gelidus), and reservoirs (Egretta garzetta, E. intermedia, Nycticorax nycticorax) based on ecological niche modeling approach. Ecological niche models predicted all species to occur across Central, South and South East Asia; however, Cx. tritaeniorhynchus, E. garzetta, E. intermedia, and N. nycticorax had broader potential distributions extending west to parts of the Arabian Peninsula. All predictions were robust and significantly better than random (P < 0.001). We also tested the JEV prediction based on 4335 additional independent human case records collected by the Chinese Information System for Disease Control and Prevention (CISDCP); 4075 cases were successfully predicted by the model (P < 0.001). Finally, we tested the ecological niche similarity among JEV, vector, and reservoir species and could not reject any of the null hypotheses of niche similarity in all combination pairs.
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Detection of central nervous system viral infections in adults in Manado, North Sulawesi, Indonesia. PLoS One 2018; 13:e0207440. [PMID: 30444898 PMCID: PMC6239303 DOI: 10.1371/journal.pone.0207440] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/31/2018] [Indexed: 02/08/2023] Open
Abstract
Central nervous system (CNS) viral infections are important causes of morbidity and mortality worldwide but the systematic survey of patients admitted to hospitals with CNS infections in many countries, including Indonesia, is limited. To obtain more information regarding the causes of CNS infections in Indonesia, this study was performed to detect and identify viral agents associated with CNS infections amongst in-patients at a referral hospital in Manado, North Sulawesi, Indonesia. Adult patients admitted to R.D. Kandou General Hospital with presumed CNS infection were enrolled. Cerebrospinal fluid, serum, and throat swab samples were collected and tested using molecular, serological, and virus isolation assays. A confirmed viral etiology was established in three and a probable/possible in 11 out of 74 patients. The most common was herpes simplex virus 1 (7/74, 9.5%), followed by Epstein-Barr virus (2/74, 2.7%), cytomegalovirus (1/74, 1.4%), enterovirus D68 (1/74, 1.4%), rhinovirus A (1/74, 1.4%), dengue virus (1/64, 1.6%), and Japanese encephalitis virus (1/64, 1.6%). There were 20 fatal cases (27.0%) during hospitalization in which eight were associated with viral causes. We identified herpes simplex virus 1 as the most common cause of CNS infection among adults in North Sulawesi with most of the cases remaining undiagnosed. Our study highlights the challenges in establishing the etiology of viral CNS infections and the importance of using a wide range of molecular and serological detection methods to identify CNS viruses.
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Garjito TA, Widiarti, Anggraeni YM, Alfiah S, Tunggul Satoto TB, Farchanny A, Samaan G, Afelt A, Manguin S, Frutos R, Aditama TY. Japanese encephalitis in Indonesia: An update on epidemiology and transmission ecology. Acta Trop 2018; 187:240-247. [PMID: 30118700 DOI: 10.1016/j.actatropica.2018.08.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/09/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
Abstract
The Japanese Encephalitis (JE) virus circulation in Indonesia was first documented in Lombok in 1960, and the virus was first isolated in 1972 from Culex tritaeniorhynchus in Bekasi, West Java and Kapuk, West Jakarta. Since then, Indonesia has been recognized as an endemic country for JE transmission. Up to now, JE cases have been found in at least 29 provinces, with Bali, West Kalimantan, East Nusa Tenggara, West Java and East Java, being the areas of highest incidence. However, routine surveillance on JE has not been established at the national level even though many surveys were conducted. JEV has been isolated from 10 mosquito species: Culex tritaeniorhynchus, Cx. gelidus, Cx. vishnui, Cx. fuscocephala, Cx. bitaeniorhynchus, Cx. quinquefasciatus, Anopheles vagus, An. kochi, An. annularis, and Armigeres subalbatus. Culex tritaeniorhynchus is the main JE vector in Indonesia. JE has been detected throughout the Indonesian archipelago from West to East. However, due to a lack of routine, systematic and standardized diagnostic approaches, the JE burden has still not been clearly established yet. Long term and systematic JE surveillance across Indonesia is a priority, the burden needs to be better assessed and appropriate control measures must be implemented.
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Liverani M, Teng S, Le MS, Coker R. Sharing public health data and information across borders: lessons from Southeast Asia. Global Health 2018; 14:94. [PMID: 30268139 PMCID: PMC6162912 DOI: 10.1186/s12992-018-0415-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/19/2018] [Indexed: 11/16/2022] Open
Abstract
Background The importance of data and information sharing for the prevention and control of infectious diseases has long been recognised. In recent years, public health emergencies such as avian influenza, drug-resistant malaria, and Ebola have brought renewed attention to the need for effective communication channels between health authorities, particularly in regional contexts where neighbouring countries share common health threats. However, little empirical research has been conducted to date to explore the range of factors that may affect the transfer, exchange, and use of public health data and expertise across borders, especially in developing contexts. Methods To explore these issues, 60 interviews were conducted with domestic and international stakeholders in Cambodia and Vietnam, selected amongst those who were involved in regional public health programmes and networks. Data analysis was structured around three categories mapped across the dataset: (1) the nature of shared data and information; (2) the nature of communication channels; and (3) how information flow may be affected by the local, regional, and global system of rules and arrangements. Results There has been a great intensification in the circulation of data, information, and expertise across borders in Southeast Asia. However, findings from this study document ways in which the movement of data and information from production sites to other places can be challenging due to different standards and practices, language barriers, different national structures and rules that govern the circulation of health information inside and outside countries, imbalances in capacities and power, and sustainability of financing arrangements. Conclusions Our study highlights the complex socio-technical nature of data and information sharing, suggesting that best practices require significant involvement of an independent third-party brokering organisation or office, which can redress imbalances between country partners at different levels in the data sharing process, create meaningful communication channels and make the most of shared information and data sets.
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Affiliation(s)
- Marco Liverani
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK. .,Faculty of Public Health, Mahidol University, Bangkok, Thailand.
| | - Srey Teng
- Department of Communicable Disease Control, Ministry of Health, Phnom Penh, Cambodia
| | - Minh Sat Le
- Ministry of Science and Technology, Hanoi, Vietnam
| | - Richard Coker
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.,Faculty of Public Health, Mahidol University, Bangkok, Thailand
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Di Francesco J, Choeung R, Peng B, Pring L, Pang S, Duboz R, Ong S, Sorn S, Tarantola A, Fontenille D, Duong V, Dussart P, Chevalier V, Cappelle J. Comparison of the dynamics of Japanese encephalitis virus circulation in sentinel pigs between a rural and a peri-urban setting in Cambodia. PLoS Negl Trop Dis 2018; 12:e0006644. [PMID: 30138381 PMCID: PMC6107123 DOI: 10.1371/journal.pntd.0006644] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 06/28/2018] [Indexed: 11/18/2022] Open
Abstract
Japanese encephalitis is mainly considered a rural disease, but there is growing evidence of a peri-urban and urban transmission in several countries, including Cambodia. We, therefore, compared the epidemiologic dynamic of Japanese encephalitis between a rural and a peri-urban setting in Cambodia. We monitored two cohorts of 15 pigs and determined the force of infection-rate at which seronegative pigs become positive-in two study farms located in a peri-urban and rural area, respectively. We also studied the mosquito abundance and diversity in proximity of the pigs, as well as the host densities in both areas. All the pigs seroconverted before the age of 6 months. The force of infection was 0.061 per day (95% confidence interval = 0.034-0.098) in the peri-urban cohort and 0.069 per day (95% confidence interval = 0.047-0.099) in the rural cohort. Several differences in the epidemiologic dynamic of Japanese encephalitis between both study sites were highlighted. The later virus amplification in the rural cohort may be linked to the later waning of maternal antibodies, but also to the higher pig density in direct proximity of the studied pigs, which could have led to a dilution of mosquito bites at the farm level. The force of infection was almost identical in both the peri-urban and the rural farms studied, which shifts the classic epidemiologic cycle of the virus. This study is a first step in improving our understanding of Japanese encephalitis virus ecology in different environments with distinct landscapes, human and animal densities.
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Affiliation(s)
- Juliette Di Francesco
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
- University of Calgary, Faculty of Veterinary Medicine, Department of Ecosystem and Public Health, Calgary, Canada
- * E-mail:
| | - Rithy Choeung
- Institut Pasteur du Cambodge, Virology Unit, Phnom Penh, Cambodia
| | - Borin Peng
- Institut Pasteur du Cambodge, Virology Unit, Phnom Penh, Cambodia
| | - Long Pring
- Royal University of Agriculture, Phnom Penh, Cambodia
| | - Senglong Pang
- Institut Pasteur du Cambodge, Virology Unit, Phnom Penh, Cambodia
| | - Raphaël Duboz
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
- UMR ASTRE, CIRAD, INRA, Université de Montpellier, Montpellier, France
| | - Sivuth Ong
- Institut Pasteur du Cambodge, Virology Unit, Phnom Penh, Cambodia
| | - San Sorn
- Ministry of Agriculture, Forestry, and Fisheries, Department of Animal Health and Production, Phnom Penh, Cambodia
| | - Arnaud Tarantola
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
| | | | - Veasna Duong
- Institut Pasteur du Cambodge, Virology Unit, Phnom Penh, Cambodia
| | - Philippe Dussart
- Institut Pasteur du Cambodge, Virology Unit, Phnom Penh, Cambodia
| | - Véronique Chevalier
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
- UMR ASTRE, CIRAD, INRA, Université de Montpellier, Montpellier, France
| | - Julien Cappelle
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
- UMR ASTRE, CIRAD, INRA, Université de Montpellier, Montpellier, France
- UMR EpiA, VetAgro Sup, INRA, Marcy l’étoile, France
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How much does direct transmission between pigs contribute to Japanese Encephalitis virus circulation? A modelling approach in Cambodia. PLoS One 2018; 13:e0201209. [PMID: 30114197 PMCID: PMC6095498 DOI: 10.1371/journal.pone.0201209] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/10/2018] [Indexed: 11/27/2022] Open
Abstract
Japanese Encephalitis (JE) is the most important cause of human encephalitis throughout Asia and the Pacific. Although JE is a vector-borne disease, it has been demonstrated experimentally that transmission between pigs can occur through direct contact. Whether pig-to-pig transmission plays a role in the natural epidemiological cycle of JE remains unknown. To assess whether direct transmission between pigs may occur under field conditions, we built two mathematical models of JE transmission incorporating vector-borne transmission alone or a combination of vector-borne and direct transmission. We used Markov Chain Monte Carlo (MCMC) techniques to estimate the parameters of the models. We fitted the models to (i) two serological datasets collected longitudinally from two pig cohorts (C1 and C2) during two periods of four months on a farm on the outskirts of Phnom-Penh, Cambodia and to (ii) a cross-sectional (CS) serological survey dataset collected from 505 swine coming from eight different provinces of Cambodia. In both cases, the model incorporating both vector-borne and direct transmission better explained the data. We computed the value of the basic reproduction number R0 (2.93 for C1, 2.66 for C2 and 2.27 for CS), as well as the vector-borne reproduction number Rpv and the direct transmission reproduction number Rpp. We then determined the contribution of direct transmission on R0 (11.90% for C1, 11.62% for C2 and 7.51% for CS). According to our results, the existence of pig-to-pig transmission is consistent with our swine serological data. Thus, direct transmission may contribute to the epidemiological cycle of JE in Cambodia. These results need to be confirmed in other eco-climatic settings, in particular in temperate areas where pig-to-pig transmission may facilitate the persistence of JE virus (JEV) during cold seasons when there are no or few mosquitoes.
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Abstract
PURPOSE OF REVIEW We examine the present global burden of Japanese encephalitis (JE) in endemic populations, summarize published cases in travelers since 2009, examine current guidelines for vaccination for international travelers, and consider challenges in prevention of this vector-borne disease. RECENT FINDINGS We identified 11 JE cases in travelers that were published in peer-reviewed literature since 2009. JE incidence in endemic countries appears to be declining but the number of JE cases reported to the World Health Organization (WHO) varied from estimates derived from other published reports based on serosurveys or sentinel surveillance. Current JE vaccines appear to be safe and are not associated with delayed hypersensitivity in contrast to the older mouse brain vaccine. Given differences between WHO-reported cases and local surveillance data, future research on true incidence is needed. Regular assessment will inform JE risk in travelers. National and international guidelines on JE vaccination varied; we suggest areas for improvement.
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Bharucha T, Sengvilaipaseuth O, Seephonelee M, Vongsouvath M, Vongsouvath M, Rattanavong S, Piorkowski G, Lecuit M, Gorman C, Pommier JD, Newton PN, de Lamballerie X, Dubot-Pérès A. Detection of Japanese Encephalitis Virus RNA in Human Throat Samples in Laos - A Pilot study. Sci Rep 2018; 8:8018. [PMID: 29789537 PMCID: PMC5964078 DOI: 10.1038/s41598-018-26333-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/10/2018] [Indexed: 11/09/2022] Open
Abstract
Japanese encephalitis virus (JEV) is the most commonly identified cause of acute encephalitis syndrome (AES) in Asia. The WHO recommended test is anti-JEV IgM-antibody-capture-enzyme-linked-immunosorbent-assay (JEV MAC-ELISA). However, data suggest this has low positive predictive value, with false positives related to other Flavivirus infections and vaccination. JEV RT-PCR in cerebrospinal fluid (CSF) and/or serum is highly specific, but is rarely positive; 0-25% of patients that fulfil the WHO definition of JE (clinical Acute Encephalitis Syndrome (AES) and JEV MAC-ELISA positive). Testing other body fluids by JEV RT-qPCR may improve the diagnosis. As a pilot study thirty patients admitted to Mahosot Hospital 2014-2017, recruited to the South-East-Asia-Encephalitis study, were tested by JEV MAC-ELISA and two JEV real-time RT-PCR (RT-qPCR) assays (NS2A and NS3). Eleven (36.7%) were JEV MAC-ELISA positive. Available CSF and serum samples of these patients were JEV RT-qPCR negative but 2 (7%) had JEV RNA detected in their throat swabs. JEV RNA was confirmed by re-testing, and sequencing of RT-qPCR products. As the first apparent report of JEV RNA detection in human throat samples, the provides new perspectives on human JEV infection, potentially informing improving JEV detection. We suggest that testing patients' throat swabs for JEV RNA is performed, in combination with molecular and serological CSF and serum investigations, on a larger scale to investigate the epidemiology of the presence of JEV in human throats. Throat swabs are an easy and non-invasive tool that could be rolled out to a wider population to improve knowledge of JEV molecular epidemiology.
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Affiliation(s)
- Tehmina Bharucha
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR. .,Division of Infection and Immunity, University College London, London, UK.
| | - Onanong Sengvilaipaseuth
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Malee Seephonelee
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Malavanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Sayaphet Rattanavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Géraldine Piorkowski
- UMR "Unité des Virus Emergents" (UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection), Marseille, France
| | - Marc Lecuit
- Institut Pasteur, Biology of Infection Unit, Inserm, U1117, Paris, France.,Paris Descartes University, Necker-Enfants Malades University Hospital, Division of Infectious Diseases and Tropical Medicine, Paris, France
| | - Christopher Gorman
- Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Jean-David Pommier
- Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - Xavier de Lamballerie
- UMR "Unité des Virus Emergents" (UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection), Marseille, France
| | - Audrey Dubot-Pérès
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, UK.,UMR "Unité des Virus Emergents" (UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection), Marseille, France
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Warrell M, Warrell DA, Tarantola A. The Imperative of Palliation in the Management of Rabies Encephalomyelitis. Trop Med Infect Dis 2017; 2:E52. [PMID: 30270909 PMCID: PMC6082067 DOI: 10.3390/tropicalmed2040052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 09/18/2017] [Accepted: 09/28/2017] [Indexed: 12/25/2022] Open
Abstract
The aim of this review is to guide clinicians in the practical management of patients suffering from rabies encephalomyelitis. This condition is eminently preventable by modern post-exposure vaccination, but is virtually always fatal in unvaccinated people. In the absence of any proven effective antiviral or other treatment, palliative care is an imperative to minimise suffering. Suspicion of rabies encephalomyelitis depends on recognising the classic symptomatology and eliciting a history of exposure to a possibly rabid mammal. Potentially treatable differential diagnoses must be eliminated, notably other infective encephalopathies. Laboratory confirmation of suspected rabies is not usually possible in many endemic areas, but is essential for public health surveillance. In a disease as agonising and terrifying as rabies encephalomyelitis, alleviation of distressing symptoms is the primary concern and overriding responsibility of medical staff. Calm, quiet conditions should be created, allowing relatives to communicate with the dying patient in safety and privacy. Palliative management must address thirst and dehydration, fever, anxiety, fear, restlessness, agitation, seizures, hypersecretion, and pain. As the infection progresses, coma and respiratory, cardiovascular, neurological, endocrine, or gastrointestinal complications will eventually ensue. When the facilities exist, the possibility of intensive care may arise, but although some patients may survive, they will be left with severe neurological sequelae. Recovery from rabies is extremely rare, and heroic measures with intensive care should be considered only in patients who have been previously vaccinated, develop rabies antibody within the first week of illness, or were infected by an American bat rabies virus. However, in most cases, clinicians must have the courage to offer compassionate palliation whenever the diagnosis of rabies encephalomyelitis is inescapable.
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Affiliation(s)
- Mary Warrell
- Oxford Vaccine Group, University of Oxford, Centre for Clinical Vaccinology & Tropical Medicine, Churchill Hospital, Old Rd, Headington, Oxford, OX3 7LJ, UK.
| | - David A Warrell
- Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DW, UK.
| | - Arnaud Tarantola
- Institut Pasteur de Nouvelle-Calédonie, BP 61 ⁻ 98845 Nouméa cedex, New Caledonia.
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30
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Jugpal TS, Dixit R, Garg A, Gupta S, Jain V, Patel R, Agarwal S. Spectrum of findings on magnetic resonance imaging of the brain in patients with neurological manifestations of dengue fever. Radiol Bras 2017; 50:285-290. [PMID: 29085161 PMCID: PMC5656068 DOI: 10.1590/0100-3984.2016.0048] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To describe the spectrum of magnetic resonance imaging (MRI) findings in
patients with neurological manifestations of dengue. Materials and Methods We included nine patients with dengue fever (three females and six males; age
range, 9–30 years), all of whom presented with neurological manifestations.
The MRI examinations, performed in 1.5 T or 3 T scanners, included
T1-weighted, T2-weighted, and fluid-attenuated inversion recovery (FLAIR)
sequences. Diffusion-weighted imaging with apparent diffusion coefficient
mapping was also employed. Fast low-angle shot and susceptibility-weighted
gradient-recalled echo sequences, as well as contrast-enhanced T1-weighted
scans, were also obtained in order to assess parenchymal enhancement. MRI
scans were analyzed for lesion distribution and imaging features. Results All patients showed areas of altered signal intensity that appeared as
hyperintensity on T2-weighted and FLAIR sequences. The most commonly
affected site was the basal ganglia-thalamus complex. Other affected sites
were the cerebellum, cerebral cortex, white matter, and brainstem. In all
cases, we observed patchy areas of restricted diffusion and focal areas of
hemorrhage. Conclusion Dengue encephalitis commonly affects the basal ganglia, thalamus, cerebellum,
cerebral cortex, and white matter. Therefore, MRI should be an indispensable
part of the evaluation of patients with neurological complications of dengue
fever.
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Affiliation(s)
| | - Rashmi Dixit
- MD, Department of Diagnostic Radiology, Maulana Azad Medical College, New Delhi, India
| | - Anju Garg
- MD, Department of Diagnostic Radiology, Maulana Azad Medical College, New Delhi, India
| | - Swati Gupta
- MD, Department of Diagnostic Radiology, Maulana Azad Medical College, New Delhi, India
| | - Virendra Jain
- MD, Department of Diagnostic Radiology, Maulana Azad Medical College, New Delhi, India
| | - Ronak Patel
- MD, Department of Diagnostic Radiology, Maulana Azad Medical College, New Delhi, India
| | - Shobhit Agarwal
- MD, Department of General Medicine, Maulana Azad Medical College, New Delhi, India
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31
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Bonell A, Lubell Y, Newton PN, Crump JA, Paris DH. Estimating the burden of scrub typhus: A systematic review. PLoS Negl Trop Dis 2017; 11:e0005838. [PMID: 28945755 PMCID: PMC5634655 DOI: 10.1371/journal.pntd.0005838] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 10/10/2017] [Accepted: 07/28/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Scrub typhus is a vector-borne zoonotic disease that can be life-threatening. There are no licensed vaccines, or vector control efforts in place. Despite increasing awareness in endemic regions, the public health burden and global distribution of scrub typhus remains poorly known. METHODS We systematically reviewed all literature from public health records, fever studies and reports available on the Ovid MEDLINE, Embase Classic + Embase and EconLit databases, to estimate the burden of scrub typhus since the year 2000. FINDINGS In prospective fever studies from Asia, scrub typhus is a leading cause of treatable non-malarial febrile illness. Sero-epidemiological data also suggest that Orientia tsutsugamushi infection is common across Asia, with seroprevalence ranging from 9.3%-27.9% (median 22.2% IQR 18.6-25.7). A substantial apparent rise in minimum disease incidence (median 4.6/100,000/10 years, highest in China with 11.2/100,000/10 years) was reported through passive national surveillance systems in South Korea, Japan, China, and Thailand. Case fatality risks from areas of reduced drug-susceptibility are reported at 12.2% and 13.6% for South India and northern Thailand, respectively. Mortality reports vary widely around a median mortality of 6.0% for untreated and 1.4% for treated scrub typhus. Limited evidence suggests high mortality in complicated scrub typhus with CNS involvement (13.6% mortality), multi-organ dysfunction (24.1%) and high pregnancy miscarriage rates with poor neonatal outcomes. INTERPRETATION Scrub typhus appears to be a truly neglected tropical disease mainly affecting rural populations, but increasingly also metropolitan areas. Rising minimum incidence rates have been reported over the past 8-10 years from countries with an established surveillance system. A wider distribution of scrub typhus beyond Asia is likely, based on reports from South America and Africa. Unfortunately, the quality and quantity of the available data on scrub typhus epidemiology is currently too limited for any economical, mathematical modeling or mapping approaches.
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Affiliation(s)
- Ana Bonell
- Oxford University Clinical Research Unit, National Hospital of Tropical Diseases, Hanoi, Vietnam
| | - Yoel Lubell
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Paul N. Newton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - John A. Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Daniel H. Paris
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Faculty of Medicine, University Basel, Basel, Switzerland
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32
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Duong V, Choeung R, Gorman C, Laurent D, Crabol Y, Mey C, Peng B, Di Francesco J, Hul V, Sothy H, Santy K, Richner B, Pommier JD, Sorn S, Chevalier V, Buchy P, de Lamballerie X, Cappelle J, Horwood PF, Dussart P. Isolation and full-genome sequences of Japanese encephalitis virus genotype I strains from Cambodian human patients, mosquitoes and pigs. J Gen Virol 2017; 98:2287-2296. [PMID: 28840803 DOI: 10.1099/jgv.0.000892] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Japanese encephalitis remains the most important cause of viral encephalitis in humans in several southeast Asian countries, including Cambodia, causing at least 65 000 cases of encephalitis per year. This vector-borne viral zoonosis - caused by Japanese encephalitis virus (JEV) - is considered to be a rural disease and is transmitted by mosquitoes, with birds and pigs being the natural reservoirs, while humans are accidental hosts. In this study we report the first two JEV isolations in Cambodia from human encephalitis cases from two studies on the aetiology of central nervous system disease, conducted at the two major paediatric hospitals in the country. We also report JEV isolation from Culextritaeniorhynchus mosquitoes and from pig samples collected in two farms, located in peri-urban and rural areas. Out of 11 reverse-transcription polymerase chain reaction-positive original samples, we generated full-genome sequences from 5 JEV isolates. Five additional partial sequences of the JEV NS3 gene from viruses detected in five pigs and one complete coding sequence of the envelope gene of a strain identified in a pig were generated. Phylogenetic analyses revealed that JEV detected in Cambodia belonged to genotype I and clustered in two clades: genotype I-a, mainly comprising strains from Thailand, and genotype I-b, comprising strains from Vietnam that dispersed northwards to China. Finally, in this study, we provide proof that the sequenced JEV strains circulate between pigs, Culex tritaeniorhynchus and humans in the Phnom Penh vicinity.
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Affiliation(s)
- Veasna Duong
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia
| | - Rithy Choeung
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia
| | - Christopher Gorman
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia
| | | | - Yoann Crabol
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia
| | - Channa Mey
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia
| | - Borin Peng
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia
| | - Juliette Di Francesco
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia
| | - Vibol Hul
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia
| | - Heng Sothy
- Kantha Bopha Hospital, Phnom Penh, Cambodia
| | - Ky Santy
- Kantha Bopha Hospital, Phnom Penh, Cambodia
| | | | - Jean-David Pommier
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia
| | - San Sorn
- General Directorate of Animal Health and Production, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia
| | - Véronique Chevalier
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia.,UMR ASTRE, CIRAD-BIOS, F-34398, Montpellier, France
| | - Philippe Buchy
- GlaxoSmithKline Vaccines R&D, 23 Rochester Park, 139234, Singapore
| | - Xavier de Lamballerie
- UMR D 190 'Emergence des Pathologies Virales' (Aix-Marseille UnivIRD French Institute of Research for Development, EHESP French School of Public Health), Marseille, France.,IHU Méditerranée Infection, APHM Public Hospitals of Marseille, 13005 Marseille, France
| | - Julien Cappelle
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia.,UMR ASTRE, CIRAD-BIOS, F-34398, Montpellier, France.,UMR EPIA, INRA, VetAgro Sup, Univ Lyon, F-69280, Marcy-l'étoile, France
| | - Paul Francis Horwood
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia.,Australian Institute of Tropical Health and Medicine, James Cook University, PO Box 6811, Cairns, QLD 4870, Australia
| | - Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia
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Islam MS, Sharif AR, Sazzad HMS, Khan AKMD, Hasan M, Akter S, Rahman M, Luby SP, Heffelfinger JD, Gurley ES. Outbreak of Sudden Death with Acute Encephalitis Syndrome Among Children Associated with Exposure to Lychee Orchards in Northern Bangladesh, 2012. Am J Trop Med Hyg 2017; 97:949-957. [PMID: 28749763 PMCID: PMC5590581 DOI: 10.4269/ajtmh.16-0856] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Recurrent outbreaks of acute encephalitis syndrome (AES) among children in lychee growing areas in Asia highlight the need to better understand the etiology and the context. We conducted a mixed-methods study to identify risk factors for disease, and behaviors and practices around lychee cultivation in an AES outbreak community in northern Bangladesh in 2012. The outbreak affected 14 children; 13 died. The major symptoms included unconsciousness, convulsion, excessive sweating, and frothy discharge. The median time from illness onset to unconsciousness was 2.5 hours. The outbreak corresponded with lychee harvesting season. Multiple pesticides including some banned in Bangladesh were frequently used in the orchards. Visiting a lychee orchard within 24 hours before onset (age-adjusted odds ratio [aOR] = 11.6 [1.02–109.8]) and 3 days (aOR = 7.2 [1.4–37.6]), and family members working in a lychee orchard (aOR = 7.2 [1.7–29.4]) and visiting any garden while pesticides were being applied (aOR = 4.9 [1.0–19.4]) in 3 days preceding illness onset were associated with illness in nearby village analysis. In neighborhood analysis, visiting an orchard that used pesticides (aOR = 8.4 [1.4–49.9]) within 3 days preceding illness onset was associated with illness. Eating lychees was not associated with illness in the case–control study. The outbreak was linked to lychee orchard exposures where agrochemicals were routinely used, but not to consumption of lychees. Lack of acute specimens was a major limitation. Future studies should target collection of environmental and food samples, acute specimens, and rigorous assessment of community use of pesticides to determine etiology.
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Affiliation(s)
| | - Ahmad Raihan Sharif
- Institute of Epidemiology Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Hossain M S Sazzad
- International Centre for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - A K M Dawlat Khan
- International Centre for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Murshid Hasan
- International Centre for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Shirina Akter
- International Centre for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Mahmudur Rahman
- Institute of Epidemiology Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Stephen P Luby
- Center for Innovation in Global Health, Stanford University, Stanford, California.,Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.,International Centre for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - James D Heffelfinger
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.,International Centre for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Emily S Gurley
- International Centre for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh
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Ngwe Tun MM, V Muthugala R, Thi Thu Thuy N, Hoai Linh Ly P, Thi Hien Thu L, Thi Dinh D, Viet Hoang N, Thi Quynh Mai L, Moi ML, C Buerano C, Morita K, Hasebe F. Dengue Associated Acute Encephalitis Syndrome Cases in Son La Province, Vietnam in 2014. Jpn J Infect Dis 2017; 70:357-361. [PMID: 27795473 DOI: 10.7883/yoken.jjid.2016.246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute encephalitis syndrome (AES) is associated with high morbidity and mortality, and affects both children and adults. The main etiologic agent is Japanese encephalitis virus (JEV); however, there are also reports of Dengue virus (DENV) encephalitis. The objectives of this study were to determine the proportion of patients with encephalitis due to JEV during the 2014 outbreak in Son La Province in Vietnam and to explore the association of DENV in non-JEV viral encephalitis cases. Of 90 patients, 6 (6.7%) were positive for anti-JEV immunoglobulin M (IgM), 5 (5.6%) were positive for anti-DENV IgM, 30 (33.3%) were positive for both anti-JEV and anti-DENV IgM, and 56 (62.2%) were positive for flavivirus immunoglobulin G (IgG). In 5 patients with AES, who had positive anti-DENV IgM results in at least one of the paired serum samples, DENV was confirmed by neutralization testing. The incidence of JEV infection was high. There is still a need to maintain and strengthen the national JEV immunization program. This noticeable occurrence of DENV infection was not reported in Son La Province in 2013-2014. Our data suggested that in addition to JEV, DENV was also a causative agent of AES in 2014 in Son La Province, and this finding also confirmed the local occurrence of DENV infection.
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Affiliation(s)
- Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine, Nagasaki University
| | | | | | | | - Le Thi Hien Thu
- Department of Virology, National Institute of Hygiene and Epidemiology
| | - Dang Thi Dinh
- Department of Virology, National Institute of Hygiene and Epidemiology
| | - Nguyen Viet Hoang
- Department of Virology, National Institute of Hygiene and Epidemiology
| | - Le Thi Quynh Mai
- Department of Virology, National Institute of Hygiene and Epidemiology
| | - Meng Ling Moi
- Department of Virology, Institute of Tropical Medicine, Nagasaki University
| | - Corazon C Buerano
- Department of Virology, Institute of Tropical Medicine, Nagasaki University
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine, Nagasaki University
| | - Futoshi Hasebe
- Department of Virology, Institute of Tropical Medicine, Nagasaki University.,Center for International Collaborative Research, Nagasaki University
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Aetiology of acute meningoencephalitis in Cambodian children, 2010-2013. Emerg Microbes Infect 2017; 6:e35. [PMID: 28536430 PMCID: PMC5520480 DOI: 10.1038/emi.2017.15] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 01/09/2023]
Abstract
Acute meningoencephalitis (AME) is associated with considerable morbidity and mortality in children in developing countries. Clinical specimens were collected from children presenting with AME at two Cambodian paediatric hospitals to determine the major aetiologies associated with AME in the country. Cerebrospinal fluid (CSF) and blood samples were screened by molecular and cell culture methods for a range of pathogens previously associated with AME in the region. CSF and serum (acute and convalescent) were screened for antibodies to arboviruses such as Japanese encephalitis virus (JEV), dengue virus (DENV), and chikungunya virus (CHIKV). From July 2010 through December 2013, 1160 children (one month to 15 years of age) presenting with AME to two major paediatric hospitals were enroled into the study. Pathogens associated with AME were identified using molecular diagnostics, cell culture and serology. According to a diagnostic algorithm, a confirmed or highly probable aetiologic agent was detected in 35.0% (n=406) of AME cases, with a further 9.2% (total: 44.2%, n=513) aetiologies defined as suspected. JEV (24.4%, n=283) was the most commonly identified pathogen followed by Orientia tsutsugamushi (4.7%, n=55), DENV (4.6%, n=53), enteroviruses (3.5%, n=41), CHIKV (2.0%, n=23) and Streptococcus pneumoniae (1.6%, n=19). The majority of aetiologies identified for paediatric AME in Cambodia were vaccine preventable and/or treatable with appropriate antimicrobials.
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Chen TH, Hu CC, Liao JT, Lee YL, Huang YW, Lin NS, Lin YL, Hsu YH. Production of Japanese Encephalitis Virus Antigens in Plants Using Bamboo Mosaic Virus-Based Vector. Front Microbiol 2017; 8:788. [PMID: 28515719 PMCID: PMC5413549 DOI: 10.3389/fmicb.2017.00788] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/18/2017] [Indexed: 12/27/2022] Open
Abstract
Japanese encephalitis virus (JEV) is among the major threats to public health in Asia. For disease control and prevention, the efficient production of safe and effective vaccines against JEV is in urgent need. In this study, we produced a plant-made JEV vaccine candidate using a chimeric virus particle (CVP) strategy based on bamboo mosaic virus (BaMV) for epitope presentation. The chimeric virus, designated BJ2A, was constructed by fusing JEV envelope protein domain III (EDIII) at the N-terminus of BaMV coat protein, with an insertion of the foot-and-mouth disease virus 2A peptide to facilitate the production of both unfused and epitope-presenting for efficient assembly of the CVP vaccine candidate. The strategy allowed stable maintenance of the fusion construct over long-term serial passages in plants. Immuno-electron microscopy examination and immunization assays revealed that BJ2A is able to present the EDIII epitope on the surface of the CVPs, which stimulated effective neutralizing antibodies against JEV infection in mice. This study demonstrates the efficient production of an effective CVP vaccine candidate against JEV in plants by the BaMV-based epitope presentation system.
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Affiliation(s)
- Tsung-Hsien Chen
- Graduate Institute of Biotechnology, National Chung Hsing UniversityTaichung, Taiwan
| | - Chung-Chi Hu
- Graduate Institute of Biotechnology, National Chung Hsing UniversityTaichung, Taiwan
| | - Jia-Teh Liao
- Graduate Institute of Biotechnology, National Chung Hsing UniversityTaichung, Taiwan
| | - Yi-Ling Lee
- Institute of Biomedical Sciences, Academia SinicaTaipei, Taiwan
| | - Ying-Wen Huang
- Graduate Institute of Biotechnology, National Chung Hsing UniversityTaichung, Taiwan
| | - Na-Sheng Lin
- Graduate Institute of Biotechnology, National Chung Hsing UniversityTaichung, Taiwan.,Institute of Plant and Microbial Biology, Academia SinicaTaipei, Taiwan
| | - Yi-Ling Lin
- Institute of Biomedical Sciences, Academia SinicaTaipei, Taiwan
| | - Yau-Heiu Hsu
- Graduate Institute of Biotechnology, National Chung Hsing UniversityTaichung, Taiwan
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Boucher A, Herrmann JL, Morand P, Buzelé R, Crabol Y, Stahl JP, Mailles A. Epidemiology of infectious encephalitis causes in 2016. Med Mal Infect 2017; 47:221-235. [PMID: 28341533 DOI: 10.1016/j.medmal.2017.02.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/17/2017] [Indexed: 10/19/2022]
Abstract
We performed a literature search in the Medline database, using the PubMed website. The incidence of presumably infectious encephalitis is estimated at 1.5-7 cases/100,000 inhabitants/year, excluding epidemics. Infectious encephalitis and immune-mediated encephalitis share similar clinical signs and symptoms. The latter accounts for a significant proportion of presumably infectious encephalitis cases without any established etiological diagnosis; as shown from a prospective cohort study where 21% of cases were due to an immune cause. Several infectious agents are frequently reported in all studies: Herpes simplex virus (HSV) is the most frequent pathogen in 65% of studies, followed by Varicella-zoster virus (VZV) in several studies. Enteroviruses are also reported; being the most frequent viruses in two studies, and the 2nd or 3rd viruses in five other studies. There are important regional differences, especially in case of vector-borne transmission: Asia and the Japanese encephalitis virus, Eastern and Northern Europe/Eastern Russia and the tick-borne encephalitis virus, Northern America and Flavivirus or Alphavirus. Bacteria can also be incriminated: Mycobacterium tuberculosis and Listeria monocytogenes are the most frequent, after HSV and VZV, in a French prospective study. The epidemiology of encephalitis is constantly evolving. Epidemiological data may indicate the emergence and/or dissemination of new causative agents. The dissemination and emergence of causative agents are fostered by environmental, social, and economical changes, but prevention programs (vaccination, vector controls) help reduce the incidence of other infectious diseases and associated encephalitis (e.g., measles).
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Affiliation(s)
- A Boucher
- Maladies infectieuses, CHU de Lille, 59000 Lille, France
| | - J L Herrmann
- Microbiologie, CHU de Garches, 92380 Garches, France
| | - P Morand
- Virologie, CHU Grenoble Alpes, 38700 La Tronche, France
| | - R Buzelé
- Médecine interne, centre hospitalier de Saint-Brieuc, 22027 Saint-Brieuc, France
| | - Y Crabol
- Médecine interne, centre hospitalier Vannes-Aufray, 56000 Vannes, France
| | - J P Stahl
- Maladies infectieuses, CHU Grenoble Alpes, Grenoble - "European Study Group for the Infections of the Brain (ESGIB)", 38700 La Tronche, France.
| | - A Mailles
- Direction des maladies infectieuses, santé publique France - "European Study Group for the Infections of the Brain (ESGIB)", 94410 Saint-Maurice, France
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Cappelle J, Duong V, Pring L, Kong L, Yakovleff M, Prasetyo DB, Peng B, Choeung R, Duboz R, Ong S, Sorn S, Dussart P, Tarantola A, Buchy P, Chevalier V. Intensive Circulation of Japanese Encephalitis Virus in Peri-urban Sentinel Pigs near Phnom Penh, Cambodia. PLoS Negl Trop Dis 2016; 10:e0005149. [PMID: 27926937 PMCID: PMC5142769 DOI: 10.1371/journal.pntd.0005149] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/31/2016] [Indexed: 11/18/2022] Open
Abstract
Despite the increased use of vaccination in several Asian countries, Japanese Encephalitis (JE) remains the most important cause of viral encephalitis in Asia in humans with an estimated 68,000 cases annually. Considered a rural disease occurring mainly in paddy-field dominated landscapes where pigs are amplifying hosts, JE may nevertheless circulate in a wider range of environment given the diversity of its potential hosts and vectors. The main objective of this study was to assess the intensity of JE transmission to pigs in a peri-urban environment in the outskirt of Phnom Penh, Cambodia. We estimated the force of JE infection in two cohorts of 15 sentinel pigs by fitting a generalised linear model on seroprevalence monitoring data observed during two four-month periods in 2014. Our results provide evidence for intensive circulation of JE virus in a periurban area near Phnom Penh, the capital and most populated city of Cambodia. Understanding JE virus transmission in different environments is important for planning JE virus control in the long term and is also an interesting model to study the complexity of vector-borne diseases. Collecting quantitative data such as the force of infection will help calibrate epidemiological model that can be used to better understand complex vector-borne disease epidemiological cycles.
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Affiliation(s)
- Julien Cappelle
- CIRAD-ES, UPR AGIRs, Montpellier, France
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
| | - Veasna Duong
- Institut Pasteur du Cambodge, Virology Unit, Phnom Penh, Cambodia
| | - Long Pring
- Royal University of Agriculture, Phnom Penh, Cambodia
| | - Lida Kong
- Royal University of Agriculture, Phnom Penh, Cambodia
| | - Maud Yakovleff
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
| | | | - Borin Peng
- Institut Pasteur du Cambodge, Virology Unit, Phnom Penh, Cambodia
| | - Rithy Choeung
- Institut Pasteur du Cambodge, Virology Unit, Phnom Penh, Cambodia
| | - Raphaël Duboz
- CIRAD-ES, UPR AGIRs, Montpellier, France
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
| | - Sivuth Ong
- Institut Pasteur du Cambodge, Virology Unit, Phnom Penh, Cambodia
| | - San Sorn
- National Veterinary Research Institute, Phnom Penh, Cambodia
| | - Philippe Dussart
- Institut Pasteur du Cambodge, Virology Unit, Phnom Penh, Cambodia
| | - Arnaud Tarantola
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
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Khandaker G, Jung J, Britton PN, King C, Yin JK, Jones CA. Long-term outcomes of infective encephalitis in children: a systematic review and meta-analysis. Dev Med Child Neurol 2016; 58:1108-1115. [PMID: 27422743 DOI: 10.1111/dmcn.13197] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2016] [Indexed: 11/26/2022]
Abstract
AIM The long-term outcomes of childhood infective encephalitis are variable and not well quantified. We aimed to systematically review the literature and undertake meta-analyses on predetermined outcomes to address this knowledge gap and identify areas for future research. METHOD We searched electronic databases, performed complementary reviews of references of fully extracted articles, and made contact with experts on infective encephalitis. Articles published up until April 2016 were selected for screening. RESULTS We evaluated sequelae of 1018 survivors of childhood infective encephalitis (934 with complete follow-up) from 16 studies. Mean age during acute encephalitis episodes was 5 years 3.6 months (range 1.2mo-17y), 57.6% were male (500/868), and mean follow-up period was 4 years 1.2 months (range 1-12y). Incomplete recovery was reported in 312 children (42.0%; 95% confidence interval [CI] 31.6-53.1% in pooled estimate). Among the other sequelae, developmental delay, abnormal behaviour, motor impairment, and seizures were reported among 35.0% (95% CI 10.0-65.0%), 18.0% (95% CI 8.0-31.0%), 17.0% (95% CI 10.0-26.0%), and 10.0% (95% CI 6.0-14.0%) respectively. INTERPRETATION Almost half of childhood infective encephalitis survivors report incomplete recovery in the long-term; most commonly developmental delay, behavioural abnormality, and neurological impairments (i.e. seizure). Well designed, large-scale prospective studies are needed to better quantify neurodevelopmental sequelae among childhood encephalitis survivors.
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Affiliation(s)
- Gulam Khandaker
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. .,National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW, Australia. .,Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Sydney, NSW, Australia.
| | - Jenny Jung
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Philip N Britton
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Catherine King
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - J Kevin Yin
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Cheryl A Jones
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, NSW, Australia
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40
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Solbrig MV, Perng GC. Current neurological observations and complications of dengue virus infection. Curr Neurol Neurosci Rep 2016; 15:29. [PMID: 25877545 DOI: 10.1007/s11910-015-0550-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Dengue, a mosquito-borne flavivirus and fastest growing tropical disease in the world, has experienced an explosion of neurologic case reports and series in recent years. Now dengue is a frequent or leading cause of encephalitis in some endemic regions, is estimated to infect one in six tourists returning from the tropics, and has been proven to have local transmission within the continental USA. High documentation of neurologic disease in recent years reflects increases in overall cases, enhanced clinical awareness and advances in diagnostics. Neurological aspects of dengue virus, along with epidemiology, treatment, and vaccine progress, are presented.
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Affiliation(s)
- Marylou V Solbrig
- Department of Pharmacology and Toxicology, School of Pharmacy, University of Kansas, 1251 Wescoe Hall Drive, Malott Hall Rm 5040, Lawrence, KS, 66045, USA,
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41
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Duong V, Tarantola A, Ong S, Mey C, Choeung R, Ly S, Bourhy H, Dussart P, Buchy P. Laboratory diagnostics in dog-mediated rabies: an overview of performance and a proposed strategy for various settings. Int J Infect Dis 2016; 46:107-14. [DOI: 10.1016/j.ijid.2016.03.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/15/2016] [Accepted: 03/15/2016] [Indexed: 10/22/2022] Open
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42
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How many patients with anti-JEV IgM in cerebrospinal fluid really have Japanese encephalitis? THE LANCET. INFECTIOUS DISEASES 2015; 15:1376-7. [PMID: 26607119 DOI: 10.1016/s1473-3099(15)00405-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/12/2015] [Indexed: 11/20/2022]
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43
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Conlan JV, Vongxay K, Khamlome B, Jarman RG, Gibbons RV, Fenwick SG, Thompson RCA, Blacksell SD. Patterns of Flavivirus Seroprevalence in the Human Population of Northern Laos. Am J Trop Med Hyg 2015; 93:1010-1013. [PMID: 26304925 PMCID: PMC4703266 DOI: 10.4269/ajtmh.15-0072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 06/23/2015] [Indexed: 11/11/2022] Open
Abstract
A total of 1,136 samples from 289 households in four provinces in northern Laos were subjected to Japanese encephalitis virus (JEV) and dengue virus hemagglutination inhibition (DENV HI). Overall, antibodies to JEV were detected by HI in 620 (54.6%) of 1,136 people; of which 217 (19.1%) had HI activity against JEV only. Antibodies to DENV4 were detected by HI in 526 (46.3%) of 1,136 people; of which 124 (10.9%) had HI activity against DENV4 only. Antibodies to DENV1–3 were detected by HI in 296 (26.1%), 274 (24.1%), and 283 (24.9) of 1,136 people, respectively; of which 7, 1, and 0, respectively, had HI activity against DENV1–3 only. JEV was the most prevalent Flavivirus in Oudomxay, Luangprabang, and Huaphan provinces and DENV4 was the most prevalent in Xiengkhouang province. Seroprevalence for JEV increased with increasing age and wealth and was higher in villages where rice was cultivated in paddy fields and highest for people of Lao-Tai ethnicity.
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Affiliation(s)
| | | | | | | | | | | | | | - Stuart D. Blacksell
- *Address correspondence to Stuart D. Blacksell, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand. E-mail:
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44
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Goutard FL, Binot A, Duboz R, Rasamoelina-Andriamanivo H, Pedrono M, Holl D, Peyre MI, Cappelle J, Chevalier V, Figuié M, Molia S, Roger FL. How to reach the poor? Surveillance in low-income countries, lessons from experiences in Cambodia and Madagascar. Prev Vet Med 2015; 120:12-26. [PMID: 25842000 DOI: 10.1016/j.prevetmed.2015.02.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 02/16/2015] [Accepted: 02/16/2015] [Indexed: 10/24/2022]
Abstract
Surveillance of animal diseases in developing countries faces many constraints. Innovative tools and methods to enhance surveillance in remote and neglected areas should be defined, assessed and applied in close connection with local farmers, national stakeholders and international agencies. The authors performed a narrative synthesis of their own publications about surveillance in Madagascar and Cambodia. They analysed the data in light of their fieldwork experiences in the two countries' very challenging environments. The burden of animal and zoonotic diseases (e.g. avian influenza, African swine fever, Newcastle disease, Rift Valley fever) is huge in both countries which are among the poorest in the world. Being poor countries implies a lack of human and financial means to ensure effective surveillance of emerging and endemic diseases. Several recent projects have shown that new approaches can be proposed and tested in the field. Several advanced participatory approaches are promising and could be part of an innovative method for improving the dialogue among different actors in a surveillance system. Thus, participatory modelling, developed for natural resources management involving local stakeholders, could be applied to health management, including surveillance. Data transmission could benefit from the large mobile-phone coverage in these countries. Ecological studies and advances in the field of livestock surveillance should guide methods for enhancing wildlife monitoring and surveillance. Under the umbrella of the One Health paradigm, and in the framework of a risk-based surveillance concept, a combination of participatory methods and modern technologies could help to overcome the constraints present in low-income countries. These unconventional approaches should be merged in order to optimise surveillance of emerging and endemic diseases in challenging environments.
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Affiliation(s)
- F L Goutard
- Cirad, AGIRs Research Unit, Montpellier, France; Kasetsart University, Bangkok, Thailand.
| | - A Binot
- Cirad, AGIRs Research Unit, Montpellier, France; Kasetsart University, Bangkok, Thailand
| | - R Duboz
- Cirad, AGIRs Research Unit, Montpellier, France; AIT, Bangkok, Thailand
| | | | - M Pedrono
- Cirad, AGIRs Research Unit, Montpellier, France; FOFIFA, Antananarivo, Madagascar
| | - D Holl
- NaVRI, Phnom Penh, Cambodia
| | - M I Peyre
- Cirad, AGIRs Research Unit, Montpellier, France; NIVR, Hanoi, Viet Nam
| | - J Cappelle
- Cirad, AGIRs Research Unit, Montpellier, France; Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - V Chevalier
- Cirad, AGIRs Research Unit, Montpellier, France
| | - M Figuié
- Cirad, MOISA Research Unit, Montpellier, France
| | - S Molia
- Cirad, AGIRs Research Unit, Montpellier, France; Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - F L Roger
- Cirad, AGIRs Research Unit, Montpellier, France; Kasetsart University, Bangkok, Thailand
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45
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Tan LV, Thai LH, Phu NH, Nghia HDT, Chuong LV, Sinh DX, Phong ND, Mai NTH, Man DNH, Hien VM, Vinh NT, Day J, Chau NVV, Hien TT, Farrar J, de Jong MD, Thwaites G, van Doorn HR, Chau TTH. Viral aetiology of central nervous system infections in adults admitted to a tertiary referral hospital in southern Vietnam over 12 years. PLoS Negl Trop Dis 2014; 8:e3127. [PMID: 25165820 PMCID: PMC4148224 DOI: 10.1371/journal.pntd.0003127] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/19/2014] [Indexed: 12/03/2022] Open
Abstract
Background Central nervous system (CNS) infections are important diseases in both children and adults worldwide. The spectrum of infections is broad, encompassing bacterial/aseptic meningitis and encephalitis. Viruses are regarded as the most common causes of encephalitis and aseptic meningitis. Better understanding of the viral causes of the diseases is of public health importance, in order to better inform immunization policy, and may influence clinical management. Methodology/Principal Findings Study was conducted at the Hospital for Tropical Diseases in Ho Chi Minh City, a primary, secondary, and tertiary referral hospital for all southern provinces of Vietnam. Between December 1996 and May 2008, patients with CNS infections of presumed viral origin were enrolled. Laboratory diagnostics consisted of molecular and serological tests targeted at 14 meningitis/encephalitis-associated viruses. Of 291 enrolled patients, fatal outcome and neurological sequelae were recorded in 10% (28/291) and 27% (78/291), respectively. Mortality was especially high (9/19, 47%) amongst those with confirmed herpes simplex encephalitis which is attributed to the limited availability of intravenous acyclovir/valacyclovir. Japanese encephalitis virus, dengue virus, herpes simplex virus, and enteroviruses were the most common viruses detected, responsible for 36 (12%), 19 (6.5%), 19 (6.5%) and 8 (2.7%) respectively, followed by rubella virus (6, 2%), varicella zoster virus (5, 1.7%), mumps virus (2, 0.7%), cytomegalovirus (1, 0.3%), and rabies virus (1, 0.3%). Conclusions/Significance Viral infections of the CNS in adults in Vietnam are associated with high morbidity and mortality. Despite extensive laboratory testing, 68% of the patients remain undiagnosed. Together with our previous reports, the data confirm that Japanese encephalitis virus, dengue virus, herpes simplex virus, and enteroviruses are the leading identified causes of CNS viral infections in Vietnam, suggest that the majority of morbidity/mortality amongst patients with a confirmed/probable diagnosis is preventable by adequate vaccination/treatment, and are therefore of public health significance. Central nervous system (CNS) infections are important diseases worldwide. The spectrum of infections is broad, encompassing bacterial/aseptic meningitis and encephalitis. Viruses are regarded as the most common causes of encephalitis and aseptic meningitis. Better understanding of the causes of the diseases is of public health importance, in order to better inform immunization policy, and influence clinical management. We describe the clinical features and infectious causes of 291 adults with clinically suspected CNS infections of presumed viral origin. We show that CNS viral infections in Vietnam are associated with high morbidity and mortality. Mortality was especially high (47%) amongst those with herpes simplex encephalitis which is attributed to the limited availability specific antiviral drugs in our setting. Japanese encephalitis virus, dengue viruses, herpes simplex virus and enteroviruses were the most common viruses detected, followed by rubella virus, varicella zoster virus, mumps virus, cytomegalovirus, and rabies virus. Our study represents the broadest yet investigation of the possible viral causes of the CNS infections in adults in Vietnam, with a diagnostic yield of 32%. The results show that the majority of morbidity/mortality amongst patients with a confirmed/probable diagnosis could be prevented by adequate vaccination or treatment, and are therefore of public health significance.
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Affiliation(s)
- Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- * E-mail:
| | - Le Hong Thai
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Ho Dang Trung Nghia
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Ly Van Chuong
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Dinh Xuan Sinh
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | | | | | - Vo Minh Hien
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Jeremy Day
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Tran Tinh Hien
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jeremy Farrar
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Menno D. de Jong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Department of Medical Microbiology, Academic Medical, Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - H. Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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