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Peng W, Li J, Yu H, Zhou W, Lin L, Ge Z, Lai J, Chen Z, Zhu L, Zhao Z, Shen Y, Jin R, Duan J, Zhang W. Activated partial thromboplastin time predicts mortality in patients with severe fever with thrombocytopenia syndrome: A multicenter study in north China. Heliyon 2024; 10:e31289. [PMID: 38867977 PMCID: PMC11167268 DOI: 10.1016/j.heliyon.2024.e31289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/14/2024] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with high lethality. This study aimed to determine whether prolonged activated partial thromboplastin time (APTT) predicted SFTS mortality. Methods SFTS patients were enrolled from 6 hospitals in the north China. Subjects were divided into training cohort and 5 externally validation cohorts. The least absolute shrinkage and selection operator Cox regression model was performed to screen potential prognostic factors. Risk factors were analyzed using multivariable regression models. Prognostic models were established by Cox regression and random survival forest (RSF) methods, and evaluated regarding discrimination, validity and clinical benefit. Time-dependent receiver operating characteristic (ROC) curve was used to evaluate the predictive effectiveness of variables. Results 1332 SFTS cases were included, in which 211 patients died. Six potential prognostic factors were screened, and pulse, breath, APTT and aspartic transaminase (AST) were independently associated with mortality in both training cohort (Yantai, N = 791) and external validation cohort (N = 541). APTT was steadily correlated with the fatality (HR: 1.039-1.144; all P < 0.01) in each five sub-validation cohorts (Dandong, Dalian, Tai'an, Qingdao and Beijing). RSF model with variables of APTT, AST, pulse and breath had considerable prognostic effectiveness, which APTT showed the highest prognostic ability with the area under the curve of 0.848 and 0.787 for 7-day and 14-day survival, respectively. Survival differences were found between high and low levels of APTT for mortality using 50s as the optimal cut-off. Conclusions SFTS patients have prolonged APTT, which is an independent risk factor for fatality. APTT≥50s was recommended as a biomarker to remind physicians to monitor and treat patients more aggressively to improve clinical prognosis.
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Affiliation(s)
- Wenjuan Peng
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
| | - Junnan Li
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
| | - Hong Yu
- Department of Infectious Disease, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Wei Zhou
- Department of Public Health Clinical Center, Dalian, China
| | - Ling Lin
- Department of Infectious Disease, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Ziruo Ge
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jianming Lai
- Department of Infectious Disease, Qing Dao No 6 People's Hospital, Qingdao, China
| | - Zhihai Chen
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Liuluan Zhu
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
| | - Zhenghua Zhao
- Department of Infectious Disease, Tai'an City Central Hospital, Tai'an, China
| | - Yi Shen
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, Dandong, China
| | - Ronghua Jin
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
| | - Jianping Duan
- Department of Infectious Disease, Qing Dao No 6 People's Hospital, Qingdao, China
| | - Wei Zhang
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Wen Y, Fang Y, Cao F, Zhang G, Cheng S, Yu Y, Huang R, Ni Z, Li J. A person-to-person transmission cluster of severe fever with thrombocytopenia syndrome characterized by mixed viral infections with familial and nosocomial clustering. Heliyon 2024; 10:e24502. [PMID: 38298613 PMCID: PMC10827760 DOI: 10.1016/j.heliyon.2024.e24502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/29/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease with sporadic occurrence and high mortality. Herein, we report an example of the in-hospital transmission of SFTS virus (SFTSV) infections with familial and nosocomial clustering in Zhejiang Province, eastern China, from March to April 2023. The epidemiological investigation and genomic analysis revealed that at least eight suspected cases of SFTS occurred in this cluster, including one death and one asymptomatic case. Our report reemphasizes the risk of familial and nosocomial SFTSV infections in healthcare settings and the urgent need for the long-term systematic surveillance of SFTSV evolution in humans and animals in the eastern coastal regions of China.
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Affiliation(s)
- Yanping Wen
- Hangzhou Center for Disease Control and Prevention, Zhejiang, China
| | - Yezhen Fang
- Shangcheng District Center for Disease Control and Prevention, Zhejiang, China
| | - Feifei Cao
- Hangzhou Center for Disease Control and Prevention, Zhejiang, China
| | - Guozhong Zhang
- Hangzhou Center for Disease Control and Prevention, Zhejiang, China
| | - Shi Cheng
- Hangzhou Center for Disease Control and Prevention, Zhejiang, China
| | - Yue Yu
- Hangzhou Center for Disease Control and Prevention, Zhejiang, China
| | - Renjie Huang
- Hangzhou Center for Disease Control and Prevention, Zhejiang, China
| | - Zhimin Ni
- Shangcheng District Center for Disease Control and Prevention, Zhejiang, China
| | - Jun Li
- Hangzhou Center for Disease Control and Prevention, Zhejiang, China
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Liu T, Zhang N, Li H, Hou S, Liu X. Analysis of severe fever with thrombocytopenia syndrome cluster in east China. Virol J 2023; 20:199. [PMID: 37658435 PMCID: PMC10474674 DOI: 10.1186/s12985-023-02155-3] [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: 02/01/2023] [Accepted: 08/08/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is a common tick-borne, natural focal disease. SFTS virus (SFTSV) transmission can occur between family members through close contact with an infected patient. In this study, we explored the possible transmission route of an outbreak cluster in east China. METHOD A case-control study was carried out to analyze the potential risk factors for person-to-person transmission. Bunia virus was detected by IgM antibody, enzyme-linked immunosorbent assay, and reverse transcription polymerase chain reaction. Chi-square, univariate, and multivariate analyses were performed to calculate the association of possible risk factors for SFTSV transmission. RESULTS Two patients had a clear history of blood and aerosols contact, and one may be exposed to aerosols in a closed environment. Five close contacts of the Index patient were IgM-positive and three were IgM and SFTSV RNA positive. Exposure to a poorly ventilated space where the corpse was stored (χ2 = 5.49, P = 0.019) and contact with the Index patient's contaminated items (χ2 = 15.77, P < 0.001) significantly associated with SFTSV infection. CONCLUSION We suspect that the cluster outbreak was possibly a person-to-person transmission of SFTSV, which may have been transmitted by directly contacting with blood of SFTS patient. The propagation of aerosols in closed environments is also an undeniable transmission.
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Affiliation(s)
- Tao Liu
- Department of Infectious Disease Control, Yantai Center for Disease Control and Prevention, 17 Fuhou Rd, Laishan District, Yantai, Shandong Province, P. R. China
| | - Nannan Zhang
- Department of Infectious Disease Control, Yantai Center for Disease Control and Prevention, 17 Fuhou Rd, Laishan District, Yantai, Shandong Province, P. R. China
| | - Haiwen Li
- Department of Infectious Disease Control, Zhaoyuan Center for Disease Control and Prevention, Yantai, Shandong Province, P. R. China
| | - Shuting Hou
- Department of Infectious Disease Control, Yantai Center for Disease Control and Prevention, 17 Fuhou Rd, Laishan District, Yantai, Shandong Province, P. R. China.
| | - Xiuwei Liu
- Department of Infectious Disease Control, Yantai Center for Disease Control and Prevention, 17 Fuhou Rd, Laishan District, Yantai, Shandong Province, P. R. China.
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Liang S, Xie W, Li Z, Zhang N, Wang X, Qin Y, Bao C, Hu J. Analysis of fatal cases of severe fever with thrombocytopenia syndrome in Jiangsu province, China, between 2011 and 2022: A retrospective study. Front Public Health 2023; 11:1076226. [PMID: 37033043 PMCID: PMC10076888 DOI: 10.3389/fpubh.2023.1076226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/21/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by the SFTS virus (SFTSV), which has a high fatality rate. This disease has become increasingly prevalent in recent years in Jiangsu province, with a noticeable rise in its incidence. Notably, fatal cases have also been increasing. Our study aimed to analyze the epidemiological characteristics and risk factors associated with the fatal cases of SFTS in Jiangsu province from 2011 to September 2022. Methods A retrospective study was performed among 698 SFTS cases during 2011-2022 in Jiangsu Province, China. Cox regression analyses were used to determine the dependent and independent risk factors that affected patient survival time. ArcGIS 10.7 was used for the visualization of the geographical distribution of the deaths from SFTS. Results There were 698 SFTS cases reported, with an increasing incidence, over the 12-year period. Among these cases, 43 deaths were reported. Fatal cases of SFTS were reported in 12 district counties from 2011 to 2022. Notably, most of the deaths occurred in Lishui county of Nanjing City. The median age of those who died was 69 years, with age ranges from 50 to 83 years. Multivariable Cox regression analysis showed that older age (>70) and living in Lishui county were risk factors for death from SFTS in Jiangsu province. Therefore, older adults aged over 70 years and residing in Lishui county were the high-risk group for SFTS mortality. Discussion Over the past 12 years, we have observed a consistent rise in the incidence of SFTS, accompanied by a relatively high case fatality rate, making it a critical public health issue. Therefore, it is urgently necessary to study the impact of meteorological factors on SFTS epidemics and devise prevention and control strategies.
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Affiliation(s)
- Shuyi Liang
- Jiangsu Provincial Center for Disease Control and Prevention, Acute Infectious Disease Control and Prevention Institute, Nanjing, China
| | - Wei Xie
- Jiangsu Provincial Center for Disease Control and Prevention, Institute of Food Safety and Assessment, Nanjing, China
| | - Zhifeng Li
- Jiangsu Provincial Center for Disease Control and Prevention, Acute Infectious Disease Control and Prevention Institute, Nanjing, China
| | - Nan Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Acute Infectious Disease Control and Prevention Institute, Nanjing, China
| | - Xiaochen Wang
- Jiangsu Provincial Center for Disease Control and Prevention, Acute Infectious Disease Control and Prevention Institute, Nanjing, China
| | - Yuanfang Qin
- Jiangsu Provincial Center for Disease Control and Prevention, Acute Infectious Disease Control and Prevention Institute, Nanjing, China
| | - Changjun Bao
- Jiangsu Provincial Center for Disease Control and Prevention, Acute Infectious Disease Control and Prevention Institute, Nanjing, China
| | - Jianli Hu
- Jiangsu Provincial Center for Disease Control and Prevention, Acute Infectious Disease Control and Prevention Institute, Nanjing, China
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Liang S, Li Z, Zhang N, Wang X, Qin Y, Xie W, Bao C, Hu J. Epidemiological and spatiotemporal analysis of severe fever with thrombocytopenia syndrome in Eastern China, 2011-2021. BMC Public Health 2023; 23:508. [PMID: 36927782 PMCID: PMC10019416 DOI: 10.1186/s12889-023-15379-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease, which is caused by severe fever with thrombocytopenia syndrome virus (SFTSV) with high fatality. Recently, the incidence of SFTS increased obviously in Jiangsu Province. However, the systematic and complete analysis of spatiotemporal patterns and clusters coupled with epidemiological characteristics of SFTS have not been reported so far. METHODS Data on SFTS cases were collected during 2011-2021. The changing epidemiological characteristics of SFTS were analyzed by adopting descriptive statistical methods. GeoDa 1.18 was applied for spatial autocorrelation analysis, and SaTScan 10.0 was used to identify spatio-temporal clustering of cases. The results were visualized in ArcMap. RESULTS The annual incidence of SFTS increased in Jiangsu Province from 2011 to 2021. Most cases (72.4%) occurred during May and August with the obvious peak months. Elderly farmers accounted for most cases, among which both males and females were susceptible. The spatial autocorrelation and spatio-temporal clustering analysis indicated that the distribution of SFTS was not random but clustered in space and time. The most likely cluster was observed in the western region of Jiangsu Province and covered one county (Xuyi county) (Relative risk = 8.18, Log likelihood ratio = 122.645, P < 0.001) located in southwestern Jiangsu Province from January 1, 2017 to December 31, 2021. The Secondary cluster also covered one county (Lishui county) (Relative risk = 7.70, Log likelihood ratio = 94.938, P < 0.001) from January 1, 2017 to December 31, 2021. CONCLUSIONS The annual number of SFTS cases showed an increasing tendency in Jiangsu Province from 2011 to 2021. Our study elucidated regions with SFTS clusters by means of ArcGIS in combination with spatial analysis. The results demonstrated solid evidences for the orientation of limited sanitary resources, surveillance in high-risk regions and early warning of epidemic seasons in future prevention and control of SFTS in Jiangsu Province.
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Affiliation(s)
- Shuyi Liang
- Acute Infectious disease control and prevention institute, Jiangsu Provincial center for disease control and prevention, Nanjing, China
| | - Zhifeng Li
- Acute Infectious disease control and prevention institute, Jiangsu Provincial center for disease control and prevention, Nanjing, China
| | - Nan Zhang
- Acute Infectious disease control and prevention institute, Jiangsu Provincial center for disease control and prevention, Nanjing, China
| | - Xiaochen Wang
- Acute Infectious disease control and prevention institute, Jiangsu Provincial center for disease control and prevention, Nanjing, China
| | - Yuanfang Qin
- Acute Infectious disease control and prevention institute, Jiangsu Provincial center for disease control and prevention, Nanjing, China
| | - Wei Xie
- Institute of Food Safety and Assessment, Jiangsu Provincial center for disease control and prevention, Nanjing, China
| | - Changjun Bao
- Acute Infectious disease control and prevention institute, Jiangsu Provincial center for disease control and prevention, Nanjing, China
| | - Jianli Hu
- Acute Infectious disease control and prevention institute, Jiangsu Provincial center for disease control and prevention, Nanjing, China.
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Qi Y, Ai L, Jiao J, Wang J, Wu D, Wang P, Zhang G, Qin Y, Hu C, Lv R, Lu N, Zhu C, Mao Y, Qi R, Li Y, Tan W. High prevalence of Rickettsia spp. in ticks from wild hedgehogs rather than domestic bovine in Jiangsu province, Eastern China. Front Cell Infect Microbiol 2022; 12:954785. [PMID: 35959365 PMCID: PMC9360493 DOI: 10.3389/fcimb.2022.954785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSpotted fever group Rickettsia (SFGR), containing various pathogenic Rickettsia spp., poses remarkable negative influences to public health by causing various severe or mild diseases. Information regarding prevalence of SFGR in ticks in Jiangsu province, Eastern China, is still limited and needs urgent investigations.MethodsHedgehog- and bovine-attached ticks were collected from Jiangsu province, Eastern China. DNA of individual ticks was extracted for nested polymerase chain reaction amplifications targeting gltA, 16S ribosomal RNA (rrs), ompA, ompB, and sca4 genes following with sequencing. SFGR-specific IgG antibodies in sera of local donators were evaluated using ELISA.ResultsOverall, 144 (83.2%) of the 173 ticks from hedgehogs and 2 (1.2%) of the 168 ticks from bovine were positive for one of the three identified Rickettsia spp., with significant difference between the two groups (P = 3.6e-52). Candidatus Rickettsia principis (9; 5.2%) and R. heilongjiangensis (135; 78.0%) were detected in Haemaphysalis flava rather than in H. longicornis ticks from hedgehogs. R. heilongjiangensis (1; 0.6%) and Candidatus R. jingxinensis (or Candidatus R. longicornii) (1; 0.6%) were identified in H. longicornis and Rhipicephalus microplus ticks from bovine, respectively. Phylogenetic analysis indicated Candidatus R. jingxinensis belonged to R. japonica subgroup, whereas Candidatus R. principis belonged to a novel subgroup. Higher serological prevalence of spotted fever and SFGR-specific IgG antibody level in humans were observed around the investigated area than in urban areas, without significant difference.ConclusionCandidatus R. principis and Candidatus R. jingxinensis were identified in Jiangsu province, Eastern China, and fully genetically characterized for the first time. The higher prevalence of SFGR in hedgehog-attached ticks as well as the higher SFGR-specific IgG antibody level and seropositive rate in humans around the investigated area suggested that more attention should be paid to SFGR. This pathogen is usually transmitted or harbored by wild animals and ticks. This study provides important epidemiological data for both physicians and public health officers in developing early prevention and control strategies against potential Rickettsia infections and in the preparation of suitable testing and treatment needs for rickettsiosis in the endemic areas.
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Affiliation(s)
- Yong Qi
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China
- Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Lele Ai
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China
- Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Jun Jiao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Junhu Wang
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China
- Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Deping Wu
- Huaian Medical District of Jinling Hospital, Medical School of Nanjing University, Huaian, China
| | | | - Guoyu Zhang
- Xuyi County Hospital of Chinese Medicine, Huaian, China
| | - Yong Qin
- Xuyi County Hospital of Chinese Medicine, Huaian, China
| | - Cheng Hu
- The 907Hospital of Chinese PLA, Nanping, China
| | - Ruichen Lv
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China
- Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Nianhong Lu
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China
- Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Changqiang Zhu
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China
- Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Yingqing Mao
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China
- Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Rui Qi
- Army Medical University, Shijiazhuang, China
| | - Yuexi Li
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China
- Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
- *Correspondence: Yuexi Li, ; Weilong Tan,
| | - Weilong Tan
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China
- Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
- *Correspondence: Yuexi Li, ; Weilong Tan,
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Zhang M, Du Y, Yang L, Zhan L, Yang B, Huang X, Xu B, Morita K, Yu F. Development of monoclonal antibody based IgG and IgM ELISA for diagnosis of severe fever with thrombocytopenia syndrome virus infection. Braz J Infect Dis 2022; 26:102386. [PMID: 35835158 PMCID: PMC9459026 DOI: 10.1016/j.bjid.2022.102386] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/28/2022] [Accepted: 06/22/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction Methods Results Conclusions
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Deng B, Rui J, Liang SY, Li ZF, Li K, Lin S, Luo L, Xu J, Liu W, Huang J, Wei H, Yang T, Liu C, Li Z, Li P, Zhao Z, Wang Y, Yang M, Zhu Y, Liu X, Zhang N, Cheng XQ, Wang XC, Hu JL, Chen T. Meteorological factors and tick density affect the dynamics of SFTS in jiangsu province, China. PLoS Negl Trop Dis 2022; 16:e0010432. [PMID: 35533208 PMCID: PMC9119627 DOI: 10.1371/journal.pntd.0010432] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 05/19/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background This study aimed to explore whether the transmission routes of severe fever with thrombocytopenia syndrome (SFTS) will be affected by tick density and meteorological factors, and to explore the factors that affect the transmission of SFTS. We used the transmission dynamics model to calculate the transmission rate coefficients of different transmission routes of SFTS, and used the generalized additive model to uncover how meteorological factors and tick density affect the spread of SFTS. Methods In this study, the time-varying infection rate coefficients of different transmission routes of SFTS in Jiangsu Province from 2017 to 2020 were calculated based on the previous multi-population multi-route dynamic model (MMDM) of SFTS. The changes in transmission routes were summarized by collecting questionnaires from 537 SFTS cases in 2018–2020 in Jiangsu Province. The incidence rate of SFTS and the infection rate coefficients of different transmission routes were dependent variables, and month, meteorological factors and tick density were independent variables to establish a generalized additive model (GAM). The optimal GAM was selected using the generalized cross-validation score (GCV), and the model was validated by the 2016 data of Zhejiang Province and 2020 data of Jiangsu Province. The validated GAMs were used to predict the incidence and infection rate coefficients of SFTS in Jiangsu province in 2021, and also to predict the effect of extreme weather on SFTS. Results The number and proportion of infections by different transmission routes for each year and found that tick-to-human and human-to-human infections decreased yearly, but infections through animal and environmental transmission were gradually increasing. MMDM fitted well with the three-year SFTS incidence data (P<0.05). The best intervention to reduce the incidence of SFTS is to reduce the effective exposure of the population to the surroundings. Based on correlation tests, tick density was positively correlated with air temperature, wind speed, and sunshine duration. The best GAM was a model with tick transmissibility to humans as the dependent variable, without considering lagged effects (GCV = 5.9247E-22, R2 = 96%). Reported incidence increased when sunshine duration was higher than 11 h per day and decreased when temperatures were too high (>28°C). Sunshine duration and temperature had the greatest effect on transmission from host animals to humans. The effect of extreme weather conditions on SFTS was short-term, but there was no effect on SFTS after high temperature and sunshine hours. Conclusions Different factors affect the infection rate coefficients of different transmission routes. Sunshine duration, relative humidity, temperature and tick density are important factors affecting the occurrence of SFTS. Hurricanes reduce the incidence of SFTS in the short term, but have little effect in the long term. The most effective intervention to reduce the incidence of SFTS is to reduce population exposure to high-risk environments. Severe fever with thrombocytopenia syndrome (SFTS) is an emerging vector-borne disease caused by SFTS virus. After the first case was detected in China in 2009, SFTS endemic areas have gradually increased, with more than 23 provinces and cities reporting SFTS cases. In order to explore the transmission mechanism of SFTS and explain the impact of meteorological factors and tick density on the transmission routes of SFTS, this study collected SFTS cases data, meteorological data and tick surveillance data in Jiangsu Province from 2017 to 2019 to investigate the study question. The multi-population and multi-route dynamic model established in the previous study was used to calculate the infection rate coefficients of various transmission routes of SFTS in Jiangsu Province, and the generalized additive model was established to further elaborate the influence of SFTS transmission mechanism.
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Affiliation(s)
- Bin Deng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Jia Rui
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Shu-yi Liang
- Department of Acute Infectious Diseases Control and Prevention, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, People’s Republic of China
| | - Zhi-feng Li
- Department of Acute Infectious Diseases Control and Prevention, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, People’s Republic of China
| | - Kangguo Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Shengnan Lin
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Li Luo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Jingwen Xu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Weikang Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Jiefeng Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Hongjie Wei
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Tianlong Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Chan Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Zhuoyang Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Peihua Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Zeyu Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Yao Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Meng Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Yuanzhao Zhu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Xingchun Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
| | - Nan Zhang
- Department of Acute Infectious Diseases Control and Prevention, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, People’s Republic of China
| | - Xiao-qing Cheng
- Department of Acute Infectious Diseases Control and Prevention, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, People’s Republic of China
| | - Xiao-chen Wang
- Department of Acute Infectious Diseases Control and Prevention, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, People’s Republic of China
| | - Jian-li Hu
- Department of Acute Infectious Diseases Control and Prevention, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, People’s Republic of China
- * E-mail: (JlH); (TC)
| | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, People’s Republic of China
- * E-mail: (JlH); (TC)
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9
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Bryden SR, Dunlop JI, Clarke AT, Fares M, Pingen M, Wu Y, Willett BJ, Patel AH, Gao GF, Kohl A, Brennan B. Exploration of immunological responses underpinning severe fever with thrombocytopenia syndrome virus infection reveals IL-6 as a therapeutic target in an immunocompromised mouse model. PNAS NEXUS 2022; 1:pgac024. [PMID: 35529317 PMCID: PMC9071185 DOI: 10.1093/pnasnexus/pgac024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/16/2022] [Accepted: 03/05/2022] [Indexed: 01/29/2023]
Abstract
Dabie bandavirus (previously severe fever with thrombocytopenia syndrome virus; SFTSV), is an emerging tick-borne bunyavirus responsible for severe fever with thrombocytopenia syndrome (SFTS), a disease with high case fatality that is characterized by high fever, thrombocytopenia, and potentially lethal hemorrhagic manifestations. Currently, neither effective therapeutic strategies nor approved vaccines exist for SFTS. Therefore, there remains a pressing need to better understand the pathogenesis of the disease and to identify therapeutic strategies to ameliorate SFTS outcomes. Using a type I interferon (IFN)-deficient mouse model, we investigated the viral tropism, disease kinetics, and the role of the virulence factor nonstructural protein (NSs) in SFTS. Ly6C+ MHCII+ cells in the lymphatic tissues were identified as an important target cell for SFTSV. Advanced SFTS was characterized by significant migration of inflammatory leukocytes, notably neutrophils, into the lymph node and spleen, however, these cells were not required to orchestrate the disease phenotype. The development of SFTS was associated with significant upregulation of proinflammatory cytokines, including high levels of IFN-γ and IL-6 in the serum, lymph node, and spleen. Humoral immunity generated by inoculation with delNSs SFTSV was 100% protective. Importantly, NSs was critical to the inhibition of the host IFNɣ response or downstream IFN-stimulated gene production and allowed for the establishment of severe disease. Finally, therapeutic but not prophylactic use of anti-IL-6 antibodies significantly increased the survival of mice following SFTSV infection and, therefore, this treatment modality presents a novel therapeutic strategy for treating severe SFTS.
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Affiliation(s)
- Steven R Bryden
- Medical Research Council–University of Glasgow Centre for Virus Research, Glasgow G61 1QH, Scotland, UK
| | - James I Dunlop
- Medical Research Council–University of Glasgow Centre for Virus Research, Glasgow G61 1QH, Scotland, UK
| | - Andrew T Clarke
- Medical Research Council–University of Glasgow Centre for Virus Research, Glasgow G61 1QH, Scotland, UK
| | - Mazigh Fares
- Medical Research Council–University of Glasgow Centre for Virus Research, Glasgow G61 1QH, Scotland, UK
| | - Marieke Pingen
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - Yan Wu
- Department of Pathogen Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China
| | - Brian J Willett
- Medical Research Council–University of Glasgow Centre for Virus Research, Glasgow G61 1QH, Scotland, UK
| | - Arvind H Patel
- Medical Research Council–University of Glasgow Centre for Virus Research, Glasgow G61 1QH, Scotland, UK
| | - George F Gao
- CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology , Chinese Academy of Sciences (CAS), Beijing 100101, China
| | - Alain Kohl
- Medical Research Council–University of Glasgow Centre for Virus Research, Glasgow G61 1QH, Scotland, UK
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10
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Liu W, Liu P, Liu WJ, Wang Q, Tong Y, Gao GF. Origins of HIV, HCoV-HKU1, SFTSV, and MERS-CoV and Beyond. China CDC Wkly 2022; 4:823-827. [PMID: 36284537 PMCID: PMC9547735 DOI: 10.46234/ccdcw2022.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/15/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Wenli Liu
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Peipei Liu
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - William J Liu
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qihui Wang
- CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Yigang Tong
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
- Yigang Tong,
| | - George F. Gao
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
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11
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Tong Y, Liu W, Liu P, Liu WJ, Wang Q, Gao GF. The origins of viruses: discovery takes time, international resources, and cooperation. Lancet 2021; 398:1401-1402. [PMID: 34600605 PMCID: PMC8483647 DOI: 10.1016/s0140-6736(21)02180-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 01/23/2023]
Affiliation(s)
- Yigang Tong
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Wenli Liu
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Peipei Liu
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - William J Liu
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Qihui Wang
- CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - George F Gao
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China.
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12
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Kuba Y, Kyan H, Azama Y, Fukuchi Y, Park ES, Kakita T, Oyama M, Maeshiro N, Miyahira M, Nidaira M, Maeda K, Morikawa S, Taniguchi K. Seroepidemiological study of severe fever with thrombocytopenia syndrome in animals and humans in Okinawa, Japan. Ticks Tick Borne Dis 2021; 12:101821. [PMID: 34525434 DOI: 10.1016/j.ttbdis.2021.101821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
In Okinawa prefecture, Japan, the first case of severe fever with thrombocytopenia syndrome (SFTS) was confirmed in August 2016, and this case remains to be the only reported case of SFTS in Okinawa. The epidemiological investigation indicated that the patient had been infected on the main island of Okinawa, but source and route of infection were unknown. Therefore, to understand the possible source and route of SFTS virus (SFTSV) infection in Okinawa, we performed a seroepidemiological study of SFTSV among animals and dwellers in Okinawa and conducted a questionnaire survey to investigate risk factors for tick bites in Okinawa. Among the 1,035 serum samples from four different animal species, anti-SFTSV antibodies were detected in only 4.2% wild mongoose (Herpestes auropunctatus) serum samples. To our knowledge, this is the first study to report the detection of anti-SFTSV antibodies in wild mongooses. Meanwhile, all 1,104 human inhabitants tested negative for anti-SFTSV antibodies, suggesting that the frequency of SFTSV exposure is low in Okinawa. Logistic regression analysis of the questionnaire results showed that outdoor activity was associated with an increased risk of tick bite among Okinawa residents. Despite the current low frequency of SFTSV infection in animals and humans, endemic circulation of the virus in Okinawa should be carefully monitored in the area for preventing future infections.
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Affiliation(s)
- Yumani Kuba
- Department of Medical Microbiology and Zoology, Okinawa Prefectural Institute of Health and Environment, 17-1 Kanekadan, Uruma, Okinawa 904-2241, Japan; Department of Child Medical Health and Development, Mie University Graduate School of Medicine, Mie, Japan.
| | - Hisako Kyan
- Department of Medical Microbiology and Zoology, Okinawa Prefectural Institute of Health and Environment, 17-1 Kanekadan, Uruma, Okinawa 904-2241, Japan
| | - Yasuhito Azama
- Department of Medical Microbiology and Zoology, Okinawa Prefectural Institute of Health and Environment, 17-1 Kanekadan, Uruma, Okinawa 904-2241, Japan
| | - Yoshimune Fukuchi
- Department of Medical Microbiology and Zoology, Okinawa Prefectural Institute of Health and Environment, 17-1 Kanekadan, Uruma, Okinawa 904-2241, Japan
| | - Eun-Sil Park
- Department of Veterinary Science, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tetsuya Kakita
- Department of Medical Microbiology and Zoology, Okinawa Prefectural Institute of Health and Environment, 17-1 Kanekadan, Uruma, Okinawa 904-2241, Japan
| | - Minori Oyama
- Department of Medical Microbiology and Zoology, Okinawa Prefectural Institute of Health and Environment, 17-1 Kanekadan, Uruma, Okinawa 904-2241, Japan
| | - Noriyuki Maeshiro
- Department of Medical Microbiology and Zoology, Okinawa Prefectural Institute of Health and Environment, 17-1 Kanekadan, Uruma, Okinawa 904-2241, Japan
| | - Masato Miyahira
- Department of Medical Microbiology and Zoology, Okinawa Prefectural Institute of Health and Environment, 17-1 Kanekadan, Uruma, Okinawa 904-2241, Japan
| | - Minoru Nidaira
- Department of Medical Microbiology and Zoology, Okinawa Prefectural Institute of Health and Environment, 17-1 Kanekadan, Uruma, Okinawa 904-2241, Japan
| | - Ken Maeda
- Department of Veterinary Science, National Institute of Infectious Diseases, Tokyo, Japan
| | - Shigeru Morikawa
- Faculty of Veterinary Medicine, Okayama University of Science, Ehime, Japan
| | - Kiyosu Taniguchi
- Department of Child Medical Health and Development, Mie University Graduate School of Medicine, Mie, Japan; Department of Pediatrics, National Hospital Organization Mie National Hospital, 357 Osato-kubota, Tsu, Mie, Japan.
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13
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Win AM, Nguyen YTH, Kim Y, Ha NY, Kang JG, Kim H, San B, Kyaw O, Htike WW, Choi DO, Lee KH, Cho NH. Genotypic Heterogeneity of Orientia tsutsugamushi in Scrub Typhus Patients and Thrombocytopenia Syndrome Co-infection, Myanmar. Emerg Infect Dis 2021; 26:1878-1881. [PMID: 32687023 PMCID: PMC7392420 DOI: 10.3201/eid2608.200135] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Serologic and molecular surveillance of serum collected from 152 suspected scrub typhus patients in Myanmar revealed Orientia tsutsugamushi of genotypic heterogeneity. In addition, potential co-infection with severe fever with thrombocytopenia syndrome virus was observed in 5 (3.3%) patients. Both scrub typhus and severe fever with thrombocytopenia syndrome are endemic in Myanmar.
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14
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Fang X, Hu J, Peng Z, Dai Q, Liu W, Liang S, Li Z, Zhang N, Bao C. Epidemiological and clinical characteristics of severe fever with thrombocytopenia syndrome bunyavirus human-to-human transmission. PLoS Negl Trop Dis 2021; 15:e0009037. [PMID: 33930022 PMCID: PMC8087050 DOI: 10.1371/journal.pntd.0009037] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) was listed as one of the most severe infectious disease by world health organization in 2017. It can mostly be transmitted by tick bite, while human-to-human transmission has occurred on multiple occasions. This study aimed to explore the epidemiological and clinical characteristics and make risk analysis of SFTS human-to-human transmission. METHODS Descriptive and spatial methods were employed to illustrate the epidemiological and clinical characteristics of SFTS human-to-human transmission. The risk of SFTS human-to-human transmission was accessed through secondary attack rate (SAR) and basic reproductive number (R0). Logistic regression analysis was used to identify the associated risk factors. RESULTS A total of 27 clusters of SFTS human-to-human transmission were reported in China and South Korea during 1996-2019. It mainly occurred among elder people in May, June and October in central and eastern China. The secondary cases developed milder clinical manifestation and better outcome than the index cases. The incubation period was 10.0 days (IQR:8.0-12.0), SAR was 1.72%-55.00%, and the average R0 to be 0.13 (95%CI:0.11-0.16). Being blood relatives of the index case, direct blood/bloody secretion contact and bloody droplet contact had more risk of infection (OR = 6.35(95%CI:3.26-12.37), 38.01 (95%CI,19.73-73.23), 2.27 (95%CI,1.01-5.19)). CONCLUSIONS SFTS human-to-human transmission in China and South Korea during 1996-2019 had obvious spatio-temporal distinction. Ongoing assessment of this transmission risk is crucial for public health authorities though it continues to be low now.
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Affiliation(s)
- Xinyu Fang
- Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu institution of Public health), Nanjing, China
| | - Jianli Hu
- Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu institution of Public health), Nanjing, China
| | - Zhihang Peng
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Qigang Dai
- Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu institution of Public health), Nanjing, China
| | - Wendong Liu
- Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu institution of Public health), Nanjing, China
| | - Shuyi Liang
- Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu institution of Public health), Nanjing, China
| | - Zhifeng Li
- Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu institution of Public health), Nanjing, China
| | - Nan Zhang
- Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu institution of Public health), Nanjing, China
| | - Changjun Bao
- Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu institution of Public health), Nanjing, China
- School of Public Health, Nanjing Medical University, Nanjing, China
- NHC Key laboratory of Enteric Pathogenic Microbiology, Nanjing, China
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15
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Wang X, Lin L, Zhao Z, Zhou W, Ge Z, Shen Y, Wang L, Zhang W, Song R, Tian D, Wen J, Cui S, Yu X, Feng Y, Liu Y, Qiang C, Duan J, Ma Y, Li X, Fan T, Zhao Y, Chen Z. The predictive effect of the platelet-to-lymphocyte ratio (PLR) and the neutrophil-to-lymphocyte ratio (NLR) on the risk of death in patients with severe fever with thrombocytopenia syndrome (SFTS): a multi-center study in China. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:208. [PMID: 33708835 PMCID: PMC7940944 DOI: 10.21037/atm-20-4736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Severe fever with thrombocytopenia syndrome is caused by infection with the severe fever with thrombocytopenia syndrome virus. Methods Between April 2011 and December 2019, data on consecutive patients who were diagnosed with severe fever with thrombocytopenia syndrome were prospectively collected from five medical centers in China. The score of the death risk model was correlated with the platelet-to-lymphocyte ratio and the neutrophil-to-lymphocyte ratio. Multivariable Cox analyses were used to identify the independent factors associated with mortality. Results During the study period, 763 patients were diagnosed with severe fever with thrombocytopenia syndrome; 415 of these patients were enrolled in our study. We found that the neutrophil-to-lymphocyte ratio of the group that died was significantly higher on admission (P=0.007) than that of the group that survived, and the neutrophil-to-lymphocyte ratio showed a positive correlation with the score of the death risk model. Multivariate Cox regression suggested that a neutrophil-to-lymphocyte ratio greater than 5.4 was an independent risk factor for survival time (HR=6.767, P=0.011). Platelet-to-lymphocyte ratio did not show a special role in this study. Conclusions A neutrophil-to-lymphocyte ratio greater than 5.4 can increase the risk of death and decrease the survival time of patients. In summary, the neutrophil-to-lymphocyte ratio provides a supplementary means for effectively managing severe fever with thrombocytopenia syndrome (SFTS).
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Affiliation(s)
- Xiankun Wang
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Ling Lin
- Department of Infectious Diseases, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Zhenghua Zhao
- Department of Infectious Diseases, Taian City Central Hospital, Taian, China
| | - Wei Zhou
- Department of Infectious Diseases, Dalian sixth people's hospital, Dalian, China
| | - Zirou Ge
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Yi Shen
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, Dandong, China
| | - Lin Wang
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Wei Zhang
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Rui Song
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Di Tian
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Jing Wen
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Shuping Cui
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Xiaoli Yu
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, Dandong, China
| | - Yang Feng
- Department of Infectious Diseases, Taian City Central Hospital, Taian, China
| | - Yuanni Liu
- Department of Infectious Diseases, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Chunqian Qiang
- Department of Infectious Diseases, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Jianping Duan
- Department of Infectious Diseases, Qing Dao No. 6 People's Hospital, Qingdao, China
| | - Yanli Ma
- Department of Infectious Diseases, Qing Dao No. 6 People's Hospital, Qingdao, China
| | - Xingwang Li
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Tianli Fan
- Department of Infectious Diseases, Qing Dao No. 6 People's Hospital, Qingdao, China
| | - Yongxiang Zhao
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, Dandong, China
| | - Zhihai Chen
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
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16
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Mao L, Deng B, Liang Y, Liu Y, Wang Z, Zhang J, Wu W, Yu L, Yao W. Epidemiological and genetic investigation of a cluster of cases of severe fever with thrombocytopenia syndrome bunyavirus. BMC Infect Dis 2020; 20:346. [PMID: 32410583 PMCID: PMC7227288 DOI: 10.1186/s12879-020-05072-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 05/04/2020] [Indexed: 01/17/2023] Open
Abstract
Background To analyze and discuss the transmission route of a cluster of cases of severe fever with thrombocytopenia syndrome bunyavirus (SFTSV). Method We performed an epidemiological investigation and a genetic analysis of patients with severe fever with thrombocytopenia syndrome (SFTS) caused by SFTSV, their close contacts and the surrounding population. Results We found that all patients had contact with the blood of the first patient. The comparison of gene sequences in the three isolated SFTSV strains showed that the strains were closely related. Six close contacts and nine individuals in the surrounding population were positive for SFTSV IgM antibody. Conclusion We suspect that the cluster outbreak was transmitted via blood and that the natural reservoir host of SFTSV exists in the patients’ environment.
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Affiliation(s)
- Lingling Mao
- Liaoning Province Center for Disease Control and Prevention, Shenyang, Liaoning Province, China
| | - Baocheng Deng
- Department of Infectious Diseases, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning Province, China
| | - Yuhong Liang
- Dalian Center for Disease Control and Prevention, Dalian, Liaoning Province, China
| | - Yun Liu
- Liaoning Province Center for Disease Control and Prevention, Shenyang, Liaoning Province, China
| | - Zijiang Wang
- Liaoning Province Center for Disease Control and Prevention, Shenyang, Liaoning Province, China
| | - Jie Zhang
- Liaoning Province Center for Disease Control and Prevention, Shenyang, Liaoning Province, China
| | - Wei Wu
- Dalian Center for Disease Control and Prevention, Dalian, Liaoning Province, China
| | - Lei Yu
- Dalian Center for Disease Control and Prevention, Dalian, Liaoning Province, China
| | - Wenqing Yao
- Liaoning Province Center for Disease Control and Prevention, Shenyang, Liaoning Province, China.
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17
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Spatial-temporal characteristics of severe fever with thrombocytopenia syndrome and the relationship with meteorological factors from 2011 to 2018 in Zhejiang Province, China. PLoS Negl Trop Dis 2020; 14:e0008186. [PMID: 32255791 PMCID: PMC7164674 DOI: 10.1371/journal.pntd.0008186] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/17/2020] [Accepted: 03/01/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Zhejiang Province has the fifth-highest incidence of severe fever with thrombocytopenia syndrome (SFTS) in China. While the top four provinces are all located in northern and central China, only Zhejiang Province is located in the Yangtze River Delta region of southeast China. This study was undertaken to identify the epidemiological characteristics of SFTS in Zhejiang from 2011 to 2018. METHODS The epidemic data from SFTS cases in Zhejiang Province from January 2011 to December 2018 were obtained from the China Information Network System of Disease Prevention and Control. Meteorological data were collected from the China Meteorological Data Sharing Service System. A multivariate time series model was used to analyze the heterogeneity of spatial-temporal transmission of the disease. Random forest analysis was performed to detect the importance of meteorological factors and the dose-response association of the incidence of SFTS with these factors. RESULTS In total, 412 SFTS cases (49 fatal) were reported from January 2011 to December 2018 in Zhejiang Province, China. The number of SFTS cases and the number of affected counties increased year by year. The case fatality rate in Zhejiang Province was 11.89%, which was the highest in China. Elderly patients and farmers were the most affected. The total effect values of the autoregressive component, spatiotemporal component and endemic component of the model in all ranges were 0.4580, 0.0377 and 0.0137, respectively. There was obvious heterogeneity across counties for the mean values of the spatiotemporal component and the autoregressive component. The autoregressive component was obviously the main factor driving the occurrence of SFTS, followed by the spatiotemporal component. The importance scores of the monthly mean pressure, mean temperature, mean relative humidity, mean two-minute wind speed, duration of sunshine and precipitation were 10.64, 8.34, 8.16, 6.37, 5.35 and 2.81, respectively. The relationship between these factors and the incidence of SFTS is complicated and nonlinear. A suitable range of meteorological factors for this disease was also detected. CONCLUSIONS The autoregressive and spatiotemporal components played an important role in driving the transmission of SFTS. Targeted preventive efforts should be made in different areas based on the main component contributing to the epidemic. For most areas, early measures several months ahead of the suitable season for the occurrence of SFTS should be implemented. The level of reporting and diagnosis of this disease should be further improved.
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18
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Thi Hai Yen N, Kim C, Jeong S, Jeon K, Choi H, Ro HJ, Kim HI, Kim Y, Kang JG, Park D, Choi MS, Lee KH, Cho NH. Severe Fever with Thrombocytopenia Syndrome Virus Infection or Mixed Infection with Scrub Typhus in South Korea in 2000-2003. Am J Trop Med Hyg 2020; 101:1096-1099. [PMID: 31482787 DOI: 10.4269/ajtmh.19-0392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome is a tick-borne viral disease, with a high mortality rate that was first reported in China in 2009. Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi, a bacterium transmitted to humans through chigger mite bites. Severe fever with thrombocytopenia syndrome and scrub typhus are endemic to South Korea. To investigate evidence of severe fever with thrombocytopenia syndrome virus (SFTSV) infection or mixed infection with scrub typhus in South Korea, we examined 2,329 sera samples collected from patients presenting from November 1, 2000, to November 1, 2003, for the diagnosis of rickettisal diseases at Seoul National University, Seoul, South Korea. We found retrospective evidence of SFTSV infection or mixed infection with scrub typhus in South Korea in 2000-2003. Severe fever with thrombocytopenia syndrome virus infections in South Korea occurred before previously reported cases and were more concurrent with those in China. It is important to consider SFTSV infection in patients with scrub typhus.
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Affiliation(s)
- Nguyen Thi Hai Yen
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Chaewon Kim
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Seonyoung Jeong
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyeongseok Jeon
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Hooncheol Choi
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyo-Jin Ro
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Hong-Il Kim
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Yuri Kim
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Endemic Disease, Seoul National University Medical Research Center and Bundang Hospital, Seoul, South Korea
| | - Jun-Gu Kang
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.,Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Endemic Disease, Seoul National University Medical Research Center and Bundang Hospital, Seoul, South Korea
| | - Dahee Park
- Department of Microbiology and Immunology, College of Medicine, Jeju National University, Jeju, South Korea
| | - Myung-Sik Choi
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea
| | - Keun Hwa Lee
- Department of Microbiology and Immunology, College of Medicine, Jeju National University, Jeju, South Korea
| | - Nam-Hyuk Cho
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Endemic Disease, Seoul National University Medical Research Center and Bundang Hospital, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
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19
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Yu KM, Jeong HW, Park SJ, Kim YI, Yu MA, Kwon HI, Kim EH, Kim SM, Lee SH, Kim SG, Choi YK. Shedding and Transmission Modes of Severe Fever With Thrombocytopenia Syndrome Phlebovirus in a Ferret Model. Open Forum Infect Dis 2019; 6:ofz309. [PMID: 31375835 PMCID: PMC6677671 DOI: 10.1093/ofid/ofz309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/28/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although human-to-human transmission of severe fever with thrombocytopenia syndrome phlebovirus (SFTSV) via direct contact with body fluids has been reported, the role of specific body fluids from SFTSV-infected hosts has not been investigated in detail. METHODS To demonstrate the virus transmission kinetics in SFTSV-infected hosts, we adapted the ferret infection model and evaluated the virus shedding periods, virus titers, and transmission modes from various specimens of infected ferrets. RESULTS Large amounts of infectious SFTSV are shed through nasal discharge, saliva, and urine from SFTSV-infected ferrets. Virus could be detected from 2 dpi and persisted until 12 dpi in these specimens, compared with the relatively short virus-shedding period in sera. Further, transmission studies revealed that SFTSV can be transmitted to close direct and indirect contact naïve animals through various mediums, especially through contact with serum and urine. Further, ferrets contacted with human urine specimens from SFTSV-positive patients were successfully infected with SFTSV, suggesting that urine specimens could be a source of SFTSV infection in humans. CONCLUSIONS Our results demonstrate that the SFTSV can be shed in various body fluids for more than 12 days and that these specimens could be a source for direct or indirect transmission through close personal contact.
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Affiliation(s)
- Kwang-Min Yu
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
- Zoonotic Infectious Diseases Research Center, Chungbuk National University, Cheongju, Republic of Korea
| | - Hye-Won Jeong
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
| | - Su-Jin Park
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
- Zoonotic Infectious Diseases Research Center, Chungbuk National University, Cheongju, Republic of Korea
| | - Young-Il Kim
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
- Zoonotic Infectious Diseases Research Center, Chungbuk National University, Cheongju, Republic of Korea
| | - Min-Ah Yu
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
| | - Hyeok-Il Kwon
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
| | - Eun-Ha Kim
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
- Zoonotic Infectious Diseases Research Center, Chungbuk National University, Cheongju, Republic of Korea
| | - Se-Mi Kim
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
- Zoonotic Infectious Diseases Research Center, Chungbuk National University, Cheongju, Republic of Korea
| | - Seung-Hun Lee
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
- Zoonotic Infectious Diseases Research Center, Chungbuk National University, Cheongju, Republic of Korea
| | - Seong-Gyu Kim
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
- Zoonotic Infectious Diseases Research Center, Chungbuk National University, Cheongju, Republic of Korea
| | - Young-Ki Choi
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
- Zoonotic Infectious Diseases Research Center, Chungbuk National University, Cheongju, Republic of Korea
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20
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Maslow JN, Kwon JJ, Mikota SK, Spruill S, Cho Y, Jeong M. Severe fever and thrombocytopenia syndrome virus infection: Considerations for vaccine evaluation of a rare disease. Hum Vaccin Immunother 2019; 15:2249-2257. [PMID: 31215838 PMCID: PMC6816409 DOI: 10.1080/21645515.2019.1633875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/29/2019] [Accepted: 06/15/2019] [Indexed: 11/03/2022] Open
Abstract
Infection caused by the severe fever and thrombocytopenia syndrome virus (SFTSV) causes a hemorrhagic illness with a mortality between 20% and 40%. Initially recognized in 2009 in China, cases have additionally been documented in Japan and Korea although retrospective studies have documented seroprevalence since 1996. Although case rates have increased due to increased awareness and more widely available diagnostics, SFTSV infection remains rare with the highest rates documented in Korea for Jeju Province (3.5 cases per 100,000 population) and the Inje-gun region (66.2 cases per 100,000). Because of the very low incidence of infection, a placebo-controlled study with 1:1 randomization to evaluate an SFTSV vaccine would require a sample size that is 25% greater than the region of study. We discuss alternatives to licensure. Vaccine effectiveness may be assessed through a registry, comparing rates of infection over time between vaccine recipients versus regional populations. Modeled data can be updated based on actual case rates and population changes over the years of follow-up. Using one model, statistically significant differences are seen after 10 years in Inje-gun and 15 years of follow-up in Jeju. This approach may be applicable to other uncommon infectious diseases for which a standard study design is difficult.
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Affiliation(s)
- Joel N. Maslow
- GeneOne Life Science, Inc., Seoul, Korea
- Department of Medicine, Morristown Medical Center, Morristown, USA
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Hu J, Li Z, Cai J, Liu D, Zhang X, Jiang R, Guo X, Liu D, Zhang Y, Cui L, Shen J, Zhu F, Bao C. A Cluster of Bunyavirus-Associated Severe Fever With Thrombocytopenia Syndrome Cases in a Coastal Plain Area in China, 2015: Identification of a Previously Unidentified Endemic Region for Severe Fever With Thrombocytopenia Bunyavirus. Open Forum Infect Dis 2019; 6:ofz209. [PMID: 31211156 PMCID: PMC6559278 DOI: 10.1093/ofid/ofz209] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/03/2019] [Indexed: 11/13/2022] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is a typical tick-borne, natural focal disease. The natural foci of SFTS were considered to exist in hilly and mountainous areas before 2015. A cluster of 3 patients exposed to a patient with a fulminant disease consistent with SFTS occurred from July to August 2015 in Dongtai County, which is characterized by alluvial plains; this prompted investigation. Methods The epidemiological, clinical, and laboratory features of 4 patients in the cluster were analyzed. Serum samples from the indigenous healthy population and native domesticated animals were collected to conduct laboratory tests, along with small wild animals and ticks. Results In 3 secondary case patients, high fever, thrombocytopenia and leukopenia developed within 8-13 days after contact with blood or bloody secretions from the index patient; SFTS was then diagnosed by means of reverse-transcription polymerase chain reaction. Genomic sequencing and analysis of S and L segments of 2 viral strains isolated from 2 secondary case patients showed that they shared 99.8%-99.9% homology in nucleotide sequence. The seroprevalences among indigenous healthy population, native livestock, native poultry, and small wild animals was 0.74%, 17.54%, 6.67%, and 1.12%, respectively. Three questing ticks, 61 feeding ticks, and 178 small wild animals were collected in August 2015. Survey on tick density and seasonal fluctuation in 2016 showed that ticks were active from March to October. All ticks were identified as Haemaphysalis longicornis. Severe fever with thrombocytopenia bunyavirus (SFTSV)-specific RNA was detected in the ticks collected in 2016, and the minimum SFTSV infection rate in these ticks was 0.54% (1 of 185).Wild mammals and ticks collected in August 2015 tested negative for SFTSV-specific RNA. Conclusions Aside from hilly or mountainous area, a coastal plain was identified as the natural foci of SFTSV in Dongtai County, China. The involvement of migration in the evolution of SFTSV might lead to a transregional transmission event of SFTSV.
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Affiliation(s)
- Jianli Hu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing
| | - Zhifeng Li
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing
| | - Jiaping Cai
- Dongtai County Center for Disease Control and Prevention
| | - Donglin Liu
- Dongtai County Center for Disease Control and Prevention
| | - Xuefeng Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing
| | - Renjie Jiang
- Yancheng Municipal Center for Disease Control and Prevention, Dongtai, China
| | - Xilin Guo
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing
| | - Dapeng Liu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing
| | - Yufu Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing
| | - Lunbiao Cui
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing
| | - Jinjin Shen
- Yancheng Municipal Center for Disease Control and Prevention, Dongtai, China
| | - Fengcai Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing
| | - Changjun Bao
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing
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Qi R, Qin XR, Wang L, Han HJ, Cui F, Yu H, Liu JW, Yu XJ. Severe fever with thrombocytopenia syndrome can masquerade as hemorrhagic fever with renal syndrome. PLoS Negl Trop Dis 2019; 13:e0007308. [PMID: 30925154 PMCID: PMC6457554 DOI: 10.1371/journal.pntd.0007308] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/10/2019] [Accepted: 03/15/2019] [Indexed: 12/23/2022] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging viral hemorrhagic fever with a high fatality rate and high frequency of person-to-person transmission and is caused by SFTSV, a tick-borne Phlebovirus. Because SFTS has similar clinical manifestations and epidemic characters (such as spatial and temporal distributions) with hemorrhagic fever with renal syndrome (HFRS) in China, we reason that SFTS patients might be misdiagnosed as HFRS. Methodology/principal findings Acute-phase sera of 128 clinically diagnosed HFRS patients were retrospectively analyzed for Hantavirus IgM antibodies with ELISA. Hantavirus-negative patients’ sera were further analyzed for SFTSV IgM antibodies with ELISA. ELISA showed that 73 of 128 (57.0%) of clinically diagnosed HFRS patients were IgM antibody positive to Hantaviruses. Among the 55 Hantavirus-IgM negative patients, four (7.3%) were IgM antibody positive to SFTSV. The results indicated that the four SFTS patients were misdiagnosed as HFRS. The misdiagnosed SFTS patients had clinical manifestations common to HFRS and were unable to be differentiated from HFRS clinically. Conclusions Our study showed that SFTS patients could be clinically misdiagnosed as HFRS. The misdiagnosis of SFTS as HFRS causes particular concern because it may increase the risk of death of SFTS patients and person-to-person transmission of SFTSV without proper care for and isolation of SFTS patients. SFTS were clinically misdiagnosed as HFRS. It could cause particular concern in China. Physicians could not rely heavily on the exposure history. Both SFTS and HFRS patients are treated based on the clinical diagnosis in China. Laboratory confirmation of both diseases is not performed in clinical hospitals and the patients’ blood was usually submitted to a local or provincial center for disease control and prevention. In most cases the confirmation diagnosis is to provide retrospective information rather than to guide clinical therapy. Therefore, physicians need to carefully differentiate SFTS and HFRS patients because the fatality of SFTS is much higher than HFRS and SFTS is easily spread from person to person by contacting infected blood or even through aerosol.
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Affiliation(s)
- Rui Qi
- Wuhan University School of Health Sciences, Wuhan, China
- State Key Laboratory of Virology, Wuhan University, Wuhan, China
| | - Xiang-rong Qin
- Wuhan University School of Health Sciences, Wuhan, China
- State Key Laboratory of Virology, Wuhan University, Wuhan, China
| | - Ling Wang
- Zibo Center for Disease Control and Prevention, Zibo City, China
| | - Hui-ju Han
- Wuhan University School of Health Sciences, Wuhan, China
- State Key Laboratory of Virology, Wuhan University, Wuhan, China
| | - Feng Cui
- Zibo Center for Disease Control and Prevention, Zibo City, China
| | - Hao Yu
- Fudan University School of Medicine, Shanghai, China
| | - Jian-wei Liu
- Wuhan University School of Health Sciences, Wuhan, China
- State Key Laboratory of Virology, Wuhan University, Wuhan, China
| | - Xue-jie Yu
- Wuhan University School of Health Sciences, Wuhan, China
- State Key Laboratory of Virology, Wuhan University, Wuhan, China
- * E-mail: ,
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