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Kofman AD, Haberling DL, Mbuyi G, Martel LD, Whitesell AN, Van Herp M, Makaya G, Corvil S, Abedi AA, Ngoma PM, Mbuyi F, Mossoko M, Koivogui E, Soke N, Gbamou N, Fonjungo PN, Keita L, Keita S, Shoemaker TR, Richards GA, Montgomery JM, Breman JG, Geisbert TW, Choi MJ, Rollin PE. Revisiting the minimum incubation period of Zaire ebolavirus. Lancet Infect Dis 2023; 23:1111-1112. [PMID: 37604181 DOI: 10.1016/s1473-3099(23)00506-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Aaron D Kofman
- Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA.
| | - Dana L Haberling
- Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA
| | - Gisele Mbuyi
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Lise D Martel
- Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA
| | - Amy N Whitesell
- Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA
| | | | | | | | | | | | | | - Mathias Mossoko
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Enogo Koivogui
- National Agency for Health Security, Ministry of Health, Conakry, Guinea
| | - Norbert Soke
- Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA
| | - Nouonan Gbamou
- National Agency for Health Security, Ministry of Health, Conakry, Guinea
| | - Peter N Fonjungo
- Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA
| | - Lamine Keita
- National Agency for Health Security, Ministry of Health, Conakry, Guinea
| | - Sakoba Keita
- National Agency for Health Security, Ministry of Health, Conakry, Guinea
| | | | - Guy A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joel M Montgomery
- Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA
| | | | - Thomas W Geisbert
- Department of Microbiology and Immunology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Mary J Choi
- Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA
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2
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Dyal J, Kofman A, Kollie JZ, Fankhauser J, Orone R, Soka MJ, Glaybo U, Kiawu A, Freeman E, Giah G, Tony HD, Faikai M, Jawara M, Kamara K, Kamara S, Flowers B, Kromah ML, Desamu-Thorpe R, Graziano J, Brown S, Morales-Betoulle ME, Cannon DL, Su K, Linderman SL, Plucinski M, Rogier E, Bradbury RS, Secor WE, Bowden KE, Phillips C, Carrington MN, Park YH, Martin MP, Aguinaga MDP, Mushi R, Haberling DL, Ervin ED, Klena JD, Massaquoi M, Nyenswah T, Nichol ST, Chiriboga DE, Williams DE, Hinrichs SH, Ahmed R, Vonhm BT, Rollin PE, Purpura LJ, Choi MJ. Risk Factors for Ebola Virus Persistence in Semen of Survivors in Liberia. Clin Infect Dis 2023; 76:e849-e856. [PMID: 35639875 PMCID: PMC10169428 DOI: 10.1093/cid/ciac424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/08/2022] [Accepted: 05/24/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Long-term persistence of Ebola virus (EBOV) in immunologically privileged sites has been implicated in recent outbreaks of Ebola virus disease (EVD) in Guinea and the Democratic Republic of Congo. This study was designed to understand how the acute course of EVD, convalescence, and host immune and genetic factors may play a role in prolonged viral persistence in semen. METHODS A cohort of 131 male EVD survivors in Liberia were enrolled in a case-case study. "Early clearers" were defined as those with 2 consecutive negative EBOV semen test results by real-time reverse-transcription polymerase chain reaction (rRT-PCR) ≥2 weeks apart within 1 year after discharge from the Ebola treatment unit or acute EVD. "Late clearers" had detectable EBOV RNA by rRT-PCR >1 year after discharge from the Ebola treatment unit or acute EVD. Retrospective histories of their EVD clinical course were collected by questionnaire, followed by complete physical examinations and blood work. RESULTS Compared with early clearers, late clearers were older (median, 42.5 years; P < .001) and experienced fewer severe clinical symptoms (median 2, P = .006). Late clearers had more lens opacifications (odds ratio, 3.9 [95% confidence interval, 1.1-13.3]; P = .03), after accounting for age, higher total serum immunoglobulin G3 (IgG3) titers (P = .005), and increased expression of the HLA-C*03:04 allele (0.14 [.02-.70]; P = .007). CONCLUSIONS Older age, decreased illness severity, elevated total serum IgG3 and HLA-C*03:04 allele expression may be risk factors for the persistence of EBOV in the semen of EVD survivors. EBOV persistence in semen may also be associated with its persistence in other immunologically protected sites, such as the eye.
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Affiliation(s)
- Jonathan Dyal
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aaron Kofman
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Romeo Orone
- ELWA Hospital, Samaritan's Purse, Monrovia, Liberia
| | - Moses J Soka
- ELWA Hospital, Samaritan's Purse, Monrovia, Liberia
| | - Uriah Glaybo
- Men's Health Screening Program, Monrovia, Liberia
| | - Armah Kiawu
- Men's Health Screening Program, Monrovia, Liberia
| | - Edna Freeman
- Men's Health Screening Program, Monrovia, Liberia
| | | | - Henry D Tony
- Men's Health Screening Program, Monrovia, Liberia
| | | | - Mary Jawara
- Men's Health Screening Program, Monrovia, Liberia
| | - Kuku Kamara
- Men's Health Screening Program, Monrovia, Liberia
| | | | | | | | - Rodel Desamu-Thorpe
- Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Graziano
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shelley Brown
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria E Morales-Betoulle
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Deborah L Cannon
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kaihong Su
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Mateusz Plucinski
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric Rogier
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard S Bradbury
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - W Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine E Bowden
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christi Phillips
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary N Carrington
- Basic Science Program, Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, Maryland, USA.,Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA.,Ragon Institute of MGH, Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - Yeon-Hwa Park
- Basic Science Program, Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, Maryland, USA
| | - Maureen P Martin
- Basic Science Program, Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, Maryland, USA
| | - Maria Del Pilar Aguinaga
- Department of Internal Medicine, Meharry Sickle Cell Center, Meharry Medical College, Nashville, Tennessee, USA.,Department of Obstetrics and Gynecology, Meharry Sickle Cell Center, Nashville, Tennessee, USA
| | - Robert Mushi
- Department of Internal Medicine, Meharry Sickle Cell Center, Meharry Medical College, Nashville, Tennessee, USA
| | - Dana L Haberling
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth D Ervin
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John D Klena
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Stuart T Nichol
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David E Chiriboga
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Desmond E Williams
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Steven H Hinrichs
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Rafi Ahmed
- Emory Vaccine Center, Emory University, Atlanta, Georgia, USA
| | | | - Pierre E Rollin
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lawrence J Purpura
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary J Choi
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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3
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Shieh WJ, Demby A, Jones T, Goldsmith CS, Rollin PE, Ksiazek TG, Peters CJ, Zaki SR. Pathology and Pathogenesis of Lassa Fever: Novel Immunohistochemical Findings in Fatal Cases and Clinico-pathologic Correlation. Clin Infect Dis 2021; 74:1821-1830. [PMID: 34463715 DOI: 10.1093/cid/ciab719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Lassa fever is a zoonotic, acute viral illness first identified in Nigeria in 1969. An estimate shows that the "at risk" seronegative population (in Sierra Leone, Guinea, and Nigeria) may be as high as 59 million, with an annual incidence of all illnesses of three million, and fatalities up to 67,000, demonstrating the serious impact of the disease on the region and global health. METHODS Histopathologic evaluation, immunohistochemical assay, and electron microscopic examination were performed on postmortem tissue samples from 12 confirmed Lassa fever cases. RESULTS Lassa fever virus antigens and viral particles were observed in multiple organ systems and cells, including cells in the mononuclear phagocytic system and other specialized cells where it had not been described previously. CONCLUSIONS The immunolocalization of Lassa fever virus antigens in fatal cases provides novel insightful information with clinical and pathogenetic implications. The extensive involvement of the mononuclear phagocytic system, including tissue macrophages and endothelial cells suggests participation of inflammatory mediators from this lineage with the resulting vascular dilatation and increasing permeability. Other findings indicate the pathogenesis of LF is multifactorial and additional studies are needed.
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Affiliation(s)
- Wun-Ju Shieh
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,All the work described in this manuscript was done at CDC, Atlanta, Georgia
| | - Austin Demby
- Ministry of Health and Sanitation, Sierra Leone.,All the work described in this manuscript was done at CDC, Atlanta, Georgia
| | - Tara Jones
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogen and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cynthia S Goldsmith
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogen and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pierre E Rollin
- All the work described in this manuscript was done at CDC, Atlanta, Georgia
| | - Thomas G Ksiazek
- Department of Pathology and Microbiology and Immunology, Galveston National Laboratory University of Texas Medical Branch, Galveston, Texas.,All the work described in this manuscript was done at CDC, Atlanta, Georgia
| | - Clarence J Peters
- All the work described in this manuscript was done at CDC, Atlanta, Georgia
| | - Sherif R Zaki
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogen and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
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Knust B, Brown S, de St Maurice A, Whitmer S, Koske SE, Ervin E, Patel K, Graziano J, Morales-Betoulle ME, House J, Cannon D, Kerins J, Holzbauer S, Austin C, Gibbons-Burgener S, Colton L, Dunn J, Zufan S, Choi MJ, Davis WR, Chiang CF, Manning CR, Roesch L, Shoemaker T, Purpura L, McQuiston J, Peterson D, Radcliffe R, Garvey A, Christel E, Morgan L, Scheftel J, Kazmierczak J, Klena JD, Nichol ST, Rollin PE. Seoul Virus Infection and Spread in United States Home-Based Ratteries: Rat and Human Testing Results From a Multistate Outbreak Investigation. J Infect Dis 2021; 222:1311-1319. [PMID: 32484879 DOI: 10.1093/infdis/jiaa307] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/31/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND During 2017, a multistate outbreak investigation occurred after the confirmation of Seoul virus (SEOV) infections in people and pet rats. A total of 147 humans and 897 rats were tested. METHODS In addition to immunoglobulin (Ig)G and IgM serology and traditional reverse-transcription polymerase chain reaction (RT-PCR), novel quantitative RT-PCR primers/probe were developed, and whole genome sequencing was performed. RESULTS Seventeen people had SEOV IgM, indicating recent infection; 7 reported symptoms and 3 were hospitalized. All patients recovered. Thirty-one facilities in 11 US states had SEOV infection, and among those with ≥10 rats tested, rat IgG prevalence ranged 2%-70% and SEOV RT-PCR positivity ranged 0%-70%. Human laboratory-confirmed cases were significantly associated with rat IgG positivity and RT-PCR positivity (P = .03 and P = .006, respectively). Genomic sequencing identified >99.5% homology between SEOV sequences in this outbreak, and these were >99% identical to SEOV associated with previous pet rat infections in England, the Netherlands, and France. Frequent trade of rats between home-based ratteries contributed to transmission of SEOV between facilities. CONCLUSIONS Pet rat owners, breeders, and the healthcare and public health community should be aware and take steps to prevent SEOV transmission in pet rats and to humans. Biosecurity measures and diagnostic testing can prevent further infections.
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Affiliation(s)
- Barbara Knust
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shelley Brown
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Shannon Whitmer
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah E Koske
- Wisconsin Department of Health Services, Madison, Wisconsin, USA
| | - Elizabeth Ervin
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ketan Patel
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Graziano
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jennifer House
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Deborah Cannon
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janna Kerins
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Chicago Department of Public Health, Chicago, Illinois, USA
| | | | - Connie Austin
- Illinois Department of Public Health, Springfield, Illinois, USA
| | | | - Leah Colton
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - John Dunn
- Tennessee Department of Health, Nashville, Tennessee, USA
| | - Sara Zufan
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary Joung Choi
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William R Davis
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cheng-Feng Chiang
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Craig R Manning
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Linda Roesch
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trevor Shoemaker
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lawrence Purpura
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer McQuiston
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Rachel Radcliffe
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina, USA
| | - Ann Garvey
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina, USA
| | | | - Laura Morgan
- Manitowoc County Health Department, Manitowoc, Wisconsin, USA
| | - Joni Scheftel
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | | | - John D Klena
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stuart T Nichol
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pierre E Rollin
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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5
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Choi MJ, Cossaboom CM, Whitesell AN, Dyal JW, Joyce A, Morgan RL, Campos-Outcalt D, Person M, Ervin E, Yu YC, Rollin PE, Harcourt BH, Atmar RL, Bell BP, Helfand R, Damon IK, Frey SE. Use of Ebola Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep 2021; 70:1-12. [PMID: 33417593 PMCID: PMC7802368 DOI: 10.15585/mmwr.rr7001a1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
This report summarizes the recommendations of the Advisory Committee on Immunization Practices (ACIP) for use of the rVSVΔG-ZEBOV-GP Ebola vaccine (Ervebo) in the United States. The vaccine contains rice-derived recombinant human serum albumin and live attenuated recombinant vesicular stomatitis virus (VSV) in which the gene encoding the glycoprotein of VSV was replaced with the gene encoding the glycoprotein of Ebola virus species Zaire ebolavirus. Persons with a history of severe allergic reaction (e.g., anaphylaxis) to rice protein should not receive Ervebo. This is the first and only vaccine currently licensed by the Food and Drug Administration for the prevention of Ebola virus disease (EVD). These guidelines will be updated based on availability of new data or as new vaccines are licensed to protect against EVD.ACIP recommends preexposure vaccination with Ervebo for adults aged ≥18 years in the U.S. population who are at highest risk for potential occupational exposure to Ebola virus species Zaire ebolavirus because they are responding to an outbreak of EVD, work as health care personnel at federally designated Ebola treatment centers in the United States, or work as laboratorians or other staff at biosafety level 4 facilities in the United States. Recommendations for use of Ervebo in additional populations at risk for exposure and other settings will be considered and discussed by ACIP in the future.
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6
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Kofman A, Linderman S, Su K, Purpura LJ, Ervin E, Brown S, Morales-Betoulle M, Graziano J, Cannon DL, Klena JD, Desamu-Thorpe R, Fankhauser J, Orone R, Soka M, Glaybo U, Massaquoi M, Nysenswah T, Nichol ST, Kollie J, Kiawu A, Freeman E, Giah G, Tony H, Faikai M, Jawara M, Kamara K, Kamara S, Flowers B, Mohammed K, Chiriboga D, Williams DE, Hinrichs SH, Ahmed R, Vonhm B, Rollin PE, Choi MJ. Characteristics of Ebola Virus Disease Survivor Blood and Semen in Liberia: Serology and RT-PCR. Clin Infect Dis 2020; 73:e3641-e3646. [PMID: 32894277 DOI: 10.1093/cid/ciaa1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Ebola virus (EBOV), species Zaire ebolavirus, may persist in the semen of male survivors of Ebola Virus Disease (EVD). We conducted a study of male survivors of the 2014-2016 EVD outbreak in Liberia and evaluated their immune responses to EBOV. We report here findings from the serologic testing of blood for EBOV-specific antibodies, molecular testing for EBOV in blood and semen, and serologic testing of peripheral blood mononuclear cells (PBMCs) in a subset of study participants. METHODS We tested for EBOV RNA in blood by qRT-PCR, and for anti-EBOV-specific IgM and IgG antibodies by enzyme-linked immunosorbent assay (ELISA) for 126 study participants. We performed peripheral blood mononuclear cell (PBMC) analysis on a subgroup of 26 IgG-negative participants. RESULTS All 126 participants tested negative for EBOV RNA in blood by qRT-PCR. The blood of 26 participants tested negative for EBOV-specific IgG antibodies by ELISA. PBMCs were collected from 23/26 EBOV IgG-negative participants. Of these, 1/23 participants had PBMCs which produced anti-EBOV-specific IgG antibodies upon stimulation with EBOV-specific GP and NP antigens. DISCUSSION The blood of EVD survivors, collected when they did not have symptoms meeting the case definition for acute or relapsed EVD, is unlikely to pose a risk for EBOV transmission. We identified one IgM/IgG negative participant who had PBMCs which produced anti-EBOV-specific antibodies upon stimulation. Immunogenicity following acute EBOV infection may exist along a spectrum and absence of antibody response should not be exclusionary in determining an individual's status as a survivor of EVD.
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Affiliation(s)
- Aaron Kofman
- Epidemic Intelligence Service, CDC.,Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | | | - Kaihong Su
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Lawrence J Purpura
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Elizabeth Ervin
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Shelley Brown
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Maria Morales-Betoulle
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | | | - Deborah L Cannon
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - John D Klena
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Rodel Desamu-Thorpe
- Office of, Public Health Preparedness and Response, Center for Preparedness and Response, CDC
| | - John Fankhauser
- ELWA Hospital, Samaritan's Purse.,Ventura County Medical Center, Ventura, CA', CA
| | | | - Moses Soka
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | | | - Moses Massaquoi
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | | | - Stuart T Nichol
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jomah Kollie
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | - Armah Kiawu
- University of Massachusetts Medical School, Worcester, MA
| | - Edna Freeman
- University of Massachusetts Medical School, Worcester, MA
| | - Giovanni Giah
- University of Massachusetts Medical School, Worcester, MA
| | - Henry Tony
- University of Massachusetts Medical School, Worcester, MA
| | - Mylene Faikai
- University of Massachusetts Medical School, Worcester, MA
| | - Mary Jawara
- University of Massachusetts Medical School, Worcester, MA
| | - Kuku Kamara
- University of Massachusetts Medical School, Worcester, MA
| | - Samuel Kamara
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | - Benjamin Flowers
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | - Kromah Mohammed
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | | | | | - Steven H Hinrichs
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Rafi Ahmed
- Emory Vaccine Center, Emory University, Atlanta, GA
| | | | - Pierre E Rollin
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Mary J Choi
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
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7
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Shoemaker TR, Nyakarahuka L, Balinandi S, Ojwang J, Tumusiime A, Mulei S, Kyondo J, Lubwama B, Sekamatte M, Namutebi A, Tusiime P, Monje F, Mayanja M, Ssendagire S, Dahlke M, Kyazze S, Wetaka M, Makumbi I, Borchert J, Zufan S, Patel K, Whitmer S, Brown S, Davis WG, Klena JD, Nichol ST, Rollin PE, Lutwama J. First Laboratory-Confirmed Outbreak of Human and Animal Rift Valley Fever Virus in Uganda in 48 Years. Am J Trop Med Hyg 2020; 100:659-671. [PMID: 30675833 PMCID: PMC6402942 DOI: 10.4269/ajtmh.18-0732] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
In March 2016, an outbreak of Rift Valley fever (RVF) was identified in Kabale district, southwestern Uganda. A comprehensive outbreak investigation was initiated, including human, livestock, and mosquito vector investigations. Overall, four cases of acute, nonfatal human disease were identified, three by RVF virus (RVFV) reverse transcriptase polymerase chain reaction (RT-PCR), and one by IgM and IgG serology. Investigations of cattle, sheep, and goat samples from homes and villages of confirmed and probable RVF cases and the Kabale central abattoir found that eight of 83 (10%) animals were positive for RVFV by IgG serology; one goat from the home of a confirmed case tested positive by RT-PCR. Whole genome sequencing from three clinical specimens was performed and phylogenetic analysis inferred the relatedness of 2016 RVFV with the 2006–2007 Kenya-2 clade, suggesting previous introduction of RVFV into southwestern Uganda. An entomological survey identified three of 298 pools (1%) of Aedes and Coquillettidia species that were RVFV positive by RT-PCR. This was the first identification of RVFV in Uganda in 48 years and the 10th independent viral hemorrhagic fever outbreak to be confirmed in Uganda since 2010.
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Affiliation(s)
- Trevor R Shoemaker
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.,Viral Special Pathogens Branch, Centers for Disease Control and Prevention-Uganda, Entebbe, Uganda
| | - Luke Nyakarahuka
- Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda.,Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Stephen Balinandi
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention-Uganda, Entebbe, Uganda
| | - Joseph Ojwang
- Global Health Security Unit, Centers for Disease Control and Prevention-Uganda, Kampala, Uganda
| | - Alex Tumusiime
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention-Uganda, Entebbe, Uganda
| | - Sophia Mulei
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Jackson Kyondo
- Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | | | | | | | - Fred Monje
- Ministry of Agriculture, Animal Industry and Fisheries, Kampala, Uganda
| | - Martin Mayanja
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Melissa Dahlke
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | - Simon Kyazze
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | - Milton Wetaka
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | - Issa Makumbi
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | - Jeff Borchert
- Global Health Security Unit, Centers for Disease Control and Prevention-Uganda, Kampala, Uganda
| | - Sara Zufan
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ketan Patel
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shannon Whitmer
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shelley Brown
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William G Davis
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John D Klena
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stuart T Nichol
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pierre E Rollin
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julius Lutwama
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
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8
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Wiley MR, Fakoli L, Letizia AG, Welch SR, Ladner JT, Prieto K, Reyes D, Espy N, Chitty JA, Pratt CB, Di Paola N, Taweh F, Williams D, Saindon J, Davis WG, Patel K, Holland M, Negrón D, Ströher U, Nichol ST, Sozhamannan S, Rollin PE, Dogba J, Nyenswah T, Bolay F, Albariño CG, Fallah M, Palacios G. Lassa virus circulating in Liberia: a retrospective genomic characterisation. Lancet Infect Dis 2019; 19:1371-1378. [PMID: 31588039 DOI: 10.1016/s1473-3099(19)30486-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/28/2019] [Accepted: 07/18/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND An alarming rise in reported Lassa fever cases continues in west Africa. Liberia has the largest reported per capita incidence of Lassa fever cases in the region, but genomic information on the circulating strains is scarce. The aim of this study was to substantially increase the available pool of data to help foster the generation of targeted diagnostics and therapeutics. METHODS Clinical serum samples collected from 17 positive Lassa fever cases originating from Liberia (16 cases) and Guinea (one case) within the past decade were processed at the Liberian Institute for Biomedical Research using a targeted-enrichment sequencing approach, producing 17 near-complete genomes. An additional 17 Lassa virus sequences (two from Guinea, seven from Liberia, four from Nigeria, and four from Sierra Leone) were generated from viral stocks at the US Centers for Disease Control and Prevention (Atlanta, GA) from samples originating from the Mano River Union (Guinea, Liberia, and Sierra Leone) region and Nigeria. Sequences were compared with existing Lassa virus genomes and published Lassa virus assays. FINDINGS The 23 new Liberian Lassa virus genomes grouped within two clades (IV.A and IV.B) and were genetically divergent from those circulating elsewhere in west Africa. A time-calibrated phylogeographic analysis incorporating the new genomes suggests Liberia was the entry point of Lassa virus into the Mano River Union region and estimates the introduction to have occurred between 300-350 years ago. A high level of diversity exists between the Liberian Lassa virus genomes. Nucleotide percent difference between Liberian Lassa virus genomes ranged up to 27% in the L segment and 18% in the S segment. The commonly used Lassa Josiah-MGB assay was up to 25% divergent across the target sites when aligned to the Liberian Lassa virus genomes. INTERPRETATION The large amount of novel genomic diversity of Lassa virus observed in the Liberian cases emphasises the need to match deployed diagnostic capabilities with locally circulating strains and underscores the importance of evaluating cross-lineage protection in the development of vaccines and therapeutics. FUNDING Defense Biological Product Assurance Office of the US Department of Defense and the Armed Forces Health Surveillance Branch and its Global Emerging Infections Surveillance and Response Section.
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Affiliation(s)
- Michael R Wiley
- Department of Environmental, Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Lawrence Fakoli
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Andrew G Letizia
- Naval Medical Research Unit Three Ghana Detachment, Accra, Ghana
| | - Stephen R Welch
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jason T Ladner
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA; Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Karla Prieto
- Department of Environmental, Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Daniel Reyes
- Department of Environmental, Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Nicole Espy
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Joseph A Chitty
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Catherine B Pratt
- Department of Environmental, Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Nicholas Di Paola
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Fahn Taweh
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Desmond Williams
- US Centers for Disease Control and Prevention, Atlanta, GA, USA; US Centers for Disease Control and Prevention, Monrovia, Liberia
| | - Jon Saindon
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William G Davis
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ketan Patel
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Ute Ströher
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stuart T Nichol
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shanmuga Sozhamannan
- Defense Biological Product Assurance Office, Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense (CBRND)-Joint Project Lead, CBRND Enabling Biotechnologies, Frederick, MD, USA; Logistics Management Institute, Tysons, VA, USA
| | - Pierre E Rollin
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Dogba
- National Public Health Institute of Liberia, Monrovia, Liberia
| | | | - Fatorma Bolay
- National Public Health Institute of Liberia, Monrovia, Liberia
| | | | - Mosoka Fallah
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Gustavo Palacios
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA.
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10
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Kulkarni PA, Chew D, Youssef-Bessler M, Hamdi HA, Montoya LA, Cervantes KB, Mazur NL, Lucas D, Wells JW, Cennimo D, Sutherland A, Di Domenico LM, Miller LP, Pierre-Louis F, Rokosz G, Nazir A, de Perio MA, Lowe L, Manning C, Mead KR, Christensen BE, Albariño CG, Ströher U, Glover M, Lifshitz EI, Tan CG, Rollin PE, Semple S. Case Report: Imported Case of Lassa Fever - New Jersey, May 2015. Am J Trop Med Hyg 2019; 99:1062-1065. [PMID: 30062993 DOI: 10.4269/ajtmh.17-0316] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report a fatal case of Lassa fever diagnosed in the United States in a Liberian traveler. We describe infection control protocols and public health response. One contact at high risk became symptomatic, but her samples tested negative for Lassa virus; no secondary cases occurred among health care, family, and community contacts.
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Affiliation(s)
- Prathit A Kulkarni
- Centers for Disease Control and Prevention, Atlanta, Georgia.,Communicable Disease Service, New Jersey Department of Health, Trenton, New Jersey
| | - Debra Chew
- University Hospital, Newark, New Jersey.,Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Hanaa A Hamdi
- Newark Department of Health and Community Wellness, Newark, New Jersey
| | - Lindsay A Montoya
- Communicable Disease Service, New Jersey Department of Health, Trenton, New Jersey
| | - Kimberly B Cervantes
- Communicable Disease Service, New Jersey Department of Health, Trenton, New Jersey
| | - Nicole L Mazur
- Communicable Disease Service, New Jersey Department of Health, Trenton, New Jersey
| | - Diana Lucas
- Communicable Disease Service, New Jersey Department of Health, Trenton, New Jersey
| | - Julia W Wells
- Communicable Disease Service, New Jersey Department of Health, Trenton, New Jersey
| | - David Cennimo
- University Hospital, Newark, New Jersey.,Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Anne Sutherland
- University Hospital, Newark, New Jersey.,Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | | | | | | | - Atif Nazir
- Newark Department of Health and Community Wellness, Newark, New Jersey
| | | | - Luis Lowe
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Craig Manning
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kenneth R Mead
- Centers for Disease Control and Prevention, Cincinnati, Ohio
| | | | | | - Ute Ströher
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maleeka Glover
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Edward I Lifshitz
- Communicable Disease Service, New Jersey Department of Health, Trenton, New Jersey
| | - Christina G Tan
- Communicable Disease Service, New Jersey Department of Health, Trenton, New Jersey
| | - Pierre E Rollin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shereen Semple
- Communicable Disease Service, New Jersey Department of Health, Trenton, New Jersey
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11
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Abstract
Lassa virus is a rodentborne arenavirus responsible for human cases of Lassa fever, a viral hemorrhagic fever, in West Africa and in travelers arriving to non–Lassa-endemic countries from West Africa. We describe a retrospective review performed through literature search of clinical and epidemiologic characteristics of all imported Lassa fever cases worldwide during 1969–2016. Our findings demonstrate that approximately half of imported cases had distinctive clinical features (defined as fever and >1 of the following: pharyngitis, sore throat, tonsillitis, conjunctivitis, oropharyngeal ulcers, or proteinuria). Delays in clinical suspicion of this diagnosis were common. In addition, no secondary transmission of Lassa fever to contacts of patients with low-risk exposures occurred, and infection of high-risk contacts was rare. Future public health investigations of such cases should focus on timely recognition of distinctive clinical features, earlier treatment of patients, and targeted public health responses focused on high-risk contacts.
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12
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Nyakarahuka L, Shoemaker TR, Balinandi S, Chemos G, Kwesiga B, Mulei S, Kyondo J, Tumusiime A, Kofman A, Masiira B, Whitmer S, Brown S, Cannon D, Chiang CF, Graziano J, Morales-Betoulle M, Patel K, Zufan S, Komakech I, Natseri N, Chepkwurui PM, Lubwama B, Okiria J, Kayiwa J, Nkonwa IH, Eyu P, Nakiire L, Okarikod EC, Cheptoyek L, Wangila BE, Wanje M, Tusiime P, Bulage L, Mwebesa HG, Ario AR, Makumbi I, Nakinsige A, Muruta A, Nanyunja M, Homsy J, Zhu BP, Nelson L, Kaleebu P, Rollin PE, Nichol ST, Klena JD, Lutwama JJ. Marburg virus disease outbreak in Kween District Uganda, 2017: Epidemiological and laboratory findings. PLoS Negl Trop Dis 2019; 13:e0007257. [PMID: 30883555 PMCID: PMC6438581 DOI: 10.1371/journal.pntd.0007257] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 03/28/2019] [Accepted: 02/22/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION In October 2017, a blood sample from a resident of Kween District, Eastern Uganda, tested positive for Marburg virus. Within 24 hour of confirmation, a rapid outbreak response was initiated. Here, we present results of epidemiological and laboratory investigations. METHODS A district task force was activated consisting of specialised teams to conduct case finding, case management and isolation, contact listing and follow up, sample collection and testing, and community engagement. An ecological investigation was also carried out to identify the potential source of infection. Virus isolation and Next Generation sequencing were performed to identify the strain of Marburg virus. RESULTS Seventy individuals (34 MVD suspected cases and 36 close contacts of confirmed cases) were epidemiologically investigated, with blood samples tested for MVD. Only four cases met the MVD case definition; one was categorized as a probable case while the other three were confirmed cases. A total of 299 contacts were identified; during follow- up, two were confirmed as MVD. Of the four confirmed and probable MVD cases, three died, yielding a case fatality rate of 75%. All four cases belonged to a single family and 50% (2/4) of the MVD cases were female. All confirmed cases had clinical symptoms of fever, vomiting, abdominal pain and bleeding from body orifices. Viral sequences indicated that the Marburg virus strain responsible for this outbreak was closely related to virus strains previously shown to be circulating in Uganda. CONCLUSION This outbreak of MVD occurred as a family cluster with no additional transmission outside of the four related cases. Rapid case detection, prompt laboratory testing at the Uganda National VHF Reference Laboratory and presence of pre-trained, well-prepared national and district rapid response teams facilitated the containment and control of this outbreak within one month, preventing nationwide and global transmission of the disease.
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Affiliation(s)
- Luke Nyakarahuka
- Department of Arbovirology, Emerging and Re-emerging Infections, Uganda Virus Research Institute (UVRI), Entebbe Uganda
- Department of Biosecurity, Ecosystems, and Veterinary Public Health, Collage of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala Uganda
| | - Trevor R. Shoemaker
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Stephen Balinandi
- Department of Arbovirology, Emerging and Re-emerging Infections, Uganda Virus Research Institute (UVRI), Entebbe Uganda
| | - Godfrey Chemos
- Kween District Health Team, Kween District Local Government, Kween, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Sophia Mulei
- Department of Arbovirology, Emerging and Re-emerging Infections, Uganda Virus Research Institute (UVRI), Entebbe Uganda
| | - Jackson Kyondo
- Department of Arbovirology, Emerging and Re-emerging Infections, Uganda Virus Research Institute (UVRI), Entebbe Uganda
| | - Alex Tumusiime
- Department of Arbovirology, Emerging and Re-emerging Infections, Uganda Virus Research Institute (UVRI), Entebbe Uganda
| | - Aaron Kofman
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Ben Masiira
- African Field Epidemiology Network, Kampala, Uganda
| | - Shannon Whitmer
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Shelley Brown
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Debi Cannon
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Cheng-Feng Chiang
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - James Graziano
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Maria Morales-Betoulle
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Ketan Patel
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Sara Zufan
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | | | - Nasan Natseri
- World Health Organization – Country Office, Kampala, Uganda
| | | | | | | | - Joshua Kayiwa
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Innocent H. Nkonwa
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Patricia Eyu
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Lydia Nakiire
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | | | - Leonard Cheptoyek
- Kween District Health Team, Kween District Local Government, Kween, Uganda
| | | | - Michael Wanje
- Kween District Health Team, Kween District Local Government, Kween, Uganda
| | | | - Lilian Bulage
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | | | - Alex R. Ario
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Issa Makumbi
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | | | | | | | - Jaco Homsy
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Bao-Ping Zhu
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Lisa Nelson
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Pontiano Kaleebu
- Department of Arbovirology, Emerging and Re-emerging Infections, Uganda Virus Research Institute (UVRI), Entebbe Uganda
| | - Pierre E. Rollin
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Stuart T. Nichol
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - John D. Klena
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Julius J. Lutwama
- Department of Arbovirology, Emerging and Re-emerging Infections, Uganda Virus Research Institute (UVRI), Entebbe Uganda
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13
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Whitmer SL, Strecker T, Cadar D, Dienes HP, Faber K, Patel K, Brown SM, Davis WG, Klena JD, Rollin PE, Schmidt-Chanasit J, Fichet-Calvet E, Noack B, Emmerich P, Rieger T, Wolff S, Fehling SK, Eickmann M, Mengel JP, Schultze T, Hain T, Ampofo W, Bonney K, Aryeequaye JND, Ribner B, Varkey JB, Mehta AK, Lyon GM, Kann G, De Leuw P, Schuettfort G, Stephan C, Wieland U, Fries JW, Kochanek M, Kraft CS, Wolf T, Nichol ST, Becker S, Ströher U, Günther S. New Lineage of Lassa Virus, Togo, 2016. Emerg Infect Dis 2019; 24:599-602. [PMID: 29460758 PMCID: PMC5823357 DOI: 10.3201/eid2403.171905] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We describe a strain of Lassa virus representing a putative new lineage that was isolated from a cluster of human infections with an epidemiologic link to Togo. This finding extends the known range of Lassa virus to Togo.
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14
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Affiliation(s)
- Inger K Damon
- From the Centers for Disease Control and Prevention, Atlanta
| | - Pierre E Rollin
- From the Centers for Disease Control and Prevention, Atlanta
| | - Mary J Choi
- From the Centers for Disease Control and Prevention, Atlanta
| | - Ray R Arthur
- From the Centers for Disease Control and Prevention, Atlanta
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15
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Kofman A, Eggers P, Kjemtrup A, Hall R, Brown SM, Morales-Betoulle M, Graziano J, Zufan SE, Whitmer SLM, Cannon DL, Chiang CF, Choi MJ, Rollin PE, Cetron MS, Yaglom HD, Duwell M, Kuhar DT, Kretschmer M, Knust B, Klena JD, Alvarado-Ramy F, Shoemaker T, Towner JS, Nichol ST. Notes from the Field: Contact Tracing Investigation after First Case of Andes Virus in the United States - Delaware, February 2018. MMWR Morb Mortal Wkly Rep 2018; 67:1162-1163. [PMID: 30335741 PMCID: PMC6193684 DOI: 10.15585/mmwr.mm6741a7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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de St Maurice A, Ervin E, Orone R, Choi M, Dokubo EK, Rollin PE, Nichol ST, Williams D, Brown J, Sacra R, Fankhauser J, Knust B. Care of Ebola Survivors and Factors Associated With Clinical Sequelae-Monrovia, Liberia. Open Forum Infect Dis 2018; 5:ofy239. [PMID: 30386807 DOI: 10.1093/ofid/ofy239] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/19/2018] [Indexed: 11/12/2022] Open
Abstract
Background The Eternal Love Winning Africa (ELWA) Clinic was the first clinic to provide free, comprehensive care to Ebola virus disease (EVD) survivors in Liberia. The objectives of this analysis were to describe the demographics and symptoms of EVD survivors at ELWA from January 2015 through March 2017 and to identify risk factors for development of sequelae. Methods Patients' demographic and clinical information was collected by chart review in June 2016 and March 2017. Associations with clinical sequelae were analyzed using the chi-square test, t test, and multivariate logistic regression. Results From January 2015 to March 2017, 329 EVD survivors were evaluated at ELWA. Most survivors experienced myalgia/arthralgia (73%; n = 239) and headache (53%; n = 173). The length of time from Ebola Treatment Unit (ETU) discharge to first clinic visit ranged from 0 to 30 months. Many visits (30%) occurred 24 or more months after ETU discharge. The proportion of visits for headache, weight loss, joint pain, visual problems, insomnia, fatigue, memory loss, decreased libido, depression, and uveitis decreased over time. More men than women had visits for depression; however, these differences were not significant. Symptom prevalence differed in adults and children; significantly more adults experienced myalgia/arthralgia (77% vs 44%), visual problems (41% vs 12%), post-EVD-related musculoskeletal pain (42% vs 15%), and insomnia (17% vs 2%). Conclusions EVD survivors frequented ELWA for EVD-related symptoms many months after ETU discharge, indicating a long-term need for care. Reported symptoms changed over time, which may reflect eventual resolution of some sequelae.
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Affiliation(s)
- A de St Maurice
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division of Pediatric Infectious Diseases, University of California Los Angeles, Los Angeles, California
| | - E Ervin
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - R Orone
- ELWA Hospital, Monrovia, Liberia
| | - M Choi
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - E K Dokubo
- Centers for Disease Control and Prevention, Monrovia, Liberia
| | - P E Rollin
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - S T Nichol
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - D Williams
- Centers for Disease Control and Prevention, Monrovia, Liberia
| | - J Brown
- ELWA Hospital, Monrovia, Liberia
| | - R Sacra
- ELWA Hospital, Monrovia, Liberia
| | | | - B Knust
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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17
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Raabe VN, Kann G, Ribner BS, Morales A, Varkey JB, Mehta AK, Lyon GM, Vanairsdale S, Faber K, Becker S, Eickmann M, Strecker T, Brown S, Patel K, De Leuw P, Schuettfort G, Stephan C, Rabenau H, Klena JD, Rollin PE, McElroy A, Ströher U, Nichol S, Kraft CS, Wolf T. Favipiravir and Ribavirin Treatment of Epidemiologically Linked Cases of Lassa Fever. Clin Infect Dis 2018; 65:855-859. [PMID: 29017278 DOI: 10.1093/cid/cix406] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/26/2017] [Indexed: 12/28/2022] Open
Abstract
Two patients with Lassa fever are described who are the first human cases treated with a combination of ribavirin and favipiravir. Both patients survived but developed transaminitis and had prolonged detectable virus RNA in blood and semen, suggesting that the possibility of sexual transmission of Lassa virus should be considered.
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Affiliation(s)
- Vanessa N Raabe
- Division of Infectious Diseases, Emory University, Atlanta, Georgia
| | - Gerrit Kann
- Department of Medicine, Infectious Diseases Unit, Goethe University Hospital, Frankfurt/Main, Germany
| | - Bruce S Ribner
- Division of Infectious Diseases, Emory University, Atlanta, Georgia
| | | | - Jay B Varkey
- Division of Infectious Diseases, Emory University, Atlanta, Georgia
| | - Aneesh K Mehta
- Division of Infectious Diseases, Emory University, Atlanta, Georgia
| | - G Marshall Lyon
- Division of Infectious Diseases, Emory University, Atlanta, Georgia
| | | | | | - Stephan Becker
- Institute of Virology and Germany Centre for Infectious Diseases Research (DZIF), Gießen-Marburg-Langen, Philipps University, Marburg, Germany
| | - Markus Eickmann
- Institute of Virology and Germany Centre for Infectious Diseases Research (DZIF), Gießen-Marburg-Langen, Philipps University, Marburg, Germany
| | - Thomas Strecker
- Institute of Virology and Germany Centre for Infectious Diseases Research (DZIF), Gießen-Marburg-Langen, Philipps University, Marburg, Germany
| | - Shelley Brown
- US Centers for Disease Control and Prevention, Viral Special Pathogens Branch, Atlanta, Georgia
| | - Ketan Patel
- US Centers for Disease Control and Prevention, Viral Special Pathogens Branch, Atlanta, Georgia
| | - Philipp De Leuw
- Department of Medicine, Infectious Diseases Unit, Goethe University Hospital, Frankfurt/Main, Germany
| | - Gundolf Schuettfort
- Department of Medicine, Infectious Diseases Unit, Goethe University Hospital, Frankfurt/Main, Germany
| | - Christoph Stephan
- Department of Medicine, Infectious Diseases Unit, Goethe University Hospital, Frankfurt/Main, Germany
| | - Holger Rabenau
- Institute of Medical Virology, University Hospital, Frankfurt, Germany
| | - John D Klena
- US Centers for Disease Control and Prevention, Viral Special Pathogens Branch, Atlanta, Georgia
| | - Pierre E Rollin
- US Centers for Disease Control and Prevention, Viral Special Pathogens Branch, Atlanta, Georgia
| | - Anita McElroy
- US Centers for Disease Control and Prevention, Viral Special Pathogens Branch, Atlanta, Georgia
| | - Ute Ströher
- US Centers for Disease Control and Prevention, Viral Special Pathogens Branch, Atlanta, Georgia
| | - Stuart Nichol
- US Centers for Disease Control and Prevention, Viral Special Pathogens Branch, Atlanta, Georgia
| | - Colleen S Kraft
- Division of Infectious Diseases, Emory University, Atlanta, Georgia.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - Timo Wolf
- Department of Medicine, Infectious Diseases Unit, Goethe University Hospital, Frankfurt/Main, Germany
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Nyakarahuka L, de St. Maurice A, Purpura L, Ervin E, Balinandi S, Tumusiime A, Kyondo J, Mulei S, Tusiime P, Lutwama J, Klena JD, Brown S, Knust B, Rollin PE, Nichol ST, Shoemaker TR. Prevalence and risk factors of Rift Valley fever in humans and animals from Kabale district in Southwestern Uganda, 2016. PLoS Negl Trop Dis 2018; 12:e0006412. [PMID: 29723189 PMCID: PMC5953497 DOI: 10.1371/journal.pntd.0006412] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 05/15/2018] [Accepted: 03/26/2018] [Indexed: 01/06/2023] Open
Abstract
Background Rift Valley fever (RVF) is a zoonotic disease caused by Rift Valley fever virus (RVFV) found in Africa and the Middle East. Outbreaks can cause extensive morbidity and mortality in humans and livestock. Following the diagnosis of two acute human RVF cases in Kabale district, Uganda, we conducted a serosurvey to estimate RVFV seroprevalence in humans and livestock and to identify associated risk factors. Methods Humans and animals at abattoirs and villages in Kabale district were sampled. Persons were interviewed about RVFV exposure risk factors. Human blood was tested for anti-RVFV IgM and IgG, and animal blood for anti-RVFV IgG. Principal findings 655 human and 1051 animal blood samples were collected. Anti-RVFV IgG was detected in 78 (12%) human samples; 3 human samples (0.5%) had detectable IgM only, and 7 (1%) had both IgM and IgG. Of the 10 IgM-positive persons, 2 samples were positive for RVFV by PCR, confirming recent infection. Odds of RVFV seropositivity were greater in participants who were butchers (odds ratio [OR] 5.1; 95% confidence interval [95% CI]: 1.7–15.1) and those who reported handling raw meat (OR 3.4; 95% CI 1.2–9.8). No persons under age 20 were RVFV seropositive. The overall animal seropositivity was 13%, with 27% of cattle, 7% of goats, and 4% of sheep seropositive. In a multivariate logistic regression, cattle species (OR 9.1; 95% CI 4.1–20.5), adult age (OR 3.0; 95% CI 1.6–5.6), and female sex (OR 2.1; 95%CI 1.0–4.3) were significantly associated with animal seropositivity. Individual human seropositivity was significantly associated with animal seropositivity by subcounty after adjusting for sex, age, and occupation (p < 0.05). Conclusions Although no RVF cases had been detected in Uganda from 1968 to March 2016, our study suggests that RVFV has been circulating undetected in both humans and animals living in and around Kabale district. RVFV seropositivity in humans was associated with occupation, suggesting that the primary mode of RVFV transmission to humans in Kabale district could be through contact with animal blood or body fluids. Viral hemorrhagic fevers are known to cause high morbidity and mortality and pose a serious threat to human and animal populations in endemic countries. An outbreak of Rift Valley fever was detected in Kabale district in March, 2016 and identified the first human cases in Uganda since 1968. There was a need to perform a rapid assessment of the burden of Rift valley fever in Kabale district, identify undetected acute cases, identify risk factors associated with human disease, identify areas at high-risk or future infections, and to determine if this was a newly emerging infection or an endemic disease. Our study found the seroprevalence to be as high as 28% in humans and 36% in animals within some subcounties of Kabale district. Human seropositivity correlated with animal seropositivity, suggesting that animal to human transmission may be the predominant mode of virus spread. Our findings also suggest that this virus may have been endemic for many years prior to these human cases being identified.
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Affiliation(s)
- Luke Nyakarahuka
- Uganda Virus Research Institute, Department of Arbovirology, Emerging and Re-emerging Infections, Entebbe, Uganda
| | - Annabelle de St. Maurice
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
- University of California Los Angeles, Division of Pediatric Infectious Disease, Los Angeles, CA
| | - Lawrence Purpura
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
| | - Elizabeth Ervin
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
| | - Stephen Balinandi
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Entebbe, Uganda
| | - Alex Tumusiime
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Entebbe, Uganda
| | - Jackson Kyondo
- Uganda Virus Research Institute, Department of Arbovirology, Emerging and Re-emerging Infections, Entebbe, Uganda
| | - Sophia Mulei
- Uganda Virus Research Institute, Department of Arbovirology, Emerging and Re-emerging Infections, Entebbe, Uganda
| | | | - Julius Lutwama
- Uganda Virus Research Institute, Department of Arbovirology, Emerging and Re-emerging Infections, Entebbe, Uganda
| | - John D. Klena
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
| | - Shelley Brown
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
| | - Barbara Knust
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
| | - Pierre E. Rollin
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
| | - Stuart T. Nichol
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
| | - Trevor R. Shoemaker
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Entebbe, Uganda
- * E-mail:
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19
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de St. Maurice A, Nyakarahuka L, Purpura L, Ervin E, Tumusiime A, Balinandi S, Kyondo J, Mulei S, Tusiime P, Manning C, Rollin PE, Knust B, Shoemaker T. Rift Valley Fever: A survey of knowledge, attitudes, and practice of slaughterhouse workers and community members in Kabale District, Uganda. PLoS Negl Trop Dis 2018; 12:e0006175. [PMID: 29505579 PMCID: PMC5860784 DOI: 10.1371/journal.pntd.0006175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 03/20/2018] [Accepted: 12/19/2017] [Indexed: 01/15/2023] Open
Abstract
Background Rift Valley Fever virus (RVF) is a zoonotic virus in the Phenuiviridae family. RVF outbreaks can cause significant morbidity and mortality in humans and animals. Following the diagnosis of two RVF cases in March 2016 in southern Kabale district, Uganda, we conducted a knowledge, attitudes and practice (KAP) survey to identify knowledge gaps and at-risk behaviors related to RVF. Methodology/Principal findings A multidisciplinary team interviewed 657 community members, including abattoir workers, in and around Kabale District, Uganda. Most participants (90%) had knowledge of RVF and most (77%) cited radio as their primary information source. Greater proportions of farmers (68%), herdsmen (79%) and butchers (88%) thought they were at risk of contracting RVF compared to persons in other occupations (60%, p<0.01). Participants most frequently identified bleeding as a symptom of RVF. Less than half of all participants reported fever, vomiting, and diarrhea as common RVF symptoms in either humans or animals. The level of knowledge about human RVF symptoms did not vary by occupation; however more farmers and butchers (36% and 51%, respectively) had knowledge of RVF symptoms in animals compared to those in other occupations (30%, p<0.01). The use of personal protective equipment (PPE) when handling animals varied by occupation, with 77% of butchers using some PPE and 12% of farmers using PPE. Although most butchers said that they used PPE, most used gumboots (73%) and aprons (60%) and less than 20% of butchers used gloves or eye protection when slaughtering. Conclusions Overall, knowledge, attitudes and practice regarding RVF in Kabale District Uganda could be improved through educational efforts targeting specific populations. Rift Valley Fever (RVF) virus is transmitted to humans from contact with infected livestock and through mosquito bites. Several human cases of RVF were diagnosed in Kabale District, Uganda in March 2016, over 40 years after the last RVF case was identified in Uganda. We administered a knowledge, attitudes, and practice survey to people living in Kabale District, near where the cases occurred. Survey results demonstrated that knowledge, attitudes and practice surrounding RVF could be improved within the community.
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Affiliation(s)
- Annabelle de St. Maurice
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
- * E-mail:
| | - Luke Nyakarahuka
- Department of Arbovirology, Emerging and Re-emerging Disease, Uganda Virus Research Institute, Entebbe, Uganda
- Makerere University, College of Veterinary Medicine, Animal Resources and Biosecurity, Department of Biosecurity, Ecosystems and Veterinary Public Health, Kampala, Uganda
| | - Lawrence Purpura
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
| | - Elizabeth Ervin
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
| | - Alex Tumusiime
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
| | - Stephen Balinandi
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
| | - Jackson Kyondo
- Department of Arbovirology, Emerging and Re-emerging Disease, Uganda Virus Research Institute, Entebbe, Uganda
| | - Sophia Mulei
- Department of Arbovirology, Emerging and Re-emerging Disease, Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Craig Manning
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
| | - Pierre E. Rollin
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
| | - Barbara Knust
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
| | - Trevor Shoemaker
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
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20
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Nyakarahuka L, Ojwang J, Tumusiime A, Balinandi S, Whitmer S, Kyazze S, Kasozi S, Wetaka M, Makumbi I, Dahlke M, Borchert J, Lutwama J, Ströher U, Rollin PE, Nichol ST, Shoemaker TR. Isolated Case of Marburg Virus Disease, Kampala, Uganda, 2014. Emerg Infect Dis 2018; 23:1001-1004. [PMID: 28518032 PMCID: PMC5443453 DOI: 10.3201/eid2306.170047] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In September 2014, a single fatal case of Marburg virus was identified in a healthcare worker in Kampala, Uganda. The source of infection was not identified, and no secondary cases were identified. We describe the rapid identification, laboratory diagnosis, and case investigation of the third Marburg virus outbreak in Uganda.
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Reynes JM, Carli D, Bour JB, Boudjeltia S, Dewilde A, Gerbier G, Nussbaumer T, Jacomo V, Rapt MP, Rollin PE, Septfons A. Seoul Virus Infection in Humans, France, 2014-2016. Emerg Infect Dis 2017; 23:973-977. [PMID: 28368241 PMCID: PMC5443425 DOI: 10.3201/eid2306.160927] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report detection of Seoul virus in 3 patients in France over a 2-year period. These patients accounted for 3 of the 4 Seoul virus infections among 434 hantavirus infections (1.7%) reported during this time. More attention should be given to this virus in Europe where surveillance has been focused mostly on Puumala and Dobrava-Belgrade hantaviruses.
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Albariño CG, Wiggleton Guerrero L, Jenks HM, Chakrabarti AK, Ksiazek TG, Rollin PE, Nichol ST. Insights into Reston virus spillovers and adaption from virus whole genome sequences. PLoS One 2017; 12:e0178224. [PMID: 28542463 PMCID: PMC5444788 DOI: 10.1371/journal.pone.0178224] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/10/2017] [Indexed: 12/11/2022] Open
Abstract
Reston virus (family Filoviridae) is unique among the viruses of the Ebolavirus genus in that it is considered non-pathogenic in humans, in contrast to the other members which are highly virulent. The virus has however, been associated with several outbreaks of highly lethal hemorrhagic fever in non-human primates (NHPs), specifically cynomolgus monkeys (Macaca fascicularis) originating in the Philippines. In addition, Reston virus has been isolated from domestic pigs in the Philippines. To better understand virus spillover events and potential adaption to new hosts, the whole genome sequences of representative Reston virus isolates were obtained using a next generation sequencing (NGS) approach and comparative genomic analysis and virus fitness analyses were performed. Nine virus genome sequences were completed for novel and previously described isolates obtained from a variety of hosts including a human case, non-human primates and pigs. Results of phylogenetic analysis of the sequence differences are consistent with multiple independent introductions of RESTV from a still unknown natural reservoir into non-human primates and swine farming operations. No consistent virus genetic markers were found specific for viruses associated with primate or pig infections, but similar to what had been seen with some Ebola viruses detected in the large Western Africa outbreak in 2014–2016, a truncated version of VP30 was identified in a subgroup of Reston viruses obtained from an outbreak in pigs 2008–2009. Finally, the genetic comparison of two closely related viruses, one isolated from a human case and one from an NHP, showed amino acid differences in the viral polymerase and detectable differences were found in competitive growth assays on human and NHP cell lines.
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Affiliation(s)
- César G. Albariño
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | | | - Harley M. Jenks
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Ayan K. Chakrabarti
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Thomas G. Ksiazek
- University of Texas Medical Branch, Galveston, TX, United States of America
| | - Pierre E. Rollin
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Stuart T. Nichol
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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23
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Mathur G, Yadav K, Ford B, Schafer IJ, Basavaraju SV, Knust B, Shieh WJ, Hill S, Locke GD, Quinlisk P, Brown S, Gibbons A, Cannon D, Kuehnert M, Nichol ST, Rollin PE, Ströher U, Miller R. High clinical suspicion of donor-derived disease leads to timely recognition and early intervention to treat solid organ transplant-transmitted lymphocytic choriomeningitis virus. Transpl Infect Dis 2017; 19. [PMID: 28423464 DOI: 10.1111/tid.12707] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 01/03/2017] [Accepted: 01/09/2017] [Indexed: 11/26/2022]
Abstract
Despite careful donor screening, unexpected donor-derived infections continue to occur in organ transplant recipients (OTRs). Lymphocytic choriomeningitis virus (LCMV) is one such transplant-transmitted infection that in previous reports has resulted in a high mortality among the affected OTRs. We report a LCMV case cluster that occurred 3 weeks post-transplant in three OTRs who received allografts from a common organ donor in March 2013. Following confirmation of LCMV infection at Centers for Disease Control and Prevention, immunosuppression was promptly reduced and ribavirin and/or intravenous immunoglobulin therapy were initiated in OTRs. The liver recipient died, but right kidney recipients survived without significant sequelae and left kidney recipient survived acute LCMV infection with residual mental status deficit. Our series highlights how early recognition led to prompt therapeutic intervention, which may have contributed to more favorable outcome in the kidney transplant recipients.
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Affiliation(s)
- Gagan Mathur
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Kunal Yadav
- Department of Internal Medicine-Infectious Diseases, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Bradley Ford
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Ilana J Schafer
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sridhar V Basavaraju
- Office of Blood, Organ, and Other Tissue Safety, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Barbara Knust
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wun-Ju Shieh
- Infectious Disease Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sam Hill
- Organ Donation Department, Iowa Donor Network, North Liberty, IA, USA
| | - Garret D Locke
- Compliance & Quality Systems, Iowa Lions Eye Bank, Iowa City, IA, USA
| | - Patricia Quinlisk
- State Health Department, Iowa Department of Public Health, Des Moines, IA, USA
| | - Shelley Brown
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ardith Gibbons
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deborah Cannon
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew Kuehnert
- Office of Blood, Organ, and Other Tissue Safety, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stuart T Nichol
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pierre E Rollin
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ute Ströher
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel Miller
- Department of Internal Medicine-Infectious Diseases, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Janvier F, Delaune D, Poyot T, Valade E, Mérens A, Rollin PE, Foissaud V. Ebola Virus RNA Stability in Human Blood and Urine in West Africa's Environmental Conditions. Emerg Infect Dis 2016; 22:292-4. [PMID: 26812135 PMCID: PMC4734543 DOI: 10.3201/eid2202.151395] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We evaluated RNA stability of Ebola virus in EDTA blood and urine samples collected from infected patients and stored in West Africa's environmental conditions. In blood, RNA was stable for at least 18 days when initial cycle threshold values were <30, but in urine, RNA degradation occurred more quickly.
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Schafer IJ, Knudsen E, McNamara LA, Agnihotri S, Rollin PE, Islam A. The Epi Info Viral Hemorrhagic Fever (VHF) Application: A Resource for Outbreak Data Management and Contact Tracing in the 2014-2016 West Africa Ebola Epidemic. J Infect Dis 2016; 214:S122-S136. [PMID: 27587635 DOI: 10.1093/infdis/jiw272] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Epi Info Viral Hemorrhagic Fever application (Epi Info VHF) was developed in response to challenges managing outbreak data during four 2012 filovirus outbreaks. Development goals included combining case and contact data in a relational database, facilitating data-driven contact tracing, and improving outbreak data consistency and use. The application was first deployed in Guinea, when the West Africa Ebola epidemic was detected, in March 2014, and has been used in 7 African countries and 2 US states. Epi Info VHF enabled reporting of compatible data from multiple countries, contributing to international Ebola knowledge. However, challenges were encountered in accommodating the epidemic's unexpectedly large magnitude, addressing country-specific needs within 1 software product, and using the application in settings with limited Internet access and information technology support. Use of Epi Info VHF in the West Africa Ebola epidemic highlighted the fundamental importance of good data management for effective outbreak response, regardless of the software used.
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Affiliation(s)
- Ilana J Schafer
- Epi Info Team, Division of Health Informatics and Surveillance Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology
| | - Erik Knudsen
- Epi Info Team, Division of Health Informatics and Surveillance
| | - Lucy A McNamara
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Pierre E Rollin
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology
| | - Asad Islam
- Epi Info Team, Division of Health Informatics and Surveillance
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26
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Horton KC, Fahmy NT, Watany N, Zayed A, Mohamed A, Ahmed AA, Rollin PE, Dueger EL. Crimean Congo Hemorrhagic Fever Virus and Alkhurma (Alkhumra) Virus in Ticks in Djibouti. Vector Borne Zoonotic Dis 2016; 16:680-2. [PMID: 27508862 DOI: 10.1089/vbz.2016.1951] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Crimean Congo hemorrhagic fever virus and Alkhumra virus, not previously reported in Djibouti, were detected among 141 (infection rate = 15.7 per 100, 95% CI: 13.4-18.1) tick pools from 81 (37%) cattle and 2 (infection rate = 0.2 per 100, 95% CI: 0.0-0.7) tick pools from 2 (1%) cattle, respectively, collected at an abattoir in 2010 and 2011.
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Affiliation(s)
- Katherine C Horton
- 1 Global Disease Detection Program, U.S. Centers for Disease Control and Prevention , Cairo, Egypt
| | - Nermeen T Fahmy
- 2 Vector Biology Research Program, U.S. Naval Medical Research Unit No. 3 , Cairo, Egypt
| | - Noha Watany
- 2 Vector Biology Research Program, U.S. Naval Medical Research Unit No. 3 , Cairo, Egypt
| | - Alia Zayed
- 2 Vector Biology Research Program, U.S. Naval Medical Research Unit No. 3 , Cairo, Egypt
| | - Abro Mohamed
- 3 Department of Epidemiology and Information Services, Ministry of Health , Djibouti, Djibouti
| | - Ammar Abdo Ahmed
- 3 Department of Epidemiology and Information Services, Ministry of Health , Djibouti, Djibouti
| | - Pierre E Rollin
- 4 Viral Special Pathogens Branch, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Erica L Dueger
- 1 Global Disease Detection Program, U.S. Centers for Disease Control and Prevention , Cairo, Egypt .,5 Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention , Atlanta, Georgia
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Wacharapluesadee S, Olival KJ, Kanchanasaka B, Duengkae P, Kaewchot S, Srongmongkol P, Ieamsaard G, Maneeorn P, Sittidetboripat N, Kaewpom T, Petcharat S, Yingsakmongkon S, Rollin PE, Towner JS, Hemachudha T. Surveillance for Ebola Virus in Wildlife, Thailand. Emerg Infect Dis 2016; 21:2271-3. [PMID: 26584224 PMCID: PMC4672430 DOI: 10.3201/eid2112.150860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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28
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Kamali A, Jamieson DJ, Kpaduwa J, Schrier S, Kim M, Green NM, Ströher U, Muehlenbachs A, Bell M, Rollin PE, Mascola L. Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States. Emerg Infect Dis 2016; 22. [PMID: 27191253 PMCID: PMC4918171 DOI: 10.3201/eid2207.160269] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Women who become pregnant after recovery pose little risk for transmitting the virus to the baby or others. Many of the survivors of the 2014–2015 epidemic of Ebola virus disease (EVD) in West Africa were women of childbearing age. Limited clinical and laboratory data exist that describe these women’s pregnancies and outcomes. We report the case of an EVD survivor who became pregnant and delivered her child in the United States, and we discuss implications of this case for infection control practices in obstetric services. Hospitals in the United States must be prepared to care for EVD survivors.
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Abstract
Many features of this outbreak reinforce the benefit of continued investment in global health security. The variety of factors that contributed to the initial undetected spread of Ebola virus disease in West Africa during 2013–2016 and the difficulty controlling the outbreak once the etiology was identified highlight priorities for disease prevention, detection, and response. These factors include occurrence in a region recovering from civil instability and lacking experience with Ebola response; inadequate surveillance, recognition of suspected cases, and Ebola diagnosis; mobile populations and extensive urban transmission; and the community’s insufficient general understanding about the disease. The magnitude of the outbreak was not attributable to a substantial change of the virus. Continued efforts during the outbreak and in preparation for future outbreak response should involve identifying the reservoir, improving in-country detection and response capacity, conducting survivor studies and supporting survivors, engaging in culturally appropriate public education and risk communication, building productive interagency relationships, and continuing support for basic research.
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30
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Muehlenbachs A, de la Rosa Vázquez O, Bausch DG, Schafer IJ, Paddock CD, Nyakio JP, Lame P, Bergeron E, McCollum AM, Goldsmith CS, Bollweg BC, Prieto MA, Lushima RS, Ilunga BK, Nichol ST, Shieh WJ, Ströher U, Rollin PE, Zaki SR. Ebola Virus Disease in Pregnancy: Clinical, Histopathologic, and Immunohistochemical Findings. J Infect Dis 2016; 215:64-69. [PMID: 27226206 DOI: 10.1093/infdis/jiw206] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/09/2016] [Indexed: 01/23/2023] Open
Abstract
Here we describe clinicopathologic features of Ebola virus disease in pregnancy. One woman infected with Sudan virus in Gulu, Uganda, in 2000 had a stillbirth and survived, and another woman infected with Bundibugyo virus had a live birth with maternal and infant death in Isiro, the Democratic Republic of the Congo in 2012. Ebolavirus antigen was seen in the syncytiotrophoblast and placental maternal mononuclear cells by immunohistochemical analysis, and no antigen was seen in fetal placental stromal cells or fetal organs. In the Gulu case, ebolavirus antigen localized to malarial parasite pigment-laden macrophages. These data suggest that trophoblast infection may be a mechanism of transplacental ebolavirus transmission.
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Affiliation(s)
| | | | | | | | - Christopher D Paddock
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Andrea M McCollum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology
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Cummings KJ, Choi MJ, Esswein EJ, de Perio MA, Harney JM, Chung WM, Lakey DL, Liddell AM, Rollin PE. Addressing Infection Prevention and Control in the First U.S. Community Hospital to Care for Patients With Ebola Virus Disease: Context for National Recommendations and Future Strategies. Ann Intern Med 2016; 165:41-49. [PMID: 27159355 DOI: 10.7326/m15-2944] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Health care personnel (HCP) caring for patients with Ebola virus disease (EVD) are at increased risk for infection with the virus. In 2014, a Texas hospital became the first U.S. community hospital to care for a patient with EVD; 2 nurses were infected while providing care. This article describes infection control measures developed to strengthen the hospital's capacity to safely diagnose and treat patients with EVD. After admission of the first patient with EVD, a multidisciplinary team from the Centers for Disease Control and Prevention (CDC) joined the hospital's infection preventionists to implement a system of occupational safety and health controls for direct patient care, handling of clinical specimens, and managing regulated medical waste. Existing engineering and administrative controls were strengthened. The personal protective equipment (PPE) ensemble was standardized, HCP were trained on donning and doffing PPE, and a system of trained observers supervising PPE donning and doffing was implemented. Caring for patients with EVD placed substantial demands on a community hospital. The experiences of the authors and others informed national policies for the care of patients with EVD and protection of HCP, including new guidance for PPE, a rapid system for deploying CDC staff to assist hospitals ("Ebola Response Team"), and a framework for a tiered approach to hospital preparedness. The designation of regional Ebola treatment centers and the establishment of the National Ebola Training and Education Center address the need for HCP to be prepared to safely care for patients with EVD and other high-consequence emerging infectious diseases.
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Affiliation(s)
- Kristin J. Cummings
- From the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Denver, Colorado; University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio; Dallas County Department of Health and Human Services and Texas Health Presbyterian Hospital Dallas, Dallas, Texas; and Texas Department of State Health Services, Austin, Texas
| | - Mary J. Choi
- From the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Denver, Colorado; University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio; Dallas County Department of Health and Human Services and Texas Health Presbyterian Hospital Dallas, Dallas, Texas; and Texas Department of State Health Services, Austin, Texas
| | - Eric J. Esswein
- From the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Denver, Colorado; University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio; Dallas County Department of Health and Human Services and Texas Health Presbyterian Hospital Dallas, Dallas, Texas; and Texas Department of State Health Services, Austin, Texas
| | - Marie A. de Perio
- From the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Denver, Colorado; University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio; Dallas County Department of Health and Human Services and Texas Health Presbyterian Hospital Dallas, Dallas, Texas; and Texas Department of State Health Services, Austin, Texas
| | - Joshua M. Harney
- From the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Denver, Colorado; University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio; Dallas County Department of Health and Human Services and Texas Health Presbyterian Hospital Dallas, Dallas, Texas; and Texas Department of State Health Services, Austin, Texas
| | - Wendy M. Chung
- From the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Denver, Colorado; University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio; Dallas County Department of Health and Human Services and Texas Health Presbyterian Hospital Dallas, Dallas, Texas; and Texas Department of State Health Services, Austin, Texas
| | - David L. Lakey
- From the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Denver, Colorado; University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio; Dallas County Department of Health and Human Services and Texas Health Presbyterian Hospital Dallas, Dallas, Texas; and Texas Department of State Health Services, Austin, Texas
| | - Allison M. Liddell
- From the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Denver, Colorado; University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio; Dallas County Department of Health and Human Services and Texas Health Presbyterian Hospital Dallas, Dallas, Texas; and Texas Department of State Health Services, Austin, Texas
| | - Pierre E. Rollin
- From the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Denver, Colorado; University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio; Dallas County Department of Health and Human Services and Texas Health Presbyterian Hospital Dallas, Dallas, Texas; and Texas Department of State Health Services, Austin, Texas
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Wacharapluesadee S, Olival KJ, Kanchanasaka B, Duengkae P, Kaewchot S, Srongmongkol P, Ieamsaard G, Maneeorn P, Sittidetboripat N, Kaewpom T, Petcharat S, Yingsakmongkon S, Rollin PE, Towner JS, Hemachudha T. Surveillance for Ebola Virus in Wildlife, Thailand. Emerg Infect Dis 2015. [DOI: 10.3201/eid2112.150869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Conger NG, Paolino KM, Osborn EC, Rusnak JM, Günther S, Pool J, Rollin PE, Allan PF, Schmidt-Chanasit J, Rieger T, Kortepeter MG. Health care response to CCHF in US soldier and nosocomial transmission to health care providers, Germany, 2009. Emerg Infect Dis 2015; 21:23-31. [PMID: 25529825 PMCID: PMC4285246 DOI: 10.3201/eid2101.141413] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Early recognition and implementation of appropriate infection control measures were effective in preventing further transmission. In 2009, a lethal case of Crimean–Congo hemorrhagic fever (CCHF), acquired by a US soldier in Afghanistan, was treated at a medical center in Germany and resulted in nosocomial transmission to 2 health care providers (HCPs). After his arrival at the medical center (day 6 of illness) by aeromedical evacuation, the patient required repetitive bronchoscopies to control severe pulmonary hemorrhage and renal and hepatic dialysis for hepatorenal failure. After showing clinical improvement, the patient died suddenly on day 11 of illness from cerebellar tonsil herniation caused by cerebral/cerebellar edema. The 2 infected HCPs were among 16 HCPs who received ribavirin postexposure prophylaxis. The infected HCPs had mild or no CCHF symptoms. Transmission may have occurred during bag-valve-mask ventilation, breaches in personal protective equipment during resuscitations, or bronchoscopies generating infectious aerosols. This case highlights the critical care and infection control challenges presented by severe CCHF cases, including the need for experience with ribavirin treatment and postexposure prophylaxis.
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McElroy AK, Erickson BR, Flietstra TD, Rollin PE, Towner JS, Nichol ST, Spiropoulou CF. Von Willebrand factor is elevated in individuals infected with Sudan virus and is associated with adverse clinical outcomes. Viral Immunol 2015; 28:71-3. [PMID: 25387000 DOI: 10.1089/vim.2014.0072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Sudan virus (SUDV) is a member of the Filoviridae family that has been associated with sporadic outbreaks of human disease in sub-Saharan Africa. The filoviruses are notable for the high frequencies with which they cause both hemorrhagic manifestations and death in infected individuals. Recently, we reported an extensive biomarker analysis of patient specimens from the Gulu SUDV outbreak. In that study, we found evidence of endothelial dysfunction and alterations of factors important to the coagulation pathways. The complex intersection between the endothelium, coagulation, and immunity is further explored in this study where we examine several additional biomarkers using the same patient specimens. We report that von Willebrand factor (vWF), a protein that promotes platelet adhesion to the injured endothelium, is elevated in SUDV-infected individuals compared to normally reported values in healthy individuals. Furthermore, vWF is associated with a fatal outcome in SUDV-infected pediatric patients. In addition, we find that vWF is elevated in individuals who have hemorrhagic manifestations of disease, suggesting excessive thrombosis in these patients.
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Affiliation(s)
- Anita K McElroy
- 1 Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention , Atlanta, Georgia
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Knust B, Schafer IJ, Wamala J, Nyakarahuka L, Okot C, Shoemaker T, Dodd K, Gibbons A, Balinandi S, Tumusiime A, Campbell S, Newman E, Lasry E, DeClerck H, Boum Y, Makumbi I, Bosa HK, Mbonye A, Aceng JR, Nichol ST, Ströher U, Rollin PE. Multidistrict Outbreak of Marburg Virus Disease-Uganda, 2012. J Infect Dis 2015. [PMID: 26209681 DOI: 10.1093/infdis/jiv351] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In October 2012, a cluster of illnesses and deaths was reported in Uganda and was confirmed to be an outbreak of Marburg virus disease (MVD). Patients meeting the case criteria were interviewed using a standard investigation form, and blood specimens were tested for evidence of acute or recent Marburg virus infection by reverse transcription-polymerase chain reaction (RT-PCR) and antibody enzyme-linked immunosorbent assay. The total count of confirmed and probable MVD cases was 26, of which 15 (58%) were fatal. Four of 15 laboratory-confirmed cases (27%) were fatal. Case patients were located in 4 different districts in Uganda, although all chains of transmission originated in Ibanda District, and the earliest case detected had an onset in July 2012. No zoonotic exposures were identified. Symptoms significantly associated with being a MVD case included hiccups, anorexia, fatigue, vomiting, sore throat, and difficulty swallowing. Contact with a case patient and attending a funeral were also significantly associated with being a case. Average RT-PCR cycle threshold values for fatal cases during the acute phase of illness were significantly lower than those for nonfatal cases. Following the institution of contact tracing, active case surveillance, care of patients with isolation precautions, community mobilization, and rapid diagnostic testing, the outbreak was successfully contained 14 days after its initial detection.
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Affiliation(s)
- Barbara Knust
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ilana J Schafer
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Trevor Shoemaker
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Entebbe
| | - Kimberly Dodd
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aridth Gibbons
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen Balinandi
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Entebbe
| | - Alex Tumusiime
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Entebbe
| | - Shelley Campbell
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Edmund Newman
- Microbiology Services- Research, Public Health England, Porton Down, United Kingdom
| | | | | | | | | | | | | | | | - Stuart T Nichol
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ute Ströher
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pierre E Rollin
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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McElroy AK, Erickson BR, Flietstra TD, Rollin PE, Nichol ST, Towner JS, Spiropoulou CF. Biomarker correlates of survival in pediatric patients with Ebola virus disease. Emerg Infect Dis 2015; 20:1683-90. [PMID: 25279581 PMCID: PMC4193175 DOI: 10.3201/eid2010.140430] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Children who had certain endothelial and immune function markers were more likely to survive infection. Outbreaks of Ebola virus disease (EVD) occur sporadically in Africa and are associated with high case-fatality rates. Historically, children have been less affected than adults. The 2000–2001 Sudan virus–associated EVD outbreak in the Gulu district of Uganda resulted in 55 pediatric and 161 adult laboratory-confirmed cases. We used a series of multiplex assays to measure the concentrations of 55 serum analytes in specimens from patients from that outbreak to identify biomarkers specific to pediatric disease. Pediatric patients who survived had higher levels of the chemokine regulated on activation, normal T-cell expressed and secreted marker and lower levels of plasminogen activator inhibitor 1, soluble intracellular adhesion molecule, and soluble vascular cell adhesion molecule than did pediatric patients who died. Adult patients had similar levels of these analytes regardless of outcome. Our findings suggest that children with EVD may benefit from different treatment regimens than those for adults.
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Martines RB, Ng DL, Greer PW, Rollin PE, Zaki SR. Tissue and cellular tropism, pathology and pathogenesis of Ebola and Marburg viruses. J Pathol 2015; 235:153-74. [PMID: 25297522 DOI: 10.1002/path.4456] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 09/30/2014] [Accepted: 10/01/2014] [Indexed: 12/19/2022]
Abstract
Ebola viruses and Marburg viruses include some of the most virulent and fatal pathogens known to humans. These viruses cause severe haemorrhagic fevers, with case fatality rates in the range 25-90%. The diagnosis of filovirus using formalin-fixed tissues from fatal cases poses a significant challenge. The most characteristic histopathological findings are seen in the liver; however, the findings overlap with many other viral and non-viral haemorrhagic diseases. The need to distinguish filovirus infections from other haemorrhagic fevers, particularly in areas with multiple endemic viral haemorrhagic agents, is of paramount importance. In this review we discuss the current state of knowledge of filovirus infections and their pathogenesis, including histopathological findings, epidemiology, modes of transmission and filovirus entry and spread within host organisms. The pathogenesis of filovirus infections is complex and involves activation of the mononuclear phagocytic system, with release of pro-inflammatory cytokines, chemokines and growth factors, endothelial dysfunction, alterations of the innate and adaptive immune systems, direct organ and endothelial damage from unrestricted viral replication late in infection, and coagulopathy. Although our understanding of the pathogenesis of filovirus infections has rapidly increased in the past few years, many questions remain unanswered.
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Affiliation(s)
- Roosecelis Brasil Martines
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Núñez JJ, Fritz CL, Knust B, Buttke D, Enge B, Novak MG, Kramer V, Osadebe L, Messenger S, Albariño CG, Ströher U, Niemela M, Amman BR, Wong D, Manning CR, Nichol ST, Rollin PE, Xia D, Watt JP, Vugia DJ. Hantavirus infections among overnight visitors to Yosemite National Park, California, USA, 2012. Emerg Infect Dis 2015; 20:386-93. [PMID: 24565589 PMCID: PMC3944872 DOI: 10.3201/eid2003.131581] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
TOC summary: A rare hantavirus outbreak reaffirms the need for control of deer mice and public awareness of the risks posed by contact with them. In summer 2012, an outbreak of hantavirus infections occurred among overnight visitors to Yosemite National Park in California, USA. An investigation encompassing clinical, epidemiologic, laboratory, and environmental factors identified 10 cases among residents of 3 states. Eight case-patients experienced hantavirus pulmonary syndrome, of whom 5 required intensive care with ventilatory support and 3 died. Staying overnight in a signature tent cabin (9 case-patients) was significantly associated with becoming infected with hantavirus (p<0.001). Rodent nests and tunnels were observed in the foam insulation of the cabin walls. Rodent trapping in the implicated area resulted in high trap success rate (51%), and antibodies reactive to Sin Nombre virus were detected in 10 (14%) of 73 captured deer mice. All signature tent cabins were closed and subsequently dismantled. Continuous public awareness and rodent control and exclusion are key measures in minimizing the risk for hantavirus infection in areas inhabited by deer mice.
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Knust B, Ströher U, Edison L, Albariño CG, Lovejoy J, Armeanu E, House J, Cory D, Horton C, Fowler KL, Austin J, Poe J, Humbaugh KE, Guerrero L, Campbell S, Gibbons A, Reed Z, Cannon D, Manning C, Petersen B, Metcalf D, Marsh B, Nichol ST, Rollin PE. Lymphocytic choriomeningitis virus in employees and mice at multipremises feeder-rodent operation, United States, 2012. Emerg Infect Dis 2014; 20:240-7. [PMID: 24447605 PMCID: PMC3901486 DOI: 10.3201/eid2002.130860] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Outbreaks can be prevented with strict biosecurity and microbiological monitoring. We investigated the extent of lymphocytic choriomeningitis virus (LCMV) infection in employees and rodents at 3 commercial breeding facilities. Of 97 employees tested, 31 (32%) had IgM and/or IgG to LCMV, and aseptic meningitis was diagnosed in 4 employees. Of 1,820 rodents tested in 1 facility, 382 (21%) mice (Mus musculus) had detectable IgG, and 13 (0.7%) were positive by reverse transcription PCR; LCMV was isolated from 8. Rats (Rattus norvegicus) were not found to be infected. S-segment RNA sequence was similar to strains previously isolated in North America. Contact by wild mice with colony mice was the likely source for LCMV, and shipments of infected mice among facilities spread the infection. The breeding colonies were depopulated to prevent further human infections. Future outbreaks can be prevented with monitoring and management, and employees should be made aware of LCMV risks and prevention.
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Edison L, Knust B, Petersen B, Gabel J, Manning C, Drenzek C, Ströher U, Rollin PE, Thoroughman D, Nichol ST. Trace-forward investigation of mice in response to lymphocytic choriomeningitis virus outbreak. Emerg Infect Dis 2014; 20:291-5. [PMID: 24447898 PMCID: PMC3901476 DOI: 10.3201/eid2010.130861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
During follow-up of a 2012 US outbreak of lymphocytic choriomeningitis virus (LCMV), we conducted a trace-forward investigation. LCMV-infected feeder mice originating from a US rodent breeding facility had been distributed to >500 locations in 21 states. All mice from the facility were euthanized, and no additional persons tested positive for LCMV infection.
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Albariño CG, Foltzer M, Towner JS, Rowe LA, Campbell S, Jaramillo CM, Bird BH, Reeder DM, Vodzak ME, Rota P, Metcalfe MG, Spiropoulou CF, Knust B, Vincent JP, Frace MA, Nichol ST, Rollin PE, Ströher U. Novel paramyxovirus associated with severe acute febrile disease, South Sudan and Uganda, 2012. Emerg Infect Dis 2014; 20:211-6. [PMID: 24447466 PMCID: PMC3901491 DOI: 10.3201/eid2002.131620] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 2012, a female wildlife biologist experienced fever, malaise, headache, generalized myalgia and arthralgia, neck stiffness, and a sore throat shortly after returning to the United States from a 6-week field expedition to South Sudan and Uganda. She was hospitalized, after which a maculopapular rash developed and became confluent. When the patient was discharged from the hospital on day 14, arthralgia and myalgia had improved, oropharynx ulcerations had healed, the rash had resolved without desquamation, and blood counts and hepatic enzyme levels were returning to reference levels. After several known suspect pathogens were ruled out as the cause of her illness, deep sequencing and metagenomics analysis revealed a novel paramyxovirus related to rubula-like viruses isolated from fruit bats.
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Abstract
In the past 20 years of surveillance for hantavirus in humans in the United States, 624 cases of hantavirus pulmonary syndrome (HPS) have been reported, 96% of which occurred in states west of the Mississippi River. Most hantavirus infections are caused by Sin Nombre virus, but cases of HPS caused by Bayou, Black Creek Canal, Monongahela, and New York viruses have been reported, and cases of domestically acquired hemorrhagic fever and renal syndrome caused by Seoul virus have also occurred. Rarely, hantavirus infections result in mild illness that does not progress to HPS. Continued testing and surveillance of clinical cases in humans will improve our understanding of the etiologic agents involved and the spectrum of diseases.
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Schafer IJ, Miller R, Ströher U, Knust B, Nichol ST, Rollin PE. Notes from the field: a cluster of lymphocytic choriomeningitis virus infections transmitted through organ transplantation-Iowa, 2013. Am J Transplant 2014; 14:1459. [PMID: 24854024 DOI: 10.1111/ajt.12802] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Schafer IJ, Miller R, Ströher U, Knust B, Nichol ST, Rollin PE. Notes from the field: a cluster of lymphocytic choriomeningitis virus infections transmitted through organ transplantation - Iowa, 2013. MMWR Morb Mortal Wkly Rep 2014; 63:249. [PMID: 24647402 PMCID: PMC4584636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
On April 26, 2013, the United Network for Organ Sharing reported to CDC a cluster of ill organ transplant recipients in Iowa with a common organ donor. Infection with lymphocytic choriomeningitis virus (LCMV) was suspected. LCMV is a rodent-borne virus that most commonly causes nonfatal, influenza-like illness and occasional aseptic meningitis, but when transmitted through organ transplantation or in utero can cause severe, life-threatening disease.
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Affiliation(s)
- Ilana J. Schafer
- EIS officer, CDC,Corresponding author: Ilana J. Schafer, , 404-639-1115
| | | | - Ute Ströher
- Viral Special Pathogens Branch, National Center for Emerging and Zoonotic Infections, CDC
| | - Barbara Knust
- Viral Special Pathogens Branch, National Center for Emerging and Zoonotic Infections, CDC
| | - Stuart T. Nichol
- Viral Special Pathogens Branch, National Center for Emerging and Zoonotic Infections, CDC
| | - Pierre E. Rollin
- Viral Special Pathogens Branch, National Center for Emerging and Zoonotic Infections, CDC
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McElroy AK, Erickson BR, Flietstra TD, Rollin PE, Nichol ST, Towner JS, Spiropoulou CF. Ebola hemorrhagic Fever: novel biomarker correlates of clinical outcome. J Infect Dis 2014; 210:558-66. [PMID: 24526742 DOI: 10.1093/infdis/jiu088] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Ebola hemorrhagic fever (EHF) outbreaks occur sporadically in Africa and result in high rates of death. The 2000-2001 outbreak of Sudan virus-associated EHF in the Gulu district of Uganda led to 425 cases, of which 216 were laboratory confirmed, making it the largest EHF outbreak on record. Serum specimens from this outbreak had been preserved in liquid nitrogen from the time of collection and were available for analysis. METHODS Available samples were tested using a series of multiplex assays to measure the concentrations of 55 biomarkers. The data were analyzed to identify statistically significant associations between the tested biomarkers and hemorrhagic manifestations, viremia, and/or death. RESULTS Death, hemorrhage, and viremia were independently associated with elevated levels of several chemokines and cytokines. Death and hemorrhage were associated with elevated thrombomodulin and ferritin levels. Hemorrhage was also associated with elevated levels of soluble intracellular adhesion molecule. Viremia was independently associated with elevated levels of tissue factor and tissue plasminogen activator. Finally, samples from nonfatal cases had higher levels of sCD40L. CONCLUSIONS These novel associations provide a better understanding of EHF pathophysiology and a starting point for researching new potential targets for therapeutic interventions.
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Affiliation(s)
- Anita K McElroy
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention Division of Pediatric Infectious Disease, Emory University School of Medicine, Atlanta, Georgia
| | - Bobbie R Erickson
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention
| | | | - Pierre E Rollin
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention
| | - Stuart T Nichol
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention
| | - Jonathan S Towner
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention
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Rollin PE, Memish ZA. Alkhurma Hemorrhagic Fever. Emerg Infect Dis 2014. [DOI: 10.1016/b978-0-12-416975-3.00005-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Olive MM, Razafindralambo N, Barivelo TA, Rafisandratantsoa JT, Soarimalala V, Goodman SM, Rollin PE, Heraud JM, Reynes JM. Absence of Rift Valley fever virus in wild small mammals, Madagascar. Emerg Infect Dis 2013; 19:1025-7. [PMID: 23735220 PMCID: PMC3713820 DOI: 10.3201/eid1906.121074] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Goldsmith CS, Ksiazek TG, Rollin PE, Comer JA, Nicholson WL, Peret TCT, Erdman DD, Bellini WJ, Harcourt BH, Rota PA, Bhatnagar J, Bowen MD, Erickson BR, McMullan LK, Nichol ST, Shieh WJ, Paddock CD, Zaki SR. Cell culture and electron microscopy for identifying viruses in diseases of unknown cause. Emerg Infect Dis 2013; 19:886-91. [PMID: 23731788 PMCID: PMC3713842 DOI: 10.3201/eid1906.130173] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During outbreaks of infectious diseases or in cases of severely ill patients, it is imperative to identify the causative agent. This report describes several events in which virus isolation and identification by electron microscopy were critical to initial recognition of the etiologic agent, which was further analyzed by additional laboratory diagnostic assays. Examples include severe acute respiratory syndrome coronavirus, and Nipah, lymphocytic choriomeningitis, West Nile, Cache Valley, and Heartland viruses. These cases illustrate the importance of the techniques of cell culture and electron microscopy in pathogen identification and recognition of emerging diseases.
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Affiliation(s)
- Cynthia S Goldsmith
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop G32, Atlanta, GA 30329, USA.
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Knust B, Holman RC, Redd J, Mehal JM, Grube SM, MacNeil A, Cheek J, Rollin PE. Lymphocytic choriomeningitis virus infections among American Indians. Emerg Infect Dis 2013; 19:328-9. [PMID: 23460992 PMCID: PMC3559050 DOI: 10.3201/eid1902.120888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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