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Loayza Mafayle R, Morales-Betoulle ME, Romero C, Cossaboom CM, Whitmer S, Alvarez Aguilera CE, Avila Ardaya C, Cruz Zambrana M, Dávalos Anajia A, Mendoza Loayza N, Montaño AM, Morales Alvis FL, Revollo Guzmán J, Sasías Martínez S, Alarcón De La Vega G, Medina Ramírez A, Molina Gutiérrez JT, Cornejo Pinto AJ, Salas Bacci R, Brignone J, Garcia J, Añez A, Mendez-Rico J, Luz K, Segales A, Torrez Cruz KM, Valdivia-Cayoja A, Amman BR, Choi MJ, Erickson BR, Goldsmith C, Graziano JC, Joyce A, Klena JD, Leach A, Malenfant JH, Nichol ST, Patel K, Sealy T, Shoemaker T, Spiropoulou CF, Todres A, Towner JS, Montgomery JM. Chapare Hemorrhagic Fever and Virus Detection in Rodents in Bolivia in 2019. N Engl J Med 2022; 386:2283-2294. [PMID: 35704480 DOI: 10.1056/nejmoa2110339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In June 2019, the Bolivian Ministry of Health reported a cluster of cases of hemorrhagic fever that started in the municipality of Caranavi and expanded to La Paz. The cause of these cases was unknown. METHODS We obtained samples for next-generation sequencing and virus isolation. Human and rodent specimens were tested by means of virus-specific real-time quantitative reverse-transcriptase-polymerase-chain-reaction assays, next-generation sequencing, and virus isolation. RESULTS Nine cases of hemorrhagic fever were identified; four of the patients with this illness died. The etiologic agent was identified as Mammarenavirus Chapare mammarenavirus, or Chapare virus (CHAPV), which causes Chapare hemorrhagic fever (CHHF). Probable nosocomial transmission among health care workers was identified. Some patients with CHHF had neurologic manifestations, and those who survived had a prolonged recovery period. CHAPV RNA was detected in a variety of human body fluids (including blood; urine; nasopharyngeal, oropharyngeal, and bronchoalveolar-lavage fluid; conjunctiva; and semen) and in specimens obtained from captured small-eared pygmy rice rats (Oligoryzomys microtis). In survivors of CHHF, viral RNA was detected up to 170 days after symptom onset; CHAPV was isolated from a semen sample obtained 86 days after symptom onset. CONCLUSIONS M. Chapare mammarenavirus was identified as the etiologic agent of CHHF. Both spillover from a zoonotic reservoir and possible person-to-person transmission were identified. This virus was detected in a rodent species, O. microtis. (Funded by the Bolivian Ministry of Health and others.).
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MESH Headings
- Animals
- Arenaviruses, New World/genetics
- Arenaviruses, New World/isolation & purification
- Bolivia/epidemiology
- Cross Infection/transmission
- Cross Infection/virology
- Disease Transmission, Infectious
- Hemorrhagic Fever, American/complications
- Hemorrhagic Fever, American/genetics
- Hemorrhagic Fever, American/transmission
- Hemorrhagic Fever, American/virology
- Hemorrhagic Fevers, Viral/genetics
- Hemorrhagic Fevers, Viral/transmission
- Hemorrhagic Fevers, Viral/virology
- High-Throughput Nucleotide Sequencing
- Humans
- Polymerase Chain Reaction
- RNA, Viral/genetics
- RNA, Viral/isolation & purification
- Rats/virology
- Rodentia/virology
- Viral Zoonoses/transmission
- Viral Zoonoses/virology
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Affiliation(s)
- Roxana Loayza Mafayle
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Maria E Morales-Betoulle
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Carla Romero
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Caitlin M Cossaboom
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Shannon Whitmer
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Carlos E Alvarez Aguilera
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Cinthia Avila Ardaya
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Mirian Cruz Zambrana
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Andrés Dávalos Anajia
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Nelly Mendoza Loayza
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Ana-Maria Montaño
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Fernando L Morales Alvis
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Jimmy Revollo Guzmán
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Sebastián Sasías Martínez
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Gricel Alarcón De La Vega
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Armando Medina Ramírez
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Jhemis T Molina Gutiérrez
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Alex J Cornejo Pinto
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Renata Salas Bacci
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Julia Brignone
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Jorge Garcia
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Arletta Añez
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Jairo Mendez-Rico
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Kleber Luz
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Ariel Segales
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Karen M Torrez Cruz
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Adolfo Valdivia-Cayoja
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Brian R Amman
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Mary J Choi
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Bobbie-Rae Erickson
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Cynthia Goldsmith
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - James C Graziano
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Allison Joyce
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - John D Klena
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Austin Leach
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Jason H Malenfant
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Stuart T Nichol
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Ketan Patel
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Tara Sealy
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Trevor Shoemaker
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Christina F Spiropoulou
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Alison Todres
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Jonathan S Towner
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
| | - Joel M Montgomery
- From Centro Nacional de Enfermedades Tropicales, Santa Cruz de la Sierra (R.L.M., C.E.A.A., C.A.A., M.C.Z., A.D.A., N.M.L., A.-M.M., F.L.M.A., J.R.G., S.S.M.), and Unidad de Epidemiología (C.R., G.A.D.L.V., A.M.R., J.T.M.G.), Unidad de Gestión de Riesgos en Salud Ambiental, Emergencias y Desastres (A.J.C.P.), and Instituto Nacional de Laboratorios de Salud "Dr. Néstor Morales Villazón" (R.S.B.), Ministerio de Salud, the Pan American Health Organization (A.A.), Hospital Obrero No. 1, Caja Nacional de Salud (A.S.), Hospital Militar Central, Hospital Municipal Boliviano Holandés (K.M.T.C.), and Hospital de Clínicas (A.V.-C.), La Paz - all in Bolivia; the Centers for Disease Control and Prevention, Atlanta (M.E.M.-B., C.M.C., S.W., B.R.A., M.J.C., B.-R.E., C.G., J.C.G., A.J., J.D.K., A.L., J.H.M., S.T.N., K.P., T. Sealy, T. Shoemaker, C.F.S., A.T., J.S.T., J.M.M.); Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui," Pergamino, Argentina (J.B., J.G.); the Pan American Health Organization, Washington, D.C. (J.M.-R.); and Universidade Federal do Rio Grande do Norte, Natal, Brazil (K.L.)
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Dudas G, Carvalho LM, Bedford T, Tatem AJ, Baele G, Faria NR, Park DJ, Ladner JT, Arias A, Asogun D, Bielejec F, Caddy SL, Cotten M, D’Ambrozio J, Dellicour S, Di Caro A, Diclaro J, Duraffour S, Elmore MJ, Fakoli LS, Faye O, Gilbert ML, Gevao SM, Gire S, Gladden-Young A, Gnirke A, Goba A, Grant DS, Haagmans BL, Hiscox JA, Jah U, Kargbo B, Kugelman JR, Liu D, Lu J, Malboeuf CM, Mate S, Matthews DA, Matranga CB, Meredith LW, Qu J, Quick J, Pas SD, Phan MVT, Pollakis G, Reusken CB, Sanchez-Lockhart M, Schaffner SF, Schieffelin JS, Sealfon RS, Simon-Loriere E, Smits SL, Stoecker K, Thorne L, Tobin EA, Vandi MA, Watson SJ, West K, Whitmer S, Wiley MR, Winnicki SM, Wohl S, Wölfel R, Yozwiak NL, Andersen KG, Blyden SO, Bolay F, Carroll M, Dahn B, Diallo B, Formenty P, Fraser C, Gao GF, Garry RF, Goodfellow I, Günther S, Happi CT, Holmes EC, Kargbo B, Keïta S, Kellam P, Koopmans MPG, Kuhn JH, Loman NJ, Magassouba N, Naidoo D, Nichol ST, Nyenswah T, Palacios G, Pybus OG, Sabeti PC, Sall A, Ströher U, Wurie I, Suchard MA, Lemey P, Rambaut A. Virus genomes reveal factors that spread and sustained the Ebola epidemic. Nature 2017; 544:309-315. [PMID: 28405027 PMCID: PMC5712493 DOI: 10.1038/nature22040] [Citation(s) in RCA: 242] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/02/2017] [Indexed: 01/03/2023]
Abstract
The 2013-2016 West African epidemic caused by the Ebola virus was of unprecedented magnitude, duration and impact. Here we reconstruct the dispersal, proliferation and decline of Ebola virus throughout the region by analysing 1,610 Ebola virus genomes, which represent over 5% of the known cases. We test the association of geography, climate and demography with viral movement among administrative regions, inferring a classic 'gravity' model, with intense dispersal between larger and closer populations. Despite attenuation of international dispersal after border closures, cross-border transmission had already sown the seeds for an international epidemic, rendering these measures ineffective at curbing the epidemic. We address why the epidemic did not spread into neighbouring countries, showing that these countries were susceptible to substantial outbreaks but at lower risk of introductions. Finally, we reveal that this large epidemic was a heterogeneous and spatially dissociated collection of transmission clusters of varying size, duration and connectivity. These insights will help to inform interventions in future epidemics.
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Affiliation(s)
- Gytis Dudas
- Institute of Evolutionary Biology, University of Edinburgh, King’s Buildings, Edinburgh, EH9 3FL, UK
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Luiz Max Carvalho
- Institute of Evolutionary Biology, University of Edinburgh, King’s Buildings, Edinburgh, EH9 3FL, UK
| | - Trevor Bedford
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Andrew J. Tatem
- WorldPop, Department of Geography and Environment, University of Southampton, Highfield, Southampton SO17 1BJ, UK
- Flowminder Foundation, Stockholm, Sweden
| | - Guy Baele
- Department of Microbiology and Immunology, Rega Institute, KU Leuven – University of Leuven, Leuven, Belgium
| | - Nuno R. Faria
- Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, UK
| | - Daniel J. Park
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Jason T. Ladner
- Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
| | - Armando Arias
- Department of Pathology, University of Cambridge, Addenbrooke’s Hospital, Cambridge, CB2 2QQ, UK
- National Veterinary Institute, Technical University of Denmark, Bülowsvej 27, 1870, Frederiksberg C, Denmark
| | - Danny Asogun
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
- The European Mobile Laboratory Consortium, 20359 Hamburg, Germany
| | - Filip Bielejec
- Department of Microbiology and Immunology, Rega Institute, KU Leuven – University of Leuven, Leuven, Belgium
| | - Sarah L. Caddy
- Department of Pathology, University of Cambridge, Addenbrooke’s Hospital, Cambridge, CB2 2QQ, UK
| | - Matthew Cotten
- Virus Genomics, Wellcome Trust Sanger Institute, Hinxton, UK
- Department of Viroscience, Erasmus University Medical Centre, P.O. Box 2040, 300 CA Rotterdam, the Netherlands
| | - Jonathan D’Ambrozio
- Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
| | - Simon Dellicour
- Department of Microbiology and Immunology, Rega Institute, KU Leuven – University of Leuven, Leuven, Belgium
| | - Antonino Di Caro
- The European Mobile Laboratory Consortium, 20359 Hamburg, Germany
- National Institute for Infectious Diseases ”L. Spallanzani” – IRCCS, Via Portuense 292, 00149 Rome, Italy
| | - JosephW. Diclaro
- Naval Medical Research Unit 3, 3A Imtidad Ramses Street, Cairo, 11517, Egypt
| | - Sophie Duraffour
- The European Mobile Laboratory Consortium, 20359 Hamburg, Germany
- Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany
| | - Michael J. Elmore
- National Infections Service, Public Health England, Porton Down, Salisbury, Wilts SP4 0JG, UK
| | | | - Ousmane Faye
- Institut Pasteur de Dakar, Arbovirus and Viral Hemorrhagic Fever Unit, 36 Avenue Pasteur, BP 220, Dakar, Sénégal
| | - Merle L. Gilbert
- Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
| | | | - Stephen Gire
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | | | - Andreas Gnirke
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Augustine Goba
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, 1 Combema Road, Kenema, Sierra Leone
- Ministry of Health and Sanitation, 4th Floor Youyi Building, Freetown, Sierra Leone
| | - Donald S. Grant
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, 1 Combema Road, Kenema, Sierra Leone
- Ministry of Health and Sanitation, 4th Floor Youyi Building, Freetown, Sierra Leone
| | - Bart L. Haagmans
- Department of Viroscience, Erasmus University Medical Centre, P.O. Box 2040, 300 CA Rotterdam, the Netherlands
| | - Julian A. Hiscox
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 2BE, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, UK
| | - Umaru Jah
- University of Makeni, Makeni, Sierra Leone
| | - Brima Kargbo
- Ministry of Health and Sanitation, 4th Floor Youyi Building, Freetown, Sierra Leone
| | - Jeffrey R. Kugelman
- Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
| | - Di Liu
- Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
| | - Jia Lu
- Department of Pathology, University of Cambridge, Addenbrooke’s Hospital, Cambridge, CB2 2QQ, UK
| | | | - Suzanne Mate
- Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
| | | | | | - Luke W. Meredith
- Department of Pathology, University of Cambridge, Addenbrooke’s Hospital, Cambridge, CB2 2QQ, UK
- University of Makeni, Makeni, Sierra Leone
| | - James Qu
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Joshua Quick
- Institute of Microbiology and Infection, University of Birmingham, Birmingham B15 2TT, UK
| | - Suzan D. Pas
- Department of Viroscience, Erasmus University Medical Centre, P.O. Box 2040, 300 CA Rotterdam, the Netherlands
| | - My VT Phan
- Virus Genomics, Wellcome Trust Sanger Institute, Hinxton, UK
- Department of Viroscience, Erasmus University Medical Centre, P.O. Box 2040, 300 CA Rotterdam, the Netherlands
| | - Georgios Pollakis
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 2BE, UK
| | - Chantal B. Reusken
- Department of Viroscience, Erasmus University Medical Centre, P.O. Box 2040, 300 CA Rotterdam, the Netherlands
| | - Mariano Sanchez-Lockhart
- Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | - John S. Schieffelin
- Department of Pediatrics, Section of Infectious Diseases, New Orleans, LA 70112, USA
| | - Rachel S. Sealfon
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
- Center for Computational Biology, Flatiron Institute, New York, NY 10010, USA
- Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ 08544, USA
| | - Etienne Simon-Loriere
- Institut Pasteur, Functional Genetics of Infectious Diseases Unit, 28 rue du Docteur Roux, 75724 Paris Cedex 15, France
- Génétique Fonctionelle des Maladies Infectieuses, CNRS URA3012, Paris 75015, France
| | - Saskia L. Smits
- Department of Viroscience, Erasmus University Medical Centre, P.O. Box 2040, 300 CA Rotterdam, the Netherlands
| | - Kilian Stoecker
- The European Mobile Laboratory Consortium, 20359 Hamburg, Germany
- Bundeswehr Institute of Microbiology, Neuherbergstrasse 11, 80937 Munich, Germany
| | - Lucy Thorne
- Department of Pathology, University of Cambridge, Addenbrooke’s Hospital, Cambridge, CB2 2QQ, UK
| | - Ekaete Alice Tobin
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
- The European Mobile Laboratory Consortium, 20359 Hamburg, Germany
| | - Mohamed A. Vandi
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, 1 Combema Road, Kenema, Sierra Leone
- Ministry of Health and Sanitation, 4th Floor Youyi Building, Freetown, Sierra Leone
| | - Simon J. Watson
- Virus Genomics, Wellcome Trust Sanger Institute, Hinxton, UK
| | - Kendra West
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Shannon Whitmer
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, Georgia, USA
| | - Michael R. Wiley
- Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Sarah M. Winnicki
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Shirlee Wohl
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Roman Wölfel
- The European Mobile Laboratory Consortium, 20359 Hamburg, Germany
- Bundeswehr Institute of Microbiology, Neuherbergstrasse 11, 80937 Munich, Germany
| | - Nathan L. Yozwiak
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Kristian G. Andersen
- The Scripps Research Institute, Department of Immunology and Microbial Science, La Jolla, CA 92037, USA
- Scripps Translational Science Institute, La Jolla, CA 92037, USA
| | - Sylvia O. Blyden
- Ministry of Social Welfare, Gender and Children’s Affairs, New Englandville, Freetown, Sierra Leone
| | - Fatorma Bolay
- Liberian Institute for Biomedical Research, Charlesville, Liberia
| | - MilesW. Carroll
- The European Mobile Laboratory Consortium, 20359 Hamburg, Germany
- National Infections Service, Public Health England, Porton Down, Salisbury, Wilts SP4 0JG, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, UK
- University of Southampton, South General Hospital, Southampton SO16 6YD, UK
| | | | | | | | - Christophe Fraser
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - George F. Gao
- Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
- Chinese Center for Disease Control and Prevention (China CDC), Beijing 102206, China
| | - Robert F. Garry
- Department of Microbiology and Immunology, New Orleans, LA 70112, USA
| | - Ian Goodfellow
- Department of Pathology, University of Cambridge, Addenbrooke’s Hospital, Cambridge, CB2 2QQ, UK
- University of Makeni, Makeni, Sierra Leone
| | - Stephan Günther
- The European Mobile Laboratory Consortium, 20359 Hamburg, Germany
- Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany
| | - Christian T. Happi
- Department of Biological Sciences, Redeemer’s University, Ede, Osun State, Nigeria
- African Center of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun State, Nigeria
| | - Edward C. Holmes
- Marie Bashir Institute for Infectious Diseases and Biosecurity, Charles Perkins Centre, School of Life and Environmental Sciences and Sydney Medical School, the University of Sydney, Sydney, NSW 2006, Australia
| | - Brima Kargbo
- Ministry of Health and Sanitation, 4th Floor Youyi Building, Freetown, Sierra Leone
| | | | - Paul Kellam
- Virus Genomics, Wellcome Trust Sanger Institute, Hinxton, UK
- Division of Infectious Diseases, Imperial College Faculty of Medicine, London W2 1PG, UK
| | - Marion P. G. Koopmans
- Department of Viroscience, Erasmus University Medical Centre, P.O. Box 2040, 300 CA Rotterdam, the Netherlands
| | - Jens H. Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, B-8200 Research Plaza, Fort Detrick, Frederick, MD 21702, USA
| | - Nicholas J. Loman
- Institute of Microbiology and Infection, University of Birmingham, Birmingham B15 2TT, UK
| | - N’Faly Magassouba
- Université Gamal Abdel Nasser de Conakry, Laboratoire des Fièvres Hémorragiques en Guinée, Conakry, Guinea
| | | | - Stuart T. Nichol
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, Georgia, USA
| | | | - Gustavo Palacios
- Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
| | - Oliver G. Pybus
- Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, UK
| | - Pardis C. Sabeti
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Amadou Sall
- Institut Pasteur de Dakar, Arbovirus and Viral Hemorrhagic Fever Unit, 36 Avenue Pasteur, BP 220, Dakar, Sénégal
| | - Ute Ströher
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, Georgia, USA
| | - Isatta Wurie
- University of Sierra Leone, Freetown, Sierra Leone
| | - Marc A. Suchard
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Department of Biomathematics David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Philippe Lemey
- Department of Microbiology and Immunology, Rega Institute, KU Leuven – University of Leuven, Leuven, Belgium
| | - Andrew Rambaut
- Institute of Evolutionary Biology, University of Edinburgh, King’s Buildings, Edinburgh, EH9 3FL, UK
- Centre for Immunology, Infection and Evolution, University of Edinburgh, King’s Buildings, Edinburgh, EH9 3FL, UK
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
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