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Hoornstra D, Azagi T, van Eck JA, Wagemakers A, Koetsveld J, Spijker R, Platonov AE, Sprong H, Hovius JW. Prevalence and clinical manifestation of Borrelia miyamotoi in Ixodes ticks and humans in the northern hemisphere: a systematic review and meta-analysis. Lancet Microbe 2022; 3:e772-e786. [PMID: 36113496 DOI: 10.1016/s2666-5247(22)00157-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/30/2022] [Accepted: 05/31/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Various studies have evaluated the infection of Ixodes ticks and humans with the relapsing fever spirochaete Borrelia miyamotoi. However, to our knowledge, the prevalence of infection and disease has not been assessed systematically. We aimed to examine the prevalence of B miyamotoi in Ixodes ticks and humans, and the disease it can cause, in the northern hemisphere. METHODS For this systematic review and meta-analysis, we searched PubMed and Web of Science up to March 1, 2021. Studies assessing Ixodes tick infection published since Jan 1, 2011 were eligible, whereas no time limitation was placed on reports of human infection and disease. We extracted B miyamotoi test positivity ratios and used a random-effects model to calculate estimated proportions of infected ticks, infected humans, and human disease with 95% CI. This study was registered with PROSPERO, CRD42021268996. FINDINGS We identified 730 studies through database searches and 316 additional studies that referenced two seminal articles on B miyamotoi. Of these 1046 studies, 157 were included in the review, reporting on 165 637 questing ticks, 45 608 unique individuals, and 504 well described cases of B miyamotoi disease in humans. In ticks, the highest prevalence of B miyamotoi was observed in Ixodes persulcatus (2·8%, 95% CI 2·4-3·1) and the lowest in Ixodes pacificus (0·7%, 0·6-0·8). The overall seroprevalence in humans was 4·4% (2·8-6·3), with significantly (p<0·0001) higher seroprevalences in the high-risk group (4·6%, 2·6-7·1), participants with confirmed or suspected Lyme borreliosis (4·8%, 1·8-8·8), and individuals suspected of having a different tick-borne disease (11·9%, 5·6-19·9) than in healthy controls (1·3%, 0·4-2·8). Participants suspected of having a different tick-borne disease tested positive for B miyamotoi by PCR significantly more often than did the high-risk group (p=0·025), with individuals in Asia more likely to test positive than those in the USA (odds ratio 14·63 [95% CI 2·80-76·41]). INTERPRETATION B miyamotoi disease should be considered an emerging infectious disease, especially in North America and Asia. Prospective studies and increased awareness are required to obtain further insights into the burden of disease. FUNDING ZonMW and the European Regional Development Fund (Interreg).
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Affiliation(s)
- Dieuwertje Hoornstra
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Tal Azagi
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Jacqueline A van Eck
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Alex Wagemakers
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Joris Koetsveld
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - René Spijker
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | - Hein Sprong
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Joppe W Hovius
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands.
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Azagi T, Harms M, Swart A, Fonville M, Hoornstra D, Mughini-Gras L, Hovius JW, Sprong H, van den Wijngaard C. Self-reported symptoms and health complaints associated with exposure to Ixodes ricinus-borne pathogens. Parasit Vectors 2022; 15:93. [PMID: 35303944 PMCID: PMC8931963 DOI: 10.1186/s13071-022-05228-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 11/03/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impact of infections with tick-borne pathogens (TBPs) other than Borrelia burgdorferi (s.l.) and tick-borne encephalitis virus (TBEV) on public health in Europe remains unclear. Our goal is to evaluate whether the presence of these TBPs in ticks can be associated with self-reported health complaints. METHODS We enrolled individuals who were bitten by I. ricinus between 2012 and 2015 and collected their relevant demographic and clinical information using a self-administered online questionnaire. A total of 4163 I. ricinus ticks sent by the participants were subject to molecular analyses for detection of specific TBPs. Associations between the presence of TBPs in ticks and self-reported complaints and symptoms were evaluated by means of a stepwise approach using a generalized linear model (GLM). RESULTS Of 17 self-reported complaints and symptoms significant in the univariate analyses, 3 had a highly significant association (P < 0.01) with at least one TBP in the multivariate analysis. Self-reported Lyme borreliosis was significantly associated (P < 0.001) with B. burgdorferi (s.l.) infection. Facial paralysis was associated (P < 0.01) with infection with B. miyamotoi, N. mikurensis and R. helvetica. Finally, a significant association (P < 0.001) was found between nocturnal sweating and A. phagocytophilum. CONCLUSIONS We found associations between the presence of TBPs in ticks feeding on humans and self-reported symptoms. Due to the subjective nature of such reports and the fact that infection was determined in the ticks and not in the patient samples, further prospective studies utilizing diagnostic modalities should be performed before any clinical outcome can be causally linked to infection with TBPs.
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Affiliation(s)
- Tal Azagi
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands.
| | - Margriet Harms
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Arno Swart
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Manoj Fonville
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Dieuwertje Hoornstra
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers Location, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Lapo Mughini-Gras
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Joppe W Hovius
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers Location, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hein Sprong
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Cees van den Wijngaard
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
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Hoornstra D, Harms MG, Gauw SA, Wagemakers A, Azagi T, Kremer K, Sprong H, van den Wijngaard CC, Hovius JW. Ticking on Pandora's box: a prospective case-control study into 'other' tick-borne diseases. BMC Infect Dis 2021; 21:501. [PMID: 34051756 PMCID: PMC8164744 DOI: 10.1186/s12879-021-06190-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 03/30/2021] [Accepted: 05/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tick-borne pathogens other than Borrelia burgdorferi sensu lato - the causative agent of Lyme borreliosis - are common in Ixodes ricinus ticks. How often these pathogens cause human disease is unknown. In addition, diagnostic tools to identify such diseases are lacking or reserved to research laboratories. To elucidate their prevalence and disease burden, the study 'Ticking on Pandora's Box' has been initiated, a collaborative effort between Amsterdam University Medical Center and the National Institute for Public Health and the Environment. METHODS The study investigates how often the tick-borne pathogens Anaplasma phagocytophilum, Babesia species, Borrelia miyamotoi, Neoehrlichia mikurensis, spotted fever group Rickettsia species and/or tick-borne encephalitis virus cause an acute febrile illness after tick-bite. We aim to determine the impact and severity of these tick-borne diseases in the Netherlands by measuring their prevalence and describing their clinical picture and course of disease. The study is designed as a prospective case-control study. We aim to include 150 cases - individuals clinically suspected of a tick-borne disease - and 3 matched healthy control groups of 200 persons each. The controls consist respectively of a group of individuals with either a tick-bite without complaints, the general population and of healthy blood donors. During a one-year follow-up we will acquire blood, urine and skin biopsy samples and ticks at baseline, 4 and 12 weeks. Additionally, participants answer modified versions of validated questionnaires to assess self-reported symptoms, among which the SF-36, on a 3 monthly basis. DISCUSSION This article describes the background and design of the study protocol of 'Ticking on Pandora's Box'. With our study we hope to provide insight into the prevalence, clinical presentation and disease burden of the tick-borne diseases anaplasmosis, babesiosis, B. miyamotoi disease, neoehrlichiosis, rickettsiosis and tick-borne encephalitis and to assist in test development as well as provide recommendations for national guidelines. TRIAL REGISTRATION NL9258 (retrospectively registered at Netherlands Trial Register, trialregister.nl in in February 2021).
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Affiliation(s)
- D Hoornstra
- Amsterdam UMC, Center for Experimental and Molecular Medicine, Amsterdam Institute of Infection and Immunology, University of Amsterdam, P.O. Box 22660 (1100 DD), Amsterdam, The Netherlands. .,National Institute for Public Health and the Environment (RIVM), Center of Infectious Disease Control, P.O. Box 1 (3720 BA), Bilthoven, The Netherlands.
| | - M G Harms
- National Institute for Public Health and the Environment (RIVM), Center of Infectious Disease Control, P.O. Box 1 (3720 BA), Bilthoven, The Netherlands
| | - S A Gauw
- Amsterdam UMC, Center for Experimental and Molecular Medicine, Amsterdam Institute of Infection and Immunology, University of Amsterdam, P.O. Box 22660 (1100 DD), Amsterdam, The Netherlands
| | - A Wagemakers
- Amsterdam UMC, Center for Experimental and Molecular Medicine, Amsterdam Institute of Infection and Immunology, University of Amsterdam, P.O. Box 22660 (1100 DD), Amsterdam, The Netherlands
| | - T Azagi
- National Institute for Public Health and the Environment (RIVM), Center of Infectious Disease Control, P.O. Box 1 (3720 BA), Bilthoven, The Netherlands
| | - K Kremer
- National Institute for Public Health and the Environment (RIVM), Center of Infectious Disease Control, P.O. Box 1 (3720 BA), Bilthoven, The Netherlands
| | - H Sprong
- National Institute for Public Health and the Environment (RIVM), Center of Infectious Disease Control, P.O. Box 1 (3720 BA), Bilthoven, The Netherlands
| | - C C van den Wijngaard
- National Institute for Public Health and the Environment (RIVM), Center of Infectious Disease Control, P.O. Box 1 (3720 BA), Bilthoven, The Netherlands
| | - J W Hovius
- Amsterdam UMC, Center for Experimental and Molecular Medicine, Amsterdam Institute of Infection and Immunology, University of Amsterdam, P.O. Box 22660 (1100 DD), Amsterdam, The Netherlands
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Azagi T, Hoornstra D, Kremer K, Hovius JWR, Sprong H. Evaluation of Disease Causality of Rare Ixodes ricinus-Borne Infections in Europe. Pathogens 2020; 9:pathogens9020150. [PMID: 32102367 PMCID: PMC7168666 DOI: 10.3390/pathogens9020150] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Received: 02/13/2020] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 12/13/2022] Open
Abstract
In Europe, Ixodes ricinus ticks transmit pathogens such as Borrelia burgdorferi sensu lato and tick-borne encephalitis virus (TBEV). In addition, there is evidence for transmission to humans from I. ricinus of Anaplasma phagocytophilum, Babesia divergens, Babesia microti, Babesia venatorum, Borrelia miyamotoi, Neoehrlichia mikurensis, Rickettsia helvetica and Rickettsia monacensis. However, whether infection with these potential tick-borne pathogens results in human disease has not been fully demonstrated for all of these tick-borne microorganisms. To evaluate the available evidence for a causative relation between infection and disease, the current study analyses European case reports published from 2008 to 2018, supplemented with information derived from epidemiological and experimental studies. The evidence for human disease causality in Europe found in this review appeared to be strongest for A. phagocytophilum and B. divergens. Nonetheless, some knowledge gaps still exist. Importantly, comprehensive evidence for pathogenicity is lacking for the remaining tick-borne microorganisms. Such evidence could be gathered best through prospective studies, for example, studies enrolling patients with a fever after a tick bite, the development of specific new serological tools, isolation of these microorganisms from ticks and patients and propagation in vitro, and through experimental studies.
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Affiliation(s)
- Tal Azagi
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven 3720 BA, The Netherlands; (K.K.); (H.S.)
- Correspondence:
| | - Dieuwertje Hoornstra
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers Location Academic Medical Center, Amsterdam 1105 AZ, The Netherlands; (D.H.); (J.W.R.H.)
| | - Kristin Kremer
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven 3720 BA, The Netherlands; (K.K.); (H.S.)
| | - Joppe W. R. Hovius
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers Location Academic Medical Center, Amsterdam 1105 AZ, The Netherlands; (D.H.); (J.W.R.H.)
| | - Hein Sprong
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven 3720 BA, The Netherlands; (K.K.); (H.S.)
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Rego ROM, Trentelman JJA, Anguita J, Nijhof AM, Sprong H, Klempa B, Hajdusek O, Tomás-Cortázar J, Azagi T, Strnad M, Knorr S, Sima R, Jalovecka M, Fumačová Havlíková S, Ličková M, Sláviková M, Kopacek P, Grubhoffer L, Hovius JW. Counterattacking the tick bite: towards a rational design of anti-tick vaccines targeting pathogen transmission. Parasit Vectors 2019; 12:229. [PMID: 31088506 PMCID: PMC6518728 DOI: 10.1186/s13071-019-3468-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/29/2019] [Indexed: 02/07/2023] Open
Abstract
Hematophagous arthropods are responsible for the transmission of a variety of pathogens that cause disease in humans and animals. Ticks of the Ixodes ricinus complex are vectors for some of the most frequently occurring human tick-borne diseases, particularly Lyme borreliosis and tick-borne encephalitis virus (TBEV). The search for vaccines against these diseases is ongoing. Efforts during the last few decades have primarily focused on understanding the biology of the transmitted viruses, bacteria and protozoans, with the goal of identifying targets for intervention. Successful vaccines have been developed against TBEV and Lyme borreliosis, although the latter is no longer available for humans. More recently, the focus of intervention has shifted back to where it was initially being studied which is the vector. State of the art technologies are being used for the identification of potential vaccine candidates for anti-tick vaccines that could be used either in humans or animals. The study of the interrelationship between ticks and the pathogens they transmit, including mechanisms of acquisition, persistence and transmission have come to the fore, as this knowledge may lead to the identification of critical elements of the pathogens' life-cycle that could be targeted by vaccines. Here, we review the status of our current knowledge on the triangular relationships between ticks, the pathogens they carry and the mammalian hosts, as well as methods that are being used to identify anti-tick vaccine candidates that can prevent the transmission of tick-borne pathogens.
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Affiliation(s)
- Ryan O. M. Rego
- Biology Centre, Institute of Parasitology, Czech Academy of Sciences, Branišovská 31, 37005 Ceske Budejovice, Czech Republic
| | - Jos J. A. Trentelman
- Amsterdam UMC, Location AMC, Center for Experimental and Molecular Medicine, Amsterdam, The Netherlands
| | - Juan Anguita
- CIC bioGUNE, 48160 Derio, Spain
- Ikerbasque, Basque Foundation for Science, 48012 Bilbao, Spain
| | - Ard M. Nijhof
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Hein Sprong
- Centre for Zoonoses and Environmental Microbiology, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Boris Klempa
- Institute of Virology, Biomedical Research Center of the Slovak Academy of Sciences, Bratislava, Slovakia
| | - Ondrej Hajdusek
- Biology Centre, Institute of Parasitology, Czech Academy of Sciences, Branišovská 31, 37005 Ceske Budejovice, Czech Republic
| | | | - Tal Azagi
- Centre for Zoonoses and Environmental Microbiology, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Martin Strnad
- Biology Centre, Institute of Parasitology, Czech Academy of Sciences, Branišovská 31, 37005 Ceske Budejovice, Czech Republic
- Faculty of Science, University of South Bohemia, Branišovská 31, 37005 Ceske Budejovice, Czech Republic
| | - Sarah Knorr
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Radek Sima
- Biology Centre, Institute of Parasitology, Czech Academy of Sciences, Branišovská 31, 37005 Ceske Budejovice, Czech Republic
| | - Marie Jalovecka
- Biology Centre, Institute of Parasitology, Czech Academy of Sciences, Branišovská 31, 37005 Ceske Budejovice, Czech Republic
- Faculty of Science, University of South Bohemia, Branišovská 31, 37005 Ceske Budejovice, Czech Republic
| | - Sabína Fumačová Havlíková
- Institute of Virology, Biomedical Research Center of the Slovak Academy of Sciences, Bratislava, Slovakia
| | - Martina Ličková
- Institute of Virology, Biomedical Research Center of the Slovak Academy of Sciences, Bratislava, Slovakia
| | - Monika Sláviková
- Institute of Virology, Biomedical Research Center of the Slovak Academy of Sciences, Bratislava, Slovakia
| | - Petr Kopacek
- Biology Centre, Institute of Parasitology, Czech Academy of Sciences, Branišovská 31, 37005 Ceske Budejovice, Czech Republic
- Faculty of Science, University of South Bohemia, Branišovská 31, 37005 Ceske Budejovice, Czech Republic
| | - Libor Grubhoffer
- Biology Centre, Institute of Parasitology, Czech Academy of Sciences, Branišovská 31, 37005 Ceske Budejovice, Czech Republic
- Faculty of Science, University of South Bohemia, Branišovská 31, 37005 Ceske Budejovice, Czech Republic
| | - Joppe W. Hovius
- Amsterdam UMC, Location AMC, Center for Experimental and Molecular Medicine, Amsterdam, The Netherlands
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Sprong H, Azagi T, Hoornstra D, Nijhof AM, Knorr S, Baarsma ME, Hovius JW. Control of Lyme borreliosis and other Ixodes ricinus-borne diseases. Parasit Vectors 2018; 11:145. [PMID: 29510749 PMCID: PMC5840726 DOI: 10.1186/s13071-018-2744-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [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] [Received: 01/04/2018] [Accepted: 02/23/2018] [Indexed: 12/25/2022] Open
Abstract
Lyme borreliosis (LB) and other Ixodes ricinus-borne diseases (TBDs) are diseases that emerge from interactions of humans and domestic animals with infected ticks in nature. Nature, environmental and health policies at (inter)national and local levels affect the risk, disease burden and costs of TBDs. Knowledge on ticks, their pathogens and the diseases they cause have been increasing, and resulted in the discovery of a diversity of control options, which often are not highly effective on their own. Control strategies involving concerted actions from human and animal health sectors as well as from nature managers have not been formulated, let alone implemented. Control of TBDs asks for a “health in all policies” approach, both at the (inter)national level, but also at local levels. For example, wildlife protection and creating urban green spaces are important for animal and human well-being, but may increase the risk of TBDs. In contrast, culling or fencing out deer decreases the risk for TBDs under specific conditions, but may have adverse effects on biodiversity or may be societally unacceptable. Therefore, in the end, nature and health workers together must carry out tailor-made control options for the control of TBDs for humans and animals, with minimal effects on the environment. In that regard, multidisciplinary approaches in environmental, but also medical settings are needed. To facilitate this, communication and collaboration between experts from different fields, which may include patient representatives, should be promoted.
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Affiliation(s)
- Hein Sprong
- Centre for Zoonoses & Environmental Microbiology, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands. .,Laboratory of Entomology, Wageningen University and Research Centre, Wageningen, the Netherlands.
| | - Tal Azagi
- Centre for Zoonoses & Environmental Microbiology, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Dieuwertje Hoornstra
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Ard M Nijhof
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Sarah Knorr
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - M Ewoud Baarsma
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Joppe W Hovius
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam, the Netherlands
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