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Archive for December 1st, 2007

Edward Tabor, editor

Elsevier, Amsterdam, the Netherlands, 2007 ISBN: 978-0-444-52074-6 Pages: 374; Price: US $94.95

With increasing international travel and globalization of the world’s economies, changing climates, and altered human behavior and demographics, multiple viruses have emerged to occupy expanded ecologic niches, producing disease syndromes in parts of the world where they had never before existed. Because most emerging viral diseases in humans in the 21st century have been zoonotic, Emerging Viruses in Human Populations focuses on this group of viruses. The resulting overview is a book useful for anyone interested in a diverse group of viral agents that have recently elicited novel disease syndromes in human populations around the world. This text does an excellent job of encompassing a wide variety of contact-transmitted enzootic viruses including severe acute respiratory syndrome-associated coronavirus, Nipah and Hendra viruses, influenza virus, hantaviruses, monkeypox viruses, and vector-transmitted agents including Crimean-Congo hemorrhagic fever, dengue, West Nile, and Japanese encephalitis viruses.

Two especially informative chapters, the first and last, introduce several emerging viral disease agents that affect humans. The authors provide a synthesis of factors that could be associated with the emergence of novel viral agents, such as environmental change, altered human demographics, and human behavior. They also discuss the defining mechanisms through which emerging viral disease can be identified and monitored.

The text outlines basic virologic characterization such as replication strategy and the role of known viral proteins in viral pathogenesis, diagnostics, treatment, and vaccine availability. Additionally, it covers epidemiology of agents, relative disease manifestation, and disease patterns identified in human populations. My only criticism regarding this fine resource is the lack of a consistent level of information presented for each viral agent. In some cases, for example, extensive information was presented on the role of all known viral proteins in replication of the virus and how these proteins contribute to disease manifestations. For other agents, the epidemiology was highlighted with relatively no coverage of viral pathogenesis.

Many of the chapters are easily readable by the general public, yet the level of detail within most of the sections makes this also an excellent reference text for research and public health professionals. I recommend this book for anyone interested in obtaining a broad perspective on the emergence of viral diseases that affect humans.

Aaron C. Brault *

* University of California, Davis, California, USA

Address for correspondence: Aaron C. Brault, Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, CA 95616, USA; email: acbrault@ucdavis.cdu

COPYRIGHT 2007 U.S. National Center for Infectious Diseases
COPYRIGHT 2007 Gale Group

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To determine reservoir hosts for Marburg virus (MARV), we examined the fauna of a mine in northeastern Democratic Republic of the Congo. The mine was associated with a protracted outbreak of Marburg hemorrhagic fever during 1998-2000. We found MARV nucleic acid in 12 bats, comprising 3.0%-3.6% of 2 species of insectivorous bat and 1 species of fruit bat. We found antibody to the virus in the serum of 9.7% of 1 of the insectivorous species and in 20.5% of the fruit bat species, but attempts to isolate virus were unsuccessful.

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Marburg virus (MARV) and Ebola virus, members of the family Filoviridae, cause outbreaks of severe hemorrhagic fever in Africa. Although humans have on occasion acquired infection from contact with tissues of diseased nonhuman primates and other mammals, the reservoir hosts of the viruses in nature remain unknown.

An outbreak of Marburg hemorrhagic fever ran a protracted course in the gold-mining village of Durba, northeastern Democratic Republic of the Congo, from October 1998 through September 2000. The outbreak involved 154 patients (48 confirmed and 106 suspected cases); the case-fatality ratio was 83% (1). Primary cases occurred in young male miners and spread as secondary cases to family members and, less frequently, to healthcare workers and others in the community. Most cases occurred in Durba, but a few secondary cases occurred elsewhere, including nosocomial infections in nearby Watsa village, where severely ill patients sought care. The occurrence of sporadic cases and short chains of human-to-human transmission suggested that infection had been repeatedly introduced into the human population; this suggestion was substantiated by the detection of at least 9 genetically distinct viruses circulating during the outbreak. Identical sequences of MARV were found in patients within but not across clusters of epidemiologically linked cases, although viruses with the same sequences reappeared at irregular intervals during the outbreak. Most (94%) affected miners worked underground in Goroumbwa Mine, rather than in the 7 opencast mines in the village. Cessation of the outbreak coincided with the flooding of Goroumbwa Mine. Interviews with long-term residents and healthcare workers and review of hospital records showed that a syndrome hemorragique de Durba [hemorrhagic syndrome of Durba] had been associated with the mine since at least 1987, and a survivor of a 1994 outbreak was found to have antibodies against MARV. The fauna of Goroumbwa Mine included bats, rodents, shrews, frogs, snakes, cockroaches, crickets, spiders, wasps, and moth flies (1). We present the results of virus reservoir host studies conducted during the outbreak.

Methods

In parallel with human epidemiologic studies, visits were made to Durba in May and October 1999 to collect specimens for virus ecostudies. The ecostudies were approved by the International Scientific and Technical Committee for Marburg Hemorrhagic Fever Control, which was coordinated by the World Health Organization on behalf of the government of the Democratic Republic of the Congo. In view of the epidemiologic findings during the outbreak, emphasis was placed on the fauna of Goroumbwa Mine. Bats were caught with mist nets at mine entrances; rodents and shrews were caught live with Sherman traps within and close to the mine; and arthropods (cockroaches, crickets, spiders, wasps, and moth flies, plus streblid, nycteribiid, and mite parasites of bats) were collected by hand or with sweepnets. Vertebrates were euthanized and dissected on site. Blood samples were collected; and samples of liver, lung, spleen, kidney, testes, brain, salivary glands, and fetuses of pregnant females were preserved along with the arthropods in liquid nitrogen dry-shipping containers for transport to the National Institute for Communicable Diseases in South Africa. Extra liver samples were collected for phylogenetic studies on bats and rodents, and formalin-fixed tissue samples were kept for possible histopathologic and immunohistochemical examination. Carcasses were fixed in formalin for [alpha]-taxonomy purposes.

Vertebrate tissue and arthropod suspensions were processed and tested for filovirus nucleic acids by reverse transcription–PCR (RT-PCR) and nested PCR by using filovirus-specific large (L) protein gene primers and nested MARV-specific viral protein 35 (VP35) primers as described for samples from human patients during the outbreak (1). Nucleotide sequencing of amplicons and sequence data analysis were also performed as described previously (2), except that MEGA version 3.1 software was used (3). Initial RT-PCR and nested PCR were performed with pooled tissue samples of individual vertebrates; when possible, for specimens that produced positive results, all tissues were retested separately. In attempts to isolate virus as detected by indirect immunofluorescence, suspensions ([approximately equal to] 10%) of vertebrate tissues pooled for individual animals and arthropods pooled by species were subjected to 3 serial passages in Vero 76 cell cultures. Serum samples from bats and rodents were tested for antibody to MARV by ELISA by using a modification of the technique described previously for human serum (1). ELISA antigen consisted of lysate of Vero cell cultures infected with the Musoke strain of MARV. Bat antibody was detected with antibat immunoglobulin–horseradish peroxidase conjugate (Bethyl, Montgomery, AL, USA) and rodent antibody with antimouse immunoglobulin conjugate (Zymed Laboratories, San Francisco, CA, USA). Net ELISA optical density values were expressed as percent positivity (PP) of a human serum sample confirmed positive for MARV and used as an internal control. Cutoff values for recording positive results were deliberately selected to be stringent at 3 x (mean + 3SD) PP values determined for stored bat (n = 188) and rodent (n = 360) serum samples that had been collected for unrelated purposes in Kruger National Park, South Africa, from 1984 through 1994, and tested at a dilution of 1:100. The Kruger bat samples were collected from 3 species of fruit bats (Megachiroptera) and 12 species of insectivorous bats (Microchiroptera), including samples from 56 Chaerephon pumila, 32 Rousettus aegyptiacus, 27 Mops condylurus, 16 Hipposideros caffer, plus 57 samples from 11 other species.

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The virus that causes dengue fever has turned up in a dozen units of blood donated in Puerto Rico. The disturbing finding suggests that authorities might need to screen for the mosquito-borne virus in endemic areas, says epidemiologist Hamish Mohammed of the Centers for Disease Control and Prevention in San Juan, Puerto Rico.

Blood from donors in Puerto Rico also goes to other Caribbean islands and the United States. Blood donations are not currently screened for dengue virus, Mohammed says.

He and his colleagues tested more than 16,000 blood donations in Puerto Rico between September and December 2005, just after the peak of dengue season. They found 12 units that showed clear evidence of dengue-virus contamination.

People donating blood are asked pointedly about their health, but that may not be enough because "blood donors may present without any obvious illness," Mohammed says. Initially, dengue cases are often mild or even asymptomatie. More-severe infections can cause high fever, chills, and severe back pain, hence the common name "break-bone fever:

Susan Stramer of the American Red Cross in Gaithersburg, Md., says that health officials are collecting blood samples donated in Puerto Rico this year for testing later. As part of a larger study starting in 2008, the Red Cross and local officials plan to begin screening blood in Puerto Rico for dengue virus at the time it is donated.–N. S.

COPYRIGHT 2007 Science Service, Inc.
COPYRIGHT 2008 Gale, Cengage Learning

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Chikungunya virus (CHIKV) is an arbovirus that belongs to me genus Alphavirus (family Togaviridae). The major vectors are Aedes aegypti and Ae. albopictus mosquitoes. Chikungunya was first described in Tanzania, Africa in 1952(1). The viral genome consists of a single - stranded, positive-sense RNA molecule of approximately 11.8 kb. Genetic analysis of CHIKV sequences show evidence that the virus originated in Africa and subsequently was introduced into Asia. Chikungunya virus was documented in the early 1960s in different parts of South and South eastern Asia. It had caused major outbreaks in India, Sri Lanka, Burma, and Thailand. The virus was isolated in India at Calcutta (Kolkata) in 1963. A well documented outbreak of CHIKV infection occurred in India in 19712, and since men the virus activity was noticeably absent for several decades in India. Small outbreaks and sporadic cases continued in Burma, Thailand, and the Philippines in the 1980s and the virus spread into Indonesia for the first time from 1982 to 1985, with outbreaks in several islands. The virus was never idle and caused major outbreaks in Thailand in 1995 and Malaysia in 19981999(1-3).

Re-emergence of chikungunya (CHIK) disease, caused by CHIKV was recorded in India during 2005-2006 after a gap of 32 years, causing 1.3 million cases in 13 States. Several islands of the Indian Ocean reported similar outbreaks in the same period. These outbreaks were attributed to the African genotype of CHIK virus. Large scale outbreaks of fever in several parts of soudiern India and areas such as the French Reunion Islands, Mauritius and Seychelles had all recorded the disease activity. This particular epidemic seems to have started in the Reunion Island. The majority of the cases were from Andhra Pradesh (AP), followed by Karnataka. Several hundred clinical cases were identified in Maharashtra and Orissa. There are two distinct lineages delineated, one from western Africa and the second from southern Africa, east Africa and Asia. Phylogenetic analysis at the nucleotide level revealed the present Indian isolates of the 2005-2006 epidemic to be related to the central African isolates from Reunion islands with high degree of homology46.

More recently, the virus was active in southern Europe having been taken by tourists from India. About 160 people were infected in Italy’s northern Ravenna region with one fatality as indicated by the European Centre for Disease Prevention and Control (www.ecdu.europa.eu)7.

The major symptoms described for the viral infection have been short episode of 2-5 days fever, 2-3 days of maculo-papular rash on the trunk and limbs. Myalgia and arthralgia were typically seen. Arthralgia was seen in 80 per cent of affected individuals involving the small joints of the hands and feet is now recognized to have the sequelae of joint inflammation and causing prolonged discomfort. Symptoms could also include headache, suffusion of the conjunctiva and slight photophobia. Laboratory testing usually does not reveal a lowered platelet count. The virus has usually not been associated with fatal outcome in infected individuals. In the recent India epidemic the clinical features observed were high 2 day fever, crippling joint pain, intense headache, insomnia and extreme degree of prostration which was seen for about 5-7 days. However, patients have complained of joint pain for much longer time periods depending on me age of the patients, with younger patients recovering within 5-15 days, middle aged recovering in 1-2.5 months and a longer recovery period for old people. It has been observed that the severity of the disease as well as its duration was less in younger patients and pregnant women. No untoward effect on pregnancy was noticed following the infection6. The National Institute of Virology (NIV), Pune, identified the 2005-2006 epidemics by IgM antibody testing in acute and early convalescent phase serum samples showing a 40 per cent rate of detection. Serum samples tested from Vellore, Tamil Nadu, at the NIV also showed about 50 per cent IgM detection rate in clinically typical cases (unpublished data). It should be noted that the virus is transmitted by the same vector Ae. aegypti mosquito that spreads dengue fever. The virus was also active in India in the period when dengue virus is usually active. The diagnosis of Chikungunya was made showing absence of dengue virus infection in individuals fitting the case definition of the former. The isolation of the virus and molecular detection of genomic RNA and its sequencing have all clearly established the 2005-2006 epidemics of chikungunya in several parts of the country.

Viral diagnostics include isolation in culture, serological tests using haemagglutination inhibition or ELISA, and also the polymerase chain reaction (PCR) tests can be used to confirm the infection; these tests are not available in India widely. Virus isolation from buffy coat cells or serum samples collected from 2-5 ml of heparinzed whole blood obtained during the first week of illness is the most definitive test. A number of cell lines like BHK-21, HeLa and Vero cells show cytopathic effects (CPE) of the CHIKV to be confirmed by neutralization test. This work must be done in biosafety level-3 (BSL-3) laboratories to reduce the risk of viral transmission. Suckling mice- or cell culturebased isolations are cumbersome and me special skills required are not available except in some laboratories such as in NTV8. An ELISA test to detect IgM is available at the NIV. Infected individuals become IgM positive by 7 days of illness and the antibody may last 6 months. In the literature there are reports of the availability of molecular diagnosis. A reverse transcriptase (RT)- PCR technique for CHIKV using nested primer pairs amplifying specific components of three structural gene regions, capsid (C), envelope E-2 and part of envelope El is described in the literature4.

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In 2004, 803 rural Iowans from the Agricultural Health Study were enrolled in a 2-year prospective study of zoonotic influenza transmission. Demographic and occupational exposure data from enrollment, 12-month, and 24-month follow-up encounters were examined for association with evidence of previous and incident influenza virus infections. When proportional odds modeling with multivariable adjustment was used, upon enrollment, swine-exposed participants (odds ratio [OR] 54.9, 95% confidence interval [CI] 13.0-232.6) and their nonswine-exposed spouses (OR 28.2, 95% CI 6.1-130.1) were found to have an increased odds of elevated antibody level to swine influenza (H1N1) virus compared with 79 nonexposed University of Iowa personnel. Further evidence of occupational swine influenza virus infections was observed through self-reported influenza-like illness data, comparisons of enrollment and follow-up serum samples, and the isolation of a reassortant swine influenza (H1N1) virus from an ill swine farmer. Study data suggest that swine workers and their nonswine-exposed spouses are at increased risk of zoonotic influenza virus infections.

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Since 1997, numerous instances of avian influenza virus infection have been documented in humans (1). The latest of such viruses, strains of subtype H5N1, have rapidly spread among domestic bird species across several continents and caused disease in >330 humans since 2003 (2). Like the influenza (H5N1) viruses that are circulating today, a highly virulent avian virus subtype, H1N1, was responsible for the 1918-1919 pandemic. Coincident with the human pandemic, this virus also infected swine, caused large-scale epizootics of swine respiratory disease in the midwestern United States, and established itself among pigs as the "classical" swine influenza virus lineage of influenza (H1N1) viruses (3,4). It also apparently moved from swine to humans, causing illness among farmers (3). Anticipating that the next pandemic virus may similarly be readily transmitted among and between pigs and humans, we sought to prospectively study swine workers for risk factors for swine influenza virus infection.

Methods

Study Population

After institutional review board approval, participants were recruited from the 89,658-person Agricultural Health Study (AHS) cohort (5) by using an informed consent process. The cohort, first assembled from 1993 through 1997, comprises primarily private pesticide applicators (predominately farmers) and their spouses living in Iowa and North Carolina. Through a stratified sampling scheme, participants living in Iowa were selected by previously reported exposures to swine or poultry, age group, sex, and proximity to the University of Iowa in Iowa City. Nonswine- and nonpoultry-exposed potential participants were similarly selected.

Potential AHS participants and their spouses were screened by telephone interviews and verified to be without immunocompromised conditions and without a history of accidental injection with swine influenza vaccines. They were then invited to participate in a 2-year prospective study of zoonotic influenza transmission. Enrollments were made through personal interviews held in 29 of the 99 counties in Iowa during the fall of 2004. After informed consent was obtained, each participant completed a questionnaire and permitted serum sample collection. Swine exposure was assessed by the participant’s response to the enrollment question: "How many years have you worked in swine production?" Participants who answered "never" were classified as nonexposed. Follow-up visits with similar questionnaires and phlebotomy were scheduled at 12 and 24 months. Upon enrollment and at 12 months, participants were given a first-class US Postal Service-ready kit with detailed instructions to complete another questionnaire and self-collect gargle and nasal swab specimens within 96 h of symptom onset if they met a case definition of influenza-like illness (fever [greater than or equal to] 38[degrees]C and a cough or sore throat). The kit contained a freezer block that participants were asked to insert into the preaddressed shipping box before dropping off specimens and questionnaires with the US Postal Service. The US post office near the University of Iowa laboratory kept these boxes refrigerated until the study team picked them up on regular work days.

Data and serum samples from nonagricultural health study controls from a concurrent cross-sectional study (6) were included in population comparisons at enrollment. Study controls were generally healthy University of Iowa students, staff, and faculty who denied having swine or poultry exposures. They were not studied at 12 and 24 months after enrollment.

Laboratory Methods

Specimens

Gargle and swab specimens were transported to the University of Iowa by the US Postal Service in Micro Test M4RT Viral Transport Media (Remel, Inc., Lenexa, KS, USA) and preserved at -80[degrees]C. These specimens were studied with both culture in MDCK cells and R-Mix FreshCells (Diagnostic Hybrids, Inc., Athens, OH, USA) and with molecular techniques.

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A serosurvey for neutralizing antibodies against West Nile virus (WNV) in common coots (Fulica atra) was conducted in Donana, Spain. Antibody prevalence was highest in 2003, intermediate in 2004, and lowest in 2005. Some birds seroreverted <1 year after first capture. Seroconversion of birds suggests local circulation of the virus.

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In western Mediterranean countries, the frequency of outbreaks of West Nile virus (WNV) infection has increased in recent decades. Evidence for WNV circulation in Spain has remained elusive, although WNV foci have recently been identified in 3 neighboring countries (Morocco, Portugal, and France) (1-3). Recent WNV activity in Spain has been shown by serologic screening in humans, with detection of WNV-specific immunoglobulin M (4) and identification of the first clinical case in 2004 (5). In avian hosts, WNV-neutralizing antibodies have been found in chicks of wild migratory birds in southern Spain (6). However, interpretation of serologic data is not straightforward because antibodies in chicks may be the result of maternal transmission through eggs (7). To ascertain local circulation of WNV in Spain, we designed a capture-recapture study in which serum samples from wild birds were obtained at different times.

The Study

We focused on the partially migratory common coot (Fulica atra) because of its high seroprevalence for WNV detected during a preliminary screening of 72 bird species (J. Figuerola et al., unpub, data). Reasons for this high seroprevalence remain unclear, although preference of this bird for mosquito-rich habitats and its relative size (weight [approximately equal to] 800 g) might be involved in this pattern. Birds were captured in Donana (37[degrees]6′N, 6[degrees]9′W) in a walk-in trap in October 2003 (3 capture sessions) and from September through February in 2004-2005 (12 sessions) and 2005-2006 (14 sessions). Overall, 853 captures of 515 different birds were conducted (1-7 captures/bird).

Blood was obtained from the tarsal vein and allowed to clot, and serum was stored at -20[degrees]C. All birds were marked with numbered metal rings. Age was determined by plumage characteristics before the birds were released. Neutralizing antibody titers for WNV (strain Eg101) were determined by using a micro-virus neutralization test as described (6). Only birds that showed neutralization (absence of a cytopathic effect) at dilutions >1:20 were considered seropositive. Controls for cytotoxicity in the absence of virus were included for every sample at a 1:10 dilution. Cytotoxic samples were excluded from the analysis.

Seroconversion was defined as a bird that was seronegative when first captured and became seropositive at recapture with an antibody titer that had increased 4-fold (8). Seroreversion was defined as a seropositive bird whose antibody titer decreased below the cut-off value of 20 at recapture. The interassay coefficient of variation of titers, expressed as [log.sub.10] (calculated using an internal control repeated in 5 different assays, mean 2.56, standard deviation 0.35) was 13.67%. This variation is similar to that observed in individual samples and repeated in different assays. In a series of 27 samples tested twice, the mean fluctuation observed was 0.29 [log.sub.10] units ([approximately equal to] 2-fold). To obtain accurate measurements of titers, particularly when assessing seroconversion/seroreversion, we analyzed samples at least twice, and when results differed, they were assayed again until a consistent result was obtained. Specificity of the test was assessed by parallel neutralization against Usutu virus (strain SAAR 1776), a flavivirus found in wild birds that belongs to the same serogroup as WNV, with a panel of sera positive for WNV by micro-virus neutralization test. All titers were higher for WNV than for Usutu virus; 93.6% were [greater than or equal to] 4x higher (Table 1). These results suggested that the neutralizing antibody response was generated by WNV or an antigenically related WNV-like virus.

Comparisons between years were restricted to data from October, the only month sampled in all 3 years. For analysis of variation in antibody prevalence within seasons, data were grouped into 2-month intervals. Prevalence was analyzed by generalized linear models with binomial distributed error, logit link, and randomly choosing 1 observation per bird.

Prevalence of WNV-neutralizing antibodies was highest in October 2003, intermediate in October 2004, and lowest in October 2005 ([chi square] 22.80, df 2, p<0.0001, p<0.05 for all pairwise comparisons) (Figure 1). Juvenile (<1 year of age) birds had lower antibody prevalences than adults in October ([chi square] 7.14, df 1, p = 0.008). Antibody prevalence increased throughout the 2004-2005 season ([chi square] 8.45, df 2, p = 0.02), but not during the 2005-2006 season ([chi square] 1.10, df 2, p = 0.58) (Figure 1).

Of 95 birds captured in 2 consecutive years, 59% had no detectable antibodies in either year, 21% seroreverted, 6.3% seroconverted, and 13.7% had antibodies in both years. Seroconversion confirms that WNV circulation is present in the study area, and seroreversion indicates that antibody titers decreased. Antibodies persisted for > 1 year in some birds, although whether this was caused by reinfection, which would stimulate the antibody response, is uncertain.

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In 2005, 880 West Nile virus cases were reported in California; 305 case-patients exhibited neuroinvasive disease, including meningitis, encephalitis, or acute flaccid paralysis. Risk factors independently associated with developing neuroinvasive disease rather than West Nile fever included older age, male sex, hypertension, and diabetes mellitus.

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Since the first identification of West Nile virus (WNV) in North America in New York, New York, in 1999, the virus has spread rapidly westward across the United States. In 2004 and 2005, California was the national epicenter of WNV activity, with 779 and 880 cases, respectively. The aim of this study was to identify potential risk factors for developing West Nile neuroinvasive disease among the WNV case-patients reported in California.

The Study

WNV human surveillance in California is conducted through several different mechanisms. Local clinicians are asked to refer patients with evidence of WNV disease, including encephalitis, aseptic meningitis, acute flaccid paralysis, or illness compatible with West Nile fever, for testing which is performed by 33 local public health laboratories and the state Viral and Rickettsial Disease Laboratory (VRDL). Persons with suspected cases are also tested through the California Encephalitis Project (1), which provides enhanced diagnostic testing for several viral agents that cause encephalitis, including WNV. In addition, Kaiser Permanente laboratories screen patients with suspected cases and forward positive specimens to VRDL for further testing, while commercial reference laboratories forward positive test results. Blood collection centers forward reports of WNV-positive donors, and local health departments perform follow-up investigations to identify donors in whom clinical disease later develops.

Local health departments use a standardized case history form to collect demographic and clinical information about patients who meet the clinical and laboratory criteria for WNV infection. Patients are classified as having West Nile fever if they exhibit symptoms of WNV infection (e.g., fever, headache, or muscle weakness) without development of neurologic manifestations (e.g., encephalitis, meningitis, or acute flaccid paralysis). The case history form includes questions about hypertension and diabetes.

The 880 case-patients identified were reported from 40 of 58 counties in California, with illness onset ranging from May through November 2005. The median age of all case-patients was 50 years (range 2-95 years), compared to a median of 78 years for the 19 WNV patients who died (range 56-92 years; p<0.0001); 55% of all patients were male. Of the 880 cases, 534 cases were classified as West Nile fever and 305 as WNV neuroinvasive disease. Not surprisingly, a greater proportion of the patients with neuroinvasive disease were hospitalized (90%) and required intensive care (27%) compared with the West Nile fever patients (31% and 2%, respectively; p<0.0001). The neuroinvasive disease patients also reported a greater frequency of severe symptoms such as altered mental status (54%) and seizures (7%) than did the West Nile fever patients (15% and 0.7%; p<0.0001 and p<0.001, respectively). Rash was reported among 22% of neuroinvasive disease patients compared with 51% of West Nile fever patients (p<0.0001), possibly because those with more severe disease are less able to mount an inflammatory response (2) (Table 1).

A greater proportion of neuroinvasive disease patients (46%) reported hypertension as an underlying medical condition than did the West Nile fever patients (29%; p<0.001). Thirty-three percent of the neuroinvasive disease patients reported having diabetes mellitus, compared with 11% of the West Nile fever patients (p<0.001).

In response to an open-ended question about past medical history, 193 (22%) of all case-patients reported other underlying illnesses. Coronary vascular disease was the most common underlying condition in both neuroinvasive disease and West Nile fever patients (23% and 17%, respectively). Other medical conditions reported for patients with neuroinvasive disease included renal insufficiency (10%) and chronic obstructive pulmonary disorder (8%); cancer (10%) and asthma (9%) were more frequently reported for West Nile fever patients.

Using SAS version 9.1 software (SAS Institute, Inc., Cary, NC, USA), we conducted a univariate analysis to compare the characteristics of patients with neuroinvasive disease to those with West Nile fever (Table 2). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by using Cochran-Mantel-Haenszel statistics. Patients with neuroinvasive disease were twice as likely to have hypertension (95% CI 1.44-3.01) and 4 times more likely to have diabetes (95% CI 2.63-6.55) than West Nile fever patients. Other risk factors for neuroinvasive disease included age >64 years (OR = 2.24, 95% CI 1.62-3.11) and male sex (OR = 1.57, 95% CI 1.18-2.09). Because of its collinearity with diabetes, hypertension was dropped from the logistic regression model. Age >64 years (p = 0.03), male sex (p<0.01), and diabetes (p<0.0001) were independently associated with neuroinvasive disease.

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Migratory birds have been implicated in the long-range spread of highly pathogenic avian influenza (HPAI) A virus (H5N1) from Asia to Europe and Africa. Although sampling of healthy wild birds representing a large number of species has not identified possible carriers of influenza virus (H5N1) into Europe, surveillance of dead and sick birds has demonstrated mute (Cygnus olor) and whooper (C. cygnus) swans as potential sentinels. Because of concerns that migratory birds could spread H5N1 subtype to the Western Hemisphere and lead to its establishment within free-living avian populations, experimental studies have addressed the susceptibility of several indigenous North American duck and gull species. We examined the susceptibility of Canada geese (Branta canadensis) to HPAI virus (H5N1). Large populations of this species can be found in periagricultural and periurban settings and thus may be of potential epidemiologic importance if H5N1 subtype were to establish itself in North American wild bird populations.

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Wild aquatic birds belonging to the orders Anseriformes and Charadriiformes have long been recognized as the natural reservoirs for all influenza type A viruses (1). Spread from such wild birds to domestic poultry and various mammalian species occurs intermittently. Most viruses that initially infect domestic poultry will replicate only within respiratory or digestive tracts and cause no or very mild disease, referred to as low-pathogenic avian influenza (LPAI) (2). However, once introduced into domestic poultry, some viruses of the H5 and H7 hemagglutinin (HA) subtypes can mutate to a highly pathogenic form, producing a systemic infection referred to as highly pathogenic avian influenza (HPAI) (2). The hypothesis that HPAI H5 and H7 viruses emerge from low-pathogenic precursors only after the H5 and H7 LPAI precursors have been introduced into domestic poultry has been supported by work demonstrating that HPAI viruses do not appear to form separate phylogenetic lineages in waterfowl (3). Except for A/tern/South Africa/1961 (H5N3), no evidence existed before 2002 that an HPAI virus could cause deaths or be maintained within wild bird populations.

In late 2003, an HPAI (H5N1) outbreak of unprecedented magnitude began in Southeast Asia. Approximately 1 year before this, a high mortality rate attributed to HPAI virus (H5N1) was observed in waterfowl and other wild birds in Hong Kong (4). This led to speculation that wild birds may have contributed to the virus spread. In the spring of 2005, mass dieoffs of wild birds occurred at Qinghai Lake, People’s Republic of China (5,6), an event heralded as the beginning of the long-range spread of HPAI (H5N1) from Asia into Europe and subsequently Africa, with migratory birds implicated as playing a role (7,8). Identifying which species of birds were involved in this spread is not only of academic interest but also of practical importance to surveillance activities because of concerns that migratory birds could also introduce H5N1 subtype into the Western Hemisphere. We examined the susceptibility of Canada geese (Branta canadensis) to infection with an HPAI virus (H5N1) and the effect that pre-exposure to an LPAI virus (H5N2) has on clinical disease, pathology, and virus shedding.

Materials and Methods

Viruses

The influenza viruses used in this study included A/ chicken/Vietnam/14/2005 (H5N1) and A/mallard/British Columbia/373/2005 (H5N2). Vietnam/05 stocks were grown and titrated on Japanese quail fibrosarcoma (QT-35) cells. This isolate bears a PQRERRRKR/GLF [HA.sub.0] cleavage site (GenBank accession no. EF535027), has an intravenous pathogenicity index of 2.97, and produced a 100% mortality rate in oronasally inoculated leghorn chickens receiving [10.sup.5], [10.sup.4], and [10.sup.3] PFU by 3, 4, and 6 days postinfection (dpi), respectively. British Columbia/05 stocks were grown and titrated in 9-day-old chicken embryos. Prior characterization of this isolate demonstrated that it has a PQRETR/GLF [HA.sub.0] cleavage site (GenBank accession no. DQ826532) typical for LPAI viruses.

Animals

Twenty-two Canada geese were captured with the permission of Environment Canada (Canadian Wildlife Service permit no. CWS06-M009) and were handled and cared for in accordance with Canadian Council on Animal Care guidelines and the animal use protocol approved by the Institutional Animal Care Committee. The geese consisted of 11 adult (6 male + 5 female) and 11 young-of-year (6 male + 5 female) birds. The latter were estimated to be [approximately equal to] 40 days of age at capture. Adult and juvenile birds were randomly assembled into 3 experimental groups, and each group subsequently housed in separate Biosafety Level-3 biocontainment cubicles: 1) a control group comprising 1 juvenile + 1 adult bird, 2) a pre-exposure group comprising 5 juvenile + 5 adult birds, and 3) a naive group comprising 5 juvenile + 5 adult birds.

After a 3-week acclimation period, the pre-exposure group was inoculated with [10.sup.6] 50% egg infectious dose ([EID.sub.50]) of British Columbia/05 applied to the nares, oral cavity, and cloaca. Twenty-eight days later, pre-exposure and naive groups were challenged with 1.7 x [10.sup.5] PFU of Vietnam/05 applied to the nares, oral cavity, and eye. The control group received a sham inoculum of minimal essential medium. Timed necropsies involving 1 juvenile and 1 adult bird from pre-exposure and naive groups were performed on days 3 and 6 postchallenge (dpc). All remaining birds were either humanely euthanized when moribund or allowed to survive until 20 or 21 days if they showed mild disease or remained clinically normal.

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African swine fever is a highly contagious disease of pigs in Africa. Although its persistence in Senegal may be caused by asymptomatic carriers involved in the domestic transmission cycle, we demonstrated that the soft tick Ornithodoros sonrai can be naturally infected with the causative agent.

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African swine fever (ASF) is one of the most severe diseases of pigs in Africa. It is caused by African swine fever virus (ASFV), an Asfatviridae virus, and usually results in acute hemorrhagic fever in susceptible animals with mortality rates up to 100% in some herds (1). ASF is defined by the World Organization for Animal Health as a highly contagious disease that can spread rapidly and have serious socioeconomic effects in international trade of pigs or pig products and food security. No treatment or vaccine is currently available, and control is essentially based on sanitary measures (1).

ASF is endemic in eastern and southern Africa, where ASFV is maintained either in a sylvatic cycle between warthogs (Phacochoerus aethiopicus) or bushpigs (Potamochoerus spp.) and soft tick vectors of the Ornithodoros moubata complex or in a domestic cycle that involves pigs of local breeds with or without tick involvement (2-4). Long-term persistence of ASFV caused by the presence of the soft tick vector O. erraticus (5) has also been reported in the Iberian Peninsula.

In west Africa, ASFV has been introduced several times since the 1970s in different countries by importing infected pigs or meat. These imports resulted in massive sporadic outbreaks that have been eradicated (6). Senegal has had several outbreaks caused by regular reemergence of ASFV since its first description in 1959, which suggests a unique epidemiology that has not been reported in most west African countries infected with ASFV (6). The presence of warthogs (7) and the soft tick O. sonrai (8) in Senegal suggest a sylvatic cycle of ASF. O. sonrai is closely related to O. erraticus and the O. moubata complex and shares similar vector competence for some pathogens, such as Borrelia, which causes human relapsing fever in Africa (9). This article reports preliminary results on potential involvement of O. sonrai in persistence and transmission of ASFV and discusses the role of reservoirs or vectors in control measures.

The Study

Tick investigations were conducted in January 2006 in the Fatick region of Sine-Saloum in west-central Senegal (Figure 1). This region is a major area of pig production and a center for trade with Dakar and Casamance in Sengal and Bissau-Guinea (10). Despite no national reporting, ASF outbreaks occur almost every year in Sine-Saloum (6,10). O. sonrai has also been found in the Fatick region of Senegal in previous investigations on human relapsing fever (11).

Three criteria were selected to assess the role of O. sonrai in ASF (12): presence of this tick in domestic pig buildings and warthog habitats, its probability of contact with domestic pigs and warthogs, and its natural infection with ASFV. We searched for O. sonrai in pigpens in 5 villages or groups of villages, 20-30 km apart per sampling site, along a north-south transect, as well as in warthog burrows in wild areas from 3 different forests (Figure 1). For tick collection, we used a portable gasoline-powered vacuum cleaner adapted for burrow-dwelling ticks (13) (Figure 2, panel B). Specimens were stored in liquid nitrogen. Pig pens and warthog burrows were systematically described to determine ecologic preferences of O. sonrai. Rodent or insectivore burrows, which are known to be favorable natural habitats for O. sonrai, were also examined at each sampling site to determine the presence or absence of the tick. Collected ticks were tested for ASFV infection by nested PCR amplification of the VP72 gene, a method considered most sensitive for detection of viral DNA in ticks (14).

[FIGURE 1 OMITTED]

O. sonrai was found in 11 of the 25 examined pigpens in villages in the 4 most northern sampling sites (Table). Specimens were always found in rodent and insectivore burrows, or in deep hollows, in openings inside pig buildings, or near sleeping or foraging areas around pig buildings, as described for the closely related Iberian soft tick O. erraticus during investigations of ASF (5) (Figure 2, panel A). O. sonrai was not found in litter or buildings, except at 1 farm in Fatick, where nearby burrows were highly infested. The village of Karang showed negative results, even in suitable microhabitats, a finding that confirmed the southern distribution limit of O. sonrai proposed by Morel (8). In wild areas, O. sonrai was not found in 10 warthog burrows examined (Figure 2, panel B), although its presence was confirmed in contiguous rodent or insectivore burrows. Of 36 ticks tested for ASFV infection, 4 from the 4 most northern sampling sites were positive for ASFV (Table). The farms where ASFV was detected in ticks had reported recent outbreaks in the summers of 2004 and 2005, except for the farm in Fatick. This farm, which belonged to a fattener/collector, had a high turnvover rate of pigs that may have caused difficulties in monitoring their health. Sequencing and BLAST analysis (www.ncbi.nlm. nih.gov) of PCR products confirmed a 100% relationship with ASFV. One sample was positive by repeated analysis. Three samples showed doubtful results when retested by PCR, which indicated low virus titers.

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In New York, an epizootic of American crow (Corvus brachyrhynchos) deaths from West Nile virus (WNV) infection occurred during winter 2004-2005, a cold season when mosquitoes are not active. Detection of WNV in feces collected at the roost suggests lateral transmission through contact or fecal contamination.

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In the northern United States, West Nile virus (WNV) is thought to overwinter in hibernating mosquitoes (1). Because reports of birds dying of WNV infection during the winter are rare, we investigated the cause of crow deaths in New York during the winter of 2004-2005.

The Study

Dead crows from a roost were reported to the Dutchess County Department of Health in December 2004 (Figure). The roost was located in coniferous and deciduous trees at the east end of the Mid-Hudson Bridge, Poughkeepsie, New York, USA. Because winter surveillance in Poughkeepsie had not previously confirmed WNV, the crows were not collected for testing.

However, after the third dead crow in January was reported, ground surveillance of the roost was initiated (Figure). Thereafter, carcasses were collected 4-5 times per week at a radius of 1/4 mile around the roost and were transported for necropsy to the New York State Department of Environmental Conservation. On March 1, 2005, the roost, culverts, and areas under the bridge were examined for overwintering mosquitoes. Temperature data from December 1, 2004, to March 31, 2005, were obtained from the National Oceanic and Atmospheric Administration, Silver Spring, Maryland, USA.

Oral swabs were collected from carcasses and screened by using VecTest (Medical Analysis Systems, Freemont, CA, USA) and Rapid Analyte Measurement Platform (RAMP; Response Biomedical Corp, Burnaby, British Columbia, Canada) (3,4). Brain tissue was submitted to the New York State Department of Health (NYS-Doll) for testing by TaqMan reverse transcription-PCR (RT-PCR) and standard RT-PCR (2,5). When possible, blood clots were collected from heart chambers for antibody testing by ELISA (6). Ectoparasites were collected from some carcasses before necropsy and tested for WNV by TaqMan RT-PCR (2).

To characterize this WNV genotype, RNA was extracted from the homogenate of a WNV-positive crow kidney (strain 05000918) by using RNeasy (QIAGEN, Valencia, CA, USA). The envelope coding region was amplified in 3 overlapping fragments by using QIAGEN One-Step RT-PCR core kit. DNA was sequenced at the Wadsworth Center Molecular Genetics Core facility by using ABI 3100 or 3700 automated sequencers (Applied Biosystems, Foster City, CA, USA). We generated the sequence (GenBank accession no. DQ823132) by using the SeqMan module within Lasergene (DNASTAR, Madison, WI, USA) and compared it with previously characterized North American strains by using MegAlign within Lasergene.

We collected 45 fecal specimens from 12 sampling points in the roost and 10 from beneath 2 carcasses. Specimens were tested for WNV RNA by using TaqMan and standard RT-PCR (2) with minor modifications; 100 mg of each specimen was diluted in 1.0 mL of BA-1, homogenized, centrifuged, and sterile filtered. RNA was extracted from the filtrate by using RNeasy (QIAGEN), and RT-PCR was conducted.

From February 10 to March 29, 98 carcasses were collected from the roost area; of these, 12(12.2%) were WNV-positive according to VecTest and RAMP and 13(13.3%) were positive according to TaqMan RT-PCR (Figure). The crow isolate was characterized as the WN02 genotype (7).

Necropsy and histopathologic findings on WNV-positive crows (n = 13) were consistent with previously reported pathologic findings (8). Necropsy findings included low body weight (84.6%), enlarged spleen (23.1%), and enlarged liver (30.8%); histopathologic findings included slight to moderate encephalitis with mild, diffuse gliosis and occasional small foci of necrosis in the gray matter of the brain. Meningoencephalitis, characteristic of WNV-positive birds (8), was not observed. WNV-negative crows (n = 85) died from traumatic injuries (51.8%), predation (16.5%), avian pox (14.1%), pneumonia (11.8%), and poisoning (5.9%). Two pools of >20 lice (Philopterus spp.: Mallophaga) from 6 WNV-positive birds and 1 pool from 1 WNV-negative bird were tested; 6 positive pools were detected from 4 positive birds.

[FIGURE OMITTED]

All 56 blood clots collected were seronegative by ELISA for flavivirus antibodies. Of the 45 ecal samples, 3 were WNV-positive; 2 of these (1 collected from beneath a WNV-positive crow; 1 from a random roost sampling point) had >800 pfu/mL, according to extrapolation from TaqMan RT-PCR.

No mosquito hibernacula were located in the areas examined, and no mosquito activity was observed by field workers. Maximum daily temperatures were [greater than or equal to] 10[degrees]C for 6 days in December, 4 days in January and February, and 5 days in March; mean temperatures were <10[degrees]C throughout the epizootic (Figure).

Conclusions

How WNV crow infections occurred during winter in New York when mosquito activity would have been limited is unclear (Figure). Reporting of crow carcasses can be as low as 10%; therefore, additional carcasses may have been observed and not reported before ground surveillance began (9). Initial crow infections could have occurred in November, when mean monthly temperature was [greater than or equal to] 10[degrees]C and mosquito infection was more probable. Maximum daily temperatures [greater than or equal to] 10[degrees]C occurred sporadically from December through March. However, mean temperatures remained at < 10[degrees]C (Figure) and photoperiods at < 12 h/day. Laboratory studies of wild-captured Culex pipiens L. females, the primary WNV vector in the northeastern United States, have shown that Cx. pipiens are unlikely to terminate diapause with photoperiods of <12 h/day and temperatures <10[degrees]C (10). Field studies in New York have shown that Cx. pipiens remain in overwintering locations until mid-April, at which time photoperiods are [greater than or equal to] 12 h/day and mean temperatures [greater than or equal to] 10[degrees]C (C. Drummond, NYSDoH Arbovirus Laboratories, unpub, data).

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