[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]
A New Segmented Virus Associated with Human Febrile Illness in China
Ze-Dong Wang, Ph.D., Bo Wang, M.D., Feng Wei, Ph.D., Shu-Zheng Han, M.S., Li Zhang, B.Sc., Zheng-Tao Yang, Ph.D., Yan Yan, Ph.D., Xiao-Long Lv, M.S., Liang Li, Ph.D., Shu-Chao Wang, Ph.D., Ming-Xin Song, Ph.D., Hao-Ji Zhang, Ph.D., et al.
In 2017, surveillance for tickborne diseases in China led to the identification of a patient who presented to a hospital in Inner Mongolia with a febrile illness that had an unknown cause. The clinical manifestation of the illness was similar to that of tickborne encephalitis virus (TBEV) infection, but neither TBEV RNA nor antibodies against the virus were detected.
We obtained a blood specimen from the index patient and attempted to isolate and identify a causative pathogen, using genome sequence analysis and electron microscopy. We also initiated a heightened surveillance program in the same hospital to screen for other patients who presented with fever, headache, and a history of tick bites. We used reverse-transcriptase–polymerase-chain-reaction (RT-PCR) and cell-culture assays to detect the pathogen and immunofluorescence and neutralization assays to determine the levels of virus-specific antibodies in serum specimens from the patients.
We found that the index patient was infected with a previously unknown segmented RNA virus, which we designated Alongshan virus (ALSV) and which belongs to the jingmenvirus group of the family Flaviviridae. ALSV infection was confirmed by RT-PCR assay in 86 patients from Inner Mongolia and Heilongjiang who presented with fever, headache, and a history of tick bites. Serologic assays showed that seroconversion had occurred in all 19 patients for whom specimens were available from the acute phase and the convalescent phase of the illness.
A newly discovered segmented virus was found to be associated with a febrile illness in northeastern China. (Funded by the National Key Research and Development Program of China and the National Natural Science Foundation of China.)
Supported by grants from the National Key Research and Development Program of China(2017YFD0501700) and the National Natural Science Foundation of China (31672542 and 31372430).
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Drs. Z.-D. Wang, B. Wang, and F. Wei, Ms. S.-Z. Han, Ms. L. Zhang, and Drs. Z.-T. Yang and Y. Yan contributed equally to this article.
We thank Profs. Ningyi Jin and Changchun Tu (Military Veterinary Institute, Academy of Military Medical Sciences), Prof. Xing-Quan Zhu (Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences), and Dr. Chengfeng Qin (Department of Virology, Beijing Institute of Microbiology and Epidemiology) for their discussions and suggestions.
From the School of Life Sciences and Engineering, Foshan University, Foshan, Guangdong Province (Z.-D.W., Z.-T.Y., H.-J.Z., S.-J.H., J.C., F.-Q.H., Q.L.), the Military Veterinary Institute, Academy of Military Medical Sciences, Changchun, Jilin Province (Z.-D.W., L.L., S.-C.W., Q.L.), MOA Key Laboratory of Animal Virology and Department of Veterinary Medicine, Zhejiang University, Hangzhou, Zhejiang Province (Z.-D.W., Y.Y., J.H., Y.-L.J., J.-Y.Z.), the Second Affiliated Hospital of Inner Mongolia University for the Nationalities, Inner Mongolia General Forestry Hospital, Yakeshi, Inner Mongolia Autonomous Region (B.W., S.-Z.H., X.-L.L., W.W.), the College of Life Science, Jilin Agricultural University, Changchun, Jilin Province (F.W., L.Z., S.L., H.-H.L.), the College of Veterinary Medicine, Northeast Agricultural University, Harbin, Heilongjiang Province (M.-X.S.), and the Department of Experimental Pathology, Institute of Radiation Medicine, Beijing (B.W.) — all in China.
Address reprint requests to Dr. Q. Liu at the School of Life Sciences and Engineering, Foshan University, Foshan, China, or at firstname.lastname@example.org; or to Dr. Zhou at the Key Laboratory of Animal Virology of Ministry of Agriculture, Zhejiang University, or at email@example.com; or to Dr. W. Wang at the Second Clinical Medical School of Inner Mongolia University for the Nationalities, or at firstname.lastname@example.org.
Keywords: Flavivirus; Tick-borne virus; Alongshan virus; China.