#Serological #Evidence of #Yersiniosis, #TBE, #WNV, #Hepatitis E, #CCHF, Lyme #Borreliosis, and #Brucellosis in Febrile Patients Presenting at Diverse Hospitals in #Kenya (Vector Borne Zoo Dis., abstract)

[Source: Vector-Borne and Zoonotic Diseases, full page: (LINK). Abstract, edited.]

Serological Evidence of Yersiniosis, Tick-Borne Encephalitis, West Nile, Hepatitis E, Crimean-Congo Hemorrhagic Fever, Lyme Borreliosis, and Brucellosis in Febrile Patients Presenting at Diverse Hospitals in Kenya

Josphat Nyataya, Moureen Maraka, Allan Lemtudo, Clement Masakhwe, Beth Mutai, Kariuki Njaanake, Benson B. Estambale, Nancy Nyakoe, Joram Siangla, and John Njenga Waitumbi

Published Online: 13 Jan 2020 / DOI: https://doi.org/10.1089/vbz.2019.2484



Data on pathogen prevalence is crucial for informing exposure and disease risk. We evaluated serological evidence of tick-borne encephalitis (TBE), West Nile (WN), Hepatitis E virus (HEV), Crimean-Congo Hemorrhagic Fever (CCHF), Yersiniosis, Lyme Disease (LD), and brucellosis in 1033 patients presenting with acute febrile illness at 9 health care facilities from diverse ecological zones of Kenya: arid and semiarid (Garissa District Hospital, Lodwar District Hospital, Marigat District Hospital, Gilgil District Hospital), Lake Victoria basin (Kisumu District Hospital, Alupe District Hospital, Kombewa Sub-County Hospital), Kisii highland (Kisii District Hospital), and coastal (Malindi District Hospital). Epidemiological information of the patients such as geography, age, gender, and keeping animals were analyzed as potential risk factors. Of the 1033 samples, 619 (59.9%) were seropositive to at least one pathogen by IgM (current exposure), IgG/IgM (recent exposure), and IgG (past exposure). Collective seroprevalence for current, recent, and past to the pathogens was 9.4%, 5.1%, and 21.1% for LD; 3.6%, 0.5%, and 12.4% for WN; 0.9%, 0.5%, and 16.9% for HEV; 5.8%, 1.3%, and 3.9% for brucellosis; 5.7%, 0.2%, and 2.3% for yersiniosis; 1.7%, 0%, and 6.2% for TBE; and 0.4%, 0%, and 1.9% for CCHF. Brucellosis risk was higher in patients recruited at Garissa District Hospital (odds ratio [OR] = 3.41), HEV (OR = 2.45) and CCHF (OR = 5.46) in Lodwar District Hospital, LD in Alupe District Hospital (OR = 5.73), Kombewa Sub-district hospital (OR = 8.17), and Malindi District hospital (OR = 3.3). Exposure to LD was highest in the younger age group, whereas yersiniosis did not vary with age. Age was a significant risk for WN, brucellosis, CCHF, TBE, and HEV and in those aged >14 years there was an increased risk to WN (OR = 2.30, p < 0.0001), brucellosis (OR = 1.84, p = 0.005), CCHF (OR = 4.35, p = 0.001), TBE (OR = 2.78, p < 0.0001), and HEV (OR = 1.94, p = 0.0001). We conclude that LD is pervasive and constitutes a significant health burden to the study population, whereas yersiniosis and CCHF are not significant threats. Going forward, community-based studies will be needed to capture the true seroprevalence rates and the associated risk factors.

Keywords: Arbovirus; WNV; CCHF; Borreliosis; TBE; Brucellosis; Seroprevalence; Kenya.


A quantitative #comparison of #WNV #incidence from 2013 to 2018 in Emilia-Romagna, #Italy (PLOS Negl Trop Dis., abstract)

[Source: PLOS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]


A quantitative comparison of West Nile virus incidence from 2013 to 2018 in Emilia-Romagna, Italy

Giovanni Marini , Mattia Calzolari, Paola Angelini, Romeo Bellini, Silvia Bellini, Luca Bolzoni, Deborah Torri, Francesco Defilippo, Ilaria Dorigatti, Birgit Nikolay, Andrea Pugliese, Roberto Rosà, Marco Tamba


Published: January 2, 2020 / DOI: https://doi.org/10.1371/journal.pntd.0007953




West Nile virus (WNV) transmission was much greater in 2018 than in previous seasons in Europe. Focusing on Emilia-Romagna region (northern Italy), we analyzed detailed entomological and epidemiological data collected in 2013–2018 to quantitatively assess environmental drivers of transmission and explore hypotheses to better understand why the 2018 epidemiological season was substantially different than the previous seasons. In particular, in 2018 WNV was detected at least two weeks before the observed circulation in 2013–2017 and in a larger number of mosquito pools. Transmission resulted in 100 neuroinvasive human cases in the region, more than the total number of cases recorded between 2013 and 2017.


We used temperature-driven mathematical models calibrated through a Bayesian approach to simulate mosquito population dynamics and WNV infection rates in the avian population. We then estimated the human transmission risk as the probability, for a person living in the study area, of being bitten by an infectious mosquito in a given week. Finally, we translated such risk into reported WNV human infections.

Principal findings

The estimated prevalence of WNV in the mosquito and avian populations were significantly higher in 2018 with respect to 2013–2017 seasons, especially in the eastern part of the region. Furthermore, peak avian prevalence was estimated to have occurred earlier, corresponding to a steeper decline towards the end of summer. The high mosquito prevalence resulted in a much greater predicted risk for human transmission in 2018, which was estimated to be up to eight times higher than previous seasons. We hypothesized, on the basis of our modelling results, that such greater WNV circulation might be partially explained by exceptionally high spring temperatures, which have likely helped to amplify WNV transmission at the beginning of the 2018 season.


Author summary

West Nile virus (WNV) is one of the most recent emerging mosquito-borne diseases in Europe and North America. While most human infections are asymptomatic, about 1% of them can result in severe neurological diseases which might be fatal. WNV transmission was unusually greater in 2018 than in previous years in many European countries, resulting in a large number of human infections. Focusing on Emilia-Romagna region (Italy), we developed an epidemiological model informed by entomological data; through that we found that exceptionally high spring temperatures might have contributed at amplifying WNV transmission at the beginning of the season, causing greater WNV prevalence in mosquito and avian populations during the summer, which resulted in a higher estimated risk for human transmission. Thus, weather anomalies at the beginning of the mosquito breeding season, which are likely to become more common under the projected scenarios of climate change, might act as an early warning signal for public health authorities, enabling them to design efficient surveillance and prevention strategies.


Citation: Marini G, Calzolari M, Angelini P, Bellini R, Bellini S, Bolzoni L, et al. (2020) A quantitative comparison of West Nile virus incidence from 2013 to 2018 in Emilia-Romagna, Italy. PLoS Negl Trop Dis 14(1): e0007953. https://doi.org/10.1371/journal.pntd.0007953

Editor: Waleed Saleh Al-Salem, Saudi Ministry of Health, SAUDI ARABIA

Received: July 10, 2019; Accepted: November 20, 2019; Published: January 2, 2020

Copyright: © 2020 Marini et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: Data used in this study was collected in the frame of “Regional Surveillance of Arboviral Diseases” financed by the Emilia-Romagna Region. I.D. acknowledges research funding from the Imperial College Junior Research Fellowship and joint Centre funding from the UK Medical Research Council and Department for International Development. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: WNV; Wild Birds; Mosquitoes; Global Warming; Italy.


#Prediction of unfavorable #outcomes in #WNV #neuroinvasive #infection – result of a multinational ID-IRI study (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 11 November 2019, 104213 / In Press, Journal Pre-proof

Prediction of unfavorable outcomes in West Nile virus neuroinvasive infection – result of a multinational ID-IRI study

Corneliu Petru Popescu a,b,c,1, Simin Aysel Florescu a,b,1, Rodrigo Hasbun d, Arjan Harxhi e, Razi Evendar f, Hasip Kahraman g, Ami Neuberger f, Daniel Codreanu b, Mihaela Florentina Zaharia a,b,c, Selma Tosun h, Emanoil Ceausu b, Simona Maria Ruta a,i, Gorana Dragovacj, k, Natalia Pshenichnaya l,m, Galina Gopatsa n, Olga Shmaylenko o, Éva Nagy, p, Jelena Djekic Malbasaj k, Mirjana Strbac j, Nenad  Pandak q, Husnu Pullukcu g, Botond Lakatos p, Yasemin Cag r, Antonio Cascio s, Ilaria Coledan t, Serkan Oncu u, Hakan Erdemc v

{a} University of Medicine and Pharmacy Carol Davila Bucharest, Romania; {b} Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases Bucharest, Romania; {c} ESCMID Study Group for Infectious Diseases of the Brain – ESGIB, Switzerland; {d} Department of Infectious Diseases, UT Health McGovern Medical School, Houston, TX, USA; {e} Service of Infectious Disease, University Hospital Center of Tirana, Tirana, Albania; {f} Infectious Diseases Institute, Rambam Health Care Campus, Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel; {g}
Ege University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey; {h} Department of Infectious Diseases and Clinical Microbiology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey; {i} Stefan S. Nicolau Institute of Virology, Bucharest, Romania; {j} Institute of Public Health of Vojvodina, Department of Prevention and Control of Diseases, Novi Sad, Serbia; {k}
University of Novi Sad, Faculty of Medicine, Department of Epidemiology, Novi Sad, Serbia; {l} National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Moscow, Russia; {m} Central Scientific Research Laboratory, Rostov State Medical University, Rostov-on-Don, Russia; {n} Department of Infectious Diseases, Rostov State Medical University, Rostov-on-Don, Russia; {o} Department of Infectious Diseases #5, City Hospital #1 named after N.A. Semashko, Rostov-on-Don, Russia; {p}
National Institute of Hematology and Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary; {q} General Hospital Slavonski Brod, Department for Infectious Diseases, School of Medicine, University of Split, Split, Croatia; {r} Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey; {s} Section of Infectious and Tropical Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Italy; {t} Department of Diagnostics and Public Health, Section of Infectious Diseases, University of Verona, Verona, Italy; {u} Department of Infectious Diseases and Clinical Microbiology, Adnan Menderes University School of Medicine, Aydin, Turkey; {v} ID-IRI, Ankara, Turkey

Received 30 August 2019, Revised 31 October 2019, Accepted 7 November 2019, Available online 11 November 2019. DOI: https://doi.org/10.1016/j.jcv.2019.104213



  • Prognosis of unfavorable outcomes in West Nile virus neuroinvasive infection.
  • The relative risk for death by age.
  • Encephalitis, meningoencephalitis, meningitis.
  • Glasgow coma score was correlated with evolution to death.
  • Risk score was calculated according to age, co-morbidities, clinical manifestations.




WNV causes 1.4% of all central nervous system infections and is the most common cause of epidemic neuro-invasive disease in humans.


Our main objective was to investigate retrospectively West Nile virus neuroinvasive disease (WNND) cases hospitalized during 2010- 2017 and identified factors that can influence prognosis.

Study design

We documented the demographic, epidemiologic, clinical and laboratory data of WNND and identified factors that can influence prognosis. The data were recruited through Infectious Diseases International Research Initiative (ID-IRI), which serves as a network for clinical researches.


We investigated 165 patients with WNND in 10 countries from three continents. 27 patients died and the mortality rate was 16.4%. In an univariate analysis age, congestive heart failure, neoplasm and ischemic heart disease (p < 0.001), neuropsychiatric disorders (p = 0.011), chronic hepatitis (p = 0.024) and hypertension (p = 0.043) were risk factors for death. Fatal evolution was also correlated with ICU addmission, disorientation, speech disorders, change in consciousnes, coma, a low Glasgow coma score, obtundation, confusion (p < 0.001), history of syncope (p = 0.002) and history of unconsciousness (p = 0.037). In a binomial logistic regresssion analysis only age and coma remained independent prediction factors for death. We created an equation that was calculated according to age, co-morbidities and clinical manifestations that may be used to establish the prognosis of WNND patients.


WNND remain an important factor for morbidity and mortality worldwide, evolution to death or survival with sequelae are not rare. Our study creates an equation that may be used in the future to establish the prognosis of WNND patients.

Keywords: West Nile virus – WNV – meningitis – encephalitis – neuroinvasive – death

{1} These authors contributed equally to this article.

© 2019 Elsevier B.V. All rights reserved.

Keywords: WNV; WNND; Neuroinvasion; Encephalitis; Meningitis; European Region.


#Entomological Data and #Detection of #WNV in #Mosquitoes in #Greece (2014–2016), Before Disease Re-Emergence in 2017 (Vector Borne Zoo Dis., abstract)

[Source: Vector Borne and Zoonotic Diseases, full page: (LINK). Abstract, edited.]

Entomological Data and Detection of West Nile Virus in Mosquitoes in Greece (2014–2016), Before Disease Re-Emergence in 2017

Eleni Patsoula, Stavroula Beleri, Nikolaos Tegos, Rima Mkrtsian, Annita Vakali, and Danai Pervanidou

Published Online: 11 Nov 2019 / DOI: https://doi.org/10.1089/vbz.2018.2422



West Nile virus (WNV) cases were seasonally recorded in humans and animals in Greece, from 2010 to 2014, and circulation of the virus was detected in different Regional Units of the country. Small scale entomological surveillance activities were carried out by several regions and regional units in Greece, during 2014–2016, with the participation of subcontractors for the vector control programs aiming to record presence/absence of mosquito species, and monitor and control mosquito populations. Mosquito traps were placed in rural and urban sites; specimens were collected, morphologically characterized, and pooled by date of collection, location, and species types. Mosquito pools containing Culex pipiens, Aedes caspius, and Aedes albopictus were examined for the presence of WNV and positive pools were detected in different areas of the country. Sequencing of a selected number of amplicons revealed WNV lineage 2 partial NS5 gene sequences. In this study, we present data on the mosquito species composition in the areas of study and WNV detection from several parts of Greece, in 6, 11, and 26 mosquito pools corresponding to the years 2014, 2015, and 2016, respectively. A total of 15 WNV human infections were reported to the public health authorities of the country in 2014, whereas no human cases were detected for 2015–2016. Taking into consideration the complex epidemiological profile of WNV and unforeseen changes in its circulation, re-emergence of WNV human cases in Greece was possible and expected, thus rendering surveillance activities imperative.

Keywords: West Nile Virus; Mosquitoes; Aedes spp.; Culex spp.; Greece.


#Phylogenetic Analysis of #Bird-Virulent #WNV Strain, #Greece (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 12—December 2019 / Research Letter

Phylogenetic Analysis of Bird-Virulent West Nile Virus Strain, Greece

George Valiakos, Konstantinos Plavos, Alexandros Vontas, Marina Sofia, Alexios Giannakopoulos, Themis Giannoulis, Vassiliki Spyrou, Constantina N. Tsokana, Dimitrios Chatzopoulos, Maria Kantere, Vasilis Diamantopoulos, Angeliki Theodorou, Spyridoula Mpellou, Athanasios Tsakris, Zissis Mamuris, and Charalambos Billinis

Author affiliations: University of Thessaly, Karditsa, Greece (G. Valiakos, K. Plavos, A. Vontas, M. Sofia, A. Giannakopoulos, T. Giannoulis, V. Spyrou, C.N. Tsokana, D. Chatzopoulos, M. Kantere, Z. Mamuris, C. Billinis); Public Health Director—Region of Peloponnese, Tripoli, Greece (V. Diamantopoulos); Directorate-General for Regional Agricultural Economics and Veterinary—Region of Peloponnese, Nafplio, Greece (A. Theodorou); Bioefarmoges Eleftheriou LP—Integrated Mosquito Control, Marathon, Greece (S. Mpellou); University of Athens, Athens, Greece (A. Tsakris)



We report the full polyprotein genomic sequence of a West Nile virus strain isolated from Eurasian magpies dying with neurologic signs in Greece. Our findings demonstrate the local genetic evolution of the West Nile virus strain responsible for a human disease outbreak in the country that began in 2010.

Keywords: West Nile Virus; Wild birds; Human; Greece.


Lack of Efficacy of High-Titered #Immunoglobulin in Patients with #WNV #CNS Disease (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 11—November 2019 / CME ACTIVITY – Research

Lack of Efficacy of High-Titered Immunoglobulin in Patients with West Nile Virus Central Nervous System Disease

John W. Gnann  , Amy Agrawal, John Hart, Martha Buitrago, Paul Carson, Diane Hanfelt-Goade, Ken Tyler, Jared Spotkov, Alison Freifeld, Thomas Moore, Jorge Reyno, Henry Masur, Penelope Jester, Ilet Dale, Yufeng Li, Inmaculada Aban, Fred D. Lakeman, Richard J. Whitley  , and for the National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group

Author affiliations: University of Alabama at Birmingham, Birmingham, Alabama, USA (J.W. Gnann, Jr., P. Jester, I. Dale, Y. Li, I. Aban, F.D. Lakeman, R.J. Whitley); National Institutes of Health Clinical Center, Bethesda, Maryland, USA (A. Agrawal, H. Masur); University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA (J. Hart); Idaho Falls Infectious Diseases PLLC, Idaho Falls, Idaho, USA (M. Buitrago); North Dakota State University, Fargo, North Dakota, USA (P. Carson); University of New Mexico, Albuquerque, New Mexico, USA (D. Hanfelt-Goade); University of Colorado at Denver Anschutz Medical Campus, Aurora, Colorado, USA (K. Tyler); Kaiser Permanente South Bay Medical Center, Harbor City, California, USA (J. Spotkov); University of Nebraska Medical Center, Omaha, Nebraska, USA (D. Freifeld); Via Christi Hospital St. Francis, Wichita, Kansas, USA (T. Moore); Infectious Diseases Consultations, Rapid City, South Dakota, USA (J. Reyno)aurie Barclay, MD, freelance writer and reviewer, Medscape, LLC. Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.



West Nile Virus (WNV) can result in clinically severe neurologic disease. There is no treatment for WNV infection, but administration of anti-WNV polyclonal human antibody has demonstrated efficacy in animal models. We compared Omr-IgG-am, an immunoglobulin product with high titers of anti-WNV antibody, with intravenous immunoglobulin (IVIG) and normal saline to assess safety and efficacy in patients with WNV neuroinvasive disease as part of a phase I/II, randomized, double-blind, multicenter study in North America. During 2003–2006, a total of 62 hospitalized patients were randomized to receive Omr-IgG-am, standard IVIG, or normal saline (3:1:1). The primary endpoint was medication safety. Secondary endpoints were morbidity and mortality, measured using 4 standardized assessments of cognitive and functional status. The death rate in the study population was 12.9%. No significant differences were found between groups receiving Omr-IgG-am compared with IVIG or saline for either the safety or efficacy endpoints.

Keywords: West Nile Virus; WNND; Immunoglobulins.


Previous #dengue or #Zika virus #exposure can drive to #infection #enhancement or neutralisation of other #flaviviruses (Mem Inst Oswaldo Cruz, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Mem Inst Oswaldo Cruz. 2019;114:e190098. doi: 10.1590/0074-02760190098. Epub 2019 Aug 12.

Previous dengue or Zika virus exposure can drive to infection enhancement or neutralisation of other flaviviruses.

Oliveira RA1,2, de Oliveira-Filho EF1,3, Fernandes AI4,5, Brito CA6, Marques ET1,7, Tenório MC1, Gil LH1.

Author information: 1 Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Virologia, Recife, PE, Brasil. 2 Universidade Federal da Paraíba, Departamento de Fisiologia e Patologia, João Pessoa, PB, Brasil. 3 Charité-Universitätsmedizin Berlin, Berlin, Germany. 4 Universidade Federal da Paraíba, Hospital Universitário Lauro Wanderley, Serviço de Doenças Infecciosas e Parasitárias, João Pessoa, PB, Brasil. 5 Universidade Federal da Paraíba, Escola Técnica de Saúde, Grupo de Estudos e Pesquisas em Imunologia Humana, João Pessoa, PB, Brasil. 6 Universidade Federal de Pernambuco, Departamento de Medicina Clínica, Recife, PE, Brasil. 7 University of Pittsburgh, Center for Vaccine Research, Department of Infectious Diseases and Microbiology, Pittsburgh, PA, USA.




Dengue virus (DENV) has circulated in Brazil for over 30 years. During this time, one serotype has cyclically replaced the other, until recently, when all four distinct serotypes began to circulate together. Persistent circulation of DENV for long time periods makes sequential infections throughout a person’s life possible. After primary DENV infection, life-long immunity is developed for the infecting serotype. Since DENV and Zika virus (ZIKV) are antigenically similar, the possibility of cross-reactions has attracted attention and has been demonstrated in vitro.


The aim of this study was to investigate whether immune-sera from DENV and ZIKV infected patients would cross-react in vitro with other Flaviviridae family members.


Cross-reaction of the studied samples with yellow fever virus (YFV), West Nile virus (WNV), Rocio virus (ROCV), Saint Louis virus (SLEV) and Ilheus virus (ILHV) has been investigated by plaque reduction neutralisation test (PRNT) and the antibody-dependent enhancement (ADE) by flow-cytometry.


Antibodies against ZIKV and DENV virus cross-reacted with other flaviviruses either neutralising or enhancing the infection. Thus, viral entrance into FcRFcɣRII-expressing cells were influenced by the cross-reactive antibodies. ZIKV or DENV immune sera enhanced cellular infection by WNV, ILHV, ROCV and SLEV. Finally, DENV immune sera presented higher neutralising activity for YFV and SLEV. While ZIKV immune sera neutralised WNV, ILHV and ROCV with high frequencies of positivity.


The co-circulation of those viruses in the same area represents a risk for the development of severe infections if they spread throughout the country. Successive flavivirus infections may have an impact on disease pathogenesis, as well as on the development of safe vaccine strategies.

PMID: 31411310 DOI: 10.1590/0074-02760190098

Keywords: Flavivirus; Dengue fever; Zika Virus; WNV; Rocio Virus; St Louis Virus; Ilheus virus; Yellow Fever; Serology; ADE; Brazil.