Evidence of West Nile virus circulation among humans in central northern Algeria.

West Nile Virus (WNV) is the most widely distributed flavivirus worldwide. It is a mosquito-borne virus, and birds constitute its natural reservoir. Humans and equines are considered accidental hosts. Human WNV infections are usually asymptomatic or express as a mild febrile syndrome; however, in around 1% of cases they are responsible for more serious neurological diseases with a potentially lethal outcome. In the Mediterranean basin the virus circulation is regarded as endemic. Outbreaks of WNV meningoencephalitis are regularly notified, especially during summer and autumn seasons. In Algeria, although some surveys have reported WNV activity in the Sahara, to date few data are available about virus circulation in the northern part of the country. We conducted this study to detect possible WNV activity in this part of Algeria. For this purpose, in 2010 a total of 164 human sera were collected from native patients of the Algiers district and surrounding areas, then tested retrospectively for IgG anti-WNV by ELISA. Plaque reduction neutralization technique (PRNT) was used for result confirmation. In this cohort, 9.8% of the 164 collected sera returned positive for anti-WNV IgG; after confirmation by PRNT; 6.7% had specific neutralizing antibodies. No statistically significant difference was observed according to the sex or transfusion status of the patients. In conclusion, these data show for the first time serological evidence of WNV circulation in Algiers and its surrounding areas. They also highlight the need for implementing an integrated surveillance programme covering all aspects of WNV disease in order to better understand the circulation dynamics of WNV in this region. Other flaviviruses antigenically related to WNV should be investigated, given the evidence of serological cross-reaction, as specific IgG antibodies decrease after PRNT confirmation.

Observational study on immune response to yellow fever and measles vaccines in 9 to 15-month old children. Is it necessary to wait 4 weeks between two live attenuated vaccines?

BACKGROUND: The use of 2 live attenuated vaccines (LAV) is recommended to be simultaneous or after an interval of at least four weeks between injections. The primary objective of this study was to compare the humoral response to yellow fever (YF) and measles vaccines among children vaccinated against these two diseases, either simultaneously or separated by an interval of 7-28 days. SUBJECTS AND METHODS: A prospective, multicenter observational study was conducted among children aged 9-15 months. The primary endpoint was the occurrence of positive yellow fever antibodies after YF vaccine by estimating the titers of neutralizing antibodies from venous blood samples. Children vaccinated against YF 7-28 days after receiving the vaccine against measles (test group) were compared with children vaccinated the same day against these two diseases (referent group). RESULTS: Analysis was performed on 284 children. Of them, fifty-four belonged to the test group. Measles serology was positive in 91.7% of children. Neutralizing antibodies against YF were detected in 90.7% of the test group and 92.9 of the referent group (p=0.6). In addition, quantitative analysis of the immune response did not show a lower response to YF vaccination when it took place 1-28 days after measles vaccination. DISCUSSION: In 1965, Petralli showed a lower response to the smallpox vaccine when injected 4-20 days after measles vaccination. Since then, recommendations are to observe an interval of four weeks between LAV not injected on the same day. Other published studies failed to show a significant difference in the immune response to a LAV injected 1-28 days after another LAV. These results suggest that the usual recommendations for immunization with two LAV may not be correct. CONCLUSION: In low income countries, the current policy should be re-evaluated. This re-evaluation should also be applied to travelers to yellow fever endemic countries.

Development of a Usutu virus specific real-time reverse transcription PCR assay based on sequenced strains from Africa and Europe.

Usutu virus (USUV) has been isolated in several African and European countries mainly from mosquitoes and birds. However, previous benign and two recent severe cases of human infections point out the need of a tool for the identification of USUV in human samples. A published real-time reverse transcription (RT) PCR assay for the detection of USUV in human blood or cerebrospinal fluid does not take into account the genetic variability of USUV in different geographic regions. Therefore, this article presents a quantitative real-time RT-PCR assay based on sequences from Europe and Africa. Primers and probe were designed in conserved regions among USUV strains that differed from closely related flaviviruses. The specificity of the assay was investigated by testing 16 other flaviviruses circulating in Africa. The sensitivity was determined by testing serial dilutions of virus and RNA standard. Intra- and inter-assay coefficients of variation were evaluated by 10 reactions in a same and in different assays, respectively. The assay provides high analytical specificity for USUV and detection limits of 1.2pfu/reaction for virus dilutions in L-15 medium or human serum and 60 copies/reaction for the RNA standard. The assay needs to be evaluated in a clinical context and integrated in standard diagnosis of flaviviral diseases.

Re-emergence of Rift Valley fever virus in Barkedji (Senegal, West Africa) in 2002-2003: identification of new vectors and epidemiological implications.

The Rift Valley fever virus (RVFV) is a threat that must not be neglected, as the consequences of RVFV are dramatic, both for human and animal health. This virus is a zoonotic virus that already has demonstrated a real capacity for re-emerging after long periods of silence, as observed in Barkedji (Senegal, West Africa) in 2002. In this article we present the 2nd emergence in Barkedji after the 1st manifestation in 1993, and for the 1st time the circulation of RVFV during 2 consecutive years among mosquito populations in Senegal. As part of the entomological surveillance program undertaken since 1990 to detect circulation of the RVFV in Barkedji, 108,336 mosquitoes belonging to 34 species and 5 genera were collected in 2002-2003. Aedes vexans and Culex poicilipes, previously known to be vectors of RVFV in Senegal, comprised 88.7% of the total collection. In 2002, Ae. vexans was the most abundant mosquito, followed by Cx. poicilipes; the opposite situation was observed in 2003. In 2002, 29 and 10 RVFV isolates were obtained from Cx. poicilipes (minimum infection rate [MIR] = 0.13%) and Ae. vexans (MIR = 0.02%) pools, respectively and the MIR for the 2 species were significantly different (chi2 = 34.65; df = 1, P < 0.001). In 2003, 7 RVFV strains were isolated from Cx. poicilipes (3, MIR = 0.03), Mansonia africana (2, MIR = 0.08), Ae. fowleri (1), and Ma. uniformis (1, MIR = 0.05). The 3 latter species were found to be associated with RVFV for the 1st time in Senegal. A significant decrease in MIR was observed from 2002 to 2003 (chi2 6.28; df = 1, P = 0.01) for Cx. poicilipes, the only species involved in the transmission during the 2 sampling years.

Evaluation of the efficiency of bird-baited traps for sampling potential West Nile fever mosquito vectors (Diptera: Culicidae) in Senegal.

The efficiency of bird-baited traps and collection heights for sampling potential West Nile mosquito vectors was studied during the 2006 rainy season (between September 27 and November 26) in Barkedji area situated in the sahelian area of Senegal (West Africa). Each night, two traps were set on the ground-level and two on the canopylevel (approximately 3 m) each containing either a chicken or a pigeon, the traps being rotated the following nights. A total of 1,030 mosquitoes were collected using 66 traps-nights. Culex species were predominant and represented 92.2% of the fauna of which 63% belonged to Cx. neavei group Theobald whereas 23.8% were Cx poicilipes (Theobald). The species of the Cx. neavei group were mainly collected by the pigeon-baited trap at canopy while Cx. poicilipes was captured similarly by pigeons and chickens placed at the canopy and ground. The implication of these results in West Nile vectors surveillance is discussed.

Environmental risk factors of West Nile virus infection of horses in the Senegal River basin.

In 2005, a serological study was carried out on horses in five ecologically contrasted zones of the Senegal River basin (Senegal) to assess West Nile virus (WNV) transmission and investigate underlying environmental risk factors. In each study zone, horses were randomly selected and blood samples taken. A land-cover map of the five study areas was built using two satellite ETM+ images. Blood samples were screened by ELISA for anti-WNV IgM and IgG and positive samples were confirmed by seroneutralization. Environmental data were analysed using a principal components analysis. The overall IgG seroprevalence rate was 85% (n=367; 95% CI 0.81-0.89). The proximity to sea water, flooded banks and salted mudflats were identified as protective factors. These environmental components are unfavourable to the presence of Culex mosquitoes suggesting that in Senegal, the distribution of the vector species is more limiting for WNV transmission than for the hosts' distribution.

[Two cases of Crimean-Congo haemorrhagic fever (CCHF) in two tourists in Senegal in 2004]. / Deux cas de fièvre hémorragique de Crimée-Congo (FHCC) contractée au Sénégal, en 2004, par des résidentes temporaires.

Two cases of Crimean-Congo haemorrhagic fever (CCHF) occurred in two French tourists during their visit in Senegal in November 2004. Febrile and hemorrhagic syndrome with ulorrhagia, petechiae, haematemesis, haematomas associated with biological signs of disseminated intramuscular coagulation were observed. For the first case who had a medical evacuation to France before diagnosis, Crimean-Congo virus infection was revealed by laboratory tests performed by the National Reference Center for Hemorrhagic Fevers (NRCHF, Institut Pasteur, Lyon) and secondly by the Centre de Référence OMS sur la Recherche des Arbovirus et des virus des Fièvres Hémorragiques (CRORA) in the Dakar Pasteur Institute (DPI). The second case diagnosed by the CRORA died after clinical deterioration with liver failure and severe haemorrhages. Healthcare workers and family members who had contact with tissue or blood from patients were followed up after the putative exposure either in France or in Senegal.

[Integrated approach to yellow fever surveillance: pilot study in Senegal in 2003-2004]. / Approche intégrée de la surveillance de la fièvre jaune: étude pilote au Sénégal en 2003-2004.

The aim was to undertake a pilot study of integrated surveillance of yellow fever (YF) in Senegal, based on i) a human surveillance involving healthcare centers in the 11 administrative regions of the country ii) an entomological surveillance including domestic and sylvatic environment and iii) screening mosquitoes for YF virus using RT-PCR method. The integrated approach of human and entomological surveillance was conducted for 2 years (2003-2004). Surveillance in human population was based on screening samples of YF suspected cases (i.e. patients with acute (< or = 15 days) febrile illness with jaundice) for YF specific IgM antibodies. The entomological surveillance was carried out by collecting mosquitoes using human landing catch method and attempt to detect YF virus on them by RT-PCR. Forty five percent of the healthcare centres notified at least one suspected YF case during 2003-2004 periods. Among the 342 sera collected over 2 years, 2 revealed anti-YF IgM antibodies leading to investigations which allowed identification of the source and place of infection and implementation of a reactive focused YF immunization campaign. In addition, YFV was detected by RT-PCR from 49 out of 1762 mosquitoes tested and distributed as follows: in the sylvatic environment, 29 from Aedes furcifer and 1 from Aedes aegypti while in the domestic area, 15 Aedes aegypti and 4 Aedes furcifer. RT-PCR was found more sensitive and rapid than viral isolation for YF virus detection in mosquitoes. The pilot study in Senegal for YF surveillance integrating human and entomological parameters in domestic and sylvatic areas showed that this approach is very efficient in detecting yellow fever virus circulation due to the complementarity of the two systems. Therefore, in the light of the encouraging results presented herein, similar studies in different context and areas are needed to further validate and allow the extension of its application to other endemic regions of Africa.

Mosquito vectors of the 1998-1999 outbreak of Rift Valley Fever and other arboviruses (Bagaza, Sanar, Wesselsbron and West Nile) in Mauritania and Senegal.

Following an outbreak of Rift Valley fever (RVF) in south-eastern Mauritania during 1998, entomological investigations were conducted for 2 years in the affected parts of Senegal and Mauritania, spanning the Sénégal River basin. A total of 92 787 mosquitoes (Diptera: Culicidae), belonging to 10 genera and 41 species, were captured in light traps. In Senegal, Culex poicilipes (41%) and Mansonia uniformis (39%) were the most abundant species caught, whereas Aedes vexans (77%) and Cx. poicilipes (15%) predominated in Mauritania. RVF virus was isolated from 63 pools of Cx. poicilipes: 36 from Senegal in 1998 and 27 from Mauritania in 1999. These results are the first field evidence of Cx. poicilipes naturally infected with RVFV, and the first isolations of this virus from mosquitoes in Mauritania - the main West African epidemic and epizootic area. Additional arbovirus isolates comprised 25 strains of Bagaza (BAG) from Aedes fowleri, Culex neavei and Cx. poicilipes; 67 Sanar (ArD 66707) from Cx. poicilipes; 51 Wesselsbron (WSL) from Ae. vexans and 30 strains of West Nile (WN) from Ma. uniformis, showing differential specific virus-vector associations in the circulation activity of these five arboviruses.

Frequent infection of Hylobates pileatus (pileated gibbon) with species-associated variants of hepatitis B virus in Cambodia.

As well as being distributed widely in human populations, hepatitis B virus (HBV) infections occur frequently in chimpanzee, gibbon and other ape populations in sub-Saharan Africa and South-East Asia. To investigate the frequency and genetic relationships of HBV infecting gibbons in Cambodia, pileated gibbons (Hylobates pileatus) that were originally wild-caught were screened for surface antigen. Twelve of 26 (46 %) were positive, of which 11 were positive for HBV DNA. Phylogenetic analysis of complete genome sequences revealed two distinct genetic groups in the gibbon/orangutan clade. Three were similar to previously described variants infecting H. pileatus in Thailand and eight formed a distinct clade, potentially representing distinct strains of HBV circulating in geographically separated populations in South-East Asia. Because of the ability of HBV to cross species barriers, large reservoirs of infection in gibbons may hamper ongoing attempts at permanent eradication of HBV infection from human populations in South-East Asia through immunization.

Use of reverse transcriptase PCR in early diagnosis of Rift Valley fever.

Reverse transcriptase PCR (RT-PCR) for diagnosis of Rift Valley fever (RVF) was evaluated by using 293 human and animal sera sampled during an RVF outbreak in Mauritania in 1998. Results of the RT-PCR diagnostic method were compared with those of virus isolation (VI) and detection of immunoglobulin M (IgM) antibodies. Our results showed that RT-PCR is a specific, sensitive tool for RVF diagnosis in the early phase of the disease and that its results do not differ significantly from those obtained by VI. Moreover, the combined results of RT-PCR and IgM antibody detection were in 100% concordance with the results of VI.

Rift Valley fever outbreak, Mauritania, 1998: seroepidemiologic, virologic, entomologic, and zoologic investigations.

A Rift Valley fever outbreak occurred in Mauritania in 1998. Seroepidemiologic and virologic investigation showed active circulation of the Rift Valley fever virus, with 13 strains isolated, and 16% (range 1.5%-38%) immunoglobulin (Ig) M-positivity in sera from 90 humans and 343 animals (sheep, goats, camels, cattle, and donkeys). One human case was fatal.

Single-tube and nested reverse transcriptase-polymerase chain reaction for detection of Rift Valley fever virus in human and animal sera.

Rift Valley fever (RVF) is an anthropozoonosis caused by a Phlebovirus (Bunyaviridae family) that has re-emerged recently in East and West Africa in 1997-1998. This emphasizes the need for early and rapid detection of the virus and an efficient surveillance system. To this goal, a single tube or a nested reverse transcriptase-polymerase chain reaction (RT-PCR) method focusing on the NSs coding region of the S segment was developed and used to detect the RVF virus (RVFV) genome, resulting respectively in the synthesis of 810 and 662 bp DNA amplimers. The assay was specific for RVFV and did not amplify any other phleboviruses known to circulate in sub-Saharan Africa. When serial dilutions of RVFV were artificially mixed with human normal serum, the minimal detection limits were 50 and 0.5 plaque forming units respectively using the simple and the nested RT-PCR. The RT-PCR method was efficient for the detection of RVFV RNA in the blood from experimentally RVFV-infected mice and lamb and the nested RT-PCR was found more sensitive than the virus isolation method. Additionally, this detection method was applied successfully for the diagnosis of human cases during the 1998 Mauritanian outbreak.

First isolation of the Rift Valley fever virus from Culex poicilipes (Diptera: Culicidae) in nature.

Following the reemergence of Rift Valley fever (RVF) virus in southeastern Mauritania in 1998, an entomological survey was undertaken in the boundary area in Senegal to assess the extent of the virus circulation. During this study, RVF virus (36 strains) was isolated for the first time from Culex poicilipes in nature. The possible role of Cx. poicilipes as an RVF vector is discussed regarding its biology and ecology.

Genetic reassortment of Rift Valley fever virus in nature.

Rift Valley fever virus (RVFV), a phlebovirus of the Bunyaviridae family, is an arthropod-borne virus which emerges periodically throughout Africa, emphasizing that it poses a major threat for animal and human populations. To assess the genetic variability of RVFV, several isolates from diverse localities of Africa were investigated by means of reverse transcription-PCR followed by direct sequencing of a region of the small (S), medium (M), and large (L) genomic segments. Phylogenetic analysis showed the existence of three major lineages corresponding to geographic variants from West Africa, Egypt, and Central-East Africa. However, incongruences detected between the L, M, and S phylogenies suggested that genetic exchange via reassortment occurred between strains from different lineages. This hypothesis, depicted by parallel phylogenies, was further confirmed by statistical tests. Our findings, which strongly suggest exchanges between strains from areas of endemicity in West and East Africa, strengthen the potential existence of a sylvatic cycle in the tropical rain forest. This also emphasizes the risk of generating uncontrolled chimeric viruses by using live attenuated vaccines in areas of endemicity.

Molecular epidemiology and emergence of Rift Valley fever.

Rift Valley fever (RVF) is a mosquito-borne viral disease which manifested itself during recent epidemics and revealed its significant potential of emergence. Studies on molecular epidemiology undertaken to better understand the factors leading to RVF emergence, have confirmed the mode of circulation of the virus and highlighted probable risks and obstacles for prevention and control. As for several other viral agents, molecular epidemiology is becoming a useful tool in the study of the emergence of RVF as a serious infectious disease.

Molecular epidemiology and emergence of Rift Valley fever

Rift Valley fever (RVF) is a mosquito-borne viral disease which manifested itself during recent epidemics and revealed its significant potential of emergence. Studies on molecular epidemiology undertaken to better understanding the factors leading to RVF emergence, have confirmed the mode of circulation of the virus and highlighted probable risks and obstacles for prevention and control. As for several other viral agents, molecular epidemiology is becoming a useful tool in the study of the emergence of RVF as a serious infectious disease.

Variability of the NS(S) protein among Rift Valley fever virus isolates.

Eighteen strains of Rift Valley fever (RVF) virus collected over a period of 38 years and isolated from diverse localities in Africa and from various hosts (human, animal and arthropod) were investigated by RT-PCR followed by sequencing of the NS(S) protein coding region. This region was chosen to analyse variability because, in contrast to the N protein, the NS(S) protein differs in various phleboviruses and there exists an RVF virus (clone 13) in which 70% of the NS(S) ORF is deleted, suggesting that this sequence is under a weak selective pressure. Sequence data indicated that percentage divergence among isolates ranged from 0 to 9.6% at the nucleotide level and from 0 to 9.5% at the amino acid level. Phylogenetic analysis based on the NS(S) gene revealed two major lineages: Egyptian and sub-Saharan. This led to the establishment of the relatedness between strains and insights into the NS(S) protein, the function of which is still undetermined. Alignment of the deduced amino acid sequences indicated that the cysteine residues are conserved, as are several motifs representing potential phosphorylation sites.