Origin of the West Nile virus responsible for an outbreak of encephalitis in the northeastern United States.

In late summer 1999, an outbreak of human encephalitis occurred in the northeastern United States that was concurrent with extensive mortality in crows (Corvus species) as well as the deaths of several exotic birds at a zoological park in the same area. Complete genome sequencing of a flavivirus isolated from the brain of a dead Chilean flamingo (Phoenicopterus chilensis), together with partial sequence analysis of envelope glycoprotein (E-glycoprotein) genes amplified from several other species including mosquitoes and two fatal human cases, revealed that West Nile (WN) virus circulated in natural transmission cycles and was responsible for the human disease. Antigenic mapping with E-glycoprotein-specific monoclonal antibodies and E-glycoprotein phylogenetic analysis confirmed these viruses as WN. This North American WN virus was most closely related to a WN virus isolated from a dead goose in Israel in 1998.

Evaluation of an IgM immunoblot kit for dengue diagnosis.

A commercial IgM immunoblot kit was evaluated for dengue diagnosis with a panel of serum specimens collected from patients in a dengue endemic area. The kit is not recommended for use in its present form because of its undesirable rate of false-positive results. However, by substituting internal controls with the reference positive and negative controls that are more representative of those seen in endemic areas and by modifying the positive and negative scoring criteria, sensitivity and specificity of 80.3% and 94.5%, respectively, were obtained. These results are comparable with those obtained with the IgM ELISA on specimens, most of which were obtained from outpatient health care facilities. With further technical modifications, inclusion of a visual guide to ensure scoring standardization, and a more complete elaboration of the limitations of the test, wide application of the kit in diagnostic laboratories should be possible.

Experimental infection of house sparrows (Passer domesticus) with Rocio virus.

Rocio encephalitis is a new epidemic flaviviral infection of man, first described in São Paulo State, Brazil in 1975. The ecology of the viral transmission cycle remains largely unknown. Experimental studies were undertaken to assess the role of a wild avian species, the House Sparrow, as a maintenance or amplifying host. Approximately two-thirds of nesting and adult sparrows developed 2- to 3-day viremias of low to moderate magnitude (2.0--4.3 log/ml). Rocio-immune birds were not protected against challenge with St. Louis encephalitis (SLE) virus, but prior SLE viral infection prevented detectable viremia in birds challenged with Rocio virus. These studies provide some support for the hypothesis that birds are hosts for Rocio virus, but the House Sparrow probably plays a relatively minor role in viral transmission. Because sparrows are relatively inefficient viremic hosts, they would be expected to play a minor role in transmission should Rocio virus be introduced into the United States.

Arbovirus infections among laboratory personnel in Ibadan, Nigeria.

Laboratory-acquired infections encountered between 1963 and 1977 among personnel of the Virus Research Laboratory, Ibadan, Nigeria, are reported. Two cases of chikungunya infection occurred and one each with Dugbe, Wesselsbron, and dengue viruses. In each case, virus was isolated or development of antibody demonstrated. Among virus and two each to chikungunya and Rift Valley fever viruses, without experiencing any clinically recognized disease.

Yellow fever monoclonal antibodies: type-specific and cross-reactive determinants identified by immunofluorescence.

Monoclonal antibodies directed against the envelope glycoprotein and the NV3 non-structural viral protein of yellow fever (YF) were tested by the indirect fluorescent antibody technique against a variety of YF virus strains and heterologous flaviviruses. Monoclonal antibodies directed against the envelope glycoprotein exhibited YF strain-specificity, YF type-specificity, broad group cross-reactivity, or limited subgroup reactivity (YF + Banzi or YF + Koutango + Zika + Usutu + Uganda S). Monoclonal antibodies directed against NV3 reacted either with YF + Koutango or with YF + Banzi. These findings generally correlated with the results of biological tests reported previously. Monoclonal antibodies that were type-specific to YF will be useful for the rapid specific identification of YF virus isolates and are available from the Centers for Disease Control on request.

Effect of human gamma interferon on yellow fever virus infection.

We studied yellow fever virus infection in two species of monkey: Saimiri sciureus (squirrel monkeys) and Macaca mulatta (rhesus monkeys). Human gamma interferon was administered intravenously in five equal doses, one was given 24 hr before infection followed by four doses 24 hr apart. Interferon reduced the levels and duration of viremia and the severity of hepatitis in squirrel monkeys. Interferon prolonged survival time and delayed the appearance of viremia and hepatitis in infected rhesus monkeys, but it did not change overall mortality.

Arbovirus investigations in Argentina, 1977-1980. II. Arthropod collections and virus isolations from Argentine mosquitoes.

Prospective surveys for arboviruses were carried out in Santa Fe, Corrientes, and Chaco provinces, Argentina, aperiodically during 1977-1980. A total of 313,233 mosquitoes and 598 biting flies other than mosquitoes were collected and tested for virus in 5,197 and 45 pools, respectively. Forty virus strains were isolated, all from mosquitoes, as follows: Santa Fe Province: 4 Gamboa group viruses from Aedeomyia squamipennis, 1 strain each of St. Louis encephalitis virus from Culex pipiens quinquefasciatus and Culex (Culex) spp.; Corrientes Province: a single strain of a newly discovered Anopheles A serogroup virus, Las Maloyas, from Anopheles albitarsis; and Chaco Province: 4 Gamboa group viruses from Ad. squamipennis, 6 strains of new Bunyaviridae (1 Antequera, 1 Barranqueras, and 4 Resistencia) from Culex (Melanoconion) delpontei, 3 strains of a new subtype of western equine encephalitis virus and 1 strain of Para virus from the Cx. (Mel.) ocossa group, 12 strains of a newly discovered subtype (VI) of the Venezuelan equine encephalitis complex from Cx. (Mel.) delpontei, and 1 strain each from Ad. squamipennis, Aedes scapularis, Ae. spp., Cx. (Cux.) spp., Cx. (Mel.) ocossa group, Mansonia spp., and Psorophora spp. Bloodmeals from 265 engorged mosquitoes were identified by precipitin test. These data, coupled with data on engorgement rates for 25,995 mosquitoes from bait collections, provide information on the host feeding patterns of several mosquito species. This information is discussed, along with data on relative abundance of mosquito species, within the context of the vector relationships of the species from which viruses were isolated. The association of Cx. (Mel.) delpontei with 18 strains of 4 different viruses in Chaco Province, plus its catholic feeding habits, clearly indicate for the first time the importance of this species as an arbovirus vector.

Arbovirus investigations in Argentina, 1977-1980. III. Identification and characterization of viruses isolated, including new subtypes of western and Venezuelan equine encephalitis viruses and four new bunyaviruses (Las Maloyas, Resistencia, Barranqueras, and Antequera).

Forty viruses isolated from mosquitoes between 1977 and 1980 in Argentina have been identified and characterized. Nineteen strains of VEE virus, identical by neutralization (N) tests, were shown by hemagglutination-inhibition tests with anti-E2 glycoprotein sera to represent a new subtype VI of the VEE complex. RNA oligonucleotide fingerprints of this virus were distinct from subtype I viruses. The virus was not lethal for English short-haired guinea pigs, indicating that it is probably not equine-virulent. Three strains of a member of the WEE virus complex were shown to differ by N tests in 1 direction from prototype WEE virus. The new WEE subtype was also found to be distinct by RNA oligonucleotide mapping. Its vector relationships indicate that it is an enzootic virus, and it has not been associated with equine disease. A new member of the Anopheles A serogroup was identified, shown to be most closely related to Lukuni and Col An 57389 viruses, and given the name Las Maloyas virus. A strain of Para virus (Bunyaviridae, Bunyavirus) was identified. Six isolates, representing 3 new viruses morphologically resembling bunyaviruses are described; the names Antequera, Barranqueras, and Resistencia are proposed for these agents, which were all isolated from Culex (Melanoconion) delpontei in Chaco Province. No serologic relationships between these viruses and other bunyaviruses were found. Since they are antigenically interrelated, they form a new (Antequera) serogroup. Eight Gamboa serogroup viruses and 2 strains of St. Louis encephalitis virus were also identified.

Arbovirus investigations in Argentina, 1977-1980. IV. Serologic surveys and sentinel equine program.

Serologic surveys of wild and domestic birds, wild mammals, and horses were conducted during arbovirus field studies in Argentina from 1977 through 1980, a non-epizootic interval. The prevalence of neutralizing antibodies to eastern equine encephalitis (EEE) was consistently higher than to western equine encephalitis (WEE) virus in all species and all areas. The presence of antibodies in short-lived avian species and in young unvaccinated horses and the demonstration of seroconversions in horses during the period, indicated that these viruses are either enzootic in, or annually reintroduced into, Argentina. Antibodies to AG80-646, a new subtype of WEE virus isolated in the subtropical north (Chaco Province) from Culex (Melanoconion) mosquitoes, were found in horses and rodents in that region. Antibodies to the TC-83 strain of Venezuelan equine encephalitis (VEE) virus were found in all areas studied. The presence of antibodies in some horses was probably related to vaccination, but the demonstration of seroconversions in sentinel horses and of antibodies in birds and wild mammals indicates active transmission of VEE virus. In 1980 a new enzootic subtype of VEE virus (AG80-663) was isolated from mosquitoes in Chaco; neutralizing antibodies to this virus were prevalent in horses and rodents in this area. Infections with Aura and Una viruses were most common in the subtropical northern provinces. Infection with St. Louis encephalitis was prevalent and widespread, and birds, principally passerine and columbiform species, appear to be the principal hosts. An interesting and unexplained finding was the absence of arbovirus antibodies, in particular SLE antibodies in house sparrows (Passer domesticus). Antibody prevalences in horses exceeded 50% in all areas, and 12% of horses surveyed in Santa Fe Province developed antibody in a 17-month period. Antibodies to other flaviviruses were rare. A high prevalence of immunity to Maguari virus was found in horses; this agent is considered to be a potential equine pathogen. Antibodies to 2 new viruses, Barranqueras and Resistencia, which had been isolated from Cx. (Melanoconion) in Chaco Province, were found in rodents there. Immunity to Gamboa group viruses was prevalent, and birds were implicated as principal hosts.

Arbovirus isolations from mosquitoes collected during and after the 1982-1983 epizootic of western equine encephalitis in Argentina.

Mosquitoes were collected in Santa Fe and Rio Negro provinces, Argentina, in 1982-1983 during a western equine encephalitis (WEE) epizootic. Totals of 153,084 mosquitoes from Santa Fe Province and 484 from Rio Negro Province were tested for virus in 2,351 pools. Seventeen virus strains were isolated, all from Santa Fe collections, as follows: 4 WEE, 6 Venezuelan equine encephalitis, 1 St. Louis encephalitis, 2 Antequera, 1 Maguari, 1 Melao, 1 new vesiculovirus (Calchaqui), and 1 Gamboa. The WEE virus isolates were from Aedes albifasciatus, Anopheles albitarsis, Mansonia species, and Psorophora pallescens. Collections during the spring and summer (1983-1984) following the epizootic yielded 49,707 mosquitoes from Santa Fe, 15,961 from Rio Negro, and 2,019 from Chubut provinces. Twenty-two virus strains were isolated, all from Santa Fe mosquitoes, as follows: 3 strains of SLE virus and 19 strains of Turlock (TUR) virus. All but one of the TUR virus isolates appear to have come from mosquitoes that engorged on a viremic chicken following entry into a bait trap. The vector relationships of each virus isolated during and after the WEE epizootic are discussed.

A newly recognized vesiculovirus, Calchaqui virus, and subtypes of Melao and Maguari viruses from Argentina, with serologic evidence for infections of humans and horses.

In 1983, 17 virus strains were isolated from mosquitoes collected during an outbreak of western equine encephalitis in Santa Fe Province, Argentina. Strains of western equine encephalitis, Venezuelan equine encephalitis, St. Louis encephalitis, and Antequera viruses were isolated, as were several bunyaviruses of the California and Bunyamwera serogroups and a new vesiculovirus. Complement fixation and neutralization tests were used to identify the California serogroup virus as a subtype of Melao virus, the Bunyamwera serogroup virus as a subtype of both Maguari and Playas viruses, and the vesiculovirus as a newly recognized agent for which the name Calchaqui virus is proposed. A limited serosurvey of horses and humans in Santa Fe Province and horses from the adjacent Santiago del Estero Province was performed to determine the prevalence of neutralizing antibody to the subtypes of Melao and Maguari viruses and to Calchaqui virus. The high prevalence of antibodies to these three agents indicates the need for further studies of their disease potential in horses, because they are closely related to several other viruses that are known equine pathogens.

Japanese encephalitis among hospitalized pediatric and adult patients with acute encephalitis syndrome in Hanoi, Vietnam 1995.

The etiologic spectrum of acute encephalitis syndrome (AES) has not been well defined in Vietnam. Cohort and case-control studies were performed on all adult and pediatric AES patients admitted to the Neurology Service of Bach Mai Hospital between June 5 and August 3, 1995. Among pediatric AES patients, 31 (67%) of 46 had acute Japanese encephalitis (JE), compared with only two (6%) of 33 adult AES patients (P < 0.0001). For confirmed JE cases, serum specimens obtained 15-21 days after symptom onset had the highest mean anti-JE IgM signal-to-noise (P/N) ratios (8.08 + 1.09 SE). A serosurvey of adult household members did not reveal any cases of recent subclinical JE infection, although 26% had evidence of past JE infection. The use of bed netting was nearly universal but did not appear to reduce the risk of AES or JE. Given the high incidence of JE, particularly among children, Vietnam seems well suited for the development of a targeted JE vaccination strategy.

Variation in virulence for mice and rhesus monkeys among St. Louis encephalitis virus strains of different origin.

The virulence characteristics of 67 strains of St. Louis encephalitis (SLE) virus isolated from various sources in North, Middle, and South America were compared in mice and rhesus monkeys. Each virus strain was titrated in mice exactly 21 days old and virulence was expressed as the ratio of intracerebral (ic)/intraperitoneal (ip) LD50. Virus strains fell into three groups: 1) high virulence (ic/ip LD50 ratio approximately 1.0); 2) intermediate virulence (variable mortality over a wide dose range); and 3) low virulence (ic/ip LD50 less than or equal to 0.00002). Virus strains isolated during Culex pipiens and Cx. nigripalpus--borne epidemics in the eastern United States were highly virulent for mice, whereas a high proportion of the endemic virus strains isolated from Cx. tarsalis in the western United States were attenuated. Virus strains isolated from birds (the usual host for SLE virus) were highly virulent, in contrast to strains from rodents and carnivores, which were attenuated. Isolates from humans exhibited variable virulence characteristics. In experimentally-infected mice, virulence correlated with high viremia, replication in extraneural tissues, and earlier neuroinvasion. Mouse virulence correlated with clinical and histopathologic markers of pathogenicity for ic inoculated rhesus monkeys. Monkeys immunized with nonpathogenic strains by subcutaneous inoculation were partially protected against ic challenge with a virulent virus strain. The virulence classification of SLE virus strains is discussed in terms of epidemiologic correlations. This classification provides a framework for future studies on the antigenic, genetic, and biochemical bases for SLE virus strain variation.

Venezuelan equine encephalitis febrile cases among humans in the Peruvian Amazon River region.

A survey was conducted from October 1, 1993 to June 30, 1995 to determine the arboviral etiologies of febrile illnesses in the city of Iquitos in the Amazon River Basin of Peru. The study subjects were patients who were enrolled at medical care clinics or in their homes by Peruvian Ministry of Health (MOH) workers as part of the passive and active disease surveillance program of the MOH. The clinical criterion for enrollment was the diagnosis of a suspected viral-associated, acute, undifferentiated febrile illness of < or = 5 days duration. A total of 598 patients were enrolled in the study. Demographic information, medical history, clinical data, and blood samples were obtained from each patient. The more common clinical features were fever, headache, myalgia, arthralgia, retro-ocular pain, and chills. Sera were tested for virus by the newborn mouse and cell culture assays. Viral isolates were identified initially by immunofluorescence using polyclonal antibody. An ELISA using viral-specific monoclonal antibodies and nucleotide sequence analysis were used to determine the specific variety of the viruses. In addition, thin and thick blood smears were observed for malaria parasites. Venezuelan equine encephalitis (VEE) virus subtype I, variety ID virus was isolated from 10 cases, including three cases in October, November, and December 1993, five cases in January and February 1994, and two cases in June 1995. The ELISA for IgM and IgG antibody indicated that VEE virus was the cause of an additional four confirmed and four presumptive cases, including five from January through March 1994 and three in August 1994. Sixteen cases were positive for malaria. The 18 cases of VEE occurred among military recruits (n = 7), agriculture workers (n = 3), students (n = 3), and general laborers (n = 5). These data indicated that an enzootic strain of VEE virus was the cause of at least 3% (18 of 598) of the cases of febrile illnesses studied in the city of Iquitos in the Amazon Basin region of Peru.

Recovery of Tonate virus ("Bijou Bridge" strain), a member of the Venezuelan equine encephalomyelitis virus complex, from Cliff Swallow nest bugs (Oeciacus vicarius) and nestling birds in North America.

A second virus with distinct biological, serological, and physiochemical properties was detected as a minority viral subpopulation in specimens of Cliff Swallow nest bugs (Oeciacus vicarius) and nestling bird sera containing Fort Morgan (FM) virus. The second virus, detected by a breakthrough neutralization test employing FM antiserum, was present in 5 of 11 FM virus-positive pools of nest bugs and in 4 of 38 birds from Colorado and South Dakota. The concentration of the second virus was 10-fold to 1,000-fold lower than that of FM virus. The second virus, which was provisionally named "Bijou Bridge" (BB) virus was shown by conventional serological tests to be a member of the Venezuelan equine encephalomyelitis (VEE) complex, and by tests employing antisera to the E2 viral glycoprotein to be identical with Tonate virus, previously isolated from birds and mosquitoes only in French Guiana. Experimental infection of House Sparrows and Cliff Swallows showed that they develop brief BB viremias and antibodies. Oe. vicarius bugs were resistant to oral infection with BB virus. The epidemiological significance of recovery of Tonate virus in North American is discussed.

First recorded outbreak of yellow fever in Kenya, 1992-1993. I. Epidemiologic investigations.

Outbreaks of yellow fever (YF) have never been recorded in Kenya. However, in September 1992, cases of hemorrhagic fever (HF) were reported in the Kerio Valley to the Kenya Ministry of Health. Early in 1993, the disease was confirmed as YF and a mass vaccination campaign was initiated. Cases of suspected YF were identified through medical record review and hospital-based disease surveillance by using a clinical case definition. Case-patients were confirmed serologically and virologically. We documented 55 persons with HF from three districts of the Rift Valley Province in the period of September 10, 1992 through March 11, 1993 (attack rate = 27.4/100,000 population). Twenty-six (47%) of the 55 persons had serologic evidence of recent YF infection, and three of these persons were also confirmed by YF virus isolation. No serum was available from the other 29 HF cases. In addition, YF virus was isolated from a person from the epidemic area who had a nonspecific febrile illness but did not meet the case definition. Five patients with confirmed cases of YF died, a case-fatality rate of 19%. Women with confirmed cases of YF were 10.9 times more likely to die than men (P = 0.010, by Fisher's exact test). Of the 26 patients with serologic or virologic evidence of YF, and for whom definite age was known, 21 (81%) were between 10 and 39 years of age, and 19 (73%) were males. All patients with confirmed YF infection lived in rural areas. There was only one instance of multiple cases within a single family, and this was associated with bush-clearing activity. This was the first documented outbreak of YF in Kenya, a classic example of a sylvatic transmission cycle. Surveillance in rural and urban areas outside the vaccination area should be intensified.

Common occurrence of concurrent infections by multiple dengue virus serotypes.

The co-circulation of all 4 dengue virus serotypes in the same community, common since the 1950s in Southeast Asia, has now become a frequent occurrence in many Caribbean Islands, Mexico, and Central and South America in the past 20 years. As a consequence, the frequency of concurrent infections would be expected to increase in these areas. To assess this, using state of the art technology, we screened viremic serum samples and mosquitoes inoculated with serum samples collected during epidemics involving multiple dengue virus serotypes in Indonesia, Mexico, and Puerto Rico for virus isolation. Of 292 samples tested, 16 (5.5%) were found to contain 2 or more dengue viruses by an indirect immunofluorescence test and/or the reverse transcriptase-polymerase chain reaction.

Identification of new Guama and Group C serogroup bunyaviruses and an ungrouped virus from Southern Brazil.

From 1975 to 1978, 36 viruses were recovered from humans, bats, birds, sentinel mice and hamsters, and from mosquitoes collected in Coastal Brazil in the state of São Paulo. Identifications of 22 of these 36 viruses have been reported. Six of the remaining 14 isolates were shown to be Guama serogroup bunyaviruses. Two of these six were strains of a newly recognized virus for which the name Cananeia virus is proposed; another is a second newly recognized Guama serogroup virus for which the name Itimirim virus is proposed; a fourth is a strain of Bertioga virus and the other two are strains of Guaratuba virus. Before these studies Guaratuba virus was considered an ungrouped bunyavirus, but cross testing by complement-fixation demonstrated that this virus, and Mirim virus as well, should be considered members of the Guama serogroup. Another six viruses were shown to be strains of a single, newly recognized Group C bunyavirus for which the name Bruconha virus is proposed. Two strains of a single virus were shown by electron microscopy to belong to the family Bunyaviridae, but serologic relationships with other members of this family of viruses were not found; the name Enseada virus is proposed for this newly recognized agent.

Venezuelan equine encephalitis and Oropouche virus infections among Peruvian army troops in the Amazon region of Peru.

An outbreak of a febrile illness characterized by headache, ocular pain, myalgia, and arthralgia occurred during June 1994 among Peruvian army troops in Northern Peru. On June 14-16, 1994, clinical data and blood samples were obtained from eight soldiers with a febrile illness, and from 26 others who had a history of febrile illness during the past three months. A follow-up blood sample was obtained 107 days later from four of the febrile and seven of the afebrile soldiers. Serum samples were tested for dengue (DEN), Oropouche (ORO), and Venezuelan equine encephalitis (VEE) IgM and IgG antibodies by an enzyme-linked immunosorbent assay (ELISA). Virus isolation was performed by inoculation of newborn mice and Vero cell cultures. Viral isolates were identified by immunofluorescence, ELISA, and nucleotide sequencing. A VEE virus infection was confirmed in three of the eight febrile soldiers, two by virus isolation, and one by serology. Antigenic analysis indicated that one of the virus isolates was similar to VEE subtype I, variety ID, viruses previously isolated in Colombia and Venezuela. Nucleotide sequence data showed that both viral isolates were identical to one another and closely related to VEE ID viruses previously isolated in Peru, Colombia, and Venezuela. Serologic results showed that two of 26 afebrile soldiers had IgM antibody to VEE and four had IgG antibody to VEE; two febrile soldiers had IgG antibody in their first serum samples. Oropouche-specific IgM antibody was detected in one of the eight febrile and five of the afebrile soldiers, and 18 of the 34 soldiers had low titers of ORO IgG antibody titers, which did not meet the diagnostic criteria for confirmed cases. All soldiers were negative for DEN IgM antibody, and 10 had flavivirus IgG antibody that reacted with DEN antigens. These data indicated that VEE ID virus was one of the causes of illness among Peruvians soldiers and that this was the first association of this VEE subtype with human disease in Peru.

First recorded outbreak of yellow fever in Kenya, 1992-1993. II. Entomologic investigations.

The first recorded outbreak of yellow fever in Kenya occurred from mid-1992 through March 1993 in the south Kerio Valley, Rift Valley Province. We conducted entomologic studies in February-March 1993 to identify the likely vectors and determine the potential for transmission in the surrounding rural and urban areas. Mosquitoes were collected by landing capture and processed for virus isolation. Container surveys were conducted around human habitation. Transmission was mainly in woodland of varying density, at altitudes of 1,300-1,800 m. The abundance of Aedes africanus in this biotope, and two isolations of virus from pools of this species, suggest that it was the principal vector in the main period of the outbreak. A third isolate was made from a pool of Ae. keniensis, a little-known species that was collected in the same biotope. Other known yellow fever vectors that were collected in the arid parts of the valley may have been involved at an earlier stage of the epidemic. Vervet monkeys and baboons were present in the outbreak area. Peridomestic mosquito species were absent but abundant at urban sites outside the outbreak area. The entomologic and epidemiologic evidence indicate that this was a sylvatic outbreak in which human cases were directly linked to the epizootic and were independent of other human cases. The region of the Kerio Valley is probably subject to recurrent wandering epizootics of yellow fever, although previous episodes of scattered human infection have gone unrecorded. The risk that the disease could emerge as an urban problem in Kenya should not be ignored.