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Hi to everybody
Expediteur: Tereza
Ville: Prague
Mail: tabarka@centrum.cz
Rubrique: Discussion sur l'épidémie
Date: 28-02-2006
Time: 15:19:03
Commentaires
Hello, I am from Czech republic and I have a question. I speak english only and I want to get some information about the virus. My friend come back to Czech republic from Mauritius and she feels sick. She has all the symptoms what I read about this sick in newspapers. She is in the hospital now. So I think, we have the first case of this virus in Czech republic...Can anybody give me advice, where to get more information? Thank you very much. Tereza
I agree with DB on this, in that I dont think the spread can be attributed to the aedes mosquito alone: the pattern of spread is just too great, and there have not been epidemic levels of mossies reported. Additionally, spraying and other anti mosquito activities should have had a marked effect on incidence - and it does not appear that this is the case. As far as I can tell, there is no let up in new cases, but the epidemic may be peaking, based on the rate of reported incidence of new cases - at least on La Reunion. DB - any latest data to back this up one way or the other? Big thanks.
H2H is a definite possibility, but, I am wondering rather more on the viruses adaptation to a new vector - either a relation i.e gnat or other type of mosquito, or some other species or common element within the food chain. The virus would have to have increased its infectivity either way, and if so, we should start to hear of mainland cases fairly soon. I hope we are wrong on this being an H5N1 variant, but until WHO or other authorites can honestly say that they have looked for this carefully and found no evidence, I am not going to discount the theory. I have not heard any report say 'we have checked and not found H5N1' - has anyone else?
Every area that it has been documented it is spreading.
So far the spreading is occuring exponential everywhere it is found.
It is spreading in areas where mosquitoes are not prevelant.
http://www.chikungunya.net/Communique/sos_mafate_2702.htm
I have lived in Florida for 20+ years and have had many mosquito exposures. I have never experienced a single mosquito biting every individual in the house. I believe they are full after one or two bites. Also, many mosquitos are killed when the individual swipes at them. The chances of a single mosquito biting, and thus infecting, every member of a household within a specific time frame is remote.
DB: Do you have any more data on any of the mainland country incidences? Is there any hard evidence that spread has started eg in France or Switzerland from the index cases?
There is a tight control on information right now so very little information is coming out.
The information that is found in other places does not look good. The latest news is that the virus is spreading in regions with very little mosquito activity. (Big Suprise!!)
Here is an example of what we can expect, these numbers come from the surrounding island of Mayoette.
January 29th: 56 cases
Febuary 25th: 1350 cases
Right now France has 30 cases, wait 2-3 more weeks and the numbers will be above 1000.
Thereare indeed some people that got infectes while they swear they havenot been bitten by moskitoes.
An informal survey is being done in the Island about this.
But, but even doctors have pubicly said that they cannot do the tests they want, and are kind of censure.
Snowy,
Let the doctors know that if they would like an open forum to publish their findings or concerns they are welcome to use FluTrackers to do so.
The Virus has been tranmitted to The Arbirovirus Departement of Pasteur Institute in Lyon, France.
Doctor Mausy of La Réunion, said the sequences would be deposed at the Genbank.
Doctor Niman is still waiting for the sequence to be seen in Genbank.
I shall contact the poster via her webmail address and hope she replies. I would really like some more details.
According to the World Health Organization (http://en.wikipedia.org/wiki/World_Health_Organization), a pandemic can start when three conditions have been met:
the emergence of a disease new to the population
the agent infects humans, causing serious illness
the agent spreads easily and sustainably among humans.While Chikungunya is not a new disease the virus currently circulating is not acting like Chikungunya. Only very rarely is Chikungunya fatal, the current virus is fatal which means something has changed. If it is mutated Chikungunya or some other disease it clearly satisfies the first requirement for being a pandemic.
The virus being called Chikungunya infects humans and causes serious illness. Therefore is satisfies the second requirement for being a pandemic.
The virus being called Chikungunya has infected 160,000 people in La Reunion in 6 weeks. The virus being called Chikungunya has now been seen in La Reunion and surrounding islands, France, India, Switzerland and now Czech Republic. Therefore is satisfies the third requirement for being a pandemic.
EINet - Newsbrief::
India (Mysore): City is showing signs of a chikungunya epidemic the FAO noted [These are the Czech Republic, France, Germany, Hungary, Poland,
http://depts.washington.edu/einet/newsbrief288.htmlHOME |
Acta Virologica 1/2002::
Veterinary Research Institute, Hudcova 70, Brno 621 32, Czech Republic Experimental transmission of Chikungunya virus by Anopheles stephensi mosquitoes
http://www.aepress.sk/acta/acta01_2003.htmHOME |
Since the virus being called Chikungunya satisifies all the requirements for being a pandemic we can now call it Pandemic Chikungunya.
I have been in contact with few docs at La Réunionsince few months, and they have rightly point out one aspect of the problem.
The mosquitoe gets infected when he darts an infected person and then imagine that mosquito in a family house, he darts its members and they become infected.
The viral load question and its virulence they have not explain tought.
Snowy,
Here is an article that describes a cluster of a disease similar to Chikungunya.
http://www.findarticles.com/p/articles/mi_m0GVK/is_7_10/ai_n6150511
A cluster of protracted migratory polyarthritis involving four adult family members occurred in January 2000 after a brief overnight outing in a rural area of Venezuela. Laboratory testing demonstrated Mayare virus as the cause of the cluster. These results documented the first human cases of Mayaro virus in Venezuela.
**********
Mayaro virus (MAYV), the cause of Mayaro fever, is a member of the genus Alphavirus, family Togaviridae, and is closely related to Chikungunya, O'nyong-nyong, Ross River, Barmah Forest, and Sindbis viruses (1-3). Infection by these viruses produce similar clinical illnesses in humans (4-8). Mayaro fever is typically a denguelike acute febrile illness 3-5 days in duration, characterized by headache, retroorbital pain, arthralgias, arthritis, myalgias, vomiting, diarrhea, and rash (8). However, joint involvement in Mayaro fever may persist for several months and in some cases precede the fever. Moderate-to-severe polyarthritis, occasionally incapacitating, is a prominent feature of the disease (8).
MAYV is enzootic in South America, where the suspected vectors are forest-dwelling Haemagogus mosquitoes, and the vertebrate hosts are marmosets and other nonhuman primates (8). Most human cases occur sporadically and involve persons who work or reside in humid tropical forests (8,9). Nevertheless, several small outbreaks of Mayaro fever have been described in residents of rural communities of the Amazon region of Brazil, Bolivia, and Peru (8-10). Airborne transmission has been reported among laboratory personnel (11). Although MAYV is enzootic in several South American countries, this report describes the first human cases of Mayaro fever in Venezuela. The cases occurred among members of the same family after a single day's exposure to a semirural forested area. The observations we report were made in response to the Ministry of Health's request to determine the cause of the cluster of cases.
The Study
Clinical cases resembling dengue fever were studied in the vicinity of Padron Agriculture Station, in Miranda State, north-central Venezuela (10[degrees] 13'22" N; 66[degrees] 17'56" W; 50 m elevation), a location where entomologic and epidemiologic studies on Venezuelan equine encephalitis virus (VEEV) and other arboviruses were conducted from 1997 to 1998 (12). This area, originally covered by lowland tropical rain forest, was converted into cacao (Theobroma cacao) plantations. Indigenous tall trees (Erythrina poeppigiana, Ceiba pentandra, Ficus sp., Hura crepitans, Baldfinia sp.), were preserved so that the area resembled a natural forest habitat. The mean temperature and annual rainfall were 27.2[degrees]C and 2,324 mm, respectively, with the rainy season normally lasting from May to December.
Four adult members of the same family (age range 26-58 years), spent a single night together in early January 2000 near the Padron Agriculture Station. While sharing an outdoor dinner, they were frequently bitten by mosquitoes. Three days later, all four had a sudden onset of malaise, fever (up to 40[degrees]C), retroocular pain, generalized headache, conjunctival suffusion, flushing of the face and neck, myalgias, and severe incapacitating polyarthralgias and polyarthritis which mainly involved the small joints of the hands, wrists, ankles, and toes. Joints became swollen and tender, but effusion was not evident. Pain was intense and worsened with motion. Limbs felt weak and very sensitive to touch. Joint stiffness in the morning and after inactivity was a prominent complaint. On day 5 of illness, a rapidly spreading maculopapular rash developed, which involved neck, trunk, and limbs. The rash persisted for 2 days, followed by desquamation. In three of the patients, painful cervical, preauricular, and retroauricular lymphadenopathies occurred and lasted approximately 2 weeks. Beyond week 2 of illness, only severe joint symptoms and lower limb hyperesthesias persisted, but they steadily resolved during a 6-month period. Clinical laboratory results were unremarkable except for a transient and mild increase in erythrocyte sedimentation rate and scram levels of alanine aminotransferase, and a moderate lymphocytosis.
Serum samples were obtained 3 months after onset of symptoms, when the patients were first seen at consultation by one of the authors. Samples were also collected an additional 3 months after the initial samples were collected. The patients' initial signs and symptoms resembled a classical febrile syndrome, and the patients had a history of suspected risk for arboviral infection. Therefore, all samples were tested initially at a 1:100 dilution for immunoglobulin (Ig) M antibodies to MAYV; VEEV; dengue viruses (DENV) 1, 2, 3, and 4; yellow fever virus (YFV); and Oropouche virus (OROV) by using an IgM antibody-capture enzyme-linked immunosorbent assay (MACEIA) (9,12). Reactive samples were subsequently retested for IgM antibody at serial dilutions ranging from 1:200 through 1:102,400 to determine endpoint titers. Serum samples were also tested by an indirect ELISA for IgG antibodies to the above-mentioned viruses (9,13). A patient with MAYV disease was defined as a person with compatible clinical illness, for whom IgM antibody titers to MAYV and VEEV were [greater than or equal to] 400 and [less than or equal to] 100, respectively.
Results
Serologic results indicated that three of the four family members had a MAYV viral infection. Assay of serum samples obtained 3 months after onset of symptoms from the three members showed high specific Mayaro viral IgM antibody ranging from 3,200 to 6,400 and IgG antibody titers ranging from 6,400 to 12,800 (Table). Testing of samples from the fourth patient were positive for MAYV IgG antibody only. Subsequent samples taken approximately 3 months later were IgM negative but remained positive for MAYV IgG antibody. All patients were negative for VEEV IgM antibody but had VEEV IgG antibody ranging from 100 to 800. Assay results for DENV and OROV IgM and IgG were negative. Simlarly, the patients were negative for YFV IgM antibody but had IgG antibody to this virus.
Conclusions
MAYV has not been isolated in Venezuela, but isolates have been obtained from humans, wild vertebrates, and mosquitoes in Colombia, Brazil, Suriname, Guyana, French Guiana, Peru, United States, and Bolivia (2,8-10,14-17). In addition, serologic survey data suggest that MAYV infection is relatively common among humans in rural populations of northern South America and the Amazon River basin (2,8,9,14-16). This virus is believed to be maintained in a sylvan cycle involving wild vertebrates, such as nonhuman primates and possibly birds, and Haemagogus mosquitoes (2,8,18). Three species of that genus, H. celeste, H. equinus, and H. lucifer, have recently been identified in the area where the Venezuela patients acquired MAYV infection (12). Also, the red howler monkey (Alouatta seniculus), a suspected host of MAYV in nature, is common in the area. Thus, the results of this study suggest that these first documented cases of Mayaro lever in Venezuela were acquired during an overnight outing in a rural area where MAYV may have been circulating in a cycle involving Haemagogus mosquitoes and red howler monkeys.
Convalescent-phase serum samples from an additional unrelated patient (a 40-year-old woman who lived in a nearby rural location), obtained approximately 4 months after she had recovered from a self-limited febrile illness with polyarthritis similar to that described in the patients involved in this report, showed high (25,600) MAYV IgG antibody titers. These samples were negative for IgM antibody, however, which provides further evidence that MAYV was enzootic in the area.
As observed in this study, Mayaro fever cases are usually sporadic and occur in persons with a history of recent activities in humid tropical forests (4,8,9,19). Typically, Mayaro lever ensues approximately 1 week after infection (4,8). However, shorter incubation periods, similar to those observed in these Venezuelan cases, are occasionally observed. Members of the family described in this outbreak had symptoms and clinical courses consistent with previously documented MAYV patients. Abrupt onset of fever, frontal headaches, myalgias, and incapacitating arthralgias were predominant complaints. A maculopapular rash, also a common manifestation in up to 90% of children and 50% of adults (4,8,9,18), was prominent in these patients, lasting 2 days and followed by desquamation. Up to one third of patients initially have nausea, vomiting, and diarrhea (4,8,9,18,19), but these symptoms were not experienced in this family.
Little information is available on the kinetics of MAYV IgM antibodies for Mayaro fever patients during long-term follow-up examinations. While obtaining acute-phase blood samples from the patients in this study was not possible, existing data indicate that detectable IgM antibody develops after viremia subsides, which is usually 4-5 days after the onset of symptoms (9,19). Our data indicated that IgM antibody persisted for >3 but <6 months for our patients. These are the first documented data on the persistence of IgM antibody following a Mayaro viral infection and will be useful for interpreting diagnostic test results. To our knowledge, this is the first report of human cases of MAYF in Venezuela and, therefore, further documents the public health importance of this disease.
Acknowledgments
We thank the Virology Laboratory at the U.S. Naval Medical Research Center, Lima, Peru, under the guidance of Carolina Guevara, for processing human specimens, and Eduardo Gotuzzo for his support of this study.
This work was supported by Work Unit Number (WUN) No. 847705 82000 25GB B0016 GEIS-LIMA. The opinions and assertions contained herein are those of the authors and are not to be construed as official or reflecting the views of the Department of the Navy or the Naval service at large.
References
(1.) Karabatsos N. Antigenic relationships of group A arboviruses by plaque reduction neutralization test. Am J Trop Med Hyg. 1975;24:527-32.
(2.) Karabatsos N, editor. International catalogue of arboviruses including certain other viruses of vertebrates. 3rd ed. San Antonio (TX): American Society Tropical Medicine and Hygiene; 1985. p. 673-4.
(3.) Calisher CH, Karabatsos N. Arbovirus serogroups: definition and geographic distribution. In: Monath TP, editor. The arboviruses: epidemiology and ecology. Vol. 1 Boca Raton (FL): CRC Press; 1988. p. 19-57.
(4.) Tesh RB. Arthritides caused by mosquito-home viruses. Annu Rev Med. 1982;33:31-40.
(5.) Phillips DA, Murray JR, Aaskov JG, Wiemers MA. Clinical and sub-clinical Barmah Forest virus infection in Queensland. Med J Aust. 1990; 152:463-6.
(6.) Espmark A, Niklasson B. Okelbo disease in Sweden: epidemiological, clinical, and virological data from the 1982 outbreak. Am J Trop Med Hyg. 1984;33:1203-11.
(7.) Anderson CR, Downs WCs Wattley GH, Ahin NW, Reese AA. Mayaro virus: a new human disease agent. Isolation from blood of patients in Trinidad, B.W.I. Am J Trop Med Hyg. 1957;6:1012-6.
(8.) Pinheiro FP, LeDuc JW. Mayaro virus disease. In: Monath TP, editor. The arboviruses: epidemiology and ecology. Vol. 3. Boca Raton (Fl.): CRC Press; 1998. p. 137-50.
(9.) Tesh RB, Watts DM, Russell KL, Karabatsos N, Damodaram C, Cabezas C, et al. Mayaro virus disease: an emerging mosquito-borne zoonosis in tropical South America. Clin Infect Dis. 1999;28:67-73.
(10.) Watts, DM. Mayaro fever. In: Strickland GT, editor. Hunter's tropical medicine and emerging infectious diseases. 8th ed. Philadelphia (PA): W.B. Saunders Co.; 2000. p. 251-2.
(11.) Junt T, Heraud JM, Lelarge J, Labeau B, Talarmin A. Determination of natural versus laborators' human infection with Mayaro virus by molecular analysis. Epidemiol Infect. 1999;123:511-3.
(12.) Salas RA, Garcia CZ, Liria J, Barrera R, Navarro JC, Medina G, et al. Ecological studies of enzootic Venezuelan equine encephalitis in north-central Venezuela, 1997-1998. Am J Trop Med Hyg. 2001 ;64:84-92.
(13.) Watts DM, Lavera W, Callahan J, Rossi C, Oberste MS, Roehrig JT, et al. Venezuelan equine encephalitis and Oropouche virus infections among Peruvian army troops in the Amazon region of Peru. Am J Trop Med Hyg. 1997;56:661-7.
(14.) Metselaar D. Isolation of arboviruses of group A and group C in Suriname. Trop Geogr Med. 1966;18:137-42.
(15.) Talarmin A, Chandler LJ, Kazanji M, De Thoisy B, Debon P, Lelarge J, et al. Mayaro virus fever in French Guiana: isolation, identification and seroprevalence. Am J Trop Med Hyg. 1998;59:452-6.
(16.) Black FL, Hierholzer WJ, Pinheiro FP, Evans AS, Woodall JP, Opton EM, et al. Evidence for persistence of infectious agents in isolated human populations. Am J Epidemiol. 1974;100:230-50.
(17.) Calisher CH, Gutierrez E, Maness KS, Lord RD. Isolation of Mayaro virus from a migrating bird captured in Louisiana in 1967. Bull Pan Am Health Organ. 1974;8:243-8.
(18.) Hoch AL, Peterson NE, LeDue JW, Pinheiro FP. An outbreak of Mayaro virus disease in Belterra, Brazil. Entomological and ecological studies. Am J Trop Med Hyg. 1981;30:689-98.
(19.) Piheiro FP, Freitas RB, Travossos da Rosa JR, Gabbay YB, Mello WA, LeDuc JW. An outbreak of Mayaro virus disease in Belterra, Brazil. I. Clinical and virological findings. Am J Trop Med Hyg. 1981;30:674-81.
Address for correspondence: Jaime R. Tortes, Instituto de Medicina Tropical, UCV, Apartado 47019, Caracas 1041-A, Venezuela, fax: +58-212-987-6590; email: torresj@mailandnews.com
Jaime R. Torres, * Kevin L. Russell, ([dagger]) Clovis Vasquez, ([double dagger]) Roberto Barrera, ([double dagger]) Robert B. Tesh, ([section]) Rosalba Salas, ([paragraph]) and Douglas M. Watts ([section])
* Universidad Central de Venezuela, Caracas, Venezuela; ([dagger]) U.S. Naval Health Research Center, San Diego, California, USA; ([double dagger]) Ministry of Health and Social Welfare, Caracas, Venezuela; ([section]) University of Texas Medical Branch at Galveston, Galveston, Texas, USA; and ([paragraph]) Caribbean Epidemiology Centre, Republic of Trinidad and Tobago
Dr. Torres is a tropical medicine professor at the Universidad Central de Venezuela in Caracas. He is head of the Infectious Diseases Section of the Tropical Medicine Institute. Internal medicine, infectious diseases, and tropical medicine are his specialties. Primary research interests include epidemiology and pathogenesis of tropical endemic infections.
This "spreading where there are no mosquitos" report has no substantiation that I have seen. Could one or two of you post links to the info?
I know that it is in France, but the patients there were in the tropics just before they caught it. Has anybody in France caught it and not been to Reunion or nearby islands? I guess the question some of us have deep in the recesses of our suspicious minds is, "Are the French reports accurate?"
As long as people go to the lower elevations to shop or work, they can get bitten by those horrible insects. I hear of death reports. What is the "new found" mortality from what was a benign illness previously?
In my novel, the survivors settle in the Mira Mesa area of San Diego because of the lack of mosquitos. (I have never been bitten outside of my home.) The whole world may come here soon. (I am not going to feed them. Tell them to bring their own sandwiches for the picnic.)
That would result in sporadic cases, not the widespread outbreak that is occuring.
If you want to try to draw a parallel to the events on La Reunion then here is one.
La Reunion is a French Tourist Island. They have always had very good mosquito control.
Take the city of Miami and have 25% of the population get infected with West Nile in 6 weeks.
It never has happened and it never will happen becuase mosquito born diseases don't spread in that manner.
Oh, and by the way, the birds are dropping dead as well. They say it is due to the spray they are using for the mosquitoes. This is a ridiculous excuse for bird deaths. Almost as ridiculous as the Ukrainian, "The birds are dropping out of the sky and dying because they are exhausted" excuse. And 40% if the island has stopped working.
Thereare indeed some people that got infectes while they swear they havenot been bitten by moskitoes.
An informal survey is being done in the Island about this.
But, but even doctors have pubicly said that they cannot do the tests they want, and are kind of censure.
Since the virus being called Chikungunya satisifies all the requirements for being a pandemic we can now call it Pandemic Chikungunya.
Only if it starts spreading in these new territories - not if it is in isolated cases that have all been in the endemic area I would say.
I have lived in Florida for 20+ years and have had many mosquito exposures. I have never experienced a single mosquito biting every individual in the house. I believe they are full after one or two bites. Also, many mosquitos are killed when the individual swipes at them. The chances of a single mosquito biting, and thus infecting, every member of a household within a specific time frame is remote.
Good point. If a mosie lives long enough, the chances of it biting every individual in a large family are pretty small. Do we know if there is a time interval between individuals contracting the disease within a family or cluster? This would indicate a higher probablity of H2H. The doctors on the ground would know the answer to onset dates in clusters, even if they have not been allowed to conduct tests. Snowy - could you ask your contacts?
My point is this, while family clusters of mosquito born diseases do occur, they are rare.
There are reports from La Reunion of every member of a family becoming ill, these families are not the average american family of 4 but families of 10 people and higher.
Right now the events in La Reunion match only one model that I know of. The model of a Pandemic virus. If anyone has another model that would explain the events of La Reunion and the surrounding areas then by all means bring it forward NOW. I would love to be wrong. However, until another model is presented I cannot believe this to be anything other than a Pandemic virus.
Agreed Florida.
As long as people go to the lower elevations to shop or work, they can get bitten by those horrible insects. I hear of death reports. What is the "new found" mortality from what was a benign illness previously?
In my novel, the survivors settle in the Mira Mesa area of San Diego because of the lack of mosquitos. (I have never been bitten outside of my home.) The whole world may come here soon. (I am not going to feed them. Tell them to bring their own sandwiches for the picnic.)
DB: Do you have any more data on any of the mainland country incidences? Is there any hard evidence that spread has started eg in France or Switzerland from the index cases?
I have been in contact with few docs at La Réunionsince few months, and they have rightly point out one aspect of the problem.
The mosquitoe gets infected when he darts an infected person and then imagine that mosquito in a family house, he darts its members and they become infected.
The viral load question and its virulence they have not explain tought.
Entrée aux Etats Unis
Expediteur: G. Choux
Ville: Saint-Gilles
Mail: gchoux@hotmail.com
Rubrique: Autre
Date: 28-02-2006
Time: 17:02:52
Commentaires
Une rumeur court selon laquelle l'entrée aux USA serait interdite aux personnes en provenance de la Réunion. Quelqu'un a-t-il des éléments à apporter sur cette question?
Machine Translation:
A rumour runs according to which the entry in the USA would be prohibited to the people coming from the Meeting. Does somebody have elements to bring on this question?
Can anyone verify the rumor that people coming from La Reunion cannot enter the United States?
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