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Japanese Encephalitis outbreak among children in Mayurbhanj, Odisha-India, 2015
Abstracts / International Journal of Infectious Diseases 53S (2016) 4–163
19.085
19.086
Potential zoonotic pathogens in bat species in South Africa
Tick-borne zoonotic bacteria in fallow deer (Dama dama) in Euganean Hills Regional Park of Italy
W. Markotter a,∗ , M. Dietrich a , M. Geldenhuys a , T. Kearney b , S. McCulloch a , M. Mortlock a , E. Seamark c , P. Janse van Vuren d , J. Weyer d , J. Paweska d a
University of Pretoria, Centre for Viral Zoonoses, Department of Medical Virology, Pretoria/ZA b Ditsong National Museum of Natural History, Pretoria/ZA c AfricanBats, Pretoria/ZA d National Institute for Communicable Diseases, Centre for Emerging and Zoonotic Diseases, Pretoria/ZA Purpose: Bats host a suite of pathogens and with several of these, the route of transmission to humans and other animals is unknown. Factors such as the availability of food resources, age, reproductive status, movement behaviour and population density have all been factors which effects the risk of infections within host populations. In addition to opportunistic short term surveillance, this study included longitudinal surveillance and the possibility of seasonal variation of pathogen prevalence. It also focus on pathogen presence in excretions to determine possible route and the risk of transmission. Methods & Materials: In 2004 we initiated surveillance in bats with the initial objective to identify rabies–related lyssaviruses but this has since expanded to include several other pathogens. We used nucleic acid detection techniques to detect partial pathogen genomes (RT-PCR or PCR) and virus neutralization assays to test for presence of antibodies. Furthermore, excretions (saliva, feaces and urine) from insectivorous bats were evaluated to determine the pathogen composition by using next generation sequencing techniques. Results: We reported ten new isolations of the rabies related viruses, Lagos bat (LBV) and Duvenhage virus. We indicated that frugivorous bats (Epomophorus wahlbergii and Rousettus aegyptiacus) maintain a high level (30–67%) of seropositivity against LBV and Nycteris thebaica and Miniopterus natalensis tested seropositive for Duvenhage virus, implicating these species as possible reservoir hosts. We reported the first detection of corona, paramyxo and filoviruses in South African bats as well as the first reports of Bartonella and Rickettsia. Longitudinal studies, specifically focused on cave dwelling fruit bats and measuring the presence of LBV antibodies over time, indicated cyclic fluctuation of antibodies with marked increases shortly after the parturition period. Metagenomic studies on excretions of insectivorous bats identified possible zoonotic pathogens such as Leptospira, Rickettsia, Bartonella, Coxiella, Adeno-, Herpes-, Picorna-, and Coronaviridae. Conclusion: Serological evidence obtained can be used to infer periods of increased virus circulation. These caves are used for traditional activities and information can be used to identify high risk periods for entry. We identified several pathogens that are being shed into the environment, potentially infecting other species. The collective data can be used to inform prevention and control strategies. http://dx.doi.org/10.1016/j.ijid.2016.11.154
61
M.L. Menandro a , M. Martini a,∗ , G. Dotto a , A. Mondin a , G. Ziron b , D. Pasotto a a
University of Padua, Department of Animal Medicine, Production and Health, Legnaro, PD/IT b Euganean Hills Regional Park, Este (PD)/IT
Purpose: In the last decades an increasing incidence of tickborne zoonoses (TBZ) has been reported in Europe. This trend regards in particular pathogens transmitted by Ixodes ricinus, which is the main vector of several viral, bacterial, and protozoan zoonotic infections. This tick species feeds on a broad range of mammals, birds and reptiles and frequently bites human. The aim of the study was to investigate the prevalence of zoonotic bacteria (Borrelia burgdorferi sensu lato, Rickettsia spp., Anaplasma spp. and Ehrlichia spp.) transmitted by ticks in a population of fallow deer (Dama dama) in the tourist area of Euganean Hills Regional Park, Veneto Region, Italy. Methods & Materials: The study was conducted over a 13 months period from March 2014 to March 2015. The presence of B. burgdorferi s.l., Rickettsia spp., Anaplasma spp. and Ehrlichia spp. was evaluated by PCR and real time PCR assays on 61 blood samples of fallow deer culled during the population control campaigns by the park operators. PCR assays were targeted to groEL (B. burgdorferi s.l.), gltA (Rickettsia spp.) and 16S rRNA (Anaplasma spp. and Ehrlichia spp.) genes. Amplicons were purified and directly sequenced. The nucleotide sequences were analyzed using the basic local alignment search tool (BLAST). Results: Eighteen samples (29,5%) were positive for A. phagocytophilum and one (1,6%) for Ehrlichia spp. BLAST analyses showed sequence identity ranging from 97% to 100% with those already present in the database. None of fallow deer tested carried B. burgdorferi and Rickettsia spp. Conclusion: The results demonstrate the presence of zoonotic tick-borne pathogens in the studied area. Although the most dangerous pathogen, B. burgdorferi, was not detected, our results underline the risk of human recreational or professional exposure to infections during the outdoor activity or manipulation of hunted animals. Furthermore, the presence of deer populations in periurban areas promotes the diffusion of ticks and increases the TBZ of humans and domestic animals. http://dx.doi.org/10.1016/j.ijid.2016.11.155 19.088 Japanese Encephalitis outbreak among children in Mayurbhanj, Odisha-India, 2015 P. Nayak a,∗ , A. Pradhan b , S. Sethi b , B. Patnaik b , M. Pradhan b , K.C. Dash b a
National Centre for Disease Control, Epidemiology, New Delhi, DELHI/IN b Directorate of Public Health, Odisha, Bhubaneswar/IN Purpose: Japanese Encephalitis (JE) is one of the leading causes of viral encephalitis in Asia. Annually 50,000 cases are reported in India with 30% deaths and 75% disability, but burden may be underestimated because many suspected outbreaks are not confirmed. During September-November, 2015 a viral encephalitis epidemic among children was reported from Mayurbhanj district, Odisha,
62
Abstracts / International Journal of Infectious Diseases 53S (2016) 4–163
India. We investigated to identify the etiology and understand epidemiological characteristics of the outbreak. Methods & Materials: A case was defined as illness among children <15 years, presenting with fever, vomiting, altered sensorium and convulsions in Mayurbhanj during September-November 2015. We reviewed medical records to find cases. We collected serum and cerebrospinal fluid (CSF) samples from case-patients to test for JE IgM ELISA at the Regional Medical Research Centre (RMRC) laboratory. Environmental and entomological surveys were conducted and 80 mosquitos were processed in 8 batches for reverse transcriptase polymerase chain reaction (RTPCR) at RMRC. Results: We identified 20 cases (67% female; median age 3 years [range: 1.5-4.6 years]) including 2 deaths. Among 20 serum and 4 CSF samples, 12 (60%) serum samples and all CSF specimens were JE IgM positive. Entomological survey showed the prevalence of Culex vishnui (larvae and adult), a known vector for JE. Rice field with stagnant water were found close to the affected households. Two batches of mosquito samples containing Culex vishnui and Culex gelidus species positive for JE based on RTPCR. Conclusion: Our investigation confirmed the JE outbreak based on clinical specimens and substantiated by presence of JE virus in the vector mosquitoes. An integrated vector control approach with continuous monitoring and high JE vaccine coverage for eligible children is recommended to prevent epidemics. http://dx.doi.org/10.1016/j.ijid.2016.11.156 19.089 Experience in treatment of residual cystic echinococcosus in children L. Ermakova a , N. Pshenichnaya b,∗ , T. Tverdokhlebova a , Y. Kirtanasov c , K. Bolatchiev d a
Rostov Research Institute of Microbiology and Parasitology, Clinic of parasitology, Rostov-on-Don/RU b Rostov State Medical University, Infectious Diseases, Rostov-on-Don/RU c Rostov regional hospital #2, Department of surgery, Rostov-on-Don/RU d Rospotrebnadzor on Karachaevo-Cherkessia Republic, Epidemiological department, Cherkessk/RU Purpose: Cystic Echinococcosis (CE) remains a relevant interdisciplinary health problem, due to a significant number of residual and recurrent forms and absence of consensus on effectiveness of anthelmintic drugs in treatment of recurrent and residual CE Methods & Materials: We reported 2 cases of residual CE in clinic of the Rostov scientific research institute of microbiology and parasitology. Results: The diagnosis of CE in first was diagnosed in a 8-year old girl in 2000. In 2003 the patient was operated due to liver CE. During an ultrasound examination of the abdominal cavity in 2004 2 new cysts (20 and 25 mm) in IV, V liver segments were recorded. Treatment was conducted with mebendazole in a daily dosage of 400 mg for 28 days with intervals of 14 days on the background therapy. Child received 5 courses of therapy. In 2004 abdominal CT scan detected large (80 mm) residual hepatic cyst, located below the diaphragm in the VII segment of the liver. Parasitic cysts had a thick calcificated shell (more than 7 mm), filled with heterogeneous content, and two cysts in the IV, V liver segments up to 20 mm with thick calcificated shells. The patient observed in the clinic during 11 years. Data of CT scan of the abdominal cavity in 2015 showed no increase in the cysts.
In November 2010, a 7-year old child received operative treatment with multiple CE (liver and right lung). The cyst of the right lung (70 mm) was removed surgically. For prevention of recurrence CE child was observed and received conservative therapy in the clinic of parasitic diseases. Patient received 3 courses of therapy with albendazole. Treatment conducted by a dose of 15 mg / kg daily for 28 days with an interval of 14 days. The child observed in the clinic until now. X-ray examination in March 2016 did not show any signs of relapse of lung echinococcosis. Ultrasonic research of the abdominal cavity indicated a reduction of the size of the residual liver cysts. Conclusion: These cases show the effectiveness of albendazole and mebendazole for the treatment of residual liver CE. http://dx.doi.org/10.1016/j.ijid.2016.11.157 19.090 Eco-epidemiological analysis of rickettsia infection in rural areas from Colombia: A multilevel approach J.C. Quintero Vélez a,∗ , L. Osorio b , A. Uribe c , C. Muskus c , C. Rojas d a
University of Antioquia, Antioquia, Medellín, ANTIOQUIA/CO b university of Antioquia, public Health Faculty, Medellín/CO c University of Antioquia, Medicine Faculty, Medellín/CO d University of Antioquia, Public Health Faculty, Medellín/CO
Purpose: Rickettsiosis is a re-emergent disease that is not the subject of epidemiological surveillance in Colombia. Rickettsia cases are generally undiagnosed and several lethal outbreaks have been reported in Colombia during the last decade. The aim of this study is to analyze eco-epidemiological aspects of rickettsia infection in two of the towns with previous reported outbreaks. Methods & Materials: A cross-sectional study was conducted enrolling 597 people living in 246 houses from nine villages in two towns in Colombia from November 2015 to January 2016. Sociodemographic and housing conditions information (exposures) was collected by interview. Blood samples were collected to assess rickettsia infection in humans, horses and dogs (IFA, cut-off=1/128). In addition, ticks from humans and animals were evaluated for Rickettsia infection by qPCR targeting gltA and OmpB genes. All participants signed an informed consent. Data were analyzed by a multilevel logistic regression model using two levels (house and village) and seropositivity as the main outcome. Results: Overall prevalence of infection by Rickettsia was 25.6% (95%CI 22.2-29.3). Four zones with higher proportion of infection in both people and animals were identified. Spotted Fever Group Rickettsia was detected in Amblyomma ticks from humans and animals. The multivariate model showed the association between working outdoors and infection was confounded by age (years) and sex (male) (ORcrude = 2.25, 95%CI 1.47-3.46; ORadjust =1.06, 95%CI 0.61-1.85). Sex and age is a risk marker for rickettsia infection in this zone (ORmen =1.88, 95%CI 1.15-3.07) and OR35years vs 10years =1.59, 95%CI 1.19-2.10). Not farming into the forest is a protection factor (OR=0.49, 95%CI 95:0.29-0.82) and the proportion of seropositive animals is strongly associated with human infection (ORproportion52.9% vs proportion8.7% =3.58, IC95:1.69-3.73). The model revealed variability among houses but not among villages (RandomEffecthouses =0.65 ± Std. Err=0.25, 95%CI 0.30-1.39 and RandomEffectvillages =0.11±StdErr=0.29, 95%CI 0.00-21.46).
19.085
19.086
Potential zoonotic pathogens in bat species in South Africa
Tick-borne zoonotic bacteria in fallow deer (Dama dama) in Euganean Hills Regional Park of Italy
W. Markotter a,∗ , M. Dietrich a , M. Geldenhuys a , T. Kearney b , S. McCulloch a , M. Mortlock a , E. Seamark c , P. Janse van Vuren d , J. Weyer d , J. Paweska d a
University of Pretoria, Centre for Viral Zoonoses, Department of Medical Virology, Pretoria/ZA b Ditsong National Museum of Natural History, Pretoria/ZA c AfricanBats, Pretoria/ZA d National Institute for Communicable Diseases, Centre for Emerging and Zoonotic Diseases, Pretoria/ZA Purpose: Bats host a suite of pathogens and with several of these, the route of transmission to humans and other animals is unknown. Factors such as the availability of food resources, age, reproductive status, movement behaviour and population density have all been factors which effects the risk of infections within host populations. In addition to opportunistic short term surveillance, this study included longitudinal surveillance and the possibility of seasonal variation of pathogen prevalence. It also focus on pathogen presence in excretions to determine possible route and the risk of transmission. Methods & Materials: In 2004 we initiated surveillance in bats with the initial objective to identify rabies–related lyssaviruses but this has since expanded to include several other pathogens. We used nucleic acid detection techniques to detect partial pathogen genomes (RT-PCR or PCR) and virus neutralization assays to test for presence of antibodies. Furthermore, excretions (saliva, feaces and urine) from insectivorous bats were evaluated to determine the pathogen composition by using next generation sequencing techniques. Results: We reported ten new isolations of the rabies related viruses, Lagos bat (LBV) and Duvenhage virus. We indicated that frugivorous bats (Epomophorus wahlbergii and Rousettus aegyptiacus) maintain a high level (30–67%) of seropositivity against LBV and Nycteris thebaica and Miniopterus natalensis tested seropositive for Duvenhage virus, implicating these species as possible reservoir hosts. We reported the first detection of corona, paramyxo and filoviruses in South African bats as well as the first reports of Bartonella and Rickettsia. Longitudinal studies, specifically focused on cave dwelling fruit bats and measuring the presence of LBV antibodies over time, indicated cyclic fluctuation of antibodies with marked increases shortly after the parturition period. Metagenomic studies on excretions of insectivorous bats identified possible zoonotic pathogens such as Leptospira, Rickettsia, Bartonella, Coxiella, Adeno-, Herpes-, Picorna-, and Coronaviridae. Conclusion: Serological evidence obtained can be used to infer periods of increased virus circulation. These caves are used for traditional activities and information can be used to identify high risk periods for entry. We identified several pathogens that are being shed into the environment, potentially infecting other species. The collective data can be used to inform prevention and control strategies. http://dx.doi.org/10.1016/j.ijid.2016.11.154
61
M.L. Menandro a , M. Martini a,∗ , G. Dotto a , A. Mondin a , G. Ziron b , D. Pasotto a a
University of Padua, Department of Animal Medicine, Production and Health, Legnaro, PD/IT b Euganean Hills Regional Park, Este (PD)/IT
Purpose: In the last decades an increasing incidence of tickborne zoonoses (TBZ) has been reported in Europe. This trend regards in particular pathogens transmitted by Ixodes ricinus, which is the main vector of several viral, bacterial, and protozoan zoonotic infections. This tick species feeds on a broad range of mammals, birds and reptiles and frequently bites human. The aim of the study was to investigate the prevalence of zoonotic bacteria (Borrelia burgdorferi sensu lato, Rickettsia spp., Anaplasma spp. and Ehrlichia spp.) transmitted by ticks in a population of fallow deer (Dama dama) in the tourist area of Euganean Hills Regional Park, Veneto Region, Italy. Methods & Materials: The study was conducted over a 13 months period from March 2014 to March 2015. The presence of B. burgdorferi s.l., Rickettsia spp., Anaplasma spp. and Ehrlichia spp. was evaluated by PCR and real time PCR assays on 61 blood samples of fallow deer culled during the population control campaigns by the park operators. PCR assays were targeted to groEL (B. burgdorferi s.l.), gltA (Rickettsia spp.) and 16S rRNA (Anaplasma spp. and Ehrlichia spp.) genes. Amplicons were purified and directly sequenced. The nucleotide sequences were analyzed using the basic local alignment search tool (BLAST). Results: Eighteen samples (29,5%) were positive for A. phagocytophilum and one (1,6%) for Ehrlichia spp. BLAST analyses showed sequence identity ranging from 97% to 100% with those already present in the database. None of fallow deer tested carried B. burgdorferi and Rickettsia spp. Conclusion: The results demonstrate the presence of zoonotic tick-borne pathogens in the studied area. Although the most dangerous pathogen, B. burgdorferi, was not detected, our results underline the risk of human recreational or professional exposure to infections during the outdoor activity or manipulation of hunted animals. Furthermore, the presence of deer populations in periurban areas promotes the diffusion of ticks and increases the TBZ of humans and domestic animals. http://dx.doi.org/10.1016/j.ijid.2016.11.155 19.088 Japanese Encephalitis outbreak among children in Mayurbhanj, Odisha-India, 2015 P. Nayak a,∗ , A. Pradhan b , S. Sethi b , B. Patnaik b , M. Pradhan b , K.C. Dash b a
National Centre for Disease Control, Epidemiology, New Delhi, DELHI/IN b Directorate of Public Health, Odisha, Bhubaneswar/IN Purpose: Japanese Encephalitis (JE) is one of the leading causes of viral encephalitis in Asia. Annually 50,000 cases are reported in India with 30% deaths and 75% disability, but burden may be underestimated because many suspected outbreaks are not confirmed. During September-November, 2015 a viral encephalitis epidemic among children was reported from Mayurbhanj district, Odisha,
62
Abstracts / International Journal of Infectious Diseases 53S (2016) 4–163
India. We investigated to identify the etiology and understand epidemiological characteristics of the outbreak. Methods & Materials: A case was defined as illness among children <15 years, presenting with fever, vomiting, altered sensorium and convulsions in Mayurbhanj during September-November 2015. We reviewed medical records to find cases. We collected serum and cerebrospinal fluid (CSF) samples from case-patients to test for JE IgM ELISA at the Regional Medical Research Centre (RMRC) laboratory. Environmental and entomological surveys were conducted and 80 mosquitos were processed in 8 batches for reverse transcriptase polymerase chain reaction (RTPCR) at RMRC. Results: We identified 20 cases (67% female; median age 3 years [range: 1.5-4.6 years]) including 2 deaths. Among 20 serum and 4 CSF samples, 12 (60%) serum samples and all CSF specimens were JE IgM positive. Entomological survey showed the prevalence of Culex vishnui (larvae and adult), a known vector for JE. Rice field with stagnant water were found close to the affected households. Two batches of mosquito samples containing Culex vishnui and Culex gelidus species positive for JE based on RTPCR. Conclusion: Our investigation confirmed the JE outbreak based on clinical specimens and substantiated by presence of JE virus in the vector mosquitoes. An integrated vector control approach with continuous monitoring and high JE vaccine coverage for eligible children is recommended to prevent epidemics. http://dx.doi.org/10.1016/j.ijid.2016.11.156 19.089 Experience in treatment of residual cystic echinococcosus in children L. Ermakova a , N. Pshenichnaya b,∗ , T. Tverdokhlebova a , Y. Kirtanasov c , K. Bolatchiev d a
Rostov Research Institute of Microbiology and Parasitology, Clinic of parasitology, Rostov-on-Don/RU b Rostov State Medical University, Infectious Diseases, Rostov-on-Don/RU c Rostov regional hospital #2, Department of surgery, Rostov-on-Don/RU d Rospotrebnadzor on Karachaevo-Cherkessia Republic, Epidemiological department, Cherkessk/RU Purpose: Cystic Echinococcosis (CE) remains a relevant interdisciplinary health problem, due to a significant number of residual and recurrent forms and absence of consensus on effectiveness of anthelmintic drugs in treatment of recurrent and residual CE Methods & Materials: We reported 2 cases of residual CE in clinic of the Rostov scientific research institute of microbiology and parasitology. Results: The diagnosis of CE in first was diagnosed in a 8-year old girl in 2000. In 2003 the patient was operated due to liver CE. During an ultrasound examination of the abdominal cavity in 2004 2 new cysts (20 and 25 mm) in IV, V liver segments were recorded. Treatment was conducted with mebendazole in a daily dosage of 400 mg for 28 days with intervals of 14 days on the background therapy. Child received 5 courses of therapy. In 2004 abdominal CT scan detected large (80 mm) residual hepatic cyst, located below the diaphragm in the VII segment of the liver. Parasitic cysts had a thick calcificated shell (more than 7 mm), filled with heterogeneous content, and two cysts in the IV, V liver segments up to 20 mm with thick calcificated shells. The patient observed in the clinic during 11 years. Data of CT scan of the abdominal cavity in 2015 showed no increase in the cysts.
In November 2010, a 7-year old child received operative treatment with multiple CE (liver and right lung). The cyst of the right lung (70 mm) was removed surgically. For prevention of recurrence CE child was observed and received conservative therapy in the clinic of parasitic diseases. Patient received 3 courses of therapy with albendazole. Treatment conducted by a dose of 15 mg / kg daily for 28 days with an interval of 14 days. The child observed in the clinic until now. X-ray examination in March 2016 did not show any signs of relapse of lung echinococcosis. Ultrasonic research of the abdominal cavity indicated a reduction of the size of the residual liver cysts. Conclusion: These cases show the effectiveness of albendazole and mebendazole for the treatment of residual liver CE. http://dx.doi.org/10.1016/j.ijid.2016.11.157 19.090 Eco-epidemiological analysis of rickettsia infection in rural areas from Colombia: A multilevel approach J.C. Quintero Vélez a,∗ , L. Osorio b , A. Uribe c , C. Muskus c , C. Rojas d a
University of Antioquia, Antioquia, Medellín, ANTIOQUIA/CO b university of Antioquia, public Health Faculty, Medellín/CO c University of Antioquia, Medicine Faculty, Medellín/CO d University of Antioquia, Public Health Faculty, Medellín/CO
Purpose: Rickettsiosis is a re-emergent disease that is not the subject of epidemiological surveillance in Colombia. Rickettsia cases are generally undiagnosed and several lethal outbreaks have been reported in Colombia during the last decade. The aim of this study is to analyze eco-epidemiological aspects of rickettsia infection in two of the towns with previous reported outbreaks. Methods & Materials: A cross-sectional study was conducted enrolling 597 people living in 246 houses from nine villages in two towns in Colombia from November 2015 to January 2016. Sociodemographic and housing conditions information (exposures) was collected by interview. Blood samples were collected to assess rickettsia infection in humans, horses and dogs (IFA, cut-off=1/128). In addition, ticks from humans and animals were evaluated for Rickettsia infection by qPCR targeting gltA and OmpB genes. All participants signed an informed consent. Data were analyzed by a multilevel logistic regression model using two levels (house and village) and seropositivity as the main outcome. Results: Overall prevalence of infection by Rickettsia was 25.6% (95%CI 22.2-29.3). Four zones with higher proportion of infection in both people and animals were identified. Spotted Fever Group Rickettsia was detected in Amblyomma ticks from humans and animals. The multivariate model showed the association between working outdoors and infection was confounded by age (years) and sex (male) (ORcrude = 2.25, 95%CI 1.47-3.46; ORadjust =1.06, 95%CI 0.61-1.85). Sex and age is a risk marker for rickettsia infection in this zone (ORmen =1.88, 95%CI 1.15-3.07) and OR35years vs 10years =1.59, 95%CI 1.19-2.10). Not farming into the forest is a protection factor (OR=0.49, 95%CI 95:0.29-0.82) and the proportion of seropositive animals is strongly associated with human infection (ORproportion52.9% vs proportion8.7% =3.58, IC95:1.69-3.73). The model revealed variability among houses but not among villages (RandomEffecthouses =0.65 ± Std. Err=0.25, 95%CI 0.30-1.39 and RandomEffectvillages =0.11±StdErr=0.29, 95%CI 0.00-21.46).