Emerging Infectious Diseases Volume 19 Issue 2

2013·8.7 MB·English

by  CDC

Emerging Infectious Diseases is a peer-reviewed journal established expressly to promote the recognition of new and
reemerging infectious diseases around the world and improve the understanding of factors involved in disease emergence, prevention, and elimination.
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Email to [email protected].
February 2013
On the Cover
Lessons and Challenges for
Georges de La Tour (1593‒1652) Measles Control from Unexpected
Large Outbreak, Malawi .....................202
La Femme à la puce
(The Flea Catcher) (1638) A. Minetti et al.
Oil on canvas (90 cm x 120 cm) Supplementary immunization activities are
crucial to reduce the number of susceptible
Musée Lorrain, Nancy.
children.
Photo P. Mignot
About the Cover p. 350
Nipah Virus Infection Outbreak with
Nosocomial and Corpse-to-Human
Transmission, Bangladesh ...............210
H.M.S. Sazzad et al.
Particularly vulnerable are health care workers
who do not use personal protective equipment
and persons who do not wash hands after
traditional burial practices.
Perspective
Research
Rift Valley Fever and a New Paradigm
of Research and Development for
Zoonotic Disease Control ..................189
O. Dar et al.
To control this disease, funding and research Laboratory-based
p. 198
should be prioritized on the basis of determined Surveillance for Hepatitis E
needs.
Virus Infection, United States,
2005–2012 ..........................218
Synopses
J. Drobeniuc et al.
Clinicians should consider this virus in the
differential diagnosis of hepatitis, regardless of
travel history.
Eastern Equine Encephalitis p. 232
Severe Lower Respiratory Tract
in Children, Massachusetts
Infection in Early Infancy and
and New Hampshire,
Pneumonia Hospitalizations among
1970–2010 ..........................194
Children, Kenya .................................223
M.A. Silverman et al.
P.K. Munywoki et al.
A short prodrome in children is associated
Close postdischarge follow-up could help
with more severe disease and increased risk
prevent future severe respiratory disease.
for death.
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 2, February 2013
Plague Outbreak in Libya, 2009,
Unrelated to Plague in Algeria ..........230
February 2013
N. Cabanel et al.
Neighboring but independent (unlinked) plague
278 Kyasanur Forest Disease, India,
foci coexist in Libya and Algeria.
2011–2012
G.S. Kasabi et al.
Phylogenetic and Ecologic
Perspectives of a Monkeypox 282 Macrolide- and Rifampin-
Outbreak, Southern Sudan, 2005 ......237 Resistant Rhodococcus equi
Y. Nakazawa et al. on a Horse Breeding Farm,
Evidence supports the Congo Basin origin of Kentucky, USA
the causative agent of this outbreak. A.J. Burton et al.
286 Campylobacter Infection in
Rift Valley Fever, Sudan,
Poultry-Processing Workers,
2007 and 2010 .....................................246
Virginia, 2008–2011
I.E. Aradaib et al.
p. 256 M.A. de Perio et al.
Viral sequences analyzed indicate recent
virus movement and support the need for
surveillance. 289 Human Granulocytic
Anaplasmosis, Japan
Historical Review N. Ohashi et al.
Lessons from the History of
293 Genetic Variants of Echovirus
Quarantine, from Plague to
13, Northern India, 2010
Influenza A ...........................................254 H.S. Maan et al.
E. Tognotti
The complex and controversial history of this
297 Transmission and Maintenance
centuries-old public health strategy offers
Cycle of Bartonella quintana in
guidance for its future use.
Rhesus Macaques, China
p. 269 H. Li et al.
Dispatches
260 Crimean-Congo Hemorrhagic 301 Borrelia crocidurae
Fever Virus in Ticks from Meningoencephalitis,
Migratory Birds, Morocco West Africa
A.M. Palomar et al. S. Goutier et al.
264 Hepatitis E Virus in Pork Liver 305 Influenza A(H5N1) Virus
Sausage, France Surveillance at Live Poultry
A. Berto et al. Markets, Cambodia, 2011
S.V. Horm et al.
267 Human Infection with Rickettsia
sibirica mongolitimonae, Spain, 309 Risk Factors for Influenza
2007–2011 A(H1N1)pdm09 among Students,
J.M. Ramos et al. Beijing, China
Y. Zheng et al.
270 Ebola Virus Antibodies in Fruit
Bats, Bangladesh 313 Risk Perceptions for Avian
K.J. Olival et al. Influenza Virus Infection among
Poultry Workers, China
Q. Yu et al.
274 Usutu Virus, Italy, 1996
H. Weissenböck et al.
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 2, February 2013
335 Imported Hepatitis E Virus,
Central African Republic, 2011
February 2013
337 Clustered Cases of Rickettsia
317 High Seroprevalence for
sibirica mongolitimonae
Typhus Group Rickettsiae,
Infection, France
Southwestern Tanzania
T. Dill et al.
338 Rickettsiae in Ticks, Japan,
Letters 2007–2011
321 Acute Schmallenberg Virus 341 Tropheryma whipplei
Infections, France, 2012 Genotypes 1 and 3,
Central Europe
322 Toscana Virus Isolated from
Sandflies, Tunisia 342 Yersinia pestis Plasminogen
Activator Gene Homolog in
324 Seroprevalence of Dengue in p. 298 Rat Tissues
American Samoa, 2010
344 Coxiella burnetii in Ticks,
326 Delayed Diagnosis of Argentina
Dirofilariasis and Complex
Ocular Surgery, Russia 346 Epizootic Hemorrhagic Disease
in Brocket Deer, Brazil
328 Lymphocytic Choriomeningitis
Virus Infections among p. 345 Book Review
American Indians
349 Spillover: Animal Infection and
330 Streptococcus suis Meningitis the Next Human Pandemic
in Swine Worker,
Minnesota, USA
About the Cover
331 Streptococcus suis and Porcine
350 The Iconography of Vermin
Reproductive and Respiratory
Syndrome, Vietnam
Etymologia
263 Quarantine
333 Hepatitis E Virus
Seroprevalence among
The opinions expressed by authors contribut-
Men Who Have Sex with Men,
ing to this journal do not necessarily reflect the
United Kingdom
opinions of the Centers for Disease Control and
Prevention or the institutions with which the
authors are affiliated.
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 2, February 2013
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Rift Valley Fever and a
New Paradigm of Research
and Development for
Zoonotic Disease Control
Osman Dar, Sabrina McIntyre, Sue Hogarth, and David Heymann
Although Rift Valley fever is a disease that, through its Although the disease disproportionately affects vul-
wider societal effects, disproportionately affects vulnerable nerable communities with low resilience to economic and
communities with poor resilience to economic and environ- environmental challenges, RVF has remained largely ne-
mental challenge, Rift Valley fever virus has since its dis- glected by major global donors and disease control pro-
covery in 1931 been neglected by major global donors and
grams. With high numbers of competent vector species
disease control programs. We describe recent outbreaks af-
present in disease-free regions, the intensification of inter-
fecting humans and animals and discuss the serious socio-
national trade in live animals, and the uncertain effects of
economic effects on the communities affected and the slow
climate change, RVF is now considered a major challenge
pace of development of new vaccines. We also discuss
in global zoonotic disease control (2).
the mixed global response, which has largely been fueled
by the classification of the virus as a potential bioterrorism
agent and its potential to migrate beyond its traditional east- Recent Outbreaks
ern African boundaries. We argue for a refocus of strategy The potential of RVFV to migrate was established af-
with increased global collaboration and a greater sense of ter large outbreaks of RVF occurred among animals and
urgency and investment that focuses on an equity-based humans in Egypt in 1977, in other geographic zones of Af-
approach in which funding and research are prioritized by rica, and then outside the African continent in Saudi Arabia
need, inspired by principles of equity and social justice.
and Yemen in 2000 (3,4). The Figure illustrates how the
disease has traveled away from its original identified loca-
Since Rift Valley fever virus (RVFV) was first iden- tion in humans and animals.
tified in 1931, after an investigation of an epizo- The Table further demonstrates the spread of the dis-
otic among sheep on a farm in the Great Rift Valley of ease; 7 of 9 major outbreaks in the past 15 years resulted
Kenya, the understanding of this zoonotic disease has in human cases outside the Rift Valley region in East Af-
grown considerably (1). With the rapid progress of molec- rica. The Table also highlights the difficulty of developing
ular biology and genetic techniques in recent years, studies adequate surveillance systems and therefore the difficulty
of prevailing circulating variants of RVFV have pointed to
a recent common ancestor that existed during 1880–1890.
This finding lends weight to the predominant hypothesis
on the origins of human outbreaks of Rift Valley fever,
which suggests that the development of industrialized agri-
culture systems and the introduction of highly susceptible
European breeds of livestock into East Africa during the
colonial era led to amplification of the virus in animal and
arthropod vectors and may have been responsible for the
establishment of the disease (2).
Author affiliations: London School of Hygiene and Tropical Medicine,
London, UK (O. Dar, S. McIntyre, S. Hogarth); Chatham House Cen-
tre on Global Health Security, London (D. Heymann); and London Figure. Geographic distribution of Rift Valley fever outbreaks
School of Hygiene and Tropical Medicine, London (D. Heymann) in animals and humans, 1997–2010 (5). Source: World Health
Organization (full map available online, wwwnc.cdc.gov/EID/
DOI: http://dx.doi.org/10.3201/eid1902.120941 article/19/2/12-0941-F1.htm).
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 2, February 2013 189
PERSPECTIVE
of accurately estimating morbidity and mortality rates for by animal exporters, and the limited options for prevention
human populations in resource-poor settings. In the 5 out- and treatment have periodically led to summary bans of
breaks for which estimated numbers of human cases have imports of livestock from disease-endemic areas.
been published, ≈339,000 infections are believed to have The ban of livestock imports to the Middle East from
occurred. In the 4 outbreaks for which estimated and re- East Africa, instituted after the 1997/1998 RVFV out-
ported cases are documented, numbers of estimated cases break in Kenya and Somalia, particularly affected the ex-
are 78× higher than numbers of reported cases (Table). port trade out of Somalia. The ban was variably enforced
This difference between estimated and known numbers by several Middle Eastern countries but most notably by
of cases highlights the inherent complexity of manag- Saudi Arabia, which imports large numbers of ruminants
ing outbreaks, monitoring their spread, and mitigating for the annual Hajj pilgrimage. In 1997, the year before
their effects. the onset of the ban, 2.8 million live animals were ex-
ported from the Somaliland port of Berbera, making it the
Socioeconomic Effects single biggest exporting port for ruminants in the world
There is a paucity of studies that have examined the that year. With the livestock trade accounting for 65%
socioeconomic effects of past outbreaks of RVFV, which of gross domestic product in Somaliland, the export ban
reflects a lack of research focus on the broader social ef- had a devastating effect on a region already suffering in
fects of the disease. One study that did examine the so- the grip of a protracted civil war (27). Estimated losses
cioeconomic effects of the 2006/2007 RVFV outbreak in from export sales out of Somaliland alone for the first 16
Kenya highlighted the concern that the outbreak had tend- months of the ban from February 1998 to May 1999 to-
ed to disproportionately affect impoverished pastoralist taled $109 million (28). By the time the ban on animal
communities, with those in the North Eastern Province of imports was lifted by Saudi Arabia in 2009, this drought-
Kenya being hardest hit (25,26). The lack of understanding and war-affected region of East Africa had already en-
of the epidemiology and pathophysiology of RVFV, poor dured many years of lost income because of prevailing
compliance with international health and safety standards fears concerning RVFV.
Table. Major Rift Valley fever outbreaks and reported cases among humans, 1997–2010*
Geographic Estimated No. cases No. deaths
Outbreak dates distribution no. cases reported confirmed Precipitation Control measures
1997 Dec–1998 Jan Kenya, 89,000 No 478 Heavy rainfall Active surveillance; safety
Somalia, documented and flooding education; distribution of masks,
Tanzania reports gloves; slaughterhouse monitoring
1998 Sep–Dec Mauritania No 300–400 6 Heavy rainfall Active surveillance; public
documented awareness/education; mosquito
estimates control; animal movement control
2000 Aug–2001 Sep Saudi Arabia, 20,000† 886 123 Rainfall; virus Active surveillance; public
Yemen introduction awareness/education; mosquito
control; animal movement control
2006 Nov–2007 Mar Kenya 75,000 700 158 Heavy rainfall Active surveillance; public
Somalia 30,000 114 51 and flooding awareness/education; mosquito
Tanzania 40,000 264 109 control; ban on livestock
slaughtering; closure of livestock
market; vaccination Jan 2007
2007 Sep–2008 Jan Sudan 75,000 747 230 Heavy rainfall Active surveillance; public
and flooding awareness/education; targeted
vaccination; ban of livestock
imports by Saudi Arabia and Egypt
2008 Jan–Jun Madagascar 10,000 476 19 Heavy rainfall Active surveillance; public
awareness; mosquito control;
animal movement control
2008 Oct–2009 May Madagascar No 236 7 Heavy rainfall Active surveillance; public
documented awareness; mosquito control;
estimates animal movement control
2010 Feb–2010 May South Africa No 242 26 Sustained Public awareness/education;
documented heavy rains mosquito control
estimates
2010 Sep–2010 Dec Mauritania No 63 13 Heavy rainfall Public awareness; mosquito
documented control; animal movement control
estimates
*Sources: (6–24). FAO, Food and Agriculture Organization of the United Nations.
†Data available for Jizan region only.

190 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 2, February 2013
Rift Valley Fever Control
Vaccine Development and Production its potential to migrate beyond its traditional East African
The slow pace of development of new vaccines (online boundaries was noted. However, the recognition that much
Technical Appendix; wwwnc.cdc.gov/EID/article/19/2/12- of the industrialized world has animals and arthropod vec-
0941-Techapp1.pdf) and diagnostic kits for RVFV and the tors capable of transmitting the virus seems to have focused
limited supplies and relatively high cost of those currently and accelerated efforts to develop improved tools for out-
available mean that there is a chronic worldwide short- break forecasting, monitoring, diagnosis, and prevention.
age and lack of availability in areas where they are most In more recent years, the classification of the virus as a
needed. To address these problems, a “pull” strategy has potential bioterrorism/agroterrorism agent has also helped
been suggested by the Food and Agriculture Organization spur investment and activity, particularly in the area of vac-
of the United Nations for the development of new RVFV cine development and diagnostics (34). Although this theo-
vaccines. In this model, governments commit themselves retical risk has contributed to increased funding over the
to buy, at an agreed-upon price, whichever vaccine meets past few decades, most notably from military sources such
predefined requirements, thus giving an incentive to phar- as the US Army Medical Research Institute of Infectious
maceutical companies to pursue the development of the Diseases, this concern might also have acted as an impedi-
most promising vaccine candidate. However, this strategy ment to the collaborative aspects of this high-quality work,
does not seem to be having much effect in the short term; with research being restricted to fewer, more expensive
the current financial crisis is limiting the purchasing power laboratories (35).
of national governments (29). Growing restrictions stemming from biosecurity con-
Before modern safety standards were instituted in cerns now affect research activity across a range of infec-
laboratories, RVFV was regularly transmitted between tious diseases and have most recently been highlighted by
laboratory staff; 47 cases were documented worldwide concerns over the publication of research into the produc-
(30,31). International regulations for working with the tion of genetically engineered variants of the influenza A
live virus, and particularly for the production of vaccine subtype H5N1 virus (36). Limiting the dissemination of
and diagnostic test kits, typically require biosafety level 3 such research findings could, in any case, curtail technol-
(BSL-3) laboratory facilities as a minimum and enhanced ogy transfer crucial to studying viruses such as RVFV and
BSL-3 Ag/ABSL-3 (with many of the features of a BSL-4 could theoretically cause expert technical knowledge and
laboratory) for working with live RVFV and loose-housed skills to be less accessible. This possibility not only has the
animals (30). potential to delay progress in developing new treatments
Fortunately, with the advent of recombinant genetic and vaccines but could also increase their costs by limit-
technology and the development of reverse transcription ing where they could be produced, resulting in decreased
PCR techniques obviating the need to handle and store production capacity and competition.
live virus, new vaccines and diagnostic tests in develop- Increased sales costs of vaccines have a variety of
ment can now be produced in laboratories of lower BSL negative consequences; in particular, this increase could
(29,32). However, for the standard techniques that do in- put at risk well-established mechanisms of international
volve storage and handling of live virus, because no re- cooperation in global infectious disease surveillance. This
ported laboratory infections have occurred since modern risk was dramatically highlighted in 2006 and 2007 when
standard infection control procedures were introduced in Indonesia refused to share samples of influenza subtype
the early 1980s (33), the case could be made for lower- H5N1 isolates with the World Health Organization. The
ing currently prescribed BSL requirements. If laboratory event caused a risk to global health and occurred in direct
workers handling live virus in these settings are all vacci- protest to the inequitable sharing of virus samples and vac-
nated, the laboratories required could possibly be reduced cine development technology (37).
to BSL-2 with controlled access in disease-endemic coun- Despite some of these challenges, some positive de-
tries, and to BSL-2 with controlled access and additional velopments have occurred in global collaborative efforts
enhancements for working with animals in non–disease- for controlling zoonotic diseases, including RVFV. These
endemic countries. Such a change could lower global include initiatives like the One Health (38) approach of
production costs of vaccines and diagnostic tests and in- integrating animal and human health challenges and the
crease their accessibility by communities most affected closer integration of multilateral agencies such as the
by RVFV. World Organisation for Animal Health, the Food and
Agriculture Organization of the United Nations, and the
Global Interest, Challenges, and Cooperation World Health Organization. These efforts have already re-
Interest in RVFV and investment in its control were sulted in improved outbreak forecasting and surveillance
only substantially increased among the global health re- of RVFV in humans and animals, facilitated by the de-
search and policy community after greater awareness of velopment of initiatives such as the Global Early Warning
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 2, February 2013 191
PERSPECTIVE
System (39,40). In addition, the rapid increase in socioeco- to be answered conclusively, exploring the case for lower-
nomic interest and investment in RVFV-affected regions ing current BSL requirements of laboratories and produc-
of Africa from emerging economies such as the People’s tion facilities could be 1 method of mitigating these costs.
Republic of China, and Middle Eastern countries such as A greater sense of urgency and investment is required
Saudi Arabia, provides an opportunity for their increased for controlling, better managing, and preventing future large-
involvement in, and funding of, RVFV control. Countries scale outbreaks of RVFV. Future long-term success lies in
benefiting from this socioeconomic interest and invest- building on global collaborative initiatives, the closer inte-
ment should develop the necessary information base and gration of multilateral agencies, and a wider participation
negotiating skill to successfully ensure that funds are chan- from livestock-importing countries and emerging economies
neled to such opportunities. that are investing in RVFV-endemic countries. A worldwide
strategy, both in tune with and inspired by principles of eq-
Conclusion uity and social justice, could ultimately deliver the best out-
In recent years, the perceived risk of RVFV becoming comes in combating this neglected tropical disease.
established in Europe and North America, and the theoreti-
Dr Dar is a consultant in communicable disease control at the
cal risk of it being used as a bioterrorism agent, has brought
London School of Hygiene and Tropical Medicine and at the UK
a welcomed increase in investment to combat the disease
Health Protection Agency. He is also an honorary research fellow
yet has skewed priority areas of focus for that investment.
at the Chatham House Centre on Global Health Security. His re-
The ideal that should be adopted is a more equity-based
search interests focus on global health, especially in low-income
approach in which funding and research are prioritized on
and conflict settings.
a needs-identified basis for the aid of those most disadvan-
taged in the global community. This approach would con-
centrate efforts on those interventions that most positively
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Such an approach would ensure research and policy
org/10.1002/path.1700340418
emphasis on the socioeconomic effects of RVFV outbreaks. 2. Pepin M, Bouloy M, Bird BH, Kemp A, Paweska J. Rift Valley fever
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192 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 2, February 2013