Viral Infections of Humans: Epidemiology and Control

743 Pages·1982·21.31 MB·English

by  Alfred S. Evans (auth.)

Viral Infections
of Humans
Epidemiology and Control
SECOND EDITION
Viral Infections
of
Humans
Epidemiology and Control
SECOND EDITION
completely revised and expanded
Edited by
Alfred S.
Evans
Yale University
New Haven, Connecticut
PLENUM MEDICAL BOOK COMPANY
New York and London
Library of Congress Cataloging in Publication Data
Main entry under title:
Viral infections of humans.
Includes bibliographies and index.
1. Virus diseases. 2. Epidemiology. 3. Virus diseases-Prevention. I. Evans,
Alfred 5., 1917 - . [DNLM: 1. Virus diseases-Prevention and control. 2 ..
Virus diseases-Occurrence. WC 500 V8155]
RA644.V55V57 1982 614.5'7 82-3684
ISBN-13: 978-1-4613-3239-8 e-ISBN-13: 978-1-4613-3237-4 AACR2
DOT: 10.1007/978-1-4613-3237-4
© 1982 Plenum Publishing Corporation
Softcover reprint ofthe hardcover 1st edition 1982
233 Spring Street, New York, N.Y. 10013
Plenum Medical Book Company is an imprint of Plenum Publishing Corporation
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
Dedication
This book is dedicated to Dr. John R. Paul, who introduced me to the field of epidemiology
and to the concepts of clinical and serological epidemiology; to Dr. Thomas F. Francis,
who arranged and supervised my Master of Public Health degree (in epidemiology) at
the University of Michigan School of Public Health; to Dr. William D. Stovall, who taught
me the potential contributions of the public health laboratory to epidemiology and to
preventi~e medicine; to Dr. David Seegal and Dr. John R. Talbott, my mentors in clinical
medicine; and to Dr. Ernst J. Witebsky, Dr. Paul F. Clark, and Dr. Victor C. Seas tone,
my teachers and associates in immunology and microbiology.
ACKNOWLEDGMENTS. This publication was supported for editorial preparation in part by
NIH grant LM 03299 from the National Library of Medicine. I also wish to thank my
wife Brigitte, and children John, Barbara, and Christopher, for their patience and support.
A. S. EVANS
v
Contribu tors
Abram S. Benenson, Gorgas Memorial Laboratory, Panama, Republic of Panama. Present
address: School of Graduate Studies and Public Health, San Diego State University,
San Diego, California
Francis L. Black, Department of Epidemiology and Public Health, Yale University School
of Medicine, New Haven, Connecticut
Carl D. Brandt, Children's Hospital National Medical Center of Washington, D.C.; and
George Washington University School of Medicine and Health Sciences, Department
of Child Health and Development, Washington, D.C.
Jacob A. Brody, Epidemiology, Demography, Biometry, National Institute on Aging,
National Institutes of Health, Bethesda, Maryland
Jordi Casals, Department of Epidemiology and Public Health, Yale University School of
Medicine, New Haven, Connecticut
Robert M. Chanock, Laboratory of Infectious Diseases, National Institute of Allergy and
Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Children's
Hospital National Medical Center of Washington, D.C.; and George Washington
University School of Medicine and Health Sciences, Department of Child Health
and Development, Washington, D.C.
tFred M. Davenport, Department of Epidemiology, School of Public Health, University
of Michigan, Ann Arbor, Michigan (Deceased March, 1982)
Floyd W. Denny, Department of Pediatrics, School of Medicine, University of North
Carolina, Chapel Hill, North Carolina
G. de-The, CNRS, Faculty of Medicine A. Carrel, Lyon and Cancer Institute-CNRS,
Villejuif, France
Wilbur G. Downs, Yale Arbovirus Research Unit, Department of Epidemiology and
Public Health, Yale University School of Medicine, New Haven, Connecticut
Alfred S. Evans, WHO Serum Reference Bank, Section of International Epidemiology,
Department of Epidemiology and Public Health, Yale University School of Medicine,
New Haven, Connecticut
Harry A. Feldman, Department of Preventive Medicine, State University of New York,
Upstate Medical Center, Syracuse, New York
Hjordis M. Foy, Department of Epidemiology and International Health, School of Public
Health and Community Medicine, University of Washington, Seattle, Washington
Clarence Joseph Gibbs, Jr., Laboratory of Central Nervous System Studies, National
Institute of NeurolOgical and Communicative Disorders and Stroke, National Insti
tutes of Health, Bethesda, Maryland
W. Paul Glezen, Department of Microbiology and Immunology, Baylor College of Med
icine, Houston Texas
Eli Gold, Department of Pediatrics, University of California, Davis, California
J. Thomas Grayston, Department of Epidemiology and International Health, School of
Public Health and Community Medicine, University of Washington, Seattle, Wash-
ington vii
viii Contributors
Harry B. Greenberg, Laboratory of Infectious Diseases, National Institute of Allergy and
Infectious Diseases, National Institutes of Health, Bethesda, Maryland
Jack M. Gwaltney, Jr., Department of Internal Medicine, University of Virginia School
of Medicine, Charlottesville, Virginia
J. H. C. Ho, Institute of Radiology and Oncology, Queen Elizabeth Hospital, Kowloon,
Hong Kong
Dorothy M. Horstmann, Department of Epidemiology and Public Health and Department
of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
Karl M. Johnson, Center for Disease Control, Special Pathogens Branch, Virology Di
vision, Bureau of Laboratories, U.S. Public Health Service, U. S. Department of
Health and Human Services, Atlanta, Georgia
William E. Josey, Department of Gynecology and Obstetrics, Emory University School
of Medicine, Atlanta, Georgia
Anthony R. Kalica, Laboratory of Infectious Diseases, National Institute of Allergy and
Infectious Diseases, National Institutes of Health, Bethesda, Maryland
Albert Z. Kapikian, Laboratory of Infectious Diseases, National Institute of Allergy and
Infectious Diseases, National Institutes of Health, Bethesda, Maryland
Hyun Wha Kim, Children's Hospital National Medical Center of Washington, D.C.; and
George Washington University School of Medicine and Health Sciences, Department
of Child Health and Development, Washington, D.C.
Frank A. Loda, Department of Pediatrics, School of Medicine, University of North Car
olina, Chapel Hill, North Carolina
Robert W. McCollum, Department of Epidemiology and Public Health, Yale University
School of Medicine, New Haven, Connecticut
Joseph L. Melnick, Department of Virology and Epidemiology, Baylor College of Med
icine, Houston, Texas
George Miller, Department of Pediatrics and Department of Epidemiology and Public
Health, Yale University School of Medicine, New Haven, Connecticut
Arnold S. Monto, Department of Epidemiology, School of Public Health, University of
Michigan, Ann Arbor, Michigan
C. S. Muir, International Agency for Research on Cancer, Lyon, France
Andre J. Nahmias, Department of Pediatrics, Emory University School of Medicine,
Atlanta, Georgia
George A. Nankervis, Department of Pediatrics, Medical College of Ohio, Toledo, Ohio
James C. Niederman, Department of Epidemiology and Public Health, Yale University
School of Medicine, New Haven, Connecticut
James M. OIeske, Department of Pediatrics, New Jersey College of Medicine, Newark,
New Jersey
Robert H. Parrott, Children's Hospital National Medical Center of Washington, D.C.;
and George Washington University School of Medicine and Health Sciences, De
partment of Child Health and Development, Washington, D.C.
WilliamJ. Rodriguez, Children's Hospital National Medical Center of Washington, D.C.;
and George Washington University School of Medicine and Health Sciences, De
partment of Child Health and Development, Washington, D.C.
Robert E. Shope, Department of Epidemiology and Public Health, Yale University School
of Medicine, New Haven, Connecticut
Thomas H. Weller, Department of Tropical Public Health, Center for Prevention of
Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
Richard G. Wyatt, Laboratory of Infectious Diseases, National Institute of Allergy and
Infectious Diseases, National Institutes of Health, Bethesda, Maryland
Preface to the
Second Edition
Each chapter of this second edition has been updated and expanded by the authors, and
two new chapters have been added. One is on viral gastroenteritis by Albert Kapikian
and his associates and deals with the rotavirus and Norwalk groups of agents. The
second, by Karl Johnson, is on the African hemorrhagic fevers caused by Marburg and
Ebola viruses. The reader will note that some viral groups such as cat scratch fever agent,
mulluscum contagiosum, human papilloma viruses, and reoviruses are not yet included.
This is because sufficient information on the agent and its epidemiology is not yet
available or because it was not regarded as a common cause of human illness.
As a guide to readers familiar with the first edition, some highlights of the new material
in the second edition are listed below.
I. Introduction and Concepts
Chapter 1, Epidemiological Concepts and Methods: New sections on investigating an
epidemic, the host, congenital infections, hospital infections, and infections in immu
nosuppressed and surgical patients have been added.
Chapter 2, Surveillance and Seroepidemiology: A new section on viruses, cancer, and
chronic disease is included.
II. Acute Viral Infections
Chapter 3, Adenoviruses: There are now 33 distinct immunological types. Severe
infections may occur in congenital immunodeficiency, among immunosuppressed pa
tients, and following measles. Type 7 has produced prolonged outbreaks in England.
Reactivation of adenovirus infections may possibly be evoked by other respiratory agents.
Healthy carrier rates may reach 18% in recruits.
Chapter 4, African Hemmorhagic Fevers: This new chapter by Karl Johnson deals with
Marburg and Ebola viruses whose importation poses a continual threat outside Ger
many and Yugoslavia, where Marburg agent has been active, and the Sudan and Zaire,
where Ebola is endemic.
Chapter 5, Arboviruses: Transovarial transmission-first of California viruses and later
of all four types of dengue virus, Japanese B encephalitis virus, and yellow fever virus
has now been demonstrated, providing an important contribution to the mechanism of
survival of these agents in nature. Venereal transmission of California LaCrosse virus
ix
X Preface to the Second Edition
also occurs. New outbreaks of yellow fever have occurred in Colombia and Trinidad and
new outbreaks of rift valley fever have occurred in Egypt.
Chapter 6, Arenaviruses: The biochemical and physical properties have now been clar
ified, and they show a remarkable uniformity in the various viruses constituting the
group. The possibility that prenatal infection with LCM may result in hydrocephalus and
chorioretinitis has been raised. Serologic surveys have suggested the existence of Lassa
virus infection in Guinea, Central African Empire, Mali, Senegal, Cameroon, and Benin,
in addition to earlier identification in Nigeria, Liberia, and Sierra Leone.
Chapter 7, Coronaviruses: New studies have confirmed the important role of these
viruses in common respiratory illnesses of children and adults. The viruses are now
known to contain a single positive strand of RNA. About 50% of corona virus infections
result in clinical illness. About 5% of common colds are caused by strain DC 43 in winter.
Chapter 8, Cytomegalovirus: Sections on pathogenesis of CMV in relation to organ
transplantation and mononucleosis, as well as sections on the risk and features of con
genital infection and disease, have been expanded. There are encouraging preliminary
results with a live CMV vaccine, but the questions of viral persistence and oncogenicity
require further evaluation.
Chapter 9, Enteroviruses: Hepatitis A is now considered an enterovirus, but it is
discussed in Chapter 12. An enterovirus unrelated to any known type was isolated in
South Africa mainly from patients diagnosed clinically as having poliomyelitis but from
whom no poliovirus could be isolated; it could be passaged only in suckling mice and
is now designated as enterovirus 71. Epidemics of acute hemorrhagic conjunctivitis
caused by enterovirus 70 occurred in Asia, with small outbreaks in Europe but not yet
in Australia or the Americas. Enterovirus 70 has now been recognized globally with
different clinical manifestations in such areas as aseptic meningitis, encephalitis, paral
ysis, and the hand, foot, mouth syndrome. Chronic cardiovascular diseases may follow
coxsackie carditis, and coxsackie B may induce severe neonatal infection; diabetes has
resulted from coxsackie B4 in one 4-year-old boy.
Chapter 10, Epstein-Barr Virus: Advances have been made in the understanding of
the immune response to EBV infections and of the pathogenesis of infectious mono
nucleosis. Psychosocial factors playa role in the development of clinical disease among
those infected. Severe and fatal complications of the EBV infection as well as the im
munoblastic B-cell sarcoma, Burkitt lymphoma, and various lytic complications occur in
immunodeficient persons, especially in those genetically related as in the X-linked lym
phoproliferative syndrome. Typical 1M in childhood and in developing countries is now
recognized through more sensitive tests, as are some syndromes such as pneumonitis
and hepatitis in the absence of other features of IM.
Chapter 11, Viral Gastroenteritis: This new chapter emphasizes the importance of the
rota virus and Norwalk group of viruses. The former causes about 50% of acute gastroen
teritis in children under 3 throughout the world, and the latter is an important cause of
outbreaks of gastroenteritis in both children and adults.
Chapter 12, Viral Hepatitis: There is increased recognition of the importance of non
A, non-B hepatitis in transfusion hepatitis as well as in sporadic cases. Antibody tests
for hepatitis A have indicated its common occurence worldwide. An important link of
hepatitis B to hepatocellular cancer is being vigorously pursued. Vaccines against HBV
are on clinical trial.
Chapter 13, Herpes Simplex Viruses 1 and 2: The immunological responses to infection,
the mechanism of latency and reactivation in nerve tissue, and the broadening spectrum
of host-response constitute new advances.
Chapter 14, Influenza Viruses: The most important advance since the appearance of
Preface to the Second Edition xi
the first edition is the ability to characterize RNA fragments of the viral genome. This
is a technical development, and whether or not it can be applied to solution of epide
miological problems has yet to be established.
Chapter 15, Measles: There is increasing recognition of natural measles under age 1
in developing countries and of focal outbreaks in unimmunized children in developed
countries. Atypical measles in persons receiving killed measles vaccine or live vaccine
under age 1 occurs in the United States but will disappear over time since CDC now
recommends vaccination at about "15 months of age." In developing countries, early
immunization at age 6-9 months is necessary to prevent measles mortality, but whether
a later booster dose is desirable has not been clearly established. The elimination of
measles by vaccination is the United States is a goal of the CDC.
Chapter 16, Mumps: In the 10 years since the licensing of live vaccine in the United
States and its increasing utilization in immunization programs, the reported case rates
have decreased from about 88 per 100,000 in 1968 to under 10 by 1978. Since, as with
measles, man is the only reservoir, there is hope of eventual eradication.
Chapter 17, Parainfluenza Viruses: Direct viral diagnosis is now possible through the
examination-by immunofluorescent techniques-of epithelial cells from throat wash
ings.
Chapter 18, Rabies: A new rabies vaccine grown in human diploid cells has now been
licensed in the United States. It requires only five doses and induces an excellent antibody
response. A revised schedule for use of vaccine and human immunoglobulin now rec
ommends their combined use after almost all types of rabies exposure, irrespective of
the time of initiation after exposure. Soap and water is recommended for local cleaning.
New diagnostic and isolation techniques are under development.
Chapter 19, Respiratory Syncytial Virus: This remains the major pathogen of the lower
respiratory tract of infancy and childhood throughout the world, but the pathogenesis
of serious disease in early infancy is not well understood. Virus-specific IgA antibodies
have been found in nasal secretions of infected infants but do not neutralize RSV. A
vaccine is not yet available, but encouraging results have been found experimentally
with a ts mutant and with a live vaccine grown in human diploid cells and injected
parenterally into seronegative infants.
Chapter 20, Rhinoviruses: While recoverable from the lower respiratory tract, rhino
viruses are probably not an important cause of viral pneumonia, croup, or bronchiolitis.
Rather, they may be a precipitant of asthmatic attacks in children through unknown
mechanisms. Psychological factors may playa role in susceptibility to rhinovirus infection
or illness. The multiplicity of specific antigenic types of varying epidemiological behavior
has thus far limited vaccine development. Administration of interferon prior to, but not
during, experimental common colds appears to reduce their severity. The evidence fa
voring vitamin C is inadequate to recommend its use for prevention or therapy.
Chapter 21, Rubella: The RA 27/3 vaccine, grown in WI 38 cells, is now available for
use in the United States. It retains ability to infect intranasally and induces a broader
antibody response-including local IgA production-and higher resistance to reinfection
than earlier vaccines. There is increasing emphasis on vaccine use in adolescents and
young women, especially at time of entrance to high school, but with a strong con
traindiction to its use in pregnant women; serological tests to identify susceptibility to
rubella are desirable prior to vaccination in women of childbearing age, as are tests for
pregnancy if doubt exists.
Chapter 22, Smallpox: No case of natural smallpox has occurred since October, 1977,
and on December 9, 1979 the Global Commission certified that smallpox had been erad
icated from the world. Thus this chapter can be regarded as a "requiem for a heavy-
xii Preface to the Second Edition
weight." However, the presence of "whitepox" virus in monkeys, the fact that the only
known difference of this virus from variola virus is its infectivity for man, and the reports
of 36 cases of monkeypox virus infection in humans up to April, 1979 all stress the need
for vigilance.
Chapter 23, Varicella-Herpes Zoster Virus: New developments include new diagnostic
and seroepidemiologic techniques, advances in our knowledge of the role of cellular im
munity in zoster infections, the proof of effectiveness of antiviral chemotherapy, and the
encouraging results with a candidate varicella vaccine developed by Japanese workers.
III. Malignant and Chronic Neurological Diseases Associated with Viruses
Chapter 24, Burkitt Lymphoma: A prospective study of 42,000 children in the West
Nile area of Africa revealed that 10 of 14 sera taken 7-54 months prior to detectable
tumor had anti-VCA titers to EB virus 2-fold or more higher than in matched controls;
a titer increase of this magnitude carried a 30-fold increased risk of BL. EBV genome was
present in tumor tissue from most biopsied cases with elevated titers and absent from
those with normal titers. About 90% of BL tumors contain a 14q + chromosome marker;
the marker has also been found in EBV -negative tumors. Strong evidence supports a
causal role of EBV in African BL.
Chapter 25, Nasopharyngeal Carcinoma: Risk factors among high-incidence-rate
Chinese are related to genetics and certain cultural practices, including feeding salted
fish to infants just before and after weaning. Certain chemicals are also suspect. In the
United States, the risk factors include a history of ENT disease and occupational exposure
to fumes, smoke, and chemical. EBV -IgA antibody is present in both serum and naso
pharyngeal washings of almost all NPC cases. In China a massive serum survey to detect
this antibody has been a rewarding method of case detection: of the 56,584 persons age
30 or more tested, 117 had EBV-IgA, among whom 20 NPC cases were subsequently
diagnosed.
Chapter 26, Cervical Cancer: Early results of prospective studies of women with and
without HSV -2 antibody have shown a 4-fold higher frequency of severe cervical dys
plasia and cancer in situ (CIS) in those with antibody; 6 of 28 women (21 %) with a primary
HSV-2 genital infection developed one of these lesions, ten times that of controls. A
possible relation of cervical cancer to HLA-B12 has been reported. New antigens may
yield better distinction between HSV-1 and HSV-2. Multiple disciplines are needed to
resolve the possible relation of HSV-2 to cervical cancer.
Chapter 27, Chronic Neurological Diseases: Kuru and Creutzfeldt-Jakob Disease (CJD)
remain rare and fatal diseases caused by agents that are probably closely related but
whose biological nature and lack of immune response remain an enigma. Kuru is still
localized in the Fore area of New Guinea, and no new infections have occurred since the
discontinuance of cannibalism; previously infected cases are still appearing with an in
cubation period of up to 30 years. CJD is worldwide with an incidence throughout of
about one per million. A comprehensive epidemiological study has been made in France.
Oral transmission of kuru and CJD to monkeys experimentally has been reported, and
the host range of CJD extends to cats, guinea pigs, and mice. The natural route of
infection of CJD remains unknown although transmission by corneal transplants and
brain electrodes from infected persons occurs, and transmission by transfusion is a po
tential hazard. Procedures for medical and surgical management of such patients have
been developed. SSPE is a rare, late manifestation of measles infection early in life that
has declined sharply with the widespread use of measles vaccine. It is not clear whether
vaccine virus itself could occasionally induce SSPE. Progressive multifocal encephalo-