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BackgroundHeartland virus (HRTV) was first described as a human pathogen in 2012. From 2013 to 2017, the Centers for Disease Control and Prevention (CDC) implemented a national protocol to evaluate patients for HRTV disease, better define its geographic distribution, epidemiology, and clinical characteristics, and develop diagnostic assays for this novel virus.MethodsIndividuals aged ≥12 years whose clinicians contacted state health departments or the CDC about testing for HRTV infections were screened for recent onset of fever with leukopenia and thrombocytopenia. A questionnaire was administered to collect data on demographics, risk factors, and signs and symptoms; blood samples were tested for the presence of HRTV RNA and neutralizing antibodies.ResultsOf 85 individuals enrolled and tested, 16 (19%) had evidence of acute HRTV infection, 1 (1%) had past infection, and 68 (80%) had no infection. Patients with acute HRTV disease were residents of 7 states, 12 (75%) were male, and the median age (range) was 71 (43–80) years. Illness onset occurred from April to September. The majority reported fatigue, anorexia, nausea, headache, confusion, arthralgia, or myalgia. Fourteen (88%) cases were hospitalized; 2 (13%) died. Fourteen (88%) participants reported finding a tick on themselves in the 2 weeks before illness onset. HRTV-infected individuals were significantly older (P < .001) and more likely to report an attached tick (P = .03) than uninfected individuals.ConclusionsHealth care providers should consider HRTV disease testing in patients with an acute febrile illness with either leukopenia or thrombocytopenia not explained by another condition or who were suspected to have a tickborne disease but did not improve following appropriate treatment.

Abstract Following the recent discovery of Bourbon virus (BRBV) as a human pathogen, and the isolation of the virus from Amblyomma americanum (L.) collected near the location of a fatal human case, we undertook a series of experiments to assess the laboratory vector competence of this tick species for BRBV. Larval ticks were infected using an immersion technique, and transstadial transmission of virus to the nymphal and then to the adult stages was demonstrated. Transstadially infected nymphs transmitted virus to adult ticks at very high rates during cofeeding, indicating the presence of infectious virus in the saliva of engorging ticks. Vertical transmission by transstadially infected females to their progeny occurred, but at a low rate. Rabbits fed on by infected ticks of all active life stages developed high titers of antibody to the virus, demonstrating host exposure to BRBV antigens/live virus during tick blood feeding. These results demonstrate that A. americanum is a competent vector of BRBV and indicate that cofeeding could be critical for enzootic maintenance.

Few studies have assessed the duration of humoral immunity following yellow fever (YF) vaccination in a non-endemic population. We evaluated seropositivity among US resident travellers based on time post-vaccination. We identified serum samples from US travellers with YF virus-specific plaque reduction neutralization testing (PRNT) performed at CDC from 1988 to 2016. Analyses were conducted to assess the effect of time since vaccination on neutralizing antibody titer counts. Among 234 travellers who had neutralizing antibody testing performed on a specimen obtained ≥1 month after vaccination, 13 received multiple YF vaccinations and 221 had one dose of YF vaccine reported. All 13 who received more than one dose of YF vaccine had a positive PRNT regardless of the amount time since most recent vaccination. Among the 221 travellers with one reported dose of YF vaccine, 155 (70%) were vaccinated within 10 years (range 1 month-9 years) and 66 (30%) were vaccinated ≥10 years (range 10-53 years) prior to serum collection. Among the 155 individuals vaccinated, <10 years prior to serum collection, 146 (94%) had a positive PRNT compared with 82% (54/66) of individuals vaccinated ≥10 years prior to serum collection (P = 0.01). Post-vaccination PRNT titers showed a time-dependent decrease. Individuals with immunocompromising conditions were less likely to have a positive PRNT (77%) compared with those who were not immunocompromised (92%; P = 0.04). Although the percentage of vaccinees with a positive PRNT and antibody titers decreased over time, a single dose of YF vaccine provided long-lasting protection in the majority of US travellers. A booster dose could be considered for certain travellers who are planning travel to a high risk area based on immune competence and time since vaccination.

The United States military regularly deploys thousands of service members throughout areas of South America and Africa that are endemic for yellow fever (YF) virus. To determine if booster doses might be needed for service members who are repetitively or continually deployed to YF endemic areas, we evaluated seropositivity among US military personnel receiving a single dose of YF vaccine based on time post-vaccination. Serum antibodies were measured using a plaque reduction neutralization test with 50% cutoff in 682 military personnel at 5–39 years post-vaccination. We determined noninferiority of immune response by comparing the proportion seropositive among those vaccinated 10–14 years previously with those vaccinated 5–9 years previously. Noninferiority was supported if the lower-bound of the 2-tailed 95% CI for p10-14years – p5-9years was ≥−0.10. Additionally, the geometric mean antibody titer (GMT) at various timepoints following vaccination were compared to the GMT at 5–9 years. The proportion of military service members with detectable neutralizing antibodies 10–14 years after a single dose of YF vaccine (95.8%, 95% CI 91.2–98.1%) was non-inferior to the proportion 5–9 years after vaccination (97.8%, 95% CI 93.7–99.3%). Additionally, GMT among vaccine recipients at 10–14 years post vaccination (99, 95% CI 82–121) was non-inferior to GMT in YF vaccine recipients at 5–9 years post vaccination (115, 95% CI 96–139). The proportion of vaccinees with neutralizing antibodies remained high, and non-inferior, among those vaccinated 15–19 years prior (98.5%, 95%CI 95.5–99.7%). Although the proportion seropositive decreased among vaccinees ≥ 20 years post vaccination, >90% remained seropositive. Neutralizing antibodies were present in > 95% of vaccine recipients for at least 19 years after vaccination, suggesting that booster doses every 10 years are not essential for most U.S. military personnel.

Following the recent discovery of Bourbon virus (BRBV) as a human pathogen, and the isolation of the virus from Amblyomma americanum (L.) collected near the location of a fatal human case, we undertook a series of experiments to assess the laboratory vector competence of this tick species for BRBV. Larval ticks were infected using an immersion technique, and transstadial transmission of virus to the nymphal and then to the adult stages was demonstrated. Transstadially infected nymphs transmitted virus to adult ticks at very high rates during cofeeding, indicating the presence of infectious virus in the saliva of engorging ticks. Vertical transmission by transstadially infected females to their progeny occurred, but at a low rate. Rabbits fed on by infected ticks of all active life stages developed high titers of antibody to the virus, demonstrating host exposure to BRBV antigens/live virus during tick blood feeding. These results demonstrate that A. americanum is a competent vector of BRBV and indicate that cofeeding could be critical for enzootic maintenance.

► We evaluated the immunogenicity of JE vaccine in previously vaccinated persons. ► We compared 1 dose in previously vaccinated subjects to 2 doses in vaccine-naïve. ► Previously vaccinated subjects had higher GMTs pre-vaccination and after each dose. ► Neutralizing antibody response was noninferior in previously vaccinated subjects. There are no data on the use of inactivated Vero cell culture-derived Japanese encephalitis (JE) vaccine (JE-VC) as a booster among individuals who previously received inactivated mouse brain-derived JE vaccine (JE-MB). Military personnel who received ≥3 doses of JE-MB or were JE vaccine-naïve were vaccinated with 2 doses of JE-VC on days 0 and 28. Serum neutralizing antibodies were measured pre-vaccination and 28 days after each dose. Non-inferiority was evaluated for seroprotection rate and geometric mean titer (GMT) between previously vaccinated participants post-dose 1 and vaccine-naïve participants post-dose 2. Fifty-three previously vaccinated and 70 JE vaccine-naïve participants were enrolled. Previously vaccinated participants had significantly higher GMTs pre-vaccination, post-dose 1, and post-dose 2. Seroprotection rates among previously vaccinated participants post-dose 1 (44/44, 100%) were noninferior to those achieved in previously naïve participants post-dose 2 (53/57, 93%). The GMT was significantly higher in previously vaccinated participants post-dose 1 (GMT 315; 95% CI 191–520) compared to previously naïve participants post-dose 2 (GMT 79; 95% CI 54–114). Among military personnel previously vaccinated with ≥3 doses of JE-MB, a single dose of JE-VC adequately boosts neutralizing antibody levels and provides at least short-term protection. Additional studies are needed to confirm these findings in other populations and determine the duration of protection following a single dose of JE-VC in prior recipients of JE-MB.

Heartland virus is a newly identified phlebovirus that was first isolated from two northwestern Missouri farmers hospitalized with fever, leukopenia, and thrombocytopenia in 2009. Based on the patients' clinical findings and their reported exposures, the virus was suspected to be transmitted by ticks. After this discovery, CDC worked with state and local partners to define the ecology and modes of transmission of Heartland virus, develop diagnostic assays, and identify additional cases to describe the epidemiology and clinical disease. From this work, it was learned that Heartland virus is found in the Lone Star tick (Amblyomma americanum). Six additional cases of Heartland virus disease were identified during 2012-2013; four of those patients were hospitalized, including one with comorbidities who died.

Heartland virus is a newly identified phlebovirus that was first isolated htm two northwestern Missouri farmers hospitalized with fever, leukopenia, and thrombocytopenia in 2009. Based on the patients' clinical findings and their reported exposures, the virus was suspected to be transmitted by ticks. After this discovery, CDC worked with state and local partners to define the ecology and modes of transmission of Heartland virus, develop diagnostic assays, and identify additional cases to describe the epidemiology and clinical disease. Here, Pastula et al report on the cases of Heartland virus disease identified during 2012-2013.

To counter a limited global supply of yellow fever vaccine, the use of a fractional dose of vaccine (one fifth of the standard dose) during an outbreak in the Democratic Republic of Congo resulted in immunogenicity consistent with expected protective titers at 1-month and 1-year follow-up.

Chikungunya virus (CHIKV) represents an emerging health threat to the United States as humans amplify CHIKV and vectors that transmit CHIKV are present in the country. To minimize the risk of CHIKV spread in the United States, healthcare providers and public health officials should be educated about recognition, diagnosis, and reporting of CHIK cases. Background.  Chikungunya virus (CHIKV) represents a threat to the United States, because humans amplify CHIKV and vectors that transmit CHIKV are present. Methods.  We described the epidemiology of laboratory-confirmed chikungunya fever (CHIK) cases in the United States in 1995–2009 and compared states with CHIKV vectors with states with returning viremic CHIK cases. For 2006–2009, we evaluated reporting of CHIK cases to ArboNET, the arboviral surveillance system. Results.  In 1995–2009, 109 CHIK cases were identified in the United States; all adult travelers. Sixty-two subjects (57%) had recently visited India, and 13 (12%) had CHIKV viremia. Of the 26 jurisdictions with CHIK cases, 22 (85%) reported the presence of CHIKV vectors. Twelve viremic travelers returned to 6 states with CHIKV vectors. Of the 106 cases identified in 2006–2009, only 27 (25%) were reported to ArboNET, with a median of 122 days (range, 44–273 days) between illness onset and reporting. Conclusions.  No locally acquired CHIK cases were identified. However, several viremic travelers returned to states with CHIKV vectors and presented a risk for local transmission. Incomplete and delayed reporting made ArboNET less useful. To minimize the risk of CHIKV spread in the United States, healthcare providers and public health officials should be educated about recognition, diagnosis, and reporting of CHIK cases.