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In June 2019, the Bolivian Ministry of Health reported a cluster of cases of hemorrhagic fever that started in the municipality of Caranavi and expanded to La Paz. The cause of these cases was unknown. We obtained samples for next-generation sequencing and virus isolation. Human and rodent specimens were tested by means of virus-specific real-time quantitative reverse-transcriptase-polymerase-chain-reaction assays, next-generation sequencing, and virus isolation. Nine cases of hemorrhagic fever were identified; four of the patients with this illness died. The etiologic agent was identified as , or Chapare virus (CHAPV), which causes Chapare hemorrhagic fever (CHHF). Probable nosocomial transmission among health care workers was identified. Some patients with CHHF had neurologic manifestations, and those who survived had a prolonged recovery period. CHAPV RNA was detected in a variety of human body fluids (including blood; urine; nasopharyngeal, oropharyngeal, and bronchoalveolar-lavage fluid; conjunctiva; and semen) and in specimens obtained from captured small-eared pygmy rice rats ( ). In survivors of CHHF, viral RNA was detected up to 170 days after symptom onset; CHAPV was isolated from a semen sample obtained 86 days after symptom onset. was identified as the etiologic agent of CHHF. Both spillover from a zoonotic reservoir and possible person-to-person transmission were identified. This virus was detected in a rodent species, . (Funded by the Bolivian Ministry of Health and others.).

Background. Hemorrhagic fever-like illness caused by a novel Bunyavirus, Huaiyangshan virus (HYSV, also known as Severe Fever with Thrombocytopenia virus [SFTSV] and Fever, Thrombocytopenia and Leukopenia Syndrome [FTLS]), has recently been described in China. Methods. Patients with laboratory-confirmed HYSV infection who were admitted to Union Hospital or Zhongnan Hospital between April 2010 and October 2010 were included in this study. Clinical and routine laboratory data were collected and blood, throat swab, urine, or feces were obtained when possible. Viral RNA was quantified by real-time reverse-transcriptase polymerase chain reaction. Blood levels of a range of cytokines, chemokines, and acute phase proteins were assayed. Results. A total of 49 patients with hemorrhagic fever caused by HYSV were included; 8 (16.3%) patients died. A fatal outcome was associated with high viral RNA load in blood at admission, as well as higher serum liver transaminase levels, more pronounced coagulation disturbances (activated partial thromboplastin time, thrombin time), and higher levels of acute phase proteins (phospholipase A, fibrinogen, hepcidin), cytokines (interleukin [IL]-6, IL-10, interferon-γ), and chemokines (IL-8, monocyte chemotactic protein 1, macrophage inflammatory protein lb). The levels of these host parameters correlated with viral RNA levels. Blood viral RNA levels gradually declined over 3-4 weeks after illness onset, accompanied by resolution of symptoms and laboratory abnormalities. Viral RNA was also detectable in throat, urine, and fecal specimens of a substantial proportion of patients, including all fatal cases assayed. Conclusions. Viral replication and host immune responses play an important role in determining the severity and clinical outcome in patients with infection by HYSV.

All viral haemorrhagic fever laboratory confirmatory testing is done at UVRI and results are available within 24-48 h after sample reception.Since 2010, the viral haemorrhagic fever laboratory has tested over 11 000 clinical samples from serosurveys, surveillance programmes, and outbreaks.In addition to the success of the viral haemorrhagic fever programme in Uganda, direct technical assistance and support for response to viral haemorrhagic fever outbreaks throughout Africa has been provided, including for the west Africa Ebola outbreak in 2014-16.8 Materials developed for the Uganda viral haemorrhagic fever programme, including standardised case reporting forms, case definitions, health education and risk communication materials, and the Epi-Info viral haemorrhagic fever application,9 were used in 2014 to the three west African countries affected by Ebola virus disease to aid in outbreak management and control since the region had no previous experience with filovirus outbreaks.Rift valley fever response-Kabale District, Uganda, March 2016, MMWR Morb Mortal Wkly Rep, Vol. 65, 2016, 1200-1201 6 JF Wamala, L Lukwago, M Malimbo, Ebola hemorrhagic fever associated with novel virus strain, Uganda, 2007-2008, Emerg Infect Dis, Vol. 16, 2010, 1087-1092 7 SI Okware, FG Omaswa, S Zaramba, An outbreak of Ebola in Uganda, Trop Med Int Health, Vol. 7, 2002, 1068-1075 8 S Bagcchi, Ebola haemorrhagic fever in west Africa, Lancet Infect Dis, Vol. 14, 2014, 375 9 IJ Schafer, E Knudsen, LA McNamara, S Agnihotri, PE Rollin, A Islam, The Epi Info Viral hemorrhagic fever (VHF) application: a resource for outbreak data management and contact tracing in the 2014-2016 West Africa Ebola epidemic, J Infect Dis, Vol. 214, Iss. suppl 3, 2016, S122-S136 10 JN Borchert, JW Tappero, R Downing, Rapidly building global health security capacity-Uganda demonstration project, 2013, MMWR Morb Mortal Wkly Rep, Vol. 63, 2014, 73-76

Background Viral hemorrhagic fevers (VHFs) belong to a group of viral infectious diseases that interfere with the blood’s clotting mechanism. VHF has a wide host range, including bats, rodents, or arthropods such as mosquitoes and ticks. Most VHFs emerge suddenly as outbreaks, making it difficult to predict occurrence. To be responsive to such outbreaks, the Noguchi Memorial Institute for Medical Research (NMIMR) provides high-end molecular and genomic diagnostics capability for surveillance of suspected VHFs in samples collected from health facilities across the country. Methods Between January 2022 and December 2023, cross-sectional surveillance for viruses was conducted in patients with suspected VHF. During the period, 2586 serum or plasma samples were collected and transported under a cold chain to the NMIMR for testing. The samples were analyzed for potential VHF viruses including yellow fever, Ebola/Marburg, Lassa fever, and Dengue viruses using Real-Time Polymerase Chain Reaction Assay. Dengue positives were serotyped using the protocol of Johnson W.B et al.,2005. Whole genome sequencing was conducted using Illumina Next Generation Sequencing Technology. Using IQ-TREE, a maximum likelihood phylogenetic analysis was carried out. Results Dengue virus (DENV) was detected in eight patient samples that subtyped to serotypes 1, 2, and 3. All dengue fever cases were resident in the Greater Accra region. The detection of serotype one increases the possibility of multiple infections in individuals and may have a worse or increased risk of severe dengue fever. Phylogenetic analysis revealed that the DENV-1 strain shared similarities to circulating strains in West Africa. Conclusion Until the emergence of recent cases, the circulating subtype has been serotyped as Dengue one. There is therefore the need to intensify surveillance and also to control the mosquito vectors which can transmit these DENV in Ghana.

Background Early detection of outbreaks requires robust surveillance and reporting at both community and health facility levels. Uganda implements Integrated Disease Surveillance and Response (IDSR) for priority diseases and uses the national District Health Information System (DHIS2) for reporting. However, investigations after the first case in the 2022 Uganda Sudan virus outbreak was confirmed on September 20, 2022 revealed many community deaths among persons with Ebola-like symptoms as far back as August. Most had sought care at private facilities. We explored possible gaps in surveillance that may have resulted in late detection of the Sudan virus disease (SVD) outbreak in Uganda. Methods Using a standardized tool, we evaluated core surveillance capacities at public and private health facilities at the hospital level and below in three sub-counties reporting the earliest SVD cases in the outbreak. Key informant interviews (KIIs) were conducted with 12 purposively-selected participants from the district local government. Focus group discussions (FGDs) were conducted with community members from six villages where early probable SVD cases were identified. KIIs and FGDs focused on experiences with SVD and Viral Hemorrhagic Fever (VHF) surveillance in the district. Thematic data analysis was used for qualitative data. Results Forty-six (85%) of 54 health facilities surveyed were privately-owned, among which 42 (91%) did not report to DHIS2 and 39 (85%) had no health worker trained on IDSR; both metrics were 100% in the eight public facilities. Weak community-based surveillance, poor private facility engagement, low suspicion index for VHF among health workers, inability of facilities to analyze and utilize surveillance data, lack of knowledge about to whom to report, funding constraints for surveillance activities, lack of IDSR training, and lack of all-cause mortality surveillance were identified as gaps potentially contributing to delayed outbreak detection. Conclusion Both systemic and knowledge-related gaps in IDSR surveillance in SVD-affected districts contributed to the delayed detection of the 2022 Uganda SVD outbreak. Targeted interventions to address these gaps in both public and private facilities across Uganda could help avert similar situations in the future.

There have been several Viral Hemorrhagic Fever (VHF) outbreaks in Nigeria which remains a public health concern. Despite the increasing number of suspected cases of VHF due to heightened surveillance activities and growing awareness, only a few cases are laboratory-confirmed to be VHF. Routinely, these samples are only tested for Lassa virus and Yellow fever virus with occasional testing for Dengue virus when indicated. The aetiology of the disease in these VHF suspected cases in Nigeria which are negative for Lassa, Yellow fever and Dengue viruses remains a puzzle. Since the clinical features exhibited by suspected VHF cases are like other endemic illnesses such as Hepatitis, there is a need to investigate the diversity and co-infections of hepatitis viruses as differentials and possible co-morbidity in suspected cases of VHFs in Nigeria. A total of three hundred and fifty (350) blood samples of 212 (60.6%) males and 138 (39.4%) females, aged <1–70 years with a mean age of 25 ±14.5, suspected of VHFs and tested negative for Lassa, Yellow fever and Dengue viruses were investigated for Hepatitis A, B, C and E viruses at the Centre for Human and Zoonotic Virology (CHAZVY), College of Medicine, University of Lagos (CMUL) using serologic and molecular techniques. The serologic analysis of these VHF suspected cases samples revealed that 126 (36%) were positive for at least one hepatitis virus. Individual prevalence for each of the hepatitis virus screened for showed that 37 (10.6%), 18 (5.1%) and 71 (20.3%) were positive for HBV, HCV and HEV respectively. All the samples were negative for HAV. A co-infection rate of 11.9% was also observed, with HCV/HEV co-infections being the most prevalent and the Northern region having the greatest burden of infection. The evidence of hepatitis virus infections in suspected cases of VHF was documented. Thus, their associations as co-morbidities and/or mortalities in this category of individuals require further investigations in endemic countries such as Nigeria. Therefore, the possible inclusion of screening for hepatitis viruses and other aetiologic agents that could mimic infections in suspected cases of VHFs in Nigeria should be thoroughly evaluated to guide informed policy on the diagnosis and management of these cases.

Deep sequencing was used to discover a novel rhabdovirus (Bas-Congo virus, or BASV) associated with a 2009 outbreak of 3 human cases of acute hemorrhagic fever in Mangala village, Democratic Republic of Congo (DRC), Africa. The cases, presenting over a 3-week period, were characterized by abrupt disease onset, high fever, mucosal hemorrhage, and, in two patients, death within 3 days. BASV was detected in an acute serum sample from the lone survivor at a concentration of 1.09 × 10(6) RNA copies/mL, and 98.2% of the genome was subsequently de novo assembled from ≈ 140 million sequence reads. Phylogenetic analysis revealed that BASV is highly divergent and shares less than 34% amino acid identity with any other rhabdovirus. High convalescent neutralizing antibody titers of >1:1000 were detected in the survivor and an asymptomatic nurse directly caring for him, both of whom were health care workers, suggesting the potential for human-to-human transmission of BASV. The natural animal reservoir host or arthropod vector and precise mode of transmission for the virus remain unclear. BASV is an emerging human pathogen associated with acute hemorrhagic fever in Africa.

The clinical syndrome referred to as viral hemorrhagic fever (VHF) can be caused by several different families of RNA viruses, including select members of the arenaviruses, bunyaviruses, filoviruses, and flaviviruses. VHF is characterized by malaise, fever, vascular permeability, decreased plasma volume, coagulation abnormalities, and varying degrees of hemorrhage. Study of the filovirus Ebola virus has demonstrated a critical role for suppression of innate antiviral defenses in viral pathogenesis. Additionally, antigen-presenting cells are targets of productive infection and immune dysregulation. Among these cell populations, monocytes and macrophages are proposed to produce damaging inflammatory cytokines, while infected dendritic cells fail to undergo proper maturation, potentially impairing adaptive immunity. Uncontrolled virus replication and accompanying inflammatory responses are thought to promote vascular leakage and coagulopathy. However, the specific molecular pathways that underlie these features of VHF remain poorly understood. The arenavirus Lassa virus and the flavivirus yellow fever virus exhibit similar molecular pathogenesis suggesting common underlying mechanisms. Because non-human primate models that closely mimic VHF are available for Ebola, Lassa, and yellow fever viruses, we propose that comparative molecular studies using these models will yield new insights into the molecular underpinnings of VHF and suggest new therapeutic approaches.

Severe fever with thrombocytopenia syndrome virus (SFTSV) causes severe hemorrhagic fever in humans and cats. Clinical symptoms of SFTS-infected cats resemble those of SFTS patients, whereas SFTS-contracted cats have high levels of viral RNA loads in the serum and body fluids. Due to the risk of direct infection from SFTS-infected cats to human, it is important to diagnose SFTS-suspected animals. In this study, a reverse transcription polymerase chain reaction (RT-PCR) was newly developed to diagnose SFTS-suspected animals without non-specific reactions. Four primer sets were newly designed from consensus sequences constructed from 108 strains of SFTSV. A RT-PCR with these four primer sets successfully and specifically detected four clades of SFTSV. Their limits of detection are 1-10 copies/reaction. Using this RT-PCR, 5 cat cases among 56 SFTS-suspected animal cases were diagnosed as SFTS. From these cats, IgM or IgG against SFTSV were detected by enzyme-linked immunosorbent assay (ELISA), but not neutralizing antibodies by plaque reduction neutralization titer (PRNT) test. This phenomenon is similar to those of fatal SFTS patients. This newly developed RT-PCR could detect SFTSV RNA of several clades and from SFTS-suspected animals. In addition to ELISA and PRNT test, the useful laboratory diagnosis systems of SFTS-suspected animals has been made in this study.

Given the growing threat posed by viral hemorrhagic fevers, the development of surveillance tools is crucial to provide accurate and rapid solutions. Public health response involves risk assessment as well as effective and sustainable surveillance to ensure downstream communication and preparedness. A serological approach that offers high precision and throughput, cost efficiency, and multiplexing capacity is critical. In this work, we evaluated a Luminex‐based multiplex microsphere immunoassay for five hemorrhagic fever viruses (HFVs) among the World Health Organization (WHO) blueprint. This five‐plex MagPix immunoassay confirmed the presence of Rift Valley fever and Crimean–Congo hemorrhagic fever, but also revealed the exposure of human populations to hantaviruses in Senegal, underscoring the importance of regular serosurveillance in the identification of HFV hotspots.