Last data update: Jun 03, 2024. (Total: 46935 publications since 2009)
Records 1-30 (of 44 Records) |
Query Trace: Lindsey NP [original query] |
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Yellow fever resurgence: An avoidable crisis
Lindsey NP , Horton J , Barrett ADT , Demanou M , Monath TP , Tomori O , Van Herp M , Zeller H , Fall IS , Cibrelus L , Erin Staples J . NPJ Vaccines 2022 7 (1) 137 Yellow fever (YF), an acute viral hemorrhagic disease transmitted by infected mosquitoes, has the potential to spread rapidly and cause serious public health impact. The disease predominantly affects people in sub-Saharan Africa and tropical South America, where 40 countries are considered endemic and at high-risk for YF outbreaks1. Despite the availability of safe and effective vaccines since the 1930s, YF outbreaks continue to occur resulting in an estimated 109,000 severe cases and 51,000 deaths annually2. These figures are likely underestimates as most mild YF cases go undetected due to nonspecific symptoms and limited surveillance or laboratory diagnostic capacity in many at-risk regions. | | Because of large explosive outbreaks in the last five years, YF has reemerged as a major international public health threat. In 2016, an explosive outbreak occurred in Angola, spreading to neighboring areas in the Democratic Republic of Congo and infecting expatriate workers, including at least 11 workers who returned to China while ill3. At the time of the outbreak in Angola, vaccination coverage and disease awareness were low as the last YF outbreak was in 1971. In addition, control measures, such as requiring a valid international certificate of vaccination for travelers, were not enforced4. Thirty million doses of YF vaccine were needed to stop the outbreak, which both outstripped the available global vaccine supply and led to the unprecedented use of fractional doses of the vaccine to prevent further disease spread5. In late 2016–2017, outbreaks of YF were also detected in coastal areas of Brazil where cases had not been reported since the 1940s and vaccination was not routinely recommended6. Again, fractional doses of the vaccine were needed to protect those residing in affected areas. Although fractional doses have been demonstrated to provide good short-term protection, questions remain if they will provide the same long-term protective immunity as a full dose7–9. Until these questions can be adequately answered, fractional doses should only be considered in emergency scenarios if there are insufficient doses of the vaccine to respond to active or imminent threats of large-scale amplification of YF10,11. |
West Nile Virus and other domestic nationally notifiable arboviral diseases - United States, 2020
Soto RA , Hughes ML , Staples JE , Lindsey NP . MMWR Morb Mortal Wkly Rep 2022 71 (18) 628-632 Arthropod-borne viruses (arboviruses) are transmitted to humans primarily through the bite of infected mosquitoes and ticks. West Nile virus (WNV), mainly transmitted by Culex species mosquitos, is the leading cause of domestically acquired arboviral disease in the United States (1). Other arboviruses cause sporadic cases of disease and occasional outbreaks. This report summarizes passive data for nationally notifiable domestic arboviruses in the United States reported to CDC for 2020. Forty-four states reported 884 cases of domestic arboviral disease, including those caused by West Nile (731), La Crosse (88), Powassan (21), St. Louis encephalitis (16), eastern equine encephalitis (13), Jamestown Canyon (13), and unspecified California serogroup (2) viruses. A total of 559 cases of neuroinvasive WNV disease were reported, for a national incidence of 0.17 cases per 100,000 population. Because arboviral diseases continue to cause serious illness and the locations of outbreaks vary annually, health care providers should consider arboviral infections in patients with aseptic meningitis or encephalitis that occur during periods when ticks and mosquitoes are active, perform recommended diagnostic testing, and promptly report cases to public health authorities to guide prevention strategies and messaging. |
West Nile virus and other domestic nationally notifiable arboviral diseases - United States, 2019
Vahey GM , Mathis S , Martin SW , Gould CV , Staples JE , Lindsey NP . MMWR Morb Mortal Wkly Rep 2021 70 (32) 1069-1074 Arthropod-borne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes and ticks. West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease in the United States (1). Other arboviruses, including La Crosse, Jamestown Canyon, Powassan, eastern equine encephalitis, and St. Louis encephalitis viruses, cause sporadic disease and occasional outbreaks. This report summarizes surveillance data for nationally notifiable domestic arboviruses reported to CDC for 2019. For 2019, 47 states and the District of Columbia (DC) reported 1,173 cases of domestic arboviral disease, including 971 (83%) WNV disease cases. Among the WNV disease cases, 633 (65%) were classified as neuroinvasive disease, for a national incidence of 0.19 cases per 100,000 population, 53% lower than the median annual incidence during 2009-2018. More Powassan and eastern equine encephalitis virus disease cases were reported in 2019 than in any previous year. Health care providers should consider arboviral infections in patients with aseptic meningitis or encephalitis, perform recommended diagnostic testing, and promptly report cases to public health authorities. Because arboviral diseases continue to cause serious illness, and annual incidence of individual viruses continues to vary with sporadic outbreaks, maintaining surveillance is important in directing prevention activities. Prevention depends on community and household efforts to reduce vector populations and personal protective measures to prevent mosquito and tick bites such as use of Environmental Protection Agency-registered insect repellent and wearing protective clothing.*(,)(†). |
La Crosse Virus Disease in the United States, 2003-2019
Vahey GM , Lindsey NP , Staples JE , Hills SL . Am J Trop Med Hyg 2021 105 (3) 807-812 La Crosse virus (LACV) is an arthropod-borne virus that can cause a nonspecific febrile illness, meningitis, or encephalitis. We reviewed U.S. LACV surveillance data for 2003-2019, including human disease cases and nonhuman infections. Overall, 318 counties in 27 states, principally in the Great Lakes, mid-Atlantic, and southeastern regions, reported LACV activity. A total of 1,281 human LACV disease cases were reported, including 1,183 (92%) neuroinvasive disease cases. The median age of cases was 8 years (range: 1 month-95 years); 1,130 (88%) were aged < 18 years, and 754 (59%) were male. The most common clinical syndromes were encephalitis (N = 960; 75%) and meningitis (N = 219, 17%). The case fatality rate was 1% (N = 15). A median of 74 cases (range: 35-130) was reported per year. The average annual national incidence of neuroinvasive disease cases was 0.02 per 100,000 persons. West Virginia, North Carolina, Tennessee, and Ohio had the highest average annual state incidences (0.16-0.61 per 100,000), accounting for 80% (N = 1,030) of cases. No animal LACV infections were reported. Nine states reported LACV-positive mosquito pools, including three states with no reported human disease cases. La Crosse virus is the most common cause of pediatric neuroinvasive arboviral disease in the United States. However, surveillance data likely underestimate LACV disease incidence. Healthcare providers should consider LACV disease in patients, especially children, with febrile illness, meningitis, or encephalitis in areas where the virus circulates and advise their patients on ways to prevent mosquito bites. |
Characterizing Areas with Increased Burden of West Nile Virus Disease in California, 2009-2018
Danforth ME , Fischer M , Snyder RE , Lindsey NP , Martin SW , Kramer VL . Vector Borne Zoonotic Dis 2021 21 (8) 620-627 West Nile virus (WNV) is a mosquito-borne flavivirus that can cause severe neurological disease in humans, for which there is no treatment or vaccine. From 2009 to 2018, California has reported more human disease cases than any other state in the United States. We sought to identify smaller geographic areas within the 10 California counties with the highest number of WNV cases that accounted for disproportionately large numbers of human cases from 2009 to 2018. Eleven areas, consisting of groups of high-burden ZIP codes, were identified in nine counties within southern California and California's Central Valley. Despite containing only 2% of California's area and 17% of the state's population, these high-burden ZIP codes accounted for 44% of WNV cases reported and had a mean annual incidence that was 2.4 times the annual state incidence. Focusing mosquito control and public education efforts in these areas would lower WNV disease burden. |
Surveillance for West Nile Virus Disease - United States, 2009-2018
McDonald E , Mathis S , Martin SW , Staples JE , Fischer M , Lindsey NP . MMWR Surveill Summ 2021 70 (1) 1-15 PROBLEM/CONDITION: West Nile virus (WNV) is an arthropodborne virus (arbovirus) in the family Flaviviridae and is the leading cause of domestically acquired arboviral disease in the contiguous United States. An estimated 70%-80% of WNV infections are asymptomatic. Symptomatic persons usually develop an acute systemic febrile illness. Less than 1% of infected persons develop neuroinvasive disease, which typically presents as encephalitis, meningitis, or acute flaccid paralysis. REPORTING PERIOD: 2009-2018. DESCRIPTION OF SYSTEM: WNV disease is a nationally notifiable condition with standard surveillance case definitions. State health departments report WNV cases to CDC through ArboNET, an electronic passive surveillance system. Variables collected include patient age, sex, race, ethnicity, county and state of residence, date of illness onset, clinical syndrome, hospitalization, and death. RESULTS: During 2009-2018, a total of 21,869 confirmed or probable cases of WNV disease, including 12,835 (59%) WNV neuroinvasive disease cases, were reported to CDC from all 50 states, the District of Columbia, and Puerto Rico. A total of 89% of all WNV patients had illness onset during July-September. Neuroinvasive disease incidence and case-fatalities increased with increasing age, with the highest incidence (1.22 cases per 100,000 population) occurring among persons aged ≥70 years. Among neuroinvasive cases, hospitalization rates were >85% in all age groups but were highest among patients aged ≥70 years (98%). The national incidence of WNV neuroinvasive disease peaked in 2012 (0.92 cases per 100,000 population). Although national incidence was relatively stable during 2013-2018 (average annual incidence: 0.44; range: 0.40-0.51), state level incidence varied from year to year. During 2009-2018, the highest average annual incidence of neuroinvasive disease occurred in North Dakota (3.16 cases per 100,000 population), South Dakota (3.06), Nebraska (1.95), and Mississippi (1.17), and the largest number of total cases occurred in California (2,819), Texas (2,043), Illinois (728), and Arizona (632). Six counties located within the four states with the highest case counts accounted for 23% of all neuroinvasive disease cases nationally. INTERPRETATION: Despite the recent stability in annual national incidence of neuroinvasive disease, peaks in activity were reported in different years for different regions of the country. Variations in vectors, avian amplifying hosts, human activity, and environmental factors make it difficult to predict future WNV disease incidence and outbreak locations. PUBLIC HEALTH ACTION: WNV disease surveillance is important for detecting and monitoring seasonal epidemics and for identifying persons at increased risk for severe disease. Surveillance data can be used to inform prevention and control activities. Health care providers should consider WNV infection in the differential diagnosis of aseptic meningitis and encephalitis, obtain appropriate specimens for testing, and promptly report cases to public health authorities. Public health education programs should focus prevention messaging on older persons, because they are at increased risk for severe neurologic disease and death. In the absence of a human vaccine, WNV disease prevention depends on community-level mosquito control and household and personal protective measures. Understanding the geographic distribution of cases, particularly at the county level, appears to provide the best opportunity for directing finite resources toward effective prevention and control activities. Additional work to further develop and improve predictive models that can foreshadow areas most likely to be impacted in a given year by WNV outbreaks could allow for proactive targeting of interventions and ultimately lowering of WNV disease morbidity and mortality. |
Duration of seropositivity following yellow fever vaccination in U.S. military service members
Lindsey NP , Perry L , Fischer M , Woolpert T , Biggerstaff BJ , Brice G , Fitzpatrick K , Kosoy OI , Laven JJ , Myers CA , Hollis EM , Staples JE . Vaccine 2020 38 (52) 8286-8291 BACKGROUND: 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. METHODS: 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 p(10-14years) - p(5-9years) was ≥-0.10. Additionally, the geometric mean antibody titer (GMT) at various timepoints following vaccination were compared to the GMT at 5-9 years. RESULTS: 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. CONCLUSIONS: 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. |
Notes from the field: Multistate outbreak of Eastern equine encephalitis virus - United States, 2019
Lindsey NP , Martin SW , Staples JE , Fischer M . MMWR Morb Mortal Wkly Rep 2020 69 (2) 50-51 Eastern equine encephalitis virus (EEEV), a mosquito-borne alphavirus, is the cause of one of the most severe arboviral diseases in North America (1). The clinical course typically begins as a systemic febrile illness but often progresses to neurologic disease (2). EEEV neuroinvasive disease is estimated to have a 30% case-fatality rate with approximately half of survivors left with neurologic sequelae (2,3). Although veterinary EEEV vaccines are available for use in horses, there are no licensed vaccines or effective treatments for humans. During 2003–2018, an average of eight EEEV disease cases were reported annually in the United States (range = 4–21 cases) (3,4). However, as of October 15, 2019, CDC received reports of 34 cases of EEEV disease from 21 counties in seven states (Figure). Cases were reported from Massachusetts (12 cases), Michigan (10), Connecticut (four), New Jersey (three), Rhode Island (three), North Carolina (one), and Tennessee (one). Dates of illness onset ranged from June 18 to September 20, 2019. Among the 34 patients, 21 (62%) had illness onset in August; 32 (94%) had a diagnosis of encephalitis, and two (6%) had a diagnosis of meningitis. Twenty-six (76%) patients were male. The median age was 64 years (range = 5–78 years); 21 (62%) of the 34 patients were aged ≥60 years. |
Epidemiology of dengue, chikungunya, and Zika virus disease in the U.S. states and territories, 2017
Adams LE , Martin SW , Lindsey NP , Lehman JA , Rivera A , Kolsin J , Landry K , Staples JE , Sharp TM , Paz-Bailey G , Fischer M . Am J Trop Med Hyg 2019 101 (4) 884-890 Dengue, chikungunya, and Zika viruses, primarily transmitted by Aedes species mosquitoes, have caused large outbreaks in the Americas, leading to travel-associated cases and local mosquito-borne transmission in the United States. We describe the epidemiology of dengue, chikungunya, and noncongenital Zika virus disease cases reported from U.S. states and territories in 2017, including 971 dengue cases, 195 chikungunya cases, and 1,118 Zika virus disease cases. Cases of all three diseases reported from the territories were reported as resulting from local mosquito-borne transmission. Cases reported from the states were primarily among travelers, with only seven locally acquired mosquito-transmitted Zika virus disease cases reported from Texas (n = 5) and Florida (n = 2). In the territories, most dengue cases (n = 508, 98%) were reported from American Samoa, whereas the majority of chikungunya (n = 39, 100%) and Zika virus disease (n = 620, 93%) cases were reported from Puerto Rico. Temporally, the highest number of Zika virus disease cases occurred at the beginning of the year, followed by a sharp decline, mirroring decreasing case numbers across the Americas following large outbreaks in 2015 and 2016. Dengue and chikungunya cases followed a more seasonal pattern, with higher case numbers from July through September. Travelers to the United States and residents of areas with active virus transmission should be informed of both the ongoing risk from dengue, chikungunya, and Zika virus disease and personal protective measures to lower their risk of mosquito bites and to help prevent the spread of these diseases. |
West Nile virus and other domestic nationally notifiable arboviral diseases - United States, 2018
McDonald E , Martin SW , Landry K , Gould CV , Lehman J , Fischer M , Lindsey NP . MMWR Morb Mortal Wkly Rep 2019 68 (31) 673-678 Arthropodborne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes and ticks. West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease in the continental United States (1). Other arboviruses, including eastern equine encephalitis, Jamestown Canyon, La Crosse, Powassan, and St. Louis encephalitis viruses, cause sporadic cases of disease and occasional outbreaks. This report summarizes surveillance data reported to CDC for 2018 on nationally notifiable arboviruses. It excludes dengue, chikungunya, and Zika viruses because they are primarily nondomestic viruses typically acquired through travel. In 2018, 48 states and the District of Columbia (DC) reported 2,813 cases of domestic arboviral disease, including 2,647 (94%) WNV disease cases. Of the WNV disease cases, 1,658 (63%) were classified as neuroinvasive disease (e.g., meningitis, encephalitis, and acute flaccid paralysis), for a national incidence of 0.51 cases of WNV neuroinvasive disease per 100,000 population. Because arboviral diseases continue to cause serious illness and have no definitive treatment, maintaining surveillance is important to direct and promote prevention activities. Health care providers should consider arboviral infections in patients with aseptic meningitis or encephalitis, perform appropriate diagnostic testing, and report cases to public health authorities. |
Patients with laboratory evidence of West Nile virus disease without reported fever
Landry K , Rabe IB , Messenger SL , Hacker JK , Salas ML , Scott-Waldron C , Haydel D , Rider E , Simonson S , Brown CM , Smole SC , Neitzel DF , Schiffman EK , Strain AK , Vetter S , Fischer M , Lindsey NP . Epidemiol Infect 2019 147 e219 In 2013, the national surveillance case definition for West Nile virus (WNV) disease was revised to remove fever as a criterion for neuroinvasive disease and require at most subjective fever for non-neuroinvasive disease. The aims of this project were to determine how often afebrile WNV disease occurs and assess differences among patients with and without fever. We included cases with laboratory evidence of WNV disease reported from four states in 2014. We compared demographics, clinical symptoms and laboratory evidence for patients with and without fever and stratified the analysis by neuroinvasive and non-neuroinvasive presentations. Among 956 included patients, 39 (4%) had no fever; this proportion was similar among patients with and without neuroinvasive disease symptoms. For neuroinvasive and non-neuroinvasive patients, there were no differences in age, sex, or laboratory evidence between febrile and afebrile patients, but hospitalisations were more common among patients with fever (P < 0.01). The only significant difference in symptoms was for ataxia, which was more common in neuroinvasive patients without fever (P = 0.04). Only 5% of non-neuroinvasive patients did not meet the WNV case definition due to lack of fever. The evidence presented here supports the changes made to the national case definition in 2013. |
Expanded Molecular Testing on Patients with Suspected West Nile Virus Disease.
Lindsey NP , Messenger SL , Hacker JK , Salas ML , Scott-Waldron C , Haydel D , Rider E , Simonson S , Brown CM , Patel P , Smole SC , Neitzel DF , Schiffman EK , Palm J , Strain AK , Vetter SM , Nefzger B , Fischer M , Rabe IB . Vector Borne Zoonotic Dis 2019 19 (9) 690-693 Most diagnostic testing for West Nile virus (WNV) disease is accomplished using serologic testing, which is subject to cross-reactivity, may require cumbersome confirmatory testing, and may fail to detect infection in specimens collected early in the course of illness. The objective of this project was to determine whether a combination of molecular and serologic testing would increase detection of WNV disease cases in acute serum samples. A total of 380 serum specimens collected </=7 days after onset of symptoms and submitted to four state public health laboratories for WNV diagnostic testing in 2014 and 2015 were tested. WNV immunoglobulin M (IgM) antibody and RT-PCR tests were performed on specimens collected </=3 days after symptom onset. WNV IgM antibody testing was performed on specimens collected 4-7 days after onset and RT-PCR was performed on IgM-positive specimens. A patient was considered to have laboratory evidence of WNV infection if they had detectable WNV IgM antibodies or WNV RNA in the submitted serum specimen. Of specimens collected </=3 days after symptom onset, 19/158 (12%) had laboratory evidence of WNV infection, including 16 positive for only WNV IgM antibodies, 1 positive for only WNV RNA, and 2 positive for both. Of specimens collected 4-7 days after onset, 21/222 (9%) were positive for WNV IgM antibodies; none had detectable WNV RNA. These findings suggest that routinely performing WNV RT-PCR on acute serum specimens submitted for WNV diagnostic testing is unlikely to identify a substantial number of additional cases beyond IgM antibody testing alone. |
Postnatally acquired Zika virus disease among children, United States, 2016-2017
Lindsey NP , Porse CC , Potts E , Hyun J , Sandhu K , Schiffman E , Cervantes KB , White JL , Mason K , Owens K , Holsinger C , Fischer M , Staples JE . Clin Infect Dis 2019 70 (2) 227-231 BACKGROUND: The clinical findings among children with postnatally acquired Zika virus disease are not well characterized. We describe and compare clinical signs and symptoms for children aged <18 years. METHODS: Zika virus disease cases were included if they met the national surveillance case definition, had illness onset in 2016 or 2017, resided in a participating state, and were reported to CDC. Pediatric cases were aged <18 years; congenital and perinatal infections were excluded. Pediatric cases were matched to adult cases (1849 years). Clinical information was compared between younger and older pediatric cases and between children and adults. RESULTS: A total of 141 pediatric Zika virus disease cases were identified; none experienced neurologic disease. Overall, 28 (20%) were treated in an emergency department, 1 (<1%) was hospitalized; none died. Of the four primary clinical signs and symptoms associated with Zika virus disease, 133 (94%) children had rash, 104 (74%) fever, 67 (48%) arthralgia, and 51 (36%) conjunctivitis. Fever, arthralgia, and myalgia were more common in older children (1217 years) than younger children (111 years). Arthralgia, arthritis, edema, and myalgia were more common in adults compared to children. CONCLUSIONS: This report supports previous findings that Zika virus disease is generally mild in children. The most common symptoms are similar to other childhood infections, and clinical findings and outcomes are similar to those in adults. Healthcare providers should consider a diagnosis of Zika virus infection in children with fever, rash, arthralgia, or conjunctivitis, who reside in or have traveled to an area where Zika virus transmission is occurring. |
Seroprevalence of Heartland virus antibodies in blood donors, northwestern Missouri, USA
Lindsey NP , Menitove JE , Biggerstaff BJ , Turabelidze G , Parton P , Peck K , Basile AJ , Kosoy OI , Fischer M , Staples JE . Emerg Infect Dis 2019 25 (2) 358-360 We estimated the seroprevalence of Heartland virus antibodies to be 0.9% (95% CI 0.4%-4.2%) in a convenience sample of blood donors from northwestern Missouri, USA, where human cases and infected ticks have been identified. Although these findings suggest that some past human infections were undetected, the estimated prevalence is low. |
Persistence of yellow fever virus-specific neutralizing antibodies after vaccination among U.S. travelers
Lindsey NP , Horiuchi KA , Corey Fulton D , Panella AJ , Kosoy OI , Velez JO , Krow-Lucal ER , Fischer M , Staples JE . J Travel Med 2018 25 (1) Background: Few studies have assessed the duration of humoral immunity following yellow fever (YF) vaccination in a non-endemic population. We evaluated seropositivity among U.S. resident travelers based on time post-vaccination. Methods: We identified serum samples from U.S. travelers with YF virus-specific plaque reduction neutralization testing (PRNT) performed at CDC from 1988-2016. Analyses were conducted to assess the effect of time since vaccination on neutralizing antibody titer counts. Results: Among 234 travelers 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 travelers 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 to 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 to those who were not immunocompromised (92%; p = 0.04). Conclusion: 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 U.S. travelers. A booster dose could be considered for certain travelers who are planning travel to a high risk area based on immune competence and time since vaccination. |
West Nile virus and other nationally notifiable arboviral diseases - United States, 2017
Curren EJ , Lehman J , Kolsin J , Walker WL , Martin SW , Staples JE , Hills SL , Gould CV , Rabe IB , Fischer M , Lindsey NP . MMWR Morb Mortal Wkly Rep 2018 67 (41) 1137-1142 Arthropodborne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes or ticks. West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease in the continental United States (1). Other arboviruses, including Jamestown Canyon, La Crosse, Powassan, St. Louis encephalitis, and eastern equine encephalitis viruses, cause sporadic cases of disease and occasional outbreaks. This report summarizes surveillance data reported to CDC from U.S. states in 2017 for nationally notifiable arboviruses. It excludes dengue, chikungunya, and Zika viruses because, in the continental United States, these viruses are acquired primarily through travel. In 2017, 48 states and the District of Columbia (DC) reported 2,291 cases of domestic arboviral disease, including 2,097 (92%) WNV disease cases. Among the WNV disease cases, 1,425 (68%) were classified as neuroinvasive disease (e.g., meningitis, encephalitis, or acute flaccid paralysis), for a national rate of 0.44 cases per 100,000 population. More Jamestown Canyon and Powassan virus disease cases were reported in 2017 than in any previous year. Because arboviral diseases continue to cause serious illness, maintaining surveillance is important to direct and promote prevention activities. |
St. Louis encephalitis virus disease in the United States, 2003-2017
Curren EJ , Lindsey NP , Fischer M , Hills SL . Am J Trop Med Hyg 2018 99 (4) 1074-1079 St. Louis encephalitis virus (SLEV), an arthropod-borne flavivirus, can cause disease presentations ranging from mild febrile illness through severe encephalitis. We reviewed U.S. national SLEV surveillance data for 2003 through 2017, including human disease cases and nonhuman infections. Over the 15-year period, 198 counties from 33 states and the District of Columbia reported SLEV activity; 97 (49%) of those counties reported SLEV activity only in nonhuman species. A total of 193 human cases of SLEV disease were reported, including 148 cases of neuroinvasive disease. A median of 10 cases were reported per year. The national average annual incidence of reported neuroinvasive disease cases was 0.03 per million. States with the highest average annual incidence of reported neuroinvasive disease cases were Arkansas, Arizona, and Mississippi. No large outbreaks occurred during the reporting period. The most commonly reported clinical syndromes were encephalitis (N = 116, 60%), febrile illness (N = 35, 18%), and meningitis (N = 25, 13%). Median age of cases was 57 years (range 2-89 years). The case fatality rate was 6% (11/193) and all deaths were among patients aged > 45 years with neuroinvasive disease. Nonhuman surveillance data indicated wider SLEV activity in California, Nevada, and Florida than the human data alone suggested. Prevention depends on community efforts to reduce mosquito populations and personal protective measures to decrease exposure to mosquitoes. |
Vital Signs: Trends in reported vectorborne disease cases - United States and Territories, 2004-2016
Rosenberg R , Lindsey NP , Fischer M , Gregory CJ , Hinckley AF , Mead PS , Paz-Bailey G , Waterman SH , Drexler NA , Kersh GJ , Hooks H , Partridge SK , Visser SN , Beard CB , Petersen LR . MMWR Morb Mortal Wkly Rep 2018 67 (17) 496-501 INTRODUCTION: Vectorborne diseases are major causes of death and illness worldwide. In the United States, the most common vectorborne pathogens are transmitted by ticks or mosquitoes, including those causing Lyme disease; Rocky Mountain spotted fever; and West Nile, dengue, and Zika virus diseases. This report examines trends in occurrence of nationally reportable vectorborne diseases during 2004-2016. METHODS: Data reported to the National Notifiable Diseases Surveillance System for 16 notifiable vectorborne diseases during 2004-2016 were analyzed; findings were tabulated by disease, vector type, location, and year. RESULTS: A total 642,602 cases were reported. The number of annual reports of tickborne bacterial and protozoan diseases more than doubled during this period, from >22,000 in 2004 to >48,000 in 2016. Lyme disease accounted for 82% of all tickborne disease reports during 2004-2016. The occurrence of mosquitoborne diseases was marked by virus epidemics. Transmission in Puerto Rico, the U.S. Virgin Islands, and American Samoa accounted for most reports of dengue, chikungunya, and Zika virus diseases; West Nile virus was endemic, and periodically epidemic, in the continental United States. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Vectorborne diseases are a large and growing public health problem in the United States, characterized by geographic specificity and frequent pathogen emergence and introduction. Differences in distribution and transmission dynamics of tickborne and mosquitoborne diseases are often rooted in biologic differences of the vectors. To effectively reduce transmission and respond to outbreaks will require major national improvement of surveillance, diagnostics, reporting, and vector control, as well as new tools, including vaccines. |
Powassan virus disease in the United States, 2006-2016
Krow-Lucal ER , Lindsey NP , Fischer M , Hills SL . Vector Borne Zoonotic Dis 2018 18 (6) 286-290 BACKGROUND: Powassan virus (POWV) is a tick-borne flavivirus that causes rare, but often severe, disease in humans. POWV neuroinvasive disease was added to the U.S. nationally notifiable disease list in 2001 and nonneuroinvasive disease was added in 2004. The only previous review of the epidemiology of POWV disease in the United States based on cases reported to the Centers for Disease Control and Prevention (CDC) covered the period from 1999 through 2005. METHODS: We describe the epidemiology and clinical features of laboratory-confirmed POWV disease cases reported to CDC from 2006 through 2016. RESULTS: There were 99 cases of POWV disease reported during the 11-year period, including 89 neuroinvasive and 10 nonneuroinvasive disease cases. There was a median of seven cases per year (range: 1-22), with the highest numbers of cases reported in 2011 (n = 16), 2013 (n = 15), and 2016 (n = 22). Cases occurred throughout the year, but peaked in May and June. Cases were reported primarily from northeastern and north-central states. Overall, 72 (73%) cases were in males and the median age was 62 years (range: 3 months-87 years). Of the 11 (11%) cases who died, all were aged >50 years. The average annual incidence of neuroinvasive POWV disease was 0.0025 cases per 100,000 persons. CONCLUSIONS: POWV disease can be a severe disease and has been diagnosed with increased frequency in recent years. However, this might reflect increased disease awareness, improved test availability, and enhanced surveillance efforts. Clinicians should consider POWV disease in patients presenting with acute encephalitis or aseptic meningitis who are resident in, or have traveled to, an appropriate geographic region. |
Eastern equine encephalitis virus in the United States, 2003-2016
Lindsey NP , Staples JE , Fischer M . Am J Trop Med Hyg 2018 98 (5) 1472-1477 Eastern equine encephalitis virus (EEEV) is a mosquito-borne alphavirus found in the eastern United States. Eastern equine encephalitis virus disease in humans is rare but can result in severe, often fatal, illness. This report summarizes the national EEEV surveillance data for 2003 through 2016, including human disease cases and nonhuman infections. Over the 14-year period, 633 counties from 33 states reported EEEV activity; 88% of those counties reported EEEV activity only in nonhuman species. A total of 121 human cases of EEEV disease were reported, with a median of eight cases reported annually. The national average annual incidence of EEEV neuroinvasive disease was 0.03 cases per million population. States with the highest average annual incidence included New Hampshire, Massachusetts, Vermont, Maine, and Alabama. Eastern equine encephalitis virus neuroinvasive disease incidence was highest among males and among persons aged < 5 and > 60 years. Overall, 118 (98%) case patients were hospitalized and 50 (41%) died. The case fatality ratio was highest among case patients aged >/= 70 years. Nonhuman surveillance data indicate that the geographic range of EEEV is much greater than human cases alone might suggest. In areas where the virus circulates, health-care providers should consider EEEV infection in the differential diagnosis for meningitis and encephalitis. Providers are encouraged to report suspected cases to their public health department to facilitate diagnosis and consider interventions to mitigate the risk of further transmission. Because human vaccines against EEEV are not available, prevention depends on community efforts to reduce mosquito populations and personal protective measures to decrease exposure to mosquitoes. |
Update: Noncongenital Zika virus disease cases - 50 U.S. states and the District of Columbia, 2016
Hall V , Walker WL , Lindsey NP , Lehman JA , Kolsin J , Landry K , Rabe IB , Hills SL , Fischer M , Staples JE , Gould CV , Martin SW . MMWR Morb Mortal Wkly Rep 2018 67 (9) 265-269 Zika virus is a flavivirus primarily transmitted to humans by Aedes aegypti mosquitoes (1). Zika virus infections also have been documented through intrauterine transmission resulting in congenital infection; intrapartum transmission from a viremic mother to her newborn; sexual transmission; blood transfusion; and laboratory exposure (1-3). Most Zika virus infections are asymptomatic or result in mild clinical illness, characterized by acute onset of fever, maculopapular rash, arthralgia, or nonpurulent conjunctivitis; Guillain-Barre syndrome, meningoencephalitis, and severe thrombocytopenia rarely have been associated with Zika virus infection (1). However, congenital Zika virus infection can result in fetal loss, microcephaly, and other birth defects (1,2). In 2016, a total of 5,168 noncongenital Zika virus disease cases were reported from U.S. states and the District of Columbia. Most cases (4,897, 95%) were in travelers returning from Zika virus-affected areas. A total of 224 (4%) cases were acquired through presumed local mosquitoborne transmission, and 47 (1%) were acquired by other routes. It is important that providers in the United States continue to test symptomatic patients who live in or recently traveled to areas with ongoing Zika virus transmission or had unprotected sex with someone who lives in or traveled to those areas. All pregnant women and their partners should take measures to prevent Zika virus infection during pregnancy. A list of affected areas and specific recommendations on how to prevent Zika virus infection during pregnancy are available at https://www.cdc.gov/pregnancy/zika/protect-yourself.html. |
West Nile Virus and other nationally notifiable arboviral diseases - United States, 2016
Burakoff A , Lehman J , Fischer M , Staples JE , Lindsey NP . MMWR Morb Mortal Wkly Rep 2018 67 (1) 13-17 Arthropod-borne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes and ticks. West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease in the continental United States (1,2). Other arboviruses, including La Crosse, Powassan, Jamestown Canyon, St. Louis encephalitis, and eastern equine encephalitis viruses, cause sporadic cases of disease and occasional outbreaks. This report summarizes surveillance data reported to CDC for 2016 for nationally notifiable arboviruses. It excludes dengue, chikungunya, and Zika viruses, as these are primarily nondomestic viruses typically acquired through travel. Forty-seven states and the District of Columbia (DC) reported 2,240 cases of domestic arboviral disease, including 2,150 (96%) WNV disease cases. Of the WNV disease cases, 1,310 (61%) were classified as neuroinvasive disease (e.g., meningitis, encephalitis, acute flaccid paralysis), for a national incidence of 0.41 cases per 100,000 population. After WNV, the most frequently reported arboviruses were La Crosse (35 cases), Powassan (22), and Jamestown Canyon (15) viruses. Because arboviral diseases continue to cause serious illness, maintaining surveillance is important to direct prevention activities. |
Investigation of acute flaccid paralysis reported with La Crosse virus infection, Ohio, USA, 2008-2014
Hennessey MJ , Pastula DM , Machesky K , Fischer M , Lindsey NP , DiOrio M , Staples JE , de Fijter S . Emerg Infect Dis 2017 23 (12) 2075-2077 Infection with La Crosse virus can cause meningoencephalitis, but it is not known to cause acute flaccid paralysis (AFP). During 2008-2014, nine confirmed or probable La Crosse virus disease cases with possible AFP were reported in Ohio, USA. After an epidemiologic and clinical investigation, we determined no patients truly had AFP. |
Chikungunya virus disease among travelers - United States, 2014-2016
Lindsey NP , Staples JE , Fischer M . Am J Trop Med Hyg 2017 98 (1) 192-197 Chikungunya virus is a mosquito-borne alphavirus that causes an acute febrile illness with severe polyarthralgia. The first local transmission of chikungunya virus in the Western Hemisphere was reported in December 2013. In the following year, the virus spread throughout much of the Americas and the number of cases among travelers increased substantially. We reviewed the epidemiology of chikungunya virus disease cases reported among U.S. travelers from 2014 to 2016. A total of 3,941 travel-acquired cases were reported from 49 states and the District of Columbia; 3,616 (92%) reported travel to other countries or territories in the Americas; the remaining 8% reported travel to Asia, Africa, or the Western Pacific. The most commonly reported travel destinations were the Dominican Republic, Puerto Rico, and Haiti. The largest number of cases (N = 2,780, 71%) had illness onset in 2014, followed by 2015 (N = 913, 23%) and 2016 (N = 248, 6%). Cases occurred in every month, but 70% of case-patients had illness onset from April to September, the months when mosquitoes are most likely to be active in the continental United States. Travel-acquired chikungunya cases will likely continue to occur and present a risk of introduction of the virus to locations in the continental United States. Clinicians and public health officials should be educated about the recognition, diagnosis, management, and timely reporting of chikungunya cases. |
Ability to serologically confirm recent Zika virus infection in areas with varying past incidence of dengue virus infection in the United States and U.S. territories in 2016
Lindsey NP , Staples JE , Powell K , Rabe IB , Fischer M , Powers AM , Kosoy OI , Mossel EC , Munoz-Jordan JL , Beltran M , Hancock WT , Toews KE , Ellis EM , Ellis BR , Panella AJ , Basile AJ , Calvert AE , Laven J , Goodman CH , Gould CV , Martin SW , Thomas JD , Villanueva J , Mataia ML , Sciulli R , Gose R , Whelen AC , Hills SL . J Clin Microbiol 2017 56 (1) Background. Cross-reactivity within flavivirus antibody assays, produced by shared epitopes in the envelope proteins, can complicate serological diagnosis of Zika virus (ZIKAV) infection. We assessed the utility of the plaque reduction neutralization test (PRNT) to confirm recent ZIKAV infections and rule out misleading positive IgM results in areas with varying past dengue virus (DENV) infection incidence. Methods. We reviewed PRNT results of sera collected for diagnosis of ZIKAV infection from January 1 through August 31, 2016 with positive ZIKAV IgM results and ZIKAV and DENV PRNT performed. PRNT result interpretations included ZIKAV, unspecified flavivirus, DENV infection, or negative. For this analysis, ZIKAV IgM was considered false-positive for samples interpreted as DENV infection or negative. Results. In US states, 208 (27%) of 759 IgM positives were confirmed as ZIKAV, compared to 11 (21%) of 52 in the US Virgin Islands (USVI), 15 (15%) of 103 in American Samoa, and 13 (11%) of 123 in Puerto Rico. In American Samoa and Puerto Rico, more than 80% of IgM positives were unspecified flavivirus infections. The false-positivity rate was 27% in US states, 18% in USVI, 2% in American Samoa, and 6% in Puerto Rico. Conclusions. In US states, PRNT provided a virus-specific diagnosis or ruled out infection in the majority of IgM positive samples. Almost a third of ZIKAV IgM positive results did not confirm; therefore, providers and patients must understand that IgM results are preliminary. In territories with historically higher DENV transmission, PRNT usually could not differentiate between ZIKAV and DENV infections. |
Updated estimation of the impact of a Japanese encephalitis immunization program with live, attenuated SA 14-14-2 vaccine in Nepal
Upreti SR , Lindsey NP , Bohara R , Choudhary GR , Shakya S , Gautam M , Giri JN , Fischer M , Hills SL . PLoS Negl Trop Dis 2017 11 (9) e0005866 BACKGROUND: Japanese encephalitis (JE) is a mosquito-borne disease that is associated with considerable morbidity and mortality in many Asian countries. The objective of this study was to describe the impact of the JE immunization program using SA 14-14-2 JE vaccine implemented in Nepal during 2006 through 2011. A previous assessment after the initial program implementation phase described a significantly lower post-campaign JE incidence compared to expected incidence; however, the previous evaluation had limited post-campaign data for some districts. METHODOLOGY/PRINCIPAL FINDINGS: JE and acute encephalitis syndrome (AES) data gathered through Nepal's routine surveillance system from 2004 through 2014 were analyzed to assess the impact of the JE immunization program implemented in 31 districts. Expected incidence rates were determined by calculating the incidence of cases per 100,000 person-years in each district before the vaccination campaigns. This rate was applied to the relevant population after the vaccination campaigns, which provided the expected number of cases had the campaign not occurred. The observed incidence rate was the number of reported cases per 100,000 person-years post-campaign. Expected and observed JE and AES cases and incidence rates were compared. The post-campaign JE incidence rate of 0.7 cases per 100,000 was 78% (95% CI 76%-79%) lower than expected had no campaign occurred and an estimated 3,011 (95% CI 2,941-3,057) JE cases were prevented. The post-vaccination AES incidence of 5.5 cases per 100,000 was 59% (58%-60%) lower than the expected and an estimated 9,497 (95% CI 9,268-9,584) AES cases were prevented. CONCLUSIONS/SIGNIFICANCE: This analysis strengthens previous findings of the substantial impact of Nepal's JE immunization program using SA 14-14-2 JE vaccine. |
West Nile Virus and other nationally notifiable arboviral diseases - United States, 2015
Krow-Lucal E , Lindsey NP , Lehman J , Fischer M , Staples JE . MMWR Morb Mortal Wkly Rep 2017 66 (2) 51-55 Arthropod-borne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes and ticks. The leading cause of domestically acquired arboviral disease in the United States is West Nile virus (WNV) (1). Other arboviruses, including La Crosse, St. Louis encephalitis, Jamestown Canyon, Powassan, and eastern equine encephalitis viruses, also cause sporadic cases and outbreaks. This report summarizes surveillance data reported to CDC in 2015 for nationally notifiable arboviruses. It excludes dengue, chikungunya, and Zika viruses, which are primarily nondomestic viruses typically acquired through travel (and are addressed in other CDC reports). In 2015, 45 states and the District of Columbia (DC) reported 2,282 cases of domestic arboviral disease. Among these cases, 2,175 (95%) were WNV disease and 1,455 (67%) of those were classified as neuroinvasive disease (meningitis, encephalitis, or acute flaccid paralysis). The national incidence of WNV neuroinvasive disease was 0.45 cases per 100,000 population. Because arboviral diseases continue to cause serious illness, maintaining surveillance is important to direct prevention activities such as reduction of vector populations and screening of blood donors. |
Zika virus disease cases - 50 states and the District of Columbia, January 1-July 31, 2016
Walker WL , Lindsey NP , Lehman JA , Krow-Lucal ER , Rabe IB , Hills SL , Martin SW , Fischer M , Staples JE . MMWR Morb Mortal Wkly Rep 2016 65 (36) 983-986 Zika virus is a mosquito-borne flavivirus primarily transmitted to humans by Aedes aegypti mosquitoes. Zika virus infections have also been documented through intrauterine transmission resulting in congenital infection; intrapartum transmission from a viremic mother to her newborn; sexual transmission; blood transfusion; and laboratory exposure. Most Zika virus infections are asymptomatic. Clinical illness, when it occurs, is generally mild and characterized by acute onset of fever, maculopapular rash, arthralgia, or nonpurulent conjunctivitis. However, Zika virus infection during pregnancy can cause adverse outcomes such as fetal loss, and microcephaly and other serious brain anomalies. Guillain-Barre syndrome, a rare autoimmune condition affecting the peripheral nervous system, also has been associated with Zika virus infection. Following the identification of local transmission of Zika virus in Brazil in May 2015, the virus has continued to spread throughout the Region of the Americas, and travel-associated cases have increased. In 2016, Zika virus disease and congenital infections became nationally notifiable conditions in the United States (8). As of September 3, 2016, a total of 2,382 confirmed and probable cases of Zika virus disease with symptom onset during January 1-July 31, 2016, had been reported from 48 of 50 U.S. states and the District of Columbia. Most cases (2,354; 99%) were travel-associated, with either direct travel or an epidemiologic link to a traveler to a Zika virus-affected area. Twenty-eight (1%) cases were reported as locally acquired, including 26 associated with mosquito-borne transmission, one acquired in a laboratory, and one with an unknown mode of transmission. Zika virus disease should be considered in patients with compatible clinical signs or symptoms who traveled to or reside in areas with ongoing Zika virus transmission or who had unprotected sex with someone who traveled to those areas. Health care providers should continue to educate patients, especially pregnant women, about the importance of avoiding infection with Zika virus, and all pregnant women should be assessed for possible Zika virus exposure at each prenatal visit. |
Adverse event reports following yellow fever vaccination, 2007-13
Lindsey NP , Rabe IB , Miller ER , Fischer M , Staples JE . J Travel Med 2016 23 (5) BACKGROUND: Yellow fever (YF) vaccines have been available since the 1930s and are generally considered safe and effective. However, rare reports of serious adverse events (SAE) following vaccination have prompted the Advisory Committee for Immunization Practices to periodically expand the list of conditions considered contraindications and precautions to vaccination. METHODS: We describe adverse events following YF vaccination reported to the U.S. Vaccine Adverse Event Reporting System (VAERS) from 2007 through 2013 and calculate age- and sex-specific reporting rates of all SAE, anaphylaxis, YF vaccine-associated neurologic disease (YEL-AND) and YF vaccine-associated viscerotropic disease (YEL-AVD). RESULTS: There were 938 adverse events following YF vaccination reported to VAERS from 2007 through 2013. Of these, 84 (9%) were classified as SAEs for a rate of 3.8 per 100 000 doses distributed. Reporting rates of SAEs increased with increasing age with a rate of 6.5 per 100 000 in persons aged 60-69 years and 10.3 for ≥70 years. The reporting rate for anaphylaxis was 1.3 per 100 000 doses distributed and was highest in persons ≤18 years (2.7 per 100 000). Reporting rates of YEL-AND and YEL-AVD were 0.8 and 0.3 per 100 000 doses distributed, respectively; both rates increased with increasing age. CONCLUSIONS: These findings reinforce the generally acceptable safety profile of YF vaccine, but highlight the importance of continued physician and traveller education regarding the risks and benefits of YF vaccination, particularly for older travellers. |
Hospital-based enhanced surveillance for West Nile virus neuroinvasive disease
Lindsey NP , Fischer M , Neitzel D , Schiffman E , Salas ML , Glaser CA , Sylvester T , Kretschmer M , Bunko A , Staples JE . Epidemiol Infect 2016 144 (15) 1-6 Accurate data on the incidence of West Nile virus (WNV) disease are important for directing public health education and control activities. The objective of this project was to assess the underdiagnosis of WNV neuroinvasive disease through laboratory testing of patients with suspected viral meningitis or encephalitis at selected hospitals serving WNV-endemic regions in three states. Of the 279 patients with cerebrospinal fluid (CSF) specimens tested for WNV immunoglobulin M (IgM) antibodies, 258 (92%) were negative, 19 (7%) were positive, and two (1%) had equivocal results. Overall, 63% (12/19) of patients with WNV IgM-positive CSF had WNV IgM testing ordered by their attending physician. Seven (37%) cases would not have been identified as probable WNV infections without the further testing conducted through this project. These findings indicate that over a third of WNV infections in patients with clinically compatible neurological illness might be undiagnosed due to either lack of testing or inappropriate testing, leading to substantial underestimates of WNV neuroinvasive disease burden. Efforts should be made to educate healthcare providers and laboratorians about the local epidemiology of arboviral diseases and the optimal tests to be used in different clinical situations. |
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