6/ 24/ 2019 National Center for Emerging and Zoonotic Infectious - PDF document

6/ 24/ 2019 National Center for Emerging and Zoonotic Infectious Diseases National Center for Emerging and Zoonotic Infectious Diseases The Story of Mosquito ‐ Borne Viruses that Cause Joint Pain Epidemiology of Arthritogenic Arboviruses among Travelers Affecting Travelers Susan Hills MBBS, MTH Medical Epidemiologist Division of Vector ‐ Borne Diseases Centers for Disease Control and Prevention 16 th Conference of the International Society of Travel Medicine June 8, 2019 1 2 Symptoms of alphaviral diseases What: Alphaviruses Sindbis virus 3 4 Why is clinician awareness of these diseases important? Potential for rapid spread  Disease burden – Common: Chikungunya – Less common: Ross River, Mayaro, O’nyong ‐ nyong, Sindbis  Geographically widely distributed Robinson MC. Trans Roy Soc Trop Med Hyg 1955 5 6 1

6/ 24/ 2019 Travelers can be sentinels of infection Traveler’s role in spread of infection Lindh E. Open Forum ID 2018 Tsuboi 2016. Emerging Infectious Diseases 7 8 Chikungunya 9 10 Transmission cycle Chikungunya Sylvatic cycle  First recognized during Aedes furcifer, Aedes africanus outbreak in Tanzania in 1952–53  ‘ that which bends up ’ or Chimpanzees, Chimpanzees, monkeys, ‘ to become contorted ’ monkeys, baboons baboons (Makonde language) Aedes furcifer, Aedes africanus Source: PAHO, 2011. Preparedness and Response for Chikungunya Virus Introduction in the Americas Available at www..paho.org Acknowledgement for graphic: Dr Ann Powers, CDC 11 12 2

6/ 24/ 2019 Transmission cycle Mosquito vectors Sylvatic cycle Urban cycle Aedes aegypti Aedes albopictus Aedes furcifer, Aedes africanus Chimpanzees, Chimpanzees, monkeys, monkeys, baboons Aedes aegypti Aedes albopictus baboons  Identified by white stripes on bodies and legs Aedes aegypti Aedes furcifer, Aedes africanus Aedes albopictus  Aggressive daytime biters with peak dawn and dusk  Breed in containers that hold water Acknowledgement for graphic: Dr Ann Powers, CDC 13 14 Chikungunya virus disease cases reported among Spread of chikungunya virus since 2004* travelers, United States, 2009–2018 – Source: Zeller H et al. J Infect Dis 2016 *As of 2015 15 16 Travel destination for U.S. travelers Risk area for chikungunya virus transmission* with chikungunya virus disease, 2018–19* – North America (5%) Pacific (2%) Central America (6%) Africa (6%) South America (10%) Asia (59%) Caribbean (15%) * Preliminary data for 126 travelers reported to ArboNET with travel destination noted *As of May 2018 www.cdc.gov 17 18 3

6/ 24/ 2019 Travelers do not need to travel far to be at risk Eurosurveillance, March 2019  Sweden  Romania  Switzerland  Israel  France  United Kingdom 19 20 Ross River virus infection Ross River virus First isolated: Ross River, Townsville, Australia, 1959 Primary vectors: Aedes and Culex species mosquitoes Reservoir hosts: Marsupials 21 22 Risk areas  Australia – Average of 5,000 cases/year with periodic outbreaks  Papua New Guinea 23 24 4

6/ 24/ 2019 Ross River virus infections in travelers to Australia Additional risk areas – Pacific Islands region  Reported in small numbers but regularly  Large outbreak South Pacific in 1979–1980  Locally, no outbreaks or cases reported since  Data suggest Ross River virus might be established or be periodically reintroduced with local transmission – Traveler cases from 1997–2009 in tourists to Fiji – Serosurvey evidence in French Polynesia and American Samoa Proll 1999. Dtsch Med Wochenschr; Klapsing 2005. Emerging Infectious Diseases; Lau 2012. Travel Medicine Infectious Diseases; Aubry 2015. International Journal of Infectious Diseases; Lau 2017, International Journal of Infectious Diseases. 25 26 Mayaro virus Mayaro virus infection First isolated: Mayaro County, Trinidad, 1954 Primary vectors: Haemagogus species mosquitoes* Venezuela Reservoir hosts: Non ‐ human primates* *Presumed 27 28 Human exposure and infection Countries with reported Mayaro cases Source: Flickr.com Source: divergenttravelers.com Source: Adapted from Acosta ‐ Ampudia Y et al, 2018. Emerging Microbes & Infections 7:163 Source: amazon ‐ rainforest.org 29 30 5

6/ 24/ 2019 Published cases in international travelers, 1996–2018 Year Nationality Travel destination Reference 1996 United States Peru 1 1997 United States Peru 1 1999* United States Bolivia 2 O’nyong ‐ nyong virus and 2008** Dutch Suriname 3 2010 French Brazil (Amazon) 4 2011 Swiss Peru (Amazon) 5 Sindbis virus infection 2012 German Bolivia (Amazon) 6 2013 German French Guiana 7 2013 Dutch Brazil (Amazon) 8 2013 French French Guiana 9 2014 German Ecuador 10 2014 German Bolivia 10 *Probable case; **Possible infection in partner also References: 1. Tesh et al, 1999. Clin ID; 2. Taylor et al, 2005. Southern Med J; 3. Hassing et al, 2010. J Infect; 4. Receveur et al, 2010. Euro Surveill; 5. Neumayer et al, 2012. Emerg ID; 6. Theilacker et al, 2013. BMC Infect Dis 7. Friedrich ‐ Janicke et al, 2014. Emerg ID. 8. Slegers et al, 2014. J Clin Virol; 9. Llagonne ‐ Barets et al, 2016. J Clin Virol; 10. Tappe et al, 2016. Emerg ID. 31 32 Geographical distribution of O’nyong ‐ nyong virus O’nyong ‐ nyong* First isolated: Uganda, 1959 Primary vectors: Anopheles species mosquitoes Vertebrate hosts: Unknown * ‘Very painful weakening of the joints ’ Source: Rezza et al, 2017. Pathogens and Global Health 33 34 O’nyong ‐ nyong cases in travelers Sindbis First isolated: Sindbis district, Egypt, 1952 Culex , Aedes, and Culiseta species Primary vectors: mosquitoes Vertebrate hosts: Birds 35 36 6

6/ 24/ 2019 Geographical distribution of Sindbis virus Summary  Chikungunya: most common disease causing arthralgia in tropical/subtropical areas  Other alphaviruses to keep in mind – Australia and the Pacific: Ross River virus disease – Africa: O’nyong ‐ nyong – South/Central America: Mayaro – South Africa, Northern Europe: Sindbis Source: Adouchief et al, 2016. Reviews in Medical Virology 37 38 Human travel Why are arboviruses emerging? ..and covering greater distances with increasing speed Increasing number and variety of destinations …allowing rapid transport of pathogens 39 40 Growth in tourist numbers Spread of vectors Predicted distribution of Aedes albopictus Predicted distribution of Aedes aegypti Source: Kraemer et al, 2015. eLife  Adaptable to a range of habitats  Adaptable to cold temperatures 41 42 7

6/ 24/ 2019 International trade Viral adaption  Chikungunya virus developed a mutation that allows easier transmission by Aedes albopictus Lucky bamboo Tires Source: Walmart.com Aedes albopictus 43 44 Climate change Urbanization • Urbanization of human populations Source: pxhere.com 45 46 What next? What is needed?  Appropriate vector  Suitable environmental conditions  Vertebrate host  Susceptible population 47 48 8

6/ 24/ 2019 Acknowledgements Dr Bertrand Sudre European Center for Disease Control and Prevention Dr Ann Powers U.S. Centers for Disease Control and Prevention Susan Hills U.S. Centers for Disease Control and Prevention Email: shills@cdc.gov 49 9