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Surveillance Open Access
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Abstract

Background

During the 2018 WNV transmission season, similarly to other endemic areas in Europe, a large number of human West Nile virus (WNV) infections were reported in Hungary.

Aims

We summarise the epidemiological and laboratory findings of the 2018 transmission season and expand experiences in flavivirus differential diagnostics.

Methods

Every patient with clinical suspicion of acute WNV infection was in parallel tested for WNV, tick-borne encephalitis virus and Usutu virus (USUV) by serological methods. Sera, whole blood and urine samples were also tested for the presence of viral nucleic acid.

Results

Until the end of December 2018, 215 locally acquired and 10 imported human WNV infections were notified in Hungary. All reported cases were symptomatic; most of them exhibited neurological symptoms. In a large proportion of tested individuals, whole blood was the most appropriate sample type for viral nucleic acid detection, but because whole blood samples were not always available, testing of urine samples also extended diagnostic possibilities. In addition, the first human USUV infection was confirmed in 2018 in a patient with aseptic meningitis. Serological cross-reactions with WNV in different serological assays were experienced, but subsequent molecular biological testing and sequence analysis identified Europe lineage 2 USUV infection.

Conclusion

Careful interpretation and simultaneous application of different laboratory methods are necessary to avoid misdiagnosis of human USUV cases. Expansion of the laboratory-confirmed case definition criteria for detection of viral RNA in any clinical specimens to include urine samples could increase diagnostic sensitivity.

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/content/10.2807/1560-7917.ES.2019.24.28.1900038
2019-07-11
2019-11-13
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.28.1900038
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References

  1. Ashraf U, Ye J, Ruan X, Wan S, Zhu B, Cao S. Usutu virus: an emerging flavivirus in Europe. Viruses. 2015;7(1):219-38.  https://doi.org/10.3390/v7010219  PMID: 25606971 
  2. Papa A. Emerging arboviral human diseases in Southern Europe. J Med Virol. 2017;89(8):1315-22.  https://doi.org/10.1002/jmv.24803  PMID: 28252204 
  3. Pealer LN, Marfin AA, Petersen LR, Lanciotti RS, Page PL, Stramer SL, et al. Transmission of West Nile virus through blood transfusion in the United States in 2002. N Engl J Med. 2003;349(13):1236-45.  https://doi.org/10.1056/NEJMoa030969  PMID: 14500806 
  4. Iwamoto M, Jernigan DB, Guasch A, Trepka MJ, Blackmore CG, Hellinger WC, et al. Transmission of West Nile virus from an organ donor to four transplant recipients. N Engl J Med. 2003;348(22):2196-203.  https://doi.org/10.1056/NEJMoa022987  PMID: 12773646 
  5. Aberle SW, Kolodziejek J, Jungbauer C, Stiasny K, Aberle JH, Zoufaly A, et al. Increase in human West Nile and Usutu virus infections, Austria, 2018. Euro Surveill. 2018;23(43):1800545.  https://doi.org/10.2807/1560-7917.ES.2018.23.43.1800545  PMID: 30376913 
  6. Cadar D, Maier P, Müller S, Kress J, Chudy M, Bialonski A, et al. Blood donor screening for West Nile virus (WNV) revealed acute Usutu virus (USUV) infection, Germany, September 2016. Euro Surveill. 2017;22(14):30501.  https://doi.org/10.2807/1560-7917.ES.2017.22.14.30501  PMID: 28422005 
  7. Bakonyi T, Jungbauer C, Aberle SW, Kolodziejek J, Dimmel K, Stiasny K, et al. Usutu virus infections among blood donors, Austria, July and August 2017 - Raising awareness for diagnostic challenges. Euro Surveill. 2017;22(41):17-00644.  https://doi.org/10.2807/1560-7917.ES.2017.22.41.17-00644  PMID: 29043962 
  8. Hinckley AF, O’Leary DR, Hayes EB. Transmission of West Nile virus through human breast milk seems to be rare. Pediatrics. 2007;119(3):e666-71.  https://doi.org/10.1542/peds.2006-2107  PMID: 17332186 
  9. O’Leary DR, Kuhn S, Kniss KL, Hinckley AF, Rasmussen SA, Pape WJ, et al. Birth outcomes following West Nile Virus infection of pregnant women in the United States: 2003-2004. Pediatrics. 2006;117(3):e537-45.  https://doi.org/10.1542/peds.2005-2024  PMID: 16510632 
  10. Hayes EB, O’Leary DR. West Nile virus infection: a pediatric perspective. Pediatrics. 2004;113(5):1375-81.  https://doi.org/10.1542/peds.113.5.1375  PMID: 15121956 
  11. Centers for Disease Control and Prevention (CDC). Laboratory-acquired West Nile virus infections--United States, 2002. MMWR Morb Mortal Wkly Rep. 2002;51(50):1133-5. PMID: 12537288 
  12. European Centre for Disease Control and Prevention (ECDC). Historical data by year – West Nile fever seasonal surveillance. Stockholm: ECDC. [Accessed: July 2019]. Available from: https://ecdc.europa.eu/en/west-nile-fever/surveillance-and-disease-data/historical
  13. Pecorari M, Longo G, Gennari W, Grottola A, Sabbatini A, Tagliazucchi S, et al. First human case of Usutu virus neuroinvasive infection, Italy, August-September 2009. Euro Surveill. 2009;14(50):19446. PMID: 20070936 
  14. Cavrini F, Gaibani P, Longo G, Pierro AM, Rossini G, Bonilauri P, et al. Usutu virus infection in a patient who underwent orthotropic liver transplantation, Italy, August-September 2009. Euro Surveill. 2009;14(50):19448. PMID: 20070935 
  15. Santini M, Vilibic-Cavlek T, Barsic B, Barbic L, Savic V, Stevanovic V, et al. First cases of human Usutu virus neuroinvasive infection in Croatia, August-September 2013: clinical and laboratory features. J Neurovirol. 2015;21(1):92-7.  https://doi.org/10.1007/s13365-014-0300-4  PMID: 25361698 
  16. Simonin Y, Sillam O, Carles MJ, Gutierrez S, Gil P, Constant O, et al. Human Usutu virus infection with atypical neurologic presentation, Montpellier, France, 2016. Emerg Infect Dis. 2018;24(5):875-8.  https://doi.org/10.3201/eid2405.171122  PMID: 29664365 
  17. Carletti F, Colavita F, Rovida F, Percivalle E, Baldanti F, Ricci I, et al. Expanding Usutu virus circulation in Italy: detection in the Lazio region, central Italy, 2017 to 2018. Euro Surveill. 2019;24(3):1800649.  https://doi.org/10.2807/1560-7917.ES.2019.24.3.1800649  PMID: 30670139 
  18. Domanović D, Gossner CM, Lieshout-Krikke R, Mayr W, Baroti-Toth K, Dobrota AM, et al. West Nile and Usutu Virus Infections and Challenges to Blood Safety in the European Union. Emerg Infect Dis. 2019;25(6):1050-7.  https://doi.org/10.3201/eid2506.181755  PMID: 31107223 
  19. Bakonyi T, Ivanics E, Erdélyi K, Ursu K, Ferenczi E, Weissenböck H, et al. Lineage 1 and 2 strains of encephalitic West Nile virus, central Europe. Emerg Infect Dis. 2006;12(4):618-23.  https://doi.org/10.3201/eid1204.051379  PMID: 16704810 
  20. Bakonyi T, Erdélyi K, Ursu K, Ferenczi E, Csörgo T, Lussy H, et al. Emergence of Usutu virus in Hungary. J Clin Microbiol. 2007;45(12):3870-4.  https://doi.org/10.1128/JCM.01390-07  PMID: 17913929 
  21. Bakonyi T, Erdélyi K, Brunthaler R, Dán Á, Weissenböck H, Nowotny N. Usutu virus, Austria and Hungary, 2010-2016. Emerg Microbes Infect. 2017;6(10):e85.  https://doi.org/10.1038/emi.2017.72  PMID: 29018253 
  22. Krisztalovics K, Ferenczi E, Molnár Z, Csohán A, Bán E, Zöldi V, et al. West Nile virus infections in Hungary, August-September 2008. Euro Surveill. 2008;13(45):19030. PMID: 19000572 
  23. European Commission. Commission Implementing Decision 2012/506/EU of 8 August 2012 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council (notified under document C(2012) 5538). Luxembourg: Publication Office of the European Union; 2012. Available from: https://publications.europa.eu/en/publication-detail/-/publication/10ed460f-0711-11e2-8e28-01aa75ed71a1/language-en
  24. Commission Directive. 2014/110/EU amending Directive 2004/33/EC as regards temporary deferral criteria for donors of allogeneic blood donations. Official Journal of the European Union. 17.12. 2014;L366:81–82. Available from: https://eur-lex.europa.eu/eli/dir/2014/110/oj
  25. Nagy A, Bán E, Nagy O, Ferenczi E, Farkas Á, Bányai K, et al. Detection and sequencing of West Nile virus RNA from human urine and serum samples during the 2014 seasonal period. Arch Virol. 2016;161(7):1797-806.  https://doi.org/10.1007/s00705-016-2844-5  PMID: 27038827 
  26. Szomor KN, Rigó Z, Bán E, Nagy L, Szalkai T, Balogh Z, et al. Serologic evidence of West Nile virus infection in patients with exanthema in Hungary. Acta Microbiol Immunol Hung. 2011;58(2):157-67.  https://doi.org/10.1556/AMicr.58.2011.2.8  PMID: 21715285 
  27. Haussig JM, Young JJ, Gossner CM, Mezei E, Bella A, Sirbu A, et al. Early start of the West Nile fever transmission season 2018 in Europe. Euro Surveill. 2018;23(32):1800428.  https://doi.org/10.2807/1560-7917.ES.2018.23.32.1800428  PMID: 30107869 
  28. Erdélyi K, Ursu K, Ferenczi E, Szeredi L, Rátz F, Skáre J, et al. Clinical and pathologic features of lineage 2 West Nile virus infections in birds of prey in Hungary. Vector Borne Zoonotic Dis. 2007;7(2):181-8.  https://doi.org/10.1089/vbz.2006.0586  PMID: 17627436 
  29. Bakonyi T, Ferenczi E, Erdélyi K, Kutasi O, Csörgő T, Seidel B, et al. Explosive spread of a neuroinvasive lineage 2 West Nile virus in Central Europe, 2008/2009. Vet Microbiol. 2013;165(1-2):61-70.  https://doi.org/10.1016/j.vetmic.2013.03.005  PMID: 23570864 
  30. Kutasi O, Bakonyi T, Lecollinet S, Biksi I, Ferenczi E, Bahuon C, et al. Equine encephalomyelitis outbreak caused by a genetic lineage 2 West Nile virus in Hungary. J Vet Intern Med. 2011;25(3):586-91.  https://doi.org/10.1111/j.1939-1676.2011.0715.x  PMID: 21457323 
  31. Vilibic-Cavlek T, Kaic B, Barbic L, Pem-Novosel I, Slavic-Vrzic V, Lesnikar V, et al. First evidence of simultaneous occurrence of West Nile virus and Usutu virus neuroinvasive disease in humans in Croatia during the 2013 outbreak. Infection. 2014;42(4):689-95.  https://doi.org/10.1007/s15010-014-0625-1  PMID: 24793998 
  32. Lustig Y, Mannasse B, Koren R, Katz-Likvornik S, Hindiyeh M, Mandelboim M, et al. Superiority of West Nile virus RNA detection in whole blood for diagnosis of acute infection. J Clin Microbiol. 2016;54(9):2294-7.  https://doi.org/10.1128/JCM.01283-16  PMID: 27335150 
  33. Niedrig M, Patel P, El Wahed AA, Schädler R, Yactayo S. Find the right sample: A study on the versatility of saliva and urine samples for the diagnosis of emerging viruses. BMC Infect Dis. 2018;18(1):707.  https://doi.org/10.1186/s12879-018-3611-x  PMID: 30594124 
  34. Nikolay B, Weidmann M, Dupressoir A, Faye O, Boye CS, Diallo M, et al. Development of a Usutu virus specific real-time reverse transcription PCR assay based on sequenced strains from Africa and Europe. J Virol Methods. 2014;197:51-4.  https://doi.org/10.1016/j.jviromet.2013.08.039  PMID: 24036076 
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