N Engl J Med. Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China

[Giuseppe]

Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China (N Engl J Med., abstract, edited)


[Source: The New England Journal of Medicine, full text: <cite cite="http://www.nejm.org/doi/full/10.1056/NEJMoa1010095">Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China ? NEJM</cite>. Abstract, edited.]

Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China

Xue-Jie Yu, M.D., Ph.D., Mi-Fang Liang, M.D., Shou-Yin Zhang, Ph.D., Yan Liu, M.D., Jian-Dong Li, Ph.D., Yu-Lan Sun, M.D., Lihong Zhang M.D., Quan-Fu Zhang, B.Sc., Vsevolod L. Popov, Ph.D., Chuan Li, B.Sc., Jing Qu, B.Sc., Qun Li, M.D., Yan-Ping Zhang, M.D., Rong Hai, M.D., Wei Wu, M.Sc., Qin Wang, Ph.D., Fa-Xian Zhan, Ph.D., Xian-Jun Wang, M.D., Biao Kan, Ph.D., Shi-Wen Wang, Ph.D., Kang-Lin Wan, Ph.D., Huai-Qi Jing, M.D., Jin-Xin Lu, M.D., Wen-Wu Yin, M.Ph., Hang Zhou, M.S, Xu-Hua Guan, Ph.D., Jia-Fa Liu, M.D., Zhen-Qiang Bi, Ph.D., Guo-Hua Liu, M.D., Jun Ren, M.D., Hua Wang, M.D., Zhuo Zhao, M.D., Jing-Dong Song, M.Sc., Jin-Rong He, B.Sc., Tao Wan, Ph.D., Jing-Shan Zhang, M.S., Xiu-Ping Fu, M.S., Li-Na Sun, Ph.D., Xiao-Ping Dong, Ph.D., Zi-Jian Feng, M.D., Wei-Zhong Yang, M.D., Tao Hong, M.D., Yu Zhang, M.D., David H. Walker, M.D., Yu Wang, M.D., Ph.D., and De-Xin Li, M.D.

March 16, 2011 (10.1056/NEJMoa1010095)


Abstract

Background
Heightened surveillance of acute febrile illness in China since 2009 has led to the identification of a severe fever with thrombocytopenia syndrome (SFTS) with an unknown cause. Infection with Anaplasma phagocytophilum has been suggested as a cause, but the pathogen has not been detected in most patients on laboratory testing.

Methods
We obtained blood samples from patients with the case definition of SFTS in six provinces in China. The blood samples were used to isolate the causal pathogen by inoculation of cell culture and for detection of viral RNA on polymerase-chain-reaction assay. The pathogen was characterized on electron microscopy and nucleic acid sequencing. We used enzyme-linked immunosorbent assay, indirect immunofluorescence assay, and neutralization testing to analyze the level of virus-specific antibody in patients' serum samples.

Results
We isolated a novel virus, designated SFTS bunyavirus, from patients who presented with fever, thrombocytopenia, leukocytopenia, and multiorgan dysfunction. RNA sequence analysis revealed that the virus was a newly identified member of the genus phlebovirus in the Bunyaviridae family. Electron-microscopical examination revealed virions with the morphologic characteristics of a bunyavirus. The presence of the virus was confirmed in 171 patients with SFTS from six provinces by detection of viral RNA, specific antibodies to the virus in blood, or both. Serologic assays showed a virus-specific immune response in all 35 pairs of serum samples collected from patients during the acute and convalescent phases of the illness.

Conclusions
A novel phlebovirus was identified in patients with a life-threatening illness associated with fever and thrombocytopenia in China.

(Funded by the China Mega-Project for Infectious Diseases and others.)

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[Shiloh]

Re: N Engl J Med. Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China

Source: http://www.bloomberg.com/news/2011-...ural-china-causes-fever-30-fatality-rate.html

Virus Identified in Rural China Causes Fever, 30% Fatality Rate
By Meg Tirrell - Mar 16, 2011 5:00 PM ET

A fever-triggering illness that has killed about 30 percent of infected patients in rural China has been traced to a new virus.

Researchers, who designated the culprit as the SFTS bunyavirus, believe the disease is transmitted by ticks that count most mammals in the Asia-Pacific region as hosts, according to a study today in the New England Journal of Medicine. SFTS is short for severe fever with thrombocytopenia syndrome.

The scientists confirmed the virus?s presence in 171 patients, who were mostly farmers living in six provinces in China, since 2009. They had fever, thrombocytopenia and leukocytopenia -- low counts of blood platelets and white blood cells -- and dysfunction in multiple organs. There is no evidence of human-to-human transmission, the researchers said...

 

[Shiloh]

Re: N Engl J Med. Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China

Also see: http://www.flutrackers.com/forum/showthread.php?t=152202&highlight=bunyavirus

China - Other Diseases Tracking
China - Henan/Shangdong Province: Unknown disease kills 31 - 33, possibly a new Bunyavirus carried by ticks

 

[alert]

Re: N Engl J Med. Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China

Please see (or merge?) the thread below, which details much of the outbreak:

http://www.flutrackers.com/forum/showthread.php?p=373777

 

[Giuseppe]

Re: N Engl J Med. Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China

Source: http://www.bloomberg.com/news/2011-...ural-china-causes-fever-30-fatality-rate.html

Virus Identified in Rural China Causes Fever, 30% Fatality Rate
By Meg Tirrell - Mar 16, 2011 5:00 PM ET

A fever-triggering illness that has killed about 30 percent of infected patients in rural China has been traced to a new virus.

Researchers, who designated the culprit as the SFTS bunyavirus, believe the disease is transmitted by ticks that count most mammals in the Asia-Pacific region as hosts, according to a study today in the New England Journal of Medicine. SFTS is short for severe fever with thrombocytopenia syndrome.

The scientists confirmed the virus?s presence in 171 patients, who were mostly farmers living in six provinces in China, since 2009. They had fever, thrombocytopenia and leukocytopenia -- low counts of blood platelets and white blood cells -- and dysfunction in multiple organs. There is no evidence of human-to-human transmission, the researchers said...

From the NEJM paper:

Among the 171 confirmed cases, there were 21 deaths (12%). However, it is not clear how SFTSV caused these deaths.

 

[alert]

Re: N Engl J Med. Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China

The text below pretty much solves the case that this virus is indeed the cause of that syndrome.

http://www.nejm.org/doi/full/10.1056/NEJMoa1010095#t=articleResults

[snip]

Epidemiologic Investigation
From June 2009 through September 2010, we detected SFTS bunyavirus RNA, specific antiviral antibodies, or both in 171 patients among 241 hospitalized patients who met the case definition for SFTS2 in Central and Northeast China. These patients included 43 in Henan, 52 in Hubei, 93 in Shandong, 31 in Anhui, 11 in Jiangsu, and 11 in Liaoning provinces. In 2010, a total of 148 of 154 laboratory-confirmed cases (96%) occurred from May to July. The ages of the patients ranged from 39 to 83 years, and 115 of 154 patients (75%) were over 50 years of age. Of these 154 patients, 86 (56%) were women, and 150 (97%) were farmers living in wooded and hilly areas and working in the fields before the onset of disease. No SFTSV was identified on real-time RT-PCR and no antibodies against SFTSV were identified in serum samples that were collected from 200 patient-matched healthy control subjects in the endemic areas, from 180 healthy subjects from nonendemic areas, and from 54 patients with suspected hemorrhagic fever with renal syndrome. Mosquitoes and ticks were commonly found in the patients' home environment. However, viral RNA was not detected in any of 5900 mosquitoes tested. On the other hand, 10 of 186 ticks (5.4%) of the species Haemaphysalis longicornis that were collected from domestic animals in the areas where the patients lived contained SFTSV RNA. The viruses in the ticks were isolated in Vero cell culture, and the RNA sequences of these viruses were very closely related but not identical to the SFTSV isolated in samples obtained from the patients (data not shown). There was no epidemiologic evidence of human-to-human transmission of the virus.

 

[Ronan Kelly]

Re: N Engl J Med. Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China

Correspondence

A Novel Bunyavirus in China
N Engl J Med 2011; 365:862-865September 1, 2011

ArticleTo the Editor:
Yu et al. (April 21 issue)1 report the emergence of an infectious disease in central China in the summer of 2009 that was identified as severe fever with thrombocytopenia syndrome (SFTS). Later that year the illness was found to be associated with infection with a novel bunyavirus, designated SFTSV. According to Yu et al., at the time of publication there was no epidemiologic evidence of human-to-human transmission of the virus. We have identified a cluster of SFTSV infections in a family that appear to have been transmitted by means of human contact.

On October 13, 2010, a 59-year-old man was admitted to a hospital in Nanjing, China, with a 1-week history of fever, gastrointestinal symptoms, leukopenia, and thrombocytopenia. According to laboratory tests, he also had an elevated aminotransferase level. The patient died in the hospital on October 21. On October 26, his son-in-law reported the development of similar symptoms, but he recovered without sequelae. Real-time reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assays of serum specimens from the two patients revealed the presence of SFTSV RNA, and SFTSV was isolated from each patient's blood. The index patient had a son who never became ill, but specimens collected from the son showed immunologic evidence of recent infection. Enzyme-linked immunosorbent assay (ELISA) performed on serum specimens collected on October 18 and 28 from the son did not detect the presence of IgM or IgG antibodies, but assays performed on November 18 and December 21 were positive for both antibodies. In addition, according to the results of indirect fluorescent-antibody and viral microneutralization testing, titers for IgG antibodies increased by a factor of 4 between October 18 and December 21.

...

http://www.nejm.org/doi/full/10.1056/NEJMc1106000
Several other correspondances at link.

 

[alert]

Re: N Engl J Med. Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China

Let us not forget that the first mention of this virus was here:

http://www.promedmail.org/pls/apex/...CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,73306

in which what is described is essentially a contagious hemorrhagic fever. At the time, there was some tendancy to dismiss that report as inaccurate because of its source; but it appears to have been essentially correct.

BTW, the link in the above post does not work.

 

[Ronan Kelly]

Re: N Engl J Med. Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China

Fixed link in #7 - Thanks alert.

 

[Emily]

Re: N Engl J Med. Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China

http://www.ncbi.nlm.nih.gov/pubmed/23917841

Sci China Life Sci. 2013 Aug;56(8):697-700. doi: 10.1007/s11427-013-4518-9. Epub 2013 Aug 7.
An emerging hemorrhagic fever in China caused by a novel bunyavirus SFTSV.
Zhang X, Liu Y, Zhao L, Li B, Yu H, Wen H, Yu XJ.
Source

School of Public Health, Shandong University, Jinan, 250012, China.
Abstract

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging hemorrhagic fever in rural areas of China and is caused by a new bunyavirus, SFTSV, named after the disease. The transmission vectors and animal hosts of SFTSV are unclear. Ticks are the most likely transmission vectors and domestic animals, including goats, dogs, and cattle, are potential amplifying hosts of SFTSV. The clinical symptoms of SFTS are nonspecific, but major symptoms include fever, gastrointestinal symptoms, myalgia, dizziness, joint pain, chills, and regional lymphadenopathy. The most common abnormalities in laboratory test results are thrombocytopenia (95%), leukocytopenia (86%), and elevated levels of serum alanine aminotransferase, aspartate aminotransferase, creatine kinase, and lactate dehydrogenase. The fatality rate for SFTS is 12% on average, and the annual incidence of the disease is approximately five per 100000 of the rural population.

PMID:
23917841
[PubMed - in process]