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Seroprevalence of Sandfly Fever Virus Infection in Military Personnel On Journal of Infection and Public Health (2017) 10, 59—63 View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Seroprevalence of sandfly fever virus infection in military personnel on the western border of Iran a,c,∗ b a Ramin Shiraly , Afra Khosravi , Saman Farahangiz a Department of Community Medicine, Shiraz University of Medical Sciences, Shiraz, Iran b Department of Immunology, Ilam University of Medical Sciences, Ilam, Iran c Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran Received 17 November 2015; received in revised form 22 January 2016; accepted 20 February 2016 KEYWORDS Summary Military troops deployed to endemic areas are at risk of contracting Sandfly fever; sandfly fever, an arthropod-borne viral infection. Although typically a self-limited Virus; disease, sandfly fever can cause significant morbidity and loss of function among Past infection; soldiers. We conducted this study to determine the extent of past SFV infection in a group of healthy Iranian military personnel in Ilam province on the western border of Military personnel Iran. A total of 201 serum samples were tested by indirect immunofluorescence assay (IFA) to detect four common sandfly fever virus serotypes. Demographic data were also collected. Overall, 37 samples (18.4%) were positive for specific IgG antibodies to sandfly viruses. Sandfly fever Sicilian virus (SFSV) and sandfly fever Naples virus (SFNV) were the most common serotypes. A positive test was inversely related to nativity (P < 0.01) but was not associated with age (P = 0.163), duration of presence in the border region (P = 0.08) or employment status (P = 0.179). Our findings indicate that past SFV infection is common among military personnel in the western border region of Iran, a Leishmania-endemic region. Therefore, it should be considered in the differential diagnosis of troops presenting with acute febrile illness in similar settings. © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Limited. All rights reserved. ∗ Corresponding author at: Department of Community Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Tel.: +98 711 234 7977. E-mail address: [email protected] (R. Shiraly). http://dx.doi.org/10.1016/j.jiph.2016.02.014 1876-0341/© 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Limited. All rights reserved. 60 R. Shiraly et al. Introduction of sandfly fever in troops serving in the border area during the autumn of 2013. The population of Sandfly fever, also called phlebotomus fever, the study consisted of all military forces deployed three-day fever or Pappataci fever, is an acute along the western border of Mehran, Ilam province. mosquito-borne infection caused by phleboviruses Inclusion criteria included being a member of the (family Bunyaviridae). The virus is transmitted armed forces (conscripted or staff) and having to humans by the bite of infected female phle- been in the area for at least 1 year, including botomine sandflies, which are also the vectors of a summer season (the period of intense sandfly the protozoan parasite Leishmania [1]. Although activity). Voluntary informed consent was required the phlebovirus genus comprises over 60 antigeni- for participation in the study. Demographic data cally distinct serotypes, only eight serotypes are including age, place of birth, employment status known to cause disease in humans. The four most and duration of presence in the border region were common serotypes associated with human infec- collected and blood samples were taken by trained tions include sandfly fever Sicilian virus (SFSV), technicians. sandfly fever Naples virus (SFNV), sandfly fever Indirect fluorescent antibody test (IFA) was used Cyprus virus (SFCV), and Toscana virus (TOSV) [2]. to detect specific immunoglobulin G (IgG) antibod- Clinical disease usually presents as an acute ies to four common strains of the virus (SFSV, SFNV, febrile illness that lasts 3 to 5 days, characterized SFCV and TOSV) in serum samples. Using the mosaic by fever, myalgia and headache. In most cases, a IgG SFV kits enables us to recognize all 4 serotypes disease follows a self-limiting course [3]. TOSV is of the virus. The laboratory kits were com- the only serotype that has been associated with mercially available from EUROIMMUN, a German acute meningitis and encephalitis [4]. company. Sandfly fever virus (SFV) infections have been The test was conducted as follows: first, cells reported from endemic regions of certain Mediter- infected with sandfly fever virus were incubated ranean and Middle Eastern countries; Phleboviruses with the patient’s diluted sera. In the case of appear to be responsible for many outbreaks of a positive reaction, specific IgG antibodies bind febrile illness among susceptible groups in these to the antigens. Next, the antibodies attached to areas [5—10]. As most native adults in endemic the antigens in the previous stage were stained regions are immune, there are few reports of clin- by a fluorescein antibody (fluorescein-labeled anti- ical cases among indigenous people [2]; therefore, human antibodies); they would be visible under a many studies have focused on SFV infection in fluorescent microscope. According to the manufac- high risk groups such as travelers to endemic areas turer’s instructions, a positive IFA test indicates and armed forces [11—13]. The disease is of par- previous (past) or acute infection with SFV. ticular importance to the military and was first Data were statistically analyzed using SPSS soft- described during World War II when nonimmune sol- ware; descriptive statistics, t-test and chi square diers entered Mediterranean regions [2,5]. test were performed. Leishmaniasis is endemic in different parts of Iran. Sandflies are vectors of both leishmaniasis and sandfly fever viruses. Therefore, it is assumed that Results SFVs are present in Leishmania-endemic areas of the country. The only published study pertaining We visited all military posts along Mehran’s west- to SFV infection in Iran was published more than ern border with Iraq. Approximately 220 military 35 years ago when Saidi et al. [14] assessed the personnel were eligible to participate in the study, prevalence of SFV infection in Isfahan province, of which 201 agreed to take part. Overall, 58% of a well-known endemic area of zoonotic cutaneous the troops were indigenous people living in Ilam leishmaniasis in central Iran [14,15]. province. The mean age of participants was 24 years The aim of this study was to assess the extent of (SD: 5.5) with a range from 19 to 46 years. Military past SFV infection in a group of military personnel in personnel included 56 (27.9%) staff officers and 145 Mehran, a small city on the western border of Iran, (72.1%) conscripted soldiers. Deployment duration which is also an endemic area of zoonotic cutaneous ranged from 12 to 156 months, with a mean of 18 leishmaniasis. months (SD: 21.1) (Table 1). Among 201 samples tested, 37 (18.4%) sera were Materials and methods found positive for phlebovirus-specific antibody by indirect immunofluorescence assay. The most com- This cross-sectional study was conducted in Ilam, mon serotype was SFSV (10.9%), followed by SFNV a province of Iran, to assess the seroepidemiology (5%), SFCV (1.5%) and TOSV (1%) (Table 2). Seroprevalence of sandfly fever virus infection in military personnel 61 residual sequelae, it may incapacitate a large Table 1 Characteristics of military personnel who number of troops and, in certain cases, require hos- participated in the study. pitalization [13]. Tests to diagnose sandfly fever are Characteristic Value not routine and efforts to diagnose the cause of Male/female: n (%) 201/0 (100/0) acute undifferentiated febrile illnesses may result Age (years): mean (SD) 24 (5.5) in further unnecessary workup and increased costs. Staff/conscripted soldiers: n (%) 56/145 (28/72) As leishmaniasis is a highly focal disease and its Duration of deployment (months): 18.1 (21.1) distribution depends on sandfly habitat [21], it is mean (SD) expected that SFVs also have a focal geographic Native/non-native: n (%) 24/177 (12/88) distribution that parallels leishmaniasis. The only previous study investigating sandfly virus infection in Iran was conducted in northeast- A positive test was inversely related to nativ- ern Isfahan, an area endemic to zoonotic cutaneous ity (P < 0.01), but was not associated with age leishmaniasis (ZCL). In this study, antibodies to (P = 0.163), duration of presence in the border SFSV and SFNV were found in 25% and 17% of the region (P = 0.08) or employment status (P = 0.179) rural population living in the area, respectively. (Table 3). The viruses were also isolated from sandflies (pre- dominantly Phlebotomus papatasi) and gerbils in this endemic region in central Iran [14]. Zoonotic Discussion cutaneous leishmaniasis (ZCL) accounts for 80% of reported cases of leishmaniasis in Iran and there are Arboviral infections remain a major health problem endemic foci of the disease, especially in the cen- for troops deployed to endemic foci in the Middle tral, western and southwestern parts of the country East and Mediterranean basin [16]. Acute febrile [19,22]. illness associated with SFVs has been reported The results of the present study and the study among Western military forces in Middle Eastern by Saidi et al. [14] suggest that SFSV and SFNV are countries affected by war, such as Afghanistan and probably present in rural areas of central and west- Iraq [12,13]. Outbreaks of undiagnosed febrile ill- ern Iran where ZCL is endemic. Saidi et al. [14] nesses among military forces can be a challenging also identified some other phlebovirus serotypes health issue as it may elicit anxious reactions in (e.g., Salehabad & Karimabad) that have not been soldiers and necessitate a thorough investigation described as human pathogenic strains [17].
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