Zoonosis Update
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Zoonosis Update Rift Valley fever virus Brian H. Bird, ScM, PhD; Thomas G. Ksiazek, DVM, PhD; Stuart T. Nichol, PhD; N. James MacLachlan, BVSc, PhD, DACVP ift Valley fever virus is a mosquito-borne pathogen ABBREVIATIONS Rof livestock and humans that historically has been responsible for widespread and devastating outbreaks of BSL Biosafety level severe disease throughout Africa and, more recently, the MP-12 Modified passage-12x PFU Plaque-forming unit Arabian Peninsula. The virus was first isolated and RVF RT Reverse transcription disease was initially characterized following the sudden RVF Rift Valley fever deaths (over a 4-week period) of approximately 4,700 lambs and ewes on a single farm along the shores of Lake Naivasha in the Great Rift Valley of Kenya in 1931.1 Since on animals that were only later identified as infected 6,7 that time, RVF virus has caused numerous economically with RVF virus. The need for a 1-medicine approach devastating epizootics that were characterized by sweep- to the diagnosis, treatment, surveillance, and control of ing abortion storms and mortality ratios of approximately RVF virus infection cannot be overstated. The close co- 100% among neonatal animals and of 10% to 20% among ordination of veterinary and human medical efforts (es- adult ruminant livestock (especially sheep and cattle).2–4 pecially in countries in which the virus is not endemic Infections in humans are typically associated with self- and health-care personnel are therefore unfamiliar with limiting febrile illnesses. However, in 1% to 2% of affected RVF) is critical to combat this important threat to the individuals, RVF infections can progress to more severe health of humans and other animals. disease including fulminant hepatitis, encephalitis, retini- Because of the potential for severe consequences tis, blindness, or a hemorrhagic syndrome; among severe- during outbreaks, RVF virus is considered a major zoo- ly affected persons who are hospitalized, the case fatality notic threat. Rift Valley fever virus is classified as a Cat- 8 ratio is approximately 10% to 20%.5 egory A overlap Select Agent by the CDC and the USDA Rift Valley fever epizootics and epidemics can rap- and as a high-consequence pathogen with the potential idly overwhelm the capacities of the public health and for international spread (List A) by the World Organi- veterinary medical communities to provide rapid diag- zation for Animal Health (Office International des Épi- 9 nostic testing and adequate medical care for affected zooties). As such, RVF virus is considered a potential humans and other animals, which can number in the threat as a biological terrorism agent that could have tens if not hundreds of thousands. Veterinarians, other dramatic direct (morbidity and death) and indirect (in- health personnel, farmers, and abattoir workers also ternational trade restrictions) impact in countries that are at high risk of infection from direct contact with are currently free of the virus. Furthermore, numerous infected animals and patients; indeed, many historical species of potentially competent mosquito vectors are 10 outbreaks of RVF disease in Africa were initially detect- present throughout North America and Europe. This ed because of illnesses among veterinarians and their review will focus on the current understanding of RVF assistants after they performed necropsies on infected virus ecology; pathogenesis and clinical signs of RVF animals. In 2008, several veterinarians, staff, and vet- disease among livestock, humans, and wildlife; the use erinary students at a South African veterinary college and limitations of rapid diagnostic testing during out- were infected after handling and performing necropsies breaks; and recent advances in vaccine design and de- velopment, as well as potential veterinary medical and From the Department of Pathology, Microbiology, and Immunology, public health consequences following introduction of School of Veterinary Medicine, University of California, Davis, CA the virus into previously unaffected areas. 95616 (Bird, MacLachlan); and Special Pathogens Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Preven- tion, Atlanta, GA 30333 (Ksiazek, Nichol). Dr. Ksiazek’s present address Etiologic Agent and Biosafety is Galveston National Laboratory, Department of Pathology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555. Rift Valley fever virus (Family, Bunyaviridae; ge- Dr. Bird was supported by the dual-degree DVM/PhD Veterinary Scien- nus, Phlebovirus) is an enveloped spherical particle (80 tist Training Program, the Graduate Group of Comparative Pathology, to 100 nm in diameter) with a tripartite single-stranded and the Students Training in Advanced Research programs of the Uni- negative-sense RNA genome (approx 11.9 kilobases).11 versity of California, Davis, School of Veterinary Medicine. The Bunyaviridae include several important veterinary The findings and conclusions in this report are those of the authors and and human medical pathogens such as Nairobi sheep do not necessarily represent the views of the funding agencies or the Centers for Disease Control and Prevention. disease virus, Akabane virus, Crimean-Congo hemor- The authors thank Dr. Robert Swanepoel for technical assistance. rhagic fever virus, La Crosse virus, sandfly fever Sicilian Address correspondence to Dr. Bird. virus, and the hantaviruses. JAVMA, Vol 234, No. 7, April 1, 2009 Vet Med Today: Zoonosis Update 883 Rift Valley fever virus is a notorious cause of acci- including movements of infected camels along trade dental infection among laboratory workers and veterinar- routes with Sudan, windblown infected mosquitoes, or ians. Direct contact with infected animals, especially dur- infected passengers on commercial airlines.24 Since the ing necropsy and obstetric procedures, is associated with 1977–1979 outbreak, RVF virus activity has occurred a high risk of infection; in any circumstances involving sporadically in Egypt, with deaths among livestock and such contact, strict adherence to universal blood-borne low numbers of human infections.25–27 pathogen precautions and to good biosafety practices is re- In 2000, the presence of RVF virus outside of Africa quired.12–15 Rift Valley fever virus particles in serum retain was reported for the first time. In the western provinces infectivity when stored at 4°C for several weeks, which is of Saudi Arabia and Yemen, an outbreak of severe human an important consideration in the safe handling of diag- and livestock disease associated with RVF virus occurred; nostic specimens.16 The virus is readily inactivated by use there were an estimated 2,000 human infections and at of strong detergents or 10% solutions of sodium hypochlo- least 245 deaths, and thousands of goats and sheep also rite (bleach) and via formalin fixation.16,17 Because of the died.19,28 This outbreak was preceded by exceptionally ease of horizontal transmission, laboratory-based investi- heavy rainfall, which resulted in large increases in the gations must be performed in BSL 3–enhanced (ie, BSL-3+ mosquito population and subsequent transmission of the or BSL-3 Agriculture) facilities in the United States.18 virus.29,30 Genetic analyses of RVF virus isolates collected during the Saudi Arabia–Yemen outbreak revealed high Epidemiology and Ecology similarity to viruses present during a 1997–1998 Kenyan outbreak, which suggested that the virus was introduced Impact of major epizootics and epidemics—Rift into Saudi Arabia and Yemen from eastern Africa.31,32 Valley fever virus infection of humans and other ani- However, as for the 1977–1979 Egyptian outbreak, the mals has been identified in approximately 30 countries, precise route of introduction is enigmatic because no and major epizootics and epidemics occur periodically epizootics in eastern Africa were reported at that time. It throughout the known geographic range of the virus is possible that viremic animals were imported into Saudi (Figure 1). The disease was initially thought to be re- Arabia or Yemen during the preceding 1997–1998 east stricted to the eastern Rift Valley region of Africa. How- African epizootic and that RVF virus circulated at levels ever, in 1951, a severe epizootic in South Africa occurred below the detection threshold until climactic conditions during which an estimated 100,000 sheep died and 500,000 ewes aborted their fetuses.19 The cause of the epizootic was not recognized as RVF virus until severe disease occurred in a veterinar- ian and several assistants following the necropsy of a dead bull.15 This outbreak initiated what has since become a repeat- ing pattern in which the recognition of RVF virus infection among humans often precedes the detection of animal disease because of the difficulties of veterinary surveillance in resource-poor settings. Traditionally, RVF virus has been restricted to sub-Saharan Africa but was detected north of the Sahara desert in 1977, where it was the cause of a mas- sive epidemic-epizootic along the Nile river and delta in Egypt.20–22 This out- break, in an apparently RVF-free area, remains the largest on record, with an estimated 200,000 human infections and at least 594 deaths among hospitalized patients.22 Losses among livestock were extensive; the costs were more than US $115 million at that time.21,23 During that outbreak, the full spectrum of hu- man RVF disease became apparent and ranged from subclinical infection to se- vere cases of hepatic necrosis with fatal hemorrhagic complications, delayed on- set encephalitis and permanent neuro- logic deficits, or severe retinitis with per- manent blindness.22 The route by which RVF virus was introduced into Egypt Figure 1—Geographic distribution of RVF virus. Countries in which epizootics or epidem- ics are known to have occurred are indicated in red with the date of each outbreak. Coun- will likely never be known, but several tries with evidence of low-level enzootic activity (antibody prevalence or occasional RVF potential scenarios have been proposed, virus isolation) are indicated in pink. To convert kilometers to miles, multiply by 0.625.