Re: China - Henan/Shangdong Province: Unknown disease kills 31 - 33, possibly a new Bunyavirus carried by ticks
And this ProMED post gives us most of the answers. Since this virus is a phlebovirus (genus), while CCHF is a nairovirus, this virus is only distantly related to CCHF, even though both are Bunyaviruses. At least 35 people have tested positive for this virus, and 11 complete sequences have been published, so the Bunyavirus is NOT an innocent bystander in an HGA outbreak. This explains very well the 2008 incident in Shandong - the 4-5 patients in that outbreak were likely infected with both HGA and this virus. It does not explain the 2006 incident, where there was apparent confirmed H2H transmission of HGA, so that outbreak requires additional explanation (such as contaminated samples).
The estimated CFR of this virus is about 30%. And they believe it is vector borne, but the vector may or may not be a tick.
In the spirit of non-geographical naming, they are referring to this virus as SFTS virus, but the other group wants to call it Dabie Mountain virus.
http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85169
Archive Number 20101005.3613
Published Date 05-OCT-2010
Subject PRO/EDR> Fatal illness, novel phlebovirus-associated - China
FATAL ILLNESS, NOVEL PHLEBOVIRUS-ASSOCIATED - CHINA
***************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: 1 Oct 2010
Source: Science, Vol. 330. no. 6000, pp. 20 - 21 [abbr., edited]
DOI: 10.1126/science.330.6000.20
<http://www.sciencemag.org/cgi/content/full/330/6000/20>
(subscription required)
Rival Teams Identify a Virus Behind Deaths in Central China
-----------------------------------------------------------
When Xue-jie Yu came to China last year [2009] to probe a lethal
fever outbreak, everyone -- Yu included -- assumed he would provide
damning testimony against a known suspect. Every summer for 3 years,
hundreds of people in central China came down with an illness
characterized by high fever and gastrointestinal (GI) distress. Many
victims bled profusely, and an alarming number of the sick -- rough
estimates are as high as 30 percent in some areas -- died. By early
2007, scientists at the Chinese Center for Disease Control and
Prevention (CDC) here fingered the killer as human granulocytic
anaplasmosis (HGA), an emerging bacterial infection from tick bites.
But to Yu, an expert on tick-borne diseases at the University of
Texas Medical Branch in Galveston, things didn't add up.
"The fatality rate was too high," Yu says, and in his experience it
was "rare" for HGA patients to have GI symptoms. Working at the
Chinese CDC's National Institute of Communicable Disease Control and
Prevention (NICDC) here, Yu tested blood samples for Anaplasma
phagocytophilum, the HGA bacterium and came up empty. Last December
[2009], his team identified a new kind of bunyavirus. The finding, in
a paper submitted to The New England Journal of Medicine (NEJM),
unmasks a dangerous new emerging virus.
Behind the scenes, however, a fierce argument has broken out over who
discovered the virus. This summer, a Chinese CDC team led by
hantavirus expert Li Dexin, director of the agency's Institute of
Virology, also uncovered a bunyavirus. They have submitted a deeper
analysis of the pathogen, including complete RNA sequences of 11
strains, to The Lancet. Yu charges Li's group with trying to rob him
of the discovery.
Several key questions are disputed or unanswered. For starters,
researchers do not know how lethal the virus is. The mortality rate
may be high in China in part because clinics often prescribe the
steroid dexamethasone to bring down high fevers; steroids suppress
the immune system, which usually worsens infections. And although the
infection shows a seasonal pattern associated with tick-borne
diseases; cases begin in early spring and peak in midsummer before
tapering off by autumn. The [putative] vector is still a mystery.
One indisputable fact is that the emerging disease has claimed scores
of lives -- mostly of farmers -- in China's heartland. The 1st
documented outbreak was in 2006, in Anhui Province. At that time, a
HGA was suspected. Curiously, however, none of the patients recalled
having been bitten by ticks. And when outbreaks recurred in 2007 and
2008, the disease did not respond to antibiotics.
That summer [presumably 2009], the pathogen surfaced in Henan and
Hubei provinces. In June, Yu went to Hubei's capital, Wuhan, to
collect blood samples from patients. Yu spotted virus particles that
December in cell culture using electron microscopy. Then in February,
he says, a member of his Texas lab, Yan Liu, "cracked the code of the
viral genome." Two days after he informed scientists at the Chinese
CDC about his findings. Chinese CDC Director Wang Yu was intrigued by
Xue-jie Yu's findings and invited him to share them at a 15 April
meeting at CDC headquarters to plot strategy for studying the
disease. Among the attendees were Li and CDC virologist Liang Mifang;
they found Yu's presentation unconvincing. "He said he isolated a
bunyavirus, but he had gotten just fragments," says Liang. Yu
confirms that the virologists were dismissive.
Yu and his colleagues have named the virus Dabie Mountain virus after
the range that straddles the borders of Hubei, Anhui, and Henan
provinces where they collected samples. But Yu was not invited back
to China this summer [2010] to continue his research. "I am the 1st
scientist to discover the viral pathogen for an emerging infectious
disease who has no access to study the virus and the disease anymore," he says.
In May [2010], the Chinese CDC set up surveillance for the pathogen
in Henan and Hubei provinces. The disease flared up in 4 other
provinces as well, and Li's team collected blood and serum from all 6
affected provinces. They amplified viral RNA sequences and from more
than 500 clones linked 14 to bunyavirus. They also isolated
bunyavirus in cell culture and sequenced 11 strains. They have named
it severe febrile and thrombocytopenic syndrome (SFTS) virus and have
classified it in the _Phlebovirus_ genus of bunyaviruses. Li's group
also detected the virus in 35 patients from 3 provinces. "It's solid
work. They clearly show that a new virus is causing disease," says a
U.S. scientist who has seen the data and asked to remain anonymous.
The squabbling has put Wang, the Chinese CDC's director, in an
awkward position. There is "no doubt," he says, that Xue-jie Yu
"discovered the novel bunyavirus." While noting that Yu's results are
not as "rich" as Li's team's, Wang says, "everyone knows what a
scientific breakthrough is, and what is accumulating work." After the
NEJM paper is published, he hopes, "other papers can go smoothly. But
it may take Wang's best diplomatic skills to get any collaboration on
the emerging virus to go smoothly.
[Byline: Richard Stone]
--
Communicated by:
Kunihiko Iizuka
[It is clear from these events that a novel bunyavirus belonging to
the genus _Phlebovirus_ is prevalent during the summer months in
several central provinces of China that may be associated with an
undiagnosed lethal disease distinct from the tick-transmitted
bacterial human granulocytic anaplasmosis (HGA). The virus does not
appear to be transmitted by ticks but the vector has not been
identified, nor has the association of this virus with a 'severe
febrile and thrombocytopenic syndrome' been unequivocally
established. Once the dispute between the 2 groups (which has been
simplified in this abbreviated account) investigating this virus has
been resolved, some clarity may emerge. Interested readers are
referred to the full account in 'Science'_.
The different members of the genus _Phlebovirus_ of the family
_Bunyaviridae_ are transmitted by phlebotomine flies, culicoides
mosquitoes or ticks. The vector of the provisionally named Dabie
Mountain phlebovirus has yet to be established. - Mod.CP]
And this ProMED post gives us most of the answers. Since this virus is a phlebovirus (genus), while CCHF is a nairovirus, this virus is only distantly related to CCHF, even though both are Bunyaviruses. At least 35 people have tested positive for this virus, and 11 complete sequences have been published, so the Bunyavirus is NOT an innocent bystander in an HGA outbreak. This explains very well the 2008 incident in Shandong - the 4-5 patients in that outbreak were likely infected with both HGA and this virus. It does not explain the 2006 incident, where there was apparent confirmed H2H transmission of HGA, so that outbreak requires additional explanation (such as contaminated samples).
The estimated CFR of this virus is about 30%. And they believe it is vector borne, but the vector may or may not be a tick.
In the spirit of non-geographical naming, they are referring to this virus as SFTS virus, but the other group wants to call it Dabie Mountain virus.
http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85169
Archive Number 20101005.3613
Published Date 05-OCT-2010
Subject PRO/EDR> Fatal illness, novel phlebovirus-associated - China
FATAL ILLNESS, NOVEL PHLEBOVIRUS-ASSOCIATED - CHINA
***************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: 1 Oct 2010
Source: Science, Vol. 330. no. 6000, pp. 20 - 21 [abbr., edited]
DOI: 10.1126/science.330.6000.20
<http://www.sciencemag.org/cgi/content/full/330/6000/20>
(subscription required)
Rival Teams Identify a Virus Behind Deaths in Central China
-----------------------------------------------------------
When Xue-jie Yu came to China last year [2009] to probe a lethal
fever outbreak, everyone -- Yu included -- assumed he would provide
damning testimony against a known suspect. Every summer for 3 years,
hundreds of people in central China came down with an illness
characterized by high fever and gastrointestinal (GI) distress. Many
victims bled profusely, and an alarming number of the sick -- rough
estimates are as high as 30 percent in some areas -- died. By early
2007, scientists at the Chinese Center for Disease Control and
Prevention (CDC) here fingered the killer as human granulocytic
anaplasmosis (HGA), an emerging bacterial infection from tick bites.
But to Yu, an expert on tick-borne diseases at the University of
Texas Medical Branch in Galveston, things didn't add up.
"The fatality rate was too high," Yu says, and in his experience it
was "rare" for HGA patients to have GI symptoms. Working at the
Chinese CDC's National Institute of Communicable Disease Control and
Prevention (NICDC) here, Yu tested blood samples for Anaplasma
phagocytophilum, the HGA bacterium and came up empty. Last December
[2009], his team identified a new kind of bunyavirus. The finding, in
a paper submitted to The New England Journal of Medicine (NEJM),
unmasks a dangerous new emerging virus.
Behind the scenes, however, a fierce argument has broken out over who
discovered the virus. This summer, a Chinese CDC team led by
hantavirus expert Li Dexin, director of the agency's Institute of
Virology, also uncovered a bunyavirus. They have submitted a deeper
analysis of the pathogen, including complete RNA sequences of 11
strains, to The Lancet. Yu charges Li's group with trying to rob him
of the discovery.
Several key questions are disputed or unanswered. For starters,
researchers do not know how lethal the virus is. The mortality rate
may be high in China in part because clinics often prescribe the
steroid dexamethasone to bring down high fevers; steroids suppress
the immune system, which usually worsens infections. And although the
infection shows a seasonal pattern associated with tick-borne
diseases; cases begin in early spring and peak in midsummer before
tapering off by autumn. The [putative] vector is still a mystery.
One indisputable fact is that the emerging disease has claimed scores
of lives -- mostly of farmers -- in China's heartland. The 1st
documented outbreak was in 2006, in Anhui Province. At that time, a
HGA was suspected. Curiously, however, none of the patients recalled
having been bitten by ticks. And when outbreaks recurred in 2007 and
2008, the disease did not respond to antibiotics.
That summer [presumably 2009], the pathogen surfaced in Henan and
Hubei provinces. In June, Yu went to Hubei's capital, Wuhan, to
collect blood samples from patients. Yu spotted virus particles that
December in cell culture using electron microscopy. Then in February,
he says, a member of his Texas lab, Yan Liu, "cracked the code of the
viral genome." Two days after he informed scientists at the Chinese
CDC about his findings. Chinese CDC Director Wang Yu was intrigued by
Xue-jie Yu's findings and invited him to share them at a 15 April
meeting at CDC headquarters to plot strategy for studying the
disease. Among the attendees were Li and CDC virologist Liang Mifang;
they found Yu's presentation unconvincing. "He said he isolated a
bunyavirus, but he had gotten just fragments," says Liang. Yu
confirms that the virologists were dismissive.
Yu and his colleagues have named the virus Dabie Mountain virus after
the range that straddles the borders of Hubei, Anhui, and Henan
provinces where they collected samples. But Yu was not invited back
to China this summer [2010] to continue his research. "I am the 1st
scientist to discover the viral pathogen for an emerging infectious
disease who has no access to study the virus and the disease anymore," he says.
In May [2010], the Chinese CDC set up surveillance for the pathogen
in Henan and Hubei provinces. The disease flared up in 4 other
provinces as well, and Li's team collected blood and serum from all 6
affected provinces. They amplified viral RNA sequences and from more
than 500 clones linked 14 to bunyavirus. They also isolated
bunyavirus in cell culture and sequenced 11 strains. They have named
it severe febrile and thrombocytopenic syndrome (SFTS) virus and have
classified it in the _Phlebovirus_ genus of bunyaviruses. Li's group
also detected the virus in 35 patients from 3 provinces. "It's solid
work. They clearly show that a new virus is causing disease," says a
U.S. scientist who has seen the data and asked to remain anonymous.
The squabbling has put Wang, the Chinese CDC's director, in an
awkward position. There is "no doubt," he says, that Xue-jie Yu
"discovered the novel bunyavirus." While noting that Yu's results are
not as "rich" as Li's team's, Wang says, "everyone knows what a
scientific breakthrough is, and what is accumulating work." After the
NEJM paper is published, he hopes, "other papers can go smoothly. But
it may take Wang's best diplomatic skills to get any collaboration on
the emerging virus to go smoothly.
[Byline: Richard Stone]
--
Communicated by:
Kunihiko Iizuka
[It is clear from these events that a novel bunyavirus belonging to
the genus _Phlebovirus_ is prevalent during the summer months in
several central provinces of China that may be associated with an
undiagnosed lethal disease distinct from the tick-transmitted
bacterial human granulocytic anaplasmosis (HGA). The virus does not
appear to be transmitted by ticks but the vector has not been
identified, nor has the association of this virus with a 'severe
febrile and thrombocytopenic syndrome' been unequivocally
established. Once the dispute between the 2 groups (which has been
simplified in this abbreviated account) investigating this virus has
been resolved, some clarity may emerge. Interested readers are
referred to the full account in 'Science'_.
The different members of the genus _Phlebovirus_ of the family
_Bunyaviridae_ are transmitted by phlebotomine flies, culicoides
mosquitoes or ticks. The vector of the provisionally named Dabie
Mountain phlebovirus has yet to be established. - Mod.CP]