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Crimean-Congo hemorrhagic fever serosurvey in at-risk professionals, Madagascar, 2008 and 2009
Soa Fy Andriamandimby, Philippe Marianneau, Jean-Théophile Rafisandratantsoa, Pierre E. Rollin, Jean-Michel Heraud, Noël Tordo,
Jean-Marc Reynes
To cite this version:
Soa Fy Andriamandimby, Philippe Marianneau, Jean-Théophile Rafisandratantsoa, Pierre E. Rollin, Jean-Michel Heraud, et al.. Crimean-Congo hemorrhagic fever serosurvey in at-risk professionals, Madagascar, 2008 and 2009. Journal of Clinical Virology, Elsevier, 2011, 52 (4), pp.370 - 372.
�10.1016/j.jcv.2011.08.008�. �pasteur-01665271�
JournalofClinicalVirology52 (2011) 370–372
ContentslistsavailableatScienceDirect
Journal of Clinical Virology
j ourna l h o me p a g e :w w w . e l s e v i e r . c o m / l o c a t e / j c v
Short communication
Crimean-Congo hemorrhagic fever serosurvey in at-risk professionals, Madagascar, 2008 and 2009
Soa Fy Andriamandimby
a,∗, Philippe Marianneau
b, Jean-Théophile Rafisandratantsoa
a, Pierre E. Rollin
c, Jean-Michel Heraud
a, Noël Tordo
d, Jean-Marc Reynes
aaNationalReferenceLaboratoryforArbovirusesandVirusesofHemorrhagicFever,VirologyUnit,InstitutPasteurdeMadagascar,Routedel’InstitutPasteur,BP1274,Antananarivo 101,Madagascar
bOIEReferenceLaboratoryforRVFVandCCHFV,AgenceNationaledeSécuritéSanitaire,31AvenueTonyGarnier,69394LyonCedex07,France
cViralSpecialPathogensBranch,WHOCollaborativeCentreforViralHemorrhagicFevers,CentersforDiseaseControlandPrevention,1600CliftonRoadMSG-14,Atlanta,GA30333, USA
dNationalReferenceCentreforViralHemorrhagicFever,WHOCollaborativeCentreforArbovirusesandViralHemorrhagicFever,OIEReferenceLaboratoryforRVFVandCCHFV, InstitutPasteur,21AvenueTonyGarnier,69365LyonCedex07,France
a r t i c l e i n f o
Articlehistory:
Received13May2011
Receivedinrevisedform25July2011 Accepted8August2011
Keywords:
Crimean-Congohemorrhagicfever Madagascar
Surveys
a b s t r a c t
Background:Crimean-Congohemorrhagicfever(CCHF)isazoonoticarboviralinfectionwithhemorrhagic manifestationandoftenafatalending.Humanbecomeinfectedmainlythroughtickbiteorbycrushing infectedtick,bycontactwithbloodortissuesfromviraemiclivestockorpatient.CCHFvirus(CCHFV)has beenisolatedonceinMadagascarbutdataontheepidemiologyofthediseaseinthecountryarevery scarce.
Objectives:ToinvestigatethecirculationandthegeographicdistributionofCCHFVinfectionamongat riskpopulationinMadagascar.
Studydesign:Anationalcross-sectionalserologicsurveywasperformedin2008–2009amongslaughter- houseworkers.
Results:Atotalof1995workerswereincluded.ArecentCCHFVinfectionwasdetectedin1ofthe1995 participants(0.5‰;95%confidenceinterval[CI]:0–0.15%),andapastCCHFVinfectionwasdetectedin 15participants(0.75%;95%CI:0.37–1.13%).
Conclusion:Overall,thepercentageofCCHFVinfectionseeninMadagascaramongat-riskprofessionals isverylowcomparedtoendemiccountries.Anassessmentoftheprevalenceinlivestockasasensitive indicatorofCCHFVactivitymustbeconsideredinordertoconfirmthelackortheweakendemicityof CCHFinMadagascar.
© 2011 Elsevier B.V. All rights reserved.
1. Background
Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne diseasecaused byavirus(CCHFV)belongingtothefamily Bun- yaviridae, genus Nairovirus (reviewed in 1, 2).This zoonosis is largelydistributedinAfrica,Asia,MiddleEastandsouthernEurope (Balkan Peninsula). Hyalomma spp. is the most important and widely distributed tick vector, but other genera (Rhipicephalus, Boophilus, Dermacentor, and Ixodes)may have beencontributed toCCHFVecologicalcycle. Ruminants,but alsosmallterrestrial mammalsandbirdsareinvolvedinanenzootictick-vertebrate-
Abbreviations: CCHF,Crimean-Congohemorrhagicfever;CCHFV,Crimean- Congohemorrhagicfevervirus;ELISA,enzyme-linkedimmunosorbentassay;CDC, CentersforDiseaseControlandPrevention.
∗Correspondingauthor.Tel.:+261202241272;fax:+261202241534.
E-mailaddress:soafy@pasteur.mg(S.F.Andriamandimby).
tickcycle.Humanbecomeinfectedthroughtickbiteorbycrushing infectedtick,bycontactwithbloodortissuesfromviraemiclive- stock,orbyunprotectedcontactwithbiologicalfluidsofaCCHF patientduringtheacutephaseofinfection.Diseaseisseenonlyin humansandfrequentlyfatalwithseverehemorrhagicsigns.Treat- mentissymptomaticandtodate,novaccineisavailable.1,2
In Madagascar, CCHFV was isolated only once, from Rhipi- cephalus(Boophilus)microplustickscollectedoncattle,inMarch 1985,inthemainslaughterhouseinAntananarivo.Animalswere comingfromTsiroanomandidy,inthehighlands,150kmWestfrom Antanananarivo.Itwasthelargestlivemarketinthecountryreceiv- ingcattlefromallplacesinMadagascar.3
Phylogenetic studiesbased on partialSsequences indicated thattheMalagasystrainwasclosertostrainsisolatedinMiddle- East and Asia than to African isolates.4 The only serological evidenceofCCHFVhumaninfection(usingimmunofluorescence assay) was demonstrated in 2 out of 149 individuals sampled in 1988 in Mandoto, a cattle breeding area in the highlands.5 1386-6532/$–seefrontmatter© 2011 Elsevier B.V. All rights reserved.
doi:10.1016/j.jcv.2011.08.008
S.F.Andriamandimbyetal./JournalofClinicalVirology52 (2011) 370–372 371
DataonCCHFepidemiologyinMadagascarareconsequentlyvery limited.
2. Objectives
Toinvestigatethecirculationandthegeographicaldistribution ofCCHFVinfectionamongatriskpopulationinMadagascar.
3. Studydesign
Weperformedanationwideserologicalsurvey,fromSeptember 2008throughMay2009,among1995humanvolunteersathigh risksofzoonoticinfectionasCCHF.6Thesevolunteerswerepeo- plelivingin106outof111administrativedistrictsofMadagascar andworkinginslaughterhouses,exposedtofreshmeatorbloodof livestocksinceatleast2007.ThestudywasapprovedbytheMala- gasyNationalEthicalCommittee.Informedwrittenconsentwas obtainedfromtheparticipants.DetectionofIgMandIgGantibodies againstCCHFVwasperformedbyELISAaspreviouslydescribed.7 Briefly,followingheatanddetergentinactivation,seraweretested byCCHFV-specificIgMandIgGELISAs.Theassayswerecompleted usinginactivatedCCHFV-infectedVeroE6cellantigensandunin- fectedVeroE6cellantigens,andusingfourdilutionsofeachserum (1/100,1/400,1/1600,1/6400).Titersandthecumulativesumof opticaldensitiesofeachdilution(SUMOD)minusthebackground absorbanceofuninfectedcontrolVeroE6cells(adjustedSUMOD) wererecorded.Resultsoftheassaysforserawereconsideredposi- tiveonlyiftheadjustedSUMODandtiterwereabovepreestablished conservativecutoffvalues,whichweresetforIgMELISA(≥0.75and
≥1/400)andIgGELISA(≥0.95and≥1/400).Positivesamplesand 3%ofthenegativesamplestestedintheInstitutPasteurinMada- gascar(IPM)weresenttotheInstitutPasteurinLyonandtothe CDCinAtlantatovalidatetheIPMELISAresults.
4. Results
Atotalof 1995persons,aged 15–85yearsparticipatetothe study.Themedian agewas34 years(36missingdata). Thesex ratiowas13.7(sixmissingdata).ArecentCCHFVinfection(pres- enceofIgM againstCCHFVandlackofIgG againstCCHFV)was detectedin1ofthe1995participants(0.5‰;95%confidenceinter- val[CI]:0–0.15%),and a pastCCHFV infection(presenceof IgG againstCCHFVandlack ofIgMagainstCCHFV) wasdetectedin 15participants(0.75%;95%CI:0.37–1.13%).Titerswere400,1600, and6400for11,3and1participants,respectively.CCHFVantibody positivesubjectsweredetectedin14ofthe106districtstestedsug- gestingascattereddistribution(Fig.1).Theseropositivitywasnot significantlyfoundassociatedwithage,sexorlocationofactivity ofparticipants(datanotshown).
5. Discussion
Overall,thepercentageof CCHFVinfectionseeninMadagas- car among at-risk professionals is very low compared to those observedin endemiccountrieslikeMauritania (7%)and United ArabEmirates(6%).7,8Thisobservationmaybeexplainedbythe lackofticksofthegeneraHyalommainMadagascar.9Rhipicephalus (Boophilus)microplus,thespeciesfoundinfectedbyCCHFVinMada- gascariswidelydistributedinthecountryupto1950mofaltitude (Stachurski,pers.comm.).However,thevectorcompetenceofthis specieshasnotbeendemonstratedinthelaboratory.2
Thelowpercentageofdetectionofhumanantibodiesagainst CCHFV and the scattered geographic distribution may be the consequenceofrepeatedintroductionsofinfectedanimals,large movementsof domesticruminantsinthecountry,and abortive
Fig. 1.Distribution of Crimean-Congo hemorrhagic fever (CCHF) in the 111 administrative districts from Madagascar, 2008 and 2009. Antibody data for immunoglobulin(Ig)levelsagainstCCHFvirusinserumsamplesfromat-riskspro- fessionalsareindicatedwithdarkverticals(IgMpositiveandIgGnegative),with darkhorizontals(IgGpositiveandIgMnegative),withdarkupwarddiagonals(IgG andIgMnegative).Nosamplewasreceivedfromdistrictsshowninwhite.
circulationsofCCHFVwithinthecountry.ForRiftValleyfever,we havegeneticevidencethatoutbreaksinMadagascarresultedfrom multiplevirusintroductionsfromtheeastAfricamainlandrather thanenzooticmaintenance.10Livestockmovementswerealready implicatedinthelargediffusionofRVFVduringthe2008–2009 outbreak.6
SincethefirstinvestigationscarriedoutbytheInstitutPasteur inthe1970s,16arbovirusesorrelatedviruseshavebeenisolated in Madagascar.9,11–13 CCHFV is the only member of the genus Nairovirusdetectedintheisland.However,wecannotexcludethe presenceof anundected nairovirus closetoCCHFVlike viruses fromtheNairobisheepdiseasegroupincludingtheeponymvirus and Dugbe virus, present and widespread in continental Africa (http://www.cdc.gov/nczved/divisions/dvbid/arbovirus.html).
Consequently,theoccurrenceofcross-reactioninourdetectionof antibodiesagainstCCHFV,ifany,highlightstheverylowcirculation ofCCHFVinMadagascar.
372 S.F.Andriamandimbyetal./JournalofClinicalVirology52 (2011) 370–372
Anassessmentoftheprevalenceinlivestockasasensitiveindi- catorofCCHFVactivitymustbeconsideredinordertoconfirmthe lackortheweakendemicityofCCHFinMadagascar.
Funding
ThisworkwasfundedbyInstitutPasteurdeMadagascar.
Competinginterests
Thereisnoconflictofinterestandabsenceofanyrelationshipor anydegreeofconflictingordualinterest,financialorofanyother naturethatmayaffectprofessionaljudgmentinrelationtothis article.
Ethicalapproval
EthicalApprovalwasgivenbythe“ComitéNationald’Ethique”
ofMadagascar.Judgement’sreferencenumber:O22-CE/MINSAN.
Acknowledgments
WethankhealthcareofficersatMinistryofPublicHealthof Madagascarfortheirassistanceincollectingthedataandsamples ofpatients.
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