Professional Documents
Culture Documents
Infections
Emphasis on the flaviviridae
May 2009
Dr Thamaini
Summary
• The arboviruses and arboviral infections
– Introduction
– General
– Specific diseases - Japanese encephalitis,
Yellow fever, WEEV, EEEV, Chikungunya, West
Nile virus, St Louis encephalitis virus, Dengue
fever, Rift valley fever, etc
• Control of arthropod borne illness – vaccines, pest
control.
Introduction
• While arthropods are not the only vectors of
microbial diseases, they comprise the most
significant and important group of vector
organisms.
• Arthropod vectors include the insects (the most
important of the arthropod vectors); the ticks and
mites.
Introduction
Arthropod-borne viruses (arboviruses) are viruses that can be
transmitted to man by arthropod vectors.
The WHO definition:
“Viruses maintained in nature principally, or to an important
extent, through biological transmission between susceptible
vertebrate hosts by haematophagus arthropods or through
transovarian and possibly venereal transmission in
arthropods: the viruses multiply and produce viremia in the
vertebrates, multiply in the tissues of arthropods, and are
passed on to new vertebrates by the bites of arthropods after a
period of extrinsic incubation.”
Classification
Arboviruses are now officially classified in six families
1. Togaviridae Genus alphavirus e.g. EEE, WEE, and VEE)
2. Bunyaviridae e.g. Rift Valley Fever. This represents the
largest group of arboviuses.
3. Flaviviridae genus flavivirus e.g. Yellow Fever, dengue,
Japanese Encephalitis
4. Reoviridae genera Coltivirus e.g Colorado tick fever virus
and Orbivirus e.g. Blue tongue virus
5. Orthomyxoviridae e.g Thogotovirus
6. Rhabdoviridae genus Vesiculovirus e.g. vesicular stomatitis
virus and lyssavirus
Flaviviruses
• The Flavivirus genus comprises more than 60 principally arthropod-
transmitted or zoonotic viruses, of which some 30 are known to
cause human disease.
• The agents are classified in the family Flaviviridae (comprises
flavivirus as well as Pestivirus and Hepacivirus.
• The public health burdens of flaviviral infections such as dengue,
yellow fever (YF), Japanese encephalitis (JE), and tick-borne
encephalitis (TBE) have been of sufficient magnitude to stimulate
the development of vaccines to control the diseases.
• Flaviviral infections are important considerations in the differential
diagnosis of central nervous system (CNS) infection, hemorrhagic
fever, and acute febrile illnesses with arthropathy or rash,
especially in returned travelers.
VIROLOGY
• Flaviviruses are spherical, positive sense RNA viruses 40 to 60
nm in diameter
• They consist of a lipid envelope covered densely with surface
projections comprising 180 copies of the M (membrane) and
180 copies of the E (envelope) glycoproteins.
• These E protein glycoproteins are organized as dimers, paired
horizontally head to tail, on the virion surface.
• The viruses are unstable in the environment and are sensitive
to heat, ultraviolet radiation, disinfectants (including alcohol
and iodine), and acid pH.
VIROLOGY
• The nucleocapsid joins the capsid (C) protein to a
single strand of positive-sense RNA of 11
kilobases, which includes a 10-kilobase open
reading frame for a single polyprotein precursor,
flanked by noncoding regions at either end.
• The order of protein gene products from the 5′
end is C, premembrane (preM, a precursor of the
mature M protein), E, and a series of seven
nonstructural proteins needed in the viral
replicative process: NS1, NS2A, NS2B, NS3, NS4A,
NS4B, NS5.
VIROLOGY
• The E protein exhibits important biologic properties, including
viral-cellular attachment, endosomal membrane fusion, and the
display of sites mediating hemagglutination and viral
neutralization.
• PreM protein chaperones the E protein in the cell secretory
pathway, preventing its misfolding, before it is cleaved to its M
form in the mature virion.
• NS1 is expressed on the surface of infected cells and is also
excreted as a complement-fixing antigen. Although antibodies to
NS1 do not neutralize the virus, they contribute to protective
immunity, probably by complement and cellmediated responses
against infected cells.
VIROLOGY
• Aside from their replicative functions, NS1, NS2A, NS3, and NS5
display epitopes mediating viral serotype and flavirviral cross-
reactive human leukocyte antigen (HLA)–restricted lymphocytic
responses.
• Viral attachment to unidentified cellular receptors is followed by
endocytic uptake of virus-containing vesicles. Acidic-induced
changes of the viral envelope lead to fusion activity, uncoating
of the nucleocapsid, and viral RNA release into the cytoplasm.
• Glycosaminoglycans and proteoglycans have been implicated as
receptors in some studies, but coreceptors may also be
involved, and viral binding evidently varies with cell type.
VIROLOGY
• The viral polyprotein is processed by repeated
passage through the rough endoplasmic
reticulum, providing the replicative complex for
further viral RNA and protein synthesis and the
assembly of nascent virions that mature through
the Golgi and trans-Golgi network.
• Immature virions collect in the highly proliferated
endoplasmic reticulum and secretory vesicles
before release,
VIROLOGY
• Flaviviruses are adapted to grow in a wide variety
of insect, tick, and vertebrate cells and at
temperatures spanning the normal temperatures
of their arthropod, reptilian, mammalian, and
avian hosts.
• A wide range of vertebrates, including mammals,
birds, and reptiles, are naturally infected as
amplifying hosts in the transmission cycle of
alternating arthropod and vertebrate infection.
These infections are usually asymptomatic, but
individual viruses may be pathogenic for
domesticated or wild animals.
VIROLOGY
• Most flaviviruses can be classified by cross-
neutralization assays into eight antigenic groups
including
– JE complex, consisting of JE, StLE, West Nile, and
Murray Valley encephalitis viruses;
– Dengue complex of dengue 1 through 4 viruses
– Tick-borne virus complex, including CEE, RSSE,
louping ill, Powassan, Kyasanur Forest disease, and
Omsk hemorrhagic fever viruses;
– YF virus;
– And other complex of non–vector-borne rodent-
and bat-associated viruses.
Epidemiology - TRANSMISSION
CYCLE
• The mosquito or tick becomes infected when
feeding on the blood of the viremic animal.
• The virus then replicates in the mosquito or tick
tissues, ultimately infecting the salivary glands.
• The mosquito or tick transmits the virus to a new
host when it injects infective salivary fluid while
taking a blood meal.
• The natural animal hosts of these viruses usually
remain unaffected and viral circulation generally
remains undetected until one of the following
occurs:
Epidemiology - TRANSMISSION
CYCLE
– Humans encroach on the natural enzootic focus
– Environmental or other conditions that favor
substantial amplification in the primary vector-host
cycle cause a sufficient number of vectors to
become infected so that the human risk is
substantially increased
– The virus escapes the primary cycle via a secondary
vector or vertebrate host, thereby bringing infected,
human-biting vectors in close proximity to human
habitation
• Although infected humans may become ill, they
usually do not develop sufficient viremia to infect
feeding vectors. As a result, humans do not usually
contribute to the transmission cycle.
Man-Arthropod-Man Cycle
Animal-Arthropod-Man Cycle
Arthropod Vectors
Mosquitoes
Japanese encephalitis, dengue, yellow fever, St. Louis
encephalitis, EEE, WEE, VEE etc.
Ticks
Crimean-Congo haemorrhagic fever, various tick-borne
encephalitides etc.
Sandflies
Sicilian sandfly fever, Rift valley fever.
Animal Reservoirs