Benny Borremans

Dilemmas in managing pregnant women with Ebola: 2 case reports

We report 2 cases of Ebola viral disease (EVD) in pregnant women who survived, initially with intact pregnancies. Respectively 31–32 days after negativation of the maternal blood EVD-polymerase chain reaction (PCR) both patients delivered a stillborn fetus with persistent EVD-PCR amniotic fluid positivity.

Lactating mothers infected with Ebola virus : EBOV RTPCR of blood only may be insufficient

We describe two Ebola virus (EBOV) RT-PCR discordant mother-child pairs. In the first, blood from the breastfeeding mother, recovering from EBOV infection, tested negative twice but her urine tested positive. Her child became infected by EBOV and died. In the second, the breastfed child remained EBOV-negative, although the mothers blood tested positive. We highlight possible benefits of EBOV RT-PCR testing in urine and breast milk and the need for hygiene counselling when those fluids are EBOV-positive. .

Presence of Mopeia Virus, an African Arenavirus, Related to Biotope and Individual Rodent Host Characteristics: Implications for Virus Transmission

The East African Mopeia virus (MOPV) is an arenavirus closely related to the highly pathogenic West African Lassa virus, even sharing the same reservoir rodent host Mastomys natalensis. Because MOPV is not known to cause human disease, it offers a unique alternative for studying Lassa virus transmission. We investigated how habitat, population density, and host characteristics are related to MOPV occurrence in M. natalensis populations in Morogoro, Tanzania. In 3 contrasting habitats, 511 M. natalensis individuals were trapped, 12.1% (58/480 tested individuals) of which tested seropositive for antibodies and 8.4% (41/489 tested individuals) for MOPV-RNA. Although population densities differ among habitats, density and habitat were not significantly correlated to MOPV-RNA or antibody presence. Antibody presence was not significantly correlated with any host characteristics. In contrast, MOPV-RNA presence was inversely related to weight, age, sexual maturity, and body mass index. The model with body mass index as predictor was the best at predicting infection probability. Thirty-five individuals were exclusively MOPV-RNA positive, 52 were exclusively antibody positive, and 6 were both MOPV-RNA and antibody positive. Interpreting these data using experimental infection results from studies on other arenaviruses, this would mean that these infections were very recent, old, and roughly 1-3 weeks after infection, respectively. The higher RNA prevalence in juveniles implies vertical transmission, or that horizontal transmission occurs mainly in this age group due to lack of immunity, higher susceptibility, and/or higher juvenile contact rates. This study demonstrates the strength of combining information on antibody and RNA presence with host characteristics, and how this information can provide valuable insights into transmission dynamics.

Sympatric occurrence of 3 arenaviruses, Tanzania.

To determine the specificity of Morogoro virus for its reservoir host, we studied its host range and genetic diversity in Tanzania. We found that 2 rodent species other than Mastomys natalensis mice carry arenaviruses. Analysis of 340 nt of the viral RNA polymerase gene showed sympatric occurrence of 3 distinct arenaviruses.

Prevalence of haemoparasites, leptospires and coccobacilli with potential for human infection in the blood of rodents and shrews from selected localities in Tanzania, Namibia and Swaziland

The prevalence of haemoparasites, leptospirosis and Yersinia pestis was investigated in rodents and shrews from Tanzania, Namibia and Swaziland. Blood smears originating from rodents and shrews from the three countries indicated the presence of Trypanosoma lewisi (72.7%; n =950), Bacillus spp. (25.6%; n =950), Borrelia sp. (0.01%; n =950) and bipolar coccobacilli (0.01%; n =950). The blood smears from Namibia (n =26) had no haemoparasites while only 1.33% (n =75) of those from Swaziland showed presence of T. lewisi. Leptospira interrogans was found in rodent blood sera from Tanzania in the following serogroup proportions (n =350): Icterohaemorrhagiae (10.29%), Pomona (2.86%), Hardjo (1.14%), Bullum (0.86%), Grippotyphosa (1.43%) and Canicola (1.14%). Serodiagnosis of antibodies against the F1 antigen of Y. pestis using the enzyme linked immunosorbent assay (ELISA) was negative for all the serum samples from central Tanzania, while two samples of serum from two species of rodents, Rhabdomys pumilio and Gerbilliscus leucogaster, collected in the Kavango Region of Namibia were positive. These results suggest an enzootic plague activity in this region in Namibia. It is concluded that zoonotic agents, that are infectious to humans, are prevalent in rodents and shrews in the three countries, and that local communities should apply rodent control measures to reduce the risk of human infections.

Density thresholds for Mopeia virus invasion and persistence in its host **Mastomys natalensis**

Well-established theoretical models predict host density thresholds for invasion and persistence of parasites with a density-dependent transmission. Studying such thresholds in reality, however, is not obvious because it requires long-term data for several fluctuating populations of different size. We developed a spatially explicit and individual-based SEIR model of Mopeia virus in multimammate mice Mastomys natalensis. This is an interesting model system for studying abundance thresholds because the host is the most common African rodent, populations fluctuate considerably and the virus is closely related to Lassa virus but non-pathogenic to humans so can be studied safely in the field. The simulations show that, while host density clearly is important, sharp thresholds are only to be expected for persistence (and not for invasion), since at short time-spans (as during invasion), stochasticity is determining. Besides host density, also the spatial extent of the host population is important. We observe the repeated local occurrence of herd immunity, leading to a decrease in transmission of the virus, while even a limited amount of dispersal can have a strong influence in spreading and re-igniting the transmission. The model is most sensitive to the duration of the infectious stage, the size of the home range and the transmission coefficient, so these are important factors to determine experimentally in the future.

Shedding dynamics of Morogoro virus, an African arenavirus closely related to Lassa virus, in its natural reservoir host Mastomys natalensis

Arenaviruses can cause mild to severe hemorrhagic fevers. Humans mainly get infected through contact with infected rodents or their excretions, yet little is known about transmission dynamics within rodent populations. Morogoro virus (MORV) is an Old World arenavirus closely related to Lassa virus with which it shares the same host species Mastomys natalensis. We injected MORV in its host, and sampled blood and excretions at frequent intervals. Infection in adults was acute; viral RNA disappeared from blood after 18 days post infection (dpi) and from excretions after 39 dpi. Antibodies were present from 7 dpi and never disappeared. Neonatally infected animals acquired a chronic infection with RNA and antibodies in blood for at least 3 months. The quantified excretion and antibody patterns can be used to inform mathematical transmission models, and are essential for understanding and controlling transmission in the natural rodent host populations.

Analysis of Diagnostic Findings From the European Mobile Laboratory in Guéckédou, Guinea, March 2014 Through March 2015

Background. A unit of the European Mobile Laboratory (EMLab) consortium was deployed to the Ebola virus disease (EVD) treatment unit in Guéckédou, Guinea, from March 2014 through March 2015. Methods. The unit diagnosed EVD and malaria, using the RealStar Filovirus Screen reverse transcription–polymerase chain reaction (RT-PCR) kit and a malaria rapid diagnostic test, respectively. Results. The cleaned EMLab database comprised 4719 samples from 2741 cases of suspected EVD from Guinea. EVD was diagnosed in 1231 of 2178 hospitalized patients (57%) and in 281 of 563 who died in the community (50%). Children aged <15 years had the highest proportion of Ebola virus–malaria parasite coinfections. The case-fatality ratio was high in patients aged <5 years (80%) and those aged >74 years (90%) and low in patients aged 10–19 years (40%). On admission, RT-PCR analysis of blood specimens from patients who died in the hospital yielded a lower median cycle threshold (Ct) than analysis of blood specimens from survivors (18.1 vs 23.2). Individuals who died in the community had a median Ct of 21.5 for throat swabs. Multivariate logistic regression on 1047 data sets revealed that low Ct values, ages of <5 and ≥45 years, and, among children aged 5–14 years, malaria parasite coinfection were independent determinants of a poor EVD outcome. Conclusions. Virus load, age, and malaria parasite coinfection play a role in the outcome of EVD.

Evaluation of short-, mid- and long-term effects of toe clipping on a wild rodent

Abstract Context. Toe clipping is a widely used method for permanent marking of small mammals, but its effects are not well known, despite the ethical and scientific implications. Most studies do not find any clear effects, but there is some indication that toe clipping can affect survival in specific cases. Although effects on survival are arguably the most important, more subtle effects are also plausible, yet very few studies have included body condition and none has investigated effects on mobility. Aims. We analysed the effects of toe clipping on free-living Mastomys natalensis, a common, morphologically and behaviourally intermediate small rodent. Methods. Using a 17-year capture–mark–recapture dataset, we compared movement, body weight and survival between newly and previously clipped animals, and tested whether any of these parameters correlated with the number of clipped toes. Key results. No evidence for a correlation between total number of clips and any of the variables was found. Newly clipped animals had a slightly smaller weight change and larger travel distance than did those that were already clipped, and we show that this is most likely due to stress caused by being captured, clipped and handled for the first time rather than to the actual clipping. Conclusions. The combination of trapping, handling and marking has a detectable effect on multimammate mice; however, there is no evidence for a clear effect of toe clipping. Implications. Our study suggests a re-evaluation of ethical guidelines on small-mammal experiments, so as to reach a rational, fact-based decision on which marking method to use.

Estimating Time of Infection Using Prior Serological and Individual Information Can Greatly Improve Incidence Estimation of Human and Wildlife Infections.

Diseases of humans and wildlife are typically tracked and studied through incidence, the number of new infections per time unit. Estimating incidence is not without difficulties, as asymptomatic infections, low sampling intervals and low sample sizes can introduce large estimation errors. After infection, biomarkers such as antibodies or pathogens often change predictably over time, and this temporal pattern can contain information about the time since infection that could improve incidence estimation. Antibody level and avidity have been used to estimate time since infection and to recreate incidence, but the errors on these estimates using currently existing methods are generally large. Using a semi-parametric model in a Bayesian framework, we introduce a method that allows the use of multiple sources of information (such as antibody level, pathogen presence in different organs, individual age, season) for estimating individual time since infection. When sufficient background data are available, this method can greatly improve incidence estimation, which we show using arenavirus infection in multimammate mice as a test case. The method performs well, especially compared to the situation in which seroconversion events between sampling sessions are the main data source. The possibility to implement several sources of information allows the use of data that are in many cases already available, which means that existing incidence data can be improved without the need for additional sampling efforts or laboratory assays.