VIRAL ZOONOSES <ul><li>ZOONOTIC VIRUSES </li></ul><ul><ul><li>TRANSMISSIBLE FROM ANIMALS </li></ul></ul><ul><ul><ul><li>AR...
VIRAL ZOONOSES PART I ARTHROPOD BORNE
transmission <ul><li>arthropod vectors (blood sucking) </li></ul><ul><li>Many arboviral diseases world wide (hundreds) </l...
VIGILANCE
<ul><li>ARBOVIRUSES </li></ul><ul><ul><li>FEBRILE DISEASES </li></ul></ul><ul><ul><li>ENCEPHALITIS </li></ul></ul><ul><ul>...
ARBOVIRUSES FAMILY ENVELOPE yes yes no SYMMETRY icosahedral helical icosahedral GENOME ssRNA (+ve) ssRNA (-ve) segmented d...
Birds Mammals Humans
<ul><li>ARTHROPOD </li></ul><ul><li>Habitat </li></ul><ul><li>Diurnal activity </li></ul><ul><li>Preferred host </li></ul>...
PREVENTION <ul><li>SURVEILLANCE </li></ul><ul><li>VECTOR CONTROL </li></ul><ul><li>REPELLENTS </li></ul><ul><li>CLOTHING <...
SYLVATIC (JUNGLE) CYCLE arthropod arthropod vertebrate human vertebrate
URBAN CYCLE human cycle note: viruses which have a human cycle may also have a sylvatic/jungle cycle arthropod arthropod h...
OUTBREAKS <ul><li>TEND TO BE SUMMER/EARLY FALL </li></ul><ul><li>SPORADIC </li></ul><ul><li>UNPREDICTABLE </li></ul>
ARBOVIRAL DISEASE <ul><li>MANY DIFFERENT ARBOVIRUSES CAUSE DISEASE </li></ul><ul><li>OFTEN SUB-CLINICAL </li></ul>
ARBOVIRAL DISEASE <ul><li>INITIAL VIRAL REPLICATION </li></ul><ul><ul><li>endothelial cells </li></ul></ul><ul><ul><li>mac...
RECOVERY <ul><li>INTERFERON </li></ul><ul><li>CELL-MEDIATED IMMUNITY </li></ul><ul><li>ANTIBODY MAY PLAY A ROLE IN PREVENT...
DIAGNOSIS <ul><ul><li>Immunological techniques </li></ul></ul><ul><ul><li>RT-PCR for viral RNA  </li></ul></ul>
RESISTANCE <ul><li>IgG </li></ul>
ARBOVIRUSES – ENCEPHALITIS North America  California serogroup (La Crosse etc)   BUNYAVIRIDAE West US, Canada, Mexico, Bra...
ARBOVIRUS ENCEPHALITIS <ul><li>SPORADIC </li></ul><ul><li>LOW % INFECTIONS -> CLINICAL CASES </li></ul><ul><li>NOT ALL CAS...
WEST NILE VIRUS <ul><li>Reservoir: birds </li></ul><ul><li>Vector: mosquito </li></ul><ul><li>human, horse </li></ul><ul><...
flavivirus West Nile virus
flavivirus West Nile virus Final 2008 West Nile Virus activity in the United States
WEST NILE VIRUS <ul><li>Symptoms: </li></ul><ul><ul><li>Fever </li></ul></ul><ul><ul><li>Meningitis </li></ul></ul><ul><ul...
West Nile Virus <ul><li>For every ~150 people infected </li></ul><ul><ul><li>~30 mild symptoms </li></ul></ul><ul><ul><ul>...
<ul><li>Case fatality ratio:   </li></ul><ul><li>Seen in all age groups but higher in the elderly </li></ul><ul><ul><li>th...
http://www.cdc.gov/ncidod/dvbid/westnile/resources/wnv_transplant%20brochure6_12_07.pdf
WEST NILE VIRUS <ul><li>transmission:   </li></ul><ul><li>Mosquito (vast majority of cases) </li></ul><ul><li>Blood transf...
Reported Human WNV Disease Cases, US 1999       62     2000     21     2001       66     2002   4156   2003   9862   2004 ...
ST. LOUIS ENCEPHALITIS <ul><li>Second commonest mosquito borne disease in US  </li></ul><ul><li>Reservoir: birds </li></ul...
EASTERN EQUINE ENCEPHALITIS <ul><li>Reservoir: birds </li></ul><ul><li>Vector: mosquito </li></ul><ul><li>Sentinels </li><...
EASTERN EQUINE ENCEPHALITIS CDC togavirus
WESTERN EQUINE ENCEPALITIS <ul><li>Reservoir: birds </li></ul><ul><li>Vector: mosquito </li></ul><ul><li>Sentinels </li></...
CALIFORNIA SEROGROUP ENCEPHALITIS (includes  La Crosse  virus) <ul><li>Recently commoner in eastern US  </li></ul><ul><li>...
La Crosse life cycle 2000 - 2 cases in SC, Charleston area bunyavirus
ARBOVIRUSES – FEVER AND HEMORRHAGIC FEVER FAMILY FLAVIVIRIDAE Dengue Yellow fever REOVIRIDAE Colorado tick fever DISTRIBUT...
COLORADO TICK FEVER -  coltivirus  <ul><li>Vector: tick </li></ul><ul><li>Mild disease in man </li></ul><ul><li>Fever, ras...
flavivirus
DENGUE FEVER <ul><li>jungle cycle (monkeys-mosquitoes) </li></ul><ul><li>urban cycle (man-mosquitoes) </li></ul><ul><li>ra...
http://news.bbc.co.uk/2/hi/americas/6422319.stm patients being treated for Dengue fever in a Paraguayan hospital flavivirus
DENGUE FEVER <ul><li>Fever (overlaps with viremic phase) </li></ul><ul><li>headache </li></ul><ul><li>retro-orbital pain <...
DENGUE HEMORRHAGIC FEVER/DENGUE SHOCK SYNDROME  <ul><li>hemorrhages </li></ul><ul><li>plasma leakage </li></ul><ul><li>hem...
DHF - petechiae CDC flavivirus
Dengue hemorrhagic fever - pleural effusion CDC Vaughn DW et al. J Infect Dis 1997; 176:322-30.
DENGUE HEMORRHAGIC FEVER <ul><li>immunopathological </li></ul><ul><li>4 serotypes (1, 2, 3, 4) </li></ul><ul><ul><li>incre...
DENGUE HEMORRHAGIC FEVER <ul><li>Immune enhancement hypothesis </li></ul><ul><ul><li>more mononuclear cells infected </li>...
DENGUE HEMORRHAGIC FEVER <ul><li>do not give aspirin, ibuprofen  </li></ul><ul><ul><li>because of anticoagulant affects </...
flavivirus
YELLOW FEVER <ul><li>jungle and urban cycles </li></ul><ul><li>hemorrhages </li></ul><ul><li>degeneration liver, kidney, h...
The end
(Time Dec 2007)
 
Aedes albopictus  is a species of mosquito which is a good vector for Dengue
 
WEST NILE VIRUS flavivirus http://www.cdc.gov/ncidod/dvbid/westnile/clinicians/epi.htm Table. Median age (in years) of dev...
WEST NILE VIRUS flavivirus
WEST NILE VIRUS <ul><li>Case fatality ratio:   </li></ul><ul><li>Higher in elderly </li></ul><ul><ul><ul><li>The 1 fatalit...
1999 West Nile virus
2000 West Nile virus
2001 West Nile virus
2002 West Nile virus
2003 West Nile virus
2004 West Nile virus
2005 West Nile virus
2006 West Nile virus
 
 
 
 
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VIRAL ZOONOSES ZOONOTIC VIRUSES TRANSMISSIBLE FROM ANIMALS

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  • Virus causes productive infections of both vertebrate and invertebrate hosts – usually infects midgut of insect, then spreads and infects insect salivary glands – now poised to infect vertebrate host when insect feeds.
  • At least 150 species mosquito in US alone. ~3500 species worldwide
  • Human may have a low viremia and so be a dead end host; or human may be able to establish a human/insect cycle if the viremia is high enough – this human/insect cycle is called an urban cycle (see next slide)
  • Usually only used to refer to situations in which man plays and IMPORTANT role in the epidemiology of the virus.
  • WNV disease should be considered in any transplant recipient with unexplained fever and/or neurological symptoms during mosquito season This is true even for recipients who develop the infection long after their transplant.
  • 1999 Case Fatality Rate = 7/62 = 11.3% 2000 Case Fatality Rate = 2/21 = 9.5% 2001 Case Fatality Rate = 9/66 = 13.6% 2002 Case Fatality Rate = 284/4156 = 6.8% 2003 Case Fatality Rate = 264/9862 = 2.7% 2004 Case Fatality Rate = 100/2539 = 3.9% 2005 Case Fatality Rate = 119/3000 = 4.0% 2006 Case Fatality Rate = 177/4269 = 4.1% 2007 Case Fatality Rate = 124/3630 = 3.4% 2008 Case Fatality Rate = 43/1338 = 3.2%
  • Benjamin Rush (physician, a signer of the Declaration of Independence, friend of Benjamin Franklin and other founding fathers) probably made the first detailed clinical description of dengue during an epidemic in Philadelphia in 1780. Fever is often associated with the viremic phase.
  • CDC: Here we see a right lateral decubitus X-ray showing a large pleural effusion, typical of DHF the day after defervescence. When the chest X-ray is taken in this position, with the patient resting on the right side, the degree of plasma leakage may be quantified by means of the pleural effusion index. The pleural effusion index is calculated as 100 times the maximum width of the right pleural effusion, divided by the maximal width of the right hemithorax.
  • eg http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5631a1.htm report August 2007: 2005 - Case of DHF in someone who apparently had first infection when living in Mexico or Texas, and then got a locally acquired second infection in Brownsville, Cameron County, South Texas. Investigations showed that from Aug-Nov there were at least 24 more cases of dengue fever in Cameron county – including some that were acquired in Texas. 64% of the Dengue fever cases met the criteria for DHF. Other pertinent facts for concern about DHF in South Texas 38% of residents of Brownsville, Texas had IgG antibodies to Dengue multiple serotypes of Dengue have been found in Brownsville since 1980 two mosquitoes that are excellent vectors for Dengue virus (Aedes aegypti and Aedes albopictus) are well established in South Texas
  • Serious epidemics have occurred on regular basis in US in many cities, including a major epidemic in Philadelphia in 1793, account of this by Benjamin Rush (see slide 39) was widely read. Last yellow fever epidemic in US was in New Orleans in 1905
  • check if figures are world wide or SE asia – article not explicit.
  • Richland county 3; Darlington county 1 (fatal, age &gt;65); Charleston county 1
  • http://www.scdhec.net/health/lab/micro/medical_entomology/arbovirus_data.htm
  • http://www.scdhec.net/health/lab/micro/medical_entomology/arbovirus_data.htm
  • http://www.scdhec.net/health/lab/micro/medical_entomology/arbovirus_data.htm
  • VIRAL ZOONOSES ZOONOTIC VIRUSES TRANSMISSIBLE FROM ANIMALS

    1. 1. VIRAL ZOONOSES <ul><li>ZOONOTIC VIRUSES </li></ul><ul><ul><li>TRANSMISSIBLE FROM ANIMALS </li></ul></ul><ul><ul><ul><li>ARTHROPODS </li></ul></ul></ul><ul><ul><ul><ul><li>often via a blood sucking arthropod </li></ul></ul></ul></ul><ul><ul><ul><li>VERTEBRATES </li></ul></ul></ul><ul><ul><ul><ul><li>bites, body fluids, inhalation etc </li></ul></ul></ul></ul>
    2. 2. VIRAL ZOONOSES PART I ARTHROPOD BORNE
    3. 3. transmission <ul><li>arthropod vectors (blood sucking) </li></ul><ul><li>Many arboviral diseases world wide (hundreds) </li></ul>
    4. 4. VIGILANCE
    5. 5. <ul><li>ARBOVIRUSES </li></ul><ul><ul><li>FEBRILE DISEASES </li></ul></ul><ul><ul><li>ENCEPHALITIS </li></ul></ul><ul><ul><li>HEMORRHAGIC FEVERS </li></ul></ul>
    6. 6. ARBOVIRUSES FAMILY ENVELOPE yes yes no SYMMETRY icosahedral helical icosahedral GENOME ssRNA (+ve) ssRNA (-ve) segmented dsRNA, segmented
    7. 7. Birds Mammals Humans
    8. 8. <ul><li>ARTHROPOD </li></ul><ul><li>Habitat </li></ul><ul><li>Diurnal activity </li></ul><ul><li>Preferred host </li></ul><ul><li>Annual activity </li></ul><ul><li>Overwintering ability </li></ul><ul><li>Transovarial transmission </li></ul><ul><li>VERTEBRATE </li></ul><ul><li>Migratory activity </li></ul><ul><li>Persistence of viremia </li></ul><ul><li>Clinical consequences </li></ul><ul><li>Reservoir ? </li></ul><ul><li>Dead end host? </li></ul>
    9. 9. PREVENTION <ul><li>SURVEILLANCE </li></ul><ul><li>VECTOR CONTROL </li></ul><ul><li>REPELLENTS </li></ul><ul><li>CLOTHING </li></ul><ul><li>TIMING OF ACTIVITY (OR CANCELLATION) </li></ul><ul><li>VACCINE </li></ul>
    10. 10. SYLVATIC (JUNGLE) CYCLE arthropod arthropod vertebrate human vertebrate
    11. 11. URBAN CYCLE human cycle note: viruses which have a human cycle may also have a sylvatic/jungle cycle arthropod arthropod human human
    12. 12. OUTBREAKS <ul><li>TEND TO BE SUMMER/EARLY FALL </li></ul><ul><li>SPORADIC </li></ul><ul><li>UNPREDICTABLE </li></ul>
    13. 13. ARBOVIRAL DISEASE <ul><li>MANY DIFFERENT ARBOVIRUSES CAUSE DISEASE </li></ul><ul><li>OFTEN SUB-CLINICAL </li></ul>
    14. 14. ARBOVIRAL DISEASE <ul><li>INITIAL VIRAL REPLICATION </li></ul><ul><ul><li>endothelial cells </li></ul></ul><ul><ul><li>macrophages/monocyte lineage </li></ul></ul><ul><li>INTERFERON (RNA VIRUSES) </li></ul><ul><ul><li>headache, fever, myalgia </li></ul></ul><ul><li>VIREMIA </li></ul><ul><ul><li>spread to target tissues, depending on tropism of virus </li></ul></ul>
    15. 15. RECOVERY <ul><li>INTERFERON </li></ul><ul><li>CELL-MEDIATED IMMUNITY </li></ul><ul><li>ANTIBODY MAY PLAY A ROLE IN PREVENTING SPREAD DURING VIREMIC PHASE </li></ul>
    16. 16. DIAGNOSIS <ul><ul><li>Immunological techniques </li></ul></ul><ul><ul><li>RT-PCR for viral RNA </li></ul></ul>
    17. 17. RESISTANCE <ul><li>IgG </li></ul>
    18. 18. ARBOVIRUSES – ENCEPHALITIS North America California serogroup (La Crosse etc)   BUNYAVIRIDAE West US, Canada, Mexico, Brazil Western equine encephalitis East US, Canada Eastern equine encephalitis   TOGAVIRIDAE North America St Louis encephalitis North America, parts of Europe, parts of Africa West Nile virus encephalitis   FLAVIVIRIDAE DISTRIBUTION FAMILY
    19. 19. ARBOVIRUS ENCEPHALITIS <ul><li>SPORADIC </li></ul><ul><li>LOW % INFECTIONS -> CLINICAL CASES </li></ul><ul><li>NOT ALL CASES -> MAJOR DISEASE </li></ul><ul><li>PROBABLY UNDERDIAGNOSED </li></ul>
    20. 20. WEST NILE VIRUS <ul><li>Reservoir: birds </li></ul><ul><li>Vector: mosquito </li></ul><ul><li>human, horse </li></ul><ul><ul><li>dead end hosts </li></ul></ul>http://www.cdc.gov/ncidod/dvbid/westnile/cycle.htm flavivirus
    21. 21. flavivirus West Nile virus
    22. 22. flavivirus West Nile virus Final 2008 West Nile Virus activity in the United States
    23. 23. WEST NILE VIRUS <ul><li>Symptoms: </li></ul><ul><ul><li>Fever </li></ul></ul><ul><ul><li>Meningitis </li></ul></ul><ul><ul><li>Encephalitis </li></ul></ul><ul><ul><li>More rarely: </li></ul></ul><ul><ul><li>Acute flaccid paralysis </li></ul></ul><ul><ul><ul><li>West Nile polio-like paralysis </li></ul></ul></ul><ul><ul><ul><ul><li>poliomyelitis - inflammation spinal cord </li></ul></ul></ul></ul>http://www.cdc.gov/ncidod/dvbid/westnile/cycle.htm flavivirus
    24. 24. West Nile Virus <ul><li>For every ~150 people infected </li></ul><ul><ul><li>~30 mild symptoms </li></ul></ul><ul><ul><ul><li>mild fever, headache, body ache, maybe rash </li></ul></ul></ul><ul><ul><ul><ul><li>may never see physician, even if do, may not be diagnosed </li></ul></ul></ul></ul><ul><ul><li>~1 severe illness </li></ul></ul><ul><ul><ul><li>e.g. encephalitis, meningitis, high fever, stiff neck, stupor, disorientation, coma, tremors, convulsions, muscle weakness </li></ul></ul></ul><ul><ul><ul><ul><li>frequency of flaccid paralysis unknown, but much less than frequency of encephalitis </li></ul></ul></ul></ul>flavivirus
    25. 25. <ul><li>Case fatality ratio: </li></ul><ul><li>Seen in all age groups but higher in the elderly </li></ul><ul><ul><li>the majority of cases of neuroinvasive diseases and fatalities are over 50 yrs age </li></ul></ul><ul><li>Transplant recipients may be at higher risk </li></ul><ul><ul><li>increased incidence of clinical disease </li></ul></ul><ul><ul><li>increased risk of severe disease </li></ul></ul>WEST NILE VIRUS flavivirus
    26. 26. http://www.cdc.gov/ncidod/dvbid/westnile/resources/wnv_transplant%20brochure6_12_07.pdf
    27. 27. WEST NILE VIRUS <ul><li>transmission: </li></ul><ul><li>Mosquito (vast majority of cases) </li></ul><ul><li>Blood transfusion (blood supply is now screened) </li></ul><ul><li>Organ donation </li></ul>flavivirus
    28. 28. Reported Human WNV Disease Cases, US 1999 62 2000 21 2001 66 2002 4156 2003 9862 2004 2539 2005 3000 2006 4269 2007 3630 2008 1338 2009 515 (as of 10-20-09) 2008 Case Fatality Rate = 44/1356 = 3.2% flavivirus
    29. 29. ST. LOUIS ENCEPHALITIS <ul><li>Second commonest mosquito borne disease in US </li></ul><ul><li>Reservoir: birds </li></ul><ul><ul><li>Man is usually a dead end host </li></ul></ul><ul><li>Vector: mosquito </li></ul><ul><li><1% infections clinical </li></ul><ul><li>Elderly at higher risk </li></ul><ul><li>CFR 3-25% </li></ul><ul><li>~100 cases/year av. </li></ul>flavivirus
    30. 30. EASTERN EQUINE ENCEPHALITIS <ul><li>Reservoir: birds </li></ul><ul><li>Vector: mosquito </li></ul><ul><li>Sentinels </li></ul><ul><ul><li>horse,quail, turkey </li></ul></ul><ul><li>Under 15yrs, over 50yrs at higher risk </li></ul><ul><li>CFR ~35% </li></ul><ul><li>~5 cases/year av. </li></ul><ul><li>horses and humans dead end hosts </li></ul>CDC togavirus
    31. 31. EASTERN EQUINE ENCEPHALITIS CDC togavirus
    32. 32. WESTERN EQUINE ENCEPALITIS <ul><li>Reservoir: birds </li></ul><ul><li>Vector: mosquito </li></ul><ul><li>Sentinels </li></ul><ul><ul><li>horse,quail, turkey </li></ul></ul><ul><li>Children at higher risk </li></ul><ul><li>CFR 3-5% </li></ul><ul><li>humans and horses dead end hosts </li></ul>togavirus USA: last confirmed human case 1999
    33. 33. CALIFORNIA SEROGROUP ENCEPHALITIS (includes La Crosse virus) <ul><li>Recently commoner in eastern US </li></ul><ul><li>Reservoir: small mammals </li></ul><ul><li>Vector: mosquitos </li></ul><ul><li>Children at higher risk </li></ul><ul><li>Low CFR </li></ul><ul><li>~80 cases/year av. </li></ul>bunyavirus
    34. 34. La Crosse life cycle 2000 - 2 cases in SC, Charleston area bunyavirus
    35. 35. ARBOVIRUSES – FEVER AND HEMORRHAGIC FEVER FAMILY FLAVIVIRIDAE Dengue Yellow fever REOVIRIDAE Colorado tick fever DISTRIBUTION World wide, especially tropics Africa, S. and C. America North America MAIN DISEASES fever, hemorrhagic fever hemorrhagic fever fever
    36. 36. COLORADO TICK FEVER - coltivirus <ul><li>Vector: tick </li></ul><ul><li>Mild disease in man </li></ul><ul><li>Fever, rash, arthralgia </li></ul><ul><li>RMSF important consideration in differential diagnosis </li></ul><ul><li>Probably common, rarely reported </li></ul>Reovirus family
    37. 37. flavivirus
    38. 38. DENGUE FEVER <ul><li>jungle cycle (monkeys-mosquitoes) </li></ul><ul><li>urban cycle (man-mosquitoes) </li></ul><ul><li>rapidly increasing disease in tropics </li></ul><ul><li>approx. 100-200 cases/yr in US due to import </li></ul><ul><ul><li>occasional indigenous transmission </li></ul></ul><ul><li>50-100 million cases per year worldwide </li></ul><ul><ul><li>~900,000 cases in Central and S. America in 2007 </li></ul></ul>flavivirus
    39. 39. http://news.bbc.co.uk/2/hi/americas/6422319.stm patients being treated for Dengue fever in a Paraguayan hospital flavivirus
    40. 40. DENGUE FEVER <ul><li>Fever (overlaps with viremic phase) </li></ul><ul><li>headache </li></ul><ul><li>retro-orbital pain </li></ul><ul><li>myalgia, arthralgia </li></ul><ul><li>severe joint and muscle pain ‘breakbone fever’ </li></ul><ul><li>sometimes rash </li></ul><ul><li>may look like flu, measles, rubella </li></ul><ul><li>more rarely encephalitis </li></ul>flavivirus
    41. 41. DENGUE HEMORRHAGIC FEVER/DENGUE SHOCK SYNDROME <ul><li>hemorrhages </li></ul><ul><li>plasma leakage </li></ul><ul><li>hemoconcentration </li></ul><ul><li>hypotension </li></ul><ul><li>circulatory failure </li></ul><ul><li>shock </li></ul>flavivirus
    42. 42. DHF - petechiae CDC flavivirus
    43. 43. Dengue hemorrhagic fever - pleural effusion CDC Vaughn DW et al. J Infect Dis 1997; 176:322-30.
    44. 44. DENGUE HEMORRHAGIC FEVER <ul><li>immunopathological </li></ul><ul><li>4 serotypes (1, 2, 3, 4) </li></ul><ul><ul><li>increase in areas in which all 4 circulate has led to more cases DHF fever in South and Central America </li></ul></ul><ul><ul><li>Entomologic, serologic and virologic conditions are now such that locally acquired DHF can occur in South Texas </li></ul></ul><ul><li>maternal antibody </li></ul>flavivirus
    45. 45. DENGUE HEMORRHAGIC FEVER <ul><li>Immune enhancement hypothesis </li></ul><ul><ul><li>more mononuclear cells infected </li></ul></ul><ul><ul><li>infected monocytes release vasoactive mediators </li></ul></ul><ul><ul><li>increased vascular permeability </li></ul></ul><ul><ul><li>hemorrhagic symptoms </li></ul></ul>flavivirus
    46. 46. DENGUE HEMORRHAGIC FEVER <ul><li>do not give aspirin, ibuprofen </li></ul><ul><ul><li>because of anticoagulant affects </li></ul></ul><ul><ul><li>(acetaminophen OK) </li></ul></ul><ul><li>children more severe disease </li></ul><ul><li>CFR depends on rapid response </li></ul><ul><ul><li>can be as low as 1% </li></ul></ul>flavivirus
    47. 47. flavivirus
    48. 48. YELLOW FEVER <ul><li>jungle and urban cycles </li></ul><ul><li>hemorrhages </li></ul><ul><li>degeneration liver, kidney, heart </li></ul><ul><li>CFR 50% </li></ul><ul><li>Vaccine (live attenuated) </li></ul><ul><ul><li>important to consider in travel to areas with yellow fever </li></ul></ul><ul><ul><li>egg grown </li></ul></ul><ul><ul><li>contraindicated in immune suppression </li></ul></ul>CDC last yellow fever epidemic in US - 1905 flavivirus
    49. 49. The end
    50. 50. (Time Dec 2007)
    51. 52. Aedes albopictus is a species of mosquito which is a good vector for Dengue
    52. 54. WEST NILE VIRUS flavivirus http://www.cdc.gov/ncidod/dvbid/westnile/clinicians/epi.htm Table. Median age (in years) of development of West Nile illness following infection Year* Fever Meningitis Encephalitis (with or without associated meningitis) Death** 2002 49 46 64 78 2003 45 46 62 80 **Most deaths were among encephalitis patients.
    53. 55. WEST NILE VIRUS flavivirus
    54. 56. WEST NILE VIRUS <ul><li>Case fatality ratio: </li></ul><ul><li>Higher in elderly </li></ul><ul><ul><ul><li>The 1 fatality in SC in 2005 was over 65 years old </li></ul></ul></ul><ul><li>Peaks about Aug-Sept </li></ul>flavivirus SC - 2005 http://westnilemaps.usgs.gov/sc_human.html SC
    55. 57. 1999 West Nile virus
    56. 58. 2000 West Nile virus
    57. 59. 2001 West Nile virus
    58. 60. 2002 West Nile virus
    59. 61. 2003 West Nile virus
    60. 62. 2004 West Nile virus
    61. 63. 2005 West Nile virus
    62. 64. 2006 West Nile virus

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