Eastern equine encephalitis in Latin America

Jean Paul Carrera, Naomi Forrester, Eryu Wang, Amy Y. Vittor, Andrew D. Haddow, Sandra Loṕez-Vergès, Ivan Abadiá, Elizabeth Castanõ, Nestor Sosa, Carmen Baéz, Dora Estripeaut, Yamilka Diáz, Davis Beltrań, Julio Cisneros, Hector G. Cedeño, Amelia P Travassos Da Rosa, Humberto Hernandez, Alex O. Martínez-Torres, Robert B. Tesh, Scott Weaver

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

BACKGROUND: The eastern equine encephalitis (EEE) and Venezuelan equine encephalitis (VEE) viruses are pathogens that infect humans and horses in the Americas. Outbreaks of neurologic disease in humans and horses were reported in Panama from May through early August 2010. METHODS: We performed antibody assays and tests to detect viral RNA and isolate the viruses in serum samples from hospitalized patients. Additional cases were identified with enhanced surveillance. RESULTS: A total of 19 patients were hospitalized for encephalitis. Among them, 7 had confirmed EEE, 3 had VEE, and 1 was infected with both viruses; 3 patients died, 1 of whom had confirmed VEE. The clinical findings for patients with EEE included brain lesions, seizures that evolved to status epilepticus, and neurologic sequelae. An additional 99 suspected or probable cases of alphavirus infection were detected during active surveillance. In total, 13 cases were confirmed as EEE, along with 11 cases of VEE and 1 case of dual infection. A total of 50 cases in horses were confirmed as EEE and 8 as VEE; mixed etiologic factors were associated with 11 cases in horses. Phylogenetic analyses of isolates from 2 cases of equine infection with the EEE virus and 1 case of human infection with the VEE virus indicated that the viruses were of enzootic lineages previously identified in Panama rather than new introductions. CONCLUSIONS: Cases of EEE in humans in Latin America may be the result of ecologic changes that increased human contact with enzootic transmission cycles, genetic changes in EEE viral strains that resulted in increased human virulence, or an altered host range.

Original languageEnglish (US)
Pages (from-to)732-744
Number of pages13
JournalNew England Journal of Medicine
Volume369
Issue number8
DOIs
StatePublished - 2013

Fingerprint

Eastern Equine Encephalomyelitis
Latin America
Venezuelan Equine Encephalomyelitides
Horses
Venezuelan Equine Encephalitis Viruses
Panama
Alphavirus Infections
Eastern equine encephalitis virus
Infection
Viruses
Status Epilepticus
Host Specificity
RNA Viruses
Viral RNA
Encephalitis
Nervous System Diseases
Nervous System
Disease Outbreaks
Virulence
Seizures

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Carrera, J. P., Forrester, N., Wang, E., Vittor, A. Y., Haddow, A. D., Loṕez-Vergès, S., ... Weaver, S. (2013). Eastern equine encephalitis in Latin America. New England Journal of Medicine, 369(8), 732-744. https://doi.org/10.1056/NEJMoa1212628

Eastern equine encephalitis in Latin America. / Carrera, Jean Paul; Forrester, Naomi; Wang, Eryu; Vittor, Amy Y.; Haddow, Andrew D.; Loṕez-Vergès, Sandra; Abadiá, Ivan; Castanõ, Elizabeth; Sosa, Nestor; Baéz, Carmen; Estripeaut, Dora; Diáz, Yamilka; Beltrań, Davis; Cisneros, Julio; Cedeño, Hector G.; Da Rosa, Amelia P Travassos; Hernandez, Humberto; Martínez-Torres, Alex O.; Tesh, Robert B.; Weaver, Scott.

In: New England Journal of Medicine, Vol. 369, No. 8, 2013, p. 732-744.

Research output: Contribution to journalArticle

Carrera, JP, Forrester, N, Wang, E, Vittor, AY, Haddow, AD, Loṕez-Vergès, S, Abadiá, I, Castanõ, E, Sosa, N, Baéz, C, Estripeaut, D, Diáz, Y, Beltrań, D, Cisneros, J, Cedeño, HG, Da Rosa, APT, Hernandez, H, Martínez-Torres, AO, Tesh, RB & Weaver, S 2013, 'Eastern equine encephalitis in Latin America', New England Journal of Medicine, vol. 369, no. 8, pp. 732-744. https://doi.org/10.1056/NEJMoa1212628
Carrera JP, Forrester N, Wang E, Vittor AY, Haddow AD, Loṕez-Vergès S et al. Eastern equine encephalitis in Latin America. New England Journal of Medicine. 2013;369(8):732-744. https://doi.org/10.1056/NEJMoa1212628
Carrera, Jean Paul ; Forrester, Naomi ; Wang, Eryu ; Vittor, Amy Y. ; Haddow, Andrew D. ; Loṕez-Vergès, Sandra ; Abadiá, Ivan ; Castanõ, Elizabeth ; Sosa, Nestor ; Baéz, Carmen ; Estripeaut, Dora ; Diáz, Yamilka ; Beltrań, Davis ; Cisneros, Julio ; Cedeño, Hector G. ; Da Rosa, Amelia P Travassos ; Hernandez, Humberto ; Martínez-Torres, Alex O. ; Tesh, Robert B. ; Weaver, Scott. / Eastern equine encephalitis in Latin America. In: New England Journal of Medicine. 2013 ; Vol. 369, No. 8. pp. 732-744.
@article{e582a7ea8d8c415b9dc25a0039124ec7,
title = "Eastern equine encephalitis in Latin America",
abstract = "BACKGROUND: The eastern equine encephalitis (EEE) and Venezuelan equine encephalitis (VEE) viruses are pathogens that infect humans and horses in the Americas. Outbreaks of neurologic disease in humans and horses were reported in Panama from May through early August 2010. METHODS: We performed antibody assays and tests to detect viral RNA and isolate the viruses in serum samples from hospitalized patients. Additional cases were identified with enhanced surveillance. RESULTS: A total of 19 patients were hospitalized for encephalitis. Among them, 7 had confirmed EEE, 3 had VEE, and 1 was infected with both viruses; 3 patients died, 1 of whom had confirmed VEE. The clinical findings for patients with EEE included brain lesions, seizures that evolved to status epilepticus, and neurologic sequelae. An additional 99 suspected or probable cases of alphavirus infection were detected during active surveillance. In total, 13 cases were confirmed as EEE, along with 11 cases of VEE and 1 case of dual infection. A total of 50 cases in horses were confirmed as EEE and 8 as VEE; mixed etiologic factors were associated with 11 cases in horses. Phylogenetic analyses of isolates from 2 cases of equine infection with the EEE virus and 1 case of human infection with the VEE virus indicated that the viruses were of enzootic lineages previously identified in Panama rather than new introductions. CONCLUSIONS: Cases of EEE in humans in Latin America may be the result of ecologic changes that increased human contact with enzootic transmission cycles, genetic changes in EEE viral strains that resulted in increased human virulence, or an altered host range.",
author = "Carrera, {Jean Paul} and Naomi Forrester and Eryu Wang and Vittor, {Amy Y.} and Haddow, {Andrew D.} and Sandra Loṕez-Verg{\`e}s and Ivan Abadi{\'a} and Elizabeth Castan{\~o} and Nestor Sosa and Carmen Ba{\'e}z and Dora Estripeaut and Yamilka Di{\'a}z and Davis Beltrań and Julio Cisneros and Cede{\~n}o, {Hector G.} and {Da Rosa}, {Amelia P Travassos} and Humberto Hernandez and Mart{\'i}nez-Torres, {Alex O.} and Tesh, {Robert B.} and Scott Weaver",
year = "2013",
doi = "10.1056/NEJMoa1212628",
language = "English (US)",
volume = "369",
pages = "732--744",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "8",

}

TY - JOUR

T1 - Eastern equine encephalitis in Latin America

AU - Carrera, Jean Paul

AU - Forrester, Naomi

AU - Wang, Eryu

AU - Vittor, Amy Y.

AU - Haddow, Andrew D.

AU - Loṕez-Vergès, Sandra

AU - Abadiá, Ivan

AU - Castanõ, Elizabeth

AU - Sosa, Nestor

AU - Baéz, Carmen

AU - Estripeaut, Dora

AU - Diáz, Yamilka

AU - Beltrań, Davis

AU - Cisneros, Julio

AU - Cedeño, Hector G.

AU - Da Rosa, Amelia P Travassos

AU - Hernandez, Humberto

AU - Martínez-Torres, Alex O.

AU - Tesh, Robert B.

AU - Weaver, Scott

PY - 2013

Y1 - 2013

N2 - BACKGROUND: The eastern equine encephalitis (EEE) and Venezuelan equine encephalitis (VEE) viruses are pathogens that infect humans and horses in the Americas. Outbreaks of neurologic disease in humans and horses were reported in Panama from May through early August 2010. METHODS: We performed antibody assays and tests to detect viral RNA and isolate the viruses in serum samples from hospitalized patients. Additional cases were identified with enhanced surveillance. RESULTS: A total of 19 patients were hospitalized for encephalitis. Among them, 7 had confirmed EEE, 3 had VEE, and 1 was infected with both viruses; 3 patients died, 1 of whom had confirmed VEE. The clinical findings for patients with EEE included brain lesions, seizures that evolved to status epilepticus, and neurologic sequelae. An additional 99 suspected or probable cases of alphavirus infection were detected during active surveillance. In total, 13 cases were confirmed as EEE, along with 11 cases of VEE and 1 case of dual infection. A total of 50 cases in horses were confirmed as EEE and 8 as VEE; mixed etiologic factors were associated with 11 cases in horses. Phylogenetic analyses of isolates from 2 cases of equine infection with the EEE virus and 1 case of human infection with the VEE virus indicated that the viruses were of enzootic lineages previously identified in Panama rather than new introductions. CONCLUSIONS: Cases of EEE in humans in Latin America may be the result of ecologic changes that increased human contact with enzootic transmission cycles, genetic changes in EEE viral strains that resulted in increased human virulence, or an altered host range.

AB - BACKGROUND: The eastern equine encephalitis (EEE) and Venezuelan equine encephalitis (VEE) viruses are pathogens that infect humans and horses in the Americas. Outbreaks of neurologic disease in humans and horses were reported in Panama from May through early August 2010. METHODS: We performed antibody assays and tests to detect viral RNA and isolate the viruses in serum samples from hospitalized patients. Additional cases were identified with enhanced surveillance. RESULTS: A total of 19 patients were hospitalized for encephalitis. Among them, 7 had confirmed EEE, 3 had VEE, and 1 was infected with both viruses; 3 patients died, 1 of whom had confirmed VEE. The clinical findings for patients with EEE included brain lesions, seizures that evolved to status epilepticus, and neurologic sequelae. An additional 99 suspected or probable cases of alphavirus infection were detected during active surveillance. In total, 13 cases were confirmed as EEE, along with 11 cases of VEE and 1 case of dual infection. A total of 50 cases in horses were confirmed as EEE and 8 as VEE; mixed etiologic factors were associated with 11 cases in horses. Phylogenetic analyses of isolates from 2 cases of equine infection with the EEE virus and 1 case of human infection with the VEE virus indicated that the viruses were of enzootic lineages previously identified in Panama rather than new introductions. CONCLUSIONS: Cases of EEE in humans in Latin America may be the result of ecologic changes that increased human contact with enzootic transmission cycles, genetic changes in EEE viral strains that resulted in increased human virulence, or an altered host range.

UR - http://www.scopus.com/inward/record.url?scp=84882756609&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84882756609&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa1212628

DO - 10.1056/NEJMoa1212628

M3 - Article

C2 - 23964935

AN - SCOPUS:84882756609

VL - 369

SP - 732

EP - 744

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 8

ER -