Virology 4 Flashcards
1
Q
Gastrointestinal/Enteric Viruses
- ___virus
- ___virus
- ___viruses
- ___virus: Virus that comes into play with outbreaks of diahhreal disease on cruise ships
____virus
- ___ ___virus
- ___viruses
- ___viruses
•
A
- rotavirus
- adenovirus
- caliciviruses
- Norovirus
- Sapporovirus
- hepatitis E virus
- astroviruses
- polioviruses
•
2
Q
Rotavirus Characteristics
- ___virus family; ___, ___ ____ capsid, ____ ___ genome; ___ segments
- ___ to environmental and GI conditions
- ___ groups, ____ serotypes
- most common cause of ___ ___ among ___
- virus ___ cells of the epithelium overlying the ___
Segmented genome
Genes are encoded by 11 segments of RNA
Naked Capsid Virus so resistant
A
- reovirus family; naked, double-layered capsid, segmented RNA genome; 11 segments
- resistant to environmental and GI conditions
- five groups, seven serotypes
- most common cause of severe diarrhea among children
- virus lyses cells of the epithelium overlying the villi
Segmented genome
Genes are encoded by 11 segments of RNA
Naked Capsid Virus so resistant
3
Q
Rotavirus Pathogenesis
It gets into ____l cells of the GI tract.
It enter ____
Virus ____ and produces a___
It makes its own toxin which contributes to the ___ ___ ass with the virus
Virus ____ these cells and infects ___ cells
___ cells begin to ___ and the ___ exit the body
A
It gets into epithelial cells of the GI tract.
It enters cytoplasm
Virus multiplies and produces a toxin
It makes its own toxin which contributes to the severe diahhrea ass with the virus
Virus leaves these cells and infects healthy cells
Epith cells begin to die and the fluids exit the body
4
Q
Rotavirus Facts and Figures
- transmitted by _____ route
- prior to vaccine, ___% infected by age 5
- may be as many as ____ viral particles/gram of stool
- some children hospitalized because of____
- infants younger than ___ ____most susceptible
- vaccination
–RotaTeq® licensed in 2006
–Rotarix® licensed in 2008
•very severe, possibly fatal infection in ____ people; may cause up to 500,000 deaths/year in ____ countries where ___ is unavailable
Vaccine is relatively new. A lot of kids are immune bc they actually had the infection.
Crowding in underdeveloped world also helps to spread the infection.
Don’t need to know names of vaccines for each virus unless she REALLY emphasized it
A
- transmitted by fecal-oral route
- prior to vaccine, >90% infected by age 5
- may be as many as 1010 viral particles/gram of stool
- some children hospitalized because of dehydration
- infants younger than 24 months most susceptible
- vaccination
–RotaTeq® licensed in 2006
–Rotarix® licensed in 2008
•very severe, possibly fatal infection in malnourished people; may cause up to 500,000 deaths/year in underdeveloped countries where vaccine is unavailable
Vaccine is relatively new. A lot of kids are immune bc they actually had the infection.
Crowding in underdeveloped world also helps to spread the infection.
Don’t need to know names of vaccines for each virus unless she REALLY emphasized it
5
Q
Enteric Adenoviruses
- types __ and ___
- most common ___ ____ in infants and children since the introduction of ___ ___
As we get protection against one virus, then other viruses emerge to create the same problems
•____day incubation period
A
- types 40 and 41
- most common diarrheal illness in infants and children since the introduction of rotavirus vaccine
As we get protection against one virus, then other viruses emerge to create the same problems
•8-10 day incubation period
6
Q
Noroviruses
- ___viruses–small, ___, ___ stranded _NA
- named for the original strain “___ ___”; caused a gastroenteritis outbreak in ___, __in 1968
- resistant to ___, ___, ____
- highly____ (___ particles can cause infection)
- fecal-oral transmission
- symptoms–___, ___, ___
Similar to ___ virus but in a different family
A
- caliciviruses–small, naked, ssRNA
- named for the original strain “Norwalk virus”; caused a gastroenteritis outbreak in Norwalk, OH in 1968
- resistant to detergents, drying, acid
- highly contagious (10 particles can cause infection)
- fecal-oral transmission
- symptoms–diarrhea, nausea, vomiting
Similar to polio virus but in a different family
7
Q
Norovirus Epidemiology
- leading cause of ___ ____ outbreaks in the U.S.
- 19-21 million cases of ____/yr
- 1.7-1.9 million ____visits/yr; 400,000 ___ visits/yr
- 56,000-71,000 ____/yr
- outbreaks common in __ ___ facilities, especially ___ ___care facilities
- causes 90% of diarrheal disease outbreaks on ___ ___
- leading cause of ___ _____ worldwide
Outbreaks common on cruise ships
Graph shows a couple of times there’s been a pandemic
No ___ or ____
For most of these GI: Just make sure that there is ___ ___ so patients don’t have any other problems ass with infection
A
Norovirus Epidemiology
- leading cause of foodborne disease outbreaks in the U.S.
- 19-21 million cases of gastroenteritis/yr
- 1.7-1.9 million outpatient visits/yr; 400,000 ER visits/yr
- 56,000-71,000 hospitalizations/yr
- outbreaks common in health care facilities, especially long-term care facilities
- causes 90% of diarrheal disease outbreaks on cruise ships
- leading cause of viral gastroenteritis worldwide
Outbreaks common on cruise ships
Graph shows a couple of times there’s been a pandemic
No trt or vaccines
For most of these GI: Just make sure that there is adequate hydration so patients don’t have any other problems ass with infection
8
Q
Poliovirus Infections
- mainly affects ___ under 5 yrs of age
- 1/___ infections leads to irreversible____
- cases have ____by 99% since 1988
- 1988—350,000 cases
- 2013—406 reported cases
- global effort to eradicate disease
- _____ vaccine used in U.S. since 2000; oral (____) vaccine used in many parts of the world
____ been eradiated in US. Last case in US was in ___. But its still out there.
Paralytic polio is not the typical presentation.
Attenuated vaccine: Given in form of a __ ___
Now we use an inactivated vaccine.
Advantages of attenuated vaccine are that you can ___ target tissue and illicit i___ ___without getting___
A
Poliovirus Infections
- mainly affects children under 5 yrs of age
- 1/200 infections leads to irreversible paralysis
- cases have decreased by 99% since 1988
- 1988—350,000 cases
- 2013—406 reported cases
- global effort to eradicate disease
- inactivated vaccine used in U.S. since 2000; oral (attenuated) vaccine used in many parts of the world
•
Basically been eradiated in US. Last case in US was in 1980. But its still out there.
Paralytic polio is not the typical presentation.
Attenuated vaccine: Given in form of a sugar cube
Now we use an inactivated vaccine.
Advantages of attenuated vaccine are that you can infect target tissue and illicit immune response without getting disease
9
Q
Cases of polio
Not ____eradicated
A
Not completely eradicated
10
Q
Coxsackievirus and Echovirus Infections
- Coxsackie A associated with diseases with ___ ___
- Coxsackie B associated with ___ and___
- most common results of infection
–____
–mild ___ ___, __-like illness
•___(aseptic) ____-echovirus __
Vesicular lesion that occur in the _____—> Coxsackie A virus
Coxsackie B virus is associated with infection of the myocardum and ___ of the lungs
Not ____ in kids
Named after___ ___
A
- Coxsackie A associated with diseases with vesicular lesions
- Coxsackie B associated with myocarditis and pleurodynia
- most common results of infection
–subclinical
–mild upper respiratory, flu-like illness
•viral (aseptic) meningitis-echovirus 11
Vesicular lesion that occur in the mouthà Coxsackie A virus
Coxsackie B virus is associated with infection of the myocardum and lining of the lungs
Not uncommon in kids
Named after coxsackie NY
11
Q
Hand, Foot, and Mouth Disease
- Coxsackie ___ is most common cause
- Enterovirus ___ associated with outbreaks
- vesicular lesions on ___, ___ and, in ___
AKA (____)
•mild, ____ illness
Coxsackie causes hand, foot and mouth disease
Serotype A16 is the most common cause
Disease is sometimes called herpangina
Febril (fever)
A
Hand, Foot, and Mouth Disease
- Coxsackie A16 is most common cause
- Enterovirus 71 associated with outbreaks
- vesicular lesions on hands, feet, in mouth (herpangina)
- mild, febrile illness
Coxsackie causes hand, foot and mouth disease
Serotype A16 is the most common cause
Disease is sometimes called herpangina
Febril (fever)
12
Q
Respiratory Tract Viruses
- ___virus
- ___virus
- _____virus
- ___virus
- ____ virus
- respiratory ____ virus
- enterovirus___
- ___
- ___
- ___
- parvovirus ___
A
- adenovirus
- coronavirus
- parainfluenzavirus
- rhinovirus
- influenza virus
- respiratory syncytial virus
- enterovirus 68
- measles
- mumps
- rubella
- parvovirus B19
13
Q
Adenovirus Characteristics
___, ____, ___ viruses
- fibers at ____; ___
- ___serotypes of human adenovirus
- ___, ___ and ___ infections
Naked so Stable in the environment
They have pentagon fibers that stick out. Fibers at vertices of pentagon are toxic to the cell
This is an important mechanism of pathogenesis of this virus
__ and __ cause enteric disease. ___ cause resp disease.
They can cause lytic infections, persistent infections and latent infections so they can hang around and cause problems
A
- naked, icosahedral, DNA viruses
- fibers at vertices; toxic
- 52 serotypes of human adenovirus
- lytic, persistent, and latent infections
Naked so Stable in the environment
They have pentagon fibers that stick out. Fibers at vertices of pentagon are toxic to the cell
This is an important mechanism of pathogenesis of this virus
40 and 41 cause enteric disease. Most cause resp disease.
They can cause lytic infections, persistent infections and latent infections so they can hang around and cause problems
14
Q
Common Adenovirus Illnesses
- endemic, ___ ___ ___–5-10% of pediatric respiratory disease
- ____
- ________
- ____ ___ ___
- _____–15% ofgastroenteritis in hospitalized patients
- acute ___ ____
- ______
- ___
Most common illnesses of adenovirus infection is acute resp disease
5-10% of pediatric resp diesease is caused by adenovirus
Adenovirus conjunctivitis: not that easy to distinguish what would be caused by bacteria. If you have bad sore throat and then get conjuntivitis, you can almost be sure it is from adenovirus
- gastroenteritis–15% of gastroenteritis in hospitalized patients
- Easy to spread
- acute hemorrhagic cystitis
- Bleeding from bladder
- meningoencephalitis
- hepatitis
Wide variety of clinical manifestations
Most significant ones are GI disease and resp disease
Problems in people who are __ ____
A
- endemic, acute respiratory disease–5-10% of pediatric respiratory disease
- pneumonia
- keratoconjunctivitis
- pharyngoconjunctival fever
•gastroenteritis–15% of
gastroenteritis in hospitalized patients
- acute hemorrhagic cystitis
- meningoencephalitis
- hepatitis
Most common illnesses of adenovirus infection is acute resp disease
5-10% of pediatric resp diesease is caused by adenovirus
Adenovirus conjunctivitis: not that easy to distinguish what would be caused by bacteria. If you have bad sore throat and then get conjuntivitis, you can almost be sure it is from adenovirus
- gastroenteritis–15% of gastroenteritis in hospitalized patients
- Easy to spread
- acute hemorrhagic cystitis
- Bleeding from bladder
- meningoencephalitis
- hepatitis
Wide variety of clinical manifestations
Most significant ones are GI disease and resp disease
Problems in people who are not immunocompetent
15
Q
Adenovirus Disease Mechanisms
- transmission
- ___
- __ __
- __ ___ for enteric ones
- ____ of___
____ objects
- ___ ____
- infection of mucoepithelial cells
- ___ tract
- ____l tract
- ____
- ____cell damage
- ___ important
- ___
- ___
- type of disease determined by tissue___ of group and ___
Virus in saliva can cause infection in the eyes
Swimming in contaminated pools
Virus can infect epithelial cells of resp tract, GI, and conjuctiva
Causes direct cell damage by the fibers that she talked about
Ab is important in protecting against reinfection and resolving the disease
A
- transmission
- aerosol
- close contact
- fecal-oral for enteric ones
- autoinoculation of eyes
- inanimate objects
- swimming pools
- infection of mucoepithelial cells
- respiratory tract
- gastrointestinal tract
- conjunctiva
- direct cell damage
- antibody important
- protection
- resolution
- type of disease determined by tissue tropism of group and serotype
Virus in saliva can cause infection in the eyes
Swimming in contaminated pools
Virus can infect epithelial cells of resp tract, GI, and conjuctiva
Causes direct cell damage by the fibers that she talked about
Ab is important in protecting against reinfection and resolving the disease
16
Q
Adenovirus Epidemiology/Treatment
- risk groups include those in ___ ___ centers, ___ ___ camps,____ clubs
- some people infected with adenoviruses can have ____ infections in their ___, ___s, and____ that __ __ ___ symptoms
- they can ___ the virus for ___ or ___
_____ infections lead to ___
•___, ___ vaccine against adenovirus types _ and _ was approved by the FDA in March 2011 for U.S. ___ personnel 17 through 50 years old
Can asymptomatically spread the virus
___ ____ vaccine for adenovirus
There was oral vaccine for types 4 and 7 used in military but not used for general popl.
Not worth a huge immunization program
A
Adenovirus Epidemiology/Treatment
- risk groups include those in day-care centers, military training camps, swimming clubs
- some people infected with adenoviruses can have ongoing infections in their tonsils, adenoids, and intestines that do not cause symptoms
- they can shed the virus for months or years
- asymptomatic infections lead to spread
- live, oral vaccine against adenovirus types 4 and 7 was approved by the FDA in March 2011 for U.S. military personnel 17 through 50 years old
Can asymptomatically spread the virus
No general vaccine for adenovirus
There was oral vaccine for types 4 and 7 used in military but not used for general popl.
Not worth a huge immunization program
17
Q
Rhinovirus Characteristics
- ____–__, ___, ___serotypes
- acid ____; do not replicate in ___ ___
- resistant to ___ and ___
- grow best at ____
- infection initiated by as little as __ viral particle
- peak illness ® ______ infectious virions/ml in nasal secretions
___ ___
Stable in the environment
100 serotypes, that’s why we get colds over and over again. Never develop good immunity to any of them
Don’t replicate in GI tract.
Grow best at 33 degrees which is the temperature of our ___ ___. That’s why cold symproms localized to upper respiratory tract
Highly infectious
A
- picornavirus–naked, RNA, 100 serotypes
- acid labile; do not replicate in gastrointestinal tract
- resistant to drying and detergents
- grow best at 33oC
- infection initiated by as little as 1 viral particle
- peak illness ® 500-1000 infectious virions/ml in nasal secretions
Common cold
Stable in the environment
100 serotypes, that’s why we get colds over and over again. Never develop good immunity to any of them
Don’t replicate in GI tract.
Grow best at 33 degrees which is the temperature of our nasal passages. That’s why cold symproms localized to upper respiratory tract
Highly infectious
18
Q
Rhinovirus Clinical Syndrome
- ___
- ____ (runny nose)–due to release of____ and____; ___ at first, then ___/___ (___ ___), and then ___ (not an indication for antibiotics; __ ___ are __ __)
- nasal obstruction
- sore throat
- headache
- ___
- occasionally __ and ____
These are the symptoms
Runny nose is clear at first and then turns white/yellow. That’s when everyone runs to to doctor. Simply reflection of immune response fighting off infection.
A
Rhinovirus Clinical Syndrome
- sneezing
- rhinorrhea (runny nose)–due to release of bradykinin and histamine; clear at first, then white/yellow (immune response), and then green (not an indication for antibiotics; normal flora are growing back)
- nasal obstruction
- sore throat
- headache
- malaise
- occasionally fever and chills
These are the symptoms
Runny nose is clear at first and then turns white/yellow. That’s when everyone runs to to doctor. Simply reflection of immune response fighting off infection.
19
Q
Rhinovirus Epidemiology/Treatment
- cause of___ of all___ ___ ___
- immunity is ___
- transmission
____
____
___ to ___–hands (virus can be recovered from the hands of 40-90% of persons with colds)
- half of all infections are ____
- disease more common in __ ___ and____ ___
- symptomatic control
- plenty of___
- ___medicines
Immunity is Transient. Bc they infect the nasal cavity you don’t get a huge immune response
___ viremia. The infection is localized. If anything there may be small ___ ___ to virus. But No ____ immunity bc of localization
Fomites: inamnimate objects
Most common way is person to person on the hands
A
- cause of 1/2 of all upper respiratory infections
- immunity is transient
- transmission
- aerosols
- fomites
- person-to-person–hands (virus can be recovered from the hands of 40-90% of persons with colds)
- half of all infections are subclinical
- disease more common in early fall and late spring
- symptomatic control
- plenty of liquids
- OTC medicines
Immunity is Transient. Bc they infect the nasal cavity you don’t get a huge immune response
No viremia. The infection is localized. If anything there may be small SIgA response to virus. But No systemic immunity bc of localization
Fomites: inamnimate objects
Most common way is person to person on the hands
20
Q
Coronavirus Characteristics
- ___, ___ virus
- ___, ___-like appearance
- grows best at____
- infects epithelial cells of the __ ___ __
Different from rhinovirus because these are enveloped
A
Coronavirus Characteristics
- enveloped, RNA virus
- solar, corona-like appearance
- grows best at 33-35oC
- infects epithelial cells of the upper respiratory tract
Different from rhinovirus because these are enveloped
21
Q
Coronavirus Epidemiology
- ___ most prevalent cause of the __ __
- cause ____% of ___ ___ tract infections and ___
- spread by ___ and in __ ___
- re-infection occurs __ ___
•
Occasionaly cause pneumonia but that is rare
re-infection occurs despite antibodies bc its just a__ ___ response in general
A
Coronavirus Epidemiology
- 2nd most prevalent cause of the common cold
- cause 5-10% of upper respiratory tract infections and pneumonia
- spread by aerosols and in large droplets
- re-infection occurs despite antibodies
•
Occasionaly cause pneumonia but that is rare
re-infection occurs despite antibodies bc its just a local immune response in general
22
Q
Severe Acute Respiratory Syndrome-SARS
- global attention in 2/2003
- caused by ___-__
- WHO notified of 305 cases of atypical pneumonia in __ ___
- SARS declared contained in 7/2003
- >8,000 cases
- 780 deaths
- 29 countries
- most recent human cases of SARS-reported in ___ in April 2004 in an outbreak resulting from ___ ___ ___
It was shown that SARS is caused by a ____
This is an example of a virus that Shows up, makes a bunch of people sick and then goes away
About __% mortality
A
Severe Acute Respiratory Syndrome-SARS
- global attention in 2/2003
- caused by SARS-CoV
- WHO notified of 305 cases of atypical pneumonia in Guangdong Province
- SARS declared contained in 7/2003
- >8,000 cases
- 780 deaths
- 29 countries
- most recent human cases of SARS-reported in China in April 2004 in an outbreak resulting from laboratory-acquired infections
It was shown that SARS is caused by a Coronavirus
This is an example of a virus that Shows up, makes a bunch of people sick and then goes away
About 10% mortality
23
Q
MERS-CoV
- first reported in___ ___ in 2012
- severe,__ ___ illness
- spread through ___ __
- ___, ___, ___ of ___
- ___% mortality
- likely origin is ___; transmitted by ___
- ___ cases in U.S. in 2014
- outbreak in ___ in 2015
Another one that popped up
Middle East Resp Syndrome
This was also a Coronavirus
Came from bats, transmitted it to camels and then people in contact with camels got infected
Cases in US were in people who had traveled to the middle east
A
MERS-CoV
- first reported in Saudi Arabia in 2012
- severe, acute respiratory illness
- spread through close contact
- fever, cough, shortness of breath
- 30% mortality
- likely origin is bats; transmitted by camels
- two cases in U.S. in 2014
- outbreak in Korea in 2015
Another one that popped up
Middle East Resp Syndrome
This was also a Coronavirus
Came from bats, transmitted it to camels and then people in contact with camels got infected
Cases in US were in people who had traveled to the middle east
24
Q
Current Status of MERS Outbreak
Still some hotspots of MERs in the__ __and __
A
Still some hotspots of MERs in the middle east and Korea.
25
Respiratory Syncytial Virus (RSV)
Characteristics
## Footnote
* \_\_\_\_\_virus--\_\_\_, \_\_NA, ____ core; cause ___ \_\_\_
* causes\_\_\_\_ infection of ___ tract
* highly \_\_\_\_
* causes \_\_\_\_, ___ in children \< 1 yr
* causes ___ \_\_\_ and ____ in young kids
* causes __ \_\_\_ in older kids and adults
Similar to virus that causes measles and mumps
Severe in kids who are less than a year old
In young kids, it causes fever and sore throat and cold
Respiratory Syncytial Virus (RSV)
Characteristics
## Footnote
* paramyxovirus--enveloped, RNA, helical core; cause syncytia formation
* causes localized infection of respiratory tract
* highly contagious
* causes bronchiolitis, pneumonia in children \< 1 yr
* causes febrile rhinitis and pharyngitis in young kids
* causes common cold in older kids and adults
Similar to virus that causes measles and mumps
Severe in kids who are less than a year old
In young kids, it causes fever and sore throat and cold
26
RSV Epidemiology
## Footnote
* the most common cause of severe ___ \_\_\_ tract disease among ___ and __ \_\_\_worldwide
* can be devastating in ___ \_\_\_
* infects nearly ___ by age 2
* large-droplet \_\_\_\_; transmitted by \_\_\_, \_\_\_\_, contact with ___ \_\_\_
* treatment with ___ (\_\_\_ analog) ____ in only most severe cases; palivizumab( ___ \_\_\_) for ____ infants
* outbreaks occur in communities __ \_\_\_, usually lasting __ months during the\_\_\_ ____ and/or ___ months
We don’t think of these resp viruses very often causing pneumonia. Some of them do.
RSV can get into to lower resp tract and cause infants and young children
Treatment for children who are infected: For RSV, its ribavirin
Ribovirin also treat\_\_\_ and \_\_\_
It’s a nucleoside analogà get into NA and prevents its replication
Its given as a ___ in babies and you can give an immune globin in severe cases or premature infants
RSV Epidemiology
## Footnote
* the most common cause of severe lower respiratory tract disease among infants and young children worldwide
* can be devastating in hospital nurseries
* infects nearly everyone by age 2
* large-droplet aerosols; transmitted by hands, fomites, contact with respiratory secretions
* treatment with ribavirin (nucleoside analog) nebulization in only most severe cases; palivizumab (immune globulin) for premature infants
* outbreaks occur in communities each year, usually lasting 4-5 months during the fall, winter, and/or spring months
We don’t think of these resp viruses very often causing pneumonia. Some of them do.
RSV can get into to lower resp tract and cause infants and young children
Treatment for children who are infected: For RSV, its ribavirin
Ribovirin also treats Hep B and C
It’s a nucleoside analogà get into NA and prevents its replication
Its given as a nebulizer in babies and you can give an immune globin in severe cases or premature infants
27
Parainfluenza Virus Characteristics
## Footnote
* \_\_\_\_
* \_\_\_ serotypes cause human disease
* infects epithelial cells of ___ respiratory tract
* \_\_\_ __ \_\_\_ causes cell damage
* clinical diseases include\_\_\_ , ___ and \_\_\_
Not influenza virus
Croup: really bad cough
Parainfluenza Virus Characteristics
## Footnote
* paramyxovirus
* four serotypes cause human disease
* infects epithelial cells of upper respiratory tract
* cell-mediated immunity causes cell damage
* clinical diseases include colds, bronchitis, croup
Not influenza virus
Croup: really bad cough
28
Parainfluenza Virus Epidemiology
## Footnote
* transmitted by __ \_\_\_ and inhalation of __ \_\_ \_\_\_
* can cause outbreaks in ___ and pediatric units
* 90% to 100% of children aged 5 years and older have antibodies to HPIV-\_; about 75% have antibodies to HPIV-\_ and -\_.
Very rarely cause anything serious
Parainfluenza Virus Epidemiology
## Footnote
* transmitted by close contact and inhalation of large-droplet aerosols
* can cause outbreaks in nurseries and pediatric units
* 90% to 100% of children aged 5 years and older have antibodies to HPIV-3; about 75% have antibodies to HPIV-1 and -2.
Very rarely cause anything serious
29
Metapneumovirus
## Footnote
* undiscovered until 2001 because it grows ___ in ___ \_\_\_
* nearly ___ \_\_\_ has been infected by age 5
\_\_\_ in adults
* more ___ \_\_\_ ___ in kids
* severe \_\_
* \_\_\_\_
* \_\_\_
* new research suggests that this virus is ___ only to ___ as a cause of severe\_\_\_ respiratory infections in the young, occurring about ___ as often
Causes colds in adults and more severe infections in kids
Metapneumovirus
## Footnote
* undiscovered until 2001 because it grows poorly in cell cultures
* nearly every child has been infected by age 5
* colds in adults
* more severe respiratory infections in kids
* severe coughing
* wheezing
* congestion
* new research suggests that this virus is second only to RSV as a cause of severe lower respiratory infections in the young, occurring about 2/3 as often
Causes colds in adults and more severe infections in kids
30
Metapneumovirus Epidemiology
\_\_\_ to \_\_\_/ ___ \_\_\_ peak
Winter to spring/early summer peak
31
Characteristics of Influenza Viruses
## Footnote
•\_\_\_\_virus-\_\_\_, _ \_NA \_\_\_\_s;
\_\_\_ types--\_ _ \_; only _ & _ cause significant human disease
* two envelope \_\_\_\_s--\_\_\_ and \_\_\_
* cause one of the most prevalent and significant __ \_\_\_ \_\_\_
Like the rotavirus, it has a segmented genome
Segmented genome of this virus contributes to the fact that we have new emerging types of this virus very freq in the popl
If you look at what comprises the flu vaccine, it will give you an h number and an n number. This refers to the type of glycoproteins that the virus that is circulating has
Characteristics of Influenza Viruses
## Footnote
* orthomyxovirus-enveloped, 8 RNA segments; three types--A, B, & C; only A & B cause significant human disease
* two envelope glycoproteins--hemagglutinin and neuraminidase
* cause one of the most prevalent and significant viral infections worldwide
Like the rotavirus, it has a segmented genome
Segmented genome of this virus contributes to the fact that we have new emerging types of this virus very freq in the popl
If you look at what comprises the flu vaccine, it will give you an h number and an n number. This refers to the type of glycoproteins that the virus that is circulating has
32
Influenza A & B Disease Mechanisms
## Footnote
* infect\_\_\_ and ___ respiratory tract
* systemic symptoms due to ___ and \_\_\_\_; ___ and ___ important for ___ \_\_\_
* local symptoms due to ___ to __ \_\_
* predisposition to ___ super-infection
* loss of __ \_\_
* induction of __ \_\_\_ to epithelial cells
A and B cause human disease
Std flu is more of an ___ resp tract infection but that can develop into a more severe infection of the ___ resp tract
IF and lymphokines are important for resolution of the disease but they are also what makes you feel so crummy. Makes you feel \_\_\_, ___ etc
Local symptoms: __ \_\_, __ \_\_
People who have received IF for trt of viral diseases, feel like they have the flu
People with bad case of flu are predisposed to bacterial super-infection bc you have a loss of natural barriers in ___ resp tract and that can help bact adhere to the epithelial cells
Influenza A & B Disease Mechanisms
## Footnote
* infect upper and lower respiratory tract
* systemic symptoms due to interferon and lymphokines; CMI and interferon important for immune resolution
* local symptoms due to damage to respiratory epithelium
* predisposition to bacterial super-infection
* loss of natural barriers
* induction of bacterial adhesion to epithelial cells
A and B cause human disease
Std flu is more of an upper resp tract infection but that can develop into a more severe infection of the lower resp tract
IF and lymphokines are important for resolution of the disease but they are also what makes you feel so crummy. Makes you feel feverish, tired, etc
Local symptoms: runny nose, sore throat
People who have received IF for trt of viral diseases, feel like they have the flu
People with bad case of flu are predisposed to bacterial super-infection bc you have a loss of natural barriers in upper resp tract and that can help bact adhere to the epithelial cells
33
Diseases Caused by Influenza Virus
## Footnote
* acute influenza in adults
* rapid onset of\_\_\_
* \_\_\_
* \_\_\_
* \_\_ \_\_
* \_\_-\_\_\_ \_\_\_
* acute influenza in kids
* similar to adults but ___ fever
\_\_\_\_ symptoms
* \_\_\_ media
* \_\_\_
* \_\_\_
* complications
* primary viral \_\_\_
* secondary ___ pneumonia
* Strep. pneumoniae
* H. influenzae
* Staph. aureus
\_\_\_\_ and\_\_\_ involvement
\_\_\_ syndromes
•\_\_\_-\_\_\_ syndrome
\_\_\_
\_\_\_\_'s syndrome
Myalgia: muscles ache
Otitis Media: ear problems due to build up of fluid is upper resp tract and sinuses
Myositis: muscle aches
Complications if virus reaches lower resp tract
primary viral pneumonia would be unusual in someone with competent immune sys
Guillain-Barre syndrome and Reye’s syndrome are why you are advised to give kids Tylenol and never Asprin
Diseases Caused by Influenza Virus
## Footnote
* acute influenza in adults
* rapid onset of fever
* malaise
* myalgia
* sore throat
* non-productive cough
* acute influenza in kids
* similar to adults but higher fever
* gastrointestinal symptoms
* otitis media
* myositis
* croup
•
* complications
* primary viral pneumonia
* secondary bacterial pneumonia
* Strep. pneumoniae
* H. influenzae
* Staph. aureus
* myositis and cardiac involvement
* neurological syndromes
* Guillain-Barre syndrome
* encephalitis
* Reye’s syndrome
Myalgia: muscles ache
Otitis Media: ear problems due to build up of fluid is upper resp tract and sinuses
Myositis: muscle aches
Complications if virus reaches lower resp tract
primary viral pneumonia would be unusual in someone with competent immune sys
Guillain-Barre syndrome and Reye’s syndrome are why you are advised to give kids Tylenol and never Asprin
34
Influenza Virus Epidemiology
## Footnote
* infects __ \_\_\_e species
* segmented genome facilitates major __ \_\_\_s by genetic ____ (type _ only); antigenic \_\_\_
* 3 known subtypes of human flu currently circulating
* \_\_\_ ___ \_\_\_ (H\_ not around since 1968)
* minor genetic changes by ____ of __ and \_\_; antigenic \_\_\_
* spread by inhalation of __ \_\_\_ \_\_\_
* transmission precedes \_\_\_\_
* prefers \_\_, __ \_\_\_ atmosphere (i.e. \_\_\_)
•
•
Antigenic drift: when flu centers try to determine contents of flu vaccine this year, they look at antigenic drifts to see if any types of mutations have occurred
Spread by resp route
Get infected before get symptoms. Asymptomatic Spread
Virus prefers cool, less humid atmosphere to cause infection (i.e. So flu season is in the winter)
Influenza Virus Epidemiology
## Footnote
* infects many vertebrate species
* segmented genome facilitates major genetic changes by genetic reassortment (type A only); antigenic shift
* 3 known subtypes of human flu currently circulating
* H1N1, H1N2, H3N2 (H2 not around since 1968)
* minor genetic changes by mutation of HA and NA; antigenic drift
* spread by inhalation of small aerosol droplets
* transmission precedes symptoms
* prefers cool, less humid atmosphere (i.e. winter)
•
•
Antigenic drift: when flu centers try to determine contents of flu vaccine this year, they look at antigenic drifts to see if any types of mutations have occurred
Spread by resp route
Get infected before get symptoms. Asymptomatic Spread
Virus prefers cool, less humid atmosphere to cause infection (i.e. So flu season is in the winter)
35
Antigenic Shift and Antigenic Drift
Shift:
Swine flu and human flu virus can both infect a single host.
8 segments of RNA replicating
Many types of RNA replicating in one cell
Some of the virus that comes out of that animal will be the original inputs (swine flu and human flu).
Some of them will be a new virus as a result of intermixing of genomic segments.
Get 3 viruses that come out. Original 2 plus intermixing of genomic segments.
That’s how new viruses emerge.
Drift: Responsible for the shifts we see every year
one virus infects the cell. Mutation occurs. New virus may come out. Old virus also comes out.
Smaller changes. Not substitution of an entire gene.
Antigenic Shift and Antigenic Drift
Shift:
Swine flu and human flu virus can both infect a single host.
8 segments of RNA replicating
Many types of RNA replicating in one cell
Some of the virus that comes out of that animal will be the original inputs (swine flu and human flu).
Some of them will be a new virus as a result of intermixing of genomic segments.
Get 3 viruses that come out. Original 2 plus intermixing of genomic segments.
That’s how new viruses emerge.
Drift: Responsible for the shifts we see every year
one virus infects the cell. Mutation occurs. New virus may come out. Old virus also comes out.
Smaller changes. Not substitution of an entire gene.
36
Influenza Pandemics
## Footnote
* 1918-1919; H1N1—\_\_\_ flu
* 20-40% of worldwide population got sick
* 50,000,000 died; 675,000 in U.S.
* 1957-1958; H2N2—\_\_\_\_ flu
* not as devastating as 1918
* 70,000 died in U.S.
* 1968-1969; H3N2—\_\_ __ flu
* 2009-2010; H1N1—\_\_\_ flu
* 40,000,000-80,000,000 infected
* 8,800-18,000 deaths
•
•
•
* 1918-1919; H1N1—Spanish flu
* 20-40% of worldwide population got sick
* 50,000,000 died; 675,000 in U.S.
* 1957-1958; H2N2—Asian flu
* not as devastating as 1918
* 70,000 died in U.S.
* 1968-1969; H3N2—Hong Kong flu
* 2009-2010; H1N1—swine flu
* 40,000,000-80,000,000 infected
* 8,800-18,000 deaths
•
•
•
37
New Flu Viruses
## Footnote
* H5N1 bird flu—2003
* highly pathogenic in domestic poultry
* 600 human cases; 60% mortality
* \_\_ ___ \_\_\_ among \_\_\_
* small outbreak in 2011
* many widespread infections in poultry in Far East
* H7N9 bird flu—2013
* no sustained spread among people
•
Bird flu: millions of chickens had to be slaughtered bc of this.
Don’t cause sig mortality in people bc cells of the ___ \_\_\_ don’t have right ____ for these viruses
New Flu Viruses
## Footnote
* H5N1 bird flu—2003
* highly pathogenic in domestic poultry
* 600 human cases; 60% mortality
* no sustained spread among people
* small outbreak in 2011
* many widespread infections in poultry in Far East
* H7N9 bird flu—2013
* no sustained spread among people
•
Bird flu: millions of chickens had to be slaughtered bc of this.
Don’t cause sig mortality in people bc cells of the resp tract don’t have right receptors for these viruses
38
Influenza Treatment
## Footnote
* \_\_\_\_\_ and ____ block ____ by targeting ___ protein of influenza \_\_\_
* zanamivir (\_\_\_) and oseltamivir (\_\_\_) inhibit ___ of influenza __ and \_\_\_
* \_\_\_\_ therapy
NA is what helps the virus ____ from the cell once it has replicated
Problem with drugs is that you need to get them before you get sick in order for them to shorten course of infection
Can’t give these drugs prophylactically
Influenza Treatment
## Footnote
* amantadine and rimantadine block uncoating by targeting M2 protein of influenza A
* zanamivir (Relenza) and oseltamivir (Tamiflu) inhibit NA of influenza A and B
* supportive therapy
NA is what helps the virus escape from the cell once it has replicated
Problem with drugs is that you need to get them before you get sick in order for them to shorten course of infection
Can’t give these drugs prophylactically
39
Influenza Prevention and Control
## Footnote
* prevention
* \_\_\_\_\_
* 2015-16 vaccine; mixture of ___ and ___ strains
* control
* airborne spread almost ___ to \_\_\_•
Influenza Prevention and Control
## Footnote
* prevention
* immunization
* 2015-16 vaccine; mixture of H1N1 and H3N2 strains
* control
* airborne spread almost impossible to limit
•
40
Enterovirus D68
## Footnote
* one of more than 100 __ \_\_\_ enteroviruses
* first identified in CA in 1962
* from mid-August 2014 to 1/15/15—1153 people in 49 states and D.C. confirmed to have EV-68
* mild to severe ___ illness mostly in \_\_\_, __ and \_\_\_
* \_\_\_ is risk factor for severe disease
This popped up last year in mid august
There were some reports that some of the infected kids had some paralysis as a result of the infection. Never proved that it was caused by E D68
Enterovirus D68
## Footnote
* one of more than 100 non-polio enteroviruses
* first identified in CA in 1962
* from mid-August 2014 to 1/15/15—1153 people in 49 states and D.C. confirmed to have EV-68
* mild to severe respiratory illness mostly in infants, children and teens
* asthma is risk factor for severe disease
This popped up last year in mid august
There were some reports that some of the infected kids had some paralysis as a result of the infection. Never proved that it was caused by E D68
41
Measles Virus Characteristics
## Footnote
* \_\_\_\_\_virus
* causes one of the\_\_\_ classic childhood rashes
* only \_\_\_serotype
\_\_\_ only host
* infects ___ cells of the ___ tract
* highly \_\_\_s; ___ symptoms
* \_\_\_ immunity
* declared ___ in \_\_\_
Only one serotype so Once you’ve had infection you are immune to it Or get vaccine with boosters
Can spread virus before get symptoms
Declared eliminated but its not
Measles Virus Characteristics
## Footnote
* paramyxovirus
* causes one of the 5 classic childhood rashes
* only one serotype
* humans only host
* infects epithelial cells of the respiratory tract
* highly contagious; precedes symptoms
* lifelong immunity
* declared eliminated in 2000
Only one serotype so Once you’ve had infection you are immune to it Or get vaccine with boosters
Can spread virus before get symptoms
Declared eliminated but its not
42
Measles Pathogenesis\
## Footnote
It gets into the resp tract where it replicates locally.
Spreads thru the\_\_\_ and causes a \_\_\_
From the blood it gets into the\_\_\_, ___ tract, ___ tract,small __ \_\_s, ___ system, \_\_
You get virus infected ____ cells
Virus tries to fight off the virus infected cells and because of that you get\_\_ and ___ of measals
Most common is a ___ which most people recover from and have life long immunity.
However rarely you can get post-infectious ___ due to the __ \_\_
You can get ___ due to \_\_\_e measels virus infecting the \_\_\_. If Virus gets into CNS and can’t replicate. Just stays in those cells and causes damage
Very rarely in person with ____ immune sys, if they get measels infection, it can be ___ bc virus is not controlled by CMI response.
Measles Pathogenesis\
## Footnote
It gets into the resp tract where it replicates locally.
Spreads thru the lymphatics and causes a viremia
From the blood it gets into the conjunctiva, respiratory tract, urinary tract,small blood vessels, lymphatic system, CNS
You get virus infected endothelial cellsc
Virus tries to fight off the virus infected cells and because of that you get signs and symptoms of measals
Most common is a rash which most people recover from and have life long immunity.
However rarely you can get post-infectious encephalitis due to the immune response
You can get SSP due to defective measels virus infecting the CNS. If Virus gets into CNS and can’t replicate. Just stays in those cells and causes damage
Very rarely in person with defective immune sys, if they get measels infection, it can be fatal bc virus is not controlled by CMI response.
43
Measles Signs & Symptoms
## Footnote
* maculopapular rash
* \_\_\_\_spots
* \_\_\_
* \_\_\_
* \_\_\_
* \_\_\_
* complications
* otitis media
* \_\_\_
* broncho\_\_\_
\_\_\_\_
Rash occurs all over the body
Oral sign called Koplik’s spots. These spots generally occur 24 hours before the rash
If you see spots, within 24 hours will see the rash
Can get into the eyes and cause photophobia
Rhinitis: runny nose
Self limiting
Measles Signs & Symptoms
## Footnote
* maculopapular rash
* Koplik’s spots
* cough
* conjunctivitis
* photophobia
* rhinitis
* complications
* otitis media
* croup
* bronchopneumonia
* encephalitis
Rash occurs all over the body
Oral sign called Koplik’s spots. These spots generally occur 24 hours before the rash
If you see spots, within 24 hours will see the rash
Can get into the eyes and cause photophobia
Rhinitis: runny nose
Self limiting
44
\_\_\_—greatest number of cases since measles elimination documented in 2000
2014 outbreak originated in \_\_\_
2014—greatest number of cases since measles elimination documented in 2000
2014 outbreak originated in Disneyland
45
Mumps Virus Characteristics
## Footnote
* \_\_\_virus
* only \_\_\_serotype
* \_\_\_ only host
* infects ___ cells of \_\_\_y tract
* can be \_\_\_
* spreads by \_\_\_
* infect ___ \_\_, \_\_\_, ___ (10% symptoms)
* inflammation causes ___ of glands
* without immunization, 90% infected by age 15
* \_\_\_ immunity
A lot like measels but has different target tissues
Huge swelling of parotid glands
Before immunizations, most people have measels and mumps by the time they were teens
Can be bilateral or unilateral
Hurts pretty bad
Mumps Virus Characteristics
## Footnote
* paramyxovirus
* only one serotype
* humans only host
* infects epithelial cells of respiratory tract
* can be subclinical
* spreads by viremia
* infects parotid gland, testes, CNS (10% symptoms)
* inflammation causes swelling of glands
* without immunization, 90% infected by age 15
* lifelong immunity
A lot like measels but has different target tissues
Huge swelling of parotid glands
Before immunizations, most people have measels and mumps by the time they were teens
Can be bilateral or unilateral
Hurts pretty bad
46
Mumps Pathogenesis
## Footnote
There has been a lot of work to see if mumps infection somehow contributes to onset of\_\_\_ \_\_\_
There seems to be a correlation. But we think its more a genetic disorder. But maybe mumps in a kid that is predisposed to the disease can kick off the disease
There has been a lot of work to see if mumps infection somehow contributes to onset of juvenile diabetes?
There seems to be a correlation. But we think its more a genetic disorder. But maybe mumps in a kid that is predisposed to the disease can kick off the disease
47
Mumps Epidemiology
## Footnote
* 2006—6,585 cases reported predominantly in college students living in dorms at midwestern schools
* 2009—another large outbreak; index case returned from UK where an ongoing outbreak involved 4,000 cases; 1,521 cases reported in NY and NJ
* 2014—outbreaks in 4 U.S. universities
•
* 2006—6,585 cases reported predominantly in college students living in dorms at midwestern schools
* 2009—another large outbreak; index case returned from UK where an ongoing outbreak involved 4,000 cases; 1,521 cases reported in NY and NJ
* 2014—outbreaks in 4 U.S. universities
•
48
Rubella Virus Characteristics
## Footnote
* \_\_\_virus-\_\_\_\_, \_\_NA
* common name is __ \_\_
* \_\_\_disease
* \_\_\_ transmission
* only ___ serotype
\_\_\_\_ only known host
\_\_\_ immunity
•problem in \_\_\_\_- ___ trimester; virus can cross \_\_\_a in __ \_\_\_women
common name is German measles or __ \_\_ \_\_\_
More __ \_\_\_ than is rubeolla which is red measles (what we just talked about)
Now this is really only a problem in pregnant women who are not immune to the virus. Can cause congenital rubella syndrome
Rubella Virus Characteristics
## Footnote
* togavirus-enveloped, RNA
* common name is German measles
* mild disease
* respiratory transmission
* only one serotype
* humans only known host
* lifelong immunity
* problem in pregnancy-1st trimester; virus can cross placenta in non-immune women
common name is German measles or 3 day measles
More self limited than is rubeolla which is red measles (what we just talked about)
Now this is really only a problem in pregnant women who are not immune to the virus. Can cause congenital rubella syndrome
49
Rubella Virus Diseases
## Footnote
* children--\_\_ day rash and __ \_\_\_
* adults--\_\_ and \_\_\_pain also; post-infectious \_\_\_\_s
* \_\_\_ ___ \_\_\_
\_\_\_\_s; other ocular defects
\_\_\_ defects
\_\_\_
•intrauterine __ \_\_\_
\_\_\_\_
•oral manifestation—\_\_\_\_s spots
Children: Swollen parotid glands
In CRS: eyes can be affected, heart, deafness, and very small birth weight.
Kid with rubella Looks like measels on the palate.
These are called Forchheimer spots
Rubella Virus Diseases
## Footnote
* children--3-day rash and swollen glands
* adults--bone and joint pain also; post-infectious encephalitis
* congenital rubella syndrome
* cataracts; other ocular defects
* heart defects
* deafness
* intrauterine growth retardation
* microcephaly
* oral manifestation—Forchheimer’s spots
Children: Swollen parotid glands
In CRS: eyes can be affected, heart, deafness, and very small birth weight.
Kid with rubella Looks like measels on the palate.
These are called Forchheimer spots
50
Parvovirus B19
## Footnote
* parvovirus-very \_\_, \_\_\_, \_\_\_, \_NA
* onl\_\_\_ serotype
* replicates in ___ \_\_\_ cells
* causes one of the five childhood\_\_\_ -\_\_\_disease
* spread by ___ and __ \_\_\_
* causes ___ and can __ \_\_
We immunize our pets against Parvo but there is a type that infects humans
Causes 5th disease
Causes rash and causes __ \_\_\_ appearance where cheeks are red
In adults and kids, there is biphasic disease where you have the initial signs of a ___ \_\_\_ feeling. And there is a post infectious (or immune) phase where this ___ occurs due to the __ \_\_\_ to the virus
Parvovirus B19
## Footnote
* parvovirus-very small, naked, icosahedral, DNA
* only one serotype
* replicates in mitotically active cells
* causes one of the five childhood rashes—Fifth disease
* spread by respiratory and oral secretions
* causes viremia and can cross placenta
We immunize our pets against Parvo but there is a type that infects humans
Causes 5th disease
Causes rash and causes Slapped cheek appearance where cheeks are red
In adults and kids, there is biphasic disease where you have the initial signs of a flu like feeling. And there is a post infectious (or immune) phase where this rash occurs due to the immune response to the virus
51
Erythema Infectiosum—Fifth Disease
## Footnote
* \_\_\_\_ disease
* l\_\_\_\_c, ___ phase--\_\_\_-like symptoms
* \_\_ \_\_\_, ___ phase
* \_\_\_
* \_\_\_
Non infectious phase has arthritic pain in joints for adults
One of the bad childhood diseases bc it persists so long
You often don’t know that you have it until you get the immune response
It’s a Problem in people with blood diseases or kids with sickle cell disease where their red blood cells are rapidly dividing bc virus infects those cells so it can cause ___ \_\_\_ in people with blood disorders
Erythema Infectiosum—Fifth Disease
## Footnote
* biphasic disease
* lytic, infectious phase--flu-like symptoms
* non-infectious, immunological phase
* rash
* arthralgia
Non infectious phase has arthritic pain in joints for adults
One of the bad childhood diseases bc it persists so long
You often don’t know that you have it until you get the immune response
It’s a Problem in people with blood diseases or kids with sickle cell disease where their red blood cells are rapidly dividing bc virus infects those cells so it can cause severe anemia in people with blood disorders
52
Definition of Emerging Viruses
## Footnote
* a class of viruses that has ___ infected humans or animals but now has the \_\_\_\_y to attain ___ proportions due to human encroachment on __ \_\_\_s, increased ___ \_\_, ____ populations in less developed countries, and, possibly, \_\_\_
* usually associated with one or more __ \_\_ or \_\_\_
* humans are often ___ \_\_\_
* \_\_\_ to ___ transmission can result in __ \_\_ \_\_
Have been around for a long time but all of the sudden bc of human activity they have the opportunity to infect a larger popl
More and more people get infected and virus can mutate
usually associated with one or more nonhuman host or vectorà can be an insect or monkey
Once a human becomes infected you can get person to person transmisiion
Definition of Emerging Viruses
## Footnote
* a class of viruses that has long infected humans or animals but now has the opportunity to attain epidemic proportions due to human encroachment on tropical rainforests, increased international travel, burgeoning populations in less developed countries, and, possibly, mutation
* usually associated with one or more nonhuman host or vector
* humans are often accidental hosts
* person-to-person transmission can result in large human outbreaks
Have been around for a long time but all of the sudden bc of human activity they have the opportunity to infect a larger popl
More and more people get infected and virus can mutate
usually associated with one or more nonhuman host or vectorà can be an insect or monkey
Once a human becomes infected you can get person to person transmisiion
53
West Nile Virus
## Footnote
* before \_\_\_, WNV never reported in the U.S.
* 62 cases in New York
* 7 deaths
* common in \_\_\_, western\_\_\_ and the\_\_ \_\_
* transmitted to humans via \_\_\_
Airplane came back with these mosquitos in the cargo hold and it started to spread and now it is in every state in the US
West Nile Virus
## Footnote
* before 1999, WNV never reported in the U.S.
* 62 cases in New York
* 7 deaths
* common in Africa, western Asia, and the Middle East
* transmitted to humans via mosquitoes
Airplane came back with these mosquitos in the cargo hold and it started to spread and now it is in every state in the US
54
Reservoir Host is \_\_\_s. Birds transmit to ___ and mosquitos can give it\_\_\_ to birds
Then you have accidental hosts which are __ and \_\_\_
Reservoir Host is birds. Birds transmit to mosquitos and mosquitos can give it back to birds
Then you have accidental hosts which are people and animals
55
Almost every state has had WN infections this year
Some just have\_\_ ___ WNV activty
Almost every state has had WN infections this year
Some just have non human WNV activty
56
West Nile Activity in Texas--2015
## Footnote
Not a __ \_\_ for WNV
They \_\_\_mosquitos and test to see if they are __ \_\_\_
Not a bad year for WNV
They entrap mosquitos and test to see if they are spreading WNV
57
West Nile Infection
## Footnote
* \_\_- \_\_\_% of infected people do not develop\_\_ \_\_
* 20% develop \_\_\_, ___ \_\_ aches, ___ pain, \_\_\_g, \_\_\_ea,\_\_\_
* most recover\_\_\_y, but fatigue and weakness can persist for \_\_\_
* 1% develop e\_\_\_ or \_\_\_; \_\_% will die
70-80% of infected people do not develop any symptoms
Know that they have it bc they go to donate blood and have Ab to WNV
West Nile Infection
## Footnote
* 70-80% of infected people do not develop any symptoms
* 20% develop fever, headache, body aches, joint pain, vomiting, diarrhea, rash
* most recover completely, but fatigue and weakness can persist for months
* 1% develop encephalitis or meningitis; 10% will die
70-80% of infected people do not develop any symptoms
Know that they have it bc they go to donate blood and have Ab to WNV
58
Hantaviruses
## Footnote
* \_\_\_-borne; __ \_\_\_vector
* \_\_ ____ diseases
**•**\_\_\_ \_\_\_r with r\_\_ ___ (not found in U.S.)
•\_\_\_ ____ \_\_\_e (HPS)
Mosquito was arthopod vector in west nile
HPS is the disease that has been seen in the US
Hantaviruses
## Footnote
* rodent-borne; no arthropod vector
* two acute diseases
* hemorrhagic fever with renal syndrome (not found in U.S.)
* hantavirus pulmonary syndrome (HPS)
Mosquito was arthopod vector in west nile
HPS is the disease that has been seen in the US
59
Hantavirus Pulmonary Syndrome
## Footnote
* first recognized in the __ \_\_\_area of __ \_\_\_ in 1993 due to unexplained deaths among __ \_\_\_
* \_\_\_ nfestation is the primary risk for exposure
* severe ___ disease with \_\_\_% mortality
•
This disease persists in this area today
Hantavirus Pulmonary Syndrome
## Footnote
* first recognized in the Four Corners area of New Mexico in 1993 due to unexplained deaths among Navajo Indians
* rodent infestation is the primary risk for exposure
* severe respiratory disease with 38% mortality
•
This disease persists in this area today
60
These are cases per state
Still largest numbers in area where it was ___ \_\_\_
Not a __ \_\_r of cases
These are cases per state
Still largest numbers in area where it was first discovered.
Not a huge number of cases
61
Dengue Virus
## Footnote
* dengue fever ranked by WHO as the\_\_ ___ \_\_\_ ___ viral disease in the world
* 30-fold increase in global incidence in last 50 years
* 40% of the world’s population live in areas where there is a risk for dengue transmission
* 50-100 million infections/yr
Most important bc it causes a __ \_\_
Increase due to our __ \_\_
* dengue fever ranked by WHO as the most important mosquito-borne viral disease in the world
* 30-fold increase in global incidence in last 50 years
* 40% of the world’s population live in areas where there is a risk for dengue transmission
* 50-100 million infections/yr
Most important bc it causes a nasty disease
Increase due to our travel patterns
62
Dengue Virus Transmission
## Footnote
Transmited by aedes aegympti \_\_\_
Mosquito bites dengue __ \_\_\_
When Mosquitos bite us, they \_\_t our blood.
D virus will replicate in __ \_\_ of the \_\_\_
Mosquito will bit another person and about ___ days later that person will get __ \_\_
\_\_\_\_ type of transmission
Not ___ to ___ transmission. Need the mosquito
Transmited by aedes aegympti mosquito
Mosquito bites dengue infected person
When Mosquitos bite us, they injest our blood.
D virus will replicate in salivary glands of the mosquito
Mosquito will bit another person and about 4-13 days later that person will get D infection
Circular type of transmission
Not human to human transmission. Need the mosquito
63
Disease Mechanisms of Dengue Virus
## Footnote
* \_ serotypes of dengue
* infection with one type __ \_\_ ___ against other types
* first infection is usually \_\_\_--\> ___ \_\_\_
* sequential infections increase risk for __ \_\_ ___ and __ \_\_ \_\_
dengue hemorrhagic fever and dengue shock syndrome
These are \_\_\_
Disease Mechanisms of Dengue Virus
## Footnote
* 4 serotypes of dengue
* infection with one type does not protect against other types
* first infection is usually mild—dengue fever
* sequential infections increase risk for dengue hemorrhagic fever and dengue shock syndrome
dengue hemorrhagic fever and dengue shock syndrome
These are fatal
64
DHF and DSS
## Footnote
You get D infection and you make antibodies against __ \_\_\_
You get reinfected
First infection predisposes you to having a __ \_\_ with __ \_\_\_
You get the problems ass with shock and you get reduced number of platelets, problems with coagulation, disseminated intravascular coagulation and severe bleeding. That can lead to death.
DHF and DSS
## Footnote
You get D infection and you make antibodies against that serotype
You get reinfected
First infection predisposes you to having a worse infection with second serotype
You get the problems ass with shock and you get reduced number of platelets, problems with coagulation, disseminated intravascular coagulation and severe bleeding. That can lead to death.
65
Global Dengue
## Footnote
\_\_\_ risk in US But present in our ___ with \_\_\_
Global Dengue
## Footnote
Low risk in US But present in our border with Mexico
66
Chikungunya Virus
## Footnote
* transmitted by Aedes ____ (same as those that transmit dengue)
* often occurs as ___ \_\_\_ with high ___ rates
* symptoms
\_\_\_ and __ \_\_\_
* join ___ and \_\_\_
* rarely ___ but symptoms can be\_\_\_ and \_\_\_
All the mosquito borne illnesses have pretty much the same symptoms
Chikungunya Virus
## Footnote
* transmitted by Aedes mosquitoes (same as those that transmit dengue)
* often occurs as large outbreaks with high attack rates
* symptoms
* fever and joint pain
* join swelling and rash
* rarely fatal but symptoms can be severe and disabling
All the mosquito borne illnesses have pretty much the same symptoms
67
Chikungunya Virus Cases as of 3/10/15
We have\_\_\_\_ in US
68
Ebola Virus
## Footnote
* \_\_\_ strains; ___ cause human disease
* discovered in 1976 near the Ebola River in Democratic Republic of the\_\_\_
* natural reservoir is most likely \_\_\_; also infects other animals in\_\_\_\_
* spreads human to human via contact with \_\_\_, \_\_\_s, \_\_\_s, and ___ \_\_, etc.
* average fatality rate is around \_\_\_%
Can spread from these reservoirs to humans by __ \_\_\_ with vector
Ebola Virus
## Footnote
* five strains; four cause human disease
* discovered in 1976 near the Ebola River in Democratic Republic of the Congo
* natural reservoir is most likely bats; also infects other animals in rainforest
* spreads human to human via contact with blood, secretions, organs, and contaminated bedding, etc.
* average fatality rate is around 50%
Can spread from these reservoirs to humans by close contact with vector
69
2014 Ebola Outbreak
## Footnote
\_\_\_\_ in history and ___ Ebola ____ in the world
2014 Ebola Outbreak
## Footnote
•largest in history and first Ebola epidemic in the world
70
Ebola Virus Disease
## Footnote
* fever \> \_\_\_°F
* severe \_\_\_
* \_\_\_ pain
* \_\_\_
* diarrhea
* vomiting
\_\_\_ or \_\_\_
•\_\_\_ studies are very promising
Ebola Virus Disease
## Footnote
* fever \> 101.5°F
* severe headache
* muscle pain
* weakness
* diarrhea
* vomiting
* bleeding or bruising
* vaccine studies are very promising
