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The New England journal of medicine2013; 369(8); 732-744; doi: 10.1056/NEJMoa1212628

Eastern equine encephalitis in Latin America.

Abstract: 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. (Funded by the National Institutes of Health and the Secretaría Nacional de Ciencia, Tecnología e Innovación, Panama.).
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Publication Date: 2013-08-24 PubMed ID: 23964935PubMed Central: PMC3839813DOI: 10.1056/NEJMoa1212628Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research examines cases of Eastern Equine Encephalitis (EEE) and Venezuelan Equine Encephalitis (VEE) in Latin America, specifically in Panama during a 2010 outbreak, offering an understanding of how humans and horses are affected by these viruses, and conclusions about their origin and transmission.

Study Methodology

  • The study utilized different diagnostic tools to verify EEE and VEE outbreaks amongst hospitalized patients in Panama between May and August 2010.
  • Serum samples from these patients were subjected to antibody assays and tests to detect viral RNA, with the aim to isolate the viruses.
  • The researchers extended their methods to identify additional cases through enhanced surveillance.

Study Findings

  • Out of 19 hospitalized patients for encephalitis, 7 were confirmed to have EEE, 3 had VEE, and 1 was infected with both viruses.
  • Three patients died and one among them was confirmed to have VEE. The patients with EEE exhibited symptoms such as brain lesions, seizures leading to status epilepticus, and neurologic sequelae.
  • Using active surveillance, they detected 99 suspected or probable cases of alphavirus infection.
  • A total of 13 cases were confirmed as EEE, and 11 cases of VEE with 1 case of dual infection.
  • 50 horse cases were confirmed to have EEE and 8 had VEE. Mixed etiologic factors were associated with 11 horse cases.
  • Through phylogenetic analyses of isolated viruses, it was found that the viruses were enzootic lineages already identified in Panama and not newly introduced.

Conclusion

  • The researchers concluded that human EEE cases in Latin America could be due to ecological changes that increased human contact with enzootic transmission cycles.
  • Genetic changes in EEE viral strains that resulted in increased human virulence, or a change in the host range, could also be reasons.

Financing for the research was provided by the National Institutes of Health and the Secretaría Nacional de Ciencia, Tecnología e Innovación, Panama. This suggests that the findings have been positively reviewed and validated by scientists globally.

Cite This Article

APA
Carrera JP, Forrester N, Wang E, Vittor AY, Haddow AD, López-Vergès S, Abadía I, Castaño E, Sosa N, Báez C, Estripeaut D, Díaz Y, Beltrán D, Cisneros J, Cedeño HG, Travassos da Rosa AP, Hernandez H, Martínez-Torres AO, Tesh RB, Weaver SC. (2013). Eastern equine encephalitis in Latin America. N Engl J Med, 369(8), 732-744. https://doi.org/10.1056/NEJMoa1212628

Publication

The New England journal of medicine
ISSN: 1533-4406
NlmUniqueID: 0255562
Country: United States
Language: English
Volume: 369
Issue: 8
Pages: 732-744

Researcher Affiliations

Carrera, Jean-Paul
  • Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama.
Forrester, Naomi
    Wang, Eryu
      Vittor, Amy Y
        Haddow, Andrew D
          López-Vergès, Sandra
            Abadía, Ivan
              Castaño, Elizabeth
                Sosa, Nestor
                  Báez, Carmen
                    Estripeaut, Dora
                      Díaz, Yamilka
                        Beltrán, Davis
                          Cisneros, Julio
                            Cedeño, Hector G
                              Travassos da Rosa, Amelia P
                                Hernandez, Humberto
                                  Martínez-Torres, Alex O
                                    Tesh, Robert B
                                      Weaver, Scott C

                                        MeSH Terms

                                        • Adolescent
                                        • Animals
                                        • Antibodies, Viral / blood
                                        • Child
                                        • Child, Preschool
                                        • Disease Outbreaks
                                        • Encephalitis Virus, Eastern Equine / genetics
                                        • Encephalitis Virus, Eastern Equine / immunology
                                        • Encephalitis Virus, Eastern Equine / isolation & purification
                                        • Encephalitis Virus, Venezuelan Equine / genetics
                                        • Encephalitis Virus, Venezuelan Equine / immunology
                                        • Encephalitis Virus, Venezuelan Equine / isolation & purification
                                        • Encephalomyelitis, Eastern Equine / epidemiology
                                        • Encephalomyelitis, Eastern Equine / veterinary
                                        • Encephalomyelitis, Venezuelan Equine / epidemiology
                                        • Encephalomyelitis, Venezuelan Equine / veterinary
                                        • Fatal Outcome
                                        • Female
                                        • Horse Diseases / epidemiology
                                        • Horses
                                        • Humans
                                        • Infant
                                        • Male
                                        • Panama / epidemiology
                                        • Phylogeny
                                        • RNA, Viral / blood

                                        Grant Funding

                                        • U54 AI057156 / NIAID NIH HHS
                                        • HHSN272201000040I / NIAID NIH HHS
                                        • HHSN27200004/DO4 / PHS HHS
                                        • HHSN27220100004OI / PHS HHS
                                        • U54-AI057156 / NIAID NIH HHS
                                        • HHSN272201000040C / NIAID NIH HHS

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