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Biological Health Hazard – Emerging Tick-borne Diseases, Heartland virus (HRTV): USA

2016/12/12

HEARTLAND VIRUS – USA: RESEARCH
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Date: Thursday, 8 December 2016
Source: Contagion Live [edited]

Although Lyme disease gets the lion’s share of headlines when it comes to tick-borne illnesses, a more recently discovered disease has scientists digging for further information. The phlebovirus [_Bunyaviridae_], known widely as Heartland virus (HRTV), was first identified in 2 people in Missouri in 2009. Since then, HRTV has yielded 5 new cases in that state along with one additional case in Tennessee. Now, scientists from the Centers for Disease Control and Prevention (CDC), the US Department of Agriculture, and Colorado State University are studying whether animals play a role in HRTV’s transmission to humans. Besides fever, fatigue, headache, nausea, and muscle pain, HRTV is noteworthy in that it causes leukopenia (low white blood cell count), thrombocytopenia (low platelet count), and modestly elevated liver enzymes. Most of the patients who contract HRTV have been hospitalized, and one, who had pre-existing health conditions, died. In 5 of the 6 newer cases, the patients were known to have been bitten by a tick before the onset of illness.

The scientists had reason to suspect that vertebrates living in close proximity to humans could be susceptible to HRTV themselves, and act as a conduit for the virus to travel from ticks to humans. “The purpose of this study was to determine the capability of different vertebrate hosts to develop virus levels in their blood that would allow ticks to become infected when they feed on these hosts,” said Aaron C Brault, PhD, a research microbiologist at the CDC’s Division of Vector-Borne Diseases and an author of the study. Dr Brault noted that raccoons found near the home of one of the HRTV patients were “quite heavily” infested with lone star ticks [_Amblyomma americanum_], which also prey on deer. If a tick bit one of these raccoons or deer and became infected, it might then go on to bite a human and cause an HRTV infection.

Taking a blood sample from an infected human, the scientists inoculated a number of mice, chickens, hamsters, goats, rabbits, and raccoons with the HRTV virus. None of these animals went on to show any detectable level of virus in their blood, with the exception of mice that had been bred to lack interferon receptors, producing an altered immune response.

Although the animals in this experiment did not display elevated levels of HRTV in their blood after inoculation, the researchers know there is more work to be done when it comes to the potential role of wild animals in human HRTV infection. “A number of factors really need to be answered to fully assess the potential health risk of HRTV for humans,” said Dr Brault. “Principally, what is the clinical disease rate in exposed humans (healthy versus individuals with comorbidities) and what is the exposure rate of people? These will likely have to be addressed by serosurveys.”

So far, all 8 of the patients diagnosed with HRTV disease in the United States have been white men over the age of 50, and all became symptomatic between May and October. Due to their leukopenia and thrombocytopenia, along with somewhat elevated liver enzymes, clinicians first assumed the patients had ehrlichiosis, another tick-borne illness. When the men did not improve after being given courses of doxycycline, doctors had to look for a different explanation. There is no routine test available for HRTV and no medications that can treat it; most patients have fully recovered as a result of supportive care.

[Byline: Laurie Saloman]

Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[The study mentioned in the report above is:
Bosco-Lauth AM, Calvert AE, Root JJ, et al: Vertebrate host susceptibility to Heartland virus. Emerg Infect Dis. 2016; 22(12): 2070-7. doi: 10.3201/eid2212.160472; https://wwwnc.cdc.gov/eid/article/22/12/16-0472_article]

Raccoons, goats, chickens, rabbits, hamsters, C57BL/6 mice, and interferon-α/β/γ receptor-deficient [Ag129]) mice were inoculated with this virus. All animals showed immune responses against HRTV after primary or secondary exposure. However, neutralizing antibody responses were limited. Only Ag129 mice showed detectable viremia and associated illness and death, which were dose dependent. Ag129 mice also showed development of mean peak viral antibody titers greater than 8 log10 PFU (plaque-forming unit)/mL, hemorrhagic hepatic lesions, splenomegaly, and large amounts of HRTV antigen in mononuclear cells and hematopoietic cells in the spleen.

In another study, serum of 1428 animals was tested and 103 were seropositive, including 55 deer, 33 raccoons, 11 coyotes, and 4 moose. This does not prove that these species are capable of infecting ticks, but it does indicate that there was enough virus replication to elicit an antibody response. Experimental inoculation of these species with ticks feeding on them would suggest that they may or may not serve as sources of infectious blood meals. Experiments with moose would be a challenge.

The report above raises the question of how ticks in nature become infected. There are several possibilities that could be explored:
– Transovarial passage of another tick-borne bunyavirus, Dugbe virus, has been shown in the tick _Amblyomma variegatum_. The question then is if the virus can be maintained in the tick population without the need to infect vertebrate hosts.

– Transmission of tick-borne Congo-Crimean hemorrhagic fever bunyavirus during mating or co-feeding of adult ticks, and subsequent transovarial transmission, appear to represent additional mechanisms of infection in the tick population, and may contribute to the maintenance of transmission in nature.

– Co-feeding of susceptible, uninfected ticks with ticks infected with Dugbe and Congo-Crimean hemorrhagic bunyaviruses has been shown to occur in the absence of a detectable viremia. Testing that possibility with HRTV would require similar co-feeding experiments. – Mod.TY]

See Also

2015
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Heartland virus – USA 20150921.3661175

2014
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Heartland virus – USA (02): (OK) 20140602.2513295
Heartland virus – USA: (MO) 20140330.2367026

2013
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Heartland virus – USA: (MO) 20130724.1841984

2012
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Heartland virus – USA (MO) 2009 20120830.1274007
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Source:
A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases


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