What chikungunya teaches us about COVID-19.
About: This article is published in Lancet Infectious Diseases.The article was published on 2021-05-19 and is currently open access. It has received 14 citations till now. The article focuses on the topics: Chikungunya.
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Max Planck Society1, University of Luxembourg2, University of Antwerp3, RWTH Aachen University4, University of Malta5, London School of Economics and Political Science6, University of Latvia7, Ludwig Maximilian University of Munich8, University of London9, Minerva Foundation Institute for Medical Research10, Medical University of Vienna11, Utrecht University12, Wrocław University of Technology13, University of Bergen14, University of Bern15, University of Minho16, University of Porto17, University of Maribor18, University of Crete19, University of Edinburgh20, University of Vienna21, Umeå University22, Dublin City University23, University of Warsaw24, National and Kapodistrian University of Athens25, Innsbruck Medical University26
TL;DR: In this article, the authors examined key aspects that are likely to influence the COVID-19 pandemic in Europe, including progress of national and global vaccination programs, emergence and spread of variants of concern (VOCs), and public responses to non-pharmaceutical interventions (NPIs).
Abstract: How will the coronavirus disease 2019 (COVID-19) pandemic develop in the coming months and years? Based on an expert survey, we examine key aspects that are likely to influence the COVID-19 pandemic in Europe. The challenges and developments will strongly depend on the progress of national and global vaccination programs, the emergence and spread of variants of concern (VOCs), and public responses to non-pharmaceutical interventions (NPIs). In the short term, many people remain unvaccinated, VOCs continue to emerge and spread, and mobility and population mixing are expected to increase. Therefore, lifting restrictions too much and too early risk another damaging wave. This challenge remains despite the reduced opportunities for transmission given vaccination progress and reduced indoor mixing in summer 2021. In autumn 2021, increased indoor activity might accelerate the spread again, whilst a necessary reintroduction of NPIs might be too slow. The incidence may strongly rise again, possibly filling intensive care units, if vaccination levels are not high enough. A moderate, adaptive level of NPIs will thus remain necessary. These epidemiological aspects combined with economic, social, and health-related consequences provide a more holistic perspective on the future of the COVID-19 pandemic.
64 citations
TL;DR: In this article, structural and biochemical aspects of SARS-CoV-2 co-emerged in India in late 2020, with the Delta variant underlying the resurgence of COVID-19, even in countries with high vaccination rates.
Abstract: The Delta and Kappa variants of SARS-CoV-2 co-emerged in India in late 2020, with the Delta variant underlying the resurgence of COVID-19, even in countries with high vaccination rates. In this study, we assess structural and biochemical aspects of viral fitness for these two variants using cryo-electron microscopy (cryo-EM), ACE2-binding and antibody neutralization analyses. Both variants demonstrate escape of antibodies targeting the N-terminal domain, an important immune hotspot for neutralizing epitopes. Compared to wild-type and Kappa lineages, Delta variant spike proteins show modest increase in ACE2 affinity, likely due to enhanced electrostatic complementarity at the RBD-ACE2 interface, which we characterize by cryo-EM. Unexpectedly, Kappa variant spike trimers form a novel head-to-head dimer-of-trimers assembly, which we demonstrate is a result of the E484Q mutation. The combination of increased antibody escape and enhanced ACE2 binding provides an explanation, in part, for the rapid global dominance of the Delta variant.
27 citations
TL;DR: In this article, all SARS-CoV-2 variants analyzed, including variants of concern (VOC) Alpha, Beta, Gamma, and Delta, exhibit enhanced binding affinity to clinical grade and phase 2 tested recombinant human soluble ACE2 (APN01).
Abstract: The recent emergence of multiple SARS-CoV-2 variants has caused considerable concern due to reduced vaccine efficacy and escape from neutralizing antibody therapeutics. It is therefore paramount to develop therapeutic strategies that inhibit all known and future SARS-CoV-2 variants. Here we report that all SARS-CoV-2 variants analyzed, including variants of concern (VOC) Alpha, Beta, Gamma, and Delta, exhibit enhanced binding affinity to clinical grade and phase 2 tested recombinant human soluble ACE2 (APN01). Importantly, soluble ACE2 neutralized infection of VeroE6 cells and human lung epithelial cells by multiple VOC strains with markedly enhanced potency when compared to reference SARS-CoV-2 isolates. Effective inhibition of infections with SARS-CoV-2 variants was validated and confirmed in two independent laboratories. These data show that SARS-CoV-2 variants that have emerged around the world, including current VOC and several variants of interest, can be inhibited by soluble ACE2, providing proof of principle of a pan-SARS-CoV-2 therapeutic.
19 citations
TL;DR: Chikungunya virus infection, an Aedes mosquito-borne febrile disease, has spread from Africa and Asia to Europe and the Americas and from the tropics and subtropics to temperate regions as mentioned in this paper .
Abstract: Abstract Purpose of Review The worldwide spread of chikungunya over the past two decades calls for greater knowledge and awareness of the virus, its route of transmission, methods of diagnosis, and the use of available treatment and prevention measures. Recent Findings Chikungunya virus infection, an Aedes mosquito-borne febrile disease, has spread from Africa and Asia to Europe and the Americas and from the tropics and subtropics to temperate regions. International travel is a pivotal influence in the emergence of chikungunya as a global public health threat, as evidenced by a growing number of published reports on travel-related chikungunya infections. The striking features of chikungunya are arthralgia and arthritis, and the disease is often mistaken for dengue. Although mortality is low, morbidity can be profound and persistent. Current treatment for chikungunya is supportive; chikungunya vaccines and therapeutics are in development. Travelers planning to visit areas where the mosquito vectors are present should be advised on preventive measures. Summary Chikungunya is an emerging disease in the Americas. Frequent travel, the presence of at least two competent mosquito species, and a largely naïve human population in the Western Hemisphere create a setting conducive to future outbreaks. Awareness of the disease and its manifestations is critical to effectively and safely manage and limit its impact. Vaccines in late-stage clinical trials offer a new pathway to prevention.
7 citations
TL;DR: In this paper, the authors monitored the SARS-CoV-2 specific immune response in convalescent coronavirus disease-2019 (COVID-19) patients up to 15 months after symptoms onset.
Abstract: Background: Information concerning the longevity of immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) following natural infection may have considerable implications for durability of immunity induced by vaccines. Here, we monitored the SARS-CoV-2 specific immune response in convalescent coronavirus disease-2019 (COVID-19) patients up to 15 months after symptoms onset.
Methods: The levels of anti-spike and anti-receptor binding domain antibodies and neutralizing activities were tested in a total of 188 samples from 136 convalescent patients who experience mild to critical COVID-19. Specific memory B and T cell responses were measured in 76 peripheral blood mononuclear cell samples collected from 54 patients. Twenty-three vaccinated individuals were included for comparison.
Findings: Following a peak at day 15-28 post-infection, the IgG antibody response and plasma neutralizing titers gradually decreased over time but stabilized after 6 months. Plasma neutralizing activity against G614 was still detected in 87% of the patients at 6-15 months. Compared to G614, the median neutralizing titers against Beta, Gamma and Delta variants in plasma collected at early (15-103 days) and late (9-15 month) convalescence were 16- and 8-fold lower, respectively. SARS-CoV-2-specific memory B and T cells reached a peak at 3-6 months and persisted in the majority of patients up to 15 months although a significant decrease in specific T cells was observed between 6 and 15 months.
Conclusion: The data suggest that antiviral specific immunity especially memory B cells in COVID-19 convalescent patients is long-lasting, but some variants of concern, including the fast-spreading Delta variant, may at least partially escape the neutralizing activity of plasma antibodies.
Funding: EU-ATAC consortium, the Italian Ministry of Health, the Swedish Research Council, SciLifeLab, and KAW.
5 citations
References
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TL;DR: Recommandations françaises pour the prise en charge du chikungunya, services de pathologie infectieuse et tropicale and services de maladies infectieuses et tropicales.
Abstract: Recommandations françaises pour la prise en charge du chikungunya . Simon a,∗, E. Javelle a, A. Cabie b, E. Bouquillard c, O. Troisgros d, G. Gentile e, I. Leparc-Goffart f, B. Hoen g, F. Gandjbakhch h, P. Rene-Corail d, J.-M. Franco i, E. Caumes j, B. Combe k, S. Poiraudeau l, F. Gane-Troplent m, F. Djossou n, T. Schaerverbeke o, A. Criquet-Hayot p, P. Carrere m, D. Malvy q, P. Gaillard i, D. Wendling r a Service de pathologie infectieuse et tropicale, hôpital d’instruction des Armées Laveran, 34, boulevard Alphonse-Laveran, CS 50004, 13384 Marseille cedex 13, France b Service de maladies infectieuses et tropicales, CHU de Fort-de-France, 97261 Fort-de-France, Martinique c Service de rhumatologie, CHU de Saint-Pierre, 97448 Saint-Pierre, Reunion d Service de médecine physique et réadaptation, CHU de Fort-de-France, 97261 Fort-de-France, Martinique e Département universitaire de médecine générale, faculté de médecine, université d’Aix-Marseille, 13005 Marseille, France f ERRIT-IRBA, HIA Laveran, centre national de référence des arboviroses, 13384 Marseille, France g Service de maladies infectieuses et tropicales, CHU de Pointe-à-Pitre, 97159 Pointe-à-Pitre, Guadeloupe h Service de rhumatologie, CHU Pitié-Salpêtrière, 75013 Paris, France i Département universitaire de médecine générale, université de la Réunion, 97490 Saint-Denis, Reunion j Service de maladies infectieuses et tropicales, CHU Pitié-Salpêtrière, 75013 Paris, France k Service de rhumatologie, CHU de Montpellier, Montpellier, France l Service de médecine physique et réadaptation, CHU de Cochin, 75014 Paris, France m Département universitaire de médecine générale, université des Antilles et de la Guyane, 97154 Pointe-à-Pitre, France n Service de maladies infectieuses et tropicales, centre hospitalier Andrée-Rosemon, 97306 Cayenne, Guyane o Service de rhumatologie, CHU Pellegrin, 33076 Bordeaux, France p Département universitaire de médecine générale, université des Antilles et de la Guyane, 97261 Fort-de-France, Martinique q Service de maladies infectieuses et tropicales, CHU Pellegrin, 97261 Bordeaux, France r Service de rhumatologie, CHU de Besançon, 25030 Besançon, France
177 citations
Journal Article•
TL;DR: The chikungunya epidemic in the year 2006 imposed heavy epidemiological burden and productivity loss to the community and quality epidemiological data from surveillance system to monitor vector-borne and zoonotic diseases would pave way for more realistic estimates of burden.
Abstract: Background & objectives: During 2006, chikungunya emerged as a major ever known epidemic in India. Disability adjusted life years (DALY) is an appropriate summary measure of population health to express epidemiological burden of diseases. We estimated the burden due to suspected chikungunya using DALYs for the first time and compared between the states and also with the burden due to other vector-borne diseases in India. The economic burden was also assessed in terms of productivity loss. Methods: Data on the reported cases of fever/suspected cases of chikungunya from different states during 2006 in India were used. Years lived with disability (YLD) were calculated for non-fatal cases to estimate DALY. Since the disability weight for chikungunya is not available, the weights available for rheumatic arthritis, comparable to the disease outcome of chikungunya were used for the estimation. The burden was estimated for both acute and chronic cases. It is considered that about 11.5% of cases were reported to have extended morbidity with persisting arthralgia. For acute disease, the average duration of illness was considered to be nine days and for chronic cases it was six months on an average. The productivity loss due to income foregone by the working class was calculated using minimum official wage. Results: National burden of chikungunya was estimated to be 25,588 DALYs lost during 2006 epidemic, with an overall burden of 45.26 DALYs per million. It varied from 0.01 to 265.62 per million in different states. Karnataka alone contributed as high as 55% of the national burden. Persistent arthralgia was found to impose heavy burden, accounting for 69% of the total DALYs. The productivity loss in terms of income foregone was estimated to be a minimum of Rs. 391 million. Interpretation & conclusion: The chikungunya epidemic in the year 2006 imposed heavy epidemiological burden and productivity loss to the community. The burden of chikungunya in terms of DALY was estimated for the first time. In view of re-emergence and spread of this infection in recent times it is warranted for derivation of disability weight for different health states of chikungunya to facilitate realistic estimates of DALYs. Quality epidemiological data from surveillance system to monitor vector-borne and zoonotic diseases would pave way for more realistic estimates of burden. The productivity loss in-terms of income foregone could be minimal as the estimation was made by using the minimum wage fixed by the government although the actual loss is expected to be higher.
139 citations
TL;DR: In this article, the authors systematically reviewed published literature and surveillance records to evaluate the global burden caused by chikungunya virus and Zika virus (ZIKV) infections between 2010 and 2019, to calculate estimates of their disability-adjusted life year (DALY) impact.
Abstract: Throughout the last decade, chikungunya virus (CHIKV) and Zika virus (ZIKV) infections have spread globally, causing a spectrum of disease that ranges from self-limited febrile illness to permanent severe disability, congenital anomalies, and early death. Nevertheless, estimates of their aggregate health impact are absent from the literature and are currently omitted from the Global Burden of Disease (GBD) reports. We systematically reviewed published literature and surveillance records to evaluate the global burden caused by CHIKV and ZIKV between 2010 and 2019, to calculate estimates of their disability-adjusted life year (DALY) impact. Extracted data on acute, chronic, and perinatal outcomes were used to create annualized DALY estimates, following techniques outlined in the GBD framework. This study is registered with PROSPERO (CRD42020192502). Of 7,877 studies identified, 916 were screened in detail, and 21 were selected for inclusion. Available data indicate that CHIKV and ZIKV caused the average yearly loss of over 106,000 and 44,000 DALYs, respectively, between 2010 and 2019. Both viruses caused substantially more burden in the Americas than in any other World Health Organization (WHO) region. This unequal distribution is likely due to a combination of limited active surveillance reporting in other regions and the lack of immunity that left the previously unexposed populations of the Americas susceptible to severe outbreaks during the last decade. Long-term rheumatic sequelae provided the largest DALY component for CHIKV, whereas congenital Zika syndrome (CZS) contributed most significantly for ZIKV. Acute symptoms and early mortality accounted for relatively less of the overall burden. Suboptimal reporting and inconsistent diagnostics limit precision when determining arbovirus incidence and frequency of complications. Despite these limitations, it is clear from our assessment that CHIKV and ZIKV represent a significant cause of morbidity that is not included in current disease burden reports. These results suggest that transmission-blocking strategies, including vector control and vaccine development, remain crucial priorities in reducing global disease burden through prevention of potentially devastating arboviral outbreaks.
55 citations
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