Equine Encephalitis

India's Deadly Chandipura Virus Outbreak is Largest in 20 Years

Donald Hackett — Thu, 29 Aug 2024 11:52:49 +0000

Reviewer:

The World Health Organization (WHO) recently confirmed that India's Chandipura virus (CHPV) has become endemic and is a substantive health risk to residents and visitors.

Between early June and August 15, 2024, the Ministry of Health and Family Welfare of the Government of India reported 245 cases of acute encephalitis syndrome (AES), including 82 deaths and a case-fatality ratio (CFR) of 33%.

Of these, 64 are confirmed cases of CHPV, and 61 have been reported from Gujarat, India.

To date, no human-to-human transmission has been reported, and there is no evidence that CHPV has been detected among those traveling from India to other countries.

Previous CHPV outbreaks have occurred regularly, but the current outbreak is the largest in the past twenty years. Historically, the CFR from CHPV infection is high (56-75%), as no specific treatment exists.

CHPV is a member of the Rhabdoviridae family and is known to cause sporadic cases and outbreaks of AES in the western, central, and southern parts of India, especially during the monsoon season. It is transmitted by vectors such as sandflies, mosquitoes, and ticks.

CHPV has not been detected in other countries but may be present in Asia, as sandfly vectors are abundant in the Southeast Asia Region.

In India, although previous encephalitis outbreaks have been associated with the Japanese encephalitis virus, several outbreaks have remained undiagnosed.

As of August 29, 2024, the WHO assessed the risk as moderate at the national level based on the above considerations. The risk assessment will be reviewed as the outbreak situation evolves.

The WHO wrote on August 23, 2024, 'Although authorities are working to control CHPV transmission, further virus transmission is possible in the coming weeks, as the monsoon season is creating favorable conditions for vector populations in the affected areas. WHO recommends vector control and protection against bites of sandflies, mosquitos, and ticks to prevent further spread of CHPV.'

As of late August 2024, there are no CHPV vaccines available.

Sub Title:

Chandipura Virus vaccines do not exist in 2024

References:

WHO - Acute encephalitis syndrome due to Chandipura virus - India

large outbreak of acute encephalitis with high fatality rate in children in Andhra Pradesh, India, in 2003, associated with Chan

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Eastern Equine Encephalitis Virus Vaccine for Humans Needed in the Northeast

Donald Hackett — Mon, 26 Aug 2024 20:32:28 +0000

Reviewer:

Robert Carlson, MD

The Massachusetts Department of Public Health (DPH) and the Massachusetts Department of Agricultural Resources (MDAR) recently announced plans to conduct aerial and truck-mounted spraying in parts of Worcester County at risk for the Eastern Equine Encephalitis (EEE) virus.

EEE is a rare but severe and potentially fatal mosquito-transmitted disease that can affect anyone.

On August 16, 2024, DPH announced this year’s first human case of EEE virus infection in Worcester County.

As of August 24, 2024, the DPH has raised the risk of the EEE virus in ten communities in Massachusetts to high or critical. During the last EEE outbreak

In 2019, 38 confirmed EEE virus cases and 15 related deaths occurred throughout the northeastern states. Massachusetts reported 17 human cases and seven deaths.

DPH says the details on the exact timing will be provided as soon as possible, but spraying is expected to occur during the week of August 26. Spraying is scheduled at night, starting shortly after dusk and ending in the early morning. Please note that this schedule is weather-dependent and may change on short notice.

Massachusetts residents can visit DPH’s website for further information as it is made available.

Seperately, on August 26, 2024, New York State Agriculture Commissioner Richard A. Ball urged horse owners across New York State to vaccinate their horses against EEE and West Nile Virus, both of which are caused by a virus spread through the bite of an infected mosquito.

In 2024, New York has already seen cases of EEE found in horses in Clinton, Franklin, Saint Lawrence, Washington, Madison, Oneida, Orange, Ulster, Cayuga, and Wayne counties.

No confirmed cases of EEE in humans in New York this year exist.

Unfortunately, no U.S. FDA-approved EEE virus vaccines are available.

However, in May 2022, results from a Phase 1 clinical trial of a trivalent vaccine candidate developed by scientists at the National Institute of Allergy and Infectious Diseases Vaccine Research Center were published in The Lancet Infectious Diseases.

These researchers designed a virus-like particle (VLP) vaccine candidate (WEVEE) that uses proteins from the outer shells of the EEE, WEE, and VEE viruses to prompt an immune response. VLPs do not contain the genetic material the viruses need to replicate inside cells, so they cannot cause infection.

This study found the favorable safety profile and neutralizing antibody responses, along with pressing public health needs, support further evaluation of the WEVEE VLP vaccine in advanced-phase clinical trials.

Following this study, Emergent BioSolutions in Gaithersburg, Maryland, was issued a commercialization license for the advanced development of this vaccine candidate.

Sub Title:

No US FDA approved Eastern Equine Encephalitis virus vaccine

References:

MA plans to spray for mosquitoes in sections of Worcester and Plymouth counties due to EEE

trivalent virus-like particle vaccine against western, eastern, and Venezuelan equine encephalitis viruses

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US CDC EEE virus case map 2024

Equine Encephalitis Virus Vaccine Shows Positive Study Results

Don Hackett — Mon, 08 Jun 2020 12:05:32 +0000

Reviewer:

Robert Carlson, MD

The first-in-human trial of a prophylactic vaccine candidate against certain equine encephalitis viruses announced topline results today.

Denmark based Bavarian Nordic A/S MVA-BN® WEV vaccine candidate is targeted at western, eastern, and Venezuelan equine encephalitis viruses, for which there are currently no preventative vaccines available.

These viruses are considered potential biological threats.

The Phase 1 trial data showed that the vaccine was well-tolerated and immunogenic across all dose groups.

Neutralizing antibody responses were observed in all dose groups, with peak levels reached after the second vaccination.

Responses were detected as early as 2 weeks after the first vaccination in the highest dose group, in which also complete seroconversion was observed after the second vaccination.

The most common vaccine-related adverse event was injection site pain.

This is important news, since the U.S Centers for Disease Control and Prevention (CDC) reported 38 cases, including 15 deaths in 2019, compared to an annual average of 7 cases over the past decade.

The majority of cases occurred in the northeastern parts of the U.S., where mosquitoes have been found to carry the virus.

This study was funded by the United States Department of Defense’s (DOD) Joint Program Executive Office for Chemical, Biological, Radiological, and Nuclear Defense’s (JPEO-CBRND) Joint Project Manager for Chemical, Biological, Radiological, and Nuclear Medical (JPM CBRN Medical) was designed to evaluate the safety, tolerability, and immunogenicity of MVA-BN WEV in 45 healthy adults in 3 treatment groups receiving different doses of the vaccine.

All subjects were revaccinated after four weeks.

These clinically meaningful Phase 1 data warrant further clinical investigation, and Bavarian Nordic is currently in the process of obtaining additional funding from the U.S. authorities for the further clinical advancement of the vaccine candidate.

“We are pleased to report positive topline results from the first-in-human trial with our vaccine candidate against equine encephalitis viruses. A safe and effective vaccine against this fatal disease is a high priority for the U.S. government and we believe that our vaccine candidate is well-positioned to meet these requirements,” said Paul Chaplin, President and Chief Executive Officer of Bavarian Nordic, in a press release.

Eastern, Venezuelan, and western equine encephalitis viruses belong to the family alphavirus and are transmitted through mosquitos. Disease transmission does not occur directly from person to person.

It takes 4 to 10 days after the bite of an infected mosquito to develop symptoms of EEE.

While the viruses vary in infection rates and severity of the disease, all three pathogens are associated with risks of flu-like symptoms, potential central nervous disorders, and death.

Approximately a third of patients who develop encephalitis due to equine encephalitis virus infection die and many of those who survive have mild to severe brain damage.

All three viruses have been investigated as potential biological weapons at various times in the past century.

The viruses belong to the U.S. list of prioritized pathogens amongst other agents, like smallpox, anthrax and other lethal diseases, which are covered by the current vaccination policy for U.S. military personnel being deployed around the globe.

However, there are currently no approved vaccines for human use against any of the equine encephalitis viruses.

This project is funded in whole or in part with federal funds under an Other Transaction Authority agreement with U.S. Army Contracting Command-New Jersey through the Medical CBRN Defense Consortium, contract MCDC-17-04-001/2018-315.

Bavarian Nordic is a fully integrated biotechnology company focused on the development, manufacture, and commercialization of life-saving vaccines.

Precision Vaccinations publishes vaccine news about equine encephalitis viruses.

Sub Title:

Bavarian Nordic MVA-BN WEV vaccine candidate is targeted at western, eastern, and Venezuelan equine encephalitis viruses

References:

BAVARIAN NORDIC ANNOUNCES TOPLINE RESULTS FROM PHASE 1 CLINICAL TRIAL OF EQUINE ENCEPHALITIS VIRUS VACCINE

CDC: Eastern Equine Encephalitis

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Thin Film Freezing Platform Signs Military Research Agreement

Don Hackett — Wed, 15 Apr 2020 22:26:22 +0000

Reviewer:

Robert Carlson, MD

Danielle Reiter, RN

A Texas based biopharmaceutical company has entered into a Cooperative Research and Development Agreement (CRADA) with the United States Army Medical Research Institute of Infectious Diseases (USAMRIID), for defensive research into countermeasures against biological warfare.

Under the terms of the CRADA announced on April 15, 2020, TFF Pharma and the USAMRIID will collaborate over a 3-year period to investigate Thin Film Freezing to formulate two different countermeasures, a monoclonal antibody against Alphaviruses (e.g. Venezuelan, Western, and Eastern equine encephalitis viruses) and a vesicular stomatitis virus vaccine against Filoviruses (e.g. Ebola, Marburg).

TFF Pharmaceuticals’ Thin Film Freezing (TFF) platform was designed to improve the solubility and absorption of poorly water-soluble drugs and is particularly suited to generate dry powder particles with properties targeted for inhalation delivery, especially to the deep lung, an area of extreme interest in respiratory medicine.

The TFF process results in a “Brittle Matrix Particle,” which possesses low bulk density, high surface area, and typically an amorphous morphology, allowing the particles to supersaturate when contacting the target site, such as lung tissue.

Based upon laboratory experiments, the aerodynamic properties of the particles are such that the portion of a drug deposited to the deep lung has the potential to reach as high as 75 percent.

USAMRIID will evaluate the immune responses induced by the dry powder formulations given by the pulmonary or intranasal route in a rodent model, as compared to the traditional routes of administration.

“Biodefense threats and emerging infectious diseases such as COVID-19 continue to be a major concern to our military and civilian populations,” said Glenn Mattes, CEO of TFF Pharmaceuticals, in a press release.

“We believe our Thin Film Freezing technology approach can produce efficacious biodefense and emerging disease countermeasure powder formulations that are highly suitable for the respiratory route of administration; highly absorbable and effectively distributed; and physiochemically stable for an extended period,” continued Mattes.

“This CRADA, with the world’s preeminent biodefense research organization, is another validation of Thin Film Freezing’s potential as an important, disruptive platform technology.”

The Company’s testing confirms that Thin Film Freezing maintains a potential vaccine’s particle size distribution and immunogenicity, is robust for extended periods at room temperature, and withstands unintentional freezing.

It can be stored and shipped free of cold-chain handling, displays extended stability for stockpiling (dry powder storage vs. liquid), and provides for needle-free vaccination (nasal or inhalation administration).

“Our warfighters - and our scientists - are frequently deployed to some of the world’s most environmentally hostile climates,” said Dr. John M. Dye, Jr., Viral Immunology branch chief, USAMRIID.

“Having biodefense countermeasures that are potentially more easily administered via a pulmonary or intranasal route, and are temperature stable, could be an important advantage in these types of environments.”

TFF continues to engage with various government and defense contracting agencies in an effort to utilize the Company’s TFF technology platform to formulate dry powder vaccines for delivery via reconstitution or lung or nasal inhalation.

For over 50 years, USAMRIID has provided leading-edge medical capabilities to deter and defend against current and emerging biological threat agents.

TFF Pharmaceuticals, Inc. is a clinical-stage biopharmaceutical company focused on developing and commercializing innovative drug products.

Biodefence news published by Precision Vaccinations.

Sub Title:

TFF Pharmaceuticals Thin Film Freezing platform improves the solubility and absorption of poorly water-soluble drugs

Reference:

TFF Pharmaceuticals Announces CRADA with the USAMRIID for use of it's Thin Film Freezing Technology Platform

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19 Massachusetts Communities at Critical Risk for Eastern Equine Encephalitis Virus

Don Hackett — Mon, 19 Aug 2019 17:53:12 +0000

Reviewer:

Robert Carlson, MD

Danielle Reiter, RN

The Massachusetts Department of Public Health (DPH) today announced that laboratory testing confirmed the 2nd case of Eastern Equine Encephalitis virus infection.

In total, there are 19 Massachusetts communities now at critical risk, 18 at high risk, and 24 at moderate risk for the Eastern Equine Encephalitis virus (EEEV), as determined by DPH as of August 16, 2019.

To protect Massachusetts residents, the DPH and the Department of Agricultural Resources conducted aerial spraying in specific areas of Bristol and Plymouth counties to reduce the mosquito population and public health risk.

A 2nd round of aerial spraying in Massachusetts is planned for late August.

This is unfortunate news since approximately 30 percent of all people with EEEV die from the disease.

Furthermore, there is not a human vaccine against EEEV infection or specific antiviral treatment available, says the Centers for Disease Control and Prevention (CDC).

Patients with suspected EEEV should be evaluated by a healthcare provider, appropriate serologic diagnostic tests ordered, and supportive treatment provided.

The EEEV occurs sporadically in Massachusetts with the most recent outbreaks occurring from 2004-2006 and 2010-2012. There were 22 human cases of EEEV infection during those 2 outbreak periods, with 14 cases reported in Bristol and Plymouth Counties.

Throughout the USA, there were 6 human EEEV cases confirmed by the CDC in 2018. EEEV transmission is most common in and around freshwater hardwood swamps in the Atlantic and Gulf Coast states, led by the states of Florida and Massachusetts.

Eastern equine encephalitis virus is an arbovirus belonging in the genus Alphavirus, family Togaviridae. Western and Venezuelan are 2 other types, says the CDC.

EEEV infection can result in 2 types of illness, systemic or encephalitic, which involves swelling of the brain. The incubation period for EEEV disease ranges from 4 to 10 days.

Systemic infection has an abrupt onset and is characterized by chills, fever, malaise, arthralgia, and myalgia. Signs and symptoms in encephalitic patients are fever, headache, irritability, restlessness, drowsiness, anorexia, vomiting, diarrhea, cyanosis, convulsions, and coma.

The illness lasts 1 to 2 weeks, and recovery is complete when there is no central nervous system involvement.

In infants, the encephalitic form is characterized by abrupt onset; in older children and adults, encephalitis is manifested after a few days of systemic illness.

Cerebrospinal fluid (CSF) findings include neutrophil-predominant pleocytosis and elevated protein levels; glucose levels are normal. Brain lesions are typical of encephalomyelitis and include neuronal destruction and vasculitis, which is perivascular and parenchymous at the cortex, midbrain, and brain stem.

Of those who recover, many are left with disabling and progressive mental and physical sequelae, which can range from minimal brain dysfunction to severe intellectual impairment, personality disorders, seizures, paralysis, and cranial nerve dysfunction.

Many patients with severe sequelae die within a few years.

EEEV is difficult to isolate from clinical samples; almost all isolates (and positive PCR results) have come from brain tissue or CSF. Serologic testing remains the primary method for diagnosing EEEV infection.

A May 2019 study reported there is a strategy to develop a EEEV vaccine candidate.

These researchers designed a trivalent vaccine to simultaneously fend off Eastern, Western, and Venezuelan equine encephalitis viruses.

This study generated a trivalent EEEV vaccine composed of virus-like particles (VLPs). In this study, nonhuman primates were immunized with trivalent VLPs were completely protected against aerosol challenge by each of the EEEVs.

These researchers said ‘Because they are replication-incompetent, these trivalent VLPs represent a potentially safe and effective vaccine that can protect against diverse encephalitis viruses.’

All Massachusetts residents have an important role to play in protecting themselves and their loved ones from illnesses caused by mosquitoes.

Apply Insect Repellent when Outdoors. Use a repellent with an EPA-registered ingredient (DEET (N, N-diethyl-m-toluamide), permethrin, picaridin (KBR 3023), oil of lemon eucalyptus [p-methane 3, 8-diol (PMD)] or IR3535) according to the instructions on the product label. DEET products should not be used on infants under two months of age and should be used in concentrations of 30% or less on older children. Oil of lemon eucalyptus should not be used on children under three years of age.
Be Aware of Peak Mosquito Hours. The hours from dusk to dawn are peak biting times for many mosquitoes. Consider rescheduling outdoor activities that occur during evening or early morning in areas of high risk.
Clothing Can Help Reduce Mosquito Bites. Wearing long-sleeves, long pants and socks when outdoors will help keep mosquitoes away from your skin.
Drain Standing Water. Mosquitoes lay their eggs in standing water. Limit the number of places around your home for mosquitoes to breed by either draining or discarding items that hold water. Check rain gutters and drains. Empty any unused flowerpots and wading pools, and change the water in birdbaths frequently.
Install or Repair Screens. Keep mosquitoes outside by having tightly-fitting screens on all of your windows and doors.

For the most up-to-date information available on spraying locations, visit the Massachusetts Department of Agricultural Resources Aerial Spraying Map.

For other updates, Q&As, and downloadable fact sheets in multiple languages visit the DPH webpage.

Sub Title:

Eastern Equine Encephalitis Virus human vaccines are not available

References:

State Public Health Officials Announce Second Human Case of EEE in the Commonwealth

CDC: Eastern Equine Encephalitis Symptoms and Treatment

A virus-like particle vaccine prevents equine encephalitis virus infection in nonhuman primates

Eastern / Western Equine Encephalomyelitis

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Florida Warns of Eastern Equine Encephalitis Virus Risk

Don Hackett — Wed, 31 Jul 2019 17:40:25 +0000

Reviewer:

Robert Carlson, MD

Danielle Reiter, RN

The Florida Department of Health in Orange County (DOH-Orange) advised residents there has been an increase in mosquito-borne disease activity in the greater Orlando area.

This advisory published on July 25, 2019, is related to several sentinel chickens in the same flock which have tested positive for Eastern equine encephalitis virus (EEEV) infection.

In 2019, 25 horses, one emu, one eagle, and 83 sentinel chickens have been reported with an EEEV infection from 27 Florida counties, as of July 27, 2019.

And the risk of EEEV transmission to humans has increased.

This is important news since approximately 30 percent of people with EEEV die and many survivors have ongoing neurologic problems, says the Centers for Disease Control and Prevention (CDC).

In the United States, an average of 7 human cases of EEEV are reported annually by the CDC. During 2018, there were 6 human cases confirmed.

Most cases of EEEV have been reported from Florida and is most common in and around freshwater hardwood swamps.

Since there is not a preventive vaccine for humans available, the CDC says the most effective way to prevent infection from Eastern Equine Encephalitis virus is to prevent mosquito bites.

The DOH-Orange reminds Florida residents and visitors to avoid being bitten by mosquitoes and to take basic precautions to help limit exposure.

To protect yourself from mosquitoes, you should remember to “Drain and Cover”.

DRAIN standing water to stop mosquitoes from multiplying

Drain water from garbage cans, house gutters, buckets, pool covers, coolers, toys, flower pots or any other containers where sprinkler or rainwater has collected.
Discard old tires, drums, bottles, cans, pots and pans, broken appliances and other items that aren't being used.
Empty and clean birdbaths and pet's water bowls at least once or twice a week.
Protect boats and vehicles from rain with tarps that don’t accumulate water.
Maintain swimming pools in good condition and appropriately chlorinated. Empty plastic swimming pools when not in use.

COVER skin with clothing or repellent

Clothing - Wear shoes, socks, and long pants and long-sleeves. This type of protection may be necessary for people who must work in areas where mosquitoes are present.
Repellent - Apply mosquito repellent to bare skin and clothing. Always use repellents according to the label. Repellents with DEET, picaridin, oil of lemon eucalyptus, para-menthane-diol, and IR3535 are effective. Use mosquito netting to protect children younger than 2 months old.

TIPS on Repellent Use

Always read label directions carefully for the approved usage before you apply a repellent. Some repellents are not suitable for children.
Products with concentrations of up to 30 percent DEET (N, N-diethyl-m-toluamide) are generally recommended. Other U.S. Environmental Protection Agency-approved repellents contain picaridin, oil of lemon eucalyptus, para-menthane-diol, or IR3535. These products are generally available at local pharmacies. Look for active ingredients to be listed on the product label.
Apply insect repellent to exposed skin, or onto clothing, but not under clothing.
In protecting children, read label instructions to be sure the repellent is age-appropriate. According to the Centers for Disease Control and Prevention (CDC), mosquito repellents containing oil of lemon eucalyptus should not be used on children under the age of three years. DEET is not recommended for children younger than two months old.
Avoid applying repellents to the hands of children. Adults should apply repellent first to their own hands and then transfer it to the child’s skin and clothing.
If additional protection is necessary, apply a permethrin repellent directly to your clothing. Again, always follow the manufacturer’s directions.

COVER doors and windows with screens

Repair broken screening on windows, doors, porches, and patios to keep mosquitoes outside

For more information on what repellent is right for you, consider using the Environmental Protection Agency’s search tool to help you choose skin-applied repellent products.

The Florida Health Department continues to conduct statewide surveillance for mosquito-borne illnesses, including West Nile virus infections, Eastern equine encephalitis, St. Louis encephalitis, malaria, chikungunya, and dengue.

Sub Title:

Eastern Equine Encephalitis Virus has 30 percent fatality risk

References:

HEALTH OFFICIALS ISSUE MOSQUITO-BORNE ILLNESSES ADVISORY

Florida Health: Florida Arbovirus Surveillance Week 30: July 21-27, 2019

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