Guillaume André Durand

We previously reported that two of three patients with severe Usutu virus (USUV) disease carried circulating autoantibodies (auto-Abs) neutralizing type I IFNs (AAN-I-IFN). Here, we studied four additional patients, bringing the total number of European patients with life-threatening USUV infection to seven (Austria, n = 1; France, n = 1; Hungary, n = 4; Italy, n = 1). Three of these patients (all male, aged 43, 77, and 78 years, one French and two Hungarian) had blood auto-Abs neutralizing at least 10 ng/ml IFN-α2 and IFN-ω and at least 1 ng/ml IFN-β. They suffered from meningitis (n = 1), meningoencephalitis (n = 1), or myocarditis (n = 1). The other four patients were similar demographically and clinically but had no detectable AAN-I-IFN. No AAN-I-IFN were found in the 63 individuals with silent USUV infection tested (P = 6.4 × 10−4, Fisher’s exact test). These AAN-I-IFN increased the risk of life-threatening USUV disease by 98.8-fold (95% CI: 4.12–2,369; P = 0.0046, Firth’s bias–corrected logistic regression) and, thus, account for almost half the cases of life-threatening USUV infection in Europe.

This case series describes the use of nucleic acid testing in screening blood donations for West Nile virus in areas of France in which the virus circulated in previous years.

Arboviral diseases are a growing global health concern. Pre-existing autoantibodies (auto-Abs) neutralizing type I interferons (IFNs) can underlie encephalitis due to West Nile virus (WNV) (∼40% of patients) and tick-borne encephalitis (TBE, due to TBE virus [TBEV]) (∼10%). We report here that these auto-Abs can also underlie severe forms of rarer arboviral infections. Auto-Abs neutralizing high concentrations of IFN-α2, IFN-β, and/or IFN-ω are present in the single case of severe Powassan virus (POWV) encephalitis studied, two of three cases of severe Usutu virus (USUV) infection studied, and the most severe of 24 cases of Ross River virus (RRV) disease studied. These auto-Abs are not found in any of the 137 individuals with silent or mild infections with these three viruses. Thus, auto-Abs neutralizing type I IFNs underlie an increasing list of severe arboviral diseases due to Flaviviridae (WNV, TBEV, POWV, USUV) or Togaviridae (RRV) viruses transmitted to humans by mosquitos (WNV, USUV, RRV) or ticks (TBEV, POWV).

Background: West Nile (WNV) and Usutu (USUV) virus are vector-borne flaviviruses causing neuroinvasive infections in both humans and animals. Entomological surveillance is a method of choice for identifying virus circulation ahead of the first human and animal cases, but performing molecular screening of vectors is expensive, and time-consuming. Methods: We implemented the MX (Molecular Xenomonitoring) strategy for the detection of WNV and USUV circulation in mosquito populations in rural and urban areas in Nouvelle-Aquitaine region (France) between July and August 2023, using modified BG Sentinel traps. We first performed molecular screening and sequencing on excreta from trapped mosquitoes before confirming the results by detecting, sequencing and isolating viruses from individual mosquitoes. Findings: We identified WNV and USUV-infected mosquitoes in 3 different areas, concurrently with the first human cases reported in the region. Trapped mosquito excreta revealed substantial virus co-circulation (75% of traps had PCR+ excreta for at least one of both viruses). Cx. pipiens was the most common species infected by both WNV and USUV. Genomic data from excreta and mosquitoes showed the circulation of WNV lineage 2 and USUV lineage Africa 3, both phylogenetically close to strains that circulated in Europe in recent years. Four WNV and 3 USUV strains were isolated from trapped mosquitoes. Interpretation: MX strategy is easy and rapid to implement on the field, and has proven its effectiveness in detecting WNV and USUV circulation in local mosquito populations. Funding: This study received funding from the Direction Générale de l’Armement (PDH 2 NBC-5-B-2212) and ARBOGEN (funded by MSDAVENIR). Research in context: Evidence before this study: WNV and USUV circulate through complex transmission cycles involving mosquitoes as vectors, birds as amplifying hosts and several mammal species as dead-end hosts. Transmission to humans primarily occurs through mosquito bites for both viruses. Notably, WNV can also be transmitted through blood donations and organ transplants. It is estimated that a significant proportion of both WNV and USUV infections in vertebrate hosts remain unreported due to their predominantly asymptomatic nature or nonspecific clinical presentation. Nevertheless, neuroinvasive and potentially fatal disease can occur, in particular among vulnerable populations such as elderly and immunocompromised patients. In France, after its first detection in 2015, USUV has been sporadically found in eastern and southern departments, with confirmed infections in birds, mosquitoes and mammals, and few human cases described. WNV has recently caused annual outbreaks of varying intensities involving humans, equids and avifauna in French departments mainly located in the Mediterranean area. Because of low viral loads and/or brief viremia, diagnosis of both pathogens is often based on serological evidence, and few genomic data are available on strains having circulated in France. Entomological surveillance can be used as an early warning method for WNV and USUV surveillance, but is costly to implement as it requires the collection of large numbers of mosquitoes to detect virus circulation when infection rates in mosquito populations are low. Therefore, viral surveillance in France still heavily relies on human and animal surveillance, i.e. late indicators of viral circulation. Added value of this study: This study describes the implementation of the MX (Molecular Xenomonitoring) strategy for the effective surveillance of WNV and USUV circulation within mosquito populations. MX uses of modified BG Sentinels that allow (i) trapped mosquitoes to survive for several days and (ii) corresponding mosquito excreta to be collected and preserved on filter paper. MX has demonstrated many advantages over traditional entomological surveillance. Firstly, screening excreta collectively deposited by a community of trapped mosquitoes for the presence of viruses in the first instance is time and cost efficient, as one sample is tested for viral RNA, regardless of the number and species diversity in the trap. Second, filter papers with mosquito excreta can be transported from the field to the laboratory at room temperature by regular postal mail, bringing real-time detection within reach. WNV and USUV RNA have been detected and sequenced directly from the mosquito excreta shortly after collection. Thirdly, MX adapters increase the longevity of trapped mosquitoes, thereby allowing extension of the time between trap collections and increasing the likelihood of virus shedding by infected mosquitoes. Fourthly, this approach is easy to implement in the field and requires neither a strong entomological background nor specific technical skills. All these aspects make the MX strategy a powerful, non-invasive and cost-effective tool for real-time monitoring of enzootic WNV and USUV circulation. Authors should describe here how their findings add value to the existing evidence.: WNV was never detected on the Atlantic seaboard of France until October 2022. Molecular evidence of WNV circulation was obtained in 3 symptomatic horses in the Nouvelle Aquitaine region in October 2022, concomitantly with an USUV human case with no recent travel history outside the region. This was a harbinger of an increase in cases over the next year. In 2023, MX succeeded in detecting the enzootic co-circulation of WNV and USUV in rural and urban areas of Nouvelle Aquitaine, simultaneously with the first cases of WNV detected by human and animal surveillance and the first human case of USUV diagnosed in the end of July 2023. Genomic and phylogenetic information was obtained directly from trapped mosquito excreta, before information derived from animal or human surveillance. Mosquitoes from traps with PCR-positive excreta were analysed individually, which allowed to calculate infection rates in mosquitoes. WNV and USUV were isolated from single Cx. pipiens mosquitoes. Cx. pipiens was the species most commonly found positive for either viruses although WNV was also detected in Ochlerotatus and Aedes mosquitoes, including one tiger mosquito ( Ae. albopictus ) in the urban environment. We argue that the MX approach is a major asset in the early warning detection of WNV and USUV circulation to alert health policy makers and take suitable control measures.

Diseases caused by arboviruses are on the increase worldwide. In addition to arthropod bites, most arboviruses can be transmitted via accessory routes. Products of human origin (labile blood products, solid organs, hematopoietic stem cells, tissues) present a risk of contamination for the recipient if the donation is made when the donor is viremic. Mainland France and its overseas territories are exposed to a complex array of imported and endemic arboviruses, which differ according to their respective location. This narrative review describes the risks of acquiring certain arboviral diseases from human products, mainly solid organs and hematopoietic stem cells, in the French context. The main risks considered in this study are infections by West Nile virus, dengue virus, and tick-borne encephalitis virus. The ancillary risks represented by Usutu virus infection, chikungunya, and Zika are also addressed more briefly. For each disease, the guidelines issued by the French High Council of Public Health, which is responsible for mitigating the risks associated with products of human origin and for supporting public health policy decisions, are briefly outlined. This review highlights the need for a “One Health” approach and to standardize recommendations at the international level in areas with the same viral epidemiology.

Diseases caused by arboviruses are on the increase worldwide. In addition to arthropod bites, most arboviruses can be transmitted via accessory routes. Products of human origin (labile blood products, solid organs, hematopoietic stem cells, tissues) present a risk of contamination for the recipient if the donation is made when the donor is viremic. This narrative review describes the risks of acquiring certain arboviral diseases from human products, mainly solid organs and hematopoietic stem cells, in the French context. Mainland France and its overseas territories are exposed to a complex array of imported and endemic arboviruses, which differ according to their respective location. The main risks considered in this study are infections by West Nile virus, dengue virus and tick-borne encephalitis virus. The ancillary risks represented by Usutu virus infection, chikungunya and Zika are also addressed more briefly. For each disease, the guidelines issued by the French High Council of Public Health, which is responsible for issuing guidelines to mitigate the risks associated with products of human origin and for supporting public health policy decisions, are briefly outlined. The aim of this review is also to contribute to the standardization of recommendations at international level in areas with the same viral epidemiology.

The presence of alphaviruses, such as chikungunya virus (CHIKV), has never been reported in Mauritania. We assessed the seroprevalence of CHIKV among Nouakchott residents. A cross-sectional study involving 1300 non-febrile patients consulting at the Nouakchott hospital center was conducted between January and June 2021. The presence of anti-CHIKV IgG and neutralizing antibodies against CHIKV, O’nyong-nyong virus (ONNV), and Semliki Forest virus (SFV) was determined by an enzyme-linked immunosorbent assay (ELISA) and a serum neutralization test, respectively, and the associated risk factors were investigated. Of the 1300 study participants, serological evidence of previous exposure to CHIKV was observed in 37 individuals (2.8%). Sex, age, reported use of repellants, and bed net ownership and usage were not associated with CHIKV seropositivity. Our results showed the co-circulation of two other alphaviruses, ONNV and SFV, in Nouakchott in 30 (2.3%) individuals. This is the first study that documents the co-circulation of CHIKV, ONNV, and SFV in Mauritania, albeit at low prevalence. Surveillance and routine testing for alphaviruses and other arboviruses in symptomatic patients should be implemented in health facilities to assess the health burden associated with these viruses. Efforts should also be made to strengthen the vector control measures.

Every year, the world faces vector-borne diseases including arboviral (arthropod-borne viral) diseases caused by several, possibly fatal flaviviruses. The way they spread is related to a complex episystem involving several elements including vector abundance, animal carriers, and the flavivirus itself, which makes the disease difficult to manage. Here, we serologically screened 556 animals (358 dogs and 198 horses) using ELISA and a serum neutralisation test (SNT) for the anti-IgG antibodies directed against the West Nile (WNV) and Usutu (USUV) viruses. The animals investigated were split into two groups according to their exposure to the risk linked to the abundance of mosquitoes and migratory birds as well as the geographical distribution of arbovirus cases (458 animals from areas exposed to risk and 98 not exposed to risk). Overall, 25/310 dogs (8.1%) and 2/148 horses (1.3%) tested positive for SNT WNV and/or USUV in geographically exposed areas. Animals in unexposed areas were all negative. The geographical distribution of WNV seroprevalence in dogs was the same as the distribution of reported autochthonous human cases. Interestingly, a non-negligible seroprevalence caused by an as yet unidentified flavivirus other than WNV, USUV, or tick-borne encephalitis virus (TBEV) was detected in 18.6% (28/150) and 3.7% (4/106) of the investigated dogs and horses from the Hérault department, in the southeast of France, respectively. These data highlight the role of outdoor dogs as suitable sentinels for the evidence of WNV and USUV circulation in each area. In addition, the serological detection of an as yet unidentified flavivirus circulating in the Hérault department deserves greater attention, as this may constitute a serious threat to public and animal health.