Rift valley fever viral load correlates with the human inflammatory response and coagulation pathway abnormalities in humans with hemorrhagic manifestations

<div><p>Rift Valley fever virus is an arbovirus that affects both livestock and humans throughout Africa and in the Middle East. Despite its endemicity throughout Africa, it is a rare event to identify an infected individual during the acute phase of the disease and an even rarer event to collect serial blood samples from the affected patient. Severely affected patients can present with hemorrhagic manifestations of disease. In this study we identified three Ugandan men with RVFV disease that was accompanied by hemorrhagic manifestations. Serial blood samples from these men were analyzed for a series of biomarkers specific for various aspects of human pathophysiology including inflammation, endothelial function and coagulopathy. There were significant differences between biomarker levels in controls and cases both early during the illness and after clearance of viremia. Positive correlation of viral load with markers of inflammation (IP-10, CRP, Eotaxin, MCP-2 and Granzyme B), markers of fibrinolysis (tPA and D-dimer), and markers of endothelial function (sICAM-1) were all noted. However, and perhaps most interesting given the fact that these individuals exhibited hemorrhagic manifestations of disease, was the finding of a negative correlation between viral load and P-selectin, ADAMTS13, and fibrinogen all of which are associated with coagulation pathways occurring on the endothelial surface.</p></div

Rift Valley Fever: A survey of knowledge, attitudes, and practice of slaughterhouse workers and community members in Kabale District, Uganda

<div><p>Background</p><p>Rift Valley Fever virus (RVF) is a zoonotic virus in the <i>Phenuiviridae</i> family. RVF outbreaks can cause significant morbidity and mortality in humans and animals. Following the diagnosis of two RVF cases in March 2016 in southern Kabale district, Uganda, we conducted a knowledge, attitudes and practice (KAP) survey to identify knowledge gaps and at-risk behaviors related to RVF.</p><p>Methodology/Principal findings</p><p>A multidisciplinary team interviewed 657 community members, including abattoir workers, in and around Kabale District, Uganda. Most participants (90%) had knowledge of RVF and most (77%) cited radio as their primary information source. Greater proportions of farmers (68%), herdsmen (79%) and butchers (88%) thought they were at risk of contracting RVF compared to persons in other occupations (60%, p<0.01). Participants most frequently identified bleeding as a symptom of RVF. Less than half of all participants reported fever, vomiting, and diarrhea as common RVF symptoms in either humans or animals. The level of knowledge about human RVF symptoms did not vary by occupation; however more farmers and butchers (36% and 51%, respectively) had knowledge of RVF symptoms in animals compared to those in other occupations (30%, p<0.01). The use of personal protective equipment (PPE) when handling animals varied by occupation, with 77% of butchers using some PPE and 12% of farmers using PPE. Although most butchers said that they used PPE, most used gumboots (73%) and aprons (60%) and less than 20% of butchers used gloves or eye protection when slaughtering.</p><p>Conclusions</p><p>Overall, knowledge, attitudes and practice regarding RVF in Kabale District Uganda could be improved through educational efforts targeting specific populations.</p></div

Types of contact with animals and animal products.

<p>Types of contact with animals and animal products.</p

Participant demographics.

<p>Participant demographics.</p

Use of personal protective equipment (PPE) in persons with animal contact by occupation.

<p>Use of personal protective equipment (PPE) in persons with animal contact by occupation.</p

Statistically significant biomarkers of endothelial function in RVF cases.

<p>The concentration of each biomarker in each patient is plotted as function of day post fever onset; Case 1 (square), Case 2 (circle), Case 3 (triangle). The grey area represents the range of the biomarker concentration that was detected in 8 normal healthy individuals. The dotted line is the limit of detection of the assay, which is the lowest level at which the assay can accurately detect the presence of the biomarker.</p

Statistically significant biomarkers of apoptosis and inflammation in RVF cases.

<p>The concentration of each biomarker in each patient is plotted as function of day post fever onset; Case 1 (square), Case 2 (circle), Case 3 (triangle). The grey area represents the range of the biomarker concentration that was detected in 8 normal healthy individuals. The dotted line is the limit of detection of the assay, which is the lowest level that the assay can accurately detect the presence of the biomarker.</p

Use of personal protective equipment in persons with animal contact by gender.

<p>Use of personal protective equipment in persons with animal contact by gender.</p

Participant knowledge of RVF symptoms by occupation.

<p>Participant knowledge of RVF symptoms by occupation.</p

Participant knowledge of RVF symptoms by gender.

<p>Participant knowledge of RVF symptoms by gender.</p