RE: [Fwd: Transplacental Transmission - Update on WNV in Pregnancy]

<x-flowed>Hello All,

The transmammary transmission of virus to puppies Tracey refers to would
also fall in the suspected but not proven catagory. We received a serum
sample from a sick 2 week old puppy with a request for WNV serology from a
lab in the midwest. The serum was strongly positive (1:4096) in our
microtiter SN. When I called the submitting institution to inform them of
the result, they indicated that the pup had died and had been identified as
WNV positive in tissues (kidney and CNS) by RT-PCR and additional testing
was being performed. I requested additional samples from the bitch (mother)
and the rest of the litter that was still alive. I believe that 2 or 3 of
the other puppies were clinically ill but recovered. About two weeks later
I received samples from 6 6 week old puppies and the bitch. The bitch and 4
out of 6 remaining puppies were strongly SN positive (pos 1:2560 to>/=8192)
. I urged the submitting institution to do an epidemiological follow up to
determine the extent of natural exposure risk, but have not heard if
anything further has been done. This was not done as a part of the zoo
surveillance project. In my opinion, the antibody titers in these puppies
would be unlikely to represent maternal transmission of antibodies as 2 of
the puppies were antibody negative. What I can do is to go back and
demonstrate maternal antibodies by testing the serum for canine distemper
antibodies or canine parvovirus antibodies. Residual maternal antibody
titers should still be present in all the puppies serum. The two week time
frame for clinical illness and death in the "index" puppy would put
infection peri-or a few days post natal. I can ask the responsible
individual at the other institution to contact you if you would like so
they can fill in the other parts of the puzzle.

All this happened at the same time the CDC was investigating mammary
transmission in humans which was all over promed.

Hope this helps.

Amy

At 12:55 PM 12/19/2002 -0500, Komar, Nick wrote:
>Transmission of WNV to puppies from milk? I am aware of the published report
>on mouse pups where transmission via milk was suspected (but not proven).
>Is there other data out there we should know about? Has it been published?
>
>Thanks,
>
>Nick Komar
>
>-----Original Message-----
>From: McNamara, Tracey [mailto:tmcnamara@wcs.org]
>Sent: Thursday, December 19, 2002 10:42 AM
>To: epi@lpzoo.org; Amy Glaser (E-mail); Gubler, Duane J.; Bunning,
>Michael; Campbell, Grant L.; Komar, Nick
>Cc: LCL3@cornell.edu
>Subject: RE: [Fwd: Transplacental Transmission - Update on WNV in
>Pregnancy]
>
>
>Hello All -
>
>I could not agree more with Nick's comments. The issue of the possibility of
>vertical transmission is one I've raised repeatedly and presented at the
>symposium in White Plains last year as well as at the AAZV meeting. At the
>latter, I said that the WN morbidity and mortality seen to date could just
>be the "tip of the iceberg" in terms of it's impact on threatened and
>endangered species. Not only do I expect us to lose "survivors" to sequelae
>of infection (ie.cardiac fibrosis; ongoing neurodegenerative disease,etc)
>but, expect we may see an impact on the reproductive performance of some
>species.
>
> Based on the amount of antigen seen in ovarian tissue of dead birds, I
>recommended that unpipped eggs and/or newborn chicks should be tested for
>the presence of WNV and solicited samples from zoos.
>
> This past season, several chicks were lost at a zoo "down south" ( I will
>have to ask the contributors if they have a problem with being identified or
>not). The eggs had been hatched indoors in an incubator and chicks were
>presumably at low risk of mosquito exposure ( I say presumably because the
>building itself did not have any special mosquito proofing other than being
>indoors). The chicks died within 2 days of being put outdoors on exhibit and
>tested positive for WNV. To me, this represented possible vertical
>transmission given that the incubation period for time of infection to time
>of death in experimental trials has been longer than 2 days. My notes on
>these cases are at home - I'll forward details later.
>
>We ( Zoo/CDC network) asked zoos to submit frozen eggs for testing along
>with newly hatched chicks. Amy G. has a number of eggs in the freezers at
>Cornell pending testing. I have received 2 chicks for histopath and
>immunostaining and these are still being processed.
>
>As far as mammals are concerned, Amy cited the transmission of WNV to
>puppies from milk and I have seen and presented the finding of perivascular
>cuffing in the brains of a newborn snow leopard cub and a fur seal pup.
>Cannot prove these lesions were related to WNV but cannot rule it out
>either. Since that time, adult snow leopards have had documented infections
>and so has a marine mammal.
>
>Once again, findings in animals gave early clues to what is now being
>described in humans. Unfortunately, due to a lack of manpower, it has been
>impossible to pursue many of these important investigations. Speaking for
>myself, I am profoundly grateful for the funding and support we have
>received from you guys at CDC. On the other hand, it is also extraordinarily
>frustrating to be hampered by a lack of the level of funding that would have
>made it possible to address the questions we face in a more timely manner.
>All the more reason to ensure that the efforts to expand the Zoo Network to
>include other diagnostic labs(so the zoo samples can be tested and reported
>in real-time fashion) be pursued. In addition, funding for follow-up
>pathology on all known seropositive birds and mammals should be actively
>sought after as I suspect it will be the only way we will be able to get a
>preview into what long term effects WN infection may produce in the nervous
>system.
>
>
> -----Original Message-----
>From: Dominic Travis [mailto:epi@lpzoo.org]
>Sent: Thursday, December 19, 2002 11:08 AM
>To: McNamara, Tracey; Amy Glaser (E-mail); Gubler, Duane J.; Bunning,
>Michael; Campbell, Grant L.; Komar, Nick
>Subject: [Fwd: Transplacental Transmission - Update on WNV in
>Pregnancy]
>
>How does this affect our discussion of chick mortality in zoos and wildlife
>- or the ecology/spread of the
>disease in wildlife?????? Has anyone done a specific study in birds? We
>had numerous chicks die in LA last
>year that people thought were unlikely WNV candidates - maybe we should
>check their parents titers.
>
>Lois Levitan wrote:
>
>> An infant born in November to a woman who contracted WNV while
>> pregnant is hospitalized in Syracuse, New York -- one of the only
>> known cases of transplacental transmission (Onondaga Co Health Dept
>> Commissioner Press Release, December 18, 2002). The following story
>> is from the Syracuse morning newspaper. For background, see ERAP's
>> WestNileVirus-l listserv postings from Oct 13, 15, and 17, 2002. --
>> LCL
>>
>> The Syracuse Post-Standard
>> SYRACUSE INFANT GETS WEST NILE FROM MOM
>> CDC says it's the first case nationally where the virus was passed on to
>fetus.
>>
>> December 19, 2002
>> By Mark Weiner
>> Staff writer
>>
>> A Syracuse newborn has West Nile virus, surprising health officials
>> who believed the disease could not be passed from pregnant mothers to
>> their children.
>>
>> The month-old girl, who was treated at Crouse Hospital, is the
>> nation's first documented case of intrauterine transmission of West
>> Nile, federal health officials plan to announce today.
>>
>> Although the baby's life is not in danger, the viral infection may
>> have caused health problems affecting the infant's central nervous
>> system, according to a report from Onondaga County health officials.
>> The 20-year-old mother, who was diagnosed with the virus in
>> September, is recovering out of the hospital.
>>
>> The U.S. Centers for Disease Control and Prevention previously told
>> pregnant women there was no evidence that West Nile, a mosquito-borne
>> disease, could be transmitted during pregnancy or birth.
>>
>> Within the past few months, health officials also discovered the
>> virus can be transmitted through a mother's breast milk and through
>> blood transfusions.
>>
>> Onondaga County Health Commissioner Dr. Lloyd Novick, whose
>> department notified the CDC of the newborn case, said there is no
>> evidence that pregnant women are more susceptible to the virus. The
>> CDC has documented six cases of West Nile in pregnant women. None of
>> the women or children died.
>>
>> Novick said all pregnant women should continue to take the same
>> precautions as the general public to avoid mosquito bites. He said
>> mosquitoes are not a concern this time of year because most are dead
>> or inactive in Central New York.
>>
>> "We're talking about something that is of exceedingly low risk, so we
>> would not advise taking any new precautions," Novick said Wednesday.
>>
>> "We're not recommending screening of pregnant mothers," he said. "But
>> since this is the first time this has happened, people have to be
>> clinically aware of the possibility in the future."
>>
>> Federal health officials declined to comment on the case Wednesday.
>> Bernadette Burden, a spokeswoman at CDC headquarters in Atlanta, said
>> West Nile would be the topic of a national media briefing with its
>> doctors today.
>>
>> New York state health officials are looking closely at the Syracuse
>> case but don't plan any immediate change in strategy or advice
>> regarding the virus.
>>
>> "In terms of what this means, it's something we're going to have to
>> consider further," said Kristine Smith, spokeswoman for the state
>> health department in Albany. "Obviously, we will be looking closely
>> at the possible ramifications. During the past year, we have learned
>> much more about the possible modes of West Nile virus transmission."
>>
>> The virus first appeared in North America with a 1999 outbreak in New
>> York City. It has continued to spread across the nation, infecting
>> people in 40 states this summer. The CDC reported 3,829 cases as of
>> Dec. 11, with 225 deaths from the virus nationwide.
>>
>> New York had 80 cases and five deaths. Illinois (778 cases), Michigan
>> (546 cases), Ohio (431 cases) and Louisiana (323 cases) had the
>> biggest outbreaks this year.
>>
>> New York health officials, who were the first in the nation to detect
>> transfusion-related cases of the virus this fall, will consider all
>> of the new discoveries this winter while reassessing their strategy
>> for dealing with the disease.
>>
>> "These findings are very new, and we want to explore them with
>> national experts," Smith said.
>>
>> "As for recommendations for pregnant women, they would be the same
>> for any other person trying to avoid West Nile virus," she said.
>> "That's to try to avoid being bitten by a mosquito."
>>
>> Those concerned about the virus should eliminate standing water on
>> their property where mosquitoes can breed, wear long sleeves and
>> pants, use repellent and avoid the outdoors at dawn and dusk, Smith
>> said.
>>
>> Novick said the risk to pregnant women is the same as the general
>> population. West Nile virus is spread by the bite of an infected
>> mosquito, and can infect people, horses, many types of birds, and
>> some other animals.
>>
>> Most people who are bitten by an infected mosquito will have no
>> symptoms or only mild flu-like symptoms. On rare occasions, West Nile
>> virus can result in severe or fatal illnesses, including
>> encephalitis, an inflammation of the brain.
>>
>> There is no evidence to suggest that West Nile virus can be spread
>> from person to person or from animal to person. But now health
>> officials will have to look closer at the mother-to-child link,
>> Novick said.
>>
>> Late this summer, the CDC and the Michigan Department of Community
>> Health investigated the West Nile infection of a woman who received a
>> blood transfusion and then became ill with the virus. She breast fed
>> her healthy baby.
>>
>> Although the infant has remained healthy, a blood sample from the
>> infant showed antibodies to West Nile, indicating the baby had been
>> infected.
>>
>> "There has been very little experience with pregnancy and West Nile
>> virus," Novick said. "Generally, newborns do well with this type of
>> infection."
>>
>> Other cases have been documented of pregnant women who have passed
>> viruses similar to West Nile to their babies, Novick said.
>>
>> Japanese encephalitis and dengue, both mosquito-borne viruses, have
>> infected newborns in rare cases in Southeast Asia. Some of those
>> children died.
>>
>> The 20-year-old Syracuse woman lived on the city's Southwest Side
>> when she was infected this summer. Health officials declined to
>> identify her.
>>
>> The woman was in her 27th week of pregnancy when she was admitted to
>> Crouse Hospital on Aug. 29 with a two-day fever, severe headache,
>> blurred vision, vomiting, and abdominal and back pain. The woman was
>> released about a week later without her symptoms being attributed to
>> West Nile.
>>
>> When the woman later complained of muscle weakness, a symptom of the
>> virus, she was re-admitted to the hospital Sept. 24 and diagnosed
>> with West Nile virus. It was the first case in an expectant mother in
>> New York state. The woman gave birth in mid-November, carrying the
>> baby to full-term.
>>
>> Tests on her daughter's spinal fluid and the umbilical cord blood
>> "revealed there probably was a West Nile virus infection," Novick
>> said.
>>
>> Novick said the child has a number of health complications.
>>
>> "It's not possible to say definitively whether these complications
>> are a result of West Nile virus," he said. "But it's certainly a
>> possibility. The child's progress will need to be followed."
>>
>> The woman lived in the same Syracuse neighborhood as a 57-year-old
>> man who became ill with the virus on Aug. 27. The man was Central New
>> York's first West Nile case in history. Two other Onondaga County
>> residents were diagnosed this year.
>>
>> Health officials focused on the Syracuse neighborhood late in the
>> summer, going door to door to eliminate old tires, debris and other
>> potential mosquito breeding grounds.
>>
>> (c) 2002 The Post-Standard. Used with permission.
>> --
>> Lois Levitan, PhD Program Leader
>> Environmental Risk Analysis Program
>> Center for the Environment
>> 213 Rice Hall, Cornell University
>> Ithaca, New York USA 14853-5601
>>
>> Phone: (607) 255-4765 Fax: (607) 255-0238
>> Email: LCL3@cornell.edu
>>
>> Program Email: envrisk@cornell.edu
>> Web:http://www.cfe.cornell.edu/ERAP
>>
>>
>----------------------------------------------------------------------------
>-------------------------------
>> WESTNILEVIRUS-L is an email discussion group for communication
>> and discussion about West Nile Virus, particularly regarding policy,
>> risk reduction and public education issues. It is moderated by
>> Dr. Lois Levitan at Cornell University's Center for the Environment.
>> To subscribe (or unsubscribe), send an email request to
><envrisk@cornell.edu>.
>> Subscribers can post to the group by sending an email to:
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>> to submit information from their locale. Archives are posted at:
>> http://www.cfe.cornell.edu/erap/WNV/WNV-L_ArchiveIndex.html
>>
>----------------------------------------------------------------------------
>--------------------------------
>
>--
>Dominic Travis DVM, MS
>Veterinary Epidemiologist
>Lincoln Park Zoo
>Chicago, IL 60614
>(P) 312-742-7225
>(F) 312-742-7823
>
>
>
>

</x-flowed>
Received on Fri Dec 27 10:00:24 2002