9

Dr Tuckweng Kok

Emerging viruses
H
ow does a new infectious disease or virus emerge?

Viral emergence
The interactions of the virus, host and the environment (viral ecology) can have profound effects on virus evolution. There are a number of mechanisms by which viruses, through interactions with the host, acquire new characteristics or adapt to a new host.

An emerging virus can be considered to be a new virus or an existing one which has increased its host range. Influenza and SARS viruses, amongst others, are examples of emerging viruses. The recent sudden and unpredicted outbreak of severe acute respiratory syndrome (SARS) affected more than 8000 people in Canada, China, Hong Kong, Singapore, Taiwan and Vietnam. The virus (either a new or existing coronavirus) acquired the ability to infect another host human beings. New strains of Influenza A viruses, causing major epidemics and pandemics, have emerged during the past century, and continue to emerge. The most notable pandemic was that of 1918 when more than 25 million people were infected. Indeed, some historians claim that the pandemic helped to end World War I.

Genetic mutation
Viruses are intracellular parasites that require the cells machinery for replication. During replication, mutations can occur that may result in a virus with increased virulence. RNA viruses, in particular, are known to be more mutable due to recombination or reassortment of their genetic materials. Influenza, human immunodeficiency virus (HIV), SARS and measles are all examples of RNA viruses. The interaction between a virus, the host and immune response is like a tugof-war. Sometimes the host wins and the virus is cleared, as in the common cold, an acute self-limiting infection.

At other times the virus wins and establishes a chronic, persistent infection without initially killing the host, for example HIV. Like other retroviruses HIV integrates its genetic material (the provirus) in the host chromosomal DNA. The provirus may remain quiescent in the cell. When trigger signals are received, a major up-regulation of proviral transcription can occur leading to vastly increased quantities of HIV being produced and resulting in host death. A virus may also acquire new genetic materials by recombination with other strains. Coronaviruses are known to have a high rate of recombination. The novel SARS coronavirus may have evolved through recombination in this way.

Increased host range

Nature provides a well balanced environment which maintains a dynamic equilibrium between the various interacting entities. However, the major thrust towards urbanisation in many developing countries, with its attendant increase in housing constructions, has led inevitably to perturbations in the balance between humans, animals and forest boundaries. One affect of this has been the increase in viral outbreaks from emerging viruses that have crossed from animal to human hosts. A recent example of an emergent virus from the forest/ urban boundary is the Nipah virus outbreak during 1998-99 in Malaysia (page 11). The vast majority of aquatic birds have asymptomatic carriage of influenza A viruses in their gastrointestinal tract.

IMVS Newsletter Number 50 Winter 2003

www.imvs.sa.gov.au
ISSN 0813-1643

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Continued from page 9
Strong evidence exists that pigs are the source for new mammalian influenza A reassortants and subsequent spread to humans. The practice of closely integrated farming of poultry and pigs in China is one of the strong contributors to potential new emerging strains of influenza A. Other emerging viruses, for example Rift Valley fever virus from East Africa, have resulted from the increase in construction of large dams and irrigation systems driven by increased agriculture. This mosquito-borne virus, is like many other arboviruses, an emerging virus. The increased use of open water storage systems for consumption or flood irrigations of rice fields, has led to increased breeding of mosquitoes and is one of the major contributors to emerging Dengue and Japanese Encephalitis viruses in Asia. The high population densities of many Asian countries has further contributed to the ease of transmission of these viruses by mosquitoes and caused severe morbidity and mortality throughout Asia. Dengue has also spread to the Americas as a result of increased trade and travel. The arboviruses have thus found a new host range by using humans as a vehicle for its spread. Preliminary findings have implicated the civet cat (a member of the squirrel family) as a likely reservoir for the SARS coronavirus. Close contacts, perhaps with farming of this animal for human consumption or extraction of its anal glands for the manufacture of perfume may have lead to this emergence. If subsequently confirmed, this provides another example of how emerging viruses may arise from human contacts/invasion of new animal territories. The spread of HIV, an emergent virus first recognised in 1981, has been assisted by increased social interactions sexual behaviour and exchange of infected needles amongst drug abusers. There are now more than 40 million people infected with this virus worldwide. With its ability to integrate in the host chromosome and thereby contribute to vertical, as well as horizontal transmission, the AIDS virus has used humans as vectors for its global spread.

in the news
Spinal research award
For the third time IMVS researchers have been awarded the worlds most prestigious prize for spinal research by the International Society for the Study of Lumbar Spine. The Advertiser (7th May 2003) reported that studies at the IMVS Adelaide Centre for Spinal Research involved mapping nerves in the spine. Researchers found that discs normally have only a meagre supply of nerves distributed around their periphery but may acquire additional nerves following damage to the outer regions. These findings suggest that back pain cannot originate from the central region of the disc because of the lack of a nerve supply essential for carrying the sensation. The study concluded that treatment of disc pain should focus on the outer region of the disc. This work is expected to lead to improved treatments for back pain. The experimental work was a collaborative effort involving the IMVS, RAH and University of Adelaide.

What can we do?

We cannot predict when new emerging viruses will cause such sudden outbreaks like SARS, influenza pandemics, AIDS, etc. The provision and use of rapid virus detection/ identification methods are essential for patient management, public health surveillance and control measures. The recent SARS outbreak has clearly shown the additional severe impact on business and trade, as well as the infinite cost of loss of human lives should we not be sufficiently prompt in recognising, detecting, identifying and controlling these outbreaks.

Did you know

These preventative approaches require multi-disciplinary interactions between the clinicians, laboratory, public health personnel, basic research and governments. Vaccines have proved effective in the prevention and control of many viral infections, e.g. influenza, measles, polio, smallpox, etc. However, the successful development and introduction of vaccines requires more research into understanding of the basic Total SARS cases biology of the specific to July 3rd 8439, virus and its interactions deaths 812. with the host. The dilemma of emerging viruses provides yet another example of the intimate integration of humans with the whole planetary environment, a fact easily overlooked in our highly urbanised cities.

Did you know

Most emergent viruses are zoonotic.

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IMVS Newsletter Number 50 Winter 2003