title: Eastern equine encephalitis in Latin America.
abstract: BACKGROUND
  The eastern equine encephalitis (EEE) and Venezuelan equine encephalitis (VEE) viruses are pathogens that infect humans and horses in the Americas. Outbreaks of neurologic disease in humans and horses were reported in Panama from May through early August 2010.
  
  
  METHODS
  We performed antibody assays and tests to detect viral RNA and isolate the viruses in serum samples from hospitalized patients. Additional cases were identified with enhanced surveillance.
  
  
  RESULTS
  A total of 19 patients were hospitalized for encephalitis. Among them, 7 had confirmed EEE, 3 had VEE, and 1 was infected with both viruses; 3 patients died, 1 of whom had confirmed VEE. The clinical findings for patients with EEE included brain lesions, seizures that evolved to status epilepticus, and neurologic sequelae. An additional 99 suspected or probable cases of alphavirus infection were detected during active surveillance. In total, 13 cases were confirmed as EEE, along with 11 cases of VEE and 1 case of dual infection. A total of 50 cases in horses were confirmed as EEE and 8 as VEE; mixed etiologic factors were associated with 11 cases in horses. Phylogenetic analyses of isolates from 2 cases of equine infection with the EEE virus and 1 case of human infection with the VEE virus indicated that the viruses were of enzootic lineages previously identified in Panama rather than new introductions.
  
  
  CONCLUSIONS
  Cases of EEE in humans in Latin America may be the result of ecologic changes that increased human contact with enzootic transmission cycles, genetic changes in EEE viral strains that resulted in increased human virulence, or an altered host range. (Funded by the National Institutes of Health and the Secretaría Nacional de Ciencia, Tecnología e Innovación, Panama.).
authors: Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama.
authors: Jean-Paul
authors: JP
authors: Carrera
authors: Naomi
authors: N
authors: Forrester
authors: Eryu
authors: E
authors: Wang
authors: Amy Y
authors: AY
authors: Vittor
authors: Andrew D
authors: AD
authors: Haddow
authors: Sandra
authors: S
authors: López-Vergès
authors: Ivan
authors: I
authors: Abadía
authors: Elizabeth
authors: E
authors: Castaño
authors: Nestor
authors: N
authors: Sosa
authors: Carmen
authors: C
authors: Báez
authors: Dora
authors: D
authors: Estripeaut
authors: Yamilka
authors: Y
authors: Díaz
authors: Davis
authors: D
authors: Beltrán
authors: Julio
authors: J
authors: Cisneros
authors: Hector G
authors: HG
authors: Cedeño
authors: Amelia P
authors: AP
authors: Travassos da Rosa
authors: Humberto
authors: H
authors: Hernandez
authors: Alex O
authors: AO
authors: Martínez-Torres
authors: Robert B
authors: RB
authors: Tesh
authors: Scott C
authors: SC
authors: Weaver
mesh_terms: D000293:Adolescent; D000818:Animals; D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004663:Encephalitis Virus, Eastern Equine / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D004666:Encephalitis Virus, Venezuelan Equine / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D020242:Encephalomyelitis, Eastern Equine / Q000453:epidemiology / Q000662:veterinary; D004685:Encephalomyelitis, Venezuelan Equine / Q000453:epidemiology / Q000662:veterinary; D017809:Fatal Outcome; D005260:Female; D006734:Horse Diseases / Q000453:epidemiology; D006736:Horses; D006801:Humans; D007223:Infant; D008297:Male; D010176:Panama / Q000453:epidemiology; D010802:Phylogeny; D012367:RNA, Viral / Q000097:blood
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral
references: Virology. 2009 Aug 1;390(2):338-47
references: 19539968
references: Trop Geogr Med. 1972 Jun;24(2):162-7
references: 5037688
references: PLoS Pathog. 2011 Dec;7(12):e1002412
references: 22174678
references: Proc Natl Acad Sci U S A. 2004 Aug 3;101(31):11344-9
references: 15277679
references: N Engl J Med. 1997 Jun 26;336(26):1867-74
references: 9197215
references: PLoS Negl Trop Dis. 2009 Jun 30;3(6):e472
references: 19564908
references: Medicina (B Aires). 1991;51(1):3-8
references: 1921689
references: J Virol. 2008 Nov;82(21):10634-46
references: 18768986
references: Am J Trop Med Hyg. 1980 Jan;29(1):133-40
references: 7352621
references: Am J Trop Med Hyg. 1968 May;17(3):432-40
references: 5690051
references: J Infect Dis. 1973 Sep;128(3):271-82
references: 4728689
references: Emerg Radiol. 2004 Aug;11(1):46-8
references: 15309665
references: J Virol. 2008 May;82(10):4920-30
references: 18353963
references: Proc Natl Acad Sci U S A. 2006 Mar 28;103(13):4994-9
references: 16549790
references: BMC Bioinformatics. 2004 Aug 19;5:113
references: 15318951
references: Future Virol. 2011;6(6):721-740
references: 21765860
references: Emerg Infect Dis. 2010 Sep;16(9):1373-80
references: 20735920
references: J Virol. 2005 Sep;79(17):11300-10
references: 16103182
references: Clin Infect Dis. 1994 Jun;18(6):985-8
references: 8086564
references: J Virol Methods. 2001 Jun;95(1-2):153-61
references: 11377722
references: PLoS Pathog. 2007 Dec;3(12):e201
references: 18069894
references: Clin Vaccine Immunol. 2011 Sep;18(9):1486-91
references: 21752946
references: Am J Trop Med Hyg. 2007 Feb;76(2):293-8
references: 17297038
references: Am J Trop Med Hyg. 1970 Sep;19(5):860-5
references: 5453912