Novel and emergent sandfly‐borne phleboviruses in Asia Minor: a systematic review

Abstract

Sandfly-transmitted phleboviruses are globally spread agents causing febrile diseases and central nervous system infections. The activity of pathogenic phleboviruses, as well as several novel strains, has been reported from Turkey, a transboundary country connecting Asia, Europe, and Africa with suitable habitats for sandflies. This study overviews all published data on phleboviruses from Turkey and evaluates the impact from the virological, epidemiological, and public health perspectives. A systematic review of Web-based global and local resources was performed. Comparison and phylogenetic analyses of particular phlebovirus sequences were also undertaken. Through the evaluation of 1693 international and regional entries, 31 manuscripts providing data on case reports or outbreaks, serological surveillance, animal infections and exposure, virus characterization, vector surveillance, and/or diagnostics were accessed. Detailed information on 5 novel phleboviruses completely or partially characterized during 2008-2015 as well as on clinical and epidemiological features of major phleboviruses established as human pathogens such as Toscana virus and sandfly fever Sicilian virus has been compiled. The ongoing activity of these agents, as indicated by consistently reported symptomatic cases and confirmed exposure in vertebrates including humans, was noted. The circulation in the Anatolian peninsula of phleboviruses with surprising diversity as well as distinct virus species is documented. Specific phlebovirus strains constitute a public health threat for local populations and travelers and must be considered in the diagnostic workup of clinically compatible cases. Human health impact and epidemiological aspects of certain viruses require further investigation via intensive surveillance.

High Rates of Neutralizing Antibodies to Toscana and Sandfly Fever Sicilian Viruses in Livestock, Kosovo

“…Our results are congruent with data from continental Greece, with rates in the same order of magnitude ( 12 ). All these findings verify the high prevalence of SFSV in the Mediterranean basin.…”

“…Because of the nature of this study, the serum was collected and stored under conditions that prevented attempts to detect viral RNA and isolate viral strains. SFSV remains an important human pathogen, as recently highlighted in Africa and Turkey ( 12 , 13 ). …”

NSs Protein of Sandfly Fever Sicilian Phlebovirus Counteracts Interferon (IFN) Induction by Masking the DNA-Binding Domain of IFN Regulatory Factor 3

“…SFSV later proved to be one of the most widespread phleboviruses; it is present across the entire Mediterranean basin, in Portugal, in the Middle East inclusive of the Arabian peninsula, in Sudan, in Ethiopia, and in Somalia and in locations as distant as India and Bangladesh ( 12 – 18 ). In regions of endemicity, seroprevalence can reach levels of up to 50% in humans and close to 80% in dogs and other domestic animals, including cattle ( 12 , 14 , 19 , 20 ). Hence, sandfly fever viruses are recognized as a significant public health threat, predominantly for immunologically naive groups such as soldiers or travelers ( 21 – 24 ).…”

Emergent Sand Fly–Borne Phleboviruses in the Balkan Region

“…The fall of communism, the breakup of the former Yugoslavia, and the following civil war and other climatic and environmental changes resulted in an increase of zoonotic infections that emerged or reemerged in the Balkans ( 28 ). As previously suggested for North Africa and in Turkey, it is time to organize systematic testing of patients with CNS infections or unexplained febrile illness for such viruses in clinical microbiology laboratories in hospitals ( 35 – 37 ).…”