| 1. |
- Wallensten, Anders, et al.
(författare)
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Surveillance of influenza A virus in migratory waterfowl in northern Europe
- 2007
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Ingår i: Emerging Infectious Diseases. - 1080-6040 .- 1080-6059. - 1080-6040 ; 13:3, s. 404-411
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Tidskriftsartikel (refereegranskat)abstract
- We conducted large-scale, systematic sampling of influenza type A virus in migratory waterfowl (mostly mallards [Anas platyrhynchos]) at Ottenby Bird Observatory, southeast Sweden. As with previous studies, we found a higher prevalence in fall than spring, and among juveniles compared with adults. However, in contrast to other studies, we found that prevalence in spring was sometimes high (mean 4.0%, highest 9.5%). This finding raises the possibility that ducks are capable of perpetuating influenza A virus of different subtypes and subtype combinations throughout the year and from 1 year to the next. Isolation of the H5 and H7 subtypes was common, which suggests risk for transmission to sensitive domestic animals such as poultry. We argue that wild bird screening can function as a sentinel system, and we give an example of how it could have been used to forecast a remote and deadly outbreak of influenza A in poultry.
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| 2. |
- Bry, Kristina, 1953, et al.
(författare)
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Communication skills training enhances nurses' ability to respond with empathy to parents' emotions in a neonatal intensive care unit
- 2016
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 105:4, s. 397-406
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Tidskriftsartikel (refereegranskat)abstract
- AimWe quantitatively analysed the effect of a course in communication on the content of nurse-parent encounters and the ability of nurses to respond to the empathic needs of parents in a level III neonatal intensive care unit. MethodsWe evaluated 36 and 45 nurse-parent encounters audio recorded before and after 13 neonatal nurses attended a communication course. The number of empathic opportunities, the nurses' responses to these and the ways they involved parents in their infants' care were studied. ResultsBoth before and after the course, the nurses talked more than the parents during the conversations. This nurse-centredness decreased after the course. The use of empathic or exploring responses to empathic opportunities increased from 19.9 9.0% to 53.8 +/- 8.9% (p = 0.027), whereas ignoring the feelings of the parents or giving inadequate advice decreased from 63.0 +/- 10.0% to 27.5 +/- 8.4% (p = 0.043) after the course. Use of statements expressing caring for the parents and encouragement for parents to participate in the care of their infant increased after the course (p = 0.0034 and p = 0.043, respectively). The nurses felt the course was very useful for their profession. ConclusionA course in communication techniques improved nurses' ability to respond to parents' feelings with empathy.
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| 3. |
- Haemig, Paul, et al.
(författare)
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Red fox and tick-borne encephalitis (TBE) in humans: Can predators influence public health?
- 2008
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 40:6-7, s. 527-532
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Tidskriftsartikel (refereegranskat)abstract
- Analysing datasets from hunting statistics and human cases of tick-borne encephalitis (TBE), we found a positive correlation between the number of human TBE cases and the number of red fox (Vulpes vulpes). Time lags were also present, indicating that high numbers of red fox in 1 y translated into high numbers of human TBE cases the following y. Results for smaller predators were mixed and inconsistent. Hares and grouse showed negative correlations with human TBE cases, suggesting that they might function as dilution hosts. Combining our findings with food web dynamics, we hypothesize a diversity of possible interactions between predators and human disease – some predators suppressing a given disease, others enhancing its spread, and still others having no effect at all. Larger-sized predators that suppress red fox numbers and activity (i.e. wolf, Canis lupus; European lynx, Lynx lynx) were once abundant in our study area but have been reduced or extirpated from most parts of it by humans. We ask what would happen to red foxes and TBE rates in humans if these larger predators were restored to their former abundances.Read More: http://informahealthcare.com/doi/abs/10.1080/00365540701805446
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| 4. |
- Holmen, Carolina, et al.
(författare)
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A Swedish national post-marketing surveillance study of natalizumab treatment in multiple sclerosis
- 2011
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Ingår i: Multiple Sclerosis Journal. - : SAGE Publications. - 1477-0970 .- 1352-4585. ; 17:6, s. 708-719
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Tidskriftsartikel (refereegranskat)abstract
- Background: A post marketing surveillance study was conducted to evaluate safety and efficacy of natalizumab in Swedish multiple sclerosis (MS) patients since its introduction in August 2006 until March 2010. Methods: Patients were registered in the web-based Swedish MS-registry at 40 locations and evaluated every 6 months. Adverse events and clinical outcomes were recorded. Results: One thousand one hundred and fifty-two patients were included (71.4% female) and 149 patients stopped treatment; the main reason was planned pregnancy. Anti-natalizumab antibodies were found in 4.5% (52 patients) of which 1.6% displayed persistent antibodies. Serious adverse events were rare, but included three cases with progressive multifocal leukoencephalopathy (PML). There were seven fatal cases, probably unrelated to the natalizumab treatment. For relapsing-remitting MS patients (n = 901), mean Expanded Disability Status Scale (EDSS, -10.7%), Multiple Sclerosis Severity Scale (MSSS, -20.4%), Multiple Sclerosis Impact Scale (MSIS-29, physical -9.9%, psychological -13.3%) and Symbol Digit Modalities Test (SDMT, +10.7%) all showed significant improvements during 24 months of treatment with natalizumab. The Swedish web-based MS quality registry proved to function as a platform for post-marketing MS drug surveillance, providing long-term data regarding drug effects and adverse events beyond clinical trials. Conclusions: Our results indicate that natalizumab is generally well tolerated and has sustained efficacy for patients with active MS, though the risk of PML is still an important concern.
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| 5. |
- Jourdain, Elsa, et al.
(författare)
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Surveillance for West Nile virus in wild birds from northern Europe.
- 2011
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Ingår i: Vector Borne and Zoonotic Diseases. - : Mary Ann Liebert Inc. - 1530-3667 .- 1557-7759. ; 11:1, s. 77-79
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Tidskriftsartikel (refereegranskat)abstract
- A total of 1935 migratory birds from 104 different species were captured in southeastern Sweden in 2005-2006 and tested for antibodies against West Nile virus (WNV). Overall, 46 birds (2.4%; binomial confidence limits, 1.8-3.2) were positive by blocking-ELISA, but only 2 (0.10%; binomial confidence limits, 0.0-0.4) had antibodies detectable by both blocking-ELISA and WNV neutralization test. ELISA-positive birds included long- and short-distance migrants likely exposed to WNV while wintering in or migrating through areas enzootic for WNV. Exposure to a cross-reactive Flavivirus was suspected for short-distance migrants of the Turdidae family, but no cross-neutralization with tick-borne encephalitis and Usutu viruses was observed.
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| 6. |
- Karlsson, Malin, et al.
(författare)
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A real-time PCR assay for the monitoring of influenza a virus in wild birds
- 2007
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Ingår i: Journal of Virological Methods. - : Elsevier BV. - 0166-0934 .- 1879-0984. ; 144:1-2, s. 27-31
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Tidskriftsartikel (refereegranskat)abstract
- A screening system including a new real-time PCR assay for the monitoring of influenza A virus in wild birds was developed. The real-time PCR assay uses SYBR green chemistry and the primers are targeting the matrix gene of influenza A virus. The performance of the assay was compared with two other assays, one assay also using SYBR green chemistry and one assay using TaqMan chemistry, i.e. a specific probe. A total of 45 fecal bird samples were analysed for influenza A virus in three different PCR reactions. Overall, 26 samples were positive in at least one of the three real-time PCR assays. Of the 26 samples, 18 were positive by all three reactions. Eight samples were found positive exclusively by the two SYBR green reactions, six of which were detected by both SYBR green reactions. Of the 26 positive samples, 15 samples were verified as positive either by virus isolation or influenza A M2-gene PCR. The results showed that the two SYBR green systems had a higher performance regarding the detection of influenza A as compared to the PCR reaction using a specific probe.
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| 7. |
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| 8. |
- Klingström, Jonas, et al.
(författare)
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Loss of cell membrane integrity in puumala hantavirus-infected patients correlates with levels of epithelial cell apoptosis and perforin.
- 2006
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Ingår i: Journal of Virology. - 0022-538X. ; 80:16, s. 8279-82
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Tidskriftsartikel (refereegranskat)abstract
- Hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome are two diseases caused by hantaviruses. Capillary leakage is a hallmark of hantavirus infection. Pathogenic hantaviruses are not cytotoxic, but elevated levels of serum lactate dehydrogenase (LDH), indicative of cellular damage, are observed in patients. We report increased levels of serum perforin, granzyme B, and the epithelial cell apoptosis marker caspase-cleaved cytokeratin-18 during Puumala hantavirus infection. Significant correlation was observed between the levels of LDH and perforin and the levels of LDH and caspase-cleaved cytokeratin-18, suggesting that tissue damage is due to an immune reaction and that epithelial apoptosis contributed significantly to the damage.
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| 9. |
- Klingström, Jonas, et al.
(författare)
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Passive immunization protects cynomolgus macaques against Puumala hantavirus challenge.
- 2008
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Ingår i: Antiviral Therapy. - 1359-6535 .- 2040-2058. ; 13:1, s. 125-33
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Hantaviruses cause two severe and often fatal human diseases: haemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). Presently, there is no effective prevention available for HFRS or HPS. Here, we studied the effect of passive immunization on the course of infection in cynomolgus macaques challenged with wild-type Puumala hantavirus (PUUV-wt). METHODS: A pool of serum drawn from previously PUUV-wt-infected monkeys was used for immunization; a pool of serum from the same monkeys that was obtained before infection was used as a control. Immunizations were administered 3 days before and 15 days after challenge with PUUV-wt. After challenge, monkeys were sampled once a week and analysed for PUUV-infection markers. RESULTS: All three monkeys treated with non-immune serum became positive for PUUV RNA in plasma and showed PUUV nucleocapsid-specific immunoglobin M (IgM) responses after challenge. In contrast, no PUUV RNA or anti-PUUV-specific IgM response was detected in the three passively immunized monkeys. As seen in PUUV-infected humans, the control monkeys showed a marked decrease in the amount of platelets and increased levels of creatinine, interleukin (1L)-6, IL-10, and tumour necrosis factor (TNF) after inoculation. In contrast, no marked changes in the amount of platelets were observed in the immunized monkeys and they did not show increased levels of creatinine, IL-6, IL-10 and TNF after virus challenge. CONCLUSION: The results show that passive immunization in monkeys, using serum from previously hantavirus-infected monkeys, can induce sterile protection and protect against pathogenesis. Convalescent-phase antibodies may represent a potential therapy that can induce immediate protection against HFRS and HPS.
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| 10. |
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| 11. |
- Lundqvist, Martin, et al.
(författare)
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The nanoparticle protein corona formed in human blood or human blood fractions
- 2017
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:4
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Tidskriftsartikel (refereegranskat)abstract
- The protein corona formed around nanoparticles in protein-rich fluids plays an important role for nanoparticle biocompatibility, as found in several studies during the last decade. Biological fluids have complex compositions and the molecular components interact and function together in intricate networks. Therefore, the process to isolate blood or the preparation of blood derivatives may lead to differences in the composition of the identified protein corona around nanoparticles. Here, we show distinct differences in the protein corona formed in whole blood, whole blood with EDTA, plasma, or serum. Furthermore, the ratio between particle surface area to protein concentration influences the detected corona. We also show that the nanoparticle size per se influences the formed protein corona due to curvature effects. These results emphasize the need of investigating the formation and biological importance of the protein corona in the same environment as the nanoparticles are intended for or released into.
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| 12. |
- Nordström, Malin, 1967-, et al.
(författare)
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Klinisk digital innovation : Principer och språkbruk för klinisk digitaliseringsförmåga
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Digitalisering och innovation är två metoder som ofta nämns i samband med utveckling av vården. Utmaningen är grannlaga inte minst eftersom det handlar om att styra mot ett rörligt mål som definieras av ett samhälle i förändring, men vården har också ett ständigt tillflöde av kunskap genom forskning och kvalitetsarbete. Även den explosionsartade användningen av teknik i samhället sätter förväntansnivåer hos såväl medborgare, patienter som vårdpersonal och forskare. I den här rapporten undersöker vi hur informatisk innovation (benämnd digitalisering) kan användas som instrument i vårdens förändringsarbete. Rapporten bygger på en studie av Innovationslabbet för eHälsa, som via en initial finansiering från Vinnova, etablerades på Karolinska Universitetssjukhuset 2013–2016. Arbetet i innovationslabbet har varit explorativt, i linje med beviljad ansökan, och genom följeforskning har vi studerat innovationsverksamheten genom 25 innovationsberättelser som författas av innovationslabbets medarbetare. Frågeställningarna har handlat förmågor i en digital plattform såväl som organisatorisk innovationsförmåga i form av strukturer, metoder och relationella mekanismer. Arbetet har genomsyrats av praktikforskning och varit indelat i tre faser: I. prövning och generering av frågeställningar II. Utforskande i teori och praktik III. Analys och rapportering. Vi betraktar denna rapport som en delrapportering av en pågående kunskapsutveckling om innovation inom vård och omsorg. Resultatet från studien visar att digital plattformsförmåga och organisatorisk innovationsförmåga måste integreras för att uppnå klinisk digitaliseringsförmåga. Om detta skall vara möjligt måste det förhärskande produktperspektivet överges till förmån från ett mer verksamhetsorienterat perspektiv, där vårdgivare har möjlighet att utveckla verksamheten baserat på behov hos patienter och vårdpersonal snarare än att fokusera på implementation av nya tekniska produkter. Våra studier och erfarenheter visar att, visst behövs nya digitala plattformar för att möta framtidens utmaningar, men det är minst lika viktigt att skapa en organisatorisk innovationsförmåga som kan hantera förändring i klinisk verksamhet när nya digitala verktyg ska utvecklas och implementeras. Utforskandet av en digital plattformsförmåga som kan stödja detta dynamiska arbetssätt visar att en plattform bör ha förmåga till processorkestrering, semantikkonvertering, MT/IT-integration samt förmågan att suga ut data från olika källsystem i syfte att skapa kliniska beslutsstöd. När det gäller strukturer för innovation argumenterar vi för innovationsarenor där legitimitet är ett centralt begrepp. Om innovation ska användas som metod i vårdens förändringsarbete, måste innovation göras legitimt. Vårt förslag att göra övergången från innovationsarenor till förvaltningsstyrning är att tillämpa genererade principer för innovationsförvaltning. Gemensamt för både innovationsarenor och innovationsförvaltning är en professionsstyrning där aktiva kliniker och systemutvecklare interagerar, i syfte att nyskapa. Vi vill även lyfta fram Triple Helix som samarbetsform, men betona vikten av ett gemensamt mål för att undvika konflikter i mål och värden.När det gäller innovationsmetoder vill vi särskilt lyfta fram alternativa metoder som innovationsupphandling, proof of concepts, nätverkande, matchning och crowdsourcing. Digitala innovationer är flerdimensionella och ett kunskapsbidrag från studien är metoden för innovationsrymd, som på ett enkelt, men ändå kraftfullt sätt kan ”spänna upp” det flerdimensionella i digitala innovationer med fokus på värde. Vi lyfter också fram de relationella mekanismer vi sett är nödvändiga för att skapa innovation. Det är lätt att tekniken hamnar i fokus i digitaliseringssammanhang, men vi vill betona att det faktiskt är människor som agerar på innovationsarenor. Med en ömsesidig respekt för profession och uppdrag, inte minst genom att fokusera ett gemensamt mål, visar vår studie att det är möjligt att bedriva innovation i gränslandet vårdteknik, befintligt-nytt och kund-leverantör.
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| 13. |
- Stoltz, Malin, et al.
(författare)
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A model system for in vitro studies of bank vole borne viruses
- 2011
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 6:12
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Tidskriftsartikel (refereegranskat)abstract
- The bank vole (Myodes glareolus) is a common small mammal in Europe and a natural host for several important emerging zoonotic viruses, e.g. Puumala hantavirus (PUUV) that causes hemorrhagic fever with renal syndrome (HFRS). Hantaviruses are known to interfere with several signaling pathways in infected human cells, and HFRS is considered an immune-mediated disease. There is no in vitro-model available for infectious experiments in bank vole cells, nor tools for analyses of bank vole immune activation and responses. Consequently, it is not known if there are any differences in the regulation of virus induced responses in humans compared to natural hosts during infection. We here present an in vitro-model for studies of bank vole borne viruses and their interactions with natural host cell innate immune responses. Bank vole embryonic fibroblasts (VEFs) were isolated and shown to be susceptible for PUUV-infection, including a wild-type PUUV strain (only passaged in bank voles). The significance of VEFs as a model system for bank vole associated viruses was further established by infection studies showing that these cells are also susceptible to tick borne encephalitis, cowpox and Ljungan virus. The genes encoding bank vole IFN-β and Mx2 were partially sequenced and protocols for semi-quantitative RT-PCR were developed. Interestingly, PUUV did not induce an increased IFN-β or Mx2 mRNA expression. Corresponding infections with CPXV and LV induced IFN-β but not Mx2, while TBEV induced both IFN-β and Mx2.In conclusion, VEFs together with protocols developed for detection of bank vole innate immune activation provide valuable tools for future studies of how PUUV and other zoonotic viruses affect cells derived from bank voles compared to human cells. Notably, wild-type PUUV which has been difficult to cultivate in vitro readily infected VEFs, suggesting that embryonic fibroblasts from natural hosts might be valuable for isolation of wild-type hantaviruses.
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| 14. |
- Stoltz, Malin, et al.
(författare)
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Lambda interferon (IFN-lambda) in serum is decreased in hantavirus-infected patients, and in vitro-established infection is insensitive to treatment with all IFNs and inhibits IFN-gamma-induced nitric oxide production.
- 2007
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Ingår i: Journal of Virology. - 0022-538X .- 1098-5514. ; 81:16, s. 8685-91
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Tidskriftsartikel (refereegranskat)abstract
- Hantaviruses, causing hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS), are known to be sensitive to nitric oxide (NO) and to pretreatment with type I and II interferons (alpha interferon [IFN-alpha]/IFN-beta and IFN-gamma, respectively). Elevated serum levels of NO and IFN-gamma have been observed in HFRS patients, but little is known regarding the systemic levels of other IFNs and the possible effects of hantaviruses on innate antiviral immune responses. In Puumala virus-infected HFRS patients (n = 18), we report that the levels of IFN-alpha and IFN-beta are similar, whereas the level of IFN-lambda (type III IFN) is significantly decreased, during acute (day of hospitalization) compared to the convalescent phase. The possible antiviral effects of IFN-lambda on the prototypic hantavirus Hantaan virus (HTNV) replication was then investigated. Pretreatment of A549 cells with IFN-lambda alone inhibited HTNV replication, and IFN-lambda combined with IFN-gamma induced additive antiviral effects. We then studied the effect of postinfection treatment with IFNs. Interestingly, an already-established HTNV infection was insensitive to subsequent IFN-alpha, -beta, -gamma, and -lambda stimulation, and HTNV-infected cells produced less NO compared to noninfected cells when stimulated with IFN-gamma and IL-1beta. Furthermore, less phosphorylated STAT1 after IFN treatment was observed in the nuclei of infected cells than in those of noninfected cells. The results suggest that hantavirus can interfere with the activation of antiviral innate immune responses in patients and inhibit the antiviral effects of all IFNs. We believe that future studies addressing the mechanisms by which hantaviruses interfere with the activation and shaping of immune responses may bring more knowledge regarding HFRS and HCPS pathogenesis.
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| 15. |
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| 16. |
- Voutilainen, Liina, et al.
(författare)
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Life-long shedding of Puumala hantavirus in wild bank voles (Myodes glareolus)
- 2015
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Ingår i: Journal of General Virology. - : Society for General Microbiology. - 0022-1317 .- 1465-2099. ; 96:6, s. 1238-1247
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Tidskriftsartikel (refereegranskat)abstract
- The knowledge of viral shedding patterns and viraemia in the reservoir host species is a key factorin assessing the human risk of zoonotic viruses. The shedding of hantaviruses (familyBunyaviridae) by their host rodents has widely been studied experimentally, but rarely in naturalsettings. Here we present the dynamics of Puumala hantavirus (PUUV) shedding and viraemia innaturally infected wild bank voles (Myodes glareolus). In a monthly capture–mark–recapturestudy, we analysed 18 bank voles for the presence and relative quantity of PUUV RNA in theexcreta and blood from 2 months before up to 8 months after seroconversion. The proportion ofanimals shedding PUUV RNA in saliva, urine and faeces peaked during the first month afterseroconversion, but continued throughout the study period with only a slight decline. The quantityof shed PUUV in reverse transcription quantitative PCR (RT-qPCR) positive excreta was constantover time. In blood, PUUV RNA was present for up to 7 months but both the probability of viraemiaand the virus load declined with time. Our findings contradict the current view of a decline in virusshedding after the acute phase and a short viraemic period in hantavirus infection – anassumption widely adopted in current epidemiological models. We suggest the life-long sheddingas a means of hantaviruses to survive over host population bottlenecks, and to disperse infragmented habitats where local host and/or virus populations face temporary extinctions. Ourresults indicate that the kinetics of pathogens in wild hosts may differ considerably from thoseobserved in laboratory settings.
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| 17. |
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| 18. |
- Wallerström, Sofie, et al.
(författare)
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Detection of antibodies against H5 and H7 strains in birds : evaluation of influenza pseudovirus particle neutralization tests
- 2014
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Ingår i: Infection Ecology & Epidemiology. - : Informa UK Limited. - 2000-8686. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Avian influenza viruses circulate in bird populations, and it is important to maintain and uphold our knowledge of the viral strains that are currently of interest in this context. Here, we describe the use of hemagglutinin-pseudotype retroviruses based on highly pathogenic influenza viruses for the screening of avian sera for influenza A antibodies. Our aim was also to determine whether the pseudovirus neutralization tests that we assessed were sensitive and simple to use compared to the traditional methods, including hemagglutination inhibition assays and microneutralization tests.MATERIAL AND METHODS: H5 and H7 pseudovirus neutralization tests were evaluated by using serum from infected rabbits. Subsequently, the assays were further investigated using a panel of serum samples from avian species. The panel contained samples that were seropositive for five different hemagglutinin subtypes as well as influenza A seronegative samples.RESULTS AND DISCUSSION: The results suggest that the pseudovirus neutralization test is an alternative to hemagglutination inhibition assays, as we observed comparable titers to those of both standard microneutralizations assays as well as hemagglutinin inhibition assays. When evaluated by a panel of avian sera, the method also showed its capability to recognize antibodies directed toward low-pathogenic H5 and H7. Hence, we conclude that it is possible to use pseudoviruses based on highly pathogenic avian influenza viruses to screen avian sera for antibodies directed against influenza A subtypes H5 and H7.
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