Reported human cases in the USA have increased from 26 (1999 to 2009) to 186 (2010 to 2020) (Centers for Disease Control and Prevention 2023). POWV can cause severe encephalitis leading to permanent neurological sequelae in 50 per cent of patients and death in 10 per cent ( Ebel 2010 Krow-Lucal et al. Powassan virus (POWV) is an emerging tick-borne flavivirus endemic to North America and Far Eastern Russia. Tick-borne flavivirus, emerging virus, phylodynamics, Powassan virus, deer tick virus 1. Finally, we isolated sixteen novel viruses in cell culture and demonstrated limited genetic change after passage, a valuable resource for future studies investigating this emerging virus. This is concordant with the documented expansion of Ixodes scapularis tick populations and suggests an increasing risk of human exposure as the vector spreads. A Bayesian skyline analysis demonstrated DTV population expansion over the last 50 years. We observed both stable infection in the Northeast USA and patterns of geographic dispersal within and between regions. High-depth, whole-genome sequencing of eighty-four POWV and DTV samples allowed us to assess geographic and temporal phylodynamics. We detected DTV-positive ticks from eight of twenty locations in the Northeast USA with an average infection rate of 1.4 per cent. Here, we use a multifaceted approach to evaluate the emergence of the II POWV lineage, known as deer tick virus (DTV), in parts of North America where human cases occur. Powassan virus (POWV Flaviviridae: Flavivirus), the only known North American tick-borne flavivirus, is of particular concern due to rising cases and the severe morbidity of POWV encephalitis. ![]() The burden of ticks and the pathogens they carry is increasing worldwide.
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