Exposure to wild primates among HIV-infected persons.HIV-1 is an immunosuppressive Immunosuppressive Any agent that suppresses the immune response of an individual. Mentioned in: Antirheumatic Drugs, Graft-vs.-Host Disease, Immunosuppressant Drugs immunosuppressive 1. pertaining to or inducing immunosuppression. 2. pathogen. Our behavioral data for 191 HIV-1-infected rural Cameroonians show frequent exposure to nonhuman primates through activities such as hunting and butchering. Immunosuppression immunosuppression Suppression of immunity with drugs, usually to prevent rejection of an organ transplant. Its aim is to allow the recipient to accept the organ permanently with no unpleasant side effects. among persons exposed to body fluids of wild nonhuman primates could favor the process of adaptation and subsequent emerqence of zoonotic Zoonotic A disease which can be spread from animals to humans. Mentioned in: Zoonosis pathogens. ********** Worldwide, [approximately equal to] 1% of the population is immunodeficient. Although immunodeficiency has numerous causes, such as malnutrition or iatrogenic iatrogenic /iat·ro·gen·ic/ (i-a´tro-jen´ik) resulting from the activity of physicians; said of any adverse condition in a patient resulting from treatment by a physician or surgeon. medical therapies for cancer and organ transplantation The transfer of organs such as the kidneys, heart, or liver from one body to another. The transplantation of human organs has become a common medical procedure. Typical organs transplanted are the kidneys, heart, liver, pancreas, cornea, skin, bones, and lungs. , the most significant factor globally is HIV-1 infection (1). In 2006, [approximately equal to] 40 million persons were infected with HIV-1, and >50% were in sub-Saharan Africa, where AIDS caused 2.1 million deaths (2). Immunodeficiency resulting from HIV-1 infection renders the host susceptible to infections usually controlled by cellular immunity cellular immunity n. See cell-mediated immunity. through unrelenting loss of CD4+ T-helper lymphocytes. This susceptibility predisposes affected persons to common disease-causing pathogens such as Mycobacterium tuberculosis Mycobacterium tuberculosis n. Tubercic bacillus. Mycobacterium tuberculosis , Salmonella spp., Coccidioides spp., and Histoplasma spp. Other pathogens that are rarely pathogenic for immunocompetent im·mu·no·com·pe·tent adj. Having the normal bodily capacity to develop an immune response following exposure to an antigen. im persons, such as Cytomegalovirus cytomegalovirus (sī'təmĕg'əlōvī`rəs), member of the herpesvirus family that can cause serious complications in persons with weakened immune systems. , human herpesvirus-8, Pneumocystis Pneumocystis /Pneu·mo·cys·tis/ (-sis´tis) a genus of yeastlike fungi. P. cari´nii is the causative agent of interstitial plasma cell pneumonia. pneu·mo·cys·tis n. spp., Cryptococcus Cryptococcus /Cryp·to·coc·cus/ (-kok´us) a genus of yeastlike fungi, including C. neofor´mans, the cause of cryptococcosis in humans.cryptococ´cal Cryp·to·coc·cus n. spp., and M. avium complex, also become common causes of disease. HIV-1--induced immunosuppression has also been proposed as a factor affecting the global emergence and reemergence of diseases (1,3). Among emerging infectious diseases in humans, [approximately equal to] 75% are caused by zoonotic pathogens (4), highlighting the potentially important risk for zoonotic exposures for HIV-1-infected populations. Central African forests, where hunting and butchering nonhuman primates are common practices, provide a ripe environment for zoonotic transmission (5). These areas have fostered human acquisition of Ebola (6,7), monkeypox (8), simian immunodeficiency viruses (9), simian foamy viruses (10), and primate T-lymphotropic viruses (11). Because HIV-1 infection is epidemic in Africa, persons involved in hunting and butchering of wild animals WILD ANIMALS. Animals in a state of nature; animals ferae naturae. Vide Animals; Ferae naturae. (including nonhuman primates) are possibly HIV-1-infected and thus at risk for successful infection with novel zoonotic viral infections. Additionally, HIV-1-induced immunosuppression in the wider community poses an additional risk for secondary transmission that could facilitate early viral adaptation to humans (12). The Study As part of a community-based HIM-1 prevention campaign, February 2001-January 2003, we collected oral questionnaire data about basic demographics and behavior associated with exposure to the blood or body fluids of wild animals. In addition, blood samples were collected and transported to a central laboratory for HIV testing. We present behavioral data pertaining to animal exposures of HIV-1-infected persons in 17 rural villages in Cameroon (5). These are key sites for the emergence of nonhuman primate retroviruses because of the high levels of human contact with wild nonhuman primates (5) and cross-species transmission of simian foamy virus (10) and primate T-lymphotropic viruses (11). Study participation was voluntary and performed under a protocol approved by the Johns Hopkins Committee for Human Research, the Cameroon National Ethical Review Board and the HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. Tri-Services Secondary Review Board. A single project assurance was obtained from the Cameroonian Ministry of Health and accepted by the National Institutes of Health Office for Protection from Research Risks. HIV testing was performed by using an ELISA/Western blot algorithm. The ORTHO HIV1/2 (ORTHO Clinical Diagnostics Gmbh, Neckargemund, Germany) ELISA ELISA (e-li´sah) Enzyme-Linked Immuno-Sorbent Assay; any enzyme immunoassay using an enzyme-labeled immunoreactant and an immunosorbent. ELISA n. was used as the screening test, and the HIV Blot 2.2 (Genelabs Diagnostics, Singapore) Western blot assay was used for confirmation. Complete questionnaire data and plasma samples were collected from 3,955 persons, of whom 46.3% were female and 53.7% were male. Age range was 16-97 years (42% 16-30, 27% 31-45, 21% 46-60, and 10% >60 years). Screening for HIV-1 infection found 191 seropositive seropositive /se·ro·pos·i·tive/ (-poz´i-tiv) showing positive results on serological examination; showing a high level of antibody. se·ro·pos·i·tive adj. persons (prevalence 4.8% overall, 1.9%-16.3% from the 17 sites), of whom 60.2% were female and 39.8% were male. No persons were HIV-2 seropositive. The HIV-1-infected persons were examined in greater detail. Within the younger age group (16-30 years), women were overrepresented o·ver·rep·re·sent·ed adj. Represented in excessive or disproportionately large numbers: "Some groups, and most notably some races, may be overrepresented and others may be underrepresented" ; among persons >30 years of age, the number of infected men and women was similar (Figure 1). Of the HIV-1-infected persons, 89.0% reported having lived in a major city or another country, compared with 82.8% of the HIV-negative study population). Agricultural activities were reported as daily activities by 46.6% of the HIV-1--positive persons; household activities, by 22.0%; and fishing, by 13.6%. Hunting was reported as a daily activity by 12.6%, and contact with wild animals was reported by an even higher proportion. Among HIV-1-positive persons, 79.6% reported butchering wild animals (as many as 20x per month), 26.2% reported hunting wild animals (also as many as 20x per month), 12.6% reported having kept a wild animal as a pet, and 95.8% reported eating wild animals (Figure 2). [FIGURE 1 OMITTED] HIV-1-infected persons had significant contact with nonhuman primates; hunting of these species was reported by 11.0%. Monkeys were hunted up to 10x per month (median 3x per month); chimpanzees and gorillas were hunted less frequently (always <1 x per month). In terms of butchering, 55.5% reported butchering nonhuman primates: monkeys [less than or equal to] 10x per month (median l x per month), chimpanzees 2x per month (median <1 x per month), and gorillas [less than or equal to] 1 x per month. Furthermore, 8.4% of HIV-1--infected persons reported keeping nonhuman primates as pets, and 83.8% reported eating nonhuman primates. Other direct animal exposures were reported by HIV-1--infected persons (Table); bites or scratches from wild animals were reported by 12.0% and from nonhuman primates by 2.6%. Although 4.7% of persons reported having received injuries during hunting and butchering, none reported having received injuries during hunting or butchering of nonhuman primates. However, 1.7% of the rural population in this area reports such injuries (5). Conclusions These data demonstrate an overlap of areas where HIV-1 is epidemic and areas where human-nonhuman primate contact is common. This overlap is cause for concern because humans and nonhuman primates share susceptibility to a range of pathogens, and the potential for successful cross-species transmission from nonhuman primates to humans is considered great (5). Access to treatment for HIV1 infection is improving but is limited in remote central African communities; progressive disease and immunosuppression develop in most persons in these areas. Exposure of immunocompromised immunocompromised /im·mu·no·com·pro·mised/ (-kom´pro-mizd) having the immune response attenuated by administration of immunosuppressive drugs, by irradiation, by malnutrition, or by certain disease processes (e.g., cancer). persons to nonhuman primates poses ongoing opportunities for zoonotic viruses to leap to humans, and the high concentration of other immunocompromised hosts offers an increased risk for secondary transmission and adaptation to humans. The emergence of HIV-1 is an example of such a process; data suggest several abortive nonhuman primate-to-human transmission events before eventual establishment of the HIV pandemic pandemic /pan·dem·ic/ (pan-dem´ik) 1. a widespread epidemic of a disease. 2. widely epidemic. pan·dem·ic adj. Epidemic over a wide geographic area. n. . This foothold gained by HIV-1 may now offer a boost for other pathogens to enter the human population. Moreover, the prevalence of HIV-1 in rural areas is lower than that in adjacent urban communities in Cameroon (13) and may increase. Such circumstances are not limited to central Africa; recent reports from Asia have demonstrated the risk for zoonotic infections with nonhuman primate viruses (14,15). And although nonhuman primates may present particular risks for disease emergence, HIV-associated immunosuppression likely increases the risk for acquisition, adaptation, and emergence of zoonoses Zoonoses Infections of humans caused by the transmission of disease agents that naturally live in animals. People become infected when they unwittingly intrude into the life cycle of the disease agent and become unnatural hosts. infecting other animals that are hunted extensively in these communities (Figure 2), such as monkeypox and hantaviruses in rodents and Lyssavirus in bats. [FIGURE 2 OMITTED] The risk for emergence of novel zoonotic infections in rural hunting communities should be considered in healthcare policy. Community health education and HIV/AIDS HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome counseling should account for the fact that many persons in these communities rely on wild animals for food and household income. Targeted interventions could include culturally appropriate suggestions for avoiding handling or butchering of wild animals, such as developing alternative food sources, or taking precautions if such activities are necessary. Reducing the prevalence of HIV-1--induced immunosuppression through prevention and treatment and minimizing zoonotic exposures will be crucial for preventing future outbreaks of novel viral pathogens in humans. Acknowledgments We thank the staff of the Johns Hopkins Cameroon Program and the US Embassy in Yaounde for assistance and the Government of Cameroon for permission to undertake this study. This work was supported by the US Military HIV Research Program, the National Institutes of Health (NIH "Not invented here." See digispeak. NIH - The United States National Institutes of Health. ) Fogarty International Center (International Research Scientist Development Award Grant no. 5 K01 TW000003-05 and AIDS International Training and Research Program Grant no. 2 D 43 TW00001017-AITRP), the NIH Director's Pioneer Award Program (grant no. DP1-OD000370), the W.W. Smith Charitable Trust, National Geographic Society National Geographic Society U.S. scientific society founded in 1888 in Washington, D.C., by a small group of eminent explorers and scientists “for the increase and diffusion of geographic knowledge. Committee for Research and Exploration, the Johns Hopkins Center for AIDS Research, and the Johns Hopkins Center for a Livable Future. References (1.) Morens DM, Folkers GK, Fauci AS. The challenge of emerging and re-emerging infectious diseases. Nature. 2004;430:242-9. (2.) Joint United Nations Program on HIV/AIDS and the World Health Organization. AIDS epidemic update: December 2006. Geneva Geneva, canton and city, Switzerland Geneva (jənē`və), Fr. Genève, canton (1990 pop. 373,019), 109 sq mi (282 sq km), SW Switzerland, surrounding the southwest tip of the Lake of Geneva. : The Program and The Organization; 2006. p. 1-90. [cited 2007 July 12]. Available from http://www.unaids.org/en/hiv_data/epi2006 (3.) Morris JG Jr, Potter M. Emergence of new pathogens as a function of changes in host susceptibility. Emerg Infect Dis. 1997;3:435-41. (4.) Taylor LH, Latham SM, Woolhouse MEJ MEJ Mouvement Eucharistique des Jeunes (Organistion Catholique) MEJ Meadville, Pennsylvania (Airport Code) . Risk factors for human disease emergence. Philos Trans R Soc Lond B Biol Sci. 2001;356:983-9. (5.) Wolfe ND, Prosser AT, Carr JK, Tamoufe U, Mpoudi-Ngole E, Ndongo Torimiro J, et al. Exposure to nonhuman primates in rural Cameroon. Emerg Infect Dis. 2004; 10:2094-9. (6.) Leroy EM, Rouquet P, Formenty P, Souquiere S, Kilbourne A, Froment JM, et al. Multiple Ebola virus transmission events and rapid decline of central African wildlife. Science. 2004;303:387-90. (7.) Rouquet P, Froment JM, Bermejo M, Yaba P, Delicat A, Rollin PE, et al. Wild animal mortality monitoring and human Ebola outbreaks, Gabon and Republic of Congo, 2001-2003. Emerg Infect Dis. 2005;11:283-90. (8.) Jezek Z, Arita I, Mutombo M, Dunn C, Nakano JH, Szczeniowski M. Four generations of probable person-to-person transmission of human monkeypox. Am J Epidemiol. 1986;123:1004-12. (9.) Hahn BH, Shaw GM, De Cock KM, Sharp PM. AIDS as a zoonosis Zoonosis Definition Zoonosis, also called zoonotic disease refers to diseases that can be passed from animals, whether wild or domesticated, to humans. : scientific and public health implications. Science. 2000;287: 607-14. (10.) Wolfe ND, Switzer WM, Carr JK, Bhullar VB, Shanmugam V, Tamoufe U, et al. Naturally acquired simian retrovirus retrovirus, type of RNA virus that, unlike other RNA viruses, reproduces by transcribing itself into DNA. An enzyme called reverse transcriptase allows a retrovirus's RNA to act as the template for this RNA-to-DNA transcription. infections in central African hunters. Lancet. 2004;363:932-7. (11.) Wolfe ND, Heneine W, Carr JK, Garcia AD, Shanmugam V, Tamoufe U, et al. Emergence of unique primate T-lymphotropic viruses among central African bushmeat Bushmeat (calque from the French viande de brousse) is the term commonly used for meat of terrestrial wild animals, killed for subsistence or commercial purposes throughout the humid tropics of the Americas, Asia and Africa. hunters. Proc Natl Acad Sci U S A. 2005;102:7994-9. (12.) Antia R, Regoes RR, Koella JC, Bergstrom CT. The role of evolution in the emergence of infectious diseases. Nature. 2003;426:658-61. (13.) Anonymous. Health and demographic survey III. Report by Government of the Republic of Cameroon Noun 1. Republic of Cameroon - a republic on the western coast of central Africa; was under French and British control until 1960 Cameroun, Cameroon capital of Cameroon, Yaounde - the capital of Cameroon Douala - the largest city of Cameroon , 2004. (14.) Engel G, Hungerford LL, Jones-Engle L, Travis DA, Eberle R, Fuentes A, et al. Risk assessment: a model for predicting cross-species transmission of simian loamy loam n. 1. Soil composed of a mixture of sand, clay, silt, and organic matter. 2. A mixture of moist clay and sand, and often straw, used especially in making bricks and foundry molds. tr.v. virus from macaques (M. fascicularis) to humans at a monkey temple in Bali, Indonesia. Am J Primatol. 2006;68:934-48. (15.) Jones-Engel L, Engel G, Schillaci MA, Rompis ALT, Putra A, Suaryana K, et al. Primate-to-human retroviral transmission in Asia. Emerg Infect Dis. 2005;11:1028-35. Matthew LeBreton, * Otto Yang, ([dagger]) Ubald Tamoufe, * Eitel Mpoudi-Ngole, ([double dagger]) Judith N. Torimiro, * Cyrille F. Djoko, * Jean K. Carr, ([section]) A. Tassy Prosser, ([paragraph]) Anne W. Rimoin, ([dagger]) Deborah L. Birx, ([paragraph]) Donald S. Burke, # and Nathan D. Wolfe ([dagger]) * Johns Hopkins Cameroon Program, Yaounde, Cameroon; ([dagger]) University of California, Los Angeles UCLA comprises the College of Letters and Science (the primary undergraduate college), seven professional schools, and five professional Health Science schools. Since 2001, UCLA has enrolled over 33,000 total students, and that number is steadily rising. , California, USA; ([double dagger]) Army Health Research Center, Yaounde, Cameroon; ([section]) University of Maryland Biotechnology Institute “UMBI” redirects here. For the Japanese Marine Biological Institute, see Usa Marine Biological Institute. Formed in 1985, the University of Maryland Biotechnology Institute (UMBI) is part of the University System of Maryland. , Baltimore, Maryland, USA; ([paragraph]) Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. , Atlanta, Georgia, USA; and # University of Pittsburgh, Pittsburgh, Pennsylvania, USA Address for correspondence: Nathan D. Wolfe, Department of Epidemiology, UCLA School of Public Health The UCLA School of Public Health is the graduate school of public health affiliated with UCLA, and is located within the Center for Health Sciences building on the UCLA campus. UCLA is located in the Westwood neighborhood of Los Angeles, California. , 650 Charles E. Young Dr. Charles E. "Chuck" Young is currently Chancellor Emeritus and Professor at the UCLA School of Public Affairs. Under his skillful leadership and guidance, UCLA went from a regional college with an operating budget of $170 million to became a world class institution with expenses Dr S, CHS (Cylinder Head Sector) An earlier method of addressing a hard disk by referencing all three physical elements of the drive. It was superseded by logical block addressing (see LBA). 71-279B, Box 177220, Los Angeles, CA 90095-1771, USA; email: nwolfe@ucla UCLA University of California at Los Angeles UCLA University Center for Learning Assistance (Illinois State University) UCLA University of Carrollton, TX and Lower Addison, TX .edu The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the Centers for Disease Control and Prevention or the institutions with which the authors are affiliated. Mr LeBreton is a wildlife ecologist who works with the Johns Hopkins Cameroon Program. His research interests include the interactions among the fields of public health, ecology, and conservation.
Table. Injuries from wild animals received by HIV-positive persons
in 17 rural villages in Cameroon, February 2001-January 2003
Participant Age,
code y Sex Injury Animal
CAM2476LE 40 M Bite or scratch Chimpanzee
CAM4401KO 30 M Bite or scratch Monkey
CAM1231NG 37 M Bite or scratch Monkey, snake
CAM2177SA 32 F Bite or scratch Monkey, snake
CAM0989MO 16 F Bite or scratch Gorilla
CAM1188NG 19 M Injury on finger Not recorded
CAM2602ND 46 F Many injuries on finger Not recorded
CAM0212MA 45 M Machete injury on finger Antelope
during butchering
CAM1669LE 44 M Injury on hand during Antelope
butchering
CAM2888HA 26 F Injuries on hand during Antelope
butchering
CAM2931HA 17 F Injured during butchering Antelope
CAM2162SA 30 M Bite or scratch Crocodile
CAM0074NY 48 M Machete injury during Pangolin
butchering
CAM2418LE 40 M Bite or scratch Pangolin
CAM1788LE 24 F Bite or scratch Pangolin
Injured on finger during Snake
butchering
CAM1172NG 59 F Bite or scratch Rodent
CAM2387LE 33 F Bite or scratch Rodent
CAM3503MB 40 M Injuries on leg during Rodent
butchering
CAM3569MB 25 M Bite or scratch Rodent
CAM4434KO 41 M Bite or scratch Rodent
CAM4225YI 38 M Bite or scratch Insects
CAM4233YI 22 F Bite or scratch Snails
CAM0908MO 39 M Bite or scratch Snake
CAM1590LE 31 M Bite or scratch Snake
CAM1970LE 28 F Bite or scratch Snake
CAM2190SA 65 F Bite or scratch Snake
CAM2345LE 30 F Bite or scratch Snake
CAM2378LE 52 F Bite or scratch Snake
CAM2973HA 40 F Bite or scratch Snake
CAM3674SO 32 M Bite or scratch Snake
CAM4020MU 32 M Bite or scratch Snake
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