Viral Infections of Humans : Epidemiology and Control

also occurs. New outbreaks of yellow fever have occurred in Colombia and Trinidad and new outbreaks of rift valley fever have occurred in Egypt. Chapter 6, Arenaviruses: The biochemical and physical properties have now been clar­ ified, and they show a remarkable uniformity in the various viruses constituting the group. The possibility that prenatal infection with LCM may result in hydrocephalus and chorioretinitis has been raised. Serologic surveys have suggested the existence of Lassa virus infection in Guinea, Central African Empire, Mali, Senegal, Cameroon, and Benin, in addition to earlier identification in Nigeria, Liberia, and Sierra Leone. Chapter 7, Coronaviruses: New studies have confirmed the important role of these viruses in common respiratory illnesses of children and adults. The viruses are now known to contain a single positive strand of RNA. About 50% of corona virus infections result in clinical illness. About 5% of common colds are caused by strain DC 43 in winter. Chapter 8, Cytomegalovirus: Sections on pathogenesis of CMV in relation to organ transplantation and mononucleosis, as well as sections on the risk and features of con­ genital infection and disease, have been expanded. There are encouraging preliminary results with a live CMV vaccine, but the questions of viral persistence and oncogenicity require further evaluation.

I. Introduction and Concepts.- l Epidemiological Concepts and Methods.- 1. Introduction.- 2. Definitions and Methods.- 3. Epidemics.- 4. Investigation of an Epidemic.- 5. The Agent.- 6. The Environment.- 7. The Host.- 8. Routes of Transmission.- 8.1. Respiratory.- 8.2. Gastrointestinal.- 8.3. Skin.- 8.4. Genital.- 8.5. Intrauterine or Transplacental.- 8.6. Genitourinary.- 8.7. Personal Contact.- 8.8. Water and Food.- 8.9. Arthropod-Borne.- 9. Pathogenesis.- 9.1. Respiratory.- 9.2. Gastrointestinal.- 9.3. Systemic Infections.- 9.4. The Exanthem.- 9.5. Infections of the Central Nervous System.- 9.6. Persistent Viral Infections.- 10. Incubation Period.- 11. The Immune Response.- 11.1. Humoral Immunity.- 11.2. Local Immunity (Secretory IgA System).- 11.3. Cell-Mediated Immunity.- 11.4. Immune Responses in the Pathogenesis of Viral Diseases.- 12. Patterns of Host Responses.- 12.1. The Biological Gradient.- 12.2. Clinical Syndromes.- 13. Diagnosis of Viral Diseases.- 13.1. Collection.- 13.2. Requests for Testing.- 13.3. Tests Employed.- 13.4. Interpretation of Tests.- 14. Proof of Causation.- 15. Control and Prevention.- 15.1. Immunization.- 15.2. Chemoprophylaxis and Therapy.- 16. References.- 17. Suggested Reading.- 2 Surveillance and Seroepidemiology.- 1. Introduction.- 2. Surveillance.- 2.1. Historical Background.- 2.2. Elements of Surveillance.- 2.3. Other Surveillance Methods.- 2.4. Surveillance in Research Studies.- 2.5. Publications on Surveillance.- 2.6. Predictive Surveillance.- 3 Seroepidemiology.- 3.1. Introduction.- 3.2. Historical Background.- 3.3. Methodology.- 3.4. Advantages and Limitations.- 3.5. Uses of Seroepidemiology.- 4. References.- II. Acute Viral Infections.- 3 Adenoviruses.- 1. Introduction.- 2. Historical Background.- 3. Methodology Involved in Epidemiological Analysis.- 3.1. Sources of Data.- 3.2. Interpretation of Laboratory Tests.- 4. Characteristics of the Virus.- 5. Descriptive Epidemiology.- 5.1. Synopsis of Descriptive Epidemiology.- 5.2. Epidemiological and Clinical Aspects of Specific Syndromes.- 6. Mechanisms and Route of Transmission.- 7. Pathogenesis and Immunity.- 8. Patterns of Host Response.- 9. Control and Prevention.- 10. Unresolved Problems.- 11. References.- 12. Suggested Reading.- 4 African Hemorrhagic Fevers Due to Marburg and Ebola Viruses.- 1. Introduction.- 2. Historical Background.- 3. Methodology Used in Epidemiological Analysis.- 3.1. Sources of Morbidity and Mortality Data.- 3.2. Laboratory Diagnosis.- 3.3. Surveys.- 3.4. Clinical Diagnosis of Acute Infection.- 4. Characteristics of Marburg and Ebola Viruses.- 4.1. Morphology and Morphogenesis.- 4.2. Physical Properties.- 4.3. Chemical Properties.- 4.4. Biological Properties.- 4.5. Serological Relationships.- 5. Descriptive Epidemiology.- 5.1. Prevalence and Incidence.- 5.2. Epidemic Behavior and Contagiousness.- 5.3. Other Epidemiological Features.- 6. Mechanism and Route of Transmission.- 6.1. Spread of Virus.- 6.2. Reservoir.- 7. Pathogenesis and Immunity.- 7.1. In Guinea Pigs and Hamsters.- 7.2. In Nonhuman Primates.- 7.3. In Man.- 8. Patterns of Host Response.- 8.1. Clinical Features.- 8.2. Diagnosis.- 9. Prevention and Control.- 9.1. General Concepts.- 9.2. Management and Disposition of Patients.- 9.3. General Strategy for Isolation and Management of Suspect “Exotic” Infections.- 10. Unresolved Problems: Detection of Infection and Disease.- 11. References.- 12. Suggested Reading.- 5 Arboviruses.- 1. Introduction.- 2. Historical Background.- 3. Methodology Involved in Epidemiolgical Analysis.- 3.1. Sources of Mortality Data.- 3.2. Sources of Morbidity Data.- 3.3. Serological Surveys.- 3.4. Laboratory Methods.- 4. Biological Charactristics of the Virus That Affect the Epidemiological Pattern.- 5. Epidemiology.- 5.1. Incidence and Prevalence.- 5.2. Epidemic Behavior.- 5.3. Geographic Distribution.- 5.4. Temporal Distribution.- 5.5. Age and Sex.- 5.6. Other Factors.- 6. Mechanism and Route of Transmission.- 7. Pathogenesis and Immunity.- 8. Patterns of Host Response.- 8.1. Clinical Features.- 8.2. Diagnosis.- 9. Control and Prevention.- 10. Characteristics of Selected Arboviruses.- 10.1. Arboviruses of Importance in the United States.- 10.2. Other Arboviruses in the United States That Affect Human Beings.- 10.3. Arboviruses Outside the United States That Affect Human Beings.- 11. Unresolved Problems.- 11.1. The Viruses.- 11.2. The Vectors.- 11.3. The Vertebrate Hosts.- 11.4. Transmission Cycles Involving Virus, Vector, and Vertebrate.- 11.5. Disease in the Vertebrate Host.- 11.6. Control.- 12. References.- 13. Suggested Reading.- 6 Arenaviruses.- 1. Introduction.- 2. Historical Background.- 3. Methodology.- 3.1. Mortality.- 3.2. Morbidity.- 3.3. Serological Surveys.- 3.4. Laboratory Diagnosis.- 4. The Viruses.- 4.1. Biochemical and Physical Properties.- 4.2. Morphology and Morphogenesis.- 4.3. Antigenic Properties.- 4.4. Biological Properties.- 5. Pathogenesis and Immunity.- 6. Lymphocytic Choriomeningitis.- 6.1. Descriptive Epidemiology.- 6.2. Mechanism and Route of Transmission.- 6.3. Patterns of Host Response.- 6.4. Treatment and Prevention.- 7. Argentinian Hemorrhagic Fever.- 7.1. Descriptive Epidemiology.- 7.2. Mechanism and Route of Transmission.- 7.3. Patterns of Host Response.- 7.4. Treatment, Control, and Prevention.- 8. Bolivian Hemorrhagic Fever.- 8.1. Descriptive Epidemiology.- 8.2. Mechanism and Route of Transmission.- 8.3. Patterns of Host Response.- 8.4. Treatment, Prevention, and Control.- 9. Lassa Fever.- 9.1. Descriptive Epidemiology.- 9.2. Mechanism and Route of Transmission.- 9.3. Patterns of Host Response.- 9.4. Treatment and Disposition of Patients.- 9.5. Prevention and Control.- 10. Hemorrhagic Fever with Renal Syndrome.- 11. Unresolved Questions.- 11.1. Vaccines.- 11.2. Serum Therapy.- 11.3. Immunopathology.- 11.4. Geographic Distribution.- 12. References.- 13. Suggested Reading.- 7 Coronaviruses.- 1. Introduction.- 2. Historical Background.- 3. Methodology.- 3.1. Sources of Mortality Data.- 3.2. Sources of Morbidity Data.- 3.3. Serological Surveys.- 3.4. Laboratory Methods.- 4. Biological Characteristics of the Virus.- 5. Descriptive Epidemiology.- 5.1. Incidence and Prevalence.- 5.2. Geographic Distribution.- 5.3. Temporal Distribution.- 5.4. Age.- 5.5. Other Factors.- 6. Mechanisms and Routes of Transmission.- 7. Pathogenesis and Immunity.- 8. Patterns of Host Response.- 9. Control and Prevention.- 10. Unresolved Problems.- 11. References.- 12. Suggested Reading.- 8 Cytomegalovirus.- 1. Introduction.- 2. Historical Background.- 3. Methodology.- 3.1. Mortality.- 3.2. Morbidity.- 3.3. Serological Surveys.- 3.4. Laboratory Diagnosis.- 4. Biological Characteristics of the Virus.- 5. Descriptive Epidemiology.- 5.1. Prevalence and Incidence.- 5.2. Geographic Distribution.- 5.3. Age and Sex.- 5.4. Temporal Distribution.- 5.5. Occupation.- 5.6. Race and Socioeconomic Setting.- 6. Mechanism of Transmission.- 7. Pathogenesis and Immunity.- 7.1. Pathogenesis.- 7.2. Immunity.- 8. Patterns of Host Response.- 8.1. Neonatal Infections.- 8.2. Infection of Children and Adults.- 9. Immunization.- 10. Unresolved Problems.- 11. References.- 12. Suggested Reading.- 9 Enteroviruses.- 1. Introduction.- 2. Historical Background.- 3. Methodology Involved in Epidemiological Analysis.- 3.1. Sources of Mortality Data.- 3.2. Sources of Mobidity Data.- 3.3. Serological and Clinical Surveys.- 3.4. Virus Isolation from Surface Waters as an Indicator of Community Infections.- 3.5. Laboratory Methods.- 4. Biological Characteristics of the Virus That Affect the Epidemiological Pattern.- 4.1. General Properties.- 4.2. Reactions to Chemical and Physical Agents.- 4.3. Antigenic Characteristics.- 4.4. Host Range in Vivo and in Vitro.- 4.5. Replication of Enteroviruses.- 5. Descriptive Epidemiology.- 5.1. General Epidemiology of Enteroviruses.- 5.2. Epidemiological Patterns of Poliomyelitis.- 6. Mechanisms and Route of Transmission.- 7. Pathogenesis and Immunity.- 7.1. Pathogenesis.- 7.2. Immunity.- 8. Patterns of Host Response and Diagnosis.- 8.1. Clinical Syndromes.- 8.2. Diagnosis.- 9. Control and Prevention of Poliomyelitis.- 9.1. Killed Polio Vaccine.- 9.2. Live Attenuated Polio Vaccine.- 9.3. Conclusions on Polio Vaccines and Their Future Use.- 9.4. Current Status of Immunity against Poliomyelitis in the United States.- 9.5. “Social Failures” of Polio Vaccine Administration.- 9.6. Nonspecific Control Measures for Poliomyelitis.- 10. Control of Other Enterovirus Infections.- 11. Control of Enteroviruses in Water.- 12. Unresolved Problems.- 13. References.- 14. Suggested Reading.- 10 Epstein-Barr Virus.- 1. Introduction.- 2. Historical Background.- 3. Methodology.- 3.1. Mortality Data.- 3.2. Morbidity Data.- 3.3. Serological Surveys.- 3.4. Laboratory Methods.- 4. Biological Characteristics of the Agent.- 4.1. The Virus.- 4.2. Proof of Causation of Infectious Mononucleosis.- 5. Descriptive Epidemiology.- 5.1. Prevalence and Incidence.- 5.2. Epidemic Behavior.- 5.3. Geographic Distribution.- 5.4. Temporal Distribution.- 5.5. Age.- 5.6. Sex.- 5.7. Race.- 5.8. Occupation.- 5.9. Occurence in Different Settings.- 5.10. Socioeconomic Factors.- 5.11. Other Factors.- 6. Mechanism and Route of Transmission.- 7. Pathogenesis and Immunity.- 8. Patterns of Host Response.- 8.1. Clinical Features.- 8.2. Diagnosis.- 9. Control and Prevention.- 10. Unsolved Problems.- 11. References.- 12. Suggested Reading.- 11 Viral Gastroenteritis.- 1. Introduction.- 2. Historical Background.- 3. Methodology Involved in Epidemiological Analysis.- 3.1. Sources of Mortality Data.- 3.2. Sources of Morbidity Data.- 3.3. Serological Surveys.- 3.4. Laboratory Methods.- 4. Biological Characteristics.- 4.1. Norwalk Group of Viruses.- 4.2. Rotaviruses.- 5. Descriptive Epidemiology.- 5.1. Norwalk Group of Viruses.- 5.2. Rotaviruses.- 6. Mechanisms and Route of Transmission.- 6.1. Norwalk Group of Viruses.- 6.2. Rotaviruses.- 7. Pathogenesis and Immunity.- 7.1. Norwalk Group of Viruses.- 7.2. Rotaviruses.- 8. Patterns of Host Response.- 8.1. Norwalk Group of Viruses.- 8.2. Rotaviruses.- 9. Control and Prevention.- 9.1. Norwalk Group of Viruses.- 9.2. Rotaviruses.- 10. Unresolved Problems.- 10.1. Norwalk Group and Miscellaneous Enteric Agents.- 10.2. Rotaviruses.- 11. References.- 12. Suggested Reading.- 12 Viral Hepatitis.- 1. Introduction.- 2. Historical Background.- 3. Methodology Involved in Epidemiological Analysis.- 3.1. Mortality.- 3.2. Morbidity.- 3.3. Serological Surveys.- 3.4. Laboratory Methods.- 4. Biological Characteristics of the Human Hepatitis Viruses.- 4.1. Hepatitis A Virus.- 4.2. Hepatitis B Virus.- 4.3. Non-A, Non-B Hepatitis Viruses.- 5. Descriptive Epidemiology.- 5.1. Viral Hepatitis A.- 5.2. Viral Hepatitis B.- 5.3. Non-A, Non-B Viral Hepatitis.- 6. Mechanisms and Routes of Transmission.- 6.1. Viral Hepatitis A.- 6.2. Viral Hepatitis B.- 6.3. Non-A, Non-B Viral Hepatitis.- 7. Pathogenesis and Immunity.- 7.1. Viral Hepatitis A.- 7.2. Viral Hepatitis B.- 7.3. Non-A, Non-B Viral Hepatitis.- 8. Patterns of Host Response.- 8.1. Clinical Features.- 8.2. Primary Hepatocellular Carcinoma.- 8.3. Laboratory Diagnosis.- 9. Control and Prevention.- 9.1. Viral Hepatitis A.- 9.2. Viral Hepatitis B.- 9.3. Non-A, Non-B Viral Hepatitis.- 10. Unresolved Problems.- 11. References.- 12. Suggested Reading.- 13 Herpes Simplex Viruses 1 and 2.- 1. Introduction and Social Aspects.- 2. Evolutionary and Historical Background.- 3. Methodology Involved in Epidemiological Analysis.- 3.1. Mortality.- 3.2. Morbidity.- 3.3. Serological Surveys.- 3.4. Laboratory Diagnosis.- 4. Biological Characteristics of Herpes Simplex Viruses 1 and 2.- 5. Descriptive Epidemiology.- 5.1. General Epidemiology.- 5.2. Epidemiological Aspects of Specific Clinical Entities.- 6. Mechanisms and Routes of Transmission.- 7. Pathogenesis and Immunity.- 8. Patterns of Host Response.- 8.1. Mouth and Respiratory and Gastrointestinal Tracts.- 8.2. Lips.- 8.3. Eyes.- 8.4. Skin.- 8.5. Urogenital tract.- 8.6. Nervous System.- 8.7. Fetus and Newborn.- 9. Control and Prevention.- 9.1. Prevention of the Initial Infection.- 9.2. Reduction of the Source of Virus Transmissible to Others.- 10. Unresolved Problems.- 10.1. Reporting.- 10.2. Virological Aspects.- 10.3. Host Factors.- 10.4. Control and Prevention.- 11. References.- 12. Suggested Reading.- 14 Influenza Viruses.- 1. Introduction.- 2. Historical Background.- 3. Epidemiological Methodology.- 3.1. Mortality Data.- 3.2. Morbidity Data.- 3.3. Serological Surveys.- 3.4. Laboratory Methods.- 4. Biological Characteristics of the Virus.- 5. Descriptive Epidemiology.- 5.1. Incidence and Prevalence Data.- 5.2. Epidemic Behavior.- 5.3. Geographic Distribution.- 5.4. Temporal Distribution.- 5.5. Age.- 5.6. Other Factors.- 6. Transmission.- 7. Pathogenesis and Immunity.- 7.1. Pathogenesis..- 7.2. Immunity.- 8. Patterns of Host Response.- 8.1. Clinical Features.- 8.2. Diagnosis.- 9. Control Measures.- 10. Unresolved Problems..- 11. References.- 12. Suggested Reading.- 15 Measles.- 1. Introduction.- 2. Historical Background.- 3. Methodology Involved in Epidemiological Analysis.- 3.1. Sources of Mortality Data.- 3.2. Sources of Morbidity Data.- 3.3. Serological Surveys.- 3.4. Laboratory Methods.- 4. Biological Characteristics of the Virus.- 5. Descriptive Epidemiology.- 5.1. Incidence.- 5.2. Epidemic Behavior.- 5.3. Geographic Distribution.- 5.4. Temporal Distribution.- 5.5. Age.- 5.6. Sex.- 5.7. Race.- 5.8. Occupation.- 5.9. Social Setting.- 5.10. Socioeconomic Status.- 5.11. Nutrition.- 6. Transmission.- 7. Pathogenesis and Immunity.- 8. Patterns of Host Response.- 8.1. Clinical Features of Unusual Forms.- 8.2. Diagnosis.- 9. Control and Prevention.- 10. Unresolved Problems.- 10.1. Vaccine Distribution in Developing Countries.- 10.2. Eradication.- 10.3. Measles and Multiple Sclerosis.- 11. References.- 16 Mumps.- 1. Introduction.- 2. Historical Background.- 3. The Agent.- 4. Methodology Involved in Epidemiological Analysis.- 4.1. Sources of Data.- 4.2. Serological Surveys.- 4.3. Laboratory Methods.- 5. Descriptive Epidemiology.- 5.1. Incidence and Prevalence.- 5.2. Survey Data.- 5.3. Epidemic Behavior and Contagiousness.- 5.4. Geographic Distribution.- 5.5. Temporal Distribution.- 5.6. Age.- 5.7. Sex.- 5.8. Race and Occupation.- 5.9. Occurrence in Different Settings.- 5.10. Other Factors.- 6. Mechanisms and Routes of Transmission.- 7. Pathogenesis and Immunity.- 8. Patterns of Host Response.- 8.1. Common Clinical Features.- 8.2. Involvement of the Central Nervous System.- 8.3. Involvement of the Heart.- 8.4. Orchitis and Sterility.- 8.5. Mumps and Diabetes.- 8.6. Other Complications.- 9. Control and Prevention.- 10. Unresolved Problems.- 11. References.- 12. Suggested Reading.- 17 Parainfluenza Viruses.- 1. Introduction.- 2. Historical Background.- 3. Methodology Involved in Epidemiological Analysis.- 3.1. Sources of Mortality Data.- 3.2. Sources of Morbidity Data.- 3.3. Serological Surveys.- 3.4. Laboratory Methods.- 4. Biological Characteristics of the Virus That Affect the Epidemiological Pattern.- 5. Descriptive Epidemiology.- 5.1. Incidence and Prevalence Data.- 5.2. Epidemic Behavior.- 5.3. Geographic Distribution.- 5.4. Temporal Distribution.- 5.5. Age Distribution.- 5.6. Sex.- 5.7. Race and Occupation.- 5.8. Occurrence in Special Epidemiological Settings.- 5.9. Socioeconomic Status.- 6. Mechanisms and Routes of Transmission.- 7. Pathogenesis and Immunity.- 7.1. Pathogenesis.- 7.2. Immunity.- 8. Patterns of Host Response.- 8.1. Clinical Manifestations.- 8.2. Diagnosis.- 9. Control and Prevention Based on Epidemiological Data.- 10. Unresolved Problems.- 11. References.- 12. Suggested Reading.- 18 Rabies.- 1. Introduction.- 2. Historical Background.- 3. Methodology Involved in Epidemiological Analysis.- 3.1. Sources of Mortality Data.- 3.2. Sources of Morbidity Data.- 3.3. Serological Surveys.- 3.4. Laboratory Methods.- 4. Biological Ch...