Résumé
Dans les infections à arbovirus transmises par des moustiques, les formes inapparentes chez l’Homme sont beaucoup plus fréquentes que les formes apparentes, mais leur rôle réel dans l’introduction et la diffusion ultérieure de ces infections dans les régions non endémiques reste à préciser. Nous avons recueilli les données utiles à la compréhension de ce problème dans la littérature scientifique, de 1952 à 2010, grâce à Pubmed et à d’autres sources bibliographiques. Ces données ont été analysées dans l’optique de déterminer si, dans les infections inapparentes humaines à arbovirus, la virémie pouvait être suffisante pour constituer un risque réel d’introduction de ces infections dans des régions jusque-là indemnes. Au cours des épidémies de dengue et d’infections à virus chikungunya (CHIKV), on pense que l’Homme est le seul hôte vertébré concerné. Puisqu’un très grand nombre d’individus sont infectés et puisque les taux de virémie varient considérablement chez les malades symptomatiques, il est raisonnable de penser que, dans un certain nombre de formes inapparentes, le taux de virémie pourrait être suffisant pour infecter des moustiques compétents. Par ailleurs, dans la dengue et les infections à CHIKV, des infections nosocomiales ont été identifiées, représentant un mode alternatif d’introduction des virus dans des régions indemnes. Dans les arboviroses zoonotiques transmises par des moustiques comme l’encéphalite japonaise ou les infections à virus West Nile (WNV), la situation est bien différente puisque l’Homme est considéré comme une impasse épidémiologique. Toutefois, si l’on tient compte du très grand nombre de formes inapparentes survenant chez l’Homme au cours des épidémies et de l’existence de modes de contamination nouveaux récemment identifiés (transfusion sanguine, greffe d’organes, voie transplacentaire), l’introduction de ces arboviroses peut ainsi être assurée dans des régions jusque-là épargnées.
Abstract
In mosquito-borne arbovirus infections in man the asymptomatic cases are much more frequent than the symptomatic ones, but their true role in the introduction and subsequent spread of such diseases in non-endemic areas remains to be clarified. We have collected pertinent data from English and French literature from 1952 to 2010 through Pubmed and other bibliographic sources. Data were analysed to assess if viremia in asymptomatic human arbovirus infections might be sufficient to represent a true risk for introduction in non-endemic areas. During dengue and chikungunya fever outbreaks, humans are believed to be the only vertebrate hosts. Since a very large number of individuals are infected and since viremic levels are known to vary by many orders of magnitude in symptomatic patients, it is reasonable to augur that a proportion of asymptomatic cases might reach levels of viremia sufficient to infect competent mosquitoes. Moreover, in both dengue and chikungunya fever, nosocomial infections have been identified representing an alternative opportunity for virus introduction in non-endemic areas. In zoonotic mosquito-borne arbovirus infections such as Japanese encephalitis or West Nile infection, the situation is quite different since humans are considered as “dead-end” hosts. However, the very large number of asymptomatic cases arising during outbreaks and the existence of newly recognised ways of contamination (blood transfusion, organ transplantation, transplacental way etc.) may also ensure their introduction and subsequent spread in new areas.
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Chastel, C. Infections inapparentes chez l’Homme : un cheval de Troie pour l’introduction et la diffusion des arbovirus transmis par des moustiques dans les régions non endémiques ?. Bull. Soc. Pathol. Exot. 104, 213–219 (2011). https://doi.org/10.1007/s13149-011-0165-1
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DOI: https://doi.org/10.1007/s13149-011-0165-1
Mots clés
- Arbovirus transmis par des moustiques
- Infections inapparentes chez l’Homme
- Risques d’introduction en région non endémique
- Dengue
- Chikungunya
- Encéphalite japonaise
- West Nile
- Fièvre de la Vallée du Rift