Page 103 - 2020 JSOM Winter

been described. Indeed, a fatal case of an immunocompetent Study Population
elderly patient resulting from primary viral pneumonia caused Military personnel aged ≥18 years who were referred to the
by HBoV has been reported in Japan. Such reports under- infectious diseases department of the Military Hospital with
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score the need for military medical providers to be familiar signs or symptoms of acute respiratory infection were offered
with HBoV and suggest that the incorporation of an assay to to voluntarily participate in the study. Each study subject gave
detect this virus into the protocols for the diagnosis of cases of a written informed consent. The study was approved by the
acute respiratory infection is warranted. 12 institutional review boards of the Military Hospital and the
Walter Reed Army Institute of Research. Patients <18 years
At present, HBoV is mainly detected using molecular tech- old and illiterate subjects were excluded (the current literacy
niques such as polymerase chain reaction (PCR) and reverse rate in Georgia is 99% ).
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transcriptase–PCR. This method detects the presence of viral
genetic material and is indicative of a current infection. Sero- Study Procedure
logic methods can also be used to detect the presence of anti- Participants were asked to complete a standardized epidemi-
bodies to the virus, but this method is not routine because of ologic questionnaire at the time of enrollment. The question-
the complexity of the procedure and lack of commercial kits naire included demographic data (e.g., gender, travel history,
and standardized procedures. Further, serologic testing is in- contact with animals, date of illness) and clinical data (e.g., signs
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dicative only of previous exposure to the virus and cannot be and symptoms, duration of illness, secondary complications).
used to identify the presence of an active infection. Molecular This study did not alter the diagnosis or treatment procedures
testing for the presence of HBoV in a recent study in Spain regularly conducted at the Military Hospital.
involved the analysis of more than 3000 nasopharyngeal as-
pirates and revealed the presence of this virus in 319 patients One nasal swab and one throat swab were obtained at the
(9.9%). Eighty of those tests (25%) detected HBoV as a sin- time of enrollment. Once a week, samples were transferred
gle pathogen, and 239 (75%) detected HBoV as a coinfection to the US Army Medical Research Directorate in Georgia lab
with other viruses. A similar study conducted in central Rus- for testing and archiving. This laboratory is located in Tbilisi,
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sia involved the screening of more than 5500 stool samples of at the Lugar Center for Public Health Research. Before test-
children with gastroenteritis for HBoV. Viral DNA consistent ing, all samples were at stored at –80°C (–112°F). Both nasal
with HBoV was found in 1.2% of the samples. In addition, it and throat swab samples were tested using a multiplex PCR
was found that coinfection was most frequently detected with platform developed by Fast-Track Diagnostics (Alzette, Lux-
rotavirus A and norovirus GII, both of which are recognized as embourg), which detects the following pathogens: influenza
common causes of acute gastroenteritis. Significantly, HBoV A, H1N1, influenza B, rhinovirus, coronavirus NL63, 229E,
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has been detected in healthy human blood, including blood OC43, HKU1, parainfluenza types 1, 2, 3, and 4, human
collected from healthy blood donors. This is concerning be- metapneumovirus A/B, respiratory syncytial virus A/B, adeno-
cause of the heavy reliance of the military healthcare system on virus, enterovirus, parechovirus, and HBoV. All laboratory
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donated blood for the stabilization and treatment of combat testing was performed following the manufacturer’s instruc-
casualties. Indeed, one study revealed that of 300 donor blood tions for the use of the Fast-Track platform.
samples that were screened for HBoV, 21 were positive. It is
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important to note that, at present, there is no restriction on the Results
use HBoV positive blood or blood products for patient care
and that testing for HBoV is not a routine practice in most To determine whether HBoV is circulating in the military pop-
blood banks and blood donor centers. 17 ulation in the country of Georgia, a cohort of military person-
nel presenting to the Military Hospital with acute respiratory
There is currently no information about HBoV prevalence in illness was enrolled into the study. Between January and De-
the country of Georgia. This is concerning, given that respira- cember 2016, 95 subjects were enrolled. Only one subject was
tory viruses are known to have a negative impact on military a female. The mean age of the subjects was 24 years. All pa-
operational readiness. In this sentinel surveillance study, we tients presented with flu-like symptoms. The highest detected
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evaluated military personnel who were referred to the Geor- temperature was 39.8°C (103.6°F), and 92% of subjects had a
gian Military Hospital with influenza-like symptoms for the fever (>38°C [>100.4°F]) at the time of presentation. None of
presence of HBoV. In addition, we screened all samples with the subjects had been vaccinated against influenza, and 30%
a panel of common respiratory viruses. HBoV was detected of the subjects required hospitalization.
in 11 of 95 respiratory samples (12%) that were collected for
this study. This is the first detection of HBoV in the country Nasal and throat swabs were collected from each subject. The
of Georgia, and the results indicate that this virus is currently presence of DNA consistent with HBoV or a panel of common
circulating among the military population and that it is most respiratory viruses was detected using a multiplex PCR assay.
likely circulating among the Georgian population. HBoV was found to be positive in 11 of the 95 subjects (12%).
Both nasal and throat swabs were positive in only one patient
(1%). The nasal swab alone was found to be positive for six
Methods
subjects (6%), and only the throat swab was positive in four
Study Site subjects (4%). Subtypes of the virus were not defined.
The Georgian Military Hospital, located in the city of Gori,
was selected as the study site. This hospital provides medi- The symptoms experienced by subjects with positive HBoV
cal service for Georgian military personnel from throughout detections did not differ markedly from those of the total
the country. In case of an outbreak of acute respiratory illness study population (Table 1). Some differences included the
(ARI), the infectious disease department of the Military Hos- presence of cough, runny eyes, ringing in the ears, malaise,
pital manages both inpatient and outpatient cases. dizziness, and sinus pain, all of which were found to be slightly

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