TBE Virus and Its Subtypes
TBE virus is a single-stranded RNA virus in the genus Flavivirus, family Flaviviridae (4). TBE virus is closely related to Powassan virus, a tickborne flavivirus transmitted in parts of the United States (5). The three main antigenic subtypes of TBE virus (i.e., European, Siberian, and Far Eastern) differ in the severity of disease they cause and geographic distribution (6). The principal geographic distribution of the European subtype virus is in parts of western and northern Europe through to the eastern European countries; the Siberian subtype virus is in Siberia and the Ural and European parts of Russia; and the Far Eastern subtype virus is in Japan, China, Mongolia, and the eastern parts of Russia; however, subtype virus distributions overlap substantially (69). Genomic studies have indicated two additional minor subtype viruses (i.e., Baikalian and Himalayan) (10,11).
TBE virus is primarily transmitted to humans by the bites of infected Ixodes sp. ticks but can also be acquired less frequently by alimentary transmission. Other rare modes of transmission include through breastfeeding, blood transfusion, solid organ transplantation, and slaughtering of viremic animals. Nymphs and adult ticks are believed to be responsible for causing most human infections. Approximately 60%70% of persons with TBE recall a bite (1219). Because TBE virus is present in the saliva of an infected tick, transmission likely occurs early during feeding (1,20).
Ixodes ricinus is the main vector for the European subtype TBE virus and Ixodes persulcatus for the Siberian and Far Eastern subtype viruses (21). I. ricinus is found in most of continental Europe and the United Kingdom and I. persulcatus in an area extending east from northeastern Europe through to China and Japan (22,23). The distributions of the two species overlap in certain countries, including Estonia, Finland, Latvia, and the European part of Russia (7,21,2327).
The preferred habitats for the vector ticks are woodland environments. The main habitats are deciduous forests for I. ricinus and coniferous forests for I. persulcatus (23,28). Ticks can be found either within the forest or on forest edges, where the forest transitions to grasslands, meadows, or marshlands, and they favor areas with low-growing dense brush and plant litter (23,2932). Recreational activities with increased risk for exposure to ticks include hiking, camping, cycling in woodland areas, hunting, fishing, birdwatching, and collecting mushrooms or berries (3336). Persons in certain occupations (e.g., farmers, forestry workers, military personnel, and researchers undertaking field work in rural areas) also might be at higher risk for exposure to infected ticks (17,37,38). Humans must enter a tick habitat to be at risk for infection because ticks do not, unaided, disperse widely (39,40). TBE virus infections acquired in urban areas (e.g., city parks) are occasionally reported; however, risk in urban areas is considered to be low (38,41,42).
The enzootic transmission cycle of TBE virus involves ticks and vertebrate hosts. Ticks are both virus vectors and reservoirs. A tick can become infected when feeding on a viremic host or through nonviremic transmission when co-feeding in close proximity to an infected tick (4345). After becoming infected, ticks remain infected through their various life stages and can transmit the virus sexually to other ticks and transovarially to their offspring (28,46,47). The main amplifying reservoir hosts are small mammals, particularly rodents (e.g., mice and voles). Larger forest animals (e.g., boar and deer) and domestic animals (e.g., cattle, dogs, goats, and sheep) do not have an important role in the maintenance of the virus in nature. However, deer and cattle have an important role in maintaining tick populations (22,23,40,48). Humans are incidental, dead-end hosts in the transmission cycle because they do not develop a level or duration of viremia sufficient to infect ticks or have sufficient numbers of attached ticks at one time to allow co-feeding (22,4951).
Alimentary transmission is a less frequent means of acquisition of TBE virus and occurs after ingestion of unpasteurized dairy products (e.g., milk and cheese) from infected cattle, goats, or sheep; transmission from goats is most commonly reported (5260). Large outbreaks linked to infected dairy products have been reported from areas where TBE is endemic, including one with approximately 600 cases (58,61,62). Approximately 47 laboratory-acquired TBE virus infections have occurred globally (6365). TBE virus transmission from infected breastfeeding women to their infants has been described in at least two published reports; one infant remained healthy and the other had severe sequelae (30,66). Other rare modes of transmission include blood transfusion, solid organ transplantation, and slaughtering of viremic animals (6769).
TBE virus is focally endemic in a geographic region extending from western and northern Europe through to northern and eastern Asia (https://www.cdc.gov/tick-borne-encephalitis/geographic-distribution/index.html). Although the geographic range of TBE virus is restricted by the presence of the tick vectors, areas of TBE virus transmission are more limited and focal than the tick distribution. TBE virus-infected ticks typically are found in discrete areas (i.e., foci) confined by the presence of environmental conditions that allow maintenance of the natural transmission cycle rather than being distributed evenly across a region (13,70,71). Natural foci can be small, with locations <1 square mile (72). Multiple factors are required for maintenance of virus circulation (e.g., favorable microclimatic conditions, interactions of ticks and vertebrate hosts, and local vegetation), which likely contribute to the focal occurrence (73). Within affected areas, tick population density and TBE virus infection rates can be highly variable. Infection rates in ticks typically range from 0.1% to 5%, although rates of approximately 40% in I. persulcatus ticks have been reported (21,7477).
During recent decades, TBE virus has emerged in new geographical foci in countries where the disease is endemic, and the overall area of recognized transmission has expanded westward and northward (1,26,7889). Since 2016, three countries have reported their first autochthonous cases (Belgium, England, and the Netherlands) (9092). New TBE foci also have been detected at higher altitudes, reaching elevations up to 2,100 meters (6,890 feet) above sea level (52,81,9395). Concurrently, in certain countries, a reduction in virus transmission and possible loss of recognized geographical foci have been documented (81,93). Various factors might be contributing to the changing distribution, including changes in climatic and ecologic conditions altering tick habitats and transmission cycles and dispersal of ticks into new areas by birds, deer, or other animals (22,40,79,96103).
In areas where TBE is endemic, approximately 5,00010,000 new cases are reported annually (9,104). However, this figure likely represents an underestimate of the actual number of cases because of underdiagnosis, underreporting, or both in certain countries (13,105108).
Incidence rates differ from country to country and depend on the local ecology and geographic distribution of the virus within the country. However, national incidence rates are not directly comparable because of variable approaches to surveillance, the extent of human and laboratory resources applied to surveillance, and the population vaccination coverage (109). Higher incidence rates are most commonly reported from the Baltic states (Estonia, Latvia, and Lithuania), Slovenia, and the Czech Republic (110).
Annual variability in countries incidence rates is typical (86,109,110). The reasons for this variability are not completely understood but reflect the complex interactions among factors that affect risk for infection, including tick density, presence of animal hosts, ecologic conditions, weather, and human behavior (35,76,109112). Longer-term fluctuations in TBE incidence also occur (81). Incidence of reported cases has increased in multiple countries in recent decades while remaining stable or decreasing in others (27,111118). In addition to the factors affecting annual variability in the short term, socioeconomic factors (e.g., political instability and poverty) can affect disease incidence over the longer term (79,93,119123). Other factors that can lead to observed increases include improved awareness of TBE, increased access to laboratory diagnostics, and better surveillance (1,13,89,109,110,124). Of note, TBE became a reportable disease in the European Union in 2012 (125). Reduced incidence in certain countries is related to increased vaccine uptake over time; for example, in Austria, a vaccination program resulted in TBE incidence decreasing approximately sixfold from 5.7 cases per 100,000 population during 19721981 to 0.9 during 20022011 (126).
TBE can occur in persons of all ages, with encephalitis reported in one infant as young as 17 days (127). Incidence is typically low in children and increases with age, generally peaking in the 6069 years age group and then decreasing in the 70 years age group (17,86,110,111,115,128130). TBE is more common in males, with reported incidence rates often 1.52 times higher than in females, likely reflecting a greater risk for tick exposure (14,35,37,67,110112,115,131,132).
The main TBE virus transmission season is AprilNovember when ticks are most active because of warmer weather in the Northern Hemisphere (12,110,112,133,134). Peak transmission generally occurs for multiple weeks during the warm, humid summer months, typically during JuneAugust in European countries. However, in central and northern Europe, two peaks might occur in summer and early fall (12,15,16,23,37,111,112,115,135137). Unlike mosquitoborne diseases, large outbreaks of tickborne diseases do not occur. Occasional cases are reported during winter because tick activity is still possible at temperatures close to freezing (23,28,109,110,138).
Approximately three fourths of TBE virus infections are asymptomatic (67,139,140). Among patients who develop clinical symptoms after a bite from an infected tick, the incubation period is typically 714 days (range = 228 days) (17,90,141). For TBE acquired through the alimentary route, the typical incubation period is shorter, usually <2 weeks and often 24 days (53,57,60,142).
The most recognized clinical presentation of TBE is central nervous system infection (i.e., aseptic meningitis, meningoencephalitis, or meningoencephalomyelitis) (Box 1). Overall, meningitis is reported in approximately 35%45% of patients, meningoencephalitis in 45%55%, and meningoencephalomyelitis in 10% (14,17,18,37,137). However, younger patients (i.e., aged approximately 15 years) more frequently have meningitis, and the percentage of patients with more severe clinical presentations usually increases with age (12,14,17,18,131,133,143148). Relatively mild forms of disease (e.g., undifferentiated febrile illness) can occur (36,149). A chronic form of disease has been reported from Russia linked to infection with the Siberian subtype virus and, rarely, the Far Eastern subtype virus and is possibly associated with long-term viral persistence (18,36,150153). Progressive, slow development of neurologic symptoms often occurs, with or without an initial acute illness. In certain patients, the incubation period can be prolonged and symptoms can first manifest many years after a tick bite. A chronic relapsing form of disease also has been reported in Russia (152,153). Immunity after TBE virus infection is considered to be lifelong (49).
TBE can have a monophasic or biphasic illness course (i.e., an isolated neurologic illness alone or neurologic disease after an initial nonspecific illness). The monophasic disease course is the most common in infections caused by the Far Eastern and Siberian subtype viruses. The biphasic course is the most frequent in patients infected with the European subtype virus; approximately 65%75% of patients infected with the European subtype virus have a biphasic illness course (14,17,18,36,133,148,151,154). When biphasic illness occurs, the initial phase includes nonspecific symptoms (e.g., fever, headache, malaise, myalgia, nausea, and vomiting). These symptoms usually last for a median of approximately 4 days (range = 110 days), followed by a period of remission of approximately 7 days (range = 133 days), followed by the second (neurologic) phase (12,17,18,133,155).
Neurologic signs and symptoms of TBE vary but can include meningeal signs, altered mental status, cognitive dysfunction (e.g., decreased concentration and memory impairment), ataxia, rigidity, tremors, and cranial nerve and limb paresis or palsies. Limb involvement is more typically unilateral than bilateral, and the upper extremities are more often affected than the lower extremities (14). Seizures are not common with TBE caused by the European subtype virus (17,153,156,157).
Increasing age is a key risk factor for more severe disease. Other risk factors include infection with the Far Eastern subtype virus and being immunocompromised, and certain studies have found a correlation with the monophasic illness course (16,18,151,158163).
Among the limited number of published case reports of women infected during pregnancy, the clinical spectrum of illness appears similar to that of the nonpregnant population (164168). Apart from two reports from the 1960s in which the diagnostic methods used to confirm maternal infection were unclear, all infants born to infected mothers were reported to be healthy at birth and transplacental transmission of TBE virus had not been confirmed.
Clinical laboratory findings with TBE are nonspecific. In the initial phase of a biphasic illness, findings can include leukopenia, thrombocytopenia, or elevated hepatic enzymes (145,149,154). In the neurologic phase of disease, findings can include a peripheral leukocytosis, an elevated erythrocyte sedimentation rate, and increased C-reactive protein levels (12,17,37,133,146). Cerebrospinal fluid (CSF) testing usually indicates a pleocytosis, typically lymphocytic, with moderately elevated protein levels (12,17,37,131,133). However, early in disease, neutrophils can predominate in CSF.
Magnetic resonance imaging (MRI) occasionally detects abnormalities in the brain or spinal cord; however, sensitivity is low for diagnosis of TBE (169). In one prospective study in Germany, 18% (18 of 102) of patients with MRI results had abnormal findings, and in a retrospective study from Austria, 9% (four of 45) of patients with MRI results had abnormalities considered TBE related (17,170). Changes, when present, are most commonly observed in the thalamus, often bilaterally, and less often in the cerebellum, basal ganglia, brainstem, or other locations (17,147,171174). In patients with myelitis, radiculitis, or both, either alone or in association with encephalitis, spinal MRI can indicate changes such as T2-hyperintensities in the anterior horns of the cervical cord (171,175179). Computerized tomography scans do not usually identify any abnormalities (169). Abnormal electroencephalogram findings are common and can include diffuse slowing and focal abnormalities (17,132,133,147,173).
The laboratory diagnosis of TBE usually is based on detection of virus-specific immunoglobulin M (IgM) antibody in CSF or serum (180). An IgM enzyme-linked immunosorbent assay is routinely used for testing samples and usually is positive when neurologic symptoms are present. However, cross-reactivity with other flavivirus antibodies can occur because TBE virus shares common antigenic sites within its E protein with multiple other flaviviruses (49). Plaque reduction neutralization tests can be performed to discriminate between cross-reacting antibodies attributable to another primary flavivirus infection or to confirm recent TBE virus infection on the basis of a fourfold or higher increase in virus-specific neutralizing antibodies between acute- and convalescent-phase serum specimens. However, in patients who have been infected previously by another flavivirus or vaccinated with a different flavivirus vaccine (e.g., Japanese encephalitis or yellow fever vaccine), cross-reactive antibodies can make identifying a specific etiologic agent difficult (180). Vaccination history, date of symptom onset, and information about other flaviviruses known to circulate in the geographic area that might cross-react in serologic assays should be considered when interpreting results. In addition, possible antibody persistence from a previous TBE virus infection should be considered; serum IgM antibodies typically are detectable for approximately 34 months after infection but can persist for 3 years (12,181,182).
TBE virus occasionally has been isolated, or TBE viral RNA has been detected by nucleic acid amplification tests (NAATs), in serum, whole blood, urine, or CSF samples when a patient has neurologic illness (50,51,67,92,127,168,183187). Although these methods are insufficiently sensitive for routine diagnostic purposes, NAATs can be of value in patients who are immunocompromised (158,188,189). In addition, if testing is done during the initial febrile (viremic) phase of illness before neurologic symptoms develop and antibodies are measurable, RNA often can be detected; however, patients usually only are tested after neurologic disease manifests (49,169,184). In fatal encephalitis cases, TBE virus RNA has been detected in brain tissue (68,184).
No commercially available tests for TBE virus infection are available in the United States. Diagnostic testing can be performed at CDC. Clinicians should contact their state or local health department or the Arboviral Diseases Branch, Division of Vector-Borne Diseases (970-221-6400) for assistance with diagnostic testing.
No specific antiviral treatment for TBE is available. Patient management consists of supportive care, treatment of symptoms, and interventions to prevent secondary complications (e.g., aspiration pneumonia or urinary tract infection) (153,169). Patients with meningoencephalitis should be closely observed because coma or neuromuscular paralysis leading to respiratory failure can develop rapidly (36).
An anti-TBE virus intravenous immunoglobulin (IVIG) preparation was previously used in Europe for postexposure prophylaxis or treatment. However, no effectiveness data from controlled clinical trials are available, and IVIG use was discontinued after reports of suspected antibody-dependent enhancement of infection resulting in a more severe course of disease (190193). In Russia and Kazakhstan, specific anti-TBE virus IVIG preparations continue to be used; information on their effectiveness is published primarily in the non-English literature (153).
The outcome of TBE largely depends on the patients age, clinical form of the disease, and virus subtype (194). Among patients with neurologic disease and infected with the European subtype virus, the case fatality rate is usually <2% (14,17,18,37,86,110,111,114,146,195,196). Fatality rates from infection with the Siberian subtype virus are higher but rarely exceed 6%8% (151). Rates of 20%40% were historically described with the Far Eastern subtype virus, although the extent of study methodology and patient inclusion criteria as contributing factors is unclear (62,151,197). In China, where the Far Eastern subtype virus is found, case-fatality rates were >25% in the 1950s; however, rates of <10% have been reported since the 1980s, purportedly related to improved disease awareness and quality of medical care (151,198). In Russia, where the Far Eastern and Siberian subtype viruses predominate, TBE mortality rates of approximately 2% have recently been reported (153).
Studies to assess frequency of sequelae have used variable symptom definitions, types of cohorts, investigation approaches, and durations of follow-up after illness to measure outcomes, making interpretation and comparison of studies difficult. A limitation of multiple studies is incomplete follow-up among the persons in the cohort, potentially biasing results. Among patients infected with the European subtype virus, sequelae have been reported in 20%40% overall, including neurologic sequelae (e.g., limb paresis or paralysis) in up to 10% (17,18,155,194,196). Sequelae have been reported with higher frequency after infection with the Far Eastern and Siberian subtype viruses, but the reported differences might be a result of methodologic differences in published reports.
The severity of reported sequelae ranges from mild symptoms with limited to no effect on quality of life to severe sequelae that interfere with activities of daily living. Reported serious outcomes of infection include permanent limb or cranial nerve palsies or paralysis, ataxia, and dysphasia (155,194). Milder symptoms include cognitive impairment (e.g., difficulties with memory or concentration), headaches, fatigue, tremors, hearing loss, emotional lability, or minor problems with balance or coordination (17,18,37,196). In a case-control study in Sweden with 92 patients and 58 controls with follow-up conducted from 2 to 15 years (median = 5.5 years) after TBE virus infection, patients scored significantly lower than controls in the domains of memory and learning, executive function (i.e., initiative and motivation), vigilance (i.e., concentration, attention, and fatigue), and physical impairment (i.e., fine motor skills, coordination, and balance) (199).
Certain symptoms can improve or resolve during the weeks to months after hospitalization (200). In one study, the median time to recovery was 13 weeks (range = 2156 weeks) among the patients who recovered completely or had only unrelated ongoing health issues (63%; 72 of 114) (196). However, patients occasionally have worsening of sequelae over time (18,173).
Severe outcomes are more frequent with increasing age and might be of particular concern for persons aged approximately 60 years (201). Older age has been correlated with a longer duration of hospitalization, lengthier time to recovery, higher case-fatality rate, and increased risk for sequelae (17,86,111,131,194,196). The association between older age and poor outcomes is likely related to immunosenescence with increasing age (202). Among children, deaths are rare and neurologic sequelae occur at low rates (<3%) (12,14,129,133,148,203). However, permanent, severe neurologic deficits can occur and subtle deficits (e.g., cognitive problems, headache, fatigue, or irritability) might be common (19,127,173,204).
TBE is rare among U.S. travelers to areas where the disease is endemic. Twelve TBE cases have been reported among U.S. adult and pediatric civilian (i.e., nonmilitary) travelers, including one case in 1979 and 11 cases during 20012021 (180,205,206) (Table 1). During 20012021, the mean was <1 reported case (range = 02 cases) annually. However, TBE cases might not have been identified if the illness was diagnosed overseas or if a clinician did not consider TBE in the differential diagnosis for a returning traveler with a compatible illness. On the basis of approximately 2025 million U.S. citizen trips to countries with TBE risk each year, and a mean of <1 diagnosed TBE case each year, the overall incidence of TBE among U.S. civilian travelers is low (207). However, certain persons who travel abroad will be at increased risk for infection because of location and season of travel, their activities, and other factors (Box 2).
Among the 12 TBE cases diagnosed in U.S. civilian travelers during 19792021, a total of 10 (83%) occurred in males, the median age was 38 years (range = 479 years), and infections were acquired in Europe, Russia, or China. Travel, and thus exposure to TBE virus, for all patients occurred during MayAugust. Among 11 travelers for whom information was available on duration of travel in areas where TBE is endemic, the median travel duration was 18 days (range = 769 days). All eight travelers with available data reported activities with risk for tick exposure, including hiking, camping, fishing, and trail running. Clinical illness occurred in a biphasic manner in eight (67%) patients. Eight (67%) patients had meningoencephalitis and four (33%) had meningitis, and no deaths occurred. Seven (58%) patients recovered completely, two (17%) had mild cognitive sequelae, one (8%) recovered but information on possible sequelae was unavailable, one (8%) had severe neurologic sequelae including dysarthria and mild limb bradykinesia, and one (8%) was discharged from acute care to a rehabilitation facility but their clinical outcome was unknown.
In addition to the 12 cases among civilian travelers, 12 TBE cases were diagnosed among U.S. military personnel (n = 8) or their dependent children (n = 4) during 20122021 (208210) (Table 2). One case occurred in 2012, and the remaining 11 occurred during 20172021. At the time of infection, all persons were living in Germany; nine persons had specific information available and all were living in Baden-Wrttemberg or Bavaria, Germanys two states with the highest number of reported annual TBE cases (86). On the basis of a mean of 1.2 cases per year among approximately 50,000 U.S. military personnel and dependents living in Germany, the TBE risk was similar to that of the local population of Baden-Wrttemberg and Bavaria where annual TBE incidence during 20122018 ranged from 0.7 to 2.0 cases per 100,000 population (86). Among the 12 TBE cases, 10 (83%) were in males, the median age was 33 years (range = 247 years), illness onsets occurred during AprilNovember, and nine (75%) had neurologic illness. Five (42%) patients recovered, including two who had short-term sequelae before complete recovery; four (33%) had no outcome information reported; and three (25%) experienced moderate sequelae.
In Europe, a median of 36 traveler cases (range = 2565 cases) wase reported to the European Centre for Disease Prevention and Control each year during 20142020 among the approximately 2,0003,800 TBE cases reported annually (211). However, because TBE is endemic in multiple areas of Europe and TBE vaccines are available, the number of traveler cases prevented by vaccination is unknown (212). Most cases occurred among persons who reported undertaking activities with risk for tick exposure, with only rare case reports of travelers with TBE acquired through ingestion of unpasteurized dairy products (142,213216). Local population TBE incidence data for multiple countries where the disease is endemic in Europe are published annually by the European Centre for Disease Prevention and Control; however, infection risk for a traveler cannot be inferred from these data because the data might be influenced by surveillance methods, reporting practices, and vaccination coverage (104).
At least 47 laboratory-acquired TBE virus infections have been reported globally, and approximately all occurred before 1980 (6365,67). Among these 47 infections, 37 (79%) resulted in disease, and the remainder were asymptomatic infections. At least four of the infections occurred among U.S. laboratory workers; three cases were overt disease with two deaths reported, one was an asymptomatic infection, and all occurred before 1980. None of the infected laboratory workers was known to have received TBE vaccine. Limited information was available on transmission routes; however, all 10 cases with information reported were attributed to aerosolization during laboratory procedures or handling of infected animal waste. Transmission through accidental percutaneous or mucosal exposures is possible. Work with TBE virus typically is restricted to biosafety level (BSL)-4 facilities and practices (217).
The US Food and Drug Administration (FDA) yesterday announced that it has approved Valneva's chikungunya vaccine, the first vaccine of its kind against the mosquito-borne disease. Called Ixchiq, the vaccine is approved for those ages 18 and older at increased risk for the disease.
Chikungunya is considered an emerging global health threat, with at least 5 million cases reported over the last 15 years, mainly in areas where the mosquito that carries the virus is endemic. The most-affected regions include Africa, Southeast Asia, and parts of the Americas. The FDA said chikungunya is spreading to new areas, which has led to a rise in global prevalence.
The disease isn't usually fatal but is known to cause fever and sometimes debilitating joint pain that can last months to years. Other symptoms include rash, headache, and muscle pain. Transmission to babies from mothers during pregnancy can cause potentially fatal infections.
Peter Marks, MD, PhD, who directs the FDA's Center for Biologics Evaluation and Research, said in a statement, "Today's approval addresses an unmet medical need and is an important advancement in the prevention of a potentially debilitating disease with limited treatment options."
The live attenuated vaccine is given as a single dose, and the vaccine effects can be similar to chikungunya illness symptoms. The FDA is requiring the company to do a postmarketing study to evaluate the risk of severe reactions following Ixchinq immunization. The prescribing information contains a warning that it's not known if the vaccine virus can transmit or cause any adverse effects in newborns.
Valneva, in a statement today, said the accelerated approval is based on neutralizing antibody titers and that continued approval hinges on studies that confirm a clinical benefit. Its phase 3 study found a 98.9% seroresponse rate at 28 days that was sustained at 96.3% 6 months after vaccination. It said it plans to commercialize the vaccine in early 2024 and is working toward a vote by the Centers for Disease Control and Prevention's vaccine advisory group in February 2024.
Infants as old as 6 months were protected from COVID-19 infections only when mothers were vaccinated prenatally, and not before pregnancy, according to a new study in JAMA Network Open.
The study is one of the largest to compare outcomes among infants whose mothers were vaccinated before pregnancy, during pregnancy, or were unvaccinated at the time of birth.
Infants younger than 6 months are at an increased risk for severe COVID-19, and accounted for 44% of all pediatric COVID hospitalizations during the Omicron dominant period beginning in December 2021. Infants younger than 6 months remain the only group ineligible for COVID vaccination in the United States.
The present study was based on outcomes seen among all infants born to registered Singapore citizens and permanent residents between January 1, 2022, and September 30, 2022. Only infants whose parents had a confirmed case of COVID-19 during their first 6 months were included in the study.
"By selecting only infants with definite infant exposure to the virus due to the close contact between parents and newborn infants, we limited the possibility of the healthy vaccinee bias and overestimation of estimated vaccine effectiveness for infants," the authors explained.
A total of 7,292 infants were included in the study, of whom 7,120 infants (97.6%) were born to mothers who had been fully vaccinated or boosted as of 14 days prior to delivery with mRNA vaccines. Of those, 39.5% were born to mothers who received their second dose during pregnancy, and 3,661 infants (50.2%) were born to mothers who received a third dose (booster) during pregnancy.
There may be a need for mRNA SARS-CoV-2 vaccination to be recommended for every pregnancy similar to maternal influenza and pertussis vaccination in order to maintain protection in newborns.
A total of 1,272 infants (17.4%) born to parents who were infected with SARS-CoV-2 postpartum also became infected during the study period, with a crude incidence rate of 174.3 per 100,000 person-days among infants born to unvaccinated mothers, 122.2 per 100,000 person-days among infants born to mothers vaccinated before pregnancy, and 128.5 per 100,000 person-days among infants born to mothers vaccinated during pregnancy.
The estimated vaccine efficacy (VE) was 15.4% (95% confidence interval [CI], -17.6% to 39.1%) for infants born to mothers vaccinated before pregnancy, and 41.5% (95% CI, 22.8% to 55.7%) among infants born to mothers vaccinated during pregnancy.
The VE increased to 44.4% (95% CI, 26.2% to 58.1%) if mothers received a third dose (booster), compared with 37.6% (95% CI, 17.2% to 53.1%) if mothers received their second dose, the authors said.
"There may be a need for mRNA SARS-CoV-2 vaccination to be recommended for every pregnancy similar to maternal influenza and pertussis vaccination in order to maintain protection in newborns," the authors said.
Deaths from a handful of viruses that spill over from animals to humans are set to increase 12-fold by 2050 due to climate change and habitat encroachment, according to a new study published in the British Medical Journal.
Three of the fourfiloviruses like Ebola and Marburg, SARS, and Nipah virusare on the World Health Organizations list of priority pathogens, noted for their potential to cause the next pandemic.
But the Ebola-like Machupo virus is also a contender, the authors of the new study argue. And regardless of which pathogen ends up fueling the next global health crisis, theyre all worthy of attention, the authors maintain.
The reason: Epidemics of the viruses they focused on are set to cause a combined death toll of more than 15,000 annually by 2050, even if they dont make an evolutionary leap that allows them to ravage the globe.
Researchers at Boston-based biotech firm Ginkgo Bioworks honed in on four viruses likely to pose a significant public health risk and endanger economic or political stability. Called zoonotic viruses, they spill over from animals to humans, who can then transmit them to other humans.
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Viruses in this family cause hemorrhagic, or bloody, fevers, which are typically accompanied by bleeding from bodily orifices and/or internal organs. The family consists of five strains of Ebola in addition to Marburgan extremely similar virus that made headlines during an outbreak in Equatorial Guinea earlier this year.
On average, Ebola kills about 50% of those it sickens, though case fatality rates have ranged from 25%-90%, according to the WHO. Marburg also kills around 50% of those it infects, though case fatality rates range from around 24% to 88%, experts say. While there are two licensed vaccines for the deadliest strain of Ebola, Zaire, there arent any for the four other strains. Nor is there an approved vaccine for Marburg, though some are in development.
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The worlds first confirmed coronavirus pandemic occurred in 2002, when SARS-CoV-1 was reported in China. It spread to more than two dozen countries in North and South America and Europe before being contained seven months later. It is thought to have originated in an animal population, perhaps bats, before being passed to civet catsa tropical animal that looks like a mix of a dog and an ocelotthen to people. A spillover could happen again.
Symptoms include headache, body aches, mild respiratory symptoms, possible diarrhea, an eventual dry cough, and pneumonia in most. SARS sickened nearly 8,100 people and killed just under 10% of them from 2002 to 2003. There is no licensed vaccine for SARS, though researchers are working on universal coronavirus vaccines that could target both SARS and COVID, among other coronaviruses.
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Nipah is a henipavirus, the most lethal of paramyxoviruses. It was first identified in pigs in Malaysia and Singapore in the late 1980s, though its natural reservoir is fruit bats. The other henipavirus known to infect people, Hendra, was first noted in racehorses and humans in Australia in 1994. Both feature respiratory illness and severe flu-like symptoms, and may progress to encephalitisinflammation of the brainalong with other neurologic symptoms and death.
Nipah kills between 45% and 75% of the people it infects. No licensed vaccines exist, though a vaccine by Moderna, in coordination with the U.S. National Institute of Allergy and Infectious Diseases Vaccine Research Center, is being evaluated.
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Also known as black typhus and Bolivian hemorrhagic fever, Machupo was first isolated in Bolivia in 1959. The Calomys callosus field mouse is a natural carrier of the virus, the symptoms of which are Ebola-like and include bleeding, high fever, pain, and rapid death.
Machupo kills between a quarter and a third of those it infects. Though there are no licensed vaccines for it, a vaccine for Argentinean hemorrhagic fevercaused by the similar Junin virusmay also offer protection against Machupo, according to Stanford University.
Researchers only looked at outbreaks that killed 50 or more people between 1963 and 2019. They didnt take into account the following viruses, which may have otherwise met their criteria:
SARS-CoV-2: The virus behind the recent COVID pandemic may have been caused by a lab leak instead of spillover from an animal like a raccoon dog or pangolin. Thus, its not certain that the virus is zoonotic. Whats more, including this disease could skew the studys numbers, making projected deaths look higher than they potentially should be. Regardless, the COVID pandemic occurred just after the studys 2019 cutoff. COVID is, however, on the WHOs list of priority pathogens.
Hantaviruses and Lassa virus: Both rodent-spread viruses were eliminated from consideration because surveillance has increased over time, potentially causing the growth of studied viruses to appear greater than it should be.
Flu and vector-borne pathogens: Flu viruses like 2009s H1N1 and vector-borne diseases like Crimean-Congo haemorrhagic fever and Zika virus were excludedthe former due to surveillance programs that have grown with time, with the potential to skew predictions on the high end, and the latter due to eradication programs that have the potential to skew predictions on the low end.
When crunching numbers on outbreaks, researchers looked at the number of dead, not the number infected. Thats because the number of fatalities is typically more accurate, given that people can contract a disease and show few or no signs of it.
After epidemics were whittled down, the scientists came up with the following calculus:
The figures are likely an underestimate, the authors cautioned.
Most of the 72 outbreaks they examined were caused by filoviruses in Africa like Marburg and Ebola, which comprised more than half of outbreaks. The duo of viruses caused more than 90% of the 17,000-plus total deaths.
While SARS was the No. 2 leading cause of deaths, at 922, it caused a significantly smaller amount of infections, mainly impacting Asiaas did the Machupo and Nipah viruses, which caused 529 deaths combined, mainly impacting South America and Asia.
The researchers findings suggest that spillover events are not an aberration or random cluster, but follow a multi-decade trend in which [such] epidemics have become both larger and more frequent, the authors wrote, adding that urgent action is needed.
One of the most important things we can continue to do is early detection and intervention, which has been shown time and time again through research to be one of the most effective ways to limit the start of an outbreak, Amanda Meadows, a data scientist at Ginkgo and lead author of the paper, told Fortune.
During the pandemic, collective gains were made in wastewater surveillance. COVID is now widely monitored in wastewater, as are other diseases like flu, RSV, and even Mpox (formerly known as monkeypox). An ideal scenario: if pre-existing wastewater surveillance systems are able to screen for potential pandemic pathogens like Ebola, Nipah, and others, giving experts a warning that an outbreak may soon occur, Meadows said.
Even if widespread wastewater surveillance isnt economically feasible, wastewater programs at major international airports like those stood up during the pandemic could alert public health officials to the arrival of such pathogens from overseas, Nita Madhav, senior director of epidemiology and modeling at Ginkgo, told Fortune. Its crucial, she added, that the world maintain the surveillance structure built during COVID for use during future pandemics.
Both Meadows and Madhav said they hope researchers and the public alike dont fall into the classic pandemic panic-neglect cycle that ensures the world is never quite ready for the next global health catastrophe.
Aside from maintaining and even improving on the surveillance network built during the COVID pandemic, Madhav said, theres more that can be done to prevent future pandemics, including small changes made on an individual level.
Pandemics and epidemics are not a foregone conclusion, Madhav said, if we can reduce drivers of risk like climate change, and implications of human interaction with land. Its really powerful that people can make personal choices that directly impact how this plays out over the next decades.
Some actions consumers can take to reduce climate change, according to the United Nations, Natural Resources Defense Council, and Imperial College London:
As the United States enters respiratory virus season and health officials roll out updated COVID-19 vaccines, a new COVID variant HV.1 has emerged and is currently sweeping the country.
The new omicron subvariant has rapidly overtaken other strains, including EG.5 aka Eris, to become the dominant variant in the U.S. As of late October, HV.1 is responsible for more than a quarter of all COVID-19 cases, and health officials are monitoring the new variant amid concerns of a winter COVID-19 surge.
HV.1 accounted for an estimated 25.2% of new COVID-19 cases during the two-week period ending Oct. 28, according to the latest data from theU.S. Centers for Disease Control and Prevention.
After HV.1, the next most common variant in the U.S. was EG.5, which made up 22% of cases, followed by FL.1.5.1 or Fornax, and XBB.1.16 orArcturus. (Globally, EG.5 is still the dominant strain, according to the World Health Organization.)
All of the most prevalent COVID-19 strains in the U.S. are offshoots of omicron, which first emerged in November 2021.
Although COVID-19 cases and hospitalizations have been trending downward after a late summer surge, HV.1 is continuing to pick up speed around the country.
Cases are expected to increase again this winter as was the case the past three years, Dr. William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center, tells TODAY.com.
As HV.1 spreads, many are curious if the new subvariant is more contagious or severe, whether it could cause different symptoms, and if the new COVID-19 vaccines will provide protection. Heres what we know about HV.1 so far.
HV.1 is part of the omicron family. You can almost think of HV.1 as a grandchild of omicron, says Schaffner. HV.1 is a sublineage of omicron XBB.1.9.2 and a direct descendent of EG.5, according to the CDC's SARS-CoV-2 lineage tree.
The COVID family of viruses likes to mutate. Weve all learned that by now," says Schaffner. While HV.1 is mutated, it's still very close to the existing omicron subvariants, Schaffner explains.
For the most part, scientists are not concerned about new variants like HV.1, which look very similar to strains we've already seen before, NBC News reported.
However, there are a few highly mutated strains which have set off alarm bells. These include BA.2.86 or Pirola, which has an extra 36 mutations that differentiate it from XBB.1.5., and a newer variant called JN.1, which has one more mutation than Pirola.
Fortunately, neither BA.2.86 nor JN.1 are common in the U.S. right now, according to the CDC JN.1 is so rare that it makes up fewer than 0.1% of SARS-CoV-2 cases.
As for HV.1, it rapidly gained steam after it was first detected this past summer. In late July, HV.1 accounted for just 0.5% of COVID-19 cases in the U.S., CDC data show.By Sept. 30, HV.1 made up 12.5% of cases, and by November, it was the dominant strain.
One of the characteristics of this entire omicron family is that they are highly transmissible," says Schaffner. Sometimes, mutations can enable a new variant to spread more effectively or quickly, per the CDC.
Right now, it appears that HV.1 could be slightly better at spreading from person to person than previous strains, NBC News reported. The increased transmissibility of HV.1 likely explains how it became dominant so quickly in the U.S., Schaffner notes.
It appears that HV.1 could also be slightly better at escaping prior immunity to COVID-19, but not enough to cause alarm, Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston, told NBC News.
Although it is more transmissible, HV.1 does not appear to produce more severe disease or lead to more hospitalizations, Schaffer says.
The symptoms caused by infection with HV.1 are similar to those caused by recent variants, says Schaffner, which include:
Congestion, sore throat and dry cough seem to be the three most prominent symptoms right now, says Schaffner.
Increasingly, doctors report that COVID-19 symptoms appear to follow a pattern of being concentrated in the upper respiratory tract, starting with a sore throat and followed by congestion or a runny nose, NBC news reported.
Coughing isn't typically a primary symptom, but it can persist. "The virus seems to produce a kind of a chronic bronchitis, so that you can have a cough syndrome that lasts beyond the period where youve recovered from other symptoms," says Schaffner.
Another trend is that COVID-19 seems to be causing milder infections, likely because people have some prior immunity. By milder, we mean it doesnt require hospitalization even though you can feel quite miserable for several days, says Schaffner.
All COVID-19 tests including PCR tests performed by a health care provider and rapid at-home antigen tests will detect HV.1, says Schaffner.
Testing is a crucial tool to protect yourself and others from COVID-19. The symptoms of HV.1 and other COVID-19 variants can look very similar to other viruses, including respiratory syncytial virus (RSV), influenza and rhinovirus, which usually causes the common cold.
"The only way to distinguish (COVID-19) from RSV and flu, both of which are now gaining steam, is by testing," says Schaffner.
Experts encourage anyone who has symptoms to get tested, especially those in high-risk groups people over the age of 65, who are immunocompromised or who have underlying health conditions.
We have treatments that can prevent more serious disease," says Schaffner, but early detection is key. COVID-19 antivirals such as Paxlovid are effective against HV.1 and other variants, but they work best when within five days of symptom onset, TODAY.com previously reported.
Testing has significantly diminished in the U.S. in the last year, which is concerning, says Schaffner.
When the U.S. federal public health emergency for COVID-19 ended in May, so did the guarantee of free testing for many people.
However, every American can still get COVID-19 tests for free or low-cost right now. One way is to order four free at-home COVID-19 tests from the government, which will be delivered by mail via the U.S. Postal Service. To order your free tests, go toCOVIDTests.gov.
In addition, all health insurance plans are required to reimburse eight at-home COVID-19 tests per month, according tothe Centers for Medicare & Medicaid Services. State Medicaid programs are also required to cover at-home tests, and Medicare beneficiaries and uninsured individuals can access free tests provided by Health & Human Services at thousands of community health centers, clinics and pharmacies.
If you still have a stockpile of tests sitting around, remember to check the expiration date and whether it's been extended bythe U.S. Food and Drug Administration.
The updated COVID-19 vaccine is recommended by the CDC for everyone ages 6 months and older. It is now widely available at pharmacies, doctor's offices and other locations around the U.S., says Schaffner.
The new boosters have been reformulated to target omicron XBB.1.5, which was the dominant COVID variant for most of 2023. While XBB.1.5 has since been overtaken by HV.1, Eris, Fornax and Arcturus, it is still closely related to these newer strains.
The updated vaccines seem to be well-matched to the variants currently circulating and making people sick, Andrew Pekosz, Ph.D., virologist at Johns Hopkins University, previously told TODAY.com.
Laboratory studies indicate that the updated booster will protect against serious disease caused by HV.1, says Schaffner. Vaccination also significantly lowers the risk of becoming hospitalized or dying, per the CDC.
However, only 23 million Americans or 4.5% of the population had received the updated shots by Oct. 27, Reuters reported.
The first phase of the new booster rollout hit several speed bumps, including supply delays, high demand, cancelled appointments and insurance obstacles. Some parents have been unable to get theirkids vaccinatedas some pharmacies and pediatrician's offices have struggled to secure enough child-size doses.
Although many of these initial issues have been resolved, says Schaffner, uptake is still slow. "We've underutilized this updated vaccine, and we anticipate that COVID will once again increase even more during the winter season," says Schaffner.
It's not too late to take advantage of the new booster, Schaffner adds, and people should get the shot as soon as they can.
The FDA has authorized three vaccine options for 2023-2024:one mRNA shot each from Moderna and Pfizer, and a protein-based non-mRNA shot from Novavax.
Insurance plans should cover the updated booster, says Schaffner, and those without insurance should still be able to get the shot for free, according to the CDC.
Were in a good place because for a considerable time now, we have not had a new variant that causes more severe disease or evades the protection of currently available vaccines, says Schaffner.
As the winter and holiday season approaches, it's important to take steps to protect yourself from COVID-19 and prevent transmission to others, especially the most vulnerable. These include:
Caroline Kee is a health reporter at TODAY based in New York City.
The Republican congressman who leads the House GOP's investigation of the origins of COVID-19 says he won't seek reelection next year
November 10, 2023, 3:46 PM ET
2 min read
WASHINGTON -- Republican Rep. Brad Wenstrup, who leads the House GOP's investigation of the origins of COVID-19, says he won't seek reelection next year.
Wenstrup represents Ohio's 2nd Congressional District and was first elected to the House in 2012. He said in a video posted on X on Thursday that he would be stepping down to spend more time with his family.
A married father of two young children, the Cincinnati native is a doctor of podiatric medicine and colonel in the Army Reserve. As chair of the House select subcommittee on the coronavirus pandemic, Wenstrup led an inquiry into the virus' origins and the government's response.
Wenstrup, who is also a longtime member of the House Intelligence Committee, has accused U.S. intelligence of withholding key facts about its investigation into the coronavirus. Republicans on the committee last year issued a staff report arguing that there are indications that the virus may have been developed as a bioweapon inside the Chinas Wuhan Institute of Virology.
U.S. officials, however, released an intelligence report in June that rejected some points raised by those who argue COVID-19 leaked from a lab, instead reiterating that American spy agencies remain divided over how the pandemic began.
Wenstrup's announcement came the same day another longtime congressman also said he would not seek reelection next year. Derek Kilmer, a Democrat who represents the 6th District in Washington, cited similar reasons as Wenstrup in reaching his decision, noting the numerous family events he has missed due to his work in the House.
Kilmer served in the Washington State legislature before he was first elected to his House seat in 2012.
They are among nearly two dozen House members to announce they won't be running again in 2024.
WHO has updated its guidelines for COVID-19 therapeutics, with revised recommendations for patients with non-severe COVID-19. This is the 13th update to these guidelines.
The guidance includes updated risk rates for hospital admission in patients with non-severe COVID-19.
The current COVID-19 virus variants tend to cause less severe disease while immunity levels are higher due to vaccination, leading to lower risks of severe illness and death for most patients.
This update includes new baseline risk estimates for hospital admission in patients with non-severe COVID-19. The new moderate risk category now includes people previously considered to be high risk including older people and/or those with chronic conditions, disabilities, and comorbidities of chronic disease. The updated risk estimates will assist healthcare professionals to identify individuals at high, moderate or low risk of hospital admission, and to tailor treatment according to WHO guidelines:
WHO continues to strongly recommend nirmatrelvir-ritonavir (also known by its brand name Paxlovid) for people at high-risk and moderate risk of hospitalization. The recommendations state that nirmatrelvir-ritonavir is considered the best choice for most eligible patients, given its therapeutic benefits, ease of administration and fewer concerns about potential harms. Nirmatrelvir-ritonavir was first recommended by WHO in April 2022.
If nirmatrelvir-ritonavir is not available to patients at high-risk of hospitalization, WHO suggests the use of molnupiravir or remdesivir instead.
WHO suggests against the use of molnupiravir and remdesivir for patients at moderate risk, judging the potential harms to outweigh the limited benefits in patients at moderate risk of hospital admission.
For people at low risk of hospitalization, WHO does not recommend any antiviral therapy. Symptoms like fever and pain can continue to be managed with analgesics like paracetamol.
WHO also recommends against use of a new antiviral (VV116) for patients, except in clinical trials.
The update also includes a strong recommendation against the use of ivermectin for patients with non-severe COVID-19. WHO continues to advise that in patients with severe or critical COVID-19, ivermectin should only be used in clinical trials.
Coronaviruses are a family of viruses that can cause a variety of diseases in many species, including respiratory diseases in cattle.
Texas A&M University School of Veterinary Medicine and Biomedical Sciences
Researchers from the Texas A&M School of Veterinary Medicine and Biomedical Sciences (VMBS) Veterinary Education, Research, and Outreach (VERO) program have joined an international team studying how coronaviruses are spread and whether an individuals microbiome (the collection of microbes living in or on the body) might impact that transmission.
Coronaviruses are a family of viruses that can cause a variety of diseases in many species, from the common cold and severe acute respiratory syndrome (SARS) in people, to diarrhea in calves and respiratory disease in adult cattle.
The research team which includes researchers from the United States, the United Kingdom, and Canada has received $3.5 million from the United States Department of Agriculture National Institute of Food and Agriculture (USDA-NIFA), the National Science Foundation, the National Institutes of Health, and the Biotechnology and Biological Sciences Research Council (BBSRC).
Their work will use cattle as a model for viral transmission during group commingling events when unfamiliar animals or people come together in a defined space and time with intensive and sustained contact.
Commingling is associated with increased disease transmission risk and possible global consequences, as the COVID-19 pandemic has highlighted. Commingling events in humans include large group events, air travel, incarceration, and classroom settings.
Among animals, commingling routinely occurs during livestock production when the bodys ability to fight disease may be lowered, while, at the same time, the body is being exposed to more pathogens.
Paul Morley, VEROs director of food animal research and one of the projects co-principal investigators
Texas A&M University School of Veterinary Medicine and Biomedical Sciences
Its more and more the nature of our society that we have these types of commingling events, through travel, socialization, and the general nature of day-to-day interactions, said Dr. Paul Morley, VEROs director of food animal research and one of the projects co-principal investigators. Being able to understand how viruses behave would help us apply preventive measures, including vaccination and antiviral treatment, for both humans and cattle.
The researchers, led by Dr. Noelle Noyes, an associate professor in the University of Minnesota College of Veterinary Medicine, will work to understand why some people and animals get infected and/or develop symptoms during commingling events but others do not.
At VERO, Morley and Dr. Matthew Scott, an assistant professor of microbial ecology and infectious disease, will work alongside three graduate students to collect samples from local beef and dairy cattle to track how bovine coronavirus, which is not able to infect people, spreads between animals.
The Texas Panhandle is one of the greatest epicenters of cattle production in the United States, Morley said. Were taking advantage of our great contacts in the cattle production industries, both beef and dairy, to look at coronavirus transmission in young calves during natural management circumstances.
Matthew Scott, an assistant professor of microbial ecology and infectious disease at VERO
Texas A&M University School of Veterinary Medicine and Biomedical Sciences
Specifically, they will look at how the virus spreads depending on factors like how many cattle are housed together and if they are moved to new locations via livestock trailers. They will also measure the cattles immune systems and microbiomes to understand if differences have an impact on whether cattle get infected.
Well be looking at virus shedding before, during, and after commingling events, as well as immune function, genes that get turned on or off, and changes in the microbiomes of the respiratory and gastrointestinal tracts, Morley said.
Using cattle from real livestock operations will ensure that data collected accurately represents real-world transmission factors.
We hope to uncover the complex multi-level mechanisms that underlie viral transmission during intensive mixing of unfamiliar calves, said Dr. Joseph Neary, principal investigator of the projects U.K. activities. These new insights will better inform calf husbandry practices to reduce infectious disease transmission risk, particularly where newly mixed calves have been sourced from multiple farms.
The study will also expand fundamental scientific understanding of viral behavior.
A unique aspect of this work is the integration of microbiome dynamics into models of virus transmission at the population level, Noyes said. Theres a lot of scientific evidence about the importance of the microbiome in individual health, but we dont have as much understanding of how population-level microbiome dynamics may influence disease transmission, particularly during situations of heightened disease risk, such as commingling.
The project is expected to last through 2026. In addition to Texas A&M University and the University of Minnesota, collaborators on the project include scientists from Mississippi State University, the University of Liverpool, and the University of Saskatchewan.
This project is the idealization of what were trying to do at VERO, working with people around the world on a big project with big impact, Morley said. The impact on our graduate students is going to be tremendous; theyll get to interact with this internationally renowned, extremely talented group of people. Its a great opportunity for them in their graduate programs.
% of population vaccinated by gender is the number of vaccinated New Yorkers who identify as male or female as a percent of 2018 Census estimates of the total male and female population. Due to federal Census data collection methods, information on other gender identities is not available and is not represented here.
% of population vaccinated by age is the number of vaccinated New Yorkers in each age group as a percent of 2018 Census estimates of the total population in each age group.
Region and County are based on the location where the vaccinated individual resides.
MIAMI On Nov. 1, a Miami federal grand jury charged three Miami residents for their alleged role in a COVID-19 relief fraud scheme.
Heidi Cid, 54, Lazaro Verdecia Hernandez, 36, and Yadier Rodriguez Arteaga, 38 all of Miami, Florida, have been charged with conspiracy to commit wire fraud, wire fraud, conspiracy to commit money laundering and money laundering, in connection with a scheme to obtain fraudulent loans under the Paycheck Protection Program (PPP).
According to the allegations in the indictment and statements made in court, Cid, Verdecia Hernandez, and Rodriguez Arteaga allegedly submitted fraudulent PPP loan applications to SBA-approved PPP lenders. In support of the fraudulent loan applications, the defendants allegedly submitted several false and fraudulent documents misrepresenting the number of the companies employees to make the businesses appear eligible for pandemic relief. According to the allegations, SBA-approved lenders disbursed over $14.5 million to bank accounts controlled by co-conspirators, who allegedly would then withdraw the money and give Cid, Verdecia Hernandez, and Rodriguez Arteaga a portion of the proceeds.
Cid, Verdecia Hernandez, and Rodriguez Arteaga made their initial appearance in federal magistrate court in Miami. If convicted, they face up to 20 years in prison on the conspiracy and fraud counts, and two years on the money laundering counts. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.
U.S. Attorney Markenzy Lapointe for the Southern District of Florida, Special Agent in Charge Rafael Barros for the United States Secret Service (USSS), and SBA OIGs Eastern Region Special Agent in Charge Amaleka McCall-Brathwaite, U.S. Small Business Administration Office of Inspector General (SBA OIG), Investigations Divisions Eastern Region, announced the charges.
USSS Miami and SBA OIG investigated the case. Assistant U.S. Attorney Thomas Haggerty is prosecuting it. Assistant U.S. Attorney Joshua Paster is handling asset forfeiture.
The following defendants have pleaded guilty for their involvement in this COVID-19 relief fraud scheme (sentencing information is noted where available):
Nancy Bahos Serna, of Miami, Florida (23-cr-20310) has made her initial appearance in federal court. Assistant U.S. Attorney Daniel Bernstein is prosecuting this case.
Javier Pico, of Miami, Florida, and Erisbel Gonzalez Gomez, of Palm Beach County, Florida (22-cr-20368) have been charged for their alleged involvement in the scheme but remain fugitives.
An indictment contains mere allegations, and all defendants are presumed innocent unless and until proven guilty in a court of law.
In March 2020, the Coronavirus Aid, Relief, and Economic Security (CARES) Act was enacted. It was designed to provide emergency financial assistance to the millions of Americans suffering the economic effects caused by the COVID-19 pandemic. Among other sources of relief, the CARES Act authorized and provided funding to the SBA to provide Economic Injury Disaster Loans (EIDLs) to eligible small businesses, including sole proprietorships and independent contractors, experiencing substantial financial disruptions due to the COVID-19 pandemic to allow them to meet financial obligations and operating expenses that could otherwise have been met had the disaster not occurred. EIDL applications were submitted directly to the SBA via the SBAs on-line application website, and the applications were processed and the loans funded for qualifying applicants directly by the SBA.
On May 17, 2021, the Attorney General established the COVID-19 Fraud Enforcement Task Force to marshal the resources of the Department of Justice in partnership with agencies across government to enhance efforts to combat and prevent pandemic-related fraud. The Task Force bolsters efforts to investigate and prosecute the most culpable domestic and international criminal actors and assists agencies tasked with administering relief programs to prevent fraud by, among other methods, augmenting and incorporating existing coordination mechanisms, identifying resources and techniques to uncover fraudulent actors and their schemes, and sharing and harnessing information and insights gained from prior enforcement efforts. For more information on the Departments response to the pandemic, please visithttps://www.justice.gov/coronavirus.
On September 15, 2022, the Attorney General selected the Southern District of Floridas U.S. Attorneys Office to head one of three national COVID-19 Fraud Strike Force Teams. The Department of Justice established the Strike Force to enhance existing efforts to combat and prevent COVID-19 related financial fraud. For more information on the departments response to the pandemic, please clickhere.
Anyone with information about allegations of attempted fraud involving COVID-19 can report it by calling the Department of Justices National Center for Disaster Fraud (NCDF) Hotline at 866-720-5721 or via the NCDF Web Complaint Form at:https://www.justice.gov/disaster-fraud/ncdf-disaster-complaint-form.
Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or at http://pacer.flsd.uscourts.gov, under case number 23-cr-20421.
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