A Serological Investigation of West Nile Virus Infections in Various Animal Species and Humans in Western Turkey

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A Serological Investigation of West Nile Virus Infections in Various
Animal Species and Humans in Western Turkey
Erol, N.,1* Gürçay, M.,2 Kırdar, S.,3 Ertuğrul, B.,4 Gür, S,.5 Koç, B.T.1 and Tan, M.T.1
Department of Virology, Faculty of Veterinary Medicine, Adnan Menderes University, 09016, Aydin, Turkey.
Ministry of Food, Agricultural and Livestock Husbandry, Institute of Veterinary Control, Virology Laboratory, 23200, Elazig,
Department of Medical Microbiology, Faculty of Medicine, Adnan Menderes University, 09100, Aydın, Turkey.
Department of Infectious Diseases, Faculty of Medicine, Adnan Menderes University, 09100, Aydın, Turkey.
Department of Virology, Faculty of Veterinary Medicine, Afyon Kocatepe University, 03200, Afyon, Turkey
Correspondence: Dr. Nural Erol, Assistant Professor, Department of Virology, Faculty of Veterinary Medicine, University of Adnan Menderes, Aydin, Turkey
09016, Tel: +90 256 2470700 (ext. 311); Fax: +90 256 2470720. Email: nuralerol@adu.edu.tr
West Nile Virus (WNV) infection, transmitted mainly through mosquito bites, is generally asymptomatic
but may also result in mild fever, meningitis, encephalitis and death in various animals and humans. The
presence of the WNV in Turkey has been reported previously. However, comparative epizootiological data
on the recent prevalence of the WNV infection in various animal species and humans in western Turkey are
limited. The objective of this study was to investigate the seroprevalence of WNV infection in animals and
humans in western Turkey. Four hundred and forty serum samples were collected from 40 cats, 60 cattle,
90 humans and 50 sheep, goats, camels, horses, and broiler breeder chickens between the years 2009 and
2012. The serum samples were tested for antibodies against the envelope protein (E) of the virus using a
commercial competitive Enzyme-Linked Immunosorbent Assay (cELISA). The human samples were retested using commercial Indirect Fluorescence Antibody Test (IFAT). No antibodies were detected in cats,
sheep, goats, and chickens. Seropositivity rates of 44% (22/50) in camels, 32% (16/50) in horses, 20% (12/60)
in cattle and 41.1% (37/90) in humans were found. The results of the seropositivity in humans obtained using
cELISA and IFAT were identical. These data suggest that the WNV infection may be present subclinically
in horses, camels, cattle and humans in western Turkey and may pose a threat to animal and human health
in the region and surrounding areas.
Keywords: West Nile Virus; Antibody; ELISA; IFAT; Western Turkey; Camel; Cattle; Horse;
West Nile virus infection (WNV) is a mosquito-borne zoonotic disease. It is classified within the family of Flaviviridae,
genus Flavivirus, positive sense, single-stranded RNA viruses (1,2). Serologically, it is classified within the Japanese
Encephalities ( JE) virus antigenic complex group of viruses
that also includes Japanese encephalitis, Murray Valley encephalitis, St. Louis encephalitis, Usutu and Kunjin viruses
Erol, N.
JUNE 2016.indb 42
(1). Transmission of the WNV is mainly through Culex spp.
of mosquitoes which serve as the “bridge” between birds
and humans (3). Mosquitoes infect many bird species and
infected birds may in turn infect mosquitoes thus serving as
intensifying hosts that eventually infect humans and other
mammalian species. The virus replicates in birds that serve
as the natural reservoirs and may, in some cases may kill the
infected bird (1).
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In addition to mosquitoes, blood transfusion, organ transplantation, and intrauterine transmission are also important
in WNV transmission in humans (4). Interestingly, the virus
was not isolated in any of the 6,457 mosquito specimens collected in Turkey (5). Animal trading and wild life movements
may also contribute to the spread of the virus (6).
Although many mammalian species can be infected experimentally, confirmed natural WNV cases have been reported
only in humans and horses (1). The infection presents with
symptoms ranging from mild fever to meningoencephalitis in
20-40% of humans whereas it is asymptomatic in the remaining 60-80% (7). The mortality rate is approximately 10% in
humans whereas it may be as high as 43% in horses (1).
The infection has been endemic in sub-Saharan Africa
where almost 90% of the adults and 50% of the children are
seropositive (6). The infection has been reported in Europe
andAustralia as well and has spread to North America in
1999 (8).Turkey is located near European countries where
the recent WNV cases in humans and animals have been
reported (9-11). The climate and ecological conditions, mosquito fauna, and its location on the routes of migratory birds
make it susceptible to the WNV infections. WNV infection
has been reported in Greece, the neighbor of Turkey in the
west as recently as 2012 (9).
Seropositivity for the virus has been reported in Turkey
for over 30 years especially in humans (3,12-14). In August
2010, a WNV outbreak in the Manisa province of Western
Turkey and its surrounding areas resulted in meningitis-related deaths (15). However, comparative studies investigating
recent seroprevalence of WNV infection in western Turkey
in humans and animals are very limited. The objective of
this study was to determine the seroprevalence of the WNV
infection in humans and various animal species in the Aegean
region of western Turkey bordering the Aegian Sea and
Eastern Europe.
Antibodies against WNV were investigated in 440 blood
serum samples collected randomly from 40 cats, 60 cattle,
90 humans and 50 sheep, goats, camels, horses, and broiler
breeder chickens in the Aydin, Denizli, Izmir and Manisa
provinces of western Turkey (Table 1). The samples were collected between 2009 and 2012 and archived for serosurveys
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for different diseases. The serum samples were obtained by
centrifugation of the blood for 30 minutes at room temperature and stored at -20oC until analyzed. No clinical signs of
the infection were observed in any of the sampled animals
or humans. Informed and free consent was obtained from
the participants or legal guardians of the minors involved.
This study was approved by the Animal Ethics and Medical
Ethics Committees of the Adnan Menderes University
(Approval No: B.30.2.ADU.
and 2013/311, respectively).
Enzyme-Linked Immunosorbent Assay (ELISA)
The serum samples were tested for antibodies against the viral
membrane protein (E) using a commercially available competitive Enzyme-Linked Immunosorbent Assay (cELISA) (ID
Screen West Nile Competition Multi-Species from IDVET
Innovative Diagnostics, Montpellier, France). Samples and
controls were added into the wells of the ELISA plates coated
with purified extracts of the WNV antigen. After incubation
and washing of the microplates, peroxidase-conjugated antiWNV antibody was added into each well. After incubation
and washing to eliminate the excess conjugate, the substrate
Table 1: Number of samples analyzed and the seropositivity rates
obtained using antibodies against West Nile virus in animals and
humans in the Aydin, Denizli, Izmir and Manisa provinces of western
Species Status Aydin Denizli Izmir Manisa Total Positivity
Tested 20
Positive 0
Tested 25
Positive 0
Tested 25
Positive 0
Tested 50
Positive 22
Positive 16
Positive 0
Tested 30
Positive 12
Tested 90
Positive 37
Samples taken from humans were re-tested using an Indirect
Fluorescence Antibody Test (IFAT) and identical results were obtained.
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Research Articles
solution TMB (3,3’,5,5’-tetramethylbenzidine) was added
to the wells. The optical density (OD) was measured at 450
nm using an ELISA reader (BioTek Absorbance Microplate
Reader, ELx808, USA). Optical density for each sample was
divided by the OD for the negative control and the result
was multiplied by 100 to obtain the S/N percentages. S/N
percentages less than or equal to 40% were considered positive and greater than 50% were considered negative. The S/N
percentages greater than 40% but less or equal to 50% were
considered equivocal. All equivocal samples were repeated and
valid results were obtained.
Indirect Fluorescent Antibody Test
The serum samples from humans diagnosed using ELISA
were re-tested using a commercially available Indirect
Fluorescent Antibody Test (IFAT) (Euroimmun, Lübeck,
Germany). The test was designed exclusively for the in vitro
detection of IgG and IgM classes of antibodies against WNV
in human serum and plasma. WNV-infected cells on the test
slides were incubated with human serum samples diluted
1:100. After incubation and washing, a secondary rabbit antihuman antibody was added on the slides. The fluorescence was
detected using a fluorescence microscope (Olympus, Japan).
The results obtained using cELISA are shown in Table 1.
No antibodies were found in cats, sheep, goats and chickens.
Seropositivity rates of 44% (22/50) in camels, 32% (16/50) in
horses, 20% (12/60) in cattle, and 41.1% (37/90) in humans
were detected. Twelve of the 30 (40%) cattle in the Aydin
province were seropositive whereas there were none among
the cattle in the nearby Denizli (0/30) province. The 37 positive and 53 negative human samples initially diagnosed using
cELISA were re-tested using IFAT and identical results were
Our results show the presence of antibodies against WNV in
camels, horses, cattle and humans in western Turkey. The reason
for this relatively high seroprevalence among animals and humans in western Turkey could be due to Turkey’s geographical
location on the routes of migratory birds that play an important
role in the epidemiology of the virus. The birds may carry the
virus from endemic areas to regions of sporadic outbreaks (16).
Erol, N.
JUNE 2016.indb 44
This study is the first evidence of WNV infection in camels in Turkey. The 44% seropositivity detected in this study is
higher than 3% reported in Canary Islands, Spain (17). The
Aydin province where the seropositive camels were located
is one of the largest centers of camel breeding in Turkey. The
41.1% seropositivity rate detected in humans in this study is
similar to the 40% seropositivity rate obtained by Olaleye et
al. (18) in Nigeria. However, the seropositivity rates in our
study were lower in sheep (0% vs. 20%) and goats (0% vs.
18%) but higher in camels (44% vs. 26%) and cattle (20%
vs. 6%) compared to the rates reported by Olaleye et al. (18).
These findings do not agree with a study by Albayrak et al.
(19) who reported that only two of the 350 serum samples
taken from 70 of each of cattle, horse, sheep, goat and water
buffalo in northern Turkey were positive using cELISA.
These results suggest that a large variation may exist in seropositivity rates among different regions of Turkey.
Data on the seroprevalence rates in cats, sheep, goats
and cattle are available in more than one province in Turkey.
Interestingly, 12 of the 30 (40%) cattle in the Aydin but none
of the cattle in the nearby Denizli (0/30) province were seropositive. The seropositivity rates in the remaining species of
the animals were same in the remaining provinces.
In this study, 32% seropositivity was detected in horses
that are considered the “dead-end host” for the virus because
they do not infect other animals or mosquitoes (1). Similar
seroprevalence rates have been reported in horses in Central
Anatolia by Ozkul et al. (20) who reported 31.6% seropositivity in 2010. The authors (Ozkul et al.) detected nucleic acid of
the virus in two of these horses using RT-PCR. In northern
Turkey, however, WNV nucleic acid was not detected in any
of the 120 horse serum samples collected from the middle
Black Sea region of Turkey (21).
In the present study, 41.1% of humans were seropositive
for WNV antibodies. This result suggests that WNV infection in humans may be more common in the west than the
other regions of Turkey. A reason for the high seroprevalence
in our study could be that humans travelling to the different
parts of the world and/or Turkey could be bringing infection to the Western Turkey which is fashionable among
both indigenous and foreign tourists. Recent seroprevalence
of WNV in southeast Turkey is only 16% (3). In central
Anatolia, Ozkul et al. (14) found antibodies against WNV
in 20.4% (18/88) of the human samples collected from 10
representative provinces of Turkey.
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In 2010, 47 human cases of West Nile virus (WNV)
infection were reported in several regions of Turkey (15).
The infection was most frequent in the Sakarya province
(0.19/100,000 population) located in the northwest of Turkey
where 10 patients died. Deaths mostly occurred in the month
of August although they were reported throughout the summer of 2010. Deaths due to WNV were also reported in
Greece and Romania in the same year, suggesting that the
infection may have spread to the nearby countries. As of
2012, 161 cases of WNV infection in Greece and 621 in
neighboring countries have been reported (9).
No antibodies against WNV were detected in the cats,
sheep, goats and chickens included in our study. The likely
cause of the absence of WNV infections in chickens is the
good practice of hygiene in the poultry farms in western
Turkey that appears to successfully limit the transmission of
infection with biological vectors.
The possible cross-reactivity of the WNV with the viruses
in the JE virus serocomplex and other flaviviruses should
be taken into consideration when interpreting the results
obtained in this study. Serological cross-reactions between
members of the JE group of flaviviruses and WNV have been
reported previously (22). Although the cELISA kit we used
in this study recognizes the antibodies against envelope protein (pE) containing an epitope common to JE virus antigen
complex, we are not aware of any cases of JE group infections
reported in Turkey.
A limitation of this study was the use of cELISA for
detection of the WNV. Although the plaque reduction neutralisation test (PRNT) is considered the “gold standard”
for the detection of WNV antibodies (23), ELISA has also
been routinely used for diagnosis (24).The cELISA has a
specificity of 99.4% and a sensitivity of 84.9% for detecting
WNV antibodies (25). The ELISAs is considered to be suitable for serological WNV surveillance programs and valid
for a wide range of species (26).In thepresent study, results
from samples taken from humans were confirmed using a
commercial IFAT test developed for the routine detection
of human IgG and IgM antibodies.
Data obtained in this study suggest that the WNV antibodies
are present in camels, horses, cattle, and humans in western
Turkey and, thus, the virus may pose a threat to animal and
human health in the region. The sampled animals and huIsrael Journal of Veterinary Medicine  Vol. 71 (2)  June 2016
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mans did not show any signs of infection suggesting that
the infection may have been subclinical. It is, thus, necessary
to conduct further research on isolation, molecular characterization, and epidemiology of the virus in this region. It
is especially important to determine which species of the
mosquitoes spread the disease, map their breeding sites,
prevent production of the larvae through water reduction
and chemical control, and educate the public to combat the
WNV infection.
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