Sie können Operatoren mit Ihrer Suchanfrage kombinieren, um diese noch präziser einzugrenzen. Klicken Sie auf den Suchoperator, um eine Erklärung seiner Funktionsweise anzuzeigen.
Findet Dokumente, in denen beide Begriffe in beliebiger Reihenfolge innerhalb von maximal n Worten zueinander stehen. Empfehlung: Wählen Sie zwischen 15 und 30 als maximale Wortanzahl (z.B. NEAR(hybrid, antrieb, 20)).
Findet Dokumente, in denen der Begriff in Wortvarianten vorkommt, wobei diese VOR, HINTER oder VOR und HINTER dem Suchbegriff anschließen können (z.B., leichtbau*, *leichtbau, *leichtbau*).
Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne infectious disease that was first identified in South Korea in 2013. To investigate the SFTS virus (SFTSV) genotypes in Gyeonggi Province, SFTSV detected in 126 patient serum samples collected between 2017 and 2022 was subjected to genetic analysis. Among SFTSV genotypes A to F, SFTSV genotype B was the most common, found in a total of 101 cases (80.2%). Within genotype B, there were 85 cases of subgenotype B-1 (67.5%) and 16 cases of subgenotype B-2 (12.7%), but no cases of subgenotype B-3. Five cases of genotype F (3.9%), one of genotype C (0.8%), and one of genotype D (0.8%) were identified. No genotype A or E strains were found. Of the 108 patients for whom epidemiological information was available, 16 (14.8%) died, 75 (68.5%) recovered, and the outcome was unknown for 18 (16.7%) patients. Although the number of samples tested was not large enough to allow a concrete conclusion, subgenotype B-1 showed the highest fatality rate (16.5%). The high prevalence and lethality of SFTSV subgenotype B-1 in a local region of South Korea showed that continuous monitoring of SFTSV genotypes is necessary.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Introduction
Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne infectious disease that was first reported in China in 2011. It is characterized by a high case-fatality rate, and its symptoms include high fever and thrombocytopenia [1]. SFTS virus (SFTSV), the causative pathogen, was identified in 2013 in South Korea and Japan, where it caused fatal infections [2, 3]. The main route of viral transmission to humans is a bite by an SFTSV-infected tick, although human-to-human transmission has occurred via contact with blood or mucous [4]. In South Korea, SFTSV transmission is mediated by ticks of the species Haemaphysalis longicornis, Haemaphysalis flava, Ixodes nipponensis, and Amblyomma testudinarium [5]. SFTSV is a member of the genus Bandavirus of the family Phenuiviridae within the order Hareavirales. The virus has a negative-strand RNA genome that is comprised of three segments: L, M, and S [1]. The L segment is 6,368 nucleotides (nt) long and encodes an RNA-dependent RNA polymerase, the M segment is 3,378 nt long and encodes the surface glycoproteins Gn and Gc, and the S segment is 1,746 nt long and encodes a nucleoprotein (NP) and a nonstructural S segment (NSs) protein [6]. Since SFTSV was first reported in China in 2011, human infections have continued to occur [7‐9]. Infection with SFTSV has several distinct clinical features, including fever lasting for 3–10 days, gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea, loss of appetite), thrombocytopenia (platelet numbers ≤ 100,000/mm2), and leukocytopenia (leukocyte numbers ≤ 4,000/mm2), and it can also cause central-nervous-system-related symptoms, such as headache, confusion, and seizures [10]. The average case-fatality rate varies among regions and years, but it is relatively high in Japan (27–35%), South Korea (16.8–47.2%), and China (5.3–16.2%) [9, 11‐13]. The reason for the differences in the fatality rates among these countries is unclear, but may include differences in the availability of epidemiological information and methods of selecting subjects for statistics, as well as differences in the underlying medical conditions and ages of SFTS patients [14‐16].
In several recent studies, at least six SFTSV genotypes (A through F) have been identified in East Asian countries, including South Korea, and the prevalence of each genotype varies by country [17‐19]. This present study was conducted to determine the local distribution of SFTSV genotypes derived from patient samples in Gyeonggi Province between 2017 and 2022 and to assess differences in the fatality rate according to SFTSV genotype and age.
Anzeige
Materials and methods
Specimen collection
Samples were collected in Gyeonggi Province, South Korea, from January 2017 to December 2022. A total of 1,299 serum samples were collected from individuals with suspected infections and tested for SFTSV. Individuals with high fever (above 38℃), symptoms of gastroenteritis (e.g., vomiting, diarrhea, nausea), thrombocytopenia, leukocytopenia, or a crust from a tick bite were referred to the Gyeonggi Province Institute of Health and Environment for genetic testing by real-time reverse transcription polymerase chain reaction (RT-PCR), and 126 were SFTSV positive. The Public Institutional Review Board designated by the Korea Ministry of Health and Welfare confirmed that this study was exempt from review (exemption confirmation number P01-202307-02-004).
Patient information
Epidemiological information on the patients who underwent SFTSV genotype analysis was provided by the Gyeonggi Infectious Disease Control Center (GIDCC). Patient information was encrypted and used only for research purposes, following the Bioethics and Safety Act and Gyeonggi Institute of Health and Environment (GIHE) research guidelines. The Public Institutional Review Board designated by the Korea Ministry of Health and Welfare confirmed that this study was exempt from review (exemption confirmation number P01-202307-02-004).
Detection of SFTSV by real-time RT-PCR
A QIAamp Viral RNA Mini Kit (QIAGEN, Valencia, CA, USA) was used to isolate SFTSV RNA according to the manufacturer’s instructions, and a real-time RT-PCR assay targeting the M and S segments of the SFTSV genome was applied to detect SFTSV, using a PowerCheck SFTSV Real-time PCR Kit (Kogene Biotech, Seoul, South Korea) according to the manufacturer’s instructions [20]. In brief, using the isolated RNA as a template, reverse transcription was performed at 50℃ for 30 min. Subsequently, one-step real-time RT-PCR was performed with primers and a probe targeting SFTSV. PCR amplification was performed with polymerase activation at 95℃ for 10 min, followed by 45 cycles of denaturation at 95℃ for 15 s and annealing-extension at 60℃ for 45 s. The cutoff cycle threshold (Ct) was set to 35 cycles according to the manufacturer’s instructions. A sample was considered positive when the Ct for both the M and S segments was below 35 cycles.
Nested RT-PCR for the M segment of SFTSV
RT-PCR, followed by nested PCR, was performed to further amplify the M segment of SFTSV in the positive specimens. In the initial RT-PCR analysis, 5 µL of RNA and 1 µL of 10 pmol primers (MF3, forward primer; MR2, reverse primer) were mixed with HyQ One-step RT-PCR PreMix (SNC Co., Hanam, South Korea) [5] and incubated at 50℃ for 30 min for first-strand cDNA synthesis. DNA amplification was performed with 35 cycles of 95℃ for 30 s, 58℃ for 40 s, and 72℃ for 30 s. For nested PCR, 1 µL of the first-strand PCR product and 1 µL containing 10 pmol primers (For, forward primer; Rev, reverse primer) were mixed with HyQ PCR PreMix (SNC Co., Hanam, South Korea) for PCR amplification. The PCR conditions were 26 cycles of 94℃ for 5 min, 94℃ for 20 s, and 59℃ for 20 s, followed by a final extension at 72℃ for 5 min. The final products were stored at 4℃ for further analysis. Primer and amplicon information is shown in Table 1.
Table 1
Nested RT-PCR primers used for detection of SFTSV
Target gene
PCR step
Primer
Sequence
Amplicon size
SFTSV M segment
1 st PCR
MF3
GAT GAG ATG GTC CAT GCT GAT TCT
560 bp
MR2
CTC ATC GGG TGG AAT GTC CTC AC
2nd PCR
For
TAA ACT TGT GTC GTG CAG GC
245 bp
Rev
CCC AGC GAC ATC TCC TTA CA
Anzeige
Genomic sequencing and phylogenetic analysis
Genome sequencing was performed by Macrogen (Seoul, South Korea). The resulting sequences were trimmed using Chromas version 2.6.6 (Technelysium Pty Ltd) to remove poor-quality sequences, and the National Center for Biotechnology Information (NCBI) was searched using the Basic Local Alignment Search Tool (BLAST) to identify related sequences. Phylogenetic analysis was performed using MEGA 7 software with reference sequences obtained from the GenBank database (Fig. 1) [21]. Phylogenetic trees were constructed by the neighbor-joining method with 1000 bootstrap replicates, and the maximum composite likelihood method was used to estimate evolutionary distances (Fig. 1).
Fig. 1
A phylogenetic analysis of 245 nucleotide sequences from the M gene of the SFTSVs isolated from the clinical specimens (●) collected in northern Gyeonggi province of South Korea from 2017 to 2022. The genotypes and subgenotypes are indicated at the right side of the tree. The dendrogram was constructed using the neighbor-joining method and maximum composite Likelihood method in MEGA 7.0 with 1000 bootstrap replicates, and bootstrap values > 70% are shown at the branch nodes. Bar, 0.005 nucleotide substitutions per site
Detection of SFTSV and identification of genotypes circulating from 2017 to 2022
During the six-year study period, a total of 1,299 serum specimens from patients with suspected SFTSV infections were tested. SFTSV was detected in 126 serum samples, for an average positivity rate of 10.2% (Table 2).
Table 2
Test results of samples from patients with suspected SFTSV infections in northern Gyeonggi Province from 2017 to 2022
2017
2018
2019
2020
2021
2022
Total
No. of specimens
205
297
167
140
260
230
1,299
No. of positive results
24
27
19
21
23
12
126
Positivity rate
11.7%
9.1%
11.4%
15.0%
8.8%
5.2%
10.2%
SFTSV genotyping analysis was performed on the 126 SFTSV-positive specimens (Table 3). The genotype was determined in 108 of the 126 cases, but it could not be determined in 18 cases (14.3%). Of the six SFTSV genotypes (A, B, C, D, E, and F), genotype B was the most frequently identified, with 101 cases (80.2%). Subgenotype B-1 was identified in 85 cases (67.5%), and subgenotype B-2 was identified in 16 cases (12.7%). Subgenotype B-3 was not detected. In addition to genotype B, five cases (3.9%) of genotype F, one case (0.8%) of genotype C, and one case (0.8%) of genotype D were identified, while no genotype A or E was detected (Fig. 1).
Table 3
Genotypes of SFTSV in northern Gyeonggi province from 2017 to 2022
SFTSV genotype/year
2017
2018
2019
2020
2021
2022
Total
A
0
B-1
16 (3)
18 (3)
14 (1)
14 (4)
16 (2)
7 (1)
85
B-2
4 (0)
3 (1)
1
2
4
2
16
B-3
0
C
1
1
D
1
1
E
0
F
2
1
1
1 (1)
5
Not genotyped
1
4
4 (2)
4 (1)
2
3 (1)
18
Total
24
27
19
21
23
12
126
Numbers in parentheses indicate the number patients who died.
Analysis of SFTS fatalities by SFTSV genotype
Of the 108 specimens for which the genotype was determined, 16 (14.8%) were from patients who died, and 74 (68.5%) were from patients who recovered. Analysis of the fatality rate for each genotype revealed that 16.5% (14/85) of the patients with subgenotype B-1, 6.3% (1/16) of those with subgenotype B-2, and 20% (1/5) of those with genotype F died (Table 4).
Table 4
Number of fatal and non-fatal cases for each genotype in northern Gyeonggi Province from 2017 to 2022
Genotype
Fatal (%)
Non-Fatal (%)
N/A*(%)
Total
B-1
14 (16.5)
57 (67.1)
14 (16.3)
85
B-2
1 (6.3)
11 (68.8)
4 (25.0)
16
C
-
1 (100.0)
-
1
D
-
1 (100.0)
-
1
F
1 (20.0)
4 (80.0)
-
5
Total
16 (14.8)
74 (68.5)
18 (16.7)
108
*N/A, not available
Distribution of SFTSV genotypes in northern Gyeonggi province
To analyze the local distribution of SFTSV, the location of presumed exposure of the SFTS patients to the virus was identified (Fig. 2). When the city or area of presumed exposure was not known, the city or area where the patient resided was used in the analysis. The results showed that subgenotype B-1 was dominant in all cities or areas of northern Gyeonggi province (i.e., Namyangju [26/28], Pocheon [16/18], and Paju [7/8]). For subgenotype B-2, the geographical distribution appeared to be restricted to the eastern part of Gyeonggi province (i.e., Gapyeong [4/6], Namyangju [2/28], and Yangpyeong [5/10]). Genotype F was mainly detected in the central part of northern Gyeonggi province (i.e., Dongducheon [1/2], Yangju [1/4], Pocheon [1/18], and Gimpo [1/1]). One case each of genotype C and D was confirmed in Paju and Pocheon, respectively. There were 17 cases in which the patient's residence and presumed exposure area could not be determined, with subgenotype B-1 in 13 cases, subgenotype B-2 in three cases, and genotype F in one case.
Fig. 2
Local distribution of SFTSV genotypes in northern Gyeonggi province, South Korea, from 2017 to 2022. The number of SFTS patients in each area in northern Gyeonggi province is shown as a stacked bar chart with different patterns for the different genotypes. Names of area or cities are shown at the left, and the bars indicate the number of patients. N/A, not available. A map of Gyeonggi province (grey) is shown at the right. The blue box shows a map of South Korea, with Gyeonggi province circled in red
Analysis of case-fatality rates in SFTSV-positive patients according to age
The case-fatality rate for different age groups was analyzed in the 126 cases for which the outcome of the disease (i.e., death or recovery) was known (Table 5). The overall case-fatality rate was 15.9% (20/126) and, consistent with previous studies, increased with age: 12.8% (5/39) in the 60–69 age group, 20.6% (7/34) in the 70–79 age group, and 34.8% (8/23) in the 80–89 age group. No SFTSV was found in patients younger than 30 years old, and no deaths occurred in patients under the age of 60.
Table 5
SFTS case-fatality rate according to age in northern Gyeonggi Province from 2017 to 2022
Age group
Fatal (%)
Non-fatal (%)
N/A*(%)
Total
30–49 years old
4 (80.0)
1 (20.0)
5
50–59 years old
19 (76)
6 (24)
25
60–69 years old
5 (12.8)
31 (79.5)
3 (7.7)
39
70–79 years old
7 (20.6)
19 (55.9)
8 (23.5)
34
80–99 years old
8 (34.8)
11 (47.8)
4 (17.4)
23
Total
20 (15.9)
84 (66.7)
22 (17.5)
126
*N/A, not available
Discussion
The increasing number of SFTSV infections and the high case-fatality rate in South Korea, averaging 18.4% in 2013–2021 according to the Korean Disease Control and Prevention Agency, KDCA, are a serious public health concern. Therefore, in this study, the genetic diversity of SFTSV and the case-fatality rate for SFTS patients in Gyeonggi Province, the province with the largest population in South Korea, were studied by identifying SFTSV genotypes and connecting these data with epidemiological information.
Genotypes of SFTSV
The prevalence of SFTSV genotype B was 80.2%, which is consistent with previous reports [11, 18]. An analysis of SFTSV genotypes conducted in 2017–2019 showed that genotype B accounted for 77.6% of SFTSV infections, followed by genotype D (10.5%) and genotype A (6.3%). Genotypes C, E, and F were found in fewer than 10 cases [11, 18, 19]. Consistent with a previous report that genotype F was detected only in Gyeonggi and Chungcheongbuk provinces of South Korea [18], we also found five cases of genotype F. We also found that subgenotype B-1 (CB3 strain) accounted for 67.5% of the SFTSV infections detected in this study, and subgenotype B-2 (CB7 strain) accounted for 12.7%. This differs from an SFTSV genotype analysis conducted in 2013–2017 in which B-2 was the most frequent subgenotype in South Korea, with a frequency of 36.1%, followed by B-3 at 21.1% and B-1 at 12.0% [11]. This difference might be explained by spatiotemporal differences in SFTSV genotypes between the study areas and time periods. In addition, the sequences that were analyzed in this study were very short, about 200 nucleotides, which might have led to errors in the case-fatality rate of genotype B or the location of the B-3 subgenotype (CB6 strain) being included within type C in the phylogenetic analysis (Fig. 1).
Relationship between case-fatality rates and SFTSV genotypes
The case-fatality rate of SFTS has been reported to be 5.3–16.2% in China, 20% in Japan, and 23.3% in South Korea [22‐24]. Genotype B has been reported to be dominant in South Korea and Japan, and genotype F (44.3%) and genotype A (21.5%) have been reported to be dominant in China. A previous study in South Korea on the relationship between SFTSV genotypes and case-fatality rates showed that subgenotypes B-2 (43.8%) and B-1 (18.8%) had relatively high case-fatality rates, while no deaths were reported in patients with genotype F [11]. However, the case-fatality rate in this study was different from those in previous reports, with genotype B accounting for 14.9% (15/101) of fatalities, with 16.5% for subgenotype B-1, and 6.3% for B-2 (Table 4). However, these values are likely to be unreliable due to the small number of SFTSV samples genotyped (108 in total). Therefore, the association of SFTSV genotype with case-fatality rate needs to be studied over a longer period of time and with a larger sample size.
Anzeige
Geographical distribution of SFTSV genotypes
The location where exposure to SFTSV was presumed to have occurred in each case was tabulated, and the number of cases involving each genotype is summarized for each location in Fig. 2. Subgenotype B-1, which was predominant in Gyeonggi province, was detected in all cities or areas of interest. Interestingly, subgenotype B-2 and genotype F appear to be restricted to the eastern and central part of Gyeonggi province, respectively. This implies that ticks carrying distinct genotypes of SFTSV are present in certain areas of Gyeonggi province. Although there is no concrete evidence that any specific genotype is more virulent than the others, this information is nevertheless important for establishing health policies to prevent tick-borne diseases caused by certain genotypes of SFTSV.
Case-fatality rates by age group
The high case-fatality rate of SFTS implies the need for public health attention in South Korea. Twenty (15.9%) deaths were confirmed among the 126 SFTSV-positive patients, and all of these patients were over 60 years old, consistent with other reports [11, 14]. Although the sample size was small (126 patients), the age dependence of the case-fatality rate in SFTS patients could still be discerned (Table 5), and this was also consistent with previous reports [11, 25]. Although an increase in case-fatality rate with age was confirmed, other factors, such as the health condition of the patient (i.e., underlying medical conditions) or how quickly they received medical attention and treatment, could have varied depending on their accessibility to healthcare. Therefore, a follow-up study with a statistical analysis of the effects of the above-mentioned factors is still needed.
Conclusion
Although this study was limited by the small sample size and shortness of the nucleotide sequences analyzed, we were able to confirm previous reports that the predominant SFTSV genotype in Gyeonggi Province of South Korea is genotype B. However, unlike in other regions of South Korea, we found subgenotype B-1 to be predominant and to have the highest case-fatality rate. The results of this study provide information on SFTSV genotype differences by region, providing a basis for the development of an SFTSV vaccine and highlighting the need for continued, large-scale research on SFTSV genotyping.
Declarations
Conflict of interest
The authors have no potential conflicts of interest to disclose.
Anzeige
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Yu XJ et al (2011) Fever with thrombocytopenia associated with a novel bunyavirus in China. N Engl J Med 364(16):1523–1532CrossRefPubMedPubMedCentral
2.
Takahashi T et al (2014) The first identification and retrospective study of Severe Fever with Thrombocytopenia Syndrome in Japan. J Infect Dis 209(6):816–827CrossRefPubMed
3.
Kim KH et al (2013) Severe fever with thrombocytopenia syndrome, South Korea, 2012. Emerg Infect Dis 19(11):1892–1894CrossRefPubMedPubMedCentral
4.
Liu Y et al (2012) Person-to-person transmission of severe fever with thrombocytopenia syndrome virus. Vector Borne Zoonotic Dis 12(2):156–160CrossRefPubMed
5.
Yun SM et al Severe fever with thrombocytopenia syndrome virus in ticks collected from humans, South Korea, (2013). Emerg Infect Dis, 2014. 20(8): pp. 1358-61. Emerg Infect Dis, 2014. 20(8): pp. 1358-61
6.
Liu Q et al (2014) Severe fever with thrombocytopenia syndrome, an emerging tick-borne zoonosis. Lancet Infect Dis 14(8):763–772CrossRefPubMed
7.
No authors listed, KDCA Infectious Disease Portal Web Site, https://www.kdca.go.kr/npt/. [cited 2022 Decemner 31]
8.
Miao D et al (2021) Epidemiology and Ecology of Severe Fever With Thrombocytopenia Syndrome in China, 20102018. Clin Infect Dis 73(11):e3851–e3858CrossRefPubMed
9.
Yokomizo K et al (2022) Clinical Presentation and Mortality of Severe Fever with Thrombocytopenia Syndrome in Japan: A Systematic Review of Case Reports. Int J Environ Res Public Health, 19(4)
10.
Li DX (2015) Severe fever with thrombocytopenia syndrome: a newly discovered emerging infectious disease. Clin Microbiol Infect 21(7):614–620CrossRefPubMed
11.
Yun SM et al (2020) Genetic and pathogenic diversity of severe fever with thrombocytopenia syndrome virus (SFTSV) in South Korea. JCI Insight, 5(2)
12.
Lee M et al (2024) Severe Fever with Thrombocytopenia Syndrome in South Korea, 2016–2021: Clinical Features of Severe Progression and Complications. Am J Trop Med Hyg 111(3):661–670CrossRefPubMedPubMedCentral
13.
Choi SJ et al (2016) Severe Fever with Thrombocytopenia Syndrome in South Korea, 2013–2015. PLoS Negl Trop Dis 10(12):e0005264CrossRefPubMedPubMedCentral
14.
Sun J et al (2016) Factors associated with Severe Fever with Thrombocytopenia Syndrome infection and fatal outcome. Sci Rep 6:33175CrossRefPubMedPubMedCentral
15.
Park SY et al (2018) Severe fever with thrombocytopenia syndrome-associated encephalopathy/encephalitis. Clin Microbiol Infect 24(4):432 e1-432 e4CrossRefPubMed
16.
Liu J et al (2017) Dynamic changes of laboratory parameters and peripheral blood lymphocyte subsets in severe fever with thrombocytopenia syndrome patients. Int J Infect Dis 58:45–51CrossRefPubMed
17.
Yoshikawa T et al (2015) Phylogenetic and Geographic Relationships of Severe Fever With Thrombocytopenia Syndrome Virus in China, South Korea, and Japan. J Infect Dis 212(6):889–898CrossRefPubMed
18.
Choi Eunji LA, Hae K, Ji H, Myung-Guk KC, Kyeong W, EunByeol C, Wooyoung (2021) Genotype analysis of severe fever with thrombocytopenia syndrome virus detected in patients. Public Health Wkly Rep 14(11):597–606
19.
Wang EunByeol LH, Wooyoung C, Chun K (2019) Laboratory-based diagnosis of severe fever with thrombocytopenia syndrome in Korea from 2017 to 2018. Public Health Wkly Rep 12(11):03–306
20.
Sun Y et al (2012) Early diagnosis of novel SFTS bunyavirus infection by quantitative real-time RT-PCR assay. J Clin Virol 53(1):48–53CrossRefPubMed
21.
Yun SM et al (2017) Molecular genomic characterization of tick- and human-derived severe fever with thrombocytopenia syndrome virus isolates from South Korea. PLoS Negl Trop Dis 11(9):e0005893CrossRefPubMedPubMedCentral
22.
Zhan J et al (2017) Current status of severe fever with thrombocytopenia syndrome in China. Virol Sin 32(1):51–62CrossRefPubMedPubMedCentral
23.
Gokuden M et al (2018) Low Seroprevalence of Severe Fever with Thrombocytopenia Syndrome Virus Antibodies in Individuals Living in an Endemic Area in Japan. Jpn J Infect Dis 71(3):225–228CrossRefPubMed
24.
Robles NJC et al (2018) Epidemiology of severe fever and thrombocytopenia syndrome virus infection and the need for therapeutics for the prevention. Clin Exp Vaccine Res 7(1):43–50CrossRefPubMedPubMedCentral
25.
Sun J et al (2017) The changing epidemiological characteristics of severe fever with thrombocytopenia syndrome in China, 2011–2016. Sci Rep 7(1):9236CrossRefPubMedPubMedCentral
Die Angst vor unbemerkter Glutenzufuhr ist für viele Zöliakiekranke ein dauernder Begleiter. Ob die Sorge auch bei intensivem Küssen angebracht ist, wurde an der Columbia University unter (fast) standardisierten Bedingungen untersucht.
Eine Hormonersatztherapie (HRT) nach einer risikoreduzierenden bilateralen Salpingo-Oophorektomie geht bei pathogenen BRCA-Varianten nicht mit einem erhöhten Brustkrebsrisiko einher. Allerdings sind die statistischen Unsicherheiten der Studie sehr groß.
Neben Lebensstilmodifikation sowie medikamentösen und interventionellen Therapien sind auch Impfungen eine wirksame Option zur Prävention kardiovaskulärer Erkrankungen. In der Versorgungsrealität findet das jedoch noch zu wenig Berücksichtigung.
