• Xiao-Ai Zhang, Yi-Dan Ma, Yun-Fa Zhang, Zhen-Yu Hu, Jing-Tao Zhang, Shuo Han, Gang Wang, Shuang Li, Xi Wang, Fang Tang, Wen-Jun Liang, Hong-Xia Yuan, Jia-Qi Zhao, Lan-Fen Jiang, Lei Zhang, Guang-Qian Si, Cong Peng, Rui Wang, Hong-Han Ge, Nan Li, Bao-Gui Jiang, Chang Li, Hao Li, and Wei Liu.
• From the State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology (X.-A.Z., Y.-D.M., Y.-F.Z., Z.-Y.H., J.-T.Z., S.H., G.W., S.L., X.W., L.Z., G.-Q.S., C.P., R.W., H.-H.G., B.-G.J., H.L., W.L.), and the Institute of Medical Prevention and Control of Public Health Emergencies, Characteristic Medical Center of the Chinese People's Armed Police Force (F.T.), Beijing, Changchun Institute of Veterinary Medicine, Chinese Academy of Agricultural Sciences, Changchun (Y.-D.M., N.L., C.L.), the School of Public Health, Anhui Medical University, Hefei (Z.-Y.H., X.W., H.L., W.L.), Medical Detachment of Inner Mongolia Autonomous Region Forest Fire Brigade Daxing'anling Branch, Yakeshi (W.-J.L.), the First Affiliated Hospital of Jinzhou Medical University, Jinzhou (H.-X.Y.), Dandong Infectious Disease Hospital, Dandong (J.-Q.Z.), and the Center for Disease Control and Prevention in Zhalainuoer District, Hulunbuir (L.-F.J.) - all in China.
• N. Engl. J. Med. 2024 Sep 5; 391 (9): 821831821-831.

BackgroundIn June 2019, a patient presented with persistent fever and multiple organ dysfunction after a tick bite at a wetland park in Inner Mongolia. Next-generation sequencing in this patient revealed an infection with a previously unknown orthonairovirus, which we designated Wetland virus (WELV).MethodsWe conducted active hospital-based surveillance to determine the prevalence of WELV infection among febrile patients with a history of tick bites. Epidemiologic investigation was performed. The virus was isolated, and its infectivity and pathogenicity were investigated in animal models.ResultsWELV is a member of the orthonairovirus genus in the Nairoviridae family and is most closely related to the tickborne Hazara orthonairovirus genogroup. Acute WELV infection was identified in 17 patients from Inner Mongolia, Heilongjiang, Jilin, and Liaoning, China, by means of reverse-transcriptase-polymerase-chain-reaction assay. These patients presented with nonspecific symptoms, including fever, dizziness, headache, malaise, myalgia, arthritis, and back pain and less frequently with petechiae and localized lymphadenopathy. One patient had neurologic symptoms. Common laboratory findings were leukopenia, thrombocytopenia, and elevated d-dimer and lactate dehydrogenase levels. Serologic assessment of convalescent-stage samples obtained from 8 patients showed WELV-specific antibody titers that were 4 times as high as those in acute-phase samples. WELV RNA was detected in five tick species and in sheep, horses, pigs, and Transbaikal zokors (Myospalax psilurus) sampled in northeastern China. The virus that was isolated from the index patient and ticks showed cytopathic effects in human umbilical-vein endothelial cells. Intraperitoneal injection of the virus resulted in lethal infections in BALB/c, C57BL/6, and Kunming mice. The Haemaphysalis concinna tick is a possible vector that can transovarially transmit WELV.ConclusionsA newly discovered orthonairovirus was identified and shown to be associated with human febrile illnesses in northeastern China. (Funded by the National Natural Science Foundation of China and the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences.).Copyright © 2024 Massachusetts Medical Society.

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