INTRODUCTION
Approximately 40% of the globe is at risk of infection by flaviviruses, such as dengue virus (DENV), an enveloped, single-stranded RNA virus transmitted primarily by
Aedes aegypti mosquitoes (
1,
2). Since severe disease from DENV infections can manifest as dengue hemorrhagic fever/dengue shock syndrome, DENV establishment in the continental United States is a major concern for public health agencies (
1). In the United States, Florida has experienced increases in local DENV transmission since 2009, driven in part by human and pathogen movement (
3).
A. aegypti is endemic throughout subtropical Florida, and the vector population has resurged recently, following its near-displacement by
A. albopictus (
4). Autochthonous DENV infection occurs sporadically, primarily in southern Florida, with limited local cases elsewhere in the state (
3).
Recently, reports have indicated that certain insect-specific viruses (ISVs) can negatively impact or enhance arbovirus (including DENV) infections in insect cells and mosquitoes (
5–7). Although the impacts of many ISVs on arboviral competence have yet to be determined, the evidence to date clearly indicates that the mosquito virome cannot be ignored and likely influences the risk of autochthonous DENV transmission once the virus is introduced into an area. Therefore, we conducted a metaviromic study of
A. aegypti adult F
1 female (first-generation) mosquitoes raised from eggs collected from ovitraps in 2016 to 2017 from Manatee County to assess the presence of any potentially influential ISVs in local mosquito populations outside southern Florida. Although no indexed human case of DENV4 was reported during 2016 to 2017 in the county, we detected and sequenced DENV4, which was maintained vertically for one generation (since the adults were raised in the laboratory from field-caught
A. aegypti eggs), in four mosquito populations from Florida’s Gulf Coast. We followed up this unexpected finding with genetic analyses to determine the DENV4 strain’s likely location of origin, to assess the time frame of virus introduction, and to investigate strain-specific mutations that may have potentially enabled adaptation to and/or persistence within local mosquito populations.
DISCUSSION
Our metavirome analysis of
A. aegypti from Manatee County has revealed potential insight into, and new possible examples of, human arboviruses and ISV relationships in a state prone to autochthonous flavivirus transmission, considered in light of previous research on such interviral relationships. The observed drop in DENV4 relative to the mosquito virome (ISVs) between 2016 and 2017 was statistically significant (
P = 0.035), opening the possibility that the ISV profile for individual mosquitoes may influence persistence of DENV4 in site-specific mosquito populations within the surveyed area. Note that our analysis was conducted on pools of mosquitoes, which limits the conclusions that can be drawn in this study versus an analysis conducted on individual mosquitoes and interviral dynamics. For example, although
Anphevirus (described in our analyses) has been shown to reduce DENV titers
in vitro during coinfections, further analysis performed using individual mosquitoes of this specific dynamic is necessary to fully determine whether
Anphevirus coinfection (occurring singly or concomitantly with other ISVs) can mediate multigenerational dengue virus persistence in mosquitoes (
12).
With respect to the role of natural infections by insect-specific flaviviruses in the proliferation of pathogenic arboviruses carried by different mosquito vector species, current knowledge is uncertain. A mosquito-specific flavivirus that we detected that is known as cell fusing agent virus (CFAV) is of particular interest. Coinfection studies performed
in vitro with DENV2 and CFAV resulted in enhanced proliferation in both (
13). The observed correlation between persistence of DENV4 infection into 2017 in Anna Maria and Cortez mosquitoes and CFAV abundance in 2016 (
Fig. 3) may provide an example of the dynamics described previously by Zhang et al., showing the enhanced replication of the two viruses (
13). An important caveat is that the research reported by Zhang et al. was conducted
in vitro. Conversely, Baidaliuk et al. demonstrated
in vivo amplification-restrictive interactions between CFAV and DENV1 (
7). How interactions between DENV4 genotype, mosquito genotype, and CFAV genotype ultimately influence the vector competence of Floridian
A. aegypti mosquitoes remains to be determined. The observed metavirome patterns set the stage for follow-up studies to characterize the precise nature of ISV-DENV-mosquito interactions
viz. vector competence.
The absence of an index human DENV4 case does not preclude the possibility that DENV4 was transmitted locally. Up to 88% of primary DENV infections are asymptomatic, with DENV4 being widely understood to cause primarily subclinical infections (
14,
15). Importantly, clinically inapparent infections could contribute to 84% of DENV transmission events through mosquitoes, so the threat of local transmission cannot be ruled out (
14). However, it is noteworthy that DENV4 was detected in adult female mosquitoes reared from wild-captured eggs, implicating transovarial transmission (TOT) in local
A. aegypti as has been shown for DENV1 in Key West, FL (
16). However, since the DENV4 signal measured in 2017 was lower than that measured in 2016, with two sites losing DENV4 prevalence, if it had played a role in maintaining DENV4 in Manatee County mosquitoes, TOT alone might have been insufficient to maintain DENV4 from 2016 to 2017. At present, vertical transmission remains only a possibility, especially since this phenomenon has not been fully described outside laboratories. Furthermore, we suspect that despite Manatee County DENV4’s divergence from Haitian strains sometime between 2006 and 2013, it likely did not enter Manatee County until 2014 or after, given its similarity to the 2014–2015 Haitian DENV4 isolates and the fact that TOT is an inefficient process. A recent review evaluating the influence of TOT in DENV epidemiology concluded that the current body of research suggests that vertical transmission is likely to be insufficient to represent an independent mechanism of DENV maintenance (
17). Tertiary mechanisms, beyond ISV composition profile and TOT, could include inapparent human-mosquito infection cycles during the summer transmission (mosquito) season, which may have also contributed to DENV4 persistence in Manatee County aegypti. The exact mechanisms of maintenance in mosquitoes and proof of local transmission are difficult to elucidate at this juncture, considering that all mosquito samples were processed for rRNA-depleted total RNA sequencing (RNASeq) and reverse-transcription PCR (RT-PCR) (i.e., no live virus can be isolated). Importantly, a comprehensive serological survey with subsequent confirmation by gold-standard neutralization assay of the population from the four sample collection sites was not possible within the estimated mean half-life of detectable anti-DENV4 virion IgM or IgG. This limitation was unavoidable since (i) the complete viral genome assembly and orthogonal confirmation occurred more than 2 years following the initial mosquito collections and (ii) there are significant confounders and logistical obstacles (well outside the current scope of the study) that complicate working with transient worker and migrant communities in the sampled area. However, the data representing complete assembly and persistence over 2 years of an individual strain of DENV4, which is supported by results from orthogonal analytical approaches, remain provocative and reveal an unappreciated ecological process for DENV4 transmission in a nonendemic setting.
Tracking and predicting movement and introduction of arbovirus into the United States, especially into Florida, can potentially lead to proactive efforts for increased monitoring and vector control at critical points of introduction into the state. DENV4 has been reported throughout the Caribbean, especially in Puerto Rico and Haiti and, more recently, in Cuba (
18). Florida has the largest populations of people of Puerto Rican, Haitian, and Cuban origin and descent in the United States, and there are ongoing efforts to develop effective “sentinel” surveillance programs that can prepare Florida to deal with potential local arbovirus transmission. As expected, our analysis suggests a Caribbean origin for the Manatee County isolate due to movements of DENV4 into Florida from Haiti and, preceding that, into Haiti from Puerto Rico. These results agree with previous findings depicting the Caribbean as a hot spot for arboviral spread in the Americas (
18–20). Diversifying selective pressure in the NS2A gene and the 2K peptide (
Fig. 5a and
b) experienced by American/Caribbean DENV4 may have contributed to the fixation of mutations driving the adaptation of DENV4 to local infections of human and mosquito populations. NS2A mutations that characterized the 1998 DENV4 outbreak in Puerto Rico are conserved between the Manatee County, Puerto Rican, and two Haitian genomes (GenBank accession no.
JF262782.1 and
KT276273.1) (
Fig. 5c) (
9). The 1981 Senegalese strain, the strain clustering closest to the Manatee County strain isolated outside the Americas (
Fig. 4a and
b), shares none of these mutations with Manatee County DENV4. An in-depth understanding of how putative “hallmark” mutations in arboviruses can lead to increased local aegypti mosquito infections is lacking, compelling further study.
We observed the expected 15-nucleotide deletion (Δ15) in the Manatee County DENV4 3′ UTR (see
Fig. S4 in the supplemental material) that is present across all circulating DENV4 strains but absent from the extinct genotype I DENV4 lineage (GQ868594_Philippines_1956). Since the Δ15 deletion maps to the HVR, it does not alter the secondary structures required for subgenomic flaviviral RNA (sfRNA) production. However, the HVR is an adenylate-rich unfolded spacer with poor sequence conservation—where no reliable secondary structure can be predicted, as our previous analyses suggested (
11). It has been speculated that these spacers favor the correct folding of adjacent functional structured RNA elements. The deletion might change the rate of folding of the downstream functional structured RNA and thus might alter sfRNA production levels. Clearly, a closer molecular exploration of the exact role of this Δ15 deletion is needed.
The potential implications of our findings are intriguing, especially considering that arboviral surveillance of mosquito populations during the extended Florida mosquito season (April to October) is limited. To our knowledge, this is the first reported characterization of a DENV4 infection in native mosquito populations in Florida in the absence of an index human case across 2 years in a specific county. These data highlight the importance of knowing when and where arboviruses are introduced and point to the potential benefit of surveilling local mosquito populations for arbovirus infections prior to an outbreak. Given the increasing number of travel-related arbovirus introductions into Florida alone and the risk of local establishment in the state, we expect that while our report is seminal, it likely represents the tip of the iceberg. Furthermore, in 2019, 16 cases of locally acquired DENV were reported for the state, including an area along the West Central Florida Gulf Coast (
21). Among the 335 travel-associated cases in 2019, DENV1 (
n = 63), DENV2 (
n = 235), and DENV3 (
n = 31) serotypes were identified by PCR from 329 samples. DENV serotypes for the local cases are reasonably predicted to mirror the geographical distribution of serotypes for the travel-associated cases. If these data and our own findings are any indication, the number of “under-the-radar” arbovirus infections of mosquito populations in migration hot spots across the state (and perhaps across other states and regions around the globe) remains significantly underestimated.
ACKNOWLEDGMENTS
We gratefully acknowledge the support of Carina Blackmore, Danielle Stanek, and Andrea Morrison from the Florida Department of Health, as well as Lisa Conti, Kelly Friend, Davis Daiker, and Adriane Rogers from the Florida Department of Agriculture and Consumer Services for their institutional collaboration with the CDC Southeastern Center of Excellence in Vector Borne Diseases: The Gateway Program. We also thank Heather Coatsworth and Kaci McCoy for useful comments. This research was supported in part by the United States Centers for Disease Control (CDC) Grant 1U01CK000510-03: Southeastern Regional Center of Excellence in Vector-Borne Diseases: The Gateway Program. The CDC had no role in the design of the study, the collection, analysis, and interpretation of data, or in writing the manuscript. Support was also provided by the University of Florida Emerging Pathogens Institute, the University of Florida Preeminence Initiative, and United States Department of Agriculture, Agricultural Research Service, project 6066-21310-005-00-D.
We declare that we have no competing interests.