Ross River virus infection
- Michael J Richards, MD, FRACP
Michael J Richards, MD, FRACP
- The Royal Melbourne Hospital
- Victoria, Australia
Ross River virus (RRV) is a group A arbovirus transmitted by mosquitoes that causes a disease manifested by polyarthritis and rash. The illness was first described in northern Australia in 1928 and subsequently has been observed widely through Australia and many islands of the western South Pacific. It is the most prevalent vector-borne disease in Australia. The virus can be transmitted by many mosquito species and survives in mosquito eggs in arid environments. Therefore, it has the capacity to spread to other geographic areas.
Other viruses that cause arthritis are discussed separately. (See "Specific viruses that cause arthritis".)
Ross River virus (RRV) infection has been described in mainland Australia , Papua New Guinea , the Solomon Islands, the islands of eastern Indonesia, the western South Pacific [3,4], Fiji , and American Samoa . As many as 500,000 people were infected in Fiji when the disease first appeared in 1979 . Outbreaks have been described in American Samoa, New Caledonia, French Polynesia, the Cook Islands, and most states of Australia [7,8]. Over 30 percent of blood donors in French Polynesia are seropositive .
In Australia, six to seven thousand people are infected annually [10,11]. The highest rates of infection have been reported from the Northern Territory . Endemic foci also occur in more temperate eastern Australia. Infection has been observed in the outskirts of Sydney since 1997 . Between 2006 and 2009, increasing modifications were noted from the Perth metropolitan area in off-seasons (June to September) . Epidemics have increased in frequency, size, and range throughout European settlements of Australia . The geographic range is expanding in Queensland  and South Australia . In Queensland, areas adjacent to Townsville, on the eastern coast, and southeast Queensland, especially in summer and autumn, are particularly affected .
RRV infection occurs most frequently in tropical coastal regions with salt marsh habitats suitable for the principal mosquito vector species . The infection is most common in spring, after summer rains, or following inundation of salt marshes by rain or tides. The virus persists in arid areas of inland Australia within desiccation-resistant mosquito eggs. Outbreaks occur after rain, when mosquitoes hatch .
Subscribers log in hereLiterature review current through: Nov 2017. | This topic last updated: Jul 01, 2016.References
- Kelly-Hope LA, Purdie DM, Kay BH. Differences in climatic factors between Ross River virus disease outbreak and nonoutbreak years. J Med Entomol 2004; 41:1116.
- Fraser JR, Cunningham AL, Muller HK, et al. Glomerulonephritis in the acute phase of Ross River virus disease (epidemic polyarthritis). Clin Nephrol 1988; 29:149.
- Fauran P, Donaldson M, Harper J, et al. Characterization of Ross River viruses isolated from patients with polyarthritis in New Caledonia and Wallis and Futuna Islands. Am J Trop Med Hyg 1984; 33:1228.
- Rosen L, Gubler DJ, Bennett PH. Epidemic polyarthritis (Ross River) virus infection in the Cook Islands. Am J Trop Med Hyg 1981; 30:1294.
- Aaskov JG, Mataika JU, Lawrence GW, et al. An epidemic of Ross River virus infection in Fiji, 1979. Am J Trop Med Hyg 1981; 30:1053.
- Tesh RB, McLean RG, Shroyer DA, et al. Ross River virus (Togaviridae: Alphavirus) infection (epidemic polyarthritis) in American Samoa. Trans R Soc Trop Med Hyg 1981; 75:426.
- Tai KS, Whelan PI, Patel MS, Currie B. An outbreak of epidemic polyarthritis (Ross River virus disease) in the Northern Territory during the 1990-1991 wet season. Med J Aust 1993; 158:522.
- Lindsay M, Oliveira N, Jasinska E, et al. An outbreak of Ross River virus disease in Southwestern Australia. Emerg Infect Dis 1996; 2:117.
- Knope KE, Kurucz N, Doggett SL, et al. Arboviral diseases and malaria in Australia, 2012-13: Annual report of the National Arbovirus and Malaria Advisory Committee. Commun Dis Intell Q Rep 2016; 40:E17.
- Knope KE, Doggett SL, Kurucz N, et al. Arboviral diseases and malaria in Australia, 2011-12: annual report of the National Arbovirus and Malaria Advisory Committee. Commun Dis Intell Q Rep 2014; 38:E122.
- Knope K, Whelan P, Smith D, et al. Arboviral diseases and malaria in Australia, 2010-11: annual report of the National Arbovirus and Malaria Advisory Committee. Commun Dis Intell Q Rep 2013; 37:E1.
- Quinn HE, Gatton ML, Hall G, et al. Analysis of Barmah Forest virus disease activity in Queensland, Australia, 1993-2003: identification of a large, isolated outbreak of disease. J Med Entomol 2005; 42:882.
- Amin J, Hueston L, Dwyer DE, Capon A. Ross River virus infection in the north-west outskirts of the Sydney basin. Commun Dis Intell 1998; 22:101.
- Selvey LA, Donnelly JA, Lindsay MD, et al. Ross River virus infection surveillance in the Greater Perth Metropolitan area--has there been an increase in cases in the winter months? Commun Dis Intell Q Rep 2014; 38:E114.
- Weinstein P, Judge D, Carver S. Biological and cultural coevolution and emerging infectious disease: Ross River virus in Australia. Med Hypotheses 2011; 76:893.
- Tong S, Hu W, McMichael AJ. Climate variability and Ross River virus transmission in Townsville Region, Australia, 1985-1996. Trop Med Int Health 2004; 9:298.
- Selden SM, Cameron AS. Changing epidemiology of Ross River virus disease in South Australia. Med J Aust 1996; 165:313.
- Yu W, Mengersen K, Dale P, et al. Epidemiologic patterns of Ross River virus disease in Queensland, Australia, 2001-2011. Am J Trop Med Hyg 2014; 91:109.
- Mackenzie JS, Smith DW. Mosquito-borne viruses and epidemic polyarthritis. Med J Aust 1996; 164:90.
- Lindsay MD, Broom AK, Wright AE, et al. Ross River virus isolations from mosquitoes in arid regions of Western Australia: implication of vertical transmission as a means of persistence of the virus. Am J Trop Med Hyg 1993; 49:686.
- Williams CR, Fricker SR, Kokkinn MJ. Environmental and entomological factors determining Ross River virus activity in the River Murray Valley of South Australia. Aust N Z J Public Health 2009; 33:284.
- Tall JA, Gatton ML, Tong S. Ross River Virus Disease Activity Associated With Naturally Occurring Nontidal Flood Events in Australia: A Systematic Review. J Med Entomol 2014; 51:1097.
- Robertson GJ, Doggett S, Seeman O, et al. Ross River virus and its vectors in Sorell Municipal Area, south-eastern Tasmania, January to March 2002. Commun Dis Intell Q Rep 2004; 28:261.
- Woodruff RE, Guest CS, Garner MG, et al. Early warning of Ross River virus epidemics: combining surveillance data on climate and mosquitoes. Epidemiology 2006; 17:569.
- Carver S, Spafford H, Storey A, Weinstein P. Dryland salinity and the ecology of Ross River virus: the ecological underpinnings of the potential for transmission. Vector Borne Zoonotic Dis 2009; 9:611.
- Jardine A, Speldewinde P, Lindsay MD, et al. Is there an association between dryland salinity and Ross River virus disease in southwestern Australia? Ecohealth 2008; 5:58.
- Jacups SP, Whelan PI, Markey PG, et al. Predictive indicators for Ross River virus infection in the Darwin area of tropical northern Australia, using long-term mosquito trapping data. Trop Med Int Health 2008; 13:943.
- Hu W, Nicholls N, Lindsay M, et al. Development of a predictive model for ross river virus disease in Brisbane, Australia. Am J Trop Med Hyg 2004; 71:129.
- Suhrbier A, La Linn M. Clinical and pathologic aspects of arthritis due to Ross River virus and other alphaviruses. Curr Opin Rheumatol 2004; 16:374.
- Reusken C, Cleton N, Medonça Melo M, et al. Ross River virus disease in two Dutch travellers returning from Australia, February to April 2015. Euro Surveill 2015; 20.
- Wolstenholme J. Ross River virus: an Australian export? Med J Aust 1992; 156:515.
- Gubler DJ. Transmission of Ross River virus by Aedes polynesiensis and Aedes aegypti. Am J Trop Med Hyg 1981; 30:1303.
- Harley D, Ritchie S, Phillips D, van den Hurk A. Mosquito isolates of Ross River virus from Cairns, Queensland, Australia. Am J Trop Med Hyg 2000; 62:561.
- Sudeep AB. Culex gelidus: an emerging mosquito vector with potential to transmit multiple virus infections. J Vector Borne Dis 2014; 51:251.
- Mylonas AD, Brown AM, Carthew TL, et al. Natural history of Ross River virus-induced epidemic polyarthritis. Med J Aust 2002; 177:356.
- Potter A, Johansen CA, Fenwick S, et al. The seroprevalence and factors associated with Ross river virus infection in western grey kangaroos (Macropus fuliginosus) in Western Australia. Vector Borne Zoonotic Dis 2014; 14:740.
- Kay BH, Boyd AM, Ryan PA, Hall RA. Mosquito feeding patterns and natural infection of vertebrates with Ross River and Barmah Forest viruses in Brisbane, Australia. Am J Trop Med Hyg 2007; 76:417.
- Carver S, Sakalidis V, Weinstein P. House mouse abundance and Ross River virus notifications in Victoria, Australia. Int J Infect Dis 2008; 12:528.
- Cheng RH, Kuhn RJ, Olson NH, et al. Nucleocapsid and glycoprotein organization in an enveloped virus. Cell 1995; 80:621.
- Smith TJ, Cheng RH, Olson NH, et al. Putative receptor binding sites on alphaviruses as visualized by cryoelectron microscopy. Proc Natl Acad Sci U S A 1995; 92:10648.
- Boyd AM, Hall RA, Gemmell RT, Kay BH. Experimental infection of Australian brushtail possums, Trichosurus vulpecula (Phalangeridae: Marsupialia), with Ross River and Barmah Forest viruses by use of a natural mosquito vector system. Am J Trop Med Hyg 2001; 65:777.
- Linn ML, Aaskov JG, Suhrbier A. Antibody-dependent enhancement and persistence in macrophages of an arbovirus associated with arthritis. J Gen Virol 1996; 77 ( Pt 3):407.
- Vollmer-Conna U, Piraino BF, Cameron B, et al. Cytokine polymorphisms have a synergistic effect on severity of the acute sickness response to infection. Clin Infect Dis 2008; 47:1418.
- Lidbury BA, Rulli NE, Musso CM, et al. Identification and characterization of a ross river virus variant that grows persistently in macrophages, shows altered disease kinetics in a mouse model, and exhibits resistance to type I interferon. J Virol 2011; 85:5651.
- Soden M, Vasudevan H, Roberts B, et al. Detection of viral ribonucleic acid and histologic analysis of inflamed synovium in Ross River virus infection. Arthritis Rheum 2000; 43:365.
- Fraser JR, Ratnamohan VM, Dowling JP, et al. The exanthem of Ross River virus infection: histology, location of virus antigen and nature of inflammatory infiltrate. J Clin Pathol 1983; 36:1256.
- Fraser JR, Cunningham AL, Mathews JD, Riglar A. Immune complexes and Ross River virus disease (epidemic polyarthritis). Rheumatol Int 1988; 8:113.
- Lidbury BA, Simeonovic C, Maxwell GE, et al. Macrophage-induced muscle pathology results in morbidity and mortality for Ross River virus-infected mice. J Infect Dis 2000; 181:27.
- Fraser JR. Epidemic polyarthritis and Ross River virus disease. Clin Rheum Dis 1986; 12:369.
- Aaskov JG, Ross P, Davies CE, et al. Epidemic polyarthritis in northeastern Australia, 1978-1979. Med J Aust 1981; 2:17.
- Allanson B, Harvey NT, Beaton PJ, Wood BA. Purpuric exanthem caused by Ross River virus infection. Pathology 2015; 47:171.
- Bennett BK, Hickie IB, Vollmer-Conna US, et al. The relationship between fatigue, psychological and immunological variables in acute infectious illness. Aust N Z J Psychiatry 1998; 32:180.
- Penna JE, Irving LG. Evidence for meningitis in Ross River virus infection. Med J Aust 1993; 159:492.
- Anstey N, Currie B, Tai KS. Ross River virus disease presenting with hematuria. Southeast Asian J Trop Med Public Health 1991; 22:281.
- Scrimgeour EM, Aaskov JG, Matz LR. Ross River virus arthritis in Papua New Guinea. Trans R Soc Trop Med Hyg 1987; 81:833.
- Lucas RE, Qiao M. A case of encephalitis in central Australia due to Ross River virus? Aust N Z J Med 1999; 29:268.
- Scrimgeour EM. Suspected Ross River virus encephalitis in Papua New Guinea. Aust N Z J Med 1999; 29:559.
- Aaskov JG, Nair K, Lawrence GW, et al. Evidence for transplacental transmission of Ross River virus in humans. Med J Aust 1981; 2:20.
- Harley D, Bossingham D, Purdie DM, et al. Ross River virus disease in tropical Queensland: evolution of rheumatic manifestations in an inception cohort followed for six months. Med J Aust 2002; 177:352.
- Flexman JP, Smith DW, Mackenzie JS, et al. A comparison of the diseases caused by Ross River virus and Barmah Forest virus. Med J Aust 1998; 169:159.
- Westley-Wise VJ, Beard JR, Sladden TJ, et al. Ross River virus infection on the North Coast of New South Wales. Aust N Z J Public Health 1996; 20:87.
- Doggett SL, Russell RC, Clancy J, et al. Barmah Forest virus epidemic on the south coast of New South Wales, Australia, 1994-1995: viruses, vectors, human cases, and environmental factors. J Med Entomol 1999; 36:861.
- Hickie I, Davenport T, Wakefield D, et al. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. BMJ 2006; 333:575.
- Lindsay MD, Johansen CA, Smith DW, et al. An outbreak of Barmah Forest virus disease in the south-west of Western Australia. Med J Aust 1995; 162:291.
- Tong S, Bi P, Hayes J, et al. Geographic variation of notified Ross River virus infections in Queensland, Australia, 1985-1996. Am J Trop Med Hyg 2001; 65:171.
- Passmore J, O'Grady KA, Moran R, Wishart E. An outbreak of Barmah Forest virus disease in Victoria. Commun Dis Intell Q Rep 2002; 26:600.
- Naish S, Hu W, Nicholls N, et al. Socio-environmental predictors of Barmah forest virus transmission in coastal areas, Queensland, Australia. Trop Med Int Health 2009; 14:247.
- Russell RC. Ross River virus: ecology and distribution. Annu Rev Entomol 2002; 47:1.
- Beard JR, Trent M, Sam GA, Delpech VC. Self-reported morbidity of Barmah Forest virus infection on the north coast of New South Wales. Med J Aust 1997; 167:525.
- Cashman P, Hueston L, Durrheim D, et al. Barmah Forest virus serology; implications for diagnosis and public health action. Commun Dis Intell Q Rep 2008; 32:263.
- Carter IW, Fraser JR, Cloonan MJ. Specific IgA antibody response in Ross River virus infection. Immunol Cell Biol 1987; 65 ( Pt 6):511.
- Sellner LN, Coelen RJ, Mackenzie JS. Sensitive detection of Ross River virus--a one-tube nested RT-PCR. J Virol Methods 1994; 49:47.
- Harley D, Ritchie S, Bain C, Sleigh AC. Risks for Ross River virus disease in tropical Australia. Int J Epidemiol 2005; 34:548.
- Tomerini DM, Dale PE, Sipe N. Does mosquito control have an effect on mosquito-borne disease? The case of Ross River virus disease and mosquito management in Queensland, Australia. J Am Mosq Control Assoc 2011; 27:39.
- Dunstan RA, Seed CR, Keller AJ. Emerging viral threats to the Australian blood supply. Aust N Z J Public Health 2008; 32:354.
- Hoad VC, Speers DJ, Keller AJ, et al. First reported case of transfusion-transmitted Ross River virus infection. Med J Aust 2015; 202:267.
- Seed CR, Hoad VC, Faddy HM, et al. Re-evaluating the residual risk of transfusion-transmitted Ross River virus infection. Vox Sang 2016; 110:317.
- Jones A, Lowry K, Aaskov J, et al. Molecular evolutionary dynamics of Ross River virus and implications for vaccine efficacy. J Gen Virol 2010; 91:182.
- Kistner O, Barrett N, Brühmann A, et al. The preclinical testing of a formaldehyde inactivated Ross River virus vaccine designed for use in humans. Vaccine 2007; 25:4845.
- Holzer GW, Coulibaly S, Aichinger G, et al. Evaluation of an inactivated Ross River virus vaccine in active and passive mouse immunization models and establishment of a correlate of protection. Vaccine 2011; 29:4132.
- Wressnigg N, van der Velden MV, Portsmouth D, et al. An inactivated Ross River virus vaccine is well tolerated and immunogenic in an adult population in a randomized phase 3 trial. Clin Vaccine Immunol 2015; 22:267.