Epidemiological investigation of Shuni virus infections in hospitals in two provinces of South Africa (2019–2021) using molecular and serological surveillance
5 affiliations
- 1Centre for Emerging Arbo and Respiratory Virus Research (CEARV), Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- 2Wageningen Bioveterinary Research, Wageningen, The Netherlands
- 3Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Greifswald, Germany
- 4Department of Paediatrics, Kalafong Provincial Tertiary Hospital, University of Pretoria, Pretoria, South Africa
- 5Emerging Viral Threats, One Health Surveillance and Vaccines (EViTOH) South African Research Chair (SARChi), Infectious Disease and Oncology Research Institute (IDORI), University of the Witwatersrand, Johannesburg, South Africa
Abstract
Shuni Virus (SHUV) is a reemerging zoonotic orthobunyavirus in the Peribunyaviridae family associated with neurological infections and birth defects in humans and animals in Africa and has emerged in the Middle East in the past 10 years. Limited epidemiological data exist in humans, partially due to a lack of clinical awareness and availability of diagnostic assays to determine the incidence of clinical cases and seroprevalence in the population. The goal of this study was to establish serologic and molecular diagnostic assays for SHUV for hospital-based surveillance and to investigate the clinical epidemiology in humans in South Africa. The incidence of SHUV infections was investigated in patients with acute fever of unknown cause with or without neurological signs (AFDUC/N) during the arbovirus season (January-June, 2019–2021). IgM and IgG ELISAs for SHUV were established using baculovirus-expressed glycoproteins and validated against virus-neutralization tests (VNT) positive sera. Orthobunyavirus quantitative RT-PCR (RT-qPCR) and IgM ELISA were used to identify acute infections, and IgG ELISA to define the seroprevalence in patients and healthy control groups in hospitals in Gauteng and Mpumalanga provinces in South Africa. In total, 3/349 (0.84%) AFDUC/N cases tested positive by RT-qPCR and confirmed as SHUV by sequencing. In total, 22/225 (9.7%) AFDUC/N patients had SHUV neutralising antibodies (VNT), of which 11/22 (50.00%) were IgM positive, with an IgM seropositivity of 4.89% (11/225 (4.89%)). Of the RT-PCR and double IgM + VNT+ patients, 60% presented with seizures and 40% with meningitis, of which 36.36% were children and 63.63% were adults, respectively. In total, 9/112 (8%) of the healthy control group tested positive on the IgG ELISA assay. These findings suggest that SHUV is a missed cause of acute neurological infections in hospitalized children and adults in South Africa and should be investigated in humans in Africa and other regions. Author summary: SHUV is a mosquito and biting midge-transmitted zoonotic virus that causes neurological disease and birth defects in humans and animals in Africa and the Middle East, yet it remains severely underdiagnosed due to limited clinical awareness and the absence of commercially available diagnostic tools. In this study, we developed and validated IgM and IgG ELISAs for SHUV in humans and applied them alongside molecular testing to investigate SHUV infections in hospitalized patients presenting with unexplained fever and/or neurological signs in Gauteng and Mpumalanga provinces of South Africa between 2019 and 2021. We found that combining molecular and serological testing identified SHUV in approximately 6% of cases during the arbovirus season, with patients presenting with febrile convulsions, seizures, and meningitis affecting both children and adults. Importantly, an 8% seroprevalence in healthy controls suggests broader exposure than previously recognized. These findings highlight SHUV as a missed but clinically important cause of neurological illness in South Africa, and the need for expanded surveillance across Africa and other regions where SHUV may be circulating undetected.
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BibTeX
@article{rakaki2026epidemiological,
title = {{Epidemiological investigation of Shuni virus infections in hospitals in two provinces of South Africa (2019–2021) using molecular and serological surveillance}},
author = {Matshepo Elizabeth Rakaki and Adriano Mendes and Paul Wichgers Schreur and Martin H. Groschup and Markus Keller and Nicolette Marie Du Plessis and Maryke De Villier and Theunis Avenant and Marietjie Venter},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = sep,
doi = {10.1371/journal.pntd.0014738},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014738},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Epidemiological investigation of Shuni virus infections in hospitals in two provinces of South Africa (2019–2021) using molecular and serological surveillance
AU - Matshepo Elizabeth Rakaki
AU - Adriano Mendes
AU - Paul Wichgers Schreur
AU - Martin H. Groschup
AU - Markus Keller
AU - Nicolette Marie Du Plessis
AU - Maryke De Villier
AU - Theunis Avenant
AU - Marietjie Venter
PY - 2026
DA - 2026/09/21
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014738
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014738
AB - Shuni Virus (SHUV) is a reemerging zoonotic orthobunyavirus in the Peribunyaviridae family associated with neurological infections and birth defects in humans and animals in Africa and has emerged in the Middle East in the past 10 years. Limited epidemiological data exist in humans, partially due to a lack of clinical awareness and availability of diagnostic assays to determine the incidence of clinical cases and seroprevalence in the population. The goal of this study was to establish serologic and molecular diagnostic assays for SHUV for hospital-based surveillance and to investigate the clinical epidemiology in humans in South Africa. The incidence of SHUV infections was investigated in patients with acute fever of unknown cause with or without neurological signs (AFDUC/N) during the arbovirus season (January-June, 2019–2021). IgM and IgG ELISAs for SHUV were established using baculovirus-expressed glycoproteins and validated against virus-neutralization tests (VNT) positive sera. Orthobunyavirus quantitative RT-PCR (RT-qPCR) and IgM ELISA were used to identify acute infections, and IgG ELISA to define the seroprevalence in patients and healthy control groups in hospitals in Gauteng and Mpumalanga provinces in South Africa. In total, 3/349 (0.84%) AFDUC/N cases tested positive by RT-qPCR and confirmed as SHUV by sequencing. In total, 22/225 (9.7%) AFDUC/N patients had SHUV neutralising antibodies (VNT), of which 11/22 (50.00%) were IgM positive, with an IgM seropositivity of 4.89% (11/225 (4.89%)). Of the RT-PCR and double IgM + VNT+ patients, 60% presented with seizures and 40% with meningitis, of which 36.36% were children and 63.63% were adults, respectively. In total, 9/112 (8%) of the healthy control group tested positive on the IgG ELISA assay. These findings suggest that SHUV is a missed cause of acute neurological infections in hospitalized children and adults in South Africa and should be investigated in humans in Africa and other regions. Author summary: SHUV is a mosquito and biting midge-transmitted zoonotic virus that causes neurological disease and birth defects in humans and animals in Africa and the Middle East, yet it remains severely underdiagnosed due to limited clinical awareness and the absence of commercially available diagnostic tools. In this study, we developed and validated IgM and IgG ELISAs for SHUV in humans and applied them alongside molecular testing to investigate SHUV infections in hospitalized patients presenting with unexplained fever and/or neurological signs in Gauteng and Mpumalanga provinces of South Africa between 2019 and 2021. We found that combining molecular and serological testing identified SHUV in approximately 6% of cases during the arbovirus season, with patients presenting with febrile convulsions, seizures, and meningitis affecting both children and adults. Importantly, an 8% seroprevalence in healthy controls suggests broader exposure than previously recognized. These findings highlight SHUV as a missed but clinically important cause of neurological illness in South Africa, and the need for expanded surveillance across Africa and other regions where SHUV may be circulating undetected.
SN - 1935-2735
ER -