Lack of evidence for long term carriers of African swine fever virus - a systematic review.

African swine fever (ASF) was first described in 1921 as a highly fatal and contagious disease which caused severe outbreaks among settlers' pigs in British East Africa. Since then the disease has expanded its geographical distribution and is currently present in large parts of Africa, Europe and Asia and considered a global threat. Although ASF is typically associated with very high case fatality rates, a certain proportion of infected animals will recover from the infection and survive. Early on it was speculated that such survivors may act as carriers of the virus, and the importance of such carries for disease persistence and spread has since then almost become an established truth. However, the scientific basis for such a role of carriers may be questioned. With this in mind, the objective of this study was to review the available literature in a systematic way and to evaluate the available scientific evidence. The selection of publications for the review was based on a database search, followed by a stepwise screening process in order to exclude duplicates and non-relevant publications based on pre-defined exclusion criteria. By this process the number of publications finally included was reduced from the 3664 hits identified in the initial database search to 39 publications, from which data was then extracted and analysed. Based on this it was clear that a definition of an ASF virus carrier is lacking, and that in general any survivor or seropositive animal has been referred to as carrier. It was also clear that evidence of any significant role of such a carrier is absent. Two types of "survivors" could be defined: 1) pigs that do not die but develop a persistent infection, characterised by periodic viraemia and often but not always accompanied by some signs of subacute to chronic disease, and 2) pigs which clear the infection independently of virulence of the virus, and which are not persistently infected and will not present with prolonged virus excretion. There is no evidence that suggests that any of these categories of survivors can be considered as "healthy" carriers, i.e. pigs that show no sign of disease but can transmit the virus to in-contact pigs. However, localized virus persistence in lymphoid tissues may occur to some extent in any of the categories of survivors, which in theory may cause infection after oral uptake. To what extent this is relevant in reality, however, can be questioned given the virus dose generally needed for oral infection.