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Garcia-Oliveira GF, Guimarães ACDS, Moreira GD, Costa TA, Arruda MS, de Mello ÉM, Silva MC, de Almeida MG, Hanley KA, Vasilakis N, Drumond BP. YELLOW ALERT: Persistent Yellow Fever Virus Circulation among Non-Human Primates in Urban Areas of Minas Gerais State, Brazil (2021-2023). Viruses 2023; 16:31. [PMID: 38257732 PMCID: PMC10818614 DOI: 10.3390/v16010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Yellow fever virus (YFV) is the agent of yellow fever (YF), which affects both humans and non-human primates (NHP). Neotropical NHP are highly susceptible to YFV and considered sentinels for YFV circulation. Brazil faced a significant YF outbreak in 2017-2018, with over 2000 human cases and 2000 epizootics cases, mainly in the State of Minas Gerais, Brazil. This study aimed to investigate whether YFV circulation persisted in NHP after the human outbreak had subsided. To this end, NHP carcass samples collected in Minas Gerais from 2021 to 2023 were screened for YFV. RNA was extracted from tissue fragments and used in RT-qPCR targeting the YFV 5'UTR. Liver and lung samples from 166 animals were tested, and the detection of the β-actin mRNA was used to ensure adequacy of RNA isolation. YFV RNA was detected in the liver of 18 NHP carcasses collected mainly from urban areas in 2021 and 2022. YFV positive NHP were mostly represented by Callithrix, from 5 out of the 12 grouped municipalities (mesoregions) in Minas Gerais state. These findings reveal the continued YFV circulation in NHP in urban areas of Minas Gerais during 2021 and 2022, with the attendant risk of re-establishing the urban YFV cycle.
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Affiliation(s)
- Gabriela F. Garcia-Oliveira
- Laboratório de Vírus, Departament of Microbiology, Universidade Federal de Minas Gerais, Belo Horizonte CEP 31270-901, Brazil; (G.F.G.-O.); (A.C.D.S.G.); (G.D.M.); (T.A.C.); (M.S.A.)
| | - Anna Catarina Dias Soares Guimarães
- Laboratório de Vírus, Departament of Microbiology, Universidade Federal de Minas Gerais, Belo Horizonte CEP 31270-901, Brazil; (G.F.G.-O.); (A.C.D.S.G.); (G.D.M.); (T.A.C.); (M.S.A.)
| | - Gabriel Dias Moreira
- Laboratório de Vírus, Departament of Microbiology, Universidade Federal de Minas Gerais, Belo Horizonte CEP 31270-901, Brazil; (G.F.G.-O.); (A.C.D.S.G.); (G.D.M.); (T.A.C.); (M.S.A.)
| | - Thais Alkifeles Costa
- Laboratório de Vírus, Departament of Microbiology, Universidade Federal de Minas Gerais, Belo Horizonte CEP 31270-901, Brazil; (G.F.G.-O.); (A.C.D.S.G.); (G.D.M.); (T.A.C.); (M.S.A.)
| | - Matheus Soares Arruda
- Laboratório de Vírus, Departament of Microbiology, Universidade Federal de Minas Gerais, Belo Horizonte CEP 31270-901, Brazil; (G.F.G.-O.); (A.C.D.S.G.); (G.D.M.); (T.A.C.); (M.S.A.)
| | - Érica Munhoz de Mello
- Centro de Controle de Zoonoses, Prefeitura de Belo Horizonte, Belo Horizonte CEP 31270-705, Minas Gerais, Brazil
| | - Marlise Costa Silva
- Laboratório de Zoonoses, Prefeitura de Belo Horizonte, Belo Horizonte CEP 31270-705, Minas Gerais, Brazil
| | | | - Kathryn A. Hanley
- Department of Biology, New Mexico State University, Las Cruces, NM 88003-8801, USA;
| | - Nikos Vasilakis
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555-0609, USA;
- Center for Vector-Borne and Zoonotic Diseases, The University of Texas Medical Branch, Galveston, TX 77555-0609, USA
- Institute for Human Infection and Immunity, University of Texas Medical Branch, Galveston, TX 77555-0610, USA
| | - Betânia Paiva Drumond
- Laboratório de Vírus, Departament of Microbiology, Universidade Federal de Minas Gerais, Belo Horizonte CEP 31270-901, Brazil; (G.F.G.-O.); (A.C.D.S.G.); (G.D.M.); (T.A.C.); (M.S.A.)
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de Rezende IM, McClure MA, Pereira LS, Fradico JRB, Cenachi ARC, Moura AS, Paladino LLDA, Dutra MRT, Alves PA, Xavier MAP, Said RFDC, Ramalho DB, Gama TDP, Martins-Filho OA, Monath TP, Teixeira-Carvalho A, Drumond BP, LaBeaud AD. Characterization and Investigation of Risk Factors for Late-Relapsing Hepatitis After Yellow Fever. Clin Infect Dis 2023; 77:565-573. [PMID: 37099356 PMCID: PMC10444002 DOI: 10.1093/cid/ciad249] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/03/2023] [Accepted: 04/20/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Late-relapsing hepatitis after yellow fever (LHep-YF) during the convalescent phase of the disease has been described during recent yellow fever (YF) outbreaks in Brazil. LHep-YF is marked by a rebound in liver enzymes and nonspecific clinical manifestations around 46-60 days after YF symptom onset. METHODS Here we have characterized the clinical course and risk factors for LHep-YF using data from a representative cohort of patients who survived YF in Brazil, 2017-2018. A total of 221 YF-positive patients were discharged from the infectious disease reference hospital in Minas Gerais and were followed up at 30, 45, and 60 days post-symptom onset. RESULTS From 46 to 60 days post-symptom onset, 16% of YF patients (n = 36/221) exhibited a rebound of aminotransferases (aspartate aminotransferase or alanine aminotransferase >500 IU/L), alkaline phosphatase, and total bilirubin levels. Other etiologies of liver inflammation such as infectious hepatitis, autoimmune hepatitis, and metabolic liver disease were ruled out. Jaundice, fatigue, headache, and low platelet levels were associated with LHep-YF. Demographic factors, clinical manifestations, laboratory tests, ultrasound findings, and viral load during the acute phase of YF were not associated with the occurrence of LHep-YF. CONCLUSIONS These findings provide new data on the clinical course of Late-relapsing hepatitis during the convalescent phase of YF and highlight the need for extended patient follow-up after acute YF.
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Affiliation(s)
- Izabela Mauricio de Rezende
- Laboratory of Viruses, Microbiology Department, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, California
| | - Max A McClure
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, California
| | | | - Jordana R B Fradico
- Integrated Group of Biomarkers Research, René Rachou Institute, Oswaldo Cruz Foundation/FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | | | - Pedro A Alves
- Immunology of Viral Diseases, René Rachou Institute, Oswaldo Cruz Foundation/FIOCRUZ
| | - Marcelo A P Xavier
- Immunology of Viral Diseases, René Rachou Institute, Oswaldo Cruz Foundation/FIOCRUZ
| | | | - Dario B Ramalho
- Eduardo de Menezes Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Thaysa D P Gama
- Eduardo de Menezes Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Olindo A Martins-Filho
- Integrated Group of Biomarkers Research, René Rachou Institute, Oswaldo Cruz Foundation/FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | | | - Andréa Teixeira-Carvalho
- Integrated Group of Biomarkers Research, René Rachou Institute, Oswaldo Cruz Foundation/FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Betânia P Drumond
- Laboratory of Viruses, Microbiology Department, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Angelle D LaBeaud
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, California
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de Rezende IM, Cenachi ARC, Costa TA, Oliveira GFG, Rabelo L, Menezes LM, Penido I, Pereira LS, Arruda MS, Gonç alves AP, Alves PA, Kroon EG, Calzavara-Silva CE, Ramalho DB, Martins-Filho OA, Teixeira-Carvalho A, LaBeaud AD, Drumond BP. Wild-type Yellow fever virus in cerebrospinal fluid from fatal cases in Brazil, 2018. FRONTIERS IN VIROLOGY (LAUSANNE, SWITZERLAND) 2022; 2:936191. [PMID: 37461745 PMCID: PMC10351615 DOI: 10.3389/fviro.2022.936191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Yellow fever virus (YFV) is the causative agent of yellow fever (YF), a hemorrhagic and viscerotropic acute disease. Severe YF has been described in approximately 15-25% of YF patients, with 20-50% of severe YF cases being fatal. Here we analyzed cerebrospinal fluid (CSF) samples collected during the YF outbreak in Brazil in 2018, aiming to investigate CNS neuroinvasion in fatal YFV cases. YFV RNA was screened by RT-qPCR targeting the 3'UTR region of the YFV genome in CSF. CSF samples were tested for the presence of anti-YFV IgM and neutralizing antibodies, coupled with routine laboratory examinations. Among the 13 patients studied, we detected anti-YFV IgM in CSF from eight patients and YFV RNA in CSF from five patients. YFV RNA genomic load in CSF samples ranged from 1.75×103 to 5.42×103 RNA copies/mL. We genotyped YFV from three CSF samples that grouped with other YFV samples from the 2018 outbreak in Brazil within the South-American I genotype. Even though descriptions of neurologic manifestations due to wild type YFV (WT-YFV) infection are rare, since the last YF outbreak in Brazil in 2017-2018, a few studies have demonstrated WT-YFV RNA in CSF samples from YF fatal cases. Serological tests indicated the presence of IgM and neutralizing antibodies against YFV in CSF samples from two patients. Although the presence of viral RNA, IgM and neutralizing antibodies in CSF samples could indicate neuroinvasiveness, further studies are needed to better elucidate the role of YFV neuroinvasion and possible impacts in disease pathogenesis.
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Affiliation(s)
- Izabela Mauricio de Rezende
- Laboratory of Viruses, Microbiology Department, Biological Sciences Institute, Federal University of Minas Gerais, Minas Gerais, Brazil
- Department of Pediatrics, Division of Infectious Disease, Stanford University School of Medicine, Stanford, CA, United States
| | | | - Thais Alkifeles Costa
- Laboratory of Viruses, Microbiology Department, Biological Sciences Institute, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Gabriela Fernanda Garcia Oliveira
- Laboratory of Viruses, Microbiology Department, Biological Sciences Institute, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Livia Rabelo
- Eduardo de Menezes Hospital, Belo Horizonte, Brazil
| | | | | | - Leonardo Soares Pereira
- Eduardo de Menezes Hospital, Belo Horizonte, Brazil
- Bendigo Heath Hospital, Bendigo, VIC, Australia
| | - Matheus Soares Arruda
- Laboratory of Viruses, Microbiology Department, Biological Sciences Institute, Federal University of Minas Gerais, Minas Gerais, Brazil
| | | | - Pedro Augusto Alves
- Immunology of Viruses Diseases, René Rachou Institute, Oswaldo Cruz Foundation/FIOCRUZ, Minas Gerais, Brazil
| | - Erna Geessien Kroon
- Laboratory of Viruses, Microbiology Department, Biological Sciences Institute, Federal University of Minas Gerais, Minas Gerais, Brazil
| | | | | | - Olindo Assis Martins-Filho
- Integrated Group of Biomarkers Research, René Rachou Institute, Oswaldo Cruz Foundation/FIOCRUZ, Minas Gerais, Brazil
| | - Andrea Teixeira-Carvalho
- Integrated Group of Biomarkers Research, René Rachou Institute, Oswaldo Cruz Foundation/FIOCRUZ, Minas Gerais, Brazil
| | - A. Desiree LaBeaud
- Department of Pediatrics, Division of Infectious Disease, Stanford University School of Medicine, Stanford, CA, United States
| | - Betânia Paiva Drumond
- Laboratory of Viruses, Microbiology Department, Biological Sciences Institute, Federal University of Minas Gerais, Minas Gerais, Brazil
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Yellow Fever Molecular Diagnosis Using Urine Specimens during Acute and Convalescent Phases of the Disease. J Clin Microbiol 2022; 60:e0025422. [PMID: 35916519 PMCID: PMC9383191 DOI: 10.1128/jcm.00254-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Prior studies have demonstrated prolonged presence of yellow fever virus (YFV) RNA in saliva and urine as an alternative to serum. To investigate the presence of YFV RNA in urine, we used RT-PCR for YFV screening in 60 urine samples collected from a large cohort of naturally infected yellow fever (YF) patients during acute and convalescent phases of YF infection from recent YF outbreaks in Brazil (2017 to 2018). Fifteen urine samples from acute phase infection (up to 15 days post-symptom onset) and four urine samples from convalescent phase infection (up to 69 days post-symptom onset), were YFV PCR-positive. We genotyped YFV detected in seven urine samples (five collected during the acute phase and two collected during the YF convalescent phase). Genotyping indicated the presence of YFV South American I genotype in these samples. To our knowledge, this is the first report of wild-type YFV RNA detection in the urine this far out from symptom onset (up to 69 DPS), including YFV RNA detection during the convalescent phase of YF infection. The detection of YFV RNA in urine is an indicative of YFV infection; however, the results of RT-PCR using urine as sample should be interpreted with care, since a negative result does not exclude the possibility of YFV infection. With a possible prolonged period of detection beyond the viremic phase, the use of urine samples coupled with serological tests, epidemiologic inquiry, and clinical assessment could provide a longer diagnostic window for laboratory YF diagnosis.
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Neighbor danger: Yellow fever virus epizootics in urban and urban-rural transition areas of Minas Gerais state, during 2017-2018 yellow fever outbreaks in Brazil. PLoS Negl Trop Dis 2020; 14:e0008658. [PMID: 33017419 PMCID: PMC7535057 DOI: 10.1371/journal.pntd.0008658] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/28/2020] [Indexed: 11/19/2022] Open
Abstract
Background From the end of 2016 until the beginning of 2019, Brazil faced a massive sylvatic yellow fever (YF) outbreak. The 2016–2019 YF epidemics affected densely populated areas, especially the Southeast region, causing thousands of deaths of humans and non-human primates (NHP). Methodology/Principal findings We conducted a molecular investigation of yellow fever virus (YFV) RNA in 781 NHP carcasses collected in the urban, urban-rural interface, and rural areas of Minas Gerais state, from January 2017 to December 2018. Samples were analyzed according to the period of sampling, NHP genera, sampling areas, and sampling areas/NHP genera to compare the proportions of YFV-positive carcasses and the estimated YFV genomic loads. YFV infection was confirmed in 38.1% of NHP carcasses (including specimens of the genera Alouatta, Callicebus, Callithrix, and Sapajus), from the urban, urban-rural interface, and rural areas. YFV RNA detection was positively associated with epidemic periods (especially from December to March) and the rural environment. Higher median viral genomic loads (one million times) were estimated in carcasses collected in rural areas compared to urban ones. Conclusions/Significance The results showed the wide occurrence of YF in Minas Gerais in epidemic and non-epidemic periods. According to the sylvatic pattern of YF, a gradient of viral dissemination from rural towards urban areas was observed. A high YF positivity was observed for NHP carcasses collected in urban areas with a widespread occurrence in 67 municipalities of Minas Gerais, including large urban centers. Although there was no documented case of urban/Aedes YFV transmission to humans in Brazil during the 2016–2019 outbreaks, YFV-infected NHP in urban areas with high infestation by Aedes aegypti poses risks for YFV urban/Aedes transmission and urbanization. Brazil faced the most massive sylvatic yellow fever (YF) outbreak in 2016–2019. The outbreak affected highly densely populated areas, and Minas Gerais was the most affected state with thousands of deaths of human and non-human primates (NHP). We investigated the yellow fever virus (YFV) RNA in NHP carcasses collected throughout Minas Gerais in 2017 and 2018. We demonstrated the wide occurrence of YFV-infected NHP, including the viral persistence during the non-epidemic dry season of 2017. YFV RNA was detected in NHP carcasses in the urban, urban-rural interface and rural areas. We have also detected new YF cases in 49 municipalities where YF cases have not been previously detected during the outbreaks. Estimates of YFV genomic load in naturally infected NHP carcasses showed high and similar loads in specimens (Alouatta, Callithrix, and Callicebus) collected in rural areas and lower genomic loads in the urban-rural interface and urban Callithrix specimens. The presence of YFV inside urban areas poses an imminent risk, although no human case was epidemiologically linked to urban/Aedes transmission during the last outbreaks in Brazil.
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