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Ahmed S, Sultana S, Kundu S, Alam SS, Hossan T, Islam MA. Global Prevalence of Zika and Chikungunya Coinfection: A Systematic Review and Meta-Analysis. Diseases 2024; 12:31. [PMID: 38391778 PMCID: PMC10888207 DOI: 10.3390/diseases12020031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Zika virus (ZIKV) and chikungunya virus (CHIKV) are arthropod-borne viruses with significant pathogenicity, posing a substantial health and economic burden on a global scale. Moreover, ZIKV-CHIKV coinfection imposes additional therapeutic challenges as there is no specific treatment for ZIKV or CHIKV infection. While a growing number of studies have documented the ZIKV-CHIKV coinfection, there is currently a lack of conclusive reports on this coinfection. Therefore, we performed a systematic review and meta-analysis to determine the true statistics of ZIKV-CHIKV coinfection in the global human population. Relevant studies were searched for in PubMed, Scopus, and Google Scholar without limitation in terms of language or publication date. A total of 33 studies containing 41,460 participants were included in this meta-analysis. The study protocol was registered with PROSPERO under the registration number CRD42020176409. The pooled prevalence and confidence intervals of ZIKV-CHIKV coinfection were computed using a random-effects model. The study estimated a combined global prevalence rate of 1.0% [95% CI: 0.7-1.2] for the occurrence of ZIKV-CHIKV coinfection. The region of North America (Mexico, Haiti, and Nicaragua) and the country of Haiti demonstrated maximum prevalence rates of 2.8% [95% CI: 1.5-4.1] and 3.5% [95% CI: 0.2-6.8], respectively. Moreover, the prevalence of coinfection was found to be higher in the paediatric group (2.1% [95% CI: 0.0-4.2]) in comparison with the adult group (0.7% [95% CI: 0.2-1.1]). These findings suggest that the occurrence of ZIKV-CHIKV coinfection varies geographically and by age group. The results of this meta-analysis will guide future investigations seeking to understand the underlying reasons for these variations and the causes of coinfection and to develop targeted prevention and control strategies.
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Affiliation(s)
- Saleh Ahmed
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Shabiha Sultana
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Shoumik Kundu
- Department of Chemistry and Biochemistry, Texas Tech University, 2500 Broadway St., Lubbock, TX 79409, USA
| | - Sayeda Sadia Alam
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | - Tareq Hossan
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Md Asiful Islam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
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Anjos RO, Portilho MM, Jacob-Nascimento LC, Carvalho CX, Moreira PSS, Sacramento GA, Nery Junior NRR, de Oliveira D, Cruz JS, Cardoso CW, Argibay HD, Plante KS, Plante JA, Weaver SC, Kitron UD, Reis MG, Ko AI, Costa F, Ribeiro GS. Dynamics of chikungunya virus transmission in the first year after its introduction in Brazil: A cohort study in an urban community. PLoS Negl Trop Dis 2023; 17:e0011863. [PMID: 38150470 PMCID: PMC10775974 DOI: 10.1371/journal.pntd.0011863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 01/09/2024] [Accepted: 12/14/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND The first chikungunya virus (CHIKV) outbreaks during the modern scientific era were identified in the Americas in 2013, reaching high attack rates in Caribbean countries. However, few cohort studies have been performed to characterize the initial dynamics of CHIKV transmission in the New World. METHODOLOGY/PRINCIPAL FINDINGS To describe the dynamics of CHIKV transmission shortly after its introduction in Brazil, we performed semi-annual serosurveys in a long-term community-based cohort of 652 participants aged ≥5 years in Salvador, Brazil, between Feb-Apr/2014 and Nov/2016-Feb/2017. CHIKV infections were detected using an IgG ELISA. Cumulative seroprevalence and seroincidence were estimated and spatial aggregation of cases was investigated. The first CHIKV infections were identified between Feb-Apr/2015 and Aug-Nov/2015 (incidence: 10.7%) and continued to be detected at low incidence in subsequent surveys (1.7% from Aug-Nov/2015 to Mar-May/2016 and 1.2% from Mar-May/2016 to Nov/206-Feb/2017). The cumulative seroprevalence in the last survey reached 13.3%. It was higher among those aged 30-44 and 45-59 years (16.1% and 15.6%, respectively), compared to younger (12.4% and 11.7% in <15 and 15-29 years, respectively) or older (10.3% in ≥60 years) age groups, but the differences were not statistically significant. The cumulative seroprevalence was similar between men (14.7%) and women (12.5%). Yet, among those aged 15-29 years, men were more often infected than women (18.1% vs. 7.4%, respectively, P = 0.01), while for those aged 30-44, a non-significant opposite trend was observed (9.3% vs. 19.0%, respectively, P = 0.12). Three spatial clusters of cases were detected in the study site and an increased likelihood of CHIKV infection was detected among participants who resided with someone with CHIKV IgG antibodies. CONCLUSIONS/SIGNIFICANCE Unlike observations in other settings, the initial spread of CHIKV in this large urban center was limited and focal in certain areas, leaving a high proportion of the population susceptible to further outbreaks. Additional investigations are needed to elucidate the factors driving CHIKV spread dynamics, including understanding differences with respect to dengue and Zika viruses, in order to guide prevention and control strategies for coping with future outbreaks.
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Affiliation(s)
| | - Moyra M Portilho
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | | | | | | | | | - Nivison R R Nery Junior
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Jaqueline S Cruz
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | | | - Hernan D Argibay
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Kenneth S Plante
- World Reference Center for Emerging Viruses and Arboviruses, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Jessica A Plante
- World Reference Center for Emerging Viruses and Arboviruses, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Scott C Weaver
- World Reference Center for Emerging Viruses and Arboviruses, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Uriel D Kitron
- Emory University, Atlanta, Georgia, United States of America
| | - Mitermayer G Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Yale University, New Haven, Connecticut, United States of America
| | - Albert I Ko
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Yale University, New Haven, Connecticut, United States of America
| | - Federico Costa
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- Yale University, New Haven, Connecticut, United States of America
- University of Liverpool, Liverpool, United Kingdom
- Lancaster University, Lancaster, United Kingdom
| | - Guilherme S Ribeiro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
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Souza RL, Nazare RJ, Argibay HD, Pellizzaro M, Anjos RO, Portilho MM, Jacob-Nascimento LC, Reis MG, Kitron UD, Ribeiro GS. Density of Aedes aegypti (Diptera: Culicidae) in a low-income Brazilian urban community where dengue, Zika, and chikungunya viruses co-circulate. Parasit Vectors 2023; 16:159. [PMID: 37149611 PMCID: PMC10163576 DOI: 10.1186/s13071-023-05766-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/03/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Low-income urban communities in the tropics often lack sanitary infrastructure and are overcrowded, favoring Aedes aegypti proliferation and arboviral transmission. However, as Ae. aegypti density is not spatially homogeneous, understanding the role of specific environmental characteristics in determining vector distribution is critical for planning control interventions. The objectives of this study were to identify the main habitat types for Ae. Aegypti, assess their spatial densities to identify major hotspots of arbovirus transmission over time and investigate underlying factors in a low-income urban community in Salvador, Brazil. We also tested the field-collected mosquitoes for arboviruses. METHODS A series of four entomological and socio-environmental surveys was conducted in a random sample of 149 households and their surroundings between September 2019 and April 2021. The surveys included searching for potential breeding sites (water-containing habitats) and for Ae. aegypti immatures in them, capturing adult mosquitoes and installing ovitraps. The spatial distribution of Ae. aegypti density indices were plotted using kernel density-ratio maps, and the spatial autocorrelation was assessed for each index. Visual differences on the spatial distribution of the Ae. aegypti hotspots were compared over time. The association of entomological findings with socio-ecological characteristics was examined. Pools of female Ae. aegypti were tested for dengue, Zika and chikungunya virus infection. RESULTS Overall, 316 potential breeding sites were found within the study households and 186 in the surrounding public spaces. Of these, 18 (5.7%) and 7 (3.7%) harbored a total of 595 and 283 Ae. aegypti immatures, respectively. The most productive breeding sites were water storage containers within the households and puddles and waste materials in public areas. Potential breeding sites without cover, surrounded by vegetation and containing organic matter were significantly associated with the presence of immatures, as were households that had water storage containers. None of the entomological indices, whether based on immatures, eggs or adults, detected a consistent pattern of vector clustering in the same areas over time. All the mosquito pools were negative for the tested arboviruses. CONCLUSIONS This low-income community displayed high diversity of Ae. aegypti habitats and a high degree of heterogeneity of vector abundance in both space and time, a scenario that likely reflects other low-income communities. Improving basic sanitation in low-income urban communities through the regular water supply, proper management of solid wastes and drainage may reduce water storage and the formation of puddles, minimizing opportunities for Ae. aegypti proliferation in such settings.
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Affiliation(s)
- Raquel L Souza
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Romero J Nazare
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Hernan D Argibay
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Maysa Pellizzaro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Rosângela O Anjos
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Moyra M Portilho
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Leile Camila Jacob-Nascimento
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Mitermayer G Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Yale School of Public Health, New Haven, CT, USA
| | | | - Guilherme S Ribeiro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.
- Universidade Federal da Bahia, Salvador, Bahia, Brazil.
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de Souza RL, Ferreira GDS, Borja LS, Nazaré RDJ, Mugabe VA, Argibay HD, Portilho MM, Jacob-Nascimento LC, Reis MG, Kitron UD, Ribeiro GS. Diversity of Mosquitoes (Diptera: Culicidae) in an Atlantic Forest Urban Park, Salvador, Brazil. J Med Entomol 2022; 59:1065-1070. [PMID: 35244168 DOI: 10.1093/jme/tjac007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Indexed: 06/14/2023]
Abstract
We identified mosquito species (Diptera: Culicidae) in an Atlantic Forest fragment located in a large urban park in Salvador, Brazil, one year after a citywide epizootic of yellow fever virus (YFV). Between May 2 and August 2, 2018, adult mosquitoes were collected using the human attraction method, followed by trapping with hand-nets, and CO2-baited light traps placed at ground level and in the canopy. We collected a total of 11,914 mosquitoes, which belonged to three tribes, five genera, and at least seven species. The most abundant taxa captured by CO2-baited light traps were Culex quinquefasciatus (Say, Diptera: Culicidae) Limatus spp. (Diptera: Culicidae), and Wyeomyia spp. (Diptera: Culicidae), while by human attraction, Cx. quinquefasciatus, Wyeomyia spp., and Aedes albopictus (Skuse, Diptera: Culicidae) were captured most often. The diversity of mosquitoes by species was greater in the park area with restinga vegetation compared to the area with dense rainforest. Although vectors commonly associated with sylvatic YFV transmission were not captured, we collected several species capable of transmission of other arboviruses. Given the high likelihood of encounters between mosquitoes and human visitors in environments, such as the one studied, periodic entomological surveys to determine the risk of arbovirus transmission in these settings are warranted.
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Affiliation(s)
- Raquel Lima de Souza
- Laboratório de Patologia e Biologia Molecular, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Gabriel Dos Santos Ferreira
- Laboratório de Patologia e Biologia Molecular, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Instituto de Biologia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Lairton Souza Borja
- Laboratório de Patologia e Biologia Molecular, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Romero de Jesus Nazaré
- Laboratório de Patologia e Biologia Molecular, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Vánio Andre Mugabe
- Laboratório de Patologia e Biologia Molecular, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Deptartmento de Ciências e Tecnologia, Universidade Licungo, Quelimane, Zambézia 106, Mozambique
| | - Hernan Darío Argibay
- Laboratório de Patologia e Biologia Molecular, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Moyra Machado Portilho
- Laboratório de Patologia e Biologia Molecular, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Leile Camila Jacob-Nascimento
- Laboratório de Patologia e Biologia Molecular, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Mitermayer Galvão Reis
- Laboratório de Patologia e Biologia Molecular, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Uriel D Kitron
- Department of Environmental Sciences, Emory University, Atlanta, GA, USA
| | - Guilherme Sousa Ribeiro
- Laboratório de Patologia e Biologia Molecular, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Cardoso CW, Oliveira e Silva MM, Bandeira AC, Silva RB, Prates APPB, Soares ÊS, Silva JJM, de Souza LJR, Souza MMDS, Muhana MA, Pires RSS, Araujo Neto JF, Santos MSS, Mafra Junior LL, Alves TP, Schramm MA, Ribeiro GS. Haff Disease in Salvador, Brazil, 2016-2021: Attack rate and detection of toxin in fish samples collected during outbreaks and disease surveillance. Lancet Reg Health Am 2021; 5:100092. [PMID: 36776458 PMCID: PMC9904022 DOI: 10.1016/j.lana.2021.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
Background From late 2016 to early 2021, cases of Haff disease, a rare cause of rhabdomyolysis, possibly due to poisoning by palytoxin-like compounds in seafood, were detected in Salvador, Brazil. Surveillance was established to detect additional cases aiming at describing the clinical characteristics of the cases, identifying associated factors, estimating disease attack rate, and investigating the presence of biotoxins and trace metals in selected fish specimens obtained from cases. Method Between December/2016-January/2021, surveillance investigated Haff disease suspected cases, and obtained clinical and fish samples to test. Findings Of 65 cases investigated during the 2016-2017 outbreak, 43 (66%) had high creatine phosphokinase (CPK) levels. Among those with laboratory-confirmed rhabdomyolysis, 38 (88%) were hospitalized, 11 (26%) required intensive care, and three (7%) dialysis. Ingestion of marine fish 24h before disease onset was reported by 74% of the cases with elevated CPK and by 41% of those without CPK measurement (P=0·02). Attack rate for individuals who ate fish related to the outbreak was 55%. Following this outbreak, surveillance identified 12 suspected cases between 2017-2019, and a second outbreak in 2020-2021, with 16 laboratory-confirmed rhabdomyolysis patients (five required intensive care; one died). No traces of ciguatoxins and metals were detected in fish specimens obtained in 2016, found to be Seriola rivoliana. Some fish samples from 2020 were screened for palytoxin (PlTX)-like compounds and contained detectable levels of molecule fragments characteristics of isobaric PlTX, ovatoxin-a (OVTX-a), OVTX-b and OVTX-d. Interpretation These findings support the hypothesis that compounds related to PlTX accumulated in marine fish may be the toxic agent causing the disease. Haff disease is a life-threatening condition, requiring clinical suspicion for patients with sudden-onset myalgia following fish ingestion. Suspected cases should be reported to health authorities for investigation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Guilherme Sousa Ribeiro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil,Corresponding author:
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Anjos RO, Mugabe VA, Moreira PSS, Carvalho CX, Portilho MM, Khouri R, Sacramento GA, Nery NRR, Reis MG, Kitron UD, Ko AI, Costa F, Ribeiro GS. Transmission of Chikungunya Virus in an Urban Slum, Brazil. Emerg Infect Dis 2021; 26:1364-1373. [PMID: 32568045 PMCID: PMC7323528 DOI: 10.3201/eid2607.190846] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
After a chikungunya outbreak in Salvador, Brazil, we performed a cross-sectional, community-based study of 1,776 inhabitants to determine chikungunya virus (CHIKV) seroprevalence, identify factors associated with exposure, and estimate the symptomatic infection rate. From November 2016 through February 2017, we collected sociodemographic and clinical data by interview and tested serum samples for CHIKV IgG. CHIKV seroprevalence was 11.8% (95% CI 9.8%–13.7%), and 15.3% of seropositive persons reported an episode of fever and arthralgia. Infections were independently and positively associated with residences served by unpaved streets, a presumptive clinical diagnosis of chikungunya, and recall of an episode of fever with arthralgia in 2015–2016. Our findings indicate that the chikungunya outbreak in Salvador may not have conferred sufficient herd immunity to preclude epidemics in the near future. The unusually low frequency of symptomatic disease points to a need for further longitudinal studies to better investigate these findings.
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de Aguiar DF, de Barros ENC, Ribeiro GS, Brasil P, Mourao MPG, Luz K, Aoki FH, Freitas ARR, Calvet GA, Oliveira E, Branco BF, Abreu A, Cheuvart B, Guignard A, de Boer M, Duarte AC, Borges MB, de Noronha TG. A prospective, multicentre, cohort study to assess the incidence of dengue illness in households from selected communities in Brazil (2014-2018). Int J Infect Dis 2021; 108:443-453. [PMID: 33894353 DOI: 10.1016/j.ijid.2021.04.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To estimate the incidence of dengue infection across geographically distinct areas of Brazil. METHODS This prospective, household-based, cohort study enrolled participants in five areas and followed them up for up to 4 years (2014-2018). Dengue seroprevalence was assessed at each scheduled visit. Suspected dengue cases were identified through enhanced passive and active surveillance. Acute symptomatic dengue infection was confirmed through reverse-transcriptase quantitative polymerase chain reaction in combination with an antigenic assay (non-structural protein 1) and serology. RESULTS Among 3300 participants enrolled, baseline seroprevalence was 76.2%, although only 23.3% of participants reported a history of dengue. Of 1284 suspected symptomatic dengue cases detected, 50 (3.9%) were laboratory-confirmed. Based on 8166.5 person-years (PY) of follow-up, the incidence of laboratory-confirmed symptomatic infection (primary endpoint) was 6.1 per 1000 PY (95% confidence interval [CI]: 4.5, 8.1). Incidence varied substantially in different years (1.8-7.4 per 1000 PY). The incidence of inapparent primary dengue infection was substantially higher: 41.7 per 1000 PY (95% CI: 31.1, 54.6). CONCLUSIONS Our findings, highlighting that the incidence of dengue infection is underestimated in Brazil, will inform the design and implementation of future dengue vaccine trials. CLINICAL TRIAL REGISTRATION NCT01751139.
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Affiliation(s)
- Daniele Fernandes de Aguiar
- Instituto de Tecnologia em Imunobiológicos Bio-Manguinhos/Fiocruz, Avenida Brasil 4.365, Manguinhos, Rio de Janeiro - RJ, 21.040-900, Brazil
| | | | - Guilherme Sousa Ribeiro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Avenida Waldemar Falcão, 121, Candeal, Salvador - BA, 40296-710, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Avenida Adhemar de Barros, s/nº - Ondina, Salvador - BA, 40170-110, Brazil
| | - Patricia Brasil
- Instituto Nacional de Infectologia Evandro Chagas (INI/Fiocruz), Avenida Brasil 4.365, Manguinhos, Rio de Janeiro - RJ, 21.040-900, Brazil
| | | | - Kleber Luz
- Centro de Pesquisas Clínicas de Natal, Rua Dr. Ponciano Barbosa, 282, Cidade Alta, Natal - RN, 59025-050, Brazil
| | - Francisco Hideo Aoki
- Universidade Estadual de Campinas, Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas - SP, 13083-970, Brazil
| | - Andre Ricardo Ribas Freitas
- São Leopoldo Mandic College, Rua Dr. José Rocha Junqueira, 13 - Pte. Preta, Campinas - SP, 13045-755, Brazil
| | - Guilherme Amaral Calvet
- Instituto Nacional de Infectologia Evandro Chagas (INI/Fiocruz), Avenida Brasil 4.365, Manguinhos, Rio de Janeiro - RJ, 21.040-900, Brazil
| | - Eduardo Oliveira
- GSK, Estrada dos Bandeirantes, 8464, Jacarepaguá, Rio de Janeiro - RJ, 22775-610, Brazil
| | - Bianca F Branco
- GSK, Estrada dos Bandeirantes, 8464, Jacarepaguá, Rio de Janeiro - RJ, 22775-610, Brazil
| | - Ariane Abreu
- GSK, Estrada dos Bandeirantes, 8464, Jacarepaguá, Rio de Janeiro - RJ, 22775-610, Brazil
| | | | | | | | - Ana Claudia Duarte
- Instituto de Tecnologia em Imunobiológicos Bio-Manguinhos/Fiocruz, Avenida Brasil 4.365, Manguinhos, Rio de Janeiro - RJ, 21.040-900, Brazil
| | - Maria Beatriz Borges
- Instituto de Tecnologia em Imunobiológicos Bio-Manguinhos/Fiocruz, Avenida Brasil 4.365, Manguinhos, Rio de Janeiro - RJ, 21.040-900, Brazil
| | - Tatiana Guimarães de Noronha
- Instituto de Tecnologia em Imunobiológicos Bio-Manguinhos/Fiocruz, Avenida Brasil 4.365, Manguinhos, Rio de Janeiro - RJ, 21.040-900, Brazil
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Catenacci LS, Ferreira MS, Fernandes D, Padda H, Travassos-da-Rosa ES, Deem SL, Vasconcelos PFC, Martins LC. Individual, household and environmental factors associated with arboviruses in rural human populations, Brazil. Zoonoses Public Health 2021; 68:203-212. [PMID: 33538403 DOI: 10.1111/zph.12811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/01/2020] [Accepted: 01/18/2021] [Indexed: 11/27/2022]
Abstract
Landscape change is one of the foremost drivers of the emergence of infectious diseases. Exploring demographic, household and environmental conditions under which infectious diseases occur may inform strategies to prevent disease emergence in human populations. We collected blood samples from 523 humans and explore factors for arbovirus emergence in Bahia, Brazil. The overall arbovirus seroprevalence was 65.2%, with the genus Flavivirus most prevalent (64.4%). Based on monotypic reactions, the population had contact with five arbovirus: Dengue 3, Ilheus, Oropouche, Caraparu and Eastern equine encephalitis virus. To our knowledge, this is the first study reporting exposure to Oropouche, Caraparu and Eastern equine encephalitis virus in human populations in Bahia, Northeast of Brazil. The best model fit demonstrated that household and environmental variables were more predictive of the risk of arbovirus exposure than demographic variables. The presence of forest and free-living monkeys in the areas close to the communities had a protective effect for the human population (i.e. lower seroprevalence). The dilution effect is considered as one explanation for this finding. These results highlight the important ecological role of wildlife-friendly agriculture.
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Affiliation(s)
- Lilian S Catenacci
- Department of Veterinary Morphophysiology, Federal University of Piauí State, Teresina, Brazil.,Federal University of Para State- Post Graduate Program PPGSAAM, Castanhal, Brazil.,Institute for Conservation Medicine, Saint Louis Zoo, St. Louis, MO, USA
| | - Milene S Ferreira
- Section of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute- Ministry of Health, Ananindeua, Brazil
| | - Debora Fernandes
- Section of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute- Ministry of Health, Ananindeua, Brazil
| | - Hannah Padda
- Institute for Conservation Medicine, Saint Louis Zoo, St. Louis, MO, USA.,Washington University in St. Louis, St. Louis, MO, USA
| | | | - Sharon L Deem
- Institute for Conservation Medicine, Saint Louis Zoo, St. Louis, MO, USA
| | - Pedro F C Vasconcelos
- Section of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute- Ministry of Health, Ananindeua, Brazil
| | - Livia C Martins
- Section of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute- Ministry of Health, Ananindeua, Brazil
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9
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Mugabe VA, Borja LS, Cardoso CW, Weaver SC, Reis MG, Kitron U, Ribeiro GS. Changes in the dynamics of dengue incidence in South and Central America are possibly due to cross-population immunity after Zika virus epidemics. Trop Med Int Health 2020; 26:272-280. [PMID: 33190402 DOI: 10.1111/tmi.13526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We tested the hypothesis that Zika virus (ZIKV) immunity may protect against dengue virus (DENV) infection, disease severity or human amplification, based on analysis of epidemiological data from our long-term surveillance study (2009-2016) in the city of Salvador, Brazil, that indicated a substantial reduction in the frequency of laboratory-confirmed dengue cases following the Zika outbreak. To assess whether similar patterns were observed across the Americas, we did a broader explorative investigation of historical series (2004 to 2019) of suspected cases of dengue fever, covering 20 DENV-endemic South and Central American countries. METHODS We used segmented linear regressions of single group interrupted time series (ITS) analysis to evaluate whether the Zika epidemic had a statistical effect on the trends of annual dengue incidence. RESULTS We observed in our 16-year historical series that in all countries, the incidence of dengue exhibited periodic oscillations over time, with a general trend of statistically significant increase during the pre-Zika period overall and for 11 of the 20 countries. Following the peak of the first population exposure to ZIKV in the Americas, in 2016, the overall rate of reported dengue cases in 2017 and 2018 in the countries under study sharply dropped (P < 0.05) and was the lowest reported since 2005. Individually in each country, a statistically significant reduction in the annual dengue incidence beginning in 2016 or in 2017-2018 occurred in 13 of the 20 studied countries. However, in 2019, reports of suspected dengue cases increased across the Americas. In Brazil, Dominican Republic, Guatemala and Honduras, dengue incidence was >5 times higher in 2019 than in 2017 and 2018, and, in 2019, they had the greater dengue incidence than in all previous years throughout the historical series. CONCLUSIONS The widespread decline in suspected dengue cases recorded in 2017 and 2018 lends further support to our previous epidemiological hypothesis of ZIKV-induced cross-species immunity to DENV. However, the cross-protection appears to be transient (around 2 years). Long-term, prospective follow-ups of dengue reports are needed to confirm (or refute) these findings, which could have significant public health implications, in particular regarding DENV vaccine development and application.
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Affiliation(s)
- Vánio A Mugabe
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil.,Universidade Licungo, Quelimane, Zambézia, Mozambique
| | - Lairton S Borja
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil
| | - Cristiane W Cardoso
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil.,Secretaria Municipal de Saúde de Salvador, Salvador, BA, Brazil
| | | | - Mitermayer G Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil.,Yale School of Public Health, New Haven, CT, USA
| | - Uriel Kitron
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil.,Emory University, Atlanta, GA, USA
| | - Guilherme S Ribeiro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil
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10
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Rodrigues AM, Souza RRM, Fonseca LMDS, Rolo CDA, Carvalho RH, Sardi SI, Campos GS. Genomic surveillance of the Chikungunya Virus (CHIKV) in Northeast Brazil after the first outbreak in 2014. Rev Soc Bras Med Trop 2020; 53:e20190583. [PMID: 32578706 PMCID: PMC7310362 DOI: 10.1590/0037-8682-0583-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/12/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION We performed an epidemiological surveillance of the Chikungunya (CHIKV) lineages in Bahia after the 2014 East/Central/South African (ECSA) genotype outbreak. METHODS Reverse-transcription polymerase chain reaction (RT-PCR), viral isolation, and phylogenetic analyses were conducted on serum samples from 605 patients with CHIKV-like symptoms during 2014-2018. RESULTS Of the 605 samples, 167 were CHIKV-positive. Viral isolation was achieved for 20 samples; their phylogenetic analysis (E2 protein) revealed the presence of ECSA lineage and reinforced the phylogenetic relationship between ECSA and Indian Ocean lineages. CONCLUSIONS The genomic surveillance of CHIKV showed that only ECSA lineage circulated in Bahia since the 2014 outbreak.
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Affiliation(s)
- Ayslany Melo Rodrigues
- Universidade Federal da Bahia, Laboratório de Virologia, Instituto de Ciências da Saúde, Salvador, BA, Brasil
| | - Rafael Ribeiro Mota Souza
- Universidade Federal da Bahia, Laboratório de Virologia, Instituto de Ciências da Saúde, Salvador, BA, Brasil
| | | | - Carolina de Araújo Rolo
- Universidade Federal da Bahia, Laboratório de Virologia, Instituto de Ciências da Saúde, Salvador, BA, Brasil
| | - Rejane Hughes Carvalho
- Universidade Federal da Bahia, Laboratório de Virologia, Instituto de Ciências da Saúde, Salvador, BA, Brasil
| | - Silvia Ines Sardi
- Universidade Federal da Bahia, Laboratório de Virologia, Departamento de Biointeração, Instituto de Ciências da Saúde, Salvador, BA, Brasil
| | - Gubio Soares Campos
- Universidade Federal da Bahia, Laboratório de Virologia, Departamento de Biointeração, Instituto de Ciências da Saúde, Salvador, BA, Brasil
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11
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Prow NA, Liu L, McCarthy MK, Walters K, Kalkeri R, Geiger J, Koide F, Cooper TH, Eldi P, Nakayama E, Diener KR, Howley PM, Hayball JD, Morrison TE, Suhrbier A. The vaccinia virus based Sementis Copenhagen Vector vaccine against Zika and chikungunya is immunogenic in non-human primates. NPJ Vaccines 2020; 5:44. [PMID: 32550013 PMCID: PMC7265471 DOI: 10.1038/s41541-020-0191-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/24/2020] [Indexed: 01/09/2023] Open
Abstract
The Sementis Copenhagen Vector (SCV) is a new vaccinia virus-derived, multiplication-defective, vaccine technology assessed herein in non-human primates. Indian rhesus macaques (Macaca mulatta) were vaccinated with a multi-pathogen recombinant SCV vaccine encoding the structural polyproteins of both Zika virus (ZIKV) and chikungunya virus (CHIKV). After one vaccination, neutralising antibody responses to ZIKV and four strains of CHIKV, representative of distinct viral genotypes, were generated. A second vaccination resulted in significant boosting of neutralising antibody responses to ZIKV and CHIKV. Following challenge with ZIKV, SCV-ZIKA/CHIK-vaccinated animals showed significant reductions in viremias compared with animals that had received a control SCV vaccine. Two SCV vaccinations also generated neutralising and IgG ELISA antibody responses to vaccinia virus. These results demonstrate effective induction of immunity in non-human primates by a recombinant SCV vaccine and illustrates the utility of SCV as a multi-disease vaccine platform capable of delivering multiple large immunogens.
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Affiliation(s)
- Natalie A Prow
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4029 Australia.,Australian Infectious Disease Research Centre, Brisbane, QLD 4029 and 4072 Australia.,Experimental Therapeutics Laboratory, School of Pharmacy and Medical Sciences, UniSA Cancer Research Institute, University of South Australia, Adelaide, SA 5000 Australia
| | - Liang Liu
- Experimental Therapeutics Laboratory, School of Pharmacy and Medical Sciences, UniSA Cancer Research Institute, University of South Australia, Adelaide, SA 5000 Australia
| | - Mary K McCarthy
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO 80045 USA
| | - Kevin Walters
- Department of Infectious Disease Research, Southern Research Institute, Frederick, MD 21701 USA
| | - Raj Kalkeri
- Department of Infectious Disease Research, Southern Research Institute, Frederick, MD 21701 USA
| | - Jillian Geiger
- Department of Infectious Disease Research, Southern Research Institute, Frederick, MD 21701 USA
| | - Fusataka Koide
- Department of Infectious Disease Research, Southern Research Institute, Frederick, MD 21701 USA
| | - Tamara H Cooper
- Experimental Therapeutics Laboratory, School of Pharmacy and Medical Sciences, UniSA Cancer Research Institute, University of South Australia, Adelaide, SA 5000 Australia
| | - Preethi Eldi
- Experimental Therapeutics Laboratory, School of Pharmacy and Medical Sciences, UniSA Cancer Research Institute, University of South Australia, Adelaide, SA 5000 Australia
| | - Eri Nakayama
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4029 Australia.,Department of Virology I, National Institute of Infectious Diseases, Tokyo, 162-8640 Japan
| | - Kerrilyn R Diener
- Experimental Therapeutics Laboratory, School of Pharmacy and Medical Sciences, UniSA Cancer Research Institute, University of South Australia, Adelaide, SA 5000 Australia.,Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, SA 5005 Australia
| | | | - John D Hayball
- Experimental Therapeutics Laboratory, School of Pharmacy and Medical Sciences, UniSA Cancer Research Institute, University of South Australia, Adelaide, SA 5000 Australia
| | - Thomas E Morrison
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO 80045 USA
| | - Andreas Suhrbier
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4029 Australia.,Australian Infectious Disease Research Centre, Brisbane, QLD 4029 and 4072 Australia
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12
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Hay JA, Minter A, Ainslie KEC, Lessler J, Yang B, Cummings DAT, Kucharski AJ, Riley S. An open source tool to infer epidemiological and immunological dynamics from serological data: serosolver. PLoS Comput Biol 2020; 16:e1007840. [PMID: 32365062 PMCID: PMC7241836 DOI: 10.1371/journal.pcbi.1007840] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/21/2020] [Accepted: 04/01/2020] [Indexed: 11/19/2022] Open
Abstract
We present a flexible, open source R package designed to obtain biological and epidemiological insights from serological datasets. Characterising past exposures for multi-strain pathogens poses a specific statistical challenge: observed antibody responses measured in serological assays depend on multiple unobserved prior infections that produce cross-reactive antibody responses. We provide a general modelling framework to jointly infer infection histories and describe immune responses generated by these infections using antibody titres against current and historical strains. We do this by linking latent infection dynamics with a mechanistic model of antibody kinetics that generates expected antibody titres over time. Our aim is to provide a flexible package to identify infection histories that can be applied to a range of pathogens. We present two case studies to illustrate how our model can infer key immunological parameters, such as antibody titre boosting, waning and cross-reaction, as well as latent epidemiological processes such as attack rates and age-stratified infection risk.
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Affiliation(s)
- James A. Hay
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Amanda Minter
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kylie E. C. Ainslie
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Bingyi Yang
- Department of Biology, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Derek A. T. Cummings
- Department of Biology, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Adam J. Kucharski
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Steven Riley
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
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13
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Kikuti M, Tauro LB, Moreira PSS, Nascimento LCJ, Portilho MM, Soares GC, Weaver SC, Reis MG, Kitron U, Ribeiro GS. Evaluation of two commercially available chikungunya virus IgM enzyme-linked immunoassays (ELISA) in a setting of concomitant transmission of chikungunya, dengue and Zika viruses. Int J Infect Dis 2019; 91:38-43. [PMID: 31704226 DOI: 10.1016/j.ijid.2019.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic performance of the Inbios (Seattle, US) and Euroimmun (Luebeck, Germany) chikungunya virus (CHIKV) IgM enzyme-linked immunoassays (ELISAs). METHODS We evaluated the tests' accuracy on sera from 372 patients enrolled in an acute febrile illness surveillance study performed in Salvador, Brazil from Sept/2014 to Jul/2016, a period of simultaneous CHIKV, dengue (DENV), and Zika (ZIKV) virus transmission. We assessed the sensitivity on acute and paired convalescent sera from RT-PCR-confirmed CHIKV cases (collected at median one and 19 days post-onset of symptoms, respectively), and the specificity on sera of RT-PCR-confirmed DENV and ZIKV cases, and on negative patients. RESULTS The Inbios and Euroimmun tests' sensitivities for acute samples were 4.0% and 10.3%, while for convalescent samples they were 92.4% and 96.9%, respectively. Overall, Inbios IgM ELISA specificities for acute and convalescent samples were 97.7% and 90.5%, respectively, and Euroimmun specificities were 88.5% and 83.9%, respectively. CONCLUSIONS Both tests presented high sensitivity for convalescent samples. However, the Euroimmun test returned more equivocal results and presented a slightly lower specificity, which might result in a higher rate of false positives if the test is used in scenarios of low CHIKV transmission, when the chance of CHIKV infection is lower.
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Affiliation(s)
- Mariana Kikuti
- Fundação Oswaldo Cruz, Salvador, Bahia, Brazil; Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Laura B Tauro
- Fundação Oswaldo Cruz, Salvador, Bahia, Brazil; Instituto de Biología Subtropical, nodo Iguazú, CONICET, UNaM, Puerto Iguazu, Misiones, Argentina
| | | | | | | | | | | | - Mitermayer G Reis
- Fundação Oswaldo Cruz, Salvador, Bahia, Brazil; Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Uriel Kitron
- Fundação Oswaldo Cruz, Salvador, Bahia, Brazil; Emory University, Atlanta, GA, USA
| | - Guilherme S Ribeiro
- Fundação Oswaldo Cruz, Salvador, Bahia, Brazil; Universidade Federal da Bahia, Salvador, Bahia, Brazil.
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14
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Silva MMO, Tauro LB, Kikuti M, Anjos RO, Santos VC, Gonçalves TSF, Paploski IAD, Moreira PSS, Nascimento LCJ, Campos GS, Ko AI, Weaver SC, Reis MG, Kitron U, Ribeiro GS. Concomitant Transmission of Dengue, Chikungunya, and Zika Viruses in Brazil: Clinical and Epidemiological Findings From Surveillance for Acute Febrile Illness. Clin Infect Dis 2019; 69:1353-1359. [PMID: 30561554 PMCID: PMC7348233 DOI: 10.1093/cid/ciy1083] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/13/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Since their emergence in the Americas, chikungunya (CHIKV) and Zika (ZIKV) viruses co-circulate with dengue virus (DENV), hampering clinical diagnosis. We investigated clinical and epidemiological characteristics of arboviral infections during the introduction and spread of CHIKV and ZIKV through northeastern Brazil. METHODS Surveillance for arboviral diseases among febrile patients was performed at an emergency health unit of Salvador, Brazil, between September 2014 and July 2016. We interviewed patients to collect data on symptoms, reviewed medical records to obtain the presumptive diagnoses, and performed molecular and serological testing to confirm DENV, CHIKV, ZIKV, or nonspecific flavivirus (FLAV) diagnosis. RESULTS Of 948 participants, 247 (26.1%) had an acute infection, of which 224 (23.6%) were single infections (DENV, 32 [3.4%]; CHIKV, 159 [16.7%]; ZIKV, 13 [1.4%]; and FLAV, 20 [2.1%]) and 23 (2.4%) coinfections (DENV/CHIKV, 13 [1.4%]; CHIKV/FLAV, 9 [0.9%]; and DENV/ZIKV, 1 [0.1%]). An additional 133 (14.0%) patients had serological evidence for a recent arboviral infection. Patients with ZIKV presented with rash and pruritus (69.2% each) more frequently than those with DENV (37.5% and 31.2%, respectively) and CHIKV (22.9% and 14.7%, respectively) (P < .001 for both comparisons). Conversely, arthralgia was more common in CHIKV (94.9%) and FLAV/CHIKV (100.0%) than in DENV (59.4%) and ZIKV (53.8%) (P < .001). A correct presumptive clinical diagnosis was made for 9%-23% of the confirmed patients. CONCLUSIONS Arboviral infections are frequent causes of febrile illness. Coinfections are not rare events during periods of intense, concomitant arboviral transmission. Given the challenge to clinically distinguish these infections, there is an urgent need for rapid, point-of-care, multiplex diagnostics.
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Affiliation(s)
| | - Laura B Tauro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Instituto Nacional de Medicina Tropical, Consejo Nacional de Investigaciones Científicas y Técnicas (National Scientific and Technical Research Council), Puerto Iguazú, Argentina
| | - Mariana Kikuti
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Viviane C Santos
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | | | - Igor A D Paploski
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- University of Minnesota, St. Paul
| | | | | | - Gúbio S Campos
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Albert I Ko
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Yale School of Public Health, New Haven
| | | | - Mitermayer G Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Uriel Kitron
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Emory University, Atlanta
| | - Guilherme S Ribeiro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
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15
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Venturi G, Fortuna C, Alves RM, Passos do Prado Paschoal AG, da Silva Júnior PJ, Remoli ME, Benedetti E, Amendola A, da Silva Batista E, Gama DVN, Barros DH, Fiorentini C, Rezza G, Leite Primo Chagas JR. Epidemiological and clinical suspicion of congenital Zika virus infection: Serological findings in mothers and children from Brazil. J Med Virol 2019; 91:1577-1583. [PMID: 31090222 PMCID: PMC6773202 DOI: 10.1002/jmv.25504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 04/17/2019] [Accepted: 05/08/2019] [Indexed: 11/27/2022]
Abstract
The emergence of Zika virus in the Americas has caused an increase of babies born with microcephaly or other neurological malformations. The differential diagnosis of Zika infection, particularly serological diagnosis, is an important but complex issue. In this study, we describe clinical manifestations of 94 suspected cases of congenital Zika from Bahia state, Brazil, and the results of serological tests performed on children and/or their mothers at an average of 71 days after birth. Anti‐Zika immunoglobulin M (IgM) antibodies were detected in 44.4% and in 7.1% of samples from mothers and children, respectively. Nearly all the IgM, and 92% of immunoglobulin G positive results were confirmed by neutralization test. Zika specific neutralizing antibodies were detected in as much as 90.4% of the cases. Moreover, dengue specific neutralizing antibodies were detected in 79.0% of Zika seropositive mothers. In conclusion, Zika IgM negative results should be considered with caution, due to a possible rapid loss of sensitivity after birth, while the NS1‐based Zika IgM enzyme‐linked immunosorbent assay test we have used has demonstrated to be highly specific. In a high percentage of cases, Zika specific neutralizing antibodies were detected, which are indicative of a past Zika infection, probably occurred during pregnancy in this population. In this study we have analyzed serum samples collected a mean of 71 days after birth from 94 suspected congenital Zika cases. Our results have shown a high percentage of positive neutralization test results for ZIKV, and also DENV, but low prevalence of anti‐ZIKV IgM antibodies. Our data confirm the difficulty of an accurate retrospective diagnosis of ZIKV congenital infection.
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Affiliation(s)
- Giulietta Venturi
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Claudia Fortuna
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Rita Maria Alves
- Pediatric Neurology Service, S. Antonio das Obras Sociais Irmã Dulce Hospital(HSA/OSID), Salvador, Bahia, Brazil
| | | | | | - Maria Elena Remoli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Eleonora Benedetti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Antonello Amendola
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | | | | | | | - Giovanni Rezza
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Janeusa Rita Leite Primo Chagas
- Pediatric Neurology Service, S. Antonio das Obras Sociais Irmã Dulce Hospital(HSA/OSID), Salvador, Bahia, Brazil.,Neurologia Pediátrica, Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
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16
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Tauro LB, Cardoso CW, Souza RL, Nascimento LC, Santos DRD, Campos GS, Sardi S, Reis OBD, Reis MG, Kitron U, Ribeiro GS. A localized outbreak of Chikungunya virus in Salvador, Bahia, Brazil. Mem Inst Oswaldo Cruz 2019; 114:e180597. [PMID: 30843962 PMCID: PMC6396974 DOI: 10.1590/0074-02760180597] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/14/2019] [Indexed: 11/22/2022] Open
Abstract
A localized Chikungunya virus (CHIKV; East/Central/South African genotype) outbreak (50 cases, 70% laboratory-confirmed; attack rate: 5.3 confirmed cases/100 people) occurred in a Salvador, Brazil neighborhood, between Apr-Jun/2017. Highly clustered cases in space and time, mostly along a single street, highlight an increased risk of CHIKV transmission among pockets of susceptible populations. This finding underscores the need for ongoing local level surveillance for arboviral outbreaks.
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Affiliation(s)
- Laura B Tauro
- Fundação Oswaldo Cruz-Fiocruz, Instituto Gonçalo Moniz, Salvador, BA, Brasil.,Instituto de Biologia Subtropical, CONICET, Puerto Iguazú, Misiones, Argentina
| | | | - Raquel L Souza
- Fundação Oswaldo Cruz-Fiocruz, Instituto Gonçalo Moniz, Salvador, BA, Brasil
| | - Leile Cj Nascimento
- Fundação Oswaldo Cruz-Fiocruz, Instituto Gonçalo Moniz, Salvador, BA, Brasil
| | | | - Gubio S Campos
- Universidade Federal da Bahia, Instituto de Ciências da Saúde, Salvador, BA, Brasil
| | - Silvia Sardi
- Universidade Federal da Bahia, Instituto de Ciências da Saúde, Salvador, BA, Brasil
| | | | - Mitermayer G Reis
- Fundação Oswaldo Cruz-Fiocruz, Instituto Gonçalo Moniz, Salvador, BA, Brasil.,Yale University, New Haven, CT, USA.,Universidade Federal da Bahia, Faculdade de Medicina, Salvador, BA, Brasil
| | - Uriel Kitron
- Fundação Oswaldo Cruz-Fiocruz, Instituto Gonçalo Moniz, Salvador, BA, Brasil.,Emory University, Atlanta, GA, USA
| | - Guilherme S Ribeiro
- Fundação Oswaldo Cruz-Fiocruz, Instituto Gonçalo Moniz, Salvador, BA, Brasil.,Universidade Federal da Bahia, Faculdade de Medicina, Salvador, BA, Brasil
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17
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Hay JA, Nouvellet P, Donnelly CA, Riley S. Potential inconsistencies in Zika surveillance data and our understanding of risk during pregnancy. PLoS Negl Trop Dis 2018; 12:e0006991. [PMID: 30532143 PMCID: PMC6301717 DOI: 10.1371/journal.pntd.0006991] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/20/2018] [Accepted: 11/12/2018] [Indexed: 02/05/2023] Open
Abstract
Background A significant increase in microcephaly incidence was reported in Northeast Brazil at the end of 2015, which has since been attributed to an epidemic of Zika virus (ZIKV) infections earlier that year. Further incidence of congenital Zika syndrome (CZS) was expected following waves of ZIKV infection throughout Latin America; however, only modest increases in microcephaly and CZS incidence have since been observed. The quantitative relationship between ZIKV infection, gestational age and congenital outcome remains poorly understood. Methodology/Principle findings We characterised the gestational-age-varying risk of microcephaly given ZIKV infection using publicly available incidence data from multiple locations in Brazil and Colombia. We found that the relative timings and shapes of ZIKV infection and microcephaly incidence curves suggested different gestational risk profiles for different locations, varying in both the duration and magnitude of gestational risk. Data from Northeast Brazil suggested a narrow window of risk during the first trimester, whereas data from Colombia suggested persistent risk throughout pregnancy. We then used the model to estimate which combination of behavioural and reporting changes would have been sufficient to explain the absence of a second microcephaly incidence wave in Bahia, Brazil; a population for which we had two years of data. We found that a 18.9-fold increase in ZIKV infection reporting rate was consistent with observed patterns. Conclusions Our study illustrates how surveillance data may be used in principle to answer key questions in the absence of directed epidemiological studies. However, in this case, we suggest that currently available surveillance data are insufficient to accurately estimate the gestational-age-varying risk of microcephaly from ZIKV infection. The methods used here may be of use in future outbreaks and may help to inform improved surveillance and interpretation in countries yet to experience an outbreak of ZIKV infection. Zika virus (ZIKV) infection is associated with the rise of microcephaly cases observed in Northeast Brazil at the end of 2015. For women in endemic or at-risk areas, understanding how the relationship between time of infection and microcephaly risk varies through pregnancy is important in informing family planning. However, a relatively modest number of congenital Zika syndrome cases have been observed following subsequent waves of ZIKV infection, limiting our understanding of gestational risk. We used a mathematical model to quantify the shape and magnitude of the gestational-age-varying risk to a fetus. Although the risk profile should be conserved regardless of location, we estimated different profiles when using surveillance data from locations in Northeast Brazil and Colombia. Our results suggest that time-dependent reporting changes likely confound the interpretation of currently available surveillance data. Furthermore, we investigated a range of behavioural and reporting rate changes that could explain two waves of ZIKV infection in Bahia, Brazil despite only one wave of microcephaly. Plausible changes in reporting could explain these data whilst remaining consistent with the hypothesis that ZIKV infection carries a significant risk of microcephaly. Further evidence is needed to disentangle the true risk of congenital Zika syndrome from time-varying reporting changes.
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Affiliation(s)
- James A. Hay
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Pierre Nouvellet
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, London, UK
- School of Life Sciences, University of Sussex, Brighton, UK
| | - Christl A. Donnelly
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, London, UK
- Department of Statistics, University of Oxford, Oxford, UK
| | - Steven Riley
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, London, UK
- * E-mail:
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18
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Catenacci LS, Nunes-Neto J, Deem SL, Palmer JL, Travassos-da Rosa ES, Tello JS. Diversity patterns of hematophagous insects in Atlantic forest fragments and human-modified areas of southern Bahia, Brazil. J Vector Ecol 2018; 43:293-304. [PMID: 30408294 DOI: 10.1111/jvec.12313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/16/2018] [Indexed: 06/08/2023]
Abstract
There have been several important outbreaks of mosquito-borne diseases in the Neotropics in recent years, particularly in Brazil. Some taxa are also considered to be indicators of environmental health. Despite the importance of understanding insect abundance and distribution to the understanding of disease dynamics and design strategies to manage them, very little is known about their ecology in many tropical regions. We studied the abundance and diversity of mosquitoes and sand flies in the Bahia State of Brazil, a point of origin for arbovirus outbreaks, including Zika and Chikungunya fever. During 2009-2014, 51 mosquito taxa were identified, belonging to three dipteran families, Ceratopogonidae, Culicidae, and Psychodidae. The family Culicidae, including the Sabethini tribe, were the most abundant (81.5%) and most taxa-rich (n=45). While season (winter and summer) was a strong factor determinant of the occurrence of the most abundant taxa, the stratification level in the forest (ground or tree level) had a strong effect and the dominant taxa at ground level were completely different from the dominant species collected at tree level. We suggest that sites with a mix of forest and agroforestry systems support the highest biodiversity of hematophagous insects as compared to highly disturbed landscapes.
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Affiliation(s)
- Lilian S Catenacci
- Curso de Medicina Veterinária, Federal University of Piauí State/CPCE, Bom Jesus, PI, Brazil
- Division of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Anannindeua, PA, Brazil
- Royal Zoological Society of Antwerp, Centre for Research and Conservation, Antwerp, Belgium
- Saint Louis Zoo, Institute for Conservation Medicine, St. Louis, MO, U.S.A
| | - Joaquim Nunes-Neto
- Division of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Anannindeua, PA, Brazil
| | - Sharon L Deem
- Saint Louis Zoo, Institute for Conservation Medicine, St. Louis, MO, U.S.A
| | - Jamie L Palmer
- Saint Louis Zoo, Institute for Conservation Medicine, St. Louis, MO, U.S.A
| | | | - J Sebastian Tello
- Missouri Botanical Garden, Center for Conservation and Sustainable Development, St. Louis, MO, U.S.A
- Pontificia Universidad Católica del Ecuador, Escuela de Biología, Quito, Ecuador
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19
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Sacchetto L, Zauli DAG, Costa GB, Guagliardo SAJ, Alvim LB, Marinho FLO, Abrahão JS, Trindade GS, Kroon EG, Mateo ECC, Drumond BP. Screening for Zika virus RNA in sera of suspected cases: a retrospective cross-sectional study. Virol J 2018; 15:155. [PMID: 30305112 DOI: 10.1186/s12985-018-1070-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Zika virus (ZIKV) became a global human health concern owing to its rapid spread worldwide and its association with congenital and neurological disorders. The current epidemiological profile of arboviruses in Brazil is characterized by widespread co-circulation of Dengue virus, Chikungunya virus, and ZIKV throughout the country. These viruses cause acute diseases frequently with overlapping symptoms, which could result in an inaccurate diagnosis based solely on clinical and epidemiological grounds. Here we conducted a screening for ZIKV RNA in serum samples from patients across Brazil with suspected ZIKV infection. METHODS Using RT-qPCR, we investigated ZIKV RNA in 3001 serum samples. Samples were passively acquired through a private laboratory network, between December 2015 and August 2016, from 27 Brazilian Federative Units. We performed descriptive statistics on demographic variables including sex, age, and geographic location. RESULTS ZIKV was detected in 11.4% (95%CI = 10.3-12.6%) of the sera. ZIKV RNA was detected in sera collected throughout the country, but during the analyzed period, RNA was more frequently detected in samples from the Southeast, Midwest, and North regions (3.9 to 5.8 times higher) when compared to the Northeast and South regions. CONCLUSIONS These data reinforce the importance of laboratory diagnosis, surveillance systems, and further epidemiological studies to understand the dynamics of outbreaks and diseases associated with ZIKV and other arboviruses.
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20
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de Laval F, d'Aubigny H, Mathéus S, Labrousse T, Ensargueix AL, Lorenzi EM, Le Flem FX, André N, Belleoud D, Leparc-Goffart I, Rousset D, Simon F, Briolant S. Evolution of symptoms and quality of life during Zika virus infection: A 1-year prospective cohort study. J Clin Virol 2018; 109:57-62. [PMID: 30523784 DOI: 10.1016/j.jcv.2018.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/18/2018] [Accepted: 09/25/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the complications of Zika virus infection have been well described, the clinical pattern has not been reported in enough detail to differentiate this infection from those with other arboviroses, and no longitudinal study has yet been published on the persistence of symptoms and quality of life. OBJECTIVES were to describe bio-clinical pattern and quality of life during ZIKV infection, and their evolution. STUDY DESIGN We present a 1-year clinical follow-up of 49 people infected with Zika virus in French Guiana, for whom the diagnosis was confirmed by RT-PCR in serum or urine. RESULTS Fever was inconsistent (95% confidence interval (CI), 39-67). Exanthema (CI, 84-100) was maculopapular, with pruritus and conjunctivitis, variable over time and disappeared 12 days after the onset of symptoms (CI, 10-14). Joint pain (CI, 39-67) occurred mainly in the hands, wrists, knees and ankles and lasted for 10 days (CI, 7-13). Asthenia (CI, 61-85) scored low (3/10) but lasted for 19 days (CI, 16-22). The last two symptoms strongly limited patients' activities in the acute stage of the disease (RAPID-3 score, CI, 5-8). None of the patients had neurological complications, but 41% (CI, 27-55) had areflexia during the first month. CONCLUSIONS We found no real chronic evolution or decreased quality of life, function or ability to work from the first month after symptom onset.
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Affiliation(s)
- Franck de Laval
- French Armed Forces Health Service in French Guiana, Cayenne, French Guiana; SSA, Service de Santé des Armées, CESPA, Centre d'épidémiologie et de santé publique des armées, Marseille, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.
| | | | - Séverine Mathéus
- National Reference Center for Arboviruses, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | - Thomas Labrousse
- French Armed Forces Health Service in French Guiana, Cayenne, French Guiana
| | | | | | | | - Nathalie André
- French Armed Forces Health Service in French Guiana, Cayenne, French Guiana
| | - Didier Belleoud
- French Armed Forces Health Service in French Guiana, Cayenne, French Guiana
| | - Isabelle Leparc-Goffart
- National Reference Center for Arboviruses, Institut de Recherche Biomédicale des Armées, Marseille, France; Unité des Virus Émergents (UVE: Aix-Marseille Univ-IRD 190-Inserm 1207-IHU Méditerranée Infection), Marseille, France
| | - Dominique Rousset
- National Reference Center for Arboviruses, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | - Fabrice Simon
- Laveran Military Teaching Hospital, Marseille, France
| | - Sébastien Briolant
- French Armed Forces Health Service in French Guiana, Cayenne, French Guiana; Unité de Parasitologie et Entomologie, Département des Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France; Aix Marseille Université, IRD, AP-HM, SSA, UMR Vecteurs - Infections Tropicales et Méditerranéennes (VITROME), IHU - Méditerranée Infection, Marseille, France
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21
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Abstract
Brazil has a well-established immunization program in which vaccines are provided through the Public Health System free of charge to the whole population, obtaining high coverage and reducing the incidence of important infectious diseases in children and adults. However, the environmental changes and high mobility rates of the population occurring in the last decades have triggered the sequential introduction of a series of vector-borne emerging infectious diseases, such as Dengue, Zika, and Chikungunya, that have imposed a considerable burden on the population, with yet unmet solutions. The first to be introduced in Brazil was the Dengue virus, reaching epidemic levels in 2010, with over 1 million cases annually, maintaining high infection rates until 2016. Brazil has invested in vaccine development. The Zika virus infection, initially assumed to have appeared during the World Cup in 2014, was later shown to have arrived earlier in 2013. Its emergence mobilized the Brazilian scientific community to define priorities and strategies, that rapidly investigated mechanisms of pathogenesis, differential diagnostics, and determined that Zika virus infection per se causes relatively mild symptoms, however, in pregnant women can cause microcephaly in the newborns. The diagnostics of Zika infection is confusing given its similar symptoms and cross-reactivity with Dengue, which also hindered the appraisal of the extent of the epidemics, which peaked in 2015 and finished in 2016. Another complicating factor was the overlap with Chikungunya virus infection, which arrived in Brazil in 2014, being prevalent in the same regions, with similar symptoms to both Dengue and Zika. Although Dengue infection can be fatal and Zika infection in pregnant woman can lead to newborns with microcephaly or an array of neurodegenerative manifestations, the Chikungunya infection is a debilitating disease leaving chronic sequelae, which unfortunately has received less attention. Precise differential diagnostics of Dengue, Zika, and Chikungunya will be necessary to evaluate the actual extent of each of these diseases during this overlapping period. Here we review the impact of these emerging infections on public health and how the scientific community was mobilized to deal with them in Brazil.
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22
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Campos MC, Dombrowski JG, Phelan J, Marinho CRF, Hibberd M, Clark TG, Campino S. Zika might not be acting alone: Using an ecological study approach to investigate potential co-acting risk factors for an unusual pattern of microcephaly in Brazil. PLoS One 2018; 13:e0201452. [PMID: 30110370 PMCID: PMC6093667 DOI: 10.1371/journal.pone.0201452] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 07/16/2018] [Indexed: 01/14/2023] Open
Abstract
Zika virus infections can cause a range of neurologic disorders including congenital microcephaly. However, while Zika infections have been notified across all regions in Brazil, there has been an unusual number of congenital microcephaly case notifications concentrated in the Northeast of the country. To address this observation, we investigated epidemiological data (2014–2016) on arbovirus co-distribution, environmental and socio-economic factors for each region in Brazil. Data on arbovirus reported cases and microcephaly were collected from several Brazilian Ministry of Health databases for each Federal unit. These were complemented by environmental management, social economic and Aedes aegypti infestation index data, extracted from multiple databases. Spatial time “ecological” analysis on the number of arboviruses transmitted by Aedes mosquitoes in Brazil show that the distribution of dengue and Zika was widespread in the whole country, with higher incidence in the West-Central region. However, reported chikungunya cases were higher in the Northeast, the region also with the highest number of microcephaly cases registered. Social economic factors (human development index and poverty index) and environmental management (water supply/storage and solid waste management) pointed the Northeast as the less wealthy region. The Northeast is also the region with the highest risk of Aedes aegypti house infestation due to the man-made larval habitats. In summary, the results of our ecological analysis support the hypothesis that the unusual distribution of microcephaly might not be due to Zika infection alone and could be accentuated by poverty and previous or co-infection with other pathogens. Our study reinforces the link between poverty and the risk of disease and the need to understand the effect on pathogenesis of sequential exposure to arboviruses and co-viral infections. Comprehensive large-scale cohort studies are required to corroborate our findings. We recommend that the list of infectious diseases screened, particularly during pregnancy, be regularly updated to include and effectively differentiate all viruses from ongoing outbreaks.
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Affiliation(s)
- Monica C. Campos
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Jamille G. Dombrowski
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Jody Phelan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Claudio R. F. Marinho
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Martin Hibberd
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Taane G. Clark
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Susana Campino
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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23
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Charlys da Costa A, Thézé J, Komninakis SCV, Sanz-Duro RL, Felinto MRL, Moura LCC, Barroso IMDO, Santos LEC, Nunes MADL, Moura AA, Lourenço J, Deng X, Delwart EL, Guimarães MRDAS, Pybus OG, Sabino EC, Faria NR. Spread of Chikungunya Virus East/Central/South African Genotype in Northeast Brazil. Emerg Infect Dis 2018; 23:1742-1744. [PMID: 28930031 PMCID: PMC5621546 DOI: 10.3201/eid2310.170307] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We investigated an outbreak of exanthematous illness in Maceió by using molecular surveillance; 76% of samples tested positive for chikungunya virus. Genetic analysis of 23 newly generated genomes identified the East/Central/South African genotype, suggesting that this lineage has persisted since mid-2014 in Brazil and may spread in the Americas and beyond.
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24
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Dexheimer Paploski IA, Souza RL, Tauro LB, Cardoso CW, Mugabe VA, Pereira Simões Alves AB, de Jesus Gomes J, Kikuti M, Campos GS, Sardi S, Weaver SC, Reis MG, Kitron U, Ribeiro GS. Epizootic Outbreak of Yellow Fever Virus and Risk for Human Disease in Salvador, Brazil. Ann Intern Med 2018; 168:301-302. [PMID: 29114780 DOI: 10.7326/m17-1949] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Igor Adolfo Dexheimer Paploski
- Universidade Federal da Bahia and Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil (I.A.D., M.K., M.G.R., G.S.R.)
| | - Raquel Lima Souza
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil (R.L.S., L.B.T., A.B.P., J.D.)
| | - Laura Beatriz Tauro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil (R.L.S., L.B.T., A.B.P., J.D.)
| | | | | | | | - Joice de Jesus Gomes
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil (R.L.S., L.B.T., A.B.P., J.D.)
| | - Mariana Kikuti
- Universidade Federal da Bahia and Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil (I.A.D., M.K., M.G.R., G.S.R.)
| | | | - Sílvia Sardi
- Universidade Federal da Bahia, Salvador, Brazil (V.A.M., G.S.C., S.S.)
| | - Scott C Weaver
- University of Texas Medical Branch, Galveston, Texas (S.C.W.)
| | - Mitermayer Galvão Reis
- Universidade Federal da Bahia and Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil (I.A.D., M.K., M.G.R., G.S.R.)
| | | | - Guilherme Sousa Ribeiro
- Universidade Federal da Bahia and Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil (I.A.D., M.K., M.G.R., G.S.R.)
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25
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Abstract
Aedes aegypti is the vector for numerous diseases in humans and other (reservoir) hosts, such as chikungunya, dengue fever and Zika virus. A new deterministic model is designed and used to assess the dynamics of the three diseases in a population where Aedes mosquitoes are abundant. The model to be designed incorporates the recently-released imperfect vaccine against dengue virus (Dengvaxia[Formula: see text] vaccine by Sanofi Pasteur) as well as allow for sexual transmission of Zika. Further, the model allows for the assessment of the population-level impact of three biological hypotheses, namely a competitive dengue–chikungunya–Zika superinfection hierarchy, an antibody-dependent enhancement of dengue over Zika and that the Dengvaxia vaccine can induce reduced susceptibility to Zika infection in vaccinated individuals. After carrying out detailed theoretical analyses to gain insight into its qualitative features, the model is then fitted to the data recorded during the 2015–2016 outbreaks of the three diseases in Mexico. Simulations of the model show a reasonable fit to observed dynamics consistent with the competitive hierarchy assumed for the interactions of the viruses. Furthermore, Zika transmission dynamics is only mildly affected by changes in the parameter related to the infectiousness of Zika in relation to dengue, even in the region where antibody-dependent enhancement is assumed. The dengue vaccine has a very marginal impact on Zika transmission dynamics (and that the vaccine, no matter the coverage and efficacy levels, is unable to reduce the reproduction number for Zika transmission to a value less than unity). The model is extended to include the effect of seasonality and local weather variability (temperature and rainfall) on the dynamics of the three diseases. Simulations of the resulting non-autonomous model, using weather and demographic data for Mexico, show that for the current mean monthly rainfall value for Mexico, the burden of the three diseases increases with increasing mean monthly temperature in the range 16–29[Formula: see text]C, and decreases with increasing mean monthly temperature thereafter. Additionally, for the current fixed mean monthly temperature and rainfall data for Mexico, simulations show maximum transmission activity of all three diseases if the temperature and rainfall values lie in the range 25–26.4[Formula: see text]C and 90–128[Formula: see text]mm, respectively (these values are typically recorded in Mexico during the months of June, July and September). Simulations for two Mexican states (Oaxaca and Chiapas) where the three diseases are endemic show maximum transmission activity for all three diseases when temperature and rainfall lie in the ranges 20–25[Formula: see text]C and 51–102[Formula: see text]mm for Oaxaca (these ranges are recorded during the months of May through September) and 19–21[Formula: see text]C and 85–107[Formula: see text]mm for Chiapas (there ranges are recorded during the months of May, July, August and October), respectively. These simulations suggest suitable time when anti-mosquito control efforts should be intensified in Mexico (and the two selected states).
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Affiliation(s)
- KAMALDEEN O. OKUNEYE
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, Arizona, 85287-1804, USA
| | | | - ABBA B. GUMEL
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, Arizona, 85287-1804, USA
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26
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Bandeira AC, Campos GS, Ribeiro GS, Cardoso CW, Bastos CJ, Pessoa TL, Araujo KA, Grassi MFR, Castro AP, Carvalho RH, Prates APPB, Gois LL, Rocha VF, Sardi SI. Clinical and laboratory evidence of Haff disease - case series from an outbreak in Salvador, Brazil, December 2016 to April 2017. ACTA ACUST UNITED AC 2017; 22:30552. [PMID: 28661391 PMCID: PMC5479974 DOI: 10.2807/1560-7917.es.2017.22.24.30552] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/14/2017] [Indexed: 11/20/2022]
Abstract
We describe a series of 15 Haff disease cases from an outbreak in Salvador, Brazil, starting early December 2016. Eleven cases were grouped in four family clusters of two to four individuals, four were isolated cases. All but one patient consumed cooked fish; 11 within 24h before symptoms onset. Cases consumed ‘Olho de Boi’ (Seriola spp.) and ’Badejo’ (Mycteroperca spp.). A total of 67 cases were detected, the last case was reported on 5 April 2017.
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Affiliation(s)
- Antonio C Bandeira
- Faculdade de Tecnologia e Ciencias - FTC - Medical School, Salvador, Brazil.,Hospital Aliança, Salvador, Brazil.,Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Brazil
| | - Gubio S Campos
- Virology Laboratory, Federal University of Bahia, Salvador, Brazil
| | - Guilherme S Ribeiro
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Brazil.,Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil
| | | | | | - Tiago L Pessoa
- Faculdade de Tecnologia e Ciencias - FTC - Medical School, Salvador, Brazil
| | | | | | | | | | | | - Luana L Gois
- Universidade Catolica do Salvador, Salvador, Brazil
| | | | - Silvia I Sardi
- Virology Laboratory, Federal University of Bahia, Salvador, Brazil
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27
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Netto EM, Moreira-Soto A, Pedroso C, Höser C, Funk S, Kucharski AJ, Rockstroh A, Kümmerer BM, Sampaio GS, Luz E, Vaz SN, Dias JP, Bastos FA, Cabral R, Kistemann T, Ulbert S, de Lamballerie X, Jaenisch T, Brady OJ, Drosten C, Sarno M, Brites C, Drexler JF. High Zika Virus Seroprevalence in Salvador, Northeastern Brazil Limits the Potential for Further Outbreaks. mBio 2017; 8. [PMID: 29138300 DOI: 10.1128/mBio.01390-17] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
During 2015 to 2016, Brazil reported more Zika virus (ZIKV) cases than any other country, yet population exposure remains unknown. Serological studies of ZIKV are hampered by cross-reactive immune responses against heterologous viruses. We conducted serosurveys for ZIKV, dengue virus (DENV), and Chikungunya virus (CHIKV) in 633 individuals prospectively sampled during 2015 to 2016, including microcephaly and non-microcephaly pregnancies, HIV-infected patients, tuberculosis patients, and university staff in Salvador in northeastern Brazil using enzyme-linked immunosorbent assays (ELISAs) and plaque reduction neutralization tests. Sera sampled retrospectively during 2013 to 2015 from 277 HIV-infected patients were used to assess the spread of ZIKV over time. Individuals were georeferenced, and sociodemographic indicators were compared between ZIKV-positive and -negative areas and areas with and without microcephaly cases. Epidemiological key parameters were modeled in a Bayesian framework. ZIKV seroprevalence increased rapidly during 2015 to 2016, reaching 63.3% by 2016 (95% confidence interval [CI], 59.4 to 66.8%), comparable to the seroprevalence of DENV (75.7%; CI, 69.4 to 81.1%) and higher than that of CHIKV (7.4%; CI, 5.6 to 9.8%). Of 19 microcephaly pregnancies, 94.7% showed ZIKV IgG antibodies, compared to 69.3% of 257 non-microcephaly pregnancies (P = 0.017). Analyses of sociodemographic data revealed a higher ZIKV burden in low socioeconomic status (SES) areas. High seroprevalence, combined with case data dynamics allowed estimates of the basic reproduction number R0 of 2.1 (CI, 1.8 to 2.5) at the onset of the outbreak and an effective reproductive number Reff of <1 in subsequent years. Our data corroborate ZIKV-associated congenital disease and an association of low SES and ZIKV infection and suggest that population immunity caused cessation of the outbreak. Similar studies from other areas will be required to determine the fate of the American ZIKV outbreak.IMPORTANCE The ongoing American Zika virus (ZIKV) outbreak involves millions of cases and has a major impact on maternal and child health. Knowledge of infection rates is crucial to project future epidemic patterns and determine the absolute risk of microcephaly upon maternal ZIKV infection during pregnancy. For unknown reasons, the vast majority of ZIKV-associated microcephaly cases are concentrated in northeastern Brazil. We analyzed different subpopulations from Salvador, a Brazilian metropolis representing one of the most affected areas during the American ZIKV outbreak. We demonstrate rapid spread of ZIKV in Salvador, Brazil, and infection rates exceeding 60%. We provide evidence for the link between ZIKV and microcephaly, report that ZIKV predominantly affects geographic areas with low socioeconomic status, and show that population immunity likely caused cessation of the outbreak. Our results enable stakeholders to identify target populations for vaccination and for trials on vaccine efficacy and allow refocusing of research efforts and intervention strategies.
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Cunha MDP, Santos CAD, Neto DFDL, Schanoski AS, Pour SZ, Passos SD, Souza MSFD, Costa DD, Zanotto PMDA. Outbreak of chikungunya virus in a vulnerable population of Sergipe, Brazil-A molecular and serological survey. J Clin Virol 2017; 97:44-49. [PMID: 29100064 DOI: 10.1016/j.jcv.2017.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/03/2017] [Accepted: 10/24/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chikungunya virus (CHIKV) is a re-emerging arbovirus that is causing outbreaks in several countries of the Americas. The virus was introduced in Brazil in 2014, and since then, several Brazilian states have notified autochthonous cases. OBJECTIVES Provide additional evidence on a CHIKV outbreak and an outline of the laboratory and clinical profile of symptomatic patients in Sergipe, Brazil. STUDY DESIGN In February 2016, we collected 142 serum samples from symptomatic patients for arboviruses in Sergipe, Brazil. All samples were submitted to qRT-PCR for the emerging arboviruses circulating in Brazil - ZIKV, CHIKV, and DENV - and later submitted to the immunoenzymatic assay. RNA positive samples were randomly selected and sequenced for characterization of the genotype involved in the outbreak. RESULTS Our study had 75.35% (107/142) positivity for CHIKV infection, with all age groups and genera being equally infected. The virus was identified in 11 of the 13 cities studied in that state, including the ECSA genotype. Importantly, fever was the only statistically significant symptoms for CHIKV infection (p<0.05), while asthenia was significantly associated with symptomatic patients that were CHIKV-negative (p<0.05). CONCLUSIONS Our findings support the importance of fever as a clinical marker and contribute to molecular and serological surveillance data, which may help in the understanding of CHIKV circulation, emergence and clinical description.
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Affiliation(s)
- Marielton Dos Passos Cunha
- Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil
| | - Cliomar Alves Dos Santos
- Health Foundation Parreiras Horta (FSPH), Central Laboratory of Public Health (LACEN/SE), State Secretary for Health, Sergipe, Brazil
| | - Daniel Ferreira de Lima Neto
- Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil
| | | | - Shahab Zaki Pour
- Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil
| | | | | | - Danuza Duarte Costa
- Health Foundation Parreiras Horta (FSPH), Central Laboratory of Public Health (LACEN/SE), State Secretary for Health, Sergipe, Brazil
| | - Paolo Marinho de Andrade Zanotto
- Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil.
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Rahim MA, Uddin KN. Chikungunya: an emerging viral infection with varied clinical presentations in Bangladesh: Reports of seven cases. BMC Res Notes 2017; 10:410. [PMID: 28810894 PMCID: PMC5558730 DOI: 10.1186/s13104-017-2723-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/29/2017] [Indexed: 11/16/2022] Open
Abstract
Background Chikungunya is an emerging and rapidly spreading viral infection in many parts of the world including Bangladesh. It shares many epidemiological and clinical characteristics with dengue. So, a sound knowledge is required for its detection and differentiation from dengue, specially in endemic regions. Case presentation We present seven confirmed cases of chikungunya having different clinical presentations occurring among middle aged males and females from different socio-economic background in Dhaka city, the capital of Bangladesh. All patients had fever and aches and pains. Less common features were rash, diarrhea, vomiting and altered liver biochemistry. Dengue was excluded in six patients. Paracetamol remained the mainstay of treatment during febrile periods, but over 50% of the patients had prolonged joint symptoms requiring non-steroidal anti-inflammatory drugs. Conclusions In spite of being a self-limiting disease, chikungunya may have different presentations and a protracted clinical course. During the febrile episode, exclusion of dengue is equally important. Physicians should be aware of the condition and public health initiatives are necessary to break the disease transmission.
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Affiliation(s)
- Muhammad Abdur Rahim
- Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, 122 Kazi Nazrul Islam Avenue, Dhaka, Bangladesh.
| | - Khwaja Nazim Uddin
- Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, 122 Kazi Nazrul Islam Avenue, Dhaka, Bangladesh
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