A clinical-ecological study of a triple viral epidemic: Zika, Dengue and Chikungunya/ Um estudo clínico-ecológico de uma tripla epidemia viral: Zika, Dengue e Chikungunya

Viviane Camara Maniero, Rodrigo Decembrino Vargas Brasil, Paulo Sérgio Cerqueira Rangel, Taiane Mendonça Camargo, Marcela Pires de Souza, Júlia Marcelo Maia Forte, Cristiane da Cruz Lamas, Sergian Vianna Cardozo

Abstract


In Brazil, since 2015, co-circulation of three arboviruses, Dengue (DENV), Chikungunya (CHIKV) and Zika (ZIKV), have presented diagnostic challenges, due to their similar clinical manifestations. Our goal was to analyze cases of arboviral illness using key clinical features and to ascertain house infestation indices (HII) in the study area. A total of 28,064 medical records were analyzed by clinical-epidemiological criteria for DENV, ZIKV and CHIKV in 2015 and 2016 at the public health unit in Xerem, Duque de Caxias, Rio de Janeiro. The collection of vectors at home breeding sites in Xerem was performed to determine the HII, in March and June 2015. The total number of cases of suspected arboviral illness in 2015 was 969, of which 444 (45.8%) were due to DENV, 146 (15.1%) to ZIKV, and 11 (1.1%) to CHIKV. In 2016, the number of suspected cases of arboviral illness was 2019, of which 324 (16.0%) were classified as DENV, 779 (38.6%) as ZIKV, and 53 (2.60%) as CHIKV. The clinical manifestations prevalent in ZIKV were rash (67.8% to 79.5%) and pruritus (63.7% to 71.4%). The HII for the immature stages of Aedes in the study area, in March and June 2015, was 11.8% for Ae. aegypti and 8.1% for Ae. albopictus, both very high. There was a strong positive correlation observed for precipitation and HII for both vectors (Ae. aegypti and Ae. albopictus), but not for temperature levels. We conclude that a triple epidemic occurred in the studied area probably due to the high infestation rates and a naive population for the two newly introduced arboviruses; whilst there are no available specific laboratory tests a practical clinical diagnosis workout is crucial.


Keywords


arboviruses, dengue, zika, chikungunya, clinical manifestations, Brazil

Full Text:

PDF

References


BRASIL. Boletim Epidemiológico: Monitoramento dos casos de dengue, febre de chikungunya e febre pelo vírus Zika até a Semana Epidemiológica 45, 2015. 2015; 46. http://portalarquivos2.saude.gov.br/images/pdf/2015/novembro/26/2015-dengue-SE45.pdf.

Rego JP. Esboço histórico das epidemias que têm grassado na cidade do Rio de Janeiro desde 1830 a 1870. Rio de Janeiro: Typhographia Nacional. 1872;2(1):44–50.

Schatzmayr HG, Nogueira RM, Travassos da Rosa AP. An outbreak of dengue virus at Rio de Janeiro —1986. Mem Inst Oswaldo Cruz. 1986 Apr-Jun; 81(2):245–6. PMID: 3587006.http://dx.doi.org/10.1590/S0074-02761986000200019.

Nogueira RM, Miagostovich M, Lampe E, Souza R, Zagne S, Schatzmayr H. Dengue epidemic in the state of Rio de Janeiro, Brazil, 1990–1: Co-circulation of dengue 1 and dengue 2 serotypes. Epidemiology and Infection, 1993. 111(1), 163-170.PMID:8348928.

Nogueira, RM, Miagostovich MP, de Filippis AM, Pereira MA, Schatzmayr HG. Dengue Virus type 3, Brazil, 2002. Emerging Infectious Diseases, 2005. v.11, n.9, p.1376-81.http://dx.doi.org/10.1590/S0074-02762001000700007.

Brasil. Boletim Epidemiológico: Monitoramento dos casos de dengue, febre de chikungunya e febre pelo vírus Zika até a Semana Epidemiológica 32, 2016. 2016;47. http://portalarquivos2.saude.gov.br/images/pdf/2016/setembro/16/2016-028---Dengue-SE32.pdf.

Schuler-Faccini L, Ribeiro EM, Feitosa IM, Horovitz DDG, Cavalcanti DP, Pessoa A, et al. Possible Association Between Zika Virus Infection and Microcephaly — Brazil, 2015. MMWR Morb Mortal Wkly Rep 2016;65:59–62.http://dx.doi.org/10.15585/mmwr.mm6503e2.

Calvet G, Aguiar RS, Melo ASO, Sampaio SA, de Filippis I, Fabri A, et al. Detection and sequencing of Zika virus from amniotic fluid of fetuses with microcephaly in Brazil: a case study. Lancet. Infectious Diseases (Print), v. 16, p. 156, 2016.http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)00095-5/fulltext.

Bezerra JMT, Araújo RGP, Melo FF, Gonçalves CM, Chaves BA, Silva BM, et al. Aedes (Stegomyia) albopictus’ dynamics influenced by spatiotemporal characteristics in a Brazilian dengue-endemic risk city. Acta Tropica, 2016;164, 431–437. http://doi.org/10.1016/j.actatropica.2016.10.010.

Gubler DJ. The economic burden of dengue. Am J Trop Med Hyg. 2012; 86(5): 743-744. Gubler DJ. The Economic Burden of Dengue. The American Journal of Tropical Medicine and Hygiene. 2012;86(5):743-744. doi:10.4269/ajtmh.2012.12-0157.

Fundação Nacional de Saúde (Brasil). Programa Nacional de Controle da Dengue-PNCD: instituído em 24 de julho de 2002. Available at:http://bvsms.saude.gov.br/bvs/publicacoes/pncd_2002.pdf.

Instituto Brasileiro de Geografia e Estatística (IBGE). Censo 2010. Available at: http://www.censo2010.ibge.gov.br/. Accessed 19.11.2017.

Brasil. Ministério da Saúde. Dengue: diagnóstico e manejo clínico: adulto e criança. 2016. http://portalsaude.saude.gov.br/images/pdf/2016/janeiro/14/dengue-manejo-adulto-crianca-5d.pdf. Accessed Nov 20, 2017.

Brasil. Ministério da Saúde. Febre de chikungunya: manejo clínico. http://bvsms.saude.gov.br/bvs/publicacoes/febre_chikungunya_manejo_clinico.pdf. Acessed Nov 20, 2017.

Brasil. Ministério da Saúde. Procedimentos a serem adotados para a vigilância da Febre do vírus Zika no Brasil. http://portalsaude.saude.gov.br/images/pdf/2016/marco/07/Nota-Informativa-zika.pdf. Accessed Nov 20, 2017.

Consoli RAGB.; Lourenco de Oliveira, R. Principais Mosquitos de Importância Sanitária no Brasil. Rio de Janeiro: Fundação Oswaldo Cruz, 1994.

Brasil. Ministério da Saúde. Levantamento Rápido de Índices para Aedesaegypti (LIRAa) para vigilância entomológica do Aedes aegypti no Brasil: Metodologia para avaliação dos índices de Breteau e Predial e tipo de recipientes. http://www.paho.org/bra/index.php?option=com_docman&view=download&category_slug=dengue-964&alias=1460-levantamento-rapido-indices-para-aedes-aegypti-liraa-2a-edicao-0&Itemid=965. Acessed Nov 20, 2017.

Brasil P, Calvet GA, Siqueira AM, Wakimoto M, de Sequeira PC, Nobre A, et al. Zika Vírus Outbreak in Rio de Janeiro, Brazil: Clinical Characterization, Epidemiological and Virological Aspects. PLoS Negl Trop Dis. 2016 10(4): e0004636.doi:10.1371/journal.pntd.0004636

Conteville LC,Zanella L, Marín MA, de Filippis AMB, Nogueira RMR, Vicente ACP, de Mendonça MCL. Phylogenetic analyses of chikungunya virus among travelers in Rio de Janeiro, Brazil, 2014-2015. Memórias Do Instituto Oswaldo Cruz, 111(5), 347–348. http://doi.org/10.1590/0074-02760160004.

Braga JU, Bressan C, Dalvi APR, Calvet GA, Daumas RP, Rodrigues N, et al. Accuracy of Zika virus disease case definition during simultaneous Dengue and Chikungunya epidemics. PLoS ONE. 2017, 12(6): e0179725.https://doi.org/10.1371/journal.pone.0179725.

Coelho FC, Durovni B, Saraceni V, Lemos C, Codeço CT, Camargo S, et al., Higher incidence of Zika in adult women than adult men in Rio de Janeiro suggests a significant contribution of sexual transmission from men to women.International Journal of Infectious Diseases 51 (2016) 128–132. http://dx.doi.org/10.1016/j.ijid.2016.08.023.

Kannan M, Rajendran R, Sunish IP, Balasubramaniam R, Arunachalam N, Paramsivan R, et al. A study on Chikungunya outbreak during 2007 in Kerala, south India. Indian J Med Res. 2009; 129(3):311–5.PMID:19491425

Moreira, J.Peixoto TM, Siqueira AM, Lamas CC. Sexually acquired Zika virus: a systematic review. Clin Microbiol Infect. 2017 May;23(5):296-305. doi: 10.1016/j.cmi.2016.12.027.

Gourinat AC, O'Connor O, Calvez E, Goarant C, Dupont-Rouzeyrol M. Detection of Zika virus in urine. Emerging infectious diseases. 2015; 21(1):84–6. Epub 2014/12/23. doi: 10.3201/eid2101.140894.

Brady OJ, Golding N, Pigott DM, Kraemer MU, Messina JP, Reiner Jr RC, et al. Global temperature constraints on Aedes aegypti and Ae. albopictus persistence and competence for dengue virus transmission. Parasit Vectors 2014;7:14.https://doi.org/10.1186/1756-3305-7-338.

Charrel RN, de Lamballerie X, Raoult D. Chikungunya outbreaks—the globalization of vector borne diseases. N Engl J Med. 2007;356: 769–71.doi: 10.1056/NEJMp078013.

Chuang T-W, Chaves LF, Chen P-J .Effects of local and regional climatic fluctuations on dengue outbreaks in southern Taiwan. PLoS ONE 2017 12(6): e0178698. https://doi.org/10.1371/journal.pone.0178698.

Van Genderen FT., Krishnadath I, Sno R, Grunberg MG, Zijlmans W, Adhin MR. First Chikungunya Outbreak in Suriname; Clinical and Epidemiological Features. PLoS Negl Trop Dis. 2016 Apr 15;10 (4):e0004625. doi: 10.1371/journal.pntd.0004625.

Lourenço-de-Oliveira R, Failloux A-B. High risk for chikungunya virus to initiate an enzootic sylvatic cycle in the tropical Americas. PLoS Negl Trop Dis. 2017, 11(6): e0005698. https://doi. org/10.1371/journal.pntd.0005698.

Chouin-Carneiro T, Vega-Rua A, Vazeille M, Yebakima A, Girod R, Goindin D, et al. Differential Susceptibilities of Aedes aegypti and Aedes albopictus from the Americas to Zika Virus. PLoS Negl Trop Dis 2016. 10(3): e0004543. doi:10.1371/ journal.pntd.0004543.

Terzian ACB et al. Evidence of natural Zika virus infection in neotropical non-human primates in Brazil. Sci Rep. 2018 Oct 30;8(1):16034.

Favoretto, S. et al. First detection of Zika virus in neotropical primates in Brazil: a possible new reservoir. bioRxiv 04939510.1101/049395 (2016).




DOI: https://doi.org/10.34117/bjdv7n6-088

Refbacks

  • There are currently no refbacks.