Dengue 4 in Ceará, Brazil: characterisation of epidemiological and laboratorial aspects and causes of death during the first epidemic in the state

BACKGROUND The first dengue cases in Brazil with laboratory confirmation occurred in the northern region of the country, with the isolation of two serotypes, dengue virus 1 (DENV-1) and DENV-4. In Ceará, the introduction of DENV-4 was reported during a DENV-1 epidemic in 2011, with only two isolations. OBJECTIVES The aim of this study was to characterise the first DENV-4 epidemic in the state of Ceará, Brazil. METHODS The study population was composed of patients with suspected dengue that were reported to health care units from January to December 2012. The laboratory confirmation of infection was made by viral isolation, reverse transcription polymerase chain reaction (RT-PCR), AgNS1, immunohistochemistry and IgM enzyme-linked immunosorbent assay (ELISA). MAIN CONCLUSIONS In the study year, 72,211 suspected dengue cases were reported and 51,865 of these cases (71.8%) were confirmed to be positive. Co-circulation of three serotypes, DENV-1, DENV-3 and DENV-4, was detected with a predominance of DENV-4 (95.3%). Most cases were not severe, but there were 44 fatal outcomes. DENV-4 Genotype II was identified for the first time in Ceará.

Vinte e cinco anos de DENV-1 no Brasil: epidemiologia Molecular de Cepas Isoladas entre 1986 e 2011 / Twenty-five years of denv-1 in brazil: molecular epidemiology of strains isolated from 1986 to 2011

Este estudo apresenta a fiogenia e caracterização molecular baseados na análise do gene do envelope (E) (1.485 nucleotídeos) dos DENV-1 (n=48) e na região codificante completa (10.176 nucleotídeos) de seis representantes dentre as 48 amostras analisadas, isolados durante as epidemias ocorridas desde a introdução do sorotipo em 1986 até 2011. Possíveis eventos de recombinação genômica também foram analisados. Os resultados baseados na análise do gene E demonstraram que os DENV-1 isolados dos estados do Rio de Janeiro, Espírito Santo, Minas Gerais, Mato Grosso do Sul, Alagoas, Ceará, Piauí e Rio Grande do Norte pertencem ao genótipo V (América/África), mas agrupam-se em clades distintos. Três grupos foram identificados, um datando entre 1986-2002 (linhagem 1a), um segundo grupo representado por vírus isolados entre 2009 e 2011 e uma cepa isolada representativa do ano de 2002 (linhagem 2) e um grupo de cepas isoladas em 2010 e 2011 (linhagem 1b). A linhagem 2 apresentou um alto suporte de bootstrap garantindo a sua separação das outras linhagens. As linhagens 1a e 1b, apesar de se agruparem em ramos distintos, foram caracterizadas no mesmo grupo, com bootstrap acima de 75 porcento. Além disso, as linhagens 1a e 1b foram mais relacionadas com as cepas americanas e a linhagem 2 com as cepas asiáticas. As substituições de aminoácidos (aa) foram observadas nos ectodomínios I e III da proteína E e foram associadas à separação das linhagens. Uma substituição em E297 diferenciou a linhagem 1a das linhagens 1b e 2. As alterações observadas em E338, E394 (ectodomínio III), E428 e E430 (região “stem”) diferenciaram as linhagens...

This study presents the phylogeny and molecular characterization based onenvelope gene (E) analysis of DENV-1 (n=48) isolated during epidemics occurred since this serotype introduction in 1986 to 2011. From those strains, six were fullysequenced (coding region) and possible genomic recombination events wereanalyzed. The results of the phylogenetic analysis based on the E gene showed that DENV-1 isolates from the states of Rio de Janeiro, Espírito Santo, Minas Gerais, Mato Grosso do Sul, Alagoas, Ceará, Piauí and Rio Grande do Norte belong to genotype V (America/Africa), but grouping in distinct clades. Three groups wereidentified, one dating from 1986 to 2002 (lineage 1a), a second group isolated between 2009 and 2011 and a representative strain isolated in 2002 (lineage 2) and a group of strains isolated in 2010 and 2011 (lineage 1b). Lineage 2 has a high bootstrap support ensuring their separation from the other lineages. The lineages 1aand 1b, despite in distinct branches, were characterized in a same group supported by a bootstrap of 75 percent. Furthermore, the lineages 1a and 1b were more closely related to the American strains, while lineage 2 to the Asian strains. Amino acids (aa)substitutions were observed in the ectodomains I and III of the E protein and were associated to the lineages separation. A substitution on E297 differentiated the lineage...

Dengue virus type 4 in Niterói, Rio de Janeiro: the role of molecular techniques in laboratory diagnosis and entomological surveillance

In Niterói, state of Rio de Janeiro, dengue virus type 4 (DENV-4) was isolated for the first time in March 2011. We analysed the laboratory findings of the first cases and evaluated the use of molecular techniques for the detection of DENV-4 in Aedes aegypti that were field-caught. Conventional reverse transcriptase-polymerase chain reaction (RT-PCR) and SimplexaTM Dengue real-time RT-PCR confirmed DENV-4 infection in all cases. Additionally, DENV-4 was confirmed in a female Ae. aegypti with 1.08 x 10³ copies/mL of virus, as determined by quantitative real-time RT-PCR. This is the first time the SimplexaTM Dengue real-time assay has been used for the classification of cases of infection and for entomological investigations. The use of these molecular techniques was shown to be important for the surveillance of dengue in humans and vectors.