Plan técnico para la ejecución de la "Jornada a nivel nacional de acciones integrales e intersectoriales para lucha contra las Arbovirosis en Centros Escolares y Centros de Votación 2024" / Technical plan for the implementation of the "National day of comprehensive and intersectoral actions to combat Arbovirosis in Schools and Voting Centers 2024

En la situación del dengue en El Salvador, inciden determinantes (ambientales, económicos, políticos y sociales), la constante migración del campo a la ciudad, una creciente urbanización sin planificación ni regulación alguna, pobreza, inequidad en el ingreso y condiciones de exclusión que relegan a la población en esta situación a exponerse permanentemente a condiciones de alto riesgo y vulnerabilidad que favorecen la persistencia de la transmisión de arbovirosis, entre ellos se pueden señalar crecimiento poblacional, construcción de viviendas inadecuadas que generan condiciones críticas de hacinamiento, deficiente abastecimiento de agua que obliga a las personas a almacenarla inadecuadamente, una deficiente recolección de desechos sólidos, todo lo cual genera condiciones adecuadas para la multiplicación del Aedes aegypti y la transmisión de la enfermedad. El Ministerio de Salud, anticipándose al retorno de alumnos a un aproximado de 5,000 centros escolares públicos y privados, además de la prevención en 1,600 centros de votación, se ha programado la ejecución de una jornada a nivel nacional de acciones, la cual tiene por objetivo el control del vector en su fase larvaria y adulta; así como, la realización de acciones gubernamentales de carácter preventivas, en el que se realizarán actividades de promoción de la salud encaminadas a la eliminación de criaderos y otras actividades que sean factibles de desarrollar por la comunidad.

In the situation of dengue in El Salvador, determinants (environmental, economic, political and social), the constant migration from the countryside to the city, a growing urbanization without any planning or regulation, affect poverty, inequity in income and conditions of exclusion that relegate the population in this situation to be permanently exposed to conditions of high risk and vulnerability that favor the persistence of transmission of arbovirosis, These include population growth, construction of inadequate housing that generates critical conditions of overcrowding, poor water supply that forces people to store it improperly, poor solid waste collection, all of which generates adequate conditions for the multiplication of Aedes aegypti and the transmission of the disease. The Ministry of Health, anticipating the return of students to approximately 5,000 public and private schools, in addition to prevention in 1,600 voting centers, has scheduled the execution of a day at the national level of actions, which has as its objective the control of the vector in its larval and adult phase; as well as the carrying out of preventive governmental actions, which will include health promotion activities aimed at the elimination of hatcheries and other activities that are feasible to develop by the community

Occurrence of arbovirus infections in two riverine populations in the municipality of Humaitá, Amazonas, Brazil

ABSTRACT Background: The riverine communities of the Amazon comprise different social groups that inhabit the rural areas on the banks of rivers and lakes. Residents usually travel by river to rural and urban areas and are then exposed to urbanized diseases such as those caused by arbovirus infection. In Brazil, emerging diseases such as dengue, Zika, chikungunya, and those caused by infection with Oropouche and Mayaro viruses necessitate epidemiological surveillance. This study was aimed at determining the frequency of positivity for immunoglobulin (Ig)G and IgM antibodies against Zika, chikungunya, and dengue viruses and performing molecular analyses to detect viral RNA for the Zika, chikungunya, dengue virus, Oropouche, and Mayaro viruses, in the same serum samples obtained from riverside populations. Methods: This cross-sectional study was conducted in a riverside population in the Humaitá municipality of the Brazilian Amazon. More than 80% of the local population participated in this study. Entomological samples were collected to identify local mosquito vectors. Results: Analysis of 205 human serological samples revealed IgG antibodies against the dengue virus in 85 individuals. No molecular positivity was observed in human samples. Entomological analyses revealed 3,187 Diptera species, with Mansonia being the most frequent genus. Aedes aegypti and Aedes albopictus were not detected in the two collections. Conclusions: IgG antibodies against the dengue virus were highly prevalent, suggesting previous exposure. The absence of the arbovirus vectors Aedes aegypti and Aedes albopictus in the samples supports the hypothesis that the infections recorded likely occurred outside the riverside communities investigated.

"Clock dial pattern", a radiologic clue to neuro-chikungunya diagnosis: a case series / "Padrão em ponteiro de relógio", uma dica radiológica para o diagnóstico de neurochikungunya: série de casos

Abstract Background Chikungunya is a mosquito-borne disease caused by the chikungunya virus (CHIKV) and can lead to neurological complications in severe cases. Objective This study examined neuroimaging patterns in chikungunya cases during two outbreaks in Brazil to identify specific patterns for diagnosis and treatment of neuro-chikungunya. Methods Eight patients with confirmed chikungunya and neurological involvement were included. Clinical examinations and MRI scans were performed, and findings were analyzed by neuroradiologists. Data on age, sex, neurological symptoms, diagnostic tests, MRI findings, and clinical outcomes were recorded. Results Patients showed different neuroimaging patterns. Six patients exhibited a "clock dial pattern" with hyperintense dotted lesions in the spinal cord periphery. One patient had thickening and enhancement of anterior nerve roots. Brain MRI revealed multiple hyperintense lesions in the white matter, particularly in the medulla oblongata, in six patients. One patient had a normal brain MRI. Conclusion The "clock dial pattern" observed in spinal cord MRI may be indicative of chikungunya-related nervous system lesions. Isolated involvement of spinal cord white matter in chikungunya can help differentiate it from other viral infections. Additionally, distinct brainstem involvement in chikungunya-associated encephalitis, particularly in the rostral region, sets it apart from other arboviral infections. Recognizing these neuroimaging patterns can contribute to early diagnosis and appropriate management of neuro-chikungunya.

Resumo Antecedentes A chikungunya é uma doença transmitida por mosquitos causada pelo vírus chikungunya (CHIKV) e pode levar a complicações neurológicas em casos graves. Objetivo Este estudo examinou padrões de neuroimagem em casos de chikungunya durante dois surtos no Brasil para identificar padrões específicos para o diagnóstico e tratamento de neurochikungunya. Métodos Oito pacientes com chikungunya confirmada e envolvimento neurológico foram incluídos. Exames clínicos e ressonâncias magnéticas (RM) foram realizados, e os achados foram analisados por neurorradiologistas. Dados sobre idade, sexo, sintomas neurológicos, testes diagnósticos, achados de RM e desfechos clínicos foram registrados. Resultados Os pacientes apresentaram diferentes padrões de neuroimagem. Seis pacientes apresentaram um "padrão de mostrador de relógio" com lesões pontilhadas hiperintensas na periferia da medula espinhal. Um paciente apresentou espessamento e realce das raízes nervosas anteriores. A RM do cérebro revelou múltiplas lesões hiperintensas na substância branca, especialmente no bulbo em seis pacientes. Um paciente apresentou uma RM cerebral normal. Conclusão O "padrão de mostrador de relógio" observado na RM da medula espinhal pode ser indicativo de lesões do sistema nervoso relacionadas à chikungunya. O envolvimento isolado da substância branca da medula espinhal na chikungunya pode ajudar a diferenciá-la de outras infecções virais. Além disso, o envolvimento distinto do tronco cerebral na encefalite associada à chikungunya, especialmente na região rostral, a distingue de outras infecções por arbovírus. O reconhecimento desses padrões de neuroimagem pode contribuir para o diagnóstico precoce e manejo adequado da neurochikungunya.

Distribución de Aedes albopictus en Ibagué: potencial riesgo de brotes de arbovirosis

Introducción. Aedes albopictus es un vector de arbovirus como dengue, Zika, chikungunya y fiebre amarilla. Los primeros reportes en el continente americano datan de 1985 y dada su capacidad de adaptación ecológica y fisiológica, se ha distribuido rápidamente en el territorio colombiano desde su primer reporte en 1998. Objetivo. Determinar la distribución de A. albopictus en las comunas de Ibagué, Colombia. Materiales y métodos. Los muestreos se realizaron entre mayo y noviembre de 2022 en zonas con abundante vegetación de las 13 comunas de Ibagué. Se emplearon aspiradores y redes entomológicas. Los mosquitos fueron transportados al Laboratorio de Investigaciones en Parasitología Tropical de la Universidad del Tolima para su determinación taxonómica. Resultados. Se identificaron 708 ejemplares de A. albopictus, distribuidos en las comunas de Ibagué. La mayor abundancia del vector se presentó en las comunas 10, 11, 7, 8, 2 y 9. Las comunas 3, 4, 5, 6, 12 y 13 presentaron abundancias relativas cercanas al 3 %, y la comuna 1 tuvo una abundancia del 2 %. Conclusiones. Aedes albopictus está distribuido en todas las comunas de Ibagué, probablemente su dispersión se ha visto favorecida por las condiciones ambientales y sociales de esta región. Se recomienda hacer seguimiento anual a las poblaciones de este vector y realizar una caracterización molecular de los arbovirus encontrados. Además, el conocer la distribución de este mosquito en la ciudad permitirá focalizar las estrategias de control entomológico y prevenir futuros brotes de arbovirosis.

Introduction. Aedes albopictus is a vector for arboviruses, such as dengue, Zika, chikungunya, and yellow fever. The first A. albopictus reports on the American continent date back to 1985. It has spread rapidly throughout Colombia since its first report in 1998 due to its ecological and physiological adaptation capability. Objective. To determine A. albopictus distribution in the 13 communes of Ibagué, Colombia. Materials and methods. Samples were collected between May and November 2022 in the 13 communes of Ibagué. Vacuum sampling and sweep-netting entomological nets were used in areas with abundant vegetation. The mosquitoes were transported to the Laboratorio de Investigaciones en Parasitología Tropical at the Universidad del Tolima for taxonomic determination. Results. We identified 708 A. albopictus specimens distributed throughout Ibague's 13 communes. The highest vector abundance occurred in communes 10, 11, 7, 8, 2, and 9; communes 3, 4, 5, 6, 12, and 13 had a relative abundance of around 3%, while commune 1 had 2% of relative abundance. Conclusions. Aedes albopictus is distributed throughout all the communes of Ibague. Its dispersion has probably been favored by this region's environmental and social conditions. We recommend annual monitoring of these vectors populations and molecular characterization of the found arboviruses. Ascertaining this mosquito's distribution throughout the city will enable focusing entomological control strategies and preventing future arbovirus outbreaks.

Métodos de aprendizaje automático para predecir el comportamiento epidemiológico de enfermedades arbovirales: revisión estructurada de literatura

Introducción: Los métodos de aprendizaje automático permiten manejar datos estructurados y no estructurados para construir modelos predictivos y apoyar la toma de decisiones. Objetivo: Identificar los métodos de aprendizaje automático aplicados para predecir el comportamiento epidemiológico de enfermedades arbovirales utilizando datos de vigilancia epidemiológica. Metodología: Se realizó búsqueda en EMBASE y PubMed, análisis bibliométrico y síntesis de la información. Resultados: Se seleccionaron 41 documentos, todos publicados en la última década. La palabra clave más frecuente fue dengue. La mayoría de los autores (88,3 %) participó en un artículo de investigación. Se encontraron 16 métodos de aprendizaje automático, el más frecuente fue Red Neuronal Artificial, seguido de Máquinas de Vectores de Soporte. Conclusiones: En la última década se incrementó la publicación de trabajos que pretenden predecir el comportamiento epidemiológico de arbovirosis por medio de diversos métodos de aprendizaje automático que incorporan series de tiempo de los casos, variables climatológicas, y otras fuentes de información de datos abiertos.

Introduction: Machine learning methods allow to manipulate structured and unstructured data to build predictive models and support decision-making. Objective: To identify machine learning methods applied to predict the epidemiological behavior of vector-borne diseases using epidemiological surveillance data. Methodology: A literature search in EMBASE and PubMed, bibliometric analysis, and information synthesis were performed. Results: A total of 41 papers were selected, all of them were published in the last decade. The most frequent keyword was dengue. Most authors (88.3 %) participated in a research article. Sixteen machine learning methods were found, the most frequent being Artificial Neural Network, followed by Support Vector Machines. Conclusions: In the last decade there has been an increase in the number of articles that aim to predict the epidemiological behavior of vector-borne diseases using by means of various machine learning methods that incorporate time series of cases, climatological variables, and other sources of open data information.

Review of dengue, zika and chikungunya infections in nervous system in endemic areas / Revisão da infecção por dengue, zika e chikungunya no sistema nervoso em áreas endêmicas

Abstract Dengue, zika, and chikungunya are arboviruses of great epidemiological relevance worldwide. The emergence and re-emergence of viral infections transmitted by mosquitoes constitute a serious human public health problem. The neurological manifestations caused by these viruses have a high potential for death or sequelae. The complications that occur in the nervous system associated with arboviruses can be a challenge for diagnosis and treatment. In endemic areas, suspected cases should include acute encephalitis, myelitis, encephalomyelitis, polyradiculoneuritis, and/or other syndromes of the central or peripheral nervous system, in the absence of a known explanation. The confirmation diagnosis is based on viral (isolation or RT-PCR) or antigens detection in tissues, blood, cerebrospinal fluid, or other body fluids, increase in IgG antibody titers between paired serum samples, specific IgM antibody in cerebrospinal fluid and serological conversion to IgM between paired serum samples (non-reactive in the acute phase and reactive in the convalescent). The cerebrospinal fluid examination can demonstrate: 1. etiological agent; 2. inflammatory reaction or protein-cytological dissociation depending on the neurological condition; 3. specific IgM, 4. intrathecal synthesis of specific IgG (dengue and chikungunya); 5. exclusion of other infectious agents. The treatment of neurological complications aims to improve the symptoms, while the vaccine represents the great hope for the control and prevention of neuroinvasive arboviruses. This narrative review summarizes the updated epidemiology, general features, neuropathogenesis, and neurological manifestations associated with dengue, zika, and chikungunya infection.

Resumo Dengue, zika e chikungunya são arboviroses de grande relevância epidemiológica em todo o mundo. A emergência e reemergência dessas infecções virais transmitidas por mosquitos constituem um grave problema de saúde pública humana. As manifestações neurológicas causadas por esses vírus têm alto potencial de morte ou sequelas. As complicações que ocorrem no sistema nervoso associadas às arboviroses podem representar um desafio diagnóstico e de tratamento. Em áreas endêmicas, casos suspeitos devem incluir encefalite, mielite, encefalomielite, polirradiculoneurite e/ou outras síndromes do sistema nervoso central ou periférico, na ausência de explicação conhecida. Caso confirmado de arbovirose neuroinvasivo é baseado na detecção viral (isolamento ou RT-PCR) ou de antígenos em tecidos, sangue, líquido cefalorraquidiano ou outros fluidos corporais, aumento dos títulos de anticorpos IgG entre amostras de soro pareadas, anticorpo IgM específico no líquido cefalorraquidiano e conversão sorológica para IgM entre amostras de soro pareadas. O exame do líquido cefalorraquidiano pode demonstrar: 1. agente etiológico; 2. reação inflamatória ou dissociação proteico-citológica, dependendo do quadro neurológico; 3. valor absoluto de IgM específica; 4. síntese intratecal de anticorpos IgG específicos (dengue e chikungunya); 5. exclusão de outros agentes infecciosos. O tratamento das complicações neurológicas visa melhorar os sintomas, enquanto a vacina representa a grande esperança para o controle e a prevenção das arboviroses neuroinvasivas. Esta revisão narrativa resume a atualização da epidemiologia, características gerais, neuropatogênese e manifestações neurológicas associadas à infecção pelos vírus da dengue, zika e chikungunya.

Características clínicas y laboratoriales de pacientes adultos ambulatorios con Chikungunya del Hospital Nacional de Itauguá de Paraguay durante la epidemia 2022-2023

Introducción: La infección aguda por chikungunya produce una infección auto-limitada caracterizada principalmente por fiebre alta, artralgias, artritis, cefalea, mialgias y exantema pruriginoso; una minoría presenta síntomas persistentes que puede evolucionar a la cronicidad. Objetivo: describir las características clínicas y laboratoriales de pacientes adultos ambulatorios con chikungunya en un hospital de referencia durante la epidemia del 2022-2023 en Paraguay. Metodología: estudio descriptivo de corte trasversal de pacientes adultos con chikungunya que consultaron en el Hospital Nacional de Itauguá entre enero-marzo de 2023. Resultados: Se incluyeron 140 pacientes entre 19 y 79 años (edad media: 46,6±13,6), 77,9 % del sexo femenino y 89,3 % del departamento Central. El 72,9 % de los pacientes fueron confirmados por RT-PCR y el resto por la serología o nexo epidemiológico. El 48,6 % tenía alguna comorbilidad, el 65% se encontraba en la fase aguda, y el resto en la fase subaguda (35 %). Los síntomas más frecuentes fueron la poliartralgia (96,4 %); artritis (98,6 %), fiebre (95,7 %), astenia (100 %), mialgias (96,4 %), cefalea (82,9 %), exantema (95 %). Los síntomas gastrointestinales fueron menos frecuentes; náuseas (37 %), vómitos (15,7 %) y diarrea (20 %). Entre los principales hallazgos laboratoriales se encontraron la proteína C reactiva aumentada (45,7 %), leucopenia (23,6 %), eritrosedimentación aumentada (27,9 %), citólisis hepática leve (13,6 %). Todos fueron tratados con paracetamol; el 60,4 % y el 87,8 % de los pacientes en fase aguda y subaguda recibieron AINES, respectivamente. Discusión: La combinación de fiebre alta y artralgia severa fue el rasgo característico de la infección por el virus chikungunya en la epidemia en Paraguay.

Introduction: Acute infection by chikungunya produces a self-limited infection characterized mainly by high fever, arthralgia, arthritis, headache, myalgia and pruritic rash; a minority presents persistent symptoms that can evolve to chronicity. Objective: to describe the clinical and laboratory characteristics of adult ambulatory patients with chikungunya at a referral hospital during the 2022-2023 epidemic in Paraguay. Method: descriptive cross-sectional study of adult patients with chikungunya infection who consulted at the Hospital National de Itauguá between January-March 2023. Results: 140 patients between 19 and 79 years old (mean age: 46.6 ± 13.6), 77.9% female and 89.3% from the Central department, were included. 72.9% of the patients were confirmed by RT-PCR and the rest by serology or epidemiological nexus. 48.6% had some comorbidity, 65% were in the acute phase, and the rest in the subacute phase (35%). The most frequent symptoms were polyarthralgia (96.4%); arthritis (98.6%), fever (95.7%), fatigue (100%), myalgia (96.4%), headache (82.9%), rash (95%). Gastrointestinal symptoms were less frequent such as; nausea (37%), vomiting (15.7%) and diarrhea (20%). Increased C-reactive protein (45.7%), leukopenia (23.6%), increased erythrocyte sedimentation rate (27.9%), and mild hepatic cytolysis (13.6%) were among the main laboratory findings. All patients were treated with paracetamol; 60.4% and 87.8% of the patients in the acute and subacute phase, respectively, received NSAIDs. Discussion: The combination of high fever and severe arthralgia can be considered the characteristic feature of chikungunya virus infection in this epidemic.

Brote de Zika en Panamá. Caracterización del primer brote epidémico del virus Zika registrado en Panamá

Introducción: La caracterización de los brotes de Zika es de gran importancia para lograr determinar los factores de riesgos individuales y colectivos que participan en su ocurrencia y es la base para el desarrollo de estrategias efectivas para la vigilancia, prevención y control de la transmisión de esta enfermedad. Objetivo: Describir epidemiológicamente las principales características del primer brote epidémico de Zika registrado en Panamá, en la Comarca de Guna Yala. Materiales y métodos: Se diseño y realizó un estudio descriptivo y retrospectivo del primer brote de Zika ocurrido entre el 27 de noviembre de 2015 y el 22 de enero de 2016 en Guna Yala, Panamá. Resultados: Se colectaron un total de 68 muestras de suero de pacientes sospechosos, 38 muestras fueron positivas por PCR para Zika en la Comarca de Guna Yala, Ustupo registró la mayor cantidad de casos (n = 29, 76,3%), el (n = 43; 86%) de los casos fueron menores de 59 años, el (n = 37; 74%) de los casos eran población económicamente activa (14 a 65 años de edad) y el (n = 30; 60%) de los casos fueron de sexo femenino. Conclusión: Este estudio ha permitido mostrar la facilidad con que las enfermedades arbovirales como el Zika puede introducirse, propagarse y llegar a producir un impacto en la salud pública de la población, el sistema de salud y establecerse en las regiones donde ocurren estos eventos sanitarios. Es necesario realizar más estudios, el fortalecimiento de la vigilancia epidemiológica y la consideración de los factores de riesgo para garantizar la sostenibilidad de las intervenciones sanitarias y lograr reducir el impacto social y económico de este arbovirosis. (provisto por Infomedic International)

Introduction: The characterization of Zika outbreaks is of great importance to determine the individual and collective risk factors involved in their occurrence and is the basis for the development of effective strategies for surveillance, prevention and control of Zika transmission. Objective: To describe epidemiologically the main characteristics of the first epidemic outbreak of Zika recorded in Panama, in the Guna Yala region.  Materials and methods: A descriptive and retrospective study of the first Zika outbreak that occurred between 27 November 2015 and 22 January 2016 in Guna Yala, Panama, was designed and conducted.  Results: A total of 68 serum samples were collected from suspected patients, 38 samples were positive by PCR for Zika in the Guna Yala Comarca, Ustupo registered the highest number of cases (n = 29, 76.3%), (n = 43; 86%) of the cases were younger than 59 years, (n = 37; 74%) of the cases were economically active population (14 to 65 years of age) and (n = 30; 60%) of the cases were female. Conclusion: This study has shown the ease with which arboviral diseases such as Zika can be introduced, spread and have an impact on the public health of the population, the health system and become established in the regions where these health events occur. Further studies strengthened epidemiological surveillance and consideration of risk factors are needed to ensure the sustainability of health interventions and to reduce the social and economic impact of this arbovirosis. (provided by Infomedic International)

Caracterización clínica y epidemiológica de la epidemia de Chikungunya en el Paraguay

Durante el verano del 2022 y 2023 ocurrió la mayor epidemia de Chikungunya en Paraguay, y una de las más grandes reportadas en la región. Estuvo centralizada en el área metropolitana de Asunción en una primera etapa, pero se expandió al resto del país durante los primeros meses del 2023. Este trabajo tiene el objetivo de describir epidemiológica y clínicamente la epidemia desde su inicio en la semana epidemiológica 40 del 2022 hasta la semana 20 del 2023. Metodología: es un estudio descriptivo que utiliza los datos públicos disponibles en la página de la Dirección General de Vigilancia de la Salud. Fueron confirmados 86.761 casos, 58% femenino, 8227 ingresos hospitalarios y 248 fallecidos. La letalidad global es de 2.8 por mil casos confirmados. Los grupos etarios más afectados corresponden a la franja de 0 a 4 años (9%), sin embargo, la mayor incidencia de casos se da en mayores de 80 años. Los principales desafíos de esta enfermedad son el abordaje multidisciplinario en la gestión del manejo del vector, la evaluación de las causas de esta alta letalidad y la necesidad de una vacuna de uso poblacional.

During the summer of 2022 and 2023, the largest Chikungunya epidemic occurred in Paraguay, and one of the largest reported in the region. It was centralized in the metropolitan area of Asunción in a first stage, but it expanded to the rest of the country during the first months of 2023. This work has the objective of describing the epidemic epidemiologically and clinically from its beginning in epidemiological week 40 of 2022 to week 20 of 2023. Methodology: it is a descriptive study that uses the public data available on the page of the General Directorate of Health Surveillance. 86,761 cases were confirmed, 58% female, 8,227 hospital admissions, and 248 deaths. The global lethality is 2.8 per thousand confirmed cases. The most affected age groups correspond to the 0 to 4-year-old group (9%), however, the highest incidence of cases occurs in people over 80 years of age. The main challenges of this disease are the multidisciplinary approach in the management of the vector, the evaluation of the causes of this high lethality and the need for a vaccine for population use.

Caracterización clínica y epidemiológica de la epidemia de Chikungunya en el Paraguay / Clinical and epidemiological characterization of the Chikungunya epidemic in Paraguay

Durante el verano del 2022 y 2023 ocurrió la mayor epidemia de Chikungunya en Paraguay, y una de las más grandes reportadas en la región. Estuvo centralizada en el área metropolitana de Asunción en una primera etapa, pero se expandió al resto del país durante los primeros meses del 2023. Este trabajo tiene el objetivo de describir epidemiológica y clínicamente la epidemia desde su inicio en la semana epidemiológica 40 del 2022 hasta la semana 20 del 2023. Metodología: es un estudio descriptivo que utiliza los datos públicos disponibles en la página de la Dirección General de Vigilancia de la Salud. Fueron confirmados 86.761 casos, 58% femenino, 8227 ingresos hospitalarios y 248 fallecidos. La letalidad global es de 2.8 por mil casos confirmados. Los grupos etarios más afectados corresponden a la franja de 0 a 4 años (9%), sin embargo, la mayor incidencia de casos se da en mayores de 80 años. Los principales desafíos de esta enfermedad son el abordaje multidisciplinario en la gestión del manejo del vector, la evaluación de las causas de esta alta letalidad y la necesidad de una vacuna de uso poblacional.

During the summer of 2022 and 2023, the largest Chikungunya epidemic occurred in Paraguay, and one of the largest reported in the region. It was centralized in the metropolitan area of Asunción in a first stage, but it expanded to the rest of the country during the first months of 2023. This work has the objective of describing the epidemic epidemiologically and clinically from its beginning in epidemiological week 40 of 2022 to week 20 of 2023. Methodology: it is a descriptive study that uses the public data available on the page of the General Directorate of Health Surveillance. 86,761 cases were confirmed, 58% female, 8,227 hospital admissions, and 248 deaths. The global lethality is 2.8 per thousand confirmed cases. The most affected age groups correspond to the 0 to 4-year-old group (9%), however, the highest incidence of cases occurs in people over 80 years of age. The main challenges of this disease are the multidisciplinary approach in the management of the vector, the evaluation of the causes of this high lethality and the need for a vaccine for population use.

Infección por hantavirus en la Provincia de Buenos Aires-Argentina. Comportamiento de la serie temporal 1997-2021

Introducción: La infección por hantavirus es endémica en América del Sur, con un amplio espectro de gravedad y una letalidad que varía entre 17 y 40 por ciento. El presente estudio recoge información de 25 años de vigilancia epidemiológica en Buenos Aires, Argentina. Objetivo: Caracterizar el comportamiento de la serie temporal 1997-2021, observando tendencia y estacionalidad. Métodos: La función de serie temporal utilizada empleó la media móvil centrada según periodos trimestrales, de forma que cada año se dividió en cuartiles. Se consideró un modelo multiplicativo. Resultados: Con una tasa de mortalidad de la serie de 0,15 por 100 mil y de letalidad de 22,6, la razón varones : mujeres fue de 3,4:1. La distribución sindrómica mostró mayor compromiso renal, siendo la tasa de mortalidad prácticamente igual en ambos sexos. Conclusión: Como enfermedad infecciosa, la infección por hantavirus reflejó en los últimos 25 años un comportamiento, recurrente y estacional, endémico y compartido en sus características clínicas con el resto de la región andina.

Background: Hantavirus infection is endemic in South America, with a wide spectrum of severity and a fatality rate that varies between 17-40 percent. This study collects information from 25 years of epidemiological surveillance in Buenos Aires, Argentina. Aim: To characterize the behavior of the 1997-2021 time series, observing trends and seasonality. Methods: The time series function used the moving average centered according to quarterly periods, so that each year was divided into quartiles. A multiplicative model is missed. Results: With a mortality rate for the series of 0.15 per 100,000 and a fatality rate of 22.6, the male : female ratio was 3.4:1. The syndromic distribution showed greater renal involvement, with the mortality rate being practically the same in both sexes. Conclusion: As an infectious disease, hantavirus has reflected in the last 25 years a behavior, recurrent and seasonal, endemic and shared in its clinical characteristics with the rest of the Andean region.

El programa del manejo integrado de vectores en el marco de la pandemia por COVID-19 en Medellín, Colombia / Integrated vector management program in the framework of the COVID-19 pandemic in Medellin, Colombia

Introducción. La pandemia por COVID-19 presionó los sistemas de salud para mantener alerta y activos los programas de control y prevención de las enfermedades transmitidas por vectores, y generó cambios en las estrategias de control vectorial en áreas urbanas afectadas por el dengue, el Zika y el chikunguña. Objetivo. Describir las adaptaciones del programa de vigilancia y control de vectores en Medellín durante la contingencia sanitaria por COVID-19. Materiales y métodos. Iniciada la emergencia sanitaria, se elaboraron protocolos de bioseguridad. Se fortaleció la vigilancia entomológica institucional en lugar de las viviendas. La información se recolectó en Medellín durante los años 2018 a 2021, en las actividades del programa de vigilancia y control de vectores, que incluyen la vigilancia epidemiológica y entomo-virológica, el levantamiento de los índices entomológicos, el monitoreo de ovitrampas, la movilización social y comunitaria, la búsqueda y eliminación de criaderos, y el control químico; estas acciones se adaptarons o incrementaron para favorecer, de una parte, el autocuidado de las comunidades en confinamiento total y parcial, y de desarrollar las acciones de prevención y control. Resultados. Se incrementó en un 40 % la vigilancia del mosquito mediante ovitrampas, la vigilancia entomo-virológica presentó un incremento de 34,4 % en el 2020 respecto al 2019, y se utilizaron herramientas virtuales para mantener y mejorar el contacto con la comunidad. Conclusión. La pandemia por COVID-19 causó gran impacto en los programas de prevención y control de las enfermedades transmitidas por vectores. Medellín adaptó rápidamente las actividades de vigilancia entomo-virológica, las acciones de control y la comunicación con la comunidad durante la pandemia, y esto permitió mantener activo el programa del manejo integrado de vectores en la ciudad.

Introduction: The COVID-19 pandemic pressured health care systems to remain alert and active in their vector-borne disease control and prevention programs, leading to changes in vector control strategies in urban areas affected by dengue, Zika and chikungunya. Objective: To describe the adaptations made to the vector control and surveillance program in Medellín during the COVID-19 health emergency. Materials and methods: Once the health emergency started, biosecurity protocols were developed. Entomological surveillance was strengthened from the institutional environment instead of homes. Data was collected in Medellín from 2018 to 2021 during the vector control and surveillance program activities, which included epidemiological and entomo- virological surveillance, entomological index survey, ovitrap monitoring, community mobilization, search and elimination of mosquito breading sites, and chemical control. These actions were adapted and/or increased to promote self-care among communities in total and partial confinement, and to develop prevention and control measures. Results: Mosquito monitoring was increased by 40% using ovitraps, entomological- virological surveillance showed an increase in 2020 of 34,4% compared to 2019 and virtual media was used to keep and improve contact with the community. Conclusion: The COVID-19 pandemic had a significant impact on arbovirus prevention and control programs. The city of Medellín quickly adapted its entomo-virological surveillance activities, control measures, and the contact with the community during the pandemic, which allow the Integrated Vector Management program to remain active in the city.

Genetic characterization of the rare Bruconha virus (Bunyavirales: Orthobunyavirus) isolated in Vale do Ribeira (Atlantic Forest biome), Southeastern Brazil

ABSTRACT Brazil is a great source of arbovirus diversity, mainly in the Amazon region. However, other biomes, especially the Atlantic Forest, may also be a hotspot for emerging viruses, including Bunyaviruses (Negarnaviricota: Bunyavirales). For instance, Vale do Ribeira, located in the Southeastern region, has been widely studied for virus surveillance, where Flavivirus, Alphavirus and Bunyaviruses were isolated during the last decades, including Bruconha virus (BRCV), a member of Orthobunyavirus genus Group C, in 1976. Recently, a new isolate of BRCV named Span321532 was obtained from an adult sentinel mouse placed in Iguape city in 2011, and a full-length genome was generated with nucleotide differences ranging between 1.5%, 5.3% and 5% (L, M and S segments, respectively) from the prototype isolated 35 years earlier. In addition, each segment placed BRCV into different clusters, showing the high variety within Bunyavirales. Although no evidence for reassortants was detected, this finding reiterates the need for new surveillance and genomic studies in the area considering the high mutation rates of arbovirus, and also to identify the hosts capable of supporting the continuous circulation of Orthobunyavirus.

Spatial analysis of Chikungunya fever incidence and the associated socioeconomic, demographic, and vector infestation factors in municipalities of Pernambuco, Brazil, 2015-2021 / Análise espacial da incidência da febre de Chikungunya e dos fatores socioeconômicos, demográficos e de infestação vetorial associados, em municípios de Pernambuco, Brasil, 2015-2021

ABSTRACT Objective: To identify the spatial patterns of chikungunya fever (CHIKF) and the associated socioeconomic, demographic, and vector infestation factors in the 1st Health Region of Pernambuco (1st HRP). Methods: This ecological study used a spatial analysis of Mean Incidence Rates (MIR) of probable cases of CHIKF reported among residents of the 19 municipalities of the 1st HRP, in 2015-2021. The univariate and bivariate global Moran indexes (I) were estimated. From the significant associations (p<0.05), clusters were identified using the local Moran index and maps. Results: A predominance of the largest CHIKF rates was identified in the east. However, there was a heterogeneous distribution of rates across municipalities, which may have contributed to the absence of spatial autocorrelation of CHIKF (I=0.03; p=0.294) in univariate I. The bivariate I revealed a positive spatial correlation between CHIKF and the Municipal Human Development Index (MHDI) (I=0.245; p=0.038), but with a cluster of cities with low incidences and low MHDI in the west. There was no spatial correlation between CHIKF and the other variables analyzed: population density, Gini index, social vulnerability index, and building infestation index for Aedes aegypti. Conclusions: The results suggest that only the MHDI influenced the occurrence of CHIKF in the 1st HRP, so that municipalities in the west demonstrated spatial dependence between lower values of MHDI and MIR. However, this spatial correlation may have occurred due to possible underreporting in the area. These findings can assist in the (re)orientation of resources for surveillance and health care services.

RESUMO Objetivo: Identificar, na Iᵃ Região de Saúde de Pernambuco (Iᵃ RSP), os padrões espaciais da febre de Chikungunya (CHIKF) e os fatores socioeconômicos, demográficos e de infestação vetorial associados. Métodos: Este estudo ecológico utilizou a análise espacial das Taxas Médias de Incidência (TMI) de casos prováveis da CHIKF notificados entre os residentes dos 19 municípios da Iᵃ RSP no período de 2015-2021. Os índices de Moran global (I) univariados e bivariados foram estimados. Das associações significativas (p<0,05), clusters foram localizados por meio do Índice de Moran Local e de mapas. Resultados: Identificou-se predominância das maiores TMI da CHIKF no leste. Entretanto, houve distribuição heterogênea das taxas dos municípios, o que pode ter contribuído para a ausência de autocorrelação espacial da CHIKF (I=0,03; p=0,294) no I univariado. O I bivariado revelou correlação espacial positiva entre a CHIKF e o Índice de Desenvolvimento Humano Municipal (IDHM) (I=0,245; p=0,038), porém com um cluster de cidades com baixas incidências e baixo IDHM no oeste. Não houve correlação espacial entre a CHIKF e as demais variáveis analisadas: densidade demográfica, Índice de Gini, Índice de Vulnerabilidade Social e Índice de Infestação Predial de Aedes aegypti. Conclusões: Os resultados sugerem que somente o IDHM influenciou na ocorrência da CHIKF na Iᵃ RSP, de forma que municípios do oeste demonstraram dependência espacial entre menores valores de IDHM e TMI. No entanto, essa correlação espacial pode ter ocorrido devido às possíveis subnotificações na área. Tais achados podem auxiliar na (re)orientação de recursos dos serviços de vigilância e assistência à saúde.

Extra-articular Manifestations of Chikungunya

ABSTRACT Chikungunya fever (CHIK) is a neglected tropical disease associated with chronic arthritis. CHIK is usually a self-limiting condition; however, extra-articular manifestations present as atypical illness in a minority of patients. These atypical features may mimic other conditions and potentially distract physicians from the true diagnosis. This review analyzes the evidence of many unusual extra-articular manifestations reported in cases of CHIK. Depending on the affected system, these unusual manifestations include encephalitis, myocarditis, acute interstitial nephritis, cutaneous manifestations, acute anterior uveitis, abdominal pain, and depression. In addition, coinfections and comorbidities may cause atypical illness and obscure the diagnosis. Further studies are required to clarify the pathophysiology and natural history of CHIK, as it remains a burdening condition. Exploring its atypical symptoms may be the missing scientific piece of this puzzle.

Detecção de flavivirus e alphavirus em mosquitos (diptera: culicidae) capturados em região próxima à Três Lagoas ­ Ms / Detection of flavivirus and alphavirus in mosquitoes (diptera: culicidae) captured in a region close to Tres Lagoas ­ Ms / Detección de flavivirus y alphavirus en mosquitos (diptera: culicidae) capturados en una región cercana a Tres Lagoas ­ Ms

Introdução: Arbovírus são causadores de doenças humanas, sendo que mudança ecológicas e aumento do contato humano-vetor aumenta a possibilidade de surtos. Objetivo: Detectar, identificar e caracterizar arbovírus presentes em mosquitos vetores capturados em regiões de mata próximas a Três Lagoas, MS. Metodologia: Mosquitos foram capturados utilizando armadilhas de luz em regiões de mata circunvizinha a Três Lagoas. Os mosquitos capturados foram classificados por gênero (chave morfológica) e agrupados em pools com até 20 espécimes, e utilizados através da reação de RT-PCR com posterior sequenciamento e análise filogenética. Resultados: Foram capturados 851 dos gêneros: Culex spp. (11 pools); Aedes spp. (13 pools); Haemagogus spp. (7 pools) e outros gêneros não identificados. Sequencias de vírus Dengue (DENV) foram amplificadas de 2/13 (15,38%) pools de Aedes spp. e uma sequência de vírus Mayaro (MAYV) 1/7 (7,7%) foi amplificada de pools de Haemagogus spp. As análises filogenéticas mostraram que as sequências de DENV agrupava-se no clado de DENV1 e DENV2. A sequência de MAYV agrupou-se junto a sequências de amostras de infecções humana por MAYV do grupo L. Conclusão: Estes resultados reforçam a circulação de DENV, que é causador de surtos anuais de doenças febris agudas no município, e detecção, por primeira vez na região, a circulação de MAYV, reforçando a necessidade de monitoramento viral constante nessa região.

Introduction: Arboviruses cause human diseases, and ecological changes and increased human-vector contact increase the possibility of outbreaks. Objective: To detect, identify and characterize arboviruses present in mosquito vectors captured in forest regions close to Tres Lagoas, MS. Methodology: Mosquitoes were captured using light traps in forest regions surrounding Tres Lagoas. The captured mosquitoes were classified by gender (morphological key) and grouped into pools with up to 20 specimens and used through the RT-PCR reaction with subsequent sequencing and phylogenetic analysis. Results: 851 of the genera were captured: Culex spp. (11 pools); Aedes spp. (13 pools); Haemagogus spp. (7 pools) and other unidentified genera. Dengue virus (DENV) sequences were amplified from 2/13 (15.38%) pools of Aedes spp. and a Mayaro virus (MAYV) sequence 1/7 (7.7%) were amplified from pools of Haemagogus spp. Phylogenetic analyzes showed that one of the DENV sequences clustered in the DENV1 and DENV2 clade. The MAYV sequence was grouped together with sequences from samples of human MAYV infections of the L group. Conclusion: These results reinforce the circulation of DENV, which causes annual outbreaks of acute febrile illnesses in the municipality, and detection, for the first time in the region, the circulation of MAYV, reinforcing the need for constant viral monitoring in this region.

Introducción: Los arbovirus causan enfermedades humanas, y los cambios ecológicos y el mayor contacto humano-vector aumentan la posibilidad de brotes. Objetivo: Detectar, identificar y caracterizar arbovirus presentes en mosquitos vectores capturados en regiones de selva próximas a Tres Lagoas, MS. Metodología: Los mosquitos fueron capturados utilizando trampas de luz en las regiones forestales que rodean Tres Lagoas. Los mosquitos capturados fueron clasificados por género (clave morfológica) y agrupados en pools de hasta 20 ejemplares, y utilizados mediante la reacción RT-PCR con posterior secuenciación y análisis filogenético. Resultados: Se capturaron 851 de los géneros: Culex spp. (11 pools); Aedes spp. (13 pools); Haemagogus spp. (7 pools) y otros géneros no identificados. Las secuencias del virus del dengue (DENV) se amplificaron a partir de 2/13 (15,38 %) grupos de Aedes spp. y una secuencia de virus Mayaro (MAYV) 1/7 (7,7%) de pools de Haemagogus spp. Los análisis filogenéticos mostraron que una de las secuencias de DENV se agrupaba en el clado DENV1 y DENV2. La secuencia de MAYV se agrupó con secuencias de muestras de infecciones humanas de MAYV del grupo L. Conclusión: Estos resultados refuerzan la circulación de DENV, causante de brotes anuales de enfermedades febriles agudas en el municipio, y la detección, por primera vez en la región, la circulación de MAYV, reforzando la necesidad de un monitoreo viral constante en esta región.

Conocimientos de los residentes de Medicina General Integral sobre prevención y control de las arbovirosis / Comprehensive General Medicine residents: their knowledge about prevention and control of arboviruses

Fundamento: las arbovirosis son enfermedades víricas transmitidas por mosquitos, las que han propagado rápidamente en todas las regiones del mundo en los últimos años, con alta incidencia en la salud de las personas y en la economía de los países. Objetivo: identificar el nivel de conocimientos de los residentes de Medicina General Integral del municipio Abreus, sobre la prevención y control de las arbovirosis. Métodos: se realizó un estudio observacional, descriptivo, de corte transversal, en la Dirección Municipal de Salud Abreus, en octubre de 2021. Se utilizaron métodos teóricos y empíricos para fundamentar la investigación, y estadísticos para el análisis de los datos encontrados. Resultados: la mayoría de los residentes manifestaron que han tenido preparación sobre la prevención y control de las arbovirosis, fundamentalmente, durante la educación en el trabajo, todos han adquirido experiencia previa en la pesquisa activa, y algunos señalaron haber atendido a enfermos; sin embargo, la mayoría presentaron dificultades para identificar las formas clínicas y el cuadro clínico de las arbovirosis. Conclusiones: se identificó el nivel de conocimientos alcanzados por los residentes de Medicina General Integral del municipio Abreus, sobre la prevención y control de las arbovirosis, el diagnóstico realizado mostró la necesidad de asumir nuevas metodologías en la educación en el trabajo a fin de lograr correctos modos de actuación y actualización sobre su prevención y control.

Background: arboviruses are viral diseases transmitted by mosquitoes, which have spread rapidly in all regions of the world in recent years, with a high impact on people's health and the economies of countries. Objective: to identify the level of knowledge of Comprehensive General Medicine residents from the Abreus municipality, about the prevention and control of arboviruses. Methods: an observational, descriptive, cross-sectional study was carried out at the Abreus Municipal Health Directorate, in October 2021. Theoretical and empirical methods were used to support the research, and statistical methods were used to analyze the data found. Results: most residents stated that they have had training on the prevention and control of arboviruses, mainly, during on-the-job education, all have acquired previous experience in active search, and some of them indicated had taken care for sick people; however, most of them had difficulties in identifying the clinical forms and clinical profile of arboviruses. Conclusions: the level of knowledge achieved by Comprehensive General Medicine residents from Abreus municipality was identified, regarding the prevention and control of arboviruses, the diagnosis made by them showed the need to conceive new methodologies in education at work in order to achieve adequate modes of action and updating their knowledge about the prevention and control of it.

Incidência e sazonalidade de casos de Chikungunya no estado do Rio de Janeiro, 2017-2020 / Incidence and seasonality of chikungunya cases in the state of Rio de Janeiro, 2017-2020 / Incidencia y estacionalidad de casos de chikungunya en el estado de Rio de janeiro, 2017-2020

Objetivo: descrever a incidência e a sazonalidade de casos notificados no Sistema de Informação de Agravos de Notificação, no estado do Rio de Janeiro, no período de 2017 a 2020. Método: estudo ecológico descritivo, com análise de dados disponibilizados pelo Departamento de Informática do Sistema Único de Saúde. Resultados: foram notificados 156.579 casos no período; 5.970 em 2017; 45.429 em 2018; 99.436 em 2019; e 5.744 em 2020; quanto à sazonalidade, em 2017 destacaram-se os meses de maio a julho; em 2018 e 2019, os meses de abril a junho; e em 2020, o período de janeiro a março. Conclusão: faz-se necessária a intensificação de ações de vigilância nas regiões de maior incidência, direcionando as políticas de controle

Objective: describe the incidence and seasonality of cases reported in the notifiable diseases information system, in the state of Rio de Janeiro, from 2017 to 2020. Method: descriptive ecological study, with analysis of data provided by the Department of Informatics of the Unified Health System. Results: 156,579 cases were reported in the period; 5,970 in 2017; 45,429 in 2018; 99,436 in 2019; and 5,744 in 2020; as for seasonality, in 2017 the months from may to july stood out; in 2018 and 2019, the months from april to june; and in 2020, the period from january to march. Conclusion: it is necessary to intensify surveillance actions in regions with the highest incidence in order to direct control policies

Objetivos: describir la incidencia y la estacionalidad de los casos notificados en el sistema de información de enfermedades de declaración obligatoria, en el estado de Río de Janeiro, de 2017 a 2020. Método: estudio ecológico descriptivo, con análisis de datos proporcionados por el Departamento de Informática del Sistema Único de Salud. Resultados: 156.579 casos fueron notificados en el período; 5.970 en 2017; 45.429 en 2018; 99.436 en 2019; y 5.744 en 2020; en cuanto a la estacionalidad, en 2017 destacaron los meses de mayo a julio; en 2018 y 2019, los meses de abril a junio; y en 2020, el período de enero a marzo. Conclusión: es necesario intensificar las acciones de vigilancia en las regiones de mayor incidencia para orientar las políticas de control

Application and consideration of metagenomic next-generation sequencing technology in the diagnosis of insect-borne diseases / 中华检验医学杂志

Insect-borne diseases are serious life-threatening infectious diseases. Rapid and accurate etiological diagnosis are the premise of timely and effective clinical treatments, reducing mortality and sequelae. Laboratory diagnoses of insect-borne diseases mainly focus on targeted serological detection and polymerase chain reaction, which is difficult to detect rare insect borne pathogens. At present, the metagenomic next-generation sequencing (mNGS) technology has moved from scientific research into clinical application. The detection of nucleic acid sequences of all organisms in infected samples by mNGS exhibited significant advantages in the diagnosis and traceability of rare pathogens. But at the same time, mNGS is also suffered with challenges such as background microbial interference, false results caused by database restrictions, pathogen resistance and host immune status information that are urgently needed for clinical treatments. This article systematically summarized applications of mNGS in the diagnosis of insect-borne pathogens and the challenges and difficulties it faces. With the continuous optimization of mNGS in the detection, it will bring new development and innovation to the etiology diagnosis of clinical infectious diseases.

Point-of-care testing technology and experimental diagnosis of insect-borne diseases: applications and challenges / 中华检验医学杂志

Insect-borne infections are causing serious public health concerns worldwide. Point-of-care testing technology for insect-borne diseases can rapidly and accurately determine the pathogens, thus it plays an important role in the application of portable disease control measurements. This article provides an overview of the point-of-care testing technology for insect-borne infectious diseases regarding its application, advantages and limitations in experimental diagnoses, and its future trends.