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.

Risque de transmission de certains arbovirus à travers le don de sang à Bamako / Risk of transmission of certain arbovirus through blood donation in the city of Bamako

Introduction. Au Mali, le dépistage de certains virus tels que la dengue, Zika et la fièvre de la vallée du Rift n'est pas systématique au centre national de transfusion sanguine (CNTS). Le risque peut être considérable en raison de leurs courtes périodes de virémie asymptomatique dans la population dont l'incidence est variable et parfois extrêmement élevée. Cette étude avait pour objectif d'explorer la possibilité de transmission de certains arbovirus à travers le don de sang au CNTS de Bamako. Méthodes. Il s'agissait d'une étude transversale, de juillet 2019 à juin 2020 à Bamako. Au total deux cents (200) donneurs de sang du CNTS ont été inclus. Les examens ont été réalisés au Centre d'Infectiologie Charles Mérieux (CICM) de Bamako avec le dépistage du génome des virus responsables de la Dengue, de la fièvre de la Vallée du Rift, et du Zika à l'aide de la technique de la RT-PCR en temps réel. Le Test de Dépistage Rapide (TDR) a été utilisé pour la détection des anticorps IgG et IgM spécifiques de la Dengue. Résultats. Le sexe masculin représente 84% (168/200). Le TDR a détecté 4,5% (9/200) de Dengue IgG positifs et aucun cas de Dengue IgM positif. La technique de RT-PCR n'a détecté aucun des trois virus. Conclusion. Cette étude prouve que le risque de transmission de certains arbovirus à travers le don de sang existe, mais il semble être minime au CNTS de Bamako

Background. In Mali, screening for certain viruses such as dengue, Zika, and Rift Valley fever is not systematic at the national blood transfusion center (CNTS). The risk can be considerable due to their short periods of asymptomatic viremia in the population with variable and sometimes extremely high incidence. The objective of this study was to explore the possibility of transmission of certain arboviruses through blood donation at the CNTS of Bamako. Methods. This was a cross-sectional study, from July 2019 to June 2020 in Bamako. A total of two hundred (200) blood donors from the CNTS were included. The examinations were performed at the Centre d'Infectiologie Charles Mérieux (CICM) in Bamako with the screening of the genome of viruses responsible for Dengue, Rift Valley fever, and Zika using the real-time RT-PCR technique. The Rapid Screening Test (RST) was used for the detection of Dengue-specific IgG and IgM antibodies. Results. Male sex represented 84% (168/200). The RDT detected 4.5% (9/200) of IgG positive Dengue and no IgM positive Dengue cases. The RT-PCR technique did not detect any of the three viruses. Conclusion. This study proves that the risk of transmission of certain arboviruses through blood donation exists, but it seems to be minimal at the CNTS of Bamako.

Fatores associados ao conhecimento da dengue no município de Parauapebas, Pará / Factors associated with knowledge of dengue in the municipality of Parauapebas, Pará

A dengue é uma das arboviroses de maior incidência no Brasil e no mundo. Compreender como ela se associa a diversos fatores é de suma importância para tentar diminuir sua incidência. Dessa forma, este estudo foi realizado no ano de 2018 em bairros, tanto da zona urbana quanto da zona rural, do município de Parauapebas, no estado do Pará, com o objetivo de gerar um modelo probabilístico para descrever a probabilidade de uma pessoa do município de Parauapebas conhecer como os patógenos da doença podem ser transmitidos e sobre os sintomas da doença. Foram utilizadas técnicas estatísticas de análise exploratória de dados para descrever as variáveis utilizadas no modelo e a regressão logística múltipla, onde, de acordo com os dados obtidos, na cidade de Parauapebas, que as mulheres têm mais de duas vezes mais chance de saber os principais sintomas da doença do que uma pessoa do sexo masculino. Constatou-se ainda que uma grande parcela da população de Parauapebas não sabe como é a forma de transmissão da dengue.

Dengue is one of the arboviruses with the highest incidence in Brazil and worldwide. Understanding how it is associated with several factors is of paramount importance in trying to reduce its incidence. Thus, this study was carried out in 2018 in neighborhoods, both in the urban and rural areas of the municipality of Parauapebas in the state of Pará, with the aim of generating a probabilistic model to identify an identification of a person in the municipality from Parauapebas knows how the pathogens of the disease can be transmitted the form of dengue transmission and about the symptoms of the disease. Statistical statistics of exploratory data analysis were used to describe the variables used in the model and multiple logistic regression, where according to the data obtained, in the city of Parauapebas, women are more than twice as likely to know the major symptoms of the disease than a male person. It was also found that a person who a large portion of the population of Parauapebas does not know how the form of transmission of dengue is.

Controladores biológicos para la reducción de índices aédicos / Biological controllers for the reduction of aedic indices

Ante la ausencia de vacunas eficaces para las arbovirosis transmitidas por el vector A. aegypti y la resistencia a insecticidas se hace necesario buscar alternativas, donde resalta el control biológico con el uso del larvicida microbiológico Bacillus thuringiensis var. israelensis (Bti). Como objetivo, se propuso determinar los índices aédicos y el uso de Bacillus thuringiensis israelensis como controlador biológico de Aedes aegypti en la localidad de Huánuco, Perú durante el segundo semestre de 2019. La investigación fue experimental de corte transversal con una muestra de 263 viviendas distribuidas en cinco bloques. Como instrumento se usó la observación y reporte de fichas a través de la inspección de cada vivienda en dos momentos, inicial y final, separadas por un lapso de 90 días. Para el análisis de los datos se usó estadística descripctiva a través de Epidat 3.0, obteniendo IA, IR e IB. Como resultado, de las 236 casas inspeccionadas, 51% (120/236) fueron no intervenidas y 49% (116/236) fueron intervenidas con Bacillus thuringiensis, de las casas no intervenidas (120/236) en la fase inicial 59% fueron positivas (con la presencia de algún estadío de A. aegypti) y en la fase final fue de 63%, por otra parte, en las casas intervenidas con Bacillus thuringiensis (CCB) (116/236) en la fase inicial 61% (71/116) estaban positivas y la fase final hubo un descenso a 32% (37/116). En conclusión, se sugiere que la aplicación de Bti constituye un componente adecuado para el manejo de poblaciones larvales de A. aegypti, en la ciudad de Perú(AU)

In the absence of effective vaccines for arboviruses transmitted by the vector A. aegypti and resistance to insecticides, it is necessary to look for alternatives, where biological control stands out with the use of the microbiological larvicide Bacillus thuringiensis var. israelensis (Bti). As an objective, it was proposed to determine the aedic indices and the use of Bacillus thuringiensis israelensis as a biological controller of Aedes aegypti in the town of Huánuco, Peru during the second half of 2019. The research was experimental cross-sectional with a sample of 263 homes distributed in five blocks. As an instrument, the observation and reporting of records was used through the inspection of each dwelling in two moments, initial and final, separated by a period of 90 days. For data analysis, descriptive statistics were used through Epidat 3.0, obtaining IA, IR and IB. As a result, of the 236 houses inspected, 51% (120/236) were not intervened and 49% (116/236) were intervened with Bacillus thuringiensis, of the houses not intervened (120/236) in the initial phase, 59% were positive (with the presence of some stage of A. aegypti) and in the final phase it was 63%, on the other hand, in the houses intervened with Bacillus thuringiensis (CCB) (116/236) in the initial phase 61% (71 /116) were positive and the final phase there was a decrease to 32% (37/116). In conclusion, it is suggested that the application of Bti constitutes an adequate component for the management of larval populations of A. aegypti, in the city of Peru(AU)

ArboAlvo: stratification method for territorial receptivity to urban arboviruses / ArboAlvo: método de estratificação da receptividade territorial às arboviroses urbanas

ABSTRACT OBJECTIVE To present the urban arboviruses (dengue, zika and chikungunya) stratification methodology by the territorial receptivity Index, an instrument for the surveillance and control of these diseases, which considers the heterogeneity of an intra-municipal territory. METHODS Ecological study that uses as unit of analysis the areas covered by health centers in Belo Horizonte. For the development of a territorial receptivity index, indicators of socio-environmental determination of urban arboviruses were selected in order to integrate the analysis of main components. The resulting components were weighted by the analytic hierarchy process and combined via map algebra. RESULTS The territorial receptivity index showed great heterogeneity of urban infrastructure conditions. The areas classified with high and very high receptivity correspond to approximately 33% of the occupied area and are mainly concentrated in the administrative planning regions of East, Northeast, North, West, and Barreiro, especially in areas surrounding the municipality. When the density of dengue cases and Aedes eggs, from 2016, were superimposed with the stratification by the index of territorial receptivity to urban arboviruses, areas of very high receptivity had a high density of cases and Aedes eggs - higher than that observed in other areas of the city, which corresponds to a very small percentage of the municipal territory (13.5%). CONCLUSION The analyses indicate the need for the development of adequate surveillance and control actions for each context, overcoming the logic of homogeneous allocation throughout the territory.

RESUMO OBJETIVO Apresentar a metodologia de estratificação das arboviroses urbanas (dengue, zika e chikungunya) pelo índice de receptividade territorial, instrumento de vigilância e controle dessas doenças que considera a heterogeneidade territorial intramunicipal. MÉTODOS Estudo ecológico que utiliza como unidade de análise as áreas de abrangência dos centros de saúde de Belo Horizonte (MG). Para a construção do índice de receptividade territorial foram selecionados indicadores de determinação socioambiental das arboviroses urbanas a fim de integrar à análise de componentes principais. As componentes resultantes foram ponderadas por análise de processos hierárquicos e agregadas por meio de álgebra de mapas. RESULTADOS O índice de receptividade territorial evidenciou grande heterogeneidade das condições de infraestrutura urbana. As áreas classificadas como alta e muito alta receptividade correspondem a aproximadamente 33% da área ocupada e se concentram sobretudo nas regiões de planejamento administrativo Leste, Nordeste, Norte, Oeste e Barreiro, principalmente em áreas limítrofes do município. Quando sobrepostas à densidade de casos de dengue e de ovos de Aedes em 2016, a estratificação pelo índice de receptividade territorial às arboviroses urbanas demonstra que áreas de muito alta receptividade apresentam uma densidade de casos, bem como de ovos de Aedes superior àquela observada nas demais áreas da cidade, o que corresponde a um percentual bastante reduzido do território municipal (13,5%). CONCLUSÕES As análises indicam a necessidade do desenvolvimento de ações de vigilância e controle adequadas para cada contexto, superando, assim, a lógica de alocação homogênea em todo o território.

Intervenciones genéticas de Aedes aegypti para el control de arbovirosis / Genetic interventions of Aedes aegypti for the control of arboviruses

La ineficacia de las estrategias actuales para el control químico de los mosquitos vectores plantea la necesidad de desarrollar enfoques novedosos, entre estos están las estrategias genéticas para reducir las poblaciones de mosquitos vectores o sustituirlos por aquellos que no son capaces de transmitir patógenos, esto se logra a través de herramientas moleculares que permiten la manipulación y transgénesis de genes. Las secuencias del genoma de los mosquitos y las bases de datos de marcadores de secuencias expresadas asociadas permiten investigaciones a gran escala para proporcionar nuevos conocimientos sobre las vías evolutivas, bioquímicas, genéticas, metabólicas y fisiológicas. Además, la genómica comparativa revela las bases de los mecanismos evolutivos con especial atención a las interacciones específicas entre vectores y patógenos. Se ha desarrollado tecnología de transgénesis para el mosquito de la fiebre amarilla y dengue, Aedes aegypti. Se ha logrado integración exitosa de ADN exógeno en la línea germinal de este mosquito con los elementos transponibles. La disponibilidad de múltiples elementos y genes marcadores proporciona un poderoso conjunto de herramientas para investigar las propiedades biológicas básicas de este insecto vector, así como los materiales para desarrollar nuevas estrategias de control genético de poblaciones de mosquitos basadas en la técnica del insecto estéril. Una de estas estrategias consiste en liberar a la población machos esterilizados por radiación; otro, de integrar un gen letal dominante bajo el control de un promotor específico en hembras inmaduras. El uso de esta técnica de modificación genética constituirá una herramienta importante para el manejo integrado de vectores(AU)

The ineffectiveness of current strategies for the chemical control of vector mosquitoes raises the need to develop novel approaches, among these are genetic strategies to reduce populations of vector mosquitoes or replace them with those that are not capable of transmitting pathogens, this is achieved through molecular tools that allow the manipulation and transgenesis of genes. Mosquito genome sequences and associated expressed sequence marker databases enable large-scale investigations to provide new insights into evolutionary, biochemical, genetic, metabolic, and physiological pathways. Furthermore, comparative genomics reveals the basis of evolutionary mechanisms with special attention to the specific interactions between vectors and pathogens. Transgenesis technology has been developed for the yellow fever and dengue mosquito, Aedes aegypti. Successful integration of exogenous DNA into the germ line of this mosquito with the transposable elements has been achieved. The availability of multiple elements and marker genes provides a powerful set of tools to investigate the basic biological properties of this insect vector, as well as the materials to develop new strategies for genetic control of mosquito populations based on the sterile insect technique. One of this strategy is to release radiation-sterilized males into the population; another, to integrate a dominant lethal gene under the control of a specific promoter in immature females. The use of this genetic modification technique will constitute an important tool for the integrated management of vectors(AU)

Conhecimento dos enfermeiros da atenção primária à saúde sobre arboviroses / Knowledge of primary health care nurses about arboviroses / Conocimientos de las enfermeras de atención primaria de salud sobre los arbovirus

Dengue, zika e chikungunya têm gerado preocupação para os gestores, profissionais de saúde e população devido à elevada morbidade, além de apresentar maior incidência nos países em desenvolvimento. Pretende-se analisar neste artigo o conhecimento autorreferido pelos enfermeiros e a atuação nas ações de controle das arboviroses na Atenção Primária à Saúde. Logo, este artigo consiste em uma pesquisa transversal, descritiva e de abordagem quantitativa, realizada com 23 enfermeiros de 23 unidades de saúde de São Carlos. Os dados foram coletados por meio de um questionário autorrespondido, utilizando um instrumento construído com base em documentos do Ministério da Saúde sobre dengue, zika e chikungunya analisados por meio da estatística descritiva. Foi destacado que 100% (23) dos enfermeiros relataram conhecimento sobre os sinais e sintomas da dengue; 52,2% (12) referiram que o paciente com chikungunya apresenta riscos de hemorragia na fase aguda; 17,4% relataram que a zika não oferece risco de alterações hemodinâmicas. Sendo assim, percebe-se que os enfermeiros possuem um conhecimento clínico adequado sobre dengue; porém, básico e superficial em relação à zika e à chikungunya, especialmente quando as doenças são pareadas.

Given their high morbidity and high incidence in developing countries, dengue, zika and chikungunya are cause concern for managers, health professionals, and the population. This study analyzes the self-reported knowledge by nurses and the actions undertaken to control arboviruses in Primary Health Care. A Cross-sectional, descriptive, and quantitative research was conducted with 23 nurses from 23 health units in São Carlos. Data were collected by means of a self-applied questionnaire, built based on Ministry of Health protocols on dengue, zika and chikungunya, analyzed using descriptive statistics. All nurses reported having knowledge about the signs and symptoms of dengue, 52.2% (12) reported that patients with chikungunya are at risk of hemorrhage in the acute phase, whereas 17.4% answered that Zika is not at risk of hemodynamic changes. The results revealed an adequate clinical knowledge on dengue, but rather basic and superficial regarding zika and chikungunya, especially when diseases are paired.

El dengue, el zika y el chikungunya han generado preocupación en los gestores, los profesionales de la salud y la población por su alta morbilidad, además de tener una mayor incidencia en los países en desarrollo. Se pretende analizar los conocimientos autoinformados por enfermeros y el desempeño de acciones de control de arbovirus en la Atención Primaria de Salud. Se trata de un estudio de enfoque transversal, descriptivo y cuantitativo, realizado con 23 enfermeros de 23 unidades de salud de São Carlos (Brasil). Los datos fueron recolectados de un cuestionario autocontestado, utilizando un instrumento construido con base en los Protocolos del Ministerio de Salud sobre dengue, zika y chikungunya, y analizados mediante estadística descriptiva. Se destaca que el 100% (23) de las enfermeras refirió tener conocimiento sobre los signos y síntomas del dengue; el 52,2% (12) dijo que el paciente con chikungunya tiene riesgo de hemorragia en la fase aguda; y el 17,4% informó que el zika no tiene riesgo de sufrir cambios hemodinámicos. Las enfermeras tienen un conocimiento clínico adecuado sobre el dengue; sin embargo, básico y superficial en relación con el zika y el chikungunya, especialmente cuando las enfermedades están emparejadas.

Seroprevalence of arboviruses in Ecuador: Implications for improved surveillance / Seroprevalencia de arbovirus en Ecuador: implicaciones para mejorar su vigilancia

Abstract | Introduction: Arthropod-borne viruses (arboviruses) cause morbidity and mortality in humans and domestic animals worldwide. The percentage of population immunity or susceptibility to these viruses in Ecuador is unknown. Objectives: To investigate the proportion of Ecuadorian populations with IgG antibodies (Abs) (past exposure/immunity) and IgM Abs (current exposure) against flaviviruses and alphaviruses and to study the activity of these viruses in Ecuador. Materials and methods: During 2009-2011, we conducted a serosurvey for selected arboviruses in humans (n=1,842), equines (n=149), and sentinel hamsters (n=84) at two coastal locations and one in the Amazon basin (Eastern Ecuador) using enzyme-linked immunosorbent assay and hemagglutination inhibition test. Results: From 20.63% to 63.61% of humans showed IgG-antibodies for the flaviviruses: Dengue virus (DENV), yellow fever virus (YFV) Saint Louis encephalitis virus, and West Nile virus (WNV); from 4.67% to 8.63% showed IgG-Abs for the alphaviruses: Venezuelan equine encephalitis virus, eastern equine encephalitis virus, and western equine encephalitis virus. IgM-Abs were found for DENV and WNV. Equines and hamsters showed antibodies to alphaviruses in all locations; two hamsters seroconverted to YFV in the Amazonia. Conclusions: The results show a YFV vaccination history and suggest the activity of arboviruses not included in the current surveillance scheme. Enhanced arbovirus and mosquito surveillance, as well as continued YFV vaccination and evaluation of its coverage/ effectiveness, are recommended.

Resumen | Introducción. Los virus transmitidos por artrópodos (arbovirus) causan morbilidad y mortalidad en humanos y animales domésticos mundialmente. Se desconoce el porcentaje de inmunidad o vulnerabilidad de la población ecuatoriana ante estos virus. Objetivos. Investigar la proporción de poblaciones ecuatorianas con anticuerpos IgG (exposición o inmunidad pasada) y anticuerpos IgM (exposición reciente) contra flavivirus y alfavirus, e investigar su actividad en Ecuador. Materiales y métodos. Entre 2009 y 2011, se llevó a cabo una encuesta serológica para arbovirus en humanos (n=1.842), equinos (n=149) y hámsters centinela (n=84) en dos localidades costeras y en una en la Amazonía, utilizando la prueba ELISA (Enzyme-Linked ImmunoSorbent Assay) y la prueba de inhibición de la hemaglutinación. Resultados. Entre el 20,63 y el 63,61 % de los humanos registraron IgG contra el virus del dengue (DENV), el de la fiebre amarilla (YFV), el de la encefalitis de San Luis y el del Nilo Occidental (WNV); entre 4,67 y 8,63 % tenían IgG para los virus de la encefalitis equina venezolana, de la encefalitis equina del este y de la encefalitis equina del oeste. Se encontró IgM para DENV y WNV. En los equinos y en los hámsters se encontraron anticuerpos contra alfavirus en todas las localidades muestreadas; dos hámsters mostraron seroconversión a YFV en la Amazonía. Conclusiones. Los resultados del estudio evidenciaron los antecedentes de vacunación contra el YFV y sugieren la actividad de arbovirus no incluidos en el esquema de vigilancia actual. Se recomienda ampliar la vigilancia de arbovirus y mosquitos, continuar con la vacunación contra el YFV, y evaluar su cobertura y efectividad.

Reconociendo el virus del chikunguña / Rediscovering the chikungunya virus

Resumen | El virus de chikunguña (CHIKV) es un Alfavirus perteneciente al grupo denominado del Viejo Mundo; estos son virus artritogénicos que causan una enfermedad febril caracterizada por artralgias y mialgias. Aunque la muerte por CHIKV es poco frecuente, la enfermedad puede llegar a ser incapacitante y generar un amplio espectro de manifestaciones atípicas, como complicaciones cardiovasculares, respiratorias, oculares, renales y dérmicas, entre otras. Cuando el dolor articular persiste por tres o más meses, da lugar a la forma crónica de la enfermedad denominada reumatismo inflamatorio crónico poschikunguña, el cual es la principal secuela de la enfermedad. Se considera que este virus no es neurotrópico, sin embargo, puede afectar el sistema nervioso central y generar secuelas graves y permanentes, principalmente, en niños y ancianos. En África, Asia y Europa se habían reportado anteriormente brotes epidémicos por CHIKV, pero solo hasta finales del 2013 se documentó la introducción del virus a las Américas; desde entonces, el virus se ha propagado a 45 países o territorios del continente y el número de casos acumulados ascendió a cerca de dos millones en dos años. Esta revisión describe de manera general la biología molecular del virus, sus manifestaciones clínicas, su patogénesis y las principales complicaciones posteriores a la infección. Además, reúne la información de la epidemia en Colombia y el continente americano publicada entre el 2014 y el 2020.

Abstract | The chikungunya virus (CHIKV) is an Alphavirus that belongs to the Old World group. These arthritogenic viruses cause a febrile illness characterized by arthralgias and myalgias. Although fatal cases during CHIKV infection are rare, the disease may be disabling and generate a broad spectrum of atypical manifestations, such as cardiovascular, respiratory, eye, kidney, and skin complications, among others. When joint pain persists for three or more months, it results in the chronic form of the disease called post-chikungunya chronic inflammatory rheumatism, which constitutes the main disease sequel. CHIKV is not considered a neurotropic virus; however, it can affect the central nervous system, especially in children and the elderly, causing severe and permanent sequelae. CHIKV outbreaks had been previously reported in Africa, Asia, and Europe, but the virus introduction to the American continent was documented until the end of 2013. Since then, the virus has spread to 45 countries and territories causing near two million cases in just two years. This review describes the molecular biology, clinical manifestations, pathogenesis, and significant post-infection complications of CHIKV. Additionally, it collects published information about the outbreak in Colombia and the American continent between 2014 and 2020.

Dengue en los inicios de la pandemia de COVID-19 en la Argentina / Dengue at the beginning of the COVID-19 pandemic in Argentina

A 11 años del primer brote de dengue en Buenos Aires, el 20 de marzo de 2020, mientras se iniciaba la cuarentena obligatoria por COVID-19, dengue pasó a ser la causa más común de consulta por fiebre. La nueva ola de casos de dengue ya se encontraba entre las predicciones de la Organización Panamericana de la Salud en función del aumento en la región de las Américas que se venía presentando desde el año anterior. La llegada del SARS-CoV-2 a principios de marzo, sumada al brote de dengue que ya estaba en curso, resultó en un nuevo desafío para el sistema de salud, mientras comenzaba un paradigma con planes de adaptación a la nueva infección pandémica en el país. La superposición de infecciones con potencial epidémico, como dengue, recuerda la importancia de no desatender otras enfermedades endémicas, emergentes y reemergentes a la sombra del nuevo fenómeno epidemiológico

Eleven years after the first dengue outbreak in Buenos Aires, on March 20, 2020, while the mandatory quarantine for COVID-19 began dengue became the most common cause of fever consultation. The new wave of dengue cases was already among the predictions of the Pan American Health Organization based on the increase in the region of the Americas that had been occurring since the previous year. The arrival of SARS-CoV-2 at the beginning of March, added to the dengue outbreak that was already underway, made a new challenge for the health system while a new paradigm was initiated with adaptation plans to the new pandemic infection in the country. The overlapping of infections with epidemic potential such as dengue recalls the importance of not neglecting other endemic, emerging and re-emerging diseases in the shadow of the new epidemiological phenomenon.

Caracterización de brote de dengue en barrios de parroquia Esmeraldas / Characterization of dengue outbreak in neighborhoods of Esmeraldas Parish

Uno de los principales problemas de los países tropicales son las enfermedades transmitidas por vectores. Entre ellas tenemos el dengue, zika y chikungunya, cuyo vector es un mosquito el Aedes aegyptiy Aedes albopictus. En el Ecuador, el dengue representa un problema prioritario en salud pública, desde el repunte del dengue en 1988 ha presentado varios ciclos epidémicos. Objetivo: Por lo anteriormente expuesto, se establece como objetivo de la investigación, caracterizar el brote de dengue que se presentó en el período Enero ­Febrero del año 2019, en barrios de la parroquia Esmeraldas, para evidenciar cuáles factores siguen recurrentes en la zona. Materiales y métodos: La investigación fue cuantitativa de corte transversal, descriptiva. La muestra fue no probabilística, los pacientes se presentaron de manera espontánea, se tomaron en cuenta variables como la edad, ocupación, síntomas, automedicación, tipo de medicamentos auto indicados, reinfección, viaje a zonas endémicas y condición de la vivienda. Las muestras fueron analizadas mediante prueba rápida Wondfo Whole Blood/Serum/Plasma test para NSI, IgG y IgM; en las instalaciones de la Escuela de Laboratorio Clínico de la Pontificia Universidad Católica de Ecuador (PUCESE). Los datos fueron procesados en Excel y analizados mediante el programa estadístico SPSS. Resultados: Los resultados que se obtuvieron permitieron caracterizar este brote relacionando las distintas variables, encontrando que en la mayoría de los casos es DSSA, dengue sin síntomas alarma y que no distingue edad, sexo, ni ocupación en el contagio. También, se encontró que las personas se automedican, en su mayoría, tratándose con paracetamol cuando los síntomas leves permanecen más de 5 días y no acuden al médico. Conclusión: Estos resultados nos permitieron concluir que este brote no presentó ninguna característica relevante que lo diferencie de los anteriores y que los factores y causas se mantienen, las personas desconocen las causas y prevención del contagio con el virus(AU)

One of the main problem in tropical countries is vector-borne diseases. Among them, we have Dengue, Zika and Chikungunya, whose vector is a mosquito Aedes aegypti and Aedes albopictus. In Ecuador, dengue represents a priority problem in public health, since the dengue rebound in 1988 has presented several epidemic cycles. Objective: For the above reasons, the objective of the research is to characterize the outbreak of dengue that occurred in the period January-February 2019, in neighborhoods of the parish of Esmeraldas, to show which factors are still recurrent in the area. Materials and methods: The research was quantitative, cross-sectional and descriptive. The sample was non-probabilistic, patients presented spontaneously, variables such as age, occupation, symptoms, self-medication, the type of self-prescribed medication, reinfection, travel to endemic areas and housing conditions were taken into account. Samples were analyzed by Wondfo Whole Blood/Serum/Plasma rapid test for NSI, IgG and IgM; at the facilities of the Clinical Laboratory School of the Pontificia Universidad Católica de Ecuador (PUCESE). Data were processed in Excel and analyzed using SPSS statistical software. The results: The results obtained allowed us to characterize this outbreak by relating the different variables, finding that in most cases it is DSSA, dengue without alarm symptoms and that it does not distinguish between age, sex or occupation in the contagion. It was also found that most people self-medicate, treating themselves with paracetamol when mild symptoms last more than 5 days and do not go to the doctor. Conclusion: These results allowed us to conclude that this outbreak did not present any relevant characteristic that differentiates it from previous outbreaks and that the factors and causes remain the same, people are unaware of the causes and prevention of infection with the virus(AU)

Arbovirus en Uruguay, un problema potencial. Revisión desde una óptica perinatal / Arbovirus in Uruguay, a potential problem. Review from a perinatal perspective / Arbovírus no Uruguai, um problema potencial. Revisão a partir de uma perspectiva perinatal

Resumen: Los arbovirus son microorganismos transmitidos al ser humano por artrópodos. Existen más de 100 tipos de arbovirus, con una presentación clínica común para todos ellos de fiebre, síntomas articulares, hemorrágicos y neurológicos1. Además, representan un riesgo particular para la mujer embarazada y el feto por el potencial teratogénico que algunos de ellos presentan, particularmente a nivel del sistema nervioso central. Utilizando los motores de búsqueda de Pubmed y de Google Scholar, realizamos una búsqueda bibliográfica enfocada a los arbovirus en general y luego enfocada en cada una de las patologías específicas abordadas, que fueron definidas en función del riesgo de ingreso a nuestro país y sus potenciales consecuencias. El objetivo de esta revisión es analizar las principales características de presentación de los arbovirus, en particular dengue, zika, chikungunya y fiebre amarilla ante la eventualidad de la aparición de casos de transmisión vertical, para que nuestros recursos humanos especializados tengan un marco de referencia del manejo actualizado. Esta revisión nos permitió concluir sobre los elementos comunes de estas virosis, así como sus potenciales afectaciones en el feto y en el recién nacido, y nos planteó el desafío vinculado a su dificultad diagnóstica por las reacciones cruzadas.

Summary: Arbovirus are microorganisms transmitted to humans through arthropods. There are more than 100 different arboviruses with a common clinical presentation of fever, articular, hemorrhagic and neurological symptoms1. They represent a mayor risk to pregnant women and fetuses due to their teratogenic effect, particularly affecting the central nervous system. We performed a specific search focused on arbovirus using search engines Pubmed and Google Scholar and we classified evidence according to the risk of a certain virus entering our country and its potential consequences. The objective of this review is to update the main clinical characteristics of arbovirus, particularly Dengue, Zika, Chikungunya and Yellow Fever particularly due to the potential introduction of these viruses in our country and the possibility of vertical transmission, so that our human resources have a guide on how to approach these patients nowadays. This review allowed us to conclude on common characteristics of these viruses, their possible consequences on fetus and newborns, and concluding on the difficulty of etiological diagnosis due to cross reactions.

Resumo: Os arbovírus são microrganismos transmitidos ao homem por artrópodes. Existem mais de 100 tipos de arbovírus, com apresentação clínica comum a todos eles de febre, sintomas articulares, hemorrágicos e neurológicos1. Além disso, representam um risco particular para a gestante e para o feto devido ao potencial teratogênico que alguns deles apresentam, principalmente ao nível do sistema nervoso central. Realizamos uma busca bibliográfica utilizando Pubmed e Google Scholar sobre arbovírus em geral e posteriormente, sobre cada uma das patologias específicas abordadas que foram definidas de acordo com o risco de entrada em nosso país e suas possíveis consequências. O objetivo desta revisão é analisar as principais características de apresentação dos arbovírus, em particular dengue, Zika, Chikungunya e febre amarela, considerando a possibilidade de casos de transmissão vertical, para servir como uma referência atualizada para os profissionais especializados nesta área. Esta revisão permitiu elaborar conclusões sobre os elementos comuns a esses vírus, bem como suas possíveis afetações no feto e no recém-nascido, e apresentou o desafio relacionado à dificuldade diagnóstica devido às reações cruzadas.

Surveillance of hemorrhagic fever and/or neuroinvasive disease: challenges of diagnosis

OBJECTIVE: To evaluate the performance of post mortem laboratory analysis in identifying the causes of hemorrhagic fever and/or neuroinvasive disease in deaths by arbovirus infection. METHODS: Retrospective cross-sectional study based on the differential analysis and final outcome obtained in patients whose samples underwent laboratory testing for arboviruses at the Pathology Center of the Adolfo Lutz Institute, in São Paulo, Brazil. RESULTS: Of the 1355 adults clinically diagnosed with hemorrhagic fever and/or neuroinvasive disease, the most commonly attributed cause of death and the most common final outcome was dengue fever. Almost half of the samples tested negative on all laboratory tests conducted. CONCLUSION: The failure to identify the causative agent in a great number of cases highlights a gap in the diagnosis of deaths of unknown etiology. Additional immunohistochemical and molecular assessments need to be added to the post-mortem protocol if all laboratory evaluations performed fail to identify a causative agent. While part of our findings may be due to technical issues related to sample fixation, better information availability when making the initial diagnosis is crucial. Including molecular approaches might lead to a significant advancement in diagnostic accuracy. DESCRIPTORS: Autopsy. Hemorrhagic Fevers, Viral, etiology. Arbovirus Infections, mortality

Arbovirus, herpesvirus, and enterovirus associated with neurological syndromes in adult patients of a university hospital, 2017-2018

Abstract INTRODUCTION: Herpesviruses, enteroviruses, and arboviruses are important because of their clinical relevance and ability to cause meningitis, encephalitis, meningoencephalitis, and other diseases. The clinical virology associated with diagnostic technologies can reduce the morbidity and mortality of such neurological manifestations. Here we aimed to identify the genomes of agents that cause neurological syndromes in cerebrospinal fluid (CSF) samples from patients with suspected nervous system infections admitted to the University Hospital of the University of Campinas, São Paulo, Brazil, in 2017-2018. METHODS: CSF samples collected from adult patients with neurological syndrome symptoms and negative CSF culture results were analyzed using polymerase chain reaction (PCR), reverse transcriptase-PCR, and real-time PCR, and their results were compared with their clinical symptoms. One CSF sample was obtained from each patient. RESULTS: Viral genomes were detected in 148/420 (35.2%) CSF samples: one of 148 (0.2%) was positive for herpes simplex virus-1; two (0.5%) for herpes simplex virus-2; eight (1.9%) for varicella-zoster virus; four (1%) for Epstein-Barr virus; one (0.2%) for cytomegalovirus; 32 (7.6%) for human herpesvirus-6; 30 (7.1%) for non-polio enterovirus; 67 (16.0%) for dengue virus, three (0.7%) for yellow fever virus, and 21 (5%) for Zika virus. CONCLUSIONS: The viral genomes were found in 35.2% of all analyzed samples, showing the high prevalence of viruses in the nervous system and the importance of using a nucleic acid amplification test to detect viral agents in CSF samples.

Boletín Integrado de Vigilancia N 510 SE 34 / Integrated Surveillance Bulletin N 510 SE 34

Generado por el Ministerio de Salud de la Nación Dirección Nacional de Epidemiología y Análisis de la Información. En primer lugar se muestra una Actualización de Eventos Priorizados donde se muestra semanalmente un panorama más sucinto de algunos eventos seleccionados. En segundo término se presentan Eventos de Notificación Obligatoria seleccionados, donde se ofrecen casos a nivel provincial comparando con el año anterior en forma de actualización semanal. Por último se muestran informes Especiales, donde se ofrece un análisis en profundidad de aquella o aquellas enfermedades escogidas

SARS-CoV-2 and arbovirus infection: a rapid systematic review

ABSTRACT BACKGROUND: The numbers of cases of arboviral diseases have increased in tropical and subtropical regions while the coronavirus disease (COVID-19) pandemic overwhelms healthcare systems worldwide. The clinical manifestations of arboviral diseases, especially dengue fever, can be very similar to COVID-19, and misdiagnoses are still a reality. In the meantime, outcomes for patients and healthcare systems in situations of possible syndemic have not yet been clarified. OBJECTIVE: We set out to conduct a systematic review to understand and summarize the evidence relating to clinical manifestations, disease severity and prognoses among patients coinfected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and arboviruses. METHODS: We conducted a rapid systematic review with meta-analysis, on prospective and retrospective cohorts, case-control studies and case series of patients with confirmed diagnoses of SARS-CoV-2 and arboviral infection. We followed the Cochrane Handbook recommendations. We searched EMBASE, MEDLINE, Cochrane Library, LILACS, Scopus and Web of Science to identify published, ongoing and unpublished studies. We planned to extract data and assess the risk of bias and the certainty of evidence of the studies included, using the Quality in Prognosis Studies tool and the Grading of Recommendations Assessment. RESULTS: We were able to retrieve 2,407 citations using the search strategy, but none of the studies fulfilled the inclusion criteria. CONCLUSION: The clinical presentations, disease severity and prognoses of patients coinfected with SARS-CoV-2 and arboviruses remain unclear. Further prospective studies are necessary in order to provide useful information for clinical decision-making processes. Protocol registration number in the PROSPERO database: CRD42020183460

Diabetes insípida y virus del Zika / Diabetes insipid us and Zika virus

La diabetes insípida es el resultado de una secreción o acción reducidas de la hormona vasopresina, expresada clínicamente por un cuadro de poliuria-polidipsia. Los arbovirus pueden tener afinidad por el sistema nervioso y se ha demostrado que el Zika desencadena un trastorno autoinmune que ataca a las células nerviosas, lo que puede traer como consecuencia una diabetes insípida central. En la literatura médica nacional e internacional revisada no se reportan casos anteriores donde se vincule la diabetes insípida con el virus del Zika. Se presenta un caso a propósito de esta asociación: paciente femenina de 53 años, diagnosticada con infección por el virus del Zika dos semanas antes de comenzar con los síntomas sugestivos de diabetes insípida. El potencial neurotrópico del virus, así como los resultados en la resonancia magnética nuclear y la determinación de marcadores de autoinmunidad anti-ADNdc positivos, son elementos que apoyan la hipótesis de que la paciente presentó una posible hipofisitis autoinmune, como respuesta inflamatoria post-infección, desarrollando diabetes insípida central transitoria(AU)

Diabetes insipidus is the result of reduced secretion or action of the vasopressin hormone, which is clinically expressed by a polyuria-polydipsia picture. Arboviruses can have a nervous system affinity and Zika has been shown to trigger an autoimmune disorder that attacks nerve cells, which can result in central diabetes insipidus. The reviewed national and international medical literatures does not report previous cases linking diabetes insipidus with Zika virus. It is presented a case about this association: 53-year-old female patient diagnosed with Zika virus infection two weeks before starting symptoms suggestive of diabetes insipidus. The neurotropic potential of the virus, as well as the results in nuclear MRI and the determination of positive anti-ADNdc autoimmunity markers are elements that support the hypothesis that the patient had a possible autoimmune hypophysis, as a post-infection inflammatory response, developing transient central diabetes insipidus(AU)