Experience of the Arbovirus Death Investigation Committee in Ceará, Brazil, in 2017: advances and challenges. / Experiência do Comitê de Investigação de Óbitos por Arboviroses no Ceará em 2017: avanços e desafios.

OBJECTIVE: to describe the experience and preliminary results of the Arbovirus Death Investigation Committee in Ceará, Brazil, in 2017. METHODS: the Committee investigates and discusses all suspected cases of arbovirus deaths reported by the epidemiological surveillance service. RESULTS: a total of 443 suspected arbovirus deaths were reported, 220 (49.7%) of which were confirmed; of these, 88.2% were from chikungunya and 11.8% from dengue; the median age of chikungunya deaths was higher when compared to dengue (77 versus 56 years) and the time until death was also longer when compared to dengue (38 versus 12 days); median time for case closure was 54.5 days; in 2017, Ceará confirmed 80.4% of Brazilian chikungunya deaths. CONCLUSION: the investigation of deaths showed that CHIK viruses were responsible for the majority of arboviral deaths in the state of Ceará, in 2017.

Trinta anos de dengue no Ceará: história, contribuições para ciência e desafios no cenário atual com tripla circulação de arbovírus / Thirty years of dengue in Ceará: history, contributions to science and challenges in the current scenario with triple arbovirus circulation

Introdução: Embora os primeiros casos de dengue no estado do Ceará tenham ocorrido em 1986, há registros da presença do mosquito Aedes aegypti desde os anos de 1851/1852. Mesmo após 30 anos, a dengue permanece como um problema grave de saúde pública com epidemias cada vez mais frequentes. Objetivo: Resgatar, reunir e sintetizar a evidência científica produzida nos primeiros 30 anos de dengue no Ceará, contribuindo para melhorar sua compreensão e as intervenções de vigilância e controle. Métodos: Realizou-se uma revisão de literatura com busca de artigos (inglês, português e espanhol) nas bases de dados Pubmed, Scielo, Clinicalkey, Lilacs, Google Acadêmico e banco virtual de teses e dissertações da CAPES, além de livros. O período de 1986 a 2016 foi usado como limite de busca e a mesma foi realizada entre os meses de agosto a novembro de 2016. Utilizaram-se os descritores controlados: dengue, Ceará, Fortaleza e Aedes; com interposição do operador boleano "AND". Resultados: Foram identificadas 574 publicações potencialmente elegíveis, sendo 461 artigos e 113 dissertações ou teses. Foram retirados 272 artigos duplicados ou que não atenderam aos critérios de inclusão. Foram lidos 114 artigos publicados em 60 revistas diferentes, sendo 72,8% artigos completos, 75,2% em inglês, 42,2% experimentais e 81,5% com abordagem quantitativa. Foi publicado apenas um artigo na década de 1980, já na década seguinte foram sete, número que cresceu bastante nos anos 2000, com 38 artigos. No entanto, já há 69 artigos publicados apenas na primeira metade da década de 2010. No período, o Ceará confirmou quase um milhão de casos de dengue, com a circulação dos quatro sorotipos (DENV1 - 1986, DENV2 - 1994, DENV3 - 2002 e DENV4 - 2011) e registrou pelo menos 14 epidemias. A partir de 2015, o Ceará passou a apresentar um cenário diferenciado de tripla epidemia, com a cocirculação autóctone de dois outros arbovírus: Chikungunya e Zika. Conclusão: Nesse período de 30 anos (1986-2016), o Ceará vivenciou várias epidemias de dengue, e, de certa forma, isto vem impulsionando a busca por respostas para o controle desta doença. Há claramente um crescimento em número de artigos publicados a cada ano, revelando a pujança dos grupos locais, que contribuiu de forma importante para a produção científica em diversos fatores relacionados à compreensão da epidemiologia e controle da dengue. (AU)

Introduction: Although the first cases of dengue in the state of Ceará occurred in 1986, there are records of the presence of the Aedes aegypti mosquito since the years 1851/1852. Even after 30 years, dengue remains a serious public health problem with frequent epidemics. Objective: To rescue, gather and synthesize scientific evidence in the first 30 years of dengue in Ceará, contributing to improve its understanding, surveillance and control interventions. Methods: An integrative review was carried out with the search of articles (English, Portuguese and Spanish) in the databases Pubmed, Scielo, Clinicalkey, Lilacs, Google Scholar and virtual bank of thesis and dissertations of CAPES, as well as books. The period from 1986 to 2016 was used as a search limit and it was carried out between August and November 2016. The following descriptors were used: dengue, Ceará, Fortaleza and Aedes; with interposition of the Boolean operator "AND". Results: 574 potentially eligible publications were identified, 461 articles and 113 dissertations or thesis. 272 duplicate articles were removed or did not meet the inclusion criteria. We have read 114 articles published in 60 different journals, 72.8% were full articles, 75.2% were in English, 42.2% were experimental and 81.5% were quantitative. Only one article was published in the 1980s, and in the next decade there were seven, this number grew up considerably in the 2000s with 38 articles. However, there are already 69 articles published only in the first half of the decade of 2010. In this period, Ceará confirmed almost 1 million cases of dengue with the circulation of the four serotypes (DENV1 - 1986, DENV2 - 1994, DENV3 - 2002 and DENV4 - 2011) and recorded at least 14 epidemics. From 2015 on, Ceará started to present a differentiated scenario of a triple epidemic, with the autochthonous co-circulation of two other arboviruses: chikungunya and Zika. Conclusion: In this period of 30 years (1986-2016), Ceará experienced. (AU)

Evaluation of the World Health Organization 2009 classification of dengue severity in autopsied individuals, during the epidemics of 2011 and 2012 in Brazil.

INTRODUCTION: The dengue classification proposed by the World Health Organization (WHO) in 2009 is considered more sensitive than the classification proposed by the WHO in 1997. However, no study has assessed the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue. In the present study, we evaluated the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue in Northeast Brazil, where the disease is endemic. METHODS: This retrospective study included 121 autopsied individuals suspected of having dengue in Northeast Brazil during the epidemics of 2011 and 2012. All the autopsied individuals included in this study were confirmed to have dengue based on the findings of laboratory examinations. RESULTS: The median age of the autopsied individuals was 34 years (range, 1 month to 93 years), and 54.5% of the individuals were males. According to the WHO 1997 classification, 9.1% (11/121) of the cases were classified as dengue hemorrhagic fever (DHF) and 3.3% (4/121) as dengue shock syndrome. The remaining 87.6% (106/121) of the cases were classified as dengue with complications. According to the 2009 classification, 100% (121/121) of the cases were classified as severe dengue. The absence of plasma leakage (58.5%) and platelet counts <100,000/mm3 (47.2%) were the most frequent reasons for the inability to classify cases as DHF. CONCLUSIONS: The WHO 2009 classification is more sensitive than the WHO 1997 classification for identifying dengue deaths among autopsied individuals suspected of having dengue.

Evaluation of the World Health Organization 2009 classification of dengue severity in autopsied individuals, during the epidemics of 2011 and 2012 in Brazil

Abstract: INTRODUCTION: The dengue classification proposed by the World Health Organization (WHO) in 2009 is considered more sensitive than the classification proposed by the WHO in 1997. However, no study has assessed the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue. In the present study, we evaluated the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue in Northeast Brazil, where the disease is endemic. METHODS: This retrospective study included 121 autopsied individuals suspected of having dengue in Northeast Brazil during the epidemics of 2011 and 2012. All the autopsied individuals included in this study were confirmed to have dengue based on the findings of laboratory examinations. RESULTS: The median age of the autopsied individuals was 34 years (range, 1 month to 93 years), and 54.5% of the individuals were males. According to the WHO 1997 classification, 9.1% (11/121) of the cases were classified as dengue hemorrhagic fever (DHF) and 3.3% (4/121) as dengue shock syndrome. The remaining 87.6% (106/121) of the cases were classified as dengue with complications. According to the 2009 classification, 100% (121/121) of the cases were classified as severe dengue. The absence of plasma leakage (58.5%) and platelet counts <100,000/mm3 (47.2%) were the most frequent reasons for the inability to classify cases as DHF. CONCLUSIONS: The WHO 2009 classification is more sensitive than the WHO 1997 classification for identifying dengue deaths among autopsied individuals suspected of having dengue.

Death by dengue fever in a Brazilian child: a case report.

BACKGROUND: Dengue is an important worldwide public health problem, and continues to spread in Brazil. This article presents the first Brazilian case report of the death of an indigenous child by dengue fever. CASE PRESENTATION: In August 2013, a child aged 2 years and from the Tremembé ethnic group, who was previously healthy with no complaints, suddenly presented intense crying, precordial pain, and general malaise. A few minutes after these non-specific symptoms, the patient started tonic-clonic convulsions and had cyanosis, a substantial increase in body temperature to the touch, cold sudoresis, sphincter relaxation, and unconsciousness. This situation remained for 15 minutes, progressing to respiratory insufficiency, with consequent absence of peripheral pulses. Death was confirmed approximately 40 minutes after the first symptoms. An autopsy was performed using the usual techniques. Immunohistochemistry was positive for dengue, and microscopic examination indicated micro perivascular edema and cerebral hemorrhage. CONCLUSION: Considering that the death occurred during the major endemic seasonal period for dengue fever, primary clinical evidence suggestive of viral infection presenting with sudden and quick death, and positive immunohistochemistry results, the case was closed as severe dengue fever. Clinicians must consider dengue as a diagnostic hypothesis among the indigenous population in Brazil.

Evaluation of the WHO classification of dengue disease severity during an epidemic in 2011 in the state of Ceará, Brazil.

In 2009, the World Health Organization (WHO) issued a new guideline that stratifies dengue-affected patients into severe (SD) and non-severe dengue (NSD) (with or without warning signs). To evaluate the new recommendations, we completed a retrospective cross-sectional study of the dengue haemorrhagic fever (DHF) cases reported during an outbreak in 2011 in northeastern Brazil. We investigated 84 suspected DHF patients, including 45 (53.6%) males and 39 (46.4%) females. The ages of the patients ranged from five-83 years and the median age was 29. According to the DHF/dengue shock syndrome classification, 53 (63.1%) patients were classified as having dengue fever and 31 (36.9%) as having DHF. According to the 2009 WHO classification, 32 (38.1%) patients were grouped as having NSD [4 (4.8%) without warning signs and 28 (33.3%) with warning signs] and 52 (61.9%) as having SD. A better performance of the revised classification in the detection of severe clinical manifestations allows for an improved detection of patients with SD and may reduce deaths. The revised classification will not only facilitate effective screening and patient management, but will also enable the collection of standardised surveillance data for future epidemiological and clinical studies.

Evaluation of the WHO classification of dengue disease severity during an epidemic in 2011 in the state of Ceara, Brazil

In 2009, the World Health Organization (WHO) issued a new guideline that stratifies dengue-affected patients into severe (SD) and non-severe dengue (NSD) (with or without warning signs). To evaluate the new recommendations, we completed a retrospective cross-sectional study of the dengue haemorrhagic fever (DHF) cases reported during an outbreak in 2011 in northeastern Brazil. We investigated 84 suspected DHF patients, including 45 (53.6%) males and 39 (46.4%) females. The ages of the patients ranged from five-83 years and the median age was 29. According to the DHF/dengue shock syndrome classification, 53 (63.1%) patients were classified as having dengue fever and 31 (36.9%) as having DHF. According to the 2009 WHO classification, 32 (38.1%) patients were grouped as having NSD [4 (4.8%) without warning signs and 28 (33.3%) with warning signs] and 52 (61.9%) as having SD. A better performance of the revised classification in the detection of severe clinical manifestations allows for an improved detection of patients with SD and may reduce deaths. The revised classification will not only facilitate effective screening and patient management, but will also enable the collection of standardised surveillance data for future epidemiological and clinical studies.