Ticks and serosurvey of anti-Rickettsia spp. antibodies in wild boars (Sus scrofa), hunting dogs and hunters of Brazil.

BACKGROUND: Rickettsia bacteria are responsible for diseases in humans and animals around the world, however few details are available regarding its ecology and circulation among wild animals and human populations at high transmission risk in Brazil. The aim of this study was to investigate the occurrence of ticks and Rickettsia spp. in wild boars, corresponding hunting dogs and hunters. METHODS: Serum samples and ticks were collected from 80 free-range wild boars, 170 hunting dogs and 34 hunters from southern and central-western Brazil, from the Atlantic Forest and Cerrado biomes, respectively, between 2016 and 2018. Serum samples were tested by indirect immunofluorescent-antibody assay (IFA) to detect IgG antibodies against Rickettsia rickettsii, Rickettsia parkeri, Rickettsia bellii, Rickettsia rhipicephali and Rickettsia amblyommatis. Tick species were identified by morphological taxonomic keys, as previously described. A total of 164 ticks including A. sculptum, A. brasiliense and A. aureolatum were tested in PCR assays for Spotted Fever Group (SFG) Rickettsia spp. RESULTS: A total of 58/80 (72.5%) wild boars, 24/170 (14.1%) hunting dogs and 5/34 (14.7%) hunters were positive (titers ≥ 64) to at least one Rickettsia species. A total of 669/1,584 (42.2%) ticks from wild boars were identified as Amblyomma sculptum, 910/1,584 (57.4%) as Amblyomma brasiliense, 4/1,584(0.24%) larvae of Amblyomma spp. and 1/1,584 (0.06%) nymph as Amblyolmma dubitatum. All 9 ticks found on hunting dogs were identified as Amblyomma aureolatum and all 22 ticks on hunters as A. sculptum. No tested tick was positive by standard PCR to SFG Rickettsia spp. CONCLUSIONS: The present study was the concomitant report of wild boar, hunting dog and hunter exposure to SFG rickettsiae agents, performed in two different Brazilian biomes. Wild boar hunting may increase the risk of human exposure and consequently tick-borne disease Wild boars may be carrying and spreading capybara ticks from their original habitats to other ecosystems. Further studies can be required to explore the ability of wild boars to infecting ticks and be part of transmission cycle of Rickettsia spp.

Accuracy of the SD BIOLINE Dengue Duo for rapid point-of-care diagnosis of dengue.

BACKGROUND: Rapid diagnosis tests (RDTs) are easy to carry out, provide fast results, and could potentially guide medical treatment decisions. We investigated the performance of a commercially available RDT, which simultaneously detects the non-structural 1 (NS1) dengue virus (DENV) antigen, and IgM and IgG DENV antibodies, using representative serum samples from individuals in a dengue endemic area in Salvador, Brazil. METHODOLOGY/PRINCIPAL FINDINGS: We evaluated the accuracy of the SD BIOLINE Dengue Duo RDT (Abbott, Santa Clara, USA; former Alere Inc, Waltham, USA) in a random collection of sera. Samples included acute-phase sera from 246 laboratory-confirmed dengue cases and 108 non-dengue febrile patients enrolled in a surveillance study for dengue detection, 73 healthy controls living in the same surveillance community, and 73 blood donors. RDT accuracy was blindly assessed based on the combined results for the NS1 and the IgM test components. The RDT sensitivity was 46.8% (38.6% for the NS1 component and 13.8% for the IgM component). Sensitivity was greater for samples obtained from patients with secondary DENV infections (49.8%) compared to primary infections (31.1%) (P: 0.02) and was also influenced by the result in the confirmatory dengue diagnostic test, ranging from 39.7% for samples of cases confirmed by IgM-ELISA seroconversion between paired samples to 90.4% for samples of cases confirmed by a positive NS1-ELISA. The RDT specificity was 94.4% for non-dengue febrile patients, 87.7% for the community healthy controls, and 95.9% for the blood donors. CONCLUSIONS/SIGNIFICANCE: The SD BIOLINE Dengue Duo RDT showed good specificities, but low sensitivity, suggesting that it may be more useful to rule in than to rule out a dengue diagnosis in dengue endemic regions.

Concomitant Transmission of Dengue, Chikungunya, and Zika Viruses in Brazil: Clinical and Epidemiological Findings From Surveillance for Acute Febrile Illness.

BACKGROUND: Since their emergence in the Americas, chikungunya (CHIKV) and Zika (ZIKV) viruses co-circulate with dengue virus (DENV), hampering clinical diagnosis. We investigated clinical and epidemiological characteristics of arboviral infections during the introduction and spread of CHIKV and ZIKV through northeastern Brazil. METHODS: Surveillance for arboviral diseases among febrile patients was performed at an emergency health unit of Salvador, Brazil, between September 2014 and July 2016. We interviewed patients to collect data on symptoms, reviewed medical records to obtain the presumptive diagnoses, and performed molecular and serological testing to confirm DENV, CHIKV, ZIKV, or nonspecific flavivirus (FLAV) diagnosis. RESULTS: Of 948 participants, 247 (26.1%) had an acute infection, of which 224 (23.6%) were single infections (DENV, 32 [3.4%]; CHIKV, 159 [16.7%]; ZIKV, 13 [1.4%]; and FLAV, 20 [2.1%]) and 23 (2.4%) coinfections (DENV/CHIKV, 13 [1.4%]; CHIKV/FLAV, 9 [0.9%]; and DENV/ZIKV, 1 [0.1%]). An additional 133 (14.0%) patients had serological evidence for a recent arboviral infection. Patients with ZIKV presented with rash and pruritus (69.2% each) more frequently than those with DENV (37.5% and 31.2%, respectively) and CHIKV (22.9% and 14.7%, respectively) (P < .001 for both comparisons). Conversely, arthralgia was more common in CHIKV (94.9%) and FLAV/CHIKV (100.0%) than in DENV (59.4%) and ZIKV (53.8%) (P < .001). A correct presumptive clinical diagnosis was made for 9%-23% of the confirmed patients. CONCLUSIONS: Arboviral infections are frequent causes of febrile illness. Coinfections are not rare events during periods of intense, concomitant arboviral transmission. Given the challenge to clinically distinguish these infections, there is an urgent need for rapid, point-of-care, multiplex diagnostics.

Congenital brain abnormalities during a Zika virus epidemic in Salvador, Brazil, April 2015 to July 2016.

BackgroundNorth-eastern Brazil was the region most affected by the outbreak of congenital Zika syndrome that followed the 2015 Zika virus (ZIKV) epidemics, with thousands of suspected microcephaly cases reported to the health authorities, mostly between late 2015 and early 2016. Aim: To describe clinical and epidemiological aspects of the outbreak of congenital brain abnormalities (CBAs) and to evaluate the accuracy of different head circumference screening criteria in predicting CBAs.MethodBetween April 2015 and July 2016, the Centers for Information and Epidemiologic Surveillance of Salvador, Brazil investigated the reported cases suspected of microcephaly and, based on intracranial imaging studies, confirmed or excluded a diagnosis of CBA. Sensitivity, specificity and positive and negative predictive values of different head circumference screening criteria in predicting CBAs were calculated.ResultsOf the 365 investigated cases, 166 (45.5%) had confirmed CBAs. The most common findings were intracranial calcifications and ventriculomegaly in 143 (86.1%) and 111 (66.9%) of the 166 CBA cases, respectively. Prevalence of CBAs peaked in December 2015 (2.24 cases/100 live births). Cases of CBAs were significantly more likely to have been born preterm and to mothers who had clinical manifestations of arboviral infection during pregnancy. None of the head circumference screening criteria performed optimally in predicting CBAs.ConclusionThis study highlights the magnitude of neurological consequences of the ZIKV epidemic and the limitations of head circumference in accurately identifying children with CBA. Gestational symptoms compatible with ZIKV infection should be combined with imaging studies for efficient detection of suspect CBAs during ZIKV epidemics.

Diagnostic performance of commercial IgM and IgG enzyme-linked immunoassays (ELISAs) for diagnosis of Zika virus infection.

BACKGROUND: Serologic detection of Zika virus (ZIKV) infections is challenging because of antigenic similarities among flaviviruses. OBJECTIVE: To evaluate the sensitivity and specificity of commercial ZIKV IgM and IgG enzyme-linked immunoassay (ELISA) kits. METHODS: We used sera from febrile patients with RT-PCR-confirmed ZIKV infection to determine sensitivity and sera from RT-PCR-confirmed dengue cases and blood donors, both of which were collected before ZIKV epidemics in Brazil (2009-2011 and 2013, respectively) to determine specificity. RESULTS: The ZIKV IgM-ELISA positivity among RT-PCR ZIKV confirmed cases was 0.0% (0/14) and 12.5% (1/8) for acute- and convalescent-phase sera, respectively, while its specificity was 100.0% (58/58) and 98.3% (58/59) for acute- and convalescent-phase sera of dengue patients, and 100.0% (23/23) for blood donors. The ZIKV IgG-ELISA sensitivity was 100.0% (6/6) on convalescent-phase sera from RT-PCR confirmed ZIKV patients, while its specificity was 27.3% (15/55) on convalescent-phase sera from dengue patients and 45.0% (9/20) on blood donors' sera. The ZIKV IgG-ELISA specificity among dengue confirmed cases was much greater among patients with primary dengue (92.3%; 12/13), compared to secondary dengue (7.1%; 3/42). CONCLUSIONS: In a setting of endemic dengue transmission, the ZIKV IgM-ELISA had high specificity, but poor sensitivity. In contrast, the ZIKV IgG-ELISA showed low specificity, particularly for patients previously exposed to dengue infections. This suggests that this ZIKV IgM-ELISA is not useful in confirming a diagnosis of ZIKV infection in suspected patients, whereas the IgG-ELISA is more suitable for ZIKV diagnosis among travelers, who reside in areas free of flavivirus transmission, rather than for serosurveys in dengue-endemic areas.

Serosurvey of bluetongue, caprine arthritis-encephalitis (CAE) and Maedi-Visna in Barbary sheep (Ammotragus lervia) of a southern Brazilian zoo / Estudo sorológico dos vírus da língua azul, da artrite-encefalite caprina e Maedi-Visna em aoudads (Ammotragus lervia) em um zoológico do Sul do Brasil

Bluetongue (BT) is an infectious and non-contagious disease of compulsory notification which may affect domestic and wild ruminants, transmitted by Culicoides spp. midges. Despite the high morbidity and mortality in sheep, role of wild animals in the BT cycle remains unclear. Caprine arthritis-encephalitis (CAE) and Maedi-Visna virus (MVV) have been reportedly found in goats and sheep, but not described in wildlife species. Accordingly, serum samples from 17 captive Barbary sheep (Ammotragus lervia) from Curitiba zoo, southern Brazil, were tested for bluetongue, caprine arthritis-encephalitis (CAE) and Maedi-Visna viruses by agar gel immunodiffusion (AGID) and enzyme linked immunosorbent assay (ELISA). Antibodies for bluetongue were observed in 6/17 (35.3%) Barbary sheep by AGID test and in 7/17 (41.2%) by ELISA. All samples were negative for the presence of antibodies against caprine arthritis-encephalitis (CAE) and Maedi-Visna viruses. These findings indicate that Barbary sheep may be infected by bluetongue virus and act as wildlife reservoir in both captive and free-range environments.(AU)

A língua azul é uma doença infecciosa e não contagiosa, de notificação obrigatória, que pode afetar ruminantes domésticos e silvestres, transmitida por mosquitos do gênero Culicoides spp. Apesar da alta morbidade e mortalidade em ovelhas, o papel de animais silvestres no ciclo do vírus da língua azul é desconhecido. A artrite encefalite caprina (CAE) e Maedi-visna vírus (MVV) tem sido encontrados em cabras e ovelhas, porém não há descrição em espécies selvagens. Amostras de soro de 17 aoudads (Ammotragus lervia), mantidos em cativeiro no Zoológico de Curitiba, Sul do Brasil, foram testadas para os vírus da língua azul, da artrite encefalite caprina (CAE) e Maedi-visna, utilizando imunodifusão em gel de ágar e o teste de ELISA (enzyme linked immunosorbent assay). Foram observados anticorpos para o vírus da língua azul em 35,3% (6/17) aoudads utilizando a imunodifusão em gel de ágar e 41,2% (7/17) no ELISA. Todas as amostras foram negativas para a presença de anticorpos contra os vírus da artrite encefalite caprina e Maedi-visna. Esses resultados indicam que os aoudads podem ser infectados pelo vírus da língua azul e atuar como um reservatório silvestre tanto em cativeiro quanto em vida livre.(AU)

Serosurvey of bluetongue, caprine arthritis-encephalitis (CAE) and Maedi-Visna in Barbary sheep (Ammotragus lervia) of a southern Brazilian zoo / Estudo sorológico dos vírus da língua azul, da artrite-encefalite caprina e Maedi-Visna em aoudads (Ammotragus lervia) em um zoológico do Sul do Brasil

Bluetongue (BT) is an infectious and non-contagious disease of compulsory notification which may affect domestic and wild ruminants, transmitted by Culicoides spp. midges. Despite the high morbidity and mortality in sheep, role of wild animals in the BT cycle remains unclear. Caprine arthritis-encephalitis (CAE) and Maedi-Visna virus (MVV) have been reportedly found in goats and sheep, but not described in wildlife species. Accordingly, serum samples from 17 captive Barbary sheep (Ammotragus lervia) from Curitiba zoo, southern Brazil, were tested for bluetongue, caprine arthritis-encephalitis (CAE) and Maedi-Visna viruses by agar gel immunodiffusion (AGID) and enzyme linked immunosorbent assay (ELISA). Antibodies for bluetongue were observed in 6/17 (35.3%) Barbary sheep by AGID test and in 7/17 (41.2%) by ELISA. All samples were negative for the presence of antibodies against caprine arthritis-encephalitis (CAE) and Maedi-Visna viruses. These findings indicate that Barbary sheep may be infected by bluetongue virus and act as wildlife reservoir in both captive and free-range environments.(AU)

A língua azul é uma doença infecciosa e não contagiosa, de notificação obrigatória, que pode afetar ruminantes domésticos e silvestres, transmitida por mosquitos do gênero Culicoides spp. Apesar da alta morbidade e mortalidade em ovelhas, o papel de animais silvestres no ciclo do vírus da língua azul é desconhecido. A artrite encefalite caprina (CAE) e Maedi-visna vírus (MVV) tem sido encontrados em cabras e ovelhas, porém não há descrição em espécies selvagens. Amostras de soro de 17 aoudads (Ammotragus lervia), mantidos em cativeiro no Zoológico de Curitiba, Sul do Brasil, foram testadas para os vírus da língua azul, da artrite encefalite caprina (CAE) e Maedi-visna, utilizando imunodifusão em gel de ágar e o teste de ELISA (enzyme linked immunosorbent assay). Foram observados anticorpos para o vírus da língua azul em 35,3% (6/17) aoudads utilizando a imunodifusão em gel de ágar e 41,2% (7/17) no ELISA. Todas as amostras foram negativas para a presença de anticorpos contra os vírus da artrite encefalite caprina e Maedi-visna. Esses resultados indicam que os aoudads podem ser infectados pelo vírus da língua azul e atuar como um reservatório silvestre tanto em cativeiro quanto em vida livre.(AU)

Serological survey of anti-Leptospira spp. antibodies in Barbary sheep (Ammotragus lervia) at the Curitiba Zoo, southern Brazil / Estudo sorológico de anticorpos anti-Leptospira spp. em aoudads (Ammotragus lervia) no zoológico de Curitiba, sul do Brasil

Leptospirosis is a worldwide zoonosis, affecting humans, domestic and wild animals. The present study aimed to evaluate prevalence of anti-Leptospira spp. antibodies in Barbary sheep at the Curitiba zoo. Microscopic agglutination test (MAT) was performed using 17 serogroups. Antibodies against Leptospira spp. were observed in 23.5% samples and Icterohaemorrhagiae was the only prevalent serogroup. The presence of anti-Leptospira antibodies in Barbary sheep indicates exposure to leptospires; thus monitoring and preventive measures are necessary in zoo's captive animals, since they can act as sentinels of environmental exposure in an area with high movement of people.(AU)

A leptospirose é uma zoonose mundial que afeta seres humanos, animais domésticos e selvagens. O presente estudo objetivou avaliar a prevalência de anticorpos anti-Leptospira spp. em aoudads do zoológico de Curitiba. Foi realizado o teste de Soroaglutinação microscópica (SAM) utilizando 17 sorogrupos. Anticorpos contra Leptospira spp. foram observados em 23.5% das amostras de aoudads e Icterohaemorrhagiae foi o único sorogrupo prevalente. A presença de anticorpos em aoudads indica exposição a leptospiras portanto monitoramento e medidas preventivas são necessários em animais confinados em zoológicos, uma vez eles podem atuar como sentinelas de exposição ambiental em uma área com alta circulação de pessoas.(AU)

Serological survey of anti-Leptospira spp. antibodies in Barbary sheep (Ammotragus lervia) at the Curitiba Zoo, southern Brazil / Estudo sorológico de anticorpos anti-Leptospira spp. em aoudads (Ammotragus lervia) no zoológico de Curitiba, sul do Brasil

Leptospirosis is a worldwide zoonosis, affecting humans, domestic and wild animals. The present study aimed to evaluate prevalence of anti-Leptospira spp. antibodies in Barbary sheep at the Curitiba zoo. Microscopic agglutination test (MAT) was performed using 17 serogroups. Antibodies against Leptospira spp. were observed in 23.5% samples and Icterohaemorrhagiae was the only prevalent serogroup. The presence of anti-Leptospira antibodies in Barbary sheep indicates exposure to leptospires; thus monitoring and preventive measures are necessary in zoo's captive animals, since they can act as sentinels of environmental exposure in an area with high movement of people.(AU)

A leptospirose é uma zoonose mundial que afeta seres humanos, animais domésticos e selvagens. O presente estudo objetivou avaliar a prevalência de anticorpos anti-Leptospira spp. em aoudads do zoológico de Curitiba. Foi realizado o teste de Soroaglutinação microscópica (SAM) utilizando 17 sorogrupos. Anticorpos contra Leptospira spp. foram observados em 23.5% das amostras de aoudads e Icterohaemorrhagiae foi o único sorogrupo prevalente. A presença de anticorpos em aoudads indica exposição a leptospiras portanto monitoramento e medidas preventivas são necessários em animais confinados em zoológicos, uma vez eles podem atuar como sentinelas de exposição ambiental em uma área com alta circulação de pessoas.(AU)

Serosurvey of bluetongue, caprine arthritis-encephalitis (CAE) and Maedi-Visna in Barbary sheep (Ammotragus lervia) of a southern Brazilian zoo

ABSTRACT: Bluetongue (BT) is an infectious and non-contagious disease of compulsory notification which may affect domestic and wild ruminants, transmitted by Culicoides spp. midges. Despite the high morbidity and mortality in sheep, role of wild animals in the BT cycle remains unclear. Caprine arthritis-encephalitis (CAE) and Maedi-Visna virus (MVV) have been reportedly found in goats and sheep, but not described in wildlife species. Accordingly, serum samples from 17 captive Barbary sheep (Ammotragus lervia) from Curitiba zoo, southern Brazil, were tested for bluetongue, caprine arthritis-encephalitis (CAE) and Maedi-Visna viruses by agar gel immunodiffusion (AGID) and enzyme linked immunosorbent assay (ELISA). Antibodies for bluetongue were observed in 6/17 (35.3%) Barbary sheep by AGID test and in 7/17 (41.2%) by ELISA. All samples were negative for the presence of antibodies against caprine arthritis-encephalitis (CAE) and Maedi-Visna viruses. These findings indicate that Barbary sheep may be infected by bluetongue virus and act as wildlife reservoir in both captive and free-range environments.

RESUMO: A língua azul é uma doença infecciosa e não contagiosa, de notificação obrigatória, que pode afetar ruminantes domésticos e silvestres, transmitida por mosquitos do gênero Culicoides spp. Apesar da alta morbidade e mortalidade em ovelhas, o papel de animais silvestres no ciclo do vírus da língua azul é desconhecido. A artrite encefalite caprina (CAE) e Maedi-visna vírus (MVV) tem sido encontrados em cabras e ovelhas, porém não há descrição em espécies selvagens. Amostras de soro de 17 aoudads (Ammotragus lervia), mantidos em cativeiro no Zoológico de Curitiba, Sul do Brasil, foram testadas para os vírus da língua azul, da artrite encefalite caprina (CAE) e Maedi-visna, utilizando imunodifusão em gel de ágar e o teste de ELISA (enzyme linked immunosorbent assay). Foram observados anticorpos para o vírus da língua azul em 35,3% (6/17) aoudads utilizando a imunodifusão em gel de ágar e 41,2% (7/17) no ELISA. Todas as amostras foram negativas para a presença de anticorpos contra os vírus da artrite encefalite caprina e Maedi-visna. Esses resultados indicam que os aoudads podem ser infectados pelo vírus da língua azul e atuar como um reservatório silvestre tanto em cativeiro quanto em vida livre.

Serological survey of anti-Leptospira spp. antibodies in Barbary sheep (Ammotragus lervia) at the Curitiba Zoo, southern Brazil

ABSTRACT: Leptospirosis is a worldwide zoonosis, affecting humans, domestic and wild animals. The present study aimed to evaluate prevalence of anti-Leptospira spp. antibodies in Barbary sheep at the Curitiba zoo. Microscopic agglutination test (MAT) was performed using 17 serogroups. Antibodies against Leptospira spp. were observed in 23.5% samples and Icterohaemorrhagiae was the only prevalent serogroup. The presence of anti-Leptospira antibodies in Barbary sheep indicates exposure to leptospires; thus monitoring and preventive measures are necessary in zoos captive animals, since they can act as sentinels of environmental exposure in an area with high movement of people.

RESUMO: A leptospirose é uma zoonose mundial que afeta seres humanos, animais domésticos e selvagens. O presente estudo objetivou avaliar a prevalência de anticorpos anti-Leptospira spp. em aoudads do zoológico de Curitiba. Foi realizado o teste de Soroaglutinação microscópica (SAM) utilizando 17 sorogrupos. Anticorpos contra Leptospira spp. foram observados em 23.5% das amostras de aoudads e Icterohaemorrhagiae foi o único sorogrupo prevalente. A presença de anticorpos em aoudads indica exposição a leptospiras portanto monitoramento e medidas preventivas são necessários em animais confinados em zoológicos, uma vez eles podem atuar como sentinelas de exposição ambiental em uma área com alta circulação de pessoas.

Differential Vector Competency of Aedes albopictus Populations from the Americas for Zika Virus.

To evaluate the potential role of Aedes albopictus (Skuse) as a vector of Zika virus (ZIKV), colonized mosquitoes of low generation number (≤ F5) from Brazil, Houston, and the Rio Grande Valley of Texas engorged on viremic mice infected with ZIKV strains originating from Senegal, Cambodia, Mexico, Brazil, or Puerto Rico. Vector competence was established by monitoring infection, dissemination, and transmission potential after 3, 7, and 14 days of extrinsic incubation. Positive saliva samples were assayed for infectious titer. Although all three mosquito populations were susceptible to all ZIKV strains, rates of infection, dissemination, and transmission differed among mosquito and virus strains. Aedes albopictus from Salvador, Brazil, were the least efficient vectors, demonstrating susceptibility to infection to two American strains of ZIKV but failing to shed virus in saliva. Mosquitoes from the Rio Grande Valley were the most efficient vectors and were capable of shedding all three tested ZIKV strains into saliva after 14 days of extrinsic incubation. In particular, ZIKV strain DakAR 41525 (Senegal 1954) was significantly more efficient at dissemination and saliva deposition than the others tested in Rio Grande mosquitoes. Overall, our data indicate that, while Ae. albopictus is capable of transmitting ZIKV, its competence is potentially dependent on geographic origin of both the mosquito population and the viral strain.

Unrecognized Emergence of Chikungunya Virus during a Zika Virus Outbreak in Salvador, Brazil.

BACKGROUND: Chikungunya virus (CHIKV) entered Brazil in 2014, causing a large outbreak in Feira de Santana, state of Bahia. Although cases have been recorded in Salvador, the capital of Bahia, located ~100 km of Feira de Santana, CHIKV transmission has not been perceived to occur epidemically, largely contrasting with the Zika virus (ZIKV) outbreak and ensuing complications reaching the city in 2015. METHODOLOGY/PRINCIPAL FINDINGS: This study aimed to determine the intensity of CHIKV transmission in Salvador between November 2014 and April 2016. Results of all the CHIKV laboratory tests performed in the public sector were obtained and the frequency of positivity was analyzed by epidemiological week. Of the 2,736 tests analyzed, 456 (16.7%) were positive. An increasing in the positivity rate was observed, starting in January/2015, and peaking at 68% in August, shortly after the exanthematous illness outbreak attributed to ZIKV. CONCLUSIONS/SIGNIFICANCE: Public health authorities and health professionals did not immediately detect the increase in CHIKV cases, likely because all the attention was directed to the ZIKV outbreak and ensuing complications. It is important that regions in the world that harbor arbovirus vectors and did not experience intense ZIKV and CHIKV transmission be prepared for the potential co-emergence of these two viruses.

Time Lags between Exanthematous Illness Attributed to Zika Virus, Guillain-Barré Syndrome, and Microcephaly, Salvador, Brazil.

Zika virus infection emerged as a public health emergency after increasing evidence for its association with neurologic disorders and congenital malformations. In Salvador, Brazil, outbreaks of acute exanthematous illness (AEI) attributed to Zika virus, Guillain-Barré syndrome (GBS), and microcephaly occurred in 2015. We investigated temporal correlations and time lags between these outbreaks to identify a common link between them by using epidemic curves and time series cross-correlations. Number of GBS cases peaked after a lag of 5-9 weeks from the AEI peak. Number of suspected cases of microcephaly peaked after a lag of 30-33 weeks from the AEI peak, which corresponded to time of potential infections of pregnant mothers during the first trimester. These findings support the association of GBS and microcephaly with Zika virus infection and provide evidence for a temporal relationship between timing of arboviral infection of pregnant women during the first trimester and birth outcome.

Influenza-like illness in an urban community of Salvador, Brazil: incidence, seasonality and risk factors.

BACKGROUND: Our understanding of the epidemiology of influenza is limited in tropical regions, which in turn has hampered identifying optimal region-specific policy to diminish disease burden. Influenza-like illness (ILI) is a clinical diagnosis that can be used as a surrogate for influenza. This study aimed to define the incidence and seasonality of ILI and to assess its association with climatic variables and school calendar in an urban community in the tropical region of Salvador, Brazil. METHODS: Between 2009 and 2013, we conducted enhanced community-based surveillance for acute febrile illnesses (AFI) among patients ≥ 5 years of age in a slum community emergency unit in Salvador, Brazil. ILI was defined as a measured temperature of ≥ 37.8 °C or reported fever in a patient with cough or sore throat for ≤ 7 days, and negative test results for dengue and leptospirosis. Seasonality was analyzed with a harmonic regression model. Negative binomial regression models were used to correlate ILI incidence with rainfall, temperature, relative humidity and the number of days per month that schools were in session while controlling for seasonality. RESULTS: There were 2,651 (45.6% of 5,817 AFI patients) ILI cases with a mean annual incidence of 60 cases/1,000 population (95% CI 58-62). Risk of ILI was highest among 5-9 year olds with an annual incidence of 105 cases/1,000 population in 2009. ILI had a clear seasonal pattern with peaks between the 35-40th week of the year. ILI peaks were higher and earlier in 5-9 year olds compared with > 19 year olds. No association was seen between ILI and precipitation, relative humidity or temperature. There was a significant association between the incidence of ILI in children 5-9 years of age and number of scheduled school days per month. CONCLUSIONS: We identified a significant burden of ILI with distinct seasonality in the Brazilian tropics and highest rates among young school-age children. Seasonal peaks of ILI in children 5-9 years of age were positively associated with the number of school days, indicating that children may play a role in the timing of seasonal influenza transmission.

Spatial Distribution of Dengue in a Brazilian Urban Slum Setting: Role of Socioeconomic Gradient in Disease Risk.

BACKGROUND: Few studies of dengue have shown group-level associations between demographic, socioeconomic, or geographic characteristics and the spatial distribution of dengue within small urban areas. This study aimed to examine whether specific characteristics of an urban slum community were associated with the risk of dengue disease. METHODOLOGY/PRINCIPAL FINDINGS: From 01/2009 to 12/2010, we conducted enhanced, community-based surveillance in the only public emergency unit in a slum in Salvador, Brazil to identify acute febrile illness (AFI) patients with laboratory evidence of dengue infection. Patient households were geocoded within census tracts (CTs). Demographic, socioeconomic, and geographical data were obtained from the 2010 national census. Associations between CTs characteristics and the spatial risk of both dengue and non-dengue AFI were assessed by Poisson log-normal and conditional auto-regressive models (CAR). We identified 651 (22.0%) dengue cases among 2,962 AFI patients. Estimated risk of symptomatic dengue was 21.3 and 70.2 cases per 10,000 inhabitants in 2009 and 2010, respectively. All the four dengue serotypes were identified, but DENV2 predominated (DENV1: 8.1%; DENV2: 90.7%; DENV3: 0.4%; DENV4: 0.8%). Multivariable CAR regression analysis showed increased dengue risk in CTs with poorer inhabitants (RR: 1.02 for each percent increase in the frequency of families earning ≤1 times the minimum wage; 95% CI: 1.01-1.04), and decreased risk in CTs located farther from the health unit (RR: 0.87 for each 100 meter increase; 95% CI: 0.80-0.94). The same CTs characteristics were also associated with non-dengue AFI risk. CONCLUSIONS/SIGNIFICANCE: This study highlights the large burden of symptomatic dengue on individuals living in urban slums in Brazil. Lower neighborhood socioeconomic status was independently associated with increased risk of dengue, indicating that within slum communities with high levels of absolute poverty, factors associated with the social gradient influence dengue transmission. In addition, poor geographic access to health services may be a barrier to identifying both dengue and non-dengue AFI cases. Therefore, further spatial studies should account for this potential source of bias.