Epidemic of jungle yellow fever in Brazil, 2000: implications of climatic alterations in disease spread.

Seventy-seven human cases of sylvatic yellow fever were reported in Brazil during the period January-June 2000. The first cases were reported 1 week after New Year's day and originated at Chapada dos Veadeiros, a tourist canyon site in Goiás state, near Brasília, the Brazilian capital. The laboratory procedures used for diagnoses included serology with an IgM capture assay and plaque reduction neutralization test, virus isolation in suckling mice and C6/36 cells, and immunohistochemistry. All cases were diagnosed by at least two different laboratory procedures, with the exception of the first three fatal cases, which were diagnosed on the basis of clinical and epidemiological information. The cases were reported in eight Brazilian states as follows: Goiás with 64.9% (50 cases); Amazonas (1); Bahia (10); Distrito Federal (1); Mato Grosso (4); Minas Gerais (2); Pará (1); São Paulo (2); and Tocantins (6). Patient ages were within the following ranges: 13-74 years old (mean 34.3), 64 (84.4%) were male, especially agricultural workers (n = 30), but tourists (n = 11), carpenters (n = 4), fishermen (n = 4), students (n = 3), truck drivers (n = 3), and other people (n = 22) were also sickened. The case fatality rate was 50.6% (39/77). In Bahia state, a serologic survey that was carried out has suggested a symptomatic/asymptomatic coefficient of 1:4. Field studies developed in Distrito Federal, Goiás, and São Paulo states showed that Haemagogus janthinomys was the mosquito species associated with the transmission. A single strain was also obtained from Aedes scapularis in Bahia. Epizootic occurrence (monkey mortality) was observed in 49 municipalities mainly in Goiás state, where 40 municipalities made reports, 21 of which also diagnosed human cases. Data obtained by the National Institute of Meteorology in Brazil showed an increase in temperature and rain in December 1999 and the first 3 months of 2000 in Goiás and surrounding states, which perhaps has contributed to the intense and widespread transmission of the yellow fever virus. The relatively small number of cases probably reflects the extensive use of yellow fever 17D-vaccine during the last 3 years, in which about 45 million doses were used. During the last months of 1999, 16 and 11 yellow fever cases were reported in Tocantins and Goiás states, respectively. It is noteworthy that the last reported autochthonous cases of sylvatic yellow fever in São Paulo and Bahia, both states outside the endemic/enzootic area, had occurred in 1953 and 1948, respectively.

Inadequate management of natural ecosystem in the Brazilian Amazon region results in the emergence and reemergence of arboviruses.

A total of 187 different species of arboviruses and other viruses in vertebrates were identified at the Evandro Chagas Institute (IEC) from 1954 to 1998, among more than 10,000 arbovirus strains isolated from humans, hematophagous insects, and wild and sentinel vertebrates. Despite intensive studies in the Brazilian Amazon region, especially in Pará State, very little is known about most of these viruses, except for information on date, time, source, and method of isolation, as well as their capacity to infect laboratory animals. This paper reviews ecological and epidemiological data and analyzes the impact of vector and host population changes on various viruses as a result of profound changes in the natural environment. Deforestation, mining, dam and highway construction, human colonization, and urbanization were the main manmade environmental changes associated with the emergence and/or reemergence of relevant arboviruses, including some known pathogens for humans.

Dengue epidemic in Belém, Pará, Brazil, 1996-97.

We describe clinical and epidemiologic findings during the first epidemic of dengue fever in Belém, Pará State, Brazil, in 1996-97. Of 40,237 serum samples, 17,440 (43%) were positive for dengue by virus isolation or serologic testing. No hemorrhagic cases or deaths were reported. Mycobacterium tuberculosis

[Laboratory-acquired human infection with SP H 114202 virus (Arenavirus: Arenaviridae family): clinical and laboratory aspects]. / Infecção humana adquirida em laboratório causada pelo virus SP H 114202 (Arenavirus: família Arenaviridae): aspectos clínicos e laboratoriais.

Here in is described the clinical and laboratorial findings of a laboratory-acquired infection caused by the virus SP H 114202 (Arenavirus, family Arenaviridae) a recently discovered agent responsible for a viral hemorrhagic fever. The patient was sick for 13 days. The disease had an abrupt onset characterized by high fever (39 degree C.), headache, chills and myalgias for 8 days. In addition, on the 3rd day, the patient developed nausea and vomiting, and in the 10th, epigastralgia, diarrhea and gengivorrhagia. Leucopenia was seen within the 1st week of onset, with counts as low as 2,500 white cells per mm3. Counts performed after the 23rd day of the onset were within normal limits. With the exception of moderate lymphocytosis, no changes were observed in differential counts. An increase in the titer of antibodies by complement fixation, neutralization and ELISA (IgM) was detected. Suckling mice and baby hamsters were inoculated intracerebrally with 0.02 ml of blood samples collected in the 2nd and 7th days of disease. Attempts to isolate the virus were also made in Vero cells. No virus was isolated. This virus was isolated before in a single occasion in São Paulo State, in 1990, from the blood of a patient with hemorrhagic fever with a fatal outcome. The manipulation of the virus under study, must be done carefully, since the transmission can occur through aerosols.

[Outbreak of classical fever of dengue caused by serotype 2 in Araguaiana, Tocantins, Brazil]. / Epidemia de febre clássica de dengue causada pelo sorotipo 2 em Araguaina, Tocantins, Brasil.

We report the first outbreak of dengue fever caused by dengue 2 (DEN 2) in Araguaina, Tocantins State. Four hundred people of 74 families, living at S. João, Araguaina Sul and Neblina districts were questioned and then bled, in order to obtain sera to test for anti-dengue antibodies. If a person was sick, a small quantity of blood was collected for virus isolation. The main clinical picture of disease was characterized by fever, headache, myalgias, arthralgias and skin rash. Were obtained 1,105 (56 females and 45 males of Culex quinquefasciatus and 567 females and 437 males of Aedes aegypti) mosquitoes from larvae collected in Araguaina. The females of Aedes aegypti obtained from larvae were allowed to feed on 8 febrile patients. The diagnosis of infection was made by both virus isolation into Aedes albopictus (C6/36) cells, and serology, by Hemagglutination-inhibition (HI) and IgM capture ELISA (MAC ELISA). No virus was isolated from mosquitoes. Although five strains of DEN 2 were obtained from humans, and another 111 infections were diagnosed serologically (IgM positive). The positivity rate of the samples was 27.75% (111 of 400), while that of the families was 66.2% (45 of 72), where at least one member of the each family was infected. It was also detected 26.1% of asymptomatic infections. All age groups were affected. Therefore, the infection was more frequent in females (33.5%) than males (23.8%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Estimation of the survival rate, the relative density and the infection rate of a population of Haemagogus janthinomys Dyar (Diptera, Culicidae) from which strains of yellow fever were isolated in Brazilian Amazon]. / Estimation du taux de survie, de la densité relative et du taux d'infection d'une population d'Haemagogus janthinomys Dyar (Diptera, Culicidae) ayant fourni des souches de fièvre jaune en Amazonie Brésilienne.

The conditions of maintenance of YF virus in brazilian Amazonia are not yet elucidated. Generally, the presence of the virus is attested by human cases of sylvatic origin. During a survey done at the exact place where a man have probably been contaminated, it was possible for the first time in South America, to estimate the mean parity rate of a population of the potential vector Haemagogus janthinomys, from which the YF virus was actually isolated. The survival rate (Ts = 0.96), the biting rate (0.60 mosquitoes/man x hour), and the infection rate (1.71%) were also determinated for the same mosquitoes and have values compatible with the probable conditions of the human contamination. However, more data are needed, in particular in relation with other possible human contaminations and/or circulation of the YF virus in the monkey population (extension and duration of the epizootic episode), in order to know what maintenance cycle is prevalent in this region: a low level transmission, with the mosquito being a "vector-reservoir", or a "constantly moving epizootic wave".

[1st register of an epidemic caused by Oropouche virus in the states of Maranhão and Goiás, Brazil]. / Primeiro registro de epidemias causadas pelo vírus Oropouche nos estados do Maranhão e Goiás, Brasil.

The authors describe the occurrence of outbreaks caused by Oropouche virus (ORO) in the states of Maranhão and Goiás, Brazil in 1988. 36 strains of the virus were obtained from the intracerebral inoculation of the blood of 120 patients into 2-3 day-old infant mice. The illness was characterized by headache, fever, pain in the muscles, joints and back, photophobia, retrobulbar pain, nausea and dizziness. 128 of 197 people examined in Porto Franco, MA, had hemagglutination-inhibiting antibodies to the agent, while 106 of them had IgM antibodies by MAC ELISA test. All age groups were infected, although the incidence was higher among who had 10 to 19 years old. There was no difference, in relation to sex infections. Recurrence of symptoms was reported in 56% of sick people. Mice inoculated with 3624 Culicoides paraensis (Ceratopogonidae) and 1970 Culex (Cux.) quinquefasciatus (Culicidae) collected in Porto Franco resulted in one single isolation of ORO virus, from the Culicoides. These are the first confirmed cases of ORO infection in Maranhão and Goiás states.

[Research on antibodies to arbovirus in the serum of residents of the village of Corte de Pedra, Valencia, Bahia]. / Pesquisa de anticorpos para arbovírus no soro de residentes no povoado de Corte de Pedra, Valença, Bahia.

A serological survey for research on antibodies to arbovirus was carried out on 288 residents of the rural zone of the village of Corte de Pedra, Valença, Bahia. It was observed that 3.8% of the sample population presented HI and N antibodies against Flaviviruses (Ilhéus 6, St. Louis 2, Yellow fever 3 and Rocio 1). One person, who had previously lived in the Amazon region, had antibodies to Mayaro. The authors were unable to detect either N antibodies for Piry virus in a random sample of 75 persons or CF antibodies against viruses of the Changuinola and Phlebotomus groups and ungrouped BE AR 408005 and BE AR 421710 in another random sample of 28 individuals. Complementary studies should be conducted in order to define the transmission of the different viruses in the area.

Carajas and Maraba viruses, two new vesiculoviruses isolated from phlebotomine sand flies in Brazil.

Two new rhabdoviruses, designated Carajas and Maraba, are described. Both were isolated from phlebotomine sand flies (Lutzomyia spp.) collected in the Amazon basin of Brazil. One recovery of Carajas virus was made from male sand flies. By complement-fixation and neutralization tests both agents were shown to be members of the vesicular stomatitis virus (VSV) serogroup (genus Vesiculovirus). The pathogenicity of the two viruses in mice and Vero cells is similar to that of VSV-Indiana and VSV-New Jersey. Both Carajas and Maraba viruses replicated in Lutzomyia longipalpis following intrathoracic inoculation, and both agents were transovarially transmitted in this sand fly species.

Characterization of eight new phlebotomus fever serogroup arboviruses (Bunyaviridae: Phlebovirus) from the Amazon region of Brazil.

Eight new members of the phlebotomus fever arbovirus serogroup (family Bunyaviridae; genus Phlebovirus) from the Amazon region of Brazil are described. One serotype was recovered from a febrile patient, three from small wild animals and four from sand flies. A small serum survey carried out with the human isolate, Alenquer virus, suggests that it rarely infects man. Complement-fixation and plaque reduction neutralization tests were done, comparing the eight new viruses with other members of the phlebotomus fever serogroup. A close antigenic relationship was demonstrated between one of the new agents (Belterra) and Rift Valley fever virus. This finding is of considerable interest and deserves further investigation. Addition of these eight new viruses to the genus Phlebovirus brings to 14 the number of serotypes known to occur in the Amazon region and to 36 the total number reported worldwide. More detailed clinical and epidemiological studies should be conducted in Amazonia in order to define the public health impact caused by phleboviruses.

An outbreak of Mayaro virus disease in Belterra, Brazil. I. Clinical and virological findings.

An outbreak of human illness caused by Mayaro (MAY) virus occurred in Belterra, Pará, Brazil in the first half of 1978. A total of 55 cases were confirmed, 43 by virus isolation and serology, and 12 by serology alone. The disease in Belterra presented as a distinct clinical syndrome characterized by fever, arthralgia and exanthema. No fatalities could be attributed to MAY virus infection. Arthralgia, accompanied by joint edema in 20% of cases, was a very prominent sign which caused temporary incapacity in many patients. Arthralgia was present in virtually all confirmed cases and persisted in some for at least 2 months, although with decreasing severity. Rash was present in two-thirds of the cases, and was either maculopapular or micropapular. The incidence of rash was higher in children than in adults. Contrary to arthralgia, which started with the onset of clinical illness, rash usually appeared on the 5th day and faded within 3-4 days. Fever, chills, headache, myalgia, lymph-adenopathy and other minor clinical manifestations were also recorded, and generally persisted for from 2-5 days. Leucopenia was a constant finding in all cases. Mild albuminuria was seen in four of 25 patients, and slight thrombocytopenia was seen in 10 of 20 cases. The fact that viremia levels higher tha 5.0 log10/1.0 ml of blood were recorded in 10 patients rises the possibility that man may have be an amplifying host in the MAY virus cycle. The MAY virus illness, as seen in Belterra, has clinical features similar to those observed in persons infected with chikungunya virus.

Oropouche virus. II. Epidemiological observations during an epidemic in Santarém, Pará, Brazil in 1975.

An epidemic of Oropouche fever occurred in Santarém, Pará, Brazil in 1975. In the first survey for Oropouche antibodies involving a random sample of an entire city, infection rates varied from 0-44%, depending on the specific area within the city. Women had higher infection rates than men, but this difference was statistically significant only for persons older than 10 years of age. An analysis of school data showed that pupils in the evening classes had a greater increase in absenteeism during the epidemic period than those attending morning or afternoon classes. These data are compatible with the concept that Culicoides paraensis rather than Culex pipiens quinquefasciatus is the main vector of Oropouche virus in Brazil.

Programa multidisciplinario de vigilancia de las enfermedades infecciosas en zonas colindantes con la carretera transamazonica en Brasil. II. Epidemiologia de las infecciones por arbovirus. / Multidisciplinary program of infections disease surveillance along the tranzamazon highway in Brasil. II - Epidemiology of arbovirus infections

Durante dos anos se llevo a cabo un importante programa de vigilancia epidemiologica en zonas colindantes con la Carretera Transamazonica en Brasil. Este articulo describe los resultados de los estudios serologicos del programa, segun la exposicion del hombre a determinados arbovirus

An outbreak of Oropouche virus diease in the vicinity of santarem, para, barzil.

An epidemic of human febrile illness caused by Oropouche virus was studied in the village of Mojui dos Campos, Pará State, in February 1975. The major clinical symptoms, fever, chills, headache, myalgia, arthralgia and dizziness persisted for 2 to 7 days. Leukopenia was commonly observed. Some patients were severely ill but no deaths were attributed to the disease. Recurrence of symptoms was reported in several people. 55 cases of recent infection were diagnosed in Mojuí dos Campos between February and April. In the same period 26 cases were recorded from the Palhal area, near to Mojuí. Two additional cases were observed, one in the small settlement of Terra Preta and the other in the town of Santarém, which are 12 and 20 km from Mojuí, respectively. Of the 83 infections, 65 were proven by virus isolation from the blood of patients and 18 by the demonstration of an increasing antibody level to the agent. Both sexes of the population were infected in equal proportions. Most patients were below 20 years of age. In the village of Mojuí dos Campos with a population of about 2,900, 45 (40,1%) out of 112 students aged 4 to 18, had HI antibodies to the virus when examined late in February. The epidemic, however, only declined after the middle of March. Two isolations of Oropouche virus were obtained from some 15,000 Culicoides inoculated into mice. About 4,000 Culicoides and all the 9,420 mosquitoes captured during the outbreak remain to be inoculated. Over 95% of the Culicoides were C. paraensis. Only 1 rodent of the genus Proechimys had HI antibodies to Oropouche virus out of the 602 wild and domestic mammals captured in the area. All 5 reptiles examined were negative. 34 (4.9%) out of the 681 wild birds and 12 (5.8%) out of the 206 domestic birds examined were positive for the presence of HI antibodies to the agent.