2023 epidemic dengue fever outbreak: the experience of a pediatric hospital in the City of Buenos Aires. / Brote epidémico de dengue 2023: experiencia de un hospital pediátrico de la Ciudad de Buenos Aires.

Introduction. Dengue is a viral infection that may be asymptomatic or include severe manifestations. This study aims to describe the characteristics of a pediatric population during the epidemic outbreak in 2023. Population and methods. This cross-sectional study included patients with probable or confirmed dengue fever who were seen from March 13, 2023, to May 19, 2023, in a pediatric hospital in the Autonomous City of Buenos Aires. Results. A total of 112 patients were included. The median age was 12 years; 58% were male. Seventy-six percent of them came from the City of Buenos Aires. Twenty-five percent had cohabitants with symptoms compatible with a suspected case. The most frequent clinical manifestations were fever, headache, retro-ocular pain, myalgia, and arthralgia. The most frequent laboratory alterations were leukopenia (65%) and elevated transaminases (60%). Twenty-one percent (24/112) presented alarm signs and required hospitalization. Leukopenia, plateletopenia, and elevated transaminases were associated with the presence of alarm signs. RT-PCR was detected in fifty-three patients; serotype 2 was the most frequent. Twenty-one patients had positive NS1 tests, 18 patients had positive IgM, and 20 patients with clinical and epidemiological links were assumed to be probable dengue cases. There were no cases of severe dengue. Conclusion. Early clinical suspicion and recognition of laboratory parameters associated with alarm signs are essential for an adequate approach to the disease and early supportive treatment during dengue infection.

Introducción. El dengue es una infección viral que puede cursar de forma asintomática o incluir manifestaciones graves. El objetivo del trabajo es describir las características de una población pediátrica durante el brote epidémico del 2023. Población y métodos. Estudio de corte transversal que incluyó pacientes con dengue probable o confirmado atendidos del 13 de marzo de 2023 al 19 de mayo de 2023 en un hospital pediátrico de la Ciudad Autónoma de Buenos Aires. Resultados. Se incluyeron 112 pacientes. La mediana de edad fue 12 años; el 58 % fueron varones. El 76 % procedía de la Ciudad Autónoma de Buenos Aires. El 25 % tenía convivientes con sintomatología compatible con caso sospechoso. Las manifestaciones clínicas más frecuentes fueron fiebre, cefalea con dolor retroocular y mioartralgias. Las alteraciones de laboratorio más frecuentes fueron la leucopenia (65 %) y la elevación de transaminasas (60 %). El 21 % (24/112) presentó signos de alarma y requirió internación. La leucopenia, la plaquetopenia y el aumento de transaminasas se asociaron con la presencia de signos de alarma. Se confirmaron 53 pacientes por PCR-RT detectable, el serotipo 2 fue el más frecuente. Se asumieron como casos probables de dengue 21 pacientes con prueba NS1 positiva, 18 pacientes con IgM positiva y 20 pacientes con clínica y nexo epidemiológico. No hubo casos de dengue grave. Conclusión. Durante la infección por dengue, la sospecha clínica precoz y el reconocimiento de los parámetros de laboratorio asociados a los signos de alarma resultan esenciales para un adecuado abordaje de la enfermedad y un tratamiento de sostén precoz.

Unexpected arboviruses found in an epidemiological surveillance of acute tropical febrile syndrome in the department of Meta, Eastern Colombia.

BACKGROUND: Nonspecific acute tropical febrile illnesses (NEATFI) are common in the Latin American tropics. Dengue, Chikungunya, Zika, Mayaro, and Usutu, among others, can coexist in the American tropics. This study aimed to surveil the arboviruses that cause| acute febrile syndrome in patients in the Meta department, Colombia. METHODS: Between June 2021 and February 2023, an epidemiological surveillance study was conducted in the Llanos of the Meta department in Eastern Colombia. RESULTS: One hundred patients in the acute phase with typical prodromal symptoms of NEATFI infection who attended the emergency department of the Villavicencio Departmental Hospital were included. ELISA tests were performed for Dengue, Usutu, Chikungunya, and Mayaro. RT-qPCR was performed to detect the arboviruses Usutu, Dengue, Zika, Mayaro, and Oropouche. The seroprevalence for the Chikungunya, Mayaro, and Usutu viruses was 41 % (28/68), 40 % (27/67), and 62 % (47/75), respectively. Seroconversion for Chikungunya was observed in one patient; two seroconverted to Mayaro and one to Usutu. The NS5 gene fragment of the Usutu virus was detected in nine febrile patients. RT-qPCR of the remaining arboviruses was negative. The clinical symptoms of the nine Usutu-positive patients were very similar to those of Dengue, Chikungunya, Zika, and Mayaro infections. CONCLUSIONS: The pervasive detection of unexpected viruses such as Usutu and Mayaro demonstrated the importance of searching for other viruses different from Dengue. Because Usutu infection and Mayaro fever have clinical features like Dengue, a new algorithm should be proposed to improve the accuracy of acute tropical fevers.

Jovens cientistas: enfrentamento às arboviroses e participação juvenil no território / Young scientists: facing arboviruses and youth participation in the territory / Jóvenes investigadores: enfrentamiento a las arbovirosis y participación juvenil en el território

O estudo analisa uma formação em Iniciação Científica sobre arboviroses, a partir da percepção de jovens estudantes, em Ceilândia ­ Distrito Federal. Objetivo: compreender em que medida a Iniciação Científica mobiliza esses jovens a participarem de ações de vigilância e promoção da saúde no território, e entender sua motivação para participar do projeto. Metodologia: abrangeu-se a análise das redações escritas para a seleção ao Curso de Formação para Iniciação Científica na Educação Básica e as Arboviroses; a administração desse curso e; posteriormente, um grupo focal com estudantes para análise do processo educativo da Iniciação Científica que vivenciaram. Resultados: a análise de conteúdo evidenciou a percepção dos alunos sobre a Iniciação Científica, centrada em seis categorias analíticas: motivação dos alunos para Iniciação Científica; processo de formação do saber; formação de jovens cientistas; saúde e meio ambiente; participação e empoderamento juvenil e percepções acerca do Sistema Público de Saúde. Conclusão: o enfrentamento às arboviroses exige políticas e intervenções de amplo espectro, e a Iniciação Científica fortaleceu esses jovens estudantes enquanto sujeitos de direitos, ampliou sua percepção sobre ciência, saúde, relação com o ambiente, com o Sistema Único de Saúde e estimulou o interesse em ações preventivas no combate às arboviroses nesses territórios.

This study analyzes a Scientific Initiation (SI) program on arboviroses, from the perception of young high school students in Ceilândia ­ Distrito Federal. Objective: It aims to understand to what extent the SI mobilizes these young people to participate in surveillance and health promotion actions in the territory and understand their motivation to participate in this project. Methodology: The methodology included the analysis of the essays written for the selection to the Training Course for Scientific Initiation in Basic Education and the Arboviroses, the administration of this course, and later a focus group with students to analyze the SI educational process they experienced. Results: The result of the Content Analysis showed that the students' perception about the SI could be grouped into six categories: students' motivation for the scientific initiation; the learning process; the training of young scientists; health and environment; youth participation and empowerment, and perceptions of the Public health system in Brazil (SUS). Conclusion: Confronting arboviroses requires broad-spectrum policies and interventions, and the SI strengthened these young students as subjects of rights, broadened their perception of science, health, relationship with the environment, with the Sistema Único de Saúde and stimulated interest in preventive actions to combat arboviroses in these territories. Keywords: Health education; Arbovirus infections; Adolescents; Public health.

Analiza una formación en Iniciación Científica (IC) sobre arbovirus, desde la percepción de jóvenes estudiantes de secundaria en Ceilândia, Distrito Federal. Objetivo: el objetivo es comprender en qué medida la IC moviliza a estos jóvenes a participar en acciones de vigilancia y promoción de la salud en el territorio, así como entender su motivación para participar en proyectos de IC. Metodología: la metodología incluyó el análisis de las redacciones escritas para la selección al Curso de Formación para Iniciación Científica en Educación Básica y Arbovirus, la administración de este curso y, posteriormente, un grupo focal con los estudiantes para analizar el proceso educativo de IC que vivieron. Resultados: los resultados del Análisis de Contenido mostraron la percepción de los estudiantes sobre la IC enfocada en seis categorías analíticas: motivación de los estudiantes por la iniciación científica; proceso de formación de conocimientos; formación de jóvenes científicos; salud y medio ambiente; participación y empoderamiento de los jóvenes y percepciones sobre el Sistema Público de Salud (SUS). Conclusiones: Enfrentar los arbovirus requiere políticas e intervenciones de amplio espectro, y la IC fortaleció a estos jóvenes estudiantes como sujetos de derechos, ampliando su percepción sobre ciencia, salud, relación con el entorno, con el Sistema Único de Salud y estimuló el interés en acciones preventivas en la lucha contra los arbovirus en estos territorios.

Vertical transmission of chikungunya virus: a worldwide concern.

The Chikungunya Virus (CHIKV) already has endemic circulation in about 100 countries and the number of infected patients increases every year, due to the effectiveness of the vector and human universal susceptibility to infection. The virus can also be transmitted from mother to child, more frequently intrapartum. About 50 % of neonates with CHIKV symptoms will have neurodevelopmental delay. It is therefore an infection of worldwide concern with a great impact on people's quality of life. The objective of this work is to describe two cases of confirmed vertical transmission by chikungunya virus, one of them with intrauterine infection and death of the neonate. Neonates with vertical chikungunya infection may present with clinical sepsis in the first few days of life, which is why this is a very important diagnosis, especially during outbreaks of the infection.

Ilheus Virus (ILHV) Resistance in Culex quinquefasciatus from the Northern Region of Brazil.

BACKGROUND: Orthoflavivirus ilheusense (ILHV) is a member of the Flaviviridae family. It was first isolated in 1944 from pools of Aedes serratus and Psorophora ferox mosquitoes; however, it has also been detected in species of the genus Culex, such as Cx. portesi and Cx. coronator. The objective of this study was to examine the vector competence of Cx. quinquefasciatus mosquitoes to ILHV infection and the subsequent transmission of the virus through their saliva during feeding on blood. METHODS: F1 generation females of Cx. quinquefasciatus (Ananindeua/PA) were orally infected with goose blood infected with strain BeH7445, and body, head and saliva samples were analyzed at 7, 14, and 21 dpi using the techniques of virus isolation in cells and indirect immunofluorescence. RESULTS: The presence of ILHV was not detected in the body and head samples of Cx. quinquefasciatus females at any of the three dpi's analyzed, indicating that the lineage of mosquitoes analyzed was resistant to ILHV. CONCLUSIONS: According to the results obtained in this study, the species Cx. quinquefasciatus proved resistant to ILHV, regardless of the virus titers to which it was exposed, which suggests the possibility that this species does not act as a vector in the ILHV transmission cycle.

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

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

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

Vertical transmission of chikungunya virus: a worldwide concern

Abstract The Chikungunya Virus (CHIKV) already has endemic circulation in about 100 countries and the number of infected patients increases every year, due to the effectiveness of the vector and human universal susceptibility to infection. The virus can also be transmitted from mother to child, more frequently intrapartum. About 50 % of neonates with CHIKV symptoms will have neurodevelopmental delay. It is therefore an infection of worldwide concern with a great impact on people's quality of life. The objective of this work is to describe two cases of confirmed vertical transmission by chikungunya virus, one of them with intrauterine infection and death of the neonate. Neonates with vertical chikungunya infection may present with clinical sepsis in the first few days of life, which is why this is a very important diagnosis, especially during outbreaks of the infection.

Worldwide distribution, symptoms and diagnosis of the coinfections between malaria and arboviral diseases: a systematic review

The coinfection between malaria (ML) and arboviral diseases represents a major global public health problem, particularly in tropical and subtropical countries. Despite its relevance, this topic is still insufficiently discussed in the current literature. Here, we aimed to investigate the worldwide distribution, symptoms, and diagnosis during coinfection between ML and arboviral diseases. We conducted a systematic review following the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and assessed the selection and eligibility criteria, created and diagrammed maps, and analysed major symptoms with 95% confidence intervals (CI) using prevalence ratio and effect size, also performing latent class analysis. A total of 85,485 studies were retrieved, of which 56 were included: 57.14% in Asia, 25% in Africa, 14.30% in South America, and 3.56% in Europe. A total of 746 individuals were reported to be coinfected with Plasmodium and arbovirus. Concurrent ML, Dengue (DEN), Chikungunya (CHIK), and Zika (ZIK) patients are more likely to present headache and skin rash. Regarding diagnosis, 58,253 were made, of which 38,176 were positive (ML and at least one arboviral disease). The magnitude of these pathogens' coexistence points out the pressing need for improvements in public health policies towards diagnosis and prevention of both diseases, especially in endemic areas.

Evaluation of the maturational auditory process in children with the infection by Zika congenital syndrome / Avaliação do processo maturacional auditivo em crianças portadoras da síndrome da infecção congênita pelo Zika vírus

ABSTRACT Purpose: to analyze the absolute latencies of waves I. III and V and the interpeak intervals I-III. III-V and I-V of the ABR recorded from different age groups of children with congenital zika virus infection and their peers without risk indicators for hearing impairment. Methods: 84 newborns and infants (N=51 study group and N=33 control group) divided into groups with different post-conceptual ages. with the results of their hearing exams analyzed by age group and compared with their peers without other risk indicators for hearing impairment. The assessment of the auditory pathway was conducted through tympanometry. otoacoustic emissions and auditory brain stem responses. Results: only the latency of wave I and the interpeak III-V showed no significant difference between the study and control groups. The absolute latency and interpeak values found in the study group were significantly lower than those found in the control group. Conclusion: the maturation of the brain stem in children with ZIKV infection occurred within normal limits. with no retrocochlear disorders until the age of 5 years.

RESUMO Objetivo: analisar as latências absolutas das ondas I. III e V e os intervalos interpicos I-III. III-V e I-V do Potencial Evocado Auditivo de Tronco Encefálico obtidos em diversos grupos etários de crianças portadoras de infecção congênita por zika vírus e nos seus pares sem indicadores de risco para deficiência auditiva. Métodos: foram recrutados 84 recém-nascidos e lactentes (N=51 grupo de estudo e N=33 grupo controle) separados por grupos com diferentes idades pós-conceptuais. sendo os resultados dos seus exames auditivos analisados por faixa etária e comparados com seus pares sem outros indicadores de risco para deficiência auditiva. A avaliação da via auditiva foi realizada por meio da timpanometria. emissões otoacústicas transientes e potencial evocado de tronco encefálico. Resultados: somente a latência da onda I e o intervalo interpico III-V não apresentaram diferença significante entre grupo de estudo e controle. Os valores de latências absolutas e interpicos encontrados no grupo de estudo foram menores do que os obtidos no grupo controle de forma significativa. Conclusão: a maturação do tronco encefálico nas crianças portadoras de infecção por Zika Vírus ocorreu dentro da normalidade. não apresentando alterações retrococleares até a idade de 5 anos.

Dengue is a product of the environment: an approach to the impacts of the environment on the Aedes aegypti mosquito and disease cases / A dengue é produto do meio: uma abordagem sobre os impactos do ambiente no mosquito Aedes aegypti e nos casos da doença

ABSTRACT Dengue is an arbovirus infection whose etiologic agent is transmitted by the Aedes aegypti mosquito. Since the early 1980s, when the circulation of the dengue virus (DENV) was confirmed in Brazil, the disease has become a growing multifactorial public health problem. This article presented the main factors that have contributed to the frequent dengue epidemics in recent years, such as the behavior of the vector, climate change, and social, political, and economic aspects. The intersection between these different factors in the dynamics of the disease is highlighted, including the increase in the mosquito population due to higher temperatures and rainy periods, as well as the influence of socioeconomic conditions on the incidence of dengue. Some mosquito control strategies are also addressed, including the use of innovative technologies such as drones and the Wolbachia bacterium, as well as the hope represented by the dengue vaccine. Nevertheless, the need for integrated and effective public policies to reduce social inequalities and the impacts of climate change on the spread of dengue is emphasized.

RESUMO A dengue é uma arbovirose cujo agente etiológico é transmitido pelo mosquito Aedes aegypti. Desde o começo dos anos 1980, quando a circulação do vírus dengue (DENV) foi confirmada no Brasil, a doença passou a ser um crescente problema multifatorial para a saúde pública. Neste artigo, apresentamos os principais fatores que contribuíram e contribuem para as frequentes epidemias de dengue ocorridas nos últimos anos, como o comportamento do vetor, as mudanças climáticas e os aspectos sociais, políticos e econômicos. Destaca-se a interseção entre esses diferentes fatores na dinâmica da doença, incluindo o aumento da população do mosquito devido a temperaturas mais altas e a períodos chuvosos, bem como a influência das condições socioeconômicas na incidência da dengue. Também são abordadas algumas estratégias de controle do mosquito, incluindo o uso de tecnologias inovadoras, como drones e a bactéria Wolbachia, bem como a esperança representada pela vacina contra a dengue. Ainda assim, enfatiza-se a necessidade de políticas públicas integradas e eficazes para reduzir as desigualdades sociais e os impactos das mudanças climáticas na propagação da dengue.

Usefulness of minimally invasive autopsy in the diagnosis of arboviruses to increase the sensitivity of the Epidemiological Surveillance System in Ceará, Brazil / Utilidad de la autopsia mínimamente invasiva en el diagnóstico de arbovirus para aumentar la sensibilidad del Sistema de Vigilancia Epidemiológica en Brasil: experiencia de Ceará, Brasil / Utilidade da autópsia minimamente invasiva no diagnóstico das arboviroses para ampliação da sensibilidade do Sistema de Vigilância Epidemiológica no Brasil: experiência do Ceará

Abstract Objective: To create a protocol for performing minimally invasive autopsies (MIA) in detecting deaths from arboviruses and report preliminary data from its application in Ceará state, Brazil. Methods: Training was provided to medical pathologists on MIA. Results: A protocol was established for performing MIA, defining criteria for sample collection, storage methods, and diagnoses to be carried out according to the type of biological sample; 43 MIAs were performed in three months. Of these, 21 (48.8%) arrived at the Death Verification Service (SVO) with arboviruses as a diagnostic hypothesis, and seven (16.3%) were confirmed (six chikungunya cases and one dengue case); cases of COVID-19 (n = 9), tuberculosis (n = 5), meningitis (n = 4), cryptococcosis (n = 1), Creutzfeldt-Jakob disease (n = 1), breast cancer (n = 1), and human rabies (n = 1) were also confirmed. Conclusion: The protocol implemented enabled identification of a larger number of suspected arbovirus-related deaths, as well as confirmation of other diseases of interest for surveillance.

Resumen Objetivo: Estabelecer un protocolo utilizado para la realización de autopsias mínimamente invasivas (AMI) para la detección de muertes por arbovirus y presentar datos preliminares de este protocolo en Ceará, Brasil. Métodos: Se llevó a cabo la capacitación de médicos patólogos en AMI. Resultados: Se estableció un protocolo para la realización de AMI, que define los criterios para la toma de muestras, métodos de almacenamiento y diagnóstico; en tres meses se realizaron 43 AMI; de estas, 21 (48,8%) llegaron al Servicio de Verificación de Óbito (SVO) con una hipótesis diagnóstica de alguna arbovirosis y siete (16,3%) fueron confirmadas (seis casos de chikungunya y uno de dengue); también se confirmaron casos de Covid-19 (n = 9), tuberculosis (n = 5), meningitis (n = 4), criptococosis (n = 1), enfermedad de Creutzfeldt-Jakob (n = 1), neoplasia de mama (n = 1) y rabia humana (n = 1). Conclusión: El protocolo implementado permitió la identificación de un mayor número de muertes sospechosas de arbovirus, además de la confirmación de otras patologías de interés.

Resumo Objetivo: Estabelecer protocolo para realização de autópsias minimamente invasivas (AMIs) na detecção de óbitos por arboviroses e relatar dados preliminares desse protocolo no Ceará, Brasil. Métodos: Médicos patologistas foram treinados em AMI. Resultados: Estabeleceu-se protocolo para AMI, definindo-se critérios para amostras a serem coletadas, suas formas de armazenamento e diagnóstico, segundo o tipo de amostra biológica; em três meses, foram realizadas 43 AMIs, das quais 21 (48,8%) chegaram ao Serviço de Verificação de Óbito (SVO) com hipótese diagnóstica de alguma arbovirose e sete (16,3%) foram confirmados (seis de chikungunya; uma de dengue); também foram confirmados casos de covid-19 (n = 9), tuberculose (n = 5), meningite (n = 4), criptococose (n = 1), doença de Creutzfeldt-Jakob (n = 1), neoplasia de mama (n = 1) e raiva humana (n = 1). Conclusão: O protocolo implantado permitiu a captação de um maior número de óbitos suspeitos de arboviroses, além da confirmação de outras patologias de interesse da vigilância.

Spatio-Temporal Cluster Detection of Dengue, Chikungunya, and Zika Viruses' Infection in Rio de Janeiro State from 2010 to 2019.

Dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) virus infections are widespread throughout the Rio de Janeiro state. The co-circulation of these emergent arboviruses constitutes a serious public health problem, resulting in outbreaks that can spatially and temporally overlap. Environmental conditions favor the presence, maintenance, and expansion of Aedes aegypti, the primary vector of these urban arboviruses. This study assessed the detection of clusters of urban arboviruses in the Rio de Janeiro state from 2010 to 2019. Notified cases of dengue, chikungunya, and Zika were grouped by year according to the onset of symptoms and their municipality of residence. The study period recorded the highest number of dengue epidemics in the state along with the simultaneous circulation of chikungunya and Zika viruses. The analyzes showed that the central municipalities of the metropolitan regions were associated with higher risk areas. Central municipalities in metropolitan regions were the first most likely clusters for dengue and Zika, and the second most likely cluster for chikungunya. Furthermore, the northwest and north regions were comprised clusters with the highest relative risk for the three arboviruses, underscoring the impact of these arboviruses in less densely populated regions of Brazil. The identification of high-risk areas over time highlights the need for effective control measures, targeted prevention and control interventions for these urban arboviral diseases.

Clinical Diagnosis of Chikungunya Infection: An Essential Aid in a Primary Care Setting Where Serological Confirmation Is Not Available.

BACKGROUND: Chikungunya virus (CHIKV) diagnosis has become a challenge for primary care physicians in areas where the Zika virus and/or Dengue virus are present. Case definitions for the three arboviral infections overlap. METHODS: A cross-sectional analysis was carried out. A bivariate analysis was made using confirmed CHIKV infection as the outcome. Variables with significant statistical association were included in an agreement consensus. Agreed variables were analyzed in a multiple regression model. The area under the receiver operating characteristic (ROC) curve was calculated to determine a cut-off value and performance. RESULTS: 295 patients with confirmed CHIKV infection were included. A screening tool was created using symmetric arthritis (4 points), fatigue (3 points), rash (2 points), and ankle joint pain (1 point). The ROC curve identified a cut-off value, and a score ≥ 5.5 was considered positive for identifying CHIKV patients with a sensibility of 64.4% and a specificity of 87.4%, positive predictive value of 85.5%, negative predictive value of 67.7%, area under the curve of 0.72, and an accuracy of 75%. CONCLUSION: We developed a screening tool for CHIKV diagnosis using only clinical symptoms as well as proposed an algorithm to aid the primary care physician.

Vector Competence of Culex quinquefasciatus from Brazil for West Nile Virus.

West Nile virus is characterized as a neurotropic pathogen, which can cause West Nile fever and is transmitted by mosquitoes of the genus Culex. In 2018, the Instituto Evandro Chagas performed the first isolation of a WNV strain in Brazil from a horse brain sample. The present study aimed to evaluate the susceptibility of orally infected Cx. quinquefasciatus from the Amazon region of Brazil to become infected and transmit the WNV strain isolated in 2018. Oral infection was performed with blood meal artificially infected with WNV, followed by analysis of infection, dissemination, and transmission rates, as well as viral titers of body, head, and saliva samples. At the 21st dpi, the infection rate was 100%, the dissemination rate was 80%, and the transmission rate was 77%. These results indicate that Cx. quinquefasciatus is susceptible to oral infection by the Brazilian strain of WNV and may act as a possible vector of the virus since it was detected in saliva from the 21st dpi.

Caracterización clínica y epidemiológica del dengue 2015-2020 Hospital Regional de la Orinoquía ESE / Clinical and epidemiological characterization of Dengue 2015-2020 Hospital Regional de la Orinoquía ESE

Resumen Introducción: el dengue es una infección viral, transmitida principalmente por Aedes aegypti, se considera un evento de interés en salud pública y es una de las arbovirosis más importante a nivel mundial en términos de morbimortalidad e impacto económico. Materiales y métodos: se realizó un estudio observacional, descriptivo y retrospectivo. Se incluyó a toda la población con diagnóstico confirmado de dengue atendidos en el Hospital Regional de la Orinoquía ESE entre 2015 y 2020. La base de datos se registró en Excel® versión 2013 y se analizó en el paquete estadístico SPSS versión 22. Resultados: pacientes con diagnóstico confirmado 3395, el 51 % (1735) corresponden a dengue sin signos de alarma, 47 % (1599) a dengue con signos de alarma y el 2 % (61) dengue grave, la edad promedio 20 años, entre nueve (9) meses a 94 años, la letalidad correspondió al0,2 %. Conclusiones: el dengue afecta a toda la población, continúa siendo una enfermedad emergente y de interés en salud publica en todos los países del mundo. En Colombia es una causa importante de morbimortalidad en todos los grupos etarios, se debe continuar estudiando su comportamiento y seguir reforzando las políticas públicas de prevención.

Abstract Introduction: Dengue is a viral infection, transmitted meanly by Aedes aegypti, it is considered like event of interest in public health. On the other hand, the arboviral disease is one of the most important to worldwide in terms of morbidity, mortality, and economic impact. Materials and methods: an observational, descriptive, retrospective, and retrospective study was made which including population with confirmed diagnosis of dengue treated at the Hospital Regional de la Orinoquía ESE between 2015 and 2020. The database was recorded in Excel version 2013 and was analyzed in statistical package SPSS version 22. Results: 3395 patients were confirmed with diagnosis of dengue, 51 % (n =1735) belong to dengue without warning signs, 47 % (n =1599) to dengue with warning signs and 2 % (n =61) severe dengue. The average age was 20 years old; the age ranges were like minimum nine (9) months and maximum 94 years old. The mortality corresponded to 0,2 %. Conclusions: Dengue affects the entire population and continues to being an emerging disease of interesting in public health around the world. In Colombia is an important cause of morbidity and mortality in all age groups, which mean that the behavior of this disease must continue to being studied. And in the end the prevention public politics must be reinforced.

Dengue, chikungunya, and Zika virus infections in Latin America and the Caribbean: a systematic review.

Objectives: To characterize the distribution profile of dengue, chikungunya, and Zika virus infections in Latin America and the Caribbean and to identify possible factors associated with the risk of dissemination and severity of these arboviruses. Methods: The protocol of this review was registered on the PROSPERO platform. Searches were carried out in the following databases: Virtual Health Library, MEDLINE/PubMed, and Embase. The search terms were: Zika virus, Zika virus infection, dengue, dengue virus, chikungunya virus, chikungunya fever, epidemiology, observational study, Latin America, and Caribbean region. Studies that addressed the distribution of these arboviruses and the risk factors associated with dengue, Zika virus disease, and chikungunya, published between January 2000 and August 2020 in English, Portuguese, and Spanish, were included. Results: Of 95 studies included, 70 identified risk factors, clinical manifestations, and outcomes for arbovirus infections and 25 described complications and/or deaths. The highest frequency of confirmed cases was for dengue. Brazil reported most cases of the three arboviruses in the period analyzed. Environmental and socioeconomic factors facilitated the proliferation and adaptation of vectors, and host-related factors were reported to aggravate dengue. Most deaths were due to chikungunya, Zika virus disease caused most neurological alterations, and dengue resulted in greater morbidity leading to more frequent hospitalization. Conclusions: The review provides a broad view of the three arboviruses and the intrinsic aspects of infections, and highlights the factors that influence the spread of these viruses in the populations studied.

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

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

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

Dengue, chikungunya, and Zika virus infections in Latin America and the Caribbean: a systematic review / Infecciones por dengue, chikungunya y el virus de Zika en América Latina y el Caribe: revisión sistemática / Dengue, zika e chikungunya na América Latina e no Caribe: revisão sistemática

ABSTRACT Objectives. To characterize the distribution profile of dengue, chikungunya, and Zika virus infections in Latin America and the Caribbean and to identify possible factors associated with the risk of dissemination and severity of these arboviruses. Methods. The protocol of this review was registered on the PROSPERO platform. Searches were carried out in the following databases: Virtual Health Library, MEDLINE/PubMed, and Embase. The search terms were: Zika virus, Zika virus infection, dengue, dengue virus, chikungunya virus, chikungunya fever, epidemiology, observational study, Latin America, and Caribbean region. Studies that addressed the distribution of these arboviruses and the risk factors associated with dengue, Zika virus disease, and chikungunya, published between January 2000 and August 2020 in English, Portuguese, and Spanish, were included. Results. Of 95 studies included, 70 identified risk factors, clinical manifestations, and outcomes for arbovirus infections and 25 described complications and/or deaths. The highest frequency of confirmed cases was for dengue. Brazil reported most cases of the three arboviruses in the period analyzed. Environmental and socioeconomic factors facilitated the proliferation and adaptation of vectors, and host-related factors were reported to aggravate dengue. Most deaths were due to chikungunya, Zika virus disease caused most neurological alterations, and dengue resulted in greater morbidity leading to more frequent hospitalization. Conclusions. The review provides a broad view of the three arboviruses and the intrinsic aspects of infections, and highlights the factors that influence the spread of these viruses in the populations studied.

RESUMEN Objetivos. Caracterizar el perfil de distribución de infecciones por dengue, chikungunya y el virus de Zika en América Latina y el Caribe, y determinar posibles factores relacionados con el riesgo de propagación y gravedad de estas arbovirosis. Métodos. Se registró el protocolo de esta revisión en la plataforma PROSPERO. Se realizaron búsquedas en las siguientes bases de datos: Virtual Health Library, MEDLINE/PubMed y Embase. Los términos de búsqueda fueron: "zika virus" [virus del Zika], "zika virus infection" [infección por el virus del Zika], "dengue", "dengue virus" [virus del dengue], "chikungunya virus" [virus del chikunguña], "chikungunya fever" [fiebre de chikunguña], "epidemiology" [epidemiología], "observational study" [estudio observacional], "Latin America" [América Latina] y "Caribbean región" [Caribe]. Se incluyeron estudios que abordaban la distribución de estas arbovirosis y los factores de riesgo asociados con el dengue, la enfermedad por el virus del Zika y el chikunguña, publicados entre enero del 2000 y agosto del 2020 en español, inglés y portugués. Resultados. De los 95 estudios incluidos, 70 establecieron factores de riesgo, manifestaciones clínicas y resultados de las infecciones por arbovirus y 25 describieron complicaciones o muertes. La mayor frecuencia de casos confirmados fue del dengue. Brasil notificó la mayoría de los casos de infección por los tres arbovirus en el período analizado. Los factores ambientales y socioeconómicos facilitaron la proliferación y adaptación de los vectores, y se notificó que los factores relacionados con el huésped agravaban el dengue. El chikunguña causó la mayor parte de las muertes, la enfermedad por el virus del Zika causó la mayor parte de las alteraciones neurológicas y el dengue fue responsable de una mayor morbilidad, lo que llevó a una hospitalización más frecuente. Conclusiones. Esta revisión ofrece un panorama de las tres arbovirosis y de los aspectos intrínsecos de las infecciones, y pone de relieve los factores que influyen en la propagación de estos virus en las poblaciones estudiadas.

RESUMO Objetivos. Descrever a distribuição das arboviroses causadas pelo vírus da dengue, zika e chikungunya na América Latina e no Caribe e identificar possíveis fatores associados ao potencial de disseminação e à gravidade dessas infecções. Métodos. O protocolo desta revisão sistemática foi registado na plataforma PROSPERO. Foram realizadas buscas nas bases de dados Biblioteca Virtual em Saúde, MEDLINE/PubMed e Embase. Os termos de busca foram: vírus zika, infecção pelo vírus zika, dengue, vírus da dengue, vírus chikungunya, febre chikungunya, epidemiologia, estudo observacional, América Latina e região do Caribe. Foram selecionados estudos publicados em inglês, português e espanhol, entre janeiro de 2000 e agosto de 2020, que tratavam da distribuição desses arbovírus e de fatores de risco associados à dengue, à infecção pelo vírus zika e à febre chikungunya. Resultados. Dos 95 estudos selecionados, 70 descreveram fatores de risco, manifestações clínicas e desfechos das arboviroses e 25 destacaram as complicações e/ou mortes. Houve uma maior taxa de casos confirmados de dengue. O Brasil foi o país onde se registrou a maioria dos casos dessas três arboviroses no período analisado. Fatores ambientais e socioeconômicos facilitaram a proliferação e a adaptação dos vetores dos arbovírus e fatores próprios do hospedeiro são determinantes na gravidade da dengue. As mortes ocorreram principalmente nos casos de febre chikungunya, as manifestações neurológicas foram mais comuns na infecção pelo vírus zika e a dengue resultou em maior morbidade e internação hospitalar. Conclusões. Esta revisão sistemática oferece um panorama destas três arboviroses e de suas peculiaridades destacando os fatores que influenciam a disseminação destes arbovírus nas populações estudadas.

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

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

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

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

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

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

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