Zika Virus Outbreak in Rio de Janeiro, Brazil: Clinical Characterization, Epidemiological and Virological Aspects.
Zika Virus Outbreak in Rio de Janeiro, Brazil: Clinical Characterization, Epidemiological and Virological Aspects.
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DOI：
10.1371/journal.pntd.0004636
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发表时间：
2016-04
影响因子：
3.8
通讯作者：
Jaenisch T
中科院分区：
文献类型：
--
作者：
Brasil P;Calvet GA;Siqueira AM;Wakimoto M;de Sequeira PC;Nobre A;Quintana Mde S;Mendonça MC;Lupi O;de Souza RV;Romero C;Zogbi H;Bressan Cda S;Alves SS;Lourenço-de-Oliveira R;Nogueira RM;Carvalho MS;de Filippis AM;Jaenisch T
2015年，巴西面临着三种具有重大公共卫生意义的虫媒病毒的共同传播。寨卡病毒（ZIKV）的出现给临床医生和公共卫生当局带来了新的挑战。由ZIKV、登革热（DENV）和基孔肯雅热（CHIKV）引起的疾病之间的重叠临床特征以及缺乏针对ZIKV的经验证的血清学测定使得准确诊断困难。Fiocruz的急性发热性疾病门诊服务于2007年启动了一项综合征临床观察研究，以捕获DENV感染的不寻常表现。2015年1月，观察到患发性疾病的病例增加。经过培训的医生使用详细的病例报告表（包括临床评估和实验室检查）对患者进行评价。实验室诊断算法包括用于检测ZIKV、CHIKV和DENV的测定。2015年1月至7月期间，根据临床标准确定了364例寨卡病毒病疑似病例。其中，262例（71.9%）进行了检测，119例（45.4%）通过检测ZIKV RNA确认。所有具有可用序列信息的样品都聚集在亚洲基因型内。这是里约热内卢州首次报告ZIKV疫情，基于大量疑似病例（n = 364）和实验室确诊病例（n = 119）。我们能够证明ZIKV早在2015年1月就在里约热内卢流行。2015年5月/6月记录了疫情的高峰。超过一半的患者报告了头痛、关节痛、肌痛、非化脓性结膜炎和下背痛，这与泛美卫生组织（PAHO）发布的疑似ZIKV疾病的病例定义一致。然而，发热，当存在时，是低强度和短期的。在我们看来，瘙痒症，第二个最常见的临床症状所提出的确诊病例，应增加到泛美卫生组织的病例定义，而发热可以给予较少的重视。2015年，ZIKV作为巴西的一种新病原体出现，强调了临床警惕和强有力的流行病学和实验室监测的必要性。寨卡病毒（ZIKV）于2015年首次在巴西被发现，引起了一种以皮疹和无发热或低热为特征的疾病的爆发。基于急性临床表现难以区分ZIKV与登革热（DENV）或（CHIKV）。该病毒与DENV密切相关，因此由于交叉反应性，抗体测试也存在区分两种病毒的问题。最近的研究结果表明，少数ZIKV病例可能会出现神经系统疾病，并且在怀孕期间报告患有ZIKV样疾病的母亲所生的婴儿可能患有先天性异常，在许多情况下是小头或大脑。在这里，我们报告了2015年上半年在里约热内卢爆发的ZIKV疾病，该疾病在2015年5月/6月达到高峰。这是第一次公开描述ZIKV在拉丁美洲爆发。值得注意的是，确诊病例早在2015年1月就出现了。根据对患者血液中病毒基因组的检测，确诊病例。证实病例和未证实病例的临床特征非常相似。已建议将瘙痒或瘙痒性皮疹添加到泛美卫生组织（PAHO）发布的病例定义中。
In 2015, Brazil was faced with the cocirculation of three arboviruses of major public health importance. The emergence of Zika virus (ZIKV) presents new challenges to both clinicians and public health authorities. Overlapping clinical features between diseases caused by ZIKV, Dengue (DENV) and Chikungunya (CHIKV) and the lack of validated serological assays for ZIKV make accurate diagnosis difficult. The outpatient service for acute febrile illnesses in Fiocruz initiated a syndromic clinical observational study in 2007 to capture unusual presentations of DENV infections. In January 2015, an increase of cases with exanthematic disease was observed. Trained physicians evaluated the patients using a detailed case report form that included clinical assessment and laboratory investigations. The laboratory diagnostic algorithm included assays for detection of ZIKV, CHIKV and DENV. 364 suspected cases of Zika virus disease were identified based on clinical criteria between January and July 2015. Of these, 262 (71.9%) were tested and 119 (45.4%) were confirmed by the detection of ZIKV RNA. All of the samples with sequence information available clustered within the Asian genotype. This is the first report of a ZIKV outbreak in the state of Rio de Janeiro, based on a large number of suspected (n = 364) and laboratory confirmed cases (n = 119). We were able to demonstrate that ZIKV was circulating in Rio de Janeiro as early as January 2015. The peak of the outbreak was documented in May/June 2015. More than half of the patients reported headache, arthralgia, myalgia, non-purulent conjunctivitis, and lower back pain, consistent with the case definition of suspected ZIKV disease issued by the Pan American Health Organization (PAHO). However, fever, when present, was low-intensity and short-termed. In our opinion, pruritus, the second most common clinical sign presented by the confirmed cases, should be added to the PAHO case definition, while fever could be given less emphasis. The emergence of ZIKV as a new pathogen for Brazil in 2015 underscores the need for clinical vigilance and strong epidemiological and laboratory surveillance. Zika virus (ZIKV) has been identified in 2015 in Brazil for the first time, causing outbreaks of an illness characterized by skin rash and absent or low grade and short-termed fever. It is difficult to distinguish ZIKV from Dengue (DENV) or (CHIKV) based on the acute clinical presentation. The virus is closely related to DENV, and therefore antibody tests also have problems distinguishing between the two viruses due to cross-reactivity. Recent findings suggest that in a minority of ZIKV cases neurological disease can develop, and that babies born from mothers reporting a ZIKV-like illness during pregnancy may suffer from congenital abnormalities, in many cases a small head or brain. Here we report about an outbreak of ZIKV disease in Rio de Janeiro in the first half of the year 2015, which reached its peak in May/June 2015. This is the first published description of a ZIKV outbreak in Latin America. It is interesting to note that confirmed cases appeared as early as January 2015. Cases were confirmed based on the detection of the viral genome in the blood of the patients. The clinical characterization of the confirmed cases and unconfirmed cases proved to be very similar. Itching or itching rash has been suggested to be added to the case definition issued by the Pan American Health Organization (PAHO).