Zika virus displacement by a chikungunya outbreak in Recife, Brazil
Zika virus displacement by a chikungunya outbreak in Recife, Brazil
复制标题
DOI：
10.1371/journal.pntd.0006055
复制
发表时间：
2017-11-01
影响因子：
3.8
通讯作者：
Marques, Ernesto T. A.
中科院分区：
文献类型：
--
作者：
Magalhaes, Tereza;Braga, Cynthia;Marques, Ernesto T. A.
巴西东北部流行由伊蚊传播的几种虫媒病毒，包括登革热病毒（DENV）、寨卡病毒（ZIKV）和基孔肯雅病毒（CHIKV）。由这些病毒引起的疾病具有重大的公共卫生相关性，然而，在这三种病毒共同传播的地区，它们的流行病学特征很少。在这里，我们对2015年5月至2016年5月在巴西累西腓招募的急性发热患者的前瞻性研究进行了分子和血清学诊断分析。方法选取巴西东北部累西腓大都会区一家紧急卫生保健诊所就诊的263例有虫媒病毒性疾病症状的急性发热患者。收集了急性期和恢复期血液样本，并采用分子和血清学方法检测DENV、ZIKV和CHIKV感染。结果急性期血清定量实时逆转录聚合酶链反应（qRTPCR）检测无DENV阳性，但ZIKV阳性26例（9.9%），CHIKV阳性132例（50.2%）。有几例疑似登革热病例，只有一例确诊病例。对ZIKV和CHIKV的特异性血清学分析证实了qRTPCR数据。在qRTPCR结果的背景下，对DENV IgM和IgG elisa分析表明，zikv阳性样本中存在高水平的交叉反应抗体。中和试验的结果与qRTPCR和ZIKV ELISA的结果高度吻合，表明DENV阳性病例很少。在研究的头几个月，寨卡病毒感染暂时聚集在一起，并在2015年8月随着寨卡病毒感染的增加而开始减少。2015年9月，CHIKV感染比例显著增加，并一直保持在较高水平，直到研究期结束，2015年8月至2016年5月，平均84.7%的招募患者被诊断出来。寨卡病毒感染呈现女性偏倚，病例分布在整个研究点；而寨卡病毒感染呈现男性偏倚，病例分布在每个月的空间聚集。结论2015 +/- 2016年累西腓大都市区发现了基孔肯雅热疫情取代的寨卡疫情的尾部。在此期间，尽管该地区官方通报了大量登革热病例，但发现的登革热病例很少。我们在这里展示了这些病例的重要流行病学特征。
BackgroundSeveral arboviruses, including dengue virus (DENV), Zika virus (ZIKV) and chikungunya virus (CHIKV), transmitted by Aedes mosquitoes, circulate in northeast Brazil. Diseases caused by these viruses are of great public health relevance, however, their epidemiological features in areas where the three viruses co-circulate are scarce. Here, we present analyses of molecular and serological diagnostics in a prospective study of acute febrile patients recruited from May 2015 to May 2016 in Recife, Brazil.MethodsTwo hundred sixty-three acute febrile patients with symptoms suggestive of an arboviral disease who attended an urgent heath care clinic in the Recife Metropolitan Region in northeast Brazil were enrolled. Acute and convalescent blood samples were collected and tested using molecular and serological assays for infection with DENV, ZIKV and CHIKV.ResultsQuantitative real-time reverse-transcriptase polymerase chain reactions (qRTPCR) performed on acute phase sera detected no patients positive for DENV, but 26 (9.9%) positive for ZIKV and 132 (50.2%) positive for CHIKV. There were a few suspected and only one confirmed dengue case. Specific serological assays for ZIKV and CHIKV confirmed the qRTPCR data. Analyses of DENV IgM and IgG ELISAs in the context of qRTPCR results suggested high levels of cross reactive antibodies in ZIKV-positive samples. Results from neutralization assays highly corroborated those from qRTPCR and ZIKV ELISA, indicating very few positive DENV cases. ZIKV infections were temporally clustered in the first months of the study and started to decrease concomitantly with an increase in CHIKV infections in August 2015. The proportion of CHIKV infections increased significantly in September 2015 and remained high until the end of the study period, with an average of 84.7% of recruited patients being diagnosed from August 2015 to May 2016. ZIKV infections exhibited a female bias and the cases were spread over the study site, while CHIKV cases had a male bias and were spatially clustered in each month.ConclusionsIn 2015 +/- 2016 in the Recife Metropolitan Region, we detected the tail end of a Zika epidemic, which was displaced by a chikungunya epidemic. Few dengue cases were identified despite a high number of official dengue notifications in the area during this period. We show here important epidemiological features of these cases.