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Zika virus displacement by a chikungunya outbreak in Recife, Brazil.
PLoS Negl Trop Dis. 2017 Nov; 11(11):e0006055.PN

Abstract

BACKGROUND

Several 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.

METHODS

Two 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.

RESULTS

Quantitative 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.

CONCLUSIONS

In 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.

Authors+Show Affiliations

Laboratory of Virology and Experimental Therapeutics, Aggeu Magalhaes Institute (Instituto Aggeu Magalhães-IAM), Oswaldo Cruz Foundation (Fundação Oswaldo Cruz-FIOCRUZ), Recife, Brazil. Arthropod-borne and infectious Diseases Laboratory (AIDL), Department of Microbiology, Immunology and Pathology, Colorado State University (CSU), Fort Collins, United States of America.Department of Parasitology, IAM, FIOCRUZ, Recife, Brazil. Institute of Integral Medicine Professor Fernando Figueira (Instituto de Medicina Integral Professor Fernando Figueira-IMIP), Recife, Brazil.Laboratory of Virology and Experimental Therapeutics, Aggeu Magalhaes Institute (Instituto Aggeu Magalhães-IAM), Oswaldo Cruz Foundation (Fundação Oswaldo Cruz-FIOCRUZ), Recife, Brazil.Statistics and Geoprocessing Laboratory, IAM, FIOCRUZ, Recife, Brazil.Laboratory of Virology and Experimental Therapeutics, Aggeu Magalhaes Institute (Instituto Aggeu Magalhães-IAM), Oswaldo Cruz Foundation (Fundação Oswaldo Cruz-FIOCRUZ), Recife, Brazil. Faculty of Medical Science, University of Pernambuco (Universidade de Pernambuco-UPE), Recife, Brazil.Urgent Health Care Unit (Unidade de Pronto Atendimento-UPA) of Paulista, IMIP, Paulista, Brazil.Urgent Health Care Unit (Unidade de Pronto Atendimento-UPA) of Paulista, IMIP, Paulista, Brazil.Urgent Health Care Unit (Unidade de Pronto Atendimento-UPA) of Paulista, IMIP, Paulista, Brazil.Urgent Health Care Unit (Unidade de Pronto Atendimento-UPA) of Paulista, IMIP, Paulista, Brazil.Urgent Health Care Unit (Unidade de Pronto Atendimento-UPA) of Paulista, IMIP, Paulista, Brazil.Institute of Integral Medicine Professor Fernando Figueira (Instituto de Medicina Integral Professor Fernando Figueira-IMIP), Recife, Brazil.Laboratory of Virology and Experimental Therapeutics, Aggeu Magalhaes Institute (Instituto Aggeu Magalhães-IAM), Oswaldo Cruz Foundation (Fundação Oswaldo Cruz-FIOCRUZ), Recife, Brazil.Laboratory of Virology and Experimental Therapeutics, Aggeu Magalhaes Institute (Instituto Aggeu Magalhães-IAM), Oswaldo Cruz Foundation (Fundação Oswaldo Cruz-FIOCRUZ), Recife, Brazil.Section Clinical Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany.Section Clinical Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany. German Centre for Infection Research (DZIF), partner site Heidelberg, Heidelberg, Germany.Laboratory of Virology and Experimental Therapeutics, Aggeu Magalhaes Institute (Instituto Aggeu Magalhães-IAM), Oswaldo Cruz Foundation (Fundação Oswaldo Cruz-FIOCRUZ), Recife, Brazil. Center for Vaccine Research, University of Pittsburgh, Pittsburgh, United States of America.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29108009

Citation

Magalhaes, Tereza, et al. "Zika Virus Displacement By a Chikungunya Outbreak in Recife, Brazil." PLoS Neglected Tropical Diseases, vol. 11, no. 11, 2017, pp. e0006055.
Magalhaes T, Braga C, Cordeiro MT, et al. Zika virus displacement by a chikungunya outbreak in Recife, Brazil. PLoS Negl Trop Dis. 2017;11(11):e0006055.
Magalhaes, T., Braga, C., Cordeiro, M. T., Oliveira, A. L. S., Castanha, P. M. S., Maciel, A. P. R., Amancio, N. M. L., Gouveia, P. N., Peixoto-da-Silva, V. J., Peixoto, T. F. L., Britto, H., Lima, P. V., Lima, A. R. S., Rosenberger, K. D., Jaenisch, T., & Marques, E. T. A. (2017). Zika virus displacement by a chikungunya outbreak in Recife, Brazil. PLoS Neglected Tropical Diseases, 11(11), e0006055. https://doi.org/10.1371/journal.pntd.0006055
Magalhaes T, et al. Zika Virus Displacement By a Chikungunya Outbreak in Recife, Brazil. PLoS Negl Trop Dis. 2017;11(11):e0006055. PubMed PMID: 29108009.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Zika virus displacement by a chikungunya outbreak in Recife, Brazil. AU - Magalhaes,Tereza, AU - Braga,Cynthia, AU - Cordeiro,Marli T, AU - Oliveira,Andre L S, AU - Castanha,Priscila M S, AU - Maciel,Ana Paula R, AU - Amancio,Nathalia M L, AU - Gouveia,Pollyanne N, AU - Peixoto-da-Silva,Valter J,Jr AU - Peixoto,Thaciana F L, AU - Britto,Helena, AU - Lima,Priscilla V, AU - Lima,Andreza R S, AU - Rosenberger,Kerstin D, AU - Jaenisch,Thomas, AU - Marques,Ernesto T A, Y1 - 2017/11/06/ PY - 2017/05/20/received PY - 2017/10/19/accepted PY - 2017/11/21/revised PY - 2017/11/7/pubmed PY - 2017/12/5/medline PY - 2017/11/7/entrez SP - e0006055 EP - e0006055 JF - PLoS neglected tropical diseases JO - PLoS Negl Trop Dis VL - 11 IS - 11 N2 - BACKGROUND: Several 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. METHODS: Two 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. RESULTS: Quantitative 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. CONCLUSIONS: In 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. SN - 1935-2735 UR - https://www.unboundmedicine.com/medline/citation/29108009/Zika_virus_displacement_by_a_chikungunya_outbreak_in_Recife_Brazil_ L2 - https://dx.plos.org/10.1371/journal.pntd.0006055 DB - PRIME DP - Unbound Medicine ER -