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A CLINICAL-ECOLOGICAL STUDY OF A TRIPLE VIRAL EPIDEMIC: ZIKA, DENGUE AND CHIKUNGUNYA
Alternative title
Um estudo clínico-ecológico de uma tripla epidemia viral: Zika, Dengue e ChikungunyaAuthor
Affilliation
University of Grande Rio. Postgraduate Program in Translational Biomedicine. Department of Health. Duque de Caxias, Rio de Janeiro, Brazil.
University of Grande Rio. Faculty of Veterinary Medicine. Department of Health. Duque de Caxias, Rio de Janeiro, Brazil.
University of Grande Rio. Faculty of Veterinary Medicine. Department of Health. Duque de Caxias, Rio de Janeiro, Brazil.
University of Grande Rio. Faculty of Medicine. Department of Health. Duque de Caxias, Rio de Janeiro, Brazil.
University of Grande Rio. Faculty of Medicine. Department of Health. Duque de Caxias, Rio de Janeiro, Brazil.
University of Grande Rio. Faculty of Medicine. Department of Health. Duque de Caxias, Rio de Janeiro, Brazil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Cardiology National Institute. Rio de Janeiro, RJ, Brazil.
University of Grande Rio. Postgraduate Program in Translational Biomedicine. Department of Health. Duque de Caxias, Rio de Janeiro, Brazil.
University of Grande Rio. Faculty of Veterinary Medicine. Department of Health. Duque de Caxias, Rio de Janeiro, Brazil.
University of Grande Rio. Faculty of Veterinary Medicine. Department of Health. Duque de Caxias, Rio de Janeiro, Brazil.
University of Grande Rio. Faculty of Medicine. Department of Health. Duque de Caxias, Rio de Janeiro, Brazil.
University of Grande Rio. Faculty of Medicine. Department of Health. Duque de Caxias, Rio de Janeiro, Brazil.
University of Grande Rio. Faculty of Medicine. Department of Health. Duque de Caxias, Rio de Janeiro, Brazil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Cardiology National Institute. Rio de Janeiro, RJ, Brazil.
University of Grande Rio. Postgraduate Program in Translational Biomedicine. Department of Health. Duque de Caxias, Rio de Janeiro, Brazil.
Abstract in Portuguese
No Brasil, desde 2015, a co-circulação de três arbovírus, Dengue (DENV), Chikungunya
(CHIKV) e Zika (ZIKV), tem apresentado desafios diagnósticos, devido a suas
manifestações clínicas semelhantes. Nosso objetivo era analisar casos de doença arboviral
usando características clínicas chave e verificar índices de infestação domiciliar (HII) na
área de estudo. Um total de 28.064 prontuários médicos foram analisados por critérios
clínico-epidemiológicos para DENV, ZIKV e CHIKV em 2015 e 2016 na unidade de
saúde pública em Xerem, Duque de Caxias, Rio de Janeiro. A coleta de vetores em locais
de reprodução domiciliar em Xerem foi realizada para determinar o HII, em março e
junho de 2015. O número total de casos de suspeita de doença arboviral em 2015 foi de
969, dos quais 444 (45,8%) eram devidos ao DENV, 146 (15,1%) ao ZIKV, e 11 (1,1%)
ao CHIKV. Em 2016, o número de casos suspeitos de doença arboviral foi 2019, dos
quais 324 (16,0%) foram classificados como DENV, 779 (38,6%) como ZIKV, e 53
(2,60%) como CHIKV. As manifestações clínicas prevalecentes em ZIKV eram erupção
cutânea (67,8% a 79,5%) e prurido (63,7% a 71,4%). O HII para as fases imaturas do
Aedes na área de estudo, em março e junho de 2015, foi de 11,8% para Ae. aegypti e
8,1% para Ae. albopictus, ambos muito elevados. Observou-se uma forte correlação
positiva para a precipitação e HII para ambos os vetores (Ae. aegypti e Ae. albopictus),
mas não para os níveis de temperatura. Concluímos que uma tripla epidemia ocorreu na
área estudada provavelmente devido às altas taxas de infestação e uma população ingênua
para os dois arbovírus recém-introduzidos; enquanto não há testes laboratoriais
específicos disponíveis, um trabalho prático de diagnóstico clínico é crucial.
Abstract
In Brazil, since 2015, co-circulation of three arboviruses, Dengue (DENV), Chikungunya
(CHIKV) and Zika (ZIKV), have presented diagnostic challenges, due to their similar
clinical manifestations. Our goal was to analyze cases of arboviral illness using key
clinical features and to ascertain house infestation indices (HII) in the study area. A total
of 28,064 medical records were analyzed by clinical-epidemiological criteria for DENV,
ZIKV and CHIKV in 2015 and 2016 at the public health unit in Xerem, Duque de Caxias,
Rio de Janeiro. The collection of vectors at home breeding sites in Xerem was performed
to determine the HII, in March and June 2015. The total number of cases of suspected
arboviral illness in 2015 was 969, of which 444 (45.8%) were due to DENV, 146 (15.1%)
to ZIKV, and 11 (1.1%) to CHIKV. In 2016, the number of suspected cases of arboviral
illness was 2019, of which 324 (16.0%) were classified as DENV, 779 (38.6%) as ZIKV,
and 53 (2.60%) as CHIKV. The clinical manifestations prevalent in ZIKV were rash
(67.8% to 79.5%) and pruritus (63.7% to 71.4%). The HII for the immature stages of
Aedes in the study area, in March and June 2015, was 11.8% for Ae. aegypti and 8.1% for
Ae. albopictus, both very high. There was a strong positive correlation observed for
precipitation and HII for both vectors (Ae. aegypti and Ae. albopictus), but not for
temperature levels. We conclude that a triple epidemic occurred in the studied area
probably due to the high infestation rates and a naive population for the two newly
introduced arboviruses; whilst there are no available specific laboratory tests a practical
clinical diagnosis workout is crucial.
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