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      Introduction of the dengue virus type 4 in the State of Mato Grosso do Sul, Brazil Translated title: Introducción del serotipo de virus dengue 4 en el Estado de Mato Grosso do Sul, Brasil Translated title: Introdução do vírus dengue sorotipo 4 no Estado de Mato Grosso do Sul, Brasil

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          Abstract

          We report on the first isolation of dengue virus serotype 4 (DENV-4) in the State of Mato Grosso do Sul, Brazil, in February, 2012. The cases were isolated in the city of Campo Grande, the state capital, and presented the classic signs and symptoms of dengue fever. DENV-4 was primarily identified through viral isolation in C6/36 clone lineage of Aedes albopictus cells; followed by indirect immunofluorescence, using type-specific monoclonal antibodies. The results were subsequently confirmed by Nested RT-PCR tests. The first description of the introduction of DENV-4 in a state whose population is susceptible to this serotype and the circulation of three other serotypes in the area is cause for concern due to the increased possibility of severe and lethal cases of the disease, and of huge epidemics.

          Translated abstract

          Informe del primer aislamiento del serotipo del virus dengue 4 (DENV-4) en el Estado de Mato Grosso do Sul, Brasil, en febrero de 2012. Los casos fueron aislados en la ciudad de Campo Grande, capital del estado, y que presentan signos y síntomas de fiebre de dengue clásico. El DENV-4 se identificó principalmente a través de aislamiento viral en C6/36 con linaje de células de Aedes albopictus; seguido por inmunofluorescencia indirecta, utilizando anticuerpos monoclonales específicos de tipo. Después, fueron confirmados por pruebas de RT-PCR anidada. La descripción de la introducción del DENV-4 por primera vez en este estado, asociado a una población susceptible a este serotipo, y también la circulación de los otros tres serotipos en la zona es muy preocupante. La razón de esta preocupación es la mayor posibilidad de que se produzcan casos severos y letales de la enfermedad, así como, la aparición de grandes epidemias.

          Translated abstract

          Relatamos o primeiro isolamento do vírus dengue sorotipo 4 (DENV-4) no Estado de Mato Grosso do Sul, Brasil, em fevereiro de 2012. Os casos foram isolados na cidade de Campo Grande, capital do estado, e apresentaram sinais e sintomas clássicos da febre do dengue. O DENV-4 foi primeiramente identificado por isolamento viral em clone C6/36 linhagem de células de Aedes albopictus seguido por imunofluorescência indireta, utilizando anticorpos monoclonais tipo-específicos. Os resutlados foram posteriormente confirmados por testes de Nested RT-PCR. A descrição de sua introdução pela primeira vez neste estado, com população suscetível a este sorotipo e onde já circularam os outros três sorotipos é muito preocupante, pois aumenta a possibilidade de ocorrer formas graves e letais desta doença, assim como possibilita a ocorrência de grandes epidemias.

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          Most cited references 30

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          Dengue Virus Serotype 4, Roraima State, Brazil

          To the Editor: In July 2010, dengue virus serotype 4 (DENV-4) reemerged in Boa Vista, the capital of Roraima State, in northern Brazil (Figure, panel A), after an absence of 28 years (1). Cases were identified during late June in the municipalities of Boa Vista and Cantá. For all patients, the clinical course of disease was classic, and all recovered uneventfully. The most commonly reported signs and symptoms were fever, headache, chills, muscle and joint pains, rash, nausea and vomiting, and retro-ocular pain. Patient ages were 11–51 years (median 31 years); 5 patients were male. Figure A) Boa Vista, Roraima State, Brazil, showing the districts where dengue virus type 4 (DENV-4) was isolated. 1, Liberdade; 2, Buritis; 3, Cauamé; 4, Santa Tereza; 5, Cidade Satélite; 6, Dr. Silvio Leite; 7, Joquel Clube; 8, Sen. Hélio Campos. B) Phylogenetic analysis of the DENV-4 envelope gene sequences (in boldface) constructed by using the neighbor-joining method, showing the cluster formed by Boa Vista and Venenzuela DENV-4 genotype I strains. Bootstrap values were set for 1,000 replicates and are placed over each main node of the tree. ROR1982 represents the DENV-4 isolated in Roraima State during the 1982 epidemic. A to B1–B4 represent genotype I subclades. Thailand 1978 and Thailand 1985 strains represent the Asian genotype II. Scale bar corresponds to 1% nucleotide sequence divergence. Because of the clinical picture, dengue was suspected, and serum samples were collected and sent to Instituto Evandro Chagas for virus isolation. Of 10 DENV strains recovered, 9 were isolated into C6/36 cell samples as described elsewhere (2). Cytopathic effects were observed on days 5–7 postinfection, and virus isolation was confirmed by use of indirect immunofluorescent assay (3). Molecular approaches led to diagnosis of 10 cases. Viral RNA was recovered from infected cells in the supernatant by using a QIAquick viral RNA extraction kit (QIAGEN, Valencia, CA, USA); genome amplification was performed by using a 1-step reverse transcription–PCR (RT-PCR) (4) and 2 set of oligonucleotides designed to amplify the entire N gene in overlapping PCR products. PCR amplification was performed on 5 DENV strains, and the envelope gene (1,425 bp) was completely sequenced by the dideoxinucleotide terminator method for 3 strains (5) by using the same set of oligonucleotides as for the RT-PCR amplification. Phylogenetic analysis was performed by using the neighbor-joining method (6) and homologous sequences of different DENV-4 strains isolated in Central and South America (7,8). The Asian genotype II strains (Thailand 1978-U18441 and Thailand 1985-AY780644) were used as outgroups to give confidence to phylogenetic groupings. Phylogenetically, the DENV-4 strains grouped in genotype I and clustered with Venezuelan strains isolated from 2004 through 2007 (Brazil/Venezuela group) and were distantly related to strains isolated in Venezuela from 1998 through 2000. This result indicates that the current DENV-4 strains isolated in Roraima State were reintroduced to Brazil through Venezuela, where DENV-4 has circulated since the 1980s (1). This result also excludes the possibility that Asian genotypes previously circulated in Brazil. The DENV-4 strains isolated from patients in Roraima State in 2010 were genetically distinct from DENV-4 strains isolated in the 1980s (Figure, panel B). During the 2010 outbreak, cocirculation of DENV-1 and DENV-2 in addition to DENV-4 was demonstrated by virus isolation (68 strains) and RT-PCR amplification (genome detection in 39 strains). The municipality of Boa Vista, which has ≈266,901 inhabitants, reported 5,243 dengue cases (3,936 dengue fever, 259 severe dengue or dengue hemorrhagic fever) in 2010 (epidemiologic week 37), many of them diagnosed by serologic testing (9). These numbers represent an increase of 154% over the 2,066 cases reported in 2009 (10). DENV-4 had been introduced to Brazil through Boa Vista before the reemergence reported here; in 1982, DENV-1 and DENV-4 were described in Brazil, and a serologic survey estimated 11,000 dengue infections (1). After that outbreak, DENV-4 was eradicated and not again detected until the episode reported here. To monitor the circulation of DENV-4 in Roraima and other Brazilian states through the present date (epidemiologic week 48), strong serologic and virologic surveillance have been conducted; cases of this serotype have not been recognized outside Roraima State. As a preventive measure in Boa Vista, a total of 10,358 dwellings were visited and 18,305 larval Aedes aegypti mosquito foci were eliminated by spraying of mosquito adulticide. Nonetheless, as summer approaches in Brazil, a heavy rainy season is expected, and DENV-4 is a candidate to become a serious threat in the country. Therefore, the Ministry of Health has prepared a plan to investigate DENV-4 circulation; it calls for early detection of disease and adoption of control measures to avoid or minimize spread of this dengue serotype throughout the country.
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            Dengue in the State of Rio de Janeiro, Brazil, 1986-1998

            This paper presents epidemiological, laboratory, and clinical data on 12 years of dengue virus activity in the State of Rio de Janeiro from the time the disease was first confirmed virologically in April 1986 through April 1998. DEN-1 and DEN-2 viruses are the serotypes circulating in the state and were responsible for the epidemics reported during the last 12 years. The results published here show both the impact of dengue virus infections on the population and laboratory advances that have improved dengue diagnosis.
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              Dengue and dengue hemorrhagic fever epidemics in Brazil: what research is needed based on trends, surveillance, and control experiences?

              Dengue epidemics account annually for several million cases and deaths worldwide. The high endemic level of dengue fever and its hemorrhagic form correlates to extensive domiciliary infestation by Aedes aegypti and multiple viral serotype human infection. This study analyzed serial case reports registered in Brazil since 1981, describing incidence evolutionary patterns and spatial distribution. Epidemic waves followed the introduction of every serotype (DEN 1 to 3), and reduction in susceptible individuals possibly accounted for decreasing case frequency. An incremental expansion of affected areas and increasing occurrence of dengue fever and its hemorrhagic form with high case fatality were noted in recent years. In contrast, efforts based solely on chemical vector control have been insufficient. Moreover, some evidence demonstrates that educational measures do not permanently modify population habits. Thus, as long as a vaccine is not available, further dengue control depends on potential results from basic interdisciplinary research and intervention evaluation studies, integrating environmental changes, community participation and education, epidemiological and virological surveillance, and strategic technological innovations aimed to stop transmission.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                csp
                Cadernos de Saúde Pública
                Cad. Saúde Pública
                Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz (Rio de Janeiro )
                1678-4464
                August 2014
                : 30
                : 8
                : 1789-1792
                Affiliations
                [1 ] Universidade Federal do Mato Grosso do Sul Brasil
                [2 ] Laboratório Central de Saúde Pública Brasil
                Article
                S0102-311X2014000901789
                10.1590/0102-311X00003914
                25210917
                Product
                Product Information: website
                Categories
                Health Policy & Services

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