Background Chikungunya virus (CHIKV) emerged in the Americas in 2013 and has caused ~2.1 million cases and over 600 deaths. A retrospective investigation was undertaken to describe clinical, epidemiological and virus genomic features associated with deaths caused by CHIKV in Ceará state, northeast Brazil. Methods Sera, cerebrospinal fluid (CSF) and tissue samples from 100 fatal cases with suspected arbovirus infection were tested for CHIKV, dengue (DENV) and Zika virus (ZIKV). Clinical, epidemiological and death reports were obtained for patients with confirmed CHIKV infection. Logistic regression analysis was undertaken to identify independent factors associated with risk of death during CHIKV infection. Phylogenetic analysis was conducted using whole genomes from a subset of cases. Results 68 fatal cases had CHIKV infection confirmed by RT-qPCR (52.9%), viral antigen (41.1%), and/or specific-IgM (63.2%). Co-detection of CHIKV with DENV were found in 22% of fatal cases, ZIKV in 2.9%, and DENV and ZIKV in 1.5%. A total of 39 CHIKV-deaths presented with neurological signs and symptoms, and CHIKV-RNA was found in the CSF of 92.3% of these patients. Fatal outcomes were associated with irreversible multiple organ dysfunction syndrome. Patients with diabetes appear to die at a higher frequency during the sub-acute phase. Genetic analysis showed circulation of two CHIKV-East Central South African (ECSA) lineages in Ceará and revealed no unique virus genomic mutation associated with fatal outcome. Conclusion The investigation of the largest cross-sectional cohort of CHIKV-deaths to date reveals that CHIKV-ECSA strains can cause death in individuals from both risk and non-risk groups, including young adults.

Introduction: Chikungunya causes fever and severe and persistent joint pain. Methods: We reported a chikungunya outbreak that occurred in Ceará State, Brazil between 2016 and 2017 with emphasis on epidemiological characterization of cases, high number of deaths, mortality-associated factors, and spatial and temporal spread of the epidemic among municipalities. Results: In November 2015, the first autochthonous cases of chikungunya were confirmed in Ceará, Brazil. In 2016-2017, 195,993 cases were reported, with an incidence of 2,186.5/100,000 inhabitants and 244 confirmed deaths. Conclusions: Rapid transmission and high mortality rate are serious problems, especially in regions with co-circulating arboviruses.

A doença do novo Coronavírus (Covid-19) é causada pelo SARS-CoV-2 e representa o agente causador de uma doença potencialmente fatal que tem se revelado um problema de saúde pública global. A pandemia causada pelo Covid-19 tem causado prejuízos severos nos sistemas de saúde em diversos países. Diante do grande número de pessoas infectadas e da ausência de tratamento específico, várias nações têm enfrentado superlotação em seus hospitais. Com a confirmação de casos desta doença no Brasil, várias ações têm sido tomadas por gestores públicos e privados, tanto a nível hospitalar quanto em nível de atenção primária, a fim de minimizar os impactos para o Sistema Único de Saúde (SUS). O presente artigo apresenta uma breve análise do papel da atenção primária na luta contra o Covid-19 em âmbito nacional, além do impacto em saúde pública e das futuras perspectivas. Com base no grande número de pessoas infectadas no mundo e a experiência de diversos sistemas de saúde, torna-se imperativo a adaptação e adequação do SUS na condução de mecanismos de resposta para pandemia, sendo a atenção primária peça fundamental neste processo

BackgroundChikungunya (CHIK) is a viral disease transmitted by mosquitoes. The first cases in Brazil were confirmed in 2014. Between 2016 and 2017, over 300,000 cases were identified during this period, with nearly 300 deaths. The clinical manifestations, pathogenesis and risk factors for occurrence of severe cases are not yet well understood, although it is known that the severity of the cases is associated with the presence of comorbidities, especially diabetes mellitus (DM).ObjectiveTo review the medical literature for the associations between DM and CHIK and to understand the potential impact on metabolic state and its complications.MethodsLiterature review was carried out to search for articles (English, Portuguese and Spanish) in Medline and Virtual Health Library databases for the period between 1952 and 2017, with the following keywords: “Chikungunya fever”, “Chikungunya virus”, “diabetes mellitus”, “diabetes”, “diabetes complications “and “multi-morbidities (MeSH) “with interposition of the Boolean operator “AND”.ResultsAfter removal of duplicities and following exclusion criteria, 11 articles were selected. Our results showed that the patients of CHIK with DM had more severe and prolonged symptoms of CHIK and more frequently required hospitalization. No study investigated the biological process to explain how hyperglycemic state worsened the clinical manifestations of Chikungunya in diabetic patients.ConclusionAn important association between DM and the severity of CHIK is observed. Prospective and more rigorous controlled studies are required to generate evidence that might y elucidate the causes of this relationship. Given the fast expanding viral infection of Chikungunya in Central and South America, Asia and Africa in recent years in the context of exponential increase in diabetes globally, the issue deserves global attention.

Introdução: Embora os primeiros casos de dengue no estado do Ceará tenham ocorrido em 1986, há registros da presença do mosquito Aedes aegypti desde os anos de 1851/1852. Mesmo após 30 anos, a dengue permanece como um problema grave de saúde pública com epidemias cada vez mais frequentes. Objetivo: Resgatar, reunir e sintetizar a evidência científica produzida nos primeiros 30 anos de dengue no Ceará, contribuindo para melhorar sua compreensão e as intervenções de vigilância e controle. Métodos: Realizou-se uma revisão de literatura com busca de artigos (inglês, português e espanhol) nas bases de dados Pubmed, Scielo, Clinicalkey, Lilacs, Google Acadêmico e banco virtual de teses e dissertações da CAPES, além de livros. O período de 1986 a 2016 foi usado como limite de busca e a mesma foi realizada entre os meses de agosto a novembro de 2016. Utilizaram-se os descritores controlados: dengue, Ceará, Fortaleza e Aedes; com interposição do operador boleano “AND”. Resultados: Foram identificadas 574 publicações potencialmente elegíveis, sendo 461 artigos e 113 dissertações ou teses. Foram retirados 272 artigos duplicados ou que não atenderam aos critérios de inclusão. Foram lidos 114 artigos publicados em 60 revistas diferentes, sendo 72,8% artigos completos, 75,2% em inglês, 42,2% experimentais e 81,5% com abordagem quantitativa. Foi publicado apenas um artigo na década de 1980, já na década seguinte foram sete, número que cresceu bastante nos anos 2000, com 38 artigos. No entanto, já há 69 artigos publicados apenas na primeira metade da década de 2010. No período, o Ceará confirmou quase um milhão de casos de dengue, com a circulação dos quatro sorotipos (DENV1 - 1986, DENV2 - 1994, DENV3 - 2002 e DENV4 - 2011) e registrou pelo menos 14 epidemias. A partir de 2015, o Ceará passou a apresentar um cenário diferenciado de tripla epidemia, com a cocirculação autóctone de dois outros arbovírus: Chikungunya e Zika. Conclusão: Nesse período de 30 anos (1986-2016), o Ceará vivenciou várias epidemias de dengue, e, de certa forma, isto vem impulsionando a busca por respostas para o controle desta doença. Há claramente um crescimento em número de artigos publicados a cada ano, revelando a pujança dos grupos locais, que contribuiu de forma importante para a produção científica em diversos fatores relacionados à compreensão da epidemiologia e controle da dengue.

BackgroundChikungunya virus infection in neonates is relatively rare and can lead to death.Case presentationWe report the occurrence of the first death of a mother and child after probable vertical transmission of chikungunya virus in Brazil. A 28-year-old pregnant woman with hypertension presented with symptoms compatible with an arboviral disease at 34 weeks’ gestation. She developed preeclampsia with severe respiratory failure which resulted in the emergency cesarean section, and the patient died 12 days after the onset of symptoms. The pre-term newborn weighed 2535 g, with an Apgar score of 4/8. He was referred to the neonatal ICU with neutrophilia and thrombocytopenia, several seizure episodes, and hemorrhagic disorders, which resulted in death. Chikungunya IgM antibody was detected in the cerebrospinal fluid.ConclusionsWe present the first documented maternal and neonatal death in Brazil after probable chikungunya infection during pregnancy.

T2D-attributable deaths significantly increased compared to the previous data, which overlapped with CHIKV incidence. The pathophysiology of this association warrants further investigations.

Background The State of Ceará, in Northeastern Brazil, suffers from a triple burden of arboviruses (dengue, Zika and chikungunya). We measured the seroprevalence of chikungunya, dengue and Zika and its associated factors in the population of Juazeiro do Norte, Southern Ceará State, Brazil. Methods A cross-sectional study of analytical and spatial analysis was performed to estimate the seroprevalence of dengue, Zika and chikungunya, in the year 2018. Participants were tested for IgM and IgG against these three viruses. Those with IgM and/or IgG positive tests results were considered positive. Poisson regression was used to analyze the factors associated with positive cases, in the same way that the spatial analysis of positive cases was performed to verify whether the cases were grouped. Results Of the 404 participants, 25.0% (103/404) were positive for CHIKV, 92.0% (373/404) for flavivirus (dengue or Zika) and of these, 37.9% (153/404) samples were classified as probable dengue infection. Of those who reported having had an arbovirus in the past, positive CHIKV cases had 58.7% arthralgia (PR = 4.31; 95% CI: 2.06–9.03; p = 0.000) mainly in the hands, ankles and feet. Age over 60 years had a positive association with cases of flavivirus (PR = 1.29; 95% CI: 1.09–1.54; p = 0.000). Fever, muscle pain, joint pain and skin rash were the most reported symptoms (46.1, 41.0, 38.3 and 28.41%, respectively). The positive cases of chikungunya and dengue or Zika were grouped in space and the city center was most affected area. Conclusions Four years after the introduction of CHIKV, where DENV has been in circulation for over 30 years, 1/4 of the population has already been exposed, showing the extent of the epidemic. The measured prevalence was much higher than that reported by local epidemiological surveillance.