Increased number of deaths during a chikungunya epidemic in Pernambuco, Brazil

Brito, Carlos; Teixeira, Maria Glória

doi:10.1590/0074-02760170124

Cited by 32 publications

(34 citation statements)

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“…Throughout Asia and the Americas, chikungunya virus outbreaks have been associated with unique clinical features [11], including long-lasting symptoms [12], and high mortality resulting from complications associated with CHIKV infection [13, 14]. In Brazil, a striking proportion of 68.1 to 75% of the population with positive serological results reporting symptoms contracted a chronic form of the disease [12, 15].…”

Section: Introductionmentioning

confidence: 99%

Chikungunya virus outbreak in the Amazon region: replacement of the Asian genotype by an ECSA lineage

Naveca

Claro

Giovanetti

et al. 2018

Preprint

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48 49 50 51 52 Corresponding authors: luiz.alcantara@ioc.fiocruz.br and nuno.faria@zoo.ox.ac.uk 3 53 Abstract 54 Background 55 Since its first detection in the Caribbean in late 2013, chikungunya virus (CHIKV) has 56 affected 51 countries in the Americas. The CHIKV epidemic in the Americas was 57 caused by the CHIKV-Asian genotype. In August 2014, local transmission of the 58 CHIKV-Asian genotype was detected in the Brazilian Amazon region. However, a 59 distinct lineage, the CHIKV-East-Central-South-America (ECSA)-genotype, was 60 detected nearly simultaneously in Feira de Santana, Bahia state, northeast Brazil. The 61 genomic diversity and the dynamics of CHIKV in the Brazilian Amazon region 62 remains poorly understood despite its importance to better understand the 63 epidemiological spread and public health impact of CHIKV in the country. 64 65 Methodology/Principal Findings 66 We report a large CHIKV outbreak (5,928 notified cases between August 2014 and 67 August 2018) in Boa vista municipality, capital city of Roraima's state, located in the 68 Brazilian Amazon region. In just 48 hours, we generated 20 novel CHIKV-ECSA 69 genomes from the Brazilian Amazon region using MinION portable genome 70 sequencing. Phylogenetic analyses revealed that despite an early introduction of the 71 Asian genotype in 2015 in Roraima, the large CHIKV outbreak in 2017 in Boa Vista 72 was caused by an ECSA-lineage most likely introduced from northeastern Brazil. 73 Epidemiological analyses suggest a basic reproductive number of R 0 of 1.66, which 74 translates in an estimated 39 (95% CI: 36 to 45) % of Roraima's population infected 75 with CHIKV-ECSA. Finally, we find a strong association between Google search 76 activity and the local laboratory-confirmed CHIKV cases in Roraima. 77 78 Conclusions/Significance 79 This study highlights the potential of combining traditional surveillance with portable 80 genome sequencing technologies and digital epidemiology to inform public health 81 surveillance in the Amazon region. Our data reveal a large CHIKV-ECSA outbreak in 82 Boa Vista, limited potential for future CHIKV outbreaks, and indicate a replacement 83 of the Asian genotype by the ECSA genotype in the Amazon region. 84 85 4 86 Author Summary 87 Until the end of 2017, Brazil notified the highest number of infections caused by 88 chikungunya virus (CHIKV) in the Americas. We investigated a large CHIKV 89 outbreak in Boa vista municipality in the Brazilian Amazon region. Rapid portable 90 genome sequencing of 20 novel isolates and subsequent genetic analysis revealed that 91 ECSA lineage was introduced from northeastern Brazil to Roraima around July 2016. 92 Epidemiological analyses suggest a basic reproductive number of R 0 of 1.66, which 93 suggests that approximately 39% of Roraima's population was infected with CHIKV-94 ECSA. Given the dominance of the CHIKV-Asian genotype in the Americas, our data 95 highlights the rapid spread of a less understood and poorly characterized CHIKV-96 ECSA genotype in Brazil. Investigations on p...

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Section: Introductionmentioning

confidence: 99%

Chikungunya virus outbreak in the Amazon region: replacement of the Asian genotype by an ECSA lineage

Naveca

Claro

Giovanetti

et al. 2018

Preprint

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“…There was no extreme weather phenomenon in Jamaica in 2014[25], neither a significant circulation of dengue virus or other arboviruses on that island in 2014 [26], there was also no intense circulation of influenza virus [27], which is known to lead to an increase in overall mortality even in tropical countries [28]. Studies on excess of mortality in Brazil have found a number of deaths above that identified by passive, conventional epidemiological surveillance [24,29].…”

Section: Discussionmentioning

confidence: 99%

Excess deaths associated with the chikungunya epidemic of 2014 in Jamaica were higher among children under 5 and over 40 years of age, an analysis based on official data

Freitas

Donalísio

2017

Preprint

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Excess deaths associated with the chikungunya epidemic of 2014 in Jamaica were higher among children under 5 and over 40 years of age, an analysis based on official data. Running title:Mortality associated chikungunya Jamaica Title:Excess deaths associated with the chikungunya epidemic of 2014 in Jamaica were higher among children under 5 and over 40 years of age, an analysis based on official data. peer-reviewed) is the author/funder. It is made available under a The copyright holder for this preprint (which was not . http://dx.doi.org/10.1101/227579 doi: bioRxiv preprint first posted online Dec. 8, 2017; Abstract:We assessed the excess of all causes of mortality by age groups during the chikungunya epidemics in Jamaica, 2014. Excess mortality was estimated by subtracting deaths observed in 2014 from that expected based on the average mortality rate of 2012-2013, with confidence interval of 99%.Overall mortality 91.9 / 100,000 population, 2,499 additional deaths than expected coincided with the peak of the epidemic, there was a strong correlation between the monthly incidence and the excess of deaths (Spearman Rho = 0.939; p <0.005). No other significant epidemiological phenomenon occurred on that island that could explain this increase in mortality. Thus, we suggest that mortality associated with chikungunya is underestimated in Jamaica, as in other countries.The excess of deaths could be a strategic tool for the epidemiological surveillance of chikungunya as it has already been used in influenza and respiratory syncytial.

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“…In addition, there are atypical and severe forms that can compromise the nervous system. The atypical manifestations and the presence of concurrent diseases, especially in the elderly, have been related to the higher lethality of chikungunya in Brazil 30 .…”

Section: Emerging and Re-emerging Arbovirusesmentioning

confidence: 99%

Conquistas do SUS no enfrentamento das doenças transmissíveis

Teixeira

Costa

Paixão

et al. 2018

Ciênc. saúde coletiva

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This article presents the development of the epidemiological situation of some of the major communicable diseases (CD) in Brazil, with emphasis on the interventions by the SUS and other social policies. The data and information were collected from Datasus, epidemiological newsletters from the Brazilian Ministry of Health, and scientific articles on the issue. The universalization, decentralization and expansion of the surveillance, control and prevention of CD has produced an impact on the morbidity and mortality of these diseases, mainly those which are vaccine-preventable. The emergence and re-emergence of three arboviruses, for which there are no effective control instruments, interrupted the downward trend in the morbidity profile of CD in Brazil. Other social and economic programs, which are geared to the needier sectors of the Brazilian population, have also contributed to the improvement of the analyzed health indicators. However, the universalization of access to healthcare services, as well as improvements in the scope of the surveillance of diseases and health risks, has played a key role in improving the health and quality of life of the population, as well as contributing to the process of the democratization of Brazil.

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Increased number of deaths during a chikungunya epidemic in Pernambuco, Brazil

Cited by 32 publications

References 6 publications

Chikungunya virus outbreak in the Amazon region: replacement of the Asian genotype by an ECSA lineage

Chikungunya virus outbreak in the Amazon region: replacement of the Asian genotype by an ECSA lineage

Excess deaths associated with the chikungunya epidemic of 2014 in Jamaica were higher among children under 5 and over 40 years of age, an analysis based on official data

Conquistas do SUS no enfrentamento das doenças transmissíveis

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