Human rabies in Brazil : a descriptive study, 2000-2017

Objetivo: descrever o perfil epidemiológico da raiva humana no Brasil. Métodos: estudo descritivo dos casos de raiva humana notificados em 2000-2017; estimou-se a incidência e distribuição espacial. Resultados: 188 casos humanos observados, na maioria homens (66,5%), residentes rurais (67,0%), menores de 15 anos de idade (49,6%), com exposição mais frequente por mordedura (81,9%); o período 2000-2008 apresentou maior frequência (85,6%), com 46,6% dos casos envolvendo cães e 45,9% morcegos; incubação mediana de 50 dias, seguida de sintomatologia predominante de febre (92,6%), agitação (85,2%), parestesia (66,7%) e disfagia/paralisia (51,9%); a maioria (70,2%) não fez profilaxia, os demais (29,8%) realizaram-na de forma inoportuna e/ou incompleta; 13 pacientes foram tratados pelo Protocolo de Recife e dois sobreviveram. Conclusão: houve redução na incidência de raiva humana e mudança no perfil epidemiológico, predominando casos transmitidos por morcegos; sugere-se investigar casos secundários e viabilizar a profilaxia pré-exposição em populações sob maior risco de acidentes com morcegos.Objective: to describe the epidemiological profile of human rabies in Brazil. Methods: this is a descriptive study of human rabies cases reported in 2000-2017, with an estimate of incidence and spatial distribution. Results: 188 cases were studied, mostly males (66.5%), rural residents (67.0%), children under 15 years (49.6%), with biting being the most frequent form of exposure (81.9%); frequency was highest in the period 2000-2008 (85.6%), with 46.6% of cases involving dogs and 45.9% bats; median incubation was 50 days, followed by, predominantly, symptoms of fever (92.6%), agitation (85.2%), paresthesia (66.7%), and dysphagia/paralysis (51.9%); the majority (70.2%) did not have prophylaxis and for the rest (29.8%) who did have prophylaxis, it was untimely and/or incomplete; 13 patients were treated according to the Recife Protocol, and two survived. Conclusion: human rabies incidence reduced and its epidemiological profile changed, with predominance of cases transmitted by bats; we suggest that secondary cases be investigated, and that pre-exposure prophylaxis be made available to populations at greater risk of accidents involving bats.Objetivo: describir el perfil epidemiológico de la rabia humana en Brasil. Métodos: descripción de los casos en 2000-2017, con estimación de la incidencia y distribución espacial. Resultados: se observaron 188 casos humanos, la mayoría de hombres (66,5%), residentes rurales (67,0%), menores de 15 años de edad (49,6%), con exposición más frecuente por mordedura (81,9%); el período 2000-2008 presentó mayor frecuencia (85,6%), con un 46,6% de los casos involucrando a perros y 45,9% a murciélagos; la incubación promedio fue de 50 días, seguida de sintomatología predominante de fiebre (92,6%), agitación (85,2%), parestesia (66,7%) y disfagia/parálisis (51,9%); la mayoría (70,2%) no hizo profilaxis y los demás (29,8%) la realizaron de forma inoportuna y/o incompleta; se trataron 13 pacientes con el Protocolo de Recife y dos sobrevivieron. Conclusión: hubo reducción en la incidencia de rabia humana y cambio en el perfil epidemiológico, predominando casos transmitidos por murciélagos; se sugiere investigar casos secundarios y viabilizar la profilaxis preexposición en poblaciones de mayor riesgo a accidentes por murciélagos

Frequency of histopathological changes in Howler monkeys ( Alouatta sp.) naturally infected with yellow fever virus in Brazil

Abstract: INTRODUCTION: Due to the importance that Howler monkeys have on the yellow fever (YF) epidemiological sylvatic cycle in Brazil, more accurate morphological diagnostic criteria needs to be established, especially considering the differences that may exist between the genera of Brazilian non-human primates (NHPs) involved in yellow fever virus (YFV) epizootics. METHODS: Records of YF epizootics in NHPs in Brazil between 2007 and 2009 were obtained from the Brazilian Ministry of Health database to select YF positive (n=98) Howler monkeys (Alouatta sp.) for this study. The changes described in the histopathological reports were categorized by organ and their frequencies calculated. RESULTS: The most frequent lesions observed in the animals with YF were hepatocyte apoptosis (Councilman body formation), midzonal hepatocyte necrosis, steatosis, liver hemorrhage, inflammatory mononuclear cell infiltration of the liver, renal acute tubular necrosis and interstitial nephritis. Midzonal hepatocyte necrosis, steatosis and hemorrhage presented positive correlations with apoptosis of hepatocytes, suggesting strong YFV pathogenic effect association; they were also the main histopathological changes in the Alouatta sp. A pronounced negative correlation between apoptosis of hepatocytes and hepatic mononuclear cell infiltration pointed to significant histopathological differences between YFV infection in Howler monkeys and humans. CONCLUSIONS: The results warn that NHPs may exhibit different response patterns following YFV infection and require a more careful diagnosis. Presumptive diagnosis based on primate histopathological lesions may contribute to public health service control

The surveillance of non-humam primates and the sylvatic yellow fever in Brazil

Submitted by Luanna Matias ([email protected]) on 2015-03-17T11:06:01Z No. of bitstreams: 2 Tese - Alessandro Pecego Martins Romano - 2012.pdf: 2327686 bytes, checksum: 033dd453809133aad159a6730bbcab88 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5)Approved for entry into archive by Luanna Matias ([email protected]) on 2015-03-17T11:10:04Z (GMT) No. of bitstreams: 2 Tese - Alessandro Pecego Martins Romano - 2012.pdf: 2327686 bytes, checksum: 033dd453809133aad159a6730bbcab88 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5)Made available in DSpace on 2015-03-17T11:10:04Z (GMT). No. of bitstreams: 2 Tese - Alessandro Pecego Martins Romano - 2012.pdf: 2327686 bytes, checksum: 033dd453809133aad159a6730bbcab88 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2012-09-19This study sought to describe the use of surveillance of non-human primates in surveillance of Sylvatic Yellow Fever and evaluate the usefulness in the prevention of human cases in Brazil. The epizootic surveillance began its records in 1999 and expanded the activity and the number of notifications after 2006, when the deaths or illnesses of nonhuman primates came to be considered an event of epidemiological relevance and therefore compulsory notification, as currently defines the ordinance 104/GM/MS/2011. 2748 epidemics were recorded in non-human primates in Brazil. The confirmation of yellow fever occurred in 8.8% of notifications. It was characteristic of yellow fever during the study period, two epizootic epidemic periods, with dispersal occurring from areas of Northern and central west with subsequent spread to the South and Southeast regions. During the study period yellow fever hit areas unvaccinated populations where the activity of epizootic surveillance helped to identify affected areas preventing human cases were recorded. The surveillance of NHP revealed the involvement of other infectious agents possibly involved in epizootics reported and highlights the potential contribution of this surveillance strategy for other infectious causes of public health importance and has been identified as seropositive for other arboviruses in primate populations in free life, demonstrating that this surveillance strategy animal may be useful to other map areas of occurrence of other arboviruses. The surveillance strategy allowed animals to detect areas of circulation of YF virus and direct vaccination campaigns, especially in outbreak situations, preventing human cases of the disease and demonstrating its utility and contribution to the monitoring of YF. This monitoring strategy can be enhanced by broadening their purposes as may possibly contribute to the surveillance of other diseases as an important interface of human and animal health.Este estudo buscou descrever o uso da vigilância de primatas não humanos na vigilância da Febre Amarela Silvestre e avaliar a utilidade na prevenção de casos humanos no Brasil. A vigilância de epizootias iniciou seus registros em 1999 e ampliou a atividade assim como o número de notificações depois de 2006, quando a morte ou adoecimentos de primatas não humanos passou a ser considerado um evento de relevância epidemiológica e, portanto, de notificação compulsória, conforme atualmente define a portaria 104/GM/MS/2011. Foram registradas 2.748 epizootias de primatas não humanos no Brasil. A confirmação para a febre amarela ocorreu em 8,8% das notificações. Foi característica da febre amarela no período do estudo, dois períodos epizoóticos epidêmicos, com dispersão das áreas de ocorrência a partir do norte e centro oeste com disseminação posterior para as regiões sudeste e sul. No período do estudo a febre amarela atingiu áreas de populações não vacinadas, na qual a atividade de vigilância de epizootias contribuiu para identificar áreas afetadas evitando que casos humanos fossem registrados. A vigilância de primatas não humanos revelou a participação de outros agentes etiológicos possivelmente envolvidos nas epizootias notificadas e destaca o potencial de contribuição dessa ferramenta de vigilância para outras causas infecciosas de importância em saúde pública assim como quando foi identificada sorologia reagente para outros arbovírus em populações de primatas em vida livre, demonstrando que essa estratégia de vigilância animal pode ser útil para outras arboviroses com importância em saúde pública. A estratégia de vigilância animal permitiu detectar áreas de circulação do vírus da FA e orientar as campanhas de vacinação, principalmente, em situações de surto, prevenindo casos humanos da doença e demonstrando sua utilidade e contribuição para a vigilância da FA. Essa estratégia de vigilância pode ser aprimorada ampliando as suas finalidades já que possivelmente pode contribuir para a vigilância de outras doenças como importante interface da saúde humana e animal

Seasonality of agricultural exposure as an important predictor of seasonal yellow fever spillover in Brazil

Yellow fever virus (YFV) is an arbovirus affecting humans and non-human primates (NHPs) with seasonal transmission. Here Hamlet et al. model the monthly occurrence of YF in humans and NHPs across Brazil and show that seasonality of agriculture is an important predictor of seasonal YF transmission

Frequência de alterações histopatológicas em macacos-macacos (Alouatta sp.) Infectados naturalmente com o vírus da febre amarela no Brasil

Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Brasília, DF, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Brasília, DF, Brasil.Universidade de Brasília. Faculdade de Agronomia e Veterinária. Brasília, DF, Brasil.Universidade de Brasília. Faculdade de Agronomia e Veterinária. Brasília, DF, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Universidade de Brasília. Faculdade de Agronomia e Veterinária. Brasília, DF, Brasil.Introduction: Due to the importance that howler monkeys have on the yellow fever (YF) epidemiological sylvatic cycle in Brazil, more accurate morphological diagnostic criteria needs to be established, especially considering the differences that may exist between the genera of Brazilian non-human primates (NHPs) involved in yellow fever virus (YFV) epizootics. Methods: Records of YF epizootics in NHPs in Brazil between 2007 and 2009 were obtained from the Brazilian Ministry of Health database to select YF positive (n=98) Howler monkeys (Alouatta sp.) for this study. The changes described in the histopathological reports were categorized by organ and their frequencies calculated. Results: The most frequent lesions observed in the animals with YF were hepatocyte apoptosis (Councilman body formation), midzonal hepatocyte necrosis, steatosis, liver hemorrhage, infl ammatory mononuclear cell infi ltration of the liver, renal acute tubular necrosis and interstitial nephritis. Midzonal hepatocyte necrosis, steatosis and hemorrhage presented positive correlations with apoptosis of hepatocytes, suggesting strong YFV pathogenic effect association; they were also the main histopathological changes in the Alouatta sp. A pronounced negative correlation between apoptosis of hepatocytes and hepatic mononuclear cell infi ltration pointed to signifi cant histopathological differences between YFV infection in Howler monkeys and humans. Conclusions: The results warn that NHPs may exhibit different response patterns following YFV infection and require a more careful diagnosis. Presumptive diagnosis based on primate histopathological lesions may contribute to public health service control

Yellow Fever Outbreaks in Unvaccinated Populations, Brazil, 2008–2009

<div><p>Due to the risk of severe vaccine-associated adverse events, yellow fever vaccination in Brazil is only recommended in areas considered at risk for disease. From September 2008 through June 2009, two outbreaks of yellow fever in previously unvaccinated populations resulted in 21 confirmed cases with 9 deaths (case-fatality, 43%) in the southern state of Rio Grande do Sul and 28 cases with 11 deaths (39%) in Sao Paulo state. Epizootic deaths of non-human primates were reported before and during the outbreak. Over 5.5 million doses of yellow fever vaccine were administered in the two most affected states. Vaccine-associated adverse events were associated with six deaths due to acute viscerotropic disease (0.8 deaths per million doses administered) and 45 cases of acute neurotropic disease (5.6 per million doses administered). Yellow fever vaccine recommendations were revised to include areas in Brazil previously not considered at risk for yellow fever.</p></div

Evolution of geographic risk classification for yellow fever vaccination recommendations in Brazil, 2001–2010.

<p>Evolution of geographic risk classification for yellow fever vaccination recommendations in Brazil, 2001–2010.</p

Yellow-fever vaccine associated serious adverse events during outbreak response vaccination in Brazil, 2008–2009.

<p>* Cases per million yellow fever vaccine doses administered during outbreak response.</p><p>**Includes 22-day old infant with vaccine-associated neurologic disease following secondary transmission of yellow fever vaccine virus through breastfeeding <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002740#pntd.0002740-Traiber1" target="_blank">[35]</a>.</p

Patient characteristics, clinical findings and laboratory values for laboratory-confirmed yellow fever, Brazil, 2008–2009.

<p>*1 confirmed case reported yellow fever vaccination nine years earlier; excludes 3 case patients with yellow fever vaccination 1–2 days before onset of symptoms.</p