Risk of chronic arthralgia and impact of pain on daily activities in a cohort of patients with chikungunya virus infection from Brazil

Objectives: To investigate risk factors for persistent arthralgia in patients with chikungunya, and describe its impact on daily activities. Methods: From September 2014 to July 2016, a surveillance study enrolled patients with acute febrile illness in Salvador, Brazil, and detected those with chikungunya virus infection using IgM enzyme-linked immunosorbent assay or reverse transcriptase polymerase chain reaction. Telephone follow-ups were performed to ascertain the progression of disease. Results: Of 153 followed cases, 65 (42.5%) reported chronic arthralgia that lasted >3 months, and 47 (30.7%) were still symptomatic at the time of the interview (approximately 1.5 years after symptom onset). Limitations in daily activities and mental distress were reported by 93.8% and 61.5% of those with chronic arthralgia, respectively. Female sex [risk ratio (RR) 1.79, 95% confidence interval (CI) 1.95–2.69] and age (RR 1.02 for each 1-year increase, 95% CI 1.01–1.03) were independent risk factors for chronic arthralgia. Chronic arthralgia was not associated with co-infection with dengue virus (RR 0.97, 95% CI 0.48–1.94) or chikungunya viral load at diagnosis (median chikungunya virus RNA of 5.60 and 5.52 log10 copies/μL for those with and without chronic arthralgia, respectively; P = 0.75). Conclusions: These findings reinforce the high frequency of chronic chikungunya arthralgia, and highlight the substantial disability associated with the persistence of pain. Development of novel strategies to mitigate the transmission of chikungunya virus and to provide long-term medical assistance for patients with chikungunya are needed urgently.Fil: Silva, Monaíse M. O.. Fundación Oswaldo Cruz; BrasilFil: Kikuti, Mariana. Universidade Federal da Bahia; Brasil. Fundación Oswaldo Cruz; BrasilFil: Anjos, Rosângela O.. Fundación Oswaldo Cruz; BrasilFil: Portilho, Moyra M.. Fundación Oswaldo Cruz; BrasilFil: Santos, Viviane C.. Fundación Oswaldo Cruz; BrasilFil: Gonçalves, Thaiza S.F.. Fundación Oswaldo Cruz; BrasilFil: Tauro, Laura Beatriz. Fundación Oswaldo Cruz; Brasil. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Moreira, Patrícia S. S.. Fundación Oswaldo Cruz; BrasilFil: Jacob Nascimento, Leile C.. Fundación Oswaldo Cruz; BrasilFil: Santana, Perla M.. Fundación Oswaldo Cruz; BrasilFil: Campos, Gúbio S.. Universidade Federal da Bahia; BrasilFil: Siqueira, André M.. Fundación Oswaldo Cruz; BrasilFil: Kitron, Uriel D.. University of Emory; Estados Unidos. Fundación Oswaldo Cruz; BrasilFil: Reis, Mitermayer G.. University of Yale; Estados Unidos. Fundación Oswaldo Cruz; Brasil. Universidade Federal da Bahia; BrasilFil: Ribeiro, Guilherme S.. Fundación Oswaldo Cruz; Brasil. Universidade Federal da Bahia; Brasi

Predominance of Rotavirus Genotype G9 during the 1999, 2000, and 2002 Seasons among Hospitalized Children in the City of Salvador, Bahia, Brazil: Implications for Future Vaccine Strategies

Two hundred eight of 648 (32%) diarrheal stool samples collected from hospitalized children under 5 years of age during a 3-year period (1999, 2000, and 2002) in the city of Salvador, in the state of Bahia, Brazil, were rotavirus positive. One hundred sixty-four of 208 (78.8%) rotavirus-positive samples had genotype G9 specificity, predominantly in association with P[8]. Other specificities detected were G1 (12.0%) and G4 (1.4%). Viruses with G2, G3, or P[4] specificity were not detected. Rotavirus genotype G9 predominated during each of the three seasons studied; it represented 89.2% of rotavirus strains detected in 1999, 85.3% in 2000, and 74.5% in 2002. G1 viruses (the globally most common G type) have a unique epidemiological characteristic of maintaining predominance during multiple consecutive rotavirus seasons. We have shown in this study for the first time that the G9 viruses also have a similar epidemiological characteristic, albeit for a shorter period of surveillance. The next generation of rotavirus vaccines will need to provide adequate protection against disease caused by G9 viruses

High-Quality Resolution of the Outbreak-Related Zika Virus Genome and Discovery of New Viruses Using Ion Torrent-Based Metatranscriptomics

Arboviruses, including the Zika virus, have recently emerged as one of the most important threats to human health. The use of metagenomics-based approaches has already proven valuable to aid surveillance of arboviral infections, and the ability to reconstruct complete viral genomes from metatranscriptomics data is key to the development of new control strategies for these diseases. Herein, we used RNA-based metatranscriptomics associated with Ion Torrent deep sequencing to allow for the high-quality reconstitution of an outbreak-related Zika virus (ZIKV) genome (10,739 nt), with extended 5′-UTR and 3′-UTR regions, using a newly-implemented bioinformatics approach. Besides allowing for the assembly of one of the largest complete ZIKV genomes to date, our strategy also yielded high-quality complete genomes of two arthropod-infecting viruses co-infecting C6/36 cell lines, namely: Alphamesonivirus 1 strain Salvador (20,194 nt) and Aedes albopictus totivirus-like (4618 nt); the latter likely represents a new viral species. Altogether, our results demonstrate that our bioinformatics approach associated with Ion Torrent sequencing allows for the high-quality reconstruction of known and unknown viral genomes, overcoming the main limitation of RNA deep sequencing for virus identification

Accuracy of the SD BIOLINE Dengue Duo for rapid point-of-care diagnosis of dengue.

BACKGROUND:Rapid diagnosis tests (RDTs) are easy to carry out, provide fast results, and could potentially guide medical treatment decisions. We investigated the performance of a commercially available RDT, which simultaneously detects the non-structural 1 (NS1) dengue virus (DENV) antigen, and IgM and IgG DENV antibodies, using representative serum samples from individuals in a dengue endemic area in Salvador, Brazil. METHODOLOGY/PRINCIPAL FINDINGS:We evaluated the accuracy of the SD BIOLINE Dengue Duo RDT (Abbott, Santa Clara, USA; former Alere Inc, Waltham, USA) in a random collection of sera. Samples included acute-phase sera from 246 laboratory-confirmed dengue cases and 108 non-dengue febrile patients enrolled in a surveillance study for dengue detection, 73 healthy controls living in the same surveillance community, and 73 blood donors. RDT accuracy was blindly assessed based on the combined results for the NS1 and the IgM test components. The RDT sensitivity was 46.8% (38.6% for the NS1 component and 13.8% for the IgM component). Sensitivity was greater for samples obtained from patients with secondary DENV infections (49.8%) compared to primary infections (31.1%) (P: 0.02) and was also influenced by the result in the confirmatory dengue diagnostic test, ranging from 39.7% for samples of cases confirmed by IgM-ELISA seroconversion between paired samples to 90.4% for samples of cases confirmed by a positive NS1-ELISA. The RDT specificity was 94.4% for non-dengue febrile patients, 87.7% for the community healthy controls, and 95.9% for the blood donors. CONCLUSIONS/SIGNIFICANCE:The SD BIOLINE Dengue Duo RDT showed good specificities, but low sensitivity, suggesting that it may be more useful to rule in than to rule out a dengue diagnosis in dengue endemic regions

Does immunity after Zika virus infection cross-protect against dengue?

Zika and dengue viruses are closely related flaviviruses, with immunological interactions and identical urban, mosquito-borne transmission.1Therefore, the recent introduction of Zika virus into the Americas and large-scale exposure of a uniformly previously unexposed population could affect subsequent transmission of dengue virus. This hypothesis had been untested, largely because sufficient epidemiological data were not available from affected locations. We explored this hypothesis in Salvador, the fourth largest city in Brazil (population 2·9 million), where extensive transmission of dengue viruses 1–42,3occurred before the introduction and spread of Zika virus in 2015.Fil: Ribeiro, Guilherme Sousa. Universidade Federal da Bahia; Brasil. Fundación Oswaldo Cruz; BrasilFil: Kikuti, Mariana. Fundación Oswaldo Cruz; Brasil. Universidade Federal da Bahia; BrasilFil: Tauro, Laura Beatriz. Fundación Oswaldo Cruz; Brasil. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Nascimento, Leile Camila J.. Fundación Oswaldo Cruz; BrasilFil: Cardoso, Cristiane W.. Secretaria Municipal de Saúde de Salvador; BrasilFil: Campos, Gúbio S.. Universidade Federal da Bahia; BrasilFil: Ko, Albert I.. Fundación Oswaldo Cruz; Brasil. University of Yale; Estados UnidosFil: Weaver, Scott C.. University of Texas Medical Branch; Estados UnidosFil: Reis, Mitermayer G.. Fundación Oswaldo Cruz; Brasil. Universidade Federal da Bahia; BrasilFil: Kitron, Uriel D.. University of Emory; Estados Unidos. Fundación Oswaldo Cruz; BrasilFil: Paploski, Igor A. D.. Universidade Federal da Bahia; BrasilFil: Silva, Monaise M. O.. Fundación Oswaldo Cruz; BrasilFil: Kasper, Amelia M.. Universidade Federal da Bahia; BrasilFil: Tavares, Aline S.. Fundación Oswaldo Cruz; BrasilFil: Cruz, Jaqueline S.. Fundación Oswaldo Cruz; BrasilFil: Moreira, Patrícia S. S.. Universidade Federal da Bahia; BrasilFil: Anjos, Rosângela O.. Fundación Oswaldo Cruz; BrasilFil: Araújo, Josélio M. G.. Universidade Federal do Rio Grande do Norte; BrasilFil: Khouri, Ricardo. Fundación Oswaldo Cruz; BrasilFil: Sardi, Silvia I.. Universidade Federal da Bahia; Brasi

Analyses of Early ZIKV Genomes Are Consistent with Viral Spread from Northeast Brazil to the Americas

The Americas, particularly Brazil, were greatly impacted by the widespread Zika virus (ZIKV) outbreak in 2015 and 2016. Efforts were made to implement genomic surveillance of ZIKV as part of the public health responses. The accuracy of spatiotemporal reconstructions of the epidemic spread relies on the unbiased sampling of the transmission process. In the early stages of the outbreak, we recruited patients exhibiting clinical symptoms of arbovirus-like infection from Salvador and Campo Formoso, Bahia, in Northeast Brazil. Between May 2015 and June 2016, we identified 21 cases of acute ZIKV infection and subsequently recovered 14 near full-length sequences using the amplicon tiling multiplex approach with nanopore sequencing. We performed a time-calibrated discrete phylogeographic analysis to trace the spread and migration history of the ZIKV. Our phylogenetic analysis supports a consistent relationship between ZIKV migration from Northeast to Southeast Brazil and its subsequent dissemination beyond Brazil. Additionally, our analysis provides insights into the migration of ZIKV from Brazil to Haiti and the role Brazil played in the spread of ZIKV to other countries, such as Singapore, the USA, and the Dominican Republic. The data generated by this study enhances our understanding of ZIKV dynamics and supports the existing knowledge, which can aid in future surveillance efforts against the virus