Socio-demographic, virological and clinical features of cases reported as suspected Zika virus Infections and factors associated with this arboviral infection in the state of Tocantins in 2015 and 2016

Em 2015 identificou-se no estado do Tocantins, endêmico para a infecção pelo vírus Dengue (DENV), a emergência do Zika vírus (ZIKV) e do vírus Chikungunya (CHIKV), motivando a realização deste estudo com objetivo de descrever as características sociodemográficas e clínicas dos casos notificados como suspeitos de infecção pelo ZIKV nos anos de 2015 e 2016 e identificar fatores associados à infecção por esse arbovírus. A partir dos registros de notificação e resultados de testes diagnósticos moleculares para ZIKV, DENV e CHIKV dos sistemas SINAN e GAL, identificaram-se 1.137 indivíduos, dos quais aproximadamente 40% apresentaram viremia por pelo menos 1 arbovírus e cerca de 2% se mostraram infectados por 2 ou mais desses agentes. Entre os monoinfectados não houve diferença em relação a características sociodemográficas. Todavia, do ponto de vista clínico, o prurido foi mais relatado nos indivíduos com zikavirose, quando comparados aos infectados pelo DENV, ao passo que a febre foi mais frequente nos participantes monoinfectados por DENV, quando comparados aos monoinfectados por ZIKV. Nos infectados pelo ZIKV, aqueles com 20 anos ou mais apresentaram frequência significativamente maior de mialgia, artralgia/artrite e conjuntivite, enquanto os menores de 20 anos apresentaram mais frequentemente febre; as mulheres apresentaram significativamente maior frequência de prurido e edema, quando comparadas aos homens e as gestantes relataram conjuntivite menos frequentemente do que mulheres em idade fértil não gestantes. Na análise multivariada, a infecção por ZIKV mostrou-se independentemente associada ao sexo feminino, à ausência de infecção por CHIKV, a tempo com sintomas inferior a 3 dias, à ocorrência de exantema e à ausência de relato de mialgia. A similitude de manifestações clínicas em infecções por arbovírus que cocirculam em uma mesma região e as características clínicas distintivas da zikavirose em diferentes grupos populacionais acarretam desafios à saúde pública e reforçam a necessidade de vigilância epidemiológica apoiada em recursos diagnósticos efetivos para subsidiar ações de prevenção e controle desses agravos na população residente e viajantesIn 2015 Zika virus (ZIKV) and Chikungunya virus (CHIKV) emerging infections were identified in the Brazilian state of Tocantins, an endemic area for Dengue virus (DENV). In such a scenario we conceived this study to describe socio-demographic and clinical features of patients reported as suspected Zika cases in 2015-2016 and to investigate factors associated with this arboviral infection. Based on notifications and results of molecular biology diagnostic tests for ZIKV, DENV e CHIKV available in the SINAN and GAL national databases, we identified 1.137 individuals, of whom about 40% exhibited viremia with at least one arbovirus and about 2% were infected with two or more of these agents. Among mono-infected patients there was no difference in socio-demographic characteristics. However, from a clinical point of view, itching was more often reported by patients with ZIKV infection as compared to those with dengue, whereas fever was more frequent among dengue patients as compared with their ZIKV-infected counterparts. Among ZIKV-infected individuals, those aged 20 or over presented myalgia, arthralgia/arthritis and conjunctivitis significantly more often, whereas those younger than 20 years old more frequently had fever; itching and edema were more often reported by women than men, and pregnant patients less frequently presented conjunctivitis as compared to non-pregnant women in fertile age. In multivariate analysis, ZIKV infection was independently associated with being female, reporting symptoms for less than 3 days, presenting rash and with not being CHIKV-infected or reporting myalgia. The fact that infections caused by different cocirculating arboviruses may present with similar clinical manifestations and that signs and symptoms of ZIKV infection may differ among population groups challenges public health and reinforces the need of epidemiological surveillance actions based on effective diagnostic resources to support control and prevention of these diseases in the local population and among traveler

Wuhan large pig roundworm virus identified in human feces in Brazil

We report here the complete genome sequence of a bipartite virus, herein denoted WLPRV/human/BRA/TO-34/201, from a sample collected in 2015 from a two-year-old child in Brazil presenting acute gastroenteritis. The virus has 98-99% identity (segments 2 and 1, respectively) with the Wuhan large pig roundworm virus (unclassified RNA virus) that was recently discovered in the stomachs of pigs from China. This is the first report of a Wuhan large pig roundworm virus detected in human specimens, and the second genome described worldwide. However, the generation of more sequence data and further functional studies are required to fully understand the ecology, epidemiology, and evolution of this new unclassified virus.FAPESPCNPqAdolfo Lutz Inst, Virol Ctr, Enter Dis Lab, Av Dr Arnaldo 355, BR-01246902 Sao Paulo, SP, BrazilFed Univ Para, Inst Biol Sci, Belem, Para, BrazilFac Med ABC, Postgrad Program Hlth Sci, Santo Andre, BrazilUniv Fed Sao Paulo, Retrovirol Lab, Sao Paulo, SP, BrazilUniv Sao Paulo, Fac Med, LIM 46, Sao Paulo, BrazilFed Univ Tocantins, Palmas, Tocantins, BrazilPubl Hlth Lab Tocantins State LACEN TO, Palmas, BrazilUniv Sao Paulo, Inst Trop Med, Av Dr Eneas de Carvalho Aguiar 470, BR-05403000 Sao Paulo, SP, BrazilBlood Syst Res Inst, San Francisco, CA USAUniv Calif San Francisco, Dept Lab Med, San Francisco, CA 94143 USAUniv Fed Sao Paulo, Retrovirol Lab, Sao Paulo, SP, BrazilFAPESP: 2015/12944-9FAPESP: 2017/00021-9FAPESP: 2016/01735-2CNPq: 400354/2016-0Web of Scienc

Plasma virome of 781 Brazilians with unexplained symptoms of arbovirus infection include a novel parvovirus and densovirus.

Plasma from patients with dengue-like symptoms was collected in 2013 to 2016 from the Brazilian states of Tocantins and Amapa. 781 samples testing negative for IgM against Dengue, Zika, and Chikungunya viruses and for flaviviruses, alphaviruses and enteroviruses RNA using RT-PCRs were analyzed using viral metagenomics. Viral particles-associated nucleic acids were enriched, randomly amplified, and deep sequenced in 102 mini-pools generating over 2 billion reads. Sequence data was analyzed for the presence of known and novel eukaryotic viral reads. Anelloviruses were detected in 80%, human pegivirus 1 in 19%, and parvovirus B19 in 17% of plasma pools. HIV and enteroviruses were detected in two pools each. Previously uncharacterized viral genomes were also identified, and their presence in single plasma samples confirmed by PCR. Chapparvovirus and ambidensovirus genomes, both in the Parvoviridae family, were partially characterized showing 33% and 34% identity in their NS1 sequences to their closest relative. Molecular surveillance using pre-existing plasma from febrile patients provides a readily scalable approach for the detection of novel, potentially emerging, viruses

New Variants of Squash Mosaic Viruses Detected in Human Fecal Samples

Squash mosaic virus (SqMV) is a phytovirus that infects great diversity of plants worldwide. In Brazil, the SqMV has been identified in the states of Ceará, Maranhão, Piauí, Rio Grande do Norte, and Tocantins. The presence of non-pathogenic viruses in animals, such as phytoviruses, may not be completely risk-free. Similarities in gene repertories between these viruses and viruses that affect animal species have been reported. The present study describes the fully sequenced genomes of SqMV found in human feces, collected in Tocantins, and analyzes the viral profile by metagenomics in the context of diarrhea symptomatology. The complete SqMV genome was obtained in 39 of 253 analyzed samples (15.5%); 97.4% of them belonged to children under 5 years old. There was no evidence that the observed symptoms were related to the presence of SqMV. Of the different virus species detected in these fecal samples, at least 4 (rotavirus, sapovirus, norovirus, parechovirus) are widely known to cause gastrointestinal symptoms. The presence of SqMV nucleic acid in fecal samples is likely due to recent dietary consumption and it is not evidence of viral replication in the human intestinal cells. Identifying the presence of SqMV in human feces and characterization of its genome is a relevant precursor to determining whether and how plant viruses interact with host cells or microorganisms in the human gastrointestinal tract

Genomic Analyses of Potential Novel Recombinant Human Adenovirus C in Brazil

Human Adenovirus species C (HAdV-C) is the most common etiologic agent of respiratory disease. In the present study, we characterized the nearly full-length genome of one potential new HAdV-C recombinant strain constituted by Penton and Fiber proteins belonging to type 89 and a chimeric Hexon protein of types 1 and 89. By using viral metagenomics techniques, we screened out, in the states of Tocantins and Pará, Northern and North regions of Brazil, from 2010 to 2016, 251 fecal samples of children between 0.5 to 2.5 years old. These children were presenting acute diarrhea not associated with common pathogens (i.e., rotavirus, norovirus). We identified two HAdV-C strains in two distinct patients. Phylogenetic analysis performed using all complete genomes available at GenBank database indicated that one strain (HAdV-C BR-245) belonged to type 1. The phylogenetic analysis also indicated that the second strain (HAdV-C BR-211) was located at the base of the clade formed by the newly HAdV-C strains type 89. Recombination analysis revealed that strain HAdV-C BR-211 is a chimera in which the variable regions of Hexon gene combined HAdV-C1 and HAdV-C89 sequences. Therefore, HAdV-C BR-211 strain possesses a genomic backbone of type HAdV-C89 and a unique insertion of HAdV-C1 in the Hexon sequence. Recombination may play an important driving force in HAdV-C diversity and evolution. Studies employing complete genomic sequencing on circulating HAdV-C strains in Brazil are needed to understand the clinical significance of the presented data

Establishment and cryptic transmission of Zika virus in Brazil and the Americas

University of Oxford. Department of Zoology, Oxford, UK / Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.University of Birmingham. Institute of Microbiology and Infection. Birmingham, UK.University of Oxford. Department of Zoology. Oxford UK.University of Oxford. Department of Zoology. Oxford, UK / Harvard Medical School. Boston, MA, USA / Boston Children's Hospital. Boston, MA, USA.University of Oxford. Department of Zoology. Oxford, UK.Fred Hutchinson Cancer Research Center. Vaccine and Infectious Disease Division. Seattle, WA, USA / University of Washington. Department of Epidemiology. Seattle, WA, USA.University of São Paulo. School of Medicine &Institute of Tropical Medicine. Department of Infectious Disease. São Paulo, SP, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.University of Oxford. Department of Statistics. Oxford, UK.University of Oxford. Department of Zoology. Oxford, UK.Institut Pasteur. Biostatistics and Integrative Biology. Mathematical Modelling of Infectious Diseases and Center of Bioinformatics. Paris, FR / Centre National de la Recherche Scientifique. Paris, FR.University of Oxford. Department of Zoology. Oxford, UK.Ministry of Health. Coordenação dos Laboratórios de Saúde. Brasília, DF, Brazil.Ministry of Health. Coordenação Geral de Vigilância e Resposta às Emergências em Saúde Pública. Brasília, DF, Brazil / Fundação Oswaldo Cruz. Center of Data and Knowledge Integration for Health. Salvador, BA, Brazil.Ministry of Health. Departamento de Vigilância das Doenças Transmissíveis. Brasilia, DF, Brazil.Ministry of Health. Coordenação Geral dos Programas de Controle e Prevenção da Malária e das Doenças Transmitidas pelo Aedes. Brasília, DF, Brazil / Pan American Health Organization (PAHO). Buenos Aires, AR.Ministry of Health. Coordenação Geral dos Programas de Controle e Prevenção da Malária e das Doenças Transmitidas pelo Aedes. Brasília, DF, Brazil / Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brazil.Ministry of Health. Coordenação Geral dos Programas de Controle e Prevenção da Malária e das Doenças Transmitidas pelo Aedes. Brasília, DF, BrazilMinistry of Health. Departamento de Vigilância das Doenças Transmissíveis. Brasilia, DF, Brazil.Ontario Institute for Cancer Research. Toronto, ON, Canada.University of Nottingham. Nottingham, UKThe Scripps Research Institute. Department of Immunology and Microbial Science. La Jolla, CA, USA.The Scripps Research Institute. Department of Immunology and Microbial Science. La Jolla, CA, USA.University of California. Departments of Laboratory Medicine and Medicine & Infectious Diseases. San Francisco, CA, USA.University of California. Departments of Laboratory Medicine and Medicine & Infectious Diseases. San Francisco, CA, USA.Instituto Mexicano del Seguro Social. División de Laboratorios de Vigilancia e Investigación Epidemiológica. Ciudad de México, MC.Instituto Mexicano del Seguro Social. División de Laboratorios de Vigilancia e Investigación Epidemiológica. Ciudad de México, MC.Universidad Nacional Autónoma de México. Instituto de Biotecnología. Cuernavaca, MC.Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brazil.Paul-Ehrlich-Institut. Langen, Germany.Laboratório Central de Saúde Pública Noel Nutels. Rio de Janeiro, RJ, Brazil.Laboratório Central de Saúde Pública Noel Nutels. Rio de Janeiro, RJ, Brazil.Laboratório Central de Saúde Pública Noel Nutels. Rio de Janeiro, RJ, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Fundação Oswaldo Cruz. Salvador, BA, Brazil.Laboratório Central de Saúde Pública. Natal, RN, Brazil.Laboratório Central de Saúde Pública. Natal, RN, Brazil / Universidade Potiguar. Natal, RN, Brazil.Laboratório Central de Saúde Pública. Natal, RN, Brazil / Faculdade Natalense de Ensino e Cultura. Natal, RN, Brazil.Laboratório Central de Saúde Pública. João Pessoa, PB, Brazil.Laboratório Central de Saúde Pública. João Pessoa, PB, Brazil.Laboratório Central de Saúde Pública. João Pessoa, PB, Brazil.Laboratório Central de Saúde Pública. João Pessoa, PB, Brazil.Fundação Oswaldo Cruz. Recife, PE, Brazil.Fundação Oswaldo Cruz. Recife, PE, Brazil.Fundação Oswaldo Cruz. Recife, PE, Brazil / Colorado State University. Department of Microbiology, Immunology &Pathology. Fort Collins, CO, USA.Fundação Oswaldo Cruz. Recife, PE, Brazil.Heidelberg University Hospital. Department for Infectious Diseases. Section Clinical Tropical Medicine. Heidelberg, Germany.Fundação Oswaldo Cruz. Recife, PE, Brazil.Laboratório Central de Saúde Pública. Maceió, AL, Brazil.Laboratório Central de Saúde Pública. Maceió, AL, Brazil.Laboratório Central de Saúde Pública. Maceió, AL, Brazil.Universidade Estadual de Feira de Santana. Feira de Santana, BA, Brazil.Secretaria de Saúde de Feira de Santana. Feira de Santana, BA, Brazil.Universidade Federal do Amazonas. Manaus, AM, Brazil.University of São Paulo. School of Medicine &Institute of Tropical Medicine. Department of Infectious Disease. São Paulo, SP, Brazil.University of São Paulo. School of Medicine &Institute of Tropical Medicine. Department of Infectious Disease. São Paulo, SP, Brazil.Hospital São Francisco. Ribeirão Preto, SP, Brazil.University of São Paulo. School of Medicine &Institute of Tropical Medicine. Department of Infectious Disease. São Paulo, SP, Brazil.Universidade Federal do Tocantins. Palmas, TO, Brazil.University of São Paulo. School of Medicine &Institute of Tropical Medicine. Department of Infectious Disease. São Paulo, SP, Brazil.University of Sydney. Sydney, Australia.University of Edinburgh. Institute of Evolutionary Biology. Edinburgh, UK / National Institutes of Health. Fogarty International Center. Bethesda, MD, USA.Fred Hutchinson Cancer Research Center. Vaccine and Infectious Disease Division. Seattle, WA, USA.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil / University of Texas Medical Branch. Department of Pathology. Galveston, TX, USA.University of São Paulo. School of Medicine &Institute of Tropical Medicine. Department of Infectious Disease. São Paulo, SP, Brazil.Fundação Oswaldo Cruz. Salvador, BA, Brazil.University of Birmingham. Institute of Microbiology and Infection. Birmingham, UK.University of Oxford. Department of Zoology, Oxford, UK / Metabiota. San Francisco, CA, USA.University of São Paulo. School of Medicine &Institute of Tropical Medicine. Department of Infectious Disease. São Paulo, SP, Brazil.Fundação Oswaldo Cruz. Salvador, BA, Brazil.Fundação Oswaldo Cruz. Salvador, BA, Brazil / University of Rome Tor Vergata. Rome, Italy.Transmission of Zika virus (ZIKV) in the Americas was first confirmed in May 2015 in northeast Brazil. Brazil has had the highest number of reported ZIKV cases worldwide (more than 200,000 by 24 December 2016) and the most cases associated with microcephaly and other birth defects (2,366 confirmed by 31 December 2016). Since the initial detection of ZIKV in Brazil, more than 45 countries in the Americas have reported local ZIKV transmission, with 24 of these reporting severe ZIKV-associated disease. However, the origin and epidemic history of ZIKV in Brazil and the Americas remain poorly understood, despite the value of this information for interpreting observed trends in reported microcephaly. Here we address this issue by generating 54 complete or partial ZIKV genomes, mostly from Brazil, and reporting data generated by a mobile genomics laboratory that travelled across northeast Brazil in 2016. One sequence represents the earliest confirmed ZIKV infection in Brazil. Analyses of viral genomes with ecological and epidemiological data yield an estimate that ZIKV was present in northeast Brazil by February 2014 and is likely to have disseminated from there, nationally and internationally, before the first detection of ZIKV in the Americas. Estimated dates for the international spread of ZIKV from Brazil indicate the duration of pre-detection cryptic transmission in recipient regions. The role of northeast Brazil in the establishment of ZIKV in the Americas is further supported by geographic analysis of ZIKV transmission potential and by estimates of the basic reproduction number of the virus