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Clinical and Ecoepidemiological Situation of Human Arboviruses in Brazilian Amazonia

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Clinical and Ecoepidemiological Situation of Human Arboviruses in Brazilian Amazonia ................ECO 92: Pu6licHedthInThAmazm. ............... Clinical and ecoepidemiological situation of human arboviruses in Brazilian Amazonia PEDROE C. VASCONCELOS',MLM P. A. TRAVASSOSDA ROSA', NICOLASDÉGALLIER~, JORGE E S. TRAVASSOSDA ROSA', FRANCISCOP. PDIHEIRO~ 'Centro Colaborador lnvestigaçäo e Adestrnriieiito em Arbovisoses da Orgariizaçüo Murzdial da Saúde, Seiviço de Arbovír*us,Iiistituto Evaiidro Chagas, Fundaçü0 Nacional de Sadde, Ministério da Saúde, Belém, PA 66065, Brazil, =ORSTOM,Iiistituto Evaridro Chagas, Belérii, PA 66065, Brazil arid 3PariAmericari Health Organizatiori, Wasliiiigtoii DC 20037-2895, USA The main aspects of clinic manifestations and epidemiological data about human arboviruses in the Brazilian Amazonian region is reviewed. Thirty four types of arboviruses from 183 types iso- lated in the Amazonia have been associated with human diseases. Four of them are important in public health and are involved with epidemics; they are namely, Dengue (DEN), Mayaro (MAY), Oropouche (ORO) and Yellow Fever (YF) viruses. ORO and DEN are associated with human epidemic diseases in urban areas while MAY and YF in rural areas. Basically, ORO causes a fe- brile disease, sometimes accompanied with aseptic meningitis. MAY and DEN are associated with rash febrile disease, while YF determines hemorrhagic fever. Thirty other arboviruses are involved with febrile illnesses in a few and sporadic cases. All arboviruses (apart from DEN) are maintained within a sylvatic cycle in the forest, where several species of hemathophagous insects act as vectors and wild vertebrates are involved as hosts. DEN has a cycle where the Aedes aegypti mosquito is the vector and man is the host. With the exception of the four viruses associated with epidemics which determine great economical and social impacts, including death (as in the case of YF), the real involvement of these viruses as systematic agents of human disease is unknown. Further stud- ies are needed to clarify unclear aspects of the epidemiological cycles of these viruses. Os principais aspectos clhicos e ecoepideniioldgicos das arboviroses outros arbovirus téni sido associados a doença febril benigna, eni associadas coni doeriça liuniana lia Aniaiônia brasileira sdo revistos. poucos e esporádicos casos. Afora o DEN, todos os arbovirus Triti fa e quatro arbovirus dentre OS f 83 tipos até o nionieiito isolados envol~*idosconi doença Iianiaiia na Aniazônia brasileira sä0 niaritidos na Aniazôiiia téni sido bicriniinados coni doença liuniana. Desses, 4 através de uni ciclo silwstre desenvolvido na floresta, onde diversas sä0 impor tan tes eni ternios de saúde pública pois estdo associados espécies de iiisetos heniatófagos e vertebrados silvestres atuani conio coni epidemias; sä0 os vírus Dengue (DEN), Mayaro (MAY), Oro- vetores e hospedeiros, respectivaniente. O vírus DEN teni uni ciclo pouche (ORO) e Febre Amarela (FA). DEN e ORO estä0 associados itrbano eni que o mosquito Aedes aegypli é o vetor e o lionieni ama coni doença liuniana epidéniica eni áreas urbanas enquanto MAY e FA coiiio Iiospedeiro. Excetuando os quatro his associados a epideniias eni áreas predoniiriantenieiire rurais. Basicanierite, o ~frusORO que causani uni grande inipacto socio-econômico, inclusive levando a deterniina uni quadro febril algunias vezes acompanhado coni niorte (no caso particular da FA), o verdadeiro papel desses vírus nieiiingite asséptica. MAY e DEN são responsáveis por quadros febris conio agentes sistenidticos de doença humana é desconliecido. NOVOS exantenidticos, enquanto o vírus FA deterniiria, iia sua apresentação estudos sdo iiecessários para esclarecer aspectos ainda obscuros dos clássica, unia siri tonratologia ripica de febre hemorrdnica. Trinta ciclos epideniioldnicos da maioria desses arbovirus. he arboviruses constitute an ecological group of vi- However, the number of types causing human diseases is ruses some types of their representing a very impor- low. Thus, of .over 200 distinct serotypes isolated in Brazil, T tant public health problem, worldwide. Very often, a few more than 30 have actually determined human dis- A arboviruses have been responsible for large epidem- ease. A small number has been incriminated as causative ics with serious impacts on human and veterinary health. agents of epidemics. On the other hand, despite the low In Brazil, the arboviruses are spread in several regions. number of epidemic arboviruses, the social and economical impacts of these outbreaks are important. Correspondence to: Pedro Femando da Costa Vasconcelos, Av. Almirante Moreover, up to the present, in Brazilian Amazonia, Barroso, 492, Caixa Postal 1128, Beltm, PA 66065, Brasil 183 distinct arboviruses have been isolated up to the end of Volume 44(2/3) March/June 1992 Ci&nciae Cultura (Journal of the Brazilian Association for lhe Advancement of Science) 117 ORSTOH Fonds Documentaire .....e.......... ECO 92: Pu6li Hedth In ThAmon, . , . 1991 (1). Of these, 34 have been associated, with human to June). Indeed, three outbreaks have been recorded in infections, on the basis of virus isolation or antibody detec- Belém during the last 30 years. The first, in 1961, (3), the tion. Twenty-seven of them, are members of 3 genus: second in 1968-1969 (4) and the third in 1979-1980, with Alphavirus, Bunyavirus and Flavivirw, and only 7 from several other localities also involved (5). Until 1980, all other genera. With few exceptions, all the virus isolations epidemics reported in Brazil had occurred in Pará State. have been obtained from individuals infected in nature. From the end of 1980 to the first quarter of 1981, a large Three agents, however, have to date been isolated from epidemic was reported in Manaus, Amazonas State. This people who had undergone a laboratory infection (Table 1). outbreak was also extended to Barcelos county. A third epi- On the other hand, only four arboviral diseases are consid- demic was registered beyond the limits of Pará State, in ered presently to be important to public health in Ama- Mazaglo, a rural locality of Amapií State (6). In 1988, new zonia. They are, Oropouche (ORO), Dengue (DEN), areas were affected by epidemics of ORO fever. Porto Mayaro (MAY) and Yellow Fever (YF). All of them, have Franco and Tocantin6polis, in MaranhFio and Goiás States, been associated with epidemic outbreaks, the first two respectively, reported thousands of cases (7). In 1991, a (ORO and DEN) in urban areas, and the latter two (MAY large epidemic was reported in Rondônia State in Ari- and YF), mainly in rural areas. Certainly, these four quemes and Ouro Preto do Oeste towns. In these towns an arboviruses are responsible for over 90% of all cases of epidemiological survey estimated that about 90,000 infec- arboviral diseases in the Amazonia. tions occurred during a 45-day period (8). This account reviews our current knowledge about the Based upon the population at risk during epidemics and pathogenic arboviruses to man in the Amazon region of estimated incidence rates taken from serological surveys, at Brazil, which will be discussed according to taxonomic sta- least 500,000 people were probably infected by ORO virus tus. in the last 30 years (1961-1991) in the Brazilian Amazon basin (1). Clinical manifestation presented by infected patients is Oropouche (ORO) basically a febrile disease. Oropouche fever is characterized by an abrupt onset. Fever, headache, myalgia, arthralgia, Oropouche fever virus is a Bunyavirzrs (Bunyaviridae), anorexia, dizziness, chills and photophobia are the symp- serologically related to the Simbu Table 1 -Arboviruses isolated in the Amazon region which are responsible for human disease (in Amazonia and the Car- group. ibbean) according to type of disease and souIrce of isolation. The outbreaks of Soicrce of' isolatiori Oropouche fever vi- Hiinlati Vertebrare rus have caused im- Geriris Airrigetiic groiip Virils Natirrcrl Lahit$ Senriiiel Wild Arrhroporl portant social and Febrile illness Alphavirus A Mucambo t + i- Febrile illness Alphavirus A Pixuna - + + economic impacts, Febrile illness Arenavirus Tacaribe Flexal - + - because the epidem- Febrile illness Bunyavirus Anopheles A Tacaiuma f - + ics are explosive and,' Febrile illness Bunyavirus Bunyamwera Xingu - - t in a short time thou- Febrile illness Bunyavirus C Apeu + + + Febrile illness Bunyavirus C Caraparu + + + sands of patients are Febrile illness Bunyavirus C Cariiparulike + i- + attacked simultane- Febrile illness Bunyavirus C 1r:lqui + + f ously. Patients some- Febrile illness Bunyavirus C Marituba + + + times present a severe Febrile illness Bunyavirus C Murutucu t + + Febrile illness Bunyavirus C Nepuyo + + + disease including Febrile illness Bunyavirus C Oriboca + + + neurologic involve- Febrile illness Bunyavirus Califomia Guaroa - - + ment (2), although, Febrile illness Bunyavirus Guama Clitu + + + Febrile illness Bunyavirus Guama Guama + + + no fatality has been Febrile illness Bunyavirus Simbu Oropouche + + + recorded to date due Febrile illness Flavivirus B Bussuquara t + + to ORO virus. When Febrile illness Flavivirus B Ilhéus + + + Febrile illness - environmental Phlebovirus Phlebotomus fever Alenquer - + Febrile illness Phlebovirus Phlebotomus fever Candiru - - + (ecologic) and epide- Febrile illness Phlebovirus Phlebotomus fever Monimbi - - - Febrile illness Phlebovirus Phlebotomus fever Serra None - m i o 10.2u i c a 1 (su scep t i b 1es , v ira1 Vesiculovirus VSV Jurona + - - - + Febrile illness Vesiculovirus ' vsv Piry - + - + - and vector circula- Rash febrile disease
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