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Clinicai and Ecoepidemiological Situation of Human Arboviruses in Brazilian Amazónia

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Clinicai and Ecoepidemiological Situation of Human Arboviruses in Brazilian Amazónia ECO 92: Vubíic Heaãíi In Títe Amazon. ' Clinicai and ecoepidemiological situation of human arboviruses in Brazilian Amazónia PEDRO F. C. VASCONCELOS', AMÉLIA R A. TRAVASSOS DA ROSA', NICOLAS DÉGALLIER% JORGE F. S. TRAVASSOS DA ROSA', FRANCISCO P. PINHEIRO' ^Centro Colaborador Investigação e Adestramento em Arboviroses da Organização Mundial da Saúde, Seniço de Arbovírus, Instituto Evandro Chagas, Fundação Nacional de Saúde, Ministério da Saúde, Belém, PA 66065, Brazil, -ORSTOM, Instituto Evandro Chagas, Belém, PA 66065, Brazil and ^PanAmerican Health Organization, Washington DC 20037-2895, USA The main aspects of clinic manifestatíons and epídemiologícal data about human arboviruses in the BraziHan Amazonian region is reviewed. Thirty four types of arboviruses from 183 types iso• lated in the Amazónia have been associated with human diseases. Four of them are important in public heaith 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 áreas while MAY and YF in rural áreas. 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. AU 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 clínicos e ecoepidemiológicos das arboviroses outros arbovírus têm sido associados a doença febril benigna em associadas com doença humana na Amazónia brasileira são revistos. poucos e esporádicos casos. Afora o DEN, todos os arbovírus Trinta e quatro arbovírus dentre os 183 tipos até o momento isolados envolvidos com doença humana na Amazónia brasileira são mantidos na Amazónia têm sido incriminados com doença humana. Desses, 4 através de um ciclo silvestre desenvolvido na floresta, onde diversas são importantes em termos de saúde ptiblica pois estão associados espécies de insetos hematófagos e vertebrados silvestres atuam como com epidemias: são os vírus Dengue (DEN). Mayaro (MAY). Oro• vetores e hospedeiros, respectivamente. O vírus DEN tem um ciclo pouche (ORO) e Febre Amarela (FA). DEN e ORO estão associados urbano em que o mosquito Aedes aegypti é o vetor e o homem atua com doença humana epidêmica em áreas urbanas enquanto MAY e FA como hospedeiro. Excetuando os quatro vírus associados a epidemias em áreas predominantemente rurais. Basicamente, o vírus ORO que causam um grande impacto socio-económico. inclusive levando a determina um quadro febril algumas vezes acompanhado com morte (no caso particular da FA), o verdadeiro papel desses vírus meningite asséptica. MAY e DEN são responsáveis por quadros febris como agentes sistemáticos de doença humana é desconhecido. Novos exantemáticos, enquanto o vírus FA determina, na sua apresentação estudos são necessários para esclarecer aspectos ainda obscuros dos clássica, uma sintomatologia típica de febre hemorrágica. Trinta ciclos epidemiológicos da maioria desses arbovírus. 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, tant pubhc heaith problem, worldwide. Very often, a few more than 30 have actually determined human dis• T arboviruses have been responsible for large epidem• ease. A small number has been incriminated as causative ics with serious impacts on human and veterinary heaith. 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 Fernando da Costa Vasconcelos, Av. Almirante Moreover, up to the present, in Brazilian Amazónia, Barroso, 492, Caixa Postal 1128. Belém, PA 66065, Brasil 183 distinct arboviruses have been isolated up to the end of Volume 44(2/3) • March/June 1992 Ciência e Cultura (Journal of the Brazilian Associatíon for tine Advancement of Science) «117 .ECO 92: PuSíic Hedtfi In Títe Amazon. 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 Flavivirus, and only 7 from several other localities also involved (5). Until 1980, ali other genera. With few exceptions, ali the virus isolations epidemics reported in Brazil had occurred in Pará State. have been obtained from individuais 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 heaith in Ama• Mazagão, a rural locality of Amapá State (6). In 1988, new zónia. They are, Oropouche (ORO), Dengue (DEN), áreas were affected by epidemics of ORO fever. Porto Mayaro (MAY) and Yellow Fever (YF). AU of them, have Franco and Tocantinópolis, in Maranhão 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 áreas, and the latter two (MAY large epidemic was reported in Rondônia State in Ari- and YF), mainly in rural áreas. Certainly, these four quemes and Ouro Preto do Oeste towns. In these towns an arboviruses are responsible for over 90% of ali cases of epidemiological survey estimated that about 90,000 infec• arboviral diseases in the Amazónia. 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). Clinicai 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 Bunyavirus (Bunyaviridae), anorexia, dizziness, chills and photophobia are the symp- serologically related to the Simbu sero• Table 1 — Arboviruses isolated in the Amazon region which are responsible for human disease (in Amazónia and the Car- group. ibbean) according to type of disease and source of isolation. The outbreaks of Source of isolation Oropouche fever vi• Human Vertehrate Type Genus Antigenic group Virus Natural Lab.inf. Sentinel Wild Arthro rus have caused im• - portant social and Febrile illness Alphavirus A Mucambo + + + + Febrile illness Alphavirus A Pixuna - + - + + economic impacts, Febrile illness Arenavirus Tacaribe Hexal - + - + - because the epidem• Febrile illness Bunyavirus Anopheles A Tacaiuma + - + - + ics are explosive and, Febrile illness Bunyavirus Bunyamwera Xingu + - - - + - in a short time thou• Febrile illness Bunyavirus C Apeu + + + + Febrile illness Bunyavirus Caraparu + + + + + sands of patients are C Febrile illness Bunyavirus c Caraparulike + - + + + attacked simultane- Febrile illness Bunyavirus c Itaqui - + + + ously. Patients some• Febrile illness Bunyavirus Marituba + - + + + c - times present a severe Febrile illness Bunyavirus c Murutucu + + + + Febrile illness Bunyavirus Nepuyo - - + + + disease including c Febrile illness Bunyavirus c Oriboca + - + + + neurologic involve• Febrile illness Bunyavirus Califórnia Guaroa + - - - + ment (2), although, Febrile illness Bunyavirus Guama Catu + - + + + - no fatality has been Febrile illness Bunyavirus Guama Guama + + + + Febrile illness Bunyavirus Simbu Oropouche + + + + + recorded to date due Febrile illness Havivirus B Bussuquara - - + + + to ORO virus. When Febrile illness Flavivirus B Ilhéus + - + + + - - - environmental Febrile illness Phlebovirus Phlebotomus fever Alenquer + + - - - (ecologic) and epide- Febrile illness Phlebovirus Phlebotomus fever Candiru + + Febrile illness Phlebovirus Phlelxjtomus fever Morumbi + - - - - m i o 1 o g i c a 1 Febrile illness Phlebovirus Phlebotomus fever Serra Norte - - - - (susceptibles, virai Febrile illness Vesiculovirus VSV Jurona + - - - + - - - and vector circula- Febrile illness Vesiculovirus VSV Piry + + tions) conditions are Rash febrile disease Alphavirus A Mayaro + + + + + Rash febrile
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