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Calvet GA, Kara EO, Bôtto-Menezes CHA, da Costa Castilho M, de Oliveira Franca RF, Habib N, Neto AM, Pereira GFM, Giozza SP, Bermúdez XPD, Fernandes TJ, Modjarrad K, Brasil P, Broutet NJN, de Filippis AMB. Detection and persistence of Zika virus in body fluids and associated factors: a prospective cohort study. Sci Rep 2023; 13:21557. [PMID: 38057382 PMCID: PMC10700488 DOI: 10.1038/s41598-023-48493-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023] Open
Abstract
This study aimed to analyze the detection and duration of the Zika virus (ZIKV) in plasma, urine, saliva, sweat, rectal swabs, vaginal secretions, breast milk, and semen and to explore risk factors associated with prolonged viral persistence. A prospective cohort study of symptomatic patients and their household contacts was conducted in Brazil from July 2017 to June 2019. A total of 260 individuals (184 women and 76 men) with confirmed ZIKV infection were enrolled and followed up for 12 months. ZIKV RNA was present in all body fluid specimens and detectable for extended periods in urine, sweat, rectal swabs, and semen. The longest detection duration was found in semen, with high viral loads in the specimens. ZIKV RNA clearance was associated with several factors, including age, sex, education level, body mass index, non-purulent conjunctivitis, joint pain, and whether the participant had a history of yellow fever vaccination. The influence of each of these factors on the low or fast viral clearance varied according to the specific body fluid under investigation. Recurrent ZIKV detection events after total viral clearance were observed in the cohort. Our findings provide valuable insights into the persistence and potential recurrence of ZIKV infection, highlighting the need for continued monitoring and follow-up of individuals infected with ZIKV and for effective prevention measures to reduce the risk of transmission.
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Affiliation(s)
- Guilherme Amaral Calvet
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Edna Oliveira Kara
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Camila Helena Aguiar Bôtto-Menezes
- Department of Malaria, Tropical Medicine Foundation Doctor Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- School of Health Sciences, Amazonas State University (UEA), Manaus, Amazonas, Brazil
| | - Marcia da Costa Castilho
- Department of Malaria, Tropical Medicine Foundation Doctor Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
| | | | - Ndema Habib
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Armando Menezes Neto
- Department of Virology and Experimental Therapy, Institute Aggeu Magalhães, Oswaldo Cruz Foundation, Recife, Pernambuco, Brazil
| | - Gerson Fernando Mendes Pereira
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections (DATHI), Ministry of Health, Brasília, Brazil
| | - Silvana Pereira Giozza
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections (DATHI), Ministry of Health, Brasília, Brazil
| | | | - Tatiana Jorge Fernandes
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Kayvon Modjarrad
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Patrícia Brasil
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Ana Maria Bispo de Filippis
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
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Martins EB, Silva MFB, Tassinari WS, de Bruycker-Nogueira F, Moraes ICV, Rodrigues CDS, Santos CC, Sampaio SA, Pina-Costa A, Fabri AA, Guerra-Campos V, Santos NA, Faria NRC, Filippis AMB, Brasil P, Calvet GA. Detection of Chikungunya virus in bodily fluids: The INOVACHIK cohort study. PLoS Negl Trop Dis 2022; 16:e0010242. [PMID: 35255099 PMCID: PMC8929700 DOI: 10.1371/journal.pntd.0010242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/17/2022] [Accepted: 02/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Chikungunya is a widely distributed, re-emerging tropical disease caused by the chikungunya virus (CHIKV). Little is known about the duration for which CHIK RNA are detectable in bodily fluids, especially genital secretions, and current evidence is based on small series or case reports. An understanding of viral dynamics across different body compartments can inform diagnostic testing algorithms and public health prevention interventions. Methodology A prospective cohort study was conducted to assess the presence and duration of detectable levels of CHIKV RNA in blood, urine, saliva, semen, and vaginal secretions. Men and women (≥ 18 years) with a positive reverse transcriptase-polymerase chain reaction (RT-PCR) test for CHIKV in the acute phase (1–14 days) of the disease were included. After enrollment, clinical data and samples were collected every 15 days over the first 2 months, and a final collection was performed 3 months after recruitment. The Kaplan–Meier interval-censoring method and the parametric Weibull model were fitted to estimate the median time of viral persistence until the lack of CHIKV RNA detection among all body fluids. Punctual estimates of the median time of CHIKV RNA persistence for each fluid were estimated using a 95% confidence interval (CI). Results From April to December 2019, 170 participants were screened. Of these, 152 (100 women) were enrolled in the study. The median and interquartile range (IQR) ages for men and women were 39.3 (IQR: 26.9, 50.7) and 43.5 (IQR: 33.8, 53.6) years, respectively. CHIKV RNA was detected in 80.3% (122/152) of serum samples, 23.0% (35/152) of urine samples, 30.3% (46/152) of saliva samples, 14.3% (6/42) of semen samples, and 20.2% (20/99) of vaginal secretion samples. The median time until the loss of CHIKV RNA detection was 19.6 days (95% CI, 17.5–21.7) in serum, 25.3 days (95% CI, 17.8–32.8) in urine, 23.1 days (95% CI, 17.9–28.4) in saliva, and 25.8 days (95% CI, 20.6–31.1) in vaginal secretion. The number of semen samples available was too small to make statistical estimates, but a last positive sample was obtained from a participant 56 days after the onset of symptoms. Conclusions CHIKV RNA could be detected in all bodily fluids studied, including genital secretions during the acute and convalescent phases and additional studies on viral infectivity in semen and vaginal secretions are warranted. This prospective cohort study of adult patients aimed to estimate the presence and duration of detectable levels of chikungunya virus RNA in bodily fluids, including genital secretions, among participants in the acute and convalescent phases of the disease. In addition to the fluids usually used for diagnosis in humans (serum and plasma), we reported the detection of chikungunya virus RNA in all body fluids. Reports have shown that chikungunya virus RNA in serum declines to undetectable levels within 1–2 weeks after symptom onset. The viral persistence in the serum in our study was longer than expected. In addition, we showed that saliva and urine contained detectable viral RNA in both the acute and convalescent phases of the disease. To the best of our knowledge, this is the first cohort study assessing the presence and persistence of CHIKV in genital fluids (vaginal secretions and semen). Knowledge of viral persistence can help inform recommendations for the control, treatment, and prevention of the disease. Additional studies on viral infectivity are warranted.
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Affiliation(s)
- Ezequias B. Martins
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
| | - Michele F. B. Silva
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Wagner S. Tassinari
- Mathematics Department, Exact Sciences Institute, Federal Rural University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Isabella C. V. Moraes
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cintia D. S. Rodrigues
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carolina C. Santos
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Simone A. Sampaio
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anielle Pina-Costa
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Allison A. Fabri
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vinícius Guerra-Campos
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nayara A. Santos
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nieli R. C. Faria
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Maria B. Filippis
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patrícia Brasil
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Guilherme A. Calvet
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
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Giozza SP, Bermúdez XPD, Kara EO, Calvet GA, de Filippis AMB, Lacerda MVG, Bôtto-Menezes CHA, da Costa Castilho M, Franca RFO, Neto AM, Storme C, Lima NS, Modjarrad K, de Oliveira MCP, Pereira GFM, Broutet N. An initiative of cooperation in Zika virus research: the experience of the ZIKABRA study in Brazil. BMC Public Health 2021; 21:572. [PMID: 33757480 PMCID: PMC7985753 DOI: 10.1186/s12889-021-10596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Zika virus outbreak has triggered a set of local and global actions for a rapid, effective, and timely public health response. A World Health Organization (WHO) initiative, supported by the Department of Chronic Condition Diseases and Sexually Transmitted Infections (DCCI) of the Health Surveillance Secretariat (SVS), Brazil Ministry of Health (MoH) and other public health funders, resulted in the start of the "Study on the persistence of Zika virus in body fluids of patients with ZIKV infection in Brazil - ZIKABRA study". The ZIKABRA study was designed to increase understanding of how long ZIKV persists in bodily fluids and informing best measures to prevent its transmission. Data collection began in July 2017 and the last follow up visit occurred in 06/26/2020. METHODS A framework for the ZIKABRA Cooperation initiative is provided through a description and analysis of the mechanisms, strategies and the ethos that have guided the models of international governance and technical cooperation in health for scientific exchange in the context of a public health emergency. Among the methodological strategies, we included a review of the legal documents that supported the ZIKABRA Cooperation; weekly documents produced in the meetings and working sessions; technical reports; memorandum of understanding and the research protocol. CONCLUSION We highlight the importance of working in cooperation between different institutional actors to achieve more significant results than that obtained by each group working in isolation. In addition, we point out the advantages of training activities, ongoing supervision, the construction of local installed research capacity, training academic and non-academic human resources, improvement of laboratory equipment, knowledge transfer and the availability of the ZIKABRA study protocol for development of similar studies, favoring the collective construction of knowledge to provide public health emergency responses. Strategy harmonization; human resources and health services; timing and recruiting particularities and processing institutional clearance in the different sites can be mentioned as challenges in this type of initiative.
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Affiliation(s)
- Silvana Pereira Giozza
- Department of Chronic Condition Diseases and Sexually Transmitted Infections, Health Surveillance Secretariat, Ministry of Health, Brazil, SRTVN Quadra 701, Lote D, Edifício PO700 - 5° andar, Brasília, Distrito Federal, 70719-040, Brazil.
| | | | | | | | | | | | | | | | | | | | - Casey Storme
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Noemia S Lima
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Kayvon Modjarrad
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Maria Cristina Pimenta de Oliveira
- Department of Chronic Condition Diseases and Sexually Transmitted Infections, Health Surveillance Secretariat, Ministry of Health, Brazil, SRTVN Quadra 701, Lote D, Edifício PO700 - 5° andar, Brasília, Distrito Federal, 70719-040, Brazil
| | - Gerson Fernando Mendes Pereira
- Department of Chronic Condition Diseases and Sexually Transmitted Infections, Health Surveillance Secretariat, Ministry of Health, Brazil, SRTVN Quadra 701, Lote D, Edifício PO700 - 5° andar, Brasília, Distrito Federal, 70719-040, Brazil
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