Experimental yellow fever virus infection in the Golden Hamster (Mesocricetus auratus). I. Virologic, biochemical, and immunologic studies

This report describes the clinical laboratory findings in golden hamsters experimentally infected with yellow fever (YF) virus. An accompanying paper describes the pathologic findings. Following intraperitoneal inoculation of a virulent strain of YF virus, hamsters developed a high-titered viremia (up to 109/mL) lasting 5--6 days and abnormal liver function tests. YF hemagglutination-inhibiting antibodies appeared 4 or 5 days after infection, often while viremia was still present. The mortality rate in YF-infected hamsters was variable, depending on the virus strain and the age of the animals. Clinical and pathologic changes in the infected hamsters were very similar to those described in experimentally infected macaques and in fatal human cases of YF, which indicates that the golden hamster may be an excellent alternative animal model, in place of nonhuman primates, for research on the pathogenesis and treatment of YF and other viscerotropic flavivirus diseases.

[A dengue epidemic in Ipupiara and Prado, Bahia. A seroepidemiologic survey]

Serologic studies in Brazil have indicated a 25% to 56% prevalence of dengue virus infections. However, these studies were carried out in populations of middle-sized and larger cities. The present study describes two epidemics of classic dengue fever in two small cities in the State of Bahia. The first occurred in 1987, in Ipupiara and was caused by dengue serotype-1 (DEN-1), the second occurred in 1995, in Prado and was caused by dengue serotype-2 (DEN-2). The laboratory diagnosis was made by the hemagglutination-inhibition test. 461 serum samples were collected in 1995 in Ipupiara (district of Chapada Diamantina) out of a population of 3,868 and 228 samples out of a total of 9,126 inhabitants of Prado (in the southernmost coastal region). The seropositivity of the samples was 11.9% (55/461) in Ipupiara and 17.5% (40/228) in Prado. These were no statistically significant differences as to age and sex between seropositive and seronegative individuals of the two cities studied. However, the seropositive cases in Ipupiara indicated a higher percentage (15.9% vs. 9.3%) of residency in or travel to other states of Brazil (p<0.03). Based on these data we estimate the occurrence of 460 and 1,597 cases of infection in Ipupiara and Prado, respectively. In conclusion, dengue virus infections in smaller cities probably have singular characteristics, since they exhibit a lesser prevalence of seropositivity caused by decreased breeding possibilities of Aedes aegypti.

[The immune state against yellow fever vaccinal virus (17D) in 2 populations of Bahia State, Brazil]

The occurrence of cases of yellow fever (YF) and also the extensive distribution of A. aegypti in Brazil, inspired a study about the estimate of immunity against vaccinal virus (17D) among the residents at two cities of the Bahia State, Ipupiara (n = 461) and Prado (n = 228). At this non-endemic area of YF, the search for serology antibody against 17D (Ab17D) and 18 another arbovirus was made thereby hemagglutination inhibition (HI). Only 1.2% (8/689) showed Ab17D, six of those with monotypic sort. The heterotypic sort for flavivirus (FLV) was interpreted as associated to immunity against 17D too, being much frequent in Prado (30.3%) than in Ipupiara (23.2%). The age > or = 50 years and residence in another states were related to seropositive for FLV, the same way that vaccination's history (17D). However, the history of vaccination presented low percentages of sensibility (< or = 45.4%) and predictive-positive value (< or = 38.4%), but high specificity (> or = 70.8%) and predictive-negative value (> or = 78.8%). Therefore, the frequency of residents with Ab17D was low (1.2%), although the higher frequency (25.5%) of antibody FLV carrier's, what signifies that 26.7% of the studied population should present protection against the YF virus.

[A seroepidemiological survey on the island of São Luis during a dengue epidemic in Maranhão]

The island of São Luis in the State of Maranhão, constituted by the municipalities of São Luis-SL (835,428 inhabitants), São José de Ribamar-SJR (60,633 inhabitants) and Paço do Lumiar-PL (80,274 inhabitants), has been suffering dengue (DEN) fever epidemics since 1995, caused by DEN-1. In 1996, from August through October, an aleatory sero-epidemiologic survey was carried out in order to estimate the incidence of DEN infection and to analyze other clinical and epidemiological parameters. A questionnaire was applied and serum samples were simultaneously obtained. Serum samples were tested by hemagglutination inhibition (HI). Results were analyzed using Lotus 123, Epi-info 6.0, Excel 5.0 and STATA softwares. A total of 1,217 serum samples were obtained (101 of PL, 100 of SJR and 1017 of SL). The rate of DEN was 55.4% in PL, 28% in SJR and 41.4% in SL, suggesting the occurrence of 401,933 infections. No difference was seen between males and females, but infection occurred more in the upper social class than in poor people (p < 0.003), and was more frequent in adults than in children (p < 0.0004). In SL, the incidence was stratified into seven sanitary districts (SD), and prevalence was found to range from 26.1% in SD4 to 56.8% in SD1 (p < 0.0001). Symptoms were more frequently reported by people whose HI was positive: they included fever, headache, chills, dizziness, retrobulbar pains, muscle and joint pains, nausea, anorexia and skin rash. In spite of the high incidence of infection, no hemorrhagic cases were reported.

[Dengue epidemic in Fortaleza, Ceará: randomized seroepidemiologic survey]

OBJECTIVE

A seroepidemiological random survey was carried out in Fortaleza city, State of Ceará, Brazil, following an epidemic of dengue virus type 2 (DEN 2), with the purpose of evaluating the frequency of clinical manifestations (signs and symptoms) and the prevalence of dengue infection.

METHOD

A questionnaire calling for information on address, sex, age, clinical, epidemiological and economic status was applied to the population, followed by venupuncture collection of 5-10 ml of blood for testing by hemagglutination-inhibition (HI). The sample was calculated to obtain a prevalence of 20% with relative risk of 10% and confidence interval of 95%. All information obtained was analyzed by computer using Epi Info 5.0, Lotus 123, Excel 5.0, and Stata software.

RESULTS AND CONCLUSIONS

A total of 1,341 serum samples were obtained from nine Health Districts (SD) and tested by hemagglutination inhibition. Of these, 589 (44%) were positive and 752 (56%) negative. Of the positive results, 93 primary responses (PR) (7%) to DEN-2 and 496 secondary responses (SR) (37%) were observed. The global prevalence in the SD ranged from 21% to 71%. There were 41% (243/589) asymptomatic infections and 59% (346/589) symptomatic infections. Data analysis showed no difference in frequency by sex, age, on schooling, although a highly statistically significant difference was found as between the different social classes, the infection most commonly observed being among people of better social status. The stratification of positive cases showed greater prevalence of AI (p < 0.001) and SI (p < 0.0001) in both sexes, among people with SR rather than PR. The most prevalent symptoms were fever, headache, muscle pains, rash, dizziness, and joint pains. Moreover, itching, retro-bulbar pain, rash, and gingival bleeding, showed statistically significant differences. On the other hand, dizziness and joint pains were more associated in the patients with SR than PR, and statistically significant differences were also observed.

[Anti-Hantavirus antibodies in school children in Salvador, Bahia]

Hantavirosis are emerging diseases in the Americas. Although considered rare in children, among the five cases diagnosed in Brazil, one was in this age group. To know the serum-prevalence of hantavirosis in the pediatric group (schoolchildren) of low social economic level in Salvador, Bahia State, and to associate demographic, socio-economic and environmental factors to the serologic results, a standard questionnaire was applied and blood samples were collected from 379 students of two public schools. Sera were tested by indirect Immunofluorescent Antibody (IFA) IgG for Hantaan Virus (HTN) and Immunoenzymatic test (ELISA) for Sin Nombre viruses. Ages varied from five to seventeen years with a mean age of 10.2 years. The proportion of sera positive to HTN virus was 13.2%, and there were no positive antibodies to SN virus. The frequency of positivity was higher in the older group, similar among sexes and racial groups, and there was no association with the exposure to urban rodents. The antibodies anti-HTN serum-prevalence in low social economic level school children is high and confirm the circulation of hantaviruses in Salvador-Bahia, Brazil; the nonobservation of antibodies anti-SN indicates that the species are other than Sin Nombre Virus.

Ilheus virus (Flaviviridae, Flavivirus) is closely related to Japanese encephalitis virus complex

The Ilheus (ILH) virus has long been known to belong to group B of the arboviruses. Previous attempts to relate it to existing serogroups within the Flavivirus genus using conventional serological techniques such as hemagglutination inhibition, neutralization and complement fixation tests have been inconclusive. We have first used denaturing gel electrophoresis to estimate the molecular weight of immunoprecipitated radiolabeled viral proteins and the cross-reactivity among ILH proteins and hyperimmune sera to several flaviviruses only from the mosquito-borne encephalitis virus serogroups. The estimated molecular weight for the three proteins was in the same order of magnitude, as previously established, for mosquito-borne flaviviruses. Cross-immunoprecipitation tests showed that NS3 protein is the most cross-reactive. Partial nucleotide sequence analyses of the NS3 gene, corresponding to an area linking the helicase and the RNA triphosphatase domains, revealed that ILH virus is very closely related to the Japanese encephalitis virus complex confirming earlier serological data.

Involvement of the central nervous system in dengue fever: three serologically confirmed cases from Fortaleza Ceará, Brazil

Three cases of dengue fever involving the central nervous system (CNS) are reported. All occurred in 1994 during a dengue (DEN) epidemic caused by serotypes DEN-1 and DEN-2. The first case examined was a 17-year-old girl who complained of fever, nuchal rigidity and genital bleeding. Three blood samples were positive by anti-dengue IgM ELISA and showed hemagglutination-inhibition (HI) test titers > or = 1,280. The second case concerned a 86-year-old women with fever, muscle and joint pains, altered consciousness, syncope, nuchal rigidity and meningismus. Her blood sample showed an HI titer of 1:320 for flaviviruses, and an IgM ELISA positive for dengue. The third case was a 67-year-old women with fever, abnormal behaviour, seizures, tremor of extremities, thrombocytopenia, increased hematocrit and leukopenia. The patient suffered a typical case of dengue hemorrhagic fever with ensuing shock and a fatal outcome. A single blood sample showed HI antibodies of > or = 1,280 and an IgM ELISA positive for dengue. No virus could be isolated from any patient by inoculation of blood into C6/36 cells and suckling mice. No other agent of disease was encountered in the patient.

[Serological evidence of the circulation of the Rocio arbovirus (Flaviviridae) in Bahia]

Eight antibody anti-Rocio cases, from four distinct cities in the state of Bahia, are described; six of them being carriers of the antibody IgG (HI and NT) and two IgM (ELISA and NT). The authors comment on the circulation of these arboviruses in the state of Bahia and on the possibility of cross reactions with other antigenically related viruses.

[Effectiveness of the yellow fever vaccine 17D: an epidemiologic evaluation in health services]

The purpose of this study was to evaluate the efficacy of the 17D yellow fever vaccine in the conditions under which it is used in public health services. In 1989, a nonconcurrent prospective study was carried out in Bocaiúva, Minas Gerais State, Brazil, 6 months after mass vaccination of the population. The study population was made up of first-grade students from all the schools in Bocaiúva. The exposed group consisted of a simple random sample of vaccinated students (n = 173) and the unexposed group consisted of all those who had not been vaccinated (n = 55). Serum samples were examined with the neutralization test in mice; these tests were conducted blind, that is, the examiner did not know the vaccination status of the subject. The serology results were as follows: of those vaccinated, 75% were seropositive, 17% were seronegative, and 7% showed an inconclusive result; in the unvaccinated children, these results were 9%, 87%, and 4%, respectively. The age-adjusted seropositivity ratio between vaccinated and unvaccinated children was 7.6 (95% CI: 3.4 to 16.7). The proportion of seropositivity attributable to vaccination, adjusted for age, was 86.8% (95% CI: 70.6 to 94.0). The results showed that the efficacy of the vaccine, defined by means of seropositivity for the virus, was below the levels expected for the 17D vaccine. This may have been due to operational failures in the conservation or application of the vaccine. The results point to the need for routine systematic evaluations by the health services after mass utilization of the vaccine.

An epidemic of sylvatic yellow fever in the southeast region of Maranhao State, Brazil, 1993-1994: epidemiologic and entomologic findings

Yellow fever virus transmission was very active in Maranhao State in Brazil in 1993 and 1994. An investigation was carried out to evaluate the magnitude of the epidemic. In 1993, a total of 932 people was examined for yellow fever from Maranhao: 70 were positive serologically, histopathologically, and/or by virus isolation, and another four cases were diagnosed clinically and epidemiologically. In Mirador (17,565 inhabitants), the incidence was 3.5 per 1,000 people (case fatality rate [number of deaths/number of cases diagnosed] = 16.4%), while in a rural yellow fever risk area (14,659 inhabitants), the incidence was 4.2 and the case-fatality rate was 16.1% (10 of 62). A total of 45.2% (28 of 62) asymptomatic infections were registered. In 1994, 49 serum samples were obtained and 16 cases were confirmed (two by virus isolation, two by seroconversion, and 12 by serology). No fatal cases were reported. In 1993, 936 potential yellow fever vectors were captured in Mirador and a single strain was isolated from a pool of Haemagogus janthinomys (infection rate = 0.16%). In 1994, 16 strains were isolated from 1,318 Hg. janthinomys (infection rate = 1.34%) and one Sabethes chloropterus (infection rate = 1.67%). Our results suggest that this was the most extensive outbreak of yellow fever in the last 20 years in Brazil. It is also clear that the lack of vaccination was the principal reason for the epidemic, which occurred between April and June, during the rainy season, a period in which the mosquito population in the forest increases.

Phenotypic analysis of yellow fever virus derived from complementary DNA

A thorough phenotypic characterization of yellow fever (YF) virus generated from cDNA is a necessary prerequisite for mapping virulence/attenuation determinants and exploring the potential of YF attenuated virus 17D as a carrier for heterologous protective epitopes. In this study, YF virus was produced from 17D cDNA clones after lipofectin-mediated RNA transfection of certified primary cultures of chicken embryo fibroblasts (YFiv5.2/SL). This virus was passaged once in embryonated chicken eggs according to current YF vaccine manufacture methodology to produce the experimental virus (YFiv5.2/VL). These viruses were characterized in established monkey neurovirulence safety tests and quantitative clinical and histologic scores were derived for each virus. The experimental vaccine viruses (YFiv5.2/SL and VL) compared favorably with another well-known YF vaccine strain (17DD) used as control virus for the histologic score. Although slightly higher clinical neurovirulence was observed for YFiv5.2 as compared with the 17DD virus, it should not preclude the use of YFiv5.2 for mapping YF virus virulence determinants.

[Human infection by Hantavirus in southern and southeastern Brazil]

The results of serological investigation on Hantavírus antibodies carried out between February 1986 and August 1990 in human populations of the States of São Paulo and Paraná, Brazil, which had close contact with urban rats or wild rodents and others small mammals are described. OBJECTIVE--To identify the human infection caused by Hantavíruses, which are the etiological agents of Hemorrhagic fever with renal syndrome. METHODS--Sera from 1063 persons were tested by enzyme immunoassay (ELISA) to Hantaan, Seoul and Puumala antigens. Plaque reduction neutralization test to the same antigens and indirect immunofluorescent test to Hantaan antigen were performed in the positive sera. RESULTS--Antibodies to Hantaan, Seoul or Puumala viruses were detected in 32 persons by enzyme immunoassay (ELISA) and immunofluorescent test. Plaque reduction neutralization test performed in these 32 sera were positive in 5 (3 for Puumala and 2 for Seoul viruses). One serum reacted with high titer to Seoul virus in all tests. It was from a male resident in the rural area of Ribeira Valley, State of São Paulo, where he was born and has always lived. He had only travelled inside the State of São Paulo. CONCLUSION--There are serological evidences of Hantavírus infections in residents of the rural areas of the Amparo Island, Paranaguá Bay, State of Paraná and the Ribeira Valley, State of São Paulo; in employees of the port of Paranaguá, State of Paraná and in patients of the Emílio Ribas Hospital, São Paulo, State of São Paulo, who had a presumptive diagnosis of leptospirosis.

New arenavirus isolated in Brazil

A new arenavirus, called Sabiá, was isolated in Brazil from a fatal case of haemorrhagic fever initially thought to be yellow fever. Antigenic and molecular characterisation indicated that Sabiá virus is a new member of the Tacaribe complex. A laboratory technician working with the agent was also infected and developed a prolonged, non-fatal influenza-like illness. Sabiá virus is yet another arenavirus causing human disease in South America.

Circulation of eastern equine encephalitis, western equine encephalitis, Ilhéus, Maguari and Tacaiuma viruses in equines of the Brazilian Pantanal, South America

Neutralizing antibodies to EEE (6.7%), WEE (1.2%), ILH (26.6%), MAG (28.2%) and TCM (15.7%) viruses were found in sera of 432 equines of the Brazilian Pantanal, area where undiagnosed horse deaths are frequently observed. A 4-fold rise in CF titer to EEE virus was detected in acute and convalescent sera of an encephalitis horse sacrificed in 1992. Antibodies to EEE, ILH, MAG and TCM viruses were detected in horses less than 2 years old indicating recent circulation of these viruses in the Pantanal. The evidence of recent equine encephalitis associated with rising CF titer to EEE warrants a more intensive study with attempts to isolate virus from horses with clinical manifestations of encephalitis.

[Characterization and antigenic relationship of 3 new Bunyaviruses in the group Anopheles A (Bunyaviridae) of arboviruses]

The isolation and characterization of three new viruses obtained from the Tucuruí hydroelectric dam region is reported. These three agents belong to the Anopheles A serogroup, genus Bunyavirus, Bunyaviridae. The Tucuruí (TUC), caraipé (CPE) and Arumateua (ART) viruses have close relationships with each other and with Trombetas (TBT) virus, an Anopheles A virus previously isolated in the Amazon Region of Brazil. These viruses form the "Trombetas complex". TUC, CPE and ART viruses were obtained from pools of Anopheles (Nyssorhynchus) sp captured in Tucuruí, Pará State, in February, August and October of 1984, respectively. Until 1990 TUC, CPE and ART were isolated 12, 32 and 28 times respectively, in the Tucuruí hydroelectric dam region. At the moment, these viruses have only been obtained from mosquitoes of the Anopheles (Nyssorhynchus) complex, especially from An. (Nys.) nuneztovari and An. (Nys.) triannulatus, that are considered to be secondary vectors of Plasmodium in Amazonia. Serological tests performed with human and wild animal sera were negative, except for one specimen Nasua nasua that had neutralization antibodies to TUC.

[Arbovirus antibodies levels in subjects of the region of Ribeirão Preto, SP (Brazil)]

Com o objetivo de conhecer os níveis de anticorpos para arbovírus, foram estudados 302 indivíduos da região de Ribeirão Preto (Brasil), moradores em 3 tipos de locais com distintas formas de organização do espaço: próximos à área de paisagem natural; com paisagem modificada para a agropecuária; comunidades urbanas. Foram efetuados testes sorológicos de inibição da hemaglutinação, neutralização e fixação do complemento para 21 arbovírus. Os resultados mostraram que 19,9% dos indivíduos investigados apresentaram anticorpos, sugerindo infecções pregressas por vários arbovírus. A maior percentagem de habitantes que se infectaram por estes agentes foi observada em locais próximos à área de paisagem natural, 38,5%. O vesiculovírus Piry foi o agente para o qual se encontrou o maior número de soros reagentes, 12,5%. A maior ocorrência de portadores de anticorpos para o vírus Piry foi observada nos indivíduos: do sexo masculino; com idade superior a 40 anos; guardas-florestais, lavradores e profissionais com atividades ligadas ao rio.

[Prevalence of neutralizing antibodies to Piry arbovirus in subjects of the region of Ribeirão Preto, State of São Paulo]

Como parte de um inquérito sorológico pesquisando anticorpos para arbovírus, em habitantes da região de Ribeirão Preto, 202 soros foram testados por neutralização em camundongos, para o vírus Piry. Trata-se de um vesículo-vírus (Rhabdoviridae) isolado em Belém do Pará, das vísceras de um marsupial e do sangue de um caso humano. O Piry é causa de doença humana aguda febril. Desconhece-se seus reservatórios animais, vetores e seu ciclo biológico. Os 202 soros testados foram obtidos por venopunção, de moradores adultos em áreas rurais e urbana da cidade de Ribeirão Preto. Os resultados mostraram prevalência de 14,3% de anticorpos neutralizantes para o vírus Piry. Conclui-se que infecções pelo Piry, ou outro agente antigenicamente relacionado, ocorram endemicamente nesta região.

Immunoperoxidase detection of Yellow Fever virus after natural and experimental infections

Accurate diagnosis of fatal Yellow Fever (YF) is important for surveillance and prevention of epidemics in regions where the virus is endemic. Immunoperoxidase (IP) staining for viral antigens offers a means to both document infection and investigate pathogenic mechanisms. We developed an indirect IP staining assay for YF, which was used to detect YF antigen in histologic sections of human liver from patients with fatal natural infections, and suckling mouse brains experimentally inoculated with an unattenuated neurotropic strain of YF virus. In human liver, specific IP staining was present in the cytoplasm of hepatocytes, but in mouse brain, specific IP staining was localized within nuclei of neurons. The distribution of IP staining corresponded to the location of degenerative morphologic changes within cells; however, IP staining was more widespread than expected on the basis of histopathologic lesions. Furthermore, the degree of inflammation was disproportionately mild compared to the extent of infection, i.e. distribution of YF antigen, both in human liver and suckling mouse brain. The results suggest that the pathogenesis of YF in humans and suckling mice is overwhelming viral infection with minimal associated host immunological and/or inflammatory response in tissues.

[Serological studies for research on arbovirus antibodies in a human population of the Vale do Ribeira region. III. Survey in inhabitants with cases of Flavivirus Rocio encephalitis]

Foi realizado inquérito sorológico para pesquisa de anticorpos de 17 arbovírus existentes no país, em coabitantes com doentes de encefalite por Rocio, residentes em zona urbana da região do Vale do Ribeira, São Paulo (Brasil), onde ocorreu recentemente uma extensa epidemia dessa moléstia. Não se verificou maior prevalência de anticorpos IH para vírus Rocio nessas pessoas quando comparadas com indivíduos que não coabitavam com doentes de encefalite. Foram observados e discutidos alguns aspectos já verificados em outros grupos populacionais estudados anteriormente: maior prevalência de anticorpos IH de arbovírus em homens, particularmente pescadores; aumento dessa prevalência com a idade e presença de pessoa com antecedente de encefalite que apresentou, exclusivamente anticorpos neutralizantes para o Alphavirus EEL, o qual até agora não tem sido responsabilizado por moléstia na região. Encontrou-se baixa proporção de indivíduos com anticorpos para Rocio e Flavivirus em geral, fato este estranhável considerando a recente epidemia.

[Serological studies in research on arbovirus antibodies in the human population of the Ribeira Valley region. II - Survey of patients of Pariquera-Açú Regional Hospital, 1980]

Foi realizado inquérito sorológico para pesquisa de anticorpos inibidores de hemaglutinaçãc de arbovírus em 516 moradores das zonas urbana e rural da região do Vale do Ribeira, Brasil, área extensamente coberta de florestas onde ocorreu recentemente uma epidemia de encefalite atribuída ao Flavivirus Rocio. Verificou-se que 24,2% destas pessoas tinham anticorpos IH para um ou mais arbovírus (11,2% para Alphavirus; 13,2% para Flavivirus; 4,6% para o Bunyavirus Caraparu e 0,8% para outros arbovírus). Alguns dos investigados, sem antecedente de vacinação contra febre amarela, apresentaram anticorpos neutralizantes para o vírus da encefalite equina do Leste, St. Louis e da febre amarela, os dois últimos ainda não isolados na região. A análise das características dos indivíduos com sorologia positiva sugeria que a transmissão de arboviroses não era fato recente e estava se fazendo em pelo menos 9 municípios da área, não só no ambiente silvestre como fora do mesmo. Os indivíduos de sexo masculino e entre estes os que trabalham em pesca, em geral no período vespertino e noturno, apresentaram maior risco à infecções arbovíricas.