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Arboviroses Chikungunya - Dengue - Febre Amarela - Zika 2016

Arboviroses Chikungunya - Dengue - Febre Amarela - Zika 2016

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Alexandre Naime Barbosa MD, PhD
Professor Doutor - Infectologia
Auxílio Didático 6º Ano Med
UNESP - Faculdade de Medicina
Nov/2016- Botucatu - SP - Brasil
The following material is part of the educational project produced by
Prof. Dr. Alexandre Naime Barbosa
Objectives
1. Education: Training for Students & Health Professionals
2. Community: Provide and Translate Scientific Information to the Population;
3. Scientific: Encourage the Scientific Discussion and Share Teaching Materials.
Authorship and Assignment
1. Content: The following data are referenced in respect to the original author;
2. Use: It is allowed to use the material, if the source is mentioned;
3. Contact: Talk to Dr. Barbosa and keep in touch with his project in:
1. Arbovirus: Overview
2. Yellow Fever
3. Dengue
4. Chikungunya
5. Zika
6. Conclusions
Arboviroses  Chikungunya - Dengue - Febre Amarela - Zika 2016
So what is the world's deadliest animal?
Maybe a smaller animal…

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Arboviroses Chikungunya - Dengue - Febre Amarela - Zika 2016

  • 1. Alexandre Naime Barbosa MD, PhD Professor Doutor - Infectologia Auxílio Didático 6º Ano Med UNESP - Faculdade de Medicina Nov/2016- Botucatu - SP - Brasil
  • 2. The following material is part of the educational project produced by Prof. Dr. Alexandre Naime Barbosa Objectives 1. Education: Training for Students & Health Professionals 2. Community: Provide and Translate Scientific Information to the Population; 3. Scientific: Encourage the Scientific Discussion and Share Teaching Materials. Authorship and Assignment 1. Content: The following data are referenced in respect to the original author; 2. Use: It is allowed to use the material, if the source is mentioned; 3. Contact: Talk to Dr. Barbosa and keep in touch with his project in:
  • 3. 1. Arbovirus: Overview 2. Yellow Fever 3. Dengue 4. Chikungunya 5. Zika 6. Conclusions
  • 5. So what is the world's deadliest animal?
  • 6. Maybe a smaller animal…
  • 7. Arbovirus: Arthropod Borne viruses WHO definition: viruses that are maintained in nature principally, or to an important extent, through biological transmission between susceptible vertebrate host by hematophagous arthropods; viruses multiply in tissues of arthropods, and are passed on to new vertebrates by bites of arthropods after a period of extrinsic incubation period.
  • 8. Cycle Type 1: Man-Arthropod-Man
  • 9. Cycle Type 2: Animal-Arthropod-Man
  • 10. Family Members Bunyaviridae La Crosse, Oropouche, Rift Valley, Sandfly, Crimean-Congo Flaviviridae Yellow Fever, Dengue, Zika, Japanese Encephalitis, Saint Louis Encephalitis, West Nile, Kyasanur Forest, Omsk Togaviridae Chikungunya, O’nyong-nyong, Ross River, Equine Encephalitis (East, West, Venezuelan), Sindbis
  • 13. Family: Flaviviridae; Genus: Flavivirus Distribution: restricted to Africa & Central and South America.
  • 14. Family: Flaviviridae; Genus: Flavivirus Distribution: restricted to Africa & Central and South America.
  • 15. Brazil: Endemic vs Transition vs Free Areas
  • 16. Brazil: Endemic vs Transition vs Free Areas
  • 17. São Paulo State: Endemic vs Transition vs Free Areas
  • 19. Brazil: YF in 2012-13
  • 21. Symptoms The majority of persons infected with yellow fever virus have no illness or only mild illness. In persons who develop symptoms, the incubation period (time from infection until illness) is typically 3–6 days. The initial symptoms include sudden onset of fever, chills, severe headache, back pain, general body aches, nausea, and vomiting, fatigue, and weakness. Most persons improve after the initial presentation.
  • 22. Symptoms After a brief remission of hours to a day, roughly 15% of cases progress to develop a more severe form of the disease. The severe form is characterized by high fever, jaundice, bleeding, and eventually shock and failure of multiple organs. Rate of Death: 50%
  • 24. Diagnosis Virus isolation – From the blood or post-mortem liver tissue Rapid diagnostic test: – Detection viral genome by PCR in blood o tissues – Not widely available Detection IgM antibodies (ELISA) – Simple sample provides a presumptive diagnosis. Confirmation is made by a rise between paired acute and convalescent samples or a fall between early and late convalescent samples. – Cross-reactions with other flaviviruses complicate the diagnosis particularity in Africa (multiple flaviviruses cocirculate).
  • 25. Treatment No specific treatments have been found to benefit patients with yellow fever. Whenever possible, yellow fever patients should be hospitalized for supportive care and close observation. Treatment is symptomatic. Rest, fluids, and use of pain relievers and medication to reduce fever may relieve symptoms of aching and fever.
  • 26. Prevention Vaccine: - Types: Inactivated mouse brain or Live attenuated - Mandatory for people that live at endemic area and travelers Others - Use insect repellent - Wear proper clothing to reduce mosquito bites - Be aware of peak mosquito hours
  • 28. Family: Flaviviridae; Genus: Flavivirus, 4 Serotypes (1,2,3,4) Distribution: all tropical and some subtropical areas - WHO: 2.5 billion people, two fifths of the world's population, at risk from dengue and estimates that there may be 50 million cases of dengue infection worldwide every year. The disease is endemic in more than 100 countries
  • 29. Brazil: 2014 - 2015 Epidemic
  • 30. Brazil: 2014 - 2015 Epidemic
  • 31. Transmission: 1 patterns (Cycle) 1. Person to person transmission by Aedes A. aegypti (America) and A. albopictus (Asia)
  • 32. Classic Dengue (Break bone Fever) - Incubation: 3-10 days; - Chills, high fever, intense headache, myalgia, arthralgia, retro-orbital pain, colic pain and abdominal tenderness. Fever biphasic (saddle type). - Maculopapular rashes develop on chest, trunk.
  • 33. Dengue Hemorrhagic Fever (DHF) & Dengue Shock Syndrome (DSS) C/F-High fever, hemorrhagic phenomena including bleeding from the eyes, nose, mouth, ear, into the gut, and oozing of blood from skin pores, thrombocytopenia, and hemoconcentration Vascular leak syndrome - blood leaks through the skin and into spaces around the lungs and abdomen. This fluid loss and severe bleeding can cause blood pressure to fall; then Dengue Shock Syndrome (DSS) sets in, which has a high mortality rate.
  • 35. Diagnosis - Isolation of virus from blood - Serology: -Antibody detection IgM -Antigen detection- NS1 ag - RT-PCR
  • 36. Treatment No antiviral therapy available Symptomatic management in majority of cases Suitable fluid replacement
  • 39. Family: Togaviridae; Genus Alphavirus Distribution:
  • 42. Transmission: 2 patterns (Cycles) 1. Person to person transmission by Aedes sp. 2. Monkey-monkey by arboreal mosq. A. aegypti (America) and A. albopictus (Asia)
  • 43. Symptoms - Fever - Severe arthritis - Chills, headache, photophobia - Nausea, abdominal pain - Rashes and petechias
  • 45. Diagnosis - Isolation of virus from blood - Serology: Antibody detection IgM/IgG - RT-PCR
  • 46. Treatment and Prevention No antiviral therapy available Symptomatic management in majority of cases No available vaccine
  • 48. Family: Flaviviridae; Genus: Flavivirus Distribution:
  • 49. 14
  • 50. - 1940 - 50: First evidences of human infections (Zika = Forest in Uganda)
  • 51. - 1940 - 50: First evidencies of human infection (East Africa) - 2007: Big epidemic in Yap Island and Micronesia (80% of total population) - 2013: French Polynesia (neurologic complications, and others) - 2015: Brazil and South America (Microcephaly)
  • 52. Beginning of 2015: - 21 cases of “Dengue-Like”: 8 RT-PCR ZKV Positives (Natal - RN)
  • 53. First Identifield Cases: - April 2015: Camaçari (BA) - May 2015: Natal (RN) - May 2015: Sumaré (SP) Route Theory - Va’a (Canoe) World Sprint Championships (RJ, Ago/2014) - Ocean Pacific Countries: French Polynesia, New Caledonia, Cook Island, Easter Island - Zika circulation starts in 2014 - Brazil Zika virus is close to Polynesia virus
  • 56. Brasil, Ministério da Saúde - 2016 Dados Oficiais do Surto 2015-16 (23/02/2016) Confirmados 583 Óbitos 120 Zika Identificado 67 Casos Suspeitos 4.107 Descartados 950
  • 57. - Família: Flaviviridae - Gênero: Flavivirus - Vírus RNA - Arbovírus - Duas linhagens - Africana - Asiática CDC - 2016
  • 58. Importância Epidemiológica: Transmissão Vetorial - Aedes aegypti, Aedes africanus e outros Aedes - Culex???
  • 59. Transmission: 2 patterns (Cycles) 1. Person to person transmission by Aedes sp. 2. Monkey-monkey by arboreal mosq. Aedes aegypti Aedes africanus, Aedes apicoargenteus Aedes furcifer Aedes luteocephalus Aedes vitattus
  • 60. Outras Vias de Menor Importância Epidemiológica - Transplacentária e Perinatal - Transfusional - Sexual - Saliva e Urina (???) - Leite Materno (??????)
  • 61. - Período de Incubação (Mosquitos): 10 dias - Reservatórios de Importância: Humanos e Pequenos Primatas - Infecção em Humanos: Células Dendríticas Linfonodos Corrente Sanguínea - Sintomas Clínicos: Leves a Moderados (Febre, Rash Cutâneo e Conjuntivite) - Associação Possível e Provável com Malformações Fetais e Sde. de Guillain-Barré - Associação Causal e Dano Neurológico Direto (e outros): em estudo e análise
  • 62. - Microcefalia pode ocorrer, mas não se limita a esse achado (Z-TORCH) - Podem ocorrer medidas normais de PC, mas com graves malformações de SNC - Necrose tecidual => Redução massa cerebral => Microcefalia - Lisencefalia, hidrocefalia, calcificações multifocais corticais e subcorticais - Perda do tecido cortical, e presença de necrose e inflamação - Lesões oftalmológicas: mácula e peri-mácula; nervo óptico - Artrogripose: endurecimento da musculatura e as articulações - Taxa de Transmissão Transplacentária: 2-5% (???) - ZKV no feto: permanência e reativação por um longo período - Momento de maior risco na gestação (???)
  • 68. Pacientes com quadro de exantema máculo-papular e DOIS dos seguintes sintomas: - febre (<38,5º C) ou - hiperemia conjuntival sem secreção ou - prurido ou - artralgia ou - edema periarticular Outros Achados: mialgia, cefaleia, edema de membros inferiores, dor retrorbital, anorexia, vômitos, diarreia ou dor abdominal. Manifestações neurológicas: - Síndrome de Guillain Barré, ADEM: 4 a 20 dias após o início dos sintomas
  • 69. Symptoms About 1 in 5 people infected with Zika virus become ill. The most common symptoms of Zika are fever, rash, joint pain, or red eyes. Other symptoms include muscle pain, headache, pain behind the eyes, and vomiting. The illness is usually mild with symptoms lasting for several days to a week. Severe disease requiring hospitalization is uncommon. Deaths due to Zika are very rare.
  • 70. Matsuda EM - 2016
  • 71. Brasil, Ministério da Saúde - 2016
  • 72. Treatment and Prevention No antiviral therapy available Symptomatic management in majority of cases No available vaccine
  • 74. Não há vacina Eliminação dos criadouros dos mosquitos Evitar locais com presença do mosquito, uso de telas Repelentes - < 6 meses: sem indicação - 6 meses - 2 anos: IR3535 - 2 anos a 12 anos: DEET 10% (no máximo, aplicar 3x/dia) ou Icaridina; > 12 anos ou gestantes: DEET > 10% ou Icaridina Uso de inseticidas Uso de cobertura de áreas expostas com roupa Atualização de carteira vacinal
  • 77. Comparison of Symptoms (Chikungunya, Dengue anda Zika)
  • 81. Obrigado pela Atenção! SAE de Infectologia HC UNESP Botucatu Faculdade de Medicina UNESP