Keywords
Epidemiology. Disease Outbreaks
Zoonoses
Disease Reservoirs
Disease Vectors
Communicable Diseases,
Communicable Diseases, Emerging
How to Cite
Abstract
OBJETIVE: To describe the investigation of a sylvatic yellow fever outbreak in the state of Sao Paulo and the main control measures undertaken. METHODS: This is a descriptive study of a sylvatic yellow fever outbreak in the Southwestern region of the state from February to April 2009. Suspected and confirmed cases in humans and in non-human primates were evaluated. Entomological investigation in sylvatic environment involved capture at ground level and in the tree canopy to identify species and detect natural infections. Control measures were performed in urban areas to control Aedes aegypti. Vaccination was directed at residents living in areas with confirmed viral circulation and also at nearby cities according to national recommendation. RESULTS: Twenty-eight human cases were confirmed (39.3% case fatality rate) in rural areas of Sarutaiá, Piraju, Tejupá, Avaré and Buri. The deaths of 56 non-human primates were also reported, 91.4% were Allouatta sp. Epizootics was confirmed in two non-human primates in the cities of Itapetininga and Buri. A total of 1,782 mosquitoes were collected, including Haemagogus leucocelaenus , Hg. janthinomys/capricornii , and Sabethes chloropterus, Sa. purpureus and Sa. undosus . Yellow fever virus was isolated from a group of Hg. Leucocelaenus from Buri. Vaccination was carried out in 49 cities, with a total of 1,018,705 doses. Nine serious post-vaccination adverse events were reported. CONCLUSIONS: The cases occurred between February and April 2009 in areas with no recorded yellow fever virus circulation in over 60 years. The outbreak region occurred outside the original recommended vaccination area with a high percentage of susceptible population. The fast adoption of control measures interrupted the human transmission within a month and the confirmation of viral circulation in humans, monkeys and mosquitoes. The results allowed the identification of new areas of viral circulation but further studies are required to clarify the dynamics of the spread of this disease.
References
Beaty B, Calisher CH, Shope RE. Arboviruses. In: Schmidt NJ, Emmons RW, editors. Diagnostic procedures for viral, rickettsial and chlamydial infections. 6. ed. Washington (DC): American Public Health Association; 1989. p. 797-855.
Bicca-Marques JC, Freitas DS. The role of monkeys, mosquitoes and human in the occurrence of a yellow fever outbreak in a fragmented landscape in south Brazil: protecting howler monkeys is a matter of public health. Trop Conserv Sci. 2010;3(1):78-89.
Bryant JE, Holmes EC, Barrett ADT. Out of Africa: A Molecular Perspective on the Introduction of Yellow Fever Virus into the Americas. PLoS Pathog. 2007;3(5):e75. DOI:10.1371/journal.ppat.0030075
Staples JE, Gershman M, Fischer M; Centers for Disease Control and Prevention (CDC). Yellow fever vaccine. Recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep.2010;59(RR-7):1-27.
Degállier N, Hervé JP, Rosa APAT, Vasconcelos P, Rosa JFST, Sá Filho G. A ecologia dos arbovírus na Amazônia: pesquisas atuais e perspectiva. Rev Fund SESP. 1986;31(2):127-30.
Deubel V, Huerre M, Cathomas G, Drouet MT, Wuscher N, LE Guenno B, et al. Molecular detection and characterization of yellow fever virus in blood and liver specimens of a non-vaccinated fatal human case. J Med Virol. 1997; 53(3):212-7. DOI:10.1002/ (SICI)1096-9071(199711)53:3<212::AIDJMV5> 3.0.CO;2-B
Forattini OP, Gomes AC, Galati EAB, Rabello EX, Iverson LB. Estudos ecológicos sobre mosquitos Culicidae no Sistema da Serra do Mar, Brasil. 1-Observações no ambiente extradomiciliar. Rev Saude Publica.1978;12(4):297-325. DOI:10.1590/ S0034-89101978000400008
Gubler DJ, Kuno G, Sather GE, Velez M, Oliver A. Mosquito cell culture and specific monoclonal antibodies in surveillance for dengue viruses. Am J Trop Med Hyg. 1984;33(1):158-65.
Hall W C, Crowell T P, Watts D M, Barros V L, Kruger H, Pinheiro F, et al. Demonstration of yellow fever and dengue antigens in formalin-fixed paraffin-embedded human liver by immunohistochemical analysis. Am J Trop Med Hyg. 1991;45(4):408-17.
Igarashi A. Isolation of Singh´s Aedes albopictus cell line clone sensitive to dengue and chikungunya virus. J Gen Virol. 1978;40(3):531-44. DOI:10.1099/0022-1317-40-3-531
Johnson BW, Chambers TV, Crabtree MB, Filippis AM, Vilarinhos PT, Resende MC, et al. Vectors competence of Brazilian Aedes aegypti and Aedes albopictus for Brazilian yellow fever virus isolated. Trans R Soc Trop Med Hyg. 2002; 96(6):611-3. DOI:10.1016/S0035- 9203(02)90326-3
Kumm HW, Cerqueira NL. The role of Aedes leucocelaenus in the epidemiology of jungle yellow fever in Brazil. Bull Ent Res. 1951;42(1):195-200. DOI:10.1017/ S0007485300025281
Kuno G, Gomez I, Gubler DJ. Detecting artificial antidengue IgM complexes using a enzyme linked immunosorbent assay. Am J Trop Med Hyg. 1987; 36(1):153-9.
Lopes OS, Sacchetta LA, Francy DB, Jakob WL, Calisher CH. Emergence of a new arbovirus disease In Brazil. III. Isolation of Rocio virus from Psorophora ferox (Humboldt, 1819). Am J Epidemiol. 1981;113(2):122-5.
Mitchell CJ, Forattini OP. Experimental transmission of Rocio encephalitis virus by Aedes scapularis (Diptera, Culicidae) from the epidemic zone in Brazil. J Med Entomol. 1984;21(1):34-7.
Mitchell CJ, Forattini OP, Miller B. Vector competence experiments with Rocio virus and three mosquito species from the epidemic zone in Brazil. Rev Saude Publica. 1986;20(3):171-7. DOI:10.1590/S0034-89101986000300001
Moreno ES, Rocco IM, Bergo E S, Brasil RA, Siciliano MM, Suzuki A, et al. Yellow Fever Working Group. Reemergence of yellow fever: detection of transmission in the State of São Paulo, Brazil, 2008. Rev Soc Bras Med Trop. 2011;44(3):290-6. DOI:10.1590/S0037- 86822011005000041
World Health Organization. Update on progress controlling yellow Yellow fever in África, 2004-2008. Wkly Epidemiol Rec. 2008; 83(50):449-60.
Rocha WL. O Serviço Especial de Defesa contra a Febre Amarela. Arq Hig S Paulo. 1937;2(3):13-105.
Souza RP, Petrella S, Coimbra TLM, Maeda AY, Rocco IM, Bisordi I, et al. Isolation of yellow fever virus (YFV) from naturally infectied Haemagogus (Conopostegus) leucocelaenus (diptera, cukicudae) in São Paulo State, Brazil, 2009. Rev Inst Med Trop S Paulo. 2011;53(3):133-9.DOI:10.1590/S0036- 46652011000300004
Tauil PL. Aspectos críticos do controle da febre amarela no Brasil. Rev Saude Publica. 2010;44(3):555-8. DOI:10.1590/ S0034-89102010005000014
Vasconcelos PFC, Rodrigues SG, Dégallier N, Moraes MAP, Rosa JFST, Mondet B, et al. Ann epidemic of sylvatic yellow fever in the southeast region of Maranhão State, Brazil, 1993-1994: epidemiologic and entomological findings. Am J Trop Med Hyg. 1997;57(2):132-7.
Vasconcelos PFC, Sperb AF, Monteiro HAO, Torres MAN, Sousa MRS, Vasconcelos HB, et al. Isolations of yellow fever vírus from Haemagogus leucocelaenus in Rio Grande do Sul State, Brazil. Trans R Soc Trop Med Hyg. 2003; 97(1):60-2. DOI:10.1016/S0035- 9203(03)90023-X
Vasconcelos PFC. Febre Amarela no Brasil: reflexões e hipóteses sobre emergência em áreas previamente livres. Rev Saude Publica. 2010; 44(6):1144-9. DOI:10.1590/S0034- 89102010005000046 a. Organização Mundial de Saúde. Yellow Fever, key facts. Geneva; 2013 [citado 2013 set 16]. (Fact sheet,100). Disponível em: http://www.who.int/mediacentre/factsheets/ fs100/en/index.html b. Franco O. História da febre amarela no Brasil. Rio de Janeiro: Ministério da Saúde; 1976. c. Secretaria de Estado da Saúde de São Paulo. Centro de Vigilância Epidemiológica “Prof. Alexandre Vranjac”. Informe técnico sobre febre amarela. São Paulo; 2006 [citado 2010 abr 23]. Disponível em:http://www.cve. saude.sp.gov.br/htm/zoo/FA_INFORME.htm d. Secretaria de Estado da Saúde de São Paulo (BR). Centro de Vigilância Epidemiológica “Prof. Alexandre Vranjac”. Casos de febre amarela silvestre em residentes do Estado de São Paulo, 2007-2008. Bol Epidemiol Paul . 2008;5(55):12-5. e. Ministério da Saúde. Secretaria de Vigilância em Saúde. Guia de vigilância epidemiológica. 7. ed. Brasília (DF); 2009. f. Travassos da Rosa APA, Travassos da Rosa ES, Travassos da Rosa JFS, Degallier N, Vasconcelos PF, Rodrigues SG, et al. Os Arbovírus no Brasil: generalidades, métodos e técnicas de estudo. Belém: Instituto Evandro Chagas; 1994. (Documento técnico, 2). g. Superintendência de Controle de Endemias. Normas e recomendações técnicas para a vigilância e controle de Aedes aegypti no Estado de São Paulo - NORTE. São Paulo; 2005. h. Ministério da Saúde. Secretaria de Vigilância em Saúde. Febre Amarela Silvestre, Brasil, 2009. Boletim de atualização de dezembro de 2009. Emergências em Saúde Pública de Importância Nacional (ESPIN) de Febre Amarela Silvestre em São Paulo e no Rio Grande do Sul e a situação epidemiológica atual no Brasil (2008/2009). São Paulo; 2009 [citado 2011 out 11]. Disponível em:http:// portal.saude.gov.br/portal/arquivos/pdf/ boletim_febre_amarela_09_12_09.pdf
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2015 Melissa Mascheretti (in memorian), Ciléa H Tengan, Helena Keiko Sato, Ana Freitas Ribeiro, Akemi Suzuki, Renato Pereira de Souza, Marina Maeda, Roosecelis Brasil, Mariza Pereira, Rosa Maria Tubaki, Dalva M V Wanderley, Carlos Magno Castelo Branco Fortaleza