Differential diagnosis of exanthematous viruses during the 2022 Mpox outbreak in Minas Gerais, Brazil.

The monkeypox virus (MPXV) outbreak, primarily endemic to Africa, has spread globally, with Brazil reporting the second-highest number of cases. The emergence of MPXV in non-endemic areas has raised concerns, particularly due to the co-circulation of other exanthematous viruses such as varicella-zoster virus (VZV) and molluscum contagiosum virus (MOCV). To perform an accurate differential diagnosis of MPXV during the ongoing outbreak in Minas Gerais, Brazil, a 5PLEX qPCR assay targeting orthopoxviruses (OPV), VZV, and MOCV was used to retrospectively analyze all clinical samples that tested negative for MPXV in the initial screening conducted at Funed. In summary, our study analyzed 1,175 clinical samples received from patients suspected of MPXV infection and found a positivity rate of 33.8% (397 samples) for MPXV using the non-variola qPCR assay. Testing the 778 MPXV-negative clinical samples using the 5PLEX qPCR assay revealed that 174 clinical samples (22.36%) tested positive for VZV. MOCV DNA was detected in 13 and other OPV in 3 clinical samples. The sequencing of randomly selected amplified clinical samples confirmed the initial molecular diagnosis. Analysis of patient profiles revealed a significant difference in the median age between groups testing positive for MPXV and VZV and a male predominance in MPXV cases. The geographic distribution of positive cases was concentrated in the most populous mesoregions of Minas Gerais state. This study highlights the challenges posed by emerging infectious diseases. It emphasizes the importance of epidemiological surveillance and accurate diagnosis in enabling timely responses for public health policies and appropriate medical care. IMPORTANCE: Brazil ranks second in the number of cases during the global monkeypox epidemic. The study, conducted in Minas Gerais, the second most populous state in Brazil with over 20 million inhabitants, utilized differential diagnostics, revealing a significant number of positive cases for other exanthematous viruses and emphasizing the need for accurate diagnoses. During the study, we were able to assess the co-circulation of other viruses alongside monkeypox, including varicella-zoster virus, molluscum contagiosum virus, and other orthopoxviruses. The significance of the research is underscored by the concentration of positive cases in populous areas, highlighting the challenges posed by emerging infectious diseases. This demographic context further amplifies the importance of the research in guiding public health policies and medical interventions, given the substantial population at risk. The study not only addresses a global concern but also holds critical implications for a state with such a large population and geographic expanse within Brazil. Overall, the study emphasizes the pivotal role of surveillance and precise diagnosis in guiding effective public health responses and ensuring appropriate medical interventions.

Analysis of the Genomic Features and Evolutionary History of Pithovirus-Like Isolates Reveals Two Major Divergent Groups of Viruses.

New representatives of the phylum Nucleocytoviricota have been rapidly described in the last decade. Despite this, not all viruses of this phylum are allocated to recognized taxonomic families, as is the case for orpheovirus, pithovirus, and cedratvirus, which form the proposed family Pithoviridae. In this study, we performed comprehensive comparative genomic analyses of 8 pithovirus-like isolates, aiming to understand their common traits and evolutionary history. Structural and functional genome annotation was performed de novo for all the viruses, which served as a reference for pangenome construction. The synteny analysis showed substantial differences in genome organization between these viruses, with very few and short syntenic blocks shared between orpheovirus and its relatives. It was possible to observe an open pangenome with a significant increase in the slope when orpheovirus was added, alongside a decrease in the core genome. Network analysis placed orpheovirus as a distant and major hub with a large fraction of unique clusters of orthologs, indicating a distant relationship between this virus and its relatives, with only a few shared genes. Additionally, phylogenetic analyses of strict core genes shared with other viruses of the phylum reinforced the divergence of orpheovirus from pithoviruses and cedratviruses. Altogether, our results indicate that although pithovirus-like isolates share common features, this group of ovoid-shaped giant viruses presents substantial differences in gene contents, genomic architectures, and the phylogenetic history of several core genes. Our data indicate that orpheovirus is an evolutionarily divergent viral entity, suggesting its allocation to a different viral family, Orpheoviridae. IMPORTANCE Giant viruses that infect amoebae form a monophyletic group named the phylum Nucleocytoviricota. Despite being genomically and morphologically very diverse, the taxonomic categories of some clades that form this phylum are not yet well established. With advances in isolation techniques, the speed at which new giant viruses are described has increased, escalating the need to establish criteria to define the emerging viral taxa. In this work, we performed a comparative genomic analysis of representatives of the putative family Pithoviridae. Based on the dissimilarity of orpheovirus from the other viruses of this putative family, we propose that orpheovirus be considered a member of an independent family, Orpheoviridae, and suggest criteria to demarcate families consisting of ovoid-shaped giant viruses.

Genomic Surveillance of Monkeypox Virus, Minas Gerais, Brazil, 2022.

Phylogenetic analysis of 34 monkeypox virus genome sequences isolated from patients in Minas Gerais, Brazil, revealed initial importation events in early June 2022, then community transmission within the state. All generated genomes belonged to the B.1 lineage responsible for a global mpox outbreak. These findings can inform public health measures.

Rapid Epidemic Expansion of Chikungunya Virus East/Central/South African Lineage, Paraguay.

The spread of Chikungunya virus is a major public health concern in the Americas. There were >120,000 cases and 51 deaths in 2023, of which 46 occurred in Paraguay. Using a suite of genomic, phylodynamic, and epidemiologic techniques, we characterized the ongoing large chikungunya epidemic in Paraguay.

T cell depletion increases humoral response by favoring T follicular helper cells expansion.

Antibody-mediated rejection is a major cause of long-term graft loss in kidney transplant patients. T follicular helper (Tfh) cells are crucial for assisting B cell differentiation and are required for an efficient antibody response. Anti-thymocyte globulin (ATG) is a widely used lymphocyte-depleting induction therapy. However, less is known about how ATG affects Tfh cell development and donor-specific antibody (DSA) formation. We observed an increase in circulating Tfh cells at 6 months after kidney transplant in patients who received ATG. Using an NP-OVA immunization model, we found that ATG-treated mice had a higher percentage of Tfh cells, germinal center B cells, and higher titers of antigen-specific antibodies compared to controls. ATG-treated animals had lower levels of IL-2, a known Bcl-6 repressor, but higher levels of IL-21, pSTAT3 and Bcl-6, favoring Tfh differentiation. In a mouse kidney transplant model, ATG-treated recipients showed an increase in Tfh cells, DSA and C4d staining in the allograft. Although ATG was effective in depleting T cells, it favored the expansion of Tfh cells following depletion. Concomitant use of IL-2, tacrolimus, or rapamycin with ATG was essential to control Tfh cell expansion. In summary, ATG depletion favors Tfh expansion, enhancing antibody-mediated response.

Contact tracing-induced Allee effect in disease dynamics.

Contact tracing, case isolation, quarantine, social distancing, and other non-pharmaceutical interventions (NPIs) have been a cornerstone in managing the COVID-19 pandemic. However, their effects on disease dynamics are not fully understood. Saturation of contact tracing caused by the increase of infected individuals has been recognized as a crucial variable by healthcare systems worldwide. Here, we model this saturation process with a mechanistic and a phenomenological model and show that it induces an Allee effect which could determine an infection threshold between two alternative states-containment and outbreak. This transition was considered elsewhere as a response to the strength of NPIs, but here we show that they may be also determined by the number of infected individuals. As a consequence, timing of NPIs implementation and relaxation after containment is critical to their effectiveness. Containment strategies such as vaccination or mobility restriction may interact with contact tracing-induced Allee effect. Each strategy in isolation tends to show diminishing returns, with a less than proportional effect of the intervention on disease containment. However, when combined, their suppressing potential is enhanced. Relaxation of NPIs after disease containment--e.g. because vaccination--have to be performed in attention to avoid crossing the infection threshold required to a novel outbreak. The recognition of a contact tracing-induced Allee effect, its interaction with other NPIs and vaccination, and the existence of tipping points contributes to the understanding of several features of disease dynamics and its response to containment interventions. This knowledge may be of relevance for explaining the dynamics of diseases in different regions and, more importantly, as input for guiding the use of NPIs, vaccination campaigns, and its combination for the management of epidemic outbreaks.

Epidemic malaria dynamics in Ethiopia: the role of self-limiting, poverty, HIV, climate change and human population growth.

BACKGROUND: During the last two decades, researchers have suggested that the changes of malaria cases in African highlands were driven by climate change. Recently, a study claimed that the malaria cases (Plasmodium falciparum) in Oromia (Ethiopia) were related to minimum temperature. Critics highlighted that other variables could be involved in the dynamics of the malaria. The literature mentions that beyond climate change, trends in malaria cases could be involved with HIV, human population size, poverty, investments in health control programmes, among others. METHODS: Population ecologists have developed a simple framework, which helps to explore the contributions of endogenous (density-dependent) and exogenous processes on population dynamics. Both processes may operate to determine the dynamic behaviour of a particular population through time. Briefly, density-dependent (endogenous process) occurs when the per capita population growth rate (R) is determined by the previous population size. An exogenous process occurs when some variable affects another but is not affected by the changes it causes. This study explores the dynamics of malaria cases (Plasmodium falciparum and Plasmodium vivax) in Oromia region in Ethiopia and explores the interaction between minimum temperature, HIV, poverty, human population size and social instability. RESULTS: The results support that malaria dynamics showed signs of a negative endogenous process between R and malaria infectious class, and a weak evidence to support the climate change hypothesis. CONCLUSION: Poverty, HIV, population size could interact to force malaria models parameters explaining the dynamics malaria observed at Ethiopia from 1985 to 2007.

Is zoonotic Plasmodium vivax malaria an obstacle for disease elimination?

BACKGROUND: The groundwork for malaria elimination does not currently consider the potential of Plasmodium zoonotic cycles that involve non-human primates (NHPs) in sylvatic environments. Since vivax malaria is less responsive to control measures, finding Plasmodium vivax infected NHPs adds even more concern. METHODS: Both Free-living monkeys in forest fragments inside the urban area and captive monkeys from a local zoo had blood samples tested for Plasmodium species. RESULTS: In this study, among the Neotropical monkeys tested, three (4.4%), one captive and two free-living, were found to be naturally infected by P. vivax. CONCLUSION: This important finding indicates that it is necessary to estimate the extent to which P. vivax NHP infection contributes to the maintenance of malaria transmission to humans. Therefore, the discussion on wildlife conservation and management must be incorporated into the malaria elimination agenda.

Bioaccumulation and human health risks of potentially toxic elements in fish species from the southeastern Carajás Mineral Province, Brazil.

Anthropogenic activities may have increased the concentrations of potentially toxic elements (PTEs) in fish from the southeastern Carajás Mineral Province in Brazil, which has not yet been studied. The objectives were to determine the quality parameters of surface water and bottom sediments, and to assess the bioaccumulation and risks of Al, Fe, Ba, Cd, Co, Cr, Cu, Mn, Mo, Ni, Pb, Ti, V and Zn in fish species from the southeastern Carajás Mineral Province. Water, sediments and fish species (Colossoma macropomum, Curimata cyprinoides, Geophagus sp., Leporinus trifasciatus, and Serrasalmus eigenmanni) were collected in 14 areas in the municipalities of Parauapebas, Marabá and Canaã dos Carajás, contemplating the Gelado Stream and the Parauapebas, Tapirapé and Itacaiúnas Rivers. Water samples were subjected to physicochemical analysis using a multiparameter meter. Concentrations of PTEs in all samples were quantified by inductively coupled plasma-optical emission spectrometry. Enrichment factor (EF) and geoaccumulation index (Igeo) were calculated to study the sediment enrichment and contamination. Ecological and human health risk assessments were performed to determine the risks to the environment and population's health. EF and Igeo revealed that the sediments from the Parauapebas River and Gelado Stream are respectively enriched by Ba, Co, Cu, Cr, Mn, Pb, and Ba, Co, Cr, Ni, Pb and V. The concentrations of Fe (1.67 mg L-1) and Mn (0.11 mg L-1) in water and the concentrations of Cr (>0.1 mg kg-1) and Pb (>2 mg kg-1) in fish were above the Brazilian legislation thresholds. The ecological risk assessment revealed considerable risk from Ni and moderate risk from multiple PTEs in sediments from the Gelado Stream. Human health risks were detected for Pb in all fish species and for Mo in L.trifasciatus. These results indicate that techniques for monitoring and controlling contamination must be implemented by the environmental agencies.

Spatial and temporal shift in the factors affecting the population dynamics of Calanus copepods in the North Sea.

The swap in abundance between two Calanus species in the North Sea during the 1980s constitutes a quintessential example of regime shift, with important ecosystemic and economic repercussions because these copepods constitute a major component of the diet of larval and juvenile cods. It is hypothesized that this transition was driven by gradual changes in primary productivity, the North Atlantic Oscillation (NAO) and sea surface temperatures (SST), and yet how these factors contribute to the population dynamics of these two species and the overall regime shift remains unclear. Here, we combine a highly resolved and spatially structured longitudinal dataset with population dynamics theory-based models to obtain a thorough and more detailed description of populations' responses to the regime shift observed in the North Sea. Our analyses highlight that this transition exhibits a clear spatial structure and involved a decoupling between the dynamics of Calanus finmarchicus and the NAO in western regions and between Calanus helgolandicus and SST in the eastern regions of the North Sea. Consequently, the observed switch in abundance between these species reflects the interaction between species-specific attributes, a well-defined spatial structure with a marked east-west axis and a decoupling between the ecological drivers and Calanus population dynamics following the shift. Succinctly, we suspect that higher water temperatures have favored C. helgolandicus and resulted in restrictive conditions for C. finmarchicus, eventually overshadowing the effects of NAO detected in historical records. Overall, our study illustrates how population dynamics theory can be successfully employed to disentangle the complex and multifactorial nature of a regime shift in response to gradually changing environmental conditions.

Virus goes viral: an educational kit for virology classes.

BACKGROUND: Viruses are the most numerous entities on Earth and have also been central to many episodes in the history of humankind. As the study of viruses progresses further and further, there are several limitations in transferring this knowledge to undergraduate and high school students. This deficiency is due to the difficulty in designing hands-on lessons that allow students to better absorb content, given limited financial resources and facilities, as well as the difficulty of exploiting viral particles, due to their small dimensions. The development of tools for teaching virology is important to encourage educators to expand on the covered topics and connect them to recent findings. Discoveries, such as giant DNA viruses, have provided an opportunity to explore aspects of viral particles in ways never seen before. Coupling these novel findings with techniques already explored by classical virology, including visualization of cytopathic effects on permissive cells, may represent a new way for teaching virology. This work aimed to develop a slide microscope kit that explores giant virus particles and some aspects of animal virus interaction with cell lines, with the goal of providing an innovative approach to virology teaching. METHODS: Slides were produced by staining, with crystal violet, purified giant viruses and BSC-40 and Vero cells infected with viruses of the genera Orthopoxvirus, Flavivirus, and Alphavirus. Slides with amoebae infected with different species of giant viruses and stained with hemacolor reagents were also produced. RESULTS: Staining of the giant viruses allowed better visualization of the viral particles, and this technique highlights the diversity in morphology and sizes among them. Hemacolor staining enabled visualization of viral factories in amoebae, and the staining of infected BSC-40 and Vero cell monolayers with crystal violet highlights plaque-forming units. CONCLUSIONS: This kit was used in practical virology classes for the Biological Sciences course (UFMG, Brazil), and it will soon be made available at a low-cost for elementary school teachers in institutions that have microscopes. We hope this tool will foster an inspiring learning environment.

Geochemical background concentrations of potentially toxic elements in soils of the Carajás Mineral Province, southeast of the Amazonian Craton.

The objective of this study was to establish background concentrations of potentially toxic elements (PTEs) in soils from the Carajás Mineral Province (CMP), southeastern Amazonian Craton. The PTEs Al, Ba, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, Ti, V, and Zn were digested in microwaves and quantified by optical emission spectrometry (ICP OES). The variability of physical-chemical and mineralogical attributes contributed to variation in PTE concentrations. High background concentrations of Al, Fe, Cr, Mn, Mo, Ni, Ti, and V and, in particular, the PTE concentrations of Cd, Cu, Cr, Ba, and Co were greater than the prevention values defined by the Brazilian National Council of Environment. Soil quality reference values (QRVs) were greater than those determined for most Brazilian states and soils in the state of Pará. The high background concentrations and QRVs of PTEs show that the region is strongly influenced by the source material, rich in ferruginous deposits and other associated minerals. The results are an important tool for establishing soil quality standards and public policies for environmental protection in regions naturally PTE enriched.

Central and peripheral nervous system involvement in Zika virus infection in a child.

A 7-year-old boy that presented an encephalomyeloradiculitis and no classic symptoms of arboviruses. Zika virus (ZIKV) was confirmed by molecular analyses of cerebrospinal fluid and 1 year later by plaque reduction neutralization test. This case demonstrates that ZIKV can be associated with diffuse nervous system infection in children.

In-depth analysis of the replication cycle of Orpheovirus.

BACKGROUND: After the isolation of Acanthamoeba polyphaga mimivirus (APMV), the study and search for new giant viruses has been intensified. Most giant viruses are associated with free-living amoebae of the genus Acanthamoeba; however other giant viruses have been isolated in Vermamoeba vermiformis, such as Faustovirus, Kaumoebavirus and Orpheovirus. These studies have considerably expanded our knowledge about the diversity, structure, genomics, and evolution of giant viruses. Until now, there has been only one Orpheovirus isolate, and many aspects of its life cycle remain to be elucidated. METHODS: In this study, we performed an in-depth characterization of the replication cycle and particles of Orpheovirus by transmission and scanning electron microscopy, optical microscopy and IF assays. RESULTS: We observed, through optical and IF microscopy, morphological changes in V. vermiformis cells during Orpheovirus infection, as well as increased motility at 12 h post infection (h.p.i.). The viral factory formation and viral particle morphogenesis were analysed by transmission electron microscopy, revealing mitochondria and membrane recruitment into and around the electron-lucent viral factories. Membrane traffic inhibitor (Brefeldin A) negatively impacted particle morphogenesis. The first structure observed during particle morphogenesis was crescent-shaped bodies, which extend and are filled by the internal content until the formation of multi-layered mature particles. We also observed the formation of defective particles with different shapes and sizes. Virological assays revealed that viruses are released from the host by exocytosis at 12 h.p.i., which is associated with an increase of particle counts in the supernatant. CONCLUSIONS: The results presented here contribute to a better understanding of the biology, structures and important steps in the replication cycle of Orpheovirus.

Isotopic Heft on the B1 l Silent Mode in Ultra-Narrow Gallium Nitride Nanowires.

Wurtzite semiconductor compounds have two silent modes, B1 l and B1 h. A silent mode is a vibrational mode that carries neither a dipole moment nor Raman polarizability. Thus, they are forbidden in both infrared reflectivity and Raman spectroscopy. Astonishingly, we detected the B1 l mode in high-quality, ultra-narrow GaN nanowires using resonant Raman scattering, although the B1 h was not observed, and there is no immediate explanation for this asymmetric finding. The Raman experiments were performed using several laser lines from 647 to 325 nm; the latter is a wavelength in which Raman becomes resonant. Actually, we observed the B1 l mode only in resonance, indicating that the appearance of this mode is related to Fröhlich electron-phonon interactions; i.e., a dipole moment emerging in the B1 l silent mode may not be present in the B1 h mode. To shed light onto the physical origin of these observations, we performed density functional theory calculations of the lattice dynamics in GaN. We performed a careful analysis of the different physical mechanisms that allow the forbidden mode to appear to explain the physics underlying the nonzero dipole moment in the B1 l mode, and the reason why this dipole moment is not present in the B1 h mode.

Ocular Vaccinia Infection in Dairy Worker, Brazil.

We studied a clinical case of vaccinia virus that caused an ocular manifestation in a dairy worker in Brazil. Biologic and molecular analyses identified a co-infection with 2 isolates from different Brazilian vaccinia virus phylogenetic groups.

The Investigation of Promoter Sequences of Marseilleviruses Highlights a Remarkable Abundance of the AAATATTT Motif in Intergenic Regions.

Viruses display a wide range of genomic profiles and, consequently, a variety of gene expression strategies. Specific sequences associated with transcriptional processes have been described in viruses, and putative promoter motifs have been elucidated for some nucleocytoplasmic large DNA viruses (NCLDV). Among NCLDV, the Marseilleviridae is a well-recognized family because of its genomic mosaicism. The marseilleviruses have an ability to incorporate foreign genes, especially from sympatric organisms inhabiting Acanthamoeba, its main known host. Here, we identified for the first time an eight-nucleotide A/T-rich promoter sequence (AAATATTT) associated with 55% of marseillevirus genes that is conserved in all marseilleviruses lineages, a higher level of conservation than that of any giant virus described to date. We instigated our prediction about the promoter motif by biological assays and by evaluating how single mutations in this octamer can impact gene expression. The investigation of sequences that regulate the expression of genes relative to lateral transfer revealed that the promoter motifs do not appear to be incorporated by marseilleviruses from donor organisms. Indeed, analyses of the intergenic regions that regulate lateral gene transfer-related genes have revealed an independent origin of the marseillevirus intergenic regions that does not match gene-donor organisms. About 50% of AAATATTT motifs spread throughout intergenic regions of the marseilleviruses are present as multiple copies. We believe that such multiple motifs are associated with increased expression of a given gene or are related to incorporation of foreign genes into the mosaic genome of marseilleviruses.IMPORTANCE The marseilleviruses draw attention because of the peculiar features of their genomes; however, little is known about their gene expression patterns or the factors that regulate those expression patterns. The limited published research on the expression patterns of the marseilleviruses and their unique genomes has led us to study the promoter motif sequences in the intergenic regions of the marseilleviruses. This work is the first to analyze promoter sequences in the genomes of the marseilleviruses. We also suggest a strong capacity to acquire foreign genes and to express those genes mediated by multiple copies of the promoter motifs available in intergenic regions. These findings contribute to an understanding of genomic expansion and plasticity observed in these giant viruses.

The fingerprint of Te-rich and stoichiometric Bi2Te3 nanowires by Raman spectroscopy.

We unambiguously show that the signature of Te-rich bismuth telluride is the appearance of three new peaks in the Raman spectra of Bi2Te3, located at 88, 117 and 137 cm(-1). For this purpose, we have grown stoichiometric Bi2Te3 nanowires as well as Te-rich nanowires. The absence of these peaks in stoichiometric nanowires, even in those with the smallest diameter, shows that they are not related to confinement effects or the lack of inversion symmetry, as stated in the literature, but to the existence of Te clusters. These Te clusters have been found in non-stoichiometric samples by high resolution electron microscopy, while they are absent in stoichiometric samples. The Raman spectra of the latter corresponds to the one for bulk Bi2Te3. The intensity of these Raman peaks are clearly correlated to the Te content. In order to ensure statistically meaningful results, we have investigated several regions from every sample.

ROLE OF IMAGING TESTS FOR PREOPERATIVE LOCATION OF PATHOLOGIC PARATHYROID TISSUE IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM.

OBJECTIVE: Primary hyperparathyroidism (PHPT) can be cured by parathyroidectomy, and the preoperative location of enlarged pathologic parathyroid glands is determined by imaging studies, especially cervical ultrasonography and scintigraphy scanning. The aim of this retrospective study was to evaluate the use of preoperative cervical ultrasonography and/or parathyroid scintigraphy in locating pathologic parathyroid tissue in a group of patients with PHPT followed in the same endocrine center. METHODS: We examined the records of 61 patients who had undergone parathyroidectomy for PHPT following (99m)Tc-sestamibi scintigraphy scan and/or cervical ultrasonography. Scintigraphic and ultrasonographic findings were compared to histopathologic results of the surgical specimens. RESULTS: Ultrasonography detected enlarged parathyroid glands in 87% (48/55) of patients with PHPT and (99m)Tc-sestamibi scintigraphy in 79% (37/47) of the cases. Ultrasonography was able to correctly predict the surgical findings in 75% (41/55) of patients and scintigraphy in 72% (34/47). Of 7 patients who had negative ultrasonography, scintigraphy correctly predicted the surgical results in 2 (29%). Of 10 patients who had negative scintigraphy, ultrasonography correctly predicted the surgical results in 4 (40%). When we analyzed only patients with solitary eutopic parathyroid adenomas, the predictive positive values of ultrasonography and scintigraphy were 90% and 86%, respectively. CONCLUSION: Cervical ultrasonography had a higher likelihood of a correct positive test and a greater predictive positive value for solitary adenoma compared to (99m)Tc-sestamibi and should be used as the first diagnostic tool for preoperative localization of affected parathyroid glands in PHPT. ABBREVIATIONS: Ca = calcium IEDE = Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione PHPT = primary hyperparathyroidism PTH = parathyroid hormone.

Whooping cough dynamics in Chile (1932-2010): disease temporal fluctuations across a north-south gradient.

BACKGROUND: The spatial-temporal dynamics of Bordetella pertussis remains as a highly interesting case in infectious disease epidemiology. Despite large-scale vaccination programs in place for over 50 years around the world, frequent outbreaks are still reported in many countries. METHODS: Here, we use annual time series of pertussis incidence from the thirteen different regions of Chile (1952-2010) to study the spatial-temporal dynamics of Pertussis. The period 1975-1995 was characterized by a strong 4 year cycle, while the last two decades of the study period (1990-2010) were characterized by disease resurgence without significant periodic patterns. RESULTS: During the first decades, differences in periodic patterns across regions can be explained by the differences in susceptible recruitment. The observed shift in periodicity from the period 1952-1974 to the period 1975-1995 across regions was relatively well predicted by the susceptible recruitment and population size. However, data on vaccination rates was not taken into account in this study. CONCLUSIONS: Our findings highlight how demography and population size have interacted with the immunization program in shaping periodicity along a unique latitudinal gradient. Widespread B. pertussis vaccination appears to lead to longer periodic dynamics, which is line with a reduction in B. pertussis transmission, but our findings indicate that regions characterized by both low birth rate and population size decreased in periodicity following immunization efforts.