Yellow fever epizootics in non-human primates, Southeast and Northeast Brazil (2017 and 2018).

BACKGROUND: Yellow fever (YF) is a severe, infectious, but non-communicable arboviral hemorrhagic disease. In the last decades, yellow fever virus (YFV) infections have been prevalent in endemic areas in Brazil, affecting human and non-human primate (NHP) populations. Monitoring of NHP infection started in 1999, and reports of epizootic diseases are considered important indicators of viral transmission, particularly in relation to the sylvatic cycle. This study presents the monitoring of YFV by real-time RT-PCR and the epidemiological findings related to the deaths of NHPs in the south-eastern states and in the north-eastern state of Bahia, during the outbreak of YF in Brazil during 2017 and 2018. METHODS: A total of 4198 samples from 2099 NHPs from south-eastern and north-eastern Brazilian states were analyzed by real-time reverse transcription polymerase chain reaction (rtRT-PCR). RESULTS: A total of 4198 samples from 2099 NHPs from south-eastern and north-eastern Brazilian states were collected between 2017 and 2018. The samples were subjected to molecular diagnostics for YFV detection using real-time reverse transcription polymerase chain reaction (rtRT-PCR) techniques. Epizootics were coincident with human YF cases. Furthermore, our results showed that the YF frequency was higher among marmosets (Callithrix sp.) than in previous reports. Viremia in species of the genus Alouatta and Callithrix differed greatly. DISCUSSION: Our results indicate a need for further investigation of the role of Callithrix spp. in the transmission cycles of YFV in Brazil. In particular, YFV transmission was observed in a region where viral circulation has not been recorded for decades and thus vaccination has not been previously recommended. CONCLUSIONS: This highlights the need to straighten epizootic surveillance and evaluate the extent of vaccination programmes in Brazil in previously considered "YFV-free" areas of the country.

Morning blood pressure surge is associated with death in hypertensive patients.

BACKGROUND: Morning blood pressure surge (MS), defined as the difference between the mean blood pressure (BP) 2 h after waking up and the mean of the three lowest BP values during sleep, has been correlated with increased cardiovascular risk. We sought to evaluate its association with cardiovascular events and death. METHODS: We retrospectively analyzed data from 632 hypertensive patients [median age 58 years (50-67 years), 37% men] who underwent ambulatory BP monitoring between January 2005 and December 2006. Patients were divided into two groups according to MS (≥41 mmHg and <41 mmHg), and mortality from any cause was retrieved after a median time of 50 months (46-54 months). RESULTS: Patients with MS of 41 mmHg or higher were older, had a higher daytime systolic BP, as well as a higher systolic and diastolic dipping, and a lower night-time diastolic BP. During follow-up, there were 19 deaths and MS of 41 mmHg or higher was associated with a higher hazard for death in the crude model [hazard ratio: 3.47 (95% confidence interval: 1.25-9.65)], as well as after adjustments for age and the presence of diabetes [hazard ratio: 3.35 (95% confidence interval: 1.18-9.49)]. CONCLUSION: An increased BP surge is associated with higher hazard for death. Future studies specifically designed to evaluate the real impact of MS on outcomes, as well as to define its optimal cutoff value, are required.