[Anti-Hantavirus antibodies in school children in Salvador, Bahia]. / Anticorpos anti-hantavírus em escolares de 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.

Anticorpos anti-hantavírus em escolares de Salvador, Bahia / 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.

As hantaviroses são doenças emergentes nas Américas e, em todo o mundo, os casos clínicos descritos foram infreqüentes entre crianças. O objetivo de investigar a freqüência de escolares portadores de anticorpos (IgG) anti-hantavírus justifica-se porque poucos estudos soroepidemiológicos pesquisaram a infecção por hantavírus no grupo pediátrico. Nos espécimes séricos de 379 escolares, de duas Escolas públicas da cidade do Salvador, Bahia, foram pesquisados os anticorpos anti-Hantaan (HTN) e anti-Sin Nombre (SN). A soropositividade de anticorpos anti-HTN foi de 13,2% (50/379) e todos os escolares foram soronegativos para o vírus SN. A soropositividade anti-HTN aumentou proporcionalmente com a idade. Não houve associação entre a soropositividade anti-HTN e as características relacionadas à exposição a roedores urbanos. A soroprevalência de anticorpos anti-HTN nos escolares estudados foi elevada e reforçou a hipótese de circulação de hantavírus em Salvador. A não observação de portadores de anticorpos anti-SN indica, provavelmente, a circulação de outros sorotipos nesta região, mais relacionados antigenicamente ao sorotipo Hantaan.

Yellow fever: a decade of reemergence.

Since the 1980s, yellow fever has reemerged across Africa and in South America. The total of 18 735 yellow fever cases and 4522 deaths reported from 1987 to 1991 represents the greatest amount of yellow fever activity reported to the World Health Organization (WHO) for any 5-year period since 1948. There is an excellent vaccine against yellow fever. At present, a high proportion of travelers to at-risk areas are reported to be immunized, reflecting widespread knowledge about the International Health Regulations. In South America, yellow fever remains an occupational hazard for forest workers, who should be immunized. However, Aedes aegypti mosquitoes are now present in urban areas in the Americas (including southern parts of the United States), and there is concern that yellow fever could erupt in explosive outbreaks. In Africa, a large proportion of cases have occurred in children. The WHO, the United Nations Children's Fund (UNICEF), and the World Bank have recommended that 33 African countries at risk for yellow fever add the vaccine to the routine Expanded Programme on Immunization; studies show that this would be highly cost-effective. To date, financing yellow fever vaccine has been a major problem for these countries, which are among the poorest in the world. For this reason, WHO has launched an appeal to raise $70 million for yellow fever control in Africa.

Infecçäo humana por Hantavirus no sul e sudeste do Brasil / Human infection by Hantavirus in southern and southeastern Brazil

Descrevem-se os resultados de inquérito sorológico para pesquisa de anticorpos de Hantavírus conduzido de fevereiro de 1986 a agosto de 1990, em grupos populacionais humanos dos Estados de Säo Paulo e Paraná, que apresentavam estreito contato com ratos urbanos ou com roedores e outros pequenos mamíferos silvestres. OBJETIVO. Identificar infecçäo humana causada por Hantavírus, agentes etiológicos da febre hemorrágica com síndrome renal. MÉTODOS. Os soros de 1.063 pessoas foram examinados com técnica imunoenzimática para detecçäo de anticorpos IgG e IgM utilizando-se antígenos dos vírus Hantaan, Seoul e Puumala. Nos soros positivos realizou-se teste de neutralizaçäo com reduçäo em placa para os mesmos antígenos e imunofluorescência indireta para o antígeno do vírus Hantaan. RESULTADOS. Observou-se presença de anticorpos anti-Hantavirus em 32 pessoas, evidenciados por testes imunoenzimáticos e de imunofluorescência. Em cinco delas foram positivos os testes de neutralizaçäo com reduçäo em placa (três para o vírus Scoul e dois para o vírus Pumala). Uma dessas pessoas apresentou alto título em todos os testes para o vírus Seoul. Trata-se de um morador da zona rural da regiäo do vale do Ribeira, que nasceu, sempre viveu no local e nunca viajou para fora do Estado de Säo Paulo. CONCLUSOES. Há evidências sorológicas de infecçäo causada por Hantavírus em moradores de área rural da Ilha do Amparo, Baia de Paranaguá, e da regiäo do Vale do Ribeira, Estado de Säo Paulo, em portuários de Paranaguá, Estado do Paraná, e em doentes internados com suspeita de leptospirose no Hospital Emílio Ribas, Säo Paulo

[Human infection by Hantavirus in southern and southeastern Brazil]. / Infecção humana por Hantavírus no Sul e Sudeste do Brasil.

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.

Infection of owl monkeys (Aotus trivirgatus) and cynomolgus monkeys (Macaca fascicularis) with hepatitis E virus from Mexico.

Owl and cynomolgus monkeys were inoculated with hepatitis E virus (HEV) to compare disease models and produce antibody and virus. By immune electron microscopy (IEM), all six owl monkeys were shown to have serologic responses manifested by unusually high levels of anti-HEV at 6 months, but only three developed hepatitis. Virus-related antigen in liver (HEV Ag) was detected by immunofluorescence microscopy of biopsies from two of four owl monkeys; one with HEV Ag also had HEV in acute-phase bile (detected by IEM) and feces (detected by infecting another owl monkey). In contrast, cynomolgus monkeys propagated HEV to higher levels and all five had hepatitis. Moderate-to-high levels of HEV Ag correlated with detectable HEV in bile for both species. Thus, the value of using HEV-infected cynomolgus was confirmed. Owl monkeys were shown to be HEV-susceptible and sources of high-level anti-HEV; Sustained anti-HEV in these monkeys may also be useful for understanding immune responses.

Venezuelan equine encephalomyelitis virus infection in and transmission by the tick Amblyomma cajennense (Arachnida: Ixodidae).

To assess a possible role of ticks as the maintenance host for epizootic strains of Venezuelan equine encephalomyelitis (VEE) virus, laboratory experiments were conducted to determine if ticks could become infected, maintain, and transmit the virus. Larval and nymphal Amblyomma cajennense (F.) and larval Dermacentor nitens Neumann ticks were exposed to epizootic VEE virus (Trinidad donkey strain) by allowing them to feed on viremic guinea pigs (strain 13). In A. cajennense, transstadial transmission was observed from larvae to nymphs and adults. Horizontal viral transmission to a mammalian host was accomplished by nymphs. Infection rates in nymphs and adults were 2% (42/2,750) and 4% (9/244), respectively, afer ingestion of virus as larvae. Virus was detected in A. cajennense adult ticks for up to 171 d after infection in the larval stage. A cajennense, exposed as nymphs, ingested virus but did not become infected (0/164 after 10 d after taking an infective bloodmeal). No virus was detected in D. nitens 7 d after exposure. These findings suggest that A. cajennense potentially could be involved in an interepizootic maintenance cycle of epizootic VEE viral strains.

Isolation of a newly recognized Bunyamwera serogroup virus from a febrile human in Panama.

A virus, strain 86MSP18, was isolated from the acute phase serum of a U.S. soldier with a febrile illness. He was stationed at Fort Sherman in the Republic of Panama when the onset of his illness occurred. A rise in neutralizing antibody to the viral isolate was observed between the patient's acute and convalescent-phase serum samples. Virus strain 86MSP18 has been shown by plaque reduction neutralization to be closely related to but distinct from Cache Valley virus and known subtypes. It appears to be a newly recognized subtype of Cache Valley virus and is believed to be the second isolation of a Cache Valley virus subtype from a human with a febrile illness. The name "Fort Sherman" virus for strain 86MSP18 is proposed.

Isolation of a Hantaan-related virus from Brazilian rats and serologic evidence of its widespread distribution in South America.

A serosurvey of domestic rats was conducted in several South American cities between September 1982 and March 1983 for evidence of hantavirus infection. Antibody-positive rats were found in Belem, São Paulo and Recife-Olinda, Brazil and in Buenos Aires, Argentina, with the highest antibody prevalence rate detected in Belem (30 positive of 54 tested, 56%). A virus isolated from tissues of a Rattus norvegicus captured in Belem, was shown to be antigenically similar to Girard Point viruses isolated from domestic rats captured in the United States and clearly distinct from prototype Hantaan virus, causative agent of Korean hemorrhagic fever in Asia. This represents the first isolation of a virus of the genus Hantavirus from South America and supports previous observations that indicate a widespread distribution of urban rat-associated hantaviruses. The abundance of domestic rats and their regionally high antibody rates suggest that risk of human hantavirus infection in some locations of South America may be significant.

Transmission of hepatitis A virus among recently captured Panamanian owl monkeys.

The presence of antibody to hepatitis A virus (anti-HAV) in 60% of procured owl monkeys (Aotus trivirgatus) held within the United States prompted a study of recently captured A trivirgatus in Panama. Only 2 of 145 newly captured monkeys, but all of 35 A trivirgatus held within a colony for over 100 days, were found to have anti-HAV. Of 41 sero-negative, newly captured monkeys followed prospectively, 25 became infected with hepatitis A virus (HAV) as evidenced by seroconversion or demonstration of virus in the liver at death. Only one monkey that survived over 60 days within the colony was not infected. HAV was identified in the feces of most infected monkeys prior to the development of antibody and was antigenically indistinguishable from human HAV in cross-blocking radioimmunoassays. This colony-centered epizootic provides strong evidence that A trivirgatus is susceptible to HAV and should be investigated further as a potential model of human hepatitis A.

An outbreak of Mayaro virus disease in Belterra, Brazil. I. Clinical and virological findings.

An outbreak of human illness caused by Mayaro (MAY) virus occurred in Belterra, Pará, Brazil in the first half of 1978. A total of 55 cases were confirmed, 43 by virus isolation and serology, and 12 by serology alone. The disease in Belterra presented as a distinct clinical syndrome characterized by fever, arthralgia and exanthema. No fatalities could be attributed to MAY virus infection. Arthralgia, accompanied by joint edema in 20% of cases, was a very prominent sign which caused temporary incapacity in many patients. Arthralgia was present in virtually all confirmed cases and persisted in some for at least 2 months, although with decreasing severity. Rash was present in two-thirds of the cases, and was either maculopapular or micropapular. The incidence of rash was higher in children than in adults. Contrary to arthralgia, which started with the onset of clinical illness, rash usually appeared on the 5th day and faded within 3-4 days. Fever, chills, headache, myalgia, lymph-adenopathy and other minor clinical manifestations were also recorded, and generally persisted for from 2-5 days. Leucopenia was a constant finding in all cases. Mild albuminuria was seen in four of 25 patients, and slight thrombocytopenia was seen in 10 of 20 cases. The fact that viremia levels higher tha 5.0 log10/1.0 ml of blood were recorded in 10 patients rises the possibility that man may have be an amplifying host in the MAY virus cycle. The MAY virus illness, as seen in Belterra, has clinical features similar to those observed in persons infected with chikungunya virus.

An outbreak of Mayaro virus disease in Belterra, Brazil. II. Epidemiology.

Epidemiological investigations of an outbreak of Mayaro (MAY) virus which occurred inthe rural village of Belterra, Pará, Brazil are reported. Human cases were first recorded in December 1977 and continued through June 1978. Approximately 20% of the more than 4,000 persons resident in Belterra were infected, and a very high proportion of those infected suffered overt clinical illness. Cases were identified in all areas of Belterra and among all age groups; however, the greatest number of cases was seen among those who resided in close proximity to the forests. Yellow fever (YF) virus was also active in Belterra concurrently with the MAY virus outbreak. Six human cases of YF were identified, of which five were fatal. The YF outbreak ended following YF vaccination of the human population.

An outbreak of Mayaro virus disease in Belterra, Brazil. III. Entomological and ecological studies.

Results in entomological and vertebrate host investigations made during dual outbreaks of Mayaro (MAY) and yellow fever (YF) viruses in Belterra, Pará, Brazil in 1978 are reported. Over 9,000 insects representing 26 species were assayed in 396 pools for the presence of arboviruses. Pools of Haemagogus janthinomys Dyar yielded the only isolates of either MAY or YF virus. The minimum field infection rate for nine isolates of MAY virus from Hg. janthinomys was 1:82, and for two isolates of YF virus was 1:368. Analysis of collection data showed Hg. janthinomys to be attracted to man as a blood source and present in all habitats sampled, although most abundant in the forest canopy. Twelve hundred bird sera and 584 mammal sera were tested by hemagglutination-inhibition (HI) tests for antibody to MAY virus. Highest MAY antibody prevalence rates were found among marmosets (Calithrix argentata, 32 positive of 119 tested, 27%). Mayaro virus was also isolated from the blood of a sylvan marmoset captured at the peak of the MAY virus outbreak. Experimental infection of marmosets with MAY virus confirmed that a substantial viremia follows infection with this virus. Marmosets were also found with HI antibody to YF virus (5/119, 4%). The results presented indicate that Hg. janthinomys was the principal vector of both MAY and YF viruses and that marmosets were the main amplifying hosts for MAY virus, and perhaps for YF virus as well.

Isolation of St. Louis encephalitis virus from a patient in Belém, Brazil.

St. Louis encephalitis (SLE) virus was isolated from a 21-year-old female hospitalized on 4 October 1978 in Belém, Brazil. Symptomatology on admission included fever, chills, severe headache, abdominal pain, myalgia, arthralgia and jaundice. SLE virus was isolated from her blood drawn on the 8th day of illness and subsequent seroconversion was documented. Serological tests showed the isolate to be closely related to the Belém prototype of SLE virus but distinct from other flaviviruses tested. The patient was discharged without sequelae after 16 days of hospitalization. Epidemiological investigations where the patient worked and lived revealed no evidence of extensive transmission of SLE virus.