Cryptic circulation of chikungunya virus in São Jose do Rio Preto, Brazil, 2015-2019.

BACKGROUND: Chikungunya virus (CHIKV) has spread across Brazil with varying incidence rates depending on the affected areas. Due to cocirculation of arboviruses and overlapping disease symptoms, CHIKV infection may be underdiagnosed. To understand the lack of CHIKV epidemics in São José do Rio Preto (SJdRP), São Paulo (SP), Brazil, we evaluated viral circulation by investigating anti-CHIKV IgG seroconversion in a prospective study of asymptomatic individuals and detecting anti-CHIKV IgM in individuals suspected of dengue infection, as well as CHIKV presence in Aedes mosquitoes. The opportunity to assess two different groups (symptomatic and asymptomatic) exposed at the same geographic region aimed to broaden the possibility of identifying the viral circulation, which had been previously considered absent. METHODOLOGY/PRINCIPAL FINDINGS: Based on a prospective population study model and demographic characteristics (sex and age), we analyzed the anti-CHIKV IgG seroconversion rate in 341 subjects by ELISA over four years. The seroprevalence increased from 0.35% in the first year to 2.3% after 3 years of follow-up. Additionally, we investigated 497 samples from a blood panel collected from dengue-suspected individuals during the 2019 dengue outbreak in SJdRP. In total, 4.4% were positive for anti-CHIKV IgM, and 8.6% were positive for IgG. To exclude alphavirus cross-reactivity, we evaluated the presence of anti-Mayaro virus (MAYV) IgG by ELISA, and the positivity rate was 0.3% in the population study and 0.8% in the blood panel samples. In CHIKV and MAYV plaque reduction neutralization tests (PRNTs), the positivity rate for CHIKV-neutralizing antibodies in these ELISA-positive samples was 46.7%, while no MAYV-neutralizing antibodies were detected. Genomic sequencing and phylogenetic analysis revealed CHIKV genotype ECSA in São José do Rio Preto, SP. Finally, mosquitoes collected to complement human surveillance revealed CHIKV positivity of 2.76% of A. aegypti and 9.09% of A. albopictus (although it was far less abundant than A. aegypti) by RT-qPCR. CONCLUSIONS/SIGNIFICANCE: Our data suggest cryptic CHIKV circulation in SJdRP detected by continual active surveillance. These low levels, but increasing, of viral circulation highlight the possibility of CHIKV outbreaks, as there is a large naïve population. Improved knowledge of the epidemiological situation might aid in outbreaks prevention.

Tratamento da hepatite C: impacto sobre o cuidador / Hepatitis C treatment: impact upon the caregiver

O objetivo deste estudo foi identificar níveis de estresse, sintomas de depressão, sobrecarga e estratégias de enfrentamento entre cuidadores de pacientes portadores de Hepatite C em tratamento no Hospital de Base, São José do Rio Preto, São Paulo. Participaram 43 cuidadores, que responderam aos seguintes instrumentos antes, durante e após o tratamento: Inventário de Sintomas de Stress de Lipp, Inventário Beck de Depressão, Escala de Modos de Enfrentamento de Problemas e Burden Interview. Predominaram cuidadores do sexo feminino (n = 31), adultos e familiares dos pacientes. A média de sobrecarga foi 22,2 (DP = 9,2). Houve um maior número de pacientes em diferentes fases do estresse e um aumento nos sintomas de depressão durante o tratamento (p = 0,03). Estratégia de enfrentamento focada no problema foi utilizada com maior frequência

The purpose of this study was to identify levels of stress, symptoms of depression, burden and coping strategies among caregivers of patients undergoing treatment for Hepatitis C at the Hospital de Base, São José do Rio Preto, São Paulo. Participants were 43 caregivers assessed before, during and after treatment with the Stress Symptoms Inventory (ISSL), the Beck Depression Inventory, the Ways of Coping Scale and the Burden Interview. Caregivers were mostly women (n = 31), adults and family members. Mean burden scores were 22.2 (SD = 9.2). There was an increase of patients with stress and with depression symptoms during the treatment (p = 0.03). Caregivers used more problem focused coping