Serological evidence of arenavirus circulation in wild rodents from central-west, southeast, and south regions of Brazil, 2002-2006.

Viral hemorrhagic fevers caused by arenaviruses are severe zoonotic diseases. In reservoirs, the presence of antibodies may indicate viral circulation in a population of a specific region, and these data can be used as an indicator for further investigations by molecular techniques. The present study aimed to detect the presence of arenavirus antibodies in wild rodents captured from 1998 to 2008 during epidemiological surveillance activities. A retrospective analysis of 2243 wild rodent blood samples using a broad cross-reactive in-house developed enzyme-linked immunosorbent assay (ELISA) revealed a 0.44% (10/2243) positive rate in wild rodents, which included Necromys lasiurus (6/1012), Calomys callosus (2/94), and Akodon sp. (2/273) species. These rodents were captured between 2002 to 2006 in Campo Alegre de Goiás/GO, Bodoquena/MS, Nuporanga/SP, and Mogi das Cruzes/SP. Our findings suggest the sylvatic circulation of arenavirus among wild rodents in the southeast region of Brazil. However, future virological and molecular studies are necessary to confirm the viral presence in these regions.

Hantavirus pulmonary syndrome, central plateau, southeastern, and southern Brazil.

Hantavirus pulmonary syndrome (HPS) is an increasing health problem in Brazil because of encroachment of sprawling urban, agricultural, and cattle-raising areas into habitats of subfamily Sigmodontinae rodents, which serve as hantavirus reservoirs. From 1993 through June 2007, a total of 884 cases of HPS were reported in Brazil (case-fatality rate 39%). To better understand this emerging disease, we collected 89 human serum samples and 68 rodent lung samples containing antibodies to hantavirus from a 2,500-km-wide area in Brazil. RNA was isolated from human samples and rodent tissues and subjected to reverse transcription-PCR. Partial sequences of nucleocapsid protein and glycoprotein genes from 22 human and 16 rodent sources indicated only Araraquara virus and Juquitiba virus lineages. The case-fatality rate of HPS was higher in the area with Araraquara virus. This virus, which may be the most virulent hantavirus in Brazil, was associated with areas that have had greater anthropogenic changes.

Hantavirus infection in Brazil: development and evaluation of an enzyme immunoassay and immunoblotting based on N recombinant protein.

The symptoms of hantavirus pulmonary syndrome may resemble those of other febrile illnesses. The development of an accurate diagnostic test should therefore improve clinical prognosis and be useful in epidemiologic studies. We evaluated the use of a recombinant antigen (rNDelta(85)) based on the S-segment sequences of a Brazilian hantavirus for detecting immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies against hantavirus in an indirect enzyme immunoassay (EIA). We assayed 613 serum samples (570 from humans and 43 from rodents). IgM EIA had a sensitivity of 94.1% and a specificity of 99.1%. IgG EIA had a sensitivity of 95.2% and a specificity of 98.4%. This evaluation confirms that rNDelta(85) IgM and IgG EIA tests are potentially useful rapid, sensitive, and cost-effective tools for detecting antibodies against hantaviruses indigenous to Brazil and other South American countries, in patients with acute or convalescent hantavirus infection, and in rodent reservoirs.

Mayaro virus: imported cases of human infection in São Paulo State, Brazil.

Mayaro virus (MAYV) is an arbovirus (Togaviridae: Alphavirus) enzootic in tropical South America and maintained in a sylvan cycle involving wild vertebrates and Haemagogus mosquitoes. MAYV cases occur sporadically in persons with a history of recent activities inside or around forests. This paper reports three cases of MAYV fever detected in men infected in Camapuã, MS, Brazil. Serum samples collected at four days and two months after the onset of the symptoms and examined by hemagglutination inhibition test, revealed monotypic seroconversion to MAYV. Isolation of the virus was obtained from one of the samples by inoculation of the first blood samples into newborn mice. A suspension of the infected mouse brain was inoculated into C6/36 cells culture and the virus was identified by indirect immunofluorescent assay with alphavirus polyclonal antibodies. RT-PCR, performed with RNA extracted from the supernatant of C6/36 infected cells in the presence of alphavirus generic primers as well as specific MAYV primers, confirmed these results. The reported cases illustrate the importance of laboratory confirmation in establishing a correct diagnosis. Clinical symptoms are not always indicative of a disease caused by an arbovirus. Also MAYV causes febrile illness, which may be mistaken for dengue.

St. Louis encephalitis virus: first isolation from a human in São Paulo State, Brazil.

This paper reports the isolation of St. Louis encephalitis virus (SLEV) from a febrile human case suspected to be dengue, in São Pedro, São Paulo State. A MAC-ELISA done on the patient's acute and convalescent sera was inconclusive and hemagglutination inhibition test detected IgG antibody for flaviviruses. An indirect immunofluorescent assay done on the C6/36 cell culture inoculated with the acute serum was positive for flaviviruses but negative when tested with dengue monoclonal antibodies. RNA extracted from the infected cell culture supernatant was amplified by RT-PCR in the presence of NS5 universal flavivirus primers and directly sequenced. Results of BLAST search indicated that this sequence shares 93% nucleotide similarity with the sequence of SLEV (strain-MSI.7), confirmed by RT-PCR performed with SLEV specific primers. Since SLEV was identified as the cause of human disease, it is necessary to improve surveillance in order to achieve early detection of this agent in the state of São Paulo and in Brazil. This finding is also an alert to health professionals about the need for more complete clinical and epidemiological investigations of febrile illnesses as in the reported case. SLEV infections can be unrecognized or confused with other ones caused by an arbovirus, such as dengue.

Pinhal Virus, a New Arenavirus Isolated from Calomys tener in Brazil.

Arenavirus Sabiá was originally isolated from a fatal human infection in Brazil, and after the occurrence of the second fatal human case in São Paulo state, epidemiologic and virologic studies were performed in the area where the patient lived, aiming at the identification of the Sabiá natural rodent reservoir. A broadly cross-reactive enzyme-linked immunosorbent assay (ELISA) was used to screen for antibody-positive samples. Antibodies to arenavirus were detected in two of the 55 samples of Calomys tener, and from these results, samples of rodents were analyzed by a broad RT-PCR assay. RT-PCR amplification detected arenavirus sequences in five of the 55 C. tener samples, and sequencing showed that this virus is a distinct form of Sabiá virus. Thus, we describe here the evidence for the circulation of a new arenavirus in Brazil (proposed name Pinhal virus) and its genetic characterization compared to other arenaviruses. This study also suggests C. tener as a probable rodent reservoir for this virus and associates this new virus with the lineage C of New World arenaviruses. Although we have defined some characteristics of this virus, so far, there is no evidence of its involvement in human disease.

Yellow fever epizootics in non-human primates, São Paulo state, Brazil, 2008-2009.

Since 2000, the expansion of Sylvatic Yellow Fever (YF) has been observed in the southeast of Brazil, being detected in areas considered silent for decades. Epizootics in non-human primates (NHPs) are considered sentinel events for the detection of human cases. It is important to report epizootic events that could have impact on the conservation status of susceptible species. We describe the epizootics in NHPs, notified in state of São Paulo, Brazil, between September 2008 to August 2009. Ninety-one epizootic events, involving 147 animals, were reported in 36 counties. Samples were obtained from 65 animals (44.2%). Most of the epizootics (46.6%) were reported between March and April, the same period during which human cases of YF occurred in the state. Biological samples were collected from animals found dead and were sent to Instituto Adolfo Lutz, in São Paulo. Two samples, collected in two counties without an indication for YF vaccination, were positive for the virus. Another 48 animals were associated with YF by clinical-epidemiological linkage with laboratory confirmed cases. Because the disease in human and NHPs occurred in the same period, the detection of the virus in NHPs did not work as sentinel, but aided in the delineation of new areas of risk.

First isolation of Dengue 4 in the state of São Paulo, Brazil, 2011.

We report the first isolation of Dengue virus 4 (DENV-4) in the state of São Paulo, from two patients - one living in São José do Rio Preto and the other one in Paulo de Faria, both cities located in the Northwest region of the state. The virus isolations were accomplished in the clone C6/36 Aedes albopictus cell line, followed by indirect immunofluorescence assays, performed with type-specific monoclonal antibodies that showed positive reactions for DENV-4. The results were confirmed by Nested RT-PCR and Real-Time RT-PCR assays. The introduction of DENV-4 in a country that already has to deal with the transmission of three other serotypes increases the possibility of the occurrence of more severe cases of the disease. The importance of early detection of dengue cases, before the virus spreads and major outbreaks occur, should be emphasized.

Reemergence of yellow fever: detection of transmission in the State of São Paulo, Brazil, 2008.

INTRODUCTION: Following yellow fever virus (YFV) isolation in monkeys from the São José do Rio Preto region and two fatal human autochthonous cases from the Ribeirão Preto region, State of São Paulo, Brazil, two expeditions for entomological research and eco-epidemiological evaluation were conducted. METHODS: A total of 577 samples from humans, 108 from monkeys and 3,049 mosquitoes were analyzed by one or more methods: virus isolation, ELISA-IgM, RT-PCR, histopathology and immunohistochemical. RESULTS: Of the 577 human samples, 531 were tested by ELISA-IgM, with 3 positives, and 235 were inoculated into mice and 199 in cell culture, resulting in one virus isolation. One sample was positive by histopathology and immunohistochemical. Using RT-PCR, 25 samples were processed with 4 positive reactions. A total of 108 specimens of monkeys were examined, 108 were inoculated into mice and 45 in cell culture. Four virus strains were isolated from Alouatta caraya. A total of 931 mosquitoes were captured in Sao Jose do Rio Preto and 2,118 in Ribeirão Preto and separated into batches. A single isolation of YFV was derived from a batch of 9 mosquitoes Psorophora ferox, collected in Urupês, Ribeirão Preto region. A serological survey was conducted with 128 samples from the municipalities of São Carlos, Rincão and Ribeirão Preto and 10 samples from contacts of patients from Ribeirão Preto. All samples were negative by ELISA-IgM for YFV. CONCLUSIONS: The results confirm the circulation of yellow fever, even though sporadic, in the Sao Paulo State and reinforce the importance of vaccination against yellow fever in areas considered at risk.

Evaluation of dengue NS1 antigen detection for diagnosis in public health laboratories, São Paulo State, 2009.

The present work evaluated the diagnostic accuracy of detection of Dengue NS1 antigen employing two NS1 assays, an immunochromatographic assay and ELISA, in the diagnostic routine of Public Health laboratories. The results obtained with NS1 assay were compared with virus isolation and, in a subpopulation of cases, they were compared with the IgM-ELISA results obtained with convalescent samples. A total of 2,321 sera samples were analyzed by one of two NS1 techniques from March to October 2009. The samples were divided into five groups: groups I, II and III included samples tested by NS1 and virus isolation, and groups IV and V included patients with a first sample tested by NS1 and a second sample tested by IgM-ELISA. Sensitivity, specificity, positive and negative predictive values, Kappa Index and Kappa Concordance were calculated. The results showed that NS1 testing in groups I, II and III had high sensitivity (98.0%, 99.5% and 99.3%), and predictive values and Kappa index between 0.9 - 1.0. Groups IV and V only had Kappa Concordance calculated, since the samples were analyzed according to the presence of NS1 antigen or IgM antibody. Concordance of 92.1% was observed when comparing the results of NS1-negative samples with IgM-ELISA. Based on the findings, it is possible to suggest that the tests for NS1 detection may be important tools for monitoring the introduction and spread of Dengue serotypes.

Isolation of yellow fever virus (YFV) from naturally infected Haemagogus (Conopostegus) leucocelaenus (diptera, cukicudae) in São Paulo State, Brazil, 2009.

After detecting the death of Howlers monkeys (genus Alouatta) and isolation of yellow fever virus (YFV) in Buri county, São Paulo, Brazil, an entomological research study in the field was started. A YFV strain was isolated from newborn Swiss mice and cultured cells of Aedes albopictus - C6/36, from a pool of six Haemagogus (Conopostegus) leucocelaenus (Hg. leucocelaenus) mosquitoes (Dyar & Shannon) collected at the study site. Virus RNA fragment was amplified by RT-PCR and sequenced. The MCC Tree generated showed that the isolated strain is related to the South American I genotype, in a monophyletic clade containing isolates from recent 2008-2010 epidemics and epizootics in Brazil. Statistical analysis commonly used were calculated to characterize the sample in relation to diversity and dominance and indicated a pattern of dominance of one or a few species. Hg. leucocelaenus was found infected in Rio Grande do Sul State as well. In São Paulo State, this is the first detection of YFV in Hg. leucocelaenus.

Dengue virus type 4 phylogenetics in Brazil 2011: looking beyond the veil.

Dengue Fever and Dengue Hemorrhagic Fever are diseases affecting approximately 100 million people/year and are a major concern in developing countries. In the present study, the phylogenetic relationship of six strains of the first autochthonous cases of DENV-4 infection occurred in Sao Paulo State, Parana State and Rio Grande do Sul State, Brazil, 2011 were studied. Nucleotide sequences of the envelope gene were determined and compared with sequences representative of the genotypes I, II, III and Sylvatic for DEN4 retrieved from GenBank. We employed a Bayesian phylogenetic approach to reconstruct the phylogenetic relationships of Brazilian DENV-4 and we estimated evolutionary rates and dates of divergence for DENV-4 found in Brazil in 2011. All samples sequenced in this study were located in Genotype II. The studied strains are monophyletic and our data suggest that they have been evolving separately for at least 4 to 6 years. Our data suggest that the virus might have been present in the region for some time, without being noticed by Health Surveillance Services due to a low level of circulation and a higher prevalence of DENV-1 and DENV- 2.

Characterization of hantaviruses circulating in Central Brazil.

In 2004, an outbreak of HCPS in Brazil made hantaviruses a national threat to the rural and urban population. During this outbreak, 164 cases were reported, and 18.3% of them occurred in the Federal District. In this study, hantavirus genomic sequences were amplified from seven patients who resided in Central Brazil and then sequenced and compared to other hantavirus sequences. The complete S segment sequence, which is 1847 bases long and potentially encodes the 428 amino acid nucleocapsid protein, was determined for one patient. Moreover, a 700 base-pair sequence of the S segment was obtained from two other patients, and we analyzed M segment sequences from all samples. It can be inferred by both identity and phylogenetic analysis that the sequences obtained are highly related to Araraquara variant and Maciel virus. Phylogenetic results show that hantaviruses isolated in Central Brazil can be divided into two monophyletic groups: one group that clusters with Araraquara variant and the other group that includes the complete S segment sequence obtained in this study. Therefore, we propose the name Paranoa for this variant that co-exists with the Araraquara-like hantavirus in Central Brazil.

Evaluation of an enzyme-linked immunosorbent assay based on Araraquara virus recombinant nucleocapsid protein.

Laboratory diagnosis of hantavirus cardiopulmonary syndrome (HCPS) in Brazil has been performed mostly by detection of IgM antibodies to recombinant antigen purified from Sin Nombre virus and Andes virus (ANDV). Recently, a recombinant nucleocapsid (rN) protein of Araraquara virus (ARAV), a Brazilian hantavirus, was obtained in Escherichia coli. To evaluate ARAV rN as antigen for antibody detection, serum samples from 30 patients from Argentina seropositive for hantavirus were tested. All samples were positive for IgG and IgM by enzyme-linked immunosorbent assay (ELISA) using either ARAV rN or ANDV rN antigens. In Brazil, six of 60 serum samples from patients with suspected HCPS (10%) were positive for IgM by ELISA using ARAV rN antigen and 7 were positive using ANDV rN antigen. For results obtained with 90 serum samples analyzed by IgM ELISA with ANDV rN antigen, the sensitivity of the IgM ELISA using ARAV rN antigen was 97.2%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 98.1%. The results show that ARAV rN is a suitable antigen for diagnosis of hantavirus infection in Brazil and Argentina.

Yellow fever epizootics in non-human primates, São Paulo state, Brazil, 2008-2009 / Epizootias de febre amarela em primatas não humanos no estado de São Paulo, Brasil, 2008-2009

Since 2000, the expansion of Sylvatic Yellow Fever (YF) has been observed in the southeast of Brazil, being detected in areas considered silent for decades. Epizootics in non-human primates (NHPs) are considered sentinel events for the detection of human cases. It is important to report epizootic events that could have impact on the conservation status of susceptible species. We describe the epizootics in NHPs, notified in state of São Paulo, Brazil, between September 2008 to August 2009. Ninety-one epizootic events, involving 147 animals, were reported in 36 counties. Samples were obtained from 65 animals (44.2%). Most of the epizootics (46.6%) were reported between March and April, the same period during which human cases of YF occurred in the state. Biological samples were collected from animals found dead and were sent to Instituto Adolfo Lutz, in São Paulo. Two samples, collected in two counties without an indication for YF vaccination, were positive for the virus. Another 48 animals were associated with YF by clinical-epidemiological linkage with laboratory confirmed cases. Because the disease in human and NHPs occurred in the same period, the detection of the virus in NHPs did not work as sentinel, but aided in the delineation of new areas of risk.

Desde 2000, vem sendo observada a expansão da febre amarela (FA) no Sudeste do Brasil, sendo detectados casos em áreas consideradas silenciosas por décadas. Epizootias em primatas não humanos (NHPs) são considerados eventos sentinela para a detecção de casos humanos. É importante relatar eventos epizoóticos que podem ter impacto sobre o estado de conservação de espécies sensíveis. Descrevemos as epizootias, notificadas em NHPs no estado de São Paulo, Brasil, entre setembro de 2008 a agosto de 2009. Noventa e um eventos epizoóticos, envolvendo 147 animais, foram notificados em 36 municípios. As amostras foram obtidas a partir de 65 animais (44,2%). A maioria das epizootias (46,6%) foram registradas entre março e abril, no mesmo período no qual YF em que casos humanos ocorreram no estado. As amostras biológicas foram coletadas de animais encontrados mortos e enviadas ao Instituto Adolfo Lutz, em São Paulo. Duas amostras, coletadas em dois municípios, sem indicação para a vacinação de febre amarela, foram positivos para o vírus. Outros 48 animais foram associados com FA por vínculo clínico-epidemiológico com casos confirmados laboratorialmente. Devido a doença em humanos e NHPs terem ocorrido no mesmo período, a detecção do vírus em NHPs não funcionou como sentinela, mas ajudou no processo de delimitação de novas áreas de risco.

Dengue no Estado de São Paulo: Situação epidemiológica e ações desenvolvidas em 2013 / Dengue in the State of São Paulo: Epidemiological situation and activities developed in 2013

São apresentadas as informações epidemiológicas da dengue no Estado de São Paulo em 2013, ano de maior incidência em toda a história da transmissão da doença no território, com 208.914 casos confirmados, sendo 99,8% da forma clássica. Dentre os 446 casos graves, a letalidade foi de 16,1%. Confirmou‑se a co‑circulação dos sorotipos DENV‑1 e DENV‑4, respectivamente, 54,1 e 43,7% dos isolamentos, ao lado da discreta detecção (6,6%) de DENV‑2. Indicadores entomológicos do primeiro trimestre do ano apontaram que 83% das regiões possuem valores compatíveis com risco de estabelecimento de transmissão de dengue, concretizado pela detecção da autoctonia em 544 (84,3%) municípios. É enfatizado o trabalho de integração das áreas envolvidas no Programa Estadual de Vigilância e Controle de dengue no acompanhamento das ações desenvolvidas, a elaboração do Plano Estadual de Vigilância e Controle de Dengue para o período de julho/2013 a junho 2014, que estabelece ações, indicadores de avaliação e metas, de acordo com a situação epidemiológica, a interlocução com as instâncias regionais na instalação e funcionamento das salas de situação, consolidando um espaço de análise que subsidie a adoção oportuna de atividades pertinentes de intervenção no nível local...

First isolation of dengue 4 in the state of São Paulo, Brazil, 2011 / Primeiro isolamento de Dengue 4 no Estado de São Paulo, Brasil, 2011

We report the first isolation of Dengue virus 4 (DENV-4) in the state of São Paulo, from two patients - one living in São José do Rio Preto and the other one in Paulo de Faria, both cities located in the Northwest region of the state. The virus isolations were accomplished in the clone C6/36 Aedes albopictus cell line, followed by indirect immunofluorescence assays, performed with type-specific monoclonal antibodies that showed positive reactions for DENV-4. The results were confirmed by Nested RT-PCR and Real-Time RT-PCR assays. The introduction of DENV-4 in a country that already has to deal with the transmission of three other serotypes increases the possibility of the occurrence of more severe cases of the disease. The importance of early detection of dengue cases, before the virus spreads and major outbreaks occur, should be emphasized.

Relatamos o primeiro isolamento do vírus Dengue 4 (DENV-4) no Estado de São Paulo, de dois pacientes residentes em São José do Rio Preto e Paulo de Faria, ambos municípios localizados na região Noroeste do Estado. O isolamento do vírus foi realizado em clone C6/36, linhagem de células de Aedes albopictus seguido por imunofluorescência indireta, realizada com anticorpos monoclonais tipo específicos, que apresentou reação positiva para DENV-4. Os resultados foram confirmados por testes de Nested RT-PCR e RT-PCR em Tempo Real. A introdução do DENV-4 no país, com uma população suscetível a esse vírus e que já convive com a transmissão de outros três sorotipos, aumenta a possibilidade da ocorrência de casos mais graves da doença. Deve ser enfatizada a importância da detecção precoce de casos de dengue, antes que ocorra a propagação do vírus e que surtos importantes aconteçam.

Avaliação de kits comerciais para detecção de antígenos NS1-dengue-São Paulo / Evaluation of commercial kits for detecting the antigen NS1-dengue-São Paulo

O vírus dengue, pertencente à família Flaviviridae, gênero Flavivirus, é constituído de RNA de fita simples que codifica proteínas estruturais e não estruturais. Possui quatro sorotipos: DENV-1, DENV-2, DENV-3 e DENV-4. O diagnóstico laboratorial rápido podeser de grande ajuda no controle da expansão da doença. O objetivo deste trabalho foi avaliar diferentes kits de detecção da proteína NS1 do vírus dengue, tendo como referência o isolamento viral. Foram utilizadas 147 amostras de soro de pacientes com suspeita de infecção pelo DENV, das quais 64 foram recebidas para isolamento devírus e 83 para ELISA IgM. O kit Dengue NS1 Ag Strip (Bio-Rad) obteve sensibilidade de 89%, especificidade de 66%, VPP 67% e VPN 88%. O Dengue Duo Test (Bioeasy) teve sensibilidade de 89%, especificidade 68%, VPP 70% e VPN 88%. O Platelia Dengue NS1ELISA Ag (Bio-Rad) apresentou sensibilidade de 95%, especificidade47%, VPP 59% e VPN 92%. O kit dengue Early ELISA (Panbio) resultou em sensibilidade de 86%, especificidade 71%, VPP 69% e VPN 86%. De forma geral, os kits avaliados podem ser empregados no diagnóstico, sempre associados a critério clínico e epidemiológico ou outros métodos laboratoriais

Evaluation of dengue NS1 antigen detection for diagnosis in public health laboratories, São Paulo State, 2009 / Avaliação da detecção do antígeno NS1 para diagnóstico de dengue nos Laboratórios de Saúde Pública, Estado de São Paulo, 2009

The present work evaluated the diagnostic accuracy of detection of Dengue NS1 antigen employing two NS1 assays, an immunochromatographic assay and ELISA, in the diagnostic routine of Public Health laboratories. The results obtained with NS1 assay were compared with virus isolation and, in a subpopulation of cases, they were compared with the IgM-ELISA results obtained with convalescent samples. A total of 2,321 sera samples were analyzed by one of two NS1 techniques from March to October 2009. The samples were divided into five groups: groups I, II and III included samples tested by NS1 and virus isolation, and groups IV and V included patients with a first sample tested by NS1 and a second sample tested by IgM-ELISA. Sensitivity, specificity, positive and negative predictive values, Kappa Index and Kappa Concordance were calculated. The results showed that NS1 testing in groups I, II and III had high sensitivity (98.0 percent, 99.5 percent and 99.3 percent), and predictive values and Kappa index between 0.9 - 1.0. Groups IV and V only had Kappa Concordance calculated, since the samples were analyzed according to the presence of NS1 antigen or IgM antibody. Concordance of 92.1 percent was observed when comparing the results of NS1-negative samples with IgM-ELISA. Based on the findings, it is possible to suggest that the tests for NS1 detection may be important tools for monitoring the introduction and spread of Dengue serotypes.

Esse estudo avaliou a acurácia do diagnóstico por detecção do antígeno NS1 do vírus Dengue empregando-se ensaios em dois formatos, imunocromatográfico e ELISA, na rotina diagnóstica dos laboratórios de Saúde Pública. Compararam-se os resultados de NS1 com os resultados de isolamento viral e, em parte dos casos, foi feita a comparação com os resultados de IgM-ELISA, obtidos nas segundas amostras. Um total de 2.321 amostras de soros, obtidas no período de março a outubro de 2009, foram analisadas por uma das duas técnicas NS1. As amostras foram divididas em cinco grupos: I, II e III, que incluíram amostras analisadas por testes NS1 e por isolamento de vírus. Os grupos IV e V incluíram pacientes com a primeira amostra processada por NS1 e segunda por IgM-ELISA. Foram analisadas sensibilidade, especificidade, valor preditivo positivo e negativo, concordância e índice Kappa. Os resultados mostraram que os grupos I, II e III apresentaram alta sensibilidade (98,0 por cento, 99,5 por cento e 99,3 por cento), valores preditivos e índice Kappa entre 0,9 - 1,0. Nos grupos IV e V, apenas concordância foi calculada, dado que as amostras foram analisadas quanto à presença de antígeno NS1 ou de anticorpos IgM. Comparando-se os resultados negativos de NS1 com IgM-ELISA houve 92,1 por cento de concordância. Com base nas constatações feitas, é possível sugerir que a detecção de NS1 pode ser importante ferramenta para monitorar a introdução e disseminação dos sorotipos de Dengue.

Reemergence of yellow fever: detection of transmission in the State of São Paulo, Brazil, 2008 / Reemergência de febre amarela: detecção de transmissão no Estado de São Paulo, Brasil, 2008

INTRODUCTION: Following yellow fever virus (YFV) isolation in monkeys from the São José do Rio Preto region and two fatal human autochthonous cases from the Ribeirão Preto region, State of São Paulo, Brazil, two expeditions for entomological research and eco-epidemiological evaluation were conducted. METHODS: A total of 577 samples from humans, 108 from monkeys and 3,049 mosquitoes were analyzed by one or more methods: virus isolation, ELISA-IgM, RT-PCR, histopathology and immunohistochemical. RESULTS: Of the 577 human samples, 531 were tested by ELISA-IgM, with 3 positives, and 235 were inoculated into mice and 199 in cell culture, resulting in one virus isolation. One sample was positive by histopathology and immunohistochemical. Using RT-PCR, 25 samples were processed with 4 positive reactions. A total of 108 specimens of monkeys were examined, 108 were inoculated into mice and 45 in cell culture. Four virus strains were isolated from Alouattacaraya. A total of 931 mosquitoes were captured in Sao Jose do Rio Preto and 2,118 in Ribeirão Preto and separated into batches. A single isolation of YFV was derived from a batch of 9 mosquitoes Psorophoraferox, collected in Urupês, Ribeirão Preto region. A serological survey was conducted with 128 samples from the municipalities of São Carlos, Rincão and Ribeirão Preto and 10 samples from contacts of patients from Ribeirão Preto. All samples were negative by ELISA-IgM for YFV. CONCLUSIONS: The results confirm the circulation of yellow fever, even though sporadic, in the Sao Paulo State and reinforce the importance of vaccination against yellow fever in areas considered at risk.

INTRODUÇÃO: A partir do isolamento do vírus febre amarela (VFA), de macacos, da região de São José do Rio Preto e de dois casos humanos autóctones fatais, da região de Ribeirão Preto, Estado de São Paulo, foram realizadas duas expedições para pesquisa entomológica e avaliação ecoepidemiológica. MÉTODOS: Um total de 577 amostras de humanos, 108 de macacos e 3.049 mosquitos foram analisados por um ou mais métodos: isolamento viral, ELISA-IgM, RT-PCR, histopatologia e imunohistoquímica. RESULTADOS: De 577 amostras humanas, 531 foram testadas por ELISA-IgM, sendo 3 positivas, 235 foram inoculadas em camundongos, 199 em cultura de células, obtendo-se 1 isolamento viral. Uma amostra foi positiva por histopatologia e imunohistoquímica. Por RT-PCR foram processadas 25 amostras com 4 reações positivas. Os 108 espécimes de macacos foram inoculados em camundongos, 45 em cultura de células, obtendo-se 4 isolamentos de VFA, de Alouatta caraya. Um total de 931 mosquitos foram capturados em São José do Rio Preto e 2.118 em Ribeirão Preto e separados em lotes. Um único isolamento de VFA foi derivado de um lote de 9 mosquitos Psorophora ferox, coletados em Urupês, região de Ribeirão Preto. Um inquérito sorológico foi realizado com 128 amostras dos municípios de São Carlos, Rincão e Ribeirão Preto e mais 10 amostras de contactantes de pacientes de Ribeirão Preto. Todas as amostras foram negativas por ELISA-IgM para VFA. CONCLUSÕES: Os resultados confirmam a circulação, mesmo que esporádica, do VFA no Estado de São Paulo e reforça a importância da vacinação antiamarílica nas áreas consideradas de risco.