INGRA MORALES CLARO

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  • article 9 Citação(ões) na Scopus
    Understanding Sabia virus infections (Brazilian mammarenavirus)
    (2022) NASTRI, Ana Catharina; DUARTE-NETO, Amaro Nunes; CASADIO, Luciana Vilas Boas; SOUZA, William Marciel de; CLARO, Ingra M.; MANULI, Erika R.; SELEGATTO, Gloria; SALOMA, Matias C.; FIALKOVITZ, Gabriel; TABORDA, Mariane; ALMEIDA, Bianca Leal de; MAGRI, Marcello C.; GUEDES, Ana Rubia; NETO, Laura Vieira Perdigao; SATAKI, Fatima Mitie; GUIMARAES, Thais; MENDES-CORREA, Maria Cassia; TOZETTO-MENDOZA, Tania R.; FUMAGALLI, Marcilio Jorge; HO, Yeh-Li; SILVA, Camila ALves Maia da; COLETTI, Thais M.; JESUS, Jacqueline Goes de; ROMANO, Camila M.; HILL, Sarah C.; PYBUS, Oliver; PINHO, Joao Renato Rebello; LEDESMA, Felipe Lourenco; CASAL, Yuri R.; KANAMURA, Cristina; ARAUJO, Leonardo Jose Tadeu de; FERREIRA, Camila Santos da Silva; GUERRA, Juliana Mariotti; FIGUEIREDO, Luiz Tadeu Moraes; DOLHNIKOFF, Marisa; FARIA, Nuno R.; SABINO, Ester C.; AVANCINI, Venacio; ALVES, Ferreira; LEVIN, Anna S.
    Background: Only two naturally occurring human Sabi ' a virus (SABV) infections have been reported, and those occurred over 20 years ago. Methods: We diagnosed two new cases of SABV infection using metagenomics in patients thought to have severe yellow fever and described new features of histopathological findings. Results: We characterized clinical manifestations, histopathology and analyzed possible nosocomial transmission. Patients presented with hepatitis, bleeding, neurological alterations and died. We traced twenty-nine hospital contacts and evaluated them clinically and by RT-PCR and neutralizing antibodies. Autopsies uncovered unique features on electron microscopy, such as hepatocyte ""pinewood knot"" lesions. Although previous reports with similar New-World arenavirus had nosocomial transmission, our data did not find any case in contact tracing. Conclusions: Although an apparent by rare, Brazilian mammarenavirus infection is an etiology for acute hemorrhagic fever syndrome. The two fatal cases had peculiar histopathological findings not previously described. The virological diagnosis was possible only by contemporary techniques such as metagenomic assays. We found no subsequent infections when we used serological and molecular tests to evaluate close contacts.
  • article 19 Citação(ões) na Scopus
    Spatiotemporal dynamics and recurrence of chikungunya virus in Brazil: an epidemiological study
    (2023) SOUZA, William M. de; LIMA, Shirlene T. S. de; MELLO, Leda M. Simoes; CANDIDO, Darlan S.; BUSS, Lewis; WHITTAKER, Charles; CLARO, Ingra M.; CHANDRADEVA, Nilani; GRANJA, Fabiana; JESUS, Ronaldo de; LEMOS, Poliana S.; TOLEDO-TEIXEIRA, Daniel A.; BARBOSA, Priscilla P.; FIRMINO, Antonio Carlos L.; AMORIM, Mariene R.; DUARTE, Larissa M. F.; JR, Ivan B. Pessoa; FORATO, Julia; VASCONCELOS, Irihane L.; MAXIMO, Ana Carolina B. M.; ARAUJO, Emerson L. L.; MELLO, Liana Perdigao; SABINO, Ester C.; PROENCA-MODENA, Jose Luiz; FARIA, Nuno R.; WEAVER, Scott
    Background Chikungunya virus (CHIKV) is an Aedes mosquito-borne virus that has caused large epidemics linked to acute, chronic, and severe clinical outcomes. Currently, Brazil has the highest number of chikungunya cases in the Americas. We aimed to investigate the spatiotemporal dynamics and recurrence pattern of chikungunya in Brazil since its introduction in 2013.Methods In this epidemiological study, we used CHIKV genomic sequencing data, CHIKV vector information, and aggregate clinical data on chikungunya cases from Brazil. The genomic data comprised 241 Brazilian CHIKV genome sequences from GenBank (n=180) and the 2022 CHIKV outbreak in Ceara state (n=61). The vector data (Breteau index and House index) were obtained from the Brazilian Ministry of Health for all 184 municipalities in Ceara state and 116 municipalities in Tocantins state in 2022. Epidemiological data on laboratory-confirmed cases of chikungunya between 2013 and 2022 were obtained from the Brazilian Ministry of Health and Laboratory of Public Health of Ceara. We assessed the spatiotemporal dynamics of chikungunya in Brazil via time series, mapping, age-sex distribution, cumulative case-fatality, linear correlation, logistic regression, and phylogenetic analyses.Findings Between March 3, 2013, and June 4, 2022, 253 545 laboratory-confirmed chikungunya cases were reported in 3316 (59 & BULL;5%) of 5570 municipalities, mainly distributed in seven epidemic waves from 2016 to 2022. To date, Ceara in the northeast has been the most affected state, with 77 418 cases during the two largest epidemic waves in 2016 and 2017 and the third wave in 2022. From 2016 to 2022 in Ceara, the odds of being CHIKV-positive were higher in females than in males (odds ratio 0 & BULL;87, 95% CI 0 & BULL;85-0 & BULL;89, p<0 & BULL;0001), and the cumulative case-fatality ratio was 1 & BULL;3 deaths per 1000 cases. Chikungunya recurrences in the states of Ceara, Tocantins (recurrence in 2022), and Pernambuco (recurrence in 2021) were limited to municipalities with few or no previously reported cases in the previous epidemic waves. The recurrence of chikungunya in Ceara in 2022 was associated with a new East-Central -South-African lineage. Population density metrics of the main CHIKV vector in Brazil, Aedes aegypti, were not correlated spatially with locations of chikungunya recurrence in Ceara and Tocantins.Interpretation Spatial heterogeneity of CHIKV spread and population immunity might explain the recurrence pattern of chikungunya in Brazil. These results can be used to inform public health interventions to prevent future chikungunya epidemic waves in urban settings.
  • article 16 Citação(ões) na Scopus
    Chikungunya virus ECSA lineage reintroduction in the northeasternmost region of Brazil
    (2021) XAVIER, Joilson; FONSECA, Vagner; BEZERRA, Joao Felipe; ALVES, Manoella do Monte; MARES-GUIA, Maria Angelica; CLARO, Ingra Morales; JESUS, Ronaldo de; ADELINO, Talita; ARAUJO, Emerson; CAVALCANTE, Karina Ribeiro Leite Jardim; TOSTA, Stephane; SOUZA, Themis Rocha de; CRUZ, Flavia Emanuelle Moreira da; FABRI, Allison de Araujo; OLIVEIRA, Elaine Cristina de; MOURA, Noely Fabiana Oliveira de; SAID, Rodrigo Fabiano do Carmo; ALBUQUERQUE, Carlos Frederico Campelo de; AZEVEDO, Vasco; OLIVEIRA, Tulio de; FILIPPIS, Ana Maria Bispo de; CUNHA, Rivaldo Venancio da; LUZ, Kleber Giovanni; GIOVANETTI, Marta; ALCANTARA, Luiz Carlos Junior
    The Northeast region of Brazil registered the second-highest incidence proportion of Chikungunya fever in 2019. In that year, an outbreak consisting of patients presenting with febrile disease associated with joint pain was reported by the public primary health care service in the city of Natal, in the state of Rio Grande do Norte, in March 2019. At first, the aetiological agent of the disease was undetermined. Since much is still unknown about chikungunya virus' (CHIKV) genomic diversity and evolutionary history in this northeasternmost state, we used a combination of portable whole-genome sequencing, molecular clock, and epidemiological analyses that revealed the reintroduction of the CHIKV East-Central-South-African (ECSA) lineage into Rio Grande do Norte. We estimated that the CHIKV ECSA lineage was first introduced into Rio Grande do Norte in early June 2014, while the 2019 outbreak clade diverged around April 2018, during a period of increased Chikungunya incidence in the Southeast region, which might have acted as a source of virus dispersion towards the Northeast region. Together, these results confirm that the ECSA lineage continues to spread across the country through interregional importation events, likely mediated by human mobility. (C) 2021 The Author(s).
  • article 393 Citação(ões) na Scopus
    Establishment and cryptic transmission of Zika virus in Brazil and the Americas
    (2017) FARIA, N. R.; QUICK, J.; CLARO, I. M.; THEZE, J.; JESUS, J. G. de; GIOVANETTI, M.; KRAEMER, M. U. G.; HILL, S. C.; BLACK, A.; COSTA, A. C. da; FRANCO, L. C.; SILVA, S. P.; WU, C. -H.; RAGHWANI, J.; CAUCHEMEZ, S.; PLESSIS, L. du; VEROTTI, M. P.; OLIVEIRA, W. K. de; CARMO, E. H.; COELHO, G. E.; SANTELLI, A. C. F. S.; VINHAL, L. C.; HENRIQUES, C. M.; SIMPSON, J. T.; LOOSE, M.; ANDERSEN, K. G.; GRUBAUGH, N. D.; SOMASEKAR, S.; CHIU, C. Y.; MUNOZ-MEDINA, J. E.; GONZALEZ-BONILLA, C. R.; ARIAS, C. F.; LEWIS-XIMENEZ, L. L.; BAYLIS, S. A.; CHIEPPE, A. O.; AGUIAR, S. F.; FERNANDES, C. A.; LEMOS, P. S.; NASCIMENTO, B. L. S.; MONTEIRO, H. A. O.; SIQUEIRA, I. C.; QUEIROZ, M. G. de; SOUZA, T. R. de; BEZERRA, J. F.; LEMOS, M. R.; PEREIRA, G. F.; LOUDAL, D.; MOURA, L. C.; DHALIA, R.; FRANCA, R. F.; MAGALHAES, T.; MARQUES JR., E. T.; JAENISCH, T.; WALLAU, G. L.; LIMA, M. C. de; NASCIMENTO, V.; CERQUEIRA, E. M. de; LIMA, M. M. de; MASCARENHAS, D. L.; MOURA NETO, J. P.; LEVIN, A. S.; TOZETTO-MENDOZA, T. R.; FONSECA, S. N.; MENDES-CORREA, M. C.; MILAGRES, F. P.; SEGURADO, A.; HOLMES, E. C.; RAMBAUT, A.; BEDFORD, T.; NUNES, M. R. T.; SABINO, E. C.; ALCANTARA, L. C. J.; LOMAN, N. J.; PYBUS, O. G.
    Transmission of Zika virus (ZIKV) in the Americas was first confirmed in May 2015 in northeast Brazil(1). Brazil has had the highest number of reported ZIKV cases worldwide (more than 200,000 by 24 December 20162) and the most cases associated with microcephaly and other birth defects (2,366 confirmed by 31 December 20162). Since the initial detection of ZIKV in Brazil, more than 45 countries in the Americas have reported local ZIKV transmission, with 24 of these reporting severe ZIKV-associated disease(3). However, the origin and epidemic history of ZIKV in Brazil and the Americas remain poorly understood, despite the value of this information for interpreting observed trends in reported microcephaly. Here we address this issue by generating 54 complete or partial ZIKV genomes, mostly from Brazil, and reporting data generated by a mobile genomics laboratory that travelled across northeast Brazil in 2016. One sequence represents the earliest confirmed ZIKV infection in Brazil. Analyses of viral genomes with ecological and epidemiological data yield an estimate that ZIKV was present in northeast Brazil by February 2014 and is likely to have disseminated from there, nationally and internationally, before the first detection of ZIKV in the Americas. Estimated dates for the international spread of ZIKV from Brazil indicate the duration of pre-detection cryptic transmission in recipient regions. The role of northeast Brazil in the establishment of ZIKV in the Americas is further supported by geographic analysis of ZIKV transmission potential and by estimates of the basic reproduction number of the virus.
  • article 54 Citação(ões) na Scopus
    Emergence of the Asian lineage of Zika virus in Angola: an outbreak investigation
    (2019) HILL, Sarah C.; VASCONCELOS, Jocelyne; NETO, Zoraima; JANDONDO, Domingos; ZE-ZE, Libia; AGUIAR, Renato Santana; XAVIER, Joilson; THEZE, Julien; MIRANDELA, Marinela; CANDIDO, Ana Luisa Micolo; VAZ, Filipa; SEBASTIAO, Cruz dos Santos; WU, Chieh-Hsi; KRAEMER, Moritz U. G.; MELO, Adriana; SCHAMBER-REIS, Bruno L. F.; AZEVEDO, Girlene S. de; TANURI, Amilcar; HIGA, Luiza M.; CLEMENTE, Carina; SILVA, Sara Pereira da; CANDIDO, Darlan da Silva; CLARO, Ingra M.; QUIBUCO, Domingos; DOMINGOS, Cristovao; POCONGO, Barbara; WATTS, Alexander G.; KHAN, Kamran; ALCANTARA, Luiz Carlos Junior; SABINO, Ester C.; LACKRITZ, Eve; PYBUS, Oliver G.; ALVES, Maria-Joao; AFONSO, Joana; FARIA, Nuno R.
    Background Zika virus infections and suspected microcephaly cases have been reported in Angola since late 2016, but no data are available about the origins, epidemiology, and diversity of the virus. We aimed to investigate the emergence and circulation of Zika virus in Angola. Methods Diagnostic samples collected by the Angolan Ministry of Health as part of routine arboviral surveillance were tested by real-time reverse transcription PCR by the Instituto Nacional de Investigacao em Saude (Ministry of Health, Luanda, Angola). To identify further samples positive for Zika virus and appropriate for genomic sequencing, we also tested samples from a 2017 study of people with HIV in Luanda. Portable sequencing was used to generate Angolan Zika virus genome sequences from three people positive for Zika virus infection by real-time reverse transcription PCR, including one neonate with microcephaly. Genetic and mobility data were analysed to investigate the date of introduction and geographical origin of Zika virus in Angola. Brain CT and MRI, and serological assays were done on a child with microcephaly to confirm microcephaly and assess previous Zika virus infection. Findings Serum samples from 54 people with suspected acute Zika virus infection, 76 infants with suspected microcephaly, 24 mothers of infants with suspected microcephaly, 336 patients with suspected dengue virus or chikungunya virus infection, and 349 samples from the HIV study were tested by real-time reverse transcription PCR. Four cases identified between December, 2016, and June, 2017, tested positive for Zika virus. Analyses of viral genomic and human mobility data suggest that Zika virus was probably introduced to Angola from Brazil between July, 2015, and June, 2016. This introduction probably initiated local circulation of Zika virus in Angola that continued until at least June, 2017. The infant with microcephaly in whom CT and MRI were done had brain abnormalities consistent with congenital Zika syndrome and serological evidence for Zika virus infection. Interpretation Our analyses show that autochthonous transmission of the Asian lineage of Zika virus has taken place in Africa. Zika virus surveillance and surveillance of associated cases of microcephaly throughout the continent is crucial.
  • article 14 Citação(ões) na Scopus
    Short report: Introduction of chikungunya virus ECSA genotype into the Brazilian Midwest and its dispersion through the Americas
    (2021) OLIVEIRA, Elaine Cristina de; FONSECA, Vagner; XAVIER, Joilson; ADELINO, Talita; CLARO, Ingra Morales; FABRI, Allison; MACARIO, Eduardo Marques; VINISKI, Ana Elisa; SOUZA, Claudio Luis Campos; COSTA, Evanil Sebastiana Gomes da; SOUSA, Claudia Soares de; DUARTE, Flavia Guimaraes Dias; MEDEIROS, Arnaldo Correia de; ALBUQUERQUE, Carlos F. Campelo de; CUNHA, Rivaldo Venancio; MOURA, Noely Fabiana Oliveira De; FILIPPIS, Ana Maria Bispo de; OLIVEIRA, Tulio de; LOURENCO, Jose; ABREU, Andre Luiz de; ALCANTARA, Luiz Carlos Junior; GIOVANETTI, Marta
    Since introduction into Brazil in 2014, chikungunya virus (CHIKV) has presented sustained transmission, although much is unknown about its circulation in the midwestern states. Here, we analyze 24 novel partial and near complete CHIKV genomes from Cuiaba, an urban metropolis located in the Brazilian midwestern state of Mato Grosso (MT). Nanopore technology was used for sequencing CHIKV complete genomes. Phylogenetic and epidemiological approaches were used to explore the recent spatio-temporal evolution and spread of the CHIKV-ECSA genotype in Midwest Brazil as well as in the Americas. Epidemiological data revealed a reduction in the number of reported cases over 2018-2020, likely as a consequence of a gradual accumulation of herd-immunity. Phylogeographic reconstructions revealed that at least two independent introductions of the ECSA lineage occurred in MT from a dispersion event originating in the northeastern region and suggest that the midwestern Brazilian region appears to have acted as a source of virus transmission towards Paraguay, a bordering South American country. Our results show a complex dynamic of transmission between epidemic seasons and suggest a possible role of Brazil as a source for international dispersion of the CHIKV-ECSA genotype to other countries in the Americas. Author summary Since its introduction into Brazil in 2014, chikungunya virus (CHIKV) has presented sustained transmission, although much is unknown about its circulation in the midwestern states. Here, using a combined strategy of a mobile sequencing mission through this region, with genomic and epidemiological analysis we generated 24 novel partial and near complete CHIKV genome sequences by means of portable nanopore sequencing of chikungunya virus isolates obtained directly from clinical samples. Our findings reinforce that continued genomic surveillance strategies are needed to assist in the monitoring and understanding of arbovirus epidemics, which might help to attenuate public health impact of infectious diseases.
  • article 16 Citação(ões) na Scopus
    First case report of monkeypox in Brazil: clinical manifestations and differential diagnosis with sexually transmitted infections
    (2022) LIMA, Evelyn Lepka de; BARRA, Luiz Alberto Costa; BORGES, Luciana Marques Sansao; MEDEIROS, Lucas Alberto; TOMISHIGE, Marcia Y. S.; SANTOS, Lucas de Souza Loureiro Abbud; SILVA, Anderson Jose Dias da; RODRIGUES, Camila Cristina Martini; AZEVEDO, Luiz Cesar Fernandes de; VILLAS-BOAS, Lucy Santos; SILVA, Camila Alves Maia da; COLETTI, Thais Moura; MANULI, Erika R.; CLARO, Ingra Morales; ROMANO, Camila Malta; RAMUNDO, Mariana Severo; MOUTINHO, Tomas; SABINO, Ester Cerdeira; LINDOSO, Jose Angelo Lauletta; FIGUEIREDO-MELLO, Claudia
    In 2022, an outbreak of monkeypox is being reported in non-endemic areas, with unusual clinical manifestations. The detailed clinical description of the first patient that received the diagnosis of monkeypox in Brazil is reported here, whose clinical manifestations can easily lead to misdiagnosis of sexually transmitted infections. A 41 years old male presented to an emergency room with a vesicular rash with eight days of evolution. He had traveled to Portugal and Spain and reported non-penetrative sexual involvement with three different male individuals. On the third day of symptoms, he sought medical care and received empirical treatment directed to sexually transmitted infections. As the symptoms did not improve, he sought medical attention at an infectious disease referral center presenting, on admission, an ulcerated penile lesion with central necrotic crusts, a disseminated pleomorphic skin rash and an oropharyngeal ulcer. The monkeypox diagnosis was suspected due to the characteristics of the lesions and the history of intimate contact with casual partners, and it was later confirmed by sequencing the almost complete monkeypox genome. The patient was hospitalized for pain control, which required opiate administration. He developed a secondary bacterial infection on the penile lesions, which were treated with oral antibiotics. He was discharged after 14 days, with lesions in process of re-epithelialization. Given the current outbreak, we must consider the possibility of monkeypox in patients with suggestive lesions, anywhere on the body (including the genitals), added to an epidemiological link or history of intimate contact with strangers or casual partners.
  • article 22 Citação(ões) na Scopus
    Field and classroom initiatives for portable sequence-based monitoring of dengue virus in Brazil
    (2021) ADELINO, Talita Emile Ribeiro; GIOVANETTI, Marta; FONSECA, Vagner; XAVIER, Joilson; ABREU, Alvaro Salgado de; NASCIMENTO, Valdinete Alves do; DEMARCHI, Luiz Henrique Ferraz; OLIVEIRA, Marluce Aparecida Assuncao; SILVA, Vinicius Lemes da; MELLO, Arabela Leal e Silva de; CUNHA, Gabriel Muricy; ABRANTES, Jayra Juliana Paiva Alves; WATANABE, Luiz Takao; REGO, Marta Ferreira da Silva; NARDY, Vanessa Brandao; AGUIAR, Shirlei Ferreira de; SANTOS, Fabiana Cristina Pereira dos; QUEIROZ, Alice Louize Nunes; NUNES, Bruno Tardelli Diniz; MARTINS, Livia Caricio; NUNES, Marcio Roberto Teixeira; SANTOS, Roselene Hans; SALLES, Flavia Cristina da Silva; CLARO, Ingra Morales; JESUS, Jaqueline Goes de; CANDIDO, Darlan da Silva; FABBRI, Cintia Marcela; GONZALEZ, Claudia; SAEZ, Lisseth; CHEN-GERMAN, Maria; BARRERA, Jaime Lagos; RAMIREZ-GONZALEZ, Jose Ernesto; OLIVEIRA, Elaine Cristina de; CAMPOS, Josefina; FALLER, Noelia Morel; VILLALOBOS, Marta Eugenia Viquez; KASLIN, Roberto; CISNEROS, Silvia Paola Salgado; ABURJAILE, Flavia Figueira; AMARAL, Carolina Dourado; FREIRE, Danielle Bandeira Costa de Sousa; CRUZ, Laura Nogueira; MATTOS, Daniel; CHAMON JUNIOR, Jorge Antonio; LANDEIRA, Leandro Ferreira Lopes; MENEZES, Mariane Talon de; ORIOLI, Ieda Maria; FERRAZ, Ariane Coelho; OLIVEIRA, Daiane Teixeira de; REIS, Alexandre Barbosa; COTA, Renata Guerra de Sa; BEZERRA, Rafael dos Santos; FALCAO, Melissa Barreto; CARVALHO, Rodrigo Dias de Oliveira; IANI, Felipe Campos de Melo; FILIPPIS, Ana Maria Bispo de; ABREU, Andre Luiz de; JESUS, Ronaldo de; ALBUQUERQUE, Carlos Frederico Campelo de; RICO, Jairo Mendez; SAID, Rodrigo Fabiano do Carmo; SILVA, Joscelio Aguiar; MOURA, Noely Fabiana Oliveira de; LEITE, Priscila; FRUTUOSO, Livia Carla Vinhal; HADDAD, Simone Kashima; MARTINEZ, Alexander; BARRETO, Fernanda Khouri; VAZQUEZ, Cynthia Carolina; CUNHA, Rivaldo Venancio da; ARAUJO, Emerson Luiz Lima; TOSTA, Stephane Fraga de Oliveira; FABRI, Allison de Araujo; CHALHOUB, Flavia Lowen Levy; LEMOS, Poliana da Silva; BRUYCKER-NOGUEIRA, Fernanda De; LICHS, Gislene Garcia de Castro; ZARDIN, Marina Castilhos Souza Umaki; SEGOVIA, Fatima Maria Cardozo; GONCALVES, Crhistinne Cavalheiro Maymone; GRILLO, Zoraida Del Carmen Fernandez; SLAVOV, Svetoslav Nanev; PEREIRA, Luiz Augusto; MENDONCA, Ana Flavia; PEREIRA, Felicidade Mota; MAGALHAES, Jurandy Junior Ferraz de; SANTOS JUNIOR, Agenor de Castro Moreira dos; LIMA, Maricelia Maia de; NOGUEIRA, Rita Maria Ribeiro; GOES-NETO, Aristoteles; AZEVEDO, Vasco Ariston de Carvalho; RAMALHO, Dario Brock; OLIVEIRA, Wanderson Kleber; MACARIO, Eduardo Marques; MEDEIROS, Arnaldo Correia de; PIMENTEL, Victor; HOLMES, Edward C.; OLIVEIRA, Tulio de; LOURENCO, Jose; ALCANTARA, Luiz Carlos Junior; CERQUEIRA, Erenilde Marques de; GRAF, Tiago; RAMALHO, Walter; NAVEGANTES, Wildo; REIS, Renato Barbosa; DUARTE, Clara Guerra; PEREIRA, Maira Alves; SILVA, Paulo Eduardo de Souza da; SOUZA, Raoni Almeida de; PAUVOLID-CORREA, Alex; PAIVA, Anne Aline Pereira de; FRITSCH, Hegger Machado; MARES-GUIA, Maria Angelica; TORRES, Maria Celeste; LIMA, Mauricio Teixeira; SEQUEIRA, Patricia; MARQUES, William de Almeida; JESUS, Jorlan Fernandes de; NAVECA, Felipe Gomes; SILVA, Alessandra Lima; PINTO, Anne Cybelle; JAISWAL, Arun Kumar; LOPES, Elisson Nogueira; COSTA, Francielly Morais Rodrigues da; QUINTANILHA-PEIXOTO, Gabriel; SOARES, Gilson Carlos; FONSECA, Paula Luize Camargos; SOUZA, Renan Pedra de; KATO, Rodrigo Bentes; SANTOS, Rodrigo Profeta Silveira; TIWARI, Sandeep; NOGUEIRA, Wylerson Guimaraes; SANTOS, Beatriz Senra Alvares da Silva; BUENO, Bruna Lopes; SIQUEIRA, Isadora Cristina de; VALLVE, Lourdes Farre; BORBA, Melina Mosquera Navarro; MAZZETTO, Alix Sandra; AGUIAR, Francisco de Assis Araujo; GOMES, Irenio da Silva
    Brazil experienced a large dengue virus (DENV) epidemic in 2019, highlighting a continuous struggle with effective control and public health preparedness. Using Oxford Nanopore sequencing, we led field and classroom initiatives for the monitoring of DENV in Brazil, generating 227 novel genome sequences of DENV1-2 from 85 municipalities (2015-2019). This equated to an over 50% increase in the number of DENV genomes from Brazil available in public databases. Using both phylogenetic and epidemiological models we retrospectively reconstructed the recent transmission history of DENV1-2. Phylogenetic analysis revealed complex patterns of transmission, with both lineage co-circulation and replacement. We identified two lineages within the DENV2 BR-4 clade, for which we estimated the effective reproduction number and pattern of seasonality. Overall, the surveillance outputs and training initiative described here serve as a proof-of-concept for the utility of real-time portable sequencing for research and local capacity building in the genomic surveillance of emerging viruses. Here, the authors present results of the ZiBRA-2 project (https://www.zibra2project.org) which is an arbovirus surveillance project, across the Midwest of Brazil using a mobile genomics laboratory, combined with a genomic surveillance training program that targeted post-graduate students, laboratory technicians, and health practitioners in universities and laboratories.
  • article 41 Citação(ões) na Scopus
    Predictors of mortality in patients with yellow fever: an observational cohort study
    (2019) KALLAS, Esper G.; ZANELLA, Luiz Gonzaga F. A. B. D'Elia; V, Carlos Henrique Moreira; BUCCHERI, Renata; DINIZ, Gabriela B. F.; CASTINEIRAS, Anna Carla P.; COSTA, Priscilla R.; DIAS, Juliana Z. C.; MARMORATO, Mariana P.; SONG, Alice T. W.; MAESTRI, Alvino; BORGES, Igor C.; JOELSONS, Daniel; CERQUEIRA, Natalia B.; SOUZA, Nathalia C. Santiago e; CLARO, Ingra Morales; SABINO, Ester C.; LEVI, Jose Eduardo; I, Vivian Avelino-Silva; HO, Yeh-Li
    Background Yellow fever virus infection results in death in around 30% of symptomatic individuals. The aim of this study was to identify predictors of death measured at hospital admission in a cohort of patients admitted to hospital during the 2018 outbreak of yellow fever in the outskirts of Sao Paulo city, Brazil. Methods In this observational cohort study, we enrolled patients with yellow fever virus from two hospitals in Sao Paolo-the Hospital das Clinicas, University of Sao Paulo and the Infectious Diseases Institute ""Emilio Ribas"". Patients older than 18 years admitted to hospital with fever or myalgia, headache, arthralgia, oedema, rash, or conjunctivitis were consecutively screened for inclusion in the present study. Consenting patients were included if they had travelled to geographical areas in which yellow fever virus cases had been previously confirmed. Yellow fever infection was confirmed by real-time PCR in blood collected at admission or tissues at autopsy. We sequenced the complete genomes of yellow fever virus from infected individuals and evaluated demographic, clinical, and laboratory findings at admission and investigated whether any of these measurements correlated with patient outcome (death). Findings Between Jan 11, 2018, and May 10, 2018, 118 patients with suspected yellow fever were admitted to Hospital das Clinicas, and 113 patients with suspected yellow fever were admitted to Infectious Diseases Institute ""Emilio Ribas"". 95 patients with suspected yellow fever were included in the study, and 136 patients were excluded. Three (3%) of 95 patients with suspected yellow fever who were included in the study were excluded because they received a different diagnosis, and 16 patients with undetectable yellow fever virus RNA were excluded. Therefore, 76 patients with confirmed yellow fever virus infection, based on detectable yellow fever virus RNA in blood (74 patients) or yellow fever virus confirmed only at the autopsy report (two patients), were included in our analysis. 27 (36%) of 76 patients died during the 60 day period after hospital admission. We generated 14 complete yellow fever virus genomes from the first 15 viral load-detectable samples. The genomes belonged to a single monophyletic clade of the South America I genotype, sub-genotype E. Older age, male sex, higher leukocyte and neutrophil counts, higher alanine aminotransferase, aspartate transaminase (AST), bilirubin, and creatinine, prolonged prothrombin time, and higher yellow fever virus RNA plasma viral load were associated with higher mortality. In a multivariate regression model, older age, elevated neutrophil count, increased AST, and higher viral load remained independently associated with death. All 11 (100%) patients with neutrophil counts of 4000 cells per mL or greater and viral loads of 5.1 log(10) copies/mL or greater died (95% CI 72-100), compared with only three (11%) of 27 (95% CI 2-29) among patients with neutrophil counts of less than 4000 cells per mL and viral loads of less than 5.1 log(10) copies/mL. Interpretation We identified clinical and laboratory predictors of mortality at hospital admission that could aid in the care of patients with yellow fever virus. Identification of these prognostic markers in patients could help clinicians prioritise admission to the intensive care unit, as patients often deteriorate rapidly. Moreover, resource allocation could be improved to prioritise key laboratory examinations that might be more useful in determining whether a patient could have a better outcome. Our findings support the important role of the virus in disease pathogenesis, suggesting that an effective antiviral could alter the clinical course for patients with the most severe forms of yellow fever.
  • article 60 Citação(ões) na Scopus
    Genomic, epidemiological and digital surveillance of Chikungunya virus in the Brazilian Amazon
    (2019) NAVECA, Felipe Gomes; CLARO, Ingra; GIOVANETTI, Marta; JESUS, Jaqueline Goes de; XAVIER, Joilson; IANI, Felipe Campos de Melo; NASCIMENTO, Valdinete Alves do; SOUZA, Victor Costa de; SILVEIRA, Paola Paz; LOURENCO, Jose; SANTILLANA, Mauricio; KRAEMER, Moritz U. G.; QUICK, Josh; HILL, Sarah C.; THEZE, Julien; CARVALHO, Rodrigo Dias de Oliveira; AZEVEDO, Vasco; SALLES, Flavia Cristina da Silva; NUNES, Marcio Roberto Teixeira; LEMOS, Poliana da Silva; CANDIDO, Darlan da Silva; PEREIRA, Glauco de Carvalho; OLIVEIRA, Marluce Aparecida Assuncao; MENESES, Catia Alexandra Ribeiro; MAITO, Rodrigo Melo; CUNHA, Claudeth Rocha Santa Brigida; CAMPOS, Daniela Palha de Sousa; CASTILHO, Marcia da Costa; SIQUEIRA, Thalita Caroline da Silva; TERRA, Tiza Matos; ALBUQUERQUE, Carlos F. Campelo de; CRUZ, Laura Nogueira da; ABREU, Andre Luis de; MARTINS, Divino Valerio; SIMOES, Daniele Silva de Moraes Vanlume; AGUIAR, Renato Santana de; LUZ, Sergio Luiz Bessa; LOMAN, Nicholas; PYBUS, Oliver G.; SABINO, Ester C.; OKUMOTO, Osnei; ALCANTARA, Luiz Carlos Junior; FARIA, Nuno Rodrigues
    Background Since its first detection in the Caribbean in late 2013, chikungunya virus (CHIKV) has affected 51 countries in the Americas. The CHIKV epidemic in the Americas was caused by the CHIKV-Asian genotype. In August 2014, local transmission of the CHIKV-Asian genotype was detected in the Brazilian Amazon region. However, a distinct lineage, the CHIKV-East-Central-South-America (ECSA)-genotype, was detected nearly simultaneously in Feira de Santana, Bahia state, northeast Brazil. The genomic diversity and the dynamics of CHIKV in the Brazilian Amazon region remains poorly understood despite its importance to better understand the epidemiological spread and public health impact of CHIKV in the country. Methodology/Principal findings We report a large CHIKV outbreak (5,928 notified cases between August 2014 and August 2018) in Boa vista municipality, capital city of Roraima's state, located in the Brazilian Amazon region. We generated 20 novel CHIKV-ECSA genomes from the Brazilian Amazon region using MinION portable genome sequencing. Phylogenetic analyses revealed that despite an early introduction of the Asian genotype in 2015 in Roraima, the large CHIKV outbreak in 2017 in Boa Vista was caused by an ECSA-lineage most likely introduced from northeastern Brazil. Epidemiological analyses suggest a basic reproductive number of R-0 of 1.66, which translates in an estimated 39 (95% CI: 36 to 45) % of Roraima's population infected with CHIKV-ECSA. Finally, we find a strong association between Google search activity and the local laboratory-confirmed CHIKV cases in Roraima. Conclusions/Significance This study highlights the potential of combining traditional surveillance with portable genome sequencing technologies and digital epidemiology to inform public health surveillance in the Amazon region. Our data reveal a large CHIKV-ECSA outbreak in Boa Vista, limited potential for future CHIKV outbreaks, and indicate a replacement of the Asian genotype by the ECSA genotype in the Amazon region.