A clinical-ecological study of a triple viral epidemic: Zika, Dengue and Chikungunya/ Um estudo clínico-ecológico de uma tripla epidemia viral: Zika, Dengue e Chikungunya

Abstract

In Brazil, since 2015, co-circulation of three arboviruses, Dengue (DENV), Chikungunya (CHIKV) and Zika (ZIKV), have presented diagnostic challenges, due to their similar clinical manifestations. Our goal was to analyze cases of arboviral illness using key clinical features and to ascertain house infestation indices (HII) in the study area. A total of 28,064 medical records were analyzed by clinical-epidemiological criteria for DENV, ZIKV and CHIKV in 2015 and 2016 at the public health unit in Xerem, Duque de Caxias, Rio de Janeiro. The collection of vectors at home breeding sites in Xerem was performed to determine the HII, in March and June 2015. The total number of cases of suspected arboviral illness in 2015 was 969, of which 444 (45.8%) were due to DENV, 146 (15.1%) to ZIKV, and 11 (1.1%) to CHIKV. In 2016, the number of suspected cases of arboviral illness was 2019, of which 324 (16.0%) were classified as DENV, 779 (38.6%) as ZIKV, and 53 (2.60%) as CHIKV. The clinical manifestations prevalent in ZIKV were rash (67.8% to 79.5%) and pruritus (63.7% to 71.4%). The HII for the immature stages of Aedes in the study area, in March and June 2015, was 11.8% for Ae. aegypti and 8.1% for Ae. albopictus, both very high. There was a strong positive correlation observed for precipitation and HII for both vectors (Ae. aegypti and Ae. albopictus), but not for temperature levels. We conclude that a triple epidemic occurred in the studied area probably due to the high infestation rates and a naive population for the two newly introduced arboviruses; whilst there are no available specific laboratory tests a practical clinical diagnosis workout is crucial.

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