Arboviruses emerging in Brazil: challenges for clinic and implications for public health

Abstract

Arboviruses have been emerging in different parts of the world due to genetic changes in the virus, alteration of the host and vector population dynamics, or because of anthropogenic environmental factors. These viruses’ capacity for adaptation is notable, as well as the likelihood of their emergence and establishment in new geographic areas. In Brazilian epidemiologic scenario, the most common arboviruses are DENV, CHIKV, and ZIKV, although others may spread in the country. Little is yet known of the impact of viral co-circulation, which would theoretically result in more intense viremia or other immunological alterations that could trigger autoimmune diseases, such as Guillain-Barré syndrome. The impact on morbidity and mortality intensifies as extensive epidemics lead to a high number of affected individuals, severe cases, and implications for health services, mainly due to the absence of treatment, vaccines, and effective prevention and control measures.

Selected mosquito-borne illnesses—Chikungunya

“…As with other arboviral infections, symptoms can range from mild to severe. 1,2,[7][8][9][10][11]22 Fatalities have been noted, although initially considered uncommon. The epidemic on Reunion Island underscored the risks associated with CHIKV, where encephalitis causing death or adverse longterm sequellae were reported.…”

“…The epidemic on Reunion Island underscored the risks associated with CHIKV, where encephalitis causing death or adverse longterm sequellae were reported. 1,2 Perinatal transmission resulting in encephalitis and limitations in neuropsychomotor development in children were reported. 1,21,23 CHIKV disease can also evolve into chronic illness, characterized by persisting polyarthralgia and joint stiffness.…”

“…1,2 Perinatal transmission resulting in encephalitis and limitations in neuropsychomotor development in children were reported. 1,21,23 CHIKV disease can also evolve into chronic illness, characterized by persisting polyarthralgia and joint stiffness. 7,9,11,22 This chronic CHIKV stage has been reported to severely incapacitate patients for a duration of weeks, and in some cases even several years after the initial infection.…”

“…7,9,11,22 This chronic CHIKV stage has been reported to severely incapacitate patients for a duration of weeks, and in some cases even several years after the initial infection. 1,2,7,[9][10][11][12] It is often referred to as an arthritogenic alphavirus. 22 The acute phase of Chikungunya (CHIKF) often comes on abruptly, although it can also take a couple of days.…”

“…7,8,11,[22][23][24] CHIKV causes high fever, and severe multi-joint pain, as well as muscle pain, headache, nausea, fatigue, and a rash (Tables 1 and 2) that follows an average incubation period of 5-7 days. [1][2][3]7,8,11,[22][23][24] Subclinical infection does occur, but the exact occurrence is unknown, with ranges from 3% to 25%, 11,25 but most patients are expected to have acute symptoms, that can last up to 2 weeks. Not unlike the symptoms of other tropical arthritogenic alphaviruses, CHIKV can cause very severe joint pain, not unlike "break bone fever" of dengue, also requiring narcotics, and has a variable duration.…”