The reintroduction of dengue virus type 3 (DENV-3) in Brazil in 2000 and its subsequent spread throughout the country was associated with genotype III viruses, the only DENV-3 genotype isolated in Brazil prior to 2002. We report here the co-circulation of two different DENV-3 genotypes in patients living in the Northern region of Brazil during the 2002-2004 epidemics. Complete genomic sequences of viral RNA were determined from these epidemics, and viruses belonging to genotypes V (Southeast Asia/South Pacific) and III were identified. This recent co-circulation of different DENV-3 genotypes in South America may have implications for pathological and epidemiological dynamics.Key words: dengue virus type 3 -genotype III and V -co-circulation -phylogenetic analysis -AmazonDengue is an emerging infectious disease affecting almost 50 million people in tropical and subtropical regions of the world. Dengue fever (DF) and dengue hemorrhagic fever (DHF) are caused by four closely related, but antigenically different dengue virus serotypes 1-4 (DENV-1-4) (Gubler & Clark 1995). Since the introduction of the DENV into Brazil in 1986, more than four million cases of dengue have been reported (Cordeiro et al. 2007), and the incidence of severe clinical symptoms has increased. No vaccine or specific therapeutic antiviral measures are available.Several studies have suggested that individuals experiencing a second dengue infection with a heterologous serotype are at greater risk for developing DHF or dengue shock syndrome (DSS) (Cummings et al. 2005, Halstead et al. 2005. However, DHF and DSS are also observed in primary cases, and not all secondary infections correspond to severe forms of the disease. Studies based on molecular epidemiology have provided evidence that differences in virulence between viral strains could play a role in the severity of the disease (Mangada & Igarashi 1998, Rico-Hesse 2003.Major dengue virus epidemics occurred in Brazil in 1986 and 1990, due to the introduction of DENV-1 and -2, respectively, and the subsequent spread of these serotypes throughout the country. DENV-3 reappeared in 1994 in Central America (Nicaragua and Panama) after 17 years of absence, and later spread to Mexico and the Caribbean (CDC 1995, Guzman et al. 1996, Usuku et al. 2001. In 2000, the presence of this serotype was re-
PATIENTS, MATERIALS AND METHODSClinical samples and viruses -A serum sample from a dengue positive patient who had traveled to an area of epidemic dengue in RJ in Southeastern Brazil, and eight serum samples from patients living in Acre (AC) and RO in Northern Brazil (Table I, Fig. 1) were kindly provided by LACEN, Curitiba and IPEPATRO, Porto Velho, respectively. All patients were diagnosed with DF. These samples were used for the characterization of DENV genomes.RNA extraction and RT-PCR -Viral RNA was isolated from 140 μl of patient serum samples, taken during the acute phase of the disease and/or from 140 μl of purified virus prepared from cell culture supernatants after three passages in C6/36 cells, ...