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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2021.tde-25082021-115149
Document
Author
Full name
Flavio Augusto de Padua Milagres
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2020
Supervisor
Committee
Segurado, Aluisio Augusto Cotrim (President)
Brasil, Patricia
Lindoso, José Angelo Lauletta
Luz, Kleber Giovanni
Title in Portuguese
Características sociodemográficas, virológicas e clínicas dos casos notificados como suspeitos de infecção pelo vírus Zika e fatores associados à infecção por esse arbovírus no estado do Tocantins no ano de 2015 e 2016
Keywords in Portuguese
Arbovírus
Brasil
Epidemiologia
Fatores de risco
Sinais e sintomas
Surtos de doenças
Vírus chikungunya
Vírus da dengue
Zika vírus
Abstract in Portuguese
Em 2015 identificou-se no estado do Tocantins, endêmico para a infecção pelo vírus Dengue (DENV), a emergência do Zika vírus (ZIKV) e do vírus Chikungunya (CHIKV), motivando a realização deste estudo com objetivo de descrever as características sociodemográficas e clínicas dos casos notificados como suspeitos de infecção pelo ZIKV nos anos de 2015 e 2016 e identificar fatores associados à infecção por esse arbovírus. A partir dos registros de notificação e resultados de testes diagnósticos moleculares para ZIKV, DENV e CHIKV dos sistemas SINAN e GAL, identificaram-se 1.137 indivíduos, dos quais aproximadamente 40% apresentaram viremia por pelo menos 1 arbovírus e cerca de 2% se mostraram infectados por 2 ou mais desses agentes. Entre os monoinfectados não houve diferença em relação a características sociodemográficas. Todavia, do ponto de vista clínico, o prurido foi mais relatado nos indivíduos com zikavirose, quando comparados aos infectados pelo DENV, ao passo que a febre foi mais frequente nos participantes monoinfectados por DENV, quando comparados aos monoinfectados por ZIKV. Nos infectados pelo ZIKV, aqueles com 20 anos ou mais apresentaram frequência significativamente maior de mialgia, artralgia/artrite e conjuntivite, enquanto os menores de 20 anos apresentaram mais frequentemente febre; as mulheres apresentaram significativamente maior frequência de prurido e edema, quando comparadas aos homens e as gestantes relataram conjuntivite menos frequentemente do que mulheres em idade fértil não gestantes. Na análise multivariada, a infecção por ZIKV mostrou-se independentemente associada ao sexo feminino, à ausência de infecção por CHIKV, a tempo com sintomas inferior a 3 dias, à ocorrência de exantema e à ausência de relato de mialgia. A similitude de manifestações clínicas em infecções por arbovírus que cocirculam em uma mesma região e as características clínicas distintivas da zikavirose em diferentes grupos populacionais acarretam desafios à saúde pública e reforçam a necessidade de vigilância epidemiológica apoiada em recursos diagnósticos efetivos para subsidiar ações de prevenção e controle desses agravos na população residente e viajantes
Title in English
Socio-demographic, virological and clinical features of cases reported as suspected Zika virus Infections and factors associated with this arboviral infection in the state of Tocantins in 2015 and 2016
Keywords in English
Arboviruses
Brazil
Chikungunya virus
Dengue virus
Disease outbreaks
Epidemiology
Risk factors
Signs and symptoms
Zika virus
Abstract in English
In 2015 Zika virus (ZIKV) and Chikungunya virus (CHIKV) emerging infections were identified in the Brazilian state of Tocantins, an endemic area for Dengue virus (DENV). In such a scenario we conceived this study to describe socio-demographic and clinical features of patients reported as suspected Zika cases in 2015-2016 and to investigate factors associated with this arboviral infection. Based on notifications and results of molecular biology diagnostic tests for ZIKV, DENV e CHIKV available in the SINAN and GAL national databases, we identified 1.137 individuals, of whom about 40% exhibited viremia with at least one arbovirus and about 2% were infected with two or more of these agents. Among mono-infected patients there was no difference in socio-demographic characteristics. However, from a clinical point of view, itching was more often reported by patients with ZIKV infection as compared to those with dengue, whereas fever was more frequent among dengue patients as compared with their ZIKV-infected counterparts. Among ZIKV-infected individuals, those aged 20 or over presented myalgia, arthralgia/arthritis and conjunctivitis significantly more often, whereas those younger than 20 years old more frequently had fever; itching and edema were more often reported by women than men, and pregnant patients less frequently presented conjunctivitis as compared to non-pregnant women in fertile age. In multivariate analysis, ZIKV infection was independently associated with being female, reporting symptoms for less than 3 days, presenting rash and with not being CHIKV-infected or reporting myalgia. The fact that infections caused by different cocirculating arboviruses may present with similar clinical manifestations and that signs and symptoms of ZIKV infection may differ among population groups challenges public health and reinforces the need of epidemiological surveillance actions based on effective diagnostic resources to support control and prevention of these diseases in the local population and among travelers
 
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Publishing Date
2021-08-30
 
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