Abstract

BackgroundArthropod-borne viruses (arboviruses) are among the most common agents of human febrile illness worldwide and the most important emerging pathogens, causing multiple notable epidemics of human disease over recent decades. Despite the public health relevance, little is know about the geographic distribution, relative impact, and risk factors for arbovirus infection in many regions of the world. Our objectives were to describe the arboviruses associated with acute undifferentiated febrile illness in participating clinics in four countries in South America and to provide detailed epidemiological analysis of arbovirus infection in Iquitos, Peru, where more extensive monitoring was conducted.Methodology/FindingsA clinic-based syndromic surveillance system was implemented in 13 locations in Ecuador, Peru, Bolivia, and Paraguay. Serum samples and demographic information were collected from febrile participants reporting to local health clinics or hospitals. Acute-phase sera were tested for viral infection by immunofluorescence assay or RT-PCR, while acute- and convalescent-phase sera were tested for pathogen-specific IgM by ELISA. Between May 2000 and December 2007, 20,880 participants were included in the study, with evidence for recent arbovirus infection detected for 6,793 (32.5%). Dengue viruses (Flavivirus) were the most common arbovirus infections, totaling 26.0% of febrile episodes, with DENV-3 as the most common serotype. Alphavirus (Venezuelan equine encephalitis virus [VEEV] and Mayaro virus [MAYV]) and Orthobunyavirus (Oropouche virus [OROV], Group C viruses, and Guaroa virus) infections were both observed in approximately 3% of febrile episodes. In Iquitos, risk factors for VEEV and MAYV infection included being male and reporting to a rural (vs urban) clinic. In contrast, OROV infection was similar between sexes and type of clinic.Conclusions/SignificanceOur data provide a better understanding of the geographic range of arboviruses in South America and highlight the diversity of pathogens in circulation. These arboviruses are currently significant causes of human illness in endemic regions but also have potential for further expansion. Our data provide a basis for analyzing changes in their ecology and epidemiology.

Highlights

  • Over the past few decades there has been a global resurgence of arthropod-borne viral pathogens worldwide [1,2], those transmitted by mosquitoes

  • Despite the public health relevance, the geographic range, relative impact, and epidemiologic characteristics associated with arbovirus infection are poorly described in many regions of the world

  • Arboviruses are a heterogeneous group, but those of medical relevance largely belong to a few virus genera, including Flavivirus, Alphavirus, and Orthobunyavirus

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Summary

Introduction

Over the past few decades there has been a global resurgence of arthropod-borne viral pathogens (arboviruses) worldwide [1,2], those transmitted by mosquitoes. Despite the public health relevance, the geographic range, relative impact, and epidemiologic characteristics associated with arbovirus infection are poorly described in many regions of the world. Prominent examples of emergent arboviruses include West Nile virus (WNV; Flavivirus) in North America, Japanese encephalitis virus (JEV; Flavivirus) in Asia, chikungunya virus (CHIKV; Alphavirus) in the Indian Ocean region and dengue viruses (DENV; Flavivirus) worldwide. Arthropod-borne viruses (arboviruses) are among the most common agents of human febrile illness worldwide and the most important emerging pathogens, causing multiple notable epidemics of human disease over recent decades. Despite the public health relevance, little is know about the geographic distribution, relative impact, and risk factors for arbovirus infection in many regions of the world. Our objectives were to describe the arboviruses associated with acute undifferentiated febrile illness in participating clinics in four countries in South America and to provide detailed epidemiological analysis of arbovirus infection in Iquitos, Peru, where more extensive monitoring was conducted

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