Differential Yellow Fever Susceptibility in New World Nonhuman Primates, Comparison with Humans, and Implications for Surveillance.

Natália C.C De Azevedo Fernandes,José L Catão-Dias,Adriana Y Maeda,Juliana S Nogueira,Fernanda G.S Vasami,Júlia De Carvalho,Isis P Jesus,Leonardo J.T De Araújo,Roberta M.F Spinola,Silvia D Iglezias,Rodrigo A Ressio,Renato Pereira De Souza,Leila Delc Saad,Cristina T Kanamura,Juliana M Guerra,Cinthya Dos Santos Cirqueira,Josué Díaz-Delgado,Mariana S Cunha

doi:10.3201/eid2701.191220

Abstract

A major outbreak of yellow fever (YF) occurred in Brazil during 2016–2018. Epizootics in New World nonhuman primates are sentinel events for YF virus circulation. However, genus-specific susceptibilities and suitability for YF surveillance remain poorly understood. We obtained and compared epidemiologic, histopathologic, immunohistochemical, and molecular results from 93 human and 1,752 primate cases submitted during the recent YF outbreak in Brazil (2017), with the support of the Brazilian National YF Surveillance Program. We detected heterogeneous YF-associated profiles among the various genera of primates we analyzed. Alouatta primates were the most reliable sentinel; Sapajus and Callicebus primates had higher viral loads but lower proportional mortality rates. Callithrix primates were the least sensitive, showing lower viral loads, lower proportional mortality rates, and no demonstrable YF virus antigen or extensive lesions in liver, despite detectable viral RNA. These differences in susceptibility, viral load, and mortality rates should be considered in strategic surveillance of epizootics and control measures for YF.

Highlights

A major outbreak of yellow fever (YF) occurred in Brazil during 2016–2018
Further knowledge of YF pathogenic aspects is needed to guarantee that samples from various species of New World primates (NWPs) would be adequately used for YF surveillance purposes to ensure appropriate diagnoses and subsequent public health responses
We hypothesized that there are different genus-specific susceptibilities among NWPs that could affect YF surveillance/monitoring. To reduce this knowledge gap, we characterized and compared the histopathologic signature of YF-associated liver disease, viral antigen detection by immunohistochemical analysis (IHC), and molecular findings in samples from humans and NWPs infected by YF virus (YFV) that were received during 2017 at Adolfo Lutz Institute (São Paulo, Brazil)

Summary

Introduction

A major outbreak of yellow fever (YF) occurred in Brazil during 2016–2018. Epizootics in New World nonhuman primates are sentinel events for YF virus circulation. Callithrix primates were the least sensitive, showing lower viral loads, lower proportional mortality rates, and no demonstrable YF virus antigen or extensive lesions in liver, despite detectable viral RNA These differences in susceptibility, viral load, and mortality rates should be considered in strategic surveillance of epizootics and control measures for YF. We hypothesized that there are different genus-specific susceptibilities among NWPs that could affect YF surveillance/monitoring To reduce this knowledge gap, we characterized and compared the histopathologic signature of YF-associated liver disease, viral antigen detection by immunohistochemical analysis (IHC), and molecular findings in samples from humans and NWPs infected by YFV that were received during 2017 at Adolfo Lutz Institute (São Paulo, Brazil)

Methods

Results

Conclusion