A localized outbreak of Chikungunya virus in Salvador, Bahia, Brazil

A localized Chikungunya virus (CHIKV; East/Central/South African genotype) outbreak (50 cases, 70% laboratory-confirmed; attack rate: 5.3 confirmed cases/100 people) occurred in a Salvador, Brazil neighborhood, between Apr-Jun/2017. Highly clustered cases in space and time, mostly along a single street, highlight an increased risk of CHIKV transmission among pockets of susceptible populations. This finding underscores the need for ongoing local level surveillance for arboviral outbreaks.

Key words:
Chikungunya virus; Alphavirus; Outbreak

Authorship

Laura B Tauro

Fundação Oswaldo Cruz-Fiocruz, Instituto Gonçalo Moniz, Salvador, BA, BrasilFundação Oswaldo Cruz-FiocruzBrazilSalvador, BA, BrazilFundação Oswaldo Cruz-Fiocruz, Instituto Gonçalo Moniz, Salvador, BA, Brasil

Instituto de Biologia Subtropical, CONICET, Puerto Iguazú, Misiones, ArgentinaInstituto de Biologia SubtropicalArgentinaPuerto Iguazú, Misiones, ArgentinaInstituto de Biologia Subtropical, CONICET, Puerto Iguazú, Misiones, Argentina

Cristiane W Cardoso

Secretaria Municipal da Saúde de Salvador, Salvador, BA, BrasilSecretaria Municipal da Saúde de SalvadorBrazilSalvador, BA, BrazilSecretaria Municipal da Saúde de Salvador, Salvador, BA, Brasil

Raquel L Souza

Leile CJ Nascimento

Daniela R dos Santos

Secretaria Municipal da Saúde de Salvador, Salvador, BA, BrasilSecretaria Municipal da Saúde de SalvadorBrazilSalvador, BA, BrazilSecretaria Municipal da Saúde de Salvador, Salvador, BA, Brasil

Gubio S Campos

Universidade Federal da Bahia, Instituto de Ciências da Saúde, Salvador, BA, BrasilUniversidade Federal da BahiaBrazilSalvador, BA, BrazilUniversidade Federal da Bahia, Instituto de Ciências da Saúde, Salvador, BA, Brasil

Silvia Sardi

Olivete B dos Reis

Secretaria Municipal da Saúde de Salvador, Salvador, BA, BrasilSecretaria Municipal da Saúde de SalvadorBrazilSalvador, BA, BrazilSecretaria Municipal da Saúde de Salvador, Salvador, BA, Brasil

Mitermayer G Reis

Yale University, New Haven, CT, USAYale UniversityUSANew Haven, CT, USAYale University, New Haven, CT, USA

Universidade Federal da Bahia, Faculdade de Medicina, Salvador, BA, BrasilUniversidade Federal da BahiaBrazilSalvador, BA, BrazilUniversidade Federal da Bahia, Faculdade de Medicina, Salvador, BA, Brasil

Uriel Kitron

Emory University, Atlanta, GA, USAEmory UniversityUSAAtlanta, GA, USAEmory University, Atlanta, GA, USA

Guilherme S Ribeiro ⁺+ Corresponding author: guilherme.ribeiro@bahia.fiocruz.br

http://orcid.org/0000-0002-6798-2059

+ Corresponding author: guilherme.ribeiro@bahia.fiocruz.br

LBT, CWC, UK and GSR - Study conception and design; LBT, CWC, RLS and DRS - acquisition of data; LBT, CWC, RLS,LCJN, GSC, SS, OBR and GSR - analysis and interpretation of data; LBT, CWC, MGR, UK and GSR - drafting of manuscript. The authors declare that they have no competing interests.

SCIMAGO INSTITUTIONS RANKINGS

Secretaria Municipal da Saúde de Salvador, Salvador, BA, BrasilSecretaria Municipal da Saúde de SalvadorBrazilSalvador, BA, BrazilSecretaria Municipal da Saúde de Salvador, Salvador, BA, Brasil

Yale University, New Haven, CT, USAYale UniversityUSANew Haven, CT, USAYale University, New Haven, CT, USA

Emory University, Atlanta, GA, USAEmory UniversityUSAAtlanta, GA, USAEmory University, Atlanta, GA, USA

Figures | Tables

Figures (3)
Tables (1)

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Fig. 1:
spatial distribution of households of Chikungunya cases during an outbreak in Coutos neighborhood, Salvador, Bahia (BA), Brazil. (A) Location of Salvador in Brazil. (B) Location of Coutos neighborhood in Salvador. (C) Spatial distribution of the households of chikungunya cases (mostly along a side street situated between a railway line and a larger avenue).

Thumbnail

Fig. 2:
consensus tree generated from nucleotide sequences of a fragment of 300 bp of the E2 protein gen, using the Neighbour joining method and a p-distance model bootstrapped 1,000 times. The sequences (MG591452, and MG591454 to MG591458) obtained in this study are highlighted in red. A West Africa Chikungunya virus (CHIKV) sequence (HM045819) is included as an outgroup. ECSA: East/Central/South African; BA: Bahia; SE: Sergipe; RJ: Rio de Janeiro.

Thumbnail

Fig. 3:
number of cases per day during the Chikungunya virus outbreak in Coutos neighborhood, Salvador, Bahia (BA), Brazil.

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TABLE
and clinical characteristics of patients suspected of Chikugunya virus (CHIKV) infection during a community outbreak in Salvador, Brazil, according to CHIKV laboratory test results, April to June 2017

Fig. 1: spatial distribution of households of Chikungunya cases during an outbreak in Coutos neighborhood, Salvador, Bahia (BA), Brazil. (A) Location of Salvador in Brazil. (B) Location of Coutos neighborhood in Salvador. (C) Spatial distribution of the households of chikungunya cases (mostly along a side street situated between a railway line and a larger avenue).

Fig. 2: consensus tree generated from nucleotide sequences of a fragment of 300 bp of the E2 protein gen, using the Neighbour joining method and a p-distance model bootstrapped 1,000 times. The sequences (MG591452, and MG591454 to MG591458) obtained in this study are highlighted in red. A West Africa Chikungunya virus (CHIKV) sequence (HM045819) is included as an outgroup. ECSA: East/Central/South African; BA: Bahia; SE: Sergipe; RJ: Rio de Janeiro.

Fig. 3: number of cases per day during the Chikungunya virus outbreak in Coutos neighborhood, Salvador, Bahia (BA), Brazil.

TABLE and clinical characteristics of patients suspected of Chikugunya virus (CHIKV) infection during a community outbreak in Salvador, Brazil, according to CHIKV laboratory test results, April to June 2017

Reported characteristics	Total suspected cases (n = 50)	Laboratory-confirmed cases^a (n = 35)	Unconfirmed cases^b (n = 15)	p-value^c
Reported characteristics	Number (%) or median (interquartile range)			p-value^c
Demographic
Female	23 (46)	17 (48)	6 (40)	0.75
Median age	38 (23 - 48)	38 (23 - 48)	42 (28 - 48)	0.84
Clinical
Fever	50 (100)	35 (100)	15 (100)	1.00
Arthralgia	50 (100)	35 (100)	15 (100)	1.00
Polyarticular^d	45 (90)	32 (91)	13 (86)	0.62
Symmetric^e	45 (90)	31 (88)	14 (93)	1.00
Myalgia	49 (98)	35 (100)	14 (93)	0.30
Prostration	43 (86)	31 (88)	12 (80)	0.41
Chills^f	39 (79)	25 (74)	14 (93)	0.14
Headache	36 (72)	26 (76)	10 (66)	0.50
Retro-orbital pain	30 (60)	20 (57)	10 (66)	0.75
Pruritus^g	27 (56)	18 (54)	9 (60)	0.76
Joint edema	24 (48)	17 (48)	7 (46)	1.00
Nausea	22 (44)	15 (42)	7 (46)	1.00
Rash	21 (42)	18 (51)	3 (20)	0.06
Conjunctival hyperemia	20 (40)	15 (42)	5 (33)	0.75
Vomit	12 (24)	8 (22)	4 (26)	1.00
Swollen lymph nodes	7 (14)	6 (17)	1 (7)	0.65

a: all 35 laboratory-confirmed patients were positive by CHIKV immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA); eight of them were also positive by CHIKV reverse transcription polymerase chain reaction (RT-PCR); b: of the 15 unconfirmed patients suspected of CHIKV infection, eight were negative, two equivocal, and five not tested by CHIKV IgM ELISA; c: Fisher exact test p-values for the comparisons between confirmed and unconfirmed cases suspected of CHIKV infection; d: polyarticular arthralgia defined by pain in more than one joint; e: symmetric arthralgia defined by pain in at least one pair of joints; f: data not available for one laboratory-confirmed CHIKV infection case; g: data not available for two laboratory-confirmed CHIKV infection cases.

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A localized outbreak of Chikungunya virus in Salvador, Bahia, Brazil

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[1] + Corresponding author: guilherme.ribeiro@bahia.fiocruz.br