Vasconcelos P F, Costa Z G, Travassos Da Rosa E S, Luna E, Rodrigues S G, Barros V L, Dias J P, Monteiro H A, Oliva O F, Vasconcelos H B, Oliveira R C, Sousa M R, Barbosa Da Silva J, Cruz A C, Martins E C, Travassos Da Rosa J F
WHO Collaborating Center for Arbovirus Reference and Research, Seção de Arbovírus do Instituto Evandro Chagas, Fundação Nacional de Saúde (FUNASA), Ministério da Saúde (MS), 66090-000, Belém, PA, Brazil.
J Med Virol. 2001 Nov;65(3):598-604.
Seventy-seven human cases of sylvatic yellow fever were reported in Brazil during the period January-June 2000. The first cases were reported 1 week after New Year's day and originated at Chapada dos Veadeiros, a tourist canyon site in Goiás state, near Brasília, the Brazilian capital. The laboratory procedures used for diagnoses included serology with an IgM capture assay and plaque reduction neutralization test, virus isolation in suckling mice and C6/36 cells, and immunohistochemistry. All cases were diagnosed by at least two different laboratory procedures, with the exception of the first three fatal cases, which were diagnosed on the basis of clinical and epidemiological information. The cases were reported in eight Brazilian states as follows: Goiás with 64.9% (50 cases); Amazonas (1); Bahia (10); Distrito Federal (1); Mato Grosso (4); Minas Gerais (2); Pará (1); São Paulo (2); and Tocantins (6). Patient ages were within the following ranges: 13-74 years old (mean 34.3), 64 (84.4%) were male, especially agricultural workers (n = 30), but tourists (n = 11), carpenters (n = 4), fishermen (n = 4), students (n = 3), truck drivers (n = 3), and other people (n = 22) were also sickened. The case fatality rate was 50.6% (39/77). In Bahia state, a serologic survey that was carried out has suggested a symptomatic/asymptomatic coefficient of 1:4. Field studies developed in Distrito Federal, Goiás, and São Paulo states showed that Haemagogus janthinomys was the mosquito species associated with the transmission. A single strain was also obtained from Aedes scapularis in Bahia. Epizootic occurrence (monkey mortality) was observed in 49 municipalities mainly in Goiás state, where 40 municipalities made reports, 21 of which also diagnosed human cases. Data obtained by the National Institute of Meteorology in Brazil showed an increase in temperature and rain in December 1999 and the first 3 months of 2000 in Goiás and surrounding states, which perhaps has contributed to the intense and widespread transmission of the yellow fever virus. The relatively small number of cases probably reflects the extensive use of yellow fever 17D-vaccine during the last 3 years, in which about 45 million doses were used. During the last months of 1999, 16 and 11 yellow fever cases were reported in Tocantins and Goiás states, respectively. It is noteworthy that the last reported autochthonous cases of sylvatic yellow fever in São Paulo and Bahia, both states outside the endemic/enzootic area, had occurred in 1953 and 1948, respectively.
2000年1月至6月期间，巴西报告了77例丛林型黄热病人间病例。首例病例在元旦后1周报告，起源于位于巴西首都巴西利亚附近戈亚斯州的一个旅游峡谷景点查帕达-多斯-韦阿代罗斯。用于诊断的实验室程序包括IgM捕获试验血清学检测、蚀斑减少中和试验、在乳鼠和C6/36细胞中进行病毒分离以及免疫组织化学检测。除前三例死亡病例根据临床和流行病学信息确诊外，所有病例均通过至少两种不同的实验室程序确诊。病例分布在巴西8个州，情况如下：戈亚斯州占64.9%（50例）；亚马孙州（1例）；巴伊亚州（10例）；联邦区（1例）；马托格罗索州（4例）；米纳斯吉拉斯州（2例）；帕拉州（1例）；圣保罗州（2例）；托坎廷斯州（6例）。患者年龄在以下范围：13 - 74岁（平均34.3岁），64名（84.4%）为男性，尤其以农业工人居多（30例），但也有游客（11例）、木匠（4例）、渔民（4例）、学生（3例）、卡车司机（3例）以及其他人员（22例）患病。病死率为50.6%（39/77）。在巴伊亚州进行的一项血清学调查显示，有症状/无症状病例系数为1:4。在联邦区、戈亚斯州和圣保罗州开展的现场研究表明，黄色趋血蚊是与之相关的传播蚊种。在巴伊亚州还从肩斑伊蚊中分离出单一毒株。在49个市观察到动物流行病（猴子死亡）发生，主要在戈亚斯州，其中40个市进行了报告，21个市还诊断出人间病例。巴西国家气象研究所获得的数据显示，1999年12月以及2000年前3个月，戈亚斯州及周边各州气温和降雨量增加，这可能促使了黄热病病毒的强烈且广泛传播。病例数量相对较少可能反映了过去3年中广泛使用了17D黄热病疫苗，在此期间使用了约4500万剂。1999年最后几个月，托坎廷斯州和戈亚斯州分别报告了16例和11例黄热病病例。值得注意的是，圣保罗州和巴伊亚州这两个非黄热病流行/动物流行区的州，上一次报告的丛林型黄热病本地病例分别发生在1953年和1948年。
