Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, University of São Paulo, São Paulo, Brazil.
Laboratório de Desenvolvimento de Vacinas, Instituto Butantan, São Paulo, Brazil.
Front Immunol. 2018 Aug 28;9:1964. doi: 10.3389/fimmu.2018.01964. eCollection 2018.
Brazil has a well-established immunization program in which vaccines are provided through the Public Health System free of charge to the whole population, obtaining high coverage and reducing the incidence of important infectious diseases in children and adults. However, the environmental changes and high mobility rates of the population occurring in the last decades have triggered the sequential introduction of a series of vector-borne emerging infectious diseases, such as Dengue, Zika, and Chikungunya, that have imposed a considerable burden on the population, with yet unmet solutions. The first to be introduced in Brazil was the Dengue virus, reaching epidemic levels in 2010, with over 1 million cases annually, maintaining high infection rates until 2016. Brazil has invested in vaccine development. The Zika virus infection, initially assumed to have appeared during the World Cup in 2014, was later shown to have arrived earlier in 2013. Its emergence mobilized the Brazilian scientific community to define priorities and strategies, that rapidly investigated mechanisms of pathogenesis, differential diagnostics, and determined that Zika virus infection causes relatively mild symptoms, however, in pregnant women can cause microcephaly in the newborns. The diagnostics of Zika infection is confusing given its similar symptoms and cross-reactivity with Dengue, which also hindered the appraisal of the extent of the epidemics, which peaked in 2015 and finished in 2016. Another complicating factor was the overlap with Chikungunya virus infection, which arrived in Brazil in 2014, being prevalent in the same regions, with similar symptoms to both Dengue and Zika. Although Dengue infection can be fatal and Zika infection in pregnant woman can lead to newborns with microcephaly or an array of neurodegenerative manifestations, the Chikungunya infection is a debilitating disease leaving chronic sequelae, which unfortunately has received less attention. Precise differential diagnostics of Dengue, Zika, and Chikungunya will be necessary to evaluate the actual extent of each of these diseases during this overlapping period. Here we review the impact of these emerging infections on public health and how the scientific community was mobilized to deal with them in Brazil.
巴西拥有完善的免疫规划，通过公共卫生系统免费向全民提供疫苗，从而实现了高覆盖率，并降低了儿童和成人中重要传染病的发病率。然而，过去几十年中环境变化和人口的高度流动性相继引发了一系列虫媒传播的新发传染病，如登革热、寨卡病毒和基孔肯雅热，这些传染病给巴西人民带来了沉重的负担，至今仍未得到解决。巴西首先引入的是登革热病毒，该病毒于 2010 年达到流行水平，每年有超过 100 万例病例，直到 2016 年仍保持着高感染率。巴西在疫苗开发方面进行了投资。寨卡病毒感染最初被认为是在 2014 年世界杯期间出现的，后来发现它早在 2013 年就已出现。寨卡病毒的出现促使巴西科学界确定了优先事项和战略，迅速研究了发病机制、鉴别诊断，并确定寨卡病毒感染会导致相对较轻的症状，但孕妇可能会导致新生儿小头畸形。由于其症状与登革热相似且存在交叉反应，寨卡病毒感染的诊断较为混乱，这也阻碍了对疫情严重程度的评估，疫情在 2015 年达到高峰，并于 2016 年结束。另一个复杂因素是与基孔肯雅热病毒感染的重叠，该病毒于 2014 年抵达巴西，在同一地区流行，与登革热和寨卡病毒的症状相似。尽管登革热感染可能致命，孕妇感染寨卡病毒可能导致新生儿小头畸形或一系列神经退行性表现，但基孔肯雅热感染是一种使人衰弱的疾病，会留下慢性后遗症，不幸的是，它受到的关注较少。在重叠期间，对登革热、寨卡病毒和基孔肯雅热进行准确的鉴别诊断，将有助于评估这些疾病的实际严重程度。在此，我们回顾了这些新发传染病对公共卫生的影响，以及巴西科学界如何动员起来应对这些传染病。
