Mondet B, da Rosa A P, Vasconcelos P F
Institut Evandro Chagas, Belém, Pará, Brésil.
Bull Soc Pathol Exot. 1996;89(2):107-13; discussion 114.
Urban yellow fever (YF) epidemics have disappeared from Brazil since about 50 years, but a selvatic cycle still exist. In many States, cases are more or less numerous each year. Ae. aegypti was eradicated in 1954, re-appeared temporarily in 1967, and then definitively in 1976-1977. Ae. aegypti is a vector of yellow few (YF), but also of dengue, whose first cases were reported in 1982. Today, dengue is endemic in many regions. A second Flavivirus vector, Aedes albopictus is present since about ten years in some States, from which Säo Paulo. The analysis of the YF cases between 1972 and 1994 allowed us to determine the epidemiologic regions. In the first region, the endemic area, the YF virus is circulating "silently" among monkeys, and the emergence of human cases is rare. In the second region, the epidemic area, some epizootics occur in a more or less cyclic way, and human cases can be numerous. Nevertheless, these outbreaks are considered "selvatic" epidemics, as long as Ae. aegypti is not concerned. From the Amazonian region, the virus moves forward along the forest galleries of the Amazone tributaries, from North to South. Actually, dengue epidemics appear in quite all States, and reflect the geographical distribution of Ae. aegypti. Recently, Ae. aegypti was found in the southern part of the Pará State, in the Carajás region considered to be the source of the main YF epidemics. In another hand, Ae. albopictus is now increasing its distribution area, specially in the suburban zones. The ecology of this potential vector, which seems to have a great adaptative capacity, give this vector an intermediate position between the forest galleries, where the YF virus circulates, and the agglomerations infested with Ae. aegypti. Since a few years, the possibility of urban YF is threatening Brazil, it is more and more predictable and we must survey very carefully the epidemiological situation in some regions of the country.
大约50年来,巴西城市黄热病疫情已消失,但仍存在丛林传播循环。在许多州,每年都会出现或多或少的病例。埃及伊蚊于1954年被根除,1967年短暂重现,然后在1976 - 1977年再次出现并最终定殖。埃及伊蚊是黄热病的传播媒介,也是登革热的传播媒介,巴西于1982年报告了首例登革热病例。如今,登革热在许多地区呈地方性流行。另一种黄病毒传播媒介白纹伊蚊大约在十年前出现在一些州,包括圣保罗州。对1972年至1994年期间黄热病病例的分析使我们能够确定流行病学区域。在第一个区域,即地方性流行区,黄热病病毒在猴子中“悄然”传播,人类病例很少出现。在第二个区域,即流行区,一些动物疫情或多或少呈周期性发生,人类病例可能较多。然而,只要不涉及埃及伊蚊,这些疫情就被视为“丛林”疫情。病毒从亚马逊地区沿着亚马逊支流的森林走廊由北向南传播。实际上,登革热疫情几乎在所有州都有出现,反映了埃及伊蚊的地理分布。最近,在帕拉州南部的卡拉雅斯地区发现了埃及伊蚊,该地区被认为是主要黄热病疫情的源头。另一方面,白纹伊蚊现在正在扩大其分布区域,特别是在郊区。这种潜在传播媒介的生态似乎具有很强的适应能力,使其在黄热病病毒传播的森林走廊和有埃及伊蚊滋生的聚居地之间处于中间位置。近年来,城市黄热病的可能性对巴西构成威胁,其发生越来越具有可预测性,我们必须非常仔细地监测该国一些地区的疫情形势。