Dengue e Chikungunya na Colômbia e em Minas Gerais, Brasil: análise clínica e epidemiológica, nos anos de 2010 a 2016.

Abstract

Introduction: Dengue and chikungunya are arboviruses transmitted by female mosquitoes of the genus Aedes. They both represent a challenge to public health authorities due to their rapid spread and the high disease burden, associated clinical complications, and lethality. The goal of this work was to analyze the clinical and epidemiological characteristics of dengue and chikungunya in Colombia and in the State of Minas Gerais (Brazil) from 2010 to 2016. Methods: Epidemiological, studies were carried out for dengue and chikungunya. (1) Ecological study: analyses of temporal and spatial distribution and propagation. (2) Historical cohort study: assessment of the epidemiological, clinical, and laboratorial factors associated with death due to severe dengue. The Epidemiological Surveillance System (SIVIGILA) in Colombia and the Information System for Notifiable Diseases (SINAN) in the state of Minas Gerais were used as sources of secondary data. (3) Longitudinal study of patients with acute febrile disease and suspicion of arbovirus infection in the municipality of Santa Luzia, (Minas Gerais, Brazil) Results: A total of 673,679 cases of dengue were confirmed in Colombia, of which 18,384 (2.7%) referred to severe dengue, with 1,500 cases (8.2%) evolving to death. The temporal dynamics and geographical expansion detected by the analyzes of positive association of spatial correlation identified 34 municipalities with the highest mortality impact. The clinical manifestations more likely to evolve to death were: increased hematocrit, ascites, shock, central nervous system (CNS) alterations, and hepatic failure. With respect to the chikungunya temporospatial analysis, three phases were defined based on the temporal trends, and 110 municipalities were identified with positive neighborhood associations. In the state of Minas Gerais, 1,249,607 dengue cases were confirmed, of which 801 evolved to death. With the gradual entry of autochthonous 507 cases of chikungunya, the same pattern of temporal distribution was identified for both diseases. The most significant clinical manifestations for dengue were plasma extravasation and pulse pressure <20 mmHg. In the municipality of Santa Luzia, 3,531 cases of arbovirus were confirmed [3,481 (98.7%) cases of dengue, 38 (1.0%) of chikungunya, and 12 (0.3%) of zika]. Conclusion: The analyses presented in this study are based on data from patients from endemic areas and allowed the identification of the temporal and spatial dynamics of the ingress and propagation of the dengue and chikungunya virus. In addition, were identified the factors that have the potential for dengue aggravation were identified, providing strategic tools for intervention and control.