title: Arboviral diseases in the Western Brazilian Amazon: a perspective and analysis from a tertiary health & research center in Manaus, State of Amazonas.
abstract: The Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), located in Manaus, the capital of the State of Amazonas (Western Brazilian Amazon), is a pioneering institution in this region regarding the syndromic surveillance of acute febrile illness, including arboviral infections. Based on the data from patients at the FMT-HVD, we have detected recurrent outbreaks in Manaus by the four dengue serotypes in the past 15 years, with increasing severity of the disease. This endemicity has culminated in the simultaneous circulation of all four serotypes in 2011, the first time this has been reported in Brazil. Between 1996 and 2009, 42 cases of yellow fever (YF) were registered in the State of Amazonas, and 71.4% (30/42) were fatal. Since 2010, no cases have been reported. Because the introduction of the yellow fever virus into a large city such as Manaus, which is widely infested by Aedes mosquitoes, may pose a real risk of a yellow fever outbreak, efforts to maintain an appropriate immunization policy for the populace are critical. Manaus has also suffered silent outbreaks of Mayaro and Oropouche fevers lately, most of which were misdiagnosed as dengue fever. The tropical conditions of the State of Amazonas favor the existence of other arboviruses capable of producing human disease. Under this real threat, represented by at least 4 arboviruses producing human infections in Manaus and in other neighboring countries, it is important to develop an efficient public health surveillance strategy, including laboratories that are able to make proper diagnoses of arboviruses.
authors.affiliation: Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Maria Paula Gomes
authors.initials: MP
authors.lastname: Mourão
authors.affiliation: Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Michele de Souza
authors.initials: Mde S
authors.lastname: Bastos
authors.affiliation: Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Regina Maria Pinto de
authors.initials: RM
authors.lastname: Figueiredo
authors.affiliation: Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: João Bosco de Lima
authors.initials: JB
authors.lastname: Gimaque
authors.affiliation: Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
authors.forename: Valquíria do Carmo Rodrigues
authors.initials: Vdo C
authors.lastname: Alves
authors.affiliation: Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Maria das Graças Gomes
authors.initials: Md
authors.lastname: Saraiva
authors.affiliation: Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Mário Luis Garcia
authors.initials: ML
authors.lastname: Figueiredo
authors.affiliation: Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Rajendranath
authors.initials: R
authors.lastname: Ramasawmy
authors.affiliation: Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Maurício Lacerda
authors.initials: ML
authors.lastname: Nogueira
authors.affiliation: Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Luiz Tadeu Moraes
authors.initials: LT
authors.lastname: Figueiredo
mesh_terms: D018354:Alphavirus Infections / Q000453:epidemiology; D000818:Animals; D001102:Arbovirus Infections / Q000453:epidemiology* / Q000821:virology*; D001938:Brazil / Q000453:epidemiology; D002044:Bunyaviridae Infections / Q000453:epidemiology; D003715:Dengue / Q000453:epidemiology; D004196:Disease Outbreaks; D006801:Humans; D007303:Insect Vectors / Q000821:virology; D015004:Yellow Fever / Q000453:epidemiology