title: Dengue severity associated with age and a new lineage of dengue virus-type 2 during an outbreak in Rio De Janeiro, Brazil.
abstract: Dengue virus-type 2 (DENV-2) caused three outbreaks, in the years 1990, 1998, and 2008, in Rio de Janeiro, Brazil. The 2008 outbreak was the most severe in reported cases, hospitalizations, and deaths. To investigate virological and epidemiological factors that may have contributed to the pathogenic profile of 2008 epidemic, 102 patients sera obtained during the epidemic and inter-epidemic periods of three outbreaks were analysed by qRT-PCR to estimate viremia levels and their correlation with the clinical, immunological, and demographic patient characteristics. DENV-2 isolates from the outbreaks were sequenced. Two DENV-2 lineages (I and II) of the American/Asian genotype were confirmed, each exclusive for 1990-2002 and 2007-2011, respectively. The mean viremia level in the 2008 samples was two orders of magnitude higher than that of the 1990-2002 samples. Severe dengue cases increased from 31% in 1990-2002 to 69% in 2007-2011; in patients aged ≤15 years, from 3% in 1990-2002 to 37% in 2007-2011. The DENV-2 lineage II and younger age significantly contributed to the pathogenic profile of 2008 epidemic in Rio de Janeiro.
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Foundation/Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
authors.forename: Priscila Conrado Guerra
authors.initials: PC
authors.lastname: Nunes
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Foundation/Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
authors.forename: Simone Alves Faria
authors.initials: SA
authors.lastname: Sampaio
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Foundation/Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
authors.forename: Nieli Rodrigues
authors.initials: NR
authors.lastname: da Costa
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Foundation/Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
authors.forename: Marcos Cesar Lima
authors.initials: MC
authors.lastname: de Mendonça
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Foundation/Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
authors.forename: Monique da Rocha Queiroz
authors.initials: Mda R
authors.lastname: Lima
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Foundation/Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
authors.forename: Saraiva Eliane M
authors.initials: SE
authors.lastname: Araujo
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Foundation/Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
authors.forename: Flávia Barreto
authors.initials: FB
authors.lastname: dos Santos
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Foundation/Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
authors.forename: Jaqueline Basto Santos
authors.initials: JB
authors.lastname: Simões
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Foundation/Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
authors.forename: Bianca de Santis
authors.initials: Bde S
authors.lastname: Gonçalves
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Foundation/Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
authors.forename: Rita Maria Ribeiro
authors.initials: RM
authors.lastname: Nogueira
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Foundation/Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
authors.forename: Ana Maria Bispo
authors.initials: AM
authors.lastname: de Filippis
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D003716:Dengue Virus / Q000145:classification / Q000235:genetics* / Q000472:pathogenicity; D004196:Disease Outbreaks; D058872:Epidemics / Q000706:statistics & numerical data; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D012367:RNA, Viral / Q000097:blood; D019595:Severe Dengue / Q000453:epidemiology* / Q000821:virology*; D012720:Severity of Illness Index; D014766:Viremia / Q000453:epidemiology / Q000821:virology; D055815:Young Adult
chemical_list: D012367:RNA, Viral
keywords: dengue outbreaks; genotype; qRT-PCR; viremia