Arboviruses emerging in Peru： Need for early detection of febrile syndrome during El Niño episodes

Derek Tantaléan-Yépez， José Sánchez-Carbonel， Gabriela Ulloa-Urizar， Diego Espinoza-Morales， Miguel Angel Aguilar-Luis，， Wilmer Silva-Caso，， María J. Pons， Juana del Valle-Mendoza，✉

1School of Medicine， Health Sciences Faculty， Universidad Peruana de Ciencias Aplicadas （UPC）， Av. San Marcos cdra 2 Cedros de Villa， Lima， Peru

2Research Center and Innovation of the Health Sciences Faculty， Universidad Peruana de Ciencias Aplicadas （UPC）， Av. San Marcos cdra 2 Cedros de Villa， Lima， Peru

Arboviruses emerging in Peru： Need for early detection of febrile syndrome during El Niño episodes

Derek Tantaléan-Yépez1， José Sánchez-Carbonel1， Gabriela Ulloa-Urizar2， Diego Espinoza-Morales1， Miguel Angel Aguilar-Luis1，2， Wilmer Silva-Caso1，2， María J. Pons2， Juana del Valle-Mendoza1，2✉

1School of Medicine， Health Sciences Faculty， Universidad Peruana de Ciencias Aplicadas （UPC）， Av. San Marcos cdra 2 Cedros de Villa， Lima， Peru

2Research Center and Innovation of the Health Sciences Faculty， Universidad Peruana de Ciencias Aplicadas （UPC）， Av. San Marcos cdra 2 Cedros de Villa， Lima， Peru

ARTICLE INFO

Article history：

Received 15 May 2016

Received in revised form 16 June 2016

Accepted 15 July 2016

Available online 20 August 2016

Febrile syndrome

The presence of El Niño Southern Oscillation （ENSO） implies the presence of fluctuating rains in coastal areas and these changes influence the occurrence of febrile syndromes outbreaks. In Peru， Aedes aegypti is the vector responsible for various viruses such as the dengue， Zika， chikungunya， which is distributed in 18 Peruvian departments. These viruses cause similar clinical characteristics in the host and for this reason rapid， sensitive and specific diagnostic tests are needed so that the patient can receive timely treatment.

Dear editor，

Dengue virus， chikungunya virus and Zika virus share Aedes aegypti as vector， which is distributed in 18 Peruvian departments，making more than 15 million people at risk［1，2］.

Invasive and adaptive capacity of mosquito is favored by environmental and sociocultural factors related to the formation of breeding sites， which include the use of containers to store water （in rural areas not supplied with potable water） and rainy climates［3］.

The presence of El Niño Southern Oscillation （ENSO） implies the presence of fluctuating rains in coastal areas and this is sufficientdata to demonstrate that the incidence of dengue and others febrile syndrome are correlated to the intensity of the events that may cause the ENSO［4］.

Same argument could be applied in chikungunya and Zika，infectious diseases because they share a clinical symptomatology with dengue， mainly characterized by fever， myalgia， headache and rash.

Actually， chikungunya and Zika viruses cause an epidemic in Caribbean and regions of South America， but in nearly future they could become a serious public health problem in Peru. Last year，chikungunya fever affected more than 1 million people in Latin America［5］.

Regarding to Zika， the incidence in South America has begun in Brazil， and it is strongly associated with congenital abnormalities such as microcephaly in newborns［6］.

Until now， in Peru， only four cases of Zika infection have been reported［7］ and， until 2014， only 11 cases of chikungunya［8］. In 2015， 39 440 cases of dengue have been reported， being the highestnumber of cases reported in the last 15 years. Among these， only 20 035 cases （50.8%） have been diagnosed［9］， while for other 49.2%，etiologic diagnosis has been not confirmed.

On the one hand， the diagnosis and subsequent notification of dengue cases are difficult due to similar clinical symptoms with others febrile syndromes. The use of molecular techniques is limited to most severe patients， and this phenomenon generates underreporting of cases. The Polymerase Chain Reaction （real-time qPCR） and IgM ELISA allow probable and suspect cases to meet laboratory criteria and enter the category of confirmed case. These laboratory techniques are needed to realize an adequate diagnosis and a correct surveillance. Unfortunately， lack of resources for the purchase of instruments to process samples makes it difficult to diagnose cases of dengue in Peru. Most probable cases are classified as ‘confirmed case’ by epidemiological link， but the introduction of molecular biology and serology could improve the correct diagnoses and should be applied to all patients with suspected dengue. The clinical diagnosis is highly sensitive molecular tests but molecular and serologic techniques have more specificity［10］.

The main reasons for the accurate and early diagnosis of dengue are the complications involving severe dengue in secondary infections （infections by a different serotype of the first infection）［11］. Coinfection with a second serotype may result in shock， organ failure and severe bleeding， so early diagnosis may result in more effective treatment.

Finally， ruled out cases of dengue， will improve the surveillance of chikungunya and other arboviruses as Zika， which are responsible for a current epidemic in countries where the vector is endemic.

Conflict of interest statement

We declare that we have no conflict of interest.

Acknowledgment

Programa Nacional de Innovación para la Competitividad y Productividad （Innóvate Perú）-contract 116-PNICP-PIAP-2015.

［1］ Perú ， Ministerio de Salud. Aprendiendo de la experiencia： lecciones aprendidas para la preparación y respuesta en el control vectorial ante brotes de dengue en el Perú ［Online］. Lima： Ministerio de Salud（MINSA）. Availible from： http：//bvs.minsa.gob.pe/LOCAL/minsa/1828. pdf ［Accessed on 11 Apr 2016］.

［2］ Dirección general de epidemiologia， MINSA. Vigilancia， prevención Y control deldengue ［Online］. Lima： Dirección general de epidemiologia（DGE ）. Availible from： http：//www.dge.gob.pe/portal/index. php？option=com_content&view=article&id=551&Itemid=385 ［Accessed on 16 Jan 2016］.

［3］ Rey JR， Lounibos P. Ecología de Aedes aegypti y Aedes albopictus en América y transmisión enfermedades. Biomédica 2015； 35（2）：177-185.

［4］ Ferreira MC. Geographical distribution of the association between El Niño South Oscillation and dengue fever in the Americas： a continental analysis using geographical information system-based techniques. Geosp Heal 2014； 9（1）： 141-151.

［5］ PAHO/WHO Date MaS （2015w - Cumulative cases） Number of reported cases of Chikungunya Fever in the Americas - EW3 ［Online］. Available from： http：//www.paho.org/hq/index.php？option=com_ docman&task=doc_download&Itemid=&gid=32983&lang=en ［Accessed on 22 Apr 2016］.

［6］ World Health Organization （WHO）. Virus Z. Zika virus microcephaly and guillain-barré syndrome ［Online］. Available from： http：//www.who.int/ entity/emergencies/zika-virus/situation-report-26-02-2016 ［Accessed on 11 May2016］.

［7］ Instituto Nacional De Salud， Ministerio de Salud del Perú. Ministerio de Salud confirma cuarto caso importado de zika en el país ［Online］. Available from： http：//www.portal.ins.gob.pe/es/acerca-de-ins/ins-c1/ acerca-del-ins/noticias/871-ministerio-de-salud-confirma-cuarto-casoimportado-de-zika-en-el-pais ［Accessed on 7 March 2016］.

［8］ MAGUINA-VARGAS， Ciro. The Chikungunya Fever： A new emerging disease of great impact in the Public Health. Rev Med Hered 2015； 26（1）：55-59.

［9］ Perú， Ministerio de Salud， Dirección General de Epidemiología. Casos de dengue por departamento ［Online］. Hasta la semana 52 del 2015. Lima：Ministerio de Salud del Perú； 2015. Availble from： http：//www.dge.gob. pe/portal/docs/vigilancia/boletines/2015/52.pdf ［Accessed on 11 Apr 2016］.

［10］ Tissera H， Amarasinghe A， Gunasena S， DeSilva AD， Yee LW， Sessions O， et al. Laboratory-enhanced dengue sentinel surveillance in Colombo district， Sri Lanka： 2012-2014. PLoS Negl Trop Dis 2016； 10（2）：e0004477.

［11］ Choi JR， Hu J， Wang S， Yang H， Wan Abas WAB， Pingguan-Murphy B，et al. Paper-based point-of-care testing for diagnosis of dengue infections. Crit Rev Biotechnol 2016； 24： 1-12.

10.1016/j.apjtm.2016.06.018

Derek Tantaléan-Yépez， School of Medicine， Health Sciences Faculty，Universidad Peruana de Ciencias Aplicadas （UPC）， Av. San Marcos cdra 2 Cedros de Villa， Lima， Peru.

E-mail： derek.2007.upc@gmail.com

✉Corresponding author： Juana del Valle Mendoza， Universidad Peruana de Ciencias Aplicadas （UPC）， Av. San Marcos cdra. 2， Cedros de Villa， Lima-Peru.

E-mail： jdelvall@upc.edu.pe

Tel： +51 13133333. Annex 2704

Fax： +51 13496025

Foundation project： It was supported by Programa Nacional de Innovación para la Competitividad y Productividad （Innóvate Perú）-contract 116-PNICP-PIAP-2015.

Dengue

Chikungunya

Zika