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Viral Kinetics in Sylvatic Yellow Fever Cases
Vivian I Avelino-Silva1, Mateus Vailant Thomazella2, Mariana Prado Marmorato2
1Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, 05403-000, Brazil.
The Journal of Infectious Diseases
|November 1, 2022
Summary
High yellow fever virus (YFV) viremia is linked to increased mortality in patients. Monitoring YFV RNA levels and early interventions may improve outcomes for this mosquito-borne disease.
Area of Science:
- Virology
- Infectious Diseases
- Epidemiology
Background:
- Yellow fever is a mosquito-borne zoonotic disease caused by the yellow fever virus (YFV).
- An outbreak in São Paulo (2017-2019) resulted in over 504 human cases and 176 deaths.
- Previous studies suggested a link between YFV viremia and mortality.
Purpose of the Study:
- To investigate the association between yellow fever virus (YFV) viremia and mortality in confirmed cases.
- To identify clinical and laboratory factors associated with YFV infection outcomes.
Main Methods:
- Quantified viral ribonucleic acid (RNA) using reverse-transcription quantitative polymerase chain reaction (RT-qPCR).
- Analyzed plasma samples from 84 confirmed YFV patients collected up to 5 time points post-symptom onset (3-120 days).
- Utilized Cox proportional hazards models to assess viremia's independent association with death.
Main Results:
- 36% of patients (30/84) died; deceased patients were older and had higher YFV viremia.
- Viremia correlated positively with neutrophils, indirect bilirubin, AST, INR, and creatinine.
- Viremia independently increased the hazard of death by 84% per unit increase in mean log10 viremia.
Conclusions:
- Monitoring YFV viremia is crucial for assessing disease severity.
- Early administration of antiviral drugs or neutralizing monoclonal antibodies may improve outcomes.
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