Date: Tue 21 Jan 2020
Source: Outbreak News Today [edited]
For the 1st time in 20 years, Brazil health authorities are reporting a confirmed case of Brazilian haemorrhagic fever. During this 20-year period, there were 4 cases in humans, 3 cases acquired in a sylvan environment in the state of Sao Paulo, and one due to infection in a laboratory environment in Para. The disease is considered to be extremely rare and highly lethal, and treatment is according to the patient's clinical condition and symptoms.
The disease incubation period is long (on average 7 to 21 days) and begins with fever, malaise, muscle pain, a rash on the body, sore throat, stomachache, and soreness behind the eyes, headache, dizziness, sensitivity to light, constipation, and bleeding from mucous membranes such as mouth and nose. As the disease progresses, there may be neurological impairment (drowsiness, mental confusion, changes in behavior and convulsion).
Between the onset of symptoms (30 Dec 2019) and death (11 Jan 2020), the current patient passed through 3 different hospitals in the municipalities of Eldorado, Pariquera-Acu and Sao Paulo, the last being the Hospital das Clinicas of the Faculty of Medicine of the University of Sao Paulo (HCFM USP). There was no history of international travel.
During his hospitalization, tests were carried out to identify diseases such as yellow fever, viral hepatitis, leptospirosis, dengue and Zika. However, the results were negative for these diseases. Complementary tests were carried out at the Special Techniques Laboratory of the Albert Einstein Hospital, which identified an arenavirus which causes Brazilian hemorrhagic fever. This result was confirmed by the Medical Research Laboratory of the Institute of Tropical Medicine, Hospital das Clinicas, USP Medical School, and Adolfo Lutz Institute.
In addition, SVS/MS has already communicated the fact to the World Health Organization and the Pan American Health Organization (WHO/PAHO), in accordance with established international protocols.
At this time, the source of the patient's infection has not been confirmed. What is known is that people contract the disease possibly through the inhalation of particles formed from the urine, feces and saliva of infected rodents. Transmission of arenaviruses from person to person can occur when there is very close and prolonged contact or in hospital environments, when personal protective equipment is not used, through contact with blood, urine, feces, saliva, vomit, semen and other secretions or excretions.
The employees of the hospitals through which the patient passed are being monitored and evaluated, as well as the family members of the confirmed case in Sao Paulo.
On Mon 20 Jan 2020, the Ministry of Health convened a meeting with representatives of all parties involved in the case: Secretariat of Sao Paulo, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo, Hospital Israelita Albert Einstein and the National Councils and State Health (Conass and Conasems). The purpose of the meeting was to verify the current scenario and the search and monitoring actions of people who had direct contact with the patient.
The Ministry of Health also offered support to the Sao Paulo Department of Health by sending a team of technicians to actively search for people who had contact with the patient and for environmental investigation.
ProMED-mail from HealthMap Alerts
Barry Atkinson <Barry.Atkinson@phe.gov.uk>
via Mary Marshall
[These are the 1st documented cases of Sabia virus infection in a long time. This confirmed case was an adult who lived in Sorocaba, Sao Paulo state.
The genome of the virus responsible for the disease was about 90% similar to the Sabia arenavirus according to Epidemiological Bulletin 03 (see below). One hopes that the environmental investigation will provide information about the circumstances under which the infection was acquired. A rodent reservoir was doubtless the direct or indirect source of the virus, as it is for other arenaviruses such as Machupo virus that causes Bolivian hemorrhagic fever. The rodent reservoir of the virus has not been identified.
The above report is a machine translation of an official report from the Brazil Ministry of Health
Coimbra, Terezinha Lisieux M. et al. New arenavirus isolated in Brazil. The Lancet, v. 343, n. 8894, p. 391-392, 1994.
Gonzalez, Jean Paul J. et al. Genetic characterization and phylogeny of Sabia virus, an emergent pathogen in Brazil. Virology, v.221, n.2, p. 318-324, 1996. - Mod.TY
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