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Am. J. Trop. Med. Hyg., 79(4), 2008, pp. 485-494
Copyright © 2008 by The American Society of Tropical Medicine and Hygiene

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Risk Factors for Dengue Virus Infection in Rural Amazonia: Population-based Cross-sectional Surveys

Mônica da Silva-Nunes*, Vanda A. F. de Souza, Cláudio S. Pannuti, Márcia A. Sperança, Ana Carolina B. Terzian, Maurício L. Nogueira, Anna M. Y. Yamamura, Marcos S. Freire, Natal S. da Silva, Rosely S. Malafronte, Pascoal T. Muniz, Helena B. Vasconcelos, Eliana V. P. da Silva, Pedro F. C. Vasconcelos, AND Marcelo U. Ferreira
Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil; Laboratory of Virology, Institute of Tropical Medicine of São Paulo, São Paulo, Brazil; Laboratory of Molecular Biology, Marília Medical School, Marília, Brazil; Laboratory of Virology, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, Brazil; Institute of Technology in Immunobiologicals, Oswaldo Cruz Foundation, Riuo de Janeiro, Brazil; Laboratory of Protozoology, Institute of Tropical Medicine of São Paulo, São Paulo, Brazil; Department of Health Sciences, Federal University of Acre, Rio Branco, Brazil; Laboratory of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Belém, Brazil

A comparison of dengue virus (DENV) antibody levels in paired serum samples collected from predominantly DENV-naive residents in an agricultural settlement in Brazilian Amazonia (baseline seroprevalence, 18.3%) showed a seroconversion rate of 3.67 episodes/100 person-years at risk during 12 months of follow-up. Multivariate analysis identified male sex, poverty, and migration from extra-Amazonian states as significant predictors of baseline DENV seropositivity, whereas male sex, a history of clinical diagnosis of dengue fever, and travel to an urban area predicted subsequent seroconversion. The laboratory surveillance of acute febrile illnesses implemented at the study site and in a nearby town between 2004 and 2006 confirmed 11 DENV infections among 102 episodes studied with DENV IgM detection, reverse transcriptase-polymerase chain reaction, and virus isolation; DENV-3 was isolated. Because DENV exposure is associated with migration or travel, personal protection measures when visiting high-risk urban areas may reduce the incidence of DENV infection in this rural population.

Received April 11, 2007. Accepted for publication July 7, 2008.

Acknowledgments: The authors thank the inhabitants of Ramal do Granada for enthusiastic participation in the study; Sebastião Bocalom Rodrigues (Mayor of Acrelândia), Damaris de Oliveira, and Nésio M. Carvalho (Municipal Government of Acrelândia) for logistic support; Adamílson L. de Souza, Camila Juncansen, Carlos E. Cavasini, and Kézia K. G. Scopel for help with fieldwork; Estéfano A. de Souza and Bruna A. Luz for data management; Cassiano P. Nunes for artwork; and Tatiana Havryliuk for reviewing the manuscript.

Financial support: This study was supported by grants from the Ministry of Health of Brazil (50148920037) and the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, 04/00373-2). M.d.S.-N. is supported by a PhD scholarship from FAPESP. C.S.P., N.S.d.S., P.F.C.V., and M.U.F. receive scholarships from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil. Focus Diagnostics (Cypress, CA) kindly donated ELISA kits for DENV and WNV antibody detection used in this study.

* Address correspondence to Mônica da Silva-Nunes, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, Av. Prof. Lineu Prestes 1374, Cidade Universitária, 05508-900 São Paulo (SP), Brazil. E-mail: msnunes1{at}yahoo.com.br

Authors’ addresses: Mônica da Silva-Nunes, Natal Santos da Silva, and Marcelo U. Ferreira, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, Av. Prof. Lineu Prestes 1374, 05508-900 São Paulo (SP), Brazil, Tel: 55-11-30917746, Fax: 55-11-30917417, E-mails: msnunes1{at}yahoo.com.br, natalss{at}gmail.com, and muferrei{at}usp.br. Vanda A. F. de Souza and Cláudio S. Pannuti, Laboratory of Virology, Institute of Tropical Medicine of São Paulo, Av. Dr. Enéas de Carvalho Aguiar 470, Cerqueira César, 05403-000 São Paulo (SP), Brazil, Tel: 55-11-30622645, Fax: 55-11-30667012, E-mails: vaueda{at}usp.br and cpannuti{at}usp.br. Márcia A. Sperança, Laboratory of Molecular Biology, Marília Medical School, Av Monte Carmelo, 650, Fragata, 17519-030 Marilia (SP), Brazil, Tel: 55-14-34331235, Fax: 55-14-34330148, E-mail: speranca{at}famema.br. Ana Carolina B. Terzian and Maurício L. Nogueira, Laboratory of Virology, Faculty of Medicine of São José do Rio Preto, Av Briga-deiro Faria Lima, 5416, 15090-000 São José do Rio Preto (SP), Brazil, Tel: 55-17-2105872, E-mails: anacarolinaterzian{at}gmail.com and mnogueira{at}famerp.br. Anna M. Y. Yamamura and Marcos S. Freire, Institute of Technology in Immunobiologicals, Oswaldo Cruz Foundation, Av: Brasil 4365, Manguinhos, 21040-900 Rio de Janeiro (RJ), Brazil, Tel: 55-21-38829317 ext. 9317, Fax: 55-21-22604727, E-mails: anna{at}bio.fiocruz.br and freire{at}bio.fiocruz.br. Rosely S. Malafronte, Laboratory of Protozoology, Institute of Tropical Medicine of São Paulo, Av. Dr. Enéas de Carvalho Aguiar 470, Cerqueira César, 05403-000 São Paulo (SP), Brazil, Tel: 55-11-30617017, Fax: 55-11-30885237, E-mail: rmalafronte{at}usp.br. Pascoal T. Muniz, Department of Health Sciences, Federal University of Acre, BR-364 km 4, Campus Universitário, 69915-900 Rio Branco (AC), Brazil, Tel: 55-68-39012648, Fax: 55-68-3901-2648, E-mail: pascoal{at}ufac.br. Helena B. Vasconcelos, Eliana V. P. da Silva, and Pedro F. C. Vasconcelos, Evandro Chagas Institute, Av. Almirante Barroso 492, 66093-020 Belém (PA), Brazil, Tel: 55-91-2114409, Fax: 55-91-2265262, E-mail: pedrovasconcelos{at}iec.pa.gov.br.

Note: Supplemental material (Appendix) appears online at www.ajtmh.org.






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