Genomic, epidemiological and digital surveillance of Chikungunya virus in the Brazilian Amazon.
Naveca FG., Claro I., Giovanetti M., de Jesus JG., Xavier J., Iani FCDM., do Nascimento VA., de Souza VC., Silveira PP., Lourenço J., Santillana M., Kraemer MUG., Quick J., Hill SC., Thézé J., Carvalho RDDO., Azevedo V., Salles FCDS., Nunes MRT., Lemos PDS., Candido DDS., Pereira GDC., Oliveira MAA., Meneses CAR., Maito RM., Cunha CRSB., Campos DPDS., Castilho MDC., Siqueira TCDS., Terra TM., de Albuquerque CFC., da Cruz LN., Abreu ALD., Martins DV., Simoes DSDMV., Aguiar RSD., Luz SLB., Loman N., Pybus OG., Sabino EC., Okumoto O., Alcantara LCJ., Faria NR.
BACKGROUND:Since its first detection in the Caribbean in late 2013, chikungunya virus (CHIKV) has affected 51 countries in the Americas. The CHIKV epidemic in the Americas was caused by the CHIKV-Asian genotype. In August 2014, local transmission of the CHIKV-Asian genotype was detected in the Brazilian Amazon region. However, a distinct lineage, the CHIKV-East-Central-South-America (ECSA)-genotype, was detected nearly simultaneously in Feira de Santana, Bahia state, northeast Brazil. The genomic diversity and the dynamics of CHIKV in the Brazilian Amazon region remains poorly understood despite its importance to better understand the epidemiological spread and public health impact of CHIKV in the country. METHODOLOGY/PRINCIPAL FINDINGS:We report a large CHIKV outbreak (5,928 notified cases between August 2014 and August 2018) in Boa vista municipality, capital city of Roraima's state, located in the Brazilian Amazon region. We generated 20 novel CHIKV-ECSA genomes from the Brazilian Amazon region using MinION portable genome sequencing. Phylogenetic analyses revealed that despite an early introduction of the Asian genotype in 2015 in Roraima, the large CHIKV outbreak in 2017 in Boa Vista was caused by an ECSA-lineage most likely introduced from northeastern Brazil. Epidemiological analyses suggest a basic reproductive number of R0 of 1.66, which translates in an estimated 39 (95% CI: 36 to 45) % of Roraima's population infected with CHIKV-ECSA. Finally, we find a strong association between Google search activity and the local laboratory-confirmed CHIKV cases in Roraima. CONCLUSIONS/SIGNIFICANCE:This study highlights the potential of combining traditional surveillance with portable genome sequencing technologies and digital epidemiology to inform public health surveillance in the Amazon region. Our data reveal a large CHIKV-ECSA outbreak in Boa Vista, limited potential for future CHIKV outbreaks, and indicate a replacement of the Asian genotype by the ECSA genotype in the Amazon region.