VEE and Human Deaths | CDC EID

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Volume 16, Number 3–March 2010
Dispatch
Venezuelan Equine Encephalitis and 2 Human Deaths, Peru
Stalin Vilcarromero, Patricia V. Aguilar, Eric S. Halsey, V. Alberto Laguna-Torres, Hugo Razuri, Juan Perez, Yadira Valderrama, Eduardo Gotuzzo, Luis Suárez, Manuel Céspedes, and Tadeusz J. Kochel
Author affiliations: Naval Medical Research Center Detachment, Lima, Peru (S. Vilcarromero, P.V. Aguilar, E.S. Halsey, V.A. Laguna-Torres, H. Razuri, J. Perez, T.J. Kochel); Universidad Peruana Cayetano Heredia, Lima (S. Vilcarromero, E. Gotuzzo); Hospital de Apoyo Yurimaguas, Loreto, Peru (Y. Valderrama); Dirección General de Epidemiología, Lima (L. Suárez); and Instituto Nacional de Salud, Lima (M. Céspedes)

Suggested citation for this article

Abstract
Studies have suggested that enzootic strains of Venezuelan equine encephalitis (VEE) subtype ID in the Amazon region, Peru, may be less pathogenic to humans than are epizootic variants. Deaths of 2 persons with evidence of acute VEE virus infection indicate that fatal VEEV infection in Peru is likely. Cases may remain underreported.
Venezuelan equine encephalitis (VEE) is an emerging zoonotic disease in the Amazon region of Peru. After dengue, it is considered the second most important arboviral disease in Peru. Most human infections with VEE virus (VEEV) are caused by subtype ID (1–5), and within subtype ID, 6 genotypes have been described (6). In Peru, the Colombia/Venezuela, Panama/Peru, and Peru/Bolivia genotypes have been identified among VEEV subtype ID isolates (1,5,7). Epidemiologic investigations have failed to detect neurologic disease or deaths among >200 VEE cases in this country (T.J. Kochel, unpub. data). Only 2 fatal cases with VEEV subtype ID have been reported, both in Panama (6,8). In contrast, fatal cases with neurologic complications (estimated mortality rate 0.7%) have been described regularly for human outbreaks caused by VEEV subtypes IAB and IC (9–12). On the basis of these reports, it has been suggested that enzootic VEEV strains in Peru may be less pathogenic to humans than the epizootic variants (13). However, only 200 cases identified in Peru may not be enough to make such an assertion.

We recently described a severe infection in a 3-year-old boy who had VEEV subtype ID (14). Here we describe 2 fatal infections in persons with evidence of acute VEEV infection in Peru. One patient had confirmed subtype ID.

The Study
In 2000, the Naval Medical Research Center Detachment (NMRCD) and the Ministry of Health of Peru established a passive surveillance study to determine arboviral causes of febrile illness (protocol NMRCD.2000.0006). Patients with acute, undifferentiated febrile illness of <7 days were invited to enroll, and demographic and clinical information was obtained at the time of enrollment. Blood samples were obtained and assayed by virus isolation, and convalescent-phase samples were obtained 10 days to 4 weeks later for serologic studies.

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Suggested Citation for this Article
Vilcarromero S, Aguilar PV, Halsey ES, Laguna-Torres VA, Razuri H, Perez J, et al. Venezuelan equine encephalitis and 2 human deaths, Peru. Emerg Infect Dis [serial on the Internet]. 2010 Mar [date cited]. http://www.cdc.gov/EID/content/16/3/553.htm

DOI: 10.3201/eid1603.090970