Tania Regina Tozetto-Mendoza, Vivian Iida Avelino-Silva, Silvia Fonseca, Ingra Morales Claro, Anderson Vicente de Paula, Anna Sara Levin, Ester Cerdeira Sabino, Maria Cassia Mendes-Correa, Walter Manso Figueiredo, Alvina Clara Felix, Nathalia C. Santiago Souza, Angela Aparecida Costa, Marta Inenami, Rosangela M. Gasparetto da Silva, José Eduardo Levi, Camila Malta Romano, Glaucia Paranhos-Baccalà, Aluisio Cotrim Segurado, Philippe Mayaud
Zika virus (ZIKV) clinical presentation and frequency/duration of shedding need further clarification. Symptomatic ZIKV-infected individuals identified in two hospitals in Sao Paulo State, Brazil, were investigated regarding clinical characteristics, shedding in body fluids, and serodynamics. Ninety-four of 235 symptomatic patients (Site A: 58%; Site B: 16%) had Real-Time PCR-confirmed ZIKV infection; fever, headache and gastrointestinal symptoms were less frequent, and rash was more frequent compared to ZIKV-negative patients. Real-Time PCR in serum had worse performance compared to plasma, while urine had the highest sensitivity. Shedding in genital fluids and saliva was rare. IgM positivity was the highest 28 days (24%); IgG positivity increased >14 days (96%) remaining positive in 94% of patients >28 days. ZIKV prevalence varied importantly in two neighboring cities during the same transmission season. Urine Real-Time PCR can improve diagnostic sensitivity; serum testing is less useful. Accurate serological tests are needed to improve diagnosis and surveillance.