Unexpected high mutations detected in new emerging variants of concern (VOCs) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), especially in the case of omicron, raises concerns and efforts to understand their evolutionary trajectory. Several hypotheses have been discussed in literature to conceptualize the source of their emergence, including intra-host viral evolution in immunocompromised patients. These patients grant opportunities for the emergence of new variants through a persisting virus winning against host immunity, and selection for viral mutations driven by treatment interventions. VOCs have in common high mutation rate exceeding the average rate of 1-2 mutations per month. Not many studies have investigated the evolutionary rate of SARS-CoV-2 in immunocompromised candidates. Therefore, the purpose of this study is to reveal potential mechanisms underlying the emergence of VOCs by exploring substitution rate of SARS-CoV-2 genomes from surveyed COVID-19 immunocompromised patient’s studies. First, SARS-CoV-2 genome sequences were collected at sequential time series throughout host infection, which were reported in the previous studies. Filtration criteria was applied to reanalyze patients with prolonged infection documented for ≥ 2 months, and comprehensive sequenced samples for ≥ 6 time points. Then, phylogenetic analysis was conducted using Nextclade (https://clades.nextstrain.org/), followed by mutation rate analysis using two substantial similar approaches to calculate the rate in i) substitutions per month and ii) substitutions per site (per year). The mutation tendency of SARS-CoV-2 in immunocompromised hosts was compared to reported VOCs, particularly to omicron. The highest observed mutation rate accounted for approximately 2.2 mutations per month, which is higher than the average rate. High mutation rate was due to prolonged infection and selection pressure by treatment interventions (i.e., convalescent plasma and antibodies). Here, higher rate of intra-host viral evolution in immunocompromised patients is detected, potentially leading to the emergence of VOC. Hence, this research highlights the need for sequencing efforts in high-risk individuals, updating treatment strategies along with further analysis on adaptive mutants pronounced due to intra-host evolution. Together, such findings provide an ultimate synergy for future public health guidelines and infection control measures.

A caracterização da variabilidade genética intra-hospedeiro do vírus da dengue (DENV) é fundamental para a compreensão de sua evolução e dinâmica populacional no contexto atual como um importante patógeno viral humano. A diversidade viral acumulada em hospedeiros infectados influencia diretamente em outros aspectos como patogênese, transmissão e imunidade do hospedeiro. Contudo, apesar de existirem vários estudos sobre a diversidade genética intra-hospedeiro em dengue, nenhum tem sido relatado para DENV-4 até o presente momento. O ressurgimento e disseminação desse sorotipo foi associado com a sua co-circulação e o substituição dos sorotipos 1, 2 e 3 durante os recentes surtos no município do Guarujá-SP. Com base neste quadro epidemiológico, este estudo visou identificar a variação genética intra-hospedeiro do DENV-4 em amostras coletadas durante o surto de 2013, utilizando tecnologias de sequenciamento de nova geração. Portanto, nós caracterizamos a variabilidade genética de DENV-4 em diferentes níveis e as forcas evolutivas que afetam essa diversidade. Em adição, foram explorados os principais eventos na transmissão das variantes de DENV-4 identificadas. Nossos resultados revelaram uma baixa diversidade genética intra-hospedeiro para DENV-4. No entanto, mutação e pressões seletivas foram mecanismos importantes na variabilidade genética do vírus. A nível populacional, as variantes estão sujeitas á seleção natural negativa, não obstante identificamos seleção positiva atuando sob sítios específicos. Nenhuma evidência de recombinação foi detectada. Além disso, contra-intuitivamente, variantes de baixa frequência estão sendo transmitidas e contribuindo para diversidade genética do DENV-4 circulando em Guarujá. Nossos resultados fornecem novas evidências potencialmente úteis para futuros trabalhos focados em infecções mistas, escape imunológico, assim como o espalhamento e diversificação viral. / Characterizing intra-host genetic variability in dengue virus (DENV) virus is paramount for understanding its evolution and population dynamics in the context of its current status as a major human viral pathogen. The extent to which viral diversity accrues in infected host influences aspects such as pathogenesis, transmission, and host immunity. Although there are several studies about intra-host genetic diversity in dengue, so far nothing has been revealed about DENV-4. In the Guarujá municipality in the State of São Paulo, the reemergence and spread of this serotype was associated with its co-circulation and the displacement of serotypes 1, 2 and 3 during recent outbreaks. Based on this epidemiological framework, we seek to identify the intra-host genetic variation of DENV-4 strains from samples collected during the 2013 outbreak by using deep sequencing technologies. We characterized the genetic variability of DENV-4 at different levels, and the forces shaping this diversity. Likewise, we explored major transmission events among DENV-4 variants. Our results revealed a low intra-host genetic diversity for DENV-4. However, we found selective and mutational pressures contributing to genetic diversity, while recombination did not seem play an important role. We further identified purifying selection at population level but sites subject to potential diversifying selection. Additionally, we observed low frequency haplotypes being transmitted among hosts and contributing to the viral diversity of DENV-4 circulating in Guarujá. Our findings provide preliminary insights for future studies in mixed infections, drug resistance, virus variant spread and immune scape. This study is the first effort to investigate the intra-host diversity of DENV-4.

A caracterização da variabilidade genética intra-hospedeiro do vírus da dengue (DENV) é fundamental para a compreensão de sua evolução e dinâmica populacional no contexto atual como um importante patógeno viral humano. A diversidade viral acumulada em hospedeiros infectados influencia diretamente em outros aspectos como patogênese, transmissão e imunidade do hospedeiro. Contudo, apesar de existirem vários estudos sobre a diversidade genética intra-hospedeiro em dengue, nenhum tem sido relatado para DENV-4 até o presente momento. O ressurgimento e disseminação desse sorotipo foi associado com a sua co-circulação e o substituição dos sorotipos 1, 2 e 3 durante os recentes surtos no município do Guarujá-SP. Com base neste quadro epidemiológico, este estudo visou identificar a variação genética intra-hospedeiro do DENV-4 em amostras coletadas durante o surto de 2013, utilizando tecnologias de sequenciamento de nova geração. Portanto, nós caracterizamos a variabilidade genética de DENV-4 em diferentes níveis e as forcas evolutivas que afetam essa diversidade. Em adição, foram explorados os principais eventos na transmissão das variantes de DENV-4 identificadas. Nossos resultados revelaram uma baixa diversidade genética intra-hospedeiro para DENV-4. No entanto, mutação e pressões seletivas foram mecanismos importantes na variabilidade genética do vírus. A nível populacional, as variantes estão sujeitas á seleção natural negativa, não obstante identificamos seleção positiva atuando sob sítios específicos. Nenhuma evidência de recombinação foi detectada. Além disso, contra-intuitivamente, variantes de baixa frequência estão sendo transmitidas e contribuindo para diversidade genética do DENV-4 circulando em Guarujá. Nossos resultados fornecem novas evidências potencialmente úteis para futuros trabalhos focados em infecções mistas, escape imunológico, assim como o espalhamento e diversificação viral. / Characterizing intra-host genetic variability in dengue virus (DENV) virus is paramount for understanding its evolution and population dynamics in the context of its current status as a major human viral pathogen. The extent to which viral diversity accrues in infected host influences aspects such as pathogenesis, transmission, and host immunity. Although there are several studies about intra-host genetic diversity in dengue, so far nothing has been revealed about DENV-4. In the Guarujá municipality in the State of São Paulo, the reemergence and spread of this serotype was associated with its co-circulation and the displacement of serotypes 1, 2 and 3 during recent outbreaks. Based on this epidemiological framework, we seek to identify the intra-host genetic variation of DENV-4 strains from samples collected during the 2013 outbreak by using deep sequencing technologies. We characterized the genetic variability of DENV-4 at different levels, and the forces shaping this diversity. Likewise, we explored major transmission events among DENV-4 variants. Our results revealed a low intra-host genetic diversity for DENV-4. However, we found selective and mutational pressures contributing to genetic diversity, while recombination did not seem play an important role. We further identified purifying selection at population level but sites subject to potential diversifying selection. Additionally, we observed low frequency haplotypes being transmitted among hosts and contributing to the viral diversity of DENV-4 circulating in Guarujá. Our findings provide preliminary insights for future studies in mixed infections, drug resistance, virus variant spread and immune scape. This study is the first effort to investigate the intra-host diversity of DENV-4.

Le virus chikungunya est un arbovirus, transmis par les moustiques du genre Aedes, qui provoque des arthralgies invalidantes et parfois des rhumatismes chroniques. Dans une première partie nous avons décrit les aspects ambulatoires cliniques, biologiques et virologiques du chikungunya (CHIK) de la phase aiguë jusqu'au 300ème jour lors de l’épidémie de la Réunion en 2006. Des scores d’aide au diagnostic ont été élaboré et une étude de la diversité virale intra-hôte a été réalisée. Pour compléter nos premiers résultats nous avons étudié une épidémie survenue en République du Congo en 2011. La description clinique était similaire à celle identifiée lors de l’épidémie de la Réunion. L’évaluation du score clinique ne permettait pas de le proposer comme outil diagnostique à l’échelle individuelle mais apparaissait comme un bon marqueur pour le suivi de la courbe épidémique. Une étude de séroprévalence et une analyse phylogénétique complètent ce travail. Le dernier travail porte sur l’utilisation de la chloroquine à la phase aiguë du CHIK lors d’une prise prophylactique chez le singe et lors d’un essai clinique chez l’homme. Le principal effet de ce type de traitement semble lié son action immuno-modulatrice ; en prise préventive il provoque une exacerbation de la symptomatologie aiguë tandis qu’en prise à la phase précoce de la maladie il augmente le risque d’évolution vers des arthralgies chroniques. En conclusion nous avons réalisé une description des formes ambulatoires du CHIK, identifié des facteurs de risques de formes chroniques, proposé des scores d’aide au diagnostic et argumenté la contre-indication de l’utilisation de la chloroquine à la phase aiguë du CHIK. / Chikungunya virus (CHIKV) is an arthropod-borne virus transmitted by Aedes mosquitoes that cause debilitating arthralgia and possible chronic rheumatism. In the first part we describe the clinical, biological and virological presentation of outpatients with chikungunya disease (CHIK) from the acute stage to the chronic stage at day 300, during the outbreak in the Reunion Island in 2006. We elaborated scores for CHIK diagnosis and we also analysed the intra-host genetic diversity.To complete our first results, we investigated a CHIKV outbreak, which occurred in the Republic of Congo in 2011. The clinical presentation was similar to the first description of the Reunion island outbreak. We assessed the clinical score which appeared to be unusable at the individual level but was still relevant to follow the epidemic curve. This work was completed by seroprevalence and phylogenetic analyses.The last study presented in this thesis focused on the use of chloroquine during the acute stage of CHIK in a non-human primate (NHP) model (prophylactic use) and during a clinical trial (therapeutic use). The main effect of chloroquine treatment at the acute stage of CHIK appeared to be related to its immuno-modulatory action; in prophylactic taking, chloroquine exacerbated acute symptoms while treatment during the early stages of the disease increased the risk of acquiring chronic arthralgia.In conclusion, we provide a detailed description of CHIK outpatients and identify risk factors for the chronic stage of the disease. We propose tentative diagnostic scores and we firmly establish that the use of chloroquine at the acute phase of CHIK is contraindicated.

Equine arteritis virus (EAV) establishes persistent infection in the stallion reproductive tract, and the carrier stallion continues to shed virus in semen for weeks to years or lifelong. The objective of this study was to elucidate the intra-host evolution of EAV during persistent infection in stallions. Seven EAV seronegative stallions were experimentally infected with EAV KY84 strain and followed for 726 days post-infection, and sequential clinical samples including semen were collected for virus isolation and next-generation sequencing (NGS). In addition, archived sequential semen samples from two stallions that were naturally infected with EAV KY84 for a long-period (up to 10 years) were also sequenced by NGS. The data demonstrated genetic bottleneck event and selection during acute infection followed by intra-host quasispecies diversification during persistent infection in the stallion reproductive tract. Also, the full-length genome of a novel EAV donkey strain from Chile and a noncytopathic bovine viral diarrhea virus-1 (ncpBVDV-1) strain contaminating rabbit kidney-13 cells were also sequenced by NGS. The EAV donkey strain was genetically distinct but antigenically cross-reacted with EAV antisera, and it was phylogenetically closely related to the South African donkey strain of EAV. Genetic and phylogenetic analyses demonstrated that ncpBVDV-1 belongs to BVDV-1b group.