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Dengue-3 rates by municipality in Puerto Rico, 1998– 1999. Patient numbers refer to the residence of the first 10 dengue-3 cases diagnosed in 1998; the sentinel clinics were in the pediatric emergency rooms of teaching hospitals in San Juan (north) and Ponce (south).
Source publication
In January 1998, dengue-3 (DEN)-3 (group III genotype) was detected in Puerto Rico after an absence of 20 years. Public health officials intensified education efforts to promote community participation in dengue control. Virologic surveillance revealed an unexpected paradox: DEN-4 and DEN-1 produced a large epidemic overlaying the DEN-3 epidemic. I...
Contexts in source publication
Context 1
... intensified virologic surveillance, this virus serotype was not detected after the January cases until April (in a 22-year-man in Vega Alta, west of Toa Baja). Subse- quently, the virus was isolated in May (two cases: a 30-year- old man and a 17-year-old man), June (five cases: a nine-year- old boy, a 17-year-old man, a 64-year-old man, a six-year-old girl and a 15-year-old girl), and almost weekly in July and thereafter (Figures 1 and 2). All the DEN-3 cases that were identified from January through June 1998 resided in the northern half of the island, and the range of the virus was approximately 100 km west (San Juan to Moca). ...
Context 2
... (38.7%) were reported as hospital- ized, and 54 (22.2%) had some hemorrhagic manifestation. DEN-3 cases were identified throughout the island (Figure 1) in 36 (46%) of the 78 municipalities, but the highest ratio (2.5) of the incidence, in contrast to all reports of dengue ( Figures 1 and 4), was observed in the northeastern quadrant of Puerto Rico, especially the San Juan metropolitan area. Cases of DEN-3 cases ranged in age from three months to 83 years (median 17 years). ...
Context 3
... (38.7%) were reported as hospital- ized, and 54 (22.2%) had some hemorrhagic manifestation. DEN-3 cases were identified throughout the island (Figure 1) in 36 (46%) of the 78 municipalities, but the highest ratio (2.5) of the incidence, in contrast to all reports of dengue ( Figures 1 and 4), was observed in the northeastern quadrant of Puerto Rico, especially the San Juan metropolitan area. Cases of DEN-3 cases ranged in age from three months to 83 years (median 17 years). ...
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Dengue virus is circulating in Pakistan since 1994, which causes major and minor outbreaks in many areas of the country. The incidence of dengue in Pakistan in past years mainly restricted to parts of Sindh and Punjab provinces. As such, a severe dengue outbreak appeared in Pakistan in 2011, particularly in Punjab province with Lahore as...
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Objectives:
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The incidence and severity of dengue in Latin America has increased substantially in recent decades and data from Puerto Rico suggests an increase in severe cases. Successful clinical management of severe dengue requires early recognition and supportive care.
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Citations
... 22 In 2021, the PRDOH reported 581 confirmed dengue cases (PCR positive) and 64 probable cases (IgM positive). 15 In the published literature, the incidence of clinically diagnosed dengue in Puerto Rico ranged from 132 cases/100 000 person-years (1996) 34 to 480 cases/100 000 person-years (1998), 35 while virologically confirmed dengue incidence ranged from 53 cases/100 000 personyears (1996) 34 to 268 cases/100 000 person-years (2010). 36 In USVI, the PAHO reported 0 cases/100 000 person-years in most ; Table S4 available at JTM online). ...
Background
Dengue is currently a global concern. The range of dengue vectors is expanding with climate change, yet United States of America (USA) studies on dengue epidemiology and burden are limited. This systematic review sought to characterize the epidemiology and disease burden of dengue within the USA.
Methods
Studies evaluating travel-related and endemic dengue in US states and territories were identified and qualitatively summarized. Commentaries and studies on ex-US cases were excluded. MEDLINE, Embase, Cochrane Library, Latin American and Caribbean Center of Health Sciences Information, Centre for Reviews and Dissemination and Clinicaltrials.gov were searched through January 2022.
Results
116 studies were included. In US states, dengue incidence was generally low, with spikes occurring in recent years in 2013–16 (0.17–0.31 cases/100,000) and peaking in 2019 (0.35 cases/100,000). Most cases (94%, n = 7895, 2010–21) were travel related. Dengue was more common in Puerto Rico (cumulative average: 200 cases/100,000, 1980–2015); in 2010–21, 99.9% of cases were locally acquired. There were <50 severe cases in US states (2010–17); fatal cases were even rarer. Severe cases in Puerto Rico peaked in 1998 (n = 173) and 2021 (n = 76). Besides lower income, risk factors in US states included having birds in residence, suggesting unspecified environmental characteristics favourable to dengue vectors. Commonly reported symptoms included fever, headache and rash; median disease duration was 3.5–11 days. Hospitalization rates increased following 2009 World Health Organization disease classification changes (pre-2009: 0–54%; post-2009: 14–75%); median length of stay was 2.7–8 days (Puerto Rico) and 2–3 days (US states). Hospitalization costs/case (2010 USD) were$14 350 (US states),$1764–$5497 (Puerto Rico) and$4207 (US Virgin Islands). In Puerto Rico, average days missed were 0.2–5.3 (work) and 2.5 (school).
Conclusions
Though dengue risk is ongoing, treatments are limited, and dengue's economic burden is high. There is an urgent need for additional preventive and therapeutic interventions.
... Despite being known as a mild serotype, the impact of the emergence of DENV-4 in an endemic region where the other three serotypes were circulating was unknown. The introduction of a new serotype of DENV is associated with the occurrence of major epidemics and increased proportion of severe cases [44], more frequent in individuals susceptible to the new serotype circulating. ...
Introduction: It is a consensus that inflammatory mediators produced by immune cells contribute to changes in endothelial permeability in dengue. We propose to relate inflammatory mediators seen in dengue patients with the in vitro alteration of endothelial cells (ECs) cultured with serum from these patients. Methods: Patients with mild (DF) to moderate and severe dengue (DFWS/Sev) were selected. ELISA quantified inflammatory mediators. Expression of adhesion molecules and CD147 were evaluated in the ECs cultured with the patient's serum by flow cytometry. We assessed endothelial permeability by measuring transendothelial electrical resistance in cocultures of ECs with patient serum. Results: Dengue infection led to an increase in inflammatory mediators-the IL-10 distinguished DF from DFWS/Sev. There were no changes in CD31, CD54, and CD106 but decreased CD147 expression in ECs. DFWS/Sev sera induced a greater difference in endothelial permeability than DF sera. Correlation statistical test indicated that low IL-10 and IFN-γ and high CCL5 maintain the integrity of ECs in DF patients. In contrast, increased TNF, IFN-γ, CXCL8, and CCL2 maintain EC integrity in DFWS/Sev patients. Conclusions: Our preliminary data suggest that a subset of inflammatory mediators may be related to the maintenance or loss of endothelial integrity, reflecting the clinical prognosis.
... In 2016, Miami, Florida experienced a relatively large Zika virus outbreak, which indicates suitable environmental conditions for urban Aedes-arbovirus transmission (Florida, 2018). Outside of the fifty U.S. states, dengue has been endemic to Puerto Rico since the 1970s, and presently all four serotypes of the virus are regularly detected in Puerto Rico (Rigau-Pérez et al., 2002;Messina et al., 2014). Given the recent increase in frequency of dengue outbreaks in the United States, it is becoming more important to understand in what regions the environment is favorable for dengue transmission and how that favorability could change as global surface temperatures rise so that precautionary measures such as enhanced vector and virus surveillance can be employed. ...
... Model predictions throughout this work are based upon parameters that we obtained largely from published literature (refer to citations in the main text). However, we condition much of this work based upon observations in San Juan, Puerto Rico, where dengue has been endemic for a number of decades (NOAA, 2018;Rigau-Pérez et al., 2002). We utilized dengue case data from 1999-2008 to estimate the value of the density-dependent parameter a, which, together with other demographic parameters, determines the size of the vector population. ...
Tropical mosquito-borne viruses have been expanding into more temperate regions in recent decades. This is partly due to the coupled effects of temperature on mosquito life history traits and viral infection dynamics and warming surface temperatures, resulting in more suitable conditions for vectors and virus transmission. In this study, we use a deterministic ordinary differential equations model to investigate how seasonal and diurnal temperature fluctuations affect the potential for dengue transmission in six U.S. cities. We specifically consider temperature-dependent mosquito larval development, adult mosquito mortality, and the extrinsic incubation period of the virus. We show that the ability of introductions to lead to outbreaks depends upon the relationship between a city's temperature profile and the time of year at which the initial case is introduced. We also investigate how the potential for outbreaks changes with predicted future increases in mean temperatures due to climate change. We find that climate change will likely lead to increases in suitability for dengue transmission and will increase the periods of the year in which introductions may lead to outbreaks, particularly in cities that typically have mild winters and warm summers, such as New Orleans, Louisiana, and El Paso, Texas. We discuss our results in the context of temperature heterogeneity within and across cities and how these differences may impact the potential for dengue emergence given present day and predicted future temperatures.
... Hurricane Georges hit Puerto Rico as a category 3 hurricane in 1998 in the midst of a large dengue epidemic, yet the storm did not exacerbate the epidemic. 14 Similarly, Hurricane Hortense hit Puerto Rico on September 10, 1996, causing heavy rains and flooding, but did not change the usual seasonal pattern of dengue transmission. 15 Nevertheless, several reports do account for increased risk of arbovirus transmission after severe storms or flooding. ...
Puerto Rico was severely impacted by Hurricanes Irma and Maria in September 2017. The island has been endemic for dengue viruses (DENV) and recently suffered epidemics of chikungunya (CHIKV 2014) and Zika (ZIKV 2016) viruses. Although severe storms tend to increase the number of vector and nuisance mosquitoes, we do not know how they influence Aedes aegypti populations and arboviral transmission. We compared the abundance of female Ae. aegypti in autocidal gravid ovitraps (AGO traps), container habitats, and presence of RNA of DENV, CHIKV, and ZIKV in this vector before and after the hurricanes in Caguas city and in four communities in southern Puerto Rico. Two of these communities were under vector control using mass AGO trapping and the other two nearby communities were not. We also investigated mosquito species composition and relative abundance (females/trap) using Biogents traps (BG-2 traps) in 59 sites in metropolitan San Juan city after the hurricanes. Mosquitoes sharply increased 5 weeks after Hurricane Maria. Ensuing abundance of Ae. aegypti was higher in Caguas and in one of the southern communities without vector control. Aedes aegypti did not significantly change in the two areas with vector control. The most abundant mosquitoes among the 26 species identified in San Juan were Culex (Melanoconion) spp., Culex quinquefasciatus, Culex nigripalpus, and Ae. aegypti. No arboviruses were detected in Ae. aegypti following the hurricanes, in contrast with observations from the previous year, so that the potential for Aedes-borne arboviral outbreaks following the storms in 2017 was low.
... Arboviral disease transmission may also increase in the weeks to months following hurricanes due to pooled flood waters providing breeding ground for mosquito and other arthropod vectors [23]. Adult mosquitos typically cannot survive the storm surge and high winds associated with hurricanes leading to reduced cases of arboviral disease immediately following the storm [24]. However, weeks to months after the hurricane, resurgence of adult mosquitoes lay eggs in persistent flood waters which can lead to increased mosquito populations and impact recovery efforts [25]. ...
... Immediately after Hurricane Georges, dengue reporting diminished for approximately 1 week before returning to the pre-hurricane epidemic levels. Despite the resurgence of dengue incidence in Puerto Rico, Hurricane Georges had minimal affect on the overall trajectory of dengue disease [24]. Additionally, no confirmed cases of dengue infections were determined in emergency relief workers working in Puerto Rico following Hurricane Georges [27]. ...
Purpose of Review
We aim to highlight the common infectious pathogens that affect evacuees, non-evacuees, and medical responders following hurricanes in the USA, in order to help clinicians quickly diagnose and treat patients and increase medical preparedness in hurricane affected areas.
Recent Findings
Hurricanes facilitate the spread of infectious pathogens through population displacement, flooding, and trauma. Hurricane shelters create conditions that lead to the spread of infectious pathogens due to overcrowding, resource limitation, and reduced hygiene. The pathogens that tend to spread during hurricanes are often endemic to the hurricane-affected area. Patients with chronic infections, such as HIV and tuberculosis, can experience disruption in medical care during hurricanes.
Summary
The Gulf and Atlantic Coasts of the USA have experienced many devastating and costly hurricanes in recent history. Hurricanes create conditions that facilitate the spread of endemic infectious pathogens, especially among evacuees and temporary residents of emergency shelters, and can also damage public health infrastructure which can disrupt medical care in patients with chronic infections. In order to mitigate the effects of hurricanes on the spread of infectious diseases, public health workers and clinicians should implement preparedness plans that ensure patients with chronic infections have sufficient supply of their medications in the event that their care is disrupted, patients have copies of their medical records, evacuation centers are appropriately staffed and supplied, infection control protocols are implemented in evacuation centers, and emergency responders are provided with education on potential infectious exposures and have access to protective equipment to minimize the spread of infectious pathogens.
... According to the World Health Organization [64], dengue disease intensi es after a ood event because of complicating factors such as changes in the habitat that promote mosquito breeding, variation of human behavior that is likely to expose them more to the vector, and temporary pause in control measures and activities. Previous studies [48,52] reported that after ood events, dengue incidence rarely increases. However, a study done in Dhaka [24] showed an evidence of increased disease cases but with reservations due to limitations such as the type of geographical area or the manner of dengue case collection. ...
Abstract Dengue fever is considered as a rapidly emerging arthropod-borne viral
disease all over the world especially in the Philippines. The disease dynamics of
dengue is affected by ecological factors, namely, urbanization and climate. This
book review discusses the significance and impact of these ecological factors, most
notably to its vector. A case study is presented on how these ecological factors currently
affect an urban city, Metro Manila, Philippines. This context is very significant
in the control of this arboviral disease.
... En la actualidad con el aumento en la tendencia de los FME, se hace más necesario que nunca, estudiar ampliamente estos vínculos, oscilación del sur y sus dos fases; la fase fría (La Niña) y su fase cálida (El Niño), están íntimamente relacionadas con la intensificación de enfermedades transmitidas por insectos, en especial el mosquito Aedes aegypti, vector que transmite dengue, zika y chikunguya. Seguinot (2005) and Rigau-Pérez, et al (2002). ...
Durante los primeros quince años de este siglo, los fenómenos meteorológicos extremos (ciclones tropicales, olas de calor, frentes fríos, incendios forestales, sequías, etc.) han mostrado una tendencia que va en aumento. El propósito principal de este artículo es efectuar un análisis de los fenómenos meteorológicos extremos (FME), con el objetivo de motivar a la reflexión a los tomadores de decisiones y al público en general sobre la necesidad de estar preparados para los posibles efectos de estos eventos Además, el artículo analiza el impacto de estos fenómenos en los diferentes aspectos del diario vivir, tales como: salud de la población con enfermedades como dengue, chikungunya, zika, irritación de ojos y piel, entre otros; así como sobre la economía del país. En el caso particular de la República Dominicana, enclavada en el centro del Caribe y su dependencia del turismo y la agricultura, el preparar planes de mitigación y adaptación con el propósito de ser más resilientes es una obligación del Estado, así como de los gobiernos municipales.
... Incidence of medically attended, clinically suspected cases of dengue has been monitored in Puerto Rico, since the late 1960s, by the Passive dengue surveillance system (PDSS). This system is operated by the Puerto Rico Department of Health (PRDH) and Centers for Disease Control and Prevention Dengue Branch (CDC-DB) [5][6][7]. In recent years, PDSS recorded dengue epidemics in 1998, 2007, 2010 and 2012-2013; the latter with 29,386 suspected dengue cases, of which approximately 54% were laboratory confirmed as dengue [8,9]. ...
Dengue is a mosquito-borne viral illness that causes a variety of health outcomes, from a mild acute febrile illness to potentially fatal severe dengue. Between 2005 and 2010, the annual number of suspected dengue cases reported to the Passive Dengue Surveillance System (PDSS) in Puerto Rico ranged from 2,346 in 2006 to 22,496 in 2010. Like other passive surveillance systems, PDSS is subject to under-reporting. To estimate the degree of under-reporting in Puerto Rico, we built separate inpatient and outpatient probability-based multiplier models, using data from two different surveillance systems—PDSS and the enhanced dengue surveillance system (EDSS). We adjusted reported cases to account for sensitivity of diagnostic tests, specimens with indeterminate results, and differences between PDSS and EDSS in numbers of reported dengue cases. In addition, for outpatients, we adjusted for the fact that less than 100% of medical providers submit diagnostic specimens from suspected cases. We estimated that a multiplication factor of between 5 (for 2010 data) to 9 (for 2006 data) must be used to correct for the under-reporting of the number of laboratory-positive dengue inpatients. Multiplication factors of between 21 (for 2010 data) to 115 (for 2008 data) must be used to correct for the under-reporting of laboratory-positive dengue outpatients. We also estimated that, after correcting for underreporting, the mean annual rate, for 2005–2010, of medically attended dengue in Puerto Rico to be between 2.1 (for dengue inpatients) to 7.8 (for dengue outpatients) per 1,000 population. These estimated rates compare to the reported rates of 0.4 (dengue outpatients) to 0.1 (dengue inpatients) per 1,000 population. The multipliers, while subject to limitations, will help public health officials correct for underreporting of dengue cases, and thus better evaluate the cost-and-benefits of possible interventions.
... Although most DENV infections are asymptomatic, the disease can also present a broad spectrum of clinical signs and symptoms, ranging from an acute undifferentiated febrile illness to severe and fatal outcomes. Fatal cases may occur in over 10% of cases and 90% of deaths occur in children under 15 years old [6]. However, in recent decades, dengue and severe dengue have become more frequent among adults [7]. ...
Background
Dengue viruses (DENV) have emerged and reemerged in Brazil in the past 30 years causing explosive epidemics. The disease may range from clinically asymptomatic infections to severe and fatal outcomes. We aimed to describe the epidemiological, clinical and laboratorial aspects of the dengue fatal cases received by a Regional Reference Laboratory, Brazil in 30 years. MethodsA total of 1047 suspected fatal dengue cases were received from 1986 to 2015 and analyzed in the Laboratory of Flavivirus, FIOCRUZ. Suspected cases were submitted to viral detection, serological and molecular methods for cases confirmation. Influence of gender, age, serotype and type of infection (primary/secondary) on death outcome, as well the interactions between serotype and age or infection and age and type of infection were also studied. ResultsA total of 359 cases (34.2%) were confirmed and DENV-1 (11.1%), DENV-2 (43.9%), DENV-3 (32.8%) and DENV-4 (13.7%) were detected. Overall, fatal cases occurred more often in primary infections (59.3%, p = 0.001). However, in 2008, fatal cases were mainly associated to secondary infections (p = 0.003). In 2008 and 2011, deaths were more frequent on children and those infected by DENV-2 presented a higher risk for fatal outcome. Moreover, children with secondary infections had a 4-fold higher risk for death. Conclusions
Dengue is a multifactorial disease and, factors such as viral strain/serotype, occurrence of secondary infections and co-morbidities may lead to a severe outcome. However, the high dengue incidence and transmission during epidemics, such as those observed in Brazil may overwhelm and collapse the public health services, potentially impacting on increased disease severity and mortality.
... The disease has a broad clinical spectrum ranging from a self-limiting disease in most individuals to a potentially fatal one [2,3]. Fatal cases may occur in over 10% of the severe cases, with 90% of deaths occurring in children under 15 years of age [4]. However, in recent decades, dengue and severe dengue have become more frequent among adults [5]. ...
Dengue is a worldwide problem characterized by a multifactorial pathogenesis. Considering the viral components, it is known that high viremia or high levels of the secreted nonstructural protein 1 (NS1) may be associated with a more severe disease. We aimed to characterize the NS1 antigenemia and viremia in dengue fatal and non-fatal cases, as potential markers of progression to a fatal outcome. NS1 antigenemia and viremia were determined in Brazilian dengue fatal cases (n = 40) and non-fatal cases (n = 40), representative of the four dengue virus (DENV) serotypes. Overall, the fatal cases presented higher NS1 levels and viremia. Moreover, the fatal cases from secondary infections showed significantly higher NS1 levels than the non-fatal ones. Here, irrespective of the disease outcome, DENV-1 cases presented higher NS1 levels than the other serotypes. However, DENV-2 and DENV-4 fatal cases had higher NS1 antigenemia than the non-fatal cases with the same serotype. The viremia in the fatal cases was higher than in the non-fatal ones, with DENV-3 and DENV-4 presenting higher viral loads. Viral components, such as NS1 and viral RNA, may be factors influencing the disease outcome. However, the host immune status, comorbidities, and access to adequate medical support cannot be ruled out as interfering in the disease outcome.
