To determine the incidence of dengue infection, we established active surveillance of febrile episodes in a cohort of schoolchildren from three schools in Medellin, Colombia. We followed a cohort of 2,379 schoolchildren in 2010 and followed 1,840 of these children the following year. During the follow-up time, 264 schoolchildren displayed 297 febrile episodes; of these, 23 episodes (7.7%) were caused by acute dengue infection. All four dengue serotypes were found, and all of the cases were mild. The most common symptoms in the dengue cases compared with those in other febrile illness were asthenia (96% versus 87%), anorexia (78% versus 57%), rhinorrhea (65.2% versus 58%), abdominal pain (56.5% versus 47.8%), arthralgia (43% versus 33%), and positive tourniquet test (13% versus 3%). This difference was not statistically significant. Pulse was elevated, and systolic arterial pressure was lower in dengue cases compared with other febrile illness (P < 0.05). Mosquito indexes were determined in 8 children's houses and in the schools. Aedes aegypti adults were found in both households and in schools, whereas Aedes aegypti larvae were found only in schools. These results showed an elevated dengue frequency in children, with symptoms similar to those of other febrile illness and transmission risk in households and schools.

Abstract. During an active surveillance study in school children in Medellin, we assessed the performance of two diagnostic strategies for dengue virus. A total of 41 patients with suspected dengue acute infection were evaluated. Diagnostic strategies consisted of one combining Panbio ® Dengue virus IgM and IgG Capture ELISAs (enzyme-linked immunosorbent assays) with reverse transcriptase polymerase chain reaction (RT-PCR) and another using a commercial rapid SD Bioline Dengue Duo (IgG/IgM + NS1 Ag) test. These two strategies were compared with the enzymelinked immunospot microneutralization test (ELISPOT-MNT). The sensitivity and specificity were 53.9% and 80.0% for the combination of Panbio ® ELISAs and RT-PCR tests, and 30.8% and 73.3% for the SD Bioline Duo test, respectively. ELISPOT-MNT detected 16.4% additional cases and revealed the presence of neutralizing antibodies in all the acute samples, evidencing that they were all secondary infections. In contrast, Panbio ® and SD Dengue Duo rapid tests only classified 23.0% and 26.9% of the cases as secondary dengue infections, respectively. Cohen's kappa coefficient and McNemar's association tests demonstrated a significant disagreement between the two diagnostic strategies and ELISPOT-MNT. Overall, these results evidence the relatively poor performances of commercial assays for the diagnosis of acute and secondary dengue infections, compared with ELISPOT-MNT, and raise concern about the accuracy of these assays for the diagnostic of dengue in endemic areas.

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BACKGROUND According to CDC and WHO guidelines, all individuals from 13 to 64 years of age should get screened for HIV infection as part of their routine medical examinations, and individuals at high risk should get tested annually. OBJECTIVE This study aimed to identify sociodemographic, healthcare, and sexual behavior predictors of provider-initiated HIV testing (PIHT) using data from the Puerto Rico National HIV Behavioral Surveillance (PR-NHBS) 2016 cycle; directed towards heterosexuals at increased risk of HIV infection (HET). METHODS A total sample of 531 eligible participants were recruited through respondent-driven sampling (RDS), where sociodemographic characteristics, healthcare utilization, and HIV testing were assessed. RESULTS Despite 72% showed high-risk sexual behavioral practices and 65.2% of the HET sample interviewed reported a low perceived risk of HIV infection, only 19% reported not receiving an HIV test offered at a recent medical visit. Multivariate analysis shows that HET who engaged in high-risk sexual behaviors (AOR = 0.52; 95% CI: 0.30–0.90) were less likely to receive HIV-test offers from their providers. CONCLUSIONS This study further emphasizes the need for healthcare providers to follow recommended guidelines for HIV testing in healthcare settings as a means of establishing preventive measures to further counteract the HIV epidemic in Puerto Rico, specifically among HET.