Despite the growing worldwide burden of dengue fever, the global economic impact of dengue illness is poorly documented. Using a common protocol, we present the first multicountry estimates of the direct and indirect costs of dengue cases in eight American and Asian countries. We conducted prospective studies of the cost of dengue in five countries in the Americas (Brazil, El Salvador, Guatemala, Panama, and Venezuela) and three countries in Asia (Cambodia, Malaysia, and Thailand). All studies followed the same core protocol with interviews and medical record reviews. The study populations were patients treated in ambulatory and hospital settings with a clinical diagnosis of dengue. Most studies were performed in 2005. Costs are in 2005 international dollars (I$). We studied 1,695 patients (48% pediatric and 52% adult); none died. The average illness lasted 11.9 days for ambulatory patients and 11.0 days for hospitalized patients. Among hospitalized patients, students lost 5.6 days of school, whereas those working lost 9.9 work days per average dengue episode. Overall mean costs were I$514 and I$1,394 for an ambulatory and hospitalized case, respectively. With an annual average of 574,000 cases reported, the aggregate annual economic cost of dengue for the eight study countries is at least I$587 million. Preliminary adjustment for under-reporting could raise this total to $1.8 billion, and incorporating costs of dengue surveillance and vector control would raise the amount further. Dengue imposes substantial costs on both the health sector and the overall economy.

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The current guideline is the result of constructive collaboration among a multidisciplinary research team to better ascertain the true economic burden of dengue across countries of the region.

Objetivos. Evaluar el nivel de susceptibilidad a insecticidas de una cepa deAedes; temefós; resistencia a los insecticidas; control vectorial; El Salvador. RESUMENDurante el año 2006, el dengue fue una de las enfermedades que más afectó a la población de El Salvador, especialmente en la región centrooccidental del país y a la población infantil (1). En esto ha desempeñado un importante papel el alto nivel de infestación con el mosquito Aedes aegypti L., que continúa siendo el vector más importante en la transmisión de la fiebre amarilla y el dengue en la Región de las Américas.Hasta ahora, la manera más exitosa de reducir la incidencia de dengue es el control del vector, en lo que el uso de insecticidas químicos es un componente importante por su eficacia en reducir las poblaciones de larvas y adultos (2). Los insecticidas más utilizados son los organofosforados (temefós para la eliminación de larvas durante el tratamiento focal y el fentión, el fenitrotión y el malatión para la eliminación de los mosquitos adultos) y los piretroides (deltametrina, lambdacialotrina, cipermetrina y ciflutrina). Estos últimos se introdujeron a partir de la década de 1990 en la mayoría de los países de América Latina para el control de los mosquitos adultos, especialmente durante las epidemias o cuando hay altos índices de infestación con A. aegypti. En El Salvador se ha utilizado el temefós para el control larval de los mosquitos vectores de enfermedades y en los últimos nueve años se han em- Palabras clave

Dengue virus (DENV) has been a major public health concern in Paraguay, with frequent outbreaks occurring since early 1988. Although control measures have been implemented, dengue remains a significant health threat in the country, and continued efforts are required for prevention and control. In response to that, in collaboration with the Central Public Health Laboratory in Asunción, we conducted a portable whole-genome sequencing and phylodynamic analysis to investigate DENV viral strains circulating in Paraguay over the past epidemics. Our genomic surveillance activities revealed the co-circulation of multiple DENV serotypes: DENV-1 genotype V, the emerging DENV-2 genotype III, BR4-L2 clade, and DENV-4 genotype II. Results additionally highlight the possible role of Brazil as a source for the international dispersion of different viral strains to other countries in the Americas emphasizing the need for increased surveillance across the borders, for the early detection and response to outbreaks. This, in turn, emphasizes the critical role of genomic surveillance in monitoring and understanding arbovirus transmission and persistence locally and over long distances.

The spread of vector-borne viruses, such as CHIKV, is a significant public health concern in the Americas, with over 120,000 cases and 51 deaths in 2023, of which 46 occurred in Paraguay. Using a suite of genomic, phylodynamic, and epidemiological techniques, we characterized the ongoing large CHIKV epidemic in Paraguay.

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