Epidemiology of Dengue Among Children Aged < 18 Months—Puerto Rico, 1999–2011

Abstract

Dengue, a mosquito-borne viral illness caused by dengue virus types (DENV)-1 to DENV-4, is endemic in Puerto Rico. Severe dengue usually occurs in individuals previously infected with DENV or among infants born to previously infected mothers. To describe clinical features of dengue in infants, we retrospectively characterized dengue patients aged < 18 months reported to the Passive Dengue Surveillance System (PDSS) during 1999–2011. To determine frequency of signs, symptoms, and disease severity, case report forms and medical records were evaluated for patients who tested positive for dengue by reverse transcriptase polymerase chain reaction or anti-DENV immunoglobulin Menzyme-linked immunosorbent assay. Of 4,178 reported patients aged < 18 months, 813 (19%) were laboratory positive. Of these, most had fever (92%), rash (53%), bleeding manifestations (52%), and thrombocytopenia (52%). Medical records were available for 145 (31%) of 472 hospitalized patients, of which 40% had dengue, 23% had dengue with warning signs, and 33% had severe dengue. Mean age of patients with severe dengue was 8 months. Anti-DENV immunoglobulin G (IgG) titers were not statistically different in patients with (50%) and without (59%) severe dengue. In this study, one-third of DENV-infected infants met the severe dengue case definition. The role of maternal anti-DENV IgG in development of severe disease warrants further study in prospective cohorts of mother-infant pairs.

Does dengue and COVID‐19 co‐infection have worse outcomes? A systematic review of current evidence

“…This has been attributed to the frequency of complications, which might affect this age group at a potentially higher rate secondary to the infection. 15 , 29 , 30 …”

“…This has been attributed to the frequency of complications, which might affect this age group at a potentially higher rate secondary to the infection. 15,29,30 Many factors can contribute to severe COVID-19, including co-infection. [31][32][33][34][35][36] The current literature reveals a solid association between COVID-19 and co-infection with different viruses and bacteria.…”

“…Previous dengue studies reported that hospital stay was remarkably longer among infants than children and adults. This has been attributed to the frequency of complications, which might affect this age group at a potentially higher rate secondary to the infection 15,29,30 …”

Pattern and Outcome of Dengue Fever in a Pediatric Tertiary Hospital: A Retrospective Report

“…Reports from Passive Dengue Surveillance System (PDSSS) in Puerto Rico reported more than 4000 cases of dengue in children of age <18 months. Of all laboratory positive cases, 58% required hospitalization and 33% of hospitalized children had severe dengue [ 14 ]. In a five-year-long study from India examining the blood samples of suspected dengue patients age 15 years or less, 25% were positive for dengue.…”

Global Epidemiology of Dengue Hemorrhagic Fever: An Update

“…Severe dengue usually occurs among patients that have been infected previously with a dengue virus (i.e., secondary infection). High rates of severe dengue infection have also been reported in infants with primary dengue virus infection that are born by mothers who have been infected previously with a dengue virus [24].…”