Dengue, chikungunya and zika arbovirus infections in Caribbean children

Abstract

Purpose of reviewDengue, chikungunya and zika have caused significant epidemics in the Caribbean in recent years. This review highlights their impact in Caribbean children.Recent findingsDengue has been increasingly intense and severe, seroprevalence is 80–100% in the Caribbean, children have increased attributable morbidity and mortality. Severe dengue, especially dengue with haemorrhage was significantly associated with haemoglobin SC disease and multiple organ-systems involved. These included the gastrointestinal and haematologic systems with extremely high lactate dehydrogenases and creatinine phosphokinases and severely abnormal bleeding indices. Despite appropriate interventions, mortality was highest within the first 48 h of admission. Chikungunya, a togavirus, affected 80% of some Caribbean populations. Paediatric presentations included high fever, skin, joint and neurological manifestations. Children less than 5 years of age had the highest morbidity and mortality. This maiden chikungunya epidemic was explosive and overwhelmed public health systems. Zika, another flavivirus, has a seroprevalence of 15% in pregnancy, so the Caribbean remains susceptible. Paediatric complications include pregnancy losses, stillbirths, Congenital Zika syndrome, Guillain–Barre syndrome, acute disseminated encephalomyelitis and transverse myelitis. Neurodevelopment stimulation programs for zika-exposed infants have been effective in improving language and positive behaviour scores.SummaryCaribbean children remain at risk for dengue, chikungunya and zika, with high attributable morbidity and mortality.

Travel surveillance uncovers dengue virus dynamics and introductions in the Caribbean

“…Using patterns of infected travelers and virus genomics, we discovered previously unrecognized DENV dynamics within the Caribbean. Dengue is a major public health concern within the Caribbean, and the past two decades have seen significant increases in morbidity and mortality in the region 5,34,39 . With dengue outbreaks increasing in frequency and severity 39 , accurate and detailed surveillance data are crucial for epidemiological investigations.…”

“…There are four genetically- and antigenically-related DENV serotypes, and while infection with one serotype generally produces long-lasting homotypic immunity, it only induces short-lived heterotypic immunity, after which infection with another serotype may result in more severe disease 1,2,4 . Almost half of the world’s population lives in dengue-endemic areas, with children bearing the majority of the disease burden 5,6 . Dengue has evolved from a sporadic disease into a major public health threat in the Americas, with reported case numbers reaching 20 million in the last 5 years in 46 countries 7 .…”

Clinical Manifestations of Dengue in Children and Adults in a Hyperendemic Region of Colombia

“…43 Likewise, in Caribbean children, Dengue, Chikungunya, and Zika have contributed to significant attributable morbidity and mortality. 44 Diagnosis is further complicated by clinical similarities and the limited availability and expense of confirmatory testing. 43 Moreover, early diagnosis or management of suspected cases can prevent the use of inappropriate treatments, such as antibiotics, which could result in grave outcomes or fatalities.…”

Ad26.M.Env ZIKV vaccine protects pregnant rhesus macaques and fetuses against Zika virus infection

“…The World Health Organization (WHO) declared an end to the ZIKV epidemic at the end of 2016 1010 ), and ZIKV transmission is currently at low levels world-wide, however vaccine development for emergency deployment remains a high priority by the WHO ( 11 ). ZIKV also remains a concern for individuals traveling to endemic areas and for individuals living in areas with continued transmission such as the Caribbean where over 15% of pregnant women continue to test positive for ZIKV ( 12 ). CDC guidance still recommends that pregnant women, partners of pregnant women, or those considering pregnancy to delay travel to areas with ZIKV outbreaks and to consult with medical providers before traveling to ZIKV endemic regions ( 13 ).…”