Dengue Outbreaks in Guánica-Ensenada and Villalba, Puerto Rico, 1972–1973

Wt, Rymzo; Bl, Cline; Ge, Kemp; Ge, Sather; Pc, Craven

doi:10.4269/ajtmh.1976.25.136

Cited by 9 publications

(4 citation statements)

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“…Between 1969 and 1978, sporadic DEN-2 activity was consistently confirmed in Villalba, even when little dengue transmission was detected on the rest of the island. 13 In the interepidemic period from 1979 to 1981, it was DEN-1 that produced endemic disease in Villalba. 14 From 1990 to 1994, DEN-2 was isolated every year except 1993.…”

Section: Discussionmentioning

confidence: 99%

Dengue activity in Puerto Rico during an interepidemic period (1995-1997).

Rigau‐Pérez¹,

Ayala-López²,

Vorndam³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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Abstract. From 1995 to 1997 dengue was reported in Puerto Rico at an average annual rate of 1.75/1,000 population, compared to 6.73 in 1994, an epidemic year. Dengue virus serotypes 1 (DEN-1), -2, and -4 were isolated each year, with DEN-2 predominating in 1995 and 1996, and DEN-4 in 1997. From 1995 through 1997 incidence was highest (0.61-0.77/1,000) in persons under 30 years of age; males and females were equally affected. Among positive cases, 28.3% to 37.9% were hospitalized; 28.9% to 35.2% had hemorrhagic manifestations; at least 1.1% to 1.6% fulfilled the criteria for dengue hemorrhagic fever/dengue shock syndrome; and 0.2% to 0.3% died. Neither hurricane preparations (1995) nor widespread floods (1996) seem to have affected dengue incidence. Most municipalities with the highest laboratory-diagnosed dengue rates in 1995 were in the eastern foothills of the central mountains, an area relatively spared by the 1994 epidemic. In the next two years, at least half of the municipalities with the highest laboratory-diagnosed dengue rates were in the west. The most intense municipal outbreak of this period (DEN-2, Villalba, 1995, rate of 11.67/1,000) is described to highlight the importance of local conditions and epidemiologic history in determining the risk of dengue.

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Section: Discussionmentioning

confidence: 99%

Dengue activity in Puerto Rico during an interepidemic period (1995-1997).

Rigau‐Pérez¹,

Ayala-López²,

Vorndam³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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“…In this manuscript, we describe a 3-year prospective study of AFI among all age groups that used a pre-defined diagnostic testing algorithm for DENV 1–4 and 21 other pathogens. We conducted this study in Puerto Rico, where malaria was eradicated in 1962 [ 19 ] and dengue has been endemic since the late 1960s [ 20 ]. We describe the frequency of dengue and other AFIs, and the distribution of these diseases in terms of person, place and seasonality.…”

Section: Introductionmentioning

confidence: 99%

Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012–2015

et al. 2017

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Identifying etiologies of acute febrile illnesses (AFI) is challenging due to non-specific presentation and limited availability of diagnostics. Prospective AFI studies provide a methodology to describe the syndrome by age and etiology, findings that can be used to develop case definitions and multiplexed diagnostics to optimize management. We conducted a 3-year prospective AFI study in Puerto Rico. Patients with fever ≤7 days were offered enrollment, and clinical data and specimens were collected at enrollment and upon discharge or follow-up. Blood and oro-nasopharyngeal specimens were tested by RT-PCR and immunodiagnostic methods for infection with dengue viruses (DENV) 1–4, chikungunya virus (CHIKV), influenza A and B viruses (FLU A/B), 12 other respiratory viruses (ORV), enterovirus, Leptospira spp., and Burkholderia pseudomallei. Clinical presentation and laboratory findings of participants infected with DENV were compared to those infected with CHIKV, FLU A/B, and ORV. Clinical predictors of laboratory-positive dengue compared to all other AFI etiologies were determined by age and day post-illness onset (DPO) at presentation. Of 8,996 participants enrolled from May 7, 2012 through May 6, 2015, more than half (54.8%, 4,930) had a pathogen detected. Pathogens most frequently detected were CHIKV (1,635, 18.2%), FLU A/B (1,074, 11.9%), DENV 1–4 (970, 10.8%), and ORV (904, 10.3%). Participants with DENV infection presented later and a higher proportion were hospitalized than those with other diagnoses (46.7% versus 27.3% with ORV, 18.8% with FLU A/B, and 11.2% with CHIKV). Predictors of dengue in participants presenting <3 DPO included leukopenia, thrombocytopenia, headache, eye pain, nausea, and dizziness, while negative predictors were irritability and rhinorrhea. Predictors of dengue in participants presenting 3–5 DPO were leukopenia, thrombocytopenia, facial/neck erythema, nausea, eye pain, signs of poor circulation, and diarrhea; presence of rhinorrhea, cough, and red conjunctiva predicted non-dengue AFI. By enrolling febrile patients at clinical presentation, we identified unbiased predictors of laboratory-positive dengue as compared to other common causes of AFI. These findings can be used to assist in early identification of dengue patients, as well as direct anticipatory guidance and timely initiation of correct clinical management.

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“…An islandwide case reporting system (later named the Passive Dengue Surveillance System [PDSS]) was established in 1969 to collect basic demographic and clinical data from patients with suspected dengue. By 1970, PDSS enabled detection of dengue cases in southwestern Puerto Rico during the dry season, providing further evidence that dengue was endemic ( 17 ); however, later reports questioned this finding ( 18 ). In 1973, CDC’s mission in Puerto Rico included studying dengue, assisting PRDH to operate PDSS, and identifying approaches to combat dengue.…”

Section: Evolution and Improvement Of Case Surveillancementioning

confidence: 99%

“…Surveillance in subsequent years demonstrated that detection of cases based solely on clinical signs and symptoms (i.e., syndromic surveillance) was insufficient to monitor dengue because clinicians were often unable to distinguish dengue from influenza, leptospirosis, rubella, and other common causes of acute febrile illness ( 9 , 18 ). In response, laboratory-based surveillance for dengue was initiated in 1974.…”

Section: Evolution and Improvement Of Case Surveillancementioning

confidence: 99%

Lessons Learned from Dengue Surveillance and Research, Puerto Rico, 1899–2013

Sharp¹,

Ryff²,

Santiago³

et al. 2019

Emerg. Infect. Dis.

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Dengue was first reported in Puerto Rico in 1899 and sporadically thereafter. Following outbreaks in 1963 and 1969, the Centers for Disease Control and Prevention has worked closely with the Puerto Rico Department of Health to monitor and reduce the public health burden of dengue. During that time, evolving epidemiologic scenarios have provided opportunities to establish, improve, and expand disease surveillance and interventional research projects. These initiatives have enriched the tools available to the global public health community to understand and combat dengue, including diagnostic tests, methods for disease and vector surveillance, and vector control techniques. Our review serves as a guide to organizations seeking to establish dengue surveillance and research programs by highlighting accomplishments, challenges, and lessons learned during more than a century of dengue surveillance and research conducted in Puerto Rico.

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Dengue Outbreaks in Guánica-Ensenada and Villalba, Puerto Rico, 1972–1973

Cited by 9 publications

References 0 publications

Dengue activity in Puerto Rico during an interepidemic period (1995-1997).

Dengue activity in Puerto Rico during an interepidemic period (1995-1997).

Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012–2015

Lessons Learned from Dengue Surveillance and Research, Puerto Rico, 1899–2013

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