Enhanced Surveillance for Fatal Dengue-Like Acute Febrile Illness in Puerto Rico, 2010-2012

Tomashek, Kay M.; Rivera, Aidsa; Torres-Velásquez, Brenda; Hunsperger, Elizabeth; Muñoz‐Jordán, Jorge L.; Sharp, Tyler M.; Rivera, Irma Nelly Gutierrez; Sanabria, Dario; Blau, Dianna M.; Galloway, Renee L.; Torres, José V.; Rodriguez, R. M.; Serrano, J; Chavez, Carlos M.; Dávila, Francisco; Pérez-Padilla, Janice; Ellis, Esther M.; Caballero, G. Christina; Wright, L.B.; Zaki, Sherif R.; Deseda, Carmen; Rodriguez, Edda; Margolis, Harold S.

doi:10.1371/journal.pntd.0005025

Cited by 21 publications

(15 citation statements)

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“…Both phases of the disease often overlap and are predicated upon the immune status of the host, and the virulence of the infecting Leptospira sp. The biphasic nature of the illness and its broad manifestations resembling other febrile illness such as dengue fever pose significant diagnostic challenges in humans [ 13 ]. Clinical presentations resembling febrile illness followed by the complications characterised by hepatic and renal abnormalities may be seen in canine patients.…”

Section: Discussionmentioning

confidence: 99%

Isolation and characterization of Leptospira interrogans serovar Copenhageni from a dog from Saint Kitts

et al. 2017

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Introduction. Leptospirosis is a zoonotic bacterial disease of global distribution affecting humans and animals. The initial phase of leptospirosis resembles many other febrile illness and due to its broad and biphasic clinical manifestations, selection and implementation of appropriate diagnostic tests can be challenging. Case presentation. This report describes a case investigation of a 14 weeks old male, orphan puppy, presented with generalised jaundice, anemia, weakness, and anorexia. Clinical abnormalities included the evidence of renal and hepatic failure. Antemortem and postmortem diagnostic investigations were conducted to identify the cause of illness. PCR testing and culture of blood was positive for Leptospira sp. Necropsy followed by histopathology evaluation revealed lesions compatible with liver and kidney damage consisting of marked diffuse hepatocellular dissociation, acute renal tubular necrosis, and mild interstitial nephritis. Conclusion. Multiple diagnostic techniques including bacterial isolation confirmed Leptospira infection in this puppy. Whole genome sequencing and analysis identified the Leptospira sp. isolated from this puppy as Leptospira interrogans serovar Copenhageni. To our knowledge, this case report describes the first isolation of Leptospira from Saint Kitts. This case highlights the usefulness of including multiple diagnostic tests for the diagnosis and epidemiological investigation of Leptospira infection. Accurate diagnosis followed by timely intervention can prevent case fatality and mortality in infected patients.

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Section: Discussionmentioning

confidence: 99%

Isolation and characterization of Leptospira interrogans serovar Copenhageni from a dog from Saint Kitts

et al. 2017

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“…Interestingly, our inpatient estimate is comparable with a multiplier found for laboratory-positive dengue deaths in Puerto Rico found using an enhanced surveillance system. In that study [ 32 ] the mortality rate was 2–3 times higher than detected previously under the passive surveillance system. One would expect fatal cases to be more readily identifiable and reported than for inpatient dengue cases.…”

Section: Discussionmentioning

confidence: 85%

Estimating dengue under-reporting in Puerto Rico using a multiplier model

et al. 2018

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Dengue is a mosquito-borne viral illness that causes a variety of health outcomes, from a mild acute febrile illness to potentially fatal severe dengue. Between 2005 and 2010, the annual number of suspected dengue cases reported to the Passive Dengue Surveillance System (PDSS) in Puerto Rico ranged from 2,346 in 2006 to 22,496 in 2010. Like other passive surveillance systems, PDSS is subject to under-reporting. To estimate the degree of under-reporting in Puerto Rico, we built separate inpatient and outpatient probability-based multiplier models, using data from two different surveillance systems—PDSS and the enhanced dengue surveillance system (EDSS). We adjusted reported cases to account for sensitivity of diagnostic tests, specimens with indeterminate results, and differences between PDSS and EDSS in numbers of reported dengue cases. In addition, for outpatients, we adjusted for the fact that less than 100% of medical providers submit diagnostic specimens from suspected cases. We estimated that a multiplication factor of between 5 (for 2010 data) to 9 (for 2006 data) must be used to correct for the under-reporting of the number of laboratory-positive dengue inpatients. Multiplication factors of between 21 (for 2010 data) to 115 (for 2008 data) must be used to correct for the under-reporting of laboratory-positive dengue outpatients. We also estimated that, after correcting for underreporting, the mean annual rate, for 2005–2010, of medically attended dengue in Puerto Rico to be between 2.1 (for dengue inpatients) to 7.8 (for dengue outpatients) per 1,000 population. These estimated rates compare to the reported rates of 0.4 (dengue outpatients) to 0.1 (dengue inpatients) per 1,000 population. The multipliers, while subject to limitations, will help public health officials correct for underreporting of dengue cases, and thus better evaluate the cost-and-benefits of possible interventions.

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“…This lower CFR maybe due to several factors including easier access to health care, effective mosquito control, water storage practices, host population genetics, vector biology, geophysical factors and other socioeconomic differences [49,51,64]. Fatal dengue cases did occur during the study period reviewed but these were likely underestimated as the reliance on passive case reporting and/or review of death certificates can fail to identify fatal cases due to misdiagnosis [71][72][73][74][75][76]. No gender bias exists in Barbados for DHF/SD as in other countries since males (n = 35) were as likely as females (n = 38) to be infected with DENV and develop DHF or SD during the study period [55].…”

Section: Dengue Disease Severitymentioning

confidence: 99%

Dengue Fever and Severe Dengue in Barbados, 2008–2016

et al. 2020

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Analysis of the temporal, seasonal and demographic distribution of dengue virus (DENV) infections in Barbados was conducted using national surveillance data from a total of 3994 confirmed dengue cases. Diagnosis was confirmed either by DENV-specific real time reverse transcriptase polymerase chain reaction (rRT-PCR), or non-structural protein 1 (NS1) antigen or enzyme linked immunosorbent assay (ELISA) tests; a case fatality rate of 0.4% (10/3994) was observed. The prevalence rate of dengue fever (DF) varied from 27.5 to 453.9 cases per 100,000 population among febrile patients who sought medical attention annually. DF cases occurred throughout the year with low level of transmission observed during the dry season (December to June), then increased transmission during rainy season (July to November) peaking in October. Three major dengue epidemics occurred in Barbados during 2010, 2013 and possibly 2016 with an emerging three-year interval. DF prevalence rate among febrile patients who sought medical attention overall was highest among the 10-19 years old age group. The highest DF hospitalisation prevalence rate was observed in 2013. Multiple serotypes circulated during the study period and Dengue virus serotype 2 (DENV-2) was the most prevalent serotype during 2010, whilst DENV-1 was the most prevalent serotype in 2013. Two DENV-1 strains from the 2013 DENV epidemic were genetically more closely related to South East Asian strains, than Caribbean or South American strains, and represent the first ever sequencing of DENV strains in Barbados. However, the small sample size (n = 2) limits any meaningful conclusions. DF prevalence rates were not significantly different between females and males. Public health planning should consider DENV inter-epidemic periodicity, the current COVID-19 pandemic and similar clinical symptomology between DF and COVID-19. The implementation of routine sequencing of DENV strains to obtain critical data can aid in battling DENV epidemics in Barbados.

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Enhanced Surveillance for Fatal Dengue-Like Acute Febrile Illness in Puerto Rico, 2010-2012

Cited by 21 publications

References 47 publications

Isolation and characterization of Leptospira interrogans serovar Copenhageni from a dog from Saint Kitts

Isolation and characterization of Leptospira interrogans serovar Copenhageni from a dog from Saint Kitts

Estimating dengue under-reporting in Puerto Rico using a multiplier model

Dengue Fever and Severe Dengue in Barbados, 2008–2016

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