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

Sharp, Tyler M.; Ryff, Kyle; Santiago, Gilberto A.; Margolis, Harold S.; Waterman, Stephen H.

doi:10.3201/eid2508.190089

Cited by 21 publications

(54 citation statements)

References 38 publications

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“…In summary, Puerto Rico experienced a large ZIKV outbreak in 2016 in which~1% of residents were reported to public health authorities and had evidence of ZIKV infection. Fine scale analysis of the epidemiologic and spatiotemporal characteristics demonstrated that, in contrast to prior epidemics of dengue and chikungunya that began in the San Juan metropolitan area [11,12], ZIKV transmission was first detected in eastern Puerto Rico in late 2015 and rapidly spread to all municipalities of the island during 2016. As expected, geography, climate, community characteristics, and human factors all influenced the observed trends of ZIKV disease.…”

Section: Plos Neglected Tropical Diseasesmentioning

confidence: 99%

“…Surveillance for dengue has operated in the Caribbean U.S. territory of Puerto Rico since the 1960s [11] and was expanded to include chikungunya in 2014 [12]. Following detection of ZIKV transmission in the Americas in 2015 [13], Puerto Rico Department of Health (PRDH) initiated laboratory-based surveillance for ZIKV disease through the existing arboviral diseases surveillance system [14].…”

Section: Introductionmentioning

confidence: 99%

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Epidemiologic and spatiotemporal trends of Zika Virus disease during the 2016 epidemic in Puerto Rico

et al. 2020

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Background After Zika virus (ZIKV) emerged in the Americas, laboratory-based surveillance for arboviral diseases in Puerto Rico was adapted to include ZIKV disease. Methods and findings Suspected cases of arboviral disease reported to Puerto Rico Department of Health were tested for evidence of infection with Zika, dengue, and chikungunya viruses by RT-PCR and IgM ELISA. To describe spatiotemporal trends among confirmed ZIKV disease cases, we analyzed the relationship between municipality-level socio-demographic, climatic, and spatial factors, and both time to detection of the first ZIKV disease case and the midpoint of the outbreak. During November 2015-December 2016, a total of 71,618 suspected arboviral disease cases were reported, of which 39,717 (55.5%; 1.1 cases per 100 residents) tested positive for ZIKV infection. The epidemic peaked in August 2016, when 71.5% of arboviral disease cases reported weekly tested positive for ZIKV infection. Incidence of ZIKV disease was highest among 20-29-year-olds (1.6 cases per 100 residents), and most (62.3%) cases were female. The most frequently reported symptoms were rash (83.0%), headache (64.6%), and myalgia (63.3%). Few patients were hospitalized (1.2%), and 13 (<0.1%) died. Early detection of ZIKV disease cases was associated with increased population size (log hazard ratio [HR]:-0.22 [95% confidence interval-0.29,-0.14]), eastern longitude (log HR:-1.04 [-1.17,-0.91]), and proximity to a city (spline estimated degrees of freedom [edf] = 2.0). Earlier midpoints of the outbreak were associated with northern latitude (log HR:-0.30 [-0.32,-0.29]), eastern longitude (spline edf = 6.5), and higher mean monthly temperature PLOS NEGLECTED TROPICAL DISEASES

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Section: Plos Neglected Tropical Diseasesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Epidemiologic and spatiotemporal trends of Zika Virus disease during the 2016 epidemic in Puerto Rico

et al. 2020

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“…Of note, during the study period, DENV-1 and DENV-4 were the main circulating serotypes in Puerto Rico. 12 Although none of the study participants was clinically diagnosed with a Zika virus infection, Y3 coincided with a Zika virus epidemic in Puerto Rico in 2016. 13 Cross-reactivity between antibodies to Zika virus and DENV has previously been reported 14,15 and is likely due to substantial similarity in the sequence type of surface glycoprotein E. 16 Based on these results, the 1 μg+AS03 B formulation administered according to different dose schedules was assessed in a subsequent clinical trial (NCT02421367; L. Lin et al, unpublished data).…”

Section: Discussionmentioning

confidence: 96%

Safety and Immunogenicity of Different Formulations of a Tetravalent Dengue Purified Inactivated Vaccine in Healthy Adults from Puerto Rico: Final Results after 3 Years of Follow-Up from a Randomized, Placebo-Controlled Phase I Study

Díaz

Koren

Lin

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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Four formulations of an investigational tetravalent dengue purified inactivated vaccine, administered as two doses one month (M) apart, were previously shown to be immunogenic and well-tolerated up to M13 of the phase I study NCT01702857. Here, we report results of the follow-up from M14 to year (Y) 3. One hundred healthy Puerto Rican adults, predominantly dengue virus (DENV)-primed, were randomized 1:1:1:1:1 to receive placebo or vaccine formulations: 1 μg/serotype/dose adjuvanted with aluminum, AS01 E or AS03 B , or aluminum-adjuvanted 4 μg/serotype/ dose. No serious adverse events occurred. Two medically-attended potential immune-mediated disease cases, vaccination unrelated, were reported (groups 1 μg+Alum and 1 μg+AS03 B ). Of 14 instances of suspected dengue, none were laboratory confirmed. Geometric mean neutralizing antibody titers against DENV 1-4 waned from M14, but remained above pre-vaccination levels for DENV 1-3, with the highest values for group 1 μg+AS03

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“…The outbreak tells us early detection and diagnosis of cases is key to controlling the spread of an epidemic; timely and effective mosquito control in the early stage of epidemic is another key measure. Thus, during the epidemic period of dengue, more proactive countermeasures must be taken such as intensifying surveillance for dengue cases, virus, and the vector Aedes ; strengthening the cooperation with customs and tourism departments to yield close partnerships that will be integral components of successful public health initiatives to combat dengue ( 6 ); and improving the capacity of medical institutions to promptly detect and diagnosis dengue cases. Through early warning and coordination, we can detect the spread of dengue-fever.…”

Section: Discussionmentioning

confidence: 99%

“…The prompt diagnosis and management of cases are key measures in controlling the spread of the outbreak, and the clinical manifestations of dengue were closely related to the diagnosis, so that correct understanding and analysis of clinical symptoms, combined with investigations of the epidemiological history, are helpful to improve the efficiency of diagnosis and treatment (4)(5). By investigating and analyzing the median onset-to-diagnosis interval in this outbreak, we found that enhancing the ability of medical faculty to quickly detect and diagnose dengue cases is highly needed.…”

Section: Discussionmentioning

confidence: 99%

An Outbreak of Dengue Virus Type 1 — Jiangxi Province, China, 2019

et al. 2020

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What is known about this topic? Dengue fever is an acute febrile illness caused by four types of dengue virus (DENV 1–4), and is a mosquito-borne infectious disease. The incidence of dengue has increased dramatically around the world in recent decades. An estimated of 3.9 billion people in 128 countries are at risk of infection with dengue viruses, 70% of whom are in Asia. In 2017, the first local infections of dengue virus (DENV-2) in Jiangxi Province was reported in Zhanggong District, Ganzhou City. What is added by this report? From August to September 2019, the first dengue outbreak happened in Xin’gan County, where 81 local dengue fever cases were reported, 35 were laboratory-confirmed cases, and 46 were clinically-diagnosed cases; all cases were dengue virus type 1. The DENV-virus strains isolated from the cases of Xin’gan County were close to the strains isolated in Singapore (MF033254|25657|Singapore|2016) and Henan (MK905537|Henan201903|China: Henan Province|2019). What are the implications for public health practice? The outbreak might have been caused by imported cases or covert infections. The outbreak in Xin’gan County indicated that more proactive countermeasures should be taken during the dengue epidemic period such as intensifying surveillance for dengue cases, virus serotype, and Aedes vector density and strengthening cooperation with customs and tourism departments. Moreover, the outbreak should prompt training in medical institutions and improved ability for doctor’s to diagnose dengue fever, which is very important for early detection of dengue cases and taking preventive measures.

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

Cited by 21 publications

References 38 publications

Epidemiologic and spatiotemporal trends of Zika Virus disease during the 2016 epidemic in Puerto Rico

Epidemiologic and spatiotemporal trends of Zika Virus disease during the 2016 epidemic in Puerto Rico

Safety and Immunogenicity of Different Formulations of a Tetravalent Dengue Purified Inactivated Vaccine in Healthy Adults from Puerto Rico: Final Results after 3 Years of Follow-Up from a Randomized, Placebo-Controlled Phase I Study

An Outbreak of Dengue Virus Type 1 — Jiangxi Province, China, 2019

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