The Nicaraguan Pediatric Dengue Cohort Study: Study Design, Methods, Use of Information Technology, and Extension to Other Infectious Diseases

Abstract

Dengue is a mosquito-borne viral disease that is a major public health problem worldwide. In 2004, the Pediatric Dengue Cohort Study was established in Managua, Nicaragua, to study the natural history and transmission of dengue in children. Here, the authors describe the study design, methods, and results from 2004 to 2008. Initially, 3,721 children 2–9 years of age were recruited through door-to-door visits. Each year, new children aged 2 years are enrolled in the study to maintain the age structure. Children are provided with medical care through the study, and data from each medical visit are recorded on systematic study forms. All participants presenting with suspected dengue or undifferentiated fever are tested for dengue by virologic, serologic, and molecular biologic assays. Yearly blood samples are collected to detect inapparent dengue virus infections. Numerous information and communications technologies are used to manage study data, track samples, and maintain quality control, including personal data assistants, barcodes, global information systems, and fingerprint scans. Close collaboration with the Nicaraguan Ministry of Health and use of almost entirely local staff are essential components for success. This study is providing critical data on the epidemiology and transmission of dengue in the Americas needed for future vaccine trials.

Serologic Imprint of Dengue Virus in Urban Haiti: Characterization of Humoral Immunity to Dengue in Infants and Young Children

“…A model for assessing the impact of dengue has recently been implemented in Nicaragua in children more than two years of age. 28,29 Such careful prospective, denominator-based, clinical studies are necessary to determine the extent of severe clinical disease associated with acquisition of dengue in infants and young children in Haiti. Studies will need to be coupled with active case surveillance, molecular-based diagnosis, detailed study of the vector, risk factors in the environment, and serial serologic determinations.…”

Index Cluster Study of Dengue Virus Infection in Nicaragua

“…The study was conducted within the Pediatric Dengue Cohort Study (PDCS), which is based at the HCSFV and has been on-going since August 2004. 5,10 In 2006 and 2007, the PDCS was composed of approximately 3,750 persons 2-12 years of age residing in District II. Active DENV infections were identified through enhanced passive surveillance by study physicians and nurses at the HCSFV and periodic home visits for follow-up.…”

“…Active DENV infections were identified through enhanced passive surveillance by study physicians and nurses at the HCSFV and periodic home visits for follow-up. 10 Participants were followed closely for all illnesses, and children who had fever were screened for signs and symptoms of dengue. Suspected dengue cases and cases of undifferentiated fever were tested for acute infection and followed-up closely while symptoms persisted.…”

Clinical Attack Rate of Chikungunya in a Cohort of Nicaraguan Children

“…13 In 2014, we included CHIKV testing in the PDCS to study the emergence of chikungunya. The PDCS consists of~3,500 children in Managua.…”