Abstract
BackgroundDengue fever is a major public health problem in Colombia. A fever surveillance study was conducted for evaluation of the clinical, epidemiological, and molecular patterns of dengue, prior to Chikungunya and Zika epidemics.MethodsIn November 2011–February 2014, a passive facility-based surveillance was implemented in Santa Cruz Hospital, Medellin, and enrolled eligible febrile patients between 1 and 65 years-of-age. Acute and convalescent blood samples were collected 10–21 days apart and tested for dengue using IgM/IgG ELISA. RNA was extracted for serotyping using RT-PCR on acute samples and genotyping was performed by sequencing.ResultsAmong 537 febrile patients enrolled during the study period, 29% (n = 155) were identified to be dengue-positive. Only 7% of dengue cases were hospitalized, but dengue-positive patients were 2.6 times more likely to be hospitalized, compared to non-dengue cases, based on a logistic regression. From those tested with RT-PCR (n = 173), 17 were dengue-confirmed based on PCR and/or virus isolation showing mostly DENV-3 (n = 9) and DENV-4 (n = 7) with 1 DENV-1. Genotyping results showed that: DENV-1 isolate belongs to the genotype V or American/African genotype; DENV-3 isolates belong to genotype III; and DENV-4 isolates belong to the II genotype and specifically to the IIb sub-genotype or linage.ConclusionsOur surveillance documented considerable dengue burden in Santa Cruz comuna during non-epidemic years, and genetic diversity of circulating DENV isolates, captured prior to Chikungunya epidemic in 2014 and Zika epidemic in 2015. Our study findings underscore the need for continued surveillance and monitoring of dengue and other arboviruses and serve as epidemiological and molecular evidence base for future studies to assess changes in DENV transmission in Medellin, given emerging and re-emerging arboviral diseases in the region.
Highlights
Dengue fever is a major public health problem in Colombia
In Colombia, dengue is hyper-endemic with circulation of all four serotypes, and there has been a significant increase in the number of cases of dengue fever (DF)/severe dengue in the last 10 years, with epidemics occurring every 3–4 years [1, 6]
Among 1342 febrile patients screened for study participation during the 28-month study period, 664 patients were eligible and 579 patients agreed to participate in the study (Fig. 3)
Summary
Dengue fever is a major public health problem in Colombia. Dengue infection, caused by dengue viruses (DENV 1–4) and transmitted by Aedes mosquitoes, is a major public health problem in tropical and sub-tropical countries, including Colombia [1]. Pasteur) was licensed in multiple countries in Asia and Latin America. This vaccine has variable efficacy and has a restricted indication in dengue-exposed subjects only from 9 years and above, due to increased risk of severe dengue in seronegative subjects [4, 5]. Colombia experienced an outbreak in 2016 with 103,822 dengue cases reported [7] since a peak observed in 2013 with 65,464 lab-confirmed cases among 127,000 clinical cases [8]
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