Abstract
BackgroundIn the context of a rapid increase of dengue cases in the Americas, a monitoring system based on systematic serological control (IgM) of patients consulting for suspected dengue was developed in Bolivia at the end of the 1990s. In the most affected city of Santa Cruz, this system was complemented by an entomological surveillance program based on periodical search for immature stages of Aedes aegypti in dwelling water-holding containers. Here, we analyze these data and describe dengue patterns over 6 years (2002–2008), highlighting the spatial distribution of patients and vectors.Methodology /Principal FindingsData mining concerned six annual epidemic cycles (2002–2008), with continuous serological and clinical results and entomological data from 16 surveys, examined at the scales of 36 urban areas and four concentric areas covering the entire city. Annual incidence varied from 0.28‰ to 0.95‰; overall incidence was higher in women and adults, and dengue dynamics followed successive periods of high (January–June) and low (July–December) transmission. Lower numbers of cases from the city center to the periphery were observed, poorly related to the more homogeneous and permanent distribution of A. aegypti. "Plant pots" were a major vector source in the city center, and "Tires" and "Odds and ends" beyond the second ring of the city.Conclusions/SignificanceOver the years, the increasing trend of dengue cases has been highlighted as well as its widespread distribution over the entire city, but an underestimation of the number of cases is strongly suspected. Contrary to popular belief, the city center appears more affected than the periphery, and dengue is not particularly related to waste. Interestingly, the clinical diagnosis of dengue by physicians improved over the years, whatever the gender, age and residential area of suspected cases.
Highlights
Dengue is currently considered the most common arthropod-borne viral infection in the world, emerging or already spreading in most tropical and subtropical countries, with 50–100 million infections annually and over half of the world population at risk
In Bolivia, dengue fever was mentioned for the first time in 1931 [3], but well-documented cases during the 1990s appeared with the isolation of DEN-1 and DEN-2 viruses [4,5,6], followed by DEN-3 at the beginning of the 2000s [3]
The Andean part of the country has remained unaffected by dengue, whereas cases are regularly reported in the Bolivian Orient, mostly in the Santa Cruz department
Summary
Dengue is currently considered the most common arthropod-borne viral infection in the world, emerging or already spreading in most tropical and subtropical countries, with 50–100 million infections annually and over half of the world population at risk The Andean part of the country has remained unaffected by dengue, whereas cases are regularly reported in the Bolivian Orient, mostly in the Santa Cruz department. According to the statistics of the Bolivian Ministry of Health and Sports In the most affected city of Santa Cruz, this system was complemented by an entomological surveillance program based on periodical search for immature stages of Aedes aegypti in dwelling water-holding containers. We analyze these data and describe dengue patterns over 6 years (2002–2008), highlighting the spatial distribution of patients and vectors.
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