Abstract
BackgroundDengue is a potentially fatal acute febrile illness (AFI) caused by four mosquito-transmitted dengue viruses (DENV-1–4) that are endemic in Puerto Rico. In January 2010, the number of suspected dengue cases reported to the passive dengue surveillance system exceeded the epidemic threshold and an epidemic was declared soon after.Methodology/Principal FindingsTo characterize the epidemic, surveillance and laboratory diagnostic data were compiled. A suspected case was a dengue-like AFI in a person reported by a health care provider with or without a specimen submitted for diagnostic testing. Laboratory-positive cases had: (i) DENV nucleic acid detected by reverse transcriptase-polymerase chain reaction (RT-PCR) in an acute serum specimen; (ii) anti-DENV IgM antibody detected by ELISA in any serum specimen; or (iii) DENV antigen or nucleic acid detected in an autopsy-tissue specimen. In 2010, a total of 26,766 suspected dengue cases (7.2 per 1,000 residents) were identified, of which 46.6% were laboratory-positive. Of 7,426 RT-PCR-positive specimens, DENV-1 (69.0%) and DENV-4 (23.6%) were detected more frequently than DENV-2 (7.3%) and DENV-3 (<0.1%). Nearly half (47.1%) of all laboratory-positive cases were adults, 49.7% had dengue with warning signs, 11.1% had severe dengue, and 40 died. Approximately 21% of cases were primary DENV infections, and 1–4 year olds were the only age group for which primary infection was more common than secondary. Individuals infected with DENV-1 were 4.2 (95% confidence interval [CI]: 1.7–9.8) and 4.0 (95% CI: 2.4–6.5) times more likely to have primary infection than those infected with DENV-2 or -4, respectively.Conclusions/SignificanceThis epidemic was long in duration and yielded the highest incidence of reported dengue cases and deaths since surveillance began in Puerto Rico in the late 1960's. This epidemic re-emphasizes the need for more effective primary prevention interventions to reduce the morbidity and mortality of dengue.
Highlights
Dengue virus (DENV) transmission is endemic throughout most of the tropics and sub-tropics and is estimated to result in,50 million symptomatic infections and,20,000 deaths each year [1,2]
Of all suspected dengue cases, 25,852 (96.6%) had a specimen tested for evidence of DENV infection, of which 25,246 (97.7%) were tested by CDC-DB and the remainder by a private laboratory; paired specimens were available for 1,996 (7.5%) cases
In 2010, Puerto Rico experienced the largest and longest dengue epidemic ever documented on the island
Summary
Dengue virus (DENV) transmission is endemic throughout most of the tropics and sub-tropics and is estimated to result in ,50 million symptomatic infections and ,20,000 deaths each year [1,2]. Infection with any DENV can result in dengue, an illness characterized by fever, headache, retro-orbital eye pain, myalgia and rash [2]. Severe dengue is more common upon secondary infection [2,7] and may be affected by the order in which an individual is infected with the respective DENV-types [2,8]. Increases in the force of DENV infection can result in a decrease in the age of primary and secondary infection [2]. Both local patterns of circulation of the four DENV-types and force of infection can influence the age groups most affected by dengue and severe dengue. In January 2010, the number of suspected dengue cases reported to the passive dengue surveillance system exceeded the epidemic threshold and an epidemic was declared soon after
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