Dengue In Colombia Research Articles

The Epidemiological Impact of Dengue in Colombia: A Systematic Review.

Dengue is the most important viral vector-borne disease in the tropics, with Colombia being one of the most affected countries. In this context, it is essential to identify and synthesize the existing evidence on the epidemiology of dengue in Colombia. A systematic review (PROSPERO CRD42021257985) was conducted by searching for epidemiological data in populations with suspected or confirmed dengue in Colombia from 2012 to 2020. We searched PubMed, EMBASE, the Cochrane Library, the LILACS, and SciELO databases, and 104 publications out of 1,234 records were selected. The dengue annual incidence rate varied through the years without a clear trend. The lowest annual incidence rate was observed in 2017 (90.7 per 100,000 population) and the highest in 2013 (476.2 per 100,000 population). The proportion of severe cases in the same period ranged between 0.89% in 2016 and 2.7% in 2012. The four dengue virus (DENV) serotypes co-circulated in the country, and DENV-2 was the predominant serotype. Fifty percent of dengue cases occurred in people under 20 years, and those between 5 and 14 years had the highest incidence rate. The mortality rate for all dengue cases ranged from 0.07% in 2020 to 0.16% in 2012 and 2015. In conclusion, dengue is a hyperendemic disease in Colombia with the circulation of four serotypes. New strategies must be implemented to prevent the contagion and impact of the disease on the population at risk.

Dengue Outbreak Caused by Multiple Virus Serotypes and Lineages, Colombia, 2023-2024.

Dengue cases rose to record levels during 2023-2024. We investigated dengue in Valle del Cauca, Colombia, to determine if specific virus serotypes or lineages caused its large outbreak. We detected all 4 serotypes and multiple lineages, suggesting that factors such as climatic conditions were likely responsible for increased dengue in Colombia.

ColDengue: A novel surveillance and control tool for Aedes aegypti

In view of the high epidemiological and economic impact of urban arboviruses associated with A. aegyptii (A-ae) in tropical countries, WHO within the 2030 agenda for Sustainable Development, highlights the need for new alternatives to control and eliminate those diseases. In response to this call, we proposed the ColDengue as a new tool of surveillance and vector control for A-ae. It is a tool operated manually and by sweeping in breeding sites. This tool was calibrated in laboratory showing effectiveness rate between 41.0 - 62.9% for larvae removal and 62.9 - 91.3% for pupae. Later ColDengue was applied in houses of Villavicencio, a hyperendemic city for dengue in Colombia. During six and eight interventions in two different neighborhoods, trials with intervals of 7 to 10 days; 10,522 larvae and 1,950 pupae of A-ae were eliminated. ColDengue in addition to responding to the traditional aedic index too allows determining the productivity of the breeding sites and the spatial-temporal dynamics for the pest mosquito. The tool presented acceptability and community adhesion above 90.0%, is fiscally sustainable (<3 USD unit), has a useful life until 6 months (with weekly use); is eco-friendly, can be used by all members of the community and is a resilient climate change strategy. Therefore, we suggest that ColDengue can be incorporated as a regular action of the health surveillance and vector control programs for urban arboviruses in Colombia and other countries of the world where domestic artificial water containers are productive for A. aegypti.

Prevention and control of dengue and chikungunya in Colombia: A cost-effectiveness analysis

BackgroundChikungunya and dengue are emerging diseases that have caused large outbreaks in various regions of the world. Both are both spread by Aedes aegypti and Aedes albopictus mosquitos. We developed a dynamic transmission model of chikungunya and dengue, calibrated to data from Colombia (June 2014 –December 2017).Methodology/Principal findingsWe evaluated the health benefits and cost-effectiveness of residual insecticide treatment, long-lasting insecticide-treated nets, routine dengue vaccination for children aged 9, catchup vaccination for individuals aged 10–19 or 10–29, and portfolios of these interventions. Model calibration resulted in 300 realistic transmission parameters sets that produced close matches to disease-specific incidence and deaths. Insecticide was the preferred intervention and was cost-effective. Insecticide averted an estimated 95 chikungunya cases and 114 dengue cases per 100,000 people, 61 deaths, and 4,523 disability-adjusted life years (DALYs). In sensitivity analysis, strategies that included dengue vaccination were cost-effective only when the vaccine cost was 14% of the current price.Conclusions/SignificanceInsecticide to prevent chikungunya and dengue in Colombia could generate significant health benefits and be cost-effective. Because of limits on diagnostic accuracy and vaccine efficacy, the cost of dengue testing and vaccination must decrease dramatically for such vaccination to be cost-effective in Colombia. The vectors for chikungunya and dengue have recently spread to new regions, highlighting the importance of understanding the effectiveness and cost-effectiveness of policies aimed at preventing these diseases.

Spatiotemporal dynamics of dengue in Colombia in relation to the combined effects of local climate and ENSO

Dengue virus (DENV) is an endemic disease in the hot and humid low-lands of Colombia. We characterize the association of monthly series of dengue cases with indices of El Niño/Southern Oscillation (ENSO) at the tropical Pacific and local climatic variables in Colombia during the period 2007-2017 at different temporal and spatial scales. For estimation purposes, we use lagged cross-correlations (Pearson test), cross-wavelet analysis (wavelet cross spectrum, and wavelet coherence), as well as a novel nonlinear causality method, PCMCI, that allows identifying common causal drivers and links among high dimensional simultaneous and time-lagged variables. Our results evidence the strong association of DENV cases in Colombia with ENSO indices and with local temperature and rainfall. El Niño (La Niña) phenomenon is related to an increase (decrease) of dengue cases nationally and in most regions and departments, with maximum correlations occurring at shorter time lags in the Pacific and Andes regions, closer to the Pacific Ocean. This association is mainly explained by the ENSO-driven increase in temperature and decrease in rainfall, especially in the Andes and Pacific regions. The influence of ENSO is not stationary, given the reduction of DENV cases since 2005, and that local climate variables vary in space and time, which prevents to extrapolate results from one region to another. The association between DENV and ENSO varies at national and regional scales when data are disaggregated by seasons, being stronger in DJF and weaker in SON. Overall, the Pacific and Andes regions control the relationship between dengue dynamics and ENSO at national scale. Cross-wavelet analysis indicates that the ENSO-DENV relation in Colombia exhibits a strong coherence in the 12 to 16-months frequency band, which implies the frequency locking between the annual cycle and the interannual (ENSO) timescales. Results of nonlinear causality metrics reveal the complex concomitant effects of ENSO and local climate variables, while offering new insights to develop early warning systems for DENV in Colombia.

Dengue Infections in Colombia: Epidemiological Trends of a Hyperendemic Country.

Dengue is a major public health problem in hyperendemic countries like Colombia, the understanding of the epidemiological trends is important for the development of efficient public health policies. We conducted a systematic review of the epidemiologic data on dengue in Colombia from 1971 to 2020. A total of 375 relevant citations were identified, 36 of which fulfilled the inclusion criteria. The data of dengue and severe dengue cases, infection fatality rate, and serotype distribution were used to understand and identify gaps in the epidemiological knowledge in Colombia. The epidemiology of dengue in this country was characterized by five main outbreaks in 1998, 2002, 2010, 2013, and 2019 with high fatality rates in comparison with the average values reported in the Americas. The case fatality rate of severe dengue exceeded 2% and all four serotypes co-circulate throughout the country with some regional variations. Overall, the behavior of dengue in Colombia is influenced by multiple factors including seasonal temperature variation and socioeconomic conditions. Additionally, the most important barriers in the epidemiological surveillance of dengue may be due to the insufficient notification rate in some regions and the low active search for the circulation of different serotypes.

Barriers that limit the implementation of thermal fogging for the control of dengue in Colombia: a study of mixed methods

BackgroundThermal fogging of Insecticides is a vector control strategy used by the Medellin Secretary of Health to combat dengue. This method is employed during outbreaks to curb populations of potentially infectious adult mosquitoes and interrupt transmission cycles. While this strategy has been used in Medellin since 2007, in some years it has not reduced dengue cases as expected. Difficulties in the implementation of fumigation strategies, such as lack of opportunity for treatment and public perception may be factors that limit its utility. The objective of this study was to identify barriers that hinder the implementation of thermal fogging, as well as attitudes and beliefs that prevent its acceptance.MethodsWe used a cross-sectional observational study of mixed methods carried out in neighborhoods prioritized for fumigation treatment in Medellin, Colombia. First, we assessed the timeliness of treatment by determining the latency period between reported dengue cases and the implementation of fumigation in response to those cases. Next, we administered structured questionnaires to residents in the area of fumigation treatments (n = 4455 homes) to quantify acceptance and rejection, as well as factors associated with rejection.ResultsThe median time between notification and treatment was 25 days (IQR 20.0–36.5). Fumigators were only able to treat 53.7% of total households scheduled for treatment; 9.6% rejected treatment, and treatment teams were unable to fumigate the remaining 36.7% of homes due to absent residents, no adults being present, and other reasons. The most frequent causes for rejection were residents being busy at the time of treatment (33.1%) and no interest in the treatment (24.5%). Other reasons for rejection include the perceptions that fumigation does not control pests other than mosquitoes (4.3%), that no mosquitoes were present in the home (3.3%), and that fumigation affects human health (3.1%).ConclusionsThe high percentage of houses where it was not possible to perform fumigation limits control of the vector. Future strategies should consider more flexible treatment schedules and incorporate informational messages to educate residents about the safety and importance of treatment.

Evolutionary history and spatio-temporal dynamics of dengue virus serotypes in an endemic region of Colombia.

Dengue is a prevalent disease in Colombia and all dengue virus serotypes (DENV-1 to -4) co-circulate in the country since 2001. However, the relative impact of gene flow and local diversification on epidemic dynamics is unknown due to heterogeneous sampling and lack of sufficient genetic data. The region of Santander is one of the areas with the highest incidence of dengue in Colombia. To provide a better understanding of the epidemiology of dengue, we inferred DENV population dynamics using samples collected between 1998 and 2015. We used Bayesian phylogenetic analysis and included 143 new envelope gene sequences from Colombia, mainly from the region of Santander, and 235 published sequences from representative countries in the Americas. We documented one single genotype for each serotype but multiple introductions. Whereas the majority of DENV-1, DENV-2, and DENV-4 strains fell into one single lineage, DENV-3 strains fell into two distinct lineages that co-circulated. The inferred times to the most recent common ancestors for the most recent clades of DENV-1, DENV-2, and DENV-4 fell between 1977 and 1987, and for DENV-3 was around 1995. Demographic reconstructions suggested a gradual increase in viral diversity over time. A phylogeographical analysis underscored that Colombia mainly receives viral lineages and a significant diffusion route between Colombia and Venezuela. Our findings contribute to a better understanding of the viral diversity and dengue epidemiology in Colombia.

Dengue mortality in Colombia, 1985-2012.

Dengue in Colombia is an important public health problem due to the huge economic and social costs it has caused, especially during the disease outbreaks. To describe the behavior of dengue mortality in Colombia between 1985 and 2012. We conducted a descriptive study. Information was obtained from mortality and population projection databases provided by the Departamento Administrativo Nacional de Estadística (DANE) for the 1985-2012 period. Mortality rates, rate ratios, and case fatality rates were estimated. A total of 1,990 dengue deaths were registered during this period in Colombia. Dengue mortality rates presented an increasing trend with statistical significance between 1985 and 1998. Higher mortality rates were reported in men both younger than 5 years and older than 65 years. Between 1995 and 2012, category 1 to 4 municipalities reported the highest mortality rates. Case fatality rates varied during the period between 0.01% and 0.39%. Dengue is an avoidable disease that should disappear from mortality statistics as a cause of death. The event is avoidable if the proposed activities from the Estrategia de Gestión Integrada (EGI)-Dengue are implemented and evaluated. We recommend encouraging the development of an informational culture to contribute to decision making and prioritizing resource allocation.

Ross-Macdonald: A model for the dengue dynamic in Cali, Colombia

Dengue is an infection transmitted by mosquitoes and is present in all tropical and subtropical regions of the planet. In recent years, the transmission of the disease has increased, predominantly in urban and semi-urban areas, and has become an important public health problem. The National Health Institute (Instituto Nacional de Salud-INS) determined Cali to be the municipality with the most cases of dengue in Colombia. According to the INS, up to epidemiological week 18 (April 28 to May 4, 2013) 5 134 cases of dengue -and 171 cases of severe dengue- have been reported. This study presents a description of the Ross-Macdonald model, and qualitative analysis of this model, and an analysis of the sensitivity of the model to changes in its parameters. Based on the adjustment of the model obtained for cases that occurred in 2010, simulations of possible scenarios of epidemic outbreaks in the city of Cali are created and analyzed.

Host biomarkers are associated with progression to dengue haemorrhagic fever: a nested case-control study

ObjectivesDengue represents the most important arboviral infection worldwide. Onset of circulatory collapse can be unpredictable. Biomarkers that can identify individuals at risk of plasma leakage may facilitate better triage and clinical management. DesignUsing a nested case-control design, we randomly selected subjects from a prospective cohort study of dengue in Colombia (n=1582). Using serum collected within 96hours of fever onset, we tested 19 biomarkers by ELISA in cases (developed dengue hemorrhagic fever or dengue shock syndrome (DHF/DSS); n=46), and controls (uncomplicated dengue fever (DF); n=65) and healthy controls (HC); n=15. ResultsAng-1 levels were lower and angptl3, sKDR, sEng, sICAM-1, CRP, CXCL10/IP-10, IL-18 binding protein, CHI3L1, C5a and Factor D levels were increased in dengue compared to HC. sICAM-1, sEng and CXCL10/IP-10 were further elevated in subjects who subsequently developed DHF/DSS (p=0.008, p=0.028 and p=0.025, respectively). In a logistic regression model, age (odds ratio (OR) (95% CI): 0.95 (0.92-0.98), p=0.001), hyperesthesia/hyperalgesia (OR; 3.8 (1.4-10.4), p=0.008) and elevated sICAM-1 (>298ng/mL: OR; 6.3 (1.5-25.7), p=0.011) at presentation were independently associated with progression to DHF/DSS. ConclusionsThese results suggest that inflammation and endothelial activation are important pathways in the pathogenesis of dengue and sICAM-1 levels may identify individuals at risk of plasma leakage.

National spatial and temporal patterns of notified dengue cases, Colombia 2007-2010.

To explore the variation in the spatial distribution of notified dengue cases in Colombia from January 2007 to December 2010 and examine associations between the disease and selected environmental risk factors. Data on the number of notified dengue cases in Colombia were obtained from the National Institute of Health (Instituto Nacional de Salud - INS) for the period 1 January 2007 through 31 December 2010. Data on environmental factors were collected from the Worldclim website. A Bayesian spatio-temporal conditional autoregressive model was used to quantify the relationship between monthly dengue cases and temperature, precipitation and elevation. Monthly dengue counts decreased by 18% (95% credible interval (CrI): 17-19%) in 2008 and increased by 30% (95% CrI: 28-31%) and 326% (95% CrI: 322-331%) in 2009 and 2010, respectively, compared to 2007. Additionally, there was a significant, nonlinear effect of monthly average precipitation. The results highlight the role of environmental risk factors in determining the spatial of dengue and show how these factors can be used to develop and refine preventive approaches for dengue in Colombia.

Influencia del clima y de la cobertura vegetal en la ocurrencia del Dengue (2001-2010)

Analyzing the spatio-temporal relationship regarding the occurrence of cases of dengue in Colombia's Córdoba Department and the temperature, rainfall and the phenological state of vegetation (vigor and density). A statistical and cartographical study of spatio-temporal distribution regarding the occurrence of cases of dengue was studied in 30 selected municipalities. Simple and multiple statistical regressions were used for analyzing disease occurrence and the aforementioned climatic variables. The statistical relationship between dengue cases and the normalized difference vegetation index (NDVI) was calculated using satellite images. A linear multiple relationship between the occurrence of dengue cases and temperature, rainfall and NDVI was calculated. Accordingly to the pertinent cartography, the disease extends over 32 % of the department; 89.7 % of the reported cases of dengue occurred in 13 of the 22 selected municipalities, Monteria being the municipality having the greatest occurrence (37.8 %). Analysis and evaluation of the statistical regressions showed that the selected climatic variables and vegetation state were significantly related to the occurrence of dengue, both separately and simultaneously. The statistical validity of the relationships calculated between the variables studied here supported the conclusion that an increase in the occurrence of cases of dengue was also directly related to a simultaneous increase in temperature, decreased rainfall and deterioration of vegetation cover (vigor and density) in the area being studied.

Fuzzy model identification of dengue epidemic in Colombia based on multiresolution analysis

This article presents a model of a dengue and severe dengue epidemic in Colombia based on the cases reported between 1995 and 2011. We present a methodological approach that combines multiresolution analysis and fuzzy systems to represent cases of dengue and severe dengue in Colombia. The performance of this proposal was compared with that obtained by applying traditional fuzzy modeling techniques on the same data set. This comparison was obtained by two performance measures that evaluate the similarity between the original data and the approximate signal: the mean square error and the variance accounted for. Finally, the predictive ability of the proposed technique was evaluated to forecast the number of dengue and severe dengue cases in a horizon of three years (2012-2015). These estimates were validated with a data set that was not included into the training stage of the model. The proposed technique allowed the creation of a model that adequately represented the dynamic of a dengue and severe dengue epidemic in Colombia. This technique achieves a significantly superior performance to that obtained with traditional fuzzy modeling techniques: the similarity between the original data and the approximate signal increases from 21.13% to 90.06% and from 18.90% to 76.83% in the case of dengue and severe dengue, respectively. Finally, the developed models generate plausible predictions that resemble validation data. The difference between the cumulative cases reported from January 2012 until July 2013 and those predicted by the model for the same period was 24.99% for dengue and only 4.22% for severe dengue. The fuzzy model identification technique based on multiresolution analysis produced a proper representation of dengue and severe dengue cases for Colombia despite the complexity and uncertainty that characterize this biological system. Additionally, the obtained models generate plausible predictions that can be used by surveillance authorities to support decision-making oriented to designing and developing control strategies.

Burden of Disease and Economic Impact of Dengue and Severe Dengue in Colombia, 2011

ObjectiveTo assess the burden of dengue disease in Colombia and its associated costs. MethodsWe estimated the burden of dengue and severe dengue in Colombia for the period 2011 to 2014 on the basis of a dynamic model calibrated against Colombian surveillance data. The model estimated the annual number of dengue and severe dengue cases for those receiving medical care and those who do not. We calculated the average cost of care per patient on the basis of a bottom-up costing of cases, and additional costs were estimated for activities of vector control and other community interventions. Economic information from a sample of local and departmental vector control programs was reviewed. ResultsThe dynamic model estimated that for 2011 and 2012 there would be 56,998 dengue cases requiring medical attention (22,799 ambulatory and 34,199 hospitalized), 1851 cases of severe dengue, and 205 deaths. The economic analysis, with 2011 data, showed that Colombia would spend between US $52.2 and US $61.0 million for dengue control activities and case management in an average year. Medical management costs would amount to US $16.9 million (CI 95% 15.2–18.5 million), while vector control activities and other community interventions would cost between US $37.08 and US $42.41 million. ConclusionsDengue infection has an important impact on the health care system budget in Colombia. Most of the economic impact corresponds to community activities directed to prevent vector infestation (68.7%–71.0%), which are expensive and whose effectiveness is controversial.

PIN31 Burden of Disease and Economic Impact of Dengue and Severe Dengue in Colombia: 2011

About 50 million dengue infections occur every year worldwide. New dengue vaccines are currently in development and policymakers need appropriate economic studies to determine their potential impact. This study aims to assess the burden of dengue disease in Colombia and its costs. We estimated the disease burden of dengue (D) and severe dengue (SD) in Colombia for 2011-2014 based on a dynamic model designed with the best available evidence and validated with the occurrence data. The annual number of D and SD cases receiving medical care were determined. We calculated the average cost of care per patient with D and SD based on a bottom-up costing of cases attended in the Colombian health facilities, additional costs were estimated from programs of vector control dengue at different administrative levels. Based on the occurrence of disease and extrapolation of national vector control programs we estimated a total annual cost of burden of dengue in Colombia. Our dengue model estimated in 2011 34,751 D consults (13,900 outpatients, 20,851 inpatients), 988 SD cases, and 102 (78-123) deaths due to dengue. In 2012 22,247 D (8899 in- 13,348 out-patients), 863 SD, and 103 (79-124) deaths. In 2013 27,588 D (11,035 in- 16,553 out-patients), 1032 SD and 105 (80-126) deaths. Finally in 2014 25,957 D (10,383 in- 15,574 out-patients), 913 SD, and 106 (80-127) deaths. The total attention costs in 2011 raised to US$ 16.86 million. That year the total cost of Dengue's vector program amounted to US$ 37.08-42.41 million. The total annual cost of dengue would amount to US$ 53.94-59.27 million in a year without outbreak. Burden of dengue disease in Colombia involves a high economic impact to the health system. In 2011 between 28.4-31.3% correspond to medical attention cost and between 68.7-71.6% are due to dengue vector control program.

Vigilancia epidemiológica incompleta de la epidemia de dengue-2 en Ibagué, Colombia, 1995-1997

From April 1995 through November 1997 a dengue epidemic occurred in Ibagué (400,000 population), Colombia, where 3,419 cases were reported and DEN 2 virus was isolated from seven patients. A sero-survey conducted in 1996 found evidence of previous dengue infection in 9.6% of the population, indicating that many infections had not been reported. The dengue infections occurred in all age groups, but children under five years of age were most frequently infected. Forty-five percent of this Ibagué population were born after the re-appearance of dengue in Colombia in 1972, but have never been infected with dengue virus. Most of the cases reported as dengue hemorrhagic fever did not fulfill the current case definition. Aedes aegypti larvae were found in 19% of dwellings surveyed, most often in uncovered low tanks used for water storage. Many residents were not acquainted with the domestic nature of the mosquito vector. Health workers attributed the failure of the dengue control programs to lack of leadership and other administrative problems.