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Abbasi M, Zaim M, Moosazadeh M, Alizadeh M, Dorosti A, Khayatzadeh S, Nikookar SH, Raeisi A, Nikpoor F, Mirolyaie A, Hokmabad BN, Bazmani A, Kaveh F, Azimi S, Enayati A. Uncovering the knowledge gap: A web-based survey of healthcare providers' understanding and management of dengue fever in East Azerbaijan, Iran. PLoS One 2024; 19:e0305528. [PMID: 38905180 PMCID: PMC11192336 DOI: 10.1371/journal.pone.0305528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/02/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Dengue fever (DF) is increasingly recognized as one of the world's major mosquito-borne diseases and causes significant morbidity and mortality in tropical and subtropical countries. Appropriate and timely diagnosis and risk stratification for severe disease are crucial in the appropriate management of this illness. Healthcare providers (HCPs) play a key role in dengue fever diagnosis, management and prevention. The present study was conducted to determine the knowledge, attitudes and practices (KAP) among HCPs in East Azerbaijan Province, Iran. METHODS A cross-sectional survey among 948 HCPs, using a structured questionnaire, was conducted in East Azerbaijan Province from May to July 2022. Data analysis was undertaken using descriptive methods, the Chi-square test or Fisher's exact test, and logistic regression. A P-value <0.05 was considered for statistical significance. RESULTS Out of the 948 (68.5% female) respondents, 227 were physicians and 721 were health professionals. The knowledge level of DF was found to be largely inadequate in the present study population (80.4%). The physician vs. health professional were a significant factor in differentiating attitude scores. The mean practice score regarding DF prevention and control measures among respondents was 8.40±1.97. CONCLUSION The findings call for urgent continuous education and training courses to increase KAP levels and increased capacity and capability for DF prevention and control. This is of outmost importance for the first point of care of DF patients.
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Affiliation(s)
- Madineh Abbasi
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Zaim
- Department of Medical Entomology & Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Moosazadeh
- Faculty of Health, Department of Medical Entomology and Vector Control, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
- Non-Communicable Disease Institute, Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahasti Alizadeh
- Health Management and Safety Promotion Research Institute, Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abbasali Dorosti
- Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Simin Khayatzadeh
- Province Health Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Hassan Nikookar
- Faculty of Health, Department of Medical Entomology and Vector Control, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - Ahmad Raeisi
- Department of Medical Entomology & Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Vector Borne Diseases, Communicable Diseases Control, Ministry of Health, Tehran, Iran
| | - Fatemeh Nikpoor
- Department of Vector Borne Diseases, Communicable Diseases Control, Ministry of Health, Tehran, Iran
- Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Mirolyaie
- Department of Vector Borne Diseases, Communicable Diseases Control, Ministry of Health, Tehran, Iran
| | - Behrooz Naghili Hokmabad
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahad Bazmani
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzad Kaveh
- Department of Vector Borne Diseases, Communicable Diseases Control, Ministry of Health, Tehran, Iran
| | - Somayeh Azimi
- Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmadali Enayati
- Department of Medical Entomology and Vector Control, School of Public Health and Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Chen LH, Marti C, Diaz Perez C, Jackson BM, Simon AM, Lu M. Epidemiology and burden of dengue fever in the United States: a systematic review. J Travel Med 2023; 30:taad127. [PMID: 37792822 DOI: 10.1093/jtm/taad127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Dengue is currently a global concern. The range of dengue vectors is expanding with climate change, yet United States of America (USA) studies on dengue epidemiology and burden are limited. This systematic review sought to characterize the epidemiology and disease burden of dengue within the USA. METHODS Studies evaluating travel-related and endemic dengue in US states and territories were identified and qualitatively summarized. Commentaries and studies on ex-US cases were excluded. MEDLINE, Embase, Cochrane Library, Latin American and Caribbean Center of Health Sciences Information, Centre for Reviews and Dissemination and Clinicaltrials.gov were searched through January 2022. RESULTS 116 studies were included. In US states, dengue incidence was generally low, with spikes occurring in recent years in 2013-16 (0.17-0.31 cases/100,000) and peaking in 2019 (0.35 cases/100,000). Most cases (94%, n = 7895, 2010-21) were travel related. Dengue was more common in Puerto Rico (cumulative average: 200 cases/100,000, 1980-2015); in 2010-21, 99.9% of cases were locally acquired. There were <50 severe cases in US states (2010-17); fatal cases were even rarer. Severe cases in Puerto Rico peaked in 1998 (n = 173) and 2021 (n = 76). Besides lower income, risk factors in US states included having birds in residence, suggesting unspecified environmental characteristics favourable to dengue vectors. Commonly reported symptoms included fever, headache and rash; median disease duration was 3.5-11 days. Hospitalization rates increased following 2009 World Health Organization disease classification changes (pre-2009: 0-54%; post-2009: 14-75%); median length of stay was 2.7-8 days (Puerto Rico) and 2-3 days (US states). Hospitalization costs/case (2010 USD) were$14 350 (US states),$1764-$5497 (Puerto Rico) and$4207 (US Virgin Islands). In Puerto Rico, average days missed were 0.2-5.3 (work) and 2.5 (school). CONCLUSIONS Though dengue risk is ongoing, treatments are limited, and dengue's economic burden is high. There is an urgent need for additional preventive and therapeutic interventions.
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Affiliation(s)
- Lin H Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, 330 Mount Auburn Street Suite 413 Cambridge, MA 02138, USA
- Associate Professor of Medicine, Harvard Medical School, 25 Shattuck Street Boston, MA 02115, USA
| | - Carlos Marti
- Department of Pediatrics, San Juan City Hospital, Paseo Dr. Jose Celso Barbosa San Juan, PR 00921, Puerto Rico
| | - Clemente Diaz Perez
- Department of Pediatrics, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, PR 00936, Puerto Rico
| | - Bianca M Jackson
- Evidence & Access, OPEN Health, 25 Recreation Park Drive, Suite 200 Hingham, MA 02043, USA
| | - Alyssa M Simon
- Evidence & Access, OPEN Health, 25 Recreation Park Drive, Suite 200 Hingham, MA 02043, USA
| | - Mei Lu
- Takeda Pharmaceuticals U.S.A., Inc., 95 Hayden Avenue Lexington, MA 0242195, USA
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Thommes E, Coudeville L, Muhammad R, Martin M, Nelson CB, Chit A. Public health impact and cost-effectiveness of implementing a 'pre-vaccination screening' strategy with the dengue vaccine in Puerto Rico. Vaccine 2022; 40:7343-7351. [PMID: 36347720 DOI: 10.1016/j.vaccine.2022.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommended 'pre-vaccination screening' as its preferred implementation strategy when using the licensed dengue vaccine (CYD-TDV; Dengvaxia, Sanofi), so that only individuals with previous dengue infection are vaccinated. The US Centers for Disease Control and Prevention (CDC) recommended use of CYD-TDV to prevent dengue in children with previous laboratory-confirmed dengue infection in regions where dengue is endemic. Here, we evaluate the public health impact and cost-effectiveness of a 'pre-vaccination screening' strategy in Puerto Rico. METHODS The current analysis builds upon a previously published transmission model used to assess the benefits/risks associated with dengue vaccination. For 'pre-vaccination screening', three alternative testing methods were assessed: one using an immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) dengue serotest, another with dengue serotesting using a rapid diagnostic test (RDT), and one using both sequentially (as recommended in Puerto Rico). The time horizon considered was 10 years. RESULTS In Puerto Rico, the disability-adjusted life years (DALYs) averted for 'pre-vaccination screening' with an ELISA-based program, RDT-based program, and both sequentially would be a median 1,192 (95% CI: 716-2,232), 2,812 (95% CI: 1,579-5,019), and 1,017 (95% CI: 561-1,738), respectively. These benefits would arise from the reduction in cases: median 24,961 (95% CI: 17,480-36,782), 58,273 (95% CI: 40,729-84,796), 20,775 (95% CI: 14,637-30,374) fewer cases, respectively. The cost per DALY averted from a payer perspective would be US$12,518 (95 %CI: US$4,749-26,922), US$10,047 (95% CI: US$3,350-23,852), and US$12,334 (95% CI: US$4,965-26,444), respectively. All three strategies would be cost saving from a societal perspective. CONCLUSIONS Our study supports the WHO and CDC 'pre-vaccination screening' guidance for CYD-TDV implementation. In Puerto Rico, regardless of the testing strategy and even with a relatively low rate of testing, it would be cost-effective from a payer perspective and cost saving from a societal perspective.
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Affiliation(s)
- Edward Thommes
- Sanofi, 1755 Steeles Avenue W, Toronto, Ontario M2R 3T4, Canada; University of Guelph, 50 Stone Road E, Guelph, Ontario N1G 2W1, Canada; York University, 4700 Keele St, Toronto, Ontario M3J 1P3, Canada.
| | | | | | - Maria Martin
- Sanofi, 1 Discovery Drive, Swiftwater, PA 18370, USA.
| | | | - Ayman Chit
- Sanofi, 1 Discovery Drive, Swiftwater, PA 18370, USA; Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada.
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Global prevalence of dengue and chikungunya coinfection: A systematic review and meta-analysis of 43,341 participants. Acta Trop 2022; 231:106408. [PMID: 35305942 DOI: 10.1016/j.actatropica.2022.106408] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/05/2022] [Accepted: 03/12/2022] [Indexed: 11/20/2022]
Abstract
Dengue and chikungunya virus are important arboviruses of public health concern. In the past decades, they have accounted for numerous outbreaks of dengue and chikungunya in different parts of the world. Several cases of concurrent infection of dengue and chikungunya have been documented. However, the true burden of this concurrent infection is unknown. Here, a systematic review and meta-analysis of published data on the prevalence of dengue and chikungunya coinfection in the human population was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Six electronic databases (Web of science, Embase, PubMed, ScienceDirect, Scopus, and Google Scholar) were searched without year or language restrictions for relevant studies. The study protocol was registered with PROSPERO (CRD42020175344). Eighty-three studies involving a total of 43,341 participants were included. The random-effects model was employed to calculate the summary estimates. A pooled global prevalence of 2.5% (95% CI: 1.8-3.4) was obtained for dengue and chikungunya coinfection. Males and females appear to be coinfected at a fairly similar rate. Among the regions, Asia accounted for the highest prevalence (3.3%, 95% CI: 2.3-4.6) while North America was the least (0.8%, 95% CI: 0.3-2.4). The prevalence estimates varied across different countries. A much higher prevalence rates were obtained for Colombia (37.4%, 95% CI: 9.1-78.1), Madagascar (18.2%, 95% CI: 10.1-30.6), Laos (12.5%, 95% CI: 5.3-26.7), Maldives (4.5%, 95% CI: 1.5-13.0) and Thailand (3.7%, 95% CI: 0.4-26.3). This first extensive systematic review and meta-analysis reveals dengue and chikungunya coinfection as a global problem worthy of consideration. It is therefore pertinent that both infections be assessed during diagnosis, mosquito vector control practices be implemented, and vaccine development strides be supported globally.
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Koonisetty KS, Aghamohammadi N, Urmi T, Yavaşoglu Sİ, Rahman MS, Nandy R, Haque U. Assessment of Knowledge, Attitudes, and Practices Regarding Dengue among Physicians: A Web-Based Cross-Sectional Survey. Behav Sci (Basel) 2021; 11:105. [PMID: 34436095 PMCID: PMC8389296 DOI: 10.3390/bs11080105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/12/2021] [Accepted: 07/17/2021] [Indexed: 11/25/2022] Open
Abstract
Dengue fever is one of the most important viral infections transmitted by Aedes mosquitoes and a major cause of morbidity and mortality globally. Accurate identification of cases and treatment of dengue patients at the early stages can reduce medical complications and dengue mortality rate. This survey aims to determine the knowledge, attitude, and practices (KAP) among physicians in dengue diagnosis and treatment. This study was conducted among physicians in Turkey as one nonendemic country and Bangladesh, India, and Malaysia as three dengue-endemic countries. The dosing frequencies, maximum doses, and contraindications in dengue fever were examined. The results found that physicians from Bangladesh, India, and Malaysia have higher KAP scores in dengue diagnosis and treatment compared to physicians in Turkey. This may be due to a lack of physician's exposure to a dengue patient as Turkey is considered a nonendemic country. This assessment may help establish a guideline for intervention strategies among physicians to have successful treatment outcomes and reduce dengue mortality.
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Affiliation(s)
- Kranthi Swaroop Koonisetty
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (R.N.); (U.H.)
| | - Nasrin Aghamohammadi
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | - Tamanna Urmi
- Department of Epidemiology, National Institute of Preventive and Social Medicine (NIPSOM), Dhaka 1212, Bangladesh;
| | - Sare İlknur Yavaşoglu
- Department of Biology, Faculty of Science and Arts, Aydın Adnan Menderes University, Aydın 09010, Turkey;
| | - Md. Shahinur Rahman
- Palli Karma Sahayak Foundation (PKSF), PKSF Bahban, E-4/B, Agargaon A/A, Sher-e-Bangla Nagar, Dhaka 1207, Bangladesh;
| | - Rajesh Nandy
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (R.N.); (U.H.)
| | - Ubydul Haque
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (R.N.); (U.H.)
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Tsheten T, Clements ACA, Gray DJ, Gyeltshen K, Wangdi K. Medical practitioner's knowledge on dengue management and clinical practices in Bhutan. PLoS One 2021; 16:e0254369. [PMID: 34270594 PMCID: PMC8284660 DOI: 10.1371/journal.pone.0254369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/24/2021] [Indexed: 12/02/2022] Open
Abstract
Background Dengue has emerged as a major public health problem in Bhutan, with increasing incidence and widening geographic spread over recent years. This study aimed to investigate the knowledge and clinical management of dengue among medical practitioners in Bhutan. Methods We administered a survey questionnaire to all practitioners currently registered under the Bhutan Medical and Health Council. The questionnaire contained items on four domains including transmission, clinical course and presentation, diagnosis and management, and surveillance and prevention of dengue. Participants were able to respond using an online Qualtrics survey, with the invitation and link distributed via email. Results A total of 97 respondents were included in the study (response rate: 12.7%), of which 61.86% were Health Assistants/Clinical Officers (HAs/COs) and 38.14% were medical doctors. The afternoon feeding behaviour of Aedes mosquito was correctly identified by only 24.7% of the respondents, and ~66.0% of them failed to identify lethargy as a warning sign for severe dengue. Knowledge on diagnosis using NS1 antigen and the clinical significance of elevated haematocrit for initial fluid replacement was strikingly low at 47.4% and 27.8% respectively. Despite dengue being a nationally notifiable disease, ~60% of respondents were not knowledgeable on the timing and type of cases to be reported. Respondent’s median score was higher for the surveillance and reporting domain, followed by their knowledge on transmission of dengue. Statistically significant factors associated with higher knowledge included respondents being a medical doctor, working in a hospital and experience of having diagnosed dengue. Conclusion The study revealed major gaps on knowledge and clinical management practices related to dengue in Bhutan. Physicians and health workers working in Basic Health Units need training and regular supervision to improve their knowledge on the care of dengue patients.
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Affiliation(s)
- Tsheten Tsheten
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
- Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan
- * E-mail:
| | - Archie C. A. Clements
- Faculty of Health Sciences, Curtin University, Perth, Australia
- Telethon Kids Institute, Nedlands, Australia
| | - Darren J. Gray
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
| | | | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
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Sharp TM, Anderson KB, Katzelnick LC, Clapham H, Johansson MA, Morrison AC, Harris E, Paz-Bailey G, Waterman SH. Knowledge gaps in the epidemiology of severe dengue impede vaccine evaluation. THE LANCET. INFECTIOUS DISEASES 2021; 22:e42-e51. [PMID: 34265259 DOI: 10.1016/s1473-3099(20)30871-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/21/2020] [Accepted: 11/03/2020] [Indexed: 10/20/2022]
Abstract
The most severe consequences of dengue virus infection include shock, haemorrhage, and major organ failure; however, the frequency of these manifestations varies, and the relative contribution of pre-existing anti-dengue virus antibodies, virus characteristics, and host factors (including age and comorbidities) are not well understood. Reliable characterisation of the epidemiology of severe dengue first depends on the use of consistent definitions of disease severity. As vaccine trials have shown, severe dengue is a crucial interventional endpoint, yet the infrequency of its occurrence necessitates the inclusion of thousands of study participants to appropriately compare its frequency among participants who have and have not been vaccinated. Hospital admission is frequently used as a proxy for severe dengue; however, lack of specificity and variability in clinical practices limit the reliability of this approach. Although previous infection with a dengue virus is the best characterised risk factor for developing severe dengue, the influence of the timing between dengue virus infections and the sequence of dengue virus infections on disease severity is only beginning to be elucidated. To improve our understanding of the diverse factors that shape the clinical spectrum of disease resulting from dengue virus infection, prospective, community-based and clinic-based immunological, virological, genetic, and clinical studies across a range of ages and geographical regions are needed.
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Affiliation(s)
- Tyler M Sharp
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, PR, USA; United States Public Health Service, Silver Springs, MD, USA.
| | - Kathryn B Anderson
- Institute for Global Health and Translational Sciences and Department of Medicine, and Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, USA; Department of Virology, Armed Forces Research Institute for Medical Sciences, Bangkok, Thailand
| | - Leah C Katzelnick
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA; Department of Biology, University of Florida, Gainesville, FL, USA
| | - Hannah Clapham
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Michael A Johansson
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, PR, USA
| | - Amy C Morrison
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Gabriela Paz-Bailey
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, PR, USA
| | - Stephen H Waterman
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, PR, USA; United States Public Health Service, Silver Springs, MD, USA
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Sharp TM, Ryff KR, Santiago GA, Margolis HS, Waterman SH. Lessons Learned from Dengue Surveillance and Research, Puerto Rico, 1899-2013. Emerg Infect Dis 2020; 25:1522-1530. [PMID: 31503540 DOI: 10.3201/eid2508.190089] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Dengue was first reported in Puerto Rico in 1899 and sporadically thereafter. Following outbreaks in 1963 and 1969, the Centers for Disease Control and Prevention has worked closely with the Puerto Rico Department of Health to monitor and reduce the public health burden of dengue. During that time, evolving epidemiologic scenarios have provided opportunities to establish, improve, and expand disease surveillance and interventional research projects. These initiatives have enriched the tools available to the global public health community to understand and combat dengue, including diagnostic tests, methods for disease and vector surveillance, and vector control techniques. Our review serves as a guide to organizations seeking to establish dengue surveillance and research programs by highlighting accomplishments, challenges, and lessons learned during more than a century of dengue surveillance and research conducted in Puerto Rico.
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Mendoza EJ, Robinson A, Dimitrova K, Mueller N, Holloway K, Makowski K, Wood H. Combining anti-IgM and IgG immunoassays for comprehensive chikungunya virus diagnostic testing. Zoonoses Public Health 2019; 66:909-917. [PMID: 31449360 DOI: 10.1111/zph.12641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/10/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Abstract
Chikungunya virus (CHIKV) is a mosquito-borne pathogen that causes CHIKV fever. Definitive diagnosis is crucial for patients experiencing symptoms similar to other arboviral diseases because they can vary in clinical consequences. An increasing number of patients experience long-term rheumatic effects of CHIKV infection, but these cases may not be optimally detected by molecular assays and anti-CHIKV IgM ELISAs (M-ELISAs) used for confirmation and screening, respectively. The subsequent confirmatory serological test, the plaque reduction neutralization test (PRNT), is laborious and time-consuming. In this study, we evaluated a new diagnostic algorithm in which the M-ELISA is conducted in parallel with an anti-CHIKV IgG ELISA (G-ELISA) and observed that the Euroimmun M-ELISA combined with the Euroimmun G-ELISA or the Abcam G-ELISA exhibited excellent sensitivity and specificity for CHIKV. The combinations demonstrated perfect and near perfect inter-rater agreement with the PRNT, respectively, suggesting their potential to be used as alternatives to the confirmatory serological PRNT assay for CHIKV.
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Affiliation(s)
- Emelissa J Mendoza
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Alyssia Robinson
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Kristina Dimitrova
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Nicole Mueller
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Kimberly Holloway
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Kai Makowski
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Heidi Wood
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
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Ruberto I, Yaglom H, Erhart LM, Plante L, Weiss J, Golenko C, Casal M, McCotter O, Adams L, Ernst K, Komatsu K. Dengue Knowledge, Attitudes, and Practices Among Arizona Health Care Providers, 2014-2015. Vector Borne Zoonotic Dis 2019; 19:434-440. [PMID: 30802177 DOI: 10.1089/vbz.2018.2370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Detection of local dengue transmission requires an aware and engaged medical community, as health care providers are the front line of public health surveillance. To assess the knowledge, attitude, and practice about dengue, an online survey was distributed among Arizona health care providers during 2014 and 2015. Materials and Methods: The survey consisted of a total of 10 knowledge, attitude, and practice questions divided as follows: 5 knowledge questions, 2 attitude questions, and 3 practice questions. The link to the Qualtrics survey was distributed through the Arizona Health Alert Network to a total of 4582 e-mail addresses, of which 335 participants opened the survey, and 196 completed and submitted their responses. Results: Less than half the respondents reported choosing the right dengue diagnostic test (40.4%) or understanding the epidemiology of dengue in Arizona (40.9%). Slightly more than half the respondents reported frequently asking for travel history (59%), and three-fourth of them would notify the local health department on suspicion of a dengue patient (76.1%). Survey score was associated with providers specialized in infectious diseases (1.88, 95% CI: 0.42-3.33, p = 0.01), medical doctors or doctors of osteopathic medicine (1.82, 95% CI: 0.98-2.65, p < 0.0001), and respondents who reported to have heard about the increase in dengue cases in Sonora (Mexico) in fall 2014 (1.51, 95% CI: 0.67-2.34, p = 0.0005), indicating better survey performance. Conclusions: These results indicate that education for health care providers on dengue should be improved particularly among general practice noninfectious disease providers who might be the first point of care for dengue patients. Findings suggest that additional training on clinical management, asking travel history, and notifying the local health department on suspicion of a dengue patient are needed.
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Affiliation(s)
- Irene Ruberto
- 1 Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona
| | - Hayley Yaglom
- 1 Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona
| | - Laura M Erhart
- 1 Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona
| | - Lydia Plante
- 1 Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona
| | - Joli Weiss
- 1 Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona
| | - Catherine Golenko
- 1 Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona
| | - Mariana Casal
- 1 Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona
| | - Orion McCotter
- 2 Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laura Adams
- 2 Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kacey Ernst
- 3 Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Ken Komatsu
- 1 Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona
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Development of standard clinical endpoints for use in dengue interventional trials. PLoS Negl Trop Dis 2018; 12:e0006497. [PMID: 30286085 PMCID: PMC6171842 DOI: 10.1371/journal.pntd.0006497] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/03/2018] [Indexed: 12/22/2022] Open
Abstract
Dengue is a major public health problem worldwide. Although several drug candidates have been evaluated in randomized controlled trials, none has been effective and at present, early recognition of severe dengue and timely supportive care are used to reduce mortality. While the first dengue vaccine was recently licensed, and several other candidates are in late stage clinical trials, future decisions regarding widespread deployment of vaccines and/or therapeutics will require evidence of product safety, efficacy and effectiveness. Standard, quantifiable clinical endpoints are needed to ensure reproducibility and comparability of research findings. To address this need, we established a working group of dengue researchers and public health specialists to develop standardized endpoints and work towards consensus opinion on those endpoints. After discussion at two working group meetings and presentations at international conferences, a Delphi methodology-based query was used to finalize and operationalize the clinical endpoints. Participants were asked to select the best endpoints from proposed definitions or offer revised/new definitions, and to indicate whether contributing items should be designated as optional or required. After the third round of inquiry, 70% or greater agreement was reached on moderate and severe plasma leakage, moderate and severe bleeding, acute hepatitis and acute liver failure, and moderate and severe neurologic disease. There was less agreement regarding moderate and severe thrombocytopenia and moderate and severe myocarditis. Notably, 68% of participants agreed that a 50,000 to 20,000 mm3 platelet range be used to define moderate thrombocytopenia; however, they remained divided on whether a rapid decreasing trend or one platelet count should be case defining. While at least 70% agreement was reached on most endpoints, the process identified areas for further evaluation and standardization within the context of ongoing clinical studies. These endpoints can be used to harmonize data collection and improve comparability between dengue clinical trials. Dengue is a major public health problem worldwide. Although several drug candidates have been evaluated in randomized controlled trials, none has been effective, and early recognition of severe dengue and timely supportive care remain the only means to reduce mortality. While the first dengue vaccine was recently licensed, and several other candidates are in late stage clinical trials, future decisions regarding deployment of such vaccines or therapeutics will require evidence of product safety, efficacy and effectiveness. Standard, quantifiable clinical endpoints are needed to ensure reproducibility and comparability of research findings. To address this need, we established a working group of dengue researchers, vaccine developers, and public health specialists to develop endpoints. After two working group meetings and discussions at international meetings, the Delphi methodology was used to clarify and further develop endpoints such that 70% or greater agreement was reached on most endpoint definitions including moderate and severe plasma leakage, moderate and severe bleeding, acute hepatitis and acute liver failure, and moderate and severe neurologic disease. The process identified areas for further evaluation and standardization within the context of ongoing clinical studies. The endpoints can be used to harmonize data collection and improve comparability between dengue clinical trials.
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Shankar MB, Rodríguez-Acosta RL, Sharp TM, Tomashek KM, Margolis HS, Meltzer MI. Estimating dengue under-reporting in Puerto Rico using a multiplier model. PLoS Negl Trop Dis 2018; 12:e0006650. [PMID: 30080848 PMCID: PMC6095627 DOI: 10.1371/journal.pntd.0006650] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 08/16/2018] [Accepted: 06/29/2018] [Indexed: 12/24/2022] Open
Abstract
Dengue is a mosquito-borne viral illness that causes a variety of health outcomes, from a mild acute febrile illness to potentially fatal severe dengue. Between 2005 and 2010, the annual number of suspected dengue cases reported to the Passive Dengue Surveillance System (PDSS) in Puerto Rico ranged from 2,346 in 2006 to 22,496 in 2010. Like other passive surveillance systems, PDSS is subject to under-reporting. To estimate the degree of under-reporting in Puerto Rico, we built separate inpatient and outpatient probability-based multiplier models, using data from two different surveillance systems—PDSS and the enhanced dengue surveillance system (EDSS). We adjusted reported cases to account for sensitivity of diagnostic tests, specimens with indeterminate results, and differences between PDSS and EDSS in numbers of reported dengue cases. In addition, for outpatients, we adjusted for the fact that less than 100% of medical providers submit diagnostic specimens from suspected cases. We estimated that a multiplication factor of between 5 (for 2010 data) to 9 (for 2006 data) must be used to correct for the under-reporting of the number of laboratory-positive dengue inpatients. Multiplication factors of between 21 (for 2010 data) to 115 (for 2008 data) must be used to correct for the under-reporting of laboratory-positive dengue outpatients. We also estimated that, after correcting for underreporting, the mean annual rate, for 2005–2010, of medically attended dengue in Puerto Rico to be between 2.1 (for dengue inpatients) to 7.8 (for dengue outpatients) per 1,000 population. These estimated rates compare to the reported rates of 0.4 (dengue outpatients) to 0.1 (dengue inpatients) per 1,000 population. The multipliers, while subject to limitations, will help public health officials correct for underreporting of dengue cases, and thus better evaluate the cost-and-benefits of possible interventions. The number of global cases of dengue has increased an estimated 30-fold from 1962 to 2012, and two-fifths of the world’s population are thought to be at risk for dengue. It has been recently estimated that the global incidence of dengue is between 50 and 100 million cases per year. These estimates of burden and impact are, however, are not considered very reliable. It has been previously established and reported that there is notable under-reporting of clinical cases of dengue, even those who sought medical treatment. This includes under-reporting of those hospitalized with laboratory-confirmed dengue. This lack of reliable estimates hampers efforts of public health officials in determining the of burden of disease and the costs-and-benefits of potential interventions. We estimated that multiplication factors ranging from 5 to 9 must be used to correct for under-reporting of laboratory-positive dengue inpatient cases reported to public health officials in Puerto Rico. Multiplication factors ranging from 21 to 115 must be used to correct for the underreporting of laboratory-positive dengue outpatients. Our results illustrate the need for, and thus potential benefits of, using our methodology to estimate the degree of under-reporting in passive dengue systems during epidemic and non-epidemic years.
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Affiliation(s)
- Manjunath B. Shankar
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Rosa L. Rodríguez-Acosta
- Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Tyler M. Sharp
- Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Kay M. Tomashek
- Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Harold S. Margolis
- Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Martin I. Meltzer
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
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Alvarez-Hernandez G, Ernst K, Acuña-Melendrez NH, Vargas-Ortega AP, Candia-Plata MDC. Medical knowledge related to Rocky Mountain spotted fever in Sonora, Mexico. Trans R Soc Trop Med Hyg 2018; 112:109-114. [PMID: 29617892 DOI: 10.1093/trstmh/try030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/09/2018] [Indexed: 11/14/2022] Open
Abstract
Background Rocky Mountain spotted fever (RMSF) is a tick-borne disease with a high case-fatality rate unless diagnosed promptly and treated timely with doxycycline. Physician knowledge about presentation and treatment can improve outcomes of RMSF in endemic regions, such as Sonora in northern Mexico, where RMSF has caused 1348 non-fatal cases and 247 deaths from 2003 to 2016. Methods A cross-sectional study was conducted with 343 physicians working in medical facilities in Sonora, Mexico. A 25-item questionnaire explored physician knowledge of clinical, epidemiological and preventive aspects of RMSF. Results Only 62% of physicians agreed that doxycycline should be used as the first choice treatment for children under 8 years with suspected RMSF. Additionally, 40% of primary care physicians correctly identified the time to initiate doxycycline, and 32% correctly identified the case-fatality rate of untreated RMSF in all patients. Conclusions Inadequate medical knowledge may adversely affect how patients infected with Rickettsia rickettsii are diagnosed and treated. Educational programs that improve the risk perception and medical knowledge about RMSF should be targeted at physicians most likely to have initial contact with diseased patients.
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Affiliation(s)
- Gerardo Alvarez-Hernandez
- Department of Medicine and Health Sciences, University of Sonora, Mexico; Hermosillo, Sonora, México, C.P. 83000
| | - Kacey Ernst
- Epidemiology and Biostatistics Department, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States 85724
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Orellano P, Vezzani D, Quaranta N, Reynoso J, Salomón OD. Estimation of expected dengue seroprevalence from passive epidemiological surveillance systems in selected areas of Argentina: A proxy to evaluate the applicability of dengue vaccination. Vaccine 2018; 36:979-985. [PMID: 29331246 DOI: 10.1016/j.vaccine.2018.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Current recommendations about dengue vaccination by the World Health Organization depend on seroprevalence levels and serological status in populations and individuals. However, seroprevalence estimation may be difficult due to a diversity of factors. Thus, estimation through models using data from epidemiological surveillance systems could be an alternative procedure to achieve this goal. OBJECTIVE To estimate the expected dengue seroprevalence in children of selected areas in Argentina, using a simple model based on data from passive epidemiological surveillance systems. METHODS A Markov model using a simulated cohort of individuals from age 0 to 9 years was developed. Parameters regarding the reported annual incidence of dengue, proportion of inapparent cases, and expansion factors for outpatient and hospitalized cases were considered as transition probabilities. The proportion of immune population at 9 years of age was taken as a proxy of the expected seroprevalence, considering this age as targeted for vaccination. The model was used to evaluate the expected seroprevalence in Misiones and Salta provinces and in Buenos Aires city, three settings showing different climatic favorability for dengue. RESULTS The estimates of the seroprevalence for the group of 9-year-old children for Misiones was 79% (95%CI:46-100%), and for Salta 22% (95%CI:14-30%), both located in northeastern and northwestern Argentina, respectively. Buenos Aires city, from central Argentina, showed a likely seroprevalence of 7% (95%CI: 3-11%). According to the deterministic sensitivity analyses, the parameter showing the highest influence on these results was the probability of inapparent cases. CONCLUSIONS This model allowed the estimation of dengue seroprevalence in settings where this information is not available. Particularly for Misiones, the expected seroprevalence was higher than 70% in a wide range of scenarios, thus in this province a vaccination strategy directed to seropositive children of >9 years should be analyzed, including further considerations as safety, cost-effectiveness, and budget impact.
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Affiliation(s)
- Pablo Orellano
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina; Universidad Tecnológica Nacional, Facultad Regional San Nicolás, San Nicolás, Argentina.
| | - Darío Vezzani
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina; Instituto Multidisciplinario sobre Ecosistemas y Desarrollo Sustentable, Facultad de Cs Exactas, UNICEN, Tandil, Argentina
| | - Nancy Quaranta
- Universidad Tecnológica Nacional, Facultad Regional San Nicolás, San Nicolás, Argentina; Comisión de Investigaciones Científicas de la Provincia de Buenos Aires, Argentina
| | - Julieta Reynoso
- Hospital Interzonal General de Agudos "San Felipe", San Nicolás, Argentina
| | - Oscar Daniel Salomón
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina; Instituto Nacional de Medicina Tropical (INMeT), Ministerio de Salud de la Nación, Puerto Iguazú, Argentina
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Dengue virus serotype 3 and Chikungunya virus co-infection in a traveller returning from India to Portugal, November 2016. IDCases 2017; 9:30-33. [PMID: 28560177 PMCID: PMC5447568 DOI: 10.1016/j.idcr.2017.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 03/29/2017] [Accepted: 03/29/2017] [Indexed: 01/23/2023] Open
Abstract
We report a case of a laboratory-confirmed Dengue and Chikungunya viruses co-infection imported from India to Portugal in early November 2016. The patient developed fever, retro-orbital pain and generalized myalgia after returning from Delhi, Jaipur, Agra, Rishikesh, Goa and Mumbai. This case highlights the importance of these arboviruses to public health in India where high rates of co-infection have been reported in the last few years, and demonstrates how challenging the laboratory diagnosis of imported co-infection cases can be in non-endemic areas.
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Adam JK, Abeyta R, Smith B, Gaul L, Thomas DL, Han G, Sharp TM, Waterman SH, Tomashek KM. Clinician Survey to Determine Knowledge of Dengue and Clinical Management Practices, Texas, 2014. Am J Trop Med Hyg 2017; 96:708-714. [PMID: 28138048 DOI: 10.4269/ajtmh.16-0367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Dengue, a mosquito-borne viral disease, is increasingly being identified as a cause of outbreaks in the United States. During July-December 2013, a total of three south Texas counties reported 53 laboratory-confirmed dengue cases; 26 were locally acquired, constituting the largest outbreak in Texas since 2005. Because dengue outbreaks are expected to continue in south Texas and early case identification and timely treatment can reduce mortality, we sought to determine clinicians' knowledge of dengue and its clinical management. A survey was sent to 2,375 south Texas clinicians; 217 (9%) completed the survey. Approximately half of participants demonstrated knowledge needed to identify dengue cases, including symptoms (56%), early indicators of shock (54%), or timing of thrombocytopenia (48%). Fewer than 20% correctly identified all prevention messages, severe dengue warning signs, or circumstances in which a dengue patient should return for care. Knowledge of clinical management was limited; few participants correctly identified scenarios when plasma leakage occurred (10%) or a crystalloid solution was indicated (7%); however, 45% correctly identified when a blood transfusion was indicated. Because of the ongoing threat of dengue, we recommend clinicians in south Texas receive dengue clinical management training.
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Affiliation(s)
- Jessica K Adam
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Roman Abeyta
- Texas Department of State Health Services, Harlingen, Texas
| | - Brian Smith
- Texas Department of State Health Services, Harlingen, Texas
| | - Linda Gaul
- Texas Department of State Health Services, Austin, Texas
| | - Dana L Thomas
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.,Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - George Han
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Tyler M Sharp
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Stephen H Waterman
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Kay M Tomashek
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Lam PK, Ngoc TV, Thu Thuy TT, Hong Van NT, Nhu Thuy TT, Hoai Tam DT, Dung NM, Hanh Tien NT, Thanh Kieu NT, Simmons C, Wills B, Wolbers M. The value of daily platelet counts for predicting dengue shock syndrome: Results from a prospective observational study of 2301 Vietnamese children with dengue. PLoS Negl Trop Dis 2017; 11:e0005498. [PMID: 28448490 PMCID: PMC5407568 DOI: 10.1371/journal.pntd.0005498] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 03/17/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Dengue is the most important mosquito-borne viral infection to affect humans. Although it usually manifests as a self-limited febrile illness, complications may occur as the fever subsides. A systemic vascular leak syndrome that sometimes progresses to life-threatening hypovolaemic shock is the most serious complication seen in children, typically accompanied by haemoconcentration and thrombocytopenia. Robust evidence on risk factors, especially features present early in the illness course, for progression to dengue shock syndrome (DSS) is lacking. Moreover, the potential value of incorporating serial haematocrit and platelet measurements in prediction models has never been assessed. METHODOLOGY/PRINCIPAL FINDINGS We analyzed data from a prospective observational study of Vietnamese children aged 5-15 years admitted with clinically suspected dengue to the Hospital for Tropical Diseases in Ho Chi Minh City between 2001 and 2009. The analysis population comprised all children with laboratory-confirmed dengue enrolled between days 1-4 of illness. Logistic regression was the main statistical model for all univariate and multivariable analyses. The prognostic value of daily haematocrit levels and platelet counts were assessed using graphs and separate regression models fitted on each day of illness. Among the 2301 children included in the analysis, 143 (6%) progressed to DSS. Significant baseline risk factors for DSS included a history of vomiting, higher temperature, a palpable liver, and a lower platelet count. Prediction models that included serial daily platelet counts demonstrated better ability to discriminate patients who developed DSS from others, than models based on enrolment information only. However inclusion of daily haematocrit values did not improve prediction of DSS. CONCLUSIONS/SIGNIFICANCE Daily monitoring of platelet counts is important to help identify patients at high risk of DSS. Development of dynamic prediction models that incorporate signs, symptoms, and daily laboratory measurements, could improve DSS prediction and thereby reduce the burden on health services in endemic areas.
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Affiliation(s)
- Phung Khanh Lam
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Tran Van Ngoc
- Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | | | | | | | - Dong Thi Hoai Tam
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | | | - Nguyen Thi Hanh Tien
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Nguyen Tan Thanh Kieu
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Cameron Simmons
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
- Department of Microbiology and Immunology, The Peter Doherty Institute, University of Melbourne, Australia
| | - Bridget Wills
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine and Global health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
| | - Marcel Wolbers
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine and Global health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
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Han GS, Gregory CJ, Biggerstaff BJ, Horiuchi K, Perez-Guerra C, Soto-Gomez E, Matos D, Margolis HS, Tomashek KM. Effect of a Dengue Clinical Case Management Course on Physician Practices in Puerto Rico. Clin Infect Dis 2016; 63:1297-1303. [PMID: 27506689 DOI: 10.1093/cid/ciw511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 07/21/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Prior to 2010, the clinical management of dengue in Puerto Rico was inconsistent with World Health Organization guidelines. A 4-hour classroom-style course on dengue clinical management was developed in 2009 and mandated for Puerto Rico medical licensure in 2010. Fifty physicians were trained as "master trainers" and gave this course to 7638 physicians. This study evaluated the effect of the course on the clinical management of hospitalized dengue patients. METHODS Pre- and post-course test responses were compared. Changes in physician practices were assessed by reviewing medical records of 430 adult and 1075 pediatric dengue patients at the 12 hospitals in Puerto Rico that reported the most cases during 2008-2009 (pre-intervention) and 2011 (post-intervention). Mixed-effects logistic regression was used to compare key indicators of dengue management. RESULTS Physician test scores increased from 48% to 72% correct. Chart reviews showed that the percentage of adult patients who did not receive corticosteroids increased from 30% to 68% (odds ratio [OR], 5.9; 95% confidence interval [CI], 3.7-9.5) and from 91% to 96% in pediatric patients (OR, 2.7; 95% CI, 1.5-4.9). Usage of isotonic intravenous saline during the critical period increased from 57% to 90% in adult patients (OR, 6.2; 95% CI, 1.9-20.4) and from 25% to 44% in pediatric patients (OR, 3.4; 95% CI, 2.2-5.3). CONCLUSIONS Management of dengue inpatients significantly improved following implementation of a classroom-style course taught by master trainers. An online version of the course was launched in 2014 to expand its reach and sustainability.
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Affiliation(s)
- George S Han
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Brad J Biggerstaff
- Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Kalanthe Horiuchi
- Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Carmen Perez-Guerra
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Eunice Soto-Gomez
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Desiree Matos
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Harold S Margolis
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Kay M Tomashek
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
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Handel AS, Ayala EB, Borbor-Cordova MJ, Fessler AG, Finkelstein JL, Espinoza RXR, Ryan SJ, Stewart-Ibarra AM. Knowledge, attitudes, and practices regarding dengue infection among public sector healthcare providers in Machala, Ecuador. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2016; 2:8. [PMID: 28883952 PMCID: PMC5531027 DOI: 10.1186/s40794-016-0024-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/25/2016] [Indexed: 11/19/2022]
Abstract
Background Dengue fever is a rapidly emerging infection throughout the tropics and subtropics with extensive public health burden. Adequate training of healthcare providers is crucial to reducing infection incidence through patient education and collaboration with public health authorities. We examined how public sector healthcare providers in a dengue-endemic region of Ecuador view and manage dengue infections, with a focus on the 2009 World Health Organization (WHO) Dengue Guidelines. Methods A 37-item questionnaire of dengue knowledge, attitudes, and practices was developed and administered to dengue healthcare providers in Machala, Ecuador. Survey focus areas included: “Demographics,” “Infection and Prevention of Dengue,” “Dengue Diagnosis and the WHO Dengue Guide,” “Laboratory Testing,” “Treatment of Dengue,” and “Opinions Regarding Dengue.” Results A total of 76 healthcare providers participated in this study, of which 82 % were medical doctors and 14 % were nurses. Fifty-eight percent of healthcare professionals practiced in ambulatory clinics and 34 % worked in a hospital. Eighty-nine percent of respondents were familiar with the 2009 WHO Dengue Guidelines, and, within that group, 97 % reported that the WHO Dengue Guide was helpful in dengue diagnosis and clinical management. Knowledge gaps identified included Aedes aegypti mosquito feeding habits and dengue epidemiology. Individuals with greater dengue-related knowledge were more likely to consider dengue a major health problem. Only 22 % of respondents correctly reported that patients with comorbidities and dengue without warning signs require hospital admission, and 25 % of providers reported never admitting patients with dengue to the hospital. Twenty percent of providers reported rarely (≤25 % of cases) obtaining laboratory confirmation of dengue infection. Providers reported patient presumptive self-medication as an ongoing problem. Thirty-one percent of healthcare providers reported inadequate access to resources needed to diagnose and treat dengue. Conclusion Participants demonstrated a high level of knowledge of dengue symptoms and treatment, but additional training regarding prevention, diagnosis, and admission criteria is needed. Interventions should not only focus on increasing knowledge, but also encourage review of the WHO Dengue Guidelines, avoidance of presumptive self-medication, and recognition of dengue as a major health problem. This study provided an assessment tool that effectively captured healthcare providers’ knowledge and identified critical gaps in practice. Electronic supplementary material The online version of this article (doi:10.1186/s40794-016-0024-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrew S Handel
- Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, NY USA
| | - Efraín Beltrán Ayala
- Universidad Técnica de Machala, Machala, Ecuador.,Ministerio de Salud Publica, Machala, El Oro Ecuador
| | - Mercy J Borbor-Cordova
- Facultad de Ingenieria Maritima, Ciencias Oceanicas y Recursos Naturales, Escuela Superior Politécnica del Litoral (ESPOL), Guayaquil, Guayas Ecuador
| | - Abigail G Fessler
- Division of Nutritional Sciences, Cornell University, Ithaca, NY USA
| | | | | | - Sadie J Ryan
- Department of Geography, University of Florida, Gainesville, FL USA.,Emerging Pathogens Institute, University of Florida, Gainesvillee, fl USA.,Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, NY USA
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Doblecki-Lewis S, Chang A, Jiddou-Yaldoo R, Tomashek KM, Stanek D, Anil L, Lichtenberger P. Knowledge, attitudes, and practices of Florida physicians regarding dengue before and after an educational intervention. BMC MEDICAL EDUCATION 2016; 16:124. [PMID: 27112138 PMCID: PMC4845440 DOI: 10.1186/s12909-016-0647-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/20/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Failure to recognize and appropriately manage dengue early in the clinical course may result in late initiation of supportive treatment for severe disease. In Florida, travel-related and autochthonous dengue occur and are likely under-recognized. The objective of this study was to evaluate physician knowledge of dengue and its management before and after an educational intervention in Florida. METHODS From 2012-13 we conducted 14 grand-rounds style lectures on dengue clinical management attended by 413 physicians, and analyzed data from the pre- and post-tests. RESULTS Of those attending, 231 and 220 completed the pre-and post-tests, respectively. Overall, the mean pre-test score for knowledge-based questions was 74.3 and average post-test score was 94.2%, indicating a mean increase of 19.9% (P < 0.0001, 95% CI 17.7-22.4). Reported confidence in dengue recognition and management also increased. Non-US trained physicians and those who had treated more than ten dengue cases performed significantly better in the pre-test. Post-test scores did not differ by subgroup. CONCLUSIONS The train-the-trainer approach with grand-rounds style presentations appear to be an effective intervention to improve knowledge of dengue among physicians.
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Affiliation(s)
- Susanne Doblecki-Lewis
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, #850 (R-21), Miami, FL, 33155, USA.
| | - Aileen Chang
- Division of General Internal Medicine, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave NW Room 5-419, Washington, DC, 20037, USA
| | - Renee Jiddou-Yaldoo
- Division of Infectious Diseases, Department of Medicine, Oakland University William Beaumont School of Medicine, Beaumont Health Grosse Pointe, 468 Cadieux Rd, Grosse Pointe, MI, 48230, USA
| | - Kay M Tomashek
- Dengue Branch, Division of Vector-borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Danielle Stanek
- Florida Department of Health, Division of Disease Control and Health Protection, Zoonotic and Vectorborne Disease, 4052 Bald Cypress Way, Bin A12, Tallahassee, FL, 32399-1712, USA
| | - Leena Anil
- Division of Infectious Disease Epidemiology, Bureau for Public Health, West Virginia Department of Health & Human Resources, 350 Capitol St. Rm. 125, Charleston, WV, 25301, USA
| | - Paola Lichtenberger
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, #864 (R-21), Miami, FL, 33155, USA
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Furuya-Kanamori L, Liang S, Milinovich G, Soares Magalhaes RJ, Clements ACA, Hu W, Brasil P, Frentiu FD, Dunning R, Yakob L. Co-distribution and co-infection of chikungunya and dengue viruses. BMC Infect Dis 2016; 16:84. [PMID: 26936191 PMCID: PMC4776349 DOI: 10.1186/s12879-016-1417-2] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/07/2016] [Indexed: 01/08/2023] Open
Abstract
Background Chikungunya and dengue infections are spatio-temporally related. The current review aims to determine the geographic limits of chikungunya, dengue and the principal mosquito vectors for both viruses and to synthesise current epidemiological understanding of their co-distribution. Methods Three biomedical databases (PubMed, Scopus and Web of Science) were searched from their inception until May 2015 for studies that reported concurrent detection of chikungunya and dengue viruses in the same patient. Additionally, data from WHO, CDC and Healthmap alerts were extracted to create up-to-date global distribution maps for both dengue and chikungunya. Results Evidence for chikungunya-dengue co-infection has been found in Angola, Gabon, India, Madagascar, Malaysia, Myanmar, Nigeria, Saint Martin, Singapore, Sri Lanka, Tanzania, Thailand and Yemen; these constitute only 13 out of the 98 countries/territories where both chikungunya and dengue epidemic/endemic transmission have been reported. Conclusions Understanding the true extent of chikungunya-dengue co-infection is hampered by current diagnosis largely based on their similar symptoms. Heightened awareness of chikungunya among the public and public health practitioners in the advent of the ongoing outbreak in the Americas can be expected to improve diagnostic rigour. Maps generated from the newly compiled lists of the geographic distribution of both pathogens and vectors represent the current geographical limits of chikungunya and dengue, as well as the countries/territories at risk of future incursion by both viruses. These describe regions of co-endemicity in which lab-based diagnosis of suspected cases is of higher priority. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1417-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luis Furuya-Kanamori
- Research School of Population Health, Australian National University, Acton, ACT 2601, Australia.
| | - Shaohong Liang
- Environmental Health Institute, National Environment Agency, Singapore, 138667, Singapore.
| | - Gabriel Milinovich
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia.
| | - Ricardo J Soares Magalhaes
- School of Veterinary Science, University of Queensland, Gatton, QLD, 4343, Australia. .,UQ Children's Health Research Centre, University of Queensland, South Brisbane, QLD, 4101, Australia.
| | - Archie C A Clements
- Research School of Population Health, Australian National University, Acton, ACT 2601, Australia.
| | - Wenbiao Hu
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia.
| | - Patricia Brasil
- Instituto Nacional de Infectologia Evandro Chagas/ Fiocruz, Rio de Janeiro, Brazil.
| | - Francesca D Frentiu
- School of Biomedical Sciences and Institute for Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia.
| | - Rebecca Dunning
- Formerly School of Biomedical Sciences, University of Queensland, St Lucia, QLD, 4072, Australia.
| | - Laith Yakob
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
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Simmons CP, McPherson K, Van Vinh Chau N, Hoai Tam DT, Young P, Mackenzie J, Wills B. Recent advances in dengue pathogenesis and clinical management. Vaccine 2015; 33:7061-8. [PMID: 26458808 DOI: 10.1016/j.vaccine.2015.09.103] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 12/31/2022]
Abstract
This review describes and commentates on recent advances in the understanding of dengue pathogenesis and immunity, plus clinical research on vaccines and therapeutics. We expand specifically on the role of the dermis in dengue virus infection, the contribution of cellular and humoral immune responses to pathogenesis and immunity, NS1 and mechanisms of virus immune evasion. Additionally we review a series of therapeutic intervention trials for dengue, as well as recent clinical research aimed at improving clinical diagnosis, risk prediction and disease classification.
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Affiliation(s)
- Cameron P Simmons
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet street, District 5, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Department of Microbiology and Immunology, University of Melbourne, Parkville, Victoria 3010, Australia.
| | - Kirsty McPherson
- Department of Microbiology and Immunology, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Nguyen Van Vinh Chau
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Viet Nam
| | - D T Hoai Tam
- University of Medicine and Pharmacy, 217 Hong Bang, District 5, Ho Chi Minh City, Viet Nam
| | - Paul Young
- School of Chemistry and Molecular Biosciences, University of Queensland, Australia
| | - Jason Mackenzie
- Department of Microbiology and Immunology, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Bridget Wills
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet street, District 5, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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