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Madewell Z, Major C, Graff N, Adams C, Rodriguez D, Morales T, Medina Lopes N, Tosado R, Sánchez‐González L, Perez‐Padilla J, Volkman H, Bertrán‐Pasarell J, Sainz de la Peña D, Munoz‐Jordan J, Santiago G, Lorenzi O, Rivera‐Amill V, Rolfes M, Paz‐Bailey G, Adams L, Wong J. Diagnostic Accuracy of the Abbott BinaxNOW COVID-19 Antigen Card Test, Puerto Rico. Influenza Other Respir Viruses 2024; 18:e13305. [PMID: 39053895 PMCID: PMC11300111 DOI: 10.1111/irv.13305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/21/2024] [Accepted: 04/17/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic underscored the need for rapid and accurate diagnostic tools. In August 2020, the Abbott BinaxNOW COVID-19 Antigen Card test became available as a timely and affordable alternative for SARS-CoV-2 molecular testing, but its performance may vary due to factors including timing and symptomatology. This study evaluates BinaxNOW diagnostic performance in diverse epidemiological contexts. METHODS Using RT-PCR as reference, we assessed performance of the BinaxNOW COVID-19 test for SARS-CoV-2 detection in anterior nasal swabs from participants of two studies in Puerto Rico from December 2020 to May 2023. Test performance was assessed by days post symptom onset, collection strategy, vaccination status, symptomatology, repeated testing, and RT-PCR cycle threshold (Ct) values. RESULTS BinaxNOW demonstrated an overall sensitivity of 84.1% and specificity of 98.8%. Sensitivity peaked within 1-6 days after symptom onset (93.2%) and was higher for symptomatic (86.3%) than asymptomatic (67.3%) participants. Sensitivity declined over the course of infection, dropping from 96.3% in the initial test to 48.4% in testing performed 7-14 days later. BinaxNOW showed 99.5% sensitivity in participants with low Ct values (≤ 25) but lower sensitivity (18.2%) for participants with higher Cts (36-40). CONCLUSIONS BinaxNOW demonstrated high sensitivity and specificity, particularly in early-stage infections and symptomatic participants. In situations where test sensitivity is crucial for clinical decision-making, nucleic acid amplification tests are preferred. These findings highlight the importance of considering clinical and epidemiological context when interpreting test results and emphasize the need for ongoing research to adapt testing strategies to emerging SARS-CoV-2 variants.
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Affiliation(s)
- Zachary J. Madewell
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Chelsea G. Major
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Nathan Graff
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Cameron Adams
- Department of Microbiology and ImmunologyUniversity of North Carolina School of MedicineChapel HillNorth CarolinaUSA
| | - Dania M. Rodriguez
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Tatiana Morales
- Ponce Research InstitutePonce Health Sciences UniversityPoncePuerto Rico
| | - Nicole A. Medina Lopes
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Rafael Tosado
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | | | - Janice Perez‐Padilla
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Hannah R. Volkman
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | | | | | - Jorge Munoz‐Jordan
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Gilberto A. Santiago
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Olga Lorenzi
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | | | - Melissa A. Rolfes
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGAUSA
| | - Gabriela Paz‐Bailey
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Laura E. Adams
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Joshua M. Wong
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
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Zúniga-Gutiérrez M, Meléndez M, Montoya SSR, Escobar HAF, López J, Paz S, Sauceda-Acosta D. Dengue Burden and Factors Influencing Severity in Honduras: A Descriptive and Analytical Study. Rev Soc Bras Med Trop 2024; 57:e004072024. [PMID: 38896654 PMCID: PMC11178375 DOI: 10.1590/0037-8682-0594-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/09/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Dengue is a disease that accounts for a major morbidity and mortality in Honduras. METHODS This descriptive study used an analytical component based on the data from the National Virology Laboratory between 2016-2022. Ordinal logistic regression was used to identify the factors associated with the classification of dengue without warning signs (DWOS), dengue with warning signs (DWS), and severe dengue (SD). RESULTS Overall, 14,687 dengue cases were included; 50.1% had DWOS, 36.5% had DWS, and 13.4% had SD. Patients that were more associated with a higher probability of DWS and SD were patients in the age groups 1-4 years (DWS OR 1.61; 95%CI:1.33-1.94), (SD OR 1.52; 95% CI:1.26-1.84), 5-9 years (DWS OR 2.01; 95% CI:1.68-2.40), (SD OR 2.00; 95% CI:1.67-2.40), and 10-19 years (DWS OR 1.55; 95% CI:1.30-1.85) (SD OR 1.57; 95% CI:1.31-1.88). The departments that were associated with a higher probability of DWS and SD were La Paz (OR 6.35; 95% CI:3.53-11.42), (OR 10.94; 95% CI:5.96-20.08), Copán (OR 6.94; 95% CI:5.05-9.53) (OR 7.33; 95% CI: 5.35-10.03), Valle (OR 5.22; 95% CI:1.25-21.82) (OR 10.71; 95% CI:2.21-51.88). CONCLUSIONS During the study period, dengue presented endemic behavior, with peaks consistent with the last two epidemics in Honduras in 2015 and 2019. The main factors associated with dengue severity were age< 19 years, male sex, and being from La Paz, Copán, or Valle.
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Affiliation(s)
- Melba Zúniga-Gutiérrez
- Universidad Nacional Autónoma de Honduras, Research Institute in
Medical Sciences and Right to Health, Epidemiology Postgraduate Program Tegucigalpa,
Honduras
| | - Marlon Meléndez
- Universidad Nacional Autónoma de Honduras, Epidemiology Postgraduate
Program. Tegucigalpa, Honduras
| | | | | | - Jorge López
- Universidad Nacional Autónoma de Honduras, Demography and
Development Postgraduate Program. Tegucigalpa, Honduras
| | - Sandra Paz
- Ministry of Health, Health Surveillance Unit, National Virology
Laboratory. Tegucigalpa, Honduras
| | - Dilcia Sauceda-Acosta
- Universidad Nacional Autónoma de Honduras, Research Institute in
Medical Sciences and Right to Health, Epidemiology Postgraduate Program Tegucigalpa,
Honduras
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Madewell ZJ, Hernandez-Romieu AC, Wong JM, Zambrano LD, Volkman HR, Perez-Padilla J, Rodriguez DM, Lorenzi O, Espinet C, Munoz-Jordan J, Frasqueri-Quintana VM, Rivera-Amill V, Alvarado-Domenech LI, Sainz D, Bertran J, Paz-Bailey G, Adams LE. Sentinel Enhanced Dengue Surveillance System - Puerto Rico, 2012-2022. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2024; 73:1-29. [PMID: 38805389 PMCID: PMC11152364 DOI: 10.15585/mmwr.ss7303a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Problem/Condition Dengue is the most prevalent mosquitoborne viral illness worldwide and is endemic in Puerto Rico. Dengue's clinical spectrum can range from mild, undifferentiated febrile illness to hemorrhagic manifestations, shock, multiorgan failure, and death in severe cases. The disease presentation is nonspecific; therefore, various other illnesses (e.g., arboviral and respiratory pathogens) can cause similar clinical symptoms. Enhanced surveillance is necessary to determine disease prevalence, to characterize the epidemiology of severe disease, and to evaluate diagnostic and treatment practices to improve patient outcomes. The Sentinel Enhanced Dengue Surveillance System (SEDSS) was established to monitor trends of dengue and dengue-like acute febrile illnesses (AFIs), characterize the clinical course of disease, and serve as an early warning system for viral infections with epidemic potential. Reporting Period May 2012-December 2022. Description of System SEDSS conducts enhanced surveillance for dengue and other relevant AFIs in Puerto Rico. This report includes aggregated data collected from May 2012 through December 2022. SEDSS was launched in May 2012 with patients with AFIs from five health care facilities enrolled. The facilities included two emergency departments in tertiary acute care hospitals in the San Juan-Caguas-Guaynabo metropolitan area and Ponce, two secondary acute care hospitals in Carolina and Guayama, and one outpatient acute care clinic in Ponce. Patients arriving at any SEDSS site were eligible for enrollment if they reported having fever within the past 7 days. During the Zika epidemic (June 2016-June 2018), patients were eligible for enrollment if they had either rash and conjunctivitis, rash and arthralgia, or fever. Eligibility was expanded in April 2020 to include reported cough or shortness of breath within the past 14 days. Blood, urine, nasopharyngeal, and oropharyngeal specimens were collected at enrollment from all participants who consented. Diagnostic testing for dengue virus (DENV) serotypes 1-4, chikungunya virus, Zika virus, influenza A and B viruses, SARS-CoV-2, and five other respiratory viruses was performed by the CDC laboratory in San Juan. Results During May 2012-December 2022, a total of 43,608 participants with diagnosed AFI were enrolled in SEDSS; a majority of participants (45.0%) were from Ponce. During the surveillance period, there were 1,432 confirmed or probable cases of dengue, 2,293 confirmed or probable cases of chikungunya, and 1,918 confirmed or probable cases of Zika. The epidemic curves of the three arboviruses indicate dengue is endemic; outbreaks of chikungunya and Zika were sporadic, with case counts peaking in late 2014 and 2016, respectively. The majority of commonly identified respiratory pathogens were influenza A virus (3,756), SARS-CoV-2 (1,586), human adenovirus (1,550), respiratory syncytial virus (1,489), influenza B virus (1,430), and human parainfluenza virus type 1 or 3 (1,401). A total of 5,502 participants had confirmed or probable arbovirus infection, 11,922 had confirmed respiratory virus infection, and 26,503 had AFI without any of the arboviruses or respiratory viruses examined. Interpretation Dengue is endemic in Puerto Rico; however, incidence rates varied widely during the reporting period, with the last notable outbreak occurring during 2012-2013. DENV-1 was the predominant virus during the surveillance period; sporadic cases of DENV-4 also were reported. Puerto Rico experienced large outbreaks of chikungunya that peaked in 2014 and of Zika that peaked in 2016; few cases of both viruses have been reported since. Influenza A and respiratory syncytial virus seasonality patterns are distinct, with respiratory syncytial virus incidence typically reaching its annual peak a few weeks before influenza A. The emergence of SARS-CoV-2 led to a reduction in the circulation of other acute respiratory viruses. Public Health Action SEDSS is the only site-based enhanced surveillance system designed to gather information on AFI cases in Puerto Rico. This report illustrates that SEDSS can be adapted to detect dengue, Zika, chikungunya, COVID-19, and influenza outbreaks, along with other seasonal acute respiratory viruses, underscoring the importance of recognizing signs and symptoms of relevant diseases and understanding transmission dynamics among these viruses. This report also describes fluctuations in disease incidence, highlighting the value of active surveillance, testing for a panel of acute respiratory viruses, and the importance of flexible and responsive surveillance systems in addressing evolving public health challenges. Various vector control strategies and vaccines are being considered or implemented in Puerto Rico, and data from ongoing trials and SEDSS might be integrated to better understand epidemiologic factors underlying transmission and risk mitigation approaches. Data from SEDSS might guide sampling strategies and implementation of future trials to prevent arbovirus transmission, particularly during the expansion of SEDSS throughout the island to improve geographic representation.
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Medina FA, Vila F, Adams LE, Cardona J, Carrion J, Lamirande E, Acosta LN, De León-Rodríguez CM, Beltran M, Grau D, Rivera-Amill V, Balmaseda A, Harris E, Madewell ZJ, Waterman SH, Paz-Bailey G, Whitehead S, Muñoz-Jordán JL. Comparison of the Sensitivity and Specificity of Commercial Anti-Dengue Virus IgG Tests to Identify Persons Eligible for Dengue Vaccination. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.19.24306097. [PMID: 38712100 PMCID: PMC11071579 DOI: 10.1101/2024.04.19.24306097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
The Advisory Committee on Immunization Practices (ACIP) recommended that dengue pre-vaccination screening tests for Dengvaxia administration have at least 98% specificity and 75% sensitivity. This study evaluates the performance of commercial anti-DENV IgG tests to identify tests that could be used for pre-vaccination screening. First, for 7 tests, we evaluated sensitivity and specificity in early convalescent dengue virus (DENV) infection, using 44 samples collected 7-30 days after symptom onset and confirmed by RT-PCR. Next, for the 5 best performing tests and two additional tests (with and without an external test reader) that became available later, we evaluated performance to detect past dengue infection among a panel of 44 specimens collected in 2018-2019 from healthy 9-16-year-old children from Puerto Rico. Finally, a full-scale evaluation was done with the 4 best performing tests using 400 specimens from the same population. We used virus focus reduction neutralization test and an in-house DENV IgG ELISA as reference standards. Of seven tests, five showed ≥75% sensitivity detecting anti-DENV IgG in early convalescent specimens with low cross-reactivity to Zika virus. For the detection of previous DENV infections the tests with the highest performance were the Euroimmun NS1 IgG ELISA (sensitivity 84.5%, specificity 97.1%) and CTK Dengue IgG rapid test R0065C with the test reader (sensitivity 76.2% specificity 98.1%). There are IgG tests available that can be used to accurately classify individuals with previous DENV infection as eligible for dengue vaccination to support safe vaccine implementation.
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Affiliation(s)
- Freddy A Medina
- Centers for Disease Control and Prevention (CDC), San Juan, PR, USA
| | - Frances Vila
- Centers for Disease Control and Prevention (CDC), San Juan, PR, USA
| | - Laura E Adams
- Centers for Disease Control and Prevention (CDC), San Juan, PR, USA
| | - Jaime Cardona
- Centers for Disease Control and Prevention (CDC), San Juan, PR, USA
| | - Jessica Carrion
- Centers for Disease Control and Prevention (CDC), San Juan, PR, USA
| | | | - Luz N Acosta
- Centers for Disease Control and Prevention (CDC), San Juan, PR, USA
| | | | - Manuela Beltran
- Centers for Disease Control and Prevention (CDC), San Juan, PR, USA
| | - Demian Grau
- Centers for Disease Control and Prevention (CDC), San Juan, PR, USA
| | | | - Angel Balmaseda
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California USA
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Rasizadeh R, Ebrahimi F, Zamani Kermanshahi A, Daei Sorkhabi A, Sarkesh A, Sadri Nahand J, Bannazadeh Baghi H. Viruses and thrombocytopenia. Heliyon 2024; 10:e27844. [PMID: 38524607 PMCID: PMC10957440 DOI: 10.1016/j.heliyon.2024.e27844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/03/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Thrombocytopenia, characterized by a decrease in platelet count, is a multifaceted clinical manifestation that can arise from various underlying causes. This review delves into the intriguing nexus between viruses and thrombocytopenia, shedding light on intricate pathophysiological mechanisms and highlighting the pivotal role of platelets in viral infections. The review further navigates the landscape of thrombocytopenia in relation to specific viruses, and sheds light on the diverse mechanisms through which hepatitis C virus (HCV), measles virus, parvovirus B19, and other viral agents contribute to platelet depletion. As we gain deeper insights into these interactions, we move closer to elucidating potential therapeutic avenues and preventive strategies for managing thrombocytopenia in the context of viral infections.
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Affiliation(s)
- Reyhaneh Rasizadeh
- Immunology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Animal Biology, Faculty of Natural Sciences, University of Tabriz, Tabriz, Iran
| | - Fatemeh Ebrahimi
- Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Amin Daei Sorkhabi
- Immunology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aila Sarkesh
- Immunology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javid Sadri Nahand
- Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Bannazadeh Baghi
- Immunology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, 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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Adams LE, Hitchings MDT, Medina FA, Rodriguez DM, Sánchez-González L, Moore H, Whitehead SS, Muñoz-Jordán JL, Rivera-Amill V, Paz-Bailey G. Previous Dengue Infection among Children in Puerto Rico and Implications for Dengue Vaccine Implementation. Am J Trop Med Hyg 2023; 109:413-419. [PMID: 37308104 PMCID: PMC10397428 DOI: 10.4269/ajtmh.23-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/20/2023] [Indexed: 06/14/2023] Open
Abstract
Limited dengue virus (DENV) seroprevalence estimates are available for Puerto Rico, which are needed to inform the potential use and cost-effectiveness of DENV vaccines. The Communities Organized to Prevent Arboviruses (COPA) is a cohort study initiated in 2018 in Ponce, Puerto Rico, to assess arboviral disease risk and provide a platform to evaluate interventions. We recruited participants from households in 38 study clusters, who were interviewed and provided a serum specimen. Specimens from 713 children aged 1 to 16 years during the first year of COPA were tested for the four DENV serotypes and ZIKV using a focus reduction neutralization assay. We assessed the seroprevalence of DENV and ZIKV by age and developed a catalytic model from seroprevalence and dengue surveillance data to estimate the force of infection for DENV during 2003-2018. Overall, 37% (n = 267) were seropositive for DENV; seroprevalence was 9% (11/128) among children aged 1 to 8 years and 44% (256/585) among children aged 9 to 16 years, exceeding the threshold over which DENV vaccination is deemed cost-effective. A total of 33% were seropositive for ZIKV, including 15% among children aged 0 to 8 years and 37% among children aged 9 to 16 years. The highest force of infection occurred in 2007, 2010, and 2012-2013, with low levels of transmission from 2016 to 2018. A higher proportion of children had evidence of multitypic DENV infection than expected, suggesting high heterogeneity in DENV risk in this setting.
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Affiliation(s)
- Laura E. Adams
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Freddy A. Medina
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Dania M. Rodriguez
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Liliana Sánchez-González
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Stephen S. Whitehead
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jorge L. Muñoz-Jordán
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Gabriela Paz-Bailey
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
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8
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Odio CD, Sánchez-González L, Delorey M, Adams LE, Jones ES, Lorenzi O, Munoz-Jordan J, Rivera-Amill V, Paz–Bailey G. The Effect of Age on Dengue Presentation and the Diagnostic Accuracy of the 2015 Pan American Health Organization Case Criteria in a Puerto Rican Cohort. Open Forum Infect Dis 2023; 10:ofad373. [PMID: 37663092 PMCID: PMC10468746 DOI: 10.1093/ofid/ofad373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/14/2023] [Indexed: 09/05/2023] Open
Abstract
Background We evaluated dengue presentation by age, the performance of the 2015 Pan American Health Organization (PAHO) case criteria in identifying dengue cases, and variables to improve specificity. Methods Patients with fever ≤7 days (N = 10 408) were recruited from 2 emergency departments from May 2012 through December 2015. Serum samples were tested for dengue, chikungunya, and nasopharyngeal swabs for respiratory viruses. Smoothing splines assessed differences in the frequencies of signs/symptoms by age. Least absolute shrinkage and selection operator regressions identified the variables that best predicted dengue. Results Among 985 dengue cases, children aged <5 years were least likely to have leukopenia, but most likely to have rash and petechiae. Adults had the highest odds of aches/pains and headaches/retro-orbital pain. The 2015 PAHO criteria had sensitivity of 93% and specificity of 25%. Specificity could be improved by requiring at least 2 of the following criteria: vomiting/nausea, petechiae, rash, or leukopenia (specificity 68%, sensitivity 71%) or by using 2015 PAHO criteria plus either (1) aspartate aminotransferase >50 IU/L or platelet count <100 000 platelets/μL (specificity 81%, sensitivity 56%) or (2) itchy skin or absence of rhinorrhea or cough (specificity 51%, sensitivity 82%). Conclusions The 2015 PAHO dengue case criteria had excellent sensitivity but poor specificity. This can be improved by adding signs/symptoms associated with dengue diagnosis.
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Affiliation(s)
- Camila D Odio
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
| | - Liliana Sánchez-González
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
| | - Mark Delorey
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention,Fort Collins, Colorado
| | - Laura E Adams
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
| | - Emma S Jones
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention,Fort Collins, Colorado
| | - Olga Lorenzi
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
| | - Jorge Munoz-Jordan
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
| | | | - Gabriela Paz–Bailey
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
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9
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Tran XD, Hoang VT, Dang TTD, Vu TP, To MM, Tran TK, Do MD, Nguyen DC, Nguyen QT, Colson P, Parola P, Marty P, Gautret P. Aetiology of Acute Undifferentiated Fever Among Children Under the Age of Five in Vietnam: A Prospective Study. J Epidemiol Glob Health 2023; 13:163-172. [PMID: 37258852 PMCID: PMC10231849 DOI: 10.1007/s44197-023-00121-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND To investigate the aetiology of acute undifferentiated fever (AUF) among children under the age of five in Vietnam. METHODS This prospective study was conducted in the Thai Binh paediatric hospital, between July 2020 and July 2021 among children with AUF at admission. Real-time PCR testing 18 microbial pathogens were done on blood samples. RESULTS 286 children were included, with median age of 16 months. 64.7% were male. 53.9% were positive for at least one pathogen by PCR. Enterovirus, human herpesvirus 6, adenovirus, and varicella zoster virus PCR were positive for 31.1, 12.6, 1.4, and 1.0% patients, respectively. Other pathogens tested negative by PCR. During the hospital stay, based on clinical criteria 47.2% children secondarily presented with signs of respiratory tract infections, 18.9% had hand, foot and mouth disease, 4.6% had chickenpox. 4.2% presented signs of central nervous system infections, 1.0% had dengue (antigenic test) and 1.0% had signs of gastrointestinal infection. Finally, 23.1% patients presented a fever with or without a rash and no other symptoms and ultimately received a diagnosis of AUF. CONCLUSION Real-time PCR of blood is useful for detecting pathogens and diagnosing infectious causes of AUF. Further prospective studies with blood and urine culture testing and PCR investigation of not only blood but also cerebrospinal fluid, throat, and skin samples according to symptoms would be of interest to confirm the predominance of viral infections in children with AUF and to guide therapeutic options.
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Affiliation(s)
- Xuan Duong Tran
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Van Thuan Hoang
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | | | | | - Minh Manh To
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | | | - Manh Dung Do
- Thai Binh Paediatric Hospital, Thai Binh, Vietnam
| | - Duy Cuong Nguyen
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Quoc Tien Nguyen
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Philippe Colson
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Philippe Parola
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Pierre Marty
- Université Côte D'Azur, Inserm, C3M, Nice Cedex 3, France
- Parasitologie-Mycologie, Centre Hospitalier Universitaire L'Archet, Nice Cedex 3, France
| | - Philippe Gautret
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam.
- IHU-Méditerranée Infection, Marseille, France.
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.
- VITROME, Institut Hospitalo-Universitaire Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.
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Pérez-Guerra CL, Rosado-Santiago C, Ramos SA, Marrero KM, González-Zeno G, Miranda-Bermúdez J, Ortíz-Ortíz M, Rivera-Amill V, Waterman S, Paz-Bailey G, Sánchez-González L. Community perceptions on challenges and solutions to implement an Aedes aegypti control project in Ponce, Puerto Rico (USA). PLoS One 2023; 18:e0284430. [PMID: 37068074 PMCID: PMC10109480 DOI: 10.1371/journal.pone.0284430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 03/30/2023] [Indexed: 04/18/2023] Open
Abstract
This study characterizes community perceptions on a large-scale project seeking to reduce the population of Aedes aegypti mosquitoes and prevent arboviral disease transmission in Ponce, Puerto Rico; and to leverage on these perceptions to make modifications to ensure effective project implementation. In 2017-2018 the team conducted informal interviews, focus groups, and in-depth interviews with leaders and residents of the communities, focusing on challenges and potential solutions to the project implementation. Possible challenges to the project implementation included the lack of geographic consistency between clusters defined by researchers and the participants' description of the communities' geographic boundaries. Few children living in the communities could affect the ability of the project to adequately measure arboviral disease incidence. Also, population attrition due to out-migration, and lack of community leaders and communication channels after Hurricane Maria could affect participation in project activities. Lack of trust on strangers was an important challenge due to criminal activity involving violence and drug use in some community areas. Solutions to the identified challenges included identifying emerging leaders and implementing community meetings to promote project activities. The information that community members provided helped us to understand the natural disasters' impact on population attrition in these communities with a disproportionate impact in younger groups, resulting in an aging population. We identified lack of community organization and leadership and increasing number of abandoned houses that could turn into Aedes aegypti breeding sites. The formative work helped to better define the geographic areas that the study would cover, evaluate the acceptability of innovative vector control methods, and identify communication methods used by residents. With this information, challenges and potential solutions in recruiting participants were anticipated, and the community engagement and communications plans were developed. We recommend selecting clusters before research, because opinions towards mosquito control technologies could vary in added clusters.
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Affiliation(s)
- Carmen L. Pérez-Guerra
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico, United States of America
| | - Coral Rosado-Santiago
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico, United States of America
| | - Sue A. Ramos
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico, United States of America
| | - Karla M. Marrero
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico, United States of America
| | - Gladys González-Zeno
- Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico, United States of America
| | - Julieanne Miranda-Bermúdez
- Puerto Rico Science, Technology and Research Trust, Puerto Rico Vector Control Unit, San Juan, Puerto Rico, United States of America
| | - Marianyoly Ortíz-Ortíz
- Puerto Rico Science, Technology and Research Trust, Puerto Rico Vector Control Unit, San Juan, Puerto Rico, United States of America
| | - Vanessa Rivera-Amill
- Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico, United States of America
| | - Stephen Waterman
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico, United States of America
| | - Gabriela Paz-Bailey
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico, United States of America
| | - Liliana Sánchez-González
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico, United States of America
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11
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Bressan CDS, Teixeira MDLB, Gouvêa MIFDS, de Pina-Costa A, Santos HFP, Calvet GA, Lupi O, Siqueira AM, Valls-de-Souza R, Valim C, Brasil P. Challenges of acute febrile illness diagnosis in a national infectious diseases center in Rio de Janeiro: 16-year experience of syndromic surveillance. PLoS Negl Trop Dis 2023; 17:e0011232. [PMID: 37011087 PMCID: PMC10101631 DOI: 10.1371/journal.pntd.0011232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 04/13/2023] [Accepted: 03/10/2023] [Indexed: 04/05/2023] Open
Abstract
INTRODUCTION Acute febrile illnesses (AFI) are a frequent chief complaint in outpatients. Because the capacity to investigate the causative pathogen of AFIs is limited in low- and middle-income countries, patient management may be suboptimal. Understanding the distribution of causes of AFI can improve patient outcomes. This study aims to describe the most common etiologies diagnosed over a 16-years period in a national reference center for tropical diseases in a large urban center in Rio de Janeiro, Brazil. METHODS From August 2004-December 2019, 3591 patients > 12 years old, with AFI and/or rash were eligible. Complementary exams for etiological investigation were requested using syndromic classification as a decision guide. Results. Among the 3591 patients included, endemic arboviruses such as chikungunya (21%), dengue (15%) and zika (6%) were the most common laboratory-confirmed diagnosis, together with travel-related malaria (11%). Clinical presumptive diagnosis lacked sensitivity for emerging diseases such as zika (31%). Rickettsia disease and leptospirosis were rarely investigated and an infrequent finding when based purely on clinical features. Respiratory symptoms increased the odds for the diagnostic remaining inconclusive. CONCLUSIONS Numerous patients did not have a conclusive etiologic diagnosis. Since syndromic classification used for standardization of etiological investigation and presumptive clinical diagnosis had moderate accuracy, it is necessary to incorporate new diagnostic technologies to improve diagnostic accuracy and surveillance capacity.
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Affiliation(s)
| | - Maria de Lourdes Benamor Teixeira
- Laboratory of Epidemiology Research and Social Determinants of Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Anielle de Pina-Costa
- Acute Febrile Illnesses Service, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | | | - Guilherme Amaral Calvet
- Acute Febrile Illnesses Service, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Otilia Lupi
- Acute Febrile Illnesses Service, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andre Machado Siqueira
- Acute Febrile Illnesses Service, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogério Valls-de-Souza
- Acute Febrile Illnesses Service, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Clarissa Valim
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Patrícia Brasil
- Acute Febrile Illnesses Service, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
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12
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Wong JM, Volkman HR, Adams LE, Oliveras García C, Martinez-Quiñones A, Perez-Padilla J, Bertrán-Pasarell J, Sainz de la Peña D, Tosado-Acevedo R, Santiago GA, Muñoz-Jordán JL, Torres-Velásquez BC, Lorenzi O, Sánchez-González L, Rivera-Amill V, Paz-Bailey G. Clinical Features of COVID-19, Dengue, and Influenza among Adults Presenting to Emergency Departments and Urgent Care Clinics-Puerto Rico, 2012-2021. Am J Trop Med Hyg 2023; 108:107-114. [PMID: 36410319 PMCID: PMC9833087 DOI: 10.4269/ajtmh.22-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/27/2022] [Indexed: 11/23/2022] Open
Abstract
Dengue and influenza are pathogens of global concern and cause febrile illness similar to COVID-19. We analyzed data from an enhanced surveillance system operating from three emergency departments and an urgent care clinic in Puerto Rico to identify clinical features predictive of influenza or dengue compared with COVID-19. Participants with fever or respiratory symptoms and aged ≥18 years enrolled May 2012-January 2021 with dengue, influenza, or SARS-CoV-2 confirmed by reverse transcriptase polymerase chain reaction were included. We calculated adjusted odds ratios (aORs) and 95% CIs using logistic regression to assess clinical characteristics of participants with COVID-19 compared to those with dengue or influenza, adjusting for age, subregion, and days from illness onset to presentation for clinical care. Among 13,431 participants, we identified 2,643 with dengue (N = 303), influenza (N = 2,064), or COVID-19 (N = 276). We found differences in days from onset to presentation among influenza (2 days [interquartile range: 1-3]), dengue (3 days [2-4]), and COVID-19 cases (4 days [2-7]; P < 0.001). Cough (aOR: 0.12 [95% CI: 0.07-0.19]) and shortness of breath (0.18 [0.08-0.44]) were less common in dengue compared with COVID-19. Facial flushing (20.6 [9.8-43.5]) and thrombocytopenia (24.4 [13.3-45.0]) were more common in dengue. Runny nose was more common in influenza compared with COVID-19 (8.3 [5.8-12.1]). In summary, cough, shortness of breath, facial flushing, and thrombocytopenia helped distinguish between dengue and COVID-19. Although few features distinguished influenza from COVID-19, presentation > 4 days after symptom onset suggests COVID-19. These findings may assist clinicians making time-sensitive decisions regarding triage, isolation, and management while awaiting pathogen-specific testing.
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Affiliation(s)
- Joshua M. Wong
- Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Laura E. Adams
- Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | | | | | | | | | | | | | | | | | - Olga Lorenzi
- Centers for Disease Control and Prevention, San Juan, Puerto Rico
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13
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Shih DC, Silver R, Henao OL, Alemu A, Audi A, Bigogo G, Colston JM, Edu-Quansah EP, Erickson TA, Gashu A, Gbelee GB, Gunter SM, Kosek MN, Logan GG, Mackey JM, Maliga A, Manzanero R, Morazan G, Morey F, Munoz FM, Murray KO, Nelson TV, Olortegui MP, Yori PP, Ronca SE, Schiaffino F, Tayachew A, Tedasse M, Wossen M, Allen DR, Angra P, Balish A, Farron M, Guerra M, Herman-Roloff A, Hicks VJ, Hunsperger E, Kazazian L, Mikoleit M, Munyua P, Munywoki PK, Namwase AS, Onyango CO, Park M, Peruski LF, Sugerman DE, Gutierrez EZ, Cohen AL. Incorporating COVID-19 into Acute Febrile Illness Surveillance Systems, Belize, Kenya, Ethiopia, Peru, and Liberia, 2020-2021. Emerg Infect Dis 2022; 28:S34-S41. [PMID: 36502419 DOI: 10.3201/eid2813.220898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Existing acute febrile illness (AFI) surveillance systems can be leveraged to identify and characterize emerging pathogens, such as SARS-CoV-2, which causes COVID-19. The US Centers for Disease Control and Prevention collaborated with ministries of health and implementing partners in Belize, Ethiopia, Kenya, Liberia, and Peru to adapt AFI surveillance systems to generate COVID-19 response information. Staff at sentinel sites collected epidemiologic data from persons meeting AFI criteria and specimens for SARS-CoV-2 testing. A total of 5,501 patients with AFI were enrolled during March 2020-October 2021; >69% underwent SARS-CoV-2 testing. Percentage positivity for SARS-CoV-2 ranged from 4% (87/2,151, Kenya) to 19% (22/115, Ethiopia). We show SARS-CoV-2 testing was successfully integrated into AFI surveillance in 5 low- to middle-income countries to detect COVID-19 within AFI care-seeking populations. AFI surveillance systems can be used to build capacity to detect and respond to both emerging and endemic infectious disease threats.
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14
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Paz-Bailey G, Sánchez-González L, Torres-Velasquez B, Jones ES, Perez-Padilla J, Sharp TM, Lorenzi O, Delorey M, Munoz-Jordan JL, Tomashek KM, Waterman SH, Alvarado LI, Rivera-Amill V. Predominance of Severe Plasma Leakage in Pediatric Patients With Severe Dengue in Puerto Rico. J Infect Dis 2022; 226:1949-1958. [PMID: 35510941 PMCID: PMC10015274 DOI: 10.1093/infdis/jiac165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/28/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We evaluated clinical and laboratory findings among patients with nonsevere or severe dengue in Puerto Rico to examine whether clinical manifestations vary by age. METHODS During 2012-2014, we enrolled patients who arrived at the emergency department with fever or history of fever within 7 days of presentation. Serum samples were tested for dengue virus (DENV) by reverse transcriptase-polymerase chain reaction (RT-PCR) and IgM enzyme-linked immunosorbent assay (ELISA). Severe dengue was defined as severe plasma leakage or shock, severe bleeding, or organ involvement at presentation, during hospitalization, or follow-up. RESULTS Of 1089 dengue patients identified, 281 (26%) were severe. Compared to those with nonsevere dengue, patients with severe dengue were more often aged 10-19 years (55% vs 40%, P < .001) and hospitalized (87% vs 30%, P < .001). Severe plasma leakage or shock was more common among children aged 0-9 (59%) or 10-19 years (86%) than adults (49%) (P < .01). Severe bleeding was less common among 10-19 year olds (24%) compared to 0-9 year olds (45%) and adults (52%; P < .01). CONCLUSIONS Severe plasma leakage was the most common presentation among children, highlighting important differences from adults. Vaccination against dengue could help prevent severe dengue among children in Puerto Rico.
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Affiliation(s)
| | | | | | - Emma S Jones
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | | | - Tyler M Sharp
- Centers for Disease Control and Prevention, San Juan, Puerto Rico
- US Public Health Service, Rockville, Maryland, USA
| | - Olga Lorenzi
- Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Mark Delorey
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | | | - Kay M Tomashek
- Centers for Disease Control and Prevention, San Juan, Puerto Rico
- US Public Health Service, Rockville, Maryland, USA
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephen H Waterman
- Centers for Disease Control and Prevention, San Juan, Puerto Rico
- US Public Health Service, Rockville, Maryland, USA
| | - Luisa I Alvarado
- Ponce Health Sciences University/Ponce Research Institute, Ponce, Puerto Rico
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15
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Cruz MA, Rivera-GonzÁlez LO, Irvin-Barnwell E, Cabrera-Marquez J, Ellis E, Ellis B, Qi B, Maniglier-Poulet C, Gerding JA, Shumate A, Andujar A, Yoder J, Laco J, Santana A, Bayleyegn T, Luna-Pinto C, Rodriguez LO, Roth J, Bermingham J, Funk RH, Raheem M. Public health branch incident management and support as part of the Federal Government response during the emergency phase of Hurricanes Irma and Maria in Puerto Rico and the US Virgin Islands. JOURNAL OF EMERGENCY MANAGEMENT (WESTON, MASS.) 2022; 19:63-77. [PMID: 36239499 PMCID: PMC11194540 DOI: 10.5055/jem.0631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
On September 6 and 20, 2017, Hurricanes Irma and Maria made landfall as major hurricanes in the US Caribbean Territories of the Virgin Islands and Puerto Rico with devastating effects. As part of the initial response, a public health team (PHT) was initially deployed as part of the US Department of Health and Human Services Incident Response Coordination Team. As a result of increased demands for additional expertise and resources, a public health branch (PHB) was established for coordinating a broad spectrum of public health response activities in support of the affected territories. This paper describes the conceptual framework for organizing these activities; summarizes some key public health activities and roles; outlines partner support and coordination with key agencies; and defines best practices and areas for improvement in disaster future operations.
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Affiliation(s)
- Miguel Angel Cruz
- National Center for Environmental Health, (Now) Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Luis O Rivera-GonzÁlez
- Toxicologist, Region 2, Office of Community Health and Hazard Assessment (OCHHA); Agency for Toxic Substances and Disease Registry (ATSDR); Centers for Disease Control and Prevention (CDC), New York, New York
| | - Elizabeth Irvin-Barnwell
- Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica Cabrera-Marquez
- Public Health Emergency Preparedness and Response Program, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Esther Ellis
- Epidemiology and Disease Reporting Program, Territorial Public Health Laboratory, Virgin Islands Department of Health, St. Croix, US Virgin Islands
| | - Brett Ellis
- Territorial Public Health Laboratory, Virgin Islands Department of Health, St. Croix, US Virgin Islands
| | - Benjamin Qi
- US Army Medical Research and Development Command, Ft. Detrick, Maryland
| | | | - Justin Andrew Gerding
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alice Shumate
- National Institute of Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio
| | - Ashley Andujar
- National Center for Emerging & Zoonotic Infectious Diseases, Atlanta, Georgia
| | - Jonathan Yoder
- National Center for Emerging & Zoonotic Infectious Diseases, Atlanta, Georgia
| | - Joseph Laco
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alberto Santana
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tesfaye Bayleyegn
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carolina Luna-Pinto
- National Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Luis Orlando Rodriguez
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph Roth
- Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John Bermingham
- Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Renée H Funk
- Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Murad Raheem
- Office of the Assistant Secretary for Preparedness and Response, Department of Health and Humans Services, New York City, New York
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16
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Sánchez-González L, Major CG, Rodriguez DM, Balajee A, Ryff KR, Lorenzi O, Linares M, Adams LE, Rivera-Amill V, Rolfes M, Paz-Bailey G. COVID-19 Vaccination Intention in a Community Cohort in Ponce, Puerto Rico. Am J Trop Med Hyg 2022; 107:268-277. [PMID: 35895388 PMCID: PMC9393461 DOI: 10.4269/ajtmh.22-0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 11/20/2022] Open
Abstract
As of January 20, 2022, > 247,000 confirmed COVID-19 cases and 3,600 deaths were reported in Puerto Rico (PR). We interviewed participants aged ≥ 14 years in the Communities Organized to Prevent Arboviruses (COPA) study, a community-based cohort in PR, about COVID-19 vaccine intention from November 12, 2020, to June 25, 2021. We used univariate and adjusted analyses to identify participant characteristics associated with vaccine intention. Among 1,542 respondents, the median age was 37 years (interquartile range 23-45) and 914 (59%) were female. Most participants (83%) reported a willingness to receive a COVID-19 vaccine. The most common reason for vaccine hesitancy was concern about the safety or side effects (64%). Willingness to receive the COVID-19 vaccine was associated with a later interview date, higher household income, previous COVID-19 diagnosis among household members, COVID-19 risk perception, influenza vaccine uptake, dengue vaccine intention, and general positive perceptions of vaccines. While parents with minors (< 21 years old) were less likely to report vaccine intention for themselves than participants without minor children, we observed similar characteristics associated with parents' willingness to vaccinate their children. Overall, COVID-19 vaccine intention was high among COPA participants. It is important that public health messaging in PR addresses COVID-19 vaccine safety and possible side effects.
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Affiliation(s)
| | - Chelsea G. Major
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Dania M. Rodriguez
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Abirami Balajee
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kyle R. Ryff
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Olga Lorenzi
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Mariely Linares
- Department of Basic Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Laura E. Adams
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Vanessa Rivera-Amill
- Department of Basic Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Melissa Rolfes
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gabriela Paz-Bailey
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
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17
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Zou M, Su C, Li T, Zhang J, Li D, Luan N, Ma D, Liu J, Sun Q, Peng X, Liu H. Genetic Characterization of Chikungunya Virus Among Febrile Dengue Fever–Like Patients in Xishuangbanna, Southwestern Part of China. Front Cell Infect Microbiol 2022; 12:914289. [PMID: 35832380 PMCID: PMC9271616 DOI: 10.3389/fcimb.2022.914289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/19/2022] [Indexed: 11/14/2022] Open
Abstract
Co-infection of chikungunya virus (CHIKV) has been recently reported during dengue fever epidemics. However, the infection of CHIKV is often neglected due to its misdiagnosis as dengue virus (DENV) infection. In the summer of 2019 when dengue fever was epidemic, we collected 697 serum samples from febrile dengue fever–like patients in Xishuangbanna, southwestern part of China. DENV RNA was detectable in 99.42% of these patients. Notably, 88 patients (12.62%) showed the presence of CHIKV RNA, among which 86 patients were co-infected with DENV and CHIKV. We sequenced and analyzed the full genome of CHIKV virus in four out of 88 samples (two CHIKV infected and two co-infected). The results suggested that the four strains were all Asian genotype and had the highest homology (99.4%) with the SZ1239 strain (accession number MG664851) isolated in 2012 and possibly introduced from Indonesia. Further comparison with the conserved sequences in the whole genome of 47 strains of CHIKV showed that there were 13 and 15 amino acid mutants in structural proteins and non-structural proteins, respectively. The previously reported adaptive mutations of E2-W64R, E2-I211T, E2-K233E, E1-A98T, and E1-K211E occurred in the four strains of this study. In conclusion, this study reports a co-infection of CHIKV during the DENV epidemic in the city Xishuangbanna, 2019. Molecular epidemiology revealed that CHIKV identified in this study was indigenous and belongs to Asian lineage with lineage-specific mutations and some reported adaptive mutations, which is distinct from the recently reported CHIKV (East/Central/South African) in Ruili, the city next to Xishuangbanna.
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Affiliation(s)
- Meng Zou
- Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical School, Kunming, China
| | - Chunyan Su
- Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical School, Kunming, China
| | - Tingting Li
- Joint Laboratory for Prevention and Control of Cross-border Transmission Disease, People’s Hospital of Xishuangbanna Dai Autonomous Prefecture, Jinghong, China
| | - Jing Zhang
- Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical School, Kunming, China
| | - Daiying Li
- Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical School, Kunming, China
| | - Ning Luan
- Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical School, Kunming, China
| | - Dehong Ma
- Joint Laboratory for Prevention and Control of Cross-border Transmission Disease, People’s Hospital of Xishuangbanna Dai Autonomous Prefecture, Jinghong, China
| | - Jiansheng Liu
- Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical School, Kunming, China
| | - Qiangming Sun
- Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical School, Kunming, China
| | - Xiaozhong Peng
- Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical School, Kunming, China
- State Key Laboratory of Medical Molecular Biology, Department of Molecular Biology and Biochemistry, Institute of Basic Medical Sciences, Medical Primate Research Center, Neuroscience Center, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Hongqi Liu
- Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical School, Kunming, China
- *Correspondence: Hongqi Liu,
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Adams LE, Sánchez-González L, Rodriguez DM, Ryff K, Major C, Lorenzi O, Delorey M, Medina FA, Muñoz-Jordán JL, Brown G, Ortiz M, Waterman SH, Rivera-Amill V, Paz-Bailey G. Risk factors for infection with chikungunya and Zika viruses in southern Puerto Rico: A community-based cross-sectional seroprevalence survey. PLoS Negl Trop Dis 2022; 16:e0010416. [PMID: 35696355 PMCID: PMC9191703 DOI: 10.1371/journal.pntd.0010416] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
Chikungunya virus (CHIKV) caused a large outbreak in Puerto Rico in 2014, followed by a Zika virus (ZIKV) outbreak in 2016. Communities Organized for the Prevention of Arboviruses (COPA) is a cohort study in southern Puerto Rico, initiated in 2018 to measure arboviral disease risk and provide a platform to evaluate interventions. To identify risk factors for infection, we assessed prevalence of previous CHIKV infection and recent ZIKV and DENV infection in a cross-sectional study among COPA participants. Participants aged 1-50 years (y) were recruited from randomly selected households in study clusters. Each participant completed an interview and provided a blood specimen, which was tested by anti-CHIKV IgG ELISA assay and anti-ZIKV and anti-DENV IgM MAC-ELISA assays. We assessed individual, household, and community factors associated with a positive result for CHIKV or ZIKV after adjusting for confounders. During 2018-2019, 4,090 participants were enrolled; 61% were female and median age was 28y (interquartile range [IQR]: 16-41). Among 4,035 participants tested for CHIKV, 1,268 (31.4%) had evidence of previous infection. CHIKV infection prevalence was lower among children 1-10 years old compared to people 11 and older (adjusted odds ratio [aOR] 2.30; 95% CI 1.71-3.08). Lower CHIKV infection prevalence was associated with home screens (aOR 0.51; 95% CI 0.42-0.61) and air conditioning (aOR 0.64; 95% CI 0.54-0.77). CHIKV infection prevalence also varied by study cluster of residence and insurance type. Few participants (16; 0.4%) had evidence of recent DENV infection by IgM. Among 4,035 participants tested for ZIKV, 651 (16%) had evidence of recent infection. Infection prevalence increased with older age, from 7% among 1-10y olds up to 19% among 41-50y olds (aOR 3.23; 95% CI 2.16-4.84). Males had an increased risk of Zika infection prevalence compared with females (aOR 1.31; 95% CI 1.09-1.57). ZIKV infection prevalence also decreased with the presence of home screens (aOR 0.66; 95% CI 0.54-0.82) and air conditioning (aOR 0.69; 95% CI 0.57-0.84). Similar infection patterns were observed for recent ZIKV infection prevalence and previous CHIKV infection prevalence by age, and the presence of screens and air conditioners in the home decreased infection risk from both viruses by as much as 50%.
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Affiliation(s)
- Laura E. Adams
- Division of Vector-borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- * E-mail:
| | - Liliana Sánchez-González
- Division of Vector-borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Dania M. Rodriguez
- Division of Vector-borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Kyle Ryff
- Division of Vector-borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Chelsea Major
- Division of Vector-borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Olga Lorenzi
- Division of Vector-borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Mark Delorey
- Division of Vector-borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Freddy A. Medina
- Division of Vector-borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Jorge L. Muñoz-Jordán
- Division of Vector-borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Grayson Brown
- Puerto Rico Vector Control Unit, San Juan, Puerto Rico
| | | | - Stephen H. Waterman
- Division of Vector-borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Gabriela Paz-Bailey
- Division of Vector-borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
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Grundy BS, Houpt ER. Opportunities and challenges to accurate diagnosis and management of acute febrile illness in adults and adolescents: A review. Acta Trop 2022; 227:106286. [PMID: 34953775 PMCID: PMC8920774 DOI: 10.1016/j.actatropica.2021.106286] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022]
Abstract
Acute febrile illnesses are common reasons to seek healthcare globally. They can be caused by diverse infectious diseases which require complex diagnostics. Current clinical guidelines provide guidance on how to manage severe illness, common localizing infections like pneumonia and urinary tract infections, as well as malaria. How to manage other cases of acute febrile illness is less clear and is the focus of this review. Without an etiologic diagnosis, clinicians frequently prescribe empiric antibiotics that may be unnecessary or inadequate. We reviewed recent studies on the etiology of acute febrile illnesses in adults and adolescents that employed multiple diagnostic modalities, including rapid diagnostic tests, serologies, and polymerase chain reaction. Although studies and etiologies were heterogenous, we enumerated the causes of febrile illness in these studies. Possible improvements in clinical decision-making algorithms are discussed.
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Affiliation(s)
- Brian S Grundy
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United States of America.
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United States of America.
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20
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Ostermeier B, Soriano-Sarabia N, Maggirwar SB. Platelet-Released Factors: Their Role in Viral Disease and Applications for Extracellular Vesicle (EV) Therapy. Int J Mol Sci 2022; 23:2321. [PMID: 35216433 PMCID: PMC8876984 DOI: 10.3390/ijms23042321] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 02/04/2023] Open
Abstract
Platelets, which are small anuclear cell fragments, play important roles in thrombosis and hemostasis, but also actively release factors that can both suppress and induce viral infections. Platelet-released factors include sCD40L, microvesicles (MVs), and alpha granules that have the capacity to exert either pro-inflammatory or anti-inflammatory effects depending on the virus. These factors are prime targets for use in extracellular vesicle (EV)-based therapy due to their ability to reduce viral infections and exert anti-inflammatory effects. While there are some studies regarding platelet microvesicle-based (PMV-based) therapy, there is still much to learn about PMVs before such therapy can be used. This review provides the background necessary to understand the roles of platelet-released factors, how these factors might be useful in PMV-based therapy, and a critical discussion of current knowledge of platelets and their role in viral diseases.
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Affiliation(s)
| | | | - Sanjay B. Maggirwar
- Department of Microbiology Immunology and Tropical Medicine, The George Washington University, 2300 I Street NW, Washington, DC 20037, USA; (B.O.); (N.S.-S.)
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Tunjungputri RN, Riswari SF, Pramudo SG, Kuntjoro L, Alisjahbana B, Nugraha HG, van der Ven A, Gasem MH, de Mast Q. Effect of oseltamivir phosphate versus placebo on platelet recovery and plasma leakage in adults with dengue and thrombocytopenia; a phase 2, multicenter, double-blind, randomized trial. PLoS Negl Trop Dis 2022; 16:e0010051. [PMID: 34995275 PMCID: PMC8789129 DOI: 10.1371/journal.pntd.0010051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/25/2022] [Accepted: 12/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Thrombocytopenia, bleeding and plasma leakage are major complications of dengue. Activation of endogenous sialidases with desialylation of platelets and endothelial cells may underlie these complications. We aimed to assess the effects of the neuraminidase inhibitor oseltamivir on platelet recovery and plasma leakage in dengue. Methods We performed a phase 2, double-blind, multicenter, randomized trial in adult dengue patients with thrombocytopenia (<70,000/μl) and a duration of illness ≤ 6 days. Oseltamivir phosphate 75mg BID or placebo were given for a maximum of five days. Primary outcomes were the time to platelet recovery (≥ 100,000/μl) or discharge from hospital and the course of measures of plasma leakage. Results A total of 70 patients were enrolled; the primary outcome could be assessed in 64 patients (31 oseltamivir; 33 placebo). Time to platelet count ≥100,000/μl (n = 55) or discharge (n = 9) were similar in the oseltamivir and placebo group (3.0 days [95% confidence interval, 2.7 to 3.3] vs. 2.9 days [2.5 to 3.3], P = 0.055). The kinetics of platelet count and parameters of plasma leakage (gall bladder thickness, hematocrit, plasma albumin, syndecan-1) were also similar between the groups. Discussion In this trial, adjunctive therapy with oseltamivir phosphate had no effect on platelet recovery or plasma leakage parameters. Trial registration ISRCTN35227717. Moderate to severe thrombocytopenia is common in the febrile and/or critical phase of dengue virus infection. Platelets are important for preservation of vascular integrity, especially during inflammation, and low platelet counts may contribute to plasma leakage. Currently, no therapeutic intervention that targets the pathogenic pathway is available for DENV infection, including therapies to prevent or reduce thrombocytopenia or plasma leakage. Oseltamivir phosphate is widely used for prevention and treatment of influenza by inhibiting viral neuraminidase. However, oseltamivir may also inhibit human endogenous neuraminidase involved in sialic acid metabolism, and as such extend the lifespan of platelets. In the phase 2 TOTO trial (Treatment Of Thrombocytopenia with Oseltamivir in acute dengue virus infection: a randomized, placebo controlled, multicenter trial) we investigated the potential of oseltamivir phosphate to shorten the time to platelet recovery and reduce plasma leakage in patients with DENV infection. In this trial involving 70 adult thrombocytopenic patients, hospitalized with acute DENV infection, adjunctive therapy with oseltamivir phosphate did not shorten platelet recovery time compared with placebo. The trial also did not show an effect of adjunctive oseltamivir on plasma leakage parameters. The reasons that oseltamivir had no apparent effect on platelet counts, markers of plasma leakage and glycocalyx distortion in this study remain speculative, but may involve one or more of the following; first, dengue-associated thrombocytopenia and plasma leakage are both multifactorial in origin and targeting neuraminidase alone may be insufficient to impact these processes. Second, oseltamivir phosphate was designed to inhibit viral neuraminidase, and data of its inhibitory actions on human neuraminidases are inconclusive. The finding in this study also suggest that while laboratory works may lead to hypotheses for novel treatment, proof of concept studies are essential to test them in a clinical setting.
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Affiliation(s)
- Rahajeng N. Tunjungputri
- Department of Internal Medicine and the Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Center for Tropical and Infectious Disease (CENTRID), Faculty of Medicine Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia
| | - Silvita Fitri Riswari
- Department of Internal Medicine and the Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Center for Care and Control of Infectious Disease (RC3ID), Universitas Padjadjaran, Bandung, Indonesia
- Parasitology Division, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia, Indonesia
| | - Setyo G. Pramudo
- Center for Tropical and Infectious Disease (CENTRID), Faculty of Medicine Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia
- Department of Internal Medicine, Diponegoro National University Hospital, Faculty of Medicine Diponegoro University, Semarang, Central Java, Indonesia
| | - Lydia Kuntjoro
- Department of Radiology, Diponegoro National University Hospital, Faculty of Medicine Diponegoro University, Semarang, Central Java, Indonesia
| | - Bachti Alisjahbana
- Research Center for Care and Control of Infectious Disease (RC3ID), Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Hasan Sadikin General Hospital, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, Indonesia, Indonesia
| | - Harry Galuh Nugraha
- Department of Radiology, Hasan Sadikin General Hospital, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, Indonesia, Indonesia
| | - Andre van der Ven
- Department of Internal Medicine and the Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Muhammad Hussein Gasem
- Center for Tropical and Infectious Disease (CENTRID), Faculty of Medicine Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia
- Department of Internal Medicine, Diponegoro National University Hospital, Faculty of Medicine Diponegoro University, Semarang, Central Java, Indonesia
| | - Quirijn de Mast
- Department of Internal Medicine and the Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
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Dhanoa A, Ngim CF, Yunos NM, Husain SMT, Pong LY, Ismail WFW, Hontz RD, Hassan SS. Contribution of Viral Respiratory Infections to Dengue-Like Illness Presentation at a Community Clinic in Southern Malaysia. Am J Trop Med Hyg 2022; 106:187-191. [PMID: 34583338 PMCID: PMC8733527 DOI: 10.4269/ajtmh.21-0648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/16/2021] [Indexed: 01/03/2023] Open
Abstract
This study explored the contribution of viral respiratory infections (VRIs) in dengue-like illness (DLI) patients and their distinguishing clinicolaboratory parameters. Two hundred DLI patients were prospectively recruited (July 1- October 1, 2019) from a community clinic in Southern Malaysia. Patients ≥ 18 years with acute fever and fulfilling the WHO criteria of probable dengue were recruited. They underwent blood testing: blood counts, rapid dengue tests (nonstructural antigen-1/IgM) and polymerase chain reaction (PCR) for dengue, Zika, chikungunya, and Leptospira. Nasopharyngeal swabs (NPSs) were collected for FilmArray®RP2plus testing. From the 200 NPSs, 58 respiratory viruses (RVs) were detected in 54 patients. Of the 96 dengue-confirmed cases, 86 had dengue mono-infection, and 10 were coinfected with RVs. Of the 104 nondengue, 44 were RV positive and 4 Leptospira positive. Zika and chikungunya virus were not detected. Overall, the etiological diagnosis was confirmed for 72% of patients. Clinicolaboratory parameters were compared between dengue mono-infection and VRI mono-infection. Patients with coinfections were excluded. Multiple logistic regression showed that recent household/neighborhood history of dengue (adjusted odds ratio [aOR]: 5.9, 95% CI = 1.7-20.7), leukopenia (aOR: 12.5, 95% CI = 2.6-61.4) and thrombocytopenia (aOR: 5.5, 95% CI = 1.3-23.0) predicted dengue. Inversely, rhinorrhoea (aOR: 0.1, 95% CI = 0.01-0.3) and cough (aOR: 0.3, 95% CI = 0.1-0.9) favored VRI. Thus, VRIs comprise many infections diagnosed initially as DLIs. Early clinicolaboratory parameters can guide physicians screen patients for further testing.
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Affiliation(s)
- Amreeta Dhanoa
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia;,Address correspondence to Amreeta Dhanoa, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia. E-mail:
| | - Chin Fang Ngim
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia
| | - Nor’azim Mohd Yunos
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia;,Faculty of Medicine, University of Malaya, Malaysia
| | | | - Lian Yih Pong
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia
| | | | | | - Sharifah Syed Hassan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia
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Quandelacy TM, Adams LE, Munoz J, Santiago GA, Kada S, Johansson MA, Alvarado LI, Rivera-Amill V, Paz–Bailey G. Reduced spread of influenza and other respiratory viral infections during the COVID-19 pandemic in southern Puerto Rico. PLoS One 2022; 17:e0266095. [PMID: 35476785 PMCID: PMC9045654 DOI: 10.1371/journal.pone.0266095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/14/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Impacts of COVID-19 mitigation measures on seasonal respiratory viruses is unknown in sub-tropical climates. METHODS We compared weekly testing and test-positivity of respiratory infections in the 2019-2020 respiratory season to the 2012-2018 seasons in southern Puerto Rico using Wilcoxon signed rank tests. RESULTS Compared to the average for the 2012-2018 seasons, test-positivity was significantly lower for Influenza A (p<0.001) & B (p<0.001), respiratory syncytial virus (RSV) (p<0.01), respiratory adenovirus (AdV) (p<0.05), and other respiratory viruses (p<0.001) following March 2020 COVID-19 stay at home orders. CONCLUSIONS Mitigation measures and behavioral social distancing choices may have reduced respiratory viral spread in southern Puerto Rico.
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Affiliation(s)
- Talia M. Quandelacy
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- * E-mail:
| | - Laura E. Adams
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Jorge Munoz
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Gilberto A. Santiago
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Sarah Kada
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Michael A. Johansson
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | | | - Gabriela Paz–Bailey
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
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Turuk J, Palo SK, Rath S, Subhadra S, Sabat J, Sahoo PK, Panda S, Pati S. Viral characteristics and clinical presentation in dengue co-infection- Findings from a facility based observational study in Odisha, India. J Family Med Prim Care 2021; 10:2958-2963. [PMID: 34660431 PMCID: PMC8483126 DOI: 10.4103/jfmpc.jfmpc_2380_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/21/2021] [Accepted: 03/23/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Dengue has affected many countries globally. Two-fifths part of the world is at risk, which can be affected by dengue disease. In India, the dengue incidence has increased in the recent past and emerged as an important health problem in many states including Odisha. Dengue disease presents with atypical clinical symptoms when associated with other co-infections. Materials and Methods: A facility-based longitudinal study was carried out over a period of 1 year to determine the dengue co-infection and its outcome. The suspected cases were clinically assessed following a standard case report format and serological investigations including serotyping were carried out. Results: 33.6% samples were dengue positive of which 78.5% were positive for NS1 Ag, 26.6% positive for dengue IgM and 5.1% to both. Among the dengue positive cases, 60.9% were male and mean age was 31.52 (±17.03) years. High occurrence of cases was during May to November with maximum in August. Among the 975 dengue positives, 57 (5.8%) were found to have co-infection. Chikungunya was the most common co-infection in 71.9%, followed by herpes simplex (HSV) (7%) and other diseases. Fever was the most common presenting symptom (98.2%), followed by myalgia (91.2%), retro orbital pain (91.2%), pain abdomen (12.3%), rash/lesion (8.8%), burning micturition (5.3%), petechiae (1.7%) and pruritus (1.7%) among the co-infected cases. Conclusions: All the four dengue serotypes were found to be circulating with DEN 2 as the most predominant one. About 5.8% of dengue cases have co-infection (mainly with Chikungunya) and clinically present with atypical signs and symptoms.
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Affiliation(s)
| | - Subrata K Palo
- Department of Public Health, ICMR-RMRC Bhubaneswar, Odisha, India
| | - Sonalika Rath
- VRDL, ICMR-RMRC Bhubaneswar, Nalco Square, Odisha, India
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Raafat N, Loganathan S, Mukaka M, Blacksell SD, Maude RJ. Diagnostic accuracy of the WHO clinical definitions for dengue and implications for surveillance: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009359. [PMID: 33901191 PMCID: PMC8102005 DOI: 10.1371/journal.pntd.0009359] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/06/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Dengue is the world’s most common mosquito-borne virus but remains diagnostically challenging due to its nonspecific presentation. Access to laboratory confirmation is limited and thus most reported figures are based on clinical diagnosis alone, the accuracy of which is uncertain. This systematic review assesses the diagnostic accuracy of the traditional (1997) and revised (2009) WHO clinical case definitions for dengue fever, the basis for most national guidelines. Methodology/Principal findings PubMed, EMBASE, Scopus, OpenGrey, and the annual Dengue Bulletin were searched for studies assessing the diagnostic accuracy of the unmodified clinical criteria. Two reviewers (NR/SL) independently assessed eligibility, extracted data, and evaluated risk of bias using a modified QUADAS-2. Additional records were found by citation network analysis. A meta-analysis was done using a bivariate mixed-effects regression model. Studies that modified criteria were analysed separately. This systematic review protocol was registered on PROSPERO (CRD42020165998). We identified 11 and 12 datasets assessing the 1997 and 2009 definition, respectively, and 6 using modified criteria. Sensitivity was 93% (95% CI: 77–98) and 93% (95% CI: 86–96) for the 1997 and 2009 definitions, respectively. Specificity was 29% (95% CI: 8–65) and 31% (95% CI: 18–48) for the 1997 and 2009 definitions, respectively. Diagnostic performance suffered at the extremes of age. No modification significantly improved accuracy. Conclusions/Significance Diagnostic accuracy of clinical criteria is poor, with significant implications for surveillance and public health responses for dengue control. As the basis for most reported figures, this has relevance to policymakers planning resource allocation and researchers modelling transmission, particularly during COVID-19. Dengue is the most common mosquito-borne disease worldwide, with half the world’s population living in at-risk areas, yet it remains difficult to diagnose. Existing laboratory tests have highly variable performance, and access to them remains limited in most dengue-endemic regions. Thus, most dengue cases are diagnosed on clinical criteria alone. While national guidelines vary, most are based on the WHO case definitions, produced in 1997 and revised in 2009. Here, we assess the diagnostic accuracy of both definitions and find that they have good sensitivity but poor specificity, particularly problematic given the co-circulation of multiple febrile illnesses in these regions. This makes it difficult for policymakers and researchers to model transmission, assess the introduction of new pathogens to a region, and correctly prioritise control measures and vaccination programmes in a region-specific manner. This is exacerbated by the ongoing COVID-19 pandemic, given rising cases of both diseases and the stark difference in necessary control measures. As such, improvements in dengue diagnostic and reporting practice are increasingly urgent. This could be achieved by incorporating symptom absence into clinical criteria, weighting symptoms depending on strength of association with dengue or timing within disease course, or using clinical criteria to allocate limited testing resources in borderline cases.
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Affiliation(s)
- Nader Raafat
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Oxford Medical School, University of Oxford, Oxford, United Kingdom
| | | | - Mavuto Mukaka
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stuart D. Blacksell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Richard James Maude
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- * E-mail:
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Warnes CM, Santacruz-Sanmartín E, Bustos Carrillo F, Vélez ID. Surveillance and Epidemiology of Dengue in Medellín, Colombia from 2009 to 2017. Am J Trop Med Hyg 2021; 104:1719-1728. [PMID: 33755586 PMCID: PMC8103481 DOI: 10.4269/ajtmh.19-0728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/22/2021] [Indexed: 11/07/2022] Open
Abstract
Dengue is the most prevalent arthropod-borne viral disease in humans, primarily transmitted by the Aedes aegypti mosquito. We conducted a descriptive analysis of dengue cases from 2009 to 2017 in Medellín, Colombia, using data available from the Secretariat of Health. We analyzed the burden of outbreak years on the healthcare system, risk of cases exhibiting severe illness, potential disease surveillance problems, gender and age as risk factors, and spatiotemporal patterns of disease occurrence. Our data consisted of 50,083 cases, separated based on whether they were diagnostic test negative, diagnostic test positive (primarily IgM ELISA), clinically confirmed, epidemiologically linked, or probable. We used dengue incidence to analyze epidemiological trends between our study years, related to human movement patterns, between gender and age-groups, and spatiotemporally. We used risk to analyze the severity of dengue cases between the study years. We identified human movement could contributed to dengue spread, and male individuals (incidence rate: 0.86; 95% CI: 0.76-0.96) and individuals younger than 15 years (incidence rate: 1.24; 95% CI: 1.13-1.34) have higher incidence of dengue and located critical parts of the city where dengue incidence was high. Analysis was limited by participant diagnostic information, data concerning circulating strains, and a lack of phylogenetic information. Understanding the characteristics of dengue is a fundamental part of improving the health outcomes of at-risk populations. This analysis will be useful to support studies and initiatives to counteract dengue and provide context to the surveillance data collected by the health authorities in Medellín.
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Affiliation(s)
- Colin M. Warnes
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellín, Colombia
| | - Eduardo Santacruz-Sanmartín
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellín, Colombia
| | | | - Iván Darío Vélez
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellín, Colombia
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Raadsen M, Du Toit J, Langerak T, van Bussel B, van Gorp E, Goeijenbier M. Thrombocytopenia in Virus Infections. J Clin Med 2021; 10:jcm10040877. [PMID: 33672766 PMCID: PMC7924611 DOI: 10.3390/jcm10040877] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
Thrombocytopenia, which signifies a low platelet count usually below 150 × 109/L, is a common finding following or during many viral infections. In clinical medicine, mild thrombocytopenia, combined with lymphopenia in a patient with signs and symptoms of an infectious disease, raises the suspicion of a viral infection. This phenomenon is classically attributed to platelet consumption due to inflammation-induced coagulation, sequestration from the circulation by phagocytosis and hypersplenism, and impaired platelet production due to defective megakaryopoiesis or cytokine-induced myelosuppression. All these mechanisms, while plausible and supported by substantial evidence, regard platelets as passive bystanders during viral infection. However, platelets are increasingly recognized as active players in the (antiviral) immune response and have been shown to interact with cells of the innate and adaptive immune system as well as directly with viruses. These findings can be of interest both for understanding the pathogenesis of viral infectious diseases and predicting outcome. In this review, we will summarize and discuss the literature currently available on various mechanisms within the relationship between thrombocytopenia and virus infections.
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Affiliation(s)
- Matthijs Raadsen
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
| | - Justin Du Toit
- Department of Haematology, Wits University Donald Gordon Medical Centre Johannesburg, Johannesburg 2041, South Africa;
| | - Thomas Langerak
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
| | - Bas van Bussel
- Department of Intensive Care Medicine, Maastricht University Medical Center Plus, 6229 HX Maastricht, The Netherlands;
- Care and Public Health Research Institute (CAPHRI), Maastricht University, 6229 GT Maastricht, The Netherlands
| | - Eric van Gorp
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
- Department of Internal Medicine, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Marco Goeijenbier
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
- Department of Internal Medicine, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands
- Correspondence:
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Sánchez-González L, Quandelacy TM, Johansson M, Torres-Velásquez B, Lorenzi O, Tavarez M, Torres S, Alvarado LI, Paz-Bailey G. Viral etiology and seasonal trends of pediatric acute febrile illness in southern Puerto Rico; a seven-year review. PLoS One 2021; 16:e0247481. [PMID: 33606839 PMCID: PMC7895389 DOI: 10.1371/journal.pone.0247481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 02/08/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Acute febrile illness (AFI) is an important cause for seeking health care among children. Knowledge of the most common etiologic agents of AFI and its seasonality is limited in most tropical regions. METHODOLOGY/PRINCIPAL FINDINGS To describe the viral etiology of AFI in pediatric patients (≤18 years) recruited through a sentinel enhanced dengue surveillance system (SEDSS) in Southern Puerto Rico, we analyzed data for patients enrolled from 2012 to May 2018. To identify seasonal patterns, we applied time-series analyses to monthly arboviral and respiratory infection case data. We calculated coherence and phase differences for paired time-series to quantify the association between each time series. A viral pathogen was found in 47% of the 14,738 patients. Influenza A virus was the most common pathogen detected (26%). The incidence of Zika and dengue virus etiologies increased with age. Arboviral infections peaked between June and September throughout the times-series. Respiratory infections have seasonal peaks occurring in the fall and winter months of each year, though patterns vary by individual respiratory pathogen. CONCLUSIONS/SIGNIFICANCE Distinct seasonal patterns and differences in relative frequency by age groups seen in this study can guide clinical and laboratory assessment in pediatric patients with AFI in Puerto Rico.
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Affiliation(s)
| | - Talia M. Quandelacy
- Dengue Branch, Centers for Disease Control and Prevention, CDC, San Juan, Puerto Rico
| | - Michael Johansson
- Dengue Branch, Centers for Disease Control and Prevention, CDC, San Juan, Puerto Rico
| | | | - Olga Lorenzi
- Dengue Branch, Centers for Disease Control and Prevention, CDC, San Juan, Puerto Rico
| | - Mariana Tavarez
- Saint Luke’s Episcopal Hospital Consortium, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Sanet Torres
- Saint Luke’s Episcopal Hospital Consortium, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Luisa I. Alvarado
- Saint Luke’s Episcopal Hospital Consortium, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Gabriela Paz-Bailey
- Dengue Branch, Centers for Disease Control and Prevention, CDC, San Juan, Puerto Rico
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Escadafal C, Geis S, Siqueira AM, Agnandji ST, Shimelis T, Tadesse BT, Massinga Loembé M, Harris V, Fernandez-Carballo BL, Macé A, Ongarello S, Rodriguez W, Dittrich S. Bacterial versus non-bacterial infections: a methodology to support use-case-driven product development of diagnostics. BMJ Glob Health 2020; 5:bmjgh-2020-003141. [PMID: 33087393 PMCID: PMC7580043 DOI: 10.1136/bmjgh-2020-003141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/28/2020] [Accepted: 09/12/2020] [Indexed: 01/28/2023] Open
Abstract
Acute febrile illness (AFI) is one of the most common reasons for seeking medical care in low-income and middle-income countries. Bacterial infections account for a relatively small proportion of AFIs; however, in the absence of a simple diagnostic test to guide clinical decisions, healthcare professionals often presume that a non-malarial febrile illness is bacterial in origin, potentially resulting in inappropriate antibiotic use. An accurate differential diagnostic tool for AFIs is thus essential, to both limit antibiotic use to bacterial infections and address the antimicrobial resistance crisis that is emerging globally, without resorting to multiple or complex pathogen-specific assays. The Biomarker for Fever-Diagnostic (BFF-Dx) study is one of the largest fever biomarker studies ever undertaken. We collected samples and classified disease aetiology in more than 1900 individuals, distributed among enrolment centres in three countries on two continents. Identical protocols were followed at each study site, and the same analyses were conducted in each setting, enabling like-with-like comparisons to be made among the large sample set generated. The BFF-Dx methodology can act as a model for other researchers, facilitating wider utility of the work in the future. The established sample collection is now accessible to researchers and companies and will facilitate the development of future fever-related diagnostic tests. Here, we outline the methodology used to determine the sample populations and to differentiate bacterial versus non-bacterial AFIs. Future publications will set out in more detail the study’s demographics, the causes of fever identified and the performance of selected biomarkers.
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Affiliation(s)
- Camille Escadafal
- Malaria and Fever Programme, Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Steffen Geis
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Chilumba, Karonga, Malawi.,London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | - A M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas (INI), FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Techalew Shimelis
- Hawassa University College of Medicine and Health Sciences, Hawassa, Southern Nations, Ethiopia
| | - Birkneh Tilahun Tadesse
- Hawassa University College of Medicine and Health Sciences, Hawassa, Southern Nations, Ethiopia.,Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Marguerite Massinga Loembé
- Africa Center for Disease Control and Prevention (ACDC), Addis Ababa, Ethiopia.,African Society for Laboratory Medicine (ASLM), Addis Ababa, Ethiopia
| | - Victoria Harris
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | | | - Aurélien Macé
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | | | | | - Sabine Dittrich
- Malaria and Fever Programme, Foundation for Innovative New Diagnostics, Geneva, Switzerland.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Laoprasopwattana K, Limpitikul W, Geater A. Using Clinical Profiles and Complete Blood Counts to Differentiate Causes of Acute Febrile Illness during the 2009-11 Outbreak of Typhoid and Chikungunya in a Dengue Endemic Area. J Trop Pediatr 2020; 66:504-510. [PMID: 32016406 DOI: 10.1093/tropej/fmaa006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIMS After the 2009-11 outbreak of typhoid and chikungunya (CHIK) in Thailand, an effort was made to use complete blood counts and clinical profiles to differentiate these diseases to facilitate earlier specific treatment. METHODS Patients aged 2-15 years having fever on first visit ≤3 days without localizing signs were enrolled retrospectively. Typhoid fever was confirmed by hemoculture, dengue by nonstructural protein-1 or polymerase chain reaction (PCR), and CHIK by PCR. Febrile children with negative results for these infections were classified as other acute febrile illness (AFI). RESULTS Of the 264 cases, 56, 164, 25 and 19 had typhoid fever, dengue viral infection (DVI), CHIK and other AFI, respectively. Arthralgia had sensitivity, specificity, positive predictive value (PPV) and negative predictive value of 0.96, 0.97, 0.80 and 0.99, respectively, to differentiate CHIK from the others. After excluding CHIK by arthralgia, the PPV of the WHO 1997 and 2009 criteria for DVI increased from 0.65 and 0.73 to 0.95 and 0.84, respectively. Children with one of myalgia, headache or leukopenia had sensitivity of 0.84, specificity of 0.76 and PPV of 0.92 to differentiate DVI from typhoid and other AFIs. Patients with one of abdominal pain, diarrhea or body temperature >39.5°C were more likely to have typhoid fever than another AFI with PPV of 0.90. CONCLUSION Using this flow chart can help direct physicians to perform more specific tests to confirm the diagnosis and provide more specific treatment. Nevertheless, clinical follow-up is the most important tool in unknown causes of febrile illness.
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Affiliation(s)
| | - Wannee Limpitikul
- Department of Pediatrics, Songkhla Hospital, Songkhla 90000, Thailand
| | - Alan Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
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31
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Sharp TM, Quandelacy TM, Adams LE, Aponte JT, Lozier MJ, Ryff K, Flores M, Rivera A, Santiago GA, Muñoz-Jordán JL, Alvarado LI, Rivera-Amill V, Garcia-Negrón M, Waterman SH, Paz-Bailey G, Johansson MA, Rivera-Garcia B. Epidemiologic and spatiotemporal trends of Zika Virus disease during the 2016 epidemic in Puerto Rico. PLoS Negl Trop Dis 2020; 14:e0008532. [PMID: 32956416 PMCID: PMC7529257 DOI: 10.1371/journal.pntd.0008532] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 10/01/2020] [Accepted: 06/28/2020] [Indexed: 12/16/2022] Open
Abstract
Background After Zika virus (ZIKV) emerged in the Americas, laboratory-based surveillance for arboviral diseases in Puerto Rico was adapted to include ZIKV disease. Methods and findings Suspected cases of arboviral disease reported to Puerto Rico Department of Health were tested for evidence of infection with Zika, dengue, and chikungunya viruses by RT-PCR and IgM ELISA. To describe spatiotemporal trends among confirmed ZIKV disease cases, we analyzed the relationship between municipality-level socio-demographic, climatic, and spatial factors, and both time to detection of the first ZIKV disease case and the midpoint of the outbreak. During November 2015–December 2016, a total of 71,618 suspected arboviral disease cases were reported, of which 39,717 (55.5%; 1.1 cases per 100 residents) tested positive for ZIKV infection. The epidemic peaked in August 2016, when 71.5% of arboviral disease cases reported weekly tested positive for ZIKV infection. Incidence of ZIKV disease was highest among 20–29-year-olds (1.6 cases per 100 residents), and most (62.3%) cases were female. The most frequently reported symptoms were rash (83.0%), headache (64.6%), and myalgia (63.3%). Few patients were hospitalized (1.2%), and 13 (<0.1%) died. Early detection of ZIKV disease cases was associated with increased population size (log hazard ratio [HR]: -0.22 [95% confidence interval -0.29, -0.14]), eastern longitude (log HR: -1.04 [-1.17, -0.91]), and proximity to a city (spline estimated degrees of freedom [edf] = 2.0). Earlier midpoints of the outbreak were associated with northern latitude (log HR: -0.30 [-0.32, -0.29]), eastern longitude (spline edf = 6.5), and higher mean monthly temperature (log HR: -0.04 [-0.05, -0.03]). Higher incidence of ZIKV disease was associated with lower mean precipitation, but not socioeconomic factors. Conclusions During the ZIKV epidemic in Puerto Rico, 1% of residents were reported to public health authorities and had laboratory evidence of ZIKV disease. Transmission was first detected in urban areas of eastern Puerto Rico, where transmission also peaked earlier. These trends suggest that ZIKV was first introduced to Puerto Rico in the east before disseminating throughout the island. During epidemics of Zika virus disease in the Americas in 2015 and 2016, assessment of transmission dynamics was limited by inconsistent laboratory testing of patients with suspected Zika virus disease. This limitation was further complicated by co-circulation of dengue and chikungunya viruses, which cause illnesses clinically similar to Zika virus disease. In Puerto Rico, all reported suspect cases of arboviral disease were tested for Zika, dengue, and chikungunya virus infection throughout the epidemic, which allowed for fine-scale analysis of epidemiologic and spatiotemporal trends. In total, 39,717 cases of Zika virus disease were detected, or roughly 1% of all residents of Puerto Rico. Young adults and females were most affected. Disease was mostly mild, as only 1% of cases were hospitalized. Thirteen patients with Zika virus disease died, most of whom had Guillain-Barré syndrome or severe underlying illnesses. Early detection of Zika virus disease cases was associated with more populated areas of eastern Puerto Rico, where early detection of peak case numbers also occurred, particularly in warmer areas. These trends suggest that, in contrast to prior epidemics of dengue and chikungunya that started in the San Juan metropolitan region, the Zika virus epidemic appears to have begun in eastern Puerto Rico.
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Affiliation(s)
- Tyler M. Sharp
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- US Public Health Service, Rockville, Maryland, United States of America
- * E-mail:
| | - Talia M. Quandelacy
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Laura E. Adams
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- US Public Health Service, Rockville, Maryland, United States of America
| | - Jomil Torres Aponte
- Office of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Matthew J. Lozier
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- US Public Health Service, Rockville, Maryland, United States of America
| | - Kyle Ryff
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Mitchelle Flores
- Biological and Chemical Emergencies Laboratory, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Aidsa Rivera
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Gilberto A. Santiago
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | | | | | | | - Stephen H. Waterman
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- US Public Health Service, Rockville, Maryland, United States of America
| | - Gabriela Paz-Bailey
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Michael A. Johansson
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Brenda Rivera-Garcia
- Biological and Chemical Emergencies Laboratory, Puerto Rico Department of Health, San Juan, Puerto Rico
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C. B. Coelho I, Haguinet F, B. Colares JK, C. B. Coelho Z, M. C. Araújo F, Dias Schwarcz W, Duarte AC, Borges B, Minguet C, Guignard A. Dengue Infection in Children in Fortaleza, Brazil: A 3-Year School-Based Prospective Cohort Study. Am J Trop Med Hyg 2020; 103:100-111. [PMID: 32342838 PMCID: PMC7356456 DOI: 10.4269/ajtmh.19-0521] [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: 07/12/2019] [Accepted: 03/25/2020] [Indexed: 01/17/2023] Open
Abstract
Dengue is endemic in Brazil. The dengue surveillance system's reliance on passive reporting may underestimate disease incidence and cannot detect asymptomatic/pauci-symptomatic cases. In this 3-year prospective cohort study (NCT01391819) in 5- to 13-year-old children from nine schools in Fortaleza (N = 2,117), we assessed dengue virus (DENV) infection seroprevalence by IgG indirect ELISA at yearly visits and disease incidence through active and enhanced passive surveillance. Real-time quantitative polymerase chain reaction (RT-qPCR) and DENV IgM/IgG capture ELISA were used for diagnosis. We further characterized confirmed and probable cases with a plaque reduction neutralization test. At enrollment, 54.1% (95% CI: 46.6, 61.4) of children were DENV IgG positive. The annual incidence of laboratory-confirmed symptomatic dengue cases was 11.0 (95% CI: 7.3, 14.7), 18.1 (10.4, 25.7), and 10.2 (0.7, 19.7), and of laboratory-confirmed or probable dengue cases with neutralizing antibody profile evocative of dengue exposure was 13.2 (6.6, 19.9), 18.7 (5.3, 32.2), and 8.4 (2.4, 19.2) per 1,000 child-years in 2012, 2013, and 2014, respectively. By RT-qPCR, we identified 14 DENV-4 cases in 2012-2013 and seven DENV-1 cases in 2014. During the course of the study, 32.8% of dengue-naive children experienced a primary infection. Primary inapparent dengue infection was detected in 20.3% (95% CI: 13.6, 29.1) of dengue-naive children in 2012, 8.7% (6.9, 10.9) in 2013, and 5.1% (4.4, 6.0) in 2014. Our results confirmed the high dengue endemicity in Fortaleza, with active and enhanced passive surveillance detecting three to five times more cases than the National System of Disease Notification.
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Affiliation(s)
| | | | - Jeová Keny B. Colares
- Secretaria de Saúde do Estado do Ceará, Hospital São José de Doenças Infecciosas, Fortaleza, Brazil
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Fortaleza, Fortaleza, Brazil
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Caraballo E, Poole-Smith BK, Tomashek KM, Torres-Velasquez B, Alvarado LI, Lorenzi OD, Ramos C, Carrión J, Hunsperger E. The detection of anti-dengue virus IgM in urine in participants enrolled in an acute febrile illness study in Puerto Rico. PLoS Negl Trop Dis 2020; 14:e0007971. [PMID: 31995560 PMCID: PMC6988914 DOI: 10.1371/journal.pntd.0007971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 12/05/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Dengue is an important arboviral disease with about 100 million dengue cases per year, of which, ~5% result in severe disease. Clinical differentiation of dengue from other acute febrile illnesses (AFI) is difficult, and diagnostic blood tests are costly. We evaluated the utility of anti-DENV IgM in urine to identify dengue cases among AFI patients enrolled in a clinical study. METHODS Between May 2012-March 2013, 1538 study participants with fever for ≤7 days were enrolled, a medical history was obtained, and serum and urine specimens were collected. Serum was tested for DENV RNA and anti-DENV IgM. Urine was tested for anti-DENV IgM, and its sensitivity and specificity to detect sera laboratory-positive dengue cases were calculated. We evaluated if urine anti-DENV IgM positivity early (≤5 days post-illness onset [DPO]) and late (6-14 DPO) in the clinical course was associated with dengue severity. RESULTS Urine anti-DENV IgM sensitivity and specificity were 47.4% and 98.5%, respectively, when compared with serum anti-DENV IgM ELISA results, and 29.7% and 91.1% when compared with serum rRT-PCR results. There was no correlation between urine anti-DENV IgM positivity and patient sex or pre-existing chronic disease. Early in the clinical course, a significantly higher proportion of those who developed dengue with warning signs had anti-DENV IgM in their urine when compared to those without warning signs (20.4% vs. 4.3%). There was no difference in the proportion with urine anti-DENV IgM positivity between severity groups late in the clinical course. CONCLUSION While detection of urine anti-DENV IgM lacked adequate diagnostic sensitivity, it is a highly specific marker for laboratory-positive dengue, and its presence early in the clinical course may distinguish those with more severe disease. Further assessment of urine anti-DENV IgM by DPO is warranted to determine its utility as an early diagnostic (and possibly prognostic) marker for dengue.
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Affiliation(s)
- Elba Caraballo
- University of Puerto Rico, UPR- Comprehensive Cancer Center(UPRCCC), Division of Cancer Biology, San Juan, Puerto Rico
- * E-mail:
| | | | - Kay M. Tomashek
- National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases (NIAID), Division of Microbiology and Infectious Diseases (DMID), Office of Clinical Research Resources (OCRR)
| | - Brenda Torres-Velasquez
- Centers for Disease Control and Prevention (CDC), Division of Vector Borne Diseases, San Juan, Puerto Rico
| | | | - Olga D. Lorenzi
- Centers for Disease Control and Prevention (CDC), Division of Vector Borne Diseases, San Juan, Puerto Rico
| | - Carmen Ramos
- Centers for Disease Control and Prevention (CDC), Division of Vector Borne Diseases, San Juan, Puerto Rico
| | - Jessica Carrión
- Centers for Disease Control and Prevention (CDC), Division of Vector Borne Diseases, San Juan, Puerto Rico
| | - Elizabeth Hunsperger
- CDC, Division of Global Health Protection, Epidemiology, Surveillance, Informatics, and Laboratory Branch, CDC-Kenya
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Luvira V, Silachamroon U, Piyaphanee W, Lawpoolsri S, Chierakul W, Leaungwutiwong P, Thawornkuno C, Wattanagoon Y. Etiologies of Acute Undifferentiated Febrile Illness in Bangkok, Thailand. Am J Trop Med Hyg 2020; 100:622-629. [PMID: 30628565 DOI: 10.4269/ajtmh.18-0407] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Acute undifferentiated febrile illness (AUFI) has been a diagnostic dilemma in the tropics. Without accurate point-of-care tests, information on local pathogens and clinical parameters is essential for presumptive diagnosis. A prospective hospital-based study was conducted at the Bangkok Hospital for Tropical Diseases from 2013 to 2015 to determine common etiologies of AUFI. A total of 397 adult AUFI cases, excluding malaria by blood smear, were enrolled. Rapid diagnostic tests for tropical infections were performed on admission, and acute and convalescent samples were tested to confirm the diagnosis. Etiologies could be identified in 271 (68.3%) cases. Dengue was the most common cause, with 157 cases (39.6%), followed by murine typhus (20 cases; 5.0%), leptospirosis (16 cases; 4.0%), influenza (14 cases; 3.5%), and bacteremia (six cases; 1.5%). Concurrent infection by at least two pathogens was reported in 37 cases (9.3%). Furthermore, characteristics of dengue and bacterial infections (including leptospirosis and rickettsioses) were compared to facilitate dengue triage, initiate early antibiotic treatment, and minimize unnecessary use of antibiotics. In conclusion, dengue was the most common pathogen for AUFI in urban Thailand. However, murine typhus and leptospirosis were not uncommon. Empirical antibiotic treatment using doxycycline or azithromycin might be more appropriate, but cost-benefit studies are required. Physicians should recognize common causes of AUFI in their localities and use clinical and laboratory clues for provisional diagnosis to provide appropriate treatment while awaiting laboratory confirmation.
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Affiliation(s)
- Viravarn Luvira
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Udomsak Silachamroon
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wirongrong Chierakul
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pornsawan Leaungwutiwong
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Charin Thawornkuno
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Yupaporn Wattanagoon
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Evaluation of Emergency Department-Based Surveillance Systems at 2 Healthcare Facilities After Hurricane Maria: Puerto Rico, 2017-2018. Disaster Med Public Health Prep 2019; 17:e1. [PMID: 31475668 PMCID: PMC7050426 DOI: 10.1017/dmp.2019.79] [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: 02/02/2023]
Abstract
OBJECTIVES Hurricane Maria caused catastrophic damage in Puerto Rico, increasing the risk for morbidity and mortality in the post-impact period. We aimed to establish a syndromic surveillance system to describe the number and type of visits at 2 emergency health-care settings in the same hospital system in Ponce, Puerto Rico. METHODS We implemented a hurricane surveillance system by interviewing patients with a short questionnaire about the reason for visit at a hospital emergency department and associated urgent care clinic in the 6 mo after Hurricane Maria. We then evaluated the system by comparing findings with data from the electronic medical record (EMR) system for the same time period. RESULTS The hurricane surveillance system captured information from 5116 participants across the 2 sites, representing 17% of all visits captured in the EMR for the same period. Most visits were associated with acute illness/symptoms (79%), followed by injury (11%). The hurricane surveillance and EMR data were similar, proportionally, by sex, age, and visit category. CONCLUSIONS The hurricane surveillance system provided timely and representative data about the number and type of visits at 2 sites. This system, or an adapted version using available electronic data, should be considered in future disaster settings.
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Santiago GA, Sharp TM, Rosenberg E, Sosa Cardona II, Alvarado L, Paz-Bailey G, Muñoz-Jordán JL. Prior Dengue Virus Infection Is Associated With Increased Viral Load in Patients Infected With Dengue but Not Zika Virus. Open Forum Infect Dis 2019; 6:5531802. [PMID: 31363765 DOI: 10.1093/ofid/ofz320] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/08/2019] [Indexed: 11/14/2022] Open
Abstract
To evaluate potential enhancement of Zika virus (ZIKV) infection among patients with prior dengue virus (DENV) infection, we compared loads of viral RNA among patients infected with ZIKV (n = 1070), DENV-2 (n = 312), or DENV-3 (n = 260). Compared to patients without prior DENV infection, patients with prior DENV infection had significantly higher mean loads of viral RNA if infected with DENV-2 (10.6 vs 11.6 log10 GCE/mL, respectively; t test, P < .0001) or DENV-3 (10.3 vs 10.9 log10 GCE/mL; P < .0001), but not ZIKV (4.7 vs 4.7 log10 GCE/mL; P = .959). These findings provide evidence against in vivo enhancement of ZIKV by anti-DENV antibodies.
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Affiliation(s)
- Gilberto A Santiago
- Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico
| | - Tyler M Sharp
- Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico.,United States Public Health Service, Silver Springs, Maryland
| | - Eli Rosenberg
- University at Albany School of Public Health, Department of Epidemiology and Biostatistics, Rensselaer, New York
| | - Iris I Sosa Cardona
- Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico.,University of Puerto Rico, Department of Microbiology and Medical Zoology, San Juan
| | - Luisa Alvarado
- Ponce Health Sciences University, Puerto Rico.,San Lucas Episcopal Hospital, Ponce, Puerto Rico
| | - Gabriela Paz-Bailey
- Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico
| | - Jorge L Muñoz-Jordán
- Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico
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Alvarado LI, Lorenzi OD, Torres-Velásquez BC, Sharp TM, Vargas L, Muñoz-Jordán JL, Hunsperger EA, Pérez-Padilla J, Rivera A, González-Zeno GE, Galloway RL, Glass Elrod M, Mathis DL, Oberste MS, Nix WA, Henderson E, McQuiston J, Singleton J, Kato C, García-Gubern C, Santiago-Rivera W, Muns-Sosa R, Ortiz-Rivera JD, Jiménez G, Rivera-Amill V, Andújar-Pérez DA, Horiuchi K, Tomashek KM. Distinguishing patients with laboratory-confirmed chikungunya from dengue and other acute febrile illnesses, Puerto Rico, 2012-2015. PLoS Negl Trop Dis 2019; 13:e0007562. [PMID: 31329598 PMCID: PMC6645456 DOI: 10.1371/journal.pntd.0007562] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/19/2019] [Indexed: 11/18/2022] Open
Abstract
Chikungunya, a mosquito-borne viral, acute febrile illness (AFI) is associated with polyarthralgia and polyarthritis. Differentiation from other AFI is difficult due to the non-specific presentation and limited availability of diagnostics. This 3-year study identified independent clinical predictors by day post-illness onset (DPO) at presentation and age-group that distinguish chikungunya cases from two groups: other AFI and dengue. Specimens collected from participants with fever ≤7 days were tested for chikungunya, dengue viruses 1-4, and 20 other pathogens. Of 8,996 participants, 18.2% had chikungunya, and 10.8% had dengue. Chikungunya cases were more likely than other groups to be older, report a chronic condition, and present <3 DPO. Regardless of timing of presentation, significant positive predictors for chikungunya versus other AFI were: joint pain, muscle, bone or back pain, skin rash, and red conjunctiva; with dengue as the comparator, red swollen joints (arthritis), joint pain, skin rash, any bleeding, and irritability were predictors. Chikungunya cases were less likely than AFI and dengue to present with thrombocytopenia, signs of poor circulation, diarrhea, headache, and cough. Among participants presenting <3 DPO, predictors for chikungunya versus other AFI included: joint pain, skin rash, and muscle, bone or back pain, and absence of thrombocytopenia, poor circulation and respiratory or gastrointestinal symptoms; when the comparator was dengue, joint pain and arthritis, and absence of thrombocytopenia, leukopenia, and nausea were early predictors. Among all groups presenting 3-5 DPO, pruritic skin became a predictor for chikungunya, joint, muscle, bone or back pain were no longer predictive, while arthritis became predictive in all age-groups. Absence of thrombocytopenia was a significant predictor regardless of DPO or comparison group. This study identified robust clinical indicators such as joint pain, skin rash and absence of thrombocytopenia that can allow early identification of and accurate differentiation between patients with chikungunya and other common causes of AFI.
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Affiliation(s)
- Luisa I. Alvarado
- Ponce Health Sciences University /Ponce Research Institute, Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America
| | - Olga D. Lorenzi
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America
| | - Brenda C. Torres-Velásquez
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America
| | - Tyler M. Sharp
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America
| | - Luzeida Vargas
- Ponce Health Sciences University /Ponce Research Institute, Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America
| | - Jorge L. Muñoz-Jordán
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America
| | - Elizabeth A. Hunsperger
- Division of Global Health Protection, Centers for Disease Control and Prevention (CDC), Kenya, Africa
| | - Janice Pérez-Padilla
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America
| | - Aidsa Rivera
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America
| | - Gladys E. González-Zeno
- Ponce Health Sciences University /Ponce Research Institute, Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America
| | - Renee L. Galloway
- Bacterial Special Pathogens Branch, Zoonoses and Select Agent Laboratory, CDC, Atlanta, Georgia, United States of America
| | - Mindy Glass Elrod
- Bacterial Special Pathogens Branch, Zoonoses and Select Agent Laboratory, CDC, Atlanta, Georgia, United States of America
| | - Demetrius L. Mathis
- Bacterial Special Pathogens Branch, Zoonoses and Select Agent Laboratory, CDC, Atlanta, Georgia, United States of America
| | - M. Steven Oberste
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, United States of America
| | - W. Allan Nix
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, United States of America
| | - Elizabeth Henderson
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, United States of America
| | - Jennifer McQuiston
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, CDC, Atlanta, Georgia, United States of America
| | - Joseph Singleton
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, CDC, Atlanta, Georgia, United States of America
| | - Cecilia Kato
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, CDC, Atlanta, Georgia, United States of America
| | - Carlos García-Gubern
- Ponce Health Sciences University /Ponce Research Institute, Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America
| | - William Santiago-Rivera
- Ponce Health Sciences University /Ponce Research Institute, Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America
| | - Robert Muns-Sosa
- Saint Luke’s Episcopal Hospital, Guayama, Puerto Rico, United States of America
| | | | - Gerson Jiménez
- Saint Luke’s Episcopal Hospital, Guayama, Puerto Rico, United States of America
| | - Vanessa Rivera-Amill
- Ponce Health Sciences University /Ponce Research Institute, Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America
| | - Doris A. Andújar-Pérez
- Ponce Health Sciences University /Ponce Research Institute, Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America
| | - Kalanthe Horiuchi
- Office of the Director, Division of Vector-Borne Diseases, CDC, Fort Collins, Colorado, United States of America
| | - Kay M. Tomashek
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
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Hottz ED, Quirino-Teixeira AC, Valls-de-Souza R, Zimmerman GA, Bozza FA, Bozza PT. Platelet function in HIV plus dengue coinfection associates with reduced inflammation and milder dengue illness. Sci Rep 2019; 9:7096. [PMID: 31068600 PMCID: PMC6506591 DOI: 10.1038/s41598-019-43275-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/12/2019] [Indexed: 12/11/2022] Open
Abstract
HIV-infected subjects under virological control still exhibit a persistent proinflammatory state. Thus, chronic HIV infection changes the host homeostasis towards an adapted immune response that may affect the outcome of coinfections. However, little is known about the impact of HIV infection on inflammatory amplification and clinical presentation in dengue. Platelets have been shown to participate in immune response in dengue and HIV. We hypothesized that altered platelet responses in HIV-infected subjects may contribute to altered inflammatory milieu and disease progression in dengue. We prospectively followed a cohort of 84 DENV-infected patients of whom 29 were coinfected with HIV under virological control. We report that dengue and HIV coinfection progress with reduced inflammation and milder disease progression with lower risk of vascular instability. Even though the degree of thrombocytopenia and platelet activation were similar between dengue-infected and HIV plus dengue-coinfected patients, plasma levels of the platelet-derived chemokines RANTES/CCL5 and PF4/CXCL4 were lower in coinfection. Consistently, platelets from coinfected patients presented defective secretion of the stored-chemokines PF4 and RANTES, but not newly synthesized IL-1β, when cultured ex vivo. These data indicate that platelets from HIV-infected subjects release lower levels of chemokines during dengue illness, which may contribute to milder clinical presentation during coinfection.
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Affiliation(s)
- Eugenio D Hottz
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC) - Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Laboratório de análise de glicoconjugados, Departamento de Bioquímica, Instituto de Ciências Biológicas (ICB) - Universidade Federal de Juiz de Fora (UFJF), Minas, Gerais, Brazil
| | - Anna Cecíllia Quirino-Teixeira
- Laboratório de análise de glicoconjugados, Departamento de Bioquímica, Instituto de Ciências Biológicas (ICB) - Universidade Federal de Juiz de Fora (UFJF), Minas, Gerais, Brazil
| | - Rogério Valls-de-Souza
- Laboratório de doenças febrís agudas, Instituto Nacional de Infectologia Evandro Chagas (INI), FIOCRUZ, Rio de Janeiro, Brazil
| | - Guy A Zimmerman
- Molecular Medicine Program, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Fernando A Bozza
- Laboratório de Medicina Intensiva, INI, FIOCRUZ, Rio de Janeiro, Brazil.
- Instituto D'Or de Pesquisa e Ensino (IDOr), Rio de Janeiro, Brazil.
| | - Patrícia T Bozza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC) - Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
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Riswari SF, Tunjungputri RN, Kullaya V, Garishah FM, Utari GSR, Farhanah N, Overheul GJ, Alisjahbana B, Gasem MH, Urbanus RT, de Groot PG, Lefeber DJ, van Rij RP, van der Ven A, de Mast Q. Desialylation of platelets induced by Von Willebrand Factor is a novel mechanism of platelet clearance in dengue. PLoS Pathog 2019; 15:e1007500. [PMID: 30849118 PMCID: PMC6426266 DOI: 10.1371/journal.ppat.1007500] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 03/20/2019] [Accepted: 12/03/2018] [Indexed: 11/19/2022] Open
Abstract
Thrombocytopenia and platelet dysfunction are commonly observed in patients with dengue virus (DENV) infection and may contribute to complications such as bleeding and plasma leakage. The etiology of dengue-associated thrombocytopenia is multifactorial and includes increased platelet clearance. The binding of the coagulation protein von Willebrand factor (VWF) to the platelet membrane and removal of sialic acid (desialylation) are two well-known mechanisms of platelet clearance, but whether these conditions also contribute to thrombocytopenia in dengue infection is unknown. In two observational cohort studies in Bandung and Jepara, Indonesia, we show that adult patients with dengue not only had higher plasma concentrations of plasma VWF antigen and active VWF, but that circulating platelets had also bound more VWF to their membrane. The amount of platelet-VWF binding correlated well with platelet count. Furthermore, sialic acid levels in dengue patients were significantly reduced as assessed by the binding of Sambucus nigra lectin (SNA) and Maackia amurensis lectin II (MAL-II) to platelets. Sialic acid on the platelet membrane is neuraminidase-labile, but dengue virus has no known neuraminidase activity. Indeed, no detectable activity of neuraminidase was present in plasma of dengue patients and no desialylation was found of plasma transferrin. Platelet sialylation was also not altered by in vitro exposure of platelets to DENV nonstructural protein 1 or cultured DENV. In contrast, induction of binding of VWF to glycoprotein 1b on platelets using the VWF-activating protein ristocetin resulted in the removal of platelet sialic acid by translocation of platelet neuraminidase to the platelet surface. The neuraminidase inhibitor oseltamivir reduced VWF-induced platelet desialylation. Our data demonstrate that excessive binding of VWF to platelets in dengue results in neuraminidase-mediated platelet desialylation and platelet clearance. Oseltamivir might be a novel treatment option for severe thrombocytopenia in dengue infection. Dengue is the most common arbovirus infection in the world. A decrease in the number of blood platelets is an almost universal finding in severe dengue. Binding of the coagulation protein von Willebrand factor (VWF) and loss of sialic acid residues from the platelet membrane are two main mechanisms of clearance of senescent platelets under non-pathological conditions. Here, we show that platelets from patients with acute dengue have bound more VWF and have lost sialic acid from their membrane. Sialic acid can be cleaved by the enzyme neuraminidase. We show that neuraminidase activity in the plasma is not increased and that neither dengue virus itself nor nonstructural protein 1, a protein secreted by dengue virus, cleave sialic acid from the platelet membrane. In contrast, binding of VWF to platelets results in translocation of neuraminidase to the platelet membrane and subsequent cleavage of sialic acid. This process could be inhibited by the neuraminidase inhibitor oseltamivir, a commonly used anti-influenza drug. Altogether, our results indicate that VWF binding to platelets is increased in dengue infection, leading to the removal of sialic acid and platelet clearance. Oseltamivir may prevent this process and thus represent a novel treatment option for low platelet numbers in dengue infection.
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Affiliation(s)
- Silvita Fitri Riswari
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rahajeng N. Tunjungputri
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Center for Tropical and Infectious Disease (CENTRID), Faculty of Medicine Diponegoro University, Dr Kariadi Hospital, Semarang, Indonesia
| | - Vesla Kullaya
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Kilimanjaro Christian Medical Center, Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Fadel M. Garishah
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Center for Tropical and Infectious Disease (CENTRID), Faculty of Medicine Diponegoro University, Dr Kariadi Hospital, Semarang, Indonesia
| | - Gloria S. R. Utari
- Center for Tropical and Infectious Disease (CENTRID), Faculty of Medicine Diponegoro University, Dr Kariadi Hospital, Semarang, Indonesia
| | - Nur Farhanah
- Center for Tropical and Infectious Disease (CENTRID), Faculty of Medicine Diponegoro University, Dr Kariadi Hospital, Semarang, Indonesia
| | - Gijs J. Overheul
- Center for Tropical and Infectious Disease (CENTRID), Faculty of Medicine Diponegoro University, Dr Kariadi Hospital, Semarang, Indonesia
- Department of Medical Microbiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bachti Alisjahbana
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - M. Hussein Gasem
- Center for Tropical and Infectious Disease (CENTRID), Faculty of Medicine Diponegoro University, Dr Kariadi Hospital, Semarang, Indonesia
| | - Rolf T. Urbanus
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Philip. G. de Groot
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dirk J. Lefeber
- Department of Neurology, Translational Metabolic Laboratory, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald P. van Rij
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Medical Microbiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andre van der Ven
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Quirijn de Mast
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
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Ball JD, Elbadry MA, Telisma T, White SK, Chavannes S, Anilis MG, Prosperi M, Cummings DAT, Lednicky JA, Morris JG, Beau de Rochars M. Clinical and Epidemiologic Patterns of Chikungunya Virus Infection and Coincident Arboviral Disease in a School Cohort in Haiti, 2014-2015. Clin Infect Dis 2019; 68:919-926. [PMID: 30184178 PMCID: PMC6399436 DOI: 10.1093/cid/ciy582] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/10/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Beginning in December 2013, an epidemic of chikungunya virus (CHIKV) infection spread across the Caribbean and into virtually all countries in the Western hemisphere, with >2.4 million cases reported through the end of 2017. METHODS We monitored a cohort of school children in rural Haiti from May 2014, through February 2015, for occurrence of acute undifferentiated febrile illness, with clinical and laboratory data available for 252 illness episodes. RESULTS Our findings document passage of the major CHIKV epidemic between May and July 2014, with 82 laboratory-confirmed cases. Subsequent peaks of febrile illness were found to incorporate smaller outbreaks of dengue virus serotypes 1 and 4 and Zika virus, with identification of additional infections with Mayaro virus, enterovirus D68, and coronavirus NL63. CHIKV and dengue virus serotype 1 infections were more common in older children, with a complaint of arthralgia serving as a significant predictor for infection with CHIKV (odds ratio, 16.2; 95% confidence interval, 8.0-34.4; positive predictive value, 66%; negative predictive value, 80%). CONCLUSIONS Viral/arboviral infections were characterized by a pattern of recurrent outbreaks and case clusters, with the CHIKV epidemic representing just one of several arboviral agents moving through the population. Although clinical presentations of these agents are similar, arthralgias are highly suggestive of CHIKV infection.
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Affiliation(s)
- Jacob D Ball
- Emerging Pathogens Institute, College of Public Health and Health Professions and College of Medicine
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine
| | - Maha A Elbadry
- Emerging Pathogens Institute, College of Public Health and Health Professions and College of Medicine
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville
| | - Taina Telisma
- Christianville School Clinic, Christianville Foundation, Gressier, Haiti
| | - Sarah K White
- Emerging Pathogens Institute, College of Public Health and Health Professions and College of Medicine
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville
| | - Sonese Chavannes
- Christianville School Clinic, Christianville Foundation, Gressier, Haiti
| | - Marie Gina Anilis
- Christianville School Clinic, Christianville Foundation, Gressier, Haiti
| | - Mattia Prosperi
- Emerging Pathogens Institute, College of Public Health and Health Professions and College of Medicine
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine
| | - Derek A T Cummings
- Emerging Pathogens Institute, College of Public Health and Health Professions and College of Medicine
- Department of Biology, College of Liberal Arts and Sciences
| | - John A Lednicky
- Emerging Pathogens Institute, College of Public Health and Health Professions and College of Medicine
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville
| | - J Glenn Morris
- Emerging Pathogens Institute, College of Public Health and Health Professions and College of Medicine
- Department of Medicine, College of Medicine
| | - Madsen Beau de Rochars
- Emerging Pathogens Institute, College of Public Health and Health Professions and College of Medicine
- Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
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Hsu CH, Cruz-Lopez F, Vargas Torres D, Perez-Padilla J, Lorenzi OD, Rivera A, Staples JE, Lugo E, Munoz-Jordan J, Fischer M, Garcia Gubern C, Rivera Garcia B, Alvarado L, Sharp TM. Risk factors for hospitalization of patients with chikungunya virus infection at sentinel hospitals in Puerto Rico. PLoS Negl Trop Dis 2019; 13:e0007084. [PMID: 30640900 PMCID: PMC6347300 DOI: 10.1371/journal.pntd.0007084] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/25/2019] [Accepted: 12/17/2018] [Indexed: 12/27/2022] Open
Abstract
Background Hospitalization of patients during outbreaks of chikungunya virus has been reported to be uncommon (0.5–8.7%), but more frequent among infants and the elderly. CHIKV was first detected in Puerto Rico in May 2014. We enrolled patients with acute febrile illness (AFI) presenting to two hospital emergency departments in Puerto Rico and tested them for CHIKV infection to describe the frequency of detection of CHIKV-infected patients, identify risk factors for hospitalization, and describe patients with severe manifestations. Methodology/Principal findings Serum specimens were collected from patients with AFI and tested by rRT-PCR. During May–December 2014, a total of 3,035 patients were enrolled, and 1,469 (48.4%) had CHIKV infection. A total of 157 (10.7%) CHIKV-infected patients were hospitalized, six (0.4%) were admitted to the intensive care unit, and two died (0.1%). Common symptoms among all CHIKV-infected patients were arthralgia (82.6%), lethargy (80.6%), and myalgia (80.5%). Compared to patients aged 1–69 years (7.3%), infant (67.2%) and elderly (17.3%) patients were nine and two times more likely to be hospitalized, respectively (relative risk [RR] and 95% confidence interval [CI] = 9.16 [7.05–11.90] and 2.36 [1.54–3.62]). Multiple symptoms of AFI were associated with decreased risk of hospitalization, including arthralgia (RR = 0.31 [0.23–0.41]) and myalgia (RR = 0.29 [0.22–0.39]). Respiratory symptoms were associated with increased risk of hospitalization, including rhinorrhea (RR = 1.68 [1.24–2.27) and cough (RR = 1.77 [1.31–2.39]). Manifestations present among <5% of patients but associated with patient hospitalization included cyanosis (RR = 2.20 [1.17–4.12) and seizures (RR = 3.23 [1.80–5.81). Discussion Among this cohort of CHIKV-infected patients, hospitalization was uncommon, admission to the ICU was infrequent, and death was rare. Risk of hospitalization was higher in patients with symptoms of respiratory illness and other manifestations that may not have been the result of CHIKV infection. Chikungunya is an emerging infectious disease caused by a virus (chikungunya virus, CHIKV) transmitted through the bite of infected mosquitos; typical symptoms are fever and joint pain. After CHIKV was first detected in Puerto Rico in 2014, an epidemic quickly spread across the island. Because previous reports identified varying frequencies of hospitalization of CHIKV-infected patients, we used an existing hospital-based disease detection system to better understand the frequency and reasons for hospitalization of CHIKV-infected patients in Puerto Rico. Among 1,469 patients with laboratory-confirmed CHIKV infection, 11% were hospitalized, most of whom were infants or elderly. Six CHIKV-infected patients were admitted to the intensive care unit, and two died. Although several illness characteristics were associated with hospitalization, most of these were not typical of chikungunya and instead suggested underlying or concomitant respiratory disease. By enrolling patients when they presented to the emergency department and testing them for evidence of CHIKV infection, we determined that hospitalization in this population occurred in roughly one-in-ten CHIKV-infected patients, one-in-two hundred were admitted to the intensive care unit, and one-in-one thousand died. These findings provide information on the spectrum of disease caused by CHIKV, and identified underlying or concomitant respiratory illness as a risk factor associated with hospitalization.
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Affiliation(s)
- Christopher H. Hsu
- Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, United States of America
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, United States of America
| | - Fabiola Cruz-Lopez
- Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico
- Ponce Health Sciences University, Ponce, Puerto Rico
| | | | - Janice Perez-Padilla
- Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico
| | - Olga D. Lorenzi
- Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico
| | - Aidsa Rivera
- Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico
| | - J. Erin Staples
- Centers for Disease Control and Prevention, Arboviral Diseases Branch, Fort Collins, CO, United States of America
| | - Esteban Lugo
- San Lucas Episcopal Hospital, Ponce, Puerto Rico
| | - Jorge Munoz-Jordan
- Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico
| | - Marc Fischer
- Centers for Disease Control and Prevention, Arboviral Diseases Branch, Fort Collins, CO, United States of America
| | - Carlos Garcia Gubern
- Ponce Health Sciences University, Ponce, Puerto Rico
- San Lucas Episcopal Hospital, Ponce, Puerto Rico
| | | | - Luisa Alvarado
- Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico
- San Lucas Episcopal Hospital, Ponce, Puerto Rico
| | - Tyler M. Sharp
- Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico
- * E-mail:
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Pérez-Padilla J, Paz-Bailey G, Meaney-Delman D, Doyle K, Gary J, Rodriguez DM, Bhatnagar J, Pérez-Rodriguez NM, Montalvo S, Alvarado L, Sharp TM. Persistent Zika Virus Infection Associated with Early Fetal Demise: A Case Report. ACTA ACUST UNITED AC 2019; 9:698-706. [PMID: 31799062 PMCID: PMC6889876 DOI: 10.4236/ojog.2019.95069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Infection with Zika virus (ZIKV) during pregnancy is known to cause birth defects and could also be linked to pregnancy loss. Case: A pregnant woman in Puerto Rico contracted ZIKV at 16 weeks gestation. ZIKV RNA persisted in serum from her initial test at 16 weeks through 24 weeks gestation, when fetal demise occurred, and was detected in placental tissue. Conclusion: Prolonged detection of ZIKV RNA in maternal serum was associated with ZIKV RNA detection in the placenta of a patient who experienced fetal demise. While detection of placenta ZIKV RNA does not establish that ZIKV conclusively caused the demise, these findings support emerging evidence that the placenta may serve as a reservoir for ZIKV, which may be associated with prolonged detection of ZIKV RNA in serum.
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Affiliation(s)
- Janice Pérez-Padilla
- Centers for Disease Control and Prevention (CDC), Dengue Branch, San Juan, Puerto Rico
| | - Gabriela Paz-Bailey
- Centers for Disease Control and Prevention (CDC), Dengue Branch, San Juan, Puerto Rico
| | - Dana Meaney-Delman
- CDC, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA
| | - Kate Doyle
- CDC, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | - Joy Gary
- CDC, Infectious Disease Pathology Branch, Atlanta, GA, USA
| | - Dania M Rodriguez
- Centers for Disease Control and Prevention (CDC), Dengue Branch, San Juan, Puerto Rico
| | - Julu Bhatnagar
- CDC, Infectious Disease Pathology Branch, Atlanta, GA, USA
| | | | - Sara Montalvo
- Ponce Health Sciences University/Saint Luke's Episcopal Hospital, Ponce, Puerto Rico
| | - Luisa Alvarado
- Ponce Health Sciences University/Saint Luke's Episcopal Hospital, Ponce, Puerto Rico
| | - Tyler M Sharp
- Centers for Disease Control and Prevention (CDC), Dengue Branch, San Juan, Puerto Rico
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Le-Viet N, Le VN, Chung H, Phan DT, Phan QD, Cao TV, Abat C, Raoult D, Parola P. Prospective case-control analysis of the aetiologies of acute undifferentiated fever in Vietnam. Emerg Microbes Infect 2019; 8:339-352. [PMID: 30866787 PMCID: PMC6455186 DOI: 10.1080/22221751.2019.1580539] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/24/2019] [Accepted: 01/29/2019] [Indexed: 01/15/2023]
Abstract
Acute undifferentiated fever (AUF) is frequently observed in tropical settings, but diagnosing the cause of AUF is often a challenge for local physicians and the physicians treating returning travellers. We conducted a case-control study in central Vietnam in 2016. A total of 378 febrile adult patients (AUFs) with a fever for ≤21 days, no evidence of localized infection and negative screening tests for dengue and malaria, and 384 afebrile adult patients (Controls) were prospectively enrolled. Whole blood, plasma, eschar swab, throat swab and urine specimens were collected and analysed. Quantitative PCR and RT-PCR were used to test for 55 bacteria, viruses and their subtypes. Serological tests were also used to test for rickettsial agents. The most common aetiology was influenza virus (20.9% in AUFs vs. 0% in Controls), followed by rickettsial agents (mainly Orientia tsutsugamushi and Rickettsia typhi) (10.8% vs. 0.3%), dengue virus (7.7% vs. 0.5%), Leptospira (4.8% vs. 0.8%), adenovirus (4.8% vs. 1.0%), and enterovirus (2.1% vs. 0%) (p < .05). The real proportion of dengue in AUF cases was underestimated because patients with dengue-positive rapid diagnosis tests were excluded from the study. The emerging agent Rickettsia felis, which had not been previously observed in Vietnam, was detected in this study. In total, 216 patients (57.1%) were given causative diagnoses, comprising 143 (66.2%) monoinfections and 73 (33.8%) coinfections. The infections caused by these agents should be considered in clinical practice and further studies. Additionally, agents susceptible to doxycycline were detected in 15.6% of AUFs; thus, this drug should be included in the panel used to treat AUF patients.
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Affiliation(s)
- Nhiem Le-Viet
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
- Department of Tropical Medicine, Quang Nam Central General Hospital, Quang Nam, Vietnam
| | - Viet-Nho Le
- School of Medicine and Pharmacy, Danang University, Danang, Vietnam
| | - Hai Chung
- Department of Tropical Medicine, Quang Nam Central General Hospital, Quang Nam, Vietnam
| | - Duc-Tuan Phan
- Department of Internal Medicine II, Quang Nam Northern Mountainous Region General Hospital, Quang Nam, Vietnam
| | - Quang-Duong Phan
- Department of Internal Medicine B, Quang Nam Regional General Hospital, Quang Nam, Vietnam
| | - Thanh-Van Cao
- Department of Tropical Medicine, Quang Nam Provincial General Hospital, Quang Nam, Vietnam
| | - Cédric Abat
- IHU-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille University, IRD, AP-HM, MEPHI, Marseille, France
| | - Philippe Parola
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
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Freitas ARR, Donalisio MR, Alarcón-Elbal PM. Excess Mortality and Causes Associated with Chikungunya, Puerto Rico, 2014-2015. Emerg Infect Dis 2018; 24:2352-2355. [PMID: 30277456 PMCID: PMC6256393 DOI: 10.3201/eid2412.170639] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
During 2014-2015, a total of 31 deaths were associated with the first chikungunya epidemic in Puerto Rico. We analyzed excess mortality from various causes for the same months during the previous 4 years and detected 1,310 deaths possibly attributable to chikungunya. Our findings raise important questions about increased mortality rates associated with chikungunya.
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Carabali M, Lim JK, Palencia DC, Lozano‐Parra A, Gelvez RM, Lee KS, Florez JP, Herrera VM, Kaufman JS, Rojas EM, Villar LA. Burden of dengue among febrile patients at the time of chikungunya introduction in Piedecuesta, Colombia. Trop Med Int Health 2018; 23:1231-1241. [PMID: 30176107 PMCID: PMC6334506 DOI: 10.1111/tmi.13147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To estimate the age-specific incidence of symptomatic dengue and chikungunya in Colombia. METHOD A passive facility-based fever surveillance study was conducted among individuals with undifferentiated fever. Confirmatory diagnostics included serological and molecular tests in paired samples, and surveillance's underreporting was assessed using capture-recapture methods. RESULTS Of 839 febrile participants 686 completed the study. There were 33.2% (295/839) dengue infections (51% primary infections), and 35.9% (191/532) of negative dengue cases there were chikungunya cases. On average, dengue cases were younger (median = 18 years) than chikungunya cases (median = 25 years). Thrombocytopaenia and abdominal pain were the main dengue predictors, while presence of rash was the main predictor for chikungunya diagnosis. Underreporting of dengue was 31%; the estimated expansion factors indicate an underreporting rate of dengue cases of threefold for all cases and of almost sixfold for inpatients. CONCLUSIONS These findings highlight the ongoing coexistence of both arboviruses, a distinct clinical profile of each condition in the study area that could be used by clinicians to generate a differential diagnosis, and the presence of underreporting, mostly among hospitalised cases.
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Affiliation(s)
- Mabel Carabali
- Global Dengue and Aedes‐transmitted Diseases ConsortiumInternational Vaccine InstituteSeoulKorea
- McGill UniversityMontrealQCCanada
| | - Jacqueline K. Lim
- Global Dengue and Aedes‐transmitted Diseases ConsortiumInternational Vaccine InstituteSeoulKorea
| | | | | | | | - Kang Sung Lee
- Global Dengue and Aedes‐transmitted Diseases ConsortiumInternational Vaccine InstituteSeoulKorea
| | | | | | | | - Elsa M. Rojas
- Universidad Industrial de SantanderBucaramangaColombia
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Paz-Bailey G, Rosenberg ES, Doyle K, Munoz-Jordan J, Santiago GA, Klein L, Perez-Padilla J, Medina FA, Waterman SH, Gubern CG, Alvarado LI, Sharp TM. Persistence of Zika Virus in Body Fluids - Final Report. N Engl J Med 2018; 379:1234-1243. [PMID: 28195756 PMCID: PMC5831142 DOI: 10.1056/nejmoa1613108] [Citation(s) in RCA: 302] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND To estimate the frequency and duration of detectable Zika virus (ZIKV) RNA in human body fluids, we prospectively assessed a cohort of newly infected participants in Puerto Rico. METHODS We evaluated samples obtained from 150 participants (including 55 men) in whom ZIKV RNA was detected on reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay in urine or blood in an enhanced arboviral clinical surveillance site. We collected serum, urine, saliva, semen, and vaginal secretions weekly for the first month and then at 2, 4, and 6 months. All specimens were tested by means of RT-PCR, and serum was tested with the use of anti-ZIKV IgM enzyme-linked immunosorbent assay. Among the participants with ZIKV RNA in any specimen at week 4, biweekly collection continued until all specimens tested negative. We used parametric Weibull regression models to estimate the time until the loss of ZIKV RNA detection in each body fluid and reported the findings in medians and 95th percentiles. RESULTS The medians and 95th percentiles for the time until the loss of ZIKV RNA detection were 14 days (95% confidence interval [CI], 11 to 17) and 54 days (95% CI, 43 to 64), respectively, in serum; 8 days (95% CI, 6 to 10) and 39 days (95% CI, 31 to 47) in urine; and 34 days (95% CI, 28 to 41) and 81 days (95% CI, 64 to 98) in semen. Few participants had detectable ZIKV RNA in saliva or vaginal secretions. CONCLUSIONS The prolonged time until ZIKV RNA clearance in serum in this study may have implications for the diagnosis and prevention of ZIKV infection. Current sexual-prevention guidelines recommend that men use condoms or abstain from sex for 6 months after ZIKV exposure; in 95% of the men in this study, ZIKV RNA was cleared from semen after about 3 months. (Funded by the Centers for Disease Control and Prevention.).
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Affiliation(s)
- Gabriela Paz-Bailey
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Eli S Rosenberg
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Kate Doyle
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Jorge Munoz-Jordan
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Gilberto A Santiago
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Liore Klein
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Janice Perez-Padilla
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Freddy A Medina
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Stephen H Waterman
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Carlos Garcia Gubern
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Luisa I Alvarado
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
| | - Tyler M Sharp
- From the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention (G.P.-B., K.D.), and the Department of Epidemiology, Emory University (E.S.R.), Atlanta; and the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (J.M.-J., G.A.S., J.P.-P., F.A.M., S.H.W., T.M.S.), and Caduceus Healthcare (L.K.), San Juan, and Ponce University School of Medicine-Saint Luke's Episcopal Hospital Consortium, Ponce (C.G.G., L.I.A.) - all in Puerto Rico
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Moreira J, Bressan CS, Brasil P, Siqueira AM. Epidemiology of acute febrile illness in Latin America. Clin Microbiol Infect 2018; 24:827-835. [PMID: 29777926 PMCID: PMC7172187 DOI: 10.1016/j.cmi.2018.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 12/11/2022]
Abstract
Background The causes of acute febrile illness (AFI) in Latin America are diverse and their complexity increases as the proportion of fever due to malaria decreases, as malaria control measures and new pathogens emerge in the region. In this context, it is important to shed light on the gaps in the epidemiological characteristics and the geographic range for many AFI aetiologies. Objectives To review studies on community-acquired fever aetiology other than malaria in Latin America, and to highlight knowledge gaps and challenges needing further investigation. Sources PubMed from 2012 to April 2018. Content We found 17 eligible studies describing 13 539 patients. The median number of pathogens tested per individual was 3.5 (range 2–17). A causative pathogen could be determined for 6661 (49.2%) individuals. The most frequently reported pathogen during the study periods was dengue virus (DENV) (14 studies), followed by chikungunya virus (nine studies) and Zika virus (seven studies). Among the studies reporting concurrent infections, 296 individuals (2.2%) were found to have co-infections. In-hospital mortality was reported in eight (47%) studies, ranging between 0% and 18%. Implications DENV fever is the febrile illness most frequently reported, reflecting its importance, while chikungunya and zika viruses present increasing trends since their emergence in the region. Studies with systematic and harmonized approaches for detection of multiple pathogens are needed and would probably reveal a higher burden of neglected pathogens such as Rickettsia spp. and arenaviruses. The lack of point-of-care tests and harmonized approach limits the care provided by health professionals and the efficacy of surveillance for AFI in the region.
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Affiliation(s)
- J Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil; Programa de Pós-Graduação em Pesquisa Clínica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - C S Bressan
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil; Programa de Pós-Graduação em Pesquisa Clínica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - P Brasil
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil; Programa de Pós-Graduação em Pesquisa Clínica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - A M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil; Programa de Pós-Graduação em Pesquisa Clínica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.
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Galán-Huerta K, Martínez-Landeros E, Delgado-Gallegos J, Caballero-Sosa S, Malo-García I, Fernández-Salas I, Ramos-Jiménez J, Rivas-Estilla A. Molecular and Clinical Characterization of Chikungunya Virus Infections in Southeast Mexico. Viruses 2018; 10:248. [DOI: https:/doi.org/10.3390/v10050248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Molecular and Clinical Characterization of Chikungunya Virus Infections in Southeast Mexico. Viruses 2018; 10:v10050248. [PMID: 29747416 PMCID: PMC5977241 DOI: 10.3390/v10050248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/29/2018] [Accepted: 04/30/2018] [Indexed: 12/28/2022] Open
Abstract
Chikungunya fever is an arthropod-borne infection caused by Chikungunya virus (CHIKV). Even though clinical features of Chikungunya fever in the Mexican population have been described before, there is no detailed information. The aim of this study was to perform a full description of the clinical features in confirmed Chikungunya-infected patients and describe the molecular epidemiology of CHIKV. We evaluated febrile patients who sought medical assistance in Tapachula, Chiapas, Mexico, from June through July 2015. Infection was confirmed with molecular and serological methods. Viruses were isolated and the E1 gene was sequenced. Phylogeny reconstruction was inferred using maximum-likelihood and maximum clade credibility approaches. We studied 52 patients with confirmed CHIKV infection. They were more likely to have wrist, metacarpophalangeal, and knee arthralgia. Two combinations of clinical features were obtained to differentiate between Chikungunya fever and acute undifferentiated febrile illness. We obtained 10 CHIKV E1 sequences that grouped with the Asian lineage. Seven strains diverged from the formerly reported. Patients infected with the divergent CHIKV strains showed a broader spectrum of clinical manifestations. We defined the complete clinical features of Chikungunya fever in patients from Southeastern Mexico. Our results demonstrate co-circulation of different CHIKV strains in the state of Chiapas.
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Hottz ED, Bozza FA, Bozza PT. Platelets in Immune Response to Virus and Immunopathology of Viral Infections. Front Med (Lausanne) 2018; 5:121. [PMID: 29761104 PMCID: PMC5936789 DOI: 10.3389/fmed.2018.00121] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/12/2018] [Indexed: 01/04/2023] Open
Abstract
Platelets are essential effector cells in hemostasis. Aside from their role in coagulation, platelets are now recognized as major inflammatory cells with key roles in the innate and adaptive arms of the immune system. Activated platelets have key thromboinflammatory functions linking coagulation to immune responses in various infections, including in response to virus. Recent studies have revealed that platelets exhibit several pattern recognition receptors (PRR) including those from the toll-like receptor, NOD-like receptor, and C-type lectin receptor family and are first-line sentinels in detecting and responding to pathogens in the vasculature. Here, we review the main mechanisms of platelets interaction with viruses, including their ability to sustain viral infection and replication, their expression of specialized PRR, and activation of thromboinflammatory responses against viruses. Finally, we discuss the role of platelet-derived mediators and platelet interaction with vascular and immune cells in protective and pathophysiologic responses to dengue, influenza, and human immunodeficiency virus 1 infections.
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Affiliation(s)
- Eugenio D Hottz
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Departamento de Bioquimica, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Fernando A Bozza
- Laboratório de Medicina Intensiva, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
| | - Patrícia T Bozza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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