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Earnest JT, Kirstein OD, Mendoza AC, Barrera-Fuentes GA, Puerta-Guardo H, Parra-Cardeña M, Yam-Trujillo K, Collins MH, Pavia-Ruz N, Ayora-Talavera G, Gonzalez-Olvera G, Medina-Barreiro A, Bibiano-Marin W, Lenhart A, Halloran ME, Longini I, Dean N, Waller LA, Crisp AM, Correa-Morales F, Palacio-Vargas J, Granja-Perez P, Villanueva S, Delfın-Gonzalez H, Gomez-Dantes H, Manrique-Saide P, Vazquez-Prokopec GM. The TIRS trial: Enrollment procedures and baseline characterization of a pediatric cohort to quantify the epidemiologic impact of targeted indoor residual spraying on Aedes-borne viruses in Merida, Mexico. PLoS One 2024; 19:e0310480. [PMID: 39292670 PMCID: PMC11410223 DOI: 10.1371/journal.pone.0310480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 09/02/2024] [Indexed: 09/20/2024] Open
Abstract
Aedes mosquito-borne viruses (ABVs) place a substantial strain on public health resources in the Americas. Vector control of Aedes mosquitoes is an important public health strategy to decrease or prevent spread of ABVs. The ongoing Targeted Indoor Residual Spraying (TIRS) trial is an NIH-sponsored clinical trial to study the efficacy of a novel, proactive vector control technique to prevent dengue virus (DENV), Zika virus (ZIKV), and chikungunya virus (CHIKV) infections in the endemic city of Merida, Yucatan, Mexico. The primary outcome of the trial is laboratory-confirmed ABV infections in neighborhood clusters. Despite the difficulties caused by the COVID-19 pandemic, by early 2021 the TIRS trial completed enrollment of 4,792 children aged 2-15 years in 50 neighborhood clusters which were allocated to control or intervention arms via a covariate-constrained randomization algorithm. Here, we describe the makeup and ABV seroprevalence of participants and mosquito population characteristics in both arms before TIRS administration. Baseline surveys showed similar distribution of age, sex, and socio-economic factors between the arms. Serum samples from 1,399 children were tested by commercially available ELISAs for presence of anti-ABV antibodies. We found that 45.1% of children were seropositive for one or more flaviviruses and 24.0% were seropositive for CHIKV. Of the flavivirus-positive participants, most were positive for ZIKV-neutralizing antibodies by focus reduction neutralization testing which indicated a higher proportion of participants with previous ZIKV than DENV infections within the cohort. Both study arms had statistically similar seroprevalence for all viruses tested, similar socio-demographic compositions, similar levels of Ae. aegypti infestation, and similar observed mosquito susceptibility to insecticides. These findings describe a population with a high rate of previous exposure to ZIKV and lower titers of neutralizing antibodies against DENV serotypes, suggesting susceptibility to future outbreaks of flaviviruses is possible, but proactive vector control may mitigate these risks.
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Affiliation(s)
- James T Earnest
- Department of Environmental Sciences, Emory University, Atlanta, GA, United States of America
| | - Oscar D Kirstein
- Central Laboratory of Entomology and Parasitology, Ministry of Health, Jerusalem, Israel
| | - Azael C Mendoza
- Unidad Colaborativa para Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Gloria A Barrera-Fuentes
- Unidad Colaborativa para Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
- Laboratorio de Hematología, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Henry Puerta-Guardo
- Unidad Colaborativa para Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
- Laboratorio de Virología, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Manuel Parra-Cardeña
- Laboratorio de Virología, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Kevin Yam-Trujillo
- Laboratorio de Virología, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Matthew H Collins
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Decatur, GA, United States of America
| | - Norma Pavia-Ruz
- Laboratorio de Hematología, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Guadalupe Ayora-Talavera
- Laboratorio de Virología, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Gabriela Gonzalez-Olvera
- Unidad Colaborativa para Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Anuar Medina-Barreiro
- Unidad Colaborativa para Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Wilberth Bibiano-Marin
- Unidad Colaborativa para Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Audrey Lenhart
- Entomology Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - M Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle WA, United States of America
- Department of Biostatistics, University of Washington, Seattle WA, United States of America
| | - Ira Longini
- Department of Biostatistics, University of Florida, Gainesville, FL, United States of America
| | - Natalie Dean
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Amy M Crisp
- Department of Biostatistics, University of Florida, Gainesville, FL, United States of America
| | - Fabian Correa-Morales
- Centro Nacional de Programas Preventivos y Control de Enfermedades (CENAPRECE) Secretaría de Salud Mexico, Mexico City, Mexico
| | | | | | | | - Hugo Delfın-Gonzalez
- Unidad Colaborativa para Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Hector Gomez-Dantes
- Health Systems Research Centre, National Institute of Public Health, Cuernavaca, México
| | - Pablo Manrique-Saide
- Unidad Colaborativa para Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
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Earnest JT, Ciau-Carillo KJ, Kirstein OD, Che-Mendoza A, Espinoza DO, Puerta-Guardo H, Yam-Trujillo K, Parra-Cardeña M, Barrera-Fuentes GA, Pavia-Ruz N, Correa-Morales F, Gomez-Dantes H, Granja-Perez P, Villanueva S, Manrique-Saide P, Ayora-Talavera G, Collins MH, Vazquez-Prokopec G. Evidence of Ongoing Transmission of Zika Virus in Mérida, Mexico. Am J Trop Med Hyg 2024; 110:724-730. [PMID: 38377614 PMCID: PMC10993846 DOI: 10.4269/ajtmh.23-0533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/05/2023] [Indexed: 02/22/2024] Open
Abstract
Since the Zika virus (ZIKV) pandemic in 2015-2017, there has been a near absence of reported cases in the Americas outside of Brazil. However, the conditions for Aedes-borne transmission persist in Latin America, and the threat of ZIKV transmission is increasing as population immunity wanes. Mexico has reported only 70 cases of laboratory-confirmed ZIKV infection since 2020, with no cases recorded in the Yucatán peninsula. Here, we provide evidence of active ZIKV transmission, despite the absence of official case reports, in the city of Mérida, Mexico, the capital of the state of Yucatán. Capitalizing on an existing cohort, we detected cases in participants with symptoms consistent with flavivirus infection from 2021 to 2022. Serum samples from suspected cases were tested for ZIKV RNA by polymerase chain reaction or ZIKV-reactive IgM by ELISA. To provide more specific evidence of exposure, focus reduction neutralization tests were performed on ELISA-positive samples. Overall, we observed 25 suspected ZIKV infections for an estimated incidence of 2.8 symptomatic cases per 1,000 persons per year. Our findings emphasize the continuing threat of ZIKV transmission in the setting of decreased surveillance and reporting.
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Affiliation(s)
- James T. Earnest
- Department of Environmental Sciences, Emory University, Atlanta, Georgia
| | - Karina Jacqueline Ciau-Carillo
- Laboratorio de Virologia, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Oscar D. Kirstein
- Department of Environmental Sciences, Emory University, Atlanta, Georgia
| | - Azael Che-Mendoza
- Unidad Colaborativa para Bioensayos Entomologicos, Campus de Ciencias Biológicas y Agropecurias, Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Daniel O. Espinoza
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Henry Puerta-Guardo
- Laboratorio de Virologia, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Mexico
- Unidad Colaborativa para Bioensayos Entomologicos, Campus de Ciencias Biológicas y Agropecurias, Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Kevin Yam-Trujillo
- Laboratorio de Virologia, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Manuel Parra-Cardeña
- Laboratorio de Virologia, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Gloria A. Barrera-Fuentes
- Unidad Colaborativa para Bioensayos Entomologicos, Campus de Ciencias Biológicas y Agropecurias, Universidad Autónoma de Yucatán, Mérida, Mexico
- Laboratorio de Hematologia, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Norma Pavia-Ruz
- Laboratorio de Hematologia, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Fabian Correa-Morales
- Centro Nacional de Programas Preventivos y Control de Enfermedades (CENAPRECE), Secretaria de Salud Mexico, Mexico City, Mexico
| | - Hector Gomez-Dantes
- Health Systems Research Centre, National Institute of Public Health, Cuernavaca, Mexico
| | | | | | - Pablo Manrique-Saide
- Unidad Colaborativa para Bioensayos Entomologicos, Campus de Ciencias Biológicas y Agropecurias, Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Guadalupe Ayora-Talavera
- Laboratorio de Virologia, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Matthew H. Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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3
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Indu PS, Anish TS, Chintha S, Libu GK, Tony L, Siju NS, Sreekumar E, Santhoshkumar A, Aravind R, Saradadevi KL, Sunija S, Johnson J, Anupriya MG, Mathew T, Reena KJ, Meenakshy V, Namitha P, Kumar NP, Kumari R, Mohamed AJ, Nagpal B, Sarkar S, Sadanandan R, Velayudhan R. The burden of dengue and force of infection among children in Kerala, India; seroprevalence estimates from Government of Kerala-WHO Dengue study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 22:100337. [PMID: 38482148 PMCID: PMC10934323 DOI: 10.1016/j.lansea.2023.100337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 11/09/2023] [Accepted: 11/22/2023] [Indexed: 04/21/2024]
Abstract
Background Dengue shows high geographic heterogeneity within and across endemic countries. In the context of increasing burden and predicted outbreaks due to climate change, understanding the heterogeneity will enable us to develop region specific targeted interventions, including vaccination. World Health Organisation (WHO) suggests standard methodologies to study the burden and heterogeneity at national and subnational levels. Regional studies with robust and standard methodology to capture heterogeneity are scarce. We estimated the seroprevalence of dengue in children aged 9-12 years and the force of infection in Kerala, India, from where Zika cases also have been reported recently. Methods We conducted a school-based cross-sectional survey in 38 clusters; selected by stratified random sampling, representing rural, urban, high burden and low-burden administrative units. Validation of Indirect IgG ELISA was done by Plaque Reduction Neutralization Test (PRNT90) using the local isolates of all four serotypes. Force of infection (FOI) was estimated using the WHO-FOI calculator. We conducted a follow-up survey among a subsample of seronegative children, to estimate the rate of sero-conversion. Results Among 5236 children tested, 1521 were positive for anti-dengue IgG antibody. The overall seroprevalence in the state was 29% (95% CI 24.1-33.9). The validity corrected seroprevalence was 30.9% in the overall sample, 46.9% in Thiruvananthapuram, 26.9% in Kozhikkode and 24.9% in Kollam. Age-specific seroprevalence increased with age; 25.7% at 9 years, 29.5% at 10 years, 30.9% at 11 years and 33.9% at 12 years. Seroprevalence varied widely across clusters (16.1%-71.4%). The estimated force of infection was 3.3/100 person-years and the seroconversion rate was 4.8/100 person-years. 90% of children who tested positive were not aware of dengue infection. All the four serotypes were identified in PRNT and 40% of positive samples had antibodies against multiple serotypes. Interpretation The study validates the WHO methodology for dengue serosurveys and confirms its feasibility in a community setting. The overall seroprevalence in the 9-12 year age group is low to moderate in Kerala; there are regional variations; high burden and low burden clusters co-exist in the same districts. The actual burden of dengue exceeds the reported numbers. Heterogeneity in prevalence, the high proportion of inapparent dengue and the hyperendemic situation suggest the need for region-specific and targeted interventions, including vaccination. Funding World Health Organization.
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Affiliation(s)
- Pillaveetil Sathyadas Indu
- Department of Community Medicine, Govt Medical College, Thiruvananthapuram, Kerala University of Health Sciences, India
| | - Thekkumkara Surendran Anish
- Department of Community Medicine, Govt Medical College, Thiruvananthapuram, Kerala University of Health Sciences, India
| | - Sujatha Chintha
- Department of Community Medicine, Govt Medical College, Thiruvananthapuram, Kerala University of Health Sciences, India
| | - Gnanaseelan Kanakamma Libu
- Department of Community Medicine, Govt Medical College, Thiruvananthapuram, Kerala University of Health Sciences, India
| | - Lawrence Tony
- Department of Community Medicine, Govt Medical College, Thiruvananthapuram, Kerala University of Health Sciences, India
| | - Nalinakshan Sudha Siju
- Department of Community Medicine, Govt Medical College, Thiruvananthapuram, Kerala University of Health Sciences, India
| | - Easwaran Sreekumar
- Molecular Virology Laboratory, Rajiv Gandhi Centre for Biotechnology (RGCB), Thiruvananthapuram, Kerala, India
- Institute of Advanced Virology (IAV), Bio 360 Life Sciences Park, Thonnakkal, Thiruvananthapuram, Kerala, India
| | - Asokan Santhoshkumar
- Department of Paediatrics, Govt Medical College, Thiruvananthapuram, Kerala University of Health Sciences, India
| | - Reghukumar Aravind
- Department of Infectious Diseases, Govt Medical College, Thiruvananthapuram, Kerala University of Health Sciences, India
| | | | | | | | | | | | | | | | - Premaletha Namitha
- Department of Community Medicine, Govt Medical College, Thiruvananthapuram, Kerala University of Health Sciences, India
| | | | | | | | | | | | | | - Raman Velayudhan
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
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4
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Lamb MM, Paniagua-Avila A, Zacarias A, Rojop N, Chacon A, Natrajan MS, Waggoner JJ, Lopez MR, Cordon-Rosales C, Huleatt JW, Bonaparte MI, Asturias EJ, Olson D. Repeated Rapid Active Sampling Surveys Demonstrated a Rapidly Changing Zika Seroprevalence among Children in a Rural Dengue-endemic Region in Southwest Guatemala during the Zika Epidemic (2015-2016). Am J Trop Med Hyg 2022; 107:1099-1106. [PMID: 36252798 PMCID: PMC9709015 DOI: 10.4269/ajtmh.22-0399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/08/2022] [Indexed: 11/07/2022] Open
Abstract
Although Central America is largely dengue virus (DENV)-endemic, the 2015-2016 Zika virus (ZIKV) pandemic brought new urgency to develop surveillance approaches capable of characterizing the rapidly changing disease burden in resource-limited settings. We conducted a pediatric DENV surveillance study in rural Guatemala, including serial cross-sectional surveys from April through September 2015 (Survey 1), in October-November 2015 (Survey 2), and January-February 2016 (Survey 3). Serum underwent DENV IgM MAC ELISA and polymerase chain reaction testing. Using banked specimens from Surveys 2 and 3, we expanded testing to include DENV 1-4 and ZIKV microneutralization (MN50), DENV NS1 IgG ELISA, and ZIKV anti-NS1 antibody Blockage of Binding (BoB) ELISA testing. Demographic risk factors for ZIKV BoB positivity were explored using multivariable generalized linear regression models. Of Survey 2 and 3 samples available (N = 382), DENV seroprevalence slightly increased (+1%-10% depending on the assay) during the surveillance period and increased with age. In contrast, ZIKV seroprevalence consistently increased over the 3-month period, including from 6% to 34% (P < 0.0001) and 10%-37% (P < 0.0001) using the MN50 ≥100 and BoB ELISA assays, respectively. Independent risk factors for ZIKV seropositivity included older age (prevalence ratio (PR)/year = 1.12, 95% confidence interval (CI) = 1.07-1.17) and primary caregiver literacy (PR = 2.80, CI = 1.30-6.06). Rapid active surveillance (RAS) surveys demonstrated a nearly 30% increase in ZIKV prevalence and a slight (≤ 10%) increase in DENV seroprevalence from October to November 2015 to January to February 2016 in rural southwest Guatemala, regardless of serologic assay used. RAS surveys may be a useful "off-the-shelf" tool to characterize arboviruses and other emerging pathogens rapidly in resource-limited settings.
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Affiliation(s)
- Molly M. Lamb
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado
| | - Alejandra Paniagua-Avila
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, FUNSALUD, Coatepeque, Quetzaltenango, Guatemala
| | - Alma Zacarias
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, FUNSALUD, Coatepeque, Quetzaltenango, Guatemala
| | - Neudy Rojop
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, FUNSALUD, Coatepeque, Quetzaltenango, Guatemala
| | - Andrea Chacon
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, FUNSALUD, Coatepeque, Quetzaltenango, Guatemala
| | - Muktha S. Natrajan
- Emory University Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia
| | - Jesse J. Waggoner
- Emory University Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia
| | - Maria Renee Lopez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Celia Cordon-Rosales
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | | | - Edwin J. Asturias
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel Olson
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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5
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Kirstein OD, Talavera GA, Wei Z, Ciau-Carrilo KJ, Koyoc-Cardeña E, Puerta-Guardo H, Rodríguez-Martín E, Medina-Barreiro A, Mendoza AC, Piantadosi AL, Manrique-Saide P, Vazquez-Prokopec GM. Natural Aedes-Borne Virus Infection Detected in Male Adult Aedes aegypti (Diptera: Culicidae) Collected From Urban Settings in Mérida, Yucatán, México. JOURNAL OF MEDICAL ENTOMOLOGY 2022; 59:1336-1346. [PMID: 35535688 PMCID: PMC9278843 DOI: 10.1093/jme/tjac048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Indexed: 05/12/2023]
Abstract
Aedes-borne viruses (ABVs) such as dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) contribute significantly to the global burden of infectious diseases, disproportionately affecting disadvantaged populations from tropical and subtropical urban areas. ABVs can be transmitted from female mosquitoes to their progeny by vertical transmission via transovarial and/or trans-egg vertical transmission and contribute to the maintenance of infected-mosquito populations year-round in endemic regions. This study describes the natural infection rate of DENV, CHIKV, and ZIKV in field-caught male Aedes (Sergentomyia) aegypti (Linnaeus) mosquitoes from Mérida, Yucatán, México, as a proxy for the occurrence of vertical virus transmission. We used indoor sequential sampling with Prokopack aspirators to collect all mosquitoes inside houses from ABV hotspots areas. Collections were performed in a DENV and CHIKV post-epidemic phase and during a period of active ZIKV transmission. We individually RT-qPCR tested all indoor collected Ae. aegypti males (1,278) followed by Sanger sequencing analysis for final confirmation. A total of 6.7% male mosquitoes were positive for ABV (CHIKV = 5.7%; DENV = 0.9%; ZIKV = 0.1%) and came from 21.0% (30/143) houses infested with males. Most ABV-positive male mosquitoes were positive for CHIKV (84.8%). The distribution of ABV-positive Ae. aegypti males was aggregated in a few households, with two houses having 11 ABV-positive males each. We found a positive association between ABV-positive males and females per house. These findings suggested the occurrence of vertical arbovirus transmission within the mosquito populations in an ABV-endemic area and, a mechanism contributing to viral maintenance and virus re-emergence among humans in post-epidemic periods.
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Affiliation(s)
- Oscar D Kirstein
- Department of Environmental Sciences. Emory University, Atlanta, GA, USA
| | - Guadalupe Ayora Talavera
- Laboratorio de Virología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Zhuoran Wei
- Department of Environmental Sciences. Emory University, Atlanta, GA, USA
| | - Karina J Ciau-Carrilo
- Laboratorio de Virología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Edgar Koyoc-Cardeña
- Unidad Colaborativa para Bioensayos Entomológicos, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Henry Puerta-Guardo
- Laboratorio de Virología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
- Unidad Colaborativa para Bioensayos Entomológicos, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Ester Rodríguez-Martín
- Laboratorio de Virología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Anuar Medina-Barreiro
- Unidad Colaborativa para Bioensayos Entomológicos, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Azael Che Mendoza
- Unidad Colaborativa para Bioensayos Entomológicos, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Anne L Piantadosi
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Pablo Manrique-Saide
- Unidad Colaborativa para Bioensayos Entomológicos, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
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6
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Devine GJ, Vazquez-Prokopec GM, Bibiano-Marín W, Pavia-Ruz N, Che-Mendoza A, Medina-Barreiro A, Villegas J, Gonzalez-Olvera G, Dunbar MW, Ong O, Ritchie SA, Churcher TS, Kirstein OD, Manrique-Saide P. The entomological impact of passive metofluthrin emanators against indoor Aedes aegypti: A randomized field trial. PLoS Negl Trop Dis 2021; 15:e0009036. [PMID: 33497375 PMCID: PMC7864418 DOI: 10.1371/journal.pntd.0009036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 02/05/2021] [Accepted: 12/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background In the absence of vaccines or drugs, insecticides are the mainstay of Aedes-borne disease control. Their utility is challenged by the slow deployment of resources, poor community compliance and inadequate household coverage. Novel application methods are required. Methodology and principal findings A 10% w/w metofluthrin “emanator” that passively disseminates insecticide from an impregnated net was evaluated in a randomized trial of 200 houses in Mexico. The devices were introduced at a rate of 1 per room and replaced at 3-week intervals. During each of 7 consecutive deployment cycles, indoor resting mosquitoes were sampled using aspirator collections. Assessments of mosquito landing behaviours were made in a subset of houses. Pre-treatment, there were no differences in Aedes aegypti indices between houses recruited to the control and treatment arms. Immediately after metofluthrin deployment, the entomological indices between the trial arms diverged. Averaged across the trial, there were significant reductions in Abundance Rate Ratios for total Ae. aegypti, female abundance and females that contained blood meals (2.5, 2.4 and 2.3-times fewer mosquitoes respectively; P<0.001). Average efficacy was 60.2% for total adults, 58.3% for females, and 57.2% for blood-fed females. The emanators also reduced mosquito landings by 90% from 12.5 to 1.2 per 10-minute sampling period (P<0.05). Homozygous forms of the pyrethroid resistant kdr alleles V410L, V1016L and F1534C were common in the target mosquito population; found in 39%, 24% and 95% of mosquitoes collected during the trial. Conclusions/Significance This is the first randomized control trial to evaluate the entomological impact of any volatile pyrethroid on urban Ae. aegypti. It demonstrates that volatile pyrethroids can have a sustained impact on Ae. aegypti population densities and human-vector contact indoors. These effects occur despite the presence of pyrethroid-resistant alleles in the target population. Formulations like these may have considerable utility for public health vector control responses. Insecticidal control tools are heavily relied on for the control of mosquito-borne viruses such as dengue, chikungunya and Zika, but the logistics associated with conventional insecticide use (e.g. space sprays and residual formulations) are challenging. Considerable time and resources are required to treat household interiors; an impediment exacerbated by the difficulty in gaining entrance to households, and sometimes by limited compliance in the community. Another constraint to effective insecticide use is that many mosquito populations are resistant to the chemicals used. Volatile pyrethroids, exhibiting both lethal and behavioural effects on mosquitoes are available in formulations that release insecticides passively to the air, at room temperature. These may be suitable for deployment in houses with the aim of creating “bite-free” spaces. By removing the need for conventional application methods, these devices might be rapidly deployed with minimum disruption to households. This is the first large-scale, randomized control trial to evaluate the entomological impacts of volatile pyrethroids in an urban environment. Using metofluthrin as an example, we confirm that some formulations have a significant impact on Aedes aegypti densities and landing behaviour indoors. These effects occur despite the presence of pyrethroid-resistance alleles associated with conventional insecticide resistance.
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Affiliation(s)
- Gregor J Devine
- Mosquito Control Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Wilbert Bibiano-Marín
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias. Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Norma Pavia-Ruz
- Centro de Investigaciones Regionales Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, México
| | - Azael Che-Mendoza
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias. Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Anuar Medina-Barreiro
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias. Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Josue Villegas
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias. Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Gabriela Gonzalez-Olvera
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias. Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Mike W Dunbar
- Department of Environmental Sciences, Emory University, Atlanta, Georgia, United States of America
| | - Oselyne Ong
- Mosquito Control Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Scott A Ritchie
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland, Cairns, Australia
| | - Thomas S Churcher
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Oscar D Kirstein
- Department of Environmental Sciences, Emory University, Atlanta, Georgia, United States of America
| | - Pablo Manrique-Saide
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias. Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
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7
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Kirstein OD, Ayora-Talavera G, Koyoc-Cardeña E, Chan Espinoza D, Che-Mendoza A, Cohuo-Rodriguez A, Granja-Pérez P, Puerta-Guardo H, Pavia-Ruz N, Dunbar MW, Manrique-Saide P, Vazquez-Prokopec GM. Natural arbovirus infection rate and detectability of indoor female Aedes aegypti from Mérida, Yucatán, Mexico. PLoS Negl Trop Dis 2021; 15:e0008972. [PMID: 33395435 PMCID: PMC7781390 DOI: 10.1371/journal.pntd.0008972] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/10/2020] [Indexed: 12/03/2022] Open
Abstract
Arbovirus infection in Aedes aegypti has historically been quantified from a sample of the adult population by pooling collected mosquitoes to increase detectability. However, there is a significant knowledge gap about the magnitude of natural arbovirus infection within areas of active transmission, as well as the sensitivity of detection of such an approach. We used indoor Ae. aegypti sequential sampling with Prokopack aspirators to collect all mosquitoes inside 200 houses with suspected active ABV transmission from the city of Mérida, Mexico, and tested all collected specimens by RT-PCR to quantify: a) the absolute arbovirus infection rate in individually tested Ae. aegypti females; b) the sensitivity of using Prokopack aspirators in detecting ABV-infected mosquitoes; and c) the sensitivity of entomological inoculation rate (EIR) and vectorial capacity (VC), two measures ABV transmission potential, to different estimates of indoor Ae. aegypti abundance. The total number of Ae. aegypti (total catch, the sum of all Ae. aegypti across all collection intervals) as well as the number on the first 10-min of collection (sample, equivalent to a routine adult aspiration session) were calculated. We individually tested by RT-PCR 2,161 Aedes aegypti females and found that 7.7% of them were positive to any ABV. Most infections were CHIKV (77.7%), followed by DENV (11.4%) and ZIKV (9.0%). The distribution of infected Aedes aegypti was overdispersed; 33% houses contributed 81% of the infected mosquitoes. A significant association between ABV infection and Ae. aegypti total catch indoors was found (binomial GLMM, Odds Ratio > 1). A 10-min indoor Prokopack collection led to a low sensitivity of detecting ABV infection (16.3% for detecting infected mosquitoes and 23.4% for detecting infected houses). When averaged across all infested houses, mean EIR ranged between 0.04 and 0.06 infective bites per person per day, and mean VC was 0.6 infectious vectors generated from a population feeding on a single infected host per house/day. Both measures were significantly and positively associated with Ae. aegypti total catch indoors. Our findings provide evidence that the accurate estimation and quantification of arbovirus infection rate and transmission risk is a function of the sampling effort, the local abundance of Aedes aegypti and the intensity of arbovirus circulation. Aedes-borne diseases comprise a serious public health burden in many parts of the world, usually affecting low income areas. The ability to detect virus circulation within a population may be key in responding to the threat of outbreaks, providing a cost-effective approach for triggering vector control. Unfortunately, gaps in the knowledge of natural Aedes-borne virus (ABV) infection in Aedes aegypti have led to uncertainties in the consideration of arbovirus surveillance in mosquitoes. Here, we show that the natural infection rate in a mosquito population may not be a function of where Aedes aegypti are, but rather where key human-mosquito contacts occur. Sampling 200 houses with suspected ABV active transmission led us to quantify high virus infection rates in all Aedes aegypti present in the house and use such information to estimate the sensitivity of indoor aspiration with Prokopack devices and two measures of ABV transmission potential. Our findings provide evidence that the accurate quantification of arbovirus infection rate and transmission risk is a function of the sampling effort, the local abundance of Aedes aegypti and the intensity of arbovirus circulation. Results from this study are relevant to understand the value of virus testing of vector populations, and for the design of entomological endpoints relevant for epidemiological trials quantifying the impact of vector control on ABVs.
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Affiliation(s)
- Oscar David Kirstein
- Department of Environmental Sciences, Emory University, Atlanta, Georgia, United States of America
| | - Guadalupe Ayora-Talavera
- Laboratorio de Virología. Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Edgar Koyoc-Cardeña
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Daniel Chan Espinoza
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Azael Che-Mendoza
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Azael Cohuo-Rodriguez
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Pilar Granja-Pérez
- Laboratorio Estatal de Salud Pública, Servicios de Salud de Yucatán, Mérida, Yucatán, México
| | - Henry Puerta-Guardo
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Norma Pavia-Ruz
- Laboratorio de Hematología. Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Mike W. Dunbar
- Department of Environmental Sciences, Emory University, Atlanta, Georgia, United States of America
| | - Pablo Manrique-Saide
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
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8
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Amaya-Larios IY, Martínez-Vega RA, Diaz-Quijano FA, Sarti E, Puentes-Rosas E, Chihu L, Ramos-Castañeda J. Risk of dengue virus infection according to serostatus in individuals from dengue endemic areas of Mexico. Sci Rep 2020; 10:19017. [PMID: 33149151 PMCID: PMC7642410 DOI: 10.1038/s41598-020-75891-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/30/2020] [Indexed: 11/09/2022] Open
Abstract
The variability in the host immune response directed against dengue virus (DENV) has demonstrated the need to understand the immune response associated with protection in incident infection. The objective was to estimate the association between serostatus and the risk of incident DENV infection. We used a prospective study from 2014 to 2016 in the localities of Axochiapan and Tepalcingo, Morelos, Mexico. We recruited 966 participants, of which, according to their infection history registered were categorized in four groups. To accomplish the objectives of this study, we selected to 400 participants older than 5 years of age were followed for 2.5 years. Blood samples were taken every 6 months to measure serological status and infection by ELISA. In individuals with at least two previous infections the risk of new infection was lower compared to a seronegative group (hazard ratio adjusted 0.49, 95% CI 0.24-0.98), adjusted for age and locality. Therefore, individuals who have been exposed two times or more to a DENV infection have a lower risk of re-infection, thus showing the role of cross-immunity and its association with protection.
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Affiliation(s)
| | - R A Martínez-Vega
- Universidad de Santander, Bucaramanga, Colombia
- Organización Latinoamericana para el Fomento de la Investigación en Salud, Bucaramanga, Colombia
| | - F A Diaz-Quijano
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - E Sarti
- Sanofi Pasteur México, CDMX, Mexico
| | | | - L Chihu
- Centro de Investigaciones Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Publica, Av Universidad 655, Santa Maria Ahuacatitlan, 62100, Cuernavaca, Morelos, Mexico
| | - J Ramos-Castañeda
- Centro de Investigaciones Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Publica, Av Universidad 655, Santa Maria Ahuacatitlan, 62100, Cuernavaca, Morelos, Mexico.
- Center for Tropical Diseases, University of Texas-Medical Branch, Galveston, USA.
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9
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Manrique-Saide P, Dean NE, Halloran ME, Longini IM, Collins MH, Waller LA, Gomez-Dantes H, Lenhart A, Hladish TJ, Che-Mendoza A, Kirstein OD, Romer Y, Correa-Morales F, Palacio-Vargas J, Mendez-Vales R, Pérez PG, Pavia-Ruz N, Ayora-Talavera G, Vazquez-Prokopec GM. The TIRS trial: protocol for a cluster randomized controlled trial assessing the efficacy of preventive targeted indoor residual spraying to reduce Aedes-borne viral illnesses in Merida, Mexico. Trials 2020; 21:839. [PMID: 33032661 PMCID: PMC7542575 DOI: 10.1186/s13063-020-04780-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/29/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Current urban vector control strategies have failed to contain dengue epidemics and to prevent the global expansion of Aedes-borne viruses (ABVs: dengue, chikungunya, Zika). Part of the challenge in sustaining effective ABV control emerges from the paucity of evidence regarding the epidemiological impact of any Aedes control method. A strategy for which there is limited epidemiological evidence is targeted indoor residual spraying (TIRS). TIRS is a modification of classic malaria indoor residual spraying that accounts for Aedes aegypti resting behavior by applying residual insecticides on exposed lower sections of walls (< 1.5 m), under furniture, and on dark surfaces. METHODS/DESIGN We are pursuing a two-arm, parallel, unblinded, cluster randomized controlled trial to quantify the overall efficacy of TIRS in reducing the burden of laboratory-confirmed ABV clinical disease (primary endpoint). The trial will be conducted in the city of Merida, Yucatan State, Mexico (population ~ 1million), where we will prospectively follow 4600 children aged 2-15 years at enrollment, distributed in 50 clusters of 5 × 5 city blocks each. Clusters will be randomly allocated (n = 25 per arm) using covariate-constrained randomization. A "fried egg" design will be followed, in which all blocks of the 5 × 5 cluster receive the intervention, but all sampling to evaluate the epidemiological and entomological endpoints will occur in the "yolk," the center 3 × 3 city blocks of each cluster. TIRS will be implemented as a preventive application (~ 1-2 months prior to the beginning of the ABV season). Active monitoring for symptomatic ABV illness will occur through weekly household visits and enhanced surveillance. Annual sero-surveys will be performed after each transmission season and entomological evaluations of Ae. aegypti indoor abundance and ABV infection rates monthly during the period of active surveillance. Epidemiological and entomological evaluation will continue for up to three transmission seasons. DISCUSSION The findings from this study will provide robust epidemiological evidence of the efficacy of TIRS in reducing ABV illness and infection. If efficacious, TIRS could drive a paradigm shift in Aedes control by considering Ae. aegypti behavior to guide residual insecticide applications and changing deployment to preemptive control (rather than in response to symptomatic cases), two major enhancements to existing practice. TRIAL REGISTRATION ClinicalTrials.gov NCT04343521 . Registered on 13 April 2020. The protocol also complies with the WHO International Clinical Trials Registry Platform (ICTRP) (Additional file 1). PRIMARY SPONSOR National Institutes of Health, National Institute of Allergy and Infectious Diseases (NIH/NIAID).
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Affiliation(s)
- Pablo Manrique-Saide
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Merida, Mexico
| | - Natalie E Dean
- Department of Biostatistics, University of Florida, Gainesville, FL, 32611, USA
| | - M Elizabeth Halloran
- Center for Inference and Dynamics of Infectious Diseases, Seattle, WA, 98109, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
- Department of Biostatistics, University of Washington, Seattle, WA, 98109, USA
| | - Ira M Longini
- Department of Biostatistics, University of Florida, Gainesville, FL, 32611, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32611, USA
| | - Matthew H Collins
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Decatur, GA, 30030, USA
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Hector Gomez-Dantes
- Health Systems Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Audrey Lenhart
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas J Hladish
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32611, USA
- Department of Biology, University of Florida, Gainesville, FL, 32611, USA
| | - Azael Che-Mendoza
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Merida, Mexico
| | - Oscar D Kirstein
- Department of Environmental Sciences, Math and Science Center, Emory University, 400 Dowman Drive, 5th floor, Suite E530, Atlanta, GA, 30322, USA
| | - Yamila Romer
- Department of Environmental Sciences, Math and Science Center, Emory University, 400 Dowman Drive, 5th floor, Suite E530, Atlanta, GA, 30322, USA
| | - Fabian Correa-Morales
- Centro Nacional de Programas Preventivos y Control de Enfermedades (CENAPRECE) Secretaría de Salud Mexico, Mexico City, Mexico
| | | | | | | | - Norma Pavia-Ruz
- Centro de Investigaciones Regionales Hideyo Noguchi, Universidad Autonoma de Yucatan, Merida, Mexico
| | - Guadalupe Ayora-Talavera
- Centro de Investigaciones Regionales Hideyo Noguchi, Universidad Autonoma de Yucatan, Merida, Mexico
| | - Gonzalo M Vazquez-Prokopec
- Department of Environmental Sciences, Math and Science Center, Emory University, 400 Dowman Drive, 5th floor, Suite E530, Atlanta, GA, 30322, USA.
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10
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Rojas A, Cardozo F, Cantero C, Stittleburg V, López S, Bernal C, Gimenez Acosta FE, Mendoza L, Pinsky BA, Arévalo de Guillén I, Páez M, Waggoner J. Characterization of dengue cases among patients with an acute illness, Central Department, Paraguay. PeerJ 2019; 7:e7852. [PMID: 31616598 PMCID: PMC6790102 DOI: 10.7717/peerj.7852] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/08/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In 2018, Paraguay experienced a large dengue virus (DENV) outbreak. The primary objective of this study was to characterize dengue cases in the Central Department, where the majority of cases occur, and identify factors associated with DENV infection. METHODS Patients were enrolled from January-May 2018 if they presented with a suspected arboviral illness. Acute-phase specimens (≤8 days after symptom onset) were tested using rRT-PCR, a rapid diagnostic test for DENV nonstructural protein 1 (NS1) and anti-DENV IgM and IgG, and ELISA for IgG against NS1 from Zika virus (ZIKV). RESULTS A total of 231 patients were enrolled (95.2% adults) at two sites: emergency care and an outpatient clinical site. Patients included 119 (51.5%) dengue cases confirmed by rRT-PCR (n = 115, 96.6%) and/or the detection of NS1 and anti-DENV IgM (n = 4, 3.4%). DENV-1 was the predominant serotype (109/115, 94.8%). Epidemiologically, dengue cases and non-dengue cases were similar, though dengue cases were less likely to reside in a house/apartment or report a previous dengue case. Clinical and laboratory findings associated with dengue included red eyes, absence of sore throat, leucopenia and thrombocytopenia. At an emergency care site, 26% of dengue cases (26/100) required hospitalization. In univariate analysis, hospitalization was associated with increased viral load, anti-DENV IgG, and thrombocytopenia. Among dengue cases that tested positive for IgG against ZIKV NS1, the odds of DENV NS1 detection in the acute phase were decreased 10-fold (OR 0.1, 0.0-0.3). CONCLUSIONS Findings from a predominantly adult population demonstrate clinical and laboratory factors associated with DENV infections and the potential severity of dengue in this group. The combination of viral load and specific IgG antibodies warrant further study as a prognostic to identify patients at risk for severe disease.
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Affiliation(s)
- Alejandra Rojas
- Departamento de Producción, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Fátima Cardozo
- Departamento de Salud Pública, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - César Cantero
- Departamento de Producción, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Victoria Stittleburg
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, United States of America
| | - Sanny López
- Departamento de Producción, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Cynthia Bernal
- Departamento de Producción, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Laura Mendoza
- Departamento de Salud Pública, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Benjamin A. Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States of America
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Ivalena Arévalo de Guillén
- Departamento de Producción, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Malvina Páez
- Departamento de Salud Pública, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Jesse Waggoner
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, United States of America
- Rollins School of Public Health, Department of Global Health, Emory University, Atlanta, GA, United States of America
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