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Matos LMD, Borges AT, Palmeira AB, Lima VM, Maciel EP, Fernandez RNM, Mendes JPL, Romero GAS. Frequency of exposure to arboviruses and characterization of Guillain Barré syndrome in a clinical cohort of patients treated at a tertiary referral center in Brasília, Federal District. Rev Soc Bras Med Trop 2022; 55:e03062021. [PMID: 35416870 PMCID: PMC9009888 DOI: 10.1590/0037-8682-0306-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/26/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Guillian Barré syndrome (GBS) is an acute autoimmune polyradiculoneuropathy
often associated with previous exposure to infectious agents. Methods: A clinical cohort of 41 patients with GBS admitted to the Base Hospital
Institute of the Federal District between May 2017 and April 2019 was
followed up for 1 year. Serological tests for arbovirus detection and
amplification of nucleic acids using polymerase chain reaction for zika
virus (ZIKV), dengue virus (DENV), and chikungunya virus (CHIKV) were
performed. Results: The cohort consisted of 61% men with a median age of 40 years, and 83% had
GBS-triggering events. A total of 54% had Grade 4 disability, 17% had Grade
3, 12% had Grade 2, 10% had Grade 5, and 7% had Grade 1. The classic form
occurred in 83% of patients. Nerve conduction evaluations revealed acute
demyelinating inflammatory polyneuropathy (51%), acute motor axonal
neuropathy (17%), acute sensory-motor neuropathy (15%), and indeterminate
forms (17%). Four patients were seropositive for DENV. There was no
laboratory detection of ZIKV or CHIKV infection. Ninety percent of patients
received human immunoglobulin. Intensive care unit admission occurred in
17.1% of the patients, and mechanical ventilation was used in 14.6%. One
patient died of Bickerstaff’s encephalitis. Most patients showed an
improvement in disability at 10 weeks of follow-up. Conclusions: GBS in the Federal District showed a variable clinical spectrum, and it was
possible to detect recent exposure to DENV.
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Affiliation(s)
- Luíza Morais de Matos
- Universidade de Brasília, Faculdade de Medicina, Núcleo de Medicina Tropical, Brasília, DF, Brasil.,Instituto Hospital de Base do Distrito Federal, Unidade de Infectologia, Brasília, DF, Brasil
| | - Ariely Teotonio Borges
- Instituto Hospital de Base do Distrito Federal, Unidade de Neurologia, Brasília, DF, Brasil
| | - Aline Barbosa Palmeira
- Instituto Hospital de Base do Distrito Federal, Unidade de Neurologia, Brasília, DF, Brasil
| | - Vinicius Moreira Lima
- Instituto Hospital de Base do Distrito Federal, Unidade de Neurologia, Brasília, DF, Brasil
| | - Ernane Pires Maciel
- Instituto Hospital de Base do Distrito Federal, Unidade de Neurologia, Brasília, DF, Brasil
| | | | - João Pedro Lima Mendes
- Universidade de Brasília, Faculdade de Medicina, Núcleo de Medicina Tropical, Brasília, DF, Brasil
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Bremer M, Kadernani YE, Wasserman S, Wilkinson RJ, Davis AG. Strategies for the diagnosis and management of meningitis in HIV-infected adults in resource limited settings. Expert Opin Pharmacother 2021; 22:2053-2070. [PMID: 34154509 DOI: 10.1080/14656566.2021.1940954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The incidence of human immunodeficiency virus-1 (HIV-1) associated meningitis has been declining in the post-combination antiretroviral treatment (ART) era, although survival rates remain low for the common causes like tuberculosis and cryptococcal disease. Diagnosis and treatment of meningitis in HIV-1 is complicated by atypical clinical presentations, limited accuracy of diagnostic tests, access to diagnostic tests, and therapeutic agents in low- and middle-income countries (LMIC) and immune reconstitution inflammatory syndrome (IRIS). AREAS COVERED We provide an overview of the common etiologies of meningitis in HIV-1-infected adults, suggest a diagnostic approach based on readily available tests, and review specific chemotherapeutic agents, host-directed therapies, supportive care, timing of ART initiation, and considerations in the management of IRIS with a focus on resource-limited settings. They identify key knowledge gaps and suggest areas for future research. EXPERT OPINION Evidence-based management of HIV-1-associated meningitis is sparse for common etiologies. More readily available and sensitive diagnostic tests as well as standardized investigation strategies are required in LMIC. There is a lack of availability of recommended drugs in areas of high HIV-1 prevalence and a limited pipeline of novel chemotherapeutic agents. Host-directed therapies have been inadequately studied.
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Affiliation(s)
- Marise Bremer
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory
| | - Yakub E Kadernani
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory
| | - Sean Wasserman
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory.,Department of Medicine, University of Cape Town, Groote Schuur Hospital, Observatory, Republic of South Africa
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory.,Department of Medicine, University of Cape Town, Groote Schuur Hospital, Observatory, Republic of South Africa.,Department of Infectious Diseases, Imperial College London, London, UK.,Francis Crick Institute, London, UK.,Faculty of Life Sciences, University College London, London, UK
| | - Angharad G Davis
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory.,Francis Crick Institute, London, UK.,Faculty of Life Sciences, University College London, London, UK
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Dynamics of data availability in disease modeling: An example evaluating the trade-offs of ultra-fine-scale factors applied to human West Nile virus disease models in the Chicago area, USA. PLoS One 2021; 16:e0251517. [PMID: 34010306 PMCID: PMC8133451 DOI: 10.1371/journal.pone.0251517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Since 1999, West Nile virus (WNV) has moved rapidly across the United States, resulting in tens of thousands of human cases. Both the number of human cases and the minimum infection rate (MIR) in vector mosquitoes vary across time and space and are driven by numerous abiotic and biotic forces, ranging from differences in microclimates to socio-demographic factors. Because the interactions among these multiple factors affect the locally variable risk of WNV illness, it has been especially difficult to model human disease risk across varying spatial and temporal scales. Cook and DuPage Counties, comprising the city of Chicago and surrounding suburbs, experience some of the highest numbers of human neuroinvasive cases of WNV in the United States. Despite active mosquito control efforts, there is consistent annual WNV presence, resulting in more than 285 confirmed WNV human cases and 20 deaths from the years 2014–2018 in Cook County alone. Methods A previous Chicago-area WNV model identified the fifty-five most high and low risk locations in the Northwest Mosquito Abatement District (NWMAD), an enclave ¼ the size of the combined Cook and DuPage county area. In these locations, human WNV risk was stratified by model performance, as indicated by differences in studentized residuals. Within these areas, an additional two-years of field collections and data processing was added to a 12-year WNV dataset that includes human cases, MIR, vector abundance, and land-use, historical climate, and socio-economic and demographic variables, and was assessed by an ultra-fine-scale (1 km spatial x 1 week temporal resolution) multivariate logistic regression model. Results Multivariate statistical methods applied to the ultra-fine-scale model identified fewer explanatory variables while improving upon the fit of the previous model. Beyond MIR and climatic factors, efforts to acquire additional covariates only slightly improved model predictive performance. Conclusions These results suggest human WNV illness in the Chicago area may be associated with fewer, but increasingly critical, key variables at finer scales. Given limited resources, these findings suggest large variations in model performance occur, depending on covariate availability, and provide guidance in variable selection for optimal WNV human illness modeling.
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Meleo-Erwin Z, Basch CH, Fera J, Garcia P. Readability of online dengue materials: The need for accessible information as part of infectious disease prevention and control efforts. Infect Dis Health 2020; 25:277-282. [PMID: 32571763 DOI: 10.1016/j.idh.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Dengue is the fastest spreading viral infection. A number of epidemics have occurred in subtropical and tropical regions of the United States. A future expansion and intensification of dengue has been predicted, partly due to changing environmental conditions. In the absence of treatment, prevention and control are vital to addressing this vector-borne disease. Health education and community engagement are a key part of such efforts. Given that the majority of Americans search for health information online, ensuring the readability of web-based dengue information is an important consideration for health officials. To date, there is a dearth of information on this topic. METHODS To address this gap, "Dengue fever" was searched using Google Chrome to generate a sample of 100 websites. Using Readable.io, the readability of these 100 sites was then determined using five different tests. The data were analyzed using SPSS. RESULTS The results indicate that the vast majority of online materials on dengue are written at a level far beyond what is recommended. Three of the five tests did not find any of the sampled sites to be appropriate in terms of readability. In general, the websites analyzed tended to be written at a level beyond the 10th grade. CONCLUSION These findings have important implications for future dengue outbreaks in the United States.
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Affiliation(s)
- Zoe Meleo-Erwin
- Department of Public Health, William Paterson University, Wayne, NJ, 07470, USA.
| | - Corey H Basch
- Department of Public Health, William Paterson University, Wayne, NJ, 07470, USA
| | - Joseph Fera
- Department of Mathematics, Lehman College, The City University of New York, USA
| | - Philip Garcia
- Department of Public Health, William Paterson University, Wayne, NJ, 07470, USA
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5
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Werner SL, Banda BK, Burnsides CL, Stuber AJ. Zoonosis: Update on Existing and Emerging Vector-Borne Illnesses in the USA. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2019; 7:91-106. [PMID: 32288973 PMCID: PMC7102350 DOI: 10.1007/s40138-019-00189-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This review describes mosquito- and tick-borne diseases found in the Western Hemisphere. It focuses on emerging diseases and recent geographic shifts in the presence of disease vectors. RECENT FINDINGS Mosquito and tick vectors have become more widespread as environmental conditions have become more favorable. Zika recently has emerged as a concern for fetal anomalies. West Nile Virus has become widespread. Lyme disease and other tick-borne diseases are more prevalent in areas previously inhospitable to these ticks. SUMMARY Healthcare providers must consider the possibility of mosquito- and tick-borne diseases in broader geographic areas and council patients traveling to endemic areas on precautions against these diseases. Treatment for suspected cases of serious tick-borne illnesses should not be delayed pending culture results.
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Affiliation(s)
- Sandra Lee Werner
- MetroHealth/Cleveland Clinic/CWRU Emergency Medicine Residency Program, Department of Emergency Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109 USA
| | - Bhanu Kirthi Banda
- MetroHealth/Cleveland Clinic/CWRU Emergency Medicine Residency Program, Department of Emergency Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109 USA
| | - Christopher Lee Burnsides
- MetroHealth/Cleveland Clinic/CWRU Emergency Medicine Residency Program, Department of Emergency Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109 USA
| | - Alexander James Stuber
- MetroHealth/Cleveland Clinic/CWRU Emergency Medicine Residency Program, Department of Emergency Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109 USA
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Development of standard clinical endpoints for use in dengue interventional trials. PLoS Negl Trop Dis 2018; 12:e0006497. [PMID: 30286085 PMCID: PMC6171842 DOI: 10.1371/journal.pntd.0006497] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/03/2018] [Indexed: 12/22/2022] Open
Abstract
Dengue is a major public health problem worldwide. Although several drug candidates have been evaluated in randomized controlled trials, none has been effective and at present, early recognition of severe dengue and timely supportive care are used to reduce mortality. While the first dengue vaccine was recently licensed, and several other candidates are in late stage clinical trials, future decisions regarding widespread deployment of vaccines and/or therapeutics will require evidence of product safety, efficacy and effectiveness. Standard, quantifiable clinical endpoints are needed to ensure reproducibility and comparability of research findings. To address this need, we established a working group of dengue researchers and public health specialists to develop standardized endpoints and work towards consensus opinion on those endpoints. After discussion at two working group meetings and presentations at international conferences, a Delphi methodology-based query was used to finalize and operationalize the clinical endpoints. Participants were asked to select the best endpoints from proposed definitions or offer revised/new definitions, and to indicate whether contributing items should be designated as optional or required. After the third round of inquiry, 70% or greater agreement was reached on moderate and severe plasma leakage, moderate and severe bleeding, acute hepatitis and acute liver failure, and moderate and severe neurologic disease. There was less agreement regarding moderate and severe thrombocytopenia and moderate and severe myocarditis. Notably, 68% of participants agreed that a 50,000 to 20,000 mm3 platelet range be used to define moderate thrombocytopenia; however, they remained divided on whether a rapid decreasing trend or one platelet count should be case defining. While at least 70% agreement was reached on most endpoints, the process identified areas for further evaluation and standardization within the context of ongoing clinical studies. These endpoints can be used to harmonize data collection and improve comparability between dengue clinical trials. Dengue is a major public health problem worldwide. Although several drug candidates have been evaluated in randomized controlled trials, none has been effective, and early recognition of severe dengue and timely supportive care remain the only means to reduce mortality. While the first dengue vaccine was recently licensed, and several other candidates are in late stage clinical trials, future decisions regarding deployment of such vaccines or therapeutics will require evidence of product safety, efficacy and effectiveness. Standard, quantifiable clinical endpoints are needed to ensure reproducibility and comparability of research findings. To address this need, we established a working group of dengue researchers, vaccine developers, and public health specialists to develop endpoints. After two working group meetings and discussions at international meetings, the Delphi methodology was used to clarify and further develop endpoints such that 70% or greater agreement was reached on most endpoint definitions including moderate and severe plasma leakage, moderate and severe bleeding, acute hepatitis and acute liver failure, and moderate and severe neurologic disease. The process identified areas for further evaluation and standardization within the context of ongoing clinical studies. The endpoints can be used to harmonize data collection and improve comparability between dengue clinical trials.
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Marcondes CB, Contigiani M, Gleiser RM. Emergent and Reemergent Arboviruses in South America and the Caribbean: Why So Many and Why Now? JOURNAL OF MEDICAL ENTOMOLOGY 2017; 54:509-532. [PMID: 28399216 DOI: 10.1093/jme/tjw209] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/20/2016] [Indexed: 06/07/2023]
Abstract
Varios arbovirus han emergido y/o reemergido en el Nuevo Mundo en las últimas décadas. Los virus Zika y chikungunya, anteriormente restringidos a África y quizás Asia, invadieron el continente, causando gran preocupación; además siguen ocurriendo brotes causados por el virus dengue en casi todos los países, con millones de casos por año. El virus West Nile invadió rápidamente América del Norte, y ya se han encontrado casos en América Central y del Sur. Otros arbovirus, como Mayaro y el virus de la encefalitis equina del este han aumentado su actividad y se han encontrado en nuevas regiones. Se han documentado cambios en la patogenicidad de algunos virus que conducen a enfermedades inesperadas. Una fauna diversa de mosquitos, cambios climáticos y en la vegetación, aumento de los viajes, y urbanizaciones no planificadas que generan condiciones adecuadas para la proliferación de Aedes aegypti (L.), Culex quinquefasciatus Say y otros mosquitos vectores, se han combinado para influir fuertemente en los cambios en la distribución y la incidencia de varios arbovirus. Se enfatiza la necesidad de realizar estudios exhaustivos de la fauna de mosquitos y modificaciones de las condiciones ambientales, sobre todo en las zonas urbanas fuertemente influenciadas por factores sociales, políticos y económicos.
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Affiliation(s)
- Carlos Brisola Marcondes
- Departamento de Microbiologia, Imunologia e Parasitologia, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina 88040-900, Brazil
| | - Marta Contigiani
- Emeritus Professor, Instituto de Virologia "Dr. J. M. Vanella", Enfermera Gordillo Gomez s/n, Ciudad Universitaria, National University of Córdoba, Córdoba, Argentina
| | - Raquel Miranda Gleiser
- Centro de Relevamiento y Evaluación de Recursos Agrícolas y Naturales (CREAN) - Instituto Multidisciplinario de Biología Vegetal (IMBIV), Universidad Nacional de Córdoba (UNC) and Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
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Sharp TM, Tomashek KM, Read JS, Margolis HS, Waterman SH. A New Look at an Old Disease: Recent Insights into the Global Epidemiology of Dengue. CURR EPIDEMIOL REP 2017; 4:11-21. [PMID: 28251039 PMCID: PMC5306284 DOI: 10.1007/s40471-017-0095-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW By all measures, the morbidity and mortality due to dengue are continuing to worsen worldwide. Although both early and recent studies have demonstrated regional differences in how dengue affects local populations, these findings were to varying extents related to disparate surveillance approaches. RECENT FINDINGS Recent studies have broadened the recognized spectrum of disease resulting from DENV infection, particularly in adults, and have also demonstrated new mechanisms of DENV spread both within and between populations. New results regarding the frequency and duration of homo- and heterotypic anti-DENV antibodies have provided important insights relevant to vaccine design and implementation. SUMMARY These observations and findings as well as difficulties in comparing the epidemiology of dengue within and between regions of the world underscore the need for population-based dengue surveillance worldwide. Enhanced surveillance should be implemented to complement passive surveillance in countries in the tropics to establish baseline data in order to define affected populations and evaluate the impact of dengue vaccines and novel vector control interventions.
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Affiliation(s)
- Tyler M. Sharp
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, PR 00920-3860 USA
| | - Kay M. Tomashek
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, PR 00920-3860 USA
| | - Jennifer S. Read
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, PR 00920-3860 USA
| | - Harold S. Margolis
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, PR 00920-3860 USA
| | - Stephen H. Waterman
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, PR 00920-3860 USA
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Solbrig MV, Perng GC. Current neurological observations and complications of dengue virus infection. Curr Neurol Neurosci Rep 2016; 15:29. [PMID: 25877545 DOI: 10.1007/s11910-015-0550-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Dengue, a mosquito-borne flavivirus and fastest growing tropical disease in the world, has experienced an explosion of neurologic case reports and series in recent years. Now dengue is a frequent or leading cause of encephalitis in some endemic regions, is estimated to infect one in six tourists returning from the tropics, and has been proven to have local transmission within the continental USA. High documentation of neurologic disease in recent years reflects increases in overall cases, enhanced clinical awareness and advances in diagnostics. Neurological aspects of dengue virus, along with epidemiology, treatment, and vaccine progress, are presented.
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Affiliation(s)
- Marylou V Solbrig
- Department of Pharmacology and Toxicology, School of Pharmacy, University of Kansas, 1251 Wescoe Hall Drive, Malott Hall Rm 5040, Lawrence, KS, 66045, USA,
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Fredericks AC, Fernandez-Sesma A. The burden of dengue and chikungunya worldwide: implications for the southern United States and California. Ann Glob Health 2014; 80:466-75. [PMID: 25960096 PMCID: PMC4427842 DOI: 10.1016/j.aogh.2015.02.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Dengue virus (DENV) spreads to humans through the bite of an infected Aedes aegypti or Aedes albopictus mosquito and is a growing public health threat to both industrialized and developing nations worldwide. Outbreaks of autochthonous dengue in the United States occurred extensively in the past but over the past 3 decades have again taken place in Florida, Hawaii, and Texas as well as in American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the US Virgin Islands. As the Aedes vectors spread worldwide it is anticipated that DENV as well as other viruses also transmitted by these vectors, such as Chikungunya virus (CHKV), will invade new areas of the world, including the United States. OBJECTIVES In this review, we describe the current burden of dengue disease worldwide and the potential introduction of DENV and CHKV into different areas of the United States. Of these areas, the state of California saw the arrival and spread of the Aedes aegypti vector beginning in 2013. This invasion presents a developing situation when considering the state's number of imported dengue cases and proximity to northern Mexico as well as the rising specter of chikungunya in the Western hemisphere. FINDINGS In light of the recent arrival of Aedes aegypti mosquito vectors to California, there is now a small but appreciable risk for endemic transmission of dengue and chikungunya within the State. It is likely, however, that if DENV or CHKV were to become endemic that the public health situation would be similar to that currently found along the Texas-Mexico border. The distribution of Aedes vectors in California as well as a discussion of several factors contributing to the risk for dengue importation are discussed and evaluated. CONCLUSIONS Dengue and chikungunya viruses present real risks to states where the Aedes vector is now established. Scientists, physicians, and public health authorities should familiarize themselves with these risks and prepare appropriately.
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Affiliation(s)
- Anthony C Fredericks
- Department of Microbiology and The Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ana Fernandez-Sesma
- Department of Microbiology and The Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.
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