Factors Associated with Dengue Virus Infection and Reinfection in Asymptomatic Children in Two Colombian Municipalities

Asymptomatic dengue infection rate: A systematic literature review

Objectives

Dengue infection is spreading worldwide. The clinical spectrum is broad and includes asymptomatic infections. This review provides an overview of the different proportions of asymptomatic infections described in epidemiological studies according to definitions, study designs, and detection methods.

Methods

Medline and Embase databases were searched without restriction of date or language. Studies were included if they reported data on the incidence or prevalence of asymptomatic dengue infections. The data were summarized and classified according to the definitions of the term 'asymptomatic'.

Results

A total of 74 studies were included. The mean proportion of asymptomatic infections among dengue-infected persons was 54% in 50 included studies. The prevalence of dengue infections detected in healthy persons was 0.2% in 24 included studies. The term 'asymptomatic' has been used to refer to 'clinically undetectable infection', but also to 'undiagnosed infection' or 'mild infection'. Only 8% were clinically undetectable laboratory-confirmed dengue infections.

Conclusion

The proportion of asymptomatic dengue infections varied greatly. Studies proving data on clinically undetectable laboratory-confirmed dengue infections were very few, but provided consistent results of low proportions of asymptomatic infections. These data challenge the assumption that the majority of dengue cases are asymptomatic.

Neurological manifestations due to dengue virus infection in children: clinical follow-up

The aim was to assess neurological complications in children with an invasive neurological disease by dengue virus (DENV) and the time to resolve symptoms after hospital discharge. A prospective study was conducted at a referral hospital for infectious diseases in Brazil between March 2014 and July 2019. All children hospitalized with neurologic manifestations and DENV RNA detected by real-time reverse transcription-polymerase chain reaction (RT-qPCR) in cerebrospinal fluid (CSF) were followed up until complete resolution of neurological complications. On average, they were followed up for 16 months. Among 56 DENV-positive children, 39% had some neurologic complications after hospital discharge and found that 19.6% were discharged with anticonvulsants due to seizures, 10.7% developed motor complications (e.g. muscle weakness, paresis, ataxia, and walking disability), 5.4% had headaches, and 14.3% had sleep disorders. Among the 56 children, only three had a clinical diagnosis of dengue because the symptoms are nonspecific and 35% showed no change in cerebrospinal fluid (CSF). The average time to resolve complications was 5.9 months (ranging from 1 m to 32 m). These results should alert physicians to the difficulties of a clinical diagnosis of an infection that causes neurological complications after discharge in a significant number of children. RT-qPCR's etiological diagnosis of DENV infection enabled better clinical follow-up for early intervention in children with neurological complications.

Dengue-chikungunya coinfection outbreak in children from Cali, Colombia in 2018-2019

OBJECTIVE

To identify the arbovirus involved in febrile cases identified in a pediatric clinic in Cali, Valle del Cauca province, Colombia, and study the clinical characteristics.

METHODS

A descriptive, prospective study enrolled 345 febrile children for 12 months in a pediatric clinic. Medical record registers documenting signs and symptoms, and serum samples were analyzed to detect DENV, CHIKV, and ZIKV by reverse transcription-polymerase chain reaction and serology methods. Diagnosis at the time of admission and discharge were compared based on laboratory test results.

RESULTS

All patients were diagnosed as severe dengue at admission. Molecular detection and serology tests identified 143 CHIKV-positive (41.4%), 20 DENV-positive (5.8%), and 123 DENV-CHIKV coinfection patients (35.7%). DENV or CHIKV serology test results of these double-infected patients yield poor performance to confirm patient cases. ZIKV infection was detected in 5 patients (1.4%), every time as double or triple infections.

CONCLUSION

. A sustained CHIKV circulation and transmission was confirmed causing febrile illness in children and indicating that this virus spreads even during the regular DENV season, leading to double infections and altering clinical symptoms. Specific clinical tests are necessary to closely identify the arbovirus involved in causing infectious diseases that can help in better treatment and mosquito-transmitted virus surveillance.

Dengue Infections in Colombia: Epidemiological Trends of a Hyperendemic Country

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

[Adequate solid waste management as a protection factor against dengue casesGestión adecuada de los residuos sólidos como factor de protección contra los casos de dengue]

Objetivo.

Verificar a existência de associação de indicadores de gestão de resíduos sólidos e socioeconômicos municipais com índices de incidência de dengue, Zika e Chikungunya nos municípios do estado brasileiro de Minas Gerais.

Métodos.

Este estudo de caráter exploratório, quantitativo e transversal abrangeu os 853 municípios do estado de Minas Gerais. Todos os dados utilizados foram secundários, coletados e agrupados por regionais de planejamento. Como variáveis independentes, foram consideradas a cobertura de coleta de resíduos sólidos urbanos, cobertura de coleta seletiva e massa de resíduos sólidos urbanos, além de um indicador da qualidade da destinação final de resídulos, índices de desenvolvimento humano municipal e de Gini, renda mensal per capita e porcentagem de vulneráveis à pobreza. Os fatores potencialmente associados aos desfechos – incidências municipais de dengue, Chikungunya e Zika – foram selecionados inicialmente através de análises univariadas. Posteriormente, os modelos de regressão linear para as incidências de dengue, Chikungunya ou Zika foram gerados considerando os preditores selecionados pela análise univariada.

Resultados.

Não foi observada associação entre gestão de resíduos sólidos e incidência de Chikungunya e Zika. Por sua vez, a incidência de dengue associou-se à gestão de resíduos sólidos e apresentou relação inversa significativa com o percentual de vulneráveis à pobreza. Houve também associação direta o índice de Gini, sugerindo que quanto maiores os registros de incidência de dengue de 2007 a 2016, maiores os valores de Gini dos municípios – ou seja, maior a desigualdade social. A cobertura da coleta seletiva apresentou relação inversa e significativa com os casos de dengue, sugerindo que quanto menor a cobertura da coleta de seletiva, maiores foram os casos registrados de dengue.

Conclusões.

A gestão de resíduos sólidos pode influenciar os casos de dengue e, por isso, deve ser considerada nas ações de saúde pública.

Sociocultural determinants of adoption of preventive practices for hantavirus: A knowledge, attitudes, and practices survey in Tonosí, Panama

Introduction

Hantaviruses are a group of single-stranded RNA viruses carried by small rodent reservoirs, transmitted to humans through inhalation of aerosolized particles of rodent feces, urine, or saliva. In Panama, the Choclo orthohantavirus has been associated with Hantavirus Pulmonary Syndrome (n = 54) and Hantavirus Fever (n = 53). In 2018, there were 107 cases of hantavirus diseases, the majority in the Tonosí district, and 4 deaths. As there is no vaccine or treatment for hantavirus, proper prevention measures by community members is key to stopping outbreaks.

Methodology and principal findings

We investigated hantavirus knowledge, attitudes, and practices in one corregimiento of Tonosí, Panama to determine what factors influence uptake of prevention practices and high level of knowledge. We conducted a cross-sectional survey with 124 residents covering hantavirus knowledge, attitudes based in the Health Belief Model (perceived severity, perceived susceptibility, perceived obstacles, perceived benefits, and cues to action) and prevention practices. There was an overall high level of knowledge (median score: 4/6), though 20% did not know the route of transmission. The mean number of reported practices performed per person was 8.4 (range: 4–12). Most people had heard of hantavirus through other community members. In linear regression, lower perceived obstacles predicted higher preventive practice score. Reported obstacles to preventive practices included physical restrictions, such as age and health state. In ordinal logistic regression, higher education level and knowing more people who had previously been sick with hantavirus contributed to higher knowledge score.

Conclusions

Future interventions should focus on removing barriers to performing preventive practices. As most people learned of hantavirus through community members, interventions should be community-based and involve those who have experienced the disease. Any future education materials should address confusions about route of transmission and be targeted at those with a lower education level.

Hantavirus is a pathogen spread by small rodents in many regions of the world. In Panama, infection with hantavirus can lead to Hantavirus Fever or Hantavirus Pulmonary Syndrome. In 2018, there were 107 cases of hantavirus infection in Panama, the majority in the Tonosí District, and 4 deaths. Currently, there is no treatment, cure, or vaccine for hantaviruses. It is important that communities carry out the recommended prevention measures. In this study, we investigated what influences people to carry out the proper prevention measures and what influences people’s knowledge of hantavirus in order to design interventions in highly affected communities. We found that barriers such as physical restrictions limit people’s ability to perform the measures. Additionally, we found that those with higher education and those that knew more people who had been sick with hantavirus were more likely to have higher knowledge of the disease. We recommend that future interventions are community-based and focus on removing obstacles to performing the recommended prevention practices and involve those who have been affected by the disease to spread information.