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Zambrano LEA, Zevallos VMV, Soraya GV, Istifiani LA, Pamungkas SA, Ulhaq ZS. Transplacental transmission of dengue infection. World J Virol 2024; 13:91325. [DOI: 10.5501/wjv.v13.i3.91325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 06/14/2024] [Accepted: 07/04/2024] [Indexed: 08/29/2024] Open
Abstract
We specifically addressed the persistent challenge of dengue in endemic regions, highlighting the potential seriousness of dengue infection through vertical transmission. Vertical dengue transmission has been well documented, particularly in hyper-endemic regions, including Ecuador. Herein, we present a neonate diagnosed with congenital dengue and review similar cases from previously published reports. Although congenital dengue is commonly infected with severe serotypes of DENV (DENV-1 and DENV-2) infections, favorable outcomes are generally observed.
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Affiliation(s)
| | - Victor Manuel Vasquez Zevallos
- Department of Medicine, Technical University of Manabi, Manabi 130101, Ecuador
- Department of Pediatrics, Verdi Cevallos Balda Hospital, Portoviejo 130105, Ecuador
| | - Gita Vita Soraya
- Department of Biochemistry, Hasanuddin University, Makassar 90245, Indonesia
| | - Lola Ayu Istifiani
- Department of Nutrition, Faculty of Health Sciences, Brawijaya University, Malang 65100, Indonesia
| | | | - Zulvikar Syambani Ulhaq
- Research Center for Preclinical and Clinical Medicine, National Research and Innovation Agency Republic of Indonesia, Cibinong 16911, Indonesia
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Buerger V, Hadl S, Schneider M, Schaden M, Hochreiter R, Bitzer A, Kosulin K, Mader R, Zoihsl O, Pfeiffer A, Loch AP, Morandi E, Nogueira ML, de Brito CAA, Croda J, Teixeira MM, Coelho ICB, Gurgel R, da Fonseca AJ, de Lacerda MVG, Moreira ED, Veiga APR, Dubischar K, Wressnigg N, Eder-Lingelbach S, Jaramillo JC. Safety and immunogenicity of a live-attenuated chikungunya virus vaccine in endemic areas of Brazil: interim results of a double-blind, randomised, placebo-controlled phase 3 trial in adolescents. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00458-4. [PMID: 39243794 DOI: 10.1016/s1473-3099(24)00458-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Chikungunya outbreaks have been reported in Brazil since 2014. Adolescents are a sensitive population who would benefit from a prophylactic vaccine. This study assessed the immunogenicity and safety of the vaccine VLA1553 in adolescents in Brazil. With an overall trial duration of 12 months, we now report data on safety and immunogenicity over a period of 28 days after vaccination. METHODS In this double-blind, randomised, placebo-controlled phase 3 trial, adolescents aged 12 to <18 years were recruited. The trial was performed at ten trial sites across Brazil. Eligible participants were generally healthy. The main exclusion criteria comprised immune-mediated or chronic arthritis or arthralgia, a known or suspected defect of the immune system, or any live vaccine received within the 4 weeks before trial vaccination. Randomisation was stratified by baseline serostatus in a 2:1 ratio to receive VLA1553 (at a dose of 1 × 104 TCID50 per 0·5 mL [ie, 50% tissue culture infectious dose]) or placebo. VLA1553 or placebo was administered intramuscularly as a single-dose immunisation on day 1. The primary endpoint was the proportion of baseline seronegative participants with chikungunya virus neutralising antibody levels of 150 or more in μPRNT50 (a micro plaque reduction neutralisation test), which was considered a surrogate of protection. The safety analysis included all participants receiving a trial vaccination. Immunogenicity analyses were performed in a subset. The trial is registered with ClinicalTrials.gov, NCT04650399. FINDINGS Between Feb 14, 2022, and March 14, 2023, 754 participants received a trial vaccination (502 received VLA1553 and 252 received placebo) with a per-protocol population of 351 participants for immunogenicity analyses (303 in the VLA1553 group and 48 in the placebo group). In participants who were seronegative at baseline, VLA1553 induced seroprotective chikungunya virus neutralising antibody levels in 247 of 250 (98·8%, 95% CI 96·5-99·8) participants 28 days after vaccination. In seropositive participants, the baseline seroprotection rate of 96·2% increased to 100% after vaccination with VLA1553. Most (365 [93%] of 393) adverse events were of mild or moderate intensity, VLA1553 was generally well tolerated. When compared with placebo, participants exposed to VLA1553 had a significantly higher frequency of related adverse events (351 [69·9%] of 502 vs 121 [48·0%] of 252; p<0·0001), mostly headache, myalgia, fatigue, and fever. Among four reported serious adverse events (three in the VLA1553 group and one in the placebo group), one was classified as possibly related to VLA1553: a high-grade fever. Among 20 adverse events of special interest (ie, symptoms suggesting chikungunya-like disease), 16 were classified as related to trial vaccination (15 in the VLA1553 group and one in the placebo group), with severe symptoms reported in four participants (fever, headache, or arthralgia). 17 adverse events of special interest resolved within 1 week. Among 85 participants with arthralgia (68 in the VLA1553 group and 17 in the placebo group), eight adolescents had short-lived (range 1-5 days), mostly mild recurring episodes (seven in the VLA1553 group and one in the placebo group). The median duration of arthralgia was 1 day (range 1-5 days). The frequency of injection site adverse events for VLA1553 was higher than in the placebo group (161 [32%] vs 62 [25%]), but rarely severe (two [<1%] in the VLA1553 group and one [<1%] in the placebo group). After administration of VLA1553, there was a significantly lower frequency of solicited adverse events in participants who were seropositive at baseline compared with those who were seronegative (53% vs 74%; p<0·0001) including headache, fatigue, fever, and arthralgia. INTERPRETATION VLA1553 was generally safe and induced seroprotective titres in almost all vaccinated adolescents with favourable safety data in adolescents who were seropositive at baseline. The data support the use of VLA1553 for the prevention of disease caused by the chikungunya virus among adolescents and in endemic areas. FUNDING Coalition for Epidemic Preparedness Innovation and EU Horizon 2020. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Mauricio Lacerda Nogueira
- Faculdade de Medicina Sao Jose Rio Preto, Sao Paulo, Brazil; Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Julio Croda
- Centro de Pesquisa Clínica da Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Mato Grosso do Sul, Brazil
| | - Mauro Martins Teixeira
- Centro de Pesquisa e Desenvolvimento de Fármacos (CPDF)-Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Minas Gerais, Brazil
| | | | - Ricardo Gurgel
- Centro de Pesquisas Clinicas Universidade Federal Sergipe, Sergipe, Brazil
| | | | | | - Edson Duarte Moreira
- Centro de Pesquisa Clínica - CPEC da Associação Obras Sociais Irmã Dulce, Bahia, Brazil
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Patiño L, Benítez AD, Carrazco-Montalvo A, Regato-Arrata M. Genomics for Arbovirus Surveillance: Considerations for Routine Use in Public Health Laboratories. Viruses 2024; 16:1242. [PMID: 39205216 PMCID: PMC11360194 DOI: 10.3390/v16081242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/13/2024] [Accepted: 07/16/2024] [Indexed: 09/04/2024] Open
Abstract
The emergence and re-emergence of arthropod-borne viruses is a public health threat. For routine surveillance in public health laboratories, cost-effective and reproducible methods are essential. In this review, we address the technical considerations of high-throughput sequencing methods (HTS) for arbovirus surveillance in national health laboratories, focusing on pre-sequencing, sequencing, and post-sequencing approaches, underlining the importance of robust wet and dry laboratory workflows for reproducible analysis. We aim to provide insights for researchers and clinicians interested in arbovirus, diagnosis, and surveillance by discussing current advances in sequencing methods and bioinformatics pipelines applied to arboviruses.
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Affiliation(s)
- Leandro Patiño
- Instituto Nacional de Investigación en Salud Pública “Leopoldo Izquieta Pérez”, Dirección Técnica de Investigación, Desarrollo e Innovación, Guayaquil 090150, Ecuador
- Facultad Ciencias de la Vida, Escuela Superior Politécnica del Litoral, ESPOL, Campus Gustavo Galindo Km. 30.5 Vía Perimetral, Guayaquil 090902, Ecuador
| | - Andrea Denisse Benítez
- Instituto de Microbiología, Universidad San Francisco de Quito USFQ, Quito 170901, Ecuador
| | - Andrés Carrazco-Montalvo
- Instituto Nacional de Investigación en Salud Pública “Leopoldo Izquieta Pérez”, Centro de Referencia Nacional de Genómica, Secuenciación y Bioinformática, Quito 170403, Ecuador;
| | - Mary Regato-Arrata
- Instituto Nacional de Investigación en Salud Pública “Leopoldo Izquieta Pérez”, Centro de Referencia Nacional de Virus Exantemáticos, Gastroentericos y Transmitidos por Vectores, Guayaquil 090150, Ecuador;
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Lapo-Talledo GJ. Dengue hospitalizations and in-hospital mortality changes in trend in Ecuador: a nationwide study from 2015 to 2022. Infect Dis (Lond) 2024; 56:632-643. [PMID: 38618674 DOI: 10.1080/23744235.2024.2341871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/08/2024] [Indexed: 04/16/2024] Open
Abstract
OBJECTIVE This study aimed to analyze dengue hospitalizations and in-hospital mortality trends in Ecuador, along with sociodemographic factors influencing adverse outcomes. METHODS This study included 31,616 dengue hospitalizations in Ecuador during 2015-2022, of which 115 (0.36%) died. Data were extracted from national hospital registries. Age adjusted rates were calculated, and for the analysis of changes in trend, a Joinpoint regression was performed. Multivariate binary and multinomial logistic regressions were performed for assessing sociodemographic factors influencing dengue adverse outcomes. RESULTS During 2015-2022, the mean age adjusted dengue hospitalization rate was 22.3 per 100,000 inhabitants with 49.41% annual decrease during 2015-2017 and 31.73% annual increase during 2017-2022 with higher rates in 2020 with 31.61, 2021 with 34.42, and 2022 with 25.81. The mean dengue in-hospital mortality rate was 0.08, mortality rates did not show significant changes during 2015-2022. Higher probability of death was observed in ages ≥50 years and ethnic minorities. People living in rural areas exhibited a 64% higher risk for complicated dengue hospitalization. CONCLUSIONS It was observed as an important accomplishment in Ecuador's ongoing efforts to improve healthcare regarding dengue. 0.36% of dengue hospitalizations ended in death which is below the recommended 1%. The increase in dengue hospitalizations in Ecuador during recent years remains a concern. The COVID-19 pandemic might have influenced dengue prevention and vector control to be neglected leading to an increase in cases.
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Shaikh MS, Faiyazuddin M, Khan MS, Pathan SK, Syed IJ, Gholap AD, Akhtar MS, Sah R, Mehta R, Sah S, Bonilla-Aldana DK, Luna C, Rodriguez-Morales AJ. Chikungunya virus vaccine: a decade of progress solving epidemiological dilemma, emerging concepts, and immunological interventions. Front Microbiol 2024; 15:1413250. [PMID: 39104592 PMCID: PMC11298817 DOI: 10.3389/fmicb.2024.1413250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/01/2024] [Indexed: 08/07/2024] Open
Abstract
Chikungunya virus (CHIKV), a single-stranded RNA virus transmitted by Aedes mosquitoes, poses a significant global health threat, with severe complications observed in vulnerable populations. The only licensed vaccine, IXCHIQ, approved by the US FDA, is insufficient to address the growing disease burden, particularly in endemic regions lacking herd immunity. Monoclonal antibodies (mAbs), explicitly targeting structural proteins E1/E2, demonstrate promise in passive transfer studies, with mouse and human-derived mAbs showing protective efficacy. This article explores various vaccine candidates, including live attenuated, killed, nucleic acid-based (DNA/RNA), virus-like particle, chimeric, subunit, and adenovirus vectored vaccines. RNA vaccines have emerged as promising candidates due to their rapid response capabilities and enhanced safety profile. This review underscores the importance of the E1 and E2 proteins as immunogens, emphasizing their antigenic potential. Several vaccine candidates, such as CHIKV/IRES, measles vector (MV-CHIK), synthetic DNA-encoded antibodies, and mRNA-lipid nanoparticle vaccines, demonstrate encouraging preclinical and clinical results. In addition to identifying potential molecular targets for antiviral therapy, the study looks into the roles played by Toll-like receptors, RIG-I, and NOD-like receptors in the immune response to CHIKV. It also offers insights into novel tactics and promising vaccine candidates. This article discusses potential antiviral targets, the significance of E1 and E2 proteins, monoclonal antibodies, and RNA vaccines as prospective Chikungunya virus vaccine candidates.
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Affiliation(s)
| | - Md. Faiyazuddin
- School of Pharmacy, Al – Karim University, Katihar, India
- Centre for Global Health Research, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | | | - Shahbaz K. Pathan
- Medmecs Medical Coding & Billing Services, Universal Business Park, Mumbai, Maharashtra, India
| | - Imran J. Syed
- Y. B. Chavan College of Pharmacy, Aurangabad, Maharashtra, India
- SBSPM’s B. Pharmacy College, Beed, Maharashtra, India
| | - Amol D. Gholap
- Department of Pharmaceutics, St. John Institute of Pharmacy and Research, Palghar, Maharashtra, India
| | - Mohammad Shabib Akhtar
- Department of Clinical Pharmacy, College of Pharmacy, Najran University, Najran, Saudi Arabia
| | - Ranjit Sah
- Green City Hospital, Kathmandu, Nepal
- Research Unit, Department of Microbiology, Dr. DY Patil Medical College, Hospital and Research Centre, DY Patil Vidyapeeth, Pune, Maharashtra, India
- Department of Public Health Dentistry, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Rachana Mehta
- Dr Lal PathLabs Nepal, Kathmandu, Nepal
- Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Babil, Iraq
- Clinical Microbiology, School of Dental Science, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, India
| | | | | | - Camila Luna
- Faculty of Health Sciences, Universidad Científica del Sur, Lima, Peru
| | - Alfonso J. Rodriguez-Morales
- Faculty of Health Sciences, Universidad Científica del Sur, Lima, Peru
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas-Institución Universitaria Visión de las Américas, Pereira, Colombia
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
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Cerpas C, Vásquez G, Moreira H, Juarez JG, Coloma J, Harris E, Bennett SN, Balmaseda Á. Introduction of New Dengue Virus Lineages of Multiple Serotypes after COVID-19 Pandemic, Nicaragua, 2022. Emerg Infect Dis 2024; 30:1203-1213. [PMID: 38782023 PMCID: PMC11138998 DOI: 10.3201/eid3006.231553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Major dengue epidemics throughout Nicaragua's history have been dominated by 1 of 4 dengue virus serotypes (DENV-1-4). To examine serotypes during the dengue epidemic in Nicaragua in 2022, we performed real-time genomic surveillance in-country and documented cocirculation of all 4 serotypes. We observed a shift toward co-dominance of DENV-1 and DENV-4 over previously dominant DENV-2. By analyzing 135 new full-length DENV sequences, we found that introductions underlay the resurgence: DENV-1 clustered with viruses from Ecuador in 2014 rather than those previously seen in Nicaragua; DENV-3, which last circulated locally in 2014, grouped instead with Southeast Asia strains expanding into Florida and Cuba in 2022; and new DENV-4 strains clustered within a South America lineage spreading to Florida in 2022. In contrast, DENV-2 persisted from the formerly dominant Nicaragua clade. We posit that the resurgence emerged from travel after the COVID-19 pandemic and that the resultant intensifying hyperendemicity could affect future dengue immunity and severity.
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Affiliation(s)
- Cristhiam Cerpas
- Sustainable Sciences Institute, Managua, Nicaragua (C. Cerpas, G. Vásquez, H. Moreira, J.G. Juarez, Á. Balmaseda)
- Laboratorio Nacional de Virologia, Centro Nacional de Diagnóstico y Referencia Ministerio de Salud, Managua (C. Cerpas, Á. Balmaseda)
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California Berkeley, Berkeley, California, USA (J. Coloma, E. Harris)
- California Academy of Sciences, San Francisco, California, USA (S.N. Bennett)
| | - Gerald Vásquez
- Sustainable Sciences Institute, Managua, Nicaragua (C. Cerpas, G. Vásquez, H. Moreira, J.G. Juarez, Á. Balmaseda)
- Laboratorio Nacional de Virologia, Centro Nacional de Diagnóstico y Referencia Ministerio de Salud, Managua (C. Cerpas, Á. Balmaseda)
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California Berkeley, Berkeley, California, USA (J. Coloma, E. Harris)
- California Academy of Sciences, San Francisco, California, USA (S.N. Bennett)
| | - Hanny Moreira
- Sustainable Sciences Institute, Managua, Nicaragua (C. Cerpas, G. Vásquez, H. Moreira, J.G. Juarez, Á. Balmaseda)
- Laboratorio Nacional de Virologia, Centro Nacional de Diagnóstico y Referencia Ministerio de Salud, Managua (C. Cerpas, Á. Balmaseda)
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California Berkeley, Berkeley, California, USA (J. Coloma, E. Harris)
- California Academy of Sciences, San Francisco, California, USA (S.N. Bennett)
| | - Jose G. Juarez
- Sustainable Sciences Institute, Managua, Nicaragua (C. Cerpas, G. Vásquez, H. Moreira, J.G. Juarez, Á. Balmaseda)
- Laboratorio Nacional de Virologia, Centro Nacional de Diagnóstico y Referencia Ministerio de Salud, Managua (C. Cerpas, Á. Balmaseda)
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California Berkeley, Berkeley, California, USA (J. Coloma, E. Harris)
- California Academy of Sciences, San Francisco, California, USA (S.N. Bennett)
| | - Josefina Coloma
- Sustainable Sciences Institute, Managua, Nicaragua (C. Cerpas, G. Vásquez, H. Moreira, J.G. Juarez, Á. Balmaseda)
- Laboratorio Nacional de Virologia, Centro Nacional de Diagnóstico y Referencia Ministerio de Salud, Managua (C. Cerpas, Á. Balmaseda)
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California Berkeley, Berkeley, California, USA (J. Coloma, E. Harris)
- California Academy of Sciences, San Francisco, California, USA (S.N. Bennett)
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Katzelnick LC, Quentin E, Colston S, Ha TA, Andrade P, Eisenberg JNS, Ponce P, Coloma J, Cevallos V. Increasing transmission of dengue virus across ecologically diverse regions of Ecuador and associated risk factors. PLoS Negl Trop Dis 2024; 18:e0011408. [PMID: 38295108 PMCID: PMC10861087 DOI: 10.1371/journal.pntd.0011408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 02/12/2024] [Accepted: 01/15/2024] [Indexed: 02/02/2024] Open
Abstract
The distribution and intensity of viral diseases transmitted by Aedes aegypti mosquitoes, including dengue, have rapidly increased over the last century. Here, we study dengue virus (DENV) transmission across the ecologically and demographically distinct regions or Ecuador. We analyzed province-level age-stratified dengue incidence data from 2000-2019 using catalytic models to estimate the force of infection of DENV over eight decades. We found that provinces established endemic DENV transmission at different time periods. Coastal provinces with the largest and most connected cities had the earliest and highest increase in DENV transmission, starting around 1980 and continuing to the present. In contrast, remote and rural areas with reduced access, like the northern coast and the Amazon regions, experienced a rise in DENV transmission and endemicity only in the last 10 to 20 years. The newly introduced chikungunya and Zika viruses have age-specific distributions of hospital-seeking cases consistent with recent emergence across all provinces. To evaluate factors associated with geographic differences in DENV transmission potential, we modeled DENV vector risk using 11,693 Aedes aegypti presence points to the resolution of 1 hectare. In total, 56% of the population of Ecuador, including in provinces identified as having increasing DENV transmission in our models, live in areas with high risk of Aedes aegypti, with population size, trash collection, elevation, and access to water as important determinants. Our investigation serves as a case study of the changes driving the expansion of DENV and other arboviruses globally and suggest that control efforts should be expanded to semi-urban and rural areas and to historically isolated regions to counteract increasing dengue outbreaks.
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Affiliation(s)
- Leah C. Katzelnick
- Viral Epidemiology and Immunity Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Emmanuelle Quentin
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Savannah Colston
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Thien-An Ha
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Paulina Andrade
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Joseph N. S. Eisenberg
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Patricio Ponce
- Centro de Investigación en Enfermedades Infeciosas y Vectoriales (CIREV), Instituto Nacional de Investigación en Salud Pública (INSPI), Quito, Ecuador
| | - Josefina Coloma
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Varsovia Cevallos
- Centro de Investigación en Enfermedades Infeciosas y Vectoriales (CIREV), Instituto Nacional de Investigación en Salud Pública (INSPI), Quito, Ecuador
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Hargrave AS, Sippy R, Cueva C, Polhemus M, Beltran E, Abbott MA, Stewart-Ibarra AM. Allergies, body mass, and hospitalization due to arbovirus infection: A prospective surveillance study in Machala, Ecuador. Epidemiol Infect 2023; 151:e181. [PMID: 37823310 PMCID: PMC10644055 DOI: 10.1017/s0950268823001656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 09/04/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023] Open
Abstract
Dengue, chikungunya, and Zika are arboviruses that cause 390 million infections annually. Risk factors for hospitalization are poorly understood. Communities affected by these diseases have an escalating prevalence of allergies and obesity, which are linked to immune dysfunction. We assessed the association of allergies or body mass with hospitalization for an arbovirus infection. From 2014 to 2017, we recruited participants with a clinical diagnosis of arbovirus infection. Arbovirus infections were laboratory-confirmed and allergies were self-reported. Mid-upper arm circumference (MUAC), weight, and height were measured. We used two logistic regression models to assess the relationships between hospitalization and allergies and between hospitalization and body mass (MUAC for participants <20 years old and body mass index (BMI) for adults ≥20 years old). Models were stratified by age group and adjusted for confounders. For allergies, 41 of 265 were hospitalized. There was no association between allergies and hospitalization. For body mass, 34 of 251 were hospitalized. There was a 43% decrease in hospitalization odds for each additional centimetre MUAC among children (aOR 0.566, 95% CI 0.252-1.019) and a 12% decrease in hospitalization odds for each additional BMI unit among adults (aOR 0.877, 95% CI 0.752-0.998). Our work encourages the exploration of the underlying mechanisms.
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Affiliation(s)
- Anita S. Hargrave
- Department of Internal Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Internal Medicine, San Francisco VA Health Care System, San Francisco, California, United States
| | - Rachel Sippy
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York, USA
- Department of Geography, University of Florida, Gainesville, Florida, United States
- Current affiliation: Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Cinthya Cueva
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Mark Polhemus
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Efrain Beltran
- Faculdad de Medicina, Universidad Técnica de Machala, El Oro, Ecuador
| | - Mark A. Abbott
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Anna M. Stewart-Ibarra
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, United States
- Inter-American Institute for Global Change Research, Montevideo, Uruguay
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De Santis O, Bouscaren N, Flahault A. Asymptomatic dengue infection rate: A systematic literature review. Heliyon 2023; 9:e20069. [PMID: 37809992 PMCID: PMC10559824 DOI: 10.1016/j.heliyon.2023.e20069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
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.
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Affiliation(s)
- Olga De Santis
- Institute of Global Health, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland
- Direction de la recherche, de l'innovation et de la coopération internationale, CHU de La Réunion, 97410, Saint-Pierre, France
| | - Nicolas Bouscaren
- Service de Santé Publique et Soutien à la Recherche, Inserm CIC1410, CHU de La Réunion, 97410 Saint-Pierre, France
| | - Antoine Flahault
- Institute of Global Health, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland
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Jones AM, Saretsky TL, Panter C, Wells JR, White F, Smith V, Kendal H, Russell K, Ruggieri M, Calhoun SR, Gater A, O'Hagan J, Anderson KB, Paz-Soldan VA, Morrison AC, Ware L, Klick M, Thomas S, Marks MA. Measuring dengue illness intensity: Development and content validity of the dengue virus daily diary (DENV-DD). J Patient Rep Outcomes 2023; 7:84. [PMID: 37610665 PMCID: PMC10447358 DOI: 10.1186/s41687-023-00624-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/01/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Dengue is the most prevalent arboviral infection causing an estimated 50-60 million cases of febrile illness globally per year, exacting considerable disease burden. Few instruments exist to assess the patient illness experience, with most based on healthcare provider assessment, lacking standardization in timepoints and symptom assessment. This study aimed to evaluate the content validity of the novel 'Dengue Virus Daily Diary (DENV-DD)', designed to measure symptom intensity and disease burden within outpatient infant to adult populations. METHODS The Dengue Illness Index Report Card was used as a foundation to create the DENV-DD, consisting of patient- and observer-reported outcome (PRO/ObsRO) instruments. In two South American dengue-endemic communities, qualitative combined concept elicitation and cognitive debriefing interviews were conducted among individuals and caregivers of children with symptomatic laboratory-confirmed dengue. Interviews were conducted across two rounds allowing DENV-DD modifications. A small-scale quantitative assessment of the DENV-DD was also conducted with data from an independent Dengue Human Infection Model (DHIM) to generate early evidence of feasibility of DENV-DD completion, instrument performance and insight into the sign/symptom trajectory over the course of illness. RESULTS Forty-eight participants were interviewed (20 adults, 20 older children/adolescents with their caregivers, 8 caregivers of younger children). A wide spectrum of signs/symptoms lasting 3-15 days were reported with fever, headache, body ache/pain, loss of appetite, and body weakness each reported by > 70% participants. DENV-DD instructions, items and response scales were understood, and items were considered relevant across ages. DHIM data supported feasibility of DENV-DD completion. CONCLUSIONS Findings demonstrate content validity of the DENV-DD (PRO/ObsRO instruments) in dengue-endemic populations. Psychometric and cultural validity studies are ongoing to support use of the DENV-DD in clinical studies.
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Affiliation(s)
- Amy M Jones
- Adelphi Values Ltd., Patient Centered Outcomes, Cheshire, UK.
| | | | | | | | - Frances White
- Adelphi Values Ltd., Patient Centered Outcomes, Cheshire, UK
| | - Verity Smith
- Adelphi Values Ltd., Patient Centered Outcomes, Cheshire, UK
| | - Helen Kendal
- Adelphi Values Ltd., Patient Centered Outcomes, Cheshire, UK
| | | | | | | | - Adam Gater
- Adelphi Values Ltd., Patient Centered Outcomes, Cheshire, UK
| | | | - Kathryn B Anderson
- Institute for Global Health and Translational Sciences, State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Valerie A Paz-Soldan
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Amy C Morrison
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Lisa Ware
- Institute for Global Health and Translational Sciences, State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Michelle Klick
- Institute for Global Health and Translational Sciences, State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Stephen Thomas
- Institute for Global Health and Translational Sciences, State University of New York, Upstate Medical University, Syracuse, NY, USA
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11
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Searles M, Jose Ronquillo Mora Y, Carlo L, Heydari N, Takyiwaa Y, Borbor-Cordova MJ, Campagna CD. Zika virus knowledge and vaccine acceptance among undergraduate students in Guayaquil, Ecuador. Vaccine X 2023; 13:100258. [PMID: 36686399 PMCID: PMC9850025 DOI: 10.1016/j.jvacx.2022.100258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 11/17/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose Zika virus (ZIKV) was declared a Public Health Emergency of International Concern (PHEIC) in 2016. Concerns surrounding the effects of ZIKV persist today and several vaccine candidates are currently in various stages of development worldwide. There is limited research on ZIKV vaccine acceptability worldwide, and little research specific to Latin American countries. This research aims to identify the general beliefs and acceptance of a potential ZIKV vaccine in the undergraduate population at Escuela Superior Politécnica del Litoral (ESPOL) in Guayaquil, Ecuador. Methods Between January and November 2019, 429 undergraduate students at ESPOL responded anonymously to a ZIKV vaccine survey. Frequencies, percentages, simple correspondence analysis, and bivariate inferential analyses were conducted using Kendall's tau-b test. Tests explored associations between likelihood of receiving a ZIKV vaccine and demographic, ZIKV information seeking, ZIKV psychosocial variables, and ZIKV information source variables. Results Among the eligible participants, 241 (56.2%) were willing to receive a ZIKV vaccine if one was made commercially available. Most students were male (61.5%), age 20-25 (63.3%), and of mixed (Mestizo) race (95.3%). Results provided insight into student's knowledge on ZIKV, revealed television as the most common information source, and found most students were willing to receive a ZIKV vaccine were one to become available. Bivariate results revealed most respondents reported feeling neutral or likely to receive a ZIKV vaccine regardless of their agreeability with ZIKV information seeking behavior and psychosocial variables. Conclusions This study provides insight into ZIKV knowledge among ESPOL university students and reveals most respondents obtained ZIKV related information from television. The most common reason for not wanting to receive a hypothetical ZIKV vaccine was vaccine hesitancy. Likelihood of receiving a ZIKV vaccine was associated with several information seeking behavior and psychosocial variables. Public health campaigns should focus on comprehensive ZIKV education efforts in this population.
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Affiliation(s)
- Madison Searles
- Institute for Global Health and Translational Science, State University of New York Upstate Medical University, 505 Irving Avenue Suite 4200, Syracuse, NY, 13210, USA
| | - Ysai Jose Ronquillo Mora
- Facultad de Ingeniería Marítima y Ciencias del Mar, Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Lorena Carlo
- Department of Health Informatics, School of Health Professions, Rutgers University, Piscataway, NJ, 08854, USA
- Facultad de Ingeniería Electricidad y Computación, Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Naveed Heydari
- Institute for Global Health and Translational Science, State University of New York Upstate Medical University, 505 Irving Avenue Suite 4200, Syracuse, NY, 13210, USA
| | - Yaa Takyiwaa
- Institute for Global Health and Translational Science, State University of New York Upstate Medical University, 505 Irving Avenue Suite 4200, Syracuse, NY, 13210, USA
- College of Medicine, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Mercy J Borbor-Cordova
- Facultad de Ingeniería Marítima y Ciencias del Mar, Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
- Pacific International Center for Disaster Risk Reduction (-RRD), ESPOL, Campus Gustavo Galindo Km. 30.5 Vía Perimetral, Guayaquil, Ecuador
| | - Christina D Campagna
- Institute for Global Health and Translational Science, State University of New York Upstate Medical University, 505 Irving Avenue Suite 4200, Syracuse, NY, 13210, USA
- Department of Public Health and Preventive Medicine, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA
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12
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Santos LL, de Aquino EC, Fernandes SM, Ternes YMF, Feres VCDR. Dengue, chikungunya, and Zika virus infections in Latin America and the Caribbean: a systematic review. Rev Panam Salud Publica 2023; 47:e34. [PMID: 36788963 PMCID: PMC9910557 DOI: 10.26633/rpsp.2023.34] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/03/2022] [Indexed: 02/11/2023] Open
Abstract
Objectives To characterize the distribution profile of dengue, chikungunya, and Zika virus infections in Latin America and the Caribbean and to identify possible factors associated with the risk of dissemination and severity of these arboviruses. Methods The protocol of this review was registered on the PROSPERO platform. Searches were carried out in the following databases: Virtual Health Library, MEDLINE/PubMed, and Embase. The search terms were: Zika virus, Zika virus infection, dengue, dengue virus, chikungunya virus, chikungunya fever, epidemiology, observational study, Latin America, and Caribbean region. Studies that addressed the distribution of these arboviruses and the risk factors associated with dengue, Zika virus disease, and chikungunya, published between January 2000 and August 2020 in English, Portuguese, and Spanish, were included. Results Of 95 studies included, 70 identified risk factors, clinical manifestations, and outcomes for arbovirus infections and 25 described complications and/or deaths. The highest frequency of confirmed cases was for dengue. Brazil reported most cases of the three arboviruses in the period analyzed. Environmental and socioeconomic factors facilitated the proliferation and adaptation of vectors, and host-related factors were reported to aggravate dengue. Most deaths were due to chikungunya, Zika virus disease caused most neurological alterations, and dengue resulted in greater morbidity leading to more frequent hospitalization. Conclusions The review provides a broad view of the three arboviruses and the intrinsic aspects of infections, and highlights the factors that influence the spread of these viruses in the populations studied.
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Affiliation(s)
- Letícia L.M. Santos
- Molecular Biology Laboratory and Technologies Applied to Laboratory DiagnosisFaculty of PharmacyFederal University of GoiasGoiâniaBrazilMolecular Biology Laboratory and Technologies Applied to Laboratory Diagnosis, Faculty of Pharmacy, Federal University of Goias, Goiânia, Brazil.
| | - Erika Carvalho de Aquino
- Public Health DepartmentInstitute of Tropical Pathology and Public HealthFederal University of GoiasGoiâniaBrazilPublic Health Department, Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, Brazil.
| | - Suleimy Marinho Fernandes
- Laboratory of Virology and Cell CultureInstitute of Tropical Pathology and Public HealthFederal University of GoiasGoiâniaBrazilLaboratory of Virology and Cell Culture, Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, Brazil.
| | - Yves Mauro F. Ternes
- Public Health DepartmentInstitute of Tropical Pathology and Public HealthFederal University of GoiasGoiâniaBrazilPublic Health Department, Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, Brazil.
| | - Valéria C. de R. Feres
- Molecular Biology Laboratory and Technologies Applied to Laboratory DiagnosisFaculty of PharmacyFederal University of GoiasGoiâniaBrazilMolecular Biology Laboratory and Technologies Applied to Laboratory Diagnosis, Faculty of Pharmacy, Federal University of Goias, Goiânia, Brazil.
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13
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Martin JL, Lippi CA, Stewart-Ibarra AM, Ayala EB, Mordecai EA, Sippy R, Heras FH, Blackburn JK, Ryan SJ. Household and climate factors influence Aedes aegypti presence in the arid city of Huaquillas, Ecuador. PLoS Negl Trop Dis 2021; 15:e0009931. [PMID: 34784348 PMCID: PMC8651121 DOI: 10.1371/journal.pntd.0009931] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 12/07/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022] Open
Abstract
Arboviruses transmitted by Aedes aegypti (e.g., dengue, chikungunya, Zika) are of major public health concern on the arid coastal border of Ecuador and Peru. This high transit border is a critical disease surveillance site due to human movement-associated risk of transmission. Local level studies are thus integral to capturing the dynamics and distribution of vector populations and social-ecological drivers of risk, to inform targeted public health interventions. Our study examines factors associated with household-level Ae. aegypti presence in Huaquillas, Ecuador, while accounting for spatial and temporal effects. From January to May of 2017, adult mosquitoes were collected from a cohort of households (n = 63) in clusters (n = 10), across the city of Huaquillas, using aspirator backpacks. Household surveys describing housing conditions, demographics, economics, travel, disease prevention, and city services were conducted by local enumerators. This study was conducted during the normal arbovirus transmission season (January—May), but during an exceptionally dry year. Household level Ae. aegypti presence peaked in February, and counts were highest in weeks with high temperatures and a week after increased rainfall. Univariate analyses with proportional odds logistic regression were used to explore household social-ecological variables and female Ae. aegypti presence. We found that homes were more likely to have Ae. aegypti when households had interruptions in piped water service. Ae. aegypti presence was less likely in households with septic systems. Based on our findings, infrastructure access and seasonal climate are important considerations for vector control in this city, and even in dry years, the arid environment of Huaquillas supports Ae. aegypti breeding habitat. Mosquito transmitted infectious diseases are a growing concern around the world. The yellow fever mosquito (Aedes aegypti) has been responsible for recent major outbreaks of disease, including dengue fever and Zika. This mosquito prefers to bite humans and lay its eggs in artificial containers such as water tanks and planters. This makes Ae. aegypti well suited to become established in growing urban areas. Controlling these mosquitoes has been an important way to reduce the risk of disease transmission. Studies that are undertaken to understand local factors that contribute to the continued survival of the mosquito can be used to inform control practices. We conducted a study in the largest Ecuadorian city on the border of Peru where we collected adult mosquitoes from houses and surveyed household members about their behaviors, perceptions, and housing infrastructure associated with the mosquito vector. Mosquitoes were most numerous in weeks with high temperatures and a week after increased rainfall. We found that houses that had unreliable water service were more likely have mosquitoes present, while houses that used septic systems were less likely to have mosquitoes present.
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Affiliation(s)
- James L. Martin
- Quantitative Disease Ecology and Conservation (QDEC) Lab, Department of Geography, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Catherine A. Lippi
- Quantitative Disease Ecology and Conservation (QDEC) Lab, Department of Geography, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Anna M. Stewart-Ibarra
- Institute for Global Health & Translational Science, SUNY Upstate Medical University
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, United States of America
- InterAmerican Institute for Global Change Research (IAI), Montevideo, Uruguay
| | | | - Erin A. Mordecai
- Biology Department, Stanford University, Stanford, California, United States of America
| | - Rachel Sippy
- Quantitative Disease Ecology and Conservation (QDEC) Lab, Department of Geography, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
- Institute for Global Health & Translational Science, SUNY Upstate Medical University
| | - Froilán Heras Heras
- Institute for Global Health & Translational Science, SUNY Upstate Medical University
| | - Jason K. Blackburn
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
- Spatial Epidemiology and Ecology Research Laboratory, Department of Geography, University of Florida, Gainesville, Florida, United States of America
| | - Sadie J. Ryan
- Quantitative Disease Ecology and Conservation (QDEC) Lab, Department of Geography, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
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14
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Carrillo-Hernandez MY, Ruiz-Saenz J, Jaimes-Villamizar L, Robledo-Restrepo SM, Martinez-Gutierrez M. Phylogenetic and evolutionary analysis of dengue virus serotypes circulating at the Colombian-Venezuelan border during 2015-2016 and 2018-2019. PLoS One 2021; 16:e0252379. [PMID: 34048474 PMCID: PMC8162668 DOI: 10.1371/journal.pone.0252379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Dengue is an endemic disease in Colombia. Norte de Santander is a region on the border of Colombia and Venezuela and has reported the co-circulation and simultaneous co-infection of different serotypes of the dengue virus (DENV). This study aimed to conduct a phylogenetic analysis on the origin and genetic diversity of DENV strains circulating in this bordering region. Serum samples were collected from patients who were clinically diagnosed with febrile syndrome associated with dengue during two periods. These samples were tested for DENV and serotyping was performed using reverse transcriptase-polymerase chain reaction. Subsequently, positive samples were amplified and the envelope protein gene of DENV was sequenced. Phylogenetic and phylogeographic analyses were performed using the sequences obtained. Basic local alignment search tool analysis confirmed that six and eight sequences belonged to DENV-1 and DENV-2, respectively. The phylogenetic analysis of DENV-1 showed that the sequences belonged to genotype V and clade I; they formed two groups: in the first group, two sequences showed a close phylogenetic relationship with strains from Ecuador and Panama, whereas the other four sequences were grouped with strains from Venezuela and Colombia. In the case of DENV-2, the analysis revealed that the sequences belonged to the Asian–American genotype and clade III. Furthermore, they formed two groups; in the first group, three sequences were grouped with strains from Colombia and Venezuela, whereas the other five were grouped with strains from Venezuela, Colombia and Honduras. This phylogenetic analysis suggests that the geographical proximity between Colombia and Venezuela is favourable for the export and import of different strains among serotypes or clades of the same DENV serotype, which could favour the spread of new outbreaks caused by new strains or genetic variants of this arbovirus. Therefore, this information highlights the importance of monitoring the transmission of DENV at border regions.
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Affiliation(s)
- Marlen Yelitza Carrillo-Hernandez
- Grupo de Investigación en Ciencias Animales-GRICA, Universidad Cooperativa de Colombia, Bucaramanga, Colombia
- Programa de Estudio y Control de Enfermedades Tropicales-PECET, Universidad de Antioquia, Medellín, Colombia
| | - Julian Ruiz-Saenz
- Grupo de Investigación en Ciencias Animales-GRICA, Universidad Cooperativa de Colombia, Bucaramanga, Colombia
| | | | - Sara Maria Robledo-Restrepo
- Programa de Estudio y Control de Enfermedades Tropicales-PECET, Universidad de Antioquia, Medellín, Colombia
| | - Marlen Martinez-Gutierrez
- Grupo de Investigación en Ciencias Animales-GRICA, Universidad Cooperativa de Colombia, Bucaramanga, Colombia
- * E-mail:
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15
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Warnes CM, Santacruz-Sanmartín E, Bustos Carrillo F, Vélez ID. Surveillance and Epidemiology of Dengue in Medellín, Colombia from 2009 to 2017. Am J Trop Med Hyg 2021; 104:1719-1728. [PMID: 33755586 PMCID: PMC8103481 DOI: 10.4269/ajtmh.19-0728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/22/2021] [Indexed: 11/07/2022] Open
Abstract
Dengue is the most prevalent arthropod-borne viral disease in humans, primarily transmitted by the Aedes aegypti mosquito. We conducted a descriptive analysis of dengue cases from 2009 to 2017 in Medellín, Colombia, using data available from the Secretariat of Health. We analyzed the burden of outbreak years on the healthcare system, risk of cases exhibiting severe illness, potential disease surveillance problems, gender and age as risk factors, and spatiotemporal patterns of disease occurrence. Our data consisted of 50,083 cases, separated based on whether they were diagnostic test negative, diagnostic test positive (primarily IgM ELISA), clinically confirmed, epidemiologically linked, or probable. We used dengue incidence to analyze epidemiological trends between our study years, related to human movement patterns, between gender and age-groups, and spatiotemporally. We used risk to analyze the severity of dengue cases between the study years. We identified human movement could contributed to dengue spread, and male individuals (incidence rate: 0.86; 95% CI: 0.76-0.96) and individuals younger than 15 years (incidence rate: 1.24; 95% CI: 1.13-1.34) have higher incidence of dengue and located critical parts of the city where dengue incidence was high. Analysis was limited by participant diagnostic information, data concerning circulating strains, and a lack of phylogenetic information. Understanding the characteristics of dengue is a fundamental part of improving the health outcomes of at-risk populations. This analysis will be useful to support studies and initiatives to counteract dengue and provide context to the surveillance data collected by the health authorities in Medellín.
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Affiliation(s)
- Colin M. Warnes
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellín, Colombia
| | - Eduardo Santacruz-Sanmartín
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellín, Colombia
| | | | - Iván Darío Vélez
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellín, Colombia
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16
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Lippi CA, Stewart-Ibarra AM, Endy TP, Abbott M, Cueva C, Heras F, Polhemus M, Beltrán-Ayala E, Ryan SJ. Exploring the utility of social-ecological and entomological risk factors for dengue infection as surveillance indicators in the dengue hyper-endemic city of Machala, Ecuador. PLoS Negl Trop Dis 2021; 15:e0009257. [PMID: 33740003 PMCID: PMC8011822 DOI: 10.1371/journal.pntd.0009257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/31/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022] Open
Abstract
The management of mosquito-borne diseases is a challenge in southern coastal Ecuador, where dengue is hyper-endemic and co-circulates with other arboviral diseases. Prior work in the region has explored social-ecological factors, dengue case data, and entomological indices. In this study, we bring together entomological and epidemiological data to describe links between social-ecological factors associated with risk of dengue transmission at the household level in Machala, Ecuador. Households surveys were conducted from 2014-2017 to assess the presence of adult Aedes aegypti (collected via aspiration) and to enumerate housing conditions, demographics, and mosquito prevention behaviors. Household-level dengue infection status was determined by laboratory diagnostics in 2014-2015. Bivariate analyses and multivariate logistic regression models were used to identify social-ecological variables associated with household presence of female Ae. aegypti and household dengue infection status, respectively. Aedes aegypti presence was associated with interruptions in water service and weekly trash collection, and household air conditioning was protective against mosquito presence. Presence of female Ae. aegypti was not associated with household dengue infections. We identified shaded patios and head of household employment status as risk factors for household-level dengue infection, while window screening in good condition was identified as protective against dengue infection. These findings add to our understanding of the systems of mosquito-borne disease transmission in Machala, and in the larger region of southern Ecuador, aiding in the development of improved vector surveillance efforts, and targeted interventions.
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Affiliation(s)
- Catherine A. Lippi
- Quantitative Disease Ecology and Conservation (QDEC) Lab Group, Department of Geography, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Anna M. Stewart-Ibarra
- Inter-American Institute for Global Change Research, Department of Montevideo, Montevideo, Uruguay
- Institute for Global Health and Translational Studies, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, United States of America
- Department of Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, United States of America
| | - Timothy P. Endy
- Institute for Global Health and Translational Studies, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, United States of America
- Department of Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, United States of America
- Department of Microbiology and Immunology, State University of New York (SUNY) Upstate Medical University, Syracuse, New York
| | - Mark Abbott
- Institute for Global Health and Translational Studies, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, United States of America
- Department of Microbiology and Immunology, State University of New York (SUNY) Upstate Medical University, Syracuse, New York
| | - Cinthya Cueva
- Institute for Global Health and Translational Studies, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, United States of America
| | - Froilán Heras
- Institute for Global Health and Translational Studies, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, United States of America
- Department of Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, United States of America
| | - Mark Polhemus
- Coalition for Epidemic Preparedness Innovations (CEPI), Washington, D.C., United States of America
| | | | - Sadie J. Ryan
- Quantitative Disease Ecology and Conservation (QDEC) Lab Group, Department of Geography, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
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17
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Maljkovic Berry I, Melendrez MC, Bishop-Lilly KA, Rutvisuttinunt W, Pollett S, Talundzic E, Morton L, Jarman RG. Next Generation Sequencing and Bioinformatics Methodologies for Infectious Disease Research and Public Health: Approaches, Applications, and Considerations for Development of Laboratory Capacity. J Infect Dis 2021; 221:S292-S307. [PMID: 31612214 DOI: 10.1093/infdis/jiz286] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Next generation sequencing (NGS) combined with bioinformatics has successfully been used in a vast array of analyses for infectious disease research of public health relevance. For instance, NGS and bioinformatics approaches have been used to identify outbreak origins, track transmissions, investigate epidemic dynamics, determine etiological agents of a disease, and discover novel human pathogens. However, implementation of high-quality NGS and bioinformatics in research and public health laboratories can be challenging. These challenges mainly include the choice of the sequencing platform and the sequencing approach, the choice of bioinformatics methodologies, access to the appropriate computation and information technology infrastructure, and recruiting and retaining personnel with the specialized skills and experience in this field. In this review, we summarize the most common NGS and bioinformatics workflows in the context of infectious disease genomic surveillance and pathogen discovery, and highlight the main challenges and considerations for setting up an NGS and bioinformatics-focused infectious disease research public health laboratory. We describe the most commonly used sequencing platforms and review their strengths and weaknesses. We review sequencing approaches that have been used for various pathogens and study questions, as well as the most common difficulties associated with these approaches that should be considered when implementing in a public health or research setting. In addition, we provide a review of some common bioinformatics tools and procedures used for pathogen discovery and genome assembly, along with the most common challenges and solutions. Finally, we summarize the bioinformatics of advanced viral, bacterial, and parasite pathogen characterization, including types of study questions that can be answered when utilizing NGS and bioinformatics.
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Affiliation(s)
- Irina Maljkovic Berry
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | | | - Kimberly A Bishop-Lilly
- Genomics and Bioinformatics Department, Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Fort Detrick, Maryland
| | - Wiriya Rutvisuttinunt
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Simon Pollett
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland.,Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Eldin Talundzic
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lindsay Morton
- Global Emerging Infections Surveillance, Armed Forces Health Surveillance Branch, Silver Spring, Maryland
| | - Richard G Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
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18
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Le BCT, Ekalaksananan T, Thaewnongiew K, Phanthanawiboon S, Aromseree S, Phanitchat T, Chuerduangphui J, Suwannatrai AT, Alexander N, Overgaard HJ, Bangs MJ, Pientong C. Interepidemic Detection of Chikungunya Virus Infection and Transmission in Northeastern Thailand. Am J Trop Med Hyg 2020; 103:1660-1669. [PMID: 32700661 DOI: 10.4269/ajtmh.20-0293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Chikungunya fever is a viral mosquito-borne, acute febrile illness associated with rash, joint pain, and occasionally prolonged polyarthritis. Chikungunya outbreaks have been reported worldwide including many provinces of Thailand. Although chikungunya virus (CHIKV) occurs in Thailand, details on its epidemiology are lacking compared with dengue, a common mosquito-borne disease in the country. Therefore, study on CHIKV and its epidemiology in both humans and mosquitoes is required to better understand its importance clinically and dynamics in community settings. So a prospective examination of virus circulation in human and mosquito populations in northeastern Thailand using serological and molecular methods, including the genetic characterization of the virus, was undertaken. The study was conducted among febrile patients in eight district hospitals in northeastern Thailand from June 2016 to October 2017. Using real-time PCR on the conserved region of nonstructural protein 1 gene, CHIKV was detected in eight (4.9%) of 161 plasma samples. Only one strain yielded a sequence of sufficient size allowing for phylogenetic analysis. In addition, anti-CHIKV IgM and IgG were detected in six (3.7%) and 17 (10.6%) patient plasma samples. The single sequenced sample belonged to the East/Central/South Africa (ECSA) genotype and was phylogenetically similar to the Indian Ocean sub-lineage. Adult Aedes mosquitoes were collected indoors and within a 100-m radius from the index case house and four neighboring houses. CHIKV was detected in two of 70 (2.9%) female Aedes aegypti mosquito pools. This study clearly demonstrated the presence and local transmission of the ECSA genotype of CHIKV in the northeastern region of Thailand.
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Affiliation(s)
- Bao Chi Thi Le
- Department of Microbiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam.,Department of Microbiology, Khon Kaen University, Khon Kaen, Thailand
| | - Tipaya Ekalaksananan
- HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, Thailand.,Department of Microbiology, Khon Kaen University, Khon Kaen, Thailand
| | - Kesorn Thaewnongiew
- Department of Disease Control, Office of Disease Prevention and Control, Region 7 Khon Kaen Ministry of Public Health, Khon Kaen, Thailand
| | | | - Sirinart Aromseree
- HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, Thailand.,Department of Microbiology, Khon Kaen University, Khon Kaen, Thailand
| | - Thipruethai Phanitchat
- Department of Medical Entomology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | | | - Neal Alexander
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hans J Overgaard
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway
| | - Michael J Bangs
- Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand.,Public Health & Malaria Control, PT Freeport Indonesia/International SOS, Kuala Kencana, Papua, Indonesia
| | - Chamsai Pientong
- Department of Microbiology, Khon Kaen University, Khon Kaen, Thailand.,HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, Thailand
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19
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Chis Ster I, Rodriguez A, Romero NC, Lopez A, Chico M, Montgomery J, Cooper P. Age-dependent seroprevalence of dengue and chikungunya: inference from a cross-sectional analysis in Esmeraldas Province in coastal Ecuador. BMJ Open 2020; 10:e040735. [PMID: 33067302 PMCID: PMC7569951 DOI: 10.1136/bmjopen-2020-040735] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES There are few population-based estimates for prevalence of past exposure to dengue and chikungunya viruses despite common epidemiological features. Here, we have developed a novel statistical method to study patterns of age-dependent prevalence of immunity in a population following exposures to two viruses which share similar epidemiological features including mode of transmission and induction of long-lasting immunity. This statistical technique accounted for sociodemographic characteristics associated with individuals and households. SETTINGS The data consist of a representative sample from an ongoing longitudinal birth cohort set-up in a tropical district in coastal Ecuador (Esmeraldas). PARTICIPANTS We collected data and blood samples from 319 individuals belonging to 152 households following epidemics of the infections in 2015 in Latin America. PRIMARY OUTCOME Plasma was tested for the presence of specific IgG antibodies to dengue and chikungunya viruses by commercial ELISA and defined a bivariate binary outcome indicating individuals' past exposure status to dengue and chikungunya (ie, presence/absence of IgG antibodies to dengue or chikungunya or both). RESULTS Dengue seroprevalence increased rapidly with age reaching 97% (95% credible interval (CrI): 93%-99%) by 60 years. Chikungunya seroprevalence peaked at 42% (95% CrI: 18%-66%) around 9 years of age and averaged 27% (95% CrI: 8.7%-51.6%) for all ages. Rural areas were more likely to be associated with dengue-only exposure while urban areas and shorter distance to the nearest household were associated with exposures to both. Women living in urban settings were more likely to be chikungunya seropositive while rural men were more likely to be dengue seropositive. CONCLUSION Dengue seroprevalence was strongly age dependent consistent with endemic exposure while that of chikungunya peaked in childhood consistent with the recent emergence of the virus in the study area. Our findings will inform control strategies for the two arboviruses in Ecuador including recommendations by the WHO on dengue vaccination.
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Affiliation(s)
- Irina Chis Ster
- Institute of Infection and Immunity, St George's University of London, London, UK
| | | | | | - Andrea Lopez
- International University of Ecuador, Quito, Ecuador
| | - Martha Chico
- International University of Ecuador, Quito, Ecuador
| | | | - Philip Cooper
- Institute of Infection and Immunity, St George's University of London, London, UK
- International University of Ecuador, Quito, Ecuador
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20
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Bandeira AC, Gois LL, Campos GS, Sardi S, Yssel H, Vieillard V, Autran B, Grassi MFR. Clinical and laboratory findings of acute Zika virus infection in patients from Salvador during the first Brazilian epidemic. Braz J Infect Dis 2020; 24:405-411. [PMID: 32941805 PMCID: PMC9392112 DOI: 10.1016/j.bjid.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/05/2020] [Accepted: 08/16/2020] [Indexed: 11/09/2022] Open
Abstract
Several major epidemics of Zika fever, caused by the ZIKA virus (ZIKV), have emerged in Brazil since early 2015, eventually spreading to other countries on the South American continent. The present study describes the clinical manifestations and laboratory findings of patients with confirmed acute ZIKV infection during the first epidemic that occurred in Salvador, Brazil. All included patients were seen at the emergency room of a private tertiary hospital located in Salvador, Brazil from 2015 through 2017. Patients were considered eligible if signs of systemic viral febrile disease were present. All individuals were tested for ZIKV and Chikungunya infection using PCR, while rapid test was used to detect Dengue virus antibodies or, alternatively, the NS1 antigen. A diagnosis of acute ZIKV infection was confirmed in 78/434 (18%) individuals with systemic viral febrile illness. Positivity was mainly observed in blood, followed by saliva and urine. Coinfection with Chikungunya and/or Dengue virus was detected in 5% of the ZIKV-infected patients. The most frequent clinical findings were myalgia, arthralgia and low-grade fever. Laboratory analysis demonstrated normal levels of hematocrit, platelets and liver enzymes. In summary, in acute settings where molecular testing remains unavailable, clinicians face difficulties to confirm the diagnosis of ZIKV infection, as they rely only on clinical examinations and conventional laboratory tests.
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Affiliation(s)
- Antonio Carlos Bandeira
- UniFTC, Faculdade de Medicina, Salvador, BA, Brazil; Fundação Oswaldo Cruz (Fiocruz), Instituto Gonçalo Moniz, Salvador, BA, Brazil.
| | - Luana Leandro Gois
- Fundação Oswaldo Cruz (Fiocruz), Instituto Gonçalo Moniz, Salvador, BA, Brazil; Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
| | - Gubio Soares Campos
- Universidade Federal da Bahia, Instituto de Ciências da Saúde, Salvador, BA, Brazil
| | - Silvia Sardi
- Universidade Federal da Bahia, Instituto de Ciências da Saúde, Salvador, BA, Brazil
| | - Hans Yssel
- Université Pierre Marie-Curie, Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses, Paris, France
| | - Vincent Vieillard
- Université Pierre Marie-Curie, Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses, Paris, France
| | - Brigitte Autran
- Université Pierre Marie-Curie, Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses, Paris, France
| | - Maria Fernanda Rios Grassi
- Fundação Oswaldo Cruz (Fiocruz), Instituto Gonçalo Moniz, Salvador, BA, Brazil; Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
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21
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Finkelstein JL, Colt S, Layden AJ, Krisher JT, Stewart-Ibarra AM, Polhemus M, Beltrán-Ayala E, Tedesco JM, Cárdenas WB, Endy T, Mehta S. Micronutrients, Immunological Parameters, and Dengue Virus Infection in Coastal Ecuador: A Nested Case-Control Study in an Infectious Disease Surveillance Program. J Infect Dis 2020; 221:91-101. [PMID: 31428794 DOI: 10.1093/infdis/jiz427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Micronutrients are known to modulate host immunity, and there is limited literature on this association in the context of dengue virus infection (DENV). METHODS Using a nested case-control design in a surveillance program, we measured the following: anthropometry; nutritional biomarkers including serum ferritin, soluble transferrin receptor, retinol-binding protein (RBP), 25-hydroxy vitamin D, folate, and vitamin B12; and a panel of immune response markers. We then compared these measures across 4 illness categories: healthy control, nonfebrile DENV, other febrile illness (OFI), and apparent DENV using multivariate polytomous logistic regression models. RESULTS Among 142 participants, serum ferritin (ng/mL) was associated with apparent DENV compared to healthy controls (odds ratio [OR], 2.66; confidence interval [CI], 1.53-4.62; P = .001), and RBP concentrations (µmol/L) were associated with apparent DENV (OR, 0.03; CI, 0.00-0.30; P = .003) and OFI (OR, 0.02; CI, 0.00-0.24; P = .003). In a subset of 71 participants, interleukin-15 levels (median fluorescent intensity) were positively associated with apparent DENV (OR, 1.09; CI, 1.03-1.14; P = .001) and negatively associated with nonfebrile DENV (OR, 0.89; CI, 0.80-0.99; P = .03) compared to healthy controls. CONCLUSIONS After adjusting for the acute-phase response, serum ferritin and RBP concentrations were associated with apparent DENV and may represent biomarkers of clinical importance in the context of dengue illness.
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Affiliation(s)
| | - Susannah Colt
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Alexander J Layden
- Division of Nutritional Sciences, Cornell University, Ithaca, New York.,University of Pittsburgh School of Medicine, Pennyslvania
| | - Jesse T Krisher
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Anna M Stewart-Ibarra
- Department of Medicine and Center for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
| | - Mark Polhemus
- Department of Medicine and Center for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
| | - Efraín Beltrán-Ayala
- Ministry of Health, Machala, El Oro, Ecuador.,Department of Medicine, Technical University of Machala, El Oro, Ecuador
| | - Julia M Tedesco
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Washington B Cárdenas
- Escuela Superior Politécnica del Litoral, Laboratorio para Investigaciones Biomédicas, Guayaquil, Ecuador
| | - Timothy Endy
- Department of Medicine and Center for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
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22
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Vitale M, Lupone CD, Kenneson-Adams A, Ochoa RJ, Ordoñez T, Beltran-Ayala E, Endy TP, Rosenbaum PF, Stewart-Ibarra AM. A comparison of passive surveillance and active cluster-based surveillance for dengue fever in southern coastal Ecuador. BMC Public Health 2020; 20:1065. [PMID: 32631315 PMCID: PMC7336448 DOI: 10.1186/s12889-020-09168-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Dengue is a major emerging infectious disease, endemic throughout the tropics and subtropics, with approximately 2.5 billion people at risk globally. Active (AS) and passive surveillance (PS), when combined, can improve our understanding of dengue's complex disease dynamics to guide effective, targeted public health interventions. The objective of this study was to compare findings from the Ministry of Health (MoH) PS to a prospective AS arbovirus research study in Machala, Ecuador in 2014 and 2015. METHODS Dengue cases in the PS system were compared to laboratory confirmed acute dengue illness cases that entered the AS study during the study period. Variables of interest included age class and sex. Outbreak detection curves by epidemiologic week, overall cumulative incidence and age-specific incidence proportions were calculated. Descriptive statistics were tabulated for all variables of interest. Chi-square tests were performed to compare demographic characteristics between the AS and PS data sets in 2014 and 2015. RESULTS 177 and 245 cases were identified from 1/1/2014 to 12/31/2015 by PS and AS, respectively; nine cases appeared in both systems. AS identified a greater number of laboratory-confirmed cases in 2014, accounting for more than 60% of dengue cases in the study area. In 2015, the opposite trend was observed with PS identifying 60% of the dengue cases in the study area. Peak transmission time in laboratory confirmed dengue illness, as noted by AS and PS was similar in 2014, whereas earlier detection (7 weeks) was observed by AS in 2015. Younger patients were more frequently identified by PS, while older patients were identified more frequently by AS. The cumulative incidence proportion for laboratory confirmed dengue illness reported via PS to the MoH was 4.12 cases per 10,000 residents in 2014, and 2.21 cases per 10,000 residents in 2015. CONCLUSIONS Each surveillance system captured distinct demographic subgroups within the Machala population, possibly due to differences in healthcare seeking behaviors, access to care, emerging threats of other viruses transmitted by the same mosquito vector and/or differences in clinical presentation. Integrating AS with pre-existing PS can aid in identifying additional cases in previously underdiagnosed subpopulations, improving our understanding of disease dynamics, and facilitating the implementation of timely public health interventions.
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Affiliation(s)
- Melissa Vitale
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, 505 Irving Avenue Suite 4200, Syracuse, NY, USA
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, USA
- College of Medicine, MD Program, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, USA
| | - Christina D Lupone
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, 505 Irving Avenue Suite 4200, Syracuse, NY, USA.
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, USA.
| | - Aileen Kenneson-Adams
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, 505 Irving Avenue Suite 4200, Syracuse, NY, USA
| | | | | | - Efráin Beltran-Ayala
- Ministry of Health, Machala, El Oro, Ecuador
- Department of Medicine, Universidad Técnica de Machala, Machala, El Oro, Ecuador
| | - Timothy P Endy
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, 505 Irving Avenue Suite 4200, Syracuse, NY, USA
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, USA
- Department of Microbiology and Immunology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, USA
| | - Paula F Rosenbaum
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, 505 Irving Avenue Suite 4200, Syracuse, NY, USA
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, USA
| | - Anna M Stewart-Ibarra
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, 505 Irving Avenue Suite 4200, Syracuse, NY, USA
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, USA
- Department of Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, USA
- Department of Montevideo, Inter-American Institute for Global Change Research, Montevideo, Uruguay
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23
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Da Conceição Araújo D, Dos Santos AD, Lima SVMA, Vaez AC, Cunha JO, Conceição Gomes Machado de Araújo K. Determining the association between dengue and social inequality factors in north-eastern Brazil: A spatial modelling. GEOSPATIAL HEALTH 2020; 15. [PMID: 32575962 DOI: 10.4081/gh.2020.854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
Dengue is a global public health problem. The Dengue Virus (DENV) serotypes are transmitted by an Aedes aegypti mosquito. Vector control is among the primary methods to prevent the disease, especially in tropical countries. This study aimed to analyze the spatial distribution of dengue and its relationship with social inequalities using spatial modelling. An ecological study with temporal and spatial analysis was conducted in the state of Sergipe, Northeast Brazil, over a period of 18 years. Spatial modelling was used to determine the influence of space on dengue incidence and social inequalities. The epidemic rates in 2008, 2012, and 2015 were identified. Spatial modelling explained 40% of the influence of social inequalities on dengue incidence in the state. The main social inequalities related to the occurrence of dengue were the percentage of people living in extreme poverty and inadequate sanitation. The epidemic situation even increased the risk of dengue in the population of the state of Sergipe. These results demonstrate the potential of spatial modelling in determining the factors associated with dengue epidemics and are useful in planning the intersectoral public health policies.
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Affiliation(s)
| | - Allan Dantas Dos Santos
- Nursing Postgraduate Program, Federal University of Sergipe and Research Group in Public Health.
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24
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Anderson KB, Stewart-Ibarra AM, Buddhari D, Beltran Ayala EF, Sippy RJ, Iamsirithaworn S, Ryan SJ, Fernandez S, Jarman RG, Thomas SJ, Endy TP. Key Findings and Comparisons From Analogous Case-Cluster Studies for Dengue Virus Infection Conducted in Machala, Ecuador, and Kamphaeng Phet, Thailand. Front Public Health 2020; 8:2. [PMID: 32117847 PMCID: PMC7028768 DOI: 10.3389/fpubh.2020.00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/03/2020] [Indexed: 11/21/2022] Open
Abstract
Dengue viruses (DENV) pose a significant and increasing threat to human health across broad regions of the globe. Currently, prevention, control, and treatment strategies are limited. Promising interventions are on the horizon, including multiple vaccine candidates under development and a renewed and innovative focus on controlling the vector, Aedes aegypti. However, significant gaps persist in our understanding of the similarities and differences in DENV epidemiology across regions of potential implementation and evaluation. In this manuscript, we highlight and compare findings from two analogous cluster-based studies for DENV transmission and pathogenesis conducted in Thailand and Ecuador to identify key features and questions for further pursuit. Despite a remarkably similar incidence of DENV infection among enrolled neighborhood contacts at the two sites, we note a higher occurrence of secondary infection and severe illness in Thailand compared to Ecuador. A higher force of infection in Thailand, defined as the incidence of infection among susceptible individuals, is suggested by the higher number of captured Aedes mosquitoes per household, the increasing proportion of asymptomatic infections with advancing age, and the high proportion of infections identified as secondary-type infections by serology. These observations should be confirmed in long-term, parallel prospective cohort studies conducted across regions, which would advantageously permit characterization of baseline immune status (susceptibility) and contemporaneous assessment of risks and risk factors for dengue illness.
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Affiliation(s)
- Kathryn B Anderson
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States.,Armed Forces Research Institute of Medical Science, Bangkok, Thailand.,Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, United States.,Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Anna M Stewart-Ibarra
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States.,Department of Montevideo, Inter-American Institute for Global Change Research (IAI), Montevideo, Uruguay
| | - Darunee Buddhari
- Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | | | - Rachel J Sippy
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States.,Department of Geography, University of Florida, Gainesville, FL, United States
| | | | - Sadie J Ryan
- Department of Geography, University of Florida, Gainesville, FL, United States.,Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
| | - Stefan Fernandez
- Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Richard G Jarman
- Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Stephen J Thomas
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States.,Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, United States.,Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Timothy P Endy
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States.,Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, United States.,Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, United States
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25
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Maljkovic Berry I, Rutvisuttinunt W, Sippy R, Beltran-Ayala E, Figueroa K, Ryan S, Srikanth A, Stewart-Ibarra AM, Endy T, Jarman RG. The origins of dengue and chikungunya viruses in Ecuador following increased migration from Venezuela and Colombia. BMC Evol Biol 2020; 20:31. [PMID: 32075576 PMCID: PMC7031975 DOI: 10.1186/s12862-020-1596-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/11/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In recent years, Ecuador and other South American countries have experienced an increase in arboviral diseases. A rise in dengue infections was followed by introductions of chikungunya and Zika, two viruses never before seen in many of these areas. Furthermore, the latest socioeconomic and political instability in Venezuela and the mass migration of its population into the neighboring countries has given rise to concerns of infectious disease spillover and escalation of arboviral spread in the region. RESULTS We performed phylogeographic analyses of dengue (DENV) and chikungunya (CHIKV) virus genomes sampled from a surveillance site in Ecuador in 2014-2015, along with genomes from the surrounding countries. Our results revealed at least two introductions of DENV, in 2011 and late 2013, that initially originated from Venezuela and/or Colombia. The introductions were subsequent to increases in the influx of Venezuelan and Colombian citizens into Ecuador, which in 2013 were 343% and 214% higher than in 2009, respectively. However, we show that Venezuela has historically been an important source of DENV dispersal in this region, even before the massive exodus of its population, suggesting already established paths of viral distribution. Like DENV, CHIKV was introduced into Ecuador at multiple time points in 2013-2014, but unlike DENV, these introductions were associated with the Caribbean. Our findings indicated no direct CHIKV connection between Ecuador, Colombia, and Venezuela as of 2015, suggesting that CHIKV was, at this point, not following the paths of DENV spread. CONCLUSION Our results reveal that Ecuador is vulnerable to arbovirus import from many geographic locations, emphasizing the need of continued surveillance and more diversified prevention strategies. Importantly, increase in human movement along established paths of viral dissemination, combined with regional outbreaks and epidemics, may facilitate viral spread and lead to novel virus introductions. Thus, strengthening infectious disease surveillance and control along migration routes and improving access to healthcare for the vulnerable populations is of utmost importance.
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Affiliation(s)
- Irina Maljkovic Berry
- Viral Diseases Branch, Walter Reed Army institute of Research, Silver Spring, MD, USA.
| | - Wiriya Rutvisuttinunt
- Viral Diseases Branch, Walter Reed Army institute of Research, Silver Spring, MD, USA
| | - Rachel Sippy
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Efrain Beltran-Ayala
- Department of Medicine, Technical University of Machala, Machala, El Oro, Ecuador
| | - Katherine Figueroa
- Viral Diseases Branch, Walter Reed Army institute of Research, Silver Spring, MD, USA
| | - Sadie Ryan
- Quantitative Disease Ecology and Conservation (QDEC) Lab, Department of Geography, University of Florida, Gainesville, FL, USA.,Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Abhinaya Srikanth
- Viral Diseases Branch, Walter Reed Army institute of Research, Silver Spring, MD, USA
| | - Anna M Stewart-Ibarra
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA.,Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.,Department of Montevideo, InterAmerican Institute for Global Change Research (IAI), Montevideo, Uruguay
| | - Timothy Endy
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.,Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Richard G Jarman
- Viral Diseases Branch, Walter Reed Army institute of Research, Silver Spring, MD, USA
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26
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Sippy R, Farrell DF, Lichtenstein DA, Nightingale R, Harris MA, Toth J, Hantztidiamantis P, Usher N, Cueva Aponte C, Barzallo Aguilar J, Puthumana A, Lupone CD, Endy T, Ryan SJ, Stewart Ibarra AM. Severity Index for Suspected Arbovirus (SISA): Machine learning for accurate prediction of hospitalization in subjects suspected of arboviral infection. PLoS Negl Trop Dis 2020; 14:e0007969. [PMID: 32059026 PMCID: PMC7046343 DOI: 10.1371/journal.pntd.0007969] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 02/27/2020] [Accepted: 12/03/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Dengue, chikungunya, and Zika are arboviruses of major global health concern. Decisions regarding the clinical management of suspected arboviral infection are challenging in resource-limited settings, particularly when deciding on patient hospitalization. The objective of this study was to determine if hospitalization of individuals with suspected arboviral infections could be predicted using subject intake data. METHODOLOGY/PRINCIPAL FINDINGS Two prediction models were developed using data from a surveillance study in Machala, a city in southern coastal Ecuador with a high burden of arboviral infections. Data were obtained from subjects who presented at sentinel medical centers with suspected arboviral infection (November 2013 to September 2017). The first prediction model-called the Severity Index for Suspected Arbovirus (SISA)-used only demographic and symptom data. The second prediction model-called the Severity Index for Suspected Arbovirus with Laboratory (SISAL)-incorporated laboratory data. These models were selected by comparing the prediction ability of seven machine learning algorithms; the area under the receiver operating characteristic curve from the prediction of a test dataset was used to select the final algorithm for each model. After eliminating those with missing data, the SISA dataset had 534 subjects, and the SISAL dataset had 98 subjects. For SISA, the best prediction algorithm was the generalized boosting model, with an AUC of 0.91. For SISAL, the best prediction algorithm was the elastic net with an AUC of 0.94. A sensitivity analysis revealed that SISA and SISAL are not directly comparable to one another. CONCLUSIONS/SIGNIFICANCE Both SISA and SISAL were able to predict arbovirus hospitalization with a high degree of accuracy in our dataset. These algorithms will need to be tested and validated on new data from future patients. Machine learning is a powerful prediction tool and provides an excellent option for new management tools and clinical assessment of arboviral infection.
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Affiliation(s)
- Rachel Sippy
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York, United States of America
- Quantitative Disease Ecology and Conservation Lab, Department of Geography, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Daniel F. Farrell
- College of Medicine, MD Program, SUNY Upstate Medical University, Syracuse, New York, United States of America
| | - Daniel A. Lichtenstein
- College of Medicine, MD Program, SUNY Upstate Medical University, Syracuse, New York, United States of America
| | - Ryan Nightingale
- College of Medicine, MD Program, SUNY Upstate Medical University, Syracuse, New York, United States of America
| | - Megan A. Harris
- College of Medicine, MD Program, SUNY Upstate Medical University, Syracuse, New York, United States of America
| | - Joseph Toth
- College of Medicine, MD Program, SUNY Upstate Medical University, Syracuse, New York, United States of America
| | - Paris Hantztidiamantis
- College of Medicine, MD Program, SUNY Upstate Medical University, Syracuse, New York, United States of America
| | - Nicholas Usher
- Office of Undergraduate Biology, Cornell University, Ithaca, New York, United States of America
| | - Cinthya Cueva Aponte
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York, United States of America
| | | | - Anthony Puthumana
- College of Medicine, MD Program, SUNY Upstate Medical University, Syracuse, New York, United States of America
| | - Christina D. Lupone
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York, United States of America
| | - Timothy Endy
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York, United States of America
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, United States of America
| | - Sadie J. Ryan
- Quantitative Disease Ecology and Conservation Lab, Department of Geography, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Anna M. Stewart Ibarra
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York, United States of America
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, United States of America
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Zhu H, Podesva P, Liu X, Zhang H, Teply T, Xu Y, Chang H, Qian A, Lei Y, Li Y, Niculescu A, Iliescu C, Neuzil P. IoT PCR for pandemic disease detection and its spread monitoring. SENSORS AND ACTUATORS. B, CHEMICAL 2020; 303:127098. [PMID: 32288256 PMCID: PMC7125887 DOI: 10.1016/j.snb.2019.127098] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 05/05/2023]
Abstract
During infectious disease outbreaks, the centers for disease control need to monitor particular areas. Considerable effort has been invested in the development of portable, user-friendly, and cost-effective systems for point-of-care (POC) diagnostics, which could also create an Internet of Things (IoT) for healthcare via a global network. However, at present IoT based on a functional POC instrument is not available. Here we show a fast, user-friendly, and affordable IoT system based on a miniaturized polymerase chain reaction device. We demonstrated the system's capability by amplification of complementary deoxyribonucleic acid (cDNA) of the dengue fever virus. The resulting data were then automatically uploaded via a Bluetooth interface to an Android-based smartphone and then wirelessly sent to a global network, instantly making the test results available anywhere in the world. The IoT system presented here could become an essential tool for healthcare centers to tackle infectious disease outbreaks identified either by DNA or ribonucleic acid.
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Affiliation(s)
- Hanliang Zhu
- Ministry of Education Key Laboratory of Micro/Nano Systems for Aerospace, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, PR China
| | - Pavel Podesva
- Ministry of Education Key Laboratory of Micro/Nano Systems for Aerospace, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, PR China
| | - Xiaocheng Liu
- Ministry of Education Key Laboratory of Micro/Nano Systems for Aerospace, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, PR China
| | - Haoqing Zhang
- Ministry of Education Key Laboratory of Micro/Nano Systems for Aerospace, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, PR China
| | - Tomas Teply
- Czech Technical University in Prague, Technická 2, 166 27 Praha 6, Czech Republic
| | - Ying Xu
- Ministry of Education Key Laboratory of Micro/Nano Systems for Aerospace, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, PR China
| | - Honglong Chang
- Ministry of Education Key Laboratory of Micro/Nano Systems for Aerospace, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, PR China
| | - Airong Qian
- School of Life Science, Northwesstern Polytechnical University, Xi'an 710072, PR China
| | - Yingfeng Lei
- Air Force Military Medical University, 169 Changle West Road, Xi'an, Shaanxi, 710032, PR China
| | - Yu Li
- School of Life Science, Northwesstern Polytechnical University, Xi'an 710072, PR China
| | - Andreea Niculescu
- Institute for Infocomm Research, ASTAR, 1 Fusionopolis Way, #21-01 Connexis (South Tower), 138632, Singapore
| | - Ciprian Iliescu
- National Institute for Research and Development in Microtechnologies, IMT-Bucharest, Bucharest 077190, Romania
| | - Pavel Neuzil
- Ministry of Education Key Laboratory of Micro/Nano Systems for Aerospace, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, PR China
- Brno University of Technology, Central European Institute of Technology, Purkyňova 123, 61200 Brno, Czech Republic
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Farovitch L, Sippy R, Beltrán-Ayala E, Endy TP, Stewart-Ibarra AM, Leydet BF. Detection of Antibodies to Spotted Fever Group Rickettsiae and Arboviral Coinfections in Febrile Individuals in 2014-2015 in Southern Coastal Ecuador. Am J Trop Med Hyg 2019; 101:1087-1090. [PMID: 31549616 PMCID: PMC6838566 DOI: 10.4269/ajtmh.19-0157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/14/2019] [Indexed: 11/07/2022] Open
Abstract
Tick-borne diseases (TBDs) are a growing public health threat and are increasingly identified as the cause of undifferentiated febrile illness. There is a significant gap in our understanding of ticks and their associated pathogens in Ecuador. An arboviral surveillance study allowed us to explore potential exposure to TBDs in febrile subjects. We tested plasma samples from 222 febrile subjects for spotted fever group rickettsial (SFGR) antibodies from southern coastal Ecuador in 2014-2015 via ELISA. Fifty-five (25%) subjects had evidence of anti-SFRG IgG or IgM antibodies. Although attempts to detect Rickettsia species in plasma by polymerase chain reaction were unsuccessful, these preliminary data suggest the possibility of endemic SFGR transmission in Ecuador. To better understand the burden and entomological risk for TBDs in Ecuador, future studies should expand TBD surveillance in humans, document common human-biting ticks, and measure pathogen carriage rates in questing ticks.
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Affiliation(s)
| | - Rachel Sippy
- State University of New York Upstate Medical University, Syracuse, New York
- University of Florida, Gainesville, Florida
| | | | - Timothy P. Endy
- State University of New York Upstate Medical University, Syracuse, New York
| | - Anna M. Stewart-Ibarra
- State University of New York Upstate Medical University, Syracuse, New York
- InterAmerican Institute for Global Change Research (IAI), Montevideo, Uruguay
| | - Brian F. Leydet
- State University of New York Upstate Medical University, Syracuse, New York
- State University of New York College of Environmental Science and Forestry, Syracuse, New York
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29
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Tauzer E, Borbor-Cordova MJ, Mendoza J, De La Cuadra T, Cunalata J, Stewart-Ibarra AM. A participatory community case study of periurban coastal flood vulnerability in southern Ecuador. PLoS One 2019; 14:e0224171. [PMID: 31652292 PMCID: PMC6814235 DOI: 10.1371/journal.pone.0224171] [Citation(s) in RCA: 15] [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: 04/16/2019] [Accepted: 10/06/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Populations in coastal cities are exposed to increasing risk of flooding, resulting in rising damages to health and assets. Adaptation measures, such as early warning systems for floods (EWSFs), have the potential to reduce the risk and impact of flood events when tailored to reflect the local social-ecological context and needs. Community perceptions and experiences play a critical role in risk management, since perceptions influence people's behaviors in response to EWSFs and other interventions. METHODS We investigated community perceptions and responses in flood-prone periurban areas in the coastal city of Machala, Ecuador. Focus groups (n = 11) were held with community members (n = 65 people) to assess perceptions of flood exposure, sensitivity, adaptive capacity, and current alert systems. Discussions were audio recorded, transcribed, and coded by topic. Participatory maps were field validated, georeferenced, and digitized using GIS software. Qualitative data were triangulated with historical government information on rainfall, flood events, population demographics, and disease outbreaks. RESULTS Flooding was associated with seasonal rainfall, El Niño events, high ocean tides, blocked drainage areas, overflowing canals, collapsed sewer systems, and low local elevation. Participatory maps revealed spatial heterogeneity in perceived flood risk across the community. Ten areas of special concern were mapped, including places with strong currents during floods, low elevation areas with schools and homes, and other places that accumulate stagnant water. Sensitive populations included children, the elderly, physically handicapped people, low-income families, and recent migrants. Flood impacts included damages to property and infrastructure, power outages, and the economic cost of rebuilding/repairs. Health impacts included outbreaks of infectious diseases, skin infections, snakebite, and injury/drowning. Adaptive capacity was weakest during the preparation and recovery stages of flooding. Participants perceived that their capacity to take action was limited by a lack of social organization, political engagement, and financial capital. People perceived that flood forecasts were too general, and instead relied on alerts via social media. CONCLUSIONS This study highlights the challenges and opportunities for climate change adaptation in coastal cities. Areas of special concern provide clear local policy targets. The participatory approach presented here (1) provides important context to shape local policy and interventions in Ecuador, complimenting data gathered through standard flood reports, (2) provides a voice for marginalized communities and a mechanism to raise local awareness, and (3) provides a research framework that can be adapted to other resource-limited coastal communities at risk of flooding.
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Affiliation(s)
- Erica Tauzer
- Institute for Global Health & Translational Science, SUNY Upstate Medical University, Syracuse, New York, United States of America
| | - Mercy J Borbor-Cordova
- Facultad de Ingeniería Marítima y Ciencias del Mar, Escuela Superior Politecnica del Litoral (ESPOL), Guayaquil, Guayas Province, Ecuador
| | - Jhoyzett Mendoza
- National Service for Risk Management and Emergencies, Guayaquil, Guayas Province, Ecuador
| | - Telmo De La Cuadra
- National Service for Risk Management and Emergencies, Guayaquil, Guayas Province, Ecuador
| | - Jorge Cunalata
- Universidad Tecnica de Machala, Machala, El Oro Province, Ecuador
| | - Anna M Stewart-Ibarra
- Institute for Global Health & Translational Science, SUNY Upstate Medical University, Syracuse, New York, United States of America
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, United States of America
- InterAmerican Institute for Global Change Research (IAI), Montevideo, Department of Montevideo, Uruguay
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30
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Cabrera M, Córdova-Lepe F, Valero-Cedeño N, Reyes-Baque J, Rodríguez-Morales AJ. Chikungunya in Ecuador, 2014–2017: Maps and more. Travel Med Infect Dis 2019; 29:63-66. [DOI: 10.1016/j.tmaid.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
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Chikungunya in Infants and Children: Is Pathogenesis Increasing? Viruses 2019; 11:v11030294. [PMID: 30909568 PMCID: PMC6466311 DOI: 10.3390/v11030294] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 12/15/2022] Open
Abstract
Chikungunya virus (CHIKV) was first extensively described in children during outbreaks in India and South Asia during the mid-1960s. Prior to the 2005 emergence of CHIKV on Reunion Island, CHIKV infection was usually described as a dengue-like illness with arthralgia in Africa and febrile hemorrhagic disease in Asia. Soon after the 2005 emergence, severe CNS consequences from vertical and perinatal transmission were described and as CHIKV continued to emerge in new areas over the next 10 years, severe manifestation of infection and sequelae were increasingly reported in infants and neonates. The following review describes the global reemergence and the syndromes of Chikungunya fever (CHIKF) in infants and children. The various manifestations of CHIKF are described and connected to the viral lineage that was documented in the area at the time the disease was described. The data show that certain manifestations of CHIKF occur with specific viral lineages and genetic motifs, which suggests that severe manifestations of CHIKF in the very young may be associated with the emergence of new viral lineages.
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Socio-Ecological Factors Associated with Dengue Risk and Aedes aegypti Presence in the Galápagos Islands, Ecuador. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050682. [PMID: 30813558 PMCID: PMC6427784 DOI: 10.3390/ijerph16050682] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/16/2019] [Accepted: 02/19/2019] [Indexed: 01/21/2023]
Abstract
Dengue fever is an emerging infectious disease in the Galápagos Islands of Ecuador, with the first cases reported in 2002 and subsequent periodic outbreaks. We report results of a 2014 pilot study conducted in Puerto Ayora (PA) on Santa Cruz Island, and Puerto Baquerizo Moreno (PB) on San Cristobal Island. To assess the socio-ecological risk factors associated with dengue and mosquito vector presence at the household level, we conducted 100 household surveys (50 on each island) in neighborhoods with prior reported dengue cases. Adult mosquitoes were collected inside and outside the home, larval indices were determined through container surveys, and heads of households were interviewed to determine demographics, self-reported prior dengue infections, housing conditions, and knowledge, attitudes, and practices regarding dengue. Multi-model selection methods were used to derive best-fit generalized linear regression models of prior dengue infection, and Aedes aegypti presence. We found that 24% of PB and 14% of PA respondents self-reported a prior dengue infection, and more PB homes than PA homes had Ae. aegypti. The top-ranked model for prior dengue infection included several factors related to human movement, household demographics, access to water quality issues, and dengue awareness. The top-ranked model for Ae. aegypti presence included housing conditions, mosquito control practices, and dengue risk perception. This is the first study of dengue risk and Ae. aegypti presence in the Galápagos Islands.
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33
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Kar M, Nisheetha A, Kumar A, Jagtap S, Shinde J, Singla M, M S, Pandit A, Chandele A, Kabra SK, Krishna S, Roy R, Lodha R, Pattabiraman C, Medigeshi GR. Isolation and molecular characterization of dengue virus clinical isolates from pediatric patients in New Delhi. Int J Infect Dis 2018; 84S:S25-S33. [PMID: 30528666 DOI: 10.1016/j.ijid.2018.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/01/2018] [Accepted: 12/04/2018] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To characterize the in vitro replication fitness, viral diversity, and phylogeny of dengue viruses (DENV) isolated from Indian patients. METHODS DENV was isolated from whole blood collected from patients by passaging in cell culture. Passage 3 viruses were used for growth kinetics in C6/36 mosquito cells. Parallel efforts also focused on the isolation of DENV RNA from plasma samples of the same patients, which were processed for next-generation sequencing. RESULTS It was possible to isolate 64 clinical isolates of DENV, mostly DENV-2. Twenty-five of these were further used for growth curve analysis in vitro, which showed a wide range of replication kinetics. The highest viral titers were associated with isolates from patients with dengue with warning signs and severe dengue cases. Full genome sequences of 21 DENV isolates were obtained. Genome analysis mapped the circulating DENV-2 strains to the Cosmopolitan genotype. CONCLUSIONS The replication kinetics of isolates from patients with mild or severe infection did not differ significantly, but the viral titers varied by two orders of magnitude between the isolates, suggesting differences in replication fitness among the circulating DENV-2.
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Affiliation(s)
- Meenakshi Kar
- Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Amul Nisheetha
- National Centre for Biological Sciences, TIFR, Bengaluru, India
| | - Anuj Kumar
- National Centre for Biological Sciences, TIFR, Bengaluru, India
| | - Suraj Jagtap
- Department of Chemical Engineering, Indian Institute of Science, Bengaluru, India
| | - Jitendra Shinde
- Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Mohit Singla
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Saranya M
- Molecular Biophysics Unit, Indian Institute of Science, Bengaluru, India
| | - Awadhesh Pandit
- National Centre for Biological Sciences, TIFR, Bengaluru, India
| | - Anmol Chandele
- ICGEB-Emory Vaccine Center, ICGEB Campus, New Delhi, India
| | - Sushil K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sudhir Krishna
- National Centre for Biological Sciences, TIFR, Bengaluru, India
| | - Rahul Roy
- Department of Chemical Engineering, Indian Institute of Science, Bengaluru, India; Molecular Biophysics Unit, Indian Institute of Science, Bengaluru, India; Center for Biosystems Science and Engineering, Indian Institute of Science, Bengaluru, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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34
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Mita-Mendoza NK, McMahon E, Kenneson A, Barbachano-Guerrero A, Beltran-Ayala E, Cueva C, King CA, Lupone CD, Castro-Sesquen YE, Gilman RH, Endy TP, Stewart-Ibarra AM. Chagas Disease in Southern Coastal Ecuador: Coinfections with Arboviruses and a Comparison of Serological Assays for Chagas Disease Diagnosis. Am J Trop Med Hyg 2018; 99:1530-1533. [PMID: 30350764 DOI: 10.4269/ajtmh.18-0441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Occurrence of Chagas disease and arbovirus coinfections is unknown, despite the vast co-endemic areas throughout the Americas. This study examined the proportion of individuals positive for Trypanosoma cruzi and coinfections with dengue, chikungunya, and Zika viruses in Machala, Ecuador (January 2014-December 2015). Chagas seropositivity was evaluated with five commercially available assays. Dengue infections were identified by nonstructural protein 1 rapid test and enzyme linked immunosorbent assay (ELISA), immunoglobulin M ELISA, and reverse transcription PCR (RT-PCR); chikungunya and Zika infections were identified by RT-PCR. Of 658 individuals, six were positive for T. cruzi (0.91%), including one T. cruzi/dengue coinfection and one T. cruzi/chikungunya/dengue coinfection. The clinical manifestations of coinfected individuals corresponded to severe dengue and dengue with warning signs, respectively. We observed discrepant results by using the Hemagen Chagas kit and the rapid test Chagas Detect Plus (false positives: 3.9% and 15.4%), highlighting the need to assess diagnostic assays in geographic regions with distinct taxonomic units of T. cruzi.
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Affiliation(s)
- Neida K Mita-Mendoza
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
| | - Elizabeth McMahon
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
| | - Aileen Kenneson
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
| | | | - Efrain Beltran-Ayala
- Department of Medicine, Universidad Tecnica de Machala, Machala, El Oro Province, Ecuador
| | - Cinthya Cueva
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
| | - Christine A King
- Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, New York
| | - Christina D Lupone
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
| | - Yagahira E Castro-Sesquen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Timothy P Endy
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York.,Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, New York.,Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
| | - Anna M Stewart-Ibarra
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York.,Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
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35
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Farrell DF, Lupone CD, Kenneson A, Cueva C, Heydari N, Barzallo Aguilera JH, Polhemus M, Endy TP, Stewart-Ibarra AM. Case Report: An Acute Chikungunya Infection and a Recent Secondary Dengue Infection in a Peripartum Case in Ecuador. Am J Trop Med Hyg 2018; 98:838-840. [PMID: 29363451 DOI: 10.4269/ajtmh.17-0781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Dengue virus (DENV) and chikungunya virus (CHIKV) are transmitted by the same mosquito vectors and now co-circulate in many parts of the world; however, coinfections and serial infections are not often diagnosed or reported. A 38-week pregnant woman was admitted to the hospital with a diagnosis of suspected DENV and CHIKV in southern coastal Ecuador. The pregnancy was complicated by mild polyhydramnios and fetal tachycardia, and a healthy newborn was born. The patient was positive for a recent secondary DENV infection (Immunoglobulin M and Immunoglobulin G positive) and an acute CHIKV infection (real-time reverse transcriptase polymerase chain reaction positive) (Asian genotype). The newborn was not tested for either virus. This case resulted in a benign clinical course with a favorable pregnancy outcome.
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Affiliation(s)
- Daniel F Farrell
- Center for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
| | - Christina D Lupone
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, New York.,Center for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
| | - Aileen Kenneson
- Center for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
| | - Cinthya Cueva
- Center for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
| | - Naveed Heydari
- Center for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
| | | | - Mark Polhemus
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York.,Center for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
| | - Timothy P Endy
- Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, New York.,Department of Medicine, SUNY Upstate Medical University, Syracuse, New York.,Center for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
| | - Anna M Stewart-Ibarra
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York.,Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, New York.,Center for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, New York
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36
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Stewart-Ibarra AM, Hargrave A, Diaz A, Kenneson A, Madden D, Romero MM, Molina JP, Saltos DM. Psychological Distress and Zika, Dengue and Chikungunya Symptoms Following the 2016 Earthquake in Bahía de Caráquez, Ecuador. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1516. [PMID: 29206195 PMCID: PMC5750934 DOI: 10.3390/ijerph14121516] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 11/24/2017] [Accepted: 11/29/2017] [Indexed: 12/29/2022]
Abstract
On 16 April 2016, a 7.8 magnitude earthquake struck coastal Ecuador, resulting in significant mortality and morbidity, damages to infrastructure, and psychological trauma. This event coincided with the first outbreak of Zika virus (ZIKV) and co-circulation with dengue virus (DENV) and chikungunya virus (CHIKV). We tested whether the degree of psychological distress was associated with the presence of suspected DENV, CHIKV, ZIKV (DCZ) infections three months after the earthquake. In July 2016, 601 household members from four communities in Bahía de Caráquez, Manabí Province, Ecuador, were surveyed in a post-disaster health evaluation. Information was collected on demographics, physical damages and injuries, chronic diseases, self-reported psychological distress, and DCZ symptoms. We calculated the prevalence of arbovirus and distress symptoms by community. ANOVA was used to compare the mean number of psychological distress symptoms between people with versus without suspected DCZ infections by age, gender, community and the need to sleep outside of the home due to damages. The prevalence of suspected DCZ infections was 9.7% and the prevalence of psychological distress was 58.1%. The average number of psychological distress symptoms was significantly higher among people with suspected DCZ infections in the periurban community of Bella Vista, in women, in adults 40-64 years of age and in individuals not sleeping at home (p < 0.05). The results of this study highlight the need to investigate the interactions between psychological distress and arboviral infections following natural disasters.
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Affiliation(s)
- Anna M Stewart-Ibarra
- Center for Global Health and Translational Science, SUNY Upstate Medical University, 750 East Adams St., Syracuse, NY 13210, USA.
| | - Anita Hargrave
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA.
| | - Avriel Diaz
- Department of Ecology, Evolution and Conservation Biology at Columbia University, New York, NY 10025, USA.
| | - Aileen Kenneson
- Center for Global Health and Translational Science, SUNY Upstate Medical University, 750 East Adams St., Syracuse, NY 13210, USA.
| | - David Madden
- Walking Palms Global Initiative, Bahía de Caráquez 131401, Manabí Province, Ecuador.
| | - Moory M Romero
- Center for Global Health and Translational Science, SUNY Upstate Medical University, 750 East Adams St., Syracuse, NY 13210, USA.
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37
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Kenneson A, Beltrán-Ayala E, Borbor-Cordova MJ, Polhemus ME, Ryan SJ, Endy TP, Stewart-Ibarra AM. Social-ecological factors and preventive actions decrease the risk of dengue infection at the household-level: Results from a prospective dengue surveillance study in Machala, Ecuador. PLoS Negl Trop Dis 2017; 11:e0006150. [PMID: 29253873 PMCID: PMC5771672 DOI: 10.1371/journal.pntd.0006150] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 01/17/2018] [Accepted: 12/03/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In Ecuador, dengue virus (DENV) infections transmitted by the Aedes aegypti mosquito are among the greatest public health concerns in urban coastal communities. Community- and household-level vector control is the principal means of controlling disease outbreaks. This study aimed to assess the impact of knowledge, attitudes, and practices (KAPs) and social-ecological factors on the presence or absence of DENV infections in the household. METHODS In 2014 and 2015, individuals with DENV infections from sentinel clinics in Machala, Ecuador, were invited to participate in the study, as well as members of their household and members of four neighboring households located within 200 meters. We conducted diagnostic testing for DENV on all study participants; we surveyed heads of households (HOHs) regarding demographics, housing conditions and KAPs. We compared KAPs and social-ecological factors between households with (n = 139) versus without (n = 80) DENV infections, using bivariate analyses and multivariate logistic regression models with and without interactions. RESULTS Significant risk factors in multivariate models included proximity to abandoned properties, interruptions in piped water, and shaded patios (p<0.05). Significant protective factors included the use of mosquito bed nets, fumigation inside the home, and piped water inside the home (p<0.05). In bivariate analyses (but not multivariate modeling), DENV infections were positively associated with HOHs who were male, employed, and of younger age than households without infections (p<0.05). DENV infections were not associated with knowledge, attitude, or reported barriers to prevention activities. DISCUSSION Specific actions that can be considered to decrease the risk of DENV infections in the household include targeting vector control in highly shaded properties, fumigating inside the home, and use of mosquito bed nets. Community-level interventions include cleanup of abandoned properties, daily garbage collection, and reliable piped water inside houses. These findings can inform interventions to reduce the risk of other diseases transmitted by the Ae. aegypti mosquito, such as chikungunya and Zika fever.
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Affiliation(s)
- Aileen Kenneson
- Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, United States of America
| | - Efraín Beltrán-Ayala
- Facultad de Medicina, Universidad Técnica de Machala, Machala, El Oro Province, Ecuador
| | - Mercy J. Borbor-Cordova
- Facultad de Ingeniería Marítima, Ciencias Biológicas, Oceánicas y Recursos Naturales, Escuela Superior Politecnica del Litoral (ESPOL), Guayaquil, Ecuador
| | - Mark E. Polhemus
- Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, United States of America
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States of America
| | - Sadie J. Ryan
- Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, United States of America
- Department of Geography, University of Florida, Gainesville, FL, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States of America
- College of Life Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - Timothy P. Endy
- Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, United States of America
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States of America
- Department of Microbiology & Immunology, SUNY Upstate Medical University, Syracuse, NY, United States of America
| | - Anna M. Stewart-Ibarra
- Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, United States of America
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States of America
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