Duane Gubler - Academia.edu (original) (raw)

Papers by Duane Gubler

Research paper thumbnail of West Nile Virus

Zimmerman/Trends, 2002

West Nile (WN) virus is a mosquito-borne flavivirus and human, equine, and avian neuropathogen. T... more West Nile (WN) virus is a mosquito-borne flavivirus and human, equine, and avian neuropathogen. The virus is indigenous to Africa, Asia, Europe, and Australia, and has recently caused large epidemics in Romania, Russia, and Israel. Birds are the natural reservoir ( ...

Research paper thumbnail of A Critical Assessment of Vector Control for Dengue Prevention

PLOS Neglected Tropical Diseases, 2015

Recently, the Vaccines to Vaccinate (v2V) initiative was reconfigured into the Partnership for De... more Recently, the Vaccines to Vaccinate (v2V) initiative was reconfigured into the Partnership for Dengue Control (PDC), a multi-sponsored and independent initiative. This redirection is consistent with the growing consensus among the dengue-prevention community that no single intervention will be sufficient to control dengue disease. The PDC's expectation is that when an effective dengue virus (DENV) vaccine is commercially available, the public health community will continue to rely on vector control because the two strategies complement and enhance one another. Although the concept of integrated intervention for dengue prevention is gaining increasingly broader acceptance, to date, no consensus has been reached regarding the details of how and what combination of approaches can be most effectively implemented to manage disease. To fill that gap, the PDC proposed a three step process: (1) a critical assessment of current vector control tools and those under development, (2) outlining a research agenda for determining, in a definitive way, what existing tools work best, and (3) determining how to combine the best vector control options, which have systematically been defined in this process, with DENV vaccines. To address the first step, the PDC convened a meeting of international experts during November 2013 in Washington, DC, to critically assess existing vector control interventions and tools under development. This report summarizes those deliberations.

Research paper thumbnail of First recorded outbreak of yellow fever in Kenya, 1992-1993. I. Epidemiologic investigations

The American journal of tropical medicine and hygiene, 1998

Outbreaks of yellow fever (YF) have never been recorded in Kenya. However, in September 1992, cas... more Outbreaks of yellow fever (YF) have never been recorded in Kenya. However, in September 1992, cases of hemorrhagic fever (HF) were reported in the Kerio Valley to the Kenya Ministry of Health. Early in 1993, the disease was confirmed as YF and a mass vaccination campaign was initiated. Cases of suspected YF were identified through medical record review and hospital-based disease surveillance by using a clinical case definition. Case-patients were confirmed serologically and virologically. We documented 55 persons with HF from three districts of the Rift Valley Province in the period of September 10, 1992 through March 11, 1993 (attack rate = 27.4/100,000 population). Twenty-six (47%) of the 55 persons had serologic evidence of recent YF infection, and three of these persons were also confirmed by YF virus isolation. No serum was available from the other 29 HF cases. In addition, YF virus was isolated from a person from the epidemic area who had a nonspecific febrile illness but did ...

Research paper thumbnail of Molecular evolution and phylogeny of dengue-4 viruses

The Journal of general virology, 1997

Nucleotide sequences of the envelope protein genes of 19 geographically and temporally distinct d... more Nucleotide sequences of the envelope protein genes of 19 geographically and temporally distinct dengue (DEN)-4 viruses were determined. Nucleic acid sequence comparison revealed that the identity among the DEN-4 viruses was greater than 92%. Similarity among deduced amino acids was between 96 and 100%; in most cases identical amino acid substitutions occurred among viruses from similar geographical regions. Alignment of nucleic acid sequences followed by parsimony analysis generated phylogenetic trees, which indicated that geographically independent evolution of DEN-4 viruses had occurred. DEN-4 viruses were separated into two genetically distinct subtypes (genotypes). Genotype-1 contains viruses from the Philippines, Thailand and Sri Lanka; genotype-2 consists of viruses from Indonesia, Tahiti, the Caribbean Islands (Puerto Rico, Dominica) and Central and South America.

Research paper thumbnail of Sylvatic transmission of arboviruses among Bornean orangutans

The American journal of tropical medicine and hygiene

Wild populations of nonhuman primates live in regions of sylvatic arbovirus transmission. To asse... more Wild populations of nonhuman primates live in regions of sylvatic arbovirus transmission. To assess the status of arbovirus transmission in Bornean forests and the susceptibility of wild orangutans to arboviral infection, blood samples of wild orangutans, semi-captive orangutans, and humans were examined. Samples were tested by plaque reduction neutralization test for antibodies to viruses representing three families (Flaviviridae, Alphaviridae, and Bunyaviridae), including dengue-2, Japanese encephalitis, Zika, Langat, Tembusu, Sindbis, Chikungunya, and Batai viruses. Both wild and semi-captive orangutan groups as well as local human populations showed serologic evidence of arbovirus infection. The presence of neutralizing antibodies among wild orangutans strongly suggests the existence of sylvatic cycles for dengue, Japanese encephalitis, and sindbis viruses in North Borneo. The present study demonstrates that orangutans are susceptible to arboviralinfections in the wild, although...

Research paper thumbnail of Seroprevalence and distribution of Flaviviridae, Togaviridae, and Bunyaviridae arboviral infections in rural Cameroonian adults

The American journal of tropical medicine and hygiene, 2006

Arboviruses from the families Flaviviridae, Togaviridae, and Bunyaviridae are suspected to cause ... more Arboviruses from the families Flaviviridae, Togaviridae, and Bunyaviridae are suspected to cause widespread morbidity in sub-Saharan African populations, but little research been done to document the burden and distribution of these pathogens. We tested serum samples from 256 Cameroonian adults from nine rural villages for the presence of Dengue-2 (DEN-2), West Nile (WN), Yellow fever (YF), Chikungunya (CHIK), O'nyong-nyong (ONN), Sindbis (SIN), and Tahyna (TAH) infection using standard plaque-reduction neutralization tests (PRNT). Of these samples, 12.5% were DEN-2 positive, 6.6% were WN positive, 26.9% were YF positive, 46.5% were CHIK seropositive, 47.7% were ONN positive, 7.8% were SIN positive, and 36.3% were TAH positive. DEN-2, YF, and CHIK seroprevalence rates were lower among individuals living in dwellings with grass or thatched roofs versus corrugated tin and in villages isolated from urban centers. Seroprevalence rates of YF and CHIK increased with age. These results...

Research paper thumbnail of Preparing for introduction of a dengue vaccine: recommendations from the 1st Dengue v2V Asia-Pacific Meeting

Vaccine, Jan 28, 2011

Infection with dengue virus is a major public health problem in the Asia-Pacific region and throu... more Infection with dengue virus is a major public health problem in the Asia-Pacific region and throughout tropical and sub-tropical regions of the world. Vaccination represents a major opportunity to control dengue and several candidate vaccines are in development. Experts in dengue and in vaccine introduction gathered for a two day meeting during which they examined the challenges inherent to the introduction of a dengue vaccine into the national immunisation programmes of countries of the Asia-Pacific. The aim was to develop a series of recommendations to reduce the delay between vaccine licensure and vaccine introduction. Major recommendations arising from the meeting included: ascertaining and publicising the full burden and cost of dengue; changing the perception of dengue in non-endemic countries to help generate global support for dengue vaccination; ensuring high quality active surveillance systems and diagnostics; and identifying sustainable sources of funding, both to support...

Research paper thumbnail of DengueTools: innovative tools and strategies for the surveillance and control of dengue

Global Health Action, 2012

Research paper thumbnail of COMMON OCCURRENCE OF CONCURRENT INFECTIONS BY MULTIPLE DENGUE VIRUS SEROTYPES

Abstract. The co-circulation of all 4 dengue virus serotypes in the same community, common since ... more Abstract. The co-circulation of all 4 dengue virus serotypes in the same community, common since the 1950s in Southeast Asia, has now become a frequent occurrence in many Caribbean Islands, Mexico, and Central and South America in the past 20 years. As a consequence, the frequency of concurrent infections would be expected to increase in these areas. To assess this,

Research paper thumbnail of Community-based dengue prevention programs in Puerto Rico: impact on knowledge, behavior, and residential mosquito infestation

The American journal of tropical medicine and hygiene, 2002

Dengue is a major health burden in Puerto Rico. Televised public service announcements and poster... more Dengue is a major health burden in Puerto Rico. Televised public service announcements and posters, elementary and pre-school educational programs, and an exhibit at the Children's Museum in Old San Juan were evaluated separately using knowledge and practices surveys administered to children and their parents, surveys of house lots for larval container habitats, focus groups, and interviews with program organizers and participants. Exposure to the programs was associated with increased dengue-related knowledge, increased proportion of tires protected from rain, decreased proportion of water storage containers positive for mosquito larvae, and increased indoor use of aerosol insecticides. Exposure to the elementary school program was associated with slightly lower indices of residential mosquito infestation. The programs have resulted in high levels of awareness, some behavior change, and limited change in larval indices. Greater emphasis on the skills necessary for community mem...

Research paper thumbnail of Outbreak of dengue fever in Palau, Western Pacific: risk factors for infection

The American journal of tropical medicine and hygiene, 2003

Between January and June 1995, an outbreak of dengue fever occurred in Palau, an island nation of... more Between January and June 1995, an outbreak of dengue fever occurred in Palau, an island nation of 32,000 inhabitants in the Western Pacific. To determine the magnitude of this outbreak and to determine modifiable risk factors to guide control strategies, we established active surveillance at the national hospital and private clinics, reviewed available clinical records, and conducted serologic and entomologic surveys. Between January 1 and July 1, 1995, 817 case-patients with acute febrile illness with body or joint aches and one of the following: headache, rash, nausea, vomiting, or hemorrhagic manifestations presented to health facilities in Palau. The epidemic peaked in the second week of April 1995. Of 338 case-patients tested, 254 (75%) had positive serologic results by an IgM capture enzyme-linked immunosorbent assay. Dengue 4 virus was isolated from 78 (51%) of 154 serum samples tested. Blood samples collected during a cross-sectional survey were tested for IgM antibody and y...

Research paper thumbnail of Excellence in research and education at the John A. Burns School of Medicine: a tribute to Edwin Cadman's vision

Hawaii medical journal, 2005

When Edwin Cadman came to the University of Hawaii (UH) in 1999 to serve as dean of the John A. B... more When Edwin Cadman came to the University of Hawaii (UH) in 1999 to serve as dean of the John A. Burns School of Medicine (JABSOM), he articulated a clear vision for its future. Dr. Cadman saw tremendous potential in our students, staff, faculty, and community. He envisioned ...

Research paper thumbnail of Community involvement in the control of Aedes aegypti

Acta Tropica, 1996

In the past 15 years, there has been a dramatic resurgence of dengue and dengue hemorrhagic fever... more In the past 15 years, there has been a dramatic resurgence of dengue and dengue hemorrhagic fever worldwide, with increased frequency of epidemics and geographic expansion of both the mosquito vectors and the viruses. The reasons for this resurgence are not well understood, but include uncontrolled and unplanned urbanization, increased movement of people and viruses by airplane and lack of

Research paper thumbnail of Approaches to Refining Estimates of Global Burden and Economics of Dengue

PLoS Neglected Tropical Diseases, 2014

Dengue presents a formidable and growing global economic and disease burden, with around half the... more Dengue presents a formidable and growing global economic and disease burden, with around half the world's population estimated to be at risk of infection. There is wide variation and substantial uncertainty in current estimates of dengue disease burden and, consequently, on economic burden estimates. Dengue disease varies across time, geography and persons affected. Variations in the transmission of four different viruses and interactions among vector density and host's immune status, age, pre-existing medical conditions, all contribute to the disease's complexity. This systematic review aims to identify and examine estimates of dengue disease burden and costs, discuss major sources of uncertainty, and suggest next steps to improve estimates. Economic analysis of dengue is mainly concerned with costs of illness, particularly in estimating total episodes of symptomatic dengue. However, national dengue disease reporting systems show a great diversity in design and implementation, hindering accurate global estimates of dengue episodes and country comparisons. A combination of immediate, short-, and long-term strategies could substantially improve estimates of disease and, consequently, of economic burden of dengue. Suggestions for immediate implementation include refining analysis of currently available data to adjust reported episodes and expanding data collection in empirical studies, such as documenting the number of ambulatory visits before and after hospitalization and including breakdowns by age. Shortterm recommendations include merging multiple data sources, such as cohort and surveillance data to evaluate the accuracy of reporting rates (by health sector, treatment, severity, etc.), and using covariates to extrapolate dengue incidence to locations with no or limited reporting. Long-term efforts aim at strengthening capacity to document dengue transmission using serological methods to systematically analyze and relate to epidemiologic data. As promising tools for diagnosis, vaccination, vector control, and treatment are being developed, these recommended steps should improve objective, systematic measures of dengue burden to strengthen health policy decisions.

Research paper thumbnail of USING DISABILITY-ADJUSTED LIFE YEARS TO ASSESS THE ECONOMIC IMPACT OF DENGUE IN PUERTO RICO: 1984-1994

This study presents the disability-adjusted life years (DALYs), a non-monetary economic measure o... more This study presents the disability-adjusted life years (DALYs), a non-monetary economic measure of impact, lost to dengue in Puerto Rico for the period 1984-1994. Data on the number of reported cases, cases with hemorrhagic manifestations, hospitalizations, and deaths were obtained from a surveillance system maintained at the Dengue Branch, Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention

Research paper thumbnail of Evaluation of diagnostic tests: dengue

Nature Reviews Microbiology, 2010

Research paper thumbnail of Serologic Evidence of West Nile Virus Infection in Horses, Yucatan State, Mexico

Research paper thumbnail of West Nile Virus in the New World: Trends in the Spread and Proliferation of West Nile Virus in the Western Hemisphere

Zoonoses and Public Health, 2009

• West Nile Virus (WNV) continues to spread in the Western Hemisphere, with new range extensions ... more • West Nile Virus (WNV) continues to spread in the Western Hemisphere, with new range extensions reported from southern South America. • The record numbers of human WNV infections recorded in Canada during 2007, up to more than 50% over previous record set in 2003, demonstrate that the public health impacts of WNV in North America could increase rather than decrease in future. • Increased capacity for surveillance and diagnosis is needed to better understand the public health risks and impacts from WNV in South America, Central America and the Caribbean Basin region.

Research paper thumbnail of Longitudinal Studies of West Nile Virus Infection in Avians, Yucatán State, México

Vector-Borne and Zoonotic Diseases, 2004

Following the introduction of West Nile virus (WNV) into North America in 1999, surveillance for ... more Following the introduction of West Nile virus (WNV) into North America in 1999, surveillance for evidence of infection with this virus in migratory and resident birds was established in Yucatin State, M6xico in March 2000. Overall, 8611 birds representing 182 species and 14 orders were captured and assayed for antibodies to WNV. Of these, 5066 (59%) birds were residents and 3545 (41%) birds were migrants. Twenty-one (0.24%) birds exhibited evidence of flavivirus infection. Of these, 8 birds had antibodies to WNV by epitope-blocking enzyme-linked immunosorbent assay. Five (0.06%) birds (gray catbird, brown-crested flycatcher, rose-breasted grosbeak, blue bunting and indigo bunting) were confirmed to have WNV infections by plaque reduction neutralization test. The WNV-infected birds were sampled in December 2002 and January 2003. The brown-crested flycatcher and blue bunting presumably were resident birds; the other WNV seropositive birds were migrants. These data provide evidence of WNV transmission among birds in the Yucatin Peninsula.

Research paper thumbnail of Cost-effectiveness of a pediatric dengue vaccine

Vaccine, 2004

To ascertain the economic feasibility of a pediatric tetravalent dengue vaccine, we developed and... more To ascertain the economic feasibility of a pediatric tetravalent dengue vaccine, we developed and calibrated a cost-effectiveness model of vaccinating children at 15 months in Southeast (SE) Asia using a societal perspective. We assumed that full immunization would require

Research paper thumbnail of West Nile Virus

Zimmerman/Trends, 2002

West Nile (WN) virus is a mosquito-borne flavivirus and human, equine, and avian neuropathogen. T... more West Nile (WN) virus is a mosquito-borne flavivirus and human, equine, and avian neuropathogen. The virus is indigenous to Africa, Asia, Europe, and Australia, and has recently caused large epidemics in Romania, Russia, and Israel. Birds are the natural reservoir ( ...

Research paper thumbnail of A Critical Assessment of Vector Control for Dengue Prevention

PLOS Neglected Tropical Diseases, 2015

Recently, the Vaccines to Vaccinate (v2V) initiative was reconfigured into the Partnership for De... more Recently, the Vaccines to Vaccinate (v2V) initiative was reconfigured into the Partnership for Dengue Control (PDC), a multi-sponsored and independent initiative. This redirection is consistent with the growing consensus among the dengue-prevention community that no single intervention will be sufficient to control dengue disease. The PDC's expectation is that when an effective dengue virus (DENV) vaccine is commercially available, the public health community will continue to rely on vector control because the two strategies complement and enhance one another. Although the concept of integrated intervention for dengue prevention is gaining increasingly broader acceptance, to date, no consensus has been reached regarding the details of how and what combination of approaches can be most effectively implemented to manage disease. To fill that gap, the PDC proposed a three step process: (1) a critical assessment of current vector control tools and those under development, (2) outlining a research agenda for determining, in a definitive way, what existing tools work best, and (3) determining how to combine the best vector control options, which have systematically been defined in this process, with DENV vaccines. To address the first step, the PDC convened a meeting of international experts during November 2013 in Washington, DC, to critically assess existing vector control interventions and tools under development. This report summarizes those deliberations.

Research paper thumbnail of First recorded outbreak of yellow fever in Kenya, 1992-1993. I. Epidemiologic investigations

The American journal of tropical medicine and hygiene, 1998

Outbreaks of yellow fever (YF) have never been recorded in Kenya. However, in September 1992, cas... more Outbreaks of yellow fever (YF) have never been recorded in Kenya. However, in September 1992, cases of hemorrhagic fever (HF) were reported in the Kerio Valley to the Kenya Ministry of Health. Early in 1993, the disease was confirmed as YF and a mass vaccination campaign was initiated. Cases of suspected YF were identified through medical record review and hospital-based disease surveillance by using a clinical case definition. Case-patients were confirmed serologically and virologically. We documented 55 persons with HF from three districts of the Rift Valley Province in the period of September 10, 1992 through March 11, 1993 (attack rate = 27.4/100,000 population). Twenty-six (47%) of the 55 persons had serologic evidence of recent YF infection, and three of these persons were also confirmed by YF virus isolation. No serum was available from the other 29 HF cases. In addition, YF virus was isolated from a person from the epidemic area who had a nonspecific febrile illness but did ...

Research paper thumbnail of Molecular evolution and phylogeny of dengue-4 viruses

The Journal of general virology, 1997

Nucleotide sequences of the envelope protein genes of 19 geographically and temporally distinct d... more Nucleotide sequences of the envelope protein genes of 19 geographically and temporally distinct dengue (DEN)-4 viruses were determined. Nucleic acid sequence comparison revealed that the identity among the DEN-4 viruses was greater than 92%. Similarity among deduced amino acids was between 96 and 100%; in most cases identical amino acid substitutions occurred among viruses from similar geographical regions. Alignment of nucleic acid sequences followed by parsimony analysis generated phylogenetic trees, which indicated that geographically independent evolution of DEN-4 viruses had occurred. DEN-4 viruses were separated into two genetically distinct subtypes (genotypes). Genotype-1 contains viruses from the Philippines, Thailand and Sri Lanka; genotype-2 consists of viruses from Indonesia, Tahiti, the Caribbean Islands (Puerto Rico, Dominica) and Central and South America.

Research paper thumbnail of Sylvatic transmission of arboviruses among Bornean orangutans

The American journal of tropical medicine and hygiene

Wild populations of nonhuman primates live in regions of sylvatic arbovirus transmission. To asse... more Wild populations of nonhuman primates live in regions of sylvatic arbovirus transmission. To assess the status of arbovirus transmission in Bornean forests and the susceptibility of wild orangutans to arboviral infection, blood samples of wild orangutans, semi-captive orangutans, and humans were examined. Samples were tested by plaque reduction neutralization test for antibodies to viruses representing three families (Flaviviridae, Alphaviridae, and Bunyaviridae), including dengue-2, Japanese encephalitis, Zika, Langat, Tembusu, Sindbis, Chikungunya, and Batai viruses. Both wild and semi-captive orangutan groups as well as local human populations showed serologic evidence of arbovirus infection. The presence of neutralizing antibodies among wild orangutans strongly suggests the existence of sylvatic cycles for dengue, Japanese encephalitis, and sindbis viruses in North Borneo. The present study demonstrates that orangutans are susceptible to arboviralinfections in the wild, although...

Research paper thumbnail of Seroprevalence and distribution of Flaviviridae, Togaviridae, and Bunyaviridae arboviral infections in rural Cameroonian adults

The American journal of tropical medicine and hygiene, 2006

Arboviruses from the families Flaviviridae, Togaviridae, and Bunyaviridae are suspected to cause ... more Arboviruses from the families Flaviviridae, Togaviridae, and Bunyaviridae are suspected to cause widespread morbidity in sub-Saharan African populations, but little research been done to document the burden and distribution of these pathogens. We tested serum samples from 256 Cameroonian adults from nine rural villages for the presence of Dengue-2 (DEN-2), West Nile (WN), Yellow fever (YF), Chikungunya (CHIK), O'nyong-nyong (ONN), Sindbis (SIN), and Tahyna (TAH) infection using standard plaque-reduction neutralization tests (PRNT). Of these samples, 12.5% were DEN-2 positive, 6.6% were WN positive, 26.9% were YF positive, 46.5% were CHIK seropositive, 47.7% were ONN positive, 7.8% were SIN positive, and 36.3% were TAH positive. DEN-2, YF, and CHIK seroprevalence rates were lower among individuals living in dwellings with grass or thatched roofs versus corrugated tin and in villages isolated from urban centers. Seroprevalence rates of YF and CHIK increased with age. These results...

Research paper thumbnail of Preparing for introduction of a dengue vaccine: recommendations from the 1st Dengue v2V Asia-Pacific Meeting

Vaccine, Jan 28, 2011

Infection with dengue virus is a major public health problem in the Asia-Pacific region and throu... more Infection with dengue virus is a major public health problem in the Asia-Pacific region and throughout tropical and sub-tropical regions of the world. Vaccination represents a major opportunity to control dengue and several candidate vaccines are in development. Experts in dengue and in vaccine introduction gathered for a two day meeting during which they examined the challenges inherent to the introduction of a dengue vaccine into the national immunisation programmes of countries of the Asia-Pacific. The aim was to develop a series of recommendations to reduce the delay between vaccine licensure and vaccine introduction. Major recommendations arising from the meeting included: ascertaining and publicising the full burden and cost of dengue; changing the perception of dengue in non-endemic countries to help generate global support for dengue vaccination; ensuring high quality active surveillance systems and diagnostics; and identifying sustainable sources of funding, both to support...

Research paper thumbnail of DengueTools: innovative tools and strategies for the surveillance and control of dengue

Global Health Action, 2012

Research paper thumbnail of COMMON OCCURRENCE OF CONCURRENT INFECTIONS BY MULTIPLE DENGUE VIRUS SEROTYPES

Abstract. The co-circulation of all 4 dengue virus serotypes in the same community, common since ... more Abstract. The co-circulation of all 4 dengue virus serotypes in the same community, common since the 1950s in Southeast Asia, has now become a frequent occurrence in many Caribbean Islands, Mexico, and Central and South America in the past 20 years. As a consequence, the frequency of concurrent infections would be expected to increase in these areas. To assess this,

Research paper thumbnail of Community-based dengue prevention programs in Puerto Rico: impact on knowledge, behavior, and residential mosquito infestation

The American journal of tropical medicine and hygiene, 2002

Dengue is a major health burden in Puerto Rico. Televised public service announcements and poster... more Dengue is a major health burden in Puerto Rico. Televised public service announcements and posters, elementary and pre-school educational programs, and an exhibit at the Children's Museum in Old San Juan were evaluated separately using knowledge and practices surveys administered to children and their parents, surveys of house lots for larval container habitats, focus groups, and interviews with program organizers and participants. Exposure to the programs was associated with increased dengue-related knowledge, increased proportion of tires protected from rain, decreased proportion of water storage containers positive for mosquito larvae, and increased indoor use of aerosol insecticides. Exposure to the elementary school program was associated with slightly lower indices of residential mosquito infestation. The programs have resulted in high levels of awareness, some behavior change, and limited change in larval indices. Greater emphasis on the skills necessary for community mem...

Research paper thumbnail of Outbreak of dengue fever in Palau, Western Pacific: risk factors for infection

The American journal of tropical medicine and hygiene, 2003

Between January and June 1995, an outbreak of dengue fever occurred in Palau, an island nation of... more Between January and June 1995, an outbreak of dengue fever occurred in Palau, an island nation of 32,000 inhabitants in the Western Pacific. To determine the magnitude of this outbreak and to determine modifiable risk factors to guide control strategies, we established active surveillance at the national hospital and private clinics, reviewed available clinical records, and conducted serologic and entomologic surveys. Between January 1 and July 1, 1995, 817 case-patients with acute febrile illness with body or joint aches and one of the following: headache, rash, nausea, vomiting, or hemorrhagic manifestations presented to health facilities in Palau. The epidemic peaked in the second week of April 1995. Of 338 case-patients tested, 254 (75%) had positive serologic results by an IgM capture enzyme-linked immunosorbent assay. Dengue 4 virus was isolated from 78 (51%) of 154 serum samples tested. Blood samples collected during a cross-sectional survey were tested for IgM antibody and y...

Research paper thumbnail of Excellence in research and education at the John A. Burns School of Medicine: a tribute to Edwin Cadman's vision

Hawaii medical journal, 2005

When Edwin Cadman came to the University of Hawaii (UH) in 1999 to serve as dean of the John A. B... more When Edwin Cadman came to the University of Hawaii (UH) in 1999 to serve as dean of the John A. Burns School of Medicine (JABSOM), he articulated a clear vision for its future. Dr. Cadman saw tremendous potential in our students, staff, faculty, and community. He envisioned ...

Research paper thumbnail of Community involvement in the control of Aedes aegypti

Acta Tropica, 1996

In the past 15 years, there has been a dramatic resurgence of dengue and dengue hemorrhagic fever... more In the past 15 years, there has been a dramatic resurgence of dengue and dengue hemorrhagic fever worldwide, with increased frequency of epidemics and geographic expansion of both the mosquito vectors and the viruses. The reasons for this resurgence are not well understood, but include uncontrolled and unplanned urbanization, increased movement of people and viruses by airplane and lack of

Research paper thumbnail of Approaches to Refining Estimates of Global Burden and Economics of Dengue

PLoS Neglected Tropical Diseases, 2014

Dengue presents a formidable and growing global economic and disease burden, with around half the... more Dengue presents a formidable and growing global economic and disease burden, with around half the world's population estimated to be at risk of infection. There is wide variation and substantial uncertainty in current estimates of dengue disease burden and, consequently, on economic burden estimates. Dengue disease varies across time, geography and persons affected. Variations in the transmission of four different viruses and interactions among vector density and host's immune status, age, pre-existing medical conditions, all contribute to the disease's complexity. This systematic review aims to identify and examine estimates of dengue disease burden and costs, discuss major sources of uncertainty, and suggest next steps to improve estimates. Economic analysis of dengue is mainly concerned with costs of illness, particularly in estimating total episodes of symptomatic dengue. However, national dengue disease reporting systems show a great diversity in design and implementation, hindering accurate global estimates of dengue episodes and country comparisons. A combination of immediate, short-, and long-term strategies could substantially improve estimates of disease and, consequently, of economic burden of dengue. Suggestions for immediate implementation include refining analysis of currently available data to adjust reported episodes and expanding data collection in empirical studies, such as documenting the number of ambulatory visits before and after hospitalization and including breakdowns by age. Shortterm recommendations include merging multiple data sources, such as cohort and surveillance data to evaluate the accuracy of reporting rates (by health sector, treatment, severity, etc.), and using covariates to extrapolate dengue incidence to locations with no or limited reporting. Long-term efforts aim at strengthening capacity to document dengue transmission using serological methods to systematically analyze and relate to epidemiologic data. As promising tools for diagnosis, vaccination, vector control, and treatment are being developed, these recommended steps should improve objective, systematic measures of dengue burden to strengthen health policy decisions.

Research paper thumbnail of USING DISABILITY-ADJUSTED LIFE YEARS TO ASSESS THE ECONOMIC IMPACT OF DENGUE IN PUERTO RICO: 1984-1994

This study presents the disability-adjusted life years (DALYs), a non-monetary economic measure o... more This study presents the disability-adjusted life years (DALYs), a non-monetary economic measure of impact, lost to dengue in Puerto Rico for the period 1984-1994. Data on the number of reported cases, cases with hemorrhagic manifestations, hospitalizations, and deaths were obtained from a surveillance system maintained at the Dengue Branch, Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention

Research paper thumbnail of Evaluation of diagnostic tests: dengue

Nature Reviews Microbiology, 2010

Research paper thumbnail of Serologic Evidence of West Nile Virus Infection in Horses, Yucatan State, Mexico

Research paper thumbnail of West Nile Virus in the New World: Trends in the Spread and Proliferation of West Nile Virus in the Western Hemisphere

Zoonoses and Public Health, 2009

• West Nile Virus (WNV) continues to spread in the Western Hemisphere, with new range extensions ... more • West Nile Virus (WNV) continues to spread in the Western Hemisphere, with new range extensions reported from southern South America. • The record numbers of human WNV infections recorded in Canada during 2007, up to more than 50% over previous record set in 2003, demonstrate that the public health impacts of WNV in North America could increase rather than decrease in future. • Increased capacity for surveillance and diagnosis is needed to better understand the public health risks and impacts from WNV in South America, Central America and the Caribbean Basin region.

Research paper thumbnail of Longitudinal Studies of West Nile Virus Infection in Avians, Yucatán State, México

Vector-Borne and Zoonotic Diseases, 2004

Following the introduction of West Nile virus (WNV) into North America in 1999, surveillance for ... more Following the introduction of West Nile virus (WNV) into North America in 1999, surveillance for evidence of infection with this virus in migratory and resident birds was established in Yucatin State, M6xico in March 2000. Overall, 8611 birds representing 182 species and 14 orders were captured and assayed for antibodies to WNV. Of these, 5066 (59%) birds were residents and 3545 (41%) birds were migrants. Twenty-one (0.24%) birds exhibited evidence of flavivirus infection. Of these, 8 birds had antibodies to WNV by epitope-blocking enzyme-linked immunosorbent assay. Five (0.06%) birds (gray catbird, brown-crested flycatcher, rose-breasted grosbeak, blue bunting and indigo bunting) were confirmed to have WNV infections by plaque reduction neutralization test. The WNV-infected birds were sampled in December 2002 and January 2003. The brown-crested flycatcher and blue bunting presumably were resident birds; the other WNV seropositive birds were migrants. These data provide evidence of WNV transmission among birds in the Yucatin Peninsula.

Research paper thumbnail of Cost-effectiveness of a pediatric dengue vaccine

Vaccine, 2004

To ascertain the economic feasibility of a pediatric tetravalent dengue vaccine, we developed and... more To ascertain the economic feasibility of a pediatric tetravalent dengue vaccine, we developed and calibrated a cost-effectiveness model of vaccinating children at 15 months in Southeast (SE) Asia using a societal perspective. We assumed that full immunization would require