Epidemiology and Disease Burden of Pediatric Dengue in Venezuela: Figure 1 (original) (raw)
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The Epidemiology of Dengue in the Americas Over the Last Three Decades: A Worrisome Reality
American Journal of Tropical Medicine and Hygiene, 2010
We have reported the epidemic patterns of dengue disease in the Region of the Americas from 1980 through 2007. Dengue cases reported to the Pan American Health Organization were analyzed from three periods: 1980-1989 (80s), 1990-1999 (90s), and 2000-2007 (2000-7). Age distribution data were examined from Brazil, Venezuela, Honduras, and Mexico. Cases increased over time: 1,033,417 (80s) to 2,725,405 (90s) to 4,759,007 . The highest concentrations were reported in the Hispanic Caribbean (39.1%) in the 80s shifting to the Southern Cone in the 90s (55%) and 2000-7 (62.9%). From 1980 through 1987, 242 deaths were reported compared with 1,391 during 2000-7. The most frequently isolated serotypes were DENV-1 and DENV-2 (90s) and DENV-2 and DENV-3 (2000-7). The highest incidence was observed among adolescents and young adults; dengue hemorrhagic fever incidence was highest among infants in Venezuela. Increasing dengue morbidity/mortality was observed in the Americas in recent decades. * A total of 1,159 cases were not included because the country was not specified. Deaths from 1990-4 are not reported.
Dengue, caused by the four serotypes of dengue virus (DENV), is the most prevalent mosquito-borne viral disease of humans. To examine the incidence and transmission of dengue, the authors performed a prospective community-based cohort study in 5,545 children aged 2–14 years in Managua, Nicaragua, between 2004 and 2010. Children were provided with medical care through study physicians who systematically recorded medical consult data, and yearly blood samples were collected to evaluate DENV infection incidence. The incidence of dengue cases observed was 16.1 cases (range 3.4– 43.5) per 1,000 person-years (95% CI: 14.5, 17.8), and a pattern of high dengue case incidence every other year was observed. The incidence of DENV infections was 90.2 infections (range 45.2–105.3) per 1,000 person-years (95% CI: 86.1, 94.5). The majority of DENV infections in young children (,6 years old) were primary (60%) and the majority of infections in older children ($9 years of age) were secondary (82%), as expected. The incidence rate of second DENV infections (121.3 per 1,000 person-years; 95% CI: 102.7, 143.4) was significantly higher than the incidence rate of primary DENV infections (78.8 per 1,000 person-years; 95% CI: 73.2, 84.9). The rigorous analytic methodology used in this study, including incidence reporting in person-years, allows comparison across studies and across different infectious diseases. This study provides important information for understanding dengue epidemiology and informing dengue vaccine policy.
Archivos Argentinos de Pediatria
Introduction. Dengue is a public health problem worldwide. It was originally confined to tropical and subtropical areas, but it is now present in other regions, such as Argentina. Epidemic outbreaks have been observed in the City of Buenos Aires since 2008, with few reports in children. Objective. To analyze and compare the clinical, epidemiological, laboratory, and evolutionary characteristics of the latest 2 dengue outbreaks outside the endemic area. Population and methods. Time-series study. Patients under 18 years of age with probable or confirmed dengue and evaluated in a children's hospital of the City of Buenos Aires during the periods 2015-2016 and 2019-2020 were included. Results. A total of 239 patients were included; 29 (12%) had a history of travel. Their median age was 132 months (interquartile range: 102-156). All had a fever. Other symptoms included headache in 170 (71%), myalgia in 129 (54%), and rash in 122 (51%). Forty patients (17%) had comorbidities. Warning signs were observed in 79 patients (33%); 14 (6%) developed severe dengue; 115 (45%) were hospitalized; none died. DENV-1 was the most common serotype. A history of travel and hospitalization prevailed in the first period; severe dengue and prior infection, in the second period. Conclusions. No patient died due to dengue in either study period. Statistically significant differences were observed in the frequency of hospitalization; a history of travel was more common in the 2015-2016 period and severe dengue, in the 2019-2020 period.
The Decline of Dengue in the Americas in 2017: Discussion of Multiple Hypotheses
Tropical Medicine & International Health
objective Since the 1980s, dengue incidence has increased 30-fold. However, in 2017, there was a noticeable reduction in reported dengue incidence cases within the Americas, including severe and fatal cases. Understanding the mechanism underlying dengue's incidence and decline in the Americas is vital for public health planning. We aimed to provide plausible explanations for the decline in 2017. methods An expert panel of representatives from scientific and academic institutions, Ministry of Health officials from Latin America and PAHO/WHO staff met in October 2017 to propose hypotheses. The meeting employed six moderated plenary discussions in which participants reviewed epidemiological evidence, suggested explanatory hypotheses, offered their expert opinions on each and developed a consensus. results The expert group established that in 2017, there was a generalised decreased incidence, severity and number of deaths due to dengue in the Americas, accompanied by a reduction in reported cases of both Zika and chikungunya virus infections, with no change in distribution among age groups affected. This decline was determined to be unlikely due to changes in epidemiological surveillance systems, as similar designs of surveillance systems exist across the region. Although sudden surveillance disruption is possible at a country or regional level, it is unlikely to occur in all countries simultaneously. Retrospective modelling with epidemiological, immunological and entomological information is needed. Host or immunological factors may have influenced the decline in dengue cases at the population level through immunity; however, herd protection requires additional evidence. Uncertainty remains regarding the effect on the outcome of sequential infections of different dengue virus (DENV) types and Zika virus (ZIKV), and vice versa. Future studies were recommended that examine the epidemiological effect of prior DENV infection on Zika incidence and severity, the epidemiological effect of prior Zika virus infection on dengue incidence and severity, immune correlates based on new-generation ELISA assays, and impact of prior DENV/other arbovirus infection on ZIKV immune response in relation to number of infections and the duration of antibodies in relation to interval of protection. Follow-up studies should also investigate whether increased vector control intensification activities contributed to the decline in transmission of one or
The growing burden of dengue in Latin America
Journal of Clinical Virology, 2009
The re-emergence and subsequent failure to control dengue in Latin America provides a compelling illustration of the clinical, political and socioeconomic challenges to eradicating dengue across the world. Insufficient political commitment, inadequate financial resources and increased urbanisation have contributed to the re-emergence and dramatic increase in dengue fever and dengue haemorrhagic fever in all 19 Latin American countries previously certified as free of Aedes aegypti. Difficulties with diagnosis, asymptomatic infection and the lack of effective surveillance systems account for the discrepancies between antibody prevalence against dengue and reported cases. Accurate incidence data and appreciation of the economic impact of dengue at regional, national and international levels are essential to securing political and economic commitment for dengue control efforts as well as increased scientific and social awareness. Environmental control efforts require an integrated and systematic approach at both the national and community level, while successful introduction of a dengue vaccine will require an educational programme that clearly communicates the cost-effectiveness and desirability of this interventional measure. In addition, countries must anticipate their national regulatory requirements, and vaccination strategies should be optimised according to the dengue epidemiology of each country. A broad scope is required to finance vaccination programmes to ensure individual countries' monetary shortcomings are addressed.
EPIDEMIOLOGICAL TRENDS OF DENGUE IN CHILDREN AND ADOLESCENTS IN BRAZIL FROM 2014 TO 2023 (Atena Editora), 2024
Dengue is one of the arboviruses of greatest global concern, representing a significant challenge for health systems around the world. The year 2024, in Brazil, has been marked by Dengue epidemics. The epidemiological investigation of this disease, which brings challenges to Brazilian public health, is relevant. The study aims to analyze epidemiological data regarding Dengue in the Brazilian pediatric population over a decade. A quantitative epidemiological analysis method was used using data from the Department of Informatics of the Unified Health System (DATASUS) regarding Dengue in Brazil between 2014 and 2023. During the period there were spikes in cases between 2014 and 2016 followed by a new trend of increase until 2023, highlighting a significant increase between 2018 and 2019. The age group with the most probable cases was 15 to 19 years old. The high number of hospitalizations, especially in 2015, highlights the severity of the disease, especially among children between 10 and 14 years old. The dengue problem requires a multifaceted approach with vector control actions, community education and investment in research and development of effective vaccines and treatments.
Dengue fever: new paradigms for a changing epidemiology
Emerging themes in epidemiology, 2005
Dengue is the most important arthropod-borne viral disease of public health significance. Compared with nine reporting countries in the 1950s, today the geographic distribution includes more than 100 countries worldwide. Many of these had not reported dengue for 20 or more years and several have no known history of the disease. The World Health Organization estimates that more than 2.5 billion people are at risk of dengue infection. First recognised in the 1950s, it has become a leading cause of child mortality in several Asian and South American countries.This paper reviews the changing epidemiology of the disease, focusing on host and societal factors and drawing on national and regional journals as well as international publications. It does not include vaccine and vector issues. We have selected areas where the literature raises challenges to prevailing views and those that are key for improved service delivery in poor countries.Shifts in modal age, rural spread, and social and ...
Dengue in Venezuela:A study on viral transmission, risk factors and clinical disease presentation
2014
Dengue virus (DENV) belongs to the Flavivirus genus of the family Flaviviridae together with yellow fever virus, West Nile virus and Japanese encephalitis virus 1. It is transmitted by the bite of the female mosquito of the Aedes genus, of which A. aegypti is the main vector, followed by A. albopictus 2. There are four different serotypes of DENV called DENV-1 to DENV-4. Infection by DENV can be asymptomatic or result in a variety of clinical manifestations ranging from comparatively mild dengue fever (DF) to severe disease such as dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) 3,4. Dengue viruses (DENVs) are present in the tropical and subtropical areas of the world and are endemic in more than 120 countries within Africa, America, Eastern Mediterranean, Asia, Australia, islands within the Indian Ocean, central and south Pacific and the Caribbean 4. The average number of DF/DHF cases reported by the World Health Organization (WHO) has increased considerably in the past decades and dengue is expanding to new areas 5. Recently, dengue outbreaks occurred in European countries including France, Croatia and Portugal (Madeira) 6. Currently, it is estimated that 390 million dengue infections occur annually worldwide, including both symptomatic and asymptomatic cases 7. Some of the reasons for the expansion of dengue are discussed below. 2. Factors Related to the Increase of Dengue Incidence 2.1. Uncontrolled Urbanization In recent years, a considerable exodus from rural to urban areas of people looking for better economic conditions has taken place in tropical and subtropical countries 8. As a consequence, an increase in population density in urban areas and the establishment of new, largely uncontrolled, urbanization has occurred 9. Irregular water supply and the lack of trash collection are some of the principal characteristics of this unplanned urbanization 8,9. The storage of water in containers and an increased use of non-biodegradable plastics that are left outdoors make appropriate mosquito breeding sites close to domestic areas 10,11. A. aegypti is a domesticated mosquito with a fly range of approximately 100m in urban areas 12. The mosquito feeds more than once in each gonotrophic cycle 13. Because A. aegypti is very sensitive to movement, it interrupts its feeding several times and tries to take bloodmeals from the same or different individuals until its meal is completed 10. The high population density is a risk factor for dengue infections due the short flying distance that the mosquito covers in order to take bloodmeals from one or General Introduction, Scope and Summary of the Thesis 12 several individuals 14. 2.2. Spread of the Dengue Viruses A boost in international tourism contributed to the globalization of the four dengue serotypes 15. The number of international air passengers has increased 40 times between 1950 and 2011 16. International movement of dengue-infected individuals is one of the main reasons of the global transmission of the disease 8. Increased travel from Latin America to the USA and from Asia to Europe represents a major risk for dengue importation according to a geo-spatial model of the transmission of the disease by infected air passengers 17. 2.3. Spread of the Dengue Vector The introduction of A. aegypti to Asia and the Americas probably occurred from Africa, where dengue outbreaks were reported among passengers traveling by ship 18. Recently, the presence of A. aegypti and A. albopictus larvae/eggs has been reported in Europe. These early stages of the mosquitos have been found in used car tires and lucky bamboo plants transported by cargo ship from the USA and Asia to Europe 19,20. Globalization has allowed the spread of the mosquito through international transport. 2.4. Inefficient Vector Control In 1947, PAHO organized a plan to eradicate the vector of yellow fever virus (A. aegypti) from the Americas 21-23. This plan, vertically established, mainly involved elimination of the mosquito larvae and the monitoring of larvae density 3,24. In addition, adult mosquitoes were eliminated through outdoor fumigations using insecticide with residual activity such as DDT 3,21. A aegypti was eliminated from 17 countries of South and Central America 25. However, this campaign gradually deteriorated and was discontinued in the early 1970s without complete mosquito eradication from Cuba, the USA, Venezuela and other Caribbean countries 26. One of the reasons for the weakening of the campaign was the declaration that the "war against yellow fever" had been won and the consequent redirection of resources to the control of other diseases 22. Another reason was the development of resistance to DDT and other organochlorine insecticides by the mosquito 26. As a consequence, A. aegypti re-emerged in several countries producing new dengue epidemics 21,25. In 1994, PAHO decided to abandon the concept of mosquito eradication. Instead, the limited resources were used to reduce the vector to levels of low importance to the health sector 12. Within this new plan, strategies of prevention and control were developed in five key areas: 1) active disease surveillance, involving clinical and laboratory-based CHAPTER 1 General Introduction, Scope and Summary of the Thesis 20 6. Dengue in Venezuela 6.1. History of Dengue Epidemics in Venezuela Although the first description of dengue-like illness in the Americas dates from 1634 106 , the first reports of such disease in Venezuela go back to 1828 and then to 1946 107. However, these reports were only based on clinical manifestations. It was not until the year 1953, when dengue virus was isolated from a patient in Trinidad, that dengue cases were laboratory confirmed 108,109. No dengue epidemics were reported in the Americas between 1946 and 1963, possibly related to the decrease of A. aegypti during the yellow fever eradication plan 110. Since the year 1963 until 2010, Venezuela has reported eight dengue epidemics. These epidemics could be a consequence of: a) Introduction of new serotypes: the epidemics in the years 1963, 1969, 1978 were attributed to the introduction of DENV-3, genotype V 21 , DENV-2, American genotype (V) 109 and DENV-1, genotype III 109,110 respectively. The presence of DENV-4 in Venezuela was first reported in the year 1985 without producing an epidemic 111. During these epidemics no cases of DHF were reported. b) Introduction of new genotypes: the first DHF outbreak reported in Venezuela, and the second in the Americas, took place in 1989-1990. A total of 12,220 dengue cases were reported in Venezuela, of which 3,108 (25.4%) were DHF, and 73 individuals died 112. During this epidemic DENV serotypes 1, 2 and 4 were circulating, but mainly serotype 2. Later, this serotype 2 was identified as the Asian genotype (III) which was gradually displacing the American genotype 91,113. Due to unknown reasons, DENV-3 disappeared from the Americas 11 and was absent from Venezuela for 32 years 94. In the year 2000 DENV serotype 3 was reintroduced producing the greatest dengue epidemic since 1989, with 104,282 reported dengue cases, including 8,727 cases (8.4%) of DHF 114. The introduced DENV serotype 3 was of genotype III 94 , which is generally considered a virulent virus 93,94. Since the re-introduction of this serotype in the year 2000, the four dengue serotypes co-circulate in Venezuela 115. c) DENV evolution "in situ": Phylogenetic analyses of samples taken during 1997-2000 in Aragua state, showed the circulation of a DENV-2 mixed genotype (American/Asian), indicating the evolution and the re-combination of this serotype in situ 116,117. This serotype was positively associated with DHF/ CHAPTER 1 glycoprotein NS1.
Epidemiology of Dengue Among Children Aged < 18 Months-Puerto Rico, 1999-2011
The American journal of tropical medicine and hygiene, 2016
Dengue, a mosquito-borne viral illness caused by dengue virus types (DENV)-1 to DENV-4, is endemic in Puerto Rico. Severe dengue usually occurs in individuals previously infected with DENV or among infants born to previously infected mothers. To describe clinical features of dengue in infants, we retrospectively characterized dengue patients aged < 18 months reported to the Passive Dengue Surveillance System (PDSS) during 1999-2011. To determine frequency of signs, symptoms, and disease severity, case report forms and medical records were evaluated for patients who tested positive for dengue by reverse transcriptase polymerase chain reaction or anti-DENV immunoglobulin Menzyme-linked immunosorbent assay. Of 4,178 reported patients aged < 18 months, 813 (19%) were laboratory positive. Of these, most had fever (92%), rash (53%), bleeding manifestations (52%), and thrombocytopenia (52%). Medical records were available for 145 (31%) of 472 hospitalized patients, of which 40% had d...