Risk factors for hospitalization of patients with chikungunya virus infection at sentinel hospitals in Puerto Rico.

BACKGROUND: Hospitalization of patients during outbreaks of chikungunya virus has been reported to be uncommon (0.5-8.7%), but more frequent among infants and the elderly. CHIKV was first detected in Puerto Rico in May 2014. We enrolled patients with acute febrile illness (AFI) presenting to two hospital emergency departments in Puerto Rico and tested them for CHIKV infection to describe the frequency of detection of CHIKV-infected patients, identify risk factors for hospitalization, and describe patients with severe manifestations. METHODOLOGY/PRINCIPAL FINDINGS: Serum specimens were collected from patients with AFI and tested by rRT-PCR. During May-December 2014, a total of 3,035 patients were enrolled, and 1,469 (48.4%) had CHIKV infection. A total of 157 (10.7%) CHIKV-infected patients were hospitalized, six (0.4%) were admitted to the intensive care unit, and two died (0.1%). Common symptoms among all CHIKV-infected patients were arthralgia (82.6%), lethargy (80.6%), and myalgia (80.5%). Compared to patients aged 1-69 years (7.3%), infant (67.2%) and elderly (17.3%) patients were nine and two times more likely to be hospitalized, respectively (relative risk [RR] and 95% confidence interval [CI] = 9.16 [7.05-11.90] and 2.36 [1.54-3.62]). Multiple symptoms of AFI were associated with decreased risk of hospitalization, including arthralgia (RR = 0.31 [0.23-0.41]) and myalgia (RR = 0.29 [0.22-0.39]). Respiratory symptoms were associated with increased risk of hospitalization, including rhinorrhea (RR = 1.68 [1.24-2.27) and cough (RR = 1.77 [1.31-2.39]). Manifestations present among <5% of patients but associated with patient hospitalization included cyanosis (RR = 2.20 [1.17-4.12) and seizures (RR = 3.23 [1.80-5.81). DISCUSSION: Among this cohort of CHIKV-infected patients, hospitalization was uncommon, admission to the ICU was infrequent, and death was rare. Risk of hospitalization was higher in patients with symptoms of respiratory illness and other manifestations that may not have been the result of CHIKV infection.

Community beliefs and practices about dengue in Puerto Rico.

OBJECTIVE: In spite of long-term endemicity and repeated government and private efforts, effective, sustained community participation for dengue prevention remains a challenge in Puerto Rico. This study explored differences found in interviews conducted in 2001 in attitudes toward dengue and its prevention by respondents' gender and whether they had a prior dengue infection. Findings may be used to develop messages to promote Aedes aegypti control practices. METHODS: From September to October 2003, 11 focus groups were conducted in San Juan, Puerto Rico. Fifty-nine persons (35 women, 24 men), >or= 18 years of age, who had been identified through the Puerto Rico dengue surveillance system participated in the focus groups. Analysis was based on grounded theory. RESULTS: Women considered dengue important because of its economic, emotional, and health impact, and they were concerned more often than men about insufficient garbage removal and water disposal. Participants with a previous dengue diagnosis were more concerned about risk of the disease, were more knowledgeable about dengue and its prevention, and recommended use of repellents more often than their counterparts without a previous dengue diagnosis. Barriers to sustained dengue prevention included misconceptions from outdated educational materials, "invisibility" of dengue compared with chronic diseases, and lack of acceptance of responsibility for dengue prevention. CONCLUSIONS: Suggested strategies to motivate residents' actions included working with government agencies to address structural problems that increase mosquito populations, improving access to information on garbage collection and water disposal through telephone hotlines, increasing publicity and information about dengue by mass media campaigns, and educating health professionals.

Community beliefs and practices about dengue in Puerto Rico / Creencias y prácticas comunitarias relacionadas con el dengue en Puerto Rico

OBJECTIVE: In spite of long-term endemicity and repeated government and private efforts, effective, sustained community participation for dengue prevention remains a challenge in Puerto Rico. This study explored differences found in interviews conducted in 2001 in attitudes toward dengue and its prevention by respondents' gender and whether they had a prior dengue infection. Findings may be used to develop messages to promote Aedes aegypti control practices. METHODS: From September to October 2003, 11 focus groups were conducted in San Juan, Puerto Rico. Fifty-nine persons (35 women, 24 men), > 18 years of age, who had been identified through the Puerto Rico dengue surveillance system participated in the focus groups. Analysis was based on grounded theory. RESULTS: Women considered dengue important because of its economic, emotional, and health impact, and they were concerned more often than men about insufficient garbage removal and water disposal. Participants with a previous dengue diagnosis were more concerned about risk of the disease, were more knowledgeable about dengue and its prevention, and recommended use of repellents more often than their counterparts without a previous dengue diagnosis. Barriers to sustained dengue prevention included misconceptions from outdated educational materials, " invisibility" of dengue compared with chronic diseases, and lack of acceptance of responsibility for dengue prevention. CONCLUSION: Suggested strategies to motivate residents' actions included working with government agencies to address structural problems that increase mosquito populations, improving access to information on garbage collection and water disposal through telephone hotlines, increasing publicity and information about dengue by mass media campaigns, and educating health professionals.

OBJETIVO: A pesar de la prolongada endemia y los reiterados esfuerzos gubernamentales y privados, la participación efectiva y sostenida de la comunidad en las tareas de prevención del dengue sigue siendo un reto en Puerto Rico. A partir de entrevistas realizadas en 2001 se analizaron las diferencias en las actitudes hacia el dengue y su prevención según el sexo de los encuestados y sus antecedentes de haber sufrido esta enfermedad. Estos resultados pueden servir para desarrollar mensajes dirigidos a promover prácticas de control de Aedes aegypti. MÉTODOS: Entre septiembre y octubre de 2003 sesionaron 11 grupos focales en San Juan, Puerto Rico. Participaron 59 personas (35 mujeres y 24 hombres) de 18 años o más, identificados a través del sistema de vigilancia de dengue de Puerto Rico. El análisis se basó en la teoría fundamentada o inductiva. RESULTADOS: Las mujeres consideraban importante el dengue por su impacto económico, emocional y sanitario y más mujeres que hombres estaban preocupadas por la insuficiente recolección de basura y disposición de aguas residuales. Los participantes con diagnóstico previo de dengue estaban más preocupados por los riesgos de la enfermedad, conocían más sobre el dengue y su prevención y con mayor frecuencia aconsejaron el uso de repelentes que sus pares sin diagnóstico previo de dengue. Entre las barreras para la prevención sostenida del dengue estaban: conceptos erróneos por materiales educativos obsoletos, la " invisibilidad" del dengue en comparación con las enfermedades crónicas y la falta de aceptación de responsabilidad por la prevención del dengue. CONCLUSIONES: Las estrategias sugeridas para motivar la acción de los residentes comprenden: trabajar con las agencias gubernamentales para resolver los problemas estructurales que incrementan las poblaciones de mosquitos, mejorar el acceso a la información sobre la recolección de basura y la disposición de las aguas residuales mediante líneas telefónicas...