Cocirculation of 4 Dengue Virus Serotypes, Putumayo Amazon Basin, 2023-2024.

Latin America is experiencing an unprecedented dengue outbreak, causing an increased health burden. We document the cocirculation of dengue viruses 1-4 in Putumayo, a remote, underserved region at the border between Ecuador and Colombia. Dengue circulation in this largely unexplored territory represents a threat to public health in Putumayo and neighboring areas.

Serotype-Specific Dengue Virus IgG Assay Using EDIII-Based Recombinant Proteins and Its Application in an Endemic Population in Northeast Brazil.

Dengue is the most prevalent arboviral disease globally, with Brazil currently experiencing a significant rise in cases. Dengue virus (DENV) typically co-circulates with other clinically and antigenically similar flaviviruses, such as Zika virus (ZIKV). The clinical diagnosis is difficult and accurate serological analysis represents an unmet challenge. Traditionally, serological analysis of DENV infection focuses on the acute phase via detection of NS1 or IgM. Developing IgG DENV-specific assays has been defiant due to the co-circulation of four antigenically distinct serotypes and a strong cross-reactivity with other arboviruses, particularly with ZIKV. The goal of this study was to produce recombinant domain III of the Envelope (EDIII) proteins of each DENV serotype and ZIKV and evaluate the ability to detect specific IgG antibodies. The antigens were tested on the ELISA platform to measure DENV-specific IgG in mice and patients infected with ZIKV and DENV. The assay differentiated serotype-specific IgG responses in susceptible mice (AG129) experimentally infected with DENV or ZIKV. In addition, the test demonstrated a robust performance achieving 87.8% sensitivity and 91.4% specificity when tested against 648 well-characterized sera collected from humans infected with DENV and/or ZIKV. The test was further applied to serum samples collected from 318 healthy individuals from an endemic region in Northwest/Central Brazil, without a previous diagnosis of DENV, and revealed that 65% of the samples reacted with at least one DENV serotype antigen, including 123 monotypic samples (88 for DENV-1) and 90 samples reacting with multiple antigens. Collectively, these results indicate that the IgG DENV-EDIII ELISA is a valuable tool for assessing the serological status of populations in endemic areas, particularly in regions where other flaviviruses, particularly ZIKV, co-circulate and offer support to establish public health policies against the disease.

Dengue and severe dengue with neurological complications: a challenge for prevention and control.

Dengue is the main urban arbovirus in the Americas. The disease manifests in a varied spectrum: from asymptomatic cases to those with neurological involvement, which is considered a severe form of the disease. Its annual reemergence represents a serious public health problem. The rise in the number of cases causes an increase in the number of patients with neurological manifestations of the disease, which can range from headaches to more serious conditions such as encephalitis and Guillain-Barré syndrome, with high potential of death or sequelae. Dengue prevention and control strategies should also be a concern for neurologists. The aim of the present study is to carry out a narrative review of the current methods to prevent dengue fever and its severe forms, such as cases with neurological complications. The main control measures include vaccination, which is still carried out on a small scale, vector control, and individual protection. The CYD-TDV/Dengvaxia and TAK-003/DENVax vaccines, licensed for use by the Brazilian National Health Regulatory Agency (Agência Nacional de Vigilância Sanitária, ANVISA, in Portuguese), show efficacy against hospitalizations of 72.7% (95% confidence interval [95%CI]: 62.3-80.3%) and of 90.4% (95%CI: 82.6-94.7%) respectively. The TV003/TV005 vaccine, which is being studied by Intituto Butantan in Brazil, shows promising results, with an efficacy of 79.6% for symptomatic dengue. Vector control is based on biotechnological and behavioral measures, as well as on the improvement of basic sanitation conditions. The main individual protection measure is the use of topical repellents (icaridin). All of these actions represent important tools for the prevention of dengue fever and its neurological complications.

A dengue é a principal arbovirose urbana das Américas. A doença manifesta-se num espectro variado: desde casos assintomáticos até aqueles com envolvimento neurológico, que são considerados formas graves da doença. Sua reemergência anual representa um grave problema de saúde pública. O aumento do número de casos provoca o aumento do número de pacientes com manifestações neurológicas da doença, que podem variar de cefaleia a condições graves, como a encefalite e a síndrome de Guillain-Barré, com elevado potencial de morte ou sequelas. As estratégias de prevenção e controle da dengue também devem ser uma preocupação dos neurologistas. O objetivo deste estudo é fazer uma revisão narrativa dos métodos atuais de prevenção da dengue e das formas graves, como os casos com complicações neurológicas. As principais medidas de controle incluem a vacinação, que ainda é realizada em pequena escala, o controle do vetor e a proteção individual. As vacinas CYD-TDV/Dengvaxia e TAK-003/DENVax, aprovadas para uso pela Agência Nacional de Vigilância Sanitária (Anvisa), apresentam eficácia contra hospitalizações de 72,7% (intervalo de confiança de 95% [IC95%]: 62,3­80,3%) e de 90,4% (IC95%: 82,6­94,7%), respectivamente. A vacina TV003/TV005, que está sendo desenvolvida pelo Instituto Butantan no Brasil, apresenta resultados promissores, com uma eficácia de 79,6% para a dengue sintomática. O controle vetorial baseia-se em medidas biotecnológicas e comportamentais, assim como na melhoria das condições de saneamento básico. A principal proteção individual é o uso de repelentes tópicos (icaridina). Todas essas ações representam importantes ferramentas para a prevenção da dengue e das suas complicações neurológicas.

[Acute undifferentiated febrile illness among outpatients: differential diagnosis between dengue, zika, Argentine hemorrhagic fever and COVID-19]. / Síndrome febril agudo inespecífico en pacientes ambulatorios: diagnóstico diferencial entre dengue, zika, fiebre hemorrágica argentina y COVID-19.

The "acute undifferentiated febrile illness" (AUFI) encompasses a range of diseases characterized by the presence of fever, often prompting consultations in emergency services. During epidemics like COVID-19 or dengue, a surge in consultations occurs, resulting in long wait times for patients. Errors in first diagnosis can result in severe consequences. The objective is to provide a comprehensive review of the clinical approach to AUFI, focusing on certain viral infections (dengue, zika, Argentine hemorrhagic fever and COVID-19). This involves a detailed examination of the clinical presentation, laboratory and radiological findings, neurological manifestations, and definitive diagnosis through specific serological tests. AUFI is characterized by the onset of acute fever lasting less than seven days, accompanied by myalgia or headache without involvement of the upper respiratory tract and without a defined cause. Most cases are caused by common, self-limiting viral infections (e.g., influenza); however, they may also stem from more serious viral infections with a broad etiological spectrum. The differential diagnosis of acute febrile syndromes includes various infectious diseases, such as those previously mentioned. The definitive diagnosis is based on serological methods, PCR and IgM. Recommendations based on scientific evidence can help with early diagnosis and prevent possible serious complications.

El "síndrome febril agudo inespecífico" (SFAI) abarca una variedad de enfermedades que se distinguen por la presencia de fiebre, convirtiéndose en una causa común de consulta en los servicios de urgencias. Durante epidemias como la del COVID-19 o dengue (brote epidémico), se observa un aumento significativo de consultas con larga fila de pacientes esperando ser atendidos. Errores u omisiones en el diagnóstico inicial pueden acarrear graves consecuencias. El objetivo es ofrecer una revisión exhaustiva del enfoque clínico del SFAI, centrándose en determinadas infecciones virales (dengue, zika, fiebre hemorrágica argentina y COVID-19). Se examina detalladamente la presentación clínica, los hallazgos de laboratorio y radiológicos, las manifestaciones neurológicas y el diagnóstico definitivo mediante pruebas serológicas específicas. El SFAI se caracteriza por la aparición de fiebre aguda que dura menos de siete días, acompañada de mialgia o dolor de cabeza, sin afectación de las vías respiratorias superiores y sin una causa definida. La mayoría de los casos se deben a infecciones virales comunes, que suelen ser autolimitadas (ej. influenza); sin embargo, también pueden ser el resultado de infecciones virales más graves con un amplio espectro etiológico. El diagnóstico diferencial de los síndromes febriles agudos abarca diversas enfermedades infecciosas, como las mencionadas previamente. El diagnóstico definitivo se basa en métodos serológicos, PCR e IgM. Las recomendaciones basadas en evidencia científica pueden ayudar a un diagnóstico temprano y prevenir serias complicaciones.

Dengue Mimickers: Which Clinical Conditions Can Resemble Dengue Fever?

Epidemics and outbreaks caused by the dengue virus pose risks to populations and have high mortality rates, causing burdens and economic costs worldwide. Brazil recently experienced an explosive increase in the number of dengue cases and fatalities. Dengue is an acute febrile illness that can progress to severe forms. It affects more than 100 countries, presenting ongoing challenges in Brazil and globally since its identification. Other conditions may be overlooked or mistaken for dengue. The most important differential diagnoses are other infectious diseases and rheumatological, hematological, gastroenterological, and neurological disorders. In this article, we discuss the primary differential diagnoses of dengue and offer a literature review highlighting the key clinical differences among clinicians. This review emphasizes the critical importance of differentiating dengue fever from infectious diseases such as meningococcemia and malaria and autoimmune and rheumatological conditions such as systemic lupus erythematosus to ensure timely and appropriate management.

Cost of dengue in Colombia: A systematic review.

BACKGROUND: Dengue is hyperendemic in Colombia. It imposes a substantial economic burden on patients, caregivers, society, and the national health system. We intend to identify and synthesize the evidence regarding the economic burden of dengue in Colombia. METHODS: A systematic review (PROSPERO CRD42021257985) of economic studies was performed. A comprehensive search was completed in PubMed, EMBASE, the Cochrane Library, the LILACS, and SciELO databases. Study selection and data extraction was made by two researchers. RESULTS: 160 records were identified. Of these, 14 studies were selected for data extraction. Direct medical cost of dengue is mainly represented by hospitalization (USD 823 to 1,754). The annual aggregated cost is near to USD 159.6 million, with ambulatory care (USD 90.1 million) and fatal cases (USD 30.7 million) representing 75% of the total cost. The aggregate indirect cost (due to loss in income while sick or as a caretaker) was USD 92.8 million. Vaccination seems to reduce the economic cost of dengue. CONCLUSIONS: Dengue financial burden could be challenging for low-income communities as those affected in Colombia. An integrated approach including vector control and the introduction of a vaccine for dengue has the potential to reduce the economic burden of the disease.

Climate-based modelling and forecasting of dengue in three endemic departments of Peru.

Amid profound climate change, incidence of dengue continues to rise and expand in distribution across the world. Here, we analysed dengue in three coastal departments of Peru which have recently experienced public health emergencies during the worst dengue crises in Latin American history. We developed a climate-based spatiotemporal modelling framework to model monthly incidence of new dengue cases in Piura, Tumbes, and Lambayeque over 140 months from 2010 to 2021. The framework enabled accurate description of in-sample and out-of-sample dengue incidence trends across the departments, as well as the characterisation of the timing, structure, and intensity of climatic relationships with human dengue incidence. In terms of dengue incidence rate (DIR) risk factors, we inferred non-linear and delayed effects of greater monthly mean maximum temperatures, extreme precipitation, sustained drought conditions, and extremes of a Peruvian-specific indicator of the El Niño Southern Oscillation. Building on our model-based understanding of climatic influences, we performed climate-model-based forecasting of dengue incidence across 2018 to 2021 with a forecast horizon of one month. Our framework enabled representative, reliable forecasts of future dengue outbreaks, including correct classification of 100% of all future outbreaks with DIR ≥ 50 (or 150) per 100,000, whilst retaining relatively low probability of 0.12 (0.05) for false alarms. Therefore, our model framework and analysis may be used by public health authorities to i) understand climatic drivers of dengue incidence, and ii) alongside our forecasts, to mitigate impacts of dengue outbreaks and potential public health emergencies by informing early warning systems and deployment of vector control resources.

Epidemiology of Dengue - Puerto Rico, 2010-2024.

Dengue is a mosquitoborne viral illness that can cause acute febrile illness, severe disease, or death. Worldwide, the number of dengue cases is increasing. During the last dengue outbreaks in Puerto Rico throughout 2010-2013, dengue virus (DENV) serotype 1 (DENV-1) predominated, and the largest proportion of cases occurred among adolescents and young adults aged 10-19 years. Dengue case data from January 1, 2010-November 4, 2024, were obtained from the Puerto Rico Department of Health. Bivariate analyses were conducted to evaluate the distribution of cases by patient age, DENV serotype, and hospitalization status during three periods: 2010-2019, 2020-2022, and 2023-2024. During 2023-2024, the median age of dengue cases increased to 26 years (95% CI = 25-27 years) compared with that during 2020-2022 (17 years; 95% CI = 17-18 years) and 2010-2019 (19 years; 95% CI = 19-19 years). After >10 years of DENV-1 predominance, the proportions of DENV serotypes 2 (DENV-2) and 3 (DENV-3) increased significantly during 2023-2024, with DENV-3 replacing DENV-1 as the predominant serotype. In addition, the proportion of dengue patients who were hospitalized increased from 35.7% (2010-2019) to 53.5% (2023-2024). The current dengue outbreak in Puerto Rico marks a shift in serotype predominance to DENV-3 and increasing percentages of cases in older age groups (61.7% in adults aged ≥20 years), although a high proportion of cases still occur among adolescents aged 10-19 years (29.5%). The current dengue outbreak also has a higher rate of hospitalizations than those in previous years. Understanding the changing epidemiology of dengue is crucial to guiding public health strategies for dengue control, including clinical management, surveillance and health care system resilience, and public outreach and education.

Impact of prior dengue infection on severity and outcomes: meta-analysis of placebo-controlled trials / Impacto de la infección previa de dengue en la gravedad y los resultados: metanálisis de ensayos controlados con placebo / Impacto da infecção prévia por dengue na gravidade e nos desfechos: metanálise de ensaios controlados por placebo

[ABSTRACT]. Objective. This study evaluated the association between serologically confirmed prior dengue infection and the subsequent risk of virologically confirmed dengue, severe dengue, dengue hospitalization, denguerelated death and all-cause mortality. Methods. A systematic review and meta-analysis were conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, CINAHL, MEDLINE, the Cochrane Library and Web of Science were searched for reports of phase III randomized controlled trials of vaccine efficacy that had data about the placebo group and information about prior infections and were published between January 1994 and March 2024. Random-effects models were used to calculate combined odds ratios (ORs), and heterogeneity was assessed. Results. Four studies from three phase III trials were included. Participants with prior infection had a lower likelihood of developing virologically confirmed dengue during follow up (OR: 0.85, 95% confidence interval [CI]: 0.75 to 0.98, P = 0.024) and the same risk of dengue hospitalization as those without prior infection (OR: 1.18, 95% CI: 0.92 to 1.53, P = 0.198). However, they had a higher rate of severe dengue (OR: 2.91, 95% CI: 1.23 to 6.87, P = 0.015). No dengue-related deaths occurred during follow up. There were no statistically significant differences in all-cause mortality between individuals with and without prior dengue (OR: 1.74, 95% CI: 0.21 to 14.08, P = 0.76). Conclusions. Prior dengue infection significantly reduced the risk of virologically confirmed dengue and increased the risk of severe dengue, but had no significant effect on dengue hospitalization, dengue-related death or all-cause mortality during follow up. These findings suggest the need to reconsider prior infection as an independent risk factor.

[RESUMEN]. Objetivo. Este estudio evaluó la asociación entre la infección previa de dengue confirmada serológicamente y el riesgo posterior de dengue confirmado virológicamente, dengue grave, hospitalización por dengue, muerte relacionada con el dengue y mortalidad por cualquier causa. Métodos. Se llevó a cabo una revisión sistemática y un metanálisis según las directrices PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Se realizaron búsquedas en PubMed, CINAHL, MEDLINE, Cochrane Library y Web of Science de presentaciones de ensayos clínicos de fase III aleatorizados y comparativos sobre la eficacia de las vacunas, que incluyeran datos del grupo placebo e información sobre infecciones previas, publicados entre enero de 1994 y marzo del 2024. Se utilizaron modelos de efectos aleatorios para calcular las razones de posibilidades (OR por su sigla en inglés) combinadas y se evaluó la heterogeneidad. Resultados. Se incluyeron cuatro estudios de tres ensayos de fase III. Los participantes con infección previa tuvieron una menor probabilidad de presentar dengue confirmado virológicamente durante el seguimiento (OR: 0,85; intervalo de confianza [IC] del 95%: 0,75 a 0,98; p = 0,024) y el mismo riesgo de hospitalización por dengue que las personas sin infección previa (OR: 1,18; IC del 95%: 0,92 a 1,53; p = 0,198). Sin embargo, presentaron una tasa de dengue grave superior (OR: 2,91; IC del 95%: 1,23 a 6,87; p = 0,015). No se produjeron muertes relacionadas con el dengue durante el seguimiento. No hubo diferencias estadísticamente significativas en la mortalidad por cualquier causa entre las personas con y sin dengue previo (OR: 1,74; IC del 95%: 0,21 a 14,08; P = 0,76). Conclusiones. La infección previa por dengue redujo significativamente el riesgo de dengue confirmado virológicamente y aumentó el riesgo de dengue grave, pero no tuvo un efecto significativo sobre la hospitalización por dengue, la muerte relacionada con el dengue o la mortalidad por cualquier causa durante el seguimiento. Estos resultados sugieren que es necesario considerar la infección previa un factor de riesgo independiente.

[RESUMO]. Objetivo. Este estudo avaliou a associação entre uma infecção prévia por dengue confirmada sorologicamente e o risco subsequente de dengue confirmada virologicamente, dengue grave, hospitalização por dengue, morte relacionada a dengue e mortalidade por todas as causas. Métodos. Foram conduzidas revisão sistemática e metanálise de acordo com as diretrizes PRISMA (sigla em inglês para “principais itens para relatar revisões sistemáticas e metanálises”). Foram feitas buscas nas bases de dados PubMed, CINAHL, MEDLINE, Biblioteca Cochrane e Web of Science por relatos de ensaios clínicos randomizados controlados de fase III sobre a eficácia de vacinas que tivessem dados sobre o grupo placebo e informações sobre infecções prévias e tivessem sido publicados entre janeiro de 1994 e março de 2024. Modelos de efeitos aleatórios foram usados para calcular as razões de chances (RCs) combinadas, e a heterogeneidade foi avaliada. Resultados. Foram incluídas quatro publicações de três ensaios clínicos de fase III. Os participantes com infecção prévia tiveram menor probabilidade de desenvolver dengue confirmada virologicamente durante o acompanhamento (RC: 0,85, intervalo de confiança [IC] de 95%: 0,75 a 0,98, P = 0,024) e o mesmo risco de hospitalização por dengue que participantes sem infecção prévia (RC: 1,18, IC de 95%: 0,92 a 1,53, P = 0,198). No entanto, eles tiveram uma taxa mais alta de dengue grave (RC: 2.91, IC de 95%: 1,23 a 6,87, P = 0,015). Não houve mortes relacionadas a dengue durante o acompanhamento. Não houve diferenças estatisticamente significantes na mortalidade por todas as causas entre indivíduos com e sem dengue prévia (RC: 1,74, IC de 95%: 0,21 a 14,08, P = 0,76). Conclusões. A infecção prévia por dengue reduziu significativamente o risco de dengue confirmada virologicamente e aumentou o risco de dengue grave, mas não teve efeito significativo na hospitalização por dengue, morte relacionada a dengue ou mortalidade por todas as causas durante o acompanhamento. Os achados sugerem a necessidade de reconsiderar a infecção prévia como fator de risco independente.

Vigilância epidemiológica das unidades de saúde da atenção secundária e terciária de Goiás: 2 ª coletânea de boletins dos núcleos de epidemiologia da RENAVEH-GO / Epidemiological surveillance of secondary and tertiary care health units in Goiás: collection of bulletins from the RENAVEH-GO epidemiology centers

Coletânea de boletins dos Núcleos de epidemiologia das unidades de saúde do estado de Goiás que notificam os casos suspeitos ou confirmados de óbitos e realizam a análise e interpretação desses dados para que sejam transformados em informação para a comunicação aos demais níveis de vigilância epidemiológica para subsidiar a tomada de decisão dos gestores de saúde. Trata-se de um estudo descritivo, realizado com dados secundários com informações provenientes das declarações de óbitos e prontuário eletrônico do paciente via Sistema de Prontuário Eletrônico do Paciente MVPEP

Collection of bulletins from the Epidemiology Centers of the health units of the state of Goiás that report suspected or confirmed cases of death and perform the analysis and interpretation of this data so that it can be transformed into information for communication to other levels of epidemiological surveillance to support the decision-making of health managers. This is a descriptive study, carried out with secondary data with information from death certificates and electronic patient records via the Electronic Patient Record System MVPEP

Caracterización clínica de dengue con signos de alarma y dengue grave en adultos: Hospital Roosevelt, Guatemala / Clinical characterization of dengue with warning signs and severe dengue in adults: Roosevelt Hospital, Guatemala / Caracterização clínica da dengue com sinais de alerta e dengue grave em adultos: Hospital Roosevelt, Guatemala

Introducción: El dengue es uno de los arbovirus de mayor importancia clínica y epidemiológica a nivel mundial. En Guatemala, durante el 2023 se registró el número más alto de casos en los últimos 10 años y un incremento de 135% en el número de casos comparado con el 2022. Objetivo: Caracterización clínica de dengue con signos de alarma y dengue grave. Metodología: Estudio descriptivo transversal retrospectivo, incluyó registros de 206 pacientes con signos de alarma de dengue que acudieron a la Emergencia de Adultos del Hospital Roosevelt de Guatemala, del 26 de septiembre al 26 de noviembre del 2023. Resultados: Predominó el sexo femenino en 54,4% y el grupo etario de 12-22 años en 51,0%. El principal signo de alarma fue el sangrado en 63,6%. Las mayores complicaciones fueron hepatopatía en 9,2%, choque en 5,8% y alteración neurológica en 2,9%. Respecto a los parámetros hematológicos, predominaron la trombocitopenia en 93,2%, leucopenia en 53,9% y linfocitosis en 71,4%. Las transaminasas AST y ALT presentaron elevación en 97,0% (96/99) y 91,0% (142/156), respectivamente. Los tiempos de coagulación se mostraron prolongados en 55,9% (104/186) para TPT y en 22,6% (42/186) para TP. Hubo 78,7% de positividad (148/188) para dengue. El 8,3% (17/206) de los pacientes fue referido al área crítica por clasificación de dengue grave. Conclusión: Estos datos aportan una mejora en el reconocimiento y el manejo clínico adecuado de casos con signos de alarma y dengue grave, que pueden contribuir para disminuir la carga de morbimortalidad de esta enfermedad en el país.

Introduction: Dengue is one of the most clinically and epidemiologically important arboviruses worldwide. In Guatemala, the highest number of cases in the last 10 years was recorded in 2023 and an increase of 135% in the number of cases compared to 2022. Objective: Clinical characterization of dengue with warning signs and severe dengue. Methodology: Retrospective cross-sectional descriptive study, included records of 206 patients with warning signs of dengue who attended the Adult Emergency of the Roosevelt Hospital in Guatemala, from September 26 to November 26, 2023. Results: The female sex predominated in 54,4% and the age group of 12-22 years in 51,0%. The main warning sign was bleeding in 63,6%. The major complications were liver disease in 9,2%, shock in 5,8% and neurological alterations in 2,9%. Regarding hematological parameters, thrombocytopenia predominated in 93,2%, leukopenia in 53,9% and lymphocytosis in 71,4%. The transaminases AST and ALT were elevated in 97,0% (96/99) and 91,0% (142/156), respectively. Coagulation times were prolonged in 55,9% (104/186) for TPT and in 22,6% (42/186) for TP. There was 78,7% positivity (148/188) for dengue. The 8,3% (17/206) of patients were referred to the critical area for classification of severe dengue. Conclusion: These data provide an improvement in the recognition and adequate clinical management of cases with warning signs and severe dengue, which can contribute to reducing the burden of morbidity and mortality from this disease in the country.

Introdução: A dengue é uma das arboviroses de maior importância clínica e epidemiológica em todo o mundo. Na Guatemala, durante 2023 foi registrado o maior número de casos dos últimos 10 anos e um aumento de 135% no número de casos em relação a 2022. Objetivo: Caracterização clínica da dengue com sinais de alerta e dengue grave. Metodologia: Estudo descritivo transversal que incluiu registros de 206 pacientes com sinais de alerta de dengue atendidos na Emergência Adulto do Hospital Roosevelt, na Guatemala, no período de 26 de setembro a 26 de novembro de 2023. Resultados: O sexo feminino predominou em 54,4% e na faixa etária de 12 a 22 anos em 51,0%. O principal sinal de alerta foi sangramento em 63,6%. As principais complicações foram doença hepática em 9,2%, choque em 5,8% e alteração neurológica em 2,9%. Em relação aos parâmetros hematológicos, houve predomínio de trombocitopenia em 93,2%, leucopenia em 53,9% e linfocitose em 71,4%. As transaminases AST e ALT foram elevadas em 97,0% (96/99) e 91,0% (142/156), respectivamente. Os tempos de coagulação foram prolongados em 55,9% (104/186) para TPT e em 22,6% (42/186) para TP. Houve 78,7% de positividade (148/188) para dengue. 8,3% (17/206) dos pacientes foram encaminhados para a área crítica devido à classificação de dengue grave. Conclusão: Esses dados proporcionam uma melhoria no reconhecimento e manejo clínico adequado dos casos com sinais de alerta e dengue grave, o que pode contribuir para a redução da carga de morbidade e mortalidade dessa doença no país.

Factores de riesgo a la exposición al virus DENV 1-4 / Risk factors for exposure to DENV1-4 virus

Objetivo: Evaluar los factores de riesgo a la exposición de virus de dengue en el Municipio Chacao entre enero y marzo de 2024. Método: La población objeto de la presente investigación estuvo conformada por todos los habitantes del municipio Chacao atendidos en los distintos ambulatorios de Salud Chacao durante los meses enero-marzo del año 2024. El presente estudio es una investigación de campo, que utilizó como técnicas de procesamiento las entrevistas estructuradas para la recopilación de datos: el registro, la clasificación y la tabulación de la información aplicada a 50 pacientes del municipio. Resultados: en 50 personas estudiadas: 52 % han estado expuestos siempre o casi siempre a mosquitos, 10 % usa medidas de protección de barrera anti zancudos permanentemente y 28 % ocasionalmente, 42 % tiene aguas estancadas cerca de su vivienda. Conclusiones: Los factores de riesgo a la exposición a virus del dengue, son multifactoriales, incluyen como intrínsecos a edad, factores inmunitarios, falta de higiene, etc. y extrínsecos (ambientales) como: ausencia o incumplimiento de políticas de saneamiento, que trae como consecuencia: estancamiento de aguas, presencia de criaderos, poca o nulas campañas de concientización, etc. La prevención y el control de exposición a virus del dengue requieren un enfoque integral que aborde la acción de planes gubernamentales de control ambiental, la promoción de la salud y la participación comunitaria para reducir la incidencia de esta enfermedad transmitida por mosquitos

Objective: To evaluate the risk factors for exposure to the dengue virus in the Chacao Municipality between January and March 2024. Method: The population object of this investigation was made up of all the inhabitants of the Chacao municipality treated in the different outpatient clinics of Salud Chacao during the months of January-March of 2024. The present study is a field investigation, which was used as techniques processing structured interviews for data collection: registration, classification and tabulation of information applied to 50 patients from the municipality. Conclusions: It is necessary to affirm that the risk factors for contracting dengue are multifactorial and include aspects that range from intrinsic factors (age of the population, immune factors, etc.) to extrinsic factors (water stagnation, lack of hygiene, presence of breeding sites, little or no awareness campaigns, etc.). Dengue prevention and control requires a comprehensive approach that addresses breeding sites elimination, health promotion, and community engagement to reduce the incidence of this mosquito-borne disease.

Boletim epidemiológico: monitoramento dos casos de arboviroses em Goiás da semana epidemiológica 01 a 50 de 2024 / Epidemiological bulletin: monitoring of arbovirus cases in Goiás from epidemiological week 01 to 50 of 2024

As arboviroses transmitidas pelo mosquito Aedes aegypt são um dos principais problemas de saúde pública no Estado de Goiás. O boletim epidemiológico das arboviroses tem o objetivo de apresentar a situação epidemiológica dos casos no estado, utilizando como fonte de dados os registros de casos suspeitos e confirmados ocorridos nos últimos anos, disponíveis no SINAN Online e SINAN Net também são apresentados dados relativos à síndrome congênita associada à infecção peli Zika vírus, disponíveis no Sistema de Registro de Eventos em Saúde Pública (RESP) - Microcefalias

Arboviruses transmitted by the Aedes aegypt mosquito are one of the main public health problems in the State of Goiás. The arboiross epidemiological bulletin aims to present the epidemiological situation of cases in the state, using records of suspected and confirmed cases as a data source. occurred in recent years, available on SINan Online and SINAN Net, data relating to congenital syndrome associated with Zika virus infection, available on the Public Health Event Registration System (RESP) - Microcephaly, is also presented

Development of an Integrated Surveillance System to Improve Preparedness for Arbovirus Outbreaks in a Dengue Endemic Setting: Descriptive Study.

Background: Dengue fever, transmitted by Aedes aegypti and Aedes albopictus mosquitoes, poses a significant public health challenge in tropical and subtropical regions. Dengue surveillance involves monitoring the incidence, distribution, and trends of infections through systematic data collection, analysis, interpretation, and dissemination. It supports public health decision-making, guiding interventions like vector control, vaccination campaigns, and public education. Objective: Herein, we report the development of a surveillance system already in use to support public health managers against dengue transmission in Foz do Iguaçu, a dengue-endemic Brazilian city located in the Triple Border with Argentina and Paraguay. Methods: We present data encompassing the fieldwork organization of more than 100 health agents; epidemiological and entomological data were gathered from November 2022 to April 2024, totalizing 18 months of data collection. Results: By registering health agents, we were able to provide support for those facing issues to fill their daily milestone of inspecting 16 traps per working day. We filtered dengue transmission in the city by patient age, gender, and reporting units, as well as according to dengue virus serotype. The entomological indices presented a strong seasonal pattern, as expected. Several longtime established routines in Foz do Iguaçu have been directly impacted by the adoption of Vigilância Integrada com Tecnologia (VITEC). Conclusions: The implementation of VITEC has enabled more efficient and accurate diagnostics of local transmission risk, leading to a better understanding of operational activity patterns and risks. Lately, local public health managers can easily identify hot spots of dengue transmission and optimize interventions toward those highly sensitive areas.

[Dengue, rabies and measles in the post-COVID-19 pandemic era]. / Dengue, rabia y sarampión en la era postpandemia de la COVID-19.

After the COVID-19 pandemic, efforts have gradually been focused on medical care, epidemiological surveillance, and preventive health programs. An example of this is the identification during 2023 by the Epidemiological Surveillance System [of Mexico] of the increase in dengue cases and the presence of serotype 3, as well as cases of measles (imported and related to importation) and, at the same time, cases of human rabies with transmission from pet animals. Mexico's health system has been characterized by achievements in vaccine-preventable pathologies, as well as the robust epidemiological surveillance system for febrile exanthematous illness and vector-transmitted diseases. In this essay, the previous and current situation of selected diseases in Mexico in the post-pandemic stage of COVID-19 is presented.

Tras el paso de la pandemia de COVID-19, paulatinamente se han encaminado los esfuerzos en la atención médica, la vigilancia epidemiológica y los programas preventivos de salud. Un ejemplo de ello es la identificación durante el 2023 por parte del Sistema de Vigilancia Epidemiológica del incremento de los casos de dengue y la presencia del serotipo 3, así como de los casos de sarampión (importado y relacionados con importación) y a la vez de los casos de rabia humana con transmisión de animal de compañía. El sistema de salud de México se ha caracterizado por logros en las patologías prevenibles por vacunación, así como por el robusto sistema de vigilancia epidemiológica de enfermedad febril exantemática y de enfermedades transmitidas por vector. En el presente ensayo se exponen la situación previa y actual de enfermedades seleccionadas en México en la etapa posterior a la pandemia de la COVID-19.

Exploring the Contrasts and Similarities of Dengue and SARS-CoV-2 Infections During the COVID-19 Era.

Extensive research has been conducted on the SARS-CoV-2 virus in association with various infectious diseases to understand the pathophysiology of the infection and potential co-infections. In tropical countries, exposure to local viruses may alter the course of SARS-CoV-2 infection and coinfection. Notably, only a portion of the antibodies produced against SARS-CoV-2 proteins demonstrate neutralizing properties, and the immune response following natural infection tends to be temporary. In contrast, long-lasting IgG antibodies are common after dengue virus infections. In cases where preexisting antibodies from an initial dengue virus infection bind to a different dengue serotype during a subsequent infection, there is a potential for antibody-dependent enhancement (ADE) and the formation of immune complexes associated with disease severity. Both SARS-CoV-2 and dengue infections can result in immunodeficiency. Viral proteins of both viruses interfere with the host's IFN-I signaling. Additionally, a cytokine storm can occur after viral infection, impairing a proper response, and autoantibodies against a wide array of proteins can appear during convalescence. Most of the reported autoantibodies are typically short-lived. Vaccines against both viruses alter the immune response, affecting the course of viral infection and enhancing clearance. A comprehensive analysis of both viral infections and pathogenicity is revisited to prevent infection, severity, and mortality.

Monitoring of pyrethroid resistance in Aedes aegypti: first report of double and triple kdr mutations in Buenos Aires Province.

BACKGROUND: Dengue is an emerging disease in Argentina due to the colonization of Aedes aegypti, the mosquito vector. Buenos Aires Province is the biggest and most populated district in Argentina, suffering dengue outbreaks of growing magnitude. During epidemic periods, pyrethroid insecticides are used in this country to control adult mosquitoes. Pyrethroid resistance in dengue vectors has been reported worldwide, making it necessary to implement resistance management strategies. The voltage-gated sodium channel is the target site of pyrethroids. Mutations in the gene encoding this protein, called kdr mutations, are usually the molecular cause of pyrethroid resistance in insects. In Ae. aegypti from the Americas, three kdr substitutions were described: V410L, V1016I, and F1534C. The diagnostic of kdr mutations is recommended for the early detection of pyrethroid resistance as well as the consequent planning of evidence-based control policies. METHODS: We distributed ovitraps across 16 localities in Buenos Aires Province, collecting 22,123 eggs. A total of 522 mosquitoes were genotyped in positions 1016 and 1534 of voltage-gated channel using multiplex high-resolution melting and/or TaqMan probe methods. A subset of 449 samples was also genotyped by a singleplex high-resolution melting method developed ad hoc and/or Sanger sequencing. RESULTS: We have documented, for the first time to our knowledge in the central region of Argentina, the presence of the 1016Ikdr + 1534Ckdr allele. Additionally, our study reports the first identification of the V410L mutation in central Argentina. These results underscore a growing trend of pyrethroid resistance in Ae. aegypti, fueled by the widespread use of these insecticides. CONCLUSIONS: We detected 1016Ikdr + 1534Ckdr and 410Lkdr mutations in central Argentina for the first time and improved the processivity and accuracy of kdr genotyping methods. The results are both a tool for resistance monitoring and a sign of alarm to direct efforts towards finding sustainable methods for vector control to complement or replace pyrethroids. Joint efforts between academia and authorities to develop and implement public policies for vector control are a productive way to transfer scientific results for their application in public health.

Retrospective epidemiologic and genomic surveillance of arboviruses in 2023 in Brazil reveals high co-circulation of chikungunya and dengue viruses.

BACKGROUND: The rapid spread and increase of chikungunya (CHIKV) and dengue (DENV) cases in Brazilian regions in 2023 has raised concerns about the impact of arboviruses on public health. Epidemiological and genomic surveillance was performed to estimate the introduction and spread of CHIKV and DENV in Brazil. METHODS: This study obtained results from the Hermes Pardini (HP), a private medical laboratory, and the Health Department of Minas Gerais state (SES-MG). We investigated the positivity rates of CHIKV and DENV by analyzing the results of 139,457 samples tested for CHIKV (44,029 in 2022 and 95,428 in 2023) and 491,528 samples tested for DENV (163,674 in 2022 and 327,854 in 2023) across the five representative geographical regions of Brazil. Genome sequencing was performed on 80 CHIKV and 153 DENV samples that had been positive for RT-PCR tests. RESULTS: In our sampling, the data from CHIKV tests indicated that the Northeast region had the highest regional positivity rate in 2022 (58.1%). However, in 2023, the Southeast region recorded the highest positivity rate (40.5%). With regard to DENV, the South region exhibited the highest regional positivity rate in both 2022 (40.8%) and 2023 (22.7%), followed by the Southeast region in both years (34.8% in 2022; 21.4% in 2023). During the first 30 epidemiological weeks of 2023 in the state of Minas Gerais (MG), there was a 5.8-fold increase in CHIKV cases and a 3.5-fold increase in DENV compared to the same period in 2022. Analysis of 151 new DENV-1 and 80 CHIKV genomes revealed the presence of three main clusters of CHIKV and circulation of several DENV lineages in MG. All CHIKV clades are closely related to genomes from previous Brazilian outbreaks in the Northeast, suggesting importation events from this region to MG. We detected the RNA of both viruses in approximately 12.75% of the confirmed positive cases, suggesting an increase of co-infection with DENV and CHIKV during the period of analysis. CONCLUSIONS: These high rates of re-emergence and co-infection with both arboviruses provide useful data for implementing control measures of Aedes vectors and the urgent implementation of public health politics to reduce the numbers of CHIKV and DENV cases in the country.

The Low-Density Lipoprotein Receptor-Related Protein-1 Is Essential for Dengue Virus Infection.

Dengue virus (DENV) causes the most prevalent and rapidly spreading arboviral disease of humans. It enters human cells by receptor-mediated endocytosis. Numerous cell-surface proteins were proposed as DENV entry factors. Among these, the phosphatidylserine receptor TIM-1 is the only one known to mediate virus internalization. However, several cellular models lacking TIM-1 are permissive to DENV infection, suggesting that other receptors exist. Here, we show that the low-density lipoprotein receptor-related protein-1 (LRP1) binds DENV virions by interacting with the DIII of the viral envelope glycoprotein. DENV infection is effectively inhibited by the purified receptor at 5 × 10-8 mol/L, and the interaction of the envelope protein with LRP1 is also blocked by a natural ligand of LRP1. The depletion of LRP1 causes 100-fold lower production of infectious virus than controls. Our results indicate that LRP1 is another DENV receptor, thus becoming an attractive target to evaluate for the development of effective antiviral drugs against DENV.

The Polypyrimidine Tract-Binding Protein Is a Transacting Factor for the Dengue Virus Internal Ribosome Entry Site.

Dengue virus (DENV) is an enveloped, positive sense, single-stranded RNA virus belonging to the Flaviviridae. Translation initiation of the DENV mRNA (vRNA) can occur following a cap-dependent, 5'-3'end-dependent internal ribosome entry site (IRES)-independent or IRES-dependent mechanism. This study evaluated the activity of DENV IRES in BHK-21 cells and the role of the polypyrimidine-tract binding protein (PTB) isoforms PTB1, PTB2, and PTB4 as IRES-transacting factors (ITAFs) for the DENV IRES. The results show that DENV-IRES activity is stimulated in DENV-replicating BHK-21 cells and cells expressing the Foot-and-mouth disease virus leader or Human rhinovirus 2A proteases. Protease activity was necessary, although a complete shutdown of cap-dependent translation initiation was not a requirement to stimulate DENV IRES activity. Regarding PTB, the results show that PTB1 > PTB2 > PTB4 stimulates DENV-IRES activity in BHK-21 cells. Mutations in the PTB RNA recognition motifs (RRMs), RRM1/RRM2 or RRM3/RRM4, differentially impact PTB1, PTB2, and PTB4's ability to promote DENV IRES-mediated translation initiation in BHK-21 cells. PTB1-induced DENV-IRES stimulation is rescinded when RRM1/RRM2 or RRM3/RRM4 are disrupted. Mutations in RRM1/RRM2 or RRM3/RRM4 do not affect the ITAF activity of PTB2. Mutating RRM3/RRM4, but not RRM1/RRM2, abolishes the ability of PTB4 to stimulate the DENV IRES. Thus, PTB1, PTB2, and PTB4 are ITAFs for the DENV IRES.