Unusual dengue virus 3 epidemic in Nicaragua, 2009.
The four dengue virus serotypes (DENV1-4) cause the most prevalent mosquito-borne viral disease affecting humans worldwide. In 2009, Nicaragua experienced the largest dengue epidemic in over a decade, marked by unusual clinical presentation, as observed in two prospective studies of pediatric dengue...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2011-11-01
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| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | http://europepmc.org/articles/PMC3210753?pdf=render |
| _version_ | 1818304966463324160 |
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| author | Gamaliel Gutierrez Katherine Standish Federico Narvaez Maria Angeles Perez Saira Saborio Douglas Elizondo Oscar Ortega Andrea Nuñez Guillermina Kuan Angel Balmaseda Eva Harris |
| author_facet | Gamaliel Gutierrez Katherine Standish Federico Narvaez Maria Angeles Perez Saira Saborio Douglas Elizondo Oscar Ortega Andrea Nuñez Guillermina Kuan Angel Balmaseda Eva Harris |
| author_sort | Gamaliel Gutierrez |
| collection | DOAJ |
| description | The four dengue virus serotypes (DENV1-4) cause the most prevalent mosquito-borne viral disease affecting humans worldwide. In 2009, Nicaragua experienced the largest dengue epidemic in over a decade, marked by unusual clinical presentation, as observed in two prospective studies of pediatric dengue in Managua. From August 2009-January 2010, 212 dengue cases were confirmed among 396 study participants at the National Pediatric Reference Hospital. In our parallel community-based cohort study, 170 dengue cases were recorded in 2009-10, compared to 13-65 cases in 2004-9. In both studies, significantly more patients experienced "compensated shock" (poor capillary refill plus cold extremities, tachycardia, tachypnea, and/or weak pulse) in 2009-10 than in previous years (42.5% [90/212] vs. 24.7% [82/332] in the hospital study (p<0.001) and 17% [29/170] vs. 2.2% [4/181] in the cohort study (p<0.001). Signs of poor peripheral perfusion presented significantly earlier (1-2 days) in 2009-10 than in previous years according to Kaplan-Meier survival analysis. In the hospital study, 19.8% of subjects were transferred to intensive care, compared to 7.1% in previous years - similar to the cohort study. DENV-3 predominated in 2008-9, 2009-10, and 2010-11, and full-length sequencing revealed no major genetic changes from 2008-9 to 2010-11. In 2008-9 and 2010-11, typical dengue was observed; only in 2009-10 was unusual presentation noted. Multivariate analysis revealed only "2009-10" as a significant risk factor for Dengue Fever with Compensated Shock. Interestingly, circulation of pandemic influenza A-H1N1 2009 in Managua was shifted such that it overlapped with the dengue epidemic. We hypothesize that prior influenza A H1N1 2009 infection may have modulated subsequent DENV infection, and initial results of an ongoing study suggest increased risk of shock among children with anti-H1N1-2009 antibodies. This study demonstrates that parameters other than serotype, viral genomic sequence, immune status, and sequence of serotypes can play a role in modulating dengue disease outcome. |
| first_indexed | 2024-12-13T06:19:05Z |
| format | Article |
| id | doaj.art-147e88be498a496ea56b95705aadc5e7 |
| institution | Directory Open Access Journal |
| issn | 1935-2727 1935-2735 |
| language | English |
| last_indexed | 2024-12-13T06:19:05Z |
| publishDate | 2011-11-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS Neglected Tropical Diseases |
| spelling | doaj.art-147e88be498a496ea56b95705aadc5e72022-12-21T23:56:52ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352011-11-01511e139410.1371/journal.pntd.0001394Unusual dengue virus 3 epidemic in Nicaragua, 2009.Gamaliel GutierrezKatherine StandishFederico NarvaezMaria Angeles PerezSaira SaborioDouglas ElizondoOscar OrtegaAndrea NuñezGuillermina KuanAngel BalmasedaEva HarrisThe four dengue virus serotypes (DENV1-4) cause the most prevalent mosquito-borne viral disease affecting humans worldwide. In 2009, Nicaragua experienced the largest dengue epidemic in over a decade, marked by unusual clinical presentation, as observed in two prospective studies of pediatric dengue in Managua. From August 2009-January 2010, 212 dengue cases were confirmed among 396 study participants at the National Pediatric Reference Hospital. In our parallel community-based cohort study, 170 dengue cases were recorded in 2009-10, compared to 13-65 cases in 2004-9. In both studies, significantly more patients experienced "compensated shock" (poor capillary refill plus cold extremities, tachycardia, tachypnea, and/or weak pulse) in 2009-10 than in previous years (42.5% [90/212] vs. 24.7% [82/332] in the hospital study (p<0.001) and 17% [29/170] vs. 2.2% [4/181] in the cohort study (p<0.001). Signs of poor peripheral perfusion presented significantly earlier (1-2 days) in 2009-10 than in previous years according to Kaplan-Meier survival analysis. In the hospital study, 19.8% of subjects were transferred to intensive care, compared to 7.1% in previous years - similar to the cohort study. DENV-3 predominated in 2008-9, 2009-10, and 2010-11, and full-length sequencing revealed no major genetic changes from 2008-9 to 2010-11. In 2008-9 and 2010-11, typical dengue was observed; only in 2009-10 was unusual presentation noted. Multivariate analysis revealed only "2009-10" as a significant risk factor for Dengue Fever with Compensated Shock. Interestingly, circulation of pandemic influenza A-H1N1 2009 in Managua was shifted such that it overlapped with the dengue epidemic. We hypothesize that prior influenza A H1N1 2009 infection may have modulated subsequent DENV infection, and initial results of an ongoing study suggest increased risk of shock among children with anti-H1N1-2009 antibodies. This study demonstrates that parameters other than serotype, viral genomic sequence, immune status, and sequence of serotypes can play a role in modulating dengue disease outcome.http://europepmc.org/articles/PMC3210753?pdf=render |
| spellingShingle | Gamaliel Gutierrez Katherine Standish Federico Narvaez Maria Angeles Perez Saira Saborio Douglas Elizondo Oscar Ortega Andrea Nuñez Guillermina Kuan Angel Balmaseda Eva Harris Unusual dengue virus 3 epidemic in Nicaragua, 2009. PLoS Neglected Tropical Diseases |
| title | Unusual dengue virus 3 epidemic in Nicaragua, 2009. |
| title_full | Unusual dengue virus 3 epidemic in Nicaragua, 2009. |
| title_fullStr | Unusual dengue virus 3 epidemic in Nicaragua, 2009. |
| title_full_unstemmed | Unusual dengue virus 3 epidemic in Nicaragua, 2009. |
| title_short | Unusual dengue virus 3 epidemic in Nicaragua, 2009. |
| title_sort | unusual dengue virus 3 epidemic in nicaragua 2009 |
| url | http://europepmc.org/articles/PMC3210753?pdf=render |
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