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Am J Trop Med Hyg. 2018 May;98(5):1444-1459. doi: 10.4269/ajtmh.17-0762. Epub 2018 Mar 1.

The Burden of Dengue Fever and Chikungunya in Southern Coastal Ecuador: Epidemiology, Clinical Presentation, and Phylogenetics from the First Two Years of a Prospective Study.

Author information

1
Center for Global Health and Translational Sciences, State University of New York (SUNY) Upstate Medical University, Syracuse, New York.
2
Department of Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, New York.
3
College of Life Sciences, University of Kwazulu-Natal, Durban, South Africa.
4
Emerging Pathogens Institute, University of Florida, Gainesville, Florida.
5
Department of Geography, University of Florida, Gainesville, Florida.
6
Department of Microbiology and Immunology, State University of New York (SUNY) Upstate Medical University, Syracuse, New York.
7
Department of Medicine, Universidad Técnica de Machala, Machala, El Oro, Ecuador.
8
Laboratorio para Investigaciónes Biomédicas, Facultad de Ciencias de la Vida, Escuela Superior Politécnica del Litoral, Guayaquil, Guayas Province, Ecuador.
9
Division of Nutritional Sciences, Cornell University, Ithaca, New York.
10
Department of Public Health and Preventative Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, New York.
11
Viral Diseases Branch, Walter Reed Army Institute of Research (WRAIR), Silver Spring, Maryland.
12
Ministry of Health, Machala, El Oro, Ecuador.

Abstract

Here, we report the findings from the first 2 years (2014-2015) of an arbovirus surveillance study conducted in Machala, Ecuador, a dengue-endemic region. Patients with suspected dengue virus (DENV) infections (index cases, N = 324) were referred from five Ministry of Health clinical sites. A subset of DENV-positive index cases (N = 44) were selected, and individuals from the index household and four neighboring homes within 200 m were recruited (N = 400). Individuals who entered the study, other than the index cases, are referred to as associates. In 2014, 70.9% of index cases and 35.6% of associates had acute or recent DENV infections. In 2015, 28.3% of index cases and 12.8% of associates had acute or recent DENV infections. For every DENV infection captured by passive surveillance, we detected an additional three acute or recent DENV infections in associates. Of associates with acute DENV infections, 68% reported dengue-like symptoms, with the highest prevalence of symptomatic acute infections in children aged less than 10 years. The first chikungunya virus (CHIKV) infections were detected on epidemiological week 12 in 2015; 43.1% of index cases and 3.5% of associates had acute CHIKV infections. No Zika virus infections were detected. Phylogenetic analyses of isolates of DENV from 2014 revealed genetic relatedness and shared ancestry of DENV1, DENV2, and DENV4 genomes from Ecuador with those from Venezuela and Colombia, indicating the presence of viral flow between Ecuador and surrounding countries. Enhanced surveillance studies, such as this, provide high-resolution data on symptomatic and inapparent infections across the population.

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