#Global #Disease #Outbreaks Associated with the 2015–2016 #ElNiño Event (Sci Rep., abstract)

[Source: Scientific Reports, full page: (LINK). Abstract, edited.]

Article | OPEN | Published: 13 February 2019

Global Disease Outbreaks Associated with the 2015–2016 El Niño Event

Assaf Anyamba, Jean-Paul Chretien, Seth C. Britch, Radina P. Soebiyanto, Jennifer L. Small, Rikke Jepsen, Brett M. Forshey, Jose L. Sanchez, Ryan D. Smith, Ryan Harris, Compton J. Tucker, William B. Karesh & Kenneth J. Linthicum

Scientific Reports, volume 9, Article number: 1930 (2019)

 

Abstract

Interannual climate variability patterns associated with the El Niño-Southern Oscillation phenomenon result in climate and environmental anomaly conditions in specific regions worldwide that directly favor outbreaks and/or amplification of variety of diseases of public health concern including chikungunya, hantavirus, Rift Valley fever, cholera, plague, and Zika. We analyzed patterns of some disease outbreaks during the strong 2015–2016 El Niño event in relation to climate anomalies derived from satellite measurements. Disease outbreaks in multiple El Niño-connected regions worldwide (including Southeast Asia, Tanzania, western US, and Brazil) followed shifts in rainfall, temperature, and vegetation in which both drought and flooding occurred in excess (14–81% precipitation departures from normal). These shifts favored ecological conditions appropriate for pathogens and their vectors to emerge and propagate clusters of diseases activity in these regions. Our analysis indicates that intensity of disease activity in some ENSO-teleconnected regions were approximately 2.5–28% higher during years with El Niño events than those without. Plague in Colorado and New Mexico as well as cholera in Tanzania were significantly associated with above normal rainfall (p < 0.05); while dengue in Brazil and southeast Asia were significantly associated with above normal land surface temperature (p < 0.05). Routine and ongoing global satellite monitoring of key climate variable anomalies calibrated to specific regions could identify regions at risk for emergence and propagation of disease vectors. Such information can provide sufficient lead-time for outbreak prevention and potentially reduce the burden and spread of ecologically coupled diseases.

Keywords: ENSO; Extreme weather; Chikungunya fever; Plague; Cholera; Global Health.

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#Impact of preexisting #dengue #immunity on #Zika virus #emergence in a dengue endemic region (Science, abstract)

[Source: Science, full page: (LINK). Abstract, edited.]

Impact of preexisting dengue immunity on Zika virus emergence in a dengue endemic region

Isabel Rodriguez-Barraquer1,*, Federico Costa2,3,4,*, Eduardo J. M. Nascimento5,*, Nivison Nery Júnior2,3, Priscila M. S. Castanha6,7, Gielson Almeida Sacramento3, Jaqueline Cruz3, Mayara Carvalho3, Daiana De Olivera3, José E. Hagan3,4, Haritha Adhikarla4, Elsio A. Wunder Jr.3,4, Danilo F. Coêlho6,8, Sasha R. Azar9, Shannan L. Rossi10, Nikos Vasilakis11, Scott C. Weaver10, Guilherme S. Ribeiro2,3,12, Angel Balmaseda13,14, Eva Harris15, Maurício L. Nogueira16, Mitermayer G. Reis3,4,12, Ernesto T. A. Marques5,6,17,*, Derek A. T. Cummings18,19,*,†, Albert I. Ko3,4,*,†

1 Department of Medicine, University of California, San Francisco, CA, USA. 2 Instituto da Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil. 3 Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Bahia, Brazil. 4 Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA. 5 Department of Infectious Disease and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA. 6 Instituto Aggeu Magalhães, Fundação Oswaldo Cruz/MS, Recife, Pernambuco, Brazil. 7 Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife, Pernambuco, Brazil. 8 Department of Fundamental Chemistry, Federal University of Pernambuco, Recife, PE 50740-540, Brazil. 9 Institute for Translational Science, University of Texas Medical Branch, Galveston, TX, USA. 10 Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA. 11 Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA. 12 Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil. 13 Sustainable Sciences Institute, Managua, Nicaragua. 14 Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua. 15 Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA. 16 Faculdade de Medicina de São Jose do Rio Preto, São Jose do Rio Preto, São Paulo, Brazil. 17 Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. 18 Department of Biology, University of Florida, Gainesville, FL, USA. 19 Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.

†Corresponding author. Email: albert.ko@yale.edu (A.I.K.); datc@ufl.edu (D.A.T.C.)

* These authors contributed equally to this work.

Science  08 Feb 2019: Vol. 363, Issue 6427, pp. 607-610 / DOI: 10.1126/science.aav6618

 

Zika dynamics in South America

The infection dynamics of Zika virus (ZIKV) are difficult to characterize. Many ZIKV infections are asymptomatic, and the clinical presentation of ZIKV is nonspecific. Rodriguez-Barraquer et al. took advantage of a long-term health study under way in Salvador, Brazil, the epicenter of the recent outbreak in the Americas. They used multiple serological assays, from before and after the emergence of ZIKV in October 2015, to distinguish ZIKV immune responses from those against Dengue virus (DENV). About 73% of the population was attacked by ZIKV. The presence of preexisting antibodies to DENV was associated with less risk of ZIKV infection and fewer symptoms.

Science, this issue p. 607

 

Abstract

The clinical outcomes associated with Zika virus (ZIKV) in the Americas have been well documented, but other aspects of the pandemic, such as attack rates and risk factors, are poorly understood. We prospectively followed a cohort of 1453 urban residents in Salvador, Brazil, and, using an assay that measured immunoglobulin G3 (IgG3) responses against ZIKV NS1 antigen, we estimated that 73% of individuals were infected during the 2015 outbreak. Attack rates were spatially heterogeneous, varying by a factor of 3 within a community spanning 0.17 square kilometers. Preexisting high antibody titers to dengue virus were associated with reduced risk of ZIKV infection and symptoms. The landscape of ZIKV immunity that now exists may affect the risk for future transmission.

Keywords: Dengue fever; Zika Virus; Brazil.

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#Serological evidence of #infection with #dengue and #Zika viruses in #horses on French #Pacific Islands (PLoS Negl Trop Dis., abstract)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Serological evidence of infection with dengue and Zika viruses in horses on French Pacific Islands

Cécile Beck , Isabelle Leparc-Goffart, Denise Desoutter, Estelle Debergé, Hervé Bichet, Steeve Lowenski, Marine Dumarest, Gaelle Gonzalez, Camille Migné, Jessica Vanhomwegen, Stéphan Zientara, Benoit Durand , Sylvie Lecollinet

Published: February 7, 2019 / DOI: https://doi.org/10.1371/journal.pntd.0007162 / This is an uncorrected proof.

 

Abstract

New Caledonia and French Polynesia are areas in which arboviruses circulate extensively. A large serological survey among horses from New Caledonia and French Polynesia was carried out to investigate the seroprevalence of flaviviruses in the horse population. Here, 293 equine sera samples were screened for flaviviruses using a competitive enzyme-linked immunosorbent assay (cELISA). The positive sera were then confirmed using a flavivirus-specific microsphere immunoassay (MIA) and seroneutralization tests. This serosurvey showed that 16.6% (27/163) and 30.8% (40/130) of horses were positive for cELISA tests in New Caledonia and French Polynesia, respectively, but the MIA technique, targeting only flaviviruses causing neuro-invasive infections in humans and horses (i.e. West Nile virus [WNV], Japanese encephalitis virus [JEV] and tick-borne encephalitis virus [TBEV]), showed negative results for more than 85% (57/67) of the cELISA-positive animals. Seroneutralization tests with the main flaviviruses circulating in the South Pacific revealed that 6.1% (10/163; confidence interval [95% CI] 3.0%-11.0%) of sera in New Caledonia and 7.7% (10/130; 95% CI 3.8%-13.7%) in French Polynesia were positive for dengue virus serotype 1 (DENV1) and 4.3% (7/163; 95% CI 1.7%-8.6%) in New Caledonia and 15.4% (20/130, 95% CI 9.7%-22.8%) in French Polynesia were found positive for Zika virus (ZIKV). Seroprevalence of the JEV and WNV flaviviruses on the 293 samples from both island groups were comparatively much lower (less than 2%). This seroprevalence study in the horse population shows that horses can be infected with dengue and Zika viruses and that these infections lead to seroconversions in horses. The consequences of these infections in horses and their role in ZIKV and DENV epidemiological cycles are two issues that deserve further investigation.

 

Author summary

New Caledonia and French Polynesia, located in the South Pacific, are facing circulation of dengue virus (DENV) for a long time and emergence of Zika virus (ZIKV) since 2013. A large serosurvey among horses’ population from these two islands was carried out to investigate the seroprevalence of the main flaviviruses circulating in the South Pacific. We find out that 6 to 7% of equine sera tested were positive for DENV serotype 1 in the two islands and 4% and 15% were positive for ZIKV in New Caledonia and French Polynesia respectively. Our study highlighted serological evidence of DENV serotype 1 and ZIKV infections of horses leading to meaningful seroconversion. Seroprevalence of other mosquito-borne flaviviruses (i.e. Japanese encephalitis and West-Nile viruses) were comparatively much lower (less than 2%) in New Caledonia and French Polynesia groups suggesting the absence of past active circulation of these viruses in both islands. This finding emphasized the need to investigate the consequences of such infections in the horse population and to determine the role of domestic animals in ZIKV and DENV epidemiological cycles.

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Citation: Beck C, Leparc-Goffart I, Desoutter D, Debergé E, Bichet H, Lowenski S, et al. (2019) Serological evidence of infection with dengue and Zika viruses in horses on French Pacific Islands. PLoS Negl Trop Dis 13(2): e0007162. https://doi.org/10.1371/journal.pntd.0007162

Editor: David W.C. Beasley, University of Texas Medical Branch, UNITED STATES

Received: July 24, 2018; Accepted: January 15, 2019; Published: February 7, 2019

Copyright: © 2019 Beck et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Flavivirus; Zika Virus; Dengue Fever; Horses; New Caledonia.

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Evaluation of a new rapid #fluorescence #immunoassay for the #diagnosis of #dengue and #Zika virus infection (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 29 January 2019 / In Press, Accepted Manuscript

Evaluation of a new rapid fluorescence immunoassay for the diagnosis of dengue and Zika virus infection

Lorenzo Zammarchi a,b,cMaria Grazia Colao d, Antonia Mantella a, c, Teresa Capobianco d, Gianna Mazzarelli d, Nunziata Ciccone d, Seble Tekle Kiros a, Elisabetta Mantengoli a, Gian Maria Rossolini a, d, Alessandro Bartoloni a,b,c

{a} Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; {b} Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy; {c} Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy; {d} Clinical Microbiology and Virology Unit, Careggi University and Hospital, Florence, Italy
Received 4 December 2018, Revised 26 January 2019, Accepted 28 January 2019, Available online 29 January 2019.

DOI: https://doi.org/10.1016/j.jcv.2019.01.011

 

Highlights

  • We evaluated a rapid Europium-based fluorescence serological test for DENV and ZIKV
  • In acute dengue, combination of FIA-NS1Ag and/or IgM showed a sensitivity of 100%
  • In past DENV, FIA-IgG test showed a sensitivity of 70%
  • In acute ZIKV, combination of FIA-ZIKV Ag and/or IgM showed a sensitivity of 72.7%
  • In past ZIKV infection combination of FIA-ZIKV IgG and IgM an overall 90% sensitivity

 

Abstract

Background

dengue (DENV) and Zika virus (ZIKV) are important mosquito-transmitted viruses.

Objectives

To investigate the performance of Standard F, Fluorescence Immunoassay (FIA, SD Biosensor Inc., Suwon, South Korea) providing results in 15 minutes to detect DENV IgG, IgM and NS1Ag, and ZIKV IgG, IgM, and Ag.

Study design

A well-characterized panel of patient samples (11 acute DENV, 11 acute ZIKV, 10 past DENV, 10 past ZIKV infection, 36 with other conditions) were tested with the FIA test.

Results

In acute DENV infection, the combination of FIA-NS1Ag and/or IgM positivity showed a sensitivity of 100%. In past DENV, FIA-IgG test showed a sensitivity of 70%. Specificity of FIA-DENV NS1Ag, IgG, and IgM was 87.5%, 83.5%, and 91.7%, respectively. The sensitivity of FIA-ZIKV IgM and FIA-ZIKV Ag, in confirmed acute infection, was 72.7% and 9.1%, respectively. FIA-ZIKV Ag did not improve the sensitivity in detecting acute ZIKV infection, being positive only in one IgM positive sample. In past ZIKV infection (32-183 days after symptom onset), FIA-ZIKV IgG and IgM showed a sensitivity of 40% and 80% respectively, generating an overall 90% sensitivity. Specificity of FIA-ZIKV Ag, IgM, and IgG was 92.6%, 100%, and 97%, respectively.

Conclusion

FIA test, a rapid and easy to perform assay, showed high sensitivity to detect acute DENV infection, but lower in acute ZIKV infection. In past ZIKV infections, the best performance of FIA test is obtained by combining detection of IgG and IgM.

Keywords: Dengue – Zika – serology – rapid – Fluorescence

© 2019 Published by Elsevier B.V.

Keywords: Zika Virus; Dengue Fever; Serology; Diagnostic tests.

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SIMULTANEOUS CIRCULATION OF #ARBOVIRUSES AND OTHER #CONGENITAL #INFECTIONS IN #PREGNANT WOMEN IN #RIO DE JANEIRO, #BRAZIL (Acta Trop., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Acta Trop. 2019 Jan 24. pii: S0001-706X(18)31538-9. doi: 10.1016/j.actatropica.2019.01.020. [Epub ahead of print]

SIMULTANEOUS CIRCULATION OF ARBOVIRUSES AND OTHER CONGENITAL INFECTIONS IN PREGNANT WOMEN IN RIO DE JANEIRO, BRAZIL.

Carvalho FR1, Medeiros T2, de Oliveira Vianna RA3, Douglass-Jaimes G4, Guerra Nunes PC5, Salgado Quintans MD6, Fernandes C7, Baêta Cavalcanti SM8, Dos Santos FB9, de Oliveira SA10, Araújo Cardoso CA11, Silva AA12.

Author information: 1 Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil. Electronic address: fabianarc@id.uff.br. 2 Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil. Electronic address: thaliamedeiros@id.uff.br. 3 Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil. Electronic address: renatavianna03@gmail.com. 4 Environmental Analysis Program, Pomona College, Claremont, CA, USA. Electronic address: guillermo.douglass-jaimes@pomona.edu. 5 Laboratório de Imunologia Viral, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. Electronic address: pricgn@ioc.fiocruz.br. 6 Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil. Electronic address: mdsquintans@id.uff.br. 7 Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil. Electronic address: cinttiafs@yahoo.com.br. 8 Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil. Electronic address: silviacavalcanti67@gmail.com. 9 Laboratório de Imunologia Viral, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. Electronic address: flaviab@ioc.fiocruz.br. 10 Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil. Electronic address: sartimos@id.uff.br. 11 Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil; Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil. Electronic address: claudetecardoso@id.uff.br. 12 Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil; Departamento de Patologia, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil. Electronic address: aasilva@id.uff.br.

 

Abstract

BACKGROUND:

Arboviruses (Zika, dengue and chikungunya) represent a major risk for pregnant women, especially because their vertical transmission can lead to neurological damage in newborns. Early diagnosis can be difficult due to similar clinical presentation with other congenital infections that are associated with congenital abnormalities.

OBJECTIVES:

To investigate the circulation of arboviruses and other pathogens responsible for congenital infections, reporting clinical aspects and geographic distribution of maternal rash in a metropolitan region of Rio de Janeiro (Brazil).

METHODS:

Cross-sectional study with pregnant women presenting rash attended at the Exanthematic Diseases Unit (Niterói, Rio de Janeiro) from 2015 to 2018. Diagnosis of arboviruses was performed by real-time PCR (RT-qPCR) and laboratorial screening for syphilis, toxoplasmosis, rubella, cytomegalovirus and HIV was assessed. Demographic data was used for georeferencing analysis.

FINDINGS:

We included 121 pregnant women, of whom Zika virus was detected in 45 cases (37.2%), chikungunya in 33 (27.3%) and dengue in one (0.8%). Five patients presented syphilis, and we observed one case each of listeria, cytomegalovirus, and a syphilis-toxoplasmosis case. Similarity of clinical symptoms was observed in all groups; however, 84.8% of patients with chikungunya presented arthralgia. Following the decline of Zika cases, chikungunya infection was mostly observed during 2017-2018. Considering pregnant women infected with arboviruses and other infections, 41% resided in urban slums, mostly in Niterói.

MAIN CONCLUSIONS:

Simultaneous circulation of arboviruses and other agents responsible for congenital infections were observed; however, we did not identify co-infections between arboviruses. In this scenario, we emphasize the importance of adequate prenatal care to provide an accurate diagnosis of maternal rash.

Copyright © 2019. Published by Elsevier B.V.

KEYWORDS: arboviruses; pregnancy; vertical transmission of infectious disease

PMID: 30685232 DOI: 10.1016/j.actatropica.2019.01.020

Keywords: Arbovirus; Zika Virus; Chikungunya Fever; Dengue fever; Pregnancy; Brazil.

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Does prior #dengue virus #exposure worsen #clinical outcomes of #Zika virus #infection? A systematic review, pooled analysis and lessons learned (PLoS Negl Trop Dis., abstract)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Does prior dengue virus exposure worsen clinical outcomes of Zika virus infection? A systematic review, pooled analysis and lessons learned

Jennifer Masel, Michael K. McCracken, Todd Gleeson, Brian Morrison, George Rutherford, Allison Imrie, Richard G. Jarman, Michael Koren, Simon Pollett

Published: January 25, 2019 / DOI: https://doi.org/10.1371/journal.pntd.0007060 / This is an uncorrected proof.

 

Abstract

Zika virus (ZIKV) recently caused a pandemic complicated by Guillain-Barre syndrome (GBS) and birth defects. ZIKV is structurally similar to the dengue viruses (DENV) and in vitro studies suggest antibody dependent enhancement occurs in ZIKV infections preceded by DENV; however, the clinical significance of this remains unclear. We undertook a PRISMA-adherent systematic review of all current human and non-human primate (NHP) data to determine if prior infection with DENV, compared to DENV-naïve hosts, is associated with a greater risk of ZIKV clinical complications or greater ZIKV peak viremia in vivo. We identified 1146 studies in MEDLINE, EMBASE and the grey literature, of which five studies were eligible. One human study indicated no increase in the risk of GBS in ZIKV infections with prior DENV exposure. Two additional human studies showed a small increase in ZIKV viremia in those with prior DENV exposure; however, this was not statistically significant nor was it associated with an increase in clinical severity or adverse pregnancy outcomes. While no meta-analysis was possible using human data, a pooled analysis of the two NHP studies leveraging extended data provided only weak evidence of a 0.39 log10 GE/mL rise in ZIKV viremia in DENV experienced rhesus macaques compared to those with no DENV exposure (p = 0.22). Using a customized quality grading criteria, we further show that no existing published human studies have offered high quality measurement of both acute ZIKV and antecedent DENV infections. In conclusion, limited human and NHP studies indicate a small and non-statistically significant increase in ZIKV viremia in DENV-experienced versus DENV-naïve hosts; however, there is no evidence that even a possible small increase in ZIKV viremia would correlate with a change in ZIKV clinical phenotype. More data derived from larger sample sizes and improved sero-assays are needed to resolve this question, which has major relevance for clinical prognosis and vaccine design.

 

Author summary

Zika virus (ZIKV) is a mosquito borne virus that recently caused a large epidemic with some cases complicated by ascending paralysis (Guillain-Barre syndrome) and birth defects. One major concern is that such complications may be more common in those who have had previous infection with the closely related mosquito-borne dengue virus (DENV) which also circulates in the tropics. Here, we undertook a thorough, structured review of all human and high-order animal literature to synthesize the current evidence about whether ZIKV outcomes are worse in those with previous DENV exposure. We further undertook a pooled analysis across the two major non-human primate studies to improve statistical power. We summarize that, in humans and in non-human primates, prior DENV exposure may lead to a small increase in ZIKV viral load during infection. However, we do not show that any possible increase in ZIKV viral replication is associated with a higher rate of Zika complications or Zika clinical severity. We further graded the quality of these published literature and indicate that substantial improvements in the immunological measurement of ZIKV and DENV exposure in humans are needed to answer these and other pertinent questions about these two epidemic pathogens.

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Citation: Masel J, McCracken MK, Gleeson T, Morrison B, Rutherford G, Imrie A, et al. (2019) Does prior dengue virus exposure worsen clinical outcomes of Zika virus infection? A systematic review, pooled analysis and lessons learned. PLoS Negl Trop Dis 13(1): e0007060. https://doi.org/10.1371/journal.pntd.0007060

Editor: David Joseph Diemert, George Washington University School of Medicine and Health Sciences, UNITED STATES

Received: August 27, 2018; Accepted: December 6, 2018; Published: January 25, 2019

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: SP and RGJ were funded by the US Department of Defense Global Emerging Infections Surveillance and Response System (DoD-GEIS), a division of the Armed Forces Health Surveillance Branch (WORK UNIT NUMBER: P0082_18_WR). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Zika Virus; Dengue Fever; A.D.E.

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Admission #Clinicopathological Factors Associated with Prolonged #Hospital Stay Among Hospitalized Patients with #Dengue Viral Infections (Vector Borne Zoo Dis., abstract)

[Source: Vector Borne and Zoonotic Diseases, full page: (LINK). Abstract, edited.]

Admission Clinicopathological Factors Associated with Prolonged Hospital Stay Among Hospitalized Patients with Dengue Viral Infections

Serric Suthesh Willeam Peter, Sharifah Syed Hassan, Victoria Phooi Khei Tan, Chin Fang Ngim, Nur Amelia Azreen Adnan, Lian Yih Pong, and Amreeta Dhanoa

Published Online: 22 Jan 2019 / DOI: https://doi.org/10.1089/vbz.2018.2379

 

Abstract

Background:

There is an escalation of frequency and magnitude of dengue epidemics in Malaysia, with a concomitant increase in patient hospitalization. Prolonged hospitalization (PH) due to dengue virus (DENV) infections causes considerable socioeconomic burden. Early identification of patients needing PH could optimize resource consumption and reduce health care costs. This study aims to identify clinicopathological factors present on admission that are associated with PH among patients with DENV infections.

Methods:

This study was conducted in a tertiary referral hospital in Southern Malaysia. Relevant clinical and laboratory data upon admission were retrieved from medical records of 253 consecutive DENV nonstructural protein 1 (NS1) antigen and PCR-positive hospitalized patients. The DENV serotype present in each patient was determined. Patients were stratified based on duration of hospital stay (<4 vs. ≥4 days). Data were analyzed using IBM® SPSS® 25.0. Multivariate logistic regression was performed to examine the association between PH and admission parameters.

Results:

Of 253 DENV hospitalized patients, 95 (37.5%) had PH (≥4 days). The mean duration of hospital stay was 3.43 ± 2.085 days (median = 3 days, interquartile range = 7 days). Diabetes mellitus (adjusted odds ratio [AOR] = 6.261, 95% confidence interval [CI] = 2.130–18.406, p = 0.001), DENV-2 serotype (AOR = 2.581, 95% CI = 1.179–5.650, p = 0.018), duration of fever ≤4 days (AOR = 2.423, 95% CI = 0.872–6.734, p = 0.09), and a shorter preadmission fever duration (AOR = 0.679, 95% CI = 0.481–0.957, p = 0.027) were independently associated with PH. However, PH was not found to be associated with symptoms on admission, secondary DENV infections or platelet count, hematocrit, or liver enzyme levels on admission.

Conclusions:

Early identification of these factors at presentation may alert clinicians to anticipate and recognize challenges in treating such patients, leading to more focused management plans that may shorten the duration of hospitalization.

Keywords: Dengue fever; Malaysia.

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