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Paraná VC, Feitosa CA, da Silva GCS, Gois LL, Santos LA. Risk factors associated with severe dengue in Latin America: A systematic review and meta-analysis. Trop Med Int Health 2024; 29:173-191. [PMID: 38263345 DOI: 10.1111/tmi.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Severe dengue is a significant health problem in Latin America, with children being the most affected. Understanding risk factors for severe dengue is crucial for enhancing patient care. Therefore, this study aims to systematically review the literature to identify the risk factors associated with severe dengue in Latin America through systematic review and meta-analysis. METHODS PubMed, SciELO, LILACS and EMBASE databases were used to search for eligible scientific articles for the review. The outcomes considered were symptoms of severe dengue, hospitalisation and death. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the quality of the studies. Data analysis was performed using STATA v 13.0 software. The degree of heterogeneity between studies was quantified using the I2 measure, and statistically significant results were defined as those with p values <0.05. RESULTS Of the 1876 articles screened, 47 articles were included in the systematic review and 45 articles were analysed through meta-analysis. Identified risk factors associated with severe dengue included secondary dengue infection, female sex, white or Caucasian ethnicity and specific signs and symptoms such as headache, myalgia and/or arthralgia, vomiting/nausea, abdominal pain or tenderness, diarrhoea, prostration, lethargy, fatigue or similar. For the death outcome, respiratory symptoms and age <18 years were identified as risk factors. On the other hand, in women, the diagnosis of positive tourniquet test, platelet count <100,000 per μL and symptoms of capillary fragility were associated with a lower probability of death. These data highlight the importance of early screening of patients, to identify possible haemorrhagic signs and reduce deaths from dengue. This study has limitations, including possible publication bias, heterogeneity of results and study design biases. CONCLUSION These findings are significant for shaping strategies, management approaches and identifying high-risk groups, which will help establish future guidelines.
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Affiliation(s)
- Victoria Cruz Paraná
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | | | | | - Luana Leandro Gois
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
- Department of Biointeraction Sciences, Institute of Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Luciane Amorim Santos
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Graduate Program in Health Sciences, College of Medicine of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil
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Mukhopadhyay K, Sengupta M, Misra SC, Majee K. Trends in emerging vector-borne viral infections and their outcome in children over two decades. Pediatr Res 2024; 95:464-479. [PMID: 37880334 DOI: 10.1038/s41390-023-02866-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023]
Abstract
This review utilizes quatitative methods and bibliometric data to analyse the trends of emerging and re-emerging vector-borne diseases, with a focus on their impact on pediatric population. To conduct this analysis, a systematic search of PubMed articles from the past two decades was performed, specifically looking at 26 different vector-borne viruses listed in WHO and CDC list of vector-borne viruses. The review found that diseases like Dengue, Zika, West Nile, and Chikungunya were frequently discussed in the literature. On the other hand, diseases such as Tick-borne encephalitis, Rift Valley fever, Venezuelan equine encephalitis, Sindbis fever, Venezuelan equine encephalitis, Ross River virus, and Eastern equine encephalitis showed an upward trend in publications, indicating potential resurgence. In addition to discussing trends and patterns, the review delves into the clinical manifestations and long-term effects of the top 10 viruses in children. It highlights various factors including deforestation, urbanization, global travel, and immunosuppression that contribute to disease emergence and resurgence. To effectively combat these vector-borne diseases, continuous surveillance is crucial. The review also emphasizes the importance of increased vaccination efforts and targeted research to address the health challenges they pose. IMPACT: This review employs quantitative analysis of publications to elucidate trends in emerging pediatric vector-borne viral diseases over two decades. Dengue, the most prevalent of these diseases, has spread to new regions. New strains of Japanese Encephalitis have caused outbreaks. Resurgence of Tick-borne Encephalitis, West Nile, and Yellow Fever due to vaccine hesitancy has also transpired. Continuous global surveillance, increased vaccination, and research into novel therapeutics are imperative to combat the substantial morbidity and mortality burden these diseases pose for children worldwide.
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Affiliation(s)
| | - Mallika Sengupta
- Microbiology, AIIMS Kalyani, Basantapur, Saguna, West Bengal, India
| | | | - Kiranmay Majee
- Student, AIIMS Kalyani, Basantapur, Saguna, West Bengal, India
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Gunale B, Farinola N, Yeolekar L, Shrivastava S, Girgis H, Poonawalla CS, Dhere RM, Arankalle V, Chandra Mishra A, Mehla R, Kulkarni PS. A Phase 1, double-blind, randomized, placebo-controlled study to evaluate the safety and immunogenicity of a tetravalent live attenuated dengue vaccine in adults. Vaccine 2023; 41:5614-5621. [PMID: 37532611 DOI: 10.1016/j.vaccine.2023.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/05/2023] [Accepted: 07/23/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Dengue fever is an important public health problem, especially in Asia and South America. A tetravalent live attenuated dengue vaccine was manufactured in India after receipt of vaccine strains from NIAID, NIH, USA. METHODS This was a Phase 1, double-blind, randomized, placebo-controlled study performed in 60 healthy adults of 18 to 45 years. Participants were randomized 2:1 to receive a single subcutaneous injection of either a tetravalent live attenuated dengue vaccine or placebo. Safety was assessed by unsolicited adverse events (AEs) and solicited reactions through 21 days after vaccination and serious adverse events (SAEs) through the entire study period of 180 days. Dengue viremia was assessed at baseline and on day 9, 11 and 13 post-vaccination using a plaque assay. Immunogenicity was assessed using the plaque reduction neutralization test (PRNT) assay using vaccine-matched wild virus serotypes (DENV 1, DENV 2, DENV 3 and DENV 4) at baseline and on 56-, 84- and 180-days post-vaccination. PRNT assay using circulating wild type DENV 1, DENV 2, DENV 3 and DENV 4 were done on day 1 and day 85 for a subset of 31 participants. RESULTS 60 participants were randomized to receive dengue vaccine (n = 40) or placebo (n = 20). 23 participants (59 %) showed DENV vaccine viremia post- vaccination for any of the four serotypes with majority on day 9 and day 11. At baseline, all participants were naïve by dengue PRNT50 for all four serotypes in both the study groups except for four in the dengue vaccine group and two in the placebo group. On day 57, the GMTs of neutralizing antibodies ranged from 66.76 (95 % CI 36.63, 121.69) to 293.84 (95 % CI 192.25, 449.11) for all four serotypes in the dengue vaccine group. On day 181 though the titers declined, they still remained much higher than the baseline. The titers in the placebo group did not change after vaccination. Seroconversion through day 85 ranged from 79.5 % for DENV 1 to 100 % for DENV2 while in the placebo group, no participant showed seroconversion through day 85. Similar trends were noted when PRNT was done using wild DENV serotypes in both vaccine and placebo groups. Among solicited reactions, injection site erythema, rash, headache, fatigue, myalgia and arthralgia were reported more frequently in the vaccine group than placebo group. All solicited reactions were of grade 1 or grade 2 severity and completely resolved. One unrelated serious adverse event was reported in the vaccine group. CONCLUSION A single dose of dengue vaccine was safe and well tolerated in adults. The vaccine was highly immunogenic with trivalent or tetravalent seroconversion and seropositivity in most of the participants. The study was funded by Serum Institute of India Pvt. Ltd., Pune, India. CLINICALTRIALS gov: NCT04035278.
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Affiliation(s)
| | | | | | | | - Hanna Girgis
- PPD, 3900 Paramount Pkwy, Morrisville, NC 27560, USA
| | | | | | - Vidya Arankalle
- Interactive Research School for Health Affairs (IRSHA), Pune, India
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Sartori L, Pereira M, Oliva S. Time-Scale Analysis and Parameter Fitting for Vector-Borne Diseases with Spatial Dynamics. Bull Math Biol 2022; 84:124. [PMID: 36121515 DOI: 10.1007/s11538-022-01083-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/07/2022] [Indexed: 11/02/2022]
Abstract
Vector-borne diseases are progressively spreading in a growing number of countries, and it has the potential to invade new areas and habitats. From the dynamical perspective, the spatial-temporal interaction of models that try to adjust to such events is rich and challenging. The first challenge is to address the dynamics of vectors (very fast and local) and the dynamics of humans (very heterogeneous and non-local). The objective of this work is to use the well-known Ross-Macdonald models, identifying different time scales, incorporating human spatial movements and estimate in a suitable way the parameters. We will concentrate on a practical example, a simplified space model, and apply it to dengue spread in the state of Rio de Janeiro, Brazil.
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Junior JBS, Massad E, Lobao-Neto A, Kastner R, Oliver L, Gallagher E. Epidemiology and costs of dengue in Brazil: a systematic literature review. Int J Infect Dis 2022; 122:521-528. [DOI: 10.1016/j.ijid.2022.06.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/02/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
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Abstract
BACKGROUND Dengue infections are on the rise in Sri Lanka and are spreading to all areas in the country. Here, we discuss the changes in dengue epidemiology in Sri Lanka in relation to changes in age distribution, changes in seroprevalence rates over time, and possible reasons contributing to such changes. METHODS AND FINDINGS Although the incidence of dengue increased 20-fold from the year 2000 to 2012 and a further 3-fold from 2012 to 2019, this increase is not reflected in a similar increase in the age-stratified seropositivity rates for dengue. For instance, the annual seroconversion rates were 0.76% in 2013 and 0.91% in 2017. The annual seroconversion rates in the 6 to 17 age group were 1.5% per year in 2003, 3.9% in 2013, and 4.1% in 2017. In addition, although a 13-fold increase in dengue was seen in those who were <19 years of age, a 52.4-fold increase was seen in the 40- to 59-year age group. The case fatality rates (CFRs) have similarly changed, with 61.8% of deaths occurring in those <19 years of age in the year 2000, while in 2012 to 2018, the highest CFR were seen in those who were aged 20 to 39 years. Although there has been a marked increase in the number of cases, the vector densities did not change during a 4-year period. The proportion of adult individuals experiencing a secondary dengue infection has also remained between 65% and 75% between the years 2004 and 2018. CONCLUSIONS A change in the ratio of symptomatic to asymptomatic infections can give rise to changes in the reported incidence of dengue. In order to take an appropriate policy decision in dengue control activities, it would be important to study the changes in virus serotypes, vector dispersion, and densities. Further, the contribution of the rise in metabolic diseases to an increase in the symptomatic as well as more severe infections due to dengue is explored.
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Affiliation(s)
- Gathsaurie Neelika Malavige
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Allergy Immunology and Cell Biology Unit (AICBU), Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Chandima Jeewandara
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Allergy Immunology and Cell Biology Unit (AICBU), Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Azhar Ghouse
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka
| | - Gayasha Somathilake
- Allergy Immunology and Cell Biology Unit (AICBU), Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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Seery V, Raiden SC, Algieri SC, Grisolía NA, Filippo D, De Carli N, Di Lalla S, Cairoli H, Chiolo MJ, Meregalli CN, Gimenez LI, Gregorio G, Sarli M, Alcalde AL, Davenport C, Bruera MJ, Simaz N, Pérez MF, Nivela V, Bayle C, Tuccillo P, Agosta MT, Pérez H, Villa Nova S, Suárez P, Takata EM, García M, Lattner J, Rolón MJ, Coll P, Sananez I, Holgado MP, Ferrero F, Geffner J, Arruvito L. Blood neutrophils from children with COVID-19 exhibit both inflammatory and anti-inflammatory markers. EBioMedicine 2021; 67:103357. [PMID: 33979758 PMCID: PMC8153212 DOI: 10.1016/j.ebiom.2021.103357] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/10/2021] [Accepted: 04/12/2021] [Indexed: 12/15/2022] Open
Abstract
Background Perhaps reflecting that children with COVID-19 rarely exhibit severe respiratory symptoms and often remain asymptomatic, little attention has been paid to explore the immune response in pediatric COVID-19. Here, we analyzed the phenotype and function of circulating neutrophils from children with COVID-19. Methods An observational study including 182 children with COVID-19, 21 children with multisystem inflammatory syndrome (MIS-C), and 40 healthy children was performed in Buenos Aires, Argentina. Neutrophil phenotype was analyzed by flow cytometry in blood samples. Cytokine production, plasma levels of IgG antibodies directed to the spike protein of SARS-CoV-2 and citrullinated histone H3 were measured by ELISA. Cell-free DNA was quantified by fluorometry. Findings Compared with healthy controls, neutrophils from children with COVID-19 showed a lower expression of CD11b, CD66b, and L-selectin but a higher expression of the activation markers HLA-DR, CD64 and PECAM-1 and the inhibitory receptors LAIR-1 and PD-L1. No differences in the production of cytokines and NETs were observed. Interestingly, the expression of CD64 in neutrophils and the serum concentration of IgG antibodies directed to the spike protein of SARS-CoV-2 distinguished asymptomatic from mild and moderate COVID-19. Interpretation Acute lung injury is a prominent feature of severe COVID-19 in adults. A low expression of adhesion molecules together with a high expression of inhibitory receptors in neutrophils from children with COVID-19 might prevent tissue infiltration by neutrophils preserving lung function.
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Affiliation(s)
- Vanesa Seery
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, Facultad de Medicina. UBA-CONICET, Paraguay 2155, C1121ABG CABA, Argentina
| | - Silvina C Raiden
- Departamento de Medicina, Hospital General de Niños Pedro de Elizalde. Av. Montes de Oca 40, CABA C1270, Argentina
| | - Silvia C Algieri
- Servicio de Pediatría, Hospital Nacional Profesor Alejandro Posadas, Marconi Morón 386, Buenos Aires B1684, Argentina
| | - Nicolás A Grisolía
- Departamento de Medicina, Hospital General de Niños Pedro de Elizalde. Av. Montes de Oca 40, CABA C1270, Argentina
| | - Daniela Filippo
- Servicio de Pediatría, Hospital Municipal Diego Thompson. Avellaneda 33, Buenos Aires B1650, Argentina
| | - Norberto De Carli
- Servicio de Pediatría, Clínica del Niño de Quilmes, Av. Lamadrid 444, Buenos Aires B1878, Argentina
| | - Sandra Di Lalla
- Departamento de Consultorios Externos, Hospital General de Niños Pedro de Elizalde, Av. Montes de Oca 40, CABA C1270, Argentina
| | - Héctor Cairoli
- Departamento de Medicina, Hospital General de Niños Pedro de Elizalde. Av. Montes de Oca 40, CABA C1270, Argentina
| | - María J Chiolo
- Departamento de Cirugía, Hospital General de Niños Pedro de Elizalde, Av. Montes de Oca 40, CABA C1270, Argentina
| | - Claudia N Meregalli
- Unidad de Terapia Intensiva Pediátrica, Departamento de Urgencias, Hospital General de Niños Pedro de Elizalde. Av. Montes de Oca 40, CABA C1270, Argentina
| | - Lorena I Gimenez
- Servicio de Pediatría, Hospital Municipal Diego Thompson. Avellaneda 33, Buenos Aires B1650, Argentina
| | - Gabriela Gregorio
- Servicio de Pediatría, Hospital Nacional Profesor Alejandro Posadas, Marconi Morón 386, Buenos Aires B1684, Argentina
| | - Mariam Sarli
- Unidad de Terapia Intensiva Pediátrica, Hospital Nacional Profesor Alejandro Posadas, Marconi Morón 386, Buenos Aires B1684, Argentina
| | - Ana L Alcalde
- Servicio de Pediatría, Hospital Nacional Profesor Alejandro Posadas, Marconi Morón 386, Buenos Aires B1684, Argentina
| | - Carolina Davenport
- Departamento de Medicina, Hospital General de Niños Pedro de Elizalde. Av. Montes de Oca 40, CABA C1270, Argentina
| | - María J Bruera
- Unidad de Terapia Intensiva Pediátrica, Hospital Nacional Profesor Alejandro Posadas, Marconi Morón 386, Buenos Aires B1684, Argentina
| | - Nancy Simaz
- Servicio de Pediatría, Hospital Nacional Profesor Alejandro Posadas, Marconi Morón 386, Buenos Aires B1684, Argentina
| | - Mariela F Pérez
- Servicio de Pediatría, Hospital Nacional Profesor Alejandro Posadas, Marconi Morón 386, Buenos Aires B1684, Argentina
| | - Valeria Nivela
- Departamento de Emergencias Pediátrica, Hospital Nacional Profesor Alejandro Posadas, Marconi Morón 386, Buenos Aires B1684, Argentina
| | - Carola Bayle
- Departamento de Emergencias Pediátrica, Hospital Nacional Profesor Alejandro Posadas, Marconi Morón 386, Buenos Aires B1684, Argentina
| | - Patricia Tuccillo
- Servicio de Pediatría, Hospital Naval Cirujano Mayor Dr. Pedro Mallo, Av. Patricias Argentinas 351, CABA C1405, Argentina
| | - María T Agosta
- Servicio de Pediatría, Hospital Naval Cirujano Mayor Dr. Pedro Mallo, Av. Patricias Argentinas 351, CABA C1405, Argentina
| | - Hernán Pérez
- Servicio de Pediatría, Hospital Naval Cirujano Mayor Dr. Pedro Mallo, Av. Patricias Argentinas 351, CABA C1405, Argentina
| | - Susana Villa Nova
- Servicio de Pediatría, Hospital General de Agudos Dr. Juan A. Fernández, Av. Cerviño 3356, CABA C1425, Argentina
| | - Patricia Suárez
- Servicio de Pediatría, Hospital General de Agudos Dr. Juan A. Fernández, Av. Cerviño 3356, CABA C1425, Argentina
| | - Eugenia M Takata
- Servicio de Pediatría, Hospital General de Agudos Dr. Juan A. Fernández, Av. Cerviño 3356, CABA C1425, Argentina
| | - Mariela García
- Servicio de Pediatría, Hospital General de Agudos Dr. Juan A. Fernández, Av. Cerviño 3356, CABA C1425, Argentina
| | - Jorge Lattner
- Servicio de Infectología Pediátrica, Hospital Naval Cirujano Mayor Dr. Pedro Mallo, Av. Patricias Argentinas 351, CABA C1405, Argentina
| | - María J Rolón
- División Infectología, Hospital General de Agudos Dr. Juan A. Fernández, Av. Cerviño 3356, CABA C1425, Argentina
| | - Patricia Coll
- División Infectología, Hospital General de Agudos Dr. Juan A. Fernández, Av. Cerviño 3356, CABA C1425, Argentina
| | - Inés Sananez
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, Facultad de Medicina. UBA-CONICET, Paraguay 2155, C1121ABG CABA, Argentina
| | - María P Holgado
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, Facultad de Medicina. UBA-CONICET, Paraguay 2155, C1121ABG CABA, Argentina
| | - Fernando Ferrero
- Departamento de Medicina, Hospital General de Niños Pedro de Elizalde. Av. Montes de Oca 40, CABA C1270, Argentina
| | - Jorge Geffner
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, Facultad de Medicina. UBA-CONICET, Paraguay 2155, C1121ABG CABA, Argentina
| | - Lourdes Arruvito
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, Facultad de Medicina. UBA-CONICET, Paraguay 2155, C1121ABG CABA, Argentina.
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Yoshimura M, Shinmura Y, Shishido T, Takagi S, Kameyama K, Sonoda K, Yoksan S, Kimachi K. Persistence of neutralizing antibody and its protective efficacy induced by a live attenuated tetravalent dengue vaccine, KD-382, in cynomolgus monkeys. Vaccine 2021; 39:3169-3178. [PMID: 33941407 DOI: 10.1016/j.vaccine.2021.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 11/30/2022]
Abstract
An effective dengue vaccine should induce a long-lasting immune response against all four serotypes simultaneously with a minimum number of immunizations. Our live attenuated tetravalent dengue vaccine candidate, KD-382, was developed using a classical host range mutation strategy (no addition of artificial genetic modification). In our previous study, cynomolgus monkeys immunized with a single dose of KD-382 seroconverted to all four serotypes. However, it is important to determine if neutralizing antibodies (NAbs) induced by KD-382 can work as a long-lasting immune response to prevent dengue. In this study, a single dose of KD-382 induced a strong NAb response against all four serotypes in cynomolgus monkeys. We also confirmed that NAb titers against all four serotypes persist for at least five years, indicating its high potential as a dengue vaccine candidate. Next, we evaluated the effect of pre-existing dengue immunity on NAb responses induced by KD-382. We administered KD-382 to cynomolgus monkeys pre-administered one of the monovalent parental wild-type strains 60 days before vaccination. Regardless of the pre-immunized serotype, all the monkeys showed sufficient tetravalent NAb responses, which lasted for over two years. All the KD-382 vaccinated monkeys were then challenged with different parental wild-type viruses than that used for pre-administration; viral RNA in the serum was less than the lower limit of quantification, indicating complete protection against secondary heterologous dengue infection without any harmful disease enhancement. Consequently, KD-382 successfully induced a long-lasting and protective tetravalent NAb response in monkeys, suggesting that KD-382 is a promising vaccine candidate usable for both dengue seronegative and seropositive individuals.
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Affiliation(s)
- Masaya Yoshimura
- KM Biologics Co., Ltd., 1-6-1 Okubo, Kita-ku, Kumamoto-shi, Kumamoto 860-8568, Japan.
| | - Yasuhiko Shinmura
- KM Biologics Co., Ltd., 1-6-1 Okubo, Kita-ku, Kumamoto-shi, Kumamoto 860-8568, Japan.
| | - Tatsuya Shishido
- KM Biologics Co., Ltd., 1-6-1 Okubo, Kita-ku, Kumamoto-shi, Kumamoto 860-8568, Japan
| | - Shota Takagi
- KM Biologics Co., Ltd., 1-6-1 Okubo, Kita-ku, Kumamoto-shi, Kumamoto 860-8568, Japan
| | - Kazuhisa Kameyama
- KM Biologics Co., Ltd., 1-6-1 Okubo, Kita-ku, Kumamoto-shi, Kumamoto 860-8568, Japan
| | - Kengo Sonoda
- KM Biologics Co., Ltd., 1-6-1 Okubo, Kita-ku, Kumamoto-shi, Kumamoto 860-8568, Japan
| | - Sutee Yoksan
- Center for Vaccine Development, Institute of Molecular Biosciences, Mahidol University, 25/25 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand
| | - Kazuhiko Kimachi
- KM Biologics Co., Ltd., 1-6-1 Okubo, Kita-ku, Kumamoto-shi, Kumamoto 860-8568, Japan.
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Warnes CM, Santacruz-Sanmartín E, Bustos Carrillo F, Vélez ID. Surveillance and Epidemiology of Dengue in Medellín, Colombia from 2009 to 2017. Am J Trop Med Hyg 2021; 104:1719-1728. [PMID: 33755586 PMCID: PMC8103481 DOI: 10.4269/ajtmh.19-0728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/22/2021] [Indexed: 11/07/2022] Open
Abstract
Dengue is the most prevalent arthropod-borne viral disease in humans, primarily transmitted by the Aedes aegypti mosquito. We conducted a descriptive analysis of dengue cases from 2009 to 2017 in Medellín, Colombia, using data available from the Secretariat of Health. We analyzed the burden of outbreak years on the healthcare system, risk of cases exhibiting severe illness, potential disease surveillance problems, gender and age as risk factors, and spatiotemporal patterns of disease occurrence. Our data consisted of 50,083 cases, separated based on whether they were diagnostic test negative, diagnostic test positive (primarily IgM ELISA), clinically confirmed, epidemiologically linked, or probable. We used dengue incidence to analyze epidemiological trends between our study years, related to human movement patterns, between gender and age-groups, and spatiotemporally. We used risk to analyze the severity of dengue cases between the study years. We identified human movement could contributed to dengue spread, and male individuals (incidence rate: 0.86; 95% CI: 0.76-0.96) and individuals younger than 15 years (incidence rate: 1.24; 95% CI: 1.13-1.34) have higher incidence of dengue and located critical parts of the city where dengue incidence was high. Analysis was limited by participant diagnostic information, data concerning circulating strains, and a lack of phylogenetic information. Understanding the characteristics of dengue is a fundamental part of improving the health outcomes of at-risk populations. This analysis will be useful to support studies and initiatives to counteract dengue and provide context to the surveillance data collected by the health authorities in Medellín.
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Affiliation(s)
- Colin M. Warnes
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellín, Colombia
| | - Eduardo Santacruz-Sanmartín
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellín, Colombia
| | | | - Iván Darío Vélez
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellín, Colombia
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do Carmo RF, Silva Júnior JVJ, Pastor AF, de Souza CDF. Spatiotemporal dynamics, risk areas and social determinants of dengue in Northeastern Brazil, 2014-2017: an ecological study. Infect Dis Poverty 2020; 9:153. [PMID: 33143752 PMCID: PMC7607617 DOI: 10.1186/s40249-020-00772-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022] Open
Abstract
Background Dengue fever is an arthropod-borne viral disease caused by dengue virus (DENV) and transmitted by Aedes mosquitoes. The Northeast region of Brazil is characterized by having one of the highest dengue rates in the country, in addition to being considered the poorest region. Here, we aimed to identify spatial clusters with the highest dengue risk, as well as to analyze the temporal behavior of the incidence rate and the effects of social determinants on the disease transmission dynamic in Northeastern Brazil. Methods This is an ecological study carried out with all confirmed cases of dengue in the Northeast Brazil between 2014 and 2017. Data were extracted from the National Notifiable Diseases Information System (SINAN) and the Brazilian Institute of Geography and Statistics (IBGE). Local empirical Bayesian model, Moran statistics and spatial scan statistics were applied. The association between dengue incidence rate and social determinants was tested using Moran’s bivariate correlation. Results A total of 509 261 cases of dengue were confirmed in the Northeast during the study period, 53.41% of them were concentrated in Pernambuco and Ceará states. Spatial analysis showed a heterogeneous distribution of dengue cases in the region, with the highest rates in the east coast. Four risk clusters were observed, involving 815 municipalities (45.45%). Moreover, social indicators related to population density, education, income, housing, and social vulnerability showed a spatial correlation with the dengue incidence rate. Conclusions This study provides information on the spatial dynamics of dengue in northeastern Brazil and its relationship with social determinants and can be used in the formulation of public health policies to reduce the impact of the disease in vulnerable populations.
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Affiliation(s)
- Rodrigo Feliciano do Carmo
- Post Graduation Program in Health and Biological Sciences, Federal University of São Francisco Valley (UNIVASF), Av. José de Sá Maniçoba, s/n, Centro, Petrolina, PE, Brazil. .,Post Graduation Program in Bioscience, Federal University of São Francisco Valley (UNIVASF), Petrolina, Brazil.
| | - José Valter Joaquim Silva Júnior
- Virology Sector, Department of Preventive Veterinary Medicine, Federal University of Santa Maria, Camobi, Santa Maria, Brazil.,Department of Microbiology and Parasitology, Federal University of Santa Maria, Camobi, Santa Maria, Brazil.,Virology Sector, Keizo Asami Immunopathology Laboratory, Federal University of Pernambuco, Recife, Brazil
| | - Andre Filipe Pastor
- Federal Institute of Education, Science and Technology of Sertão Pernambucano (IF Sertao-PE), Floresta, Brazil
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11
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Lim JK, Matendechero SH, Alexander N, Lee JS, Lee KS, Namkung S, Andia E, Oyembo N, Lim SK, Kanyi H, Bae SH, Yang JS, Ochola MA, Edwards T, Yoon IK, Njenga SM. Clinical and epidemiologic characteristics associated with dengue fever in Mombasa, Kenya. Int J Infect Dis 2020; 100:207-215. [PMID: 32891734 PMCID: PMC7670221 DOI: 10.1016/j.ijid.2020.08.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Information on dengue in Africa is limited. To estimate the proportion of dengue-positive cases among febrile patients and describe clinical indicators of dengue, we conducted passive health facility-based fever surveillance in Mombasa, Kenya. METHODS Non-malarial febrile patients between one and 55 years were enrolled at three health facilities between March 2016 and May 2017. Acute and convalescent blood samples were collected with an interval of 10-21 days. Acute samples were tested with dengue RDT and a selected subset with RT-PCR, and acute/convalescent samples with IgM/IgG ELISA. RESULTS Among 482 enrollees, 295 (61.2%) were dengue-positive based on laboratory results. The surveillance covered the beginning of a dengue outbreak in April-May 2017, during which 73.9% of enrollees were dengue-positive. By contrast, during the non-outbreak period, 54.6% were dengue-positive. Dengue case status was positively associated with rash, fatigue, headache, retro-orbital pain, nausea/vomiting, nose bleeding, gum bleeding, loss of appetite, myalgia, and arthralgia. Dengue-positive cases in our study had mostly mild disease, with only two requiring observation, and no DHF. CONCLUSIONS The clinical response was generally mild relative to what was observed in SE Asia and the Americas. Given the high level of DENV transmission in Mombasa, more data would be needed to further understand the disease burden and improve case detection for surveillance/monitoring of outbreaks.
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Affiliation(s)
- Jacqueline Kyungah Lim
- International Vaccine Institute, Seoul, Republic of Korea; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
| | | | - Neal Alexander
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Jung-Seok Lee
- International Vaccine Institute, Seoul, Republic of Korea
| | - Kang Sung Lee
- International Vaccine Institute, Seoul, Republic of Korea
| | - Suk Namkung
- International Vaccine Institute, Seoul, Republic of Korea
| | - Esther Andia
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Noah Oyembo
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Sl-Ki Lim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Henry Kanyi
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - So Hee Bae
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jae Seung Yang
- International Vaccine Institute, Seoul, Republic of Korea
| | - Mary A Ochola
- Coast Provincial General Hospital, Mombasa County, Kenya
| | - Tansy Edwards
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - In-Kyu Yoon
- Coalition for Epidemic Preparedness Innovations (CEPI), Washington, D.C., USA
| | - Sammy M Njenga
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
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12
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Abstract
The COVID-19 pandemic has ignited interest in age-specific manifestations of infection but surprisingly little is known about relative severity of infectious disease between the extremes of age. In a systematic analysis we identified 142 datasets with information on severity of disease by age for 32 different infectious diseases, 19 viral and 13 bacterial. For almost all infections, school-age children have the least severe disease, and severity starts to rise long before old age. Indeed, for many infections even young adults have more severe disease than children, and dengue was the only infection that was most severe in school-age children. Together with data on vaccine response in children and young adults, the findings suggest peak immune function is reached around 5-14 years of age. Relative immune senescence may begin much earlier than assumed, before accelerating in older age groups. This has major implications for understanding resilience to infection, optimal vaccine scheduling, and appropriate health protection policies across the life course.
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Affiliation(s)
- Judith R Glynn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Paul A H Moss
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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13
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Maier SB, Massad E, Amaku M, Burattini MN, Greenhalgh D. The optimal age of vaccination against dengue in Brazil based on serotype-specific forces of infection derived from serological data. Math Med Biol 2020; 38:1-27. [PMID: 32671383 DOI: 10.1093/imammb/dqaa007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 06/06/2020] [Accepted: 06/06/2020] [Indexed: 11/14/2022]
Abstract
In this paper, we study a single serotype transmission model of dengue to determine the optimal vaccination age for Dengvaxia. The transmission dynamics are modelled with an age-dependent force of infection. The force of infection for each serotype is derived from the serological profile of dengue in Brazil without serotype distinction and from serotype-specific reported cases. The risk due to an infection is measured by the probability of requiring hospitalization based on Brazilian Ministry of Health data. The optimal vaccination age is determined for any number and combination of the four distinct dengue virus serotypes DENv1-4. The lifetime expected risk is adapted to include antibody dependent enhancement (ADE) and permanent cross-immunity after two heterologous infections. The risk is assumed to be serostatus-dependent. The optimal vaccination age is computed for constant, serostatus-specific vaccine efficacies. Additionally, the vaccination age is restricted to conform to the licence of Dengvaxia in Brazil and the achievable and minimal lifetime expected risks are compared. The optimal vaccination age obtained for the risk of hospitalization varies significantly with the assumptions relating to ADE and cross-immunity. Risk-free primary infections lead to higher optimal vaccination ages, as do asymptomatic third and fourth infections. Sometimes vaccination is not recommended at all, e.g. for any endemic area with a single serotype if primary infections are risk-free. Restricting the vaccination age to Dengvaxia licensed ages mostly leads to only a slightly higher lifetime expected risk and the vaccine should be administered as close as possible to the optimal vaccination age.
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Affiliation(s)
- Sandra B Maier
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, UK
| | - Eduardo Massad
- School of Applied Mathematics, Fundacao Getulio Vargas, Rio de Janeiro, Brazil, LIM01-Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil, London School of Hygiene and Tropical Medicine, London, UK
| | - Marcos Amaku
- LIM01-Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo N Burattini
- LIM01-Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - David Greenhalgh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, UK
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14
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Kumar A, Mayers S, Welch J, Taitt J, Benskin GA, Nielsen. The spectrum of disease severity, the burden of hospitalizations and associated risk factors in confirmed dengue among persons of all ages: findings from a population based longitudinal study from Barbados. Infect Dis (Lond) 2020; 52:396-404. [PMID: 32286109 DOI: 10.1080/23744235.2020.1749723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: Dengue can be severe and potentially fatal in a small proportion. Risk factors for severe dengue have been highlighted but long term population based study is lacking. We assesses the severity and hospitalization in dengue.Methods: This is a longitudinal population based prospective study of all persons with confirmed dengue in Barbados during the years 2006 through 2015. Most recent WHO criteria were used for classifying dengue severity. Disease severity and hospitalization need were two main outcomes.Results: There were 2939 ambulatory and 1234 hospitalized cases. Compared to those in the age group 16-60 years, the risk of hospitalization was higher among persons over 61 years (RR = 1.8) and those under 16 years (RR = 1.7). Overall, 190 (4.4%), 771 (17.8%) and 3202 (73.7%) were classified as severe and dengue with and without warning signs respectively. The risk of severe dengue was higher in the over 60 years age group compared to the 16-60 years (RR = 1.97). Primary infection was at a lower risk of severe dengue compared to secondary infection (RR = 0.46).Conclusions: Less than 5% of dengue presents with severe disease, the risk being highest among the elderly and those with previous dengue.
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Affiliation(s)
- Alok Kumar
- The Faculty of Medical Sciences, The University of the West Indies, Bridgetown, Barbados.,The Queen Elizabeth Hospital, Bridgetown, Barbados
| | | | | | - Janine Taitt
- The Queen Elizabeth Hospital, Bridgetown, Barbados
| | | | - Nielsen
- The Faculty of Medical Sciences, The University of the West Indies, Bridgetown, Barbados.,The Queen Elizabeth Hospital, Bridgetown, Barbados
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15
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Maier SB, Massad E, Amaku M, Burattini MN, Greenhalgh D. The Optimal Age of Vaccination Against Dengue with an Age-Dependent Biting Rate with Application to Brazil. Bull Math Biol 2020; 82:12. [PMID: 31933012 PMCID: PMC6957571 DOI: 10.1007/s11538-019-00690-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 12/13/2019] [Indexed: 11/07/2022]
Abstract
In this paper we introduce a single serotype transmission model, including an age-dependent mosquito biting rate, to find the optimal vaccination age against dengue in Brazil with Dengvaxia. The optimal vaccination age and minimal lifetime expected risk of hospitalisation are found by adapting a method due to Hethcote (Math Biosci 89:29–52). Any number and combination of the four dengue serotypes DENv1–4 is considered. Successful vaccination against a serotype corresponds to a silent infection. The effects of antibody-dependent enhancement (ADE) and permanent cross-immunity after two heterologous infections are studied. ADE is assumed to imply risk-free primary infections, while permanent cross-immunity implies risk-free tertiary and quaternary infections. Data from trials of Dengvaxia indicate vaccine efficacy to be age and serostatus dependent and vaccination of seronegative individuals to induce an increased risk of hospitalisation. Some of the scenarios are therefore reconsidered taking these findings into account. The optimal vaccination age is compared to that achievable under the current age restriction of the vaccine. If vaccination is not considered to induce risk, optimal vaccination ages are very low. The assumption of ADE generally leads to a higher optimal vaccination age in this case. For a single serotype vaccination is not recommended in the case of ADE. Permanent cross-immunity results in a slightly lower optimal vaccination age. If vaccination induces a risk, the optimal vaccination ages are much higher, particularly for permanent cross-immunity. ADE has no effect on the optimal vaccination age when permanent cross-immunity is considered; otherwise, it leads to a slight increase in optimal vaccination age.
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Affiliation(s)
- Sandra B Maier
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, G1 1XH, U.K
| | - Eduardo Massad
- LIM01-Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.,London School of Hygiene and Tropical Medicine, London, U.K.,School of Applied Mathematics, Fundação Getulio Vargas, Rio de Janeiro, RJ, Brazil
| | - Marcos Amaku
- LIM01-Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo N Burattini
- LIM01-Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.,Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - David Greenhalgh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, G1 1XH, U.K..
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16
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Guimarães LM, Cunha GMD. Diferenças por sexo e idade no preenchimento da escolaridade em fichas de vigilância em capitais brasileiras com maior incidência de dengue, 2008-2017. CAD SAUDE PUBLICA 2020; 36:e00187219. [DOI: 10.1590/0102-311x00187219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/01/2020] [Indexed: 11/22/2022] Open
Abstract
O Brasil figura entre os países com o maior número de casos de dengue no mundo. Sistemas de notificação são fundamentais para acompanhar a evolução do agravo, porém são pouco preenchidos. O conhecimento do nível educacional dos indivíduos é importante para o entendimento do papel da desigualdade social no risco de adoecimento. O objetivo deste artigo é descrever o preenchimento da escolaridade nas fichas de notificação para dengue disponibilizadas pelo Sistema de Informação de Agravos de Notificação (SINAN) entre 2008 e 2017, por sexo e faixa etária, entre as capitais das regiões Nordeste e Sudeste do país. O desfecho de interesse foi o preenchimento da variável escolaridade. As probabilidades preditas de preenchimento da escolaridade foram obtidas utilizando-se modelos logísticos multiníveis. Esse preenchimento foi baixo nas capitais, sendo em oito delas inferior a 30% no período. A chance de ter a escolaridade preenchida decresceu com o avançar da idade, independentemente do sexo e do ano. Mulheres com até 60 anos apresentaram maiores chances de preenchimento da escolaridade que os homens. De um modo geral, os homens registraram 9% menos chances de ter a escolaridade preenchida do que as mulheres. No modelo com interação houve uma intensificação da diferença, ou seja, houve uma piora no preenchimento com o progredir da idade, principalmente entre as mulheres. Diante do exposto, o mau preenchimento das fichas favorece a geração de dados deficientes e duvidosos, e a escolaridade, embora pouco valorizada no ato do preenchimento, tem importância central nesta conjuntura.
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17
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Estofolete CF, de Oliveira Mota MT, Bernardes Terzian AC, de Aguiar Milhim BHG, Ribeiro MR, Nunes DV, Mourão MP, Rossi SL, Nogueira ML, Vasilakis N. Unusual clinical manifestations of dengue disease - Real or imagined? Acta Trop 2019; 199:105134. [PMID: 31415737 DOI: 10.1016/j.actatropica.2019.105134] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 01/10/2023]
Abstract
The disease caused by each of the four serotypes of dengue virus (DENV) have plagued humans since last century. Symptoms of dengue virus (DENV) infection range from asymptomatic to dengue fever (DF) to severe dengue disease (SDD). One third of the world's population lives in regions with active urban DENV transmission, and thousands of serologically naïve travelers visit these areas annually, making a significant portion of the human population at risk of being infected. Even though lifelong immunity to the homotypic serotype is achieved after a primary DENV infection. Heterotypic DENV infections may be exacerbated by a pre-existing immune memory to the primary infection and can result in an increased probability of severe disease. Not only, age, comorbidities and presence of antibodies transferred passively from dengue-immune mother to infants are considered risk factors to dengue severe forms. Plasma leakage and multiple organ impairment are well documented in the literature, affecting liver, lung, brain, muscle, and kidney. However, unusual manifestation, severe or not, have been reported and may require medical attention. This review will summarize and discuss the increasing reports of unusual manifestations in the clinical course of dengue infection.
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Affiliation(s)
| | | | | | | | - Milene Rocha Ribeiro
- São José do Rio Preto School of Medicine (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Delzi Vinha Nunes
- São José do Rio Preto School of Medicine (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Maria Paula Mourão
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation (FMT-HVD), Manaus, Amazonas, Brazil
| | - Shannan L Rossi
- University of Texas Medical Branch (UTMB), Galveston, Texas, USA
| | | | - Nikos Vasilakis
- University of Texas Medical Branch (UTMB), Galveston, Texas, USA.
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18
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Rojas A, Cardozo F, Cantero C, Stittleburg V, López S, Bernal C, Gimenez Acosta FE, Mendoza L, Pinsky BA, Arévalo de Guillén I, Páez M, Waggoner J. Characterization of dengue cases among patients with an acute illness, Central Department, Paraguay. PeerJ 2019; 7:e7852. [PMID: 31616598 PMCID: PMC6790102 DOI: 10.7717/peerj.7852] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/08/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In 2018, Paraguay experienced a large dengue virus (DENV) outbreak. The primary objective of this study was to characterize dengue cases in the Central Department, where the majority of cases occur, and identify factors associated with DENV infection. METHODS Patients were enrolled from January-May 2018 if they presented with a suspected arboviral illness. Acute-phase specimens (≤8 days after symptom onset) were tested using rRT-PCR, a rapid diagnostic test for DENV nonstructural protein 1 (NS1) and anti-DENV IgM and IgG, and ELISA for IgG against NS1 from Zika virus (ZIKV). RESULTS A total of 231 patients were enrolled (95.2% adults) at two sites: emergency care and an outpatient clinical site. Patients included 119 (51.5%) dengue cases confirmed by rRT-PCR (n = 115, 96.6%) and/or the detection of NS1 and anti-DENV IgM (n = 4, 3.4%). DENV-1 was the predominant serotype (109/115, 94.8%). Epidemiologically, dengue cases and non-dengue cases were similar, though dengue cases were less likely to reside in a house/apartment or report a previous dengue case. Clinical and laboratory findings associated with dengue included red eyes, absence of sore throat, leucopenia and thrombocytopenia. At an emergency care site, 26% of dengue cases (26/100) required hospitalization. In univariate analysis, hospitalization was associated with increased viral load, anti-DENV IgG, and thrombocytopenia. Among dengue cases that tested positive for IgG against ZIKV NS1, the odds of DENV NS1 detection in the acute phase were decreased 10-fold (OR 0.1, 0.0-0.3). CONCLUSIONS Findings from a predominantly adult population demonstrate clinical and laboratory factors associated with DENV infections and the potential severity of dengue in this group. The combination of viral load and specific IgG antibodies warrant further study as a prognostic to identify patients at risk for severe disease.
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Affiliation(s)
- Alejandra Rojas
- Departamento de Producción, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Fátima Cardozo
- Departamento de Salud Pública, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - César Cantero
- Departamento de Producción, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Victoria Stittleburg
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, United States of America
| | - Sanny López
- Departamento de Producción, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Cynthia Bernal
- Departamento de Producción, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Laura Mendoza
- Departamento de Salud Pública, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Benjamin A. Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States of America
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Ivalena Arévalo de Guillén
- Departamento de Producción, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Malvina Páez
- Departamento de Salud Pública, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Jesse Waggoner
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, United States of America
- Rollins School of Public Health, Department of Global Health, Emory University, Atlanta, GA, United States of America
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19
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Abstract
Dengue is the world's most prevalent and important arboviral disease. More than 50% of the world's population lives at daily risk of infection and it is estimated more than 95 million people a year seek medical care following infection. Severe disease can manifest as plasma leakage and potential for clinically significant hemorrhage, shock, and death. Treatment is supportive and there is currently no licensed anti-dengue virus prophylactic or therapeutic compound. A single dengue vaccine, Sanofi Pasteur's Dengvaxia®, has been licensed in 20 countries but uptake has been poor. A safety signal in dengue seronegative vaccine recipients stimulated an international re-look at the vaccine performance profile, new World Health Organization recommendations for use, and controversy in the Philippines involving the government, regulatory agencies, Sanofi Pasteur, clinicians responsible for testing and administering the vaccine, and the parents of vaccinated children. In this review, we provide an overview of Dengvaxia's® development and discuss what has been learned about product performance since its licensure.
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Affiliation(s)
- Stephen J Thomas
- State University of New York, Upstate Medical University, Division of Infectious Diseases, Institute for Global Health and Translational Sciences , Syracuse , NY , USA
| | - In-Kyu Yoon
- Global Dengue & Aedes-Transmitted Diseases Consortium, International Vaccine Institute, SNU Research Park , Gwanak-gu , Republic of Korea
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20
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Díaz Y, Chen-Germán M, Quiroz E, Carrera JP, Cisneros J, Moreno B, Cerezo L, Martinez-Torres AO, Moreno L, Barahona de Mosca I, Armién B, Chen R, Vasilakis N, López-Vergès S. Molecular Epidemiology of Dengue in Panama: 25 Years of Circulation. Viruses 2019; 11:E764. [PMID: 31434193 DOI: 10.3390/v11080764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 07/16/2019] [Accepted: 07/24/2019] [Indexed: 11/16/2022] Open
Abstract
Dengue virus (DENV) is the most prevalent arbovirus in terms of human public health importance globally. In addition to DENV epidemiological surveillance, genomic surveillance may help investigators understand the epidemiological dynamics, geographic distribution, and temporal patterns of DENV circulation. Herein, we aimed to reconstruct the molecular epidemiology and phylogeny of DENV in Panama to connect the epidemiological history of DENV dispersal and circulation in Latin America. We retrospectively analyzed the epidemiological data obtained during 25 years of DENV surveillance in Panama. DENV was reintroduced in Panama in 1993 after a 35 year absence of autochthonous transmission. The increase in the number of total dengue cases has been accompanied by an increase in severe and fatal cases, with the highest case fatality rate recorded in 2011. All four serotypes were detected in Panama, which is characterized by serotype replacement and/or co-circulation of multiple serotypes. Phylogenetic analysis of datasets collected from envelope (E) gene sequences obtained from viruses isolated from human sera demonstrated that circulating viruses were highly diverse and clustered in distinct clades, with co-circulation of clades from the same genotype. Our analyses also suggest that Panamanian strains were related to viruses from different regions of the Americas, suggesting a continuous exchange of viruses within the Americas.
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21
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Gonçalves BDS, Nogueira RMR, Bispo de Filippis AM, Horta MAP. Factors predicting the severity of dengue in patients with warning signs in Rio de Janeiro, Brazil (1986–2012). Trans R Soc Trop Med Hyg 2019; 113:670-677. [DOI: 10.1093/trstmh/trz066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/29/2019] [Accepted: 06/25/2019] [Indexed: 01/15/2023] Open
Abstract
AbstractBackgroundSince 1981, >12 million cases of dengue have been reported in Brazil. Early prediction of severe dengue with no warning signs is crucial to avoid progression to severe dengue. Here we aimed to identify early markers of dengue severity and characterize dengue infection in patients in Rio de Janeiro.MethodsWe evaluated early severity markers, serotypes, infection status, number of days of illness and viral loads associated with dengue fever in patients from Rio de Janeiro, Brazil through an observational retrospective study (1986–2012). We compared dengue without warning signs and dengue with warning signs/severe dengue (DWWS/SD). Infection status was classified by enzyme-linked immunosorbent assay and viraemia was quantified by quantitative real-time reverse transcription polymerase chain reaction.ResultsThe presence of DWWS/ SD was significantly associated with younger age; patients 13–19 y of age had a significantly greater chance of presenting warning signs. Dengue virus type 3 (DENV3) was more likely to induce DWWS/SD, which was more frequent on days 4–5 of illness.ConclusionsDENV3, 4–5 d of illness and 13–19 y of age were early biomarkers of dengue severity. To our knowledge, this was the first study to analyse the characteristics of dengue severity in the state of Rio de Janeiro over 27 y of epidemics since the introduction of DENV.
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Affiliation(s)
- Bianca De Santis Gonçalves
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Av Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil
| | - Rita Maria Ribeiro Nogueira
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Av Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil
| | - Ana Maria Bispo de Filippis
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Av Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil
| | - Marco Aurélio Pereira Horta
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Av Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil
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Ren J, Ling F, Sun J, Gong Z, Liu Y, Shi X, Zhang R, Zhai Y, Chen E, Chen Z. Epidemiological profile of dengue in Zhejiang Province, southeast China. PLoS One 2018; 13:e0208810. [PMID: 30533054 PMCID: PMC6289432 DOI: 10.1371/journal.pone.0208810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/23/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Dengue is one of the most important vector-bore infectious diseases in China because of its drastic increase in incidence, geographic extension and profound influence on China's economy. This study aims to retrospectively uncover the epidemiological profile of dengue in Zhejiang, one of the most developed provinces in China, and to find the problem existing in dengue control and prevention. METHODOLOGY Descriptive analyses on the dengue incidence and associated factors were performed. We also identified potential space-time cluster and generated the risk map of dengue. PRINCIPAL FINDINGS A total of 529 cases were reported in Zhejiang Province from 2005 to 2016, and 44.4% were imported. 67.7% of cases were 25~60 years old and the overall male-to-female sex ratio was 1.09:1. Dengue was reported all year round and 70.7% of cases occurred between August and October. Indigenous cases were only reported in the period between July to November and more than half occurred in September. Geographically, dengue was most distributed in Jinghua (3.62 per million), Shaoxing (1.00 per million) and Taizhou (0.81 per million) prefecture level cities. Outbreaks were confirmed in Yiwu, Keqiao and Huangyan counties in 2009, 2015, and 2016, respectively. 73.9% cases would seek medical advice within two days after onset and be confirmed within 9 days after onset. 75.6% would be recognized as dengue within 8 days after their first visit. The time intervals between onset and confirmation (median 7 vs 6 days; Wilcoxon rank sum test Z = -2.40, P = 0.016), first visit and confirmation (median 7 vs 6 days; Wilcoxon rank sum test Z = -2.59, P = 0.009) of indigenous cases were significantly longer than those of imported ones. However, the time intervals between onset and first visit for indigenous cases was shorter (median 0 vs 1 days; Wilcoxon rank sum test Z = -2.10, P = 0.036). Fever (99.1%), fatigue (81.9), rash (63.7%), headache (67.2%) and myalgia (52.60%) were the most frequently mentioned symptoms. CONCLUSIONS Zhejiang has recently witnessed an increase in incidence and geographic extension of dengue. Timely diagnosis is important to stop local transmission and outbreak.
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Affiliation(s)
- Jiangping Ren
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
- Field Epidemiology Training Program of Zhejiang Province, Hangzhou, China
| | - Feng Ling
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
| | - Jimin Sun
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
| | - Zhenyu Gong
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
| | - Ying Liu
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - Xuguang Shi
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - Rong Zhang
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - Yujia Zhai
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - Enfu Chen
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
- * E-mail: (EC); (ZC)
| | - Zhiping Chen
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
- * E-mail: (EC); (ZC)
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Wunderlich J, Acuña-soto R, Alonso WJ. Dengue hospitalisations in Brazil: annual wave from West to East and recent increase among children. Epidemiol Infect 2018; 146:236-45. [DOI: 10.1017/s0950268817002801] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYThe number of dengue epidemics in Brazil has increased dramatically in the last 15 years. In this study, we analysed the seasonal patterns in the incidence of hospitalisations due to dengue across the different states of Brazil and compared these with the corresponding climatic patterns. We discovered that the seasonality of dengue hospitalisations in Brazil has a clear zonal gradient, characterised by the progression of primary peaks from West to East during the first half of the year, which may be associated with the increased vapour pressure and rainfall during this period, leading to increased mosquito abundance and activity. We also found that the proportion of children among hospitalised individuals was especially high during the peak outbreaks in 2007/2008 and 2010. This may be due to the emergence and spread of the new DENV-2 Southeast Asian genotype lineage II from 2007, which has probably arrived from the Caribbean and may have caused an increase in incidence and severity of the disease, particularly among children. Our findings may allow health systems to improve control interventions and contribute to reducing dengue morbidity and mortality by using integrated vector control in conjunction with early diagnosis and prompt supportive care.
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Maier SB, Huang X, Massad E, Amaku M, Burattini MN, Greenhalgh D. Analysis of the optimal vaccination age for dengue in Brazil with a tetravalent dengue vaccine. Math Biosci 2017; 294:15-32. [PMID: 28935561 DOI: 10.1016/j.mbs.2017.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 05/18/2017] [Accepted: 09/11/2017] [Indexed: 02/06/2023]
Abstract
In this paper we study a mathematical model to analyse the optimal vaccination age against Dengue in Brazil. Data from Brazil are used to estimate the basic reproduction numbers for each of the four Dengue serotypes and then the optimal vaccination age is calculated using a method due to Hethcote [1]. The vaccine has different efficacies against each serotype. Vaccination that is too early is ineffective as individuals are protected by maternal antibodies but leaving vaccination until later may allow the disease to spread. First of all the optimal vaccination ages are calculated where there is just one serotype in circulation and then when there are multiple serotypes. The calculations are done using data both assuming constant vaccine efficacy and age-dependent vaccine efficacy against a given serotype. The multiple serotype calculations are repeated assuming that the first infection is a risky infection and that it is not (to model Dengue Antibody Enhancement). The calculations are then repeated when any third or fourth Dengue infections are asymptomatic, so that two Dengue infections with different serotypes provide effective permanent immunity. The calculations are also repeated when the age-dependent risk function (fitted to Brazilian data) is hospitalisation from Dengue and when it is mortality due to Dengue. We find a wide variety of optimal vaccination ages depending on both the serotypes in circulation and the assumptions of the model.
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Affiliation(s)
- Sandra B Maier
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, UK
| | - Xiao Huang
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, UK
| | - Eduardo Massad
- LIM01-Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Marcos Amaku
- LIM01-Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo N Burattini
- LIM01-Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - David Greenhalgh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, UK.
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