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      Dengue Virus Serotype 4, Northeastern Peru, 2008

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          Abstract

          In 2008, dengue virus serotype 4 (DENV-4) emerged in northeastern Peru, causing a large outbreak and displacing DENV-3, which had predominated for the previous 6 years. Phylogenetic analysis of 2008 and 2009 isolates support their inclusion into DENV-4 genotype II, forming a lineage distinct from strains that had previously circulated in the region.

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          Dengue and dengue hemorrhagic fever in the Americas: lessons and challenges.

          María G Guzmán, Gustavo Kouri (2003)
          The incidence of dengue and dengue hemorrhagic fever (DF/DHF) has increased significantly over the last decades. Yearly, an estimated 50-100 million cases of DF and about 250000-500000 cases of DHF occur worldwide. The epidemiological situation in Latin America now resembles that in Southeast Asia. Here, the main clinical, epidemiological and virological observations in the American region are presented and compared with those previously reported from Southeast Asia. During 2002, more than 30 Latin American countries reported over 1000000 DF cases. DHF occurred in 20 countries with more than 17000 DHF cases, including 225 fatalities. The co-circulation of multiple serotypes has been reported from many countries. In the Americas, DHF is observed both in children and adults; secondary infection by a different dengue virus serotype has been confirmed as an important risk factor for this severe form of the disease. However, some new risk factors such as the interval of dengue virus infections and the ethnicity and underlying chronic conditions of the patient have also been identified. The sequence of dengue virus infections and association with certain genotypes are further factors of importance. We also discuss the control and prevention strategies. In conclusion, without urgent action for the prevention and control of dengue/DHF and its vector, the current situation will worsen and, more dramatical, there is a risk of the urbanization of yellow fever.
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            Cross-protective immunity can account for the alternating epidemic pattern of dengue virus serotypes circulating in Bangkok.

            Annemieke M. H. Boots, E C Holmes, Radhika Mammen … (2006)
            Dengue virus, the causative agent of dengue fever and its more serious manifestation dengue hemorrhagic fever, is widespread throughout tropical and subtropical regions. The virus exists as four distinct serotypes, all of which have cocirculated in Bangkok for several decades with epidemic outbreaks occurring every 8-10 years. We analyze time-series data of monthly infection incidence, revealing a distinctive pattern with epidemics of serotypes 1, 2, and 3 occurring at approximately the same time and an isolated epidemic of serotype 4 occurring in the intervening years. Phylogenetic analysis of virus samples collected over the same period shows that clade replacement events are linked to the epidemic cycle and indicates that there is an interserotypic immune reaction. Using an epidemic model with stochastic seasonal forcing showing 8- to 10-year epidemic oscillations, we demonstrate that moderate cross-protective immunity gives rise to persistent out-of-phase oscillations similar to those observed in the data, but that strong or weak cross-protection or cross-enhancement only produces in-phase patterns. This behavior suggests that the epidemic pattern observed in Bangkok is the result of cross-protective immunity and may be significantly altered by changes in the interserotypic immune reaction.
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              Failure of secondary infection with American genotype dengue 2 to cause dengue haemorrhagic fever.

              Douglas Watts, Kevin R. Porter, Pavithat Putvatana … (1999)
              Population-based epidemiological studies have shown that infection with dengue type 2 (DEN-2) virus in individuals previously infected with a different serotype of the virus is a major risk factor for dengue haemorrhagic fever and dengue shock syndrome. However, the western hemisphere was spared epidemics of these two syndromes, until the introduction of a southeast Asian DEN-2 genotype. Possibly American DEN-2 genotype strains lacked properties necessary to cause severe disease. We report on a major epidemic of DEN-2 in Peru in 1995, about 5 years after an epidemic of DEN-1 in the same population. In Iquitos, a city of 344,686 inhabitants in Peru, cases of dengue fever were studied prospectively from 1990. Acute phase of illness serum samples from patients were tested for virus in C6/36 cells, and virus isolates were identified by immunofluorescence. Isolates of dengue 2 virus obtained from patients during an outbreak of mild febrile illness in 1995 were sequenced to determine the genotype. Serological analysis of paired samples from the patients was done with an IgM capture ELISA and an indirect IgG ELISA. In addition, serum samples collected annually between 1993 and 1996 from a large cohort of students were tested for dengue IgG antibody by an ELISA. Serum samples from a random sample of 129 students from this cohort were tested for dengue neutralising antibodies to quantify the serotype specific infection rates. Among the 129 students (aged 7-20 years in 1993) who had serum samples available before and after the epidemic, 78 (60.5%) had a secondary DEN-2 virus infection. By extrapolation, 49,266 of the 81,479 children (aged 5-14 years) in Iquitos would have experienced such infections. From previous studies, between 887 and 10,247 cases of dengue haemorrhagic fever and dengue shock syndrome would have been expected. No cases were found. DEN-2 isolates were of the American genotype. This prospective study shows that secondary infection by the American DEN-2 genotype did not cause dengue haemorrhagic fever and dengue shock syndrome.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): November 2009
                Volume: 15
                Issue: 11
                Pages: 1815-1818
                Affiliations
                [1]US Naval Medical Research Center Detachment, Lima and Iquitos, Peru (B.M. Forshey, A.C. Morrison, C. Cruz, C. Rocha, S. Vilcarromero, C. Guevara, T.J. Kochel)
                [2]University of California, Davis, California, USA (A.C. Morrison)
                [3]Laboratorio Regional de Diagnostico e Investigación del Dengue y otras Enfermedades Virales, Maracay, Estado Aragua, Venezuela (D.E. Camacho, G. Comach)
                [4]Instituto Nacional de Higiene y Medicina Tropical "Leopoldo Izquieta Pérez", Guayaquil, Ecuador (A. Alava)
                [5]Naval Hospital, Guayaquil (C. Madrid); Dirección General de Epidemiología, Ministerio de Salud, Lima (L. Beingolea)
                [6]Instituto Nacional de Salud, Lima (V. Suarez)
                Author notes
                Address for correspondence: Tadeusz J. Kochel, 3230 Lima Pl, Washington, DC, 20521–3230, USA; email: tad.kochel@ 123456med.navy.mil
                Article
                Publisher ID: 09-0663
                DOI: 10.3201/eid1511.090663
                PMC ID: 2857240
                PubMed ID: 19891873
                SO-VID: e3fe78c9-54c8-4678-a787-2a77c149fff5
                History
                Categories
                Subject: Dispatch

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: dengue virus,dispatch,peru,south america,vector-borne infections,mosquitoes,viruses
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: dengue virus, dispatch, peru, south america, vector-borne infections, mosquitoes, viruses

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