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Epidemiological and Clinical Observations on Patients with Dengue in Puerto Rico: Results from the First Year of Enhanced Surveillance—June 2005–May 2006

From June 2005 to May 2006, a clinic-based enhanced surveillance system for dengue was implemented in a Puerto Rican municipality to provide a population-based measure of disease incidence and clinical outcomes. We obtained demographic and clinical information from suspected cases and performed serologic and virologic testing. We used World Health Organization (WHO) criteria to classify cases and applied a simplified case definition for severe dengue illness. There were 7.7 laboratory-positive cases of dengue per 1,000 population. The highest incidence, 13.4 per 1,000, was among 10 to 19 year olds. Of the 156 laboratory-positive cases, three patients (1.9%) met WHO criteria for dengue hemorrhagic fever, and 30 patients (19.2%) had at least one severe clinical manifestation of dengue infection. Our data suggest that in a community with endemic dengue, enhanced surveillance is useful for detecting symptomatic infections. Furthermore, the simplified case definition for severe dengue may be useful in clinic-based surveillance.

Received December 5, 2007. Accepted for publication March 1, 2008.

Acknowledgments: The authors are extremely grateful to the personnel of the Centro de Servicios Primarios de Salud de Patillas as well as to the personnel of Genesis and CIMA Laboratories for their interest and hard work. The authors thank Dr. Jose G. Rigau-Pérez for his guidance and advice, Gladys Gonzalez-Zeno for her assistance in collecting data, and Valerie R. Johnson and Jay P. Schryer for editorial assistance.

Financial support: This work was supported by funding from Sanofi Pasteur.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

^* Address correspondence to Mary M. Ramos, Department of Pediatrics, University of New Mexico, 300 San Mateo Blvd, NE, Suite 902, Albuquerque, NM 87108. E-mail: mramos{at}salud.unm.edu

Authors’ addresses: Mary M. Ramos, Department of Pediatrics, University of New Mexico, 300 San Mateo Blvd, NE, suite 902, Albuquerque, NM 87108, Tel: 505-222-8684, Fax: 505-222-8675, E-mail: mramos{at}salud.unm.edu. D. Fermin Argüello, Luz Quiñones, Jorge L. Muñoz, and Kay M. Tomashek, Dengue Branch, Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, PR 00920, Tel: 787-706-2399, Fax: 787-706-2496. Christine Luxemburger, Sanofi Pasteur, 2 avenue du Pont Pasteur, 69007 Lyon, France. Mark Beatty, SNU Research Park, San 4-8 Bongcheon-7 dong, Kwanak-gu, Seoul, Korea 151-919, Tel: 82-2-881-1277, Fax: 82-881-1215. Jean Lang, Sanofi Pasteur, Campus Mérieux, 1541 avenue Marcel Mérieux, 69280 Marcyl’Etoile, France.