Previous Dengue Infection among Children in Puerto Rico and Implications for Dengue Vaccine Implementation

Laura E. Adams Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico;

Search for other papers by Laura E. Adams in
Current site
Google Scholar
PubMed
Close
,
Matt D. T. Hitchings University of Florida, Gainesville, Florida;

Search for other papers by Matt D. T. Hitchings in
Current site
Google Scholar
PubMed
Close
,
Freddy A. Medina Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico;

Search for other papers by Freddy A. Medina in
Current site
Google Scholar
PubMed
Close
,
Dania M. Rodriguez Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico;

Search for other papers by Dania M. Rodriguez in
Current site
Google Scholar
PubMed
Close
,
Liliana Sánchez-González Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico;

Search for other papers by Liliana Sánchez-González in
Current site
Google Scholar
PubMed
Close
,
Hannah Moore University of Georgia, Athens, Georgia;

Search for other papers by Hannah Moore in
Current site
Google Scholar
PubMed
Close
,
Stephen S. Whitehead Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland,

Search for other papers by Stephen S. Whitehead in
Current site
Google Scholar
PubMed
Close
,
Jorge L. Muñoz-Jordán Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico;

Search for other papers by Jorge L. Muñoz-Jordán in
Current site
Google Scholar
PubMed
Close
,
Vanessa Rivera-Amill Ponce Health Sciences University/Ponce Research Institute, Ponce, Puerto Rico

Search for other papers by Vanessa Rivera-Amill in
Current site
Google Scholar
PubMed
Close
, and
Gabriela Paz-Bailey Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico;

Search for other papers by Gabriela Paz-Bailey in
Current site
Google Scholar
PubMed
Close
Restricted access

ABSTRACT.

Limited dengue virus (DENV) seroprevalence estimates are available for Puerto Rico, which are needed to inform the potential use and cost-effectiveness of DENV vaccines. The Communities Organized to Prevent Arboviruses (COPA) is a cohort study initiated in 2018 in Ponce, Puerto Rico, to assess arboviral disease risk and provide a platform to evaluate interventions. We recruited participants from households in 38 study clusters, who were interviewed and provided a serum specimen. Specimens from 713 children aged 1 to 16 years during the first year of COPA were tested for the four DENV serotypes and ZIKV using a focus reduction neutralization assay. We assessed the seroprevalence of DENV and ZIKV by age and developed a catalytic model from seroprevalence and dengue surveillance data to estimate the force of infection for DENV during 2003–2018. Overall, 37% (n = 267) were seropositive for DENV; seroprevalence was 9% (11/128) among children aged 1 to 8 years and 44% (256/585) among children aged 9 to 16 years, exceeding the threshold over which DENV vaccination is deemed cost-effective. A total of 33% were seropositive for ZIKV, including 15% among children aged 0 to 8 years and 37% among children aged 9 to 16 years. The highest force of infection occurred in 2007, 2010, and 2012–2013, with low levels of transmission from 2016 to 2018. A higher proportion of children had evidence of multitypic DENV infection than expected, suggesting high heterogeneity in DENV risk in this setting.

    • Supplemental Materials (PDF 554.59 KB)

Author Notes

Address correspondence to Laura Adams, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, Puerto Rico. E-mail: leadams@cdc.gov

Financial support: This work was supported by grant nos. U01CK000437/U01CK000580 and in part by the Intramural Research Program of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Approval for the COPA project was obtained from the Ponce Medical School Foundation, Inc. Institutional Review Board (protocol no. 171110-VR). Written consent to participate was obtained from all adult participants and emancipated minors; parental written consent and participant assent was obtained for children.

Disclaimer: The views expressed in this manuscript do not necessarily represent the views of the Centers for Disease Control and Prevention or the U.S. government.

Authors’ addresses: Laura E. Adams, Freddy A. Medina, Dania M. Rodriguez, Liliana Sánchez-González, Jorge L. Muñoz-Jordán, and Gabriela Paz-Bailey, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico, E-mails: leadams@cdc.gov, fkt3@cdc.gov, lvn0@cdc.gov, naq5@cdc.gov, ckq2@cdc.gov, and gmb5@cdc.gov. Matt D. T. Hitchings, University of Florida, Gainesville, FL, E-mail: mhitchings@ufl.edu. Hannah Moore, University of Georgia, Athens, GA, E-mail: hmm58269@uga.edu. Stephen S. Whitehead, Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, E-mail: swhitehead@niaid.nih.gov. Vanessa Rivera-Amill, Ponce Health Sciences University/Ponce Research Institute, Ponce, Puerto Rico, E-mail: vrivera@psm.edu.

  • 1.

    Bhatt S et al., 2013. The global distribution and burden of dengue. Nature 496: 504507.

  • 2.

    Katzelnick LC, Gresh L, Halloran ME, Mercado JC, Kuan G, Gordon A, Balmaseda A, Harris E, 2017. Antibody-dependent enhancement of severe dengue disease in humans. Science 358: 929932.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Paz-Bailey G, Adams L, Wong JM, Poehling KA, Chen WH, McNally V, Atmar RL, Waterman SH, 2021. Dengue vaccine: recommendations of the advisory committee on immunization practices, United States, 2021. MMWR Recomm Rep 70: 1.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Sridhar S et al., 2018. Effect of dengue serostatus on dengue vaccine safety and efficacy. N Engl J Med 379: 327340.

  • 5.

    Hadinegoro SR, Arredondo-García JL, Capeding MR, Deseda C, Chotpitayasunondh T, Dietze R, Hj Muhammad Ismail H, Reynales H, Limkittikul K, Rivera-Medina DM, 2015. Efficacy and long-term safety of a dengue vaccine in regions of endemic disease. N Engl J Med 373: 11951206.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Flasche S et al., 2016. The long-term safety, public health impact, and cost-effectiveness of routine vaccination with a recombinant, live-attenuated dengue vaccine (Dengvaxia): a model comparison study. PLoS Med 13: e1002181.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    España G, Yao Y, Anderson KB, Fitzpatrick MC, Smith DL, Morrison AC, Wilder-Smith A, Scott TW, Perkins TA, 2019. Model-based assessment of public health impact and cost-effectiveness of dengue vaccination following screening for prior exposure. PLoS Negl Trop Dis 13: e0007482.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Sharp TM, Ryff KR, Santiago GA, Margolis HS, Waterman SH, 2019. Lessons learned from dengue surveillance and research, Puerto Rico, 1899–2013. Emerg Infect Dis 25: 15221530.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Sharp TM et al., 2020. Epidemiologic and spatiotemporal trends of Zika Virus disease during the 2016 epidemic in Puerto Rico. PLoS Negl Trop Dis 14: e0008532.

  • 10.

    Simmons G et al., 2016. High incidence of chikungunya virus and frequency of viremic blood donations during epidemic, Puerto Rico, USA, 2014. Emerg Infect Dis 22: 1221.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Pan American Health Organization , 2022. Reported Cases of Dengue Fever in the Americas by Country or Territory. Available at: https://www3.paho.org/data/index.php/en/mnu-topics/indicadores-dengue-en/dengue-nacional-en/252-dengue-pais-ano-en.html. Accessed April 29, 2022.

    • PubMed
    • Export Citation
  • 12.

    Argüello DF et al., 2015. Incidence of dengue virus infection in school-aged children in Puerto Rico: a prospective seroepidemiologic study. Am J Trop Med Hyg 92: 486.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    L’Azou M et al., 2018. Dengue seroprevalence: data from the clinical development of a tetravalent dengue vaccine in 14 countries (2005–2014). Trans R Soc Trop Med Hyg 112: 158168.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Sánchez-González L et al., 2021. Assessment of community support for Wolbachia-mediated population suppression as a control method for Aedes aegypti mosquitoes in a community cohort in Puerto Rico. PLoS Negl Trop Dis 15: e0009966.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Adams LE et al., 2022. Risk factors for infection with chikungunya and Zika viruses in southern Puerto Rico: a community-based cross-sectional seroprevalence survey. PLoS Negl Trop Dis 16: e0010416.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Van Buuren S, Groothuis-Oudshoorn K, 2011. mice: Multivariate Imputation by Chained Equations in R. J Stat Softw 45: 167.

  • 17.

    Tomashek KM et al., 2017. Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012–2015. PLoS Negl Trop Dis 11: e0005859.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Bureau of the Census , 2019. Annual Estimates of the Resident Population for the United States, Regions, States, and Puerto Rico. April 1, 2010 to July 1, 2019 (NST-EST2019-01). U.S. Census Bureau.

    • PubMed
    • Export Citation
  • 19.

    Rodriguez-Barraquer I, Salje H, Cummings DA, 2019. Opportunities for improved surveillance and control of dengue from age-specific case data. eLife 8: e45474.

  • 20.

    Imai N, Dorigatti I, Cauchemez S, Ferguson NM, 2016. Estimating dengue transmission intensity from case-notification data from multiple countries. PLoS Negl Trop Dis 10: e0004833.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Imai N, Dorigatti I, Cauchemez S, Ferguson NM, 2015. Estimating dengue transmission intensity from sero-prevalence surveys in multiple countries. PLoS Negl Trop Dis 9: e0003719.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Cummings DA, Iamsirithaworn S, Lessler JT, McDermott A, Prasanthong R, Nisalak A, Jarman RG, Burke DS, Gibbons RV, 2009. The impact of the demographic transition on dengue in Thailand: insights from a statistical analysis and mathematical modeling. PLoS Med 6: e1000139.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Ferguson NM, Donnelly CA, Anderson RM, 1999. Transmission dynamics and epidemiology of dengue: insights from age-stratified sero-prevalence surveys. Philos Trans R Soc Lond B Biol Sci 354: 757768.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Stan Development Team , 2020. RStan: The R Interface to Stan. R package version 2.21.2. Available at: http://mc-stan.org/. Accessed February 6, 2023.

    • PubMed
    • Export Citation
  • 25.

    Vehtari A, Gabry J, Magnusson M, Yao Y, Bürkner P, Paananen T, Gelman A, 2023. loo: Efficient Leave-one-out Cross-validation and WAIC for Bayesian Models. R package version 2.6.0. Available at: https://mc-stan.org/loo/. Accessed February 6, 2023.

    • PubMed
    • Export Citation
  • 26.

    Duris F, Gazdarica J, Gazdaricova I, Strieskova L, Budis J, Turna J, Szemes T, 2018. Mean and variance of ratios of proportions from categories of a multinomial distribution. J Stat Distrib Appl 5: 120.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Montoya M et al., 2018. Longitudinal analysis of antibody cross-neutralization following Zika virus and dengue virus infection in Asia and the Americas. J Infect Dis 218: 536545.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Braga C, Luna CF, Martelli CM, de Souza WV, Cordeiro MT, Alexander N, de Albuquerque MdF, Júnior JC, Marques ET, 2010. Seroprevalence and risk factors for dengue infection in socio-economically distinct areas of Recife, Brazil. Acta Trop 113: 234240.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Waterman SH, Novak RJ, Sather GE, Bailey RE, Rios I, Gubler DJ, 1985. Dengue transmission in two Puerto Rican Communities in 1982. Am J Trop Med Hyg 34: 625632.

  • 30.

    Mulligan K, Dixon J, Joanna Sinn C-L, Elliott SJ, 2015. Is dengue a disease of poverty? A systematic review. Pathog Glob Health 109: 1018.

  • 31.

    Ribeiro dos Santos G et al., 2022. Individual, household, and community drivers of dengue virus infection risk in Kamphaeng Phet Province, Thailand. J Infect Dis 226: 13481356.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Walters M, Perkins TA, 2020. Hidden heterogeneity and its influence on dengue vaccination impact. Infect Dis Model 5: 783797.

  • 33.

    Lam HM et al., 2019. Serological inference of past primary and secondary dengue infection: implications for vaccination. J R Soc Interface 16: 20190207.

Past two years Past Year Past 30 Days
Abstract Views 1475 1032 93
Full Text Views 472 419 4
PDF Downloads 273 198 7
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save