Characteristics of a dengue outbreak in a remote pacific island chain--Republic of The Marshall Islands, 2011-2012.
Dengue is a potentially fatal acute febrile illness caused by four mosquito-transmitted dengue viruses (DENV-1-4). Although dengue outbreaks regularly occur in many regions of the Pacific, little is known about dengue in the Republic of the Marshall Islands (RMI). To better understand dengue in RMI,...
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Public Library of Science (PLoS)
2014-01-01
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| Online Access: | https://doi.org/10.1371/journal.pone.0108445 |
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| author | Tyler M Sharp Andrew J Mackay Gilberto A Santiago Elizabeth Hunsperger Eric J Nilles Janice Perez-Padilla Kinisalote S Tikomaidraubuta Candimar Colon Manuel Amador Tai-Ho Chen Paul Lalita Jorge L Muñoz-Jordán Roberto Barrera Justina Langidrik Kay M Tomashek |
| author_facet | Tyler M Sharp Andrew J Mackay Gilberto A Santiago Elizabeth Hunsperger Eric J Nilles Janice Perez-Padilla Kinisalote S Tikomaidraubuta Candimar Colon Manuel Amador Tai-Ho Chen Paul Lalita Jorge L Muñoz-Jordán Roberto Barrera Justina Langidrik Kay M Tomashek |
| author_sort | Tyler M Sharp |
| collection | DOAJ |
| description | Dengue is a potentially fatal acute febrile illness caused by four mosquito-transmitted dengue viruses (DENV-1-4). Although dengue outbreaks regularly occur in many regions of the Pacific, little is known about dengue in the Republic of the Marshall Islands (RMI). To better understand dengue in RMI, we investigated an explosive outbreak that began in October 2011. Suspected cases were reported to the Ministry of Health, serum specimens were tested with a dengue rapid diagnostic test (RDT), and confirmatory testing was performed using RT-PCR and IgM ELISA. Laboratory-positive cases were defined by detection of DENV nonstructural protein 1 by RDT, DENV nucleic acid by RT-PCR, or anti-DENV IgM antibody by RDT or ELISA. Secondary infection was defined by detection of anti-DENV IgG antibody by ELISA in a laboratory-positive acute specimen. During the four months of the outbreak, 1,603 suspected dengue cases (3% of the RMI population) were reported. Of 867 (54%) laboratory-positive cases, 209 (24%) had dengue with warning signs, six (0.7%) had severe dengue, and none died. Dengue incidence was highest in residents of Majuro and individuals aged 10-29 years, and ∼95% of dengue cases were experiencing secondary infection. Only DENV-4 was detected by RT-PCR, which phylogenetic analysis demonstrated was most closely related to a virus previously identified in Southeast Asia. Cases of vertical DENV transmission, and DENV/Salmonella Typhi and DENV/Mycobacterium leprae co-infection were identified. Entomological surveys implicated water storage containers and discarded tires as the most important development sites for Aedes aegypti and Ae. albopictus, respectively. Although this is the first documented dengue outbreak in RMI, the age groups of cases and high prevalence of secondary infection demonstrate prior DENV circulation. Dengue surveillance should continue to be strengthened in RMI and throughout the Pacific to identify and rapidly respond to future outbreaks. |
| format | Article |
| id | doaj-art-bc01df35e40b4c85832280a997660926 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj-art-bc01df35e40b4c85832280a9976609262025-08-20T03:10:03ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0199e10844510.1371/journal.pone.0108445Characteristics of a dengue outbreak in a remote pacific island chain--Republic of The Marshall Islands, 2011-2012.Tyler M SharpAndrew J MackayGilberto A SantiagoElizabeth HunspergerEric J NillesJanice Perez-PadillaKinisalote S TikomaidraubutaCandimar ColonManuel AmadorTai-Ho ChenPaul LalitaJorge L Muñoz-JordánRoberto BarreraJustina LangidrikKay M TomashekDengue is a potentially fatal acute febrile illness caused by four mosquito-transmitted dengue viruses (DENV-1-4). Although dengue outbreaks regularly occur in many regions of the Pacific, little is known about dengue in the Republic of the Marshall Islands (RMI). To better understand dengue in RMI, we investigated an explosive outbreak that began in October 2011. Suspected cases were reported to the Ministry of Health, serum specimens were tested with a dengue rapid diagnostic test (RDT), and confirmatory testing was performed using RT-PCR and IgM ELISA. Laboratory-positive cases were defined by detection of DENV nonstructural protein 1 by RDT, DENV nucleic acid by RT-PCR, or anti-DENV IgM antibody by RDT or ELISA. Secondary infection was defined by detection of anti-DENV IgG antibody by ELISA in a laboratory-positive acute specimen. During the four months of the outbreak, 1,603 suspected dengue cases (3% of the RMI population) were reported. Of 867 (54%) laboratory-positive cases, 209 (24%) had dengue with warning signs, six (0.7%) had severe dengue, and none died. Dengue incidence was highest in residents of Majuro and individuals aged 10-29 years, and ∼95% of dengue cases were experiencing secondary infection. Only DENV-4 was detected by RT-PCR, which phylogenetic analysis demonstrated was most closely related to a virus previously identified in Southeast Asia. Cases of vertical DENV transmission, and DENV/Salmonella Typhi and DENV/Mycobacterium leprae co-infection were identified. Entomological surveys implicated water storage containers and discarded tires as the most important development sites for Aedes aegypti and Ae. albopictus, respectively. Although this is the first documented dengue outbreak in RMI, the age groups of cases and high prevalence of secondary infection demonstrate prior DENV circulation. Dengue surveillance should continue to be strengthened in RMI and throughout the Pacific to identify and rapidly respond to future outbreaks.https://doi.org/10.1371/journal.pone.0108445 |
| spellingShingle | Tyler M Sharp Andrew J Mackay Gilberto A Santiago Elizabeth Hunsperger Eric J Nilles Janice Perez-Padilla Kinisalote S Tikomaidraubuta Candimar Colon Manuel Amador Tai-Ho Chen Paul Lalita Jorge L Muñoz-Jordán Roberto Barrera Justina Langidrik Kay M Tomashek Characteristics of a dengue outbreak in a remote pacific island chain--Republic of The Marshall Islands, 2011-2012. PLoS ONE |
| title | Characteristics of a dengue outbreak in a remote pacific island chain--Republic of The Marshall Islands, 2011-2012. |
| title_full | Characteristics of a dengue outbreak in a remote pacific island chain--Republic of The Marshall Islands, 2011-2012. |
| title_fullStr | Characteristics of a dengue outbreak in a remote pacific island chain--Republic of The Marshall Islands, 2011-2012. |
| title_full_unstemmed | Characteristics of a dengue outbreak in a remote pacific island chain--Republic of The Marshall Islands, 2011-2012. |
| title_short | Characteristics of a dengue outbreak in a remote pacific island chain--Republic of The Marshall Islands, 2011-2012. |
| title_sort | characteristics of a dengue outbreak in a remote pacific island chain republic of the marshall islands 2011 2012 |
| url | https://doi.org/10.1371/journal.pone.0108445 |
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