dengue deaths in puerto rico lessons learned from the 2007 epidemic登革热死亡2007年波多黎各教训流行病.pdfVIP

Dengue Deaths in Puerto Rico: Lessons Learned from the 2007 Epidemic 1 1 ´ 1 2 Kay M. Tomashek *, Christopher J. Gregory , Aidsa Rivera Sanchez , Matthew A. Bartek , Enid J. Garcia 3¤a 1 ˜ ´ 1 1¤b Rivera , Elizabeth Hunsperger , Jorge L. Munoz-Jordan , Wellington Sun 1 Dengue Branch, Division of Vector-Borne Diseases (DVBD), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, 2 University of Massachusetts Medical School, Worcester, Massachusetts, United States of America, 3 Puerto Rico Department of Health, San Juan, Puerto Rico Abstract Background: The incidence and severity of dengue in Latin America has increased substantially in recent decades and data from Puerto Rico suggests an increase in severe cases. Successful clinical management of severe dengue requires early recognition and supportive care. Methods: Fatal cases were identified among suspected dengue cases reported to two disease surveillance systems and from death certificates. To be included, fatal cases had to have specimen submitted for dengue diagnostic testing including nucleic acid amplification for dengue virus (DENV) in serum or tissue, immunohistochemical testing of tissue, and immunoassay detection of anti-DENV IgM from serum. Medical records from laboratory-positive dengue fatal case-patients were reviewed to identify possible determinants for death. Results: Among 10,576 reported dengue cases, 40 suspect fatal cases were identified, of which 11 were