Sentinel Enhanced Dengue Surveillance System - Puerto Rico, 2012-2022.

IF 37.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Zachary J Madewell, Alfonso C Hernandez-Romieu, Joshua M Wong, Laura D Zambrano, Hannah R Volkman, Janice Perez-Padilla, Dania M Rodriguez, Olga Lorenzi, Carla Espinet, Jorge Munoz-Jordan, Verónica M Frasqueri-Quintana, Vanessa Rivera-Amill, Luisa I Alvarado-Domenech, Diego Sainz, Jorge Bertran, Gabriela Paz-Bailey, Laura E Adams
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Enhanced surveillance is necessary to determine disease prevalence, to characterize the epidemiology of severe disease, and to evaluate diagnostic and treatment practices to improve patient outcomes. The Sentinel Enhanced Dengue Surveillance System (SEDSS) was established to monitor trends of dengue and dengue-like acute febrile illnesses (AFIs), characterize the clinical course of disease, and serve as an early warning system for viral infections with epidemic potential.</p><p><strong>Reporting period: </strong>May 2012-December 2022.</p><p><strong>Description of system: </strong>SEDSS conducts enhanced surveillance for dengue and other relevant AFIs in Puerto Rico. This report includes aggregated data collected from May 2012 through December 2022. SEDSS was launched in May 2012 with patients with AFIs from five health care facilities enrolled. 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引用次数: 0

Abstract

Problem/condition: Dengue is the most prevalent mosquitoborne viral illness worldwide and is endemic in Puerto Rico. Dengue's clinical spectrum can range from mild, undifferentiated febrile illness to hemorrhagic manifestations, shock, multiorgan failure, and death in severe cases. The disease presentation is nonspecific; therefore, various other illnesses (e.g., arboviral and respiratory pathogens) can cause similar clinical symptoms. Enhanced surveillance is necessary to determine disease prevalence, to characterize the epidemiology of severe disease, and to evaluate diagnostic and treatment practices to improve patient outcomes. The Sentinel Enhanced Dengue Surveillance System (SEDSS) was established to monitor trends of dengue and dengue-like acute febrile illnesses (AFIs), characterize the clinical course of disease, and serve as an early warning system for viral infections with epidemic potential.

Reporting period: May 2012-December 2022.

Description of system: SEDSS conducts enhanced surveillance for dengue and other relevant AFIs in Puerto Rico. This report includes aggregated data collected from May 2012 through December 2022. SEDSS was launched in May 2012 with patients with AFIs from five health care facilities enrolled. The facilities included two emergency departments in tertiary acute care hospitals in the San Juan-Caguas-Guaynabo metropolitan area and Ponce, two secondary acute care hospitals in Carolina and Guayama, and one outpatient acute care clinic in Ponce. Patients arriving at any SEDSS site were eligible for enrollment if they reported having fever within the past 7 days. During the Zika epidemic (June 2016-June 2018), patients were eligible for enrollment if they had either rash and conjunctivitis, rash and arthralgia, or fever. Eligibility was expanded in April 2020 to include reported cough or shortness of breath within the past 14 days. Blood, urine, nasopharyngeal, and oropharyngeal specimens were collected at enrollment from all participants who consented. Diagnostic testing for dengue virus (DENV) serotypes 1-4, chikungunya virus, Zika virus, influenza A and B viruses, SARS-CoV-2, and five other respiratory viruses was performed by the CDC laboratory in San Juan.

Results: During May 2012-December 2022, a total of 43,608 participants with diagnosed AFI were enrolled in SEDSS; a majority of participants (45.0%) were from Ponce. During the surveillance period, there were 1,432 confirmed or probable cases of dengue, 2,293 confirmed or probable cases of chikungunya, and 1,918 confirmed or probable cases of Zika. The epidemic curves of the three arboviruses indicate dengue is endemic; outbreaks of chikungunya and Zika were sporadic, with case counts peaking in late 2014 and 2016, respectively. The majority of commonly identified respiratory pathogens were influenza A virus (3,756), SARS-CoV-2 (1,586), human adenovirus (1,550), respiratory syncytial virus (1,489), influenza B virus (1,430), and human parainfluenza virus type 1 or 3 (1,401). A total of 5,502 participants had confirmed or probable arbovirus infection, 11,922 had confirmed respiratory virus infection, and 26,503 had AFI without any of the arboviruses or respiratory viruses examined.

Interpretation: Dengue is endemic in Puerto Rico; however, incidence rates varied widely during the reporting period, with the last notable outbreak occurring during 2012-2013. DENV-1 was the predominant virus during the surveillance period; sporadic cases of DENV-4 also were reported. Puerto Rico experienced large outbreaks of chikungunya that peaked in 2014 and of Zika that peaked in 2016; few cases of both viruses have been reported since. Influenza A and respiratory syncytial virus seasonality patterns are distinct, with respiratory syncytial virus incidence typically reaching its annual peak a few weeks before influenza A. The emergence of SARS-CoV-2 led to a reduction in the circulation of other acute respiratory viruses.

Public health action: SEDSS is the only site-based enhanced surveillance system designed to gather information on AFI cases in Puerto Rico. This report illustrates that SEDSS can be adapted to detect dengue, Zika, chikungunya, COVID-19, and influenza outbreaks, along with other seasonal acute respiratory viruses, underscoring the importance of recognizing signs and symptoms of relevant diseases and understanding transmission dynamics among these viruses. This report also describes fluctuations in disease incidence, highlighting the value of active surveillance, testing for a panel of acute respiratory viruses, and the importance of flexible and responsive surveillance systems in addressing evolving public health challenges. Various vector control strategies and vaccines are being considered or implemented in Puerto Rico, and data from ongoing trials and SEDSS might be integrated to better understand epidemiologic factors underlying transmission and risk mitigation approaches. Data from SEDSS might guide sampling strategies and implementation of future trials to prevent arbovirus transmission, particularly during the expansion of SEDSS throughout the island to improve geographic representation.

哨点强化登革热监测系统 - 波多黎各,2012-2022 年。
问题/条件:登革热是全球最流行的蚊媒病毒性疾病,在波多黎各呈地方性流行。登革热的临床表现范围很广,从轻微、无差别的发热性疾病到出血性表现、休克、多器官功能衰竭,严重者甚至死亡。登革热的症状没有特异性,因此其他各种疾病(如虫媒病毒和呼吸道病原体)也会引起类似的临床症状。有必要加强监测,以确定疾病的流行情况,描述严重疾病的流行病学特征,并评估诊断和治疗方法,从而改善患者的预后。建立登革热哨点强化监测系统(SEDSS)的目的是监测登革热和登革热样急性发热性疾病(AFIs)的发病趋势,描述疾病的临床过程,并作为具有流行潜力的病毒感染的预警系统:报告期:2012 年 5 月至 2022 年 12 月:SEDSS 对波多黎各的登革热和其他相关 AFI 进行强化监测。本报告包括从 2012 年 5 月至 2022 年 12 月收集的汇总数据。SEDSS 于 2012 年 5 月启动,五个医疗机构的 AFI 患者加入了该系统。这些医疗机构包括位于圣胡安-瓜瓜斯-瓜伊纳布大都会区和庞塞的两家三级急症医院的急诊科、位于卡罗莱纳和瓜亚马的两家二级急症医院以及位于庞塞的一家急症门诊诊所。到达任何一个 SEDSS 站点的患者只要报告在过去 7 天内发烧,就有资格加入。在寨卡疫情期间(2016 年 6 月至 2018 年 6 月),如果患者出现皮疹和结膜炎、皮疹和关节痛或发热,则有资格加入。2020 年 4 月,资格范围扩大到包括过去 14 天内报告的咳嗽或呼吸急促。所有同意的参与者在入组时均采集了血液、尿液、鼻咽和口咽标本。登革热病毒(DENV)血清型 1-4、基孔肯雅病毒、寨卡病毒、甲型和乙型流感病毒、SARS-CoV-2 以及其他五种呼吸道病毒的诊断检测由圣胡安的疾病预防控制中心实验室进行:2012 年 5 月至 2022 年 12 月期间,SEDSS 共登记了 43 608 名确诊为 AFI 的参与者;其中大部分参与者(45.0%)来自庞塞。在监测期间,共有 1,432 例登革热确诊或疑似病例,2,293 例基孔肯雅确诊或疑似病例,1,918 例寨卡确诊或疑似病例。这三种虫媒病毒的流行曲线表明,登革热呈地方性流行;基孔肯雅和寨卡病毒的爆发是零星的,病例数分别在 2014 年末和 2016 年达到高峰。大多数常见的呼吸道病原体是甲型流感病毒(3756 例)、SARS-CoV-2(1586 例)、人类腺病毒(1550 例)、呼吸道合胞病毒(1489 例)、乙型流感病毒(1430 例)和人类副流感病毒 1 型或 3 型(1401 例)。共有 5,502 人确诊或可能感染了虫媒病毒,11,922 人确诊感染了呼吸道病毒,26,503 人感染了 AFI,但没有感染任何虫媒病毒或呼吸道病毒:登革热在波多黎各呈地方性流行;然而,在报告所述期间,发病率变化很大,最近一次显著爆发发生在 2012-2013 年。在监测期间,DENV-1 是主要的病毒;也有零星的 DENV-4 病例报告。波多黎各在 2014 年和 2016 年分别经历了基孔肯雅病毒和寨卡病毒的大规模爆发,前者在 2014 年达到高峰,后者在 2016 年达到高峰;此后这两种病毒的病例报告很少。甲型流感和呼吸道合胞病毒的季节性模式截然不同,呼吸道合胞病毒的发病率通常比甲型流感早几周达到年度高峰:SEDSS 是唯一一个以站点为基础的强化监测系统,旨在收集波多黎各 AFI 病例的信息。本报告说明,SEDSS 可用于检测登革热、寨卡、基孔肯雅、COVID-19 和流感爆发以及其他季节性急性呼吸道病毒,强调了识别相关疾病的体征和症状以及了解这些病毒之间传播动态的重要性。本报告还介绍了疾病发病率的波动情况,强调了主动监测、急性呼吸道病毒检测组的价值,以及灵活、反应迅速的监测系统在应对不断变化的公共卫生挑战方面的重要性。波多黎各正在考虑或实施各种病媒控制策略和疫苗,可能会整合正在进行的试验和 SEDSS 的数据,以更好地了解传播的流行病学因素和风险缓解方法。
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来源期刊
Mmwr Surveillance Summaries
Mmwr Surveillance Summaries PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
60.50
自引率
1.20%
发文量
9
期刊介绍: The Morbidity and Mortality Weekly Report (MMWR) Series, produced by the Centers for Disease Control and Prevention (CDC), is commonly referred to as "the voice of CDC." Serving as the primary outlet for timely, reliable, authoritative, accurate, objective, and practical public health information and recommendations, the MMWR is a crucial publication. Its readership primarily includes physicians, nurses, public health practitioners, epidemiologists, scientists, researchers, educators, and laboratorians.
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