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The high burden of dengue and chikungunya in southern coastal Ecuador: Epidemiology, clinical presentation, and phylogenetics from a prospective study in Machala in 2014 and 2015

View ORCID ProfileAnna M. Stewart-Ibarra, Aileen Kenneson, Christine A. King, Mark Abbott, Arturo Barbachano-Guerrero, Efraín Beltrán-Ayala, Mercy J. Borbor-Cordova, Washington B. Cárdenas, Cinthya Cueva, Julia L. Finkelstein, Christina D. Lupone, Richard G. Jarman, Irina Maljkovic Berry, Saurabh Mehta, Mark Polhemus, Mercy Silva, Sadie J. Ryan, Timothy P. Endy
doi: https://doi.org/10.1101/102004
Anna M. Stewart-Ibarra
1Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
2Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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  • ORCID record for Anna M. Stewart-Ibarra
  • For correspondence: stewarta@upstate.edu
Aileen Kenneson
1Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
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Christine A. King
1Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
3Department of Microbiology & Immunology, SUNY Upstate Medical University, Syracuse, NY, USA
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Mark Abbott
1Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
3Department of Microbiology & Immunology, SUNY Upstate Medical University, Syracuse, NY, USA
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Arturo Barbachano-Guerrero
3Department of Microbiology & Immunology, SUNY Upstate Medical University, Syracuse, NY, USA
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Efraín Beltrán-Ayala
4Universidad Técnica de Machala, Machala, El Oro Province, Ecuador
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Mercy J. Borbor-Cordova
5Escuela Superior Politecnica del Litoral (ESPOL), Guayaquil, Ecuador
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Washington B. Cárdenas
5Escuela Superior Politecnica del Litoral (ESPOL), Guayaquil, Ecuador
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Cinthya Cueva
1Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
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Julia L. Finkelstein
6Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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Christina D. Lupone
1Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
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Richard G. Jarman
7Viral Diseases Branch of the Walter Reed Army Institute of Research (WRAIR), Silver Springs, MD, USA
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Irina Maljkovic Berry
7Viral Diseases Branch of the Walter Reed Army Institute of Research (WRAIR), Silver Springs, MD, USA
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Saurabh Mehta
6Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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Mark Polhemus
1Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
2Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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Mercy Silva
8Ministry of Health, Machala, El Oro, Ecuador
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Sadie J. Ryan
1Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
9Department of Geography, University of Florida, Gainesville, FL, USA
10Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
11College of Life Sciences, University of Kwazulu-Natal, Durban, South Africa
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Timothy P. Endy
1Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
2Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
3Department of Microbiology & Immunology, SUNY Upstate Medical University, Syracuse, NY, USA
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Abstract

Background Dengue (DENV), chikugunya (CHIKV) and zika (ZIKV) viruses are arboviruses transmitted by the Ae. aegypti mosquito, that cause febrile illness and present a major public health challenge in tropical low– and middle-income countries such as Ecuador. Here we report the methods and findings from the first two years (January 1, 2014 to December 31, 2015) of an active and passive surveillance study conducted in the southern coastal city of Machala, Ecuador.

Methods Individuals whom presented at one of four sentinel clinics or the central hospital of the Ministry of Health with suspected DENV (index cases) were recruited into the study (n = 324). Index cases with confirmed acute DENV infection triggered a cluster investigation (n = 44) of DENV infections in the index household and four neighboring households (associates) within 200 meters, (n = 397). We conducted genomic sequencing and phylogenetic analysis of select DENV positive samples from 2014.

Results In 2014, 72.5% of index patients and 35.6% of associates had evidence of acute or recent DENV infections. In 2015, 28.3% and 12.85% of index patients and associates, respectively, had acute or recent infections. The first cases of CHIKV were detected in an associate on epidemiological week 12 in 2015. There were a total of 54 cases of acute CHIKV infections, including seven DENV/CHIKV co-infections. No cases of ZIKV were detected. DENV symptoms varied significantly by age and by primary versus secondary infections. Symptoms that were associated with DENV and CHIKV infections are presented. Phylogenetic analyses of isolates revealed genetic relatedness and shared ancestry of DENV1, DENV2 and DENV4 genomes from Ecuador with those from Venezuela and Colombia, as well as more than one introduction of the same serotype into Ecuador, indicating presence of viral flow between Ecuador and the surrounding countries.

Discussion Findings from this study highlight the importance of (1) implementing rapid active surveillance protocols and (2) strengthening local molecular diagnostic capacities in resource-limited settings where DENV, CHIKV, and ZIKV co-circulate.

Copyright 
The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license.
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The high burden of dengue and chikungunya in southern coastal Ecuador: Epidemiology, clinical presentation, and phylogenetics from a prospective study in Machala in 2014 and 2015
Anna M. Stewart-Ibarra, Aileen Kenneson, Christine A. King, Mark Abbott, Arturo Barbachano-Guerrero, Efraín Beltrán-Ayala, Mercy J. Borbor-Cordova, Washington B. Cárdenas, Cinthya Cueva, Julia L. Finkelstein, Christina D. Lupone, Richard G. Jarman, Irina Maljkovic Berry, Saurabh Mehta, Mark Polhemus, Mercy Silva, Sadie J. Ryan, Timothy P. Endy
bioRxiv 102004; doi: https://doi.org/10.1101/102004
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The high burden of dengue and chikungunya in southern coastal Ecuador: Epidemiology, clinical presentation, and phylogenetics from a prospective study in Machala in 2014 and 2015
Anna M. Stewart-Ibarra, Aileen Kenneson, Christine A. King, Mark Abbott, Arturo Barbachano-Guerrero, Efraín Beltrán-Ayala, Mercy J. Borbor-Cordova, Washington B. Cárdenas, Cinthya Cueva, Julia L. Finkelstein, Christina D. Lupone, Richard G. Jarman, Irina Maljkovic Berry, Saurabh Mehta, Mark Polhemus, Mercy Silva, Sadie J. Ryan, Timothy P. Endy
bioRxiv 102004; doi: https://doi.org/10.1101/102004

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