Tomashek Kay M, Rivera Aidsa, Torres-Velasquez Brenda, Hunsperger Elizabeth A, Munoz-Jordan Jorge L, Sharp Tyler M, Rivera Irma, Sanabria Dario, Blau Dianna M, Galloway Renee, Torres Jose, Rodriguez Rosa, Serrano Javier, Chávez Carlos, Dávila Francisco, Perez-Padilla Janice, Ellis Esther M, Caballero Gladys, Wright Laura, Zaki Sherif R, Deseda Carmen, Rodriguez Edda, Margolis Harold S
Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico.
Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico.
PLoS Negl Trop Dis. 2016 Oct 11;10(10):e0005025. doi: 10.1371/journal.pntd.0005025. eCollection 2016 Oct.
Dengue is a leading cause of morbidity throughout the tropics; however, accurate population-based estimates of mortality rates are not available.
METHODS/PRINCIPAL FINDINGS: We established the Enhanced Fatal Acute Febrile Illness Surveillance System (EFASS) to estimate dengue mortality rates in Puerto Rico. Healthcare professionals submitted serum and tissue specimens from patients who died from a dengue-like acute febrile illness, and death certificates were reviewed to identify additional cases. Specimens were tested for markers of dengue virus (DENV) infection by molecular, immunologic, and immunohistochemical methods, and were also tested for West Nile virus, Leptospira spp., and other pathogens based on histopathologic findings. Medical records were reviewed and clinical data abstracted. A total of 311 deaths were identified, of which 58 (19%) were DENV laboratory-positive. Dengue mortality rates were 1.05 per 100,000 population in 2010, 0.16 in 2011 and 0.36 in 2012. Dengue mortality was highest among adults 19-64 years and seniors ≥65 years (1.17 and 1.66 deaths per 100,000, respectively). Other pathogens identified included 34 Leptospira spp. cases and one case of Burkholderia pseudomallei and Neisseria meningitidis.
CONCLUSIONS/SIGNIFICANCE: EFASS showed that dengue mortality rates among adults were higher than reported for influenza, and identified a leptospirosis outbreak and index cases of melioidosis and meningitis.
登革热是热带地区发病的主要原因；然而，目前尚无基于人群的准确死亡率估计。
方法/主要发现：我们建立了强化致命急性发热疾病监测系统（EFASS），以估计波多黎各的登革热死亡率。医疗保健专业人员提交了死于登革热样急性发热疾病患者的血清和组织样本，并对死亡证明进行审查以识别其他病例。通过分子、免疫和免疫组织化学方法对样本进行登革热病毒（DENV）感染标志物检测，并根据组织病理学发现对西尼罗河病毒、钩端螺旋体属及其他病原体进行检测。查阅医疗记录并提取临床数据。共识别出311例死亡病例，其中58例（19%）DENV实验室检测呈阳性。2010年登革热死亡率为每10万人1.05例，2011年为0.16例，2012年为0.36例。登革热死亡率在19 - 64岁成年人及≥65岁老年人中最高（分别为每10万人1.17例和1.66例死亡）。识别出的其他病原体包括34例钩端螺旋体属病例、1例类鼻疽杆菌病例和1例脑膜炎奈瑟菌病例。
结论/意义：EFASS显示成年人中的登革热死亡率高于流感报告数据，并识别出一次钩端螺旋体病暴发以及类鼻疽和脑膜炎的首例病例。
