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波多黎各儿童的既往登革热感染及其对登革热疫苗实施的影响。

Previous Dengue Infection among Children in Puerto Rico and Implications for Dengue Vaccine Implementation.

机构信息

Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico.

University of Florida, Gainesville, Florida.

出版信息

Am J Trop Med Hyg. 2023 Jun 12;109(2):413-419. doi: 10.4269/ajtmh.23-0091. Print 2023 Aug 2.

Abstract

Limited dengue virus (DENV) seroprevalence estimates are available for Puerto Rico, which are needed to inform the potential use and cost-effectiveness of DENV vaccines. The Communities Organized to Prevent Arboviruses (COPA) is a cohort study initiated in 2018 in Ponce, Puerto Rico, to assess arboviral disease risk and provide a platform to evaluate interventions. We recruited participants from households in 38 study clusters, who were interviewed and provided a serum specimen. Specimens from 713 children aged 1 to 16 years during the first year of COPA were tested for the four DENV serotypes and ZIKV using a focus reduction neutralization assay. We assessed the seroprevalence of DENV and ZIKV by age and developed a catalytic model from seroprevalence and dengue surveillance data to estimate the force of infection for DENV during 2003-2018. Overall, 37% (n = 267) were seropositive for DENV; seroprevalence was 9% (11/128) among children aged 1 to 8 years and 44% (256/585) among children aged 9 to 16 years, exceeding the threshold over which DENV vaccination is deemed cost-effective. A total of 33% were seropositive for ZIKV, including 15% among children aged 0 to 8 years and 37% among children aged 9 to 16 years. The highest force of infection occurred in 2007, 2010, and 2012-2013, with low levels of transmission from 2016 to 2018. A higher proportion of children had evidence of multitypic DENV infection than expected, suggesting high heterogeneity in DENV risk in this setting.

摘要

波多黎各的登革热病毒 (DENV) 血清流行率估计有限,这些估计对于告知 DENV 疫苗的潜在使用和成本效益是必要的。社区组织预防虫媒病毒 (COPA) 是一项于 2018 年在波多黎各蓬塞启动的队列研究,旨在评估虫媒病毒病风险并提供评估干预措施的平台。我们从 38 个研究集群的家庭中招募参与者,对他们进行访谈并提供血清样本。在 COPA 的第一年,对 713 名年龄在 1 至 16 岁的儿童的样本使用焦点减少中和测定法检测了四种 DENV 血清型和寨卡病毒。我们按年龄评估了 DENV 和寨卡病毒的血清流行率,并根据血清流行率和登革热监测数据开发了一个催化模型,以估计 2003-2018 年 DENV 的感染率。总体而言,37%(n=267)的人对 DENV 呈血清阳性;年龄在 1 至 8 岁的儿童中血清阳性率为 9%(11/128),年龄在 9 至 16 岁的儿童中为 44%(256/585),超过了认为 DENV 疫苗接种具有成本效益的阈值。共有 33%的人对寨卡病毒呈血清阳性,其中年龄在 0 至 8 岁的儿童中为 15%,年龄在 9 至 16 岁的儿童中为 37%。感染率最高的是 2007 年、2010 年和 2012-2013 年,而 2016 年至 2018 年的传播水平较低。与预期相比,更多的儿童有多种 DENV 感染的证据,这表明在这种情况下 DENV 风险存在高度异质性。

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