The impact of infections transmitted by mosquitoes is global. Arboviral diseases such as dengue, chikungunya, and Zika are a significant health concern due to the expanding geographical range of many mosquito species. Emphasis on disease surveillance systems is central to evaluate the effectiveness of primary and secondary dengue prevention methods and strategies, including the introduction of dengue vaccines and new vector control methods. In the current application, the study team will address specific and fundamental gaps in the diagnosis and clinical management of dengue and other acute febrile illnesses (AFI); ultimately, evaluating the efficacy of vector control strategies in reducing the incidence of arbovirus infection through a combination of both clinic- and community-based surveillance systems. The study team?s long-term goal is to mitigate arboviral and other AFI disease burdens by improving diagnosis, clinical management, and prevention strategies. The study?s central hypothesis is that arbovirus infections and AFI disease surveillance, through the continuation of SEDSS and COPA, will promote evidence-driven public health policy decisions and reduce the burden of disease. The rationale for the current study is that understanding the etiology, epidemiology, and severity of arboviral diseases will allow the United States to be better prepared and respond to critical vector- borne disease outbreaks. The study team will test the central hypothesis by pursuing two specific aims: 1) Explore the natural history of dengue and arboviral infections and other acute febrile illnesses in their differential diagnosis to understand their epidemiology, spectrum of disease, and outcomes to provide recommendations for diagnosis and clinical management, and; 2) Define the correlates of risk and protection of arbovirus transmission in the setting of vector-reduction strategies.
Under Specific Aim 1, the team will strengthen hospital surveillance of acute febrile illness (AFI) and maintain an AFI platform for conducting clinical research.
For Specific Aim 2, the team will maintain a community-based cohort to assess the incidence and prevalence of arboviral infection, as well as, evaluate the incidence, prevalence, and etiology of other AFIs in selected communities. Central to both aims is the establishment of a data management system and the continuation of strengthening collaborations with the local government, community leaders, and other stakeholders to ensure continuity of the established program. The proposed research is significant because it is expected to deliver robust and broad knowledge regarding the epidemiologic patterns of common arboviral diseases in the context of other AFI of the present and those that may emerge in the geographical setting. Such results provide evidence- based responses to critical questions regarding dengue (and other arboviruses) diagnosis, immune response, and clinical management. Also, the community-based system will be central to evaluate the efficacy of vector control strategies in reducing the incidence of arboviral diseases in humans and assessing its potential use among other populations.
The public health significance of the proposed project is high given the considerable burden of disease due to dengue, the importance of other infectious agents, and the impending threat of arboviruses' introduction in Puerto Rico that include most recently, chikungunya and Zika. The current proposal also includes close collaboration with the Puerto Rico Vector Control Unit, which will allow a better understanding of the vector and local epidemiological conditions that impact dengue and arboviruses transmission. This study will enhance the understanding of the etiology, epidemiology, and severity of arboviral diseases, allowing the United States to be better prepared and respond to critical vector-borne disease outbreaks that can lead to devastating morbidity and mortality. Through a better understanding of these disease threats, and their control and prevention, morbidity and mortality may be decreased and global health security increased.