672. Emergence of Dengue Virus Type 4 throughout Peru 2006 - 2010
Session: Abstracts: Virology
Friday, October 22, 2010
Background: Dengue virus (DENV) infection is a significant cause of morbidity and mortality in tropical areas around the world, including the neotropics of South America.   DENV serotypes have been circulating in Peru since at least 1990 when DENV-1 appeared in residents of Iquitos in the northeastern Amazon region. Subsequent introductions of heterologous serotypes have since been observed, including DENV-2 in 1995, DENV-3 in 2000, and DENV-4 in 2006. Herein, we describe the spatial patterns of DENV spread throughout Peru subsequent to the introduction of DENV-4.

Methods: Patients with fever (> 38°C) and symptoms consistent with dengue fever were recruited from sites in six cities of Peru. DENV serotypes were identified by virus isolation and immunofluorescence assay.

Results:  From 2006-2007, 5,189 subjects were evaluated and 808 (16%) had infection with DENV, but only one of these had DENV-4. From January 2008-February 2010, DENV was isolated from 1,458 (26%) of the 5,685 subjects recruited, and DENV4 was found in 720 (49.3% of all dengue cases).  In 2009 and 2010, DENV-4 displaced DENV-3 as the predominant serotype in the northeastern rainforest region (Iquitos and Yurimaguas) and central rainforest region (La Merced), representing 95.8% of all isolates.  In contrast, in the northern coastal region (Tumbes and Piura), DENV-1 continued to be the dominant serotype (92% of all isolates in 2009 and 2010) and DENV-4 comprised the remainder of the cases (8%). No evidence of DENV-4 penetration further into southern Peru (Puerto Maldonado) has been observed.  Instead, DENV-3 remains the dominant serotype, with co-circulation of DENV-1 and DENV-2, as well.

Conclusion: While all four serotypes were detected in Peru during the study period, DENV transmission was characterized by regional and not national patterns.  Considering the putative role for secondary infection as a risk factor for severe disease, these studies have direct relevance for understanding disease outcomes in Peru. 


Subject Category: V. Virology including clinical and basic studies of viral infections, including hepatitis

Speakers:
Edna Roxana Caceda, Biologist , Virology, Naval Medical Research Center Detachment, Lima, Peru
Brett Forshey, PhD , Naval Medical Research Center Detachment - Iquitos, Iquitos, Peru
Carolina Guevara, Biologist , Virology, Naval Medical Research Center Detachment, Lima, Peru
Stalin Vilcarromero, MD , Naval Medical Research Center Detachment - Iquitos, Iquitos, Peru
Juan Sulca, Biologist , Virology, Naval Medical Research Center Detachment, Lima, Peru
Tadeusz J. Kochel, PhD , Virology, Naval Medical Research Center Detachment, Lima, Peru
Eric S. Halsey, PhD , Virology, Naval Medical Research Center Detachment, Lima, Peru
Carlos Alvarez, MD , DISA - Loreto, Iquitos, Peru

Disclosures:

E. R. Caceda, None

B. Forshey, None

C. Guevara, None

S. Vilcarromero, None

J. Sulca, None

T. J. Kochel, None

E. S. Halsey, None

C. Alvarez, None

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