Enhanced Surveillance for Fatal Dengue-Like Acute Febrile Illness in Puerto Rico, 2010-2012

Kay M. Tomashek, Aidsa Rivera, Brenda Torres-Velasquez, Elizabeth A. Hunsperger, Jorge L. Munoz-Jordan, Tyler M. Sharp, Irma Rivera, Dario Sanabria, Dianna M. Blau, Renee Galloway, Jose Torres, Rosa Rodriguez, Javier Serrano, Carlos Chávez, Francisco Dávila, Janice Perez-Padilla, Esther M. Ellis, Gladys Caballero, Laura Wright, Sherif R. ZakiCarmen Deseda, Edda Rodriguez, Harold S. Margolis

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background: 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.

Original languageEnglish (US)
Article numbere0005025
JournalPLoS neglected tropical diseases
Issue number10
StatePublished - Oct 11 2016
Externally publishedYes

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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