- INTRODUCTION
- MATERIALS AND METHODS
- RESULTS
- DISCUSSION
- Limitations of surveillance system.
- Limitations of diagnostic assay.
- Disease transmission patterns and viral activity.
- Age, disease manifestations, and immune status.
- Spatial and temporal disease distribution.
- Possible transmission clusters.
- Possible viral entry and spread of dengue viruses.
- General epidemiology.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1
Gubler DJ, 1997. Dengue and dengue hemorrhagic fever: its history and resurgence as a global health problem. Gubler DJ, Kuno G, eds. Dengue and Dengue Hemorrhagic Fever. First edition. Wallingford, UK: CAB International, 1–22.
-
2
Ehrenkranz NJ, Ventura AK, Cuadrado RR, Pond WL, Porter JE, 1971. Pandemic dengue in Caribbean countries and the southern United States–past, present and potential problems. N Engl J Med 285 :1460–1469.
-
3
Gratz NG, Knudsen AB, 1996. The Rise and Spread of Dengue, Dengue Haemorrhagic Fever and Its Vectors: A Historical Review (Up to 1995). Geneva: World Health Organization.
-
4
Hospedales CJ, 1990. Dengue fever in the Caribbean. West Indian Med J 39 :59–62.
-
5
Caribbean Commission on Health and Development, 2006. National Library of Jamaica Cataloguing in Publication Data: Pan American Health Organization (PAHO) and Caribbean Community Secretariat (CARICOM).
-
6
World Health Organization, DengueNet. The DengueNet database and geographic information system, Available at: http://www.who.int/csr/disease/dengue/denguenet/en/index.html. Accessed March 21, 2009.
-
7
Pinheiro FP, 1989. Dengue in the Americas, 1980–1987. Epidemiol Bull 10 :1–8.
-
8
Gubler DJ, Trent DW, 1993. Emergence of epidemic dengue/ dengue hemorrhagic fever as a public health problem in the Americas. Infect Agents Dis 2 :383–393.
-
9
Guzman MG, Kouri G, 2003. Dengue and dengue hemorrhagic fever in the Americas: lessons and challenges. J Clin Virol 27 :1–13.
-
10
Campione-Piccardo J, Ruben M, Vaughan H, Morris-Glasgow V, 2003. Dengue viruses in the Caribbean. Twenty years of dengue virus isolates from the Caribbean Epidemiology Centre. West Indian Med J 52 :191–198.
-
11
Gubler DJ, 1998. The global pandemic of dengue/dengue hemorrhagic fever: current status and prospects for the future. Ann Acad Med Singapore 27 :227–234.
-
12
Kurane I, 2007. Dengue hemorrhagic fever with special emphasis on immunopathogenesis. Comp Immunol Microbiol Infect Dis 30 :329–340.
-
13
Kurane I, Ennis FA, 1997. Immunopathogenesis of dengue virus infections. Gubler DJ, Kuno G, eds. Dengue and Dengue Hemorrhagic Fever. First edition. Wallingford, UK: Cab International, 273–290.
-
14
Pang T, Cardosa MJ, Guzman MG, 2007. Of cascades and perfect storms: the immunopathogenesis of dengue haemorrhagic fever-dengue shock syndrome (DHF/DSS). Immunol Cell Biol 85 :43–45.
-
15
Green S, Rothman A, 2006. Immunopathological mechanisms in dengue and dengue hemorrhagic fever. Curr Opin Infect Dis 19 :429–436.
-
16
Kuno G, 1997. Factors influencing the transmission of dengue viruses. Gubler DJ, Kuno G, eds. Dengue and Dengue Hemorrhagic Fever. First edition. Wallingford, UK: Cab International, 61–88.
-
17
Kuno G, 1995. Review of the factors modulating dengue transmission. Epidemiol Rev 17 :321–335.
-
18
Anderson JR, Rico-Hesse R, 2006. Aedes aegypti vectorial capacity is determined by the infecting genotype of dengue virus. Am J Trop Med Hyg 75 :886–892.
-
19
Alvarez M, Rodriguez-Roche R, Bernardo L, Vazquez S, Morier L, Gonzalez D, Castro O, Kouri G, Halstead SB, Guzman MG, 2006. Dengue hemorrhagic fever caused by sequential dengue 1–3 virus infections over a long time interval: Havana epidemic, 2001–2002. Am J Trop Med Hyg 75 :1113–1117.
-
20
Guzman MG, Kouri GP, Bravo J, Soler M, Vazquez S, Morier L, 1990. Dengue hemorrhagic fever in Cuba, 1981: a retrospective seroepidemiologic study. Am J Trop Med Hyg 42 :179–184.
-
21
Bravo JR, Guzman MG, Kouri GP, 1987. Why dengue haemorrhagic fever in Cuba? 1. Individual risk factors for dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS). Trans R Soc Trop Med Hyg 81 :816–820.
-
22
Rigau-Perez JG, Ayala-Lopez A, Garcia-Rivera EJ, Hudson SM, Vorndam V, Reiter P, Cano MP, Clark GG, 2002. The reappearance of dengue-3 and a subsequent dengue-4 and dengue-1 epidemic in Puerto Rico in 1998. Am J Trop Med Hyg 67 :355–362.
-
23
Rigau-Pérez JG, Ayuso-Lamadrid A, Wolff DR, Reiter P, Kuno G, The Puerto Rico Association of Epidemiologists, 1994. Dengue severity throughout seasonal changes in incidence in Puerto Rico, 1989–1992. Am J Trop Med Hyg 51 :408–415.
-
24
Morens DM, Rigau-Perez JG, Lopez-Correa RH, Moore CG, Ruiz-Tiben EE, Sather GE, Chiriboga J, Eliason DA, Casta-Velez A, Woodall JP, 1986. Dengue in Puerto Rico, 1977: public health response to characterize and control an epidemic of multiple serotypes. Am J Trop Med Hyg 35 :197–211.
-
25
Bennett SN, Holmes EC, Chirivella M, Rodriguez DM, Beltran M, Vorndam V, Gubler DJ, McMillan WO, 2003. Selection-driven evolution of emergent dengue virus. Mol Biol Evol 20 :1650–1658.
-
26
Rodriguez-Roche R, Alvarez M, Gritsun T, Halstead S, Kouri G, Gould EA, Guzman MG, 2005. Virus evolution during a severe dengue epidemic in Cuba, 1997. Virology 334 :154–159.
-
27
Central Intelligence Agency, The 2008 World Factbook, U.S. Government. Available at: http://www.cia.gov/cia/publications/factbook/index.html. Accessed March 21, 2009.
-
28
Encyclopc′dia Britannica, 2008. Greater Antilles. Encyclopedia Britannica Online. Available at: http://www.britannica.com/eb/article-9037895. Accessed March 21, 2009.
-
29
Pan American Health Organization, Number of Reported Cases of Dengue and Dengue Hemorrhagic Fever (DHF), Region of the Americas. Dengue Surveillance: Incidence/Mortality/Case Fatality, Available at: www.paho.org/english/ad/dpc/cd/dengue.htm. Accessed March 21, 2009.
-
30
Meditz SW, Hanratty DM, 1987. Caribbean Islands: A Country Study (Grenada). Washington, DC: GPO for the Library of Congress, Federal Research Division of the Library of Congress. Available at: http://countrystudies.us/caribbean-islands/. Accessed March 21, 2009.
-
31
Pan American Health Organization, 1994. Dengue and Dengue Hemorrhagic Fever in the Americas: Guidelines for Prevention and Control. Washington, DC: Pan American Health Organization (PAHO).
-
32
World Health Organization, 1997. Dengue Haemorrhagic Fever: Diagnosis, Treatment, Prevention and Control. Geneva, Switzerland: World Health Organization (WHO).
-
33
Lanciotti RS, Calisher CH, Gubler DJ, Chang GJ, Vorndam AV, 1992. Rapid detection and typing of dengue viruses from clinical samples by using reverse transcriptase-polymerase chain reaction. J Clin Microbiol 30 :545–551.
-
34
Chungue E, Marche G, Plichart R, Boutin JP, Roux J, 1989. Comparison of immunoglobulin G enzyme-linked immunosorbent assay (IgG-ELISA) and haemaglutination inhibition (HI) test for the detection of dengue antibodies. Prevalence of dengue IgG-ELISA antibodies in Tahiti. Trans R Soc Trop Med Hyg 83 :708–711.
-
35
Kuno G, Gomez I, Gubler DJ, 1991. An ELISA procedure for the diagnosis of dengue infections. J Virol Methods 33 :101–113.
-
36
Miagostovich MP, Nogueira RMR, dos Santos FB, Schatzmayr HG, Araujo ESM, Vorndam V, 1999. Evaluation of an IgG enzyme-linked immunosorbent assay for dengue diagnosis. J Clin Virol 14 :183–189.
-
37
Felsenstein J, 1993.PHYLIP [Phylogeny Inference Package], version 3.5c. Seattle, WA: University of Washington.
-
38
Pan American Health Organization, The History of Dengue and Dengue Hemorrhagic Fever (DHF) in the Region of the Americas, 1635–2001: A Timeline for Dengue in the Americas. Pan American Health Organization: Division of Disease Prevention and Control. Available at: http://www.paho.org/English/AD/DPC/CD/dengue_history.htm. Accessed March 21, 2009.
-
39
Rahman M, Rahman K, Siddque AK, Shoma S, Kamal AH, Ali KS, Nisaluk A, Breiman RF, 2002. First outbreak of dengue hemorrhagic fever, Bangladesh. Emerg Infect Dis 8 :738–740.
-
40
Guilarde AO, Turchi MD, Jr JB, Feres VC, Rocha B, Levi JE, Souza VA, Boas LS, Pannuti CS, Martelli CM, 2008. Dengue and dengue hemorrhagic fever among adults: clinical outcomes related to viremia, serotypes, and antibody response. J Infect Dis 197 :817–824.
-
41
Pelaez O, Guzman MG, Kouri G, Perez R, San Martin JL, Vazquez S, Rosario D, Mora R, Quintana I, Bisset J, Cancio R, Masa AM, Castro O, Gonzalez D, Avila LC, Rodriguez R, Alvarez M, Pelegrino JL, Bernardo L, Prado I, 2004. Dengue 3 epidemic, Havana, 2001. Emerg Infect Dis 10 :719–722.
-
42
World Health Organization, 2009. Fact sheet No. 117: Dengue and dengue haemorrhagic fever. Available at: http://www.who.int/mediacentre/factsheets/fs117/en/index.html. Accessed March 21, 2009.
-
43
Torres JR, Torres-Viera JM, García HSJR, Baddour Y, Bajares A, Castro JM, 2004. Prognostic factors of clinical outcome in non-paediatric patients with dengue haemorrhagic fever/dengue shock syndrome. Dengue Bull 28 :68–76.
-
44
Lee MS, Hwang KP, Chen TC, Lu PL, Chen TP, 2006. Clinical characteristics of dengue and dengue hemorrhagic fever in a medical center of southern Taiwan during the 2002 epidemic. J Microbiol Immunol Infect 39 :121–129.
-
45
Gubler DJ, 2004. Cities spawn epidemic dengue viruses. Nat Med 10 :129–130.
-
46
Chadee DD, Martinez R, 2000. Landing periodicity of Aedes aegypti with implications for dengue transmission in Trinidad, West Indies. J Vector Ecol 25 :158–163.
-
47
Guha-Sapir D, Schimmer B, 2005. Dengue fever: new paradigms for a changing epidemiology. Emerg Themes Epidemiol 2 :1.
-
48
Lanciotti RS, Lewis JG, Gubler DJ, Trent DW, 1994. Molecular evolution and epidemiology of dengue-3 viruses. J Gen Virol 75 :65–75.
-
49
Pan American Health Organization, 1982. Dengue-4 in the Americas. Epidemiol Bull 3 :7.
| Past two years | Past Year | Past 30 Days | |
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| Abstract Views | 201 | 171 | 24 |
| Full Text Views | 438 | 5 | 0 |
| PDF Downloads | 89 | 5 | 0 |
Dengue Transmission in the Small-Island Setting: Investigations from the Caribbean Island of Grenada
Karin L. Schiøler
Karin L. Schiøler
Department of International Health, Immunology, and Microbiology, University of Copenhagen, Denmark; Windward Islands Research and Education Foundation, St. George’s University, Grenada
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Calum N. Macpherson
Calum N. Macpherson
Department of International Health, Immunology, and Microbiology, University of Copenhagen, Denmark; Windward Islands Research and Education Foundation, St. George’s University, Grenada
Search for other papers by Calum N. Macpherson in
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The Caribbean region has experienced a major surge in dengue activity in recent decades. Yet, for many, and especially the smaller islands, the true extent and general epidemiology of dengue transmission remains unclear because of inadequate systems of surveillance and reporting. We established an active surveillance system supported by laboratory-based diagnosis on the small island of Grenada, from January 2001 through June 2002. The surveillance data provided evidence of three distinct modes of disease dynamics in the form of low endemic, pre-epidemic, and overt epidemic transmission of mostly benign dengue fever. A shift in serotype activity and modal age was evident during the noted transition, with the more densely populated south end of the island presenting the focus of transmission.
Author Notes
- INTRODUCTION
- MATERIALS AND METHODS
- RESULTS
- DISCUSSION
- Limitations of surveillance system.
- Limitations of diagnostic assay.
- Disease transmission patterns and viral activity.
- Age, disease manifestations, and immune status.
- Spatial and temporal disease distribution.
- Possible transmission clusters.
- Possible viral entry and spread of dengue viruses.
- General epidemiology.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1
Gubler DJ, 1997. Dengue and dengue hemorrhagic fever: its history and resurgence as a global health problem. Gubler DJ, Kuno G, eds. Dengue and Dengue Hemorrhagic Fever. First edition. Wallingford, UK: CAB International, 1–22.
-
2
Ehrenkranz NJ, Ventura AK, Cuadrado RR, Pond WL, Porter JE, 1971. Pandemic dengue in Caribbean countries and the southern United States–past, present and potential problems. N Engl J Med 285 :1460–1469.
-
3
Gratz NG, Knudsen AB, 1996. The Rise and Spread of Dengue, Dengue Haemorrhagic Fever and Its Vectors: A Historical Review (Up to 1995). Geneva: World Health Organization.
-
4
Hospedales CJ, 1990. Dengue fever in the Caribbean. West Indian Med J 39 :59–62.
-
5
Caribbean Commission on Health and Development, 2006. National Library of Jamaica Cataloguing in Publication Data: Pan American Health Organization (PAHO) and Caribbean Community Secretariat (CARICOM).
-
6
World Health Organization, DengueNet. The DengueNet database and geographic information system, Available at: http://www.who.int/csr/disease/dengue/denguenet/en/index.html. Accessed March 21, 2009.
-
7
Pinheiro FP, 1989. Dengue in the Americas, 1980–1987. Epidemiol Bull 10 :1–8.
-
8
Gubler DJ, Trent DW, 1993. Emergence of epidemic dengue/ dengue hemorrhagic fever as a public health problem in the Americas. Infect Agents Dis 2 :383–393.
-
9
Guzman MG, Kouri G, 2003. Dengue and dengue hemorrhagic fever in the Americas: lessons and challenges. J Clin Virol 27 :1–13.
-
10
Campione-Piccardo J, Ruben M, Vaughan H, Morris-Glasgow V, 2003. Dengue viruses in the Caribbean. Twenty years of dengue virus isolates from the Caribbean Epidemiology Centre. West Indian Med J 52 :191–198.
-
11
Gubler DJ, 1998. The global pandemic of dengue/dengue hemorrhagic fever: current status and prospects for the future. Ann Acad Med Singapore 27 :227–234.
-
12
Kurane I, 2007. Dengue hemorrhagic fever with special emphasis on immunopathogenesis. Comp Immunol Microbiol Infect Dis 30 :329–340.
-
13
Kurane I, Ennis FA, 1997. Immunopathogenesis of dengue virus infections. Gubler DJ, Kuno G, eds. Dengue and Dengue Hemorrhagic Fever. First edition. Wallingford, UK: Cab International, 273–290.
-
14
Pang T, Cardosa MJ, Guzman MG, 2007. Of cascades and perfect storms: the immunopathogenesis of dengue haemorrhagic fever-dengue shock syndrome (DHF/DSS). Immunol Cell Biol 85 :43–45.
-
15
Green S, Rothman A, 2006. Immunopathological mechanisms in dengue and dengue hemorrhagic fever. Curr Opin Infect Dis 19 :429–436.
-
16
Kuno G, 1997. Factors influencing the transmission of dengue viruses. Gubler DJ, Kuno G, eds. Dengue and Dengue Hemorrhagic Fever. First edition. Wallingford, UK: Cab International, 61–88.
-
17
Kuno G, 1995. Review of the factors modulating dengue transmission. Epidemiol Rev 17 :321–335.
-
18
Anderson JR, Rico-Hesse R, 2006. Aedes aegypti vectorial capacity is determined by the infecting genotype of dengue virus. Am J Trop Med Hyg 75 :886–892.
-
19
Alvarez M, Rodriguez-Roche R, Bernardo L, Vazquez S, Morier L, Gonzalez D, Castro O, Kouri G, Halstead SB, Guzman MG, 2006. Dengue hemorrhagic fever caused by sequential dengue 1–3 virus infections over a long time interval: Havana epidemic, 2001–2002. Am J Trop Med Hyg 75 :1113–1117.
-
20
Guzman MG, Kouri GP, Bravo J, Soler M, Vazquez S, Morier L, 1990. Dengue hemorrhagic fever in Cuba, 1981: a retrospective seroepidemiologic study. Am J Trop Med Hyg 42 :179–184.
-
21
Bravo JR, Guzman MG, Kouri GP, 1987. Why dengue haemorrhagic fever in Cuba? 1. Individual risk factors for dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS). Trans R Soc Trop Med Hyg 81 :816–820.
-
22
Rigau-Perez JG, Ayala-Lopez A, Garcia-Rivera EJ, Hudson SM, Vorndam V, Reiter P, Cano MP, Clark GG, 2002. The reappearance of dengue-3 and a subsequent dengue-4 and dengue-1 epidemic in Puerto Rico in 1998. Am J Trop Med Hyg 67 :355–362.
-
23
Rigau-Pérez JG, Ayuso-Lamadrid A, Wolff DR, Reiter P, Kuno G, The Puerto Rico Association of Epidemiologists, 1994. Dengue severity throughout seasonal changes in incidence in Puerto Rico, 1989–1992. Am J Trop Med Hyg 51 :408–415.
-
24
Morens DM, Rigau-Perez JG, Lopez-Correa RH, Moore CG, Ruiz-Tiben EE, Sather GE, Chiriboga J, Eliason DA, Casta-Velez A, Woodall JP, 1986. Dengue in Puerto Rico, 1977: public health response to characterize and control an epidemic of multiple serotypes. Am J Trop Med Hyg 35 :197–211.
-
25
Bennett SN, Holmes EC, Chirivella M, Rodriguez DM, Beltran M, Vorndam V, Gubler DJ, McMillan WO, 2003. Selection-driven evolution of emergent dengue virus. Mol Biol Evol 20 :1650–1658.
-
26
Rodriguez-Roche R, Alvarez M, Gritsun T, Halstead S, Kouri G, Gould EA, Guzman MG, 2005. Virus evolution during a severe dengue epidemic in Cuba, 1997. Virology 334 :154–159.
-
27
Central Intelligence Agency, The 2008 World Factbook, U.S. Government. Available at: http://www.cia.gov/cia/publications/factbook/index.html. Accessed March 21, 2009.
-
28
Encyclopc′dia Britannica, 2008. Greater Antilles. Encyclopedia Britannica Online. Available at: http://www.britannica.com/eb/article-9037895. Accessed March 21, 2009.
-
29
Pan American Health Organization, Number of Reported Cases of Dengue and Dengue Hemorrhagic Fever (DHF), Region of the Americas. Dengue Surveillance: Incidence/Mortality/Case Fatality, Available at: www.paho.org/english/ad/dpc/cd/dengue.htm. Accessed March 21, 2009.
-
30
Meditz SW, Hanratty DM, 1987. Caribbean Islands: A Country Study (Grenada). Washington, DC: GPO for the Library of Congress, Federal Research Division of the Library of Congress. Available at: http://countrystudies.us/caribbean-islands/. Accessed March 21, 2009.
-
31
Pan American Health Organization, 1994. Dengue and Dengue Hemorrhagic Fever in the Americas: Guidelines for Prevention and Control. Washington, DC: Pan American Health Organization (PAHO).
-
32
World Health Organization, 1997. Dengue Haemorrhagic Fever: Diagnosis, Treatment, Prevention and Control. Geneva, Switzerland: World Health Organization (WHO).
-
33
Lanciotti RS, Calisher CH, Gubler DJ, Chang GJ, Vorndam AV, 1992. Rapid detection and typing of dengue viruses from clinical samples by using reverse transcriptase-polymerase chain reaction. J Clin Microbiol 30 :545–551.
-
34
Chungue E, Marche G, Plichart R, Boutin JP, Roux J, 1989. Comparison of immunoglobulin G enzyme-linked immunosorbent assay (IgG-ELISA) and haemaglutination inhibition (HI) test for the detection of dengue antibodies. Prevalence of dengue IgG-ELISA antibodies in Tahiti. Trans R Soc Trop Med Hyg 83 :708–711.
-
35
Kuno G, Gomez I, Gubler DJ, 1991. An ELISA procedure for the diagnosis of dengue infections. J Virol Methods 33 :101–113.
-
36
Miagostovich MP, Nogueira RMR, dos Santos FB, Schatzmayr HG, Araujo ESM, Vorndam V, 1999. Evaluation of an IgG enzyme-linked immunosorbent assay for dengue diagnosis. J Clin Virol 14 :183–189.
-
37
Felsenstein J, 1993.PHYLIP [Phylogeny Inference Package], version 3.5c. Seattle, WA: University of Washington.
-
38
Pan American Health Organization, The History of Dengue and Dengue Hemorrhagic Fever (DHF) in the Region of the Americas, 1635–2001: A Timeline for Dengue in the Americas. Pan American Health Organization: Division of Disease Prevention and Control. Available at: http://www.paho.org/English/AD/DPC/CD/dengue_history.htm. Accessed March 21, 2009.
-
39
Rahman M, Rahman K, Siddque AK, Shoma S, Kamal AH, Ali KS, Nisaluk A, Breiman RF, 2002. First outbreak of dengue hemorrhagic fever, Bangladesh. Emerg Infect Dis 8 :738–740.
-
40
Guilarde AO, Turchi MD, Jr JB, Feres VC, Rocha B, Levi JE, Souza VA, Boas LS, Pannuti CS, Martelli CM, 2008. Dengue and dengue hemorrhagic fever among adults: clinical outcomes related to viremia, serotypes, and antibody response. J Infect Dis 197 :817–824.
-
41
Pelaez O, Guzman MG, Kouri G, Perez R, San Martin JL, Vazquez S, Rosario D, Mora R, Quintana I, Bisset J, Cancio R, Masa AM, Castro O, Gonzalez D, Avila LC, Rodriguez R, Alvarez M, Pelegrino JL, Bernardo L, Prado I, 2004. Dengue 3 epidemic, Havana, 2001. Emerg Infect Dis 10 :719–722.
-
42
World Health Organization, 2009. Fact sheet No. 117: Dengue and dengue haemorrhagic fever. Available at: http://www.who.int/mediacentre/factsheets/fs117/en/index.html. Accessed March 21, 2009.
-
43
Torres JR, Torres-Viera JM, García HSJR, Baddour Y, Bajares A, Castro JM, 2004. Prognostic factors of clinical outcome in non-paediatric patients with dengue haemorrhagic fever/dengue shock syndrome. Dengue Bull 28 :68–76.
-
44
Lee MS, Hwang KP, Chen TC, Lu PL, Chen TP, 2006. Clinical characteristics of dengue and dengue hemorrhagic fever in a medical center of southern Taiwan during the 2002 epidemic. J Microbiol Immunol Infect 39 :121–129.
-
45
Gubler DJ, 2004. Cities spawn epidemic dengue viruses. Nat Med 10 :129–130.
-
46
Chadee DD, Martinez R, 2000. Landing periodicity of Aedes aegypti with implications for dengue transmission in Trinidad, West Indies. J Vector Ecol 25 :158–163.
-
47
Guha-Sapir D, Schimmer B, 2005. Dengue fever: new paradigms for a changing epidemiology. Emerg Themes Epidemiol 2 :1.
-
48
Lanciotti RS, Lewis JG, Gubler DJ, Trent DW, 1994. Molecular evolution and epidemiology of dengue-3 viruses. J Gen Virol 75 :65–75.
-
49
Pan American Health Organization, 1982. Dengue-4 in the Americas. Epidemiol Bull 3 :7.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 201 | 171 | 24 |
| Full Text Views | 438 | 5 | 0 |
| PDF Downloads | 89 | 5 | 0 |