{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T08:13:49Z","timestamp":1793088829451,"version":"4.5.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0009261","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,12,30]],"date-time":"2021-12-30T00:00:00Z","timestamp":1640822400000}}],"reference-count":11,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T00:00:00Z","timestamp":1639612800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"\n Background<\/jats:title>\n During 2017, twenty health districts (locations) implemented a dengue outbreak Early Warning and Response System (EWARS) in Mexico, which processes epidemiological, meteorological and entomological alarm indicators to predict dengue outbreaks and triggers early response activities.<\/jats:p>\n Out of the 20 priority districts where more than one fifth of all national disease transmission in Mexico occur, eleven districts were purposely selected and analyzed. Nine districts presented outbreak alarms by EWARS but without subsequent outbreaks (\u201cnon-outbreak districts\u201d) and two presented alarms with subsequent dengue outbreaks (\u201coutbreak districts\u201d). This evaluation study assesses and compares the impact of alarm-informed response activities and the consequences of failing a timely and adequate response across the outbreak groups.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Five indicators of dengue outbreak response (larval control, entomological studies with water container interventions, focal spraying and indoor residual spraying) were quantitatively analyzed across two groups (\u201doutbreak districts\u201d and \u201cnon-outbreak districts\u201d). However, for quality control purposes, only qualitative concluding remarks were derived from the fifth response indicator (fogging).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The average coverage of vector control responses was significantly higher in non-outbreak districts and across all four indicators. In the \u201coutbreak districts\u201d the response activities started late and were of much lower intensity compared to \u201cnon-outbreak districts\u201d. Vector control teams at districts-level demonstrated diverse levels of compliance with local guidelines for \u2018initial\u2019, \u2018early\u2019 and \u2018late\u2019 responses to outbreak alarms, which could potentially explain the different outcomes observed following the outbreak alarms.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Failing timely and adequate response of alarm signals generated by EWARS showed to negatively impact the disease outbreak control process. On the other hand, districts with adequate and timely response guided by alarm signals demonstrated successful records of outbreak prevention. This study presents important operational scenarios when failing or successding EWARS but warrants investigating the effectiveness and cost-effectiveness of EWARS using a more robust designs.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pntd.0009261","type":"journal-article","created":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T13:52:36Z","timestamp":1639662756000},"page":"e0009261","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["Validation of the Early Warning and Response System (EWARS) for dengue outbreaks: Evidence from the national vector control program in Mexico"],"prefix":"10.1371","volume":"15","author":[{"given":"David","family":"Benitez-Valladares","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Kroeger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo S\u00e1nchez","family":"Tejeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9607-110X","authenticated-orcid":true,"given":"Laith","family":"Hussain-Alkhateeb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,12,16]]},"reference":[{"key":"pntd.0009261.ref001","volume-title":"Global Strategy for Dengue Prevention and Control 2012\u20132020","author":"World Health Organization","year":"2012"},{"key":"pntd.0009261.ref002","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1038\/nature12060","article-title":"The global distribution and burden of dengue","volume":"496","author":"S Bhatt","journal-title":"Nature"},{"key":"pntd.0009261.ref003","doi-asserted-by":"crossref","first-page":"7","DOI":"10.17533\/udea.rfnsp.15464","article-title":"Distribuci\u00f3n espacial del dengue basado en herramientas del Sistema de Informaci\u00f3n Geogr\u00e1fica, Valle de Aburr\u00e1, Colombia.","volume":"32","author":"A. L Libardo","year":"2014","journal-title":"Revista Facultad Nacional de Salud P\u00fablica"},{"key":"pntd.0009261.ref004","article-title":"Towards an evidence based model of dengue surveillance and outbreak response in Latin America and Asia","author":"S Badurdeen","year":"2013","journal-title":"Sharing experiences:BMC Public Health"},{"key":"pntd.0009261.ref005","first-page":"2016","article-title":"Alarm variables for dengue outbreaks: A multi-centre study in Asia and Latin America","volume":"111","author":"LR Bowman","journal-title":"PLoS ONE"},{"key":"pntd.0009261.ref006","author":"World Health Organization & UNICEF\/UNDP\/World Bank\/WHO Special Programme for Research and Training in Tropical Diseases","year":"2020","journal-title":"The early warning and response system (EWARS) for dengue outbreaks: operational guide using the web-based dashboard"},{"key":"pntd.0009261.ref007","article-title":"Early warning and response system (EWARS) for dengue outbreaks: Recent advancements towards widespread applications in critical settings","volume":"13","author":"L Hussain-Alkhateeb","journal-title":"PLoS ONE"},{"key":"pntd.0009261.ref008","author":"Centro Nacional de Programas Preventivos y Control de Enfermedades","year":"2013","journal-title":"Programa de Acci\u00f3n Espec\u00edfico de Prevenci\u00f3n y Control de Dengue 2013\u20132018"},{"key":"pntd.0009261.ref009","article-title":"Acciones de Control","author":"Centro Nacional de Programas Preventivos y Control de Enfermedades","year":"2014"},{"key":"pntd.0009261.ref010","article-title":"Gu\u00eda Metodol\u00f3gia para la Aplicaci\u00f3n Intradomiciliar de Insecticida de Acci\u00f3n Residual con Equipo Aspersor(Motomochila)","author":"Centro Nacional de Programas Preventivos y Control de Enfermedades"},{"key":"pntd.0009261.ref011","article-title":"Assessing the Relationship between Vector Indices and Dengue Transmission: A Systematic Review of the Evidence","volume":"8","author":"LR Bowman","journal-title":"PLoS Neglected Tropical Diseases"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0009261","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,12,30]],"date-time":"2021-12-30T00:00:00Z","timestamp":1640822400000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0009261","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,14]],"date-time":"2024-09-14T12:27:48Z","timestamp":1726316868000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0009261"}},"subtitle":[],"editor":[{"given":"Elvina","family":"Viennet","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,12,16]]},"references-count":11,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0009261","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2021.02.23.432448","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,16]]}}}