{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T22:13:11Z","timestamp":1768255991631,"version":"3.49.0"},"reference-count":43,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,4,7]],"date-time":"2022-04-07T00:00:00Z","timestamp":1649289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U01 GH002235"],"award-info":[{"award-number":["U01 GH002235"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>The Acute Febrile Illness (AFI) Surveillance Network in Belize is a country-wide active surveillance program aimed at diagnosing vector-borne, respiratory, and enteric pathogens among patients presenting to 11 participating hospitals and clinics with new onset fever. This study describes the epidemiology of dengue virus (DENV) infections in Belize diagnosed through AFI surveillance in 2020. Of the 894 patients enrolled and PCR-tested for DENV in this period, 44 DENV-positive cases (5%) were identified. All four DENV serotypes were detected, with two cases testing positive for DENV serotype 4, which is the first report of this serotype in Belize since 2004. The majority of DENV cases (66%) were diagnosed in the Belize District, which contains the largest urban center in the country (Belize City). Positive cases were detected between January 2020 and September 2020, with the majority (89%) diagnosed during the dry season between January and April, unlike years prior when cases were more often diagnosed during the wet season. Clinical signs and symptoms varied slightly between DENV serotypes. Active surveillance of DENV among AFI cases provides insight into the epidemiologic and clinical characteristics of DENV in Belize. This information is important for informing public health interventions to mitigate DENV transmission.<\/jats:p>","DOI":"10.3390\/v14040768","type":"journal-article","created":{"date-parts":[[2022,4,7]],"date-time":"2022-04-07T22:23:23Z","timestamp":1649370203000},"page":"768","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Epidemiological and Clinical Characteristics of Acute Dengue Virus Infections Detected through Acute Febrile Illness Surveillance, Belize 2020"],"prefix":"10.3390","volume":"14","author":[{"given":"Anh N.","family":"Ly","sequence":"first","affiliation":[{"name":"Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, TX 77030, USA"},{"name":"Department of Epidemiology and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Russell","family":"Manzanero","sequence":"additional","affiliation":[{"name":"Belize Ministry of Health and Wellness, Belmopan, Belize"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrianna","family":"Maliga","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0648-6828","authenticated-orcid":false,"given":"Sarah M.","family":"Gunter","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, TX 77030, USA"},{"name":"The William T. Shearer Center for Human Immunobiology, Texas Children\u2019s Hospital, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shannon E.","family":"Ronca","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, TX 77030, USA"},{"name":"The William T. Shearer Center for Human Immunobiology, Texas Children\u2019s Hospital, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Zielinski-Gutierrez","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention\u2014Central America Region, Guatemala City 01015, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis","family":"Morey","sequence":"additional","affiliation":[{"name":"Belize Ministry of Health and Wellness, Belmopan, Belize"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kim","family":"Bautista","sequence":"additional","affiliation":[{"name":"Belize Ministry of Health and Wellness, Belmopan, Belize"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1578-6125","authenticated-orcid":false,"given":"Andres","family":"Espinosa-Bode","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention\u2014Central America Region, Guatemala City 01015, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1353-9948","authenticated-orcid":false,"given":"Beatriz","family":"L\u00f3pez","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention\u2014Central America Region, Guatemala City 01015, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loren","family":"Cadena","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention\u2014Central America Region, Guatemala City 01015, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafael C.","family":"Fuentes","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention\u2014Central America Region, Guatemala City 01015, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy A.","family":"Erickson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flor M.","family":"Munoz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joy","family":"Mackey","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerhaldine","family":"Moraz\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, TX 77030, USA"},{"name":"Belize Ministry of Health and Wellness, Belmopan, Belize"},{"name":"Central Medical Laboratory, Belize Ministry of Health and Wellness, Belize City, Belize"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristy O.","family":"Murray","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, TX 77030, USA"},{"name":"The William T. 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Dis., 2.","DOI":"10.1371\/journal.pntd.0000300"},{"key":"ref_4","unstructured":"World Health Organization (2020, August 16). Dengue and Severe Dengue. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/dengue-and-severe-dengue."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1590\/S0102-311X2007001300004","article-title":"The Health and Economic Impact of Dengue in Latin America","volume":"23","author":"Torres","year":"2007","journal-title":"Cad. Sa\u00fade P\u00fablica"},{"key":"ref_6","unstructured":"Statistical Institute of Belize (2020, March 06). Postcensal Estimates by Age Group and Sex, 2010\u20132020. Available online: http:\/\/sib.org.bz\/statistics\/population\/."},{"key":"ref_7","unstructured":"Central Intelligence Agency (2021, January 24). The World Factbook: Belize, Available online: https:\/\/www.cia.gov\/the-world-factbook\/countries\/belize\/."},{"key":"ref_8","unstructured":"National Meteorological Service of Belize (2021, October 04). Climate Summary: The Climate of Belize, Available online: http:\/\/nms.gov.bz\/climate-services\/climate-summary\/."},{"key":"ref_9","unstructured":"The World Bank (2020, October 09). World Bank Country and Lending Groups, Available online: https:\/\/datahelpdesk.worldbank.org\/knowledgebase\/articles\/906519-world-bank-country-and-lending-groups."},{"key":"ref_10","unstructured":"Belize Ministry of Health (2020, October 26). Belize Health Sector Strategic Plan 2014\u20132024, Available online: http:\/\/health.gov.bz\/www\/attachments\/article\/801\/Belize%20Health%20Sector%20Strategic%20Plan%202014-2024-April%202014.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"642","DOI":"10.4269\/ajtmh.14-0107","article-title":"Seroprevalence of Seven Zoonotic Pathogens in Pregnant Women from the Caribbean","volume":"91","author":"Dillon","year":"2014","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_12","unstructured":"Belize Ministry of Health (2020, September 02). Vector Control, Available online: https:\/\/health.gov.bz\/www\/organogram\/214-vector-control."},{"key":"ref_13","unstructured":"World Health Organization, Special Programme for Research, and Training in Tropical Diseases (2009). Dengue: Guidelines for Diagnosis, Treatment, Prevention, and Control, World Health Organization."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"427","DOI":"10.4269\/ajtmh.18-0755","article-title":"Optimizing PCR Detection of Zika Virus from Various Body Fluids","volume":"100","author":"Gorchakov","year":"2019","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.3201\/eid1408.080287","article-title":"Genetic and Serologic Properties of Zika Virus Associated with an Epidemic, Yap State, Micronesia, 2007","volume":"14","author":"Lanciotti","year":"2008","journal-title":"Emerg. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Gorchakov, R., Gulas-Wroblewski, B.E., Ronca, S.E., Ruff, J.C., Nolan, M.S., Berry, R., Alvarado, R.E., Gunter, S.M., and Murray, K.O. (2019). Optimizing PCR Detection of West Nile Virus from Body Fluid Specimens to Delineate Natural History in an Infected Human Cohort. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20081934"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"764","DOI":"10.3201\/eid1305.070015","article-title":"Chikungunya Virus in US Travelers Returning from India, 2006","volume":"13","author":"Lanciotti","year":"2007","journal-title":"Emerg. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/1743-422X-6-10","article-title":"Development of Real Time PCR for Detection and Quantitation of Dengue Viruses","volume":"6","author":"Gurukumar","year":"2009","journal-title":"Virol. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.mcp.2018.10.001","article-title":"One-Step Multiplex Real-Time RT-PCR for Detection and Typing of Dengue Virus","volume":"43","author":"Mun","year":"2019","journal-title":"Mol. Cell. Probes"},{"key":"ref_20","unstructured":"(2020). Stata, StataCorp LLC."},{"key":"ref_21","unstructured":"(2020). ArcGIS Desktop, Esri Inc."},{"key":"ref_22","unstructured":"Meerman, J., and Clabaugh, J. (2021, February 28). Biodiversity and Environmental Resource Data System of Belize. Available online: http:\/\/www.biodiversity.bz\/."},{"key":"ref_23","unstructured":"Statistical Institute of Belize (2021, February 18). Postcensal Estimates by Administrative Area and Sex, 2010\u20132020. Available online: http:\/\/sib.org.bz\/statistics\/population\/."},{"key":"ref_24","unstructured":"Pan American Health Organization, and World Health Organization (2021, January 24). Dengue serotypes by Year for Countries and Territories of the Americas. Available online: https:\/\/www.paho.org\/data\/index.php\/en\/mnu-topics\/indicadores-dengue-en\/dengue-nacional-en\/517-dengue-serotypes-en.html?start=1."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"317","DOI":"10.3389\/fcimb.2017.00317","article-title":"Global Epidemiology of Dengue Outbreaks in 1990\u20132015: A Systematic Review and Meta-Analysis","volume":"7","author":"Guo","year":"2017","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_26","unstructured":"Pan American Health Organization, and World Health Organization (2021, March 06). PAHO Warns of the Complex Situation of Dengue in Latin America and the Caribbean. Available online: https:\/\/www.paho.org\/hq\/index.php?option=com_content&view=article&id=15365:paho-warns-of-the-complex-situation-of-dengue-in-latin-america-and-the-caribbean&Itemid=135&lang=en."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Dhanoa, A., Hassan, S.S., Ngim, C.F., Lau, C.F., Chan, T.S., Adnan, N.A.A., Eng, W.W.H., Gan, H.M., and Rajasekaram, G. (2016). Impact of Dengue Virus (DENV) Co-Infection on Clinical Manifestations, Disease Severity and Laboratory Parameters. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-1731-8"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e119","DOI":"10.1017\/S0950268820000229","article-title":"Dengue Virus Co-Infections with Multiple Serotypes Do Not Result in a Different Clinical Outcome Compared to Mono-Infections","volume":"148","author":"Senaratne","year":"2020","journal-title":"Epidemiol. Infect."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Afreen, N., Naqvi, I.H., Broor, S., Ahmed, A., and Parveen, S. (2015). Phylogenetic and Molecular Clock Analysis of Dengue Serotype 1 and 3 from New Delhi, India. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0141628"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"725","DOI":"10.4269\/ajtmh.1999.61.725","article-title":"Common Occurrence of Concurrent Infections by Multiple Dengue Virus Serotypes","volume":"61","author":"Beaty","year":"1999","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.ijid.2018.06.020","article-title":"An Epidemiological Study of Dengue and Its Coinfections in Delhi","volume":"74","author":"Savargaonkar","year":"2018","journal-title":"Int. J. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.jiph.2013.01.004","article-title":"Episode of Coexisting Infections with Multiple Dengue Virus Serotypes in Central Karnataka, India","volume":"6","author":"VinodKumar","year":"2013","journal-title":"J. Infect. Public Health"},{"key":"ref_33","unstructured":"Centers for Disease Control and Prevention (2021, March 07). Dengue and Dengue Hemorrhagic Fever, Available online: https:\/\/www.cdc.gov\/dengue\/resources\/denguedhf-information-for-health-care-practitioners_2009.pdf."},{"key":"ref_34","unstructured":"Belize Tourism Board (2021, January 24). Travel & Tourism Statistics Digest. Available online: https:\/\/infogram.com\/overnight-tourist-arrivals-1hdw2j7kjq1x2l0."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"15335","DOI":"10.1038\/s41598-019-51787-5","article-title":"Urbanization Creates Diverse Aquatic Habitats for Immature Mosquitoes in Urban Areas","volume":"9","author":"Wilke","year":"2019","journal-title":"Sci. Rep"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Li, Y., Kamara, F., Zhou, G., Puthiyakunnon, S., Li, C., Liu, Y., Zhou, Y., Yao, L., Yan, G., and Chen, X.-G. (2014). Urbanization Increases Aedes Albopictus Larval Habitats and Accelerates Mosquito Development and Survivorship. PLoS Negl. Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0003301"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"128","DOI":"10.4269\/ajtmh.2010.09-0346","article-title":"The Epidemiology of Dengue in the Americas Over the Last Three Decades: A Worrisome Reality","volume":"82","author":"Brathwaite","year":"2010","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_38","unstructured":"Pan American Health Organization, and World Health Organization (2021, February 24). Suspected Dengue Cases. Available online: https:\/\/www.paho.org\/data\/index.php\/en\/mnu-topics\/indicadores-dengue-en\/dengue-nacional-en\/252-dengue-pais-ano-en.html?start=2."},{"key":"ref_39","unstructured":"UN Resident Coordinator\u2019s Office for Belize, UN Emergency Technical Team, and UN Office for the Coordination of Humanitarian Affairs (2021, February 24). Belize: Hurricane Nana Flash Update No. 01, As of 03 September 2020-Belize. Available online: https:\/\/reliefweb.int\/report\/belize\/belize-hurricane-nana-flash-update-no-01-03-september-2020."},{"key":"ref_40","unstructured":"UN Resident Coordinator\u2019s Office for Belize, UN Emergency Technical Team, and UN Office for the Coordination of Humanitarian Affairs (2021, February 24). Belize: Hurricane Iota Flash Update No. 01, As of 24 November 2020-Belize. Available online: https:\/\/reliefweb.int\/report\/belize\/belize-hurricane-iota-flash-update-no-01-24-november-2020."},{"key":"ref_41","unstructured":"(2021, February 24). UN Resident Coordinator\u2019s Office for Belize; UN Emergency Technical Team; UN Office for the Coordination of Humanitarian Affairs. Belize: Hurricane Eta Flash Update No. 01, As of 10 November 2020-Belize. Available online: https:\/\/reliefweb.int\/report\/belize\/belize-hurricane-eta-flash-update-no-01-10-november-2020."},{"key":"ref_42","unstructured":"Government of Belize (2021, February 24). Ministry of Health Announces First Case of COVID-19, Available online: https:\/\/www.pressoffice.gov.bz\/ministry-of-health-announces-first-case-of-covid-19\/."},{"key":"ref_43","unstructured":"Overseas Security Advisory Council (2021, February 24). Health Alert: Belize, State of Emergency for Next 30 Days, Available online: https:\/\/www.osac.gov\/Content\/Report\/d7e46f05-2bae-4b28-acf1-1854f537c53e."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/14\/4\/768\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:50:05Z","timestamp":1760136605000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/14\/4\/768"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,7]]},"references-count":43,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["v14040768"],"URL":"https:\/\/doi.org\/10.3390\/v14040768","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,7]]}}}