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This study sought to characterize dengue relative to other acute illness cases and use phylogenetic analysis to understand the outbreak\u2019s origin. Individuals with an acute illness (\u22647 days) were enrolled and tested for DENV nonstructural protein 1 (NS1) and viral RNA by real-time RT-PCR. Near-complete genome sequences were obtained from 62 DENV-4 positive samples. From January 2019 to March 2020, 799 participants were enrolled: 253 dengue (14 severe dengue, 5.5%) and 546 other acute illness cases. DENV-4 was detected in 238 dengue cases (94.1%). NS1 detection by rapid test was 52.5% sensitive (53\/101) and 96.5% specific (387\/401) for dengue compared to rRT-PCR. DENV-4 sequences were grouped into two clades within genotype II. No clustering was observed based on dengue severity, location, or date. Sequences obtained here were most closely related to 2018 DENV-4 sequences from Paraguay, followed by a 2013 sequence from southern Brazil. 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Outbreak strains seem to have been circulating in Paraguay and Brazil prior to 2018, highlighting the importance of sustained DENV genomic surveillance.<\/jats:p>","DOI":"10.3390\/v16020181","type":"journal-article","created":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T06:54:12Z","timestamp":1706165652000},"page":"181","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Characterization of Dengue Virus 4 Cases in Paraguay, 2019\u20132020"],"prefix":"10.3390","volume":"16","author":[{"given":"Alejandra","family":"Rojas","sequence":"first","affiliation":[{"name":"Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunci\u00f3n, San Lorenzo 111241, Paraguay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Shen","sequence":"additional","affiliation":[{"name":"Rollins School of Public Health, Emory University, Atlanta, GA 30322, 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Virol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e180320","DOI":"10.1590\/0074-02760180320","article-title":"Dengue 4 in Ceara, Brazil: Characterisation of epidemiological and laboratorial aspects and causes of death during the first epidemic in the state","volume":"113","author":"Ramalho","year":"2018","journal-title":"Mem. Inst. Oswaldo Cruz"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"990","DOI":"10.4269\/ajtmh.2008.78.990","article-title":"Influence of the dengue serotype, previous dengue infection, and plasma viral load on clinical presentation and outcome during a dengue-2 and dengue-4 co-epidemic","volume":"78","author":"Thomas","year":"2008","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Fried, J.R., Gibbons, R.V., Kalayanarooj, S., Thomas, S.J., Srikiatkhachorn, A., Yoon, I.K., Jarman, R.G., Green, S., Rothman, A.L., and Cummings, D.A. (2010). Serotype-specific differences in the risk of dengue hemorrhagic fever: An analysis of data collected in Bangkok, Thailand from 1994 to 2006. PLoS Neglected Trop. Dis., 4.","DOI":"10.1371\/journal.pntd.0000617"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Sabchareon, A., Sirivichayakul, C., Limkittikul, K., Chanthavanich, P., Suvannadabba, S., Jiwariyavej, V., Dulyachai, W., Pengsaa, K., Margolis, H.S., and Letson, G.W. (2012). Dengue infection in children in Ratchaburi, Thailand: A cohort study. I. Epidemiology of symptomatic acute dengue infection in children, 2006\u20132009. PLoS Neglected Trop. Dis., 6.","DOI":"10.1371\/journal.pntd.0001732"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Sharp, T.M., Hunsperger, E., Santiago, G.A., Munoz-Jordan, J.L., Santiago, L.M., Rivera, A., Rodriguez-Acosta, R.L., Gonzalez Feliciano, L., Margolis, H.S., and Tomashek, K.M. (2013). Virus-specific differences in rates of disease during the 2010 Dengue epidemic in Puerto Rico. PLoS Neglected Trop. Dis., 7.","DOI":"10.1371\/journal.pntd.0002159"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"999","DOI":"10.4269\/ajtmh.14-0628","article-title":"Dengue serotype-specific differences in clinical manifestation, laboratory parameters and risk of severe disease in adults, singapore","volume":"92","author":"Yung","year":"2015","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Vicente, C.R., Herbinger, K.H., Froschl, G., Malta Romano, C., de Souza Areias Cabidelle, A., and Cerutti Junior, C. (2016). Serotype influences on dengue severity: A cross-sectional study on 485 confirmed dengue cases in Vitoria, Brazil. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-1668-y"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1186\/s40249-017-0328-9","article-title":"Dengue-specific serotype related to clinical severity during the 2012\/2013 epidemic in centre of Brazil","volume":"6","author":"Rocha","year":"2017","journal-title":"Infect. Dis. Poverty"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Nunes, P.C.G., de Filippis, A.M.B., Lima, M., Faria, N., de Bruycker-Nogueira, F., Santos, J.B., Heringer, M., Chouin-Carneiro, T., Couto-Lima, D., and de Santis Goncalves, B. (2018). 30 years of dengue fatal cases in Brazil: A laboratorial-based investigation of 1047 cases. BMC Infect. Dis., 18.","DOI":"10.1186\/s12879-018-3255-x"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1007\/s00705-016-2886-8","article-title":"Population genomics of dengue virus serotype 4: Insights into genetic structure and evolution","volume":"161","author":"Waman","year":"2016","journal-title":"Arch. Virol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1016\/j.celrep.2018.10.006","article-title":"Genetic Variation between Dengue Virus Type 4 Strains Impacts Human Antibody Binding and Neutralization","volume":"25","author":"Gallichotte","year":"2018","journal-title":"Cell Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/S0042-6822(02)00033-8","article-title":"Molecular evolution and phylogeny of dengue type 4 virus in the Caribbean","volume":"306","author":"Foster","year":"2003","journal-title":"Virology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.3201\/eid2705.204244","article-title":"Epidemiologic History and Genetic Diversity Origins of Chikungunya and Dengue Viruses, Paraguay","volume":"27","author":"Graf","year":"2021","journal-title":"Emerg. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1858","DOI":"10.3201\/eid1811.120217","article-title":"Phylogeography of dengue virus serotype 4, Brazil, 2010\u20132011","volume":"18","author":"Nunes","year":"2012","journal-title":"Emerg. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"14680","DOI":"10.1128\/JVI.79.23.14680-14687.2005","article-title":"Invasion and maintenance of dengue virus type 2 and type 4 in the Americas","volume":"79","author":"Carrington","year":"2005","journal-title":"J. Virol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1093\/molbev\/msp285","article-title":"Epidemic dynamics revealed in dengue evolution","volume":"27","author":"Bennett","year":"2010","journal-title":"Mol. Biol. Evol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1093\/molbev\/msg182","article-title":"Selection-driven evolution of emergent dengue virus","volume":"20","author":"Bennett","year":"2003","journal-title":"Mol. Biol. Evol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Jimenez-Silva, C.L., Carreno, M.F., Ortiz-Baez, A.S., Rey, L.A., Villabona-Arenas, C.J., and Ocazionez, R.E. (2018). Evolutionary history and spatio-temporal dynamics of dengue virus serotypes in an endemic region of Colombia. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0203090"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.virusres.2015.11.009","article-title":"Insights into the molecular evolution of Dengue virus type 4 in Puerto Rico over two decades of emergence","volume":"213","author":"Martin","year":"2016","journal-title":"Virus Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1590\/S0036-46652014000500014","article-title":"False-negative dengue cases in Roraima, Brazil: An approach regarding the high number of negative results by NS1 ag kits","volume":"56","author":"Acosta","year":"2014","journal-title":"Rev. Inst. Med. Trop. Sao Paulo"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1016\/j.jcv.2013.10.021","article-title":"Dengue-4 false negative results by Panbio(R) Dengue Early ELISA assay in Brazil","volume":"58","author":"Colombo","year":"2013","journal-title":"J. Clin. Virol. Off. Publ. Pan Am. Soc. Clin. Virol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Sea, V.R., Cruz, A.C., Gurgel, R.Q., Nunes, B.T., Silva, E.V., Dolabella, S.S., and dos Santos, R.L. (2013). Underreporting of Dengue-4 in Brazil due to low sensitivity of the NS1 Ag test in routine control programs. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0064056"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2090","DOI":"10.1128\/JCM.00521-16","article-title":"Use of a Rapid Test for Diagnosis of Dengue during Suspected Dengue Outbreaks in Resource-Limited Regions","volume":"54","author":"Hunsperger","year":"2016","journal-title":"J. Clin. Microbiol."},{"key":"ref_30","unstructured":"World Health Organization (2009). Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control, WHO Press."},{"key":"ref_31","unstructured":"Direcci\u00f3n de Vigilancia de la Salud, Ministerio de Salud P\u00fablica y Bienestar Social (2022, September 20). Arbovirosis, Available online: https:\/\/dgvs.mspbs.gov.py\/page\/#arbovirosis.html."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Rojas, A., Moreira Soares, A., Mendoza, L.P., Acosta, M.E., Aria, L., Paez, M., Herebia, L., Vallejos, M.A., de Guillen, Y., and Aquino, V.H. (2021). Revisiting the dengue epidemic of 2011 in Paraguay: Molecular epidemiology of dengue virus in the Asuncion metropolitan area. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-06487-9"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e7852","DOI":"10.7717\/peerj.7852","article-title":"Characterization of dengue cases among patients with an acute illness, Central Department, Paraguay","volume":"7","author":"Rojas","year":"2019","journal-title":"PeerJ"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Halsey, E.S., Marks, M.A., Gotuzzo, E., Fiestas, V., Suarez, L., Vargas, J., Aguayo, N., Madrid, C., Vimos, C., and Kochel, T.J. (2012). Correlation of serotype-specific dengue virus infection with clinical manifestations. PLoS Neglected Trop. Dis., 6.","DOI":"10.1371\/journal.pntd.0001638"},{"key":"ref_35","unstructured":"Pan American Health Organization (2022, July 01). Dengue. Available online: https:\/\/www3.paho.org\/data\/index.php\/es\/temas\/indicadores-dengue.html."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Vazquez, C., Alcantara, L.C.J., Fonseca, V., Lima, M., Xavier, J., Adelino, T., Fritsch, H., Castro, E., de Oliveira, C., and Schuab, G. (2023). Retrospective Spatio-Temporal Dynamics of Dengue Virus 1, 2 and 4 in Paraguay. Viruses, 15.","DOI":"10.3390\/v15061275"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Direcci\u00f3n de Vigilancia de la Salud, Ministerio de Salud P\u00fablica y Bienestar Social (2022, September 20). Bolet\u00edn Epidemiol\u00f3gico SE 1a la SE 21. 2019, (21), Available online: https:\/\/dgvs.mspbs.gov.py\/boletin-epidemiologico-semanal.","DOI":"10.33610\/23576189.2019.21"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Direcci\u00f3n de Vigilancia de la Salud, Ministerio de Salud P\u00fablica y Bienestar Social (2022, September 20). Bolet\u00edn Epidemiol\u00f3gico, SE 1 a la SE 52 (29-12-2019 al 26-12-2020). 2020, (52), Available online: https:\/\/dgvs.mspbs.gov.py\/boletin-epidemiologico-semanal.","DOI":"10.33610\/23576189.2020.52"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"625","DOI":"10.4269\/ajtmh.19-0707","article-title":"Implementation of a Multiplex rRT-PCR for Zika, Chikungunya, and Dengue Viruses: Improving Arboviral Detection in an Endemic Region","volume":"102","author":"Cantero","year":"2020","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.3201\/eid2207.160326","article-title":"Single-Reaction Multiplex Reverse Transcription PCR for Detection of Zika, Chikungunya, and Dengue Viruses","volume":"22","author":"Waggoner","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Waggoner, J.J., Abeynayake, J., Sahoo, M.K., Gresh, L., Tellez, Y., Gonzalez, K., Ballesteros, G., Pierro, A.M., Gaibani, P., and Guo, F.P. (2013). Single-reaction, multiplex, real-time rt-PCR for the detection, quantitation, and serotyping of dengue viruses. PLoS Neglected Trop. Dis., 7.","DOI":"10.1371\/journal.pntd.0002116"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1093\/bioinformatics\/bty695","article-title":"Genome Detective: An automated system for virus identification from high-throughput sequencing data","volume":"35","author":"Vilsker","year":"2019","journal-title":"Bioinformatics"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1038\/nmeth.4285","article-title":"ModelFinder: Fast model selection for accurate phylogenetic estimates","volume":"14","author":"Kalyaanamoorthy","year":"2017","journal-title":"Nat. Methods"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"vew007","DOI":"10.1093\/ve\/vew007","article-title":"Exploring the temporal structure of heterochronous sequences using TempEst (formerly Path-O-Gen)","volume":"2","author":"Rambaut","year":"2016","journal-title":"Virus Evol."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Bouckaert, R., Heled, J., Kuhnert, D., Vaughan, T., Wu, C.H., Xie, D., Suchard, M.A., Rambaut, A., and Drummond, A.J. (2014). BEAST 2: A software platform for Bayesian evolutionary analysis. PLoS Comput. Biol., 10.","DOI":"10.1371\/journal.pcbi.1003537"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.meegid.2018.04.032","article-title":"Understanding dengue virus evolution to support epidemic surveillance and counter-measure development","volume":"62","author":"Pollett","year":"2018","journal-title":"Infect. Genet. Evol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"45","DOI":"10.7883\/yoken.JJID.2014.063","article-title":"Dengue virus 4 (DENV-4) re-emerges after 30 years in Brazil: Cocirculation of DENV-2, DENV-3, and DENV-4 in Bahia","volume":"68","author":"Campos","year":"2015","journal-title":"Jpn. J. Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e180251","DOI":"10.1590\/0074-02760180251","article-title":"Origin, tempo, and mode of the spread of DENV-4 Genotype IIB across the state of S\u00e3o Paulo, Brazil during the 2012\u20132013 outbreak","volume":"114","author":"Cunha","year":"2019","journal-title":"Mem. Inst. Oswaldo Cruz"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"de Souza, R.P., Rocco, I.M., Maeda, A.Y., Spenassatto, C., Bisordi, I., Suzuki, A., Silveira, V.R., Silva, S.J., Azevedo, R.M., and Tolentino, F.M. (2011). Dengue virus type 4 phylogenetics in Brazil 2011: Looking beyond the veil. PLoS Neglected Trop. Dis., 5.","DOI":"10.1371\/journal.pntd.0001439"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1093\/trstmh\/trs091","article-title":"Virological surveillance for early warning of dengue epidemics in the State of Rio de Janeiro, Brazil","volume":"107","author":"Macedo","year":"2013","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1093\/infdis\/jix195","article-title":"Characterization of Dengue Virus Infections Among Febrile Children Clinically Diagnosed With a Non-Dengue Illness, Managua, Nicaragua","volume":"215","author":"Waggoner","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1073\/pnas.1522136113","article-title":"Neutralizing antibody titers against dengue virus correlate with protection from symptomatic infection in a longitudinal cohort","volume":"113","author":"Katzelnick","year":"2016","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"910","DOI":"10.4269\/ajtmh.2007.77.910","article-title":"Analysis of repeat hospital admissions for dengue to estimate the frequency of third or fourth dengue infections resulting in admissions and dengue hemorrhagic fever, and serotype sequences","volume":"77","author":"Gibbons","year":"2007","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1093\/oxfordjournals.aje.a113932","article-title":"Risk factors in dengue shock syndrome: A prospective epidemiologic study in Rayong, Thailand. I. The 1980 outbreak","volume":"120","author":"Sangkawibha","year":"1984","journal-title":"Am. J. Epidemiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1038\/s41467-022-28231-w","article-title":"Fine-scale heterogeneity in population density predicts wave dynamics in dengue epidemics","volume":"13","author":"King","year":"2022","journal-title":"Nat. Commun."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.jviromet.2014.02.031","article-title":"A simple heat dissociation method increases significantly the ELISA detection sensitivity of the nonstructural-1 glycoprotein in patients infected with DENV type-4","volume":"204","author":"Nogueira","year":"2014","journal-title":"J. Virol. Methods"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Nunes, P.C.G., Nogueira, R.M.R., Heringer, M., Chouin-Carneiro, T., Damasceno Dos Santos Rodrigues, C., de Filippis, A.M.B., Lima, M., and Dos Santos, F.B. (2018). NS1 Antigenemia and Viraemia Load: Potential Markers of Progression to Dengue Fatal Outcome?. Viruses, 10.","DOI":"10.3390\/v10060326"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1002\/jmv.24764","article-title":"Utility of dengue NS1 antigen rapid diagnostic test for use in difficult to reach areas and its comparison with dengue NS1 ELISA and qRT-PCR","volume":"89","author":"Shukla","year":"2017","journal-title":"J. Med. Virol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"27663","DOI":"10.1038\/srep27663","article-title":"The Use of NS1 Rapid Diagnostic Test and qRT-PCR to Complement IgM ELISA for Improved Dengue Diagnosis from Single Specimen","volume":"6","author":"Teoh","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1093\/infdis\/jiw103","article-title":"Performance of Dengue Diagnostic Tests in a Single-Specimen Diagnostic Algorithm","volume":"214","author":"Hunsperger","year":"2016","journal-title":"J. Infect. Dis."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Hunsperger, E.A., Yoksan, S., Buchy, P., Nguyen, V.C., Sekaran, S.D., Enria, D.A., Vazquez, S., Cartozian, E., Pelegrino, J.L., and Artsob, H. (2014). Evaluation of commercially available diagnostic tests for the detection of dengue virus NS1 antigen and anti-dengue virus IgM antibody. PLoS Neglected Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0003171"}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/16\/2\/181\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:49:07Z","timestamp":1760104147000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/16\/2\/181"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,25]]},"references-count":61,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["v16020181"],"URL":"https:\/\/doi.org\/10.3390\/v16020181","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,25]]}}}