{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T14:39:58Z","timestamp":1767969598819,"version":"3.49.0"},"reference-count":25,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,2,3]]},"abstract":"<jats:p>Dengue, a mosquito-borne viral illness caused by dengue virus types (DENV)-1 to DENV-4, is endemic in Puerto Rico. Severe dengue usually occurs in individuals previously infected with DENV or among infants born to previously infected mothers. To describe clinical features of dengue in infants, we retrospectively characterized dengue patients aged &lt; 18 months reported to the Passive Dengue Surveillance System (PDSS) during 1999\u20132011. To determine frequency of signs, symptoms, and disease severity, case report forms and medical records were evaluated for patients who tested positive for dengue by reverse transcriptase polymerase chain reaction or anti-DENV immunoglobulin Menzyme-linked immunosorbent assay. Of 4,178 reported patients aged &lt; 18 months, 813 (19%) were laboratory positive. Of these, most had fever (92%), rash (53%), bleeding manifestations (52%), and thrombocytopenia (52%). Medical records were available for 145 (31%) of 472 hospitalized patients, of which 40% had dengue, 23% had dengue with warning signs, and 33% had severe dengue. Mean age of patients with severe dengue was 8 months. Anti-DENV immunoglobulin G (IgG) titers were not statistically different in patients with (50%) and without (59%) severe dengue. In this study, one-third of DENV-infected infants met the severe dengue case definition. The role of maternal anti-DENV IgG in development of severe disease warrants further study in prospective cohorts of mother-infant pairs.<\/jats:p>","DOI":"10.4269\/ajtmh.15-0382","type":"journal-article","created":{"date-parts":[[2015,12,29]],"date-time":"2015-12-29T03:03:18Z","timestamp":1451358198000},"page":"404-408","source":"Crossref","is-referenced-by-count":9,"title":["Epidemiology of Dengue Among Children Aged &lt; 18 Months\u2014Puerto Rico, 1999\u20132011"],"prefix":"10.4269","volume":"94","author":[{"given":"Anne M.","family":"Hause","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janice","family":"Perez-Padilla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kalanthe","family":"Horiuchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George S.","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Hunsperger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Aiwazian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harold S.","family":"Margolis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kay M.","family":"Tomashek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"Lancet","first-page":"1644","article-title":"Dengue","volume":"370","author":"Halstead","year":"2007"},{"key":"ref2","series-title":"Dengue Guidelines for Diagnosis, Treatment, Prevention and Control: New Edition","author":"World Health Organization","year":"2009"},{"key":"ref3","series-title":"Am J Trop Med Hyg","first-page":"411","article-title":"Evidence that maternal dengue antibodies are important in the development of dengue hemorrhagic fever in infants","volume":"38","author":"Kliks","year":"1988"},{"key":"ref4","series-title":"Science","first-page":"476","article-title":"Pathogenesis of dengue: challenges to molecular biology","volume":"239","author":"Halstead","year":"1988"},{"issue":"Suppl 4","key":"ref5","series-title":"Rev Infect Dis","first-page":"S830","article-title":"Antibody, macrophages, dengue virus infection, shock, and hemorrhage: a pathogenetic cascade","volume":"11","author":"Halstead","year":"1989"},{"key":"ref6","series-title":"Rev Med Virol","first-page":"387","article-title":"Antibody-dependent enhancement of viral infection: molecular mechanisms and in vivo implications","volume":"13","author":"Takada","year":"2003"},{"key":"ref7","series-title":"Aust J Exp Biol Med Sci","first-page":"465","article-title":"Enhancement of the infectivity of arboviruses by specific antisera produced in domestic fowls","volume":"42","author":"Hawkes","year":"1964"},{"key":"ref8","series-title":"J Exp Med","first-page":"201","article-title":"Dengue viruses and mononuclear phagocytes. I. Infection enhancement by non-neutralizing antibody","volume":"146","author":"Halstead","year":"1977"},{"key":"ref9","series-title":"J Immunol","first-page":"3183","article-title":"Human IgG Fc receptor II mediates antibody-dependent enhancement of dengue virus infection","volume":"144","author":"Littaua","year":"1990"},{"key":"ref10","series-title":"J Virol","first-page":"3939","article-title":"Role of dendritic cells in antibody-dependent enhancement of dengue virus infection","volume":"82","author":"Boonnak","year":"2008"},{"key":"ref11","series-title":"Emerg Infect Dis","first-page":"1474","article-title":"Dengue hemorrhagic fever in infants: research opportunities ignored","volume":"8","author":"Halstead","year":"2002"},{"key":"ref12","series-title":"J Infect Dis","first-page":"416","article-title":"Maternal antibody and viral factors in the pathogenesis of dengue virus in infants","volume":"196","author":"Simmons","year":"2007"},{"key":"ref13","series-title":"J Infect Dis","first-page":"1893","article-title":"Dengue virus infections and maternal antibody decay in a prospective birth cohort study of Vietnamese infants","volume":"200","author":"Chau","year":"2009"},{"key":"ref14","series-title":"J Med Virol","first-page":"102","article-title":"Changes in levels of anti-dengue virus IgG subclasses in patients with disease of varying severity","volume":"40","author":"Thein","year":"1993"},{"key":"ref15","series-title":"Pediatr Int","first-page":"337","article-title":"Placental transfer of IgG subclasses in a Japanese population","volume":"42","author":"Hashira","year":"2000"},{"key":"ref16","series-title":"Am J Trop Med Hyg","first-page":"123","article-title":"Transplacentally transferred maternal-infant antibodies to dengue virus","volume":"69","author":"Watanaveeradej","year":"2003"},{"key":"ref17","series-title":"Am J Trop Med Hyg","first-page":"467","article-title":"Description of a large island-wide outbreak of dengue in Puerto Rico, 2007","volume":"81","author":"Tomashek","year":"2009"},{"key":"ref18","series-title":"PLoS Negl Trop Dis","first-page":"e2159","article-title":"Virus-specific differences in rates of disease during the 2010 Dengue epidemic in Puerto Rico","volume":"7","author":"Sharp","year":"2013"},{"key":"ref19","series-title":"J Clin Microbiol","first-page":"1823","article-title":"Standardization of immunoglobulin M capture enzyme-linked immunosorbent assays for routine diagnosis of arboviral infections","volume":"38","author":"Martin","year":"2000"},{"key":"ref20","series-title":"PLoS Negl Trop Dis","first-page":"e2311","article-title":"Analytical and clinical performance of the CDC real time RT-PCR assay for detection and typing of dengue virus","volume":"7","author":"Santiago","year":"2013"},{"key":"ref21","series-title":"J Clin Virol","first-page":"183","article-title":"Evaluation of an IgG enzyme-linked immunosorbent assay for dengue diagnosis","volume":"14","author":"Miagostovich","year":"1999"},{"key":"ref22","series-title":"Dengue Haemorrhagic Fever: Diagnosis, Treatment, Prevention and Control","author":"World Health Organization","year":"1997"},{"key":"ref23","series-title":"Am J Trop Med Hyg","first-page":"330","article-title":"The incidence, characteristics, and presentation of dengue virus infections during infancy","volume":"82","author":"Capeding","year":"2010"},{"key":"ref24","series-title":"J Infect Dis","first-page":"516","article-title":"Dengue in Vietnamese infants\u2013results of infection-enhancement assays correlate with age-related disease epidemiology, and cellular immune responses correlate with disease severity","volume":"198","author":"Chau","year":"2008"},{"key":"ref25","series-title":"J Infect Dis","first-page":"221","article-title":"Dengue hemorrhagic fever in infants: a study of clinical and cytokine profiles","volume":"189","author":"Nguyen","year":"2004"}],"container-title":["The American Society of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/94\/2\/article-p404.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/94\/2\/article-p404.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/94\/2\/article-p404.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T22:13:12Z","timestamp":1723068792000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/94\/2\/article-p404.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,2,3]]},"references-count":25,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.15-0382","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,2,3]]}}}