{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:32:29Z","timestamp":1790620349025,"version":"4.1.0"},"reference-count":42,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    We evaluated health care\u2013seeking behavior among dengue patients in Puerto Rico (PR) before (January 1, 2014\u2013March 31, 2020) and after (April 1, 2020\u2013February 28, 2023) the COVID-19 outbreak declaration in PR (\u201cafter COVID-19\u201d) and calculated age-adjusted odds ratios of illness duration at presentation and hospitalization rates. A total of 70 and 185 patients with dengue were identified before and after COVID-19 began respectively. Dengue virus 1 (DENV-1) was the most common dengue serotype (89%) identified in both periods. The median age of patients with dengue was higher after COVID-19 (18, interquartile range [IQR]: 12\u201332 years) than before (14, IQR: 7\u201322 years). A higher proportion of patients presented &gt;3 days post illness onset after COVID-19 (66%,\n                    <jats:italic>n<\/jats:italic>\n                    = 123) in comparison with before (49%,\n                    <jats:italic>n<\/jats:italic>\n                    = 34) (OR = 1.16; 95% CI: 1.02\u20131.33). These findings indicate that the COVID-19 outbreak may have affected health care\u2013seeking behavior among patients with dengue in PR, delaying care and potentially negatively affecting patient outcomes.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0586","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T18:00:18Z","timestamp":1771351218000},"page":"738-741","source":"Crossref","is-referenced-by-count":1,"title":["Delays in Seeking Health Care among Patients with Dengue Recruited in a Sentinel Surveillance System in Puerto Rico before and after the COVID-19 Pandemic"],"prefix":"10.4269","volume":"114","author":[{"given":"Jett","family":"Choquette","sequence":"first","affiliation":[{"name":"University of Vermont, Larner College of Medicine, Burlington, Vermont;"},{"name":"Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dania M.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsea G.","family":"Major","sequence":"additional","affiliation":[{"name":"Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janice","family":"P\u00e9rez-Padilla","sequence":"additional","affiliation":[{"name":"Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilberto A.","family":"Santiago","sequence":"additional","affiliation":[{"name":"Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Bertran-Pasarell","sequence":"additional","affiliation":[{"name":"Auxilio Mutuo Hospital, San Juan, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Sainz de la Pe\u00f1a","sequence":"additional","affiliation":[{"name":"Auxilio Mutuo Hospital, San Juan, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar","family":"Domenech","sequence":"additional","affiliation":[{"name":"Centro Medico Episcopal San Lucas, Ponce, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Soto","sequence":"additional","affiliation":[{"name":"Centro Medico Episcopal San Lucas, Ponce, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Rivera-Amill","sequence":"additional","affiliation":[{"name":"Ponce Health Sciences University-Ponce Research Institute, Ponce, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura E.","family":"Adams","sequence":"additional","affiliation":[{"name":"Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana","family":"S\u00e1nchez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Sci Transl Med","first-page":"eaax4144","article-title":"Mapping global variation in dengue transmission intensity","volume":"12","author":"Cattarino","year":"2020"},{"key":"b2","series-title":"PLoS Negl Trop Dis","first-page":"e0007213","article-title":"Global expansion and redistribution of Aedes-borne virus transmission risk with climate change","volume":"13","author":"Ryan","year":"2019"},{"key":"b3","article-title":"Global Dengue Surveillance.","year":"2025"},{"key":"b4","series-title":"MMWR Surveill Summ","first-page":"1","article-title":"Epidemiologic trends of dengue in U.S. territories, 2010\u20132020","volume":"72","author":"Ryff","year":"2023"},{"key":"b5","series-title":"Am J Trop Med Hyg","first-page":"107","article-title":"Clinical features of COVID-19, dengue, and influenza among adults presenting to emergency departments and urgent care clinics \u2013 Puerto Rico, 2012\u20132021","volume":"108","author":"Wong","year":"2023"},{"key":"b6","article-title":"Dengue: Guidelines for Patient Care in the Region of the Americas, 2nd Edition.","year":"2016"},{"key":"b7","article-title":"Dengue Guidelines for Diagnosis, Treatment, Prevention and Control: New Edition","year":"2009"},{"key":"b8","series-title":"Lancet","first-page":"667","article-title":"Dengue","volume":"403","author":"Paz-Bailey","year":"2024"},{"key":"b9","series-title":"Am J Emerg Med","first-page":"74","article-title":"Decline in emergency department visits during the COVID-19 quarantine","volume":"71","author":"Daoud","year":"2023"},{"key":"b10","series-title":"Pediatr Rep","first-page":"58","article-title":"Impact of the COVID-19 pandemic on the pediatric hospital visits: Evidence from the State of Florida","volume":"14","author":"Symum","year":"2022"},{"key":"b11","series-title":"J Public Health (Oxf)","first-page":"731","article-title":"Comparison of presentations to the emergency department during the COVID-19 pandemic (COPED-C)","volume":"43","author":"Kociejowski","year":"2021"},{"key":"b12","series-title":"Eur Heart J Qual Care Clin Outcomes","first-page":"210","article-title":"Admission of patients with STEMI since the outbreak of the COVID-19 pandemic: A survey by the European Society of Cardiology","volume":"6","author":"Pessoa-Amorim","year":"2020"},{"key":"b13","series-title":"Sci Rep","first-page":"17849","article-title":"Trends in hospital capacity and utilization in Puerto Rico by health regions, 2010\u20132020","volume":"14","author":"Stimpson","year":"2024"},{"key":"b14","series-title":"BMJ Open","first-page":"e049222","article-title":"Impact of COVID-19 on emergency department attendance in an Australia hospital: A parallel convergent mixed methods study","volume":"11","author":"Jessup","year":"2021"},{"key":"b15","series-title":"BMJ Open","first-page":"e072117","article-title":"Factors associated with emergency department avoidance during the COVID-19 pandemic and alternatives sought: A cross-sectional, telephone-based survey of frequent emergency department users in Beirut, Lebanon","volume":"13","author":"Mahmassani","year":"2023"},{"key":"b16","series-title":"Ann Emerg Med","first-page":"595","article-title":"An analysis of changes in emergency department visits after a state declaration during the time of COVID-19","volume":"76","author":"Westgard","year":"2020"},{"key":"b17","series-title":"PLoS One","first-page":"e0247481","article-title":"Viral etiology and seasonal trends of pediatric acute febrile illness in southern Puerto Rico; a seven-year review","volume":"16","author":"S\u00e1nchez-Gonz\u00e1lez","year":"2021"},{"key":"b18","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"1112","article-title":"Epidemiology of dengue \u2013 Puerto Rico, 2010-2024","volume":"73","author":"Rodriguez","year":"2024"},{"key":"b19","article-title":"Programas de Salud. Tu Salud y COVID-19.","year":"2025"},{"key":"b20","series-title":"Am J Trop Med Hyg","first-page":"1290","article-title":"Did COVID-19 or COVID-19 vaccines influence the patterns of dengue in 2021? An exploratory analysis of two observational studies from North India","volume":"109","author":"Kaur","year":"2023"},{"key":"b21","series-title":"Infect Dis (Lond)","first-page":"632","article-title":"Dengue hospitalizations and in-hospital mortality changes in trend in Ecuador: A nationwide study from 2015 to 2022","volume":"56","author":"Lapo-Talledo","year":"2024"},{"key":"b1","series-title":"Sci Transl Med","first-page":"eaax4144","article-title":"Mapping global variation in dengue transmission intensity","volume":"12","author":"Cattarino","year":"2020"},{"key":"b2","series-title":"PLoS Negl Trop Dis","first-page":"e0007213","article-title":"Global expansion and redistribution of Aedes-borne virus transmission risk with climate change","volume":"13","author":"Ryan","year":"2019"},{"key":"b3","article-title":"Global Dengue Surveillance.","year":"2025"},{"key":"b4","series-title":"MMWR Surveill Summ","first-page":"1","article-title":"Epidemiologic trends of dengue in U.S. territories, 2010\u20132020","volume":"72","author":"Ryff","year":"2023"},{"key":"b5","series-title":"Am J Trop Med Hyg","first-page":"107","article-title":"Clinical features of COVID-19, dengue, and influenza among adults presenting to emergency departments and urgent care clinics \u2013 Puerto Rico, 2012\u20132021","volume":"108","author":"Wong","year":"2023"},{"key":"b6","article-title":"Dengue: Guidelines for Patient Care in the Region of the Americas, 2nd Edition.","year":"2016"},{"key":"b7","article-title":"Dengue Guidelines for Diagnosis, Treatment, Prevention and Control: New Edition","year":"2009"},{"key":"b8","series-title":"Lancet","first-page":"667","article-title":"Dengue","volume":"403","author":"Paz-Bailey","year":"2024"},{"key":"b9","series-title":"Am J Emerg Med","first-page":"74","article-title":"Decline in emergency department visits during the COVID-19 quarantine","volume":"71","author":"Daoud","year":"2023"},{"key":"b10","series-title":"Pediatr Rep","first-page":"58","article-title":"Impact of the COVID-19 pandemic on the pediatric hospital visits: Evidence from the State of Florida","volume":"14","author":"Symum","year":"2022"},{"key":"b11","series-title":"J Public Health (Oxf)","first-page":"731","article-title":"Comparison of presentations to the emergency department during the COVID-19 pandemic (COPED-C)","volume":"43","author":"Kociejowski","year":"2021"},{"key":"b12","series-title":"Eur Heart J Qual Care Clin Outcomes","first-page":"210","article-title":"Admission of patients with STEMI since the outbreak of the COVID-19 pandemic: A survey by the European Society of Cardiology","volume":"6","author":"Pessoa-Amorim","year":"2020"},{"key":"b13","series-title":"Sci Rep","first-page":"17849","article-title":"Trends in hospital capacity and utilization in Puerto Rico by health regions, 2010\u20132020","volume":"14","author":"Stimpson","year":"2024"},{"key":"b14","series-title":"BMJ Open","first-page":"e049222","article-title":"Impact of COVID-19 on emergency department attendance in an Australia hospital: A parallel convergent mixed methods study","volume":"11","author":"Jessup","year":"2021"},{"key":"b15","series-title":"BMJ Open","first-page":"e072117","article-title":"Factors associated with emergency department avoidance during the COVID-19 pandemic and alternatives sought: A cross-sectional, telephone-based survey of frequent emergency department users in Beirut, Lebanon","volume":"13","author":"Mahmassani","year":"2023"},{"key":"b16","series-title":"Ann Emerg Med","first-page":"595","article-title":"An analysis of changes in emergency department visits after a state declaration during the time of COVID-19","volume":"76","author":"Westgard","year":"2020"},{"key":"b17","series-title":"PLoS One","first-page":"e0247481","article-title":"Viral etiology and seasonal trends of pediatric acute febrile illness in southern Puerto Rico; a seven-year review","volume":"16","author":"S\u00e1nchez-Gonz\u00e1lez","year":"2021"},{"key":"b18","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"1112","article-title":"Epidemiology of dengue \u2013 Puerto Rico, 2010-2024","volume":"73","author":"Rodriguez","year":"2024"},{"key":"b19","article-title":"Programas de Salud. Tu Salud y COVID-19.","year":"2025"},{"key":"b20","series-title":"Am J Trop Med Hyg","first-page":"1290","article-title":"Did COVID-19 or COVID-19 vaccines influence the patterns of dengue in 2021? An exploratory analysis of two observational studies from North India","volume":"109","author":"Kaur","year":"2023"},{"key":"b21","series-title":"Infect Dis (Lond)","first-page":"632","article-title":"Dengue hospitalizations and in-hospital mortality changes in trend in Ecuador: A nationwide study from 2015 to 2022","volume":"56","author":"Lapo-Talledo","year":"2024"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/114\/4\/article-p738.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/114\/4\/article-p738.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/114\/4\/article-p738.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T19:21:31Z","timestamp":1775071291000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/114\/4\/article-p738.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":42,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.25-0586","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]}}}