Figure 1.
Dengue epidemics in prospective pediatric studies in Managua, Nicaragua, 2004–10.
A, Number of confirmed dengue cases by month, cohort study, 2004–10; B, number of confirmed dengue cases by month, hospital study, 2005–10.
Table 1.
Characteristics of confirmed dengue cases, Cohort Study, 2004–10, and Hospital Study, 2005–2010.
Figure 2.
Presentation of signs of poor peripheral perfusion in hospital study dengue cases, 2005–9 vs. 2009–10.
A, cold extremities, B, poor capillary refill (>2 sec), and C, compensated shock. Left panel, frequency of presentation by day; right panel, Kaplan-Meier survival function adjusted for early presentation (days 1–3 after onset of fever).
Figure 3.
Presentation of signs of poor peripheral perfusion in the dengue cohort study, 2004–9 vs. 2009–10.
A, cold extremities and B, poor capillary refill (>2 sec). Left panel, frequency of presentation by day; right panel, Kaplan-Meier survival function adjusted for early presentation (days 1–3 after onset of fever).
Table 2.
Clinical signs and symptoms of confirmed dengue cases in 2009–10 compared to previous years, 2004–10.
Table 3.
Year 2009–10 as most significant risk factor in Cox regression models of compensated shock, 2004–10.
Figure 4.
Classification of severity among confirmed dengue cases by year.
Dengue cases were classified according to WHO classification (Dengue Hemorrhagic Fever and Dengue Shock Syndrome), Dengue Fever with Compensated Shock (DFCS), and Dengue with Signs Associated with Shock (DSAS), in A, cohort study, 2004–10, and B, hospital study, 2005–10.
Table 4.
Multivariate analysis of risk factors for DFCS compared to other dengue cases, Hospital Study, 2005–10.
Figure 5.
Phylogenetic analysis of Nicaraguan DENV-3 sequences from 2008–2010.
Seventeen, 82, and 28 sequences from 2008 (pink), 2009 (blue) and 2010 (teal), respectively, were aligned using Muscle and clustered using phyML. Six isolates from Venezuela (“Ven”), Martinique (“Martinique”), Thailand (“Thai”) and Puerto Rico (“PR”) from the Asian-American genotype are also shown to root the tree and demonstrate similarities among the Nicaraguan isolates.
Figure 6.
Presentation of signs of poor peripheral perfusion in DENV-3 cases from the hospital study, 2009–10 vs. 2005–9/2010–11.
Kaplan-Meier survivor function was adjusted for early presentation (days 1–3 after onset of fever) for A, cold extremities, B, capillary refill >2 seconds, and C, compensated shock.
Table 5.
Demographic and clinical characteristics of DENV-3 cases, Hospital Study, 2005–11.
Table 6.
Year 2009–10 as most significant risk factor in Cox regression models of compensated shock, DENV-3 cases, Hospital Study, 2005–11.
Table 7.
Relative risk of DFCS and DFCS/DSS/DSAS in 2009–10 in DENV-3 cases, Hospital Study.
Figure 7.
Epidemiologic curves of dengue and Influenza A H1N1-2009 in the cohort study and Nicaragua, 2009.
A, Influenza A H1N1 and dengue cases in the cohort study by week, 2009. B, Influenza A H1N1 and dengue cases in Nicaragua by week, 2009. National surveillance statistics for influenza (CNDR/Ministry of Health) were used to determine the cases of Influenza H1N1 2009 by week in 2009.