Best practices in dengue surveillance: a report from the Asia-Pacific and Americas Dengue Prevention Boards

Background

Dengue fever is a virus infection that is spread by the Aedes aegypti mosquito and can cause severe disease especially in children. Dengue fever is a major problem in tropical and sub-tropical regions of the world.

Methodology/Principal Findings

We invited dengue experts from around the world to attend meetings to discuss dengue surveillance. We reviewed literature, heard detailed reports on surveillance programs, and shared expert opinions.

Results

Presentations by 22 countries were heard during the 2.5 day meetings. We describe the best methods of surveillance in general, the stakeholders in dengue surveillance, and the steps from mosquito bite to reporting of a dengue case to explore how best to carry out dengue surveillance. We also provide details and a comparison of the dengue surveillance programs by the presenting countries.

Conclusions/Significance

The experts provided recommendations for achieving the best possible data from dengue surveillance accepting the realities of the real world (e.g., limited funding and staff). Their recommendations included: (1) Every dengue endemic country should make reporting of dengue cases to the government mandatory; (2) electronic reporting systems should be developed and used; (3) at minimum dengue surveillance data should include incidence, hospitalization rates, deaths by age group; (4) additional studies should be completed to check the sensitivity of the system; (5) laboratories should share expertise and data; (6) tests that identify dengue virus should be used in patients with fever for four days or less and antibody tests should be used after day 4 to diagnose dengue; and (7) early detection and prediction of dengue outbreaks should be goals for national surveillance systems.     

Multi-Country Evaluation of the Sensitivity and Specificity of Two Commercially-Available NS1 ELISA Assays for Dengue Diagnosis

Background

Early diagnosis of dengue can assist patient triage and management and prevent unnecessary treatments and interventions. Commercially available assays that detect the dengue virus protein NS1 in the plasma/serum of patients offers the possibility of early and rapid diagnosis.

Methodology/Principal Findings

The sensitivity and specificity of the Pan-E Dengue Early ELISA and the Platelia™ Dengue NS1 Ag assays were compared against a reference diagnosis in 1385 patients in 6 countries in Asia and the Americas. Platelia was more sensitive (66%) than Pan-E (52%) in confirmed dengue cases. Sensitivity varied by geographic region, with both assays generally being more sensitive in patients from SE Asia than the Americas. Both kits were more sensitive for specimens collected within the first few days of illness onset relative to later time points. Pan-E and Platelia were both 100% specific in febrile patients without evidence of acute dengue. In patients with other confirmed diagnoses and healthy blood donors, Platelia was more specific (100%) than Pan-E (90%). For Platelia, when either the NS1 test or the IgM test on the acute sample was positive, the sensitivity versus the reference result was 82% in samples collected in the first four days of fever. NS1 sensitivity was not associated to disease severity (DF or DHF) in the Platelia test, whereas a trend for higher sensitivity in DHF cases was seen in the Pan-E test (however combined with lower overall sensitivity).

Conclusions/Significance

Collectively, this multi-country study suggests that the best performing NS1 assay (Platelia) had moderate sensitivity (median 64%, range 34–76%) and high specificity (100%) for the diagnosis of dengue. The poor sensitivity of the evaluated assays in some geographical regions suggests further assessments are needed. The combination of NS1 and IgM detection in samples collected in the first few days of fever increased the overall dengue diagnostic sensitivity.     

Elevated Systemic Hepcidin and Iron Depletion in Obese Premenopausal Females

Hepcidin, the body's main regulator of systemic iron homeostasis, is upregulated in response to inflammation and is thought to play a role in the manifestation of iron deficiency (ID) observed in obese populations. We determined systemic hepcidin levels and its association with body mass, inflammation, erythropoiesis, and iron status in premenopausal obese and nonobese women (n = 20/group) matched for hemoglobin (Hb). The obese participants also had liver and abdominal visceral and subcutaneous adipose tissue assessed for tissue iron accumulation and hepcidin mRNA expression. Despite similar Hb levels, the obese women had significantly higher serum hepcidin (88.02 vs. 9.70 ng/ml; P < 0.0001) and serum transferrin receptor (sTfR) (P = 0.001) compared to nonobese. In the obese women hepcidin was not correlated with serum iron (r = ?0.02), transferrin saturation (Tsat) (r = 0.17) or sTfR (r = ?0.12); in the nonobese it was significantly positively correlated with Tsat (r = 0.70) and serum iron (r = 0.58), and inversely with sTfR (r = ?0.63). Detectable iron accumulation in the liver and abdominal adipose tissue of the obese women was minimal. Liver hepcidin mRNA expression was ～700 times greater than adipose tissue production and highly correlated with circulating hepcidin levels (r = 0.61). Serum hepcidin is elevated in obese women despite iron depletion, suggesting that it is responding to inflammation rather than iron status. The source of excess hepcidin appears to be the liver and not adipose tissue. The ID of obesity is predominantly a condition of a true body iron deficit rather than maldistribution of iron due to inflammation. However, these findings suggest inflammation may perpetuate this condition by hepcidin‐mediated inhibition of dietary iron absorption.     

Hairy roots cultures from different Solanaceous species have varying capacities to produce E. coli B-subunit heat-labile toxin antigen

The gene encoding enterotoxigenic Escherichia coli B-subunit heat-labile toxin (LTB) antigen was co-transformed into hairy root cultures of Nicotiana tabacum (tobacco), Solanum lycopersicum (tomato) and Petunia parodii (petunia) under the CaMV35S promoter. Tobacco and petunia roots contained ~65–70 μg LTB g⁻¹ tissue whilst hairy roots of tomato contained ~10 μg LTB g⁻¹. Antigen at ~600 ng ml⁻¹ was detected in growth medium of tobacco and petunia. Tobacco roots with higher LTB levels showed growth retardation of ~80% whereas petunia hairy roots with similar levels of LTB showed only ~35% growth retardation, relative to vector controls. Regeneration of plants from LTB-containing tobacco hairy roots was readily achieved and re-initiated hairy roots from greenhouse-grown plants showed similar growth and LTB production characteristics as the original hairy root cultures.     

To Poach or Not to Poach an Endangered Species: Elucidating the Economic and Social Drivers Behind Illegal Sea Turtle Hunting in Baja California Sur,Mexico

Despite complete legal protection, improvements in infrastructure, and market conditions that provide easier access to other protein sources, illegal poaching of sea turtles for consumption in Baja California Sur (BCS), Mexico remains a major threat to their recovery. Few studies have focused on understanding the economic and social drivers behind this activity, which is fundamental to determining best practices for discouraging it. From June 2007 to April 2008 we conducted eight in-depth, semi-structured interviews with sea turtle poachers at five coastal communities in BCS to determine the drivers influencing them. The most prevalent reasons for illegal poaching were direct economic benefits, lack of law enforcement and ease of escape from or bribery of authorities, and strong family tradition. Our results suggest that to reduce illegal poaching it will be necessary to better enforce existing environmental laws, reduce social acceptance of sea turtle hunting throughout the region, educate fishers on the ecological importance of sea turtles, and show fishers direct economic benefits from non-consumptive use of sea turtles, such as ecotourism.     

Asynchronous development of honey bee host and Varroa destructor (Mesostigmata: Varroidae) influences reproductive potential of mites

A high proportion of nonreproductive (NR) Varroa destructor Anderson & Trueman (Mesostigmata: Varroidae), is commonly observed in honey bee colonies displaying the varroa sensitive hygienic trait (VSH). This study was conducted to determine the influence of brood removal and subsequent host reinvasion of varroa mites on mite reproduction. We collected foundress mites from stages of brood (newly sealed larvae, prepupae, white-eyed pupae, and pink-eyed pupae) and phoretic mites from adult bees. We then inoculated these mites into cells containing newly sealed larvae. Successful reproduction (foundress laid both a mature male and female) was low (13%) but most common in mites coming from sealed larvae. Unsuccessful reproductive attempts (foundress failed to produce both a mature male and female) were most common in mites from sealed larvae (22%) and prepupae (61%). Lack of any progeny was most common for mites from white-eyed (83%) and pink-eyed pupae (92%). We also collected foundress mites from sealed larvae and transferred them to cells containing newly sealed larvae, prepupae, white-eyed pupae, or pink-eyed pupae. Successful reproduction only occurred in the transfers to sealed larvae (26%). Unsuccessful reproductive attempts were most common in transfers to newly sealed larvae (40%) and to prepupae (25%). Unsuccessful attempts involved the production of immature progeny (60%), the production of only mature daughters (26%) or the production of only a mature male (14%). Generally, lack of progeny was not associated with mites having a lack of stored sperm. Our results suggest that mites exposed to the removal of prepupae or older brood due to hygiene are unlikely to produce viable mites if they invade new hosts soon after brood removal. Asynchrony between the reproductive status of reinvading mites and the developmental stage of their reinvasion hosts may be a primary cause of NR mites in hygienic colonies. Even if reinvading mites use hosts having the proper age for infestation, only a minority of them will reproduce.     

The single‐subunit RING‐type E3 ubiquitin ligase RSL1 targets PYL4 and PYR1 ABA receptors in plasma membrane to modulate abscisic acid signaling

Membrane‐delimited events play a crucial role for ABA signaling and PYR/PYL/RCAR ABA receptors, clade A PP2Cs and SnRK2/CPK kinases modulate the activity of different plasma membrane components involved in ABA action. Therefore, the turnover of PYR/PYL/RCARs in the proximity of plasma membrane might be a step that affects receptor function and downstream signaling. In this study we describe a single‐subunit RING‐type E3 ubiquitin ligase RSL1 that interacts with the PYL4 and PYR1 ABA receptors at the plasma membrane. Overexpression of RSL1 reduces ABA sensitivity and rsl1 RNAi lines that impair expression of several members of the RSL1/RFA gene family show enhanced sensitivity to ABA. RSL1 bears a C‐terminal transmembrane domain that targets the E3 ligase to plasma membrane. Accordingly, bimolecular fluorescent complementation (BiFC) studies showed the RSL1–PYL4 and RSL1–PYR1 interaction is localized to plasma membrane. RSL1 promoted PYL4 and PYR1 degradation in vivo and mediated in vitro ubiquitylation of the receptors. Taken together, these results suggest ubiquitylation of ABA receptors at plasma membrane is a process that might affect their function via effect on their half‐life, protein interactions or trafficking.