Lessons Learned from Dengue Surveillance and Research, Puerto Rico, 1899-2013

Abstract

Dengue was first reported in Puerto Rico in 1899 and sporadically thereafter. Following outbreaks in 1963 and 1969, the Centers for Disease Control and Prevention has worked closely with the Puerto Rico Department of Health to monitor and reduce the public health burden of dengue. During that time, evolving epidemiologic scenarios have provided opportunities to establish, improve, and expand disease surveillance and interventional research projects. These initiatives have enriched the tools available to the global public health community to understand and combat dengue, including diagnostic tests, methods for disease and vector surveillance, and vector control techniques. Our review serves as a guide to organizations seeking to establish dengue surveillance and research programs by highlighting accomplishments, challenges, and lessons learned during more than a century of dengue surveillance and research conducted in Puerto Rico.

Keywords: Puerto Rico; dengue; history; research; surveillance; viruses.

Figure 1

Prominent public health figures in Puerto Rico during the early 1900s. A) Assistant Surgeon General Arthur H. Glennan, pictured circa 1895. B) Walter W. King, Chief Quarantine Officer of the US Quarantine Station, San Juan, Puerto Rico, pictured in 1915. C) San Juan Health Commissioner William F. Lippitt, pictured in 1899. D) From left to right: Puerto Rican tropical medicine physicians Isaac González Martínez and Pedro Gutiérrez Igaravídez met with yellow fever expert Henry Rose Carter, San Juan Commissioner of Health William Lippitt, Mariano Lebredo from Cuba, William Gorgas, and (not pictured) Bailey K. Ashford and Walter W. King to determine the etiology of an outbreak in 1915 that was ultimately attributed to dengue. Images were obtained from the National Library of Medicine (A–C) or were originally published in Puerto Rico Ilustrado (https://en.wikipedia.org/wiki/Puerto_Rico_Ilustrado) (D).

Figure 2

Suspected dengue cases reported to the Puerto Rico Department of Health, by month, 1986–2013. The healthcare system of Puerto Rico changed from public to semiprivate in 1994.

Figure 3

Timeline of incorporation of laboratory techniques used to diagnose suspected dengue reported through the islandwide Passive Dengue Surveillance System in Puerto Rico, 1963–2013. CDC, Centers for Disease Control and Prevention; DENV, dengue virus; RT-PCR, reverse transcription PCR.

Figure 4

Incidence of laboratory-positive dengue cases reported to Puerto Rico Department of Health by municipality during epidemics in 2007 (A), 2010 (B), and 2012–2013 (C).