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About the Authors:
Germán Añez
* E-mail: [email protected] (GA); [email protected] (MR)
Affiliation: Laboratory of Emerging Pathogens, Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, United States Food and Drug Administration, Bethesda, Maryland, United States of America
Maria E. Morales-Betoulle
Affiliation: United States Naval Medical Research Unit No. 3 (NAMRU-3), Cairo, Egypt
Maria Rios
* E-mail: [email protected] (GA); [email protected] (MR)
Affiliation: Laboratory of Emerging Pathogens, Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, United States Food and Drug Administration, Bethesda, Maryland, United States of America
Introduction
Dengue, the most common arboviral disease in the world, is caused by any of the four serotypes of dengue virus (DENV-1 to 4), genus Flavivirus, family Flaviviridae. DENV is transmitted in its urban cycle through the bite of mosquitoes from the genus Aedes, mainly Aedes aegypti. DENV RNA encodes 3 structural (Capsid, C; pre-Membrane/Membrane, prM/M and envelope, E) and 7 non-structural proteins (NS1, NS2A, NS2B, NS3, NS4A, NS4B and NS5) [1]. The four DENV are genetically distant from each other and form a number of subtypes (or genotypes) that vary from serotype to serotype [2]. For DENV-2, there are five epidemic genotypes: Asian I (AS-I), Asian II (AS-II), American/Asian (AM/AS), Cosmopolitan (COS) and American (AM), and a sylvatic genotype restricted to strains collected from forests in Africa and South East Asia [3], [4], [5].
DENV was first isolated in the Americas in 1953 and the disease has been present in Central America since 1978, when epidemics caused by DENV-1 were reported in Belize, Guatemala, El Salvador and Honduras [6]. Central America is the isthmian portion of the American continent constituted by Belize, Costa Rica, Guatemala, Honduras, El Salvador, Nicaragua and Panama. That region is epidemiologically dynamic for dengue, where transmission of the four DENV serotypes occurs. It has been suggested that this dynamic involves an active cycle of exchange of viral strains between South and Central America and the Caribbean [2], [7], [8]. Dengue is hyperendemic in Central America as well as in most of the countries of the continent, especially after the re-introduction of DENV-3 in the 90s [9]. Between 1999 and 2010, more than 700,000 cases of dengue have been reported in Central America, >24,000 of which correspond...