title: Evolution of dengue disease and entomological monitoring in Santa Cruz, Bolivia 2002 - 2008.
abstract: BACKGROUND
  In the context of a rapid increase of dengue cases in the Americas, a monitoring system based on systematic serological control (IgM) of patients consulting for suspected dengue was developed in Bolivia at the end of the 1990s. In the most affected city of Santa Cruz, this system was complemented by an entomological surveillance program based on periodical search for immature stages of Aedes aegypti in dwelling water-holding containers. Here, we analyze these data and describe dengue patterns over 6 years (2002-2008), highlighting the spatial distribution of patients and vectors.
  Data mining concerned six annual epidemic cycles (2002-2008), with continuous serological and clinical results and entomological data from 16 surveys, examined at the scales of 36 urban areas and four concentric areas covering the entire city. Annual incidence varied from 0.28‰ to 0.95‰; overall incidence was higher in women and adults, and dengue dynamics followed successive periods of high (January-June) and low (July-December) transmission. Lower numbers of cases from the city center to the periphery were observed, poorly related to the more homogeneous and permanent distribution of A. aegypti. "Plant pots" were a major vector source in the city center, and "Tires" and "Odds and ends" beyond the second ring of the city.
  
  
  CONCLUSIONS
  Over the years, the increasing trend of dengue cases has been highlighted as well as its widespread distribution over the entire city, but an underestimation of the number of cases is strongly suspected. Contrary to popular belief, the city center appears more affected than the periphery, and dengue is not particularly related to waste. Interestingly, the clinical diagnosis of dengue by physicians improved over the years, whatever the gender, age and residential area of suspected cases.
authors.affiliation: INTERTRYP (CIRAD- IRD, Interactions hôte-vecteur-parasite dans les maladies dues aux Trypanosomatidés), Institut de Recherche pour le Développement (IRD), Montpellier, France; Centro Nacional de Enfermedades Tropicales, Santa Cruz, Bolivia.
authors.forename: Philippe
authors.initials: P
authors.lastname: Brémond
authors.affiliation: Centro Nacional de Enfermedades Tropicales, Santa Cruz, Bolivia.
authors.forename: Yelin
authors.initials: Y
authors.lastname: Roca
authors.affiliation: INTERTRYP (CIRAD- IRD, Interactions hôte-vecteur-parasite dans les maladies dues aux Trypanosomatidés), Institut de Recherche pour le Développement (IRD), Montpellier, France.
authors.forename: Simone Frédérique
authors.initials: SF
authors.lastname: Brenière
authors.affiliation: INTERTRYP (CIRAD- IRD, Interactions hôte-vecteur-parasite dans les maladies dues aux Trypanosomatidés), Institut de Recherche pour le Développement (IRD), Montpellier, France; Centro Nacional de Enfermedades Tropicales, Santa Cruz, Bolivia.
authors.forename: Annie
authors.initials: A
authors.lastname: Walter
authors.affiliation: Centro Nacional de Enfermedades Tropicales, Santa Cruz, Bolivia.
authors.forename: Zaira
authors.initials: Z
authors.lastname: Barja-Simon
authors.affiliation: Servicio Departamental de Salud, Santa Cruz, Bolivia.
authors.forename: Roberto Torres
authors.initials: RT
authors.lastname: Fernández
authors.affiliation: Centro Nacional de Enfermedades Tropicales, Santa Cruz, Bolivia.
authors.forename: Jorge
authors.initials: J
authors.lastname: Vargas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001179:Arthropod Vectors; D001838:Bolivia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000453:epidemiology* / Q000635:transmission; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012621:Seasons; D055815:Young Adult