title: Surveillance for Chikungunya and Dengue During the First Year of Chikungunya Virus Circulation in Puerto Rico.
abstract: After chikungunya virus (CHIKV) transmission was detected in Puerto Rico in May 2014, multiple surveillance systems were used to describe epidemiologic trends and CHIKV-associated disease. Of 28 327 cases reported via passive surveillance, 6472 were tested for evidence of CHIKV infection, and results for 4399 (68%) were positive. Of 250 participants in household cluster investigations, 70 (28%) had evidence of recent CHIKV infection. Enhanced surveillance for chikungunya at 2 hospitals identified 1566 patients who tested positive for CHIKV, of whom 10.9% were hospitalized. Enhanced surveillance for fatal cases enabled identification of 31 cases in which CHIKV was detected in blood or tissue specimens. All surveillance systems detected a peak incidence of chikungunya in September 2014 and continued circulation in 2015. Concomitant surveillance for dengue demonstrated low incidence, which had decreased before CHIKV was introduced. Multifaceted chikungunya surveillance in Puerto Rico resolved gaps in traditional passive surveillance and enabled a holistic description of the spectrum of disease associated with CHIKV infection.
authors.affiliation: Dengue Branch, Centers for Disease Control and Prevention (CDC).
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Sharp
authors.affiliation: Puerto Rico Department of Health, San Juan.
authors.forename: Kyle R
authors.initials: KR
authors.lastname: Ryff
authors.affiliation: Ponce Health Sciences University.|San Lucas Episcopal Hospital, Ponce, Puerto Rico.
authors.forename: Luisa
authors.initials: L
authors.lastname: Alvarado
authors.affiliation: Infectious Diseases Pathology Branch, CDC, Atlanta, Georgia.
authors.forename: Wun-Ju
authors.initials: WJ
authors.lastname: Shieh
authors.affiliation: Infectious Diseases Pathology Branch, CDC, Atlanta, Georgia.
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
authors.affiliation: Dengue Branch, Centers for Disease Control and Prevention (CDC).
authors.forename: Harold S
authors.initials: HS
authors.lastname: Margolis
authors.affiliation: Puerto Rico Department of Health, San Juan.
authors.forename: Brenda
authors.initials: B
authors.lastname: Rivera-Garcia
mesh_terms: D065632:Chikungunya Fever / Q000453:epidemiology* / Q000401:mortality / Q000821:virology*; D002646:Chikungunya virus / Q000302:isolation & purification; D003715:Dengue / Q000453:epidemiology* / Q000821:virology; D003716:Dengue Virus / Q000302:isolation & purification; D062665:Epidemiological Monitoring; D005191:Family Characteristics; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D011647:Puerto Rico / Q000453:epidemiology
keywords: Puerto Rico; chikungunya; dengue; surveillance