Dengue Literature Review

Latin America

7 min read

Latin America

Overview

Latin America encompasses the Caribbean (Cuba), Central America (Nicaragua), and South America (Brazil), representing dengue settings ranging from Cuba’s epidemic-by-importation pattern to Nicaragua’s endemic pediatric transmission and Brazil’s high-burden endemic circulation. The region contributes six sources to this wiki spanning epidemiology, immunology, autoimmune case reports, and a viral infection ANA comparator.

Cuba

Cuba has experienced a series of major dengue epidemics, each caused by a distinct serotype introduced in sequence, making it an epidemiologically valuable setting for studying multi-serotype exposure and its immunological consequences. The Instituto Pedro Kourí (IPK) in Havana is Cuba’s leading tropical medicine research institution and the primary source of Cuban dengue research.

Key Points from Literature

  • Cuban epidemic history: DENV-1 (1977, ~50% of population infected), DENV-2 Asian genotype (1981, ~25% of population, large DHF/DSS epidemic), DENV-2 again (1997, localised Santiago de Cuba outbreak), DENV-3 Asian genotype (2001, Havana, 78 confirmed DHF + 12,811 DF cases), DENV-4 (2006, Havana, eliminated within months) (see Garcia2009 - Long-term Clinical Symptoms Post-Dengue, Garcia2010 - Asymptomatic Dengue FcγRIIa Polymorphism).
  • Cuba’s non-endemic, epidemic-by-importation pattern and strong vector control record make it a natural model for studying genetic determinants of dengue severity without confounding by continuous transmission.
  • The 2006 DENV-4 Havana epidemic provided a cohort of hospitalised adults (97 symptomatic) and asymptomatic individuals (42) with well-documented infection histories, enabling unique follow-up studies on sequelae and genetic risk factors.
  • Among 26 symptomatic patients followed 2 years post-epidemic: 12 had tetravalent infection history (DENV-1→2→3→4), 4 had tertiary history, 5 had secondary history, and only 5 had primary DENV-4 infection (see Garcia2009 - Long-term Clinical Symptoms Post-Dengue).
  • Havana City FcγRIIa genotype distribution: 55% RR, 32% HR, 13% HH — substantially higher RR frequency than Asian populations (6–10% RR). This population-level difference may partly explain why severe dengue is more common in Asia (see Garcia2010 - Asymptomatic Dengue FcγRIIa Polymorphism).

1997 Santiago de Cuba DENV-2 epidemic

  • A localised DENV-2 outbreak in Santiago de Cuba in 1997, 16 years after the island-wide 1981 DENV-2 epidemic; individuals exposed in 1981 were re-exposed to DENV-2 rather than to a new serotype.
  • The overt:subclinical ratio was nearly 1:1 in those sensitised (prior DENV-1 exposure + now secondary DENV-2).
  • An amino acid change in the DENV-2 E protein occurred during the course of this epidemic, associated with month-by-month increases in DHF incidence — suggesting within-epidemic viral evolution affecting severity.
  • This epidemic provided key evidence that within the same secondary serotype combination (DENV-1→DENV-2), viral genotype changes can shift the overt:subclinical and DF:DHF ratio (see Guzman2016 - Dengue Infection).

Cuban vector control programme

  • Cuba launched a comprehensive Ae. aegypti control programme in 1981 following the DENV-2 DHF epidemic — one of the first national-scale programmes in the Americas.
  • Three pillars: larval source reduction (eliminating standing water), adulticidal spraying, and community participation in surveillance and elimination.
  • Plus space spraying (fogging) to rapidly suppress adult mosquito populations during epidemic response.
  • Programme successfully controlled epidemic dengue for approximately 30 years.
  • Programme eventually failed due to economic difficulties and reintroduction of dengue through population movement — illustrating that vector control requires sustained funding and political will.
  • The Cuban programme is cited alongside Singapore’s as an international benchmark for urban dengue control (see Aedes aegypti) (see Guzman2016 - Dengue Infection).

2013 La Habana expert consensus

  • International dengue experts met in Havana in 2013 and reviewed clinical classification data; the consensus confirmed a decrease in disease lethality following the introduction of the 2009 WHO classification system (compared with the 1997 WHO DF/DHF/DSS classification).
  • The 2009 system’s warning signs criteria provide earlier identification of at-risk patients, enabling earlier hospitalisation and fluid management — credited with the mortality reduction (see Guzman2016 - Dengue Infection).

Sources (Cuba)

Nicaragua

Nicaragua is an endemic dengue setting in Central America, with active transmission of multiple DENV serotypes. The country has been a site for longitudinal dengue cohort studies, particularly in Managua, capitalising on the high incidence of dengue in the pediatric population. The Hospital Infantil Manuel de Jesús Rivera (HIMJR) in Managua is a key referral centre for paediatric dengue cases and has served as a recruitment site for immunological studies requiring longitudinal follow-up.

Key Points from Literature

HIMJR Pediatric Cohort — Longitudinal Antibody Kinetics

Bos2025 - Longitudinal Antibody Dynamics After Dengue recruited 79 pediatric dengue patients at HIMJR, Managua, with DENV-1 and DENV-3 as the circulating serotypes. Patients were followed at four timepoints post-infection (<1M, 3M, 6M, 18M) and assessed for 84 dengue-specific antibody features spanning isotype, subclass, antigen target, and cross-reactivity.

Key findings from this cohort:

  • Cross-reactive E protein IgG (XR E-IgG) rises 6–18M post-primary infection (t½ = −2.13 years)
  • NS1-IgG wanes (t½ ≈ 2.1 years)
  • IgA seropositivity ≈ 100% at 18M; IgM ≈ 50% at 18M post-primary
  • IgG3 substantial at 18M; IgG4 rising long-term
  • EDI/II-targeting cross-reactive IgG drives the rising trajectory; EDIII-targeting antibodies flat

Note: Bos2025 is a preprint (medRxiv) and has not yet been peer reviewed.

Sources (Nicaragua)

Brazil

Brazil is the largest country in South America and one of the highest-burden dengue countries globally. The wiki currently has two sources from Brazil: one dengue case report (Jardim2012, Campinas/São Paulo state) and one viral hepatitis comparator study (Codes2002, Salvador/Bahia). The dengue source documents a rare autoimmune presentation of secondary DHF; the hepatitis source provides baseline ANA rates in acute viral infection relevant to interpreting dengue ANA data.

Key Points from Literature

Dengue (Campinas, São Paulo state)

Jardim2012 - Autoimmune Features DHF Case Report presents the only dengue case from Brazil in this wiki: a 22-year-old woman with secondary DENV-3 DHF (Campinas, São Paulo) showing an unusual constellation of autoimmune features:

  • ANA 1/320 mitotic spindle pattern — the only mitotic spindle ANA documented in dengue in this wiki; targets centromere/spindle apparatus proteins rather than nuclear DNA/histones
  • Cryoglobulinemia detected during acute illness
  • Selective C3 depression (0.39 g/L) with C4 normal — suggesting alternative pathway complement consumption rather than classical pathway
  • LE cells in pleural fluid cytology — requiring anti-nuclear IgG + complement activation + neutrophil phagocytosis; first documented in dengue pleural fluid in this wiki
  • Triple serositis: pleural effusion, pericardial effusion, ascites
  • DIC: fibrinogen 85.5 mg%, PT 20.2→36.4 sec, APTT 39.5→50.7 sec
  • All autoimmune features fully resolved at follow-up; anti-dsDNA remained negative throughout
  • No serositis mechanism worked up (dengue IC vs. anti-nuclear IC deposition not distinguished)

Viral Hepatitis Comparator (Salvador, Bahia)

Codes2002 - Autoantibodies in Acute Viral Hepatitis is a prospective study from Salvador, Bahia (UFBA hepatology outpatient clinic, n=156, 1992–2000) of autoantibodies in acute viral hepatitis (HAV/HBV/HCV/HEV/non A-E). It is not a dengue study, but is included as a baseline comparator:

  • ANA acute phase: 20.5% positive (homogeneous, ≥1:40) — established benchmark for infection-triggered ANA
  • ANA convalescence (90 days): 6.4% still positive
  • ASMA: 14.8% → 3.9%
  • No prognostic consequence; autoantibodies are transient epiphenomena (see Codes2002 - Autoantibodies in Acute Viral Hepatitis, n=156 prospective cohort)

Sources (Brazil)

Contradictions & Debates

  • No within-country or cross-country contradictions in this region yet. The Cuban, Nicaraguan, and Brazilian sources address largely distinct topics (epidemiology/genetics, antibody kinetics, autoimmune complications/comparators) and do not conflict.

Sources

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