PubMed · 11629974
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A M Rutten. 1991. [Not Available].. https://pubmed.ncbi.nlm.nih.gov/11629974/
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In 1988, the Ministers of Health in the Caribbean Community resolved to eliminate cases of indigenous measles. Specific performance indicators were developed to regularly monitor the program. In 1998, selected countries in the Caribbean elected to accelerate rubella control. As a first step, surveillance for both measles and rubella was integrated, using the measles eradication system as a template. Between 1995 and 2000, 98%-99% of the surveillance sites reported weekly. During that time, the number of suspected measles and rubella cases that were disqualified by laboratory testing remained relatively constant at 94%-99%; however, the indicator for suspected cases investigated within 48 h improved from 89% in 1996 to 95% in 2000. This integrated surveillance system has thus proven to be as effective and efficient as the measles surveillance system alone. Limited changes were made to the initial measles system, and the transition was relatively smooth. The integrated system has been crucial to the control of rubella and for the maintenance of measles elimination in the Caribbean.
We sequenced the E gene and adjacent prM/M and NS1 junctions (1940 bp) of 48 Dengue-4 (DEN-4) isolates collected between 1981 and 1999 from 8 Caribbean islands and from 7 South and Central American countries. Phylogenetic analysis confirms a single introduction in the early 1980s and a high degree of gene flow resulting in a pattern of evolution defined more by time period than geographic origin, especially within the Caribbean basin. A modern Caribbean clade consisting of four distinct lineages has arisen, comprised of isolates from Caribbean islands and nearby regions of South America. This clade is defined by three amino acid substitutions in the E (aa 163 and 351) and NS1 (aa 52) proteins. These findings highlight the importance of migration and gene flow in dengue viral change and suggest that efforts to understand disease dynamics in the Caribbean basin need to focus at regional, rather than local scales.
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