190 research outputs found

    Unusual Dengue Virus 3 Epidemic in Nicaragua, 2009

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    The four dengue virus serotypes (DENV1–4) cause the most prevalent mosquito-borne viral disease affecting humans worldwide. In 2009, Nicaragua experienced the largest dengue epidemic in over a decade, marked by unusual clinical presentation, as observed in two prospective studies of pediatric dengue in Managua. From August 2009–January 2010, 212 dengue cases were confirmed among 396 study participants at the National Pediatric Reference Hospital. In our parallel community-based cohort study, 170 dengue cases were recorded in 2009–10, compared to 13–65 cases in 2004–9. In both studies, significantly more patients experienced “compensated shock” (poor capillary refill plus cold extremities, tachycardia, tachypnea, and/or weak pulse) in 2009–10 than in previous years (42.5% [90/212] vs. 24.7% [82/332] in the hospital study (p<0.001) and 17% [29/170] vs. 2.2% [4/181] in the cohort study (p<0.001). Signs of poor peripheral perfusion presented significantly earlier (1–2 days) in 2009–10 than in previous years according to Kaplan-Meier survival analysis. In the hospital study, 19.8% of subjects were transferred to intensive care, compared to 7.1% in previous years – similar to the cohort study. DENV-3 predominated in 2008–9, 2009–10, and 2010–11, and full-length sequencing revealed no major genetic changes from 2008–9 to 2010–11. In 2008–9 and 2010–11, typical dengue was observed; only in 2009–10 was unusual presentation noted. Multivariate analysis revealed only “2009–10” as a significant risk factor for Dengue Fever with Compensated Shock. Interestingly, circulation of pandemic influenza A-H1N1 2009 in Managua was shifted such that it overlapped with the dengue epidemic. We hypothesize that prior influenza A H1N1 2009 infection may have modulated subsequent DENV infection, and initial results of an ongoing study suggest increased risk of shock among children with anti-H1N1-2009 antibodies. This study demonstrates that parameters other than serotype, viral genomic sequence, immune status, and sequence of serotypes can play a role in modulating dengue disease outcome

    Contribution of sea-ice loss to Arctic amplification is regulated by Pacific Ocean decadal variability

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    The pace of Arctic warming is about double that at lower latitudes – a robust phenomenon known as Arctic amplification (AA)1. Many diverse climate processes and feedbacks cause AA2-7, including positive feedbacks associated with diminished sea ice6,7. However, the precise contribution of sea-ice loss to AA remains uncertain7,8. Through analyses of both observations and model simulations, we show that the contribution of sea-ice loss to wintertime AA appears dependent on the phase of the Pacific Decadal Oscillation (PDO). Our results suggest that for the same pattern and amount of sea-ice loss, consequent Arctic warming is larger during the negative PDO phase, relative to the positive phase, leading to larger reductions in the poleward gradient of tropospheric thickness and to more pronounced reductions in the upper-level westerlies. Given the oscillatory nature of the PDO, this relationship has the potential to increase skill in decadal-scale predictability of Arctic and sub-Arctic climate. Our results indicate that Arctic warming in response to the ongoing long-term sea-ice decline9,10 is greater (reduced) during periods of negative (positive) PDO phase. We speculate that the observed recent shift to the positive PDO phase, if maintained and all other factors being equal, could act to temporarily reduce the pace of wintertime Arctic warming in the near future.J.A.S. was funded by a UK Natural Environment Research Council (NERC) grants NE/J019585/1 and NE/M006123/1. J.A.F. was supported by an NSF/ARCSS grant (1304097) and NASA grant (NNX14AH896). The model simulations were performed on the ARCHER UK National Supercomputing Service. We thank the NOAA ESRL and Met Office Hadley Centre for provision of observational and reanalysis data sets. We also thank D. Ackerley for helping to diagnose the cause of model crashes, C. Deser for commenting on the manuscript prior to submission, and two anonymous reviewers for constructive criticism
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