RT info:eu-repo/semantics/article T1 Characterization of dengue virus 4 cases in Paraguay, 2019–2020 A1 Rojas Segovia, Alejandra María A1 Shen, John A1 Cardozo, Fátima A1 Bernal, Cynthia A1 Caballero, Oliver A1 Ping, Sara A1 Key, Autum A1 Haider, Ali A1 Arévalo de Guillén, Yvalena A1 Langjahr Penayo, Patricia Elena A1 Acosta de Hetter, María Eugenia A1 Aria, Laura Silvana A1 Mendoza Torres, Laura Patricia A1 Páez Acchiardi, Gloria Malvina A1 Von-Horoch, Marta A1 Luraschi, Patricia A1 Cabral, Sandra A1 Sánchez, María Cecilia A1 Torres, Aurelia A1 Pinsky, Benjamin A. A1 Piantadosi, Anne A1 Waggoner, Jesse J. A2 Universidad Nacional de Asunción. Instituto de Investigaciones en Ciencias de la Salud AB In 2019–2020, dengue virus (DENV) type 4 emerged to cause the largest DENV outbreak in Paraguay’s history. This study sought to characterize dengue relative to other acute illness cases and use phylogenetic analysis to understand the outbreak’s origin. Individuals with an acute illness (≤7 days) were enrolled and tested for DENV nonstructural protein 1 (NS1) and viral RNA by real-time RT-PCR. Near-complete genome sequences were obtained from 62 DENV-4 positive samples. From January 2019 to March 2020, 799 participants were enrolled: 253 dengue (14 severe dengue, 5.5%) and 546 other acute illness cases. DENV-4 was detected in 238 dengue cases (94.1%). NS1 detection by rapid test was 52.5% sensitive (53/101) and 96.5% specific (387/401) for dengue compared to rRT-PCR. DENV-4 sequences were grouped into two clades within genotype II. No clustering was observed based on dengue severity, location, or date. Sequences obtained here were most closely related to 2018 DENV-4 sequences from Paraguay, followed by a 2013 sequence from southern Brazil. DENV-4 can result in large outbreaks, including severe cases, and is poorly detected with available rapid diagnostics. Outbreak strains seem to have been circulating in Paraguay and Brazil prior to 2018, highlighting the importance of sustained DENV genomic surveillance. PB Multidisciplinary Digital Publishing Institute YR 2024 FD 2024-01-25 LK http://hdl.handle.net/20.500.14066/4367 UL http://hdl.handle.net/20.500.14066/4367 LA eng NO Rojas, A.; Shen, J.; Cardozo, F.; Bernal, C.; Caballero, O.; Ping, S.; Key, A.; Haider, A.; de Guillen, Y.; Langjahr, P.; et al. Characterization of dengue virus 4 cases in Paraguay, 2019–2020. Viruses 2024, 16, 181. https://doi.org/10.3390/v16020181 NO Correspondence: arojass@iics.una.py (A.R.); jjwaggo@emory.edu (J.J.W.) NO Consejo Nacional de Ciencia y Tecnología DS MINDS@UW RD 24-ago-2024