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First cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the Dominican Republic (DR) were reported in early 2020. During the first trimester of 2021 a national vaccination campaign was deployed, including whole-virus inactivated, adenovirus-based, and mRNA vaccines platforms. To better understand the effectiveness and efficiency of vaccines to reduce COVID-19 related deaths, among vaccinated (2-doses), unvaccinated and partially vaccinated (1-doses), and SARS-CoV-2 variants we analyzed clinical and molecular data obtained from breakthrough infections in hospitalized individuals. Samples from SARS-CoV-2 infected hospitalized patients were collected for viral sequencing. During the study period, we analyzed the data of thirty-three (n=33) COVID-19 case-patients from June to September 2021. Studied cases reported receiving a whole-virus attenuated vaccine (CoronaVac) in 36.8%. The survival rate among two-dose vaccinated individuals was 73% (95% CI, 70.8 to 74.2) compared to 65% in unvaccinated individuals. Molecular variant analysis of variant circulation among infections was initially due to B.1.621 (Mu) and rapidly shifting to B.1.617 (Delta) variants. No differences in outcomes between Mu, Iota, or Delta infections were observed. This suggests that VOIs can also have a deleterious impact on vaccinated individuals.

COVID-19 is a worldwide public health threat. Diagnosis by RT-PCR has been employed as the standard method to confirm viral infection. Sample pooling testing can optimize the resources by reducing the workload and reagents shortage, and be useful in laboratories and countries with limited resources. This study aims to evaluate SARS-CoV-2 detection by sample pooling testing in comparison with individual sample testing.We created 210 pools out of 245 samples, varying from 4 to 10 samples per pool, each containing a positive sample. We conducted detection of SARS-CoV-2-specific RdRp/E target sites.Pooling of three samples for SARS-CoV-2 detection might be an efficient strategy to perform without losing RT-PCR sensitivity.Considering the positivity rate in Dominican Republic and that larger sample pools have higher probabilities of obtaining false negative results, the optimal sample size to perform a pooling strategy shall be three samples.La COVID-19 es una amenaza de salud pública mundial. La RT-PCR es el método estándar para confirmar la infección. La estrategia de pruebas de muestras agrupadas puede reducir la carga de trabajo y la escasez de reactivos, y ser útil en países con escasos recursos. Evaluamos la detección del SARS-CoV-2 mediante esta estrategia en comparación con pruebas individuales.Creamos 210 grupos de 245 muestras, de 4 a 10 muestras por grupo, cada uno con una muestra positiva. Realizamos extracción de ARN y qRT-PCR para detectar la presencia de la diana RdRp/E.La combinación de hasta 3 muestras para la detección del SARS-CoV-2 podría ser una estrategia eficaz sin perder la sensibilidad.Considerando la tasa de positividad en República Dominicana y que los grupos con más muestras tienen mayor probabilidad de obtener resultados falsos negativos, el tamaño óptimo para realizar esta estrategia es de 3 muestras.

PURPOSE: Transgender women (TW) in the Dominican Republic (DR) are at high risk for syphillis infection. Although treatable, infection rates remain at epidemic proportions. METHODS: In 2016, we conducted a national survey, with serological sampling of TW in the DR (n=255). RESULTS: In our sample, syphillis seropositivity was 47.45%. There was a statistically significant association between age (t=−2.93, df, p

To propose appropriate containment measures and optimize surveillance strategies, it is of utmost importance to understand the dynamics of SARS-CoV-2 transmission within different age groups and its symptomatic and asymptomatic presentations. This study aimed to understand the cycle-threshold (Ct) of SARS-CoV-2 within individuals attending hospital-based facilities in the Dominican Republic. A total of 3,309 saliva samples were analysed from 14 provinces, which yielded a positivity rate of 18.01% (n=596) across 24 sites. Saliva specimens and levels of viral RNA were quantified by RT-qPCR. Overall mean Ct values were 29.3 cycles and significantly correlated with community positivity rate (r=-0.034, p=0.04). There was no significant difference in mean Ct values between studied age groups [F (19, 30) = 0.65, p = 0.5] and no significant correlation between mean Ct by age groups and community positivity. When comparing asymptomatic and symptomatic patients by age groups, the patients between 5 and 17 years old demonstrated a statistically significant mean difference in Ct values with 27.5 and 32.4 cycles, respectively (t (14) = -2.3, p = 0.03). Results identified in this study demonstrate how understanding community viral load is crucial for optimal SARS-CoV-2 surveillance and should be evaluated in the context of transmissibility dynamics.

The Coronavirus Disease 2019 (COVID-19) pandemic has been spread across the globe for almost a year, causing economic, social, and psychological impacts with yet unknown dimensions. In emerging and reemerging pathogen surveillance and detection, polymerase chain reaction (PCR) is a classic laboratory technique that has been widely used for the amplification and identification of nucleic acids. Analysis of volatile organic compounds (VOCs) in breath has been long reviewed as a potential diagnostics tool for many diseases. The overall specificity for SARS-CoV-2 of these methods was a calculated 69%,30 which is a low value for reliable detection. Breath tests are not a sufficiently evidence-based approach for rapid screening and to "secure" or creating "sanctuary" regions for touristic purposes. Therefore, policy-makers must cautiously point out the importance of further evaluation and structured studies confronting gold-standards with new devices.

Exposure to stigma, violence, sex work, and substance use are associated with increased HIV risk, but relationships between these factors have not been fully elucidated among transgender women whose data are often aggregated with men who have sex with men and other sexual and gender minorities. Considering this gap, we aimed to identify a serologically confirmed HIV estimate for transgender women and examine the relationships between stigma, sex work, substance use, and HIV among a national sample of transgender women in Dominican Republic. We analyzed biomarkers and self-report data from the third wave of Dominican Republic's Encuesta de Vigilancia y Comportamiento con Vinculación Serológica, employing logistic and negative binomial regression to estimate models (n = 307). HIV rate was 35.8%. Nearly 75% of respondents engaged in sex work. Over 20% reported experiencing violence; 61.6% reported being stigmatized. Participation in sex work was associated with higher levels of stigma [incidence rate ratio (IRR): 1.70, p

espanolObjetivo. Como pais caribeno, la Republica Dominicana es considerada endemica para HTLV-1. El proposito de este trabajo es analizar la seroprevalencia y la tendencia del HTLV-1/2 en donantes de Santo Domingo, que al ser la capital concentra la mayoria de las donaciones. Tambien pretendemos comparar nuestros hallazgos con los datos de los paises vecinos. Pacientes y metodos. Hemos realizado un estudio transversal retrospectivo de los 10 centros de transfusion de Santo Domingo que comunicaron la deteccion de HTLV y las otras infecciones de transmision sanguinea en su totalidad, que representan mas del 40% de las donaciones de la provincia. Se determino la seroprevalencia anual de HTLV-1/2, la prevalencia del periodo (2012-2017) y la tendencia temporal. Resultados. Se evaluaron un total de 352.960 donaciones. La prevalencia de HTLV-1/2 en el periodo estudiado fue del 0,26% (929/352.960) (IC del 95%: 0,24–0,28%). Encontramos un marcado predominio de la donacion de reemplazo en comparacion con la voluntaria. Por lo tanto, este estudio puede proporcionar claves sobre la prevalencia general de la infeccion. Conclusiones. La seroprevalencia de HTLV-1/2 en donantes de sangre de Santo Domingo, Republica Dominicana, ha sido relativamente baja y estable en el periodo estudiado. EnglishObjectives. Being a Caribbean country, the Dominican Republic is considered endemic for HTLV-1. Viral screening in blood banks is recommended for this blood borne infection. The purpose of this work is to analyze the seroprevalence and trends of HTLV-1/2 in the Dominican Republic blood donors; it is focused on Santo Domingo, the capital of the country, which has the largest blood donation activity. We also aim at comparing our findings with published data from neighboring countries. Patients and methods. We performed a retrospective cross-sectional study of 10 blood centers of Santo Domingo, which reported HTLV and the other blood-transmitted infections in full. They represent more than 40% of the province’s blood donations. Annual seroprevalence of HTLV-1/2, period prevalence (2012-2017), and time trend were determined. Results. A total of 352,960 blood donations were evaluated. The HTLV-1/2 period prevalence was 0.26% (929/352,960) (95% CI: 0.24–0.28%). We also found a marked predominance of replacement donation (90.4%) in comparison to voluntary contributions (9.6%). Therefore, this blood donor study may provide clues on the general prevalence of the infection. Conclusions. Seroprevalence of HTLV-1/2 in blood donors of Santo Domingo, Dominican Republic, showed a relatively low and steady trend in the studied period.

Seroprevalence surveys are of utmost importance to assess the proportion of a population that has developed antibodies against a newly introduced virus and could therefore potentially exhibit immunologic protection against subsequent infection. This study aims to understand the distribution of IgM and IgG antibodies in the Dominican Republic. We surveyed a total of 12,897 participants between April and June 2020 in 10 provinces of the Dominican Republic. Survey efforts in emerging hotspots yielded a positivity for all participants of anti–SARS-CoV-2 IgM of 3.8% and IgG of 5.4%, indicating that the pathogen was in circulation before the identification of those particular communities as hotspots. We found important age differences between participants who participated in the serological study where a higher mean age is associated IgM positivity and a lower age with IgG positivity. Our results highlight the need for strategies that involve community-based seroprevalence monitoring. These should preclude syndromic case identification. Also, the higher mean age of IgM-positive participants suggests that strategies based on syndromic surveillance could identify hotspots at later phases, based on the number of cases detected at the healthcare center, as such community-based seroprevalence monitoring may be an effective intervention for future outbreaks.

Here, we report the genome sequences of five severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains that were obtained from symptomatic individuals with travel histories during community surveillance in the Dominican Republic in 2020. These sequences provide a starting point for further genomic studies of gene flow and molecular diversity in the Caribbean nation. Phylogenetic analysis suggests that all genomes correspond to the B.1 variant.

Nearly complete genome sequences were obtained for a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant of concern and two variants of interest from nasopharyngeal swab samples obtained during surveillance activities in urban communities, among individuals with no previous travel history, in Santo Domingo, Dominican Republic.

An outbreak of African Swine Fever Virus (ASFV) has been reported in La Hispaniola. Ecological niches of transmission and further characterization of vectors involved should be included in a research agenda to reduce the impact on emerging pathogens affecting food security in a previous afflicted region.

Antecedentes: Aedes spp. y la dinámica del virus del dengue está altamente influenciada por factores ambientales. Una relación detallada entre el clima y la enfermedad en los períodos inter e intra-epidémicos podrían beneficiar la vigilancia del dengue para optimizar la preparación y las políticas adecuadas de control de vectores. Métodos: se analizaron los informes de casos de dengue y las variables climáticas en Santo Domingo, República Dominicana, para determinar la correlación del período 2012-2018 y los diferentes tiempos de retraso. Se llevó a cabo un análisis de regresión de dichas variables para comprender mejor las relaciones entre las tasas de incidencia del dengue y los cambios climáticos. Resultados: durante los brotes epidémicos, la temperatura (r = 0.73, p

Mosquito-borne diseases are a major public health concern in the Caribbean. Domestic water-storage containers are preferred breeding habitats for synanthropic mosquito species, among which Aedes aegypti stands out due to its role in arbovirus transmission. To determine the microenvironmental features associated with container-dwelling mosquitoes, a house-to-house cross-sectional entomological survey was carried out in 9 Dominican provinces affected by Zika virus in 2016. All containers with the potential to store water were sampled, all immature mosquitoes were collected, and information on the type, capacity, volume of stored water, building material, presence of flowers, and house location was documented. The specimens were identified and larval indices (House index [HI], Container index [CI], Breteau index [BI], and Ae. aegypti Breeding Percentage) were applied. A total of 665 dwellings were surveyed across 30 neighborhoods. A total of 1,420 water-filled container habitats were sampled, 19.3% of which harbored immature mosquitoes of 5 species, including 4 important vectors. The dominance of Ae. aegypti was marked, as it was present in all sampled neighborhoods, inhabiting 272 containers (19.1%). Larval indices were higher than the threshold values accepted (5% for the HI and BI, and 3% for the CI) in almost all neighborhoods. The presence of Aedes spp. was associated with the serviceability of water-holding containers (χ2 = 16.56522; P < 0.001), and the difference in volume between water-holding containers was associated with the presence of Aedes spp. infection (χ2 = 4; P < 0.001), the containers up to 5 liters being the most infested. This is the first entomological research based on synanthropic mosquito breeding habitats that cover urban areas of the 3 macro-regions of the Dominican Republic.

The COVID-19 pandemic forced healthcare systems globally to handle a dramatic surge in healthcare utilization while also taxing available testing resources. In the context of healthcare systems in Latin America and the Caribbean, COVID-19 added to the existing burden of infectious diseases related to endemic infections such as arboviruses and HIV. In the Dominican Republic, testing is supplied mostly by the private sector and a national public laboratory. The surge in testing demands laid bare a lack of installed capacities both in laboratory facilities and equipment and trained staff in molecular biology laboratory procedures. This article discusses a case of how science diplomacy and a relatively new law fostering public-private partnerships allowed a university to play a major role in public health response while generating knowledge to inform public policy decisions in an unprecedented manner in the country. Science diplomacy is discussed in the context of decolonization and the importance of the local gaze when creating academic partnerships in the context of global health emergencies.

El cambio climático tiene importantes implicaciones de salud pública, las cuales se incrementan en la malaria. En zonas donde nunca antes se había identificado las diferentes especies de Plasmodium se convirtió en realidad. Por consiguiente, la comprensión de la relación entre esta enfermedad y el clima se ha convertido en una prioridad de salud global. En este estudio extrajimos los casos reportados de malaria y los informes climáticos de bases de datos de información pública entre 2012 y 2018. Mediante análisis de regresión confrontamos los casos de malaria semanales con promedios climáticos de semana de retraso. Durante los períodos inter-epidémicos la humedad relativa (b = .1101, p

This article describes the social, biological, and programmatic interactions between HIV and SARS-CoV-2 co-infections in The Caribbean region. The country islands represent the second most affected region by HIV/AIDS after Sub-Saharan Africa. After the first confirmed COVID-19 cases in the region, it is necessary to reinvent the programmatic interventions designed to eliminate HIV transmission, and implement innovative interventions that are not yet currently available like PrEP, HIV self-testing, and multiple medication dispensing. COVID-19 pandemic offers an opportunity to governments, community-based organizations, and international partners to maintain the HIV care continuum, with particular efforts made to ensure timely access to, and to avoid disruption of routinely HIV services.

The newly introduced severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causative agent of coronavirus disease 2019 (COVID-19) was confirmed in the Dominican Republic on the 29thof February 2020. Dominican Republic’s COVID-19 response is a hybrid of previous experiences in other latitudes, based on epidemiological characteristics of individuals, clinical progression of COVID‐19, and quarantine intervention reinforced by the authority. Prevention against SARS-CoV-2 in the DR had involve massive disinfection campaigns, educational resources, community-engagement, case detection, and cluster isolation. COVID-19 strategies shall be focused on community leader mobilization in high incidence spots and emerging hotspots, with clear political leadership by governmental authorities. In this, the political leadership with the guidance of experts will be trusted and civilians will assume the responsibility of staying home. Very soon we will see the impact of this virus in the continent, late adopters of international health regulations will face the worst scenarios, those with a more resilient programming are having better outcomes. As effective those interventions, as faster will be the economic recovery.

Purpose: Studies on drug use in transgender populations, particularly those in resource-limited settings, are scarce. Considering that drug use can be a coping mechanism to deal with stigma and traumatic experiences, we examined associations between stigma, trauma, and drug use in a national sample of transgender women from the Dominican Republic. Methods: Bivariate analyses examined differences between drug users and abstainers (n=287). Multivariate analyses reported odds ratios (OR) with general drug, marijuana, and cocaine use as outcomes (n=243). Results: A quarter of respondents (24.5%) experienced sexual abuse, 12.1% were tortured, and 20.1% experienced a murder attempt. More than a quarter reported using illegal drugs (26.1%). Drug users had lower socioeconomic status; 30.0% of drug users had a primary level of education or less (18.2% of abstainers) and 17.6% of drug users had higher income, defined as greater than 10,001 pesos (∼$210 United States Dollars, USD) per month (28.1% of abstainers). More than half of drug users experienced some form of trauma (51.4%) compared to 43.5% of abstainers, and 28.4% of drug users, compared to 17.1% of abstainers, experienced a murder attempt on her life. Independent sample t-tests found significant differences between drug users and abstainers. Transgender women who experienced sexual abuse had three times high odds of using cocaine. Drug users were more likely to have experienced sexual abuse and attempted suicide (p

Objective: Road traffic accidents (RTAs) are the number one cause of traumatic brain injuries (TBIs) worldwide. This study examines RTA-related TBIs in the Dominican Republic, a country in ...

Objectives: This study examines associations between alcohol use, high risk sexual behaviors, and experiences of stigma among transgender women across the Dominican Republic. Data from the 2015 Tra...

Background: Transgender populations, and especially those in resource-limited settings, are at an elevated risk of experiencing stigma and discrimination. Aims: This study sought to examine the relationship between parental, familial, and other social support, experiences of stigma and discrimination, quality of life, and sex work in a national sample of transgender women in the Dominican Republic (n = 291). Methods: Descriptive analyses for the outcome variable, sex work, as well as for measures associated with socio-demographics, social support, stigma, quality of life, and experiences of abuse and violence were performed. Bivariate analysis examined differences between respondents involved in sex work and those not involved in sex work. Results: We found that participation in sex work was associated with low social support and quality of life and increased experiences of stigma, discrimination, and abuse. Specifically, Dominican transgender women involved in sex work received less social support than their non-sex working peers; they experienced heightened arguments and problems with non-parental family members, professors or bosses, classmates, and close friends, as well of loss of friendships. Involvement in sex work was also associated with higher levels of stigma and discrimination, lower quality of life, and experiences of sexual abuse, torture, and experiences of attempted murder on one’s life. Discussion: Transgender women participating in sex work require more rather than less social support from family members and loved ones, especially in areas where workplace discrimination policies that affect transgender individuals are nebulous, such as the Dominican Republic.

Background:We previously reported an association between tryptophan (Trp) catabolism and immune dysfunction in HIV monoinfection. Coinfection with HIV is associated with more rapid evolution of hepatitis C virus (HCV)-associated liver disease despite antiretroviral therapy (ART), possibly due to immune dysregulation. We hypothesized that liver fibrosis in HIV/HCV coinfection would be associated with immune dysfunction and alterations in Trp metabolism.Methods:Trp catabolism and inflammatory soluble markers were assessed in plasma samples from ART-treated HIV/HCV-coinfected patients (n = 90) compared with ART-treated HIV-monoinfected patients and noninfected subjects. Furthermore, 17 additional coinfected patients with sustained virological response (SVR) were assessed longitudinally 6 months after completion of interferon-alpha/ribavirin treatment.Results:HIV/HCV patients had higher Trp catabolism compared with HIV-monoinfected and healthy individuals. Elevated kynurenine levels in HIV/HCV patients with liver fibrosis correlated with the prognostic aspartate aminotransaminase to platelet ratio (APRI scores) and insulin levels. Furthermore, HIV/HCV patients had elevated levels of disease progression markers interleukin-6 and induced protein 10 and shared similar levels of markers of microbial translocation (intestinal fatty acid-binding protein, soluble CD14 and lipopolysaccharide-binding protein) compared with HIV-monoinfected and healthy individuals. Successful HCV treatment improved APRI score and markers of disease progression and microbial translocation although elevated Trp catabolism remained unchanged 6 months after SVR.Conclusion:ART-treated HIV/HCV-coinfected patients had elevated immunosuppressive Trp catabolism when compared with monoinfected HIV-treated patients, which did not normalize after SVR. These findings suggest that a necroinflammatory liver syndrome persists through inflammation by Trp catabolism after 6 month of SVR.

Background Human immunodeficiency virus (HIV) increases the risk of acquiring human T-cell lymphotropic virus (HTLV) and subsequently HTLV's progression to tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP/HAM). Existing data have exclusively reported generalized rates of HIV and HTLV-1 chronic viral infections in the Dominican Republic. To our knowledge, no published studies have focused on the rates of HTLV-1/2 in transactional sex workers and drug users, both higher risk groups, in the Dominican Republic. Methods From December 2012 to April 2013 we conducted a study to estimate the seroprevalence of HTLV-1/2 immunoglobulin G (IgG) and HIV antibodies among transactional sex workers and intravenous drug users in Santo Domingo, Dominican Republic. Serological status was analysed with behaviour and demographic data. Results We collected and analysed plasma from 200 participants with a mean age of 27.4 y in men and 25.2 y in women. The overall weighted seroprevalence of HTLV-1/2 IgG antibodies was 13.91% (95% CI 7.59 to 20.23) in men and 10.59% (95% CI 4.05 to 17.13) in women. The overall weighted seroprevalence of HIV-1 was 13.91% (95% CI 7.59 to 20.23%) in men and 17.65% (95% CI 9.55 to 25.75) in women. Male intravenous drug users had an exceptionally high rate of HTLV-positive HIV co-infection, at 75% (95% CI 44.99 to 105.01). Although there an association has been found between HTLV/HIV co-infections and sex work, the adjusted odds revealed a confounding role of HIV infection. Conclusions The results highlight the urgent need for enhanced public health preventive strategies among high-risk populations in the Dominican Republic and other resource-constrained Caribbean settings, as well as global adoption of routine screening for HTLV-associated infections, particularly in these high-risk, underserved populations.

Two recent researches described the spread of East/Central/South African (ECSA) lineage of chikungunya virus (CHIKV) in the Northeastern and Southeastern Brazil (Charlys da Costa et al. 2017, Cunha et al. 2017) . Initial studies in Northern Brazil, as observed in Caribbean, identified the Asian as the circulating lineage of the chikungunya. However, da Charlys da Costa et al. and Cunha et al. reported the exclusive occurrence of ECSA in two different Brazilian regions: Northeast as well as in Rio de Janeiro State (Charlys da Costa et al. 2017, Cunha et al. 2017) , suggesting that the ECSA is the predominant lineage in highly populated Brazilian areas. Despite the well-described vector competence of Aedes mosquitoes for CHIKV transmission, Aedes(Stegomyia)albopictus seems to have a greater competence for transmission of ECSA lineage compared to the Asian lineage (Vega-Rúa et al. 2015) , particularly when variable temperatures mimicking daily fluctuations of temperate climate (Vega-Rúa et al. 2015) . This statement is consistent with the fact that A albopictus has not been denounced as a vector of large outbreaks of chikungunya caused by the Asian genotype. This invasive species have capability of cold-tolerant diapausing eggs, it is paramount to establishment in temperate areas (Mitchell 1995) and new regions are invaded each year (Kraemer et al. 2015) . The predominance of the ECSA lineage in Brazil represents a potential risk of CHIKV dispersion to areas where Ae. albopictus has a broader distribution, particularly in temperate climates, including United States and Europe (Kraemer et al. 2015) , territories with intense commercial and touristic relationship with Brazil. Furthermore, the predominance of ECSA in Brazil can contributes to a better comprehension of the current distinct epidemiological scenarios between Caribbean - where explosive epidemics occurred with Aedes(Stegomyia) aegypti and Asian lineage predominated - and Brazil - with an apparent slower dispersion of CHIKV, where Ae.aegypti predominate but ECSA was prevalent linage. Both studies highlighted the importance of virological surveillance for analysis of current epidemiological scenarios and prediction of potential patterns of spreading of arboviral diseases, locally and worldwide.

Background In 2014 there was a large chikungunya epidemic in the Dominican Republic, with 539 099 reported cases and 6 deaths. Although chikungunya is considered a low-mortality disease, studies have suggested this is an underestimation. This study assessed deaths associated with the epidemic. Methods Mortality data were obtained from the National Statistics Office, the surveillance system for acute febrile illnesses, and the National Epidemiological Surveillance System. Expected all-cause mortality by age group was estimated using the years 2010-2012 as the baseline. The excess deaths were calculated as the difference between observed and expected deaths during the epidemic. Results The mortality rate increased during the chikungunya epidemic in 2014. There was a strong correlation between monthly excess of deaths and chikungunya cases (Pearson's r=0.89). There was an excess of deaths (>99% confidence interval) among individuals 40 y of age. The mortality rates were higher among the elderly. The death excess was 2853. Correcting for the estimated underreporting, there were 4952 deaths during the chikungunya epidemic (49.8 deaths/100 000 population). Conclusion This study suggests that chikungunya is an important cause of death (underlying or contributing). It is urgent to review clinical protocols and investigate the causes associated with deaths during chikungunya epidemics.

Entre las enfermedades infecciosas emergentes, el grupo de las arbovirosis tiene un notable impacto mundial debido a su potencial epidemico y propagacion sin precedentes. Estas enfermedades, de naturaleza principalmente zoonotica, constituyen un serio problema de salud publica en las Americas y especialmente en el Caribe, donde algunas presentan un patron de transmision practicamente ininterrumpido durante todo el ano, convirtiendose ademas en un obstaculo al desarrollo economico. De hecho, en las ultimas decadas se ha observado un aumento significativo de brotes epidemicos causados por arbovirus emergentes y reemergentes en muchos paises caribenos, como es el caso de la Republica Dominicana, donde enfermedades como el dengue, chikungunya y mas recientemente los virus Zika y Mayaro estan causando gran alarma en el sistema sanitario. Indudablemente, otros factores como la falta de recursos y planes adecuados de accion son motivos, entre otros, que influyen negativamente en el control de estas virosis. El presente trabajo pretende trata la situacion de las principales arbovirosis vehiculadas por mosquitos (Diptera: Culicidae) que afectan a las islas del Caribe, en especial a La Espanola, la segunda en extension de las Antillas.

Studies on attempted suicide in transgender populations, particularly those in resource-limited settings, are scarce. We examined the relationships between stigma, trauma, and suicide attempts in a national sample of transgender women from the Dominican Republic. Bivariate analysis examined differences between suicide attempters and nonattempters (n = 298). Multivariate analysis reported odds ratios with attempted suicide as the outcome (n = 260). About a quarter of respondents (23.9%) experienced sexual abuse, 12.3% were tortured, and 20.3% experienced a murder attempt. More than a quarter reported using illegal drugs. Independent sample t tests found significant differences between suicide attempters and nonattempters. Attempters were more likely to have experienced sexual abuse, psychological abuse, torture, and a murder attempt (p