Dengue deaths in Puerto Rico: lessons learned from the 2007 epidemic.

Despite the well-publicized island-wide epidemic in 2007 and an increasing trend in severe disease [5] , the true incidence of fatal dengue is likely under-estimated because of underreporting and under-recognition [6] , [7] , which has included failure to designate dengue as an underlying cause of death on death certificates [8] .

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