The increasing geographical spread and disease incidence of arboviral infections are among the greatest public health concerns in the Americas. The region has observed an increasing trend in dengue incidence in the last decades, evolving from low to hyperendemicity. Yellow fever incidence has also intensified in this period, expanding from sylvatic-restricted activity to urban outbreaks. Chikungunya started spreading pandemically in 2005 at an unprecedented pace, reaching the Americas in 2013. The following year, Zika also emerged in the region with an explosive outbreak, carrying devastating congenital abnormalities and neurologic disorders and becoming one of the greatest global health crises in years. The inadequate arbovirus surveillance in the region and the lack of serologic tests to differentiate among viruses poses substantial challenges. The evidence for vector control interventions remains weak. Clinical management remains the mainstay of arboviral disease control. Currently, only yellow fever and dengue vaccines are licensed in the Americas, with several candidate vaccines in clinical trials. The Global Arbovirus Group of Experts provides in this article an overview of progress, challenges, and recommendations on arboviral prevention and control for countries of the Americas.

The rapid identification of drug-resistant strains of Mycobacterium tuberculosis is crucial for the timely initiation of appropriate antituberculosis therapy. The performance of the Genotype MTBDRplus assay was compared with that of the Bactec 460 TB system, a "gold standard" culture-based method. The Genotype MTBDRplus assay was quicker and more cost-effective for the detection of rifampin resistance, but it was not as good for the detection of isoniazid-resistant strains in our setting.The major serious challenges associated with the management of tuberculosis in Caribbean countries are diagnosis of the infection, drug resistance, and the paucity of reports on the prevalence of drug resistance. Although laboratories in many of these countries have the ability to perform smear microscopy, there is still a shortage of a laboratory capability for the performance of accurate, rapid culture and drug susceptibility tests (DSTs). As a result, many cases with low bacillary loads are misdiagnosed, underdiagnosed, or poorly treated.The rapid detection of drug-resistant Mycobacterium tuberculosis strains facilitates early access to the appropriate therapy, reduces rates of transmission, and improves treatment outcomes (12). M. tuberculosis resistance to isoniazid (INH) and rifampin (RIF), which are two of the most important antituberculosis drugs, often results in treatment failure and death (6); hence, the detection of resistance to these agents is crucial.The phenotypic DST method is routinely performed only after a pure, viable culture is obtained, and this usually takes 4 to 6 weeks, resulting in long diagnostic delays (7). The administration of inappropriate therapy during the period of delay may lead to the acquisition of further drug resistance as well as the dissemination of drug-resistant strains through person-toperson transmission. To improve treatment and prevent the transmission of drug-resistant M. tuberculosis strains, effective alternative diagnostic tests that will enable the rapid detection of drug resistance after the collection of specimens from infected patients are required. This study was carried out to determine the turnaround time, cost, and reliability of the Genotype MTBDRplus assay, a relatively new molecular test, in comparison with those of the Bactec 460 TB system, a "gold standard" conventional method, for the identification and the detection of susceptibility to INH and RIF of M. tuberculosis isolates from the Caribbean. MATERIALS AND METHODSEighty-one samples (26 sputum specimens and 55 culture material specimens on Lowenstein-Jensen medium) received at the Caribbean Epidemiology Centre of Trinidad and Tobago from several Caribbean islands for further confirmatory tests were used for this study. These were processed by standard microbiological methods (9, 11) to identify and confirm the presence of M. tuberculosis as well as to carry out the DSTs (3, 14). Informed consent was not required since no detailed patient information was known and the results were not linked to a patient identif...