In 1990 the U.S. Naval Medical Research Center Detachment (NMRCD) initiated a clinic-based surveillance program to determine the etiologies of febrile illness in Iquitos, Peru [10] (link)–[12] (link). In 2000 NMRCD collaborated with local Ministries of Health to expand the surveillance program into other regions of Peru and South America, including sites in Ecuador, Bolivia, and Paraguay. In addition to Iquitos, in 2000 the study was implemented at regional sites in or near Piura, Cusco, Tumbes, and Yurimaguas, Peru, as well as Santa Cruz, Bolivia (Figure 1 ; Table 1 ). Additional sites were later added in Concepción, Magdalena, and Cochabamba (Villa Tunari and Eterazama), Bolivia; Guayaquil, Ecuador; Asunción, Paraguay; and La Merced and Puerto Maldonado, Perú. Participants were recruited when reporting with acute febrile illness to public, private, or military health facilities in and around these regional centers. Details of the study sites are described in Table 1 . Study sites were selected based largely on locations in hot and humid climates conducive for arbovirus transmission, typically situated near or in tropical rainforest regions. Notable exceptions include Piura, Tumbes, and Cusco, which are located in coastal desert (Piura and Tumbes) or highlands (Cusco; Figure 1 and Table 1 ) regions. It should be noted that the study staff in Cusco (Hospital Regional) on occasion attended to participants arriving from surrounding highlands rainforest regions.
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