Dengue Bulletin. 2016 Dec. Vol-39
World Health Organization, Regional Office for South-East Asia ( 2016 )
Capillary leak syndrome in dengue fever.
Verma, Sudhir Kumar; Gutch, Manish; Agarwal, Abhishek; Vaish, AK ( 2011-12 )
Capillary leak syndrome (CLS) has been described in dengue fever but its exact features have not been clearly defined. We present here the findings in 25 cases of CLS recently seen by us during an outbreak of dengue fever in northern India. Besides fever, body ache and bleeding manifestations, ascites was present in 84% cases, pleural effusion in 76% cases, and both ascites and pleural effusion in 60% of cases. The pleural effusion was right-sided in 52.6% cases, bilateral in 47.4% cases and only left-sided in none of the cases. The fluid accumulation seen was moderate and frequently involved both abdomen and pleural cavity. The fluid rapidly cleared in a week’s time without any specific treatment. These cases can pose considerable diagnostic challenge which is discussed here.
Haemogram profile of dengue fever in adults during 19 September – 12 November 2008: A study of 40 cases from Delhi.
Advani, Sonia; Agarwal, Shikha; Verma, Jitender ( 2011-12 )
Dengue illness appears similar to other febrile illnesses in its early stages, which means its diagnosis is often delayed or confused with other illnesses. To address this issue, we analysed the haemogram profile of 40 patients (>12 years) hospitalized with DHF in Delhi from 19 September to 12 November 2008 to predict outbreaks and severity levels of the disease. Such studies could prove useful in disease management, diagnosing dengue and predicting the likelihood of haemorrhaging. All the patients were diagnosed, managed and monitored according to a standard protocol. Of the 40 patients who fulfilled the World Health Organization (WHO) criteria of DHF, 30 (75%) were male. All patients presented with fever and IgM dengue serology was positive in 100% cases. The haemogram profile shows that the lymphocyte level is a highly deviated parameter whereas the red blood corpuscles (RBC) count and mean corpuscular haemoglobin concentration (MCHC) are the least deviated parameters after performing standard deviation tests.hi
Involvement of the central nervous system in dengue fever and its outcome.
Kulkarni, ML; Kumar, Saurabh ( 2011-12 )
The involvement of the central nervous system in dengue-affected children, the spectrum of neurological manifestations and the presence of dengue-specific IgM antibodies in the cerebrospinal fluid (CSF) was studied. A prospective study was conducted of all consecutive serum-positive dengue patients (n=100) admitted to the hospitals attached to the Jagadguru Jayadeva Murugharajendra Medical College, Davangere, Karnataka state, India, from January 2009 to September 2010. Children who presented with neurological symptoms were grouped separately and CSF was cultured and routine tests for cells, sugar, protein and chlorides were done. Further CSF was subjected for dengue IgM estimation. The study showed that the neurological incidence was 40%. Seizures were present in 70% of cases and altered sensorium was present in 80% of cases. Papilloedema and cranial nerve palsy were observed in 30% of cases and meningeal signs were present in 80% of cases. CSF protein was high in 80% of cases and pleocytosis was present in 80% of cases. CSF IgM was positive in 35% of cases. The mortality observed in this study was 4%. It was concluded that dengue fever encompasses an expanding clinical spectrum and is not just restricted to the WHO-specified criteria for making a diagnosis of dengue fever other than dengue haemorrhagic fever and dengue shock syndrome. It frequently causes encephalitis probably due to a direct neurotropic effect of dengue virus.
Differentiating early adult dengue from acute viral respiratory infections – A comparative analysis.
Thein, Tun-Linn; Ooi, Eng-Eong; Low, Jenny GH; Leo, Yee-Sin ( 2011-12 )
The clinical presentations of dengue disease in adults are not fully described. Differentiating dengue from other acute viral respiratory infections (ARIs) is important. We conducted a prospective study from January 2008 to March 2010, recruiting subjects with early febrile illness presenting within the first 72 hours of illness at primary care outpatient clinics. This study evaluates cases enrolled to identify distinguishing clinical features of early dengue infection from ARIs. Acute and convalescent venous blood and nasal swab specimens were collected. Dengue was confirmed by RT-PCR, virus isolation, IgM/IgG seroconversion or fourfold IgG titre increase in paired blood samples. Non-dengue cases were tested for respiratory viruses from nasal swabs by RT-PCR. Dengue was confirmed in 49 patients along with 151 cases of influenza, 10 of parainfluenza and 29 patients of other viruses. The demographics between dengue (n=49) and PCR-positive viral ARI cases (n=190) did not differ significantly except by age (mean 39.1 years vs 33.7 years respectively; P
Evaluation of an immunochromatographic test for early and rapid detection of dengue virus infection in the context of Bangladesh.
Sharmin, Rabeya; Tabassum, Shahina; Jahan, Munira; Nessa, Afzalun; Mamun, KZ ( 2011-12 )
Early, accurate and rapid diagnosis of dengue virus infection is important for early case management and for reducing its associated complications, DHF/DSS. In this study, an early and rapid diagnosis of dengue virus infection was performed from single serum samples by two serological methods. Blood samples collected from a total of 201 clinically-suspected dengue fever patients were tested for IgM and IgG antibodies by a rapid immunochromatographic test (ICT), and also by IgM and IgG antibody Capture ELISA. Of these, 126 (62.7%) patients tested positive for dengue antibodies by ICT, of which 70 (55.6%) were primary and 56 (44.4%) were secondary cases. By ELISA, 137 (68.2%) tested positive for dengue antibodies, of which 80 (58.4%) were primary and 57 (41.6%) were secondary cases. Before 5 days of fever, 20.2% primary and 10.1% secondary dengue infections were detected by ICT, while 30.3% primary and 12.6% secondary dengue infections were detected by ELISA. At day 5 of fever, ICT detected 42.8% cases as primary and 34.7% as secondary dengue infections, but ELISA detected 51.0% primary and 32.6% secondary infections. After 5 days of fever, ICT detected primary dengue infection in 45.2% cases and secondary infection in 42.5% cases, while ELISA detected 42.5% primary dengue infection and 42.5% secondary infection. When compared with ELISA, ICT showed 86.7% sensitivity and 96.5% specificity for IgM detection, whereas for IgG it was 94.7% and 98.6% respectively.
A hypothetical intervention to reduce plasma leakage in dengue haemorrhagic fever.
Sellahewa, Kolitha H ( 2011-12 )
Plasma leakage from increased vascular permeability, if left unattended, will lead to intravascular volume depletion. The ensuing tissue hypoperfusion and the consequent life-threatening complications may have a fatal outcome in dengue haemorrhagic fever (DHF). Although an accurately calculated volume of fluid infused during the critical phase of plasma leakage can prevent such an eventuality, the practical difficulties in its execution with properly-timed adjustments to the fluid infusion rate and the aggressive monitoring needed during this phase of the illness can limit the expected benefits of an exclusively fluid-based regime. An intervention to reduce plasma leakage in DHF complementing the standard fluid regime conceivably would improve the outcome. It is my hypothesis that fresh frozen plasma (FFP) by Fc receptor blockade and the associated reduction in immune-enhanced viral replication could reduce cytokine-mediated increase in vascular permeability. Additionally, albumin in FFP, by adhering to the glycocalyx, could further compromise fluid fluxes during the critical phase of DHF. However, this hypothesis needs to be tested by a randomized controlled study.
Entomological investigations of dengue vectors in epidemic-prone districts of Pakistan during 2006–2010.
Mukhtar, Muhammad; Tahir, Zarfishan; Baloch, Taj Muhammad; Mansoor, Faisal; Kamran, Jaleel ( 2011-12 )
Intensive entomological investigations were carried out in seven dengue epidemic-prone districts of Pakistan, classifying them into three geographical regions, viz. southern, central and northern Pakistan. A total of 5132 water habitats from 2136 households in and around dengue-positive houses were sampled. Additionally, 264 samples each at least 30 metres away from dengue-positive houses were also collected from outdoor habitats. Only indoor samples data were used for the estimation of entomological indices. House Index, Container Index and Breteau Index were estimated at 39.42%, 27.96% and 67.20 respectively. Underground water tanks showed the highest (42.38%) positivity, followed by earthen pots (36.97%), drums (33.38%) and the least (4.58%) from discarded containers. From outdoor sites, only 5.05% (n=14) samples were found positive. Aedes aegypti and Aedes albopictus species exhibited a distinct association with different geographical regions. In the south of the country only Ae. aegypti was recorded in all (n=452) positive habitats while in the central part, both Ae. aegypti and Ae. albopictus were reported from 88.2% (n=253) and 11.8% (n=34) of the total 287 positive habitats respectively. In the north/submountainous region, 88.45% (n=628) of 710 positive samples were found infested with Ae. albopictus. Both species showed a significant population-rising trend from September to November, similar to the dengue case-load trend.
Update on dengue in Africa.
Teles, Fernando RR ( 2011-12 )
Dengue fever is a major public health problem worldwide, being considered one of the most important re-emerging diseases of today. Dengue viruses and their mosquito vectors, while being widely spread across all tropical and subtropical regions of the world, have recently emerged in temperate regions as well. In Africa, both the virus and the vector mosquitoes exist, but, unlike in Asia or South America, human dengue cases have been identified only occasionally, without reports of severe outbreaks, until a few years ago. Recent episodes in the African continent evidenced the lack of effective and reliable programmes for surveillance and control of dengue outbreaks. This paper tries to give a brief overview of the current status of dengue in Africa and to assess the main risk factors for any massive outbreaks in the future, while outlining the currently envisaged strategies to face this emergent threat.
Identifying and visualizing spatial patterns and hot spots of clinically-confirmed dengue fever cases and female Aedes aegypti mosquitoes in Jeddah, Saudi Arabia.
Khormi, Hassan Muhsan; Kumar, Lalit ( 2011-12 )
Understanding the distribution of dengue fever in time and space is the foundation for its control and management programmes. Different technologies, especially the Geographic Information System (GIS) and its tools and methods, have been used to illustrate and visualize the prevalence of some mosquito-borne diseases and abundance of their vectors. The aim of this study was to illustrate the spatial distribution and spatial pattern of this disease and female Aedes aegypti mosquitoes in the epidemic-prone area of Jeddah, and also to show the hot spot districts with the highest risk levels. The study was conducted in Jeddah county, Saudi Arabia. The clinically-confirmed cases registries of dengue fever have been continuously and systematically collected since 2006 by the Dengue Fever Operation Room of Jeddah Health Affairs. The computerized databases of these two government departments have recorded weekly notifications of dengue fever cases and its vector (female Aedes mosquito). The female Aedes mosquito counts and identification were provided by the laboratory of mosquito, which belongs to the Jeddah Municipality. Two GIS techniques were used to achieve the aims of this study. The multi-distance spatial cluster (Ripley’s K-function) was used to estimate the spatial pattern and distribution while the Getis-Ord Gi* statistic was used to model and visualize the hot spots and the risk models. The results showed that the spatial patterns and distribution of dengue fever cases from 2006 to 2009 were clustered at multiple distances with statistically significant clustering. They also showed that most Aedes mosquitoes were clustered while some of them were dispersed at larger distances, especially in 2007, 2008, 2009 and 2010. Also, areas with various risk levels of dengue fever and its vector were identified in different geographical locations (districts) for different epidemic years using the Getis-Ord Gi*. Identifying dengue fever and its vector cluster and hot spots can be greatly enhanced through the use of a variety of analytical techniques that are available in the Geographic Information System. Getis-Ord Gi* and multi-distance spatial cluster (Ripley’s K-function) can be implemented as routine procedures along with dengue fever control and prevention programmes.
Overcoming data limitations: design of a multicomponent study for estimating the economic burden of dengue in India.
Halasa, Yara A; Dogra, Vishal; Arora, Narendra; Tyagi, BK; Nandan, Deoki; Shepard, Donald S ( 2011-12 )
Dengue is emerging as a serious global health problem. Estimating the economic burden of dengue is crucial to inform policy-makers of the disease’s societal impact and may assist in implementing appropriate control strategies. However, developing such studies is constrained by limited data and other challenges. This paper shows how analyzing hospital records carefully can adjust surveillance data for possible under-reporting and misdiagnosis of dengue, merging information on treatment patterns with macro costing to estimate the cost of dengue episode by age and severity in various treatment settings, and combining adjusted surveillance data with cost information can estimate the aggregate cost of dengue illness in India and in other endemic countries.
Clinical and biochemical characteristics of suspected dengue fever in an ambulatory care family medical clinic, Aga Khan University,Karachi, Pakistan.
Jahan, Firdous; Nanji, Kashmira; Qidwai, Waris; Roshan, Rozina; Waseem, Hira ( 2011-12 )
A medical chart review was carried out in an ambulatory family medical clinic attached to the Aga Khan University Hospital, Karachi, Pakistan. The study revealed that all febrile patients the mean fever spike was 39.8°C. The common symptoms were bodyache (46%), nausea (12%) and headache (10%). Other clinical findings were eye pain, backache and anorexia. Out of thirteen patients who had dengue IgM done, nine showed positive results. In laboratory examination, thrombocytopenia was found in 53.4% of patients. Low haemoglobin was found in 51% and leucopenia in 32.9% of patients.
Geographical association between socioeconomics and age of dengue haemorrhagic fever patients in Surabaya, Indonesia.
Nagao, Yoshiro; Rachmie, Esty M; Ochi, Shiro; Padmidewi, Maria M; Kuntarianto; Kawabata, Masato ( 2011-12 )
A study was designed to correlate the ages of dengue patients to the geographical and temporal demographic structure in 28 districts in Surabaya, Indonesia, between 1996 and 2005. The geographical distribution of the mean patient age was stable throughout the study period. The mean patient age did not correlate with the demographic structure but was related to the prevalence of poor housing where mosquito density was high. These results suggested that socioeconomic factors which affect mosquito abundance are more important determinants of the mean age of DHF patients than the demographic variables.
Aedes aegypti indices and KAP study in Sangam Vihar, south Delhi, during the XIX Commonwealth Games, New Delhi, 2010.
Singh, RK; Mittal, PK; Yadav, NK; Gehlot, OP; Dhiman, RC ( 2011-12 )
Dengue fever (DF) cases were reported in Delhi during August 2010. As the XIXth Commonwealth Games were to be held in Delhi in October 2010, entomological and community knowledge, attitude and practices (KAP) studies were carried out to assist the Municipal Corporation of Delhi (MCD) for better implementation of vector control activities in the city. A total of 495 houses were searched for Aedes aegypti breeding in all kinds of temporary and permanent water receptacles in both indoors and outdoors in a thickly-populated, illegally-constructed locality, named Sangam Vihar, in south Delhi. The overall House Index (HI), Container Index (CI) and Breteau Index (BI) were 44.44%, 19.01% and 91.92 respectively. For KAP, a pre-tested, structured questionnaire was used for data collection. Out of the 384 households surveyed, 156 were aware about dengue and only 12 households knew that virus was the causative agent for DF. A majority (378) of the households practised water storage and 48 of them stored water for more than one week. No preventive/control measures were adopted to prevent mosquito breeding in the water-holding containers by a majority of the households (45.57%). 57% of them did not know the biting habits of dengue vector mosquitoes. The results of the study indicated that the community’s knowledge about dengue fever, its transmission, vector breeding sources, biting habits and preventive measures was poor.
( 2010-12 )
The WHO Regional Office for South-East Asia, in collaboration with the Western Pacific Region, has been jointly publishing the annual Dengue Bulletin. The objective of the Bulletin is to disseminate updated information on the current status of DF/DHF infection, changing epidemiological patterns, new attempted control strategies, clinical management, information about circulating DENV strains and all other related aspects. The Bulletin also accepts review articles, short notes, book reviews and letters to the editor on DF/DHF-related subjects. Proceedings of national/international meetings for information of research workers and programme managers are also published. All manuscripts received for publication are subjected to in-house review by professional experts and are peer-reviewed by international experts in the respective disciplines.
Cost and burden of dengue and chikungunya from the Americas to Asia.
Shepard, Donald S ( 2010-12 )
The ten studies in this special issue document the substantial and growing burden of dengue in the Americas, Africa and Asia, and the burden of a chikungunya outbreak in India. Luiz Tadeu Moraes Figuedo’s paper on dengue in Brazil confirms the country’s worsening trend from 1999–2009, where cases rose at 6.2% per year and dengue deaths at 12.0% per year. Carmen Perez and co-workers, reporting on dengue vector control in Puerto Rico, found that 83% of the costs (US$ 1.97 per person per year) were funded by the lowest and often the least financed level of government: municipalities. Examining dengue cases imported into France, Guy LaRuche documented the alarming increase in cases originating from Cote d’Ivoire from only one case in 2006–07 to six cases in 2008. Using modeling and Monte Carlo simulations, Tiina Murtola and co-authors estimated the “immediate” cost of chikungunya and dengue in India at US$ 1.48 billion (range US$ 0.64 billion to US$ 3.60 billion). Tapasvi Puwar and co-workers, reporting on a 2006 household survey in Ahmedabad, found that only 23% of chikungunya cases sought care in public facilities, so that under-reporting must be considerable. Extending the analysis of this chikungunyua outbreak, Dileep Mavalankar and co-authors placed its economic cost at US$ 8.6-US$ 17.3 million. Ami T. Bhavsar and co-authors, studying dengue cases hospitalized at a private hospital in Surat, India, found that the economic cost of a case averaged US$ 585.57 (US$ 439.44 for direct medical costs and US$ 146.13 for indirect costs). Lee Han Lim and coworkers, estimated the “immediate” cost of dengue to Malaysia and Thailand at US$ 133 to $135 million, respectively. Sukhontha Kongsin and co-authors found that on a per capita basis, costs of dengue in Thailand in 2005 averaged US$ 3.55, of which 28% was due to vector control and 72% due to dengue illness. Examining the burden of dengue on households in Cambodia, Jose A Suaya and co-authors found that and 53% needed to sell household property to fund dengue treatment. Effective methods to prevent the disease would, therefore, result in important economic benefits in many tropical countries.
Dengue in Brazil during 1999–2009: a review.
Figueiredo, Luiz Tadeu Moraes ( 2010-12 )
Over the period 1999 through 2009, the incidence of dengue in Brazil has shown an upward trend with more than 700 000 cases per year reported during 2002 and 2008. Despite efforts to control Aedes aegypti, a hyper-endemic situation has remained with large outbreaks involving all the four dengue serotypes (DENV-1 to 4). The average age of DHF/DSS cases has decreased, making it a disease affecting children. The number of fatalities has also increased. While other countries in the Americas have also witnessed an upward trend in case numbers, Brazil has been subject to more extreme peaks. Other arboviruses also cause sporadic human cases which are commonly confused with dengue and remain undiagnosed.
Economic cost of dengue public prevention activities in Puerto Rico.
Pérez-Guerra, Carmen L; Halasa, Yara A; Rivera, Reinaldo; Peña, Marisol; Ramírez, Viani; Cano, Martha Patricia; Shepard, Donald S; Puerto Rico ( 2010-12 )
Dengue fever has become a major global public health problem in Puerto Rico. Approximately 5000 suspected cases were reported annually between 2002 and 2007. Vector control is currently the only approach to control the disease and includes prevention education, fumigation, inspections and clean-up campaigns. The annual cost to the public sector of dengue prevention, which includes surveillance and vector control activities, was estimated as part of a study of the economic burden of dengue in Puerto Rico. A telephonic survey was implemented to identify municipalities with vector control programmes and public agencies with dengue surveillance systems. Onsite interviews were conducted using a structured questionnaire. The economic cost of dengue was summarized by line item, function and year from 2002 through 2007. The Puerto Rico Department of Health (PRDH) and 12 municipalities out of 78 conducted vector control activities in different magnitudes during the study years. The cumulative cost of dengue vector control in the public sector was US$ 46.22 million for the years 2002–2007. PRDH spent an average of US$ 1.29 million ($0.33 per capita) per year, while the municipalities spent an average of US$ 6.41 million (US$ 1.64 per capita) per year. Clean-up campaigns had the highest share of average expenditure, followed by fumigation, surveillance and inspection. Puerto Rico’s per capita expenditure on dengue prevention activities is similar to that of other countries in the region. On average, Puerto Rico’s per capita spending on dengue illness is US$ 5.48 compared with US$ 1.97 spent on vector control.
Preliminary estimate of immediate cost of chikungunya and dengue to Gujarat, India.
Murtola, Tiina M; Vasan, SS; Puwar, Tapasvi I; Govil, Dipti; Field, Robert W; Gong, Hong-Fei; Bhavsar-Vyas, Ami; Suaya, Jose A; Howard, Marion; Shepard, Donald S; Kohli, Vijay Kumar; Prajapati, PB; Singh, Amarjit; Mavalankar, Dileep V; Chikungunya ( 2010-12 )
This study aims to provide a preliminary estimate of the immediate cost of chikungunya and dengue to household in the Indian state of Gujarat. Combining nine earlier studies and data from interviews, we analysed the costs of non-fatal illness and of intervention programmes; building a more comprehensive picture of the immediate cost of these Aedes aegypti mosquito-borne diseases to Gujarat. The “RUHA matrix” was used to estimate the cost of illness by combining the shares of reported (R) and unreported (U) hospitalized (H) and ambulatory (A) cases of chikungunya and dengue with ambulatory and hospitalization costs per case and the number of reported cases. Using Monte Carlo sensitivity analysis, the immediate cost to households incurred on account of chikungunya and dengue to Gujarat was estimated to be 3.8 (range 1.6–9.1) billion Indian rupees (INR) per annum (US$ 90 million, range US$ 38 and US$ 217 million). It is hoped that this preliminary estimate will trigger more refined studies on cost of illness as well as cost-effectiveness of vaccines and other interventions to combat these neglected tropical diseases.
Prevalence of chikungunya in the city of Ahmedabad, India, during the 2006 outbreak: a community-based study.
Puwar, Tapasvi; Sheth, Jay K; Kohli, Vijay; Yadav, Rajpal ( 2010-12 )
Prevalence of chikungunya in the city of Ahmedabad, India during the 2006 outbreak was investigated to estimate the prevalence of suspected chikungunya cases to find out demographic parameters and proportion of various symptoms among suspected chikungunya cases, and to evaluate the effectiveness of control measures implemented by the public health sector. A total of 6667 people from 1301 households were surveyed. The prevalence of suspected chikungunya cases was 32.9% (31.8% – 34.2%). Prevalence was higher in females (p