|Year : 2017 | Volume
| Issue : 3 | Page : 104-107
The epidemiology of dengue viral infection in developing countries: A systematic review
Monica Singh1, Arindam Chakraborty1, Sanjay Kumar1, Amod Kumar2
1 Department of Microbiology, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh, India
2 Department of Pathology, Patna Medical College and Hospital, Patna, Bihar, India
|Date of Submission||19-Feb-2017|
|Date of Acceptance||01-Aug-2017|
|Date of Web Publication||6-Oct-2017|
Department of Microbiology, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Dengue is the fastest growing mosquito-borne viral infection and is prevalent in the tropical regions of the world. It causes a wide spectrum of illness from mild asymptomatic illness to severe fatal dengue hemorrhagic fever/dengue shock syndrome. Its impact today is thirty times >50 years ago. Global incidence of dengue has drastically upped in the last few years. According to the World Health Organization, there are about 390 million cases of dengue fever worldwide, and of the total number of cases, 96 million require medical treatment. Worldwide, it has been seen a doubling up of cases on dengue from 2015 to 2016 and it can cause infection in all age groups. As vaccines or antiviral drugs are not available for dengue viruses, the only effective way to prevent dengue is to control the mosquito vector, Aedes aegypti and prevent its bite.
Keywords: Dengue, dengue-specific IgM, ELISA, vector-borne disease
|How to cite this article:|
Singh M, Chakraborty A, Kumar S, Kumar A. The epidemiology of dengue viral infection in developing countries: A systematic review. J Health Res Rev 2017;4:104-7
|How to cite this URL:|
Singh M, Chakraborty A, Kumar S, Kumar A. The epidemiology of dengue viral infection in developing countries: A systematic review. J Health Res Rev [serial online] 2017 [cited 2018 Jul 20];4:104-7. Available from: http://www.jhrr.org/text.asp?2017/4/3/104/216063
| Introduction|| |
In this era, in which the public health news often sensationalizes uncommon infection syndromes or pathogens, dengue virus (family flaviviridae) infection is an increasingly important endemic problem in many parts of the world. There are four antigenetically related but distinct serotypes of the dengue virus: DENV-1, DENV-2, DENV-3, and DENV-4. Each serotype has several subtypes or genotypes. In humans, one serotype produces lifelong immunity against reinfection but only temporary and partial immunity against the other serotypes. Each serotype has exceptional characteristics and can present with brutal manifestations in a particular population depending on its interaction with the host response. The World Health Organization (WHO) has taken several preventive measures to control the spread of dengue virus infection. However, still new outbreaks were reported in several parts of the world during postmonsoon season. Newer diagnostic techniques, public awareness programs, better education, and proper monitoring of vector control are required to prevent such outbreaks.
In the microbiology laboratory, the commonly used diagnostic methods for confirming dengue infection involve virus isolation, detection of virus antigen or RNA in plasma or serum or tissues, and the presence of dengue virus-specific antibodies in serum and other body fluids. As the molecular techniques are expensive, most of the referral laboratories prefer detection of IgM, IgG, and NS1 by ELISA as confirmatory test, and it is also recommended by the WHO also. Several studies from different developing countries have reported high prevalence of dengue among the population.,,,, However, there are many review article are available for dengue infection, but none of the review article were reviewed for the overall situation of the dengue infection in the developing countries. In contrast of this in the present article, we tried to review the overall situation of dengue infection in the developing countries include India.
| Methodology|| |
A literature search of Medline, PubMed, was done using the term “dengue virus infection in India; incidence of dengue in India; dengue infection in developing country, dengue outbreak in Africa, dengue outbreak in Southeast Asia, dengue outbreak in South America” to find all the articles that considered epidemiology of dengue infection in India and other developing countries. On the basis of title and displayed abstract, articles were chosen for the selected topics. Among the non-English articles, only those with abstract in English were reviewed and included. Of the published articles, 27 original articles and five reviewed were excluded in which studies were mainly focused on epidemiology of dengue viral infection.
Data on prevalence, risk factors, dengue serotypes, and outcome were collected.
Dengue viral infection in India
A recent map-based study by the University of Oxford had estimated that India had the largest number of dengue cases, with about 33 million symptomatic and another 100 million asymptomatic infections occurring annually.
One of the main reasons of enhance rate of outbreak is due to increased travel among people to adjacent states for the rationale of jobs and education. Another reason may be due to poor sanitation amenities add to fertile breeding grounds for the vectors. Several studies have reported high prevalence of dengue from different part of the country. However, from central India, there is very few data regarding the prevalence of dengue. The cocirculation of multiple dengue virus serotypes and genotypes is alarming in Uttar Pradesh, India.
The months of September, October, and November are most common period for dengue transmission in India, which is similar with the studies done by Gupta et al. and Ukey et al. from central India., They also reported that this variation may be mainly due to postmonsoon collection of water and increased availability of breeding sites for the mosquitoes.
Different studies also show the low prevalence of dengue infection in female than male., However, this is discordant with the studies done in different parts of India, where female predominance was observed. This gender variation regarding the incidence of infection may be due to household orientation and less migration of women in rural areas.
It is also observed that the young people (aged 21–30 year) were mostly affected from North India. In a study conducted in Delhi documented that among the study population, 21–30 years age group individuals are most affected one. A study from Kanpur showed that 0–15 years of age group individuals were most exaggerated.,
Dengue viral infection in Africa
There are limited data available about the incidence of dengue in Africa. In the last 60 years, 22 African countries have reported sporadic cases or outbreaks of dengue, which indicate that there is high prevalence of dengue virus infection in all or many parts of Africa.
Available data strongly suggest that dengue viral transmission is endemic to 34 countries in all regions of Africa. Of these countries, 22 have reported local disease transmission, 20 have reported laboratory confirmed cases, and 2 (Egypt and Zanzibar) have reported only clinical cases that were not laboratory confirmed. In the remaining 12 countries, dengue was reported from travelers returning to countries but never reported as occurring locally.
Dengue in Brazil
The first epidemic of dengue was reported in the state of Rio de Janeiro of Brazil in middle of 18th century. Between 1981 and 2006, 4,243,049 dengue cases were reported in Brazil, including 338 deaths. The highest number of reports came from the Northeast and Southeast regions of Brazil.
Between 2007 and 2008, there are extreme outbreaks in the state of Rio de Janeiro with a higher number of severe cases than earlier outbreaks, primarily among children and adolescents. In these 2 years, 851 deaths due to severe dengue were registered in the country. In 2008, around 80% of the cases reported in the country occurred in the Southeast and Northeast regions.
In 2009–2010, over a million suspected cases of dengue and 665 deaths were reported in Brazil. DENV-2 was the predominant type followed by DENV-1.
When compared to 2012, there was a decline in the number of cases compared to 2011; but in 2013, the incidence of dengue increased by 190%. In 2014, the Brazilian Ministry of Health had reported 591,080 cases of dengue for an incidence rate of 291.5/100,000 population and 410 deaths. In 2015, the Brazilian Ministry of Health has registered 1,254,907 notified cases of dengue, representing an increase which is more than twofold compared to that of 2014, and it is being considered a new epidemic in the country, with 530 deaths.
Dengue in Saudi Arabia
In Saudi Arabia, the first experience of virus isolation during a dengue outbreak was in 1994 in Jeddah, where 289 confirmed cases were recorded. In 1997, emergence of dengue occurred with DENV-3 identified during the rainy season in Jeddah. The virus was not isolated in the next 7 years until 2004 when DENV-1, DENV-2, and DENV-3 were isolated in Jeddah. The next outbreaks occurred in Jeddah in the winter seasons of 2005 and 2006; In 2008, the first cases were reported from Al-Madinah with DENV-1 and DENV-2 isolated serotypes. In 2009, the Saudi MOH reported a total of 3350 cases of DF in the Kingdom and estimated the case fatality rate to be 4.6 per thousand.
A study conducted in 2011 that included 1026 soldiers in five administrative units in Jazan found a low seroprevalence of dengue of only 0.1%. Another study was conducted in 2013 in 30 hospitals and 387 primary healthcare centers in Jizan and Aseer, two cities in Southern Saudi Arabia. This study detected 31.7% positive cases of dengue virus IgG among 965 random patients attending the outpatient clinics for any reason.
Yet, another study conducted in 2013 recognized an increased incidence of DF in the first half of that year, male with the age of 15 and 29 were mostly infected by dengue viruses.
Dengue in Malaysia
In Malaysia, onset of dengue infection was dated back in the year 1901 following transmission from Singapore to Penang. First epidemic outbreak was then alarmed in 1973, recording a total of 969 cases and 54 deaths. The average number of dengue cases and death tolls had recorded a surge of 14% and 8%, respectively per annum, over the years of 2000–2010. Even worse, Malaysia had suffered an increment of 250% infections in 2014. Based on the latest record, a total number of 59,866 dengue cases and 165 deaths had been reported in the first half of 2015.
Dengue in Sri Lanka
Sri Lanka has been affected by dengue viral infection for over two decades. Dengue infections have been endemic in Sri Lanka since the mid-1960s. The presence of dengue hemorrhagic fever (DF) in all of the major towns situated below 1200 m elevation was confirmed in 1966 and in 19761978. In Sri Lanka, although the highest incidence of dengue fever is seen in the Western Province (44.9% in 2007), there has been a dramatic increase in the incidence in all other provinces. In the recent past, the incidence of dengue has been more marked in the North Central Province (11.8% in 2007 vs. 4.8% in 2004), Wayamba Province (15.9% in 2007 vs. 10.2% in 2004), and Sabaragamuwa Province (12.2% in 2007 vs. 6% in 2004 (Epidemiology Unit, Ministry of Health, Sri Lanka).,
Dengue in other Asian country
In Indonesia, the number of reported dengue cases started to rise from 2004, reaching a plateau between 2007 and 2009 and is following an endemic pattern. In other countries such as Bangladesh, Myanmar, and the Maldives, dengue viral infection follows an endemic pattern.
The repeated epidemics of dengue have been reported from several Asian countries, with rising numbers of cases from the 1950s through the 1970s. Increases in disease transmission and the frequency of epidemics have also been the result of circulation of multiple serotypes in Asia. Thirty-five nearly 75% of the current global disease burden due to dengue viruses is reported in the Southeast Asia region together with Western Pacific region. Until 2003, only eight countries in the region had reported dengue cases. By 2009, all affiliate states apart from the democratic peoples' Republic of Korea had reported dengue outbreaks. Korea is the only country in the Southeast Asia region that has no reports of indigenous spread of dengue. Bhutan also reported its first dengue outbreak in 2004. Nepal reported its first indigenous case of DF in November 2004.,
| Conclusion|| |
We can tell an increasing trend of dengue virus infection affecting the young adolescents and females. As most cases were reported during the postmonsoon period, in the absent of protective vaccine persistent and effective measures must be taken to control the transmitting vectors to prevent dengue outbreaks or else in the near future, it will be difficult to control such infection.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dar L, Gupta E, Narang P, Broor S. Co-circulation of dengue serotypes, Delhi, India. Emerg Infect Dis 2006;12:352-3.
Ahmed NH, Broor S. Dengue fever outbreak in Delhi, North India: A clinico-epidemiological study. Indian J Community Med 2015;40:135-8.
] [Full text]
Mishra G, Jain A, Prakash O, Prakash S, Kumar R, Garg RK, et al.
Molecular characterization of dengue viruses circulating during 2009-2012 in Uttar Pradesh, India. J Med Virol 2015;87:68-75.
Gupta E, Mohan S, Bajpai M, Choudhary A, Singh G. Circulation of dengue virus-1 (DENV-1) serotype in Delhi, during 2010-11 after dengue virus-3 (DENV-3) predominance: A single centre hospital-based study. J Vector Borne Dis 2012;49:82-5. [Full text]
Dar L, Broor S, Sengupta S, Xess I, Seth P. The first major outbreak of dengue hemorrhagic fever in Delhi, India. Emerg Infect Dis 1999;5:589-90.
Agarwal R, Kapoor S, Nagar R, Misra A, Tandon R, Mathur A, et al.
A clinical study of the patients with dengue hemorrhagic fever during the epidemic of 1996 at Lucknow, India. Southeast Asian J Trop Med Public Health 1999;30:735-40.
Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al
. The global distribution and burden of dengue. Nature 2013;496:504-7.
Gupta E, Dar L, Narang P, Srivastava VK, Broor S. Serodiagnosis of dengue during an outbreak at a tertiary care hospital in Delhi. Indian J Med Res 2005;121:36-8.
Ukey P, Bondade S, Paunipagar P, Powar R, Akulwar S. Study of seroprevalence of dengue fever in central India. Indian J Community Med 2010;35:517-9.
] [Full text]
Garg A, Garg J, Rao YK, Upadhyay GC, Sakhuja S. Prevalence of dengue among clinically suspected febrile episodes at a teaching hospital in North India. J Infect Dis Immun 2011;3:85-9.
Kumar A, Rao CR, Pandit V, Shetty S, Bammigatti C, Samarasinghe CM, et al.
Clinical manifestations and trend of dengue cases admitted in a tertiary care hospital, Udupi district, Karnataka. Indian J Community Med 2010;35:386-90.
] [Full text]
Gunasekaran P, Kaveri K, Mohana S, Arunagiri K, Babu BV, Priya PP, et al.
Dengue disease status in Chennai (2006-2008): A retrospective analysis. Indian J Med Res 2011;133:322-5.
] [Full text]
Chakravarti A, Kumaria R. Eco-epidemiological analysis of 17 dengue infection during an outbreak of dengue fever, India. Virol J 2005;2:32.
Amarasinghe A, Kuritsky NJ, Letson WG, Margolis SH. Dengue virus infection in Africa. Emerg Infect Dis 2017;17:1349-54.
Pinheiro F, Nelson M. Re-emergence of dengue and emergence of dengue hemorrhagic fever in the Americas. Dengue Bull 1997;21:16-24.
Nogueira RM, de Araújo JM, Schatzmayr HG. Dengue viruses in Brazil, 1986-2006. Rev Panam Salud Publica 2007;22:358-63.
Daumas RP, Passos SR, Oliveira RV, Nogueira RM, Georg I, Marzochi KB, et al.
Clinical and laboratory features that discriminate dengue from other febrile illnesses: A diagnostic accuracy study in Rio de Janeiro, Brazil. BMC Infect Dis 2013;13:77.
dos Santos FB, Nogueira FB, Castro MG, Nunes PC, de Filippis AM, Faria NR, et al.
First report of multiple lineages of dengue viruses type 1 in Rio de Janeiro, Brazil. Virol J 2011;8:387.
Dettogni RS, Louro ID. Phylogenetic characterization of dengue virus type 2 in Espírito Santo, Brazil. Mol Biol Rep 2012;39:71-80.
Fakeeh M, Zaki AM. Virologic and serologic surveillance for dengue fever in Jeddah, Saudi Arabia, 1994-1999. Am J Trop Med Hyg 2001;65:764-7.
Khan NA, Azhar EI, El-Fiky S, Madani HH, Abuljadial MA, Ashshi AM, et al.
Clinical profile and outcome of hospitalized patients during first outbreak of dengue in Makkah, Saudi Arabia. Acta Trop 2008;105:39-44.
Ministry of Health, Department of Statistics. Health Statistical Year Book 2009. Riyadh, KSA: Saudi Ministry of Health; 2010.
Alhaeli A, Bahkali S, Ali A, Househ MS, El-Metwally AA. The epidemiology of dengue fever in Saudi Arabia: A systematic review. J Infect Public Health 2016;9:117-24.
Skae FM. Dengue fever in Penang. Br Med J 1902;2:1581-2.
Wallace HG, Lim TW, Rudnick A, Knudsen AB, Cheong WH, Chew V, et al.
Dengue hemorrhagic fever in Malaysia: The 1973 epidemic. Southeast Asian J Trop Med Public Health 1980;11:1-13.
Mia MS, Begum RA, Er AC, Abidin RD, Pereira JJ. Trends of dengue infections in Malaysia, 2000-2010. Asian Pac J Trop Med 2013;6:462-6.
Pang EL, Loh HS. Current perspectives on dengue episode in Malaysia. Asian Pac J Trop Med 2016;9:395-401.
Arthropod-borne and rodent-borne viral diseases. Report of a WHO scientific group. World Health Organ Tech Rep Ser 1985;719:1-116.
Sirisena PD, Noordeen F. Evolution of dengue in Sri Lanka-changes in the virus, vector, and climate. Int J Infect Dis 2014;19:6-12.
Dorji T, Yoon IK, Holmes EC, Wangchuk S, Tobgay T, Nisalak A, et al.
Diversity and origin of dengue virus serotypes 1, 2, and 3, Bhutan. Emerg Infect Dis 2009;15:1630-2.