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Zohra T, Din M, Ikram A, Bashir A, Jahangir H, Baloch IS, Irshad S, Waris A, Salman M, Iqtadar S, Ayaz M. Demographic and clinical features of dengue fever infection in Pakistan: a cross-sectional epidemiological study. Trop Dis Travel Med Vaccines 2024; 10:11. [PMID: 38581059 PMCID: PMC10998367 DOI: 10.1186/s40794-024-00221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/26/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Dengue fever caused by dengue virus is a tropical disease and is among the deadliest vector-borne diseases. The humid and hot summers of Pakistan support the probation of the vectors responsible for the transmission of viral and other parasitic diseases. METHODOLOGY A retrospective study, from 2012- 2019, of dengue infected individuals from the Punjab province of Pakistan was carried out to analyze epidemiology, clinical and laboratory findings of subjects with dengue virus infection. Data was derived from National Institute of Health (NIH) followed by Dengue control program of Pakistan, covering the incidence rate in 36 districts of Punjab and Islamabad Capital Territory (ICT) respectively. Patients data including the presence of dengue specific antigen or/and antibodies such as NS1 and IgG/IgM were observed. The study also included the analysis of demographic data, geographic data, and the month-wise distribution of dengue cases to examine seasonal trends. RESULTS We analyzed 25,682 dengue infected individuals. The statistical analysis revealed a significant association between genders in which male population was more affected by dengue than females. It was also noted that the middle age group was the most affected age group while the highest number of cases were reported in October. Rawalpindi and Lahore were the most affected cities in Punjab province while Islamabad represented the highest number of cases during the recent outbreak in 2019. The IgM and IgG antibodies were highly prevalent among the infected patients. CONCLUSION Dengue is endemic in Pakistan, circulating throughout the year. Highest number of cases were observed in the month of October, September and November respectively. Association between climate change and vector-borne diseases need to be investigated in Pakistan as they significantly influence the timing and intensity of dengue and other disease outbreaks. Further exploration of hematological parameters is required to better diagnose and treat the disease. For the effective control of dengue outbreaks, awareness campaigns on sewage management and vector control along with social factors are strongly recommended for better control and eradication of the disease.
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Affiliation(s)
- Tanzeel Zohra
- National Institutes of Health, Islamabad, 45500, Pakistan.
| | - Misbahud Din
- Quaid-I-Azam University, Islamabad, 45320, Pakistan
| | - Aamer Ikram
- National Institutes of Health, Islamabad, 45500, Pakistan
| | - Adnan Bashir
- Health Information Systems Program, Islamabad, Pakistan
| | - Haroon Jahangir
- Primary and Secondary Healthcare Department, Government of Punjab, Lahore, Pakistan
| | | | - Sundas Irshad
- Primary and Secondary Healthcare Department, Government of Punjab, Lahore, Pakistan
| | - Abdul Waris
- Quaid-I-Azam University, Islamabad, 45320, Pakistan
| | | | - Somia Iqtadar
- Dengue Expert Advisory Group Punjab, King Edward Medical University, Lahore, 54000, Pakistan
| | - Muhammad Ayaz
- Department of Pharmacy, University of Malakand Khyber, Chakdara, 18800, Pakistan.
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Sajid M, Tur Razia I, Kanwal A, Ahsan M, Tahir RA, Sajid M, Khan MS, Mukhtar N, Parveen G, Sehgal SA. Computational Advancement towards the Identification of Natural Inhibitors for Dengue Virus: A Brief Review. Comb Chem High Throughput Screen 2024; 27:2464-2484. [PMID: 37859315 DOI: 10.2174/0113862073244468230921050703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/19/2023] [Accepted: 08/03/2023] [Indexed: 10/21/2023]
Abstract
Viral infectious illnesses represent a severe hazard to human health due to their widespread incidence worldwide. Among these ailments, the dengue virus (DENV) infection stands out. World Health Organization (WHO) estimates that DENV infection affects ~400 million people each year, with potentially fatal symptoms showing up in 1% of the cases. In several instances, academic and pharmaceutical researchers have conducted several pilot and clinical studies on a variety of topics, including viral epidemiology, structure and function analyses, infection source and route, therapeutic targets, vaccinations, and therapeutic drugs. Amongst Takeda, TAK-003, Sanofi, Dengvaxia®, and Butantan/NIH/Merck, Dengvaxia® (CYD-TDV) is the only licensed vaccination yet; however, the potential inhibitors are under development. The biology and evolution of DENVs are briefly discussed in this review, which also compiles the most recent studies on prospective antiviral targets and antiviral candidates. In conclusion, the triumphs and failures have influenced the development of anti-DENV medications, and the findings in this review article will stimulate more investigation.
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Affiliation(s)
- Muhammad Sajid
- Department of Biotechnology, University of Okara, Okara, Punjab, Pakistan
| | - Iashia Tur Razia
- Department of Biotechnology, University of Okara, Okara, Punjab, Pakistan
| | - Ayesha Kanwal
- Department of Biotechnology, University of Okara, Okara, Punjab, Pakistan
| | - Muhammad Ahsan
- Institute of Environmental and Agricultural Sciences, University of Okara, Okara, Punjab, Pakistan
| | - Rana Adnan Tahir
- Department of Biosciences, COMSATS University Islamabad, Sahiwal Campus, Sahiwal, Punjab, Pakistan
| | - Muhammad Sajid
- Department of Biotechnology, University of Okara, Okara, Punjab, Pakistan
| | | | - Naila Mukhtar
- Department of Botany, University of Okara, Okara, Punjab, Pakistan
| | - Gulnaz Parveen
- Department of Botany, Women University Swabi, Swabi, KPK, Pakistan
| | - Sheikh Arslan Sehgal
- Department of Bioinformatics, Institute of Biochemistry, Biotechnology, and Bioinformatics, The Islamia University of Bahawalpur, Punjab, Pakistan
- Department of Bioinformatics, University of Okara, Okara, Punjab, Pakistan
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Saeed A, Ali S, Khan F, Muhammad S, Reboita MS, Khan AW, Goheer MA, Khan MA, Kumar R, Ikram A, Jabeen A, Pongpanich S. Modelling the impact of climate change on dengue outbreaks and future spatiotemporal shift in Pakistan. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2023; 45:3489-3505. [PMID: 36367603 DOI: 10.1007/s10653-022-01429-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/31/2022] [Indexed: 06/01/2023]
Abstract
Climate change has a significant impact on the intensity and spread of dengue outbreaks. The objective of this study is to assess the number of dengue transmission suitable days (DTSD) in Pakistan for the baseline (1976-2005) and future (2006-2035, 2041-2070, and 2071-2099) periods under Representative Concentration Pathway (RCP4.5 and RCP8.5) scenarios. Moreover, potential spatiotemporal shift and future hotspots of DTSD due to climate change were also identified. The analysis is based on fourteen CMIP5 models that have been downscaled and bias-corrected with quantile delta mapping technique, which addresses data stationarity constraints while preserving future climate signal. The results show a higher DTSD during the monsoon season in the baseline in the study area except for Sindh (SN) and South Punjab (SP). In future periods, there is a temporal shift (extension) towards pre- and post-monsoon. During the baseline period, the top ten hotspot cities with a higher frequency of DTSD are Karachi, Hyderabad, Sialkot, Jhelum, Lahore, Islamabad, Balakot, Peshawar, Kohat, and Faisalabad. However, as a result of climate change, there is an elevation-dependent shift in DTSD to high-altitude cities, e.g. in the 2020s, Kotli, Muzaffarabad, and Drosh; in the 2050s, Garhi Dopatta, Quetta, and Zhob; and in the 2080s, Chitral and Bunji. Karachi, Islamabad, and Balakot will remain highly vulnerable to dengue outbreaks for all the future periods of the twenty-first century. Our findings also indicate that DTSD would spread across Pakistan, particularly in areas where we have never seen dengue infections previously. The good news is that the DTSD in current hotspot cities is projected to decrease in the future due to climate change. There is also a temporal shift in the region during the post- and pre-monsoon season, which provides suitable breeding conditions for dengue mosquitos due to freshwater; therefore, local authorities need to take adaption and mitigation actions.
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Affiliation(s)
- Alia Saeed
- Health Services Academy, Islamabad, Pakistan
| | - Shaukat Ali
- Global Change Impact Studies Centre (GCISC), Ministry of Climate Change, Islamabad, Pakistan
| | - Firdos Khan
- School of Natural Sciences (SNS), National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Sher Muhammad
- International Centre for Integrated Mountain Development (ICIMOD), Kathmandu, Nepal
| | | | | | - Muhammad Arif Goheer
- Global Change Impact Studies Centre (GCISC), Ministry of Climate Change, Islamabad, Pakistan
| | | | - Ramesh Kumar
- Health Services Academy, Islamabad, Pakistan.
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand.
| | - Aamer Ikram
- National Institute of Health, Islamabad, Pakistan
| | - Aliya Jabeen
- National Institute of Health, Islamabad, Pakistan
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Khattak A, Khan S, Ali I, Gul A, Khabir MN, Javed B, Adnan M, Khan SN, Attaullah S. Burden and distribution of dengue infection in Pakistan (2000-19): a review. BRAZ J BIOL 2023; 84:e267982. [PMID: 37075435 DOI: 10.1590/1519-6984.267982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/22/2023] [Indexed: 04/21/2023] Open
Abstract
The goal of this study is to review the overall prevalence, burden, and distribution of the dengue disease in Pakistan from 2000 to 2019. Literature was searched using different search engines like Google scholar, PubMed, etc. providing the keywords "Dengue disease/infection, Dengue virus, DENV, DF/DHF/ DSS Pakistan". All the published research papers/reports on the dengue virus over the period 2000 to 2019 were studied and selected data were summarized using MS Excel for windows such as total cases, age wise, gender, DENV serotype distribution, total DHF, and DSS patients. The literature providing insufficient data was excluded. The total number of cases reported during 2000-19 were 201,269. The maximum number of cases during the mentioned literature survey period was reported in Khyber Pakhtunkhwa (KP) (23.3%) followed by Punjab (3.8%) and Sindh (1.9%). The majority of dengue-infected cases were reported as Dengue fever (74.4%) followed by DHF (24.1%) and DSS (1.5%). Overall the deaths during the mentioned literature survey were 1082, of which the maximum mortalities were reported from KP (N=248) followed by Punjab (N=220). DENV remains a major public health problem in Pakistan and seems to remain endemic for a long time. The total prevalence of dengue infection is increased accordingly with time from 2000 to 2019. Moreover, all the four serotypes exist in Pakistan with increased mortalities.
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Affiliation(s)
- A Khattak
- University of Peshawar, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - S Khan
- University of Peshawar, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - I Ali
- Gulf University for Science and Technology, Center for Applied Mathematics and Bioinformatics, Mubarak Al-Abdullah, Kuwait
- COMSATS University, Department of Biosciences, Islamabad, Pakistan
| | - A Gul
- University of Peshawar, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - M N Khabir
- University of Peshawar, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - B Javed
- University of Peshawar, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - M Adnan
- University of Peshawar, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - S N Khan
- Kohat University of Science and Technology, Department of Zoology, Kohat, Pakistan
| | - S Attaullah
- Islamia College Peshawar, Department of Zoology, Peshawar, Pakistan
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Ali A, Nisar S, Khan MA, Mohsan SAH, Noor F, Mostafa H, Marey M. A Privacy-Preserved Internet-of-Medical-Things Scheme for Eradication and Control of Dengue Using UAV. MICROMACHINES 2022; 13:1702. [PMID: 36296055 PMCID: PMC9609698 DOI: 10.3390/mi13101702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/30/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
Dengue is a mosquito-borne viral infection, found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas. Countries like Pakistan receive heavy rains annually resulting in floods in urban cities due to poor drainage systems. Currently, different cities of Pakistan are at high risk of dengue outbreaks, as multiple dengue cases have been reported due to poor flood control and drainage systems. After heavy rain in urban areas, mosquitoes are provided with a favorable environment for their breeding and transmission through stagnant water due to poor maintenance of the drainage system. The history of the dengue virus in Pakistan shows that there is a closed relationship between dengue outbreaks and a rainfall. There is no specific treatment for dengue; however, the outbreak can be controlled through internet of medical things (IoMT). In this paper, we propose a novel privacy-preserved IoMT model to control dengue virus outbreaks by tracking dengue virus-infected patients based on bedding location extracted using call data record analysis (CDRA). Once the bedding location of the patient is identified, then the actual infected spot can be easily located by using geographic information system mapping. Once the targeted spots are identified, then it is very easy to eliminate the dengue by spraying the affected areas with the help of unmanned aerial vehicles (UAVs). The proposed model identifies the targeted spots up to 100%, based on the bedding location of the patient using CDRA.
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Affiliation(s)
- Amir Ali
- Military College of Signals (MCS), National University of Sciences and Technology, Islamabad 44000, Pakistan
| | - Shibli Nisar
- Military College of Signals (MCS), National University of Sciences and Technology, Islamabad 44000, Pakistan
| | - Muhammad Asghar Khan
- Department of Electrical Engineering, Hamdard University, Islamabad 44000, Pakistan
- Smart Systems Engineering Laboratory, College of Engineering, Prince Sultan University, Riyadh 11586, Saudi Arabia
| | | | - Fazal Noor
- Faculty of Computer and Information Systems, Islamic University of Madinah, Madinah 400411, Saudi Arabia
| | - Hala Mostafa
- Department of Information Technology, College of Computer and Information Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Mohamed Marey
- Smart Systems Engineering Laboratory, College of Engineering, Prince Sultan University, Riyadh 11586, Saudi Arabia
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Khan J, Adil M, Wang G, Tsheten T, Zhang D, Pan W, Khan MA, Rehman IU, Zheng X, Wu Z, Wu Y. A cross-sectional study to assess the epidemiological situation and associated risk factors of dengue fever; knowledge, attitudes, and practices about dengue prevention in Khyber Pakhtunkhwa Province, Pakistan. Front Public Health 2022; 10:923277. [PMID: 35968472 PMCID: PMC9372552 DOI: 10.3389/fpubh.2022.923277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background Dengue fever has been responsible for around 12 countrywide large outbreaks in Pakistan, resulting in 286,262 morbidities and 1,108 deaths. Khyber Pakhtunkhwa (KP) is the most recently impacted province. This study aimed to investigate the molecular, epidemiological, and potential elements that contribute to increasing dengue transmission patterns, and knowledge, attitude, and practice (KAP) toward dengue in KP province. Method This cross-sectional community-based study was conducted (June-December, 2021) in two phases. Phase I involved the epidemiological (n = 5,242) and molecular analysis of DENV in 500 randomly collected blood samples of the 2021 dengue outbreak in KP. Phase II focused on assessing dengue-KAP levels in healthy communities (n = 14,745, aged >18 years), adopting a cross-sectional clustered multistage sampling in eight districts (dengue-hotspot vs. non-hotspot) of KP. Chi-square tests and logistic regression analysis were applied. Results Peshawar district had the highest dengue cases (60.0%) associated with the predominant co-circulation of DENV-2 (45.8%) and DENV-3 (50.4%) serotypes. A rise in cases was reported in October (41.8%) followed by September (27.9%) and August (14.4%; p < 0.001). Males (63.7%, p < 0.001) and individuals aged 16–30 years (37.0%, p < 0.001) were highly affected. General workers (18.0%), families with a monthly income of 10,000–20,000 Pak rupees (50.5%), unmarried (71.0%), uneducated (31%), families with higher human density (>10 individuals per household), and those (29.0%) who faced power outages for more than 7/24 h were the most affected. Moreover, co-morbidities like renal failure and bronchial asthma were associated with disease severity. A community survey on KAP revealed that an average of 74, 60, and 43% of the participants demonstrated good knowledge, attitudes, and dengue preventive practices, respectively. Conclusion Multiple poor socioeconomic elements are influencing dengue fever transmission in the province. Higher KAP levels may explain the low frequency of dengue in non-hotspot districts. Our study emphasizes the need for effective and long-term public health education, strengthened vector surveillance, and expanded laboratory capacity for better diagnosis and management of dengue cases to better predict the burden and seasonality of disease in the country.
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Affiliation(s)
- Jehangir Khan
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Disease Control of the Ministry of Education, Sun Yat-sen University-Michigan State University Joint Center of Vector Control for Tropical Disease, Zhongshan School of Medicine, Guangzhou, China
- Chinese Atomic Energy Agency Center of Excellence on Nuclear Technology Applications for Insect Control, Sun Yat-sen University, Guangzhou, China
- Department of Zoology, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | | | - Gang Wang
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Disease Control of the Ministry of Education, Sun Yat-sen University-Michigan State University Joint Center of Vector Control for Tropical Disease, Zhongshan School of Medicine, Guangzhou, China
- Chinese Atomic Energy Agency Center of Excellence on Nuclear Technology Applications for Insect Control, Sun Yat-sen University, Guangzhou, China
| | - Tsheten Tsheten
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
- Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan
| | - Dongjing Zhang
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Disease Control of the Ministry of Education, Sun Yat-sen University-Michigan State University Joint Center of Vector Control for Tropical Disease, Zhongshan School of Medicine, Guangzhou, China
- Chinese Atomic Energy Agency Center of Excellence on Nuclear Technology Applications for Insect Control, Sun Yat-sen University, Guangzhou, China
| | - Wenjie Pan
- Guangzhou SYSU Nuclear and Insect Biotechnology Co., Ltd., Guangzhou, China
| | - Munir Ahmad Khan
- Medical Unit, Khyber Teaching Hospital Peshawar, Peshawar, Pakistan
| | - Inayat ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Xiaoying Zheng
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Disease Control of the Ministry of Education, Sun Yat-sen University-Michigan State University Joint Center of Vector Control for Tropical Disease, Zhongshan School of Medicine, Guangzhou, China
- Chinese Atomic Energy Agency Center of Excellence on Nuclear Technology Applications for Insect Control, Sun Yat-sen University, Guangzhou, China
| | - Zhongdao Wu
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Disease Control of the Ministry of Education, Sun Yat-sen University-Michigan State University Joint Center of Vector Control for Tropical Disease, Zhongshan School of Medicine, Guangzhou, China
- Chinese Atomic Energy Agency Center of Excellence on Nuclear Technology Applications for Insect Control, Sun Yat-sen University, Guangzhou, China
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
- *Correspondence: Zhongdao Wu
| | - Yu Wu
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Disease Control of the Ministry of Education, Sun Yat-sen University-Michigan State University Joint Center of Vector Control for Tropical Disease, Zhongshan School of Medicine, Guangzhou, China
- Chinese Atomic Energy Agency Center of Excellence on Nuclear Technology Applications for Insect Control, Sun Yat-sen University, Guangzhou, China
- Yu Wu
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Dengue and Chikungunya virus co-infection in major metropolitan cities of provinces of Punjab and Khyber Pakhtunkhwa: A multi-center study. PLoS Negl Trop Dis 2021; 15:e0009802. [PMID: 34555034 PMCID: PMC8491885 DOI: 10.1371/journal.pntd.0009802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 10/05/2021] [Accepted: 09/09/2021] [Indexed: 11/19/2022] Open
Abstract
Dengue has become endemic in Pakistan with annual recurrence. A sudden increase in the dengue cases was reported from Rawalpindi in 2016, while an outbreak occurred for the first time in Peshawar in 2017. Therefore, a multi-center study was carried out to determine the circulating dengue virus (DENV) serotypes and Chikungunya virus (CHIKV) co-infection in Lahore, Rawalpindi, and Peshawar cities in 2016–18. A hospital-based cross-sectional study was carried out in Lahore and Rawalpindi in 2016–18, while a community-based study was carried out in Peshawar in 2017. The study participants were tested for dengue NS1 antigen using an immunochromatographic device while anti-dengue IgM/IgG antibodies were detected by indirect ELISA. All NS1 positive samples were used for DENV serotyping using multiplex real-time PCR assay. Additionally, dengue samples were tested for CHIKV co-infection using IgM/IgG ELISA. A total of 6291 samples were collected among which 8.11% were NS1 positive while 2.5% were PCR positive. DENV-2 was the most common serotype (75.5%) detected, followed by DENV-1 in 16.1%, DENV-3 in 3.9% and DENV-4 in 0.7% while DENV-1 and DENV-4 concurrent infections were detected in 3.9% samples. DENV-1 was the predominant serotype (62.5%) detected from Lahore and Rawalpindi, while DENV-2 was the only serotype detected from Peshawar. Comorbidities resulted in a significant increase (p-value<0.001) in the duration of hospital stay of the patients. Type 2 diabetes mellitus substantially (p-value = 0.004) contributed to the severity of the disease. Among a total of 590 dengue positive samples, 11.8% were also positive for CHIKV co-infection. Co-circulation of multiple DENV serotypes and CHIKV infection in Pakistan is a worrisome situation demanding the urgent attention of the public health experts to strengthen vector surveillance. Mosquitoes are responsible for the transmission of many different types of infectious pathogens and parasites to humans. Some of these pathogens include viruses like dengue and chikungunya viruses which cause diseases in humans. Dengue virus has four different types (1, 2, 3, and 4) present in nature. In this study, we detected all four dengue virus types in hospitalized patients in Lahore and Rawalpindi. While only dengue virus type-2 was detected from Peshawar city. The secondary infections with different dengue virus types than the previous one might result in a more severe form of the disease. Therefore, the population of Peshawar is at risk of developing a severe form of dengue fever in the future in case of infection from another dengue virus type. The data of hospitalized patients showed that other diseases in addition to dengue fever result in an increased hospital stay. Comorbidities like diabetes also increase the risk of developing a more severe form of dengue fever. Combined infections of both dengue and chikungunya viruses were detected from Lahore, Rawalpindi, and Peshawar. The transmission of dengue and chikungunya viruses and the co-circulation of multiple dengue virus types not only impose public health burden but also result in economic losses.
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Ahmad N, Khan T, Jamal SM. A Comprehensive Study of Dengue Epidemics and Persistence of Anti-Dengue Virus Antibodies in District Swat, Pakistan. Intervirology 2020; 63:46-56. [PMID: 33049733 DOI: 10.1159/000510347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dengue fever is one of the most common human arbovirus infections worldwide. In Pakistan, dengue initially became endemic in the big cities and then expanded to remote areas of the country. The current study reports the dengue epidemics, anti-DENV antibodies prevalence during the active and post-dengue infection, risk factors, disease symptoms, and spotting dengue infection densities in district Swat of Pakistan. METHODS Clinical signs and demographic data of dengue suspected individuals were collected at the time of screening through non-structural protein-1 antigen detection test during 2013-2015. Moreover, selected dengue confirmed individuals were screened for the presence of anti-dengue immunoglobulin (Ig) M and G during the active infection period and post-dengue infection. RESULTS A total of 8,770 individuals were infected with dengue in 2013 with 36 (0.41%) case fatalities, 307 in 2014 with no case fatality, and 13 in 2015 with no case fatality. The number of male and female cases were 6,139 and 2,631 in 2013, 183 and 124 in 2014, and only 10 and 3 in 2015, respectively. Among all the localities, Tehsil Babozai, an urban setting, reported the highest number of dengue patients during all the study years, that is, 7,673 (87.49% of the total cases) in 2013, 294 (95.76% of the total cases) in 2014, and 13 (100% cases) in 2015. Among 6 age groups, 21-30 years was found to be highly infected in 2013 (37.13% of all cases) and 2014 (33.55%). Furthermore, 1,231 (21.94% of all cases) had IgM antibodies and 71 (1.26%) had IgG antibodies in 2013, 78 (26% of all cases) had IgM antibodies and 7 (2.33%) had IgG antibodies in 2014, and only 4 (30.76%) patients had IgM and 0 (0%) had IgG antibodies in 2015. Furthermore, urban areas had the highest infection density in district Swat. The majority of the patients in rural areas had a traveling history to the urban areas before their illness. CONCLUSION To sum up, male gender, young individuals, and those living in urban areas were at the greater risk of dengue infection.
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Affiliation(s)
- Naveed Ahmad
- Department of Biotechnology, University of Malakand, Chakdara, Pakistan
| | - Tariq Khan
- Department of Biotechnology, University of Malakand, Chakdara, Pakistan
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Din M, Asghar M, Ali M. COVID-19 and dengue coepidemics: A double trouble for overburdened health systems in developing countries. J Med Virol 2020; 93:601-602. [PMID: 32706408 PMCID: PMC7404527 DOI: 10.1002/jmv.26348] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/22/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Misbahud Din
- Department of Biotechnology, Quaid-i-Azam University Islamabad, Islamabad, Pakistan
| | - Madiha Asghar
- Department of Biotechnology, Quaid-i-Azam University Islamabad, Islamabad, Pakistan
| | - Muhammad Ali
- Department of Biotechnology, Quaid-i-Azam University Islamabad, Islamabad, Pakistan
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10
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Haqqi A, Awan UA, Ali M, Saqib MAN, Ahmed H, Afzal MS. COVID-19 and dengue virus coepidemics in Pakistan: A dangerous combination for an overburdened healthcare system. J Med Virol 2020; 93:80-82. [PMID: 32510175 PMCID: PMC7300443 DOI: 10.1002/jmv.26144] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Aleena Haqqi
- Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Pakistan
| | - Usman Ayub Awan
- Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Pakistan
| | - Muhammad Ali
- Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Pakistan
| | - Muhammad Arif Nadeem Saqib
- Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Pakistan
| | - Haroon Ahmed
- Department of Biosciences, COMSATS University, Islamabad, Pakistan
| | - Muhammad Sohail Afzal
- Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Pakistan
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Khan E, Prakoso D, Imtiaz K, Malik F, Farooqi JQ, Long MT, Barr KL. The Clinical Features of Co-circulating Dengue Viruses and the Absence of Dengue Hemorrhagic Fever in Pakistan. Front Public Health 2020; 8:287. [PMID: 32626679 PMCID: PMC7311566 DOI: 10.3389/fpubh.2020.00287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022] Open
Abstract
Dengue virus (DENV) is the most common and widespread arboviral infection worldwide. Though all four DENV serotypes cocirculate in nature, the clinicopathological framework of these serotypes is undefined in Pakistan. A cross-sectional, observational study was performed to document the circulation of various arboviruses in the Sindh region of Pakistan. Here we describe a population of patients diagnosed with DENV spanning a 2-year period. This study used an orthogonal system of NS1 antigen ELISA followed by RT-PCR for DENV detection and subtyping. A total of 168 NS1 positive patients were evaluated of which 91 patients were serotyped via RT-PCR. There was no significant difference between sex or age for infection risk and peak transmission occurred during the Autumn months. DENV2 was the most common serotype followed by DENV1 then DENV3, then DENV4. The data show that DENV1 patients were more likely to have abnormal liver function tests; DENV2 infected patients were more likely to exhibit arthralgia and neurological symptoms; DENV3 patients were more likely to complain of burning micturition and have elevated lymphocyte counts and low hematocrit; and DENV4 patients were more likely to report headaches and rash. Notably, no dengue hemorrhagic fever or other manifestations of severe dengue fever were present in patients with primary or secondary infections. We were able to identify significantly more NS1 antigen positive patients than RT-PCR. This study demonstrates that all four DENV serotypes are co-circulating and co-infecting in Pakistan.
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Affiliation(s)
- Erum Khan
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Aga Khan University, Karachi, Pakistan
| | - Dhani Prakoso
- Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Kehkashan Imtiaz
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Aga Khan University, Karachi, Pakistan
| | - Faisal Malik
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Aga Khan University, Karachi, Pakistan
| | - Joveria Q Farooqi
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Aga Khan University, Karachi, Pakistan
| | - Maureen T Long
- Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Kelli L Barr
- Department of Biology, Baylor University, Waco, TX, United States
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Ali A, Fatima Z, Wahid B, Rafique S, Idrees M. Cosmopolitan A1 lineage of dengue virus serotype 2 is circulating in Pakistan: A study from 2017 dengue viral outbreak. J Med Virol 2019; 91:1909-1917. [PMID: 31273791 DOI: 10.1002/jmv.25537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 05/14/2019] [Indexed: 11/10/2022]
Abstract
Dengue viral infection has become a challenge in tropical and subtropical countries where dengue virus is endemic. Its epidemics are occurring at higher rates amid its circulation throughout the year. Since the first documented outbreak in Pakistan in 1994, this region has reported many sporadic cases and epidemics. There is availability of small scale demographic and epidemiological studies on dengue viral infection in Pakistan. The year 2017 witnessed a huge dengue outbreak in Peshawar city of Pakistan with 69 deaths and 24 807 laboratory-confirmed cases. We suspect that the circulation of a different lineage or genotype could be responsible for the enhanced number of infected patients in Pakistan's 2017 outbreak since previous studies have already described this phenomenon in other countries. For this, we collected 1447 suspected blood samples and their epidemiological data. After serotyping through polymerase chain reaction nine samples of Dengue virus2 (DENV2) were randomly selected and were subjected to Sanger's sequencing for genotyping analysis. The mean distance, genetic diversity, and phylogenetic analysis were carried out using K2 model. The phylogenetic analysis split Pakistani isolates into two lineages, the sequences from 2017 outbreak in Peshawar grouped within A1 lineage of cosmopolitan genotype (IV) of DENV2. The difference in distance, genetic diversity, and amino acids composition strongly back the results that the new lineage is circulating in the region. This is significant as Pakistan is struggling to control dengue epidemics which have caused much loss in both monetary and health sectors.
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Affiliation(s)
- Amjad Ali
- Department of Genetics, Hazara University, Mansehra, Khyber Pakhtunkhwa, Pakistan.,Molecular Virology Laboratory, Centre for Applied Molecular Biology (CAMB), University of the Punjab, Lahore, Pakistan
| | - Zareen Fatima
- Department of Biological Sciences, International Islamic University, Islamabad, Pakistan
| | - Braira Wahid
- Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Pakistan
| | - Shazia Rafique
- Divison of Virology, Center of Excellence in Molecular Biology (CEMB), University of the Punjab, Lahore, Pakistan
| | - Muhammad Idrees
- Divison of Virology, Center of Excellence in Molecular Biology (CEMB), University of the Punjab, Lahore, Pakistan.,Hazara University, Mansehra, Pakistan
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Khan H, Ahmad I. DENGUE EPIDEMIC APPREHENDED IN PAKISTAN: KNOWLEDGE AND PREVENTIVE MEASURES CAN AVERT IT. GOMAL JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.46903/gjms/17.01.2014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Dengue fever (DF) is a viral disease transmitted by Aedes aegypti and Aedes albopictus mosquitoes. Dengue virus (DENV) has four subtypes or serotypes i.e. DENV-1, DEVNV-2, DENV-3, and DENV-4.1,2 The incubation period is 3 to 14 days. Infection with one subtype confers life-long immunity to that type only. However, infection to other serotype in future may result in more severe disease with increased chances of serious complications.1 The disease affects some 50-100 million people worldwide every year. Out of whom about 1-2% patients develop its serious complications like dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), resulting in about 22,000 deaths per year. Dengue fever (DF) is endemic in all the regions of Pakistan and 3204 confirmed cases of dengue fever were reported during 2018.3-5 Pakistan has seen dengue epidemics in the past and such epidemics are always apprehended from August to October every year because of favourable seasonal conditions for its vector to flourish. Dengue epidemics are really like a nightmare and timely measures against the culprit mosquitoes is the only way to avoid these epidemics. The Field Epidemiology & Disease Surveillance Division of Ministry of National Health Services, Regulations & Coordination has issued an advisory for the prevention and control of Dengue fever, has timely issued the guidelines for the year 2019.3,6,7 Early identification and good clinical management are important to reduce its mortality.3 A study from D.I.Khan of Khyber Pukhtunkhwa province has shown that knowledge regarding the DF is low and the public needs to be educated about dengue disease and its prevention utilizing all the sources of information employing mass media, print as well as electronic.3,8 The health departments of both the Federal and Provincial Governments are leaving no stone unturned to increase the public awareness. The academia is also motivated to have research and write on this topic to further enhance the knowledge so that we see the preventive efforts in the practice among the masses.
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Cloning and Expression of NS3 Gene of Pakistani Isolate Type 2 Dengue Virus. J Vet Res 2018; 62:17-26. [PMID: 29978123 PMCID: PMC5957457 DOI: 10.2478/jvetres-2018-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/08/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction Dengue is one of the major emerging viral diseases in the world, with dramatic increases in reported cases in the last few decades and annual worldwide occurrence of approximately 390 million infections. It is a highly important mosquito-vectored disease and is a problem in tropical and subtropical areas of the world. The major aim of this study was to clone and express the dengue NS3 gene, in service to its therapeutic importance for the development of stable cell lines. Material and Methods Blood samples from dengue fever (DF) patients were collected and subjected to PCR amplification of the NS3 gene of dengue virus serotype-2 (DENV-2). The NS3 gene was amplified using gene specific primers and cloned in the TA cloning vectors. Results The gene was successfully expressed in mammalian expression vector pcDNA3.1. The current finding was different from a previously reported DENV-2 strain replicon constructed in different cells, in which the whole genetic material of the virus was used instead of an active protease gene, and which gave a low yield of replicon expressing cells. Conclusion Recombinant NS3 could be used to produce an antibody that is possibly helpful for developing a single step diagnostic assay to detect the dengue virus NS3 antigen in sera of dengue patients.
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Atique S, Chan TC, Chen CC, Hsu CY, Iqtidar S, Louis VR, Shabbir SA, Chuang TW. Investigating spatio-temporal distribution and diffusion patterns of the dengue outbreak in Swat, Pakistan. J Infect Public Health 2018; 11:550-557. [PMID: 29287804 DOI: 10.1016/j.jiph.2017.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 11/29/2017] [Accepted: 12/06/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Dengue has been endemic to Pakistan in the last two decades. There was a massive outbreak in the Swat valley in 2013. Here we demonstrate the spatio-temporal clustering and diffusion patterns of the dengue outbreak. METHODS Dengue case data were acquired from the hospital records in the Swat district of Pakistan. Ring maps visualize the distribution and diffusion of the number of cases and incidence of dengue at the level of the union council. We applied space-time scan statistics to identify spatio-temporal clusters. Ordinary least squares and geographically weighted regression models were used to evaluate the impact of elevation, population density, and distance to the river. RESULTS The results show that dengue distribution is not random, but clustered in space and time in the Swat district. Males constituted 68% of the cases while females accounted for about 32%. A majority of the cases (>55%) were younger than 40 years of age. The southern part was a major hotspot affected by the dengue outbreak in 2013. There are two space-time clusters in the spatio-temporal analysis. GWR and OLS show that population density is a significant explanatory variable for the dengue outbreak, while GWR exhibits better performance in terms of 'R2=0.49 and AICc=700'. CONCLUSION Dengue fever is clustered in the southern part of the Swat district. This region is relatively urban in character, with most of the population of the district residing here. There is a need to strengthen the surveillance system for reporting dengue cases in order to respond to future outbreaks in a robust way.
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Affiliation(s)
- Suleman Atique
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Ta-Chien Chan
- Center for Geographic Information Science, Research Center for Humanities and Social Sciences, Academia Sinica, Taiwan
| | - Chien-Chou Chen
- Center for Geographic Information Science, Research Center for Humanities and Social Sciences, Academia Sinica, Taiwan
| | - Chien-Yeh Hsu
- Master's Program in Global Health and Development, Taipei Medical University, Taiwan; Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Somia Iqtidar
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Valérie R Louis
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - Syed A Shabbir
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Ting-Wu Chuang
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Khan J, Khan I, Ghaffar A, Khalid B. Epidemiological trends and risk factors associated with dengue disease in Pakistan (1980-2014): a systematic literature search and analysis. BMC Public Health 2018; 18:745. [PMID: 29907109 PMCID: PMC6003098 DOI: 10.1186/s12889-018-5676-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/05/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Dengue is becoming more common in Pakistan with its alarming spreading rate. A historical review needs to be carried out to find the root causes of dengue dynamics, the factors responsible for its spread and lastly to formulate future strategies for its control. METHODS We searched (January, 2015) all the published literature between 1980 and 2014 to determine spread/burden of dengue disease in Pakistan. RESULTS A total of 81 reports were identified, showing high numbers of dengue cases in 2010, 2011, and 2013. The tendency of dengue to occur in younger than in older age groups was evident throughout the survey period and all four serotypes were recorded, with DENV1 the least common. Most dengue hemorrhagic fever (DHF) cases fell in the 20-45 years age range. High frequencies tended to be observed first in the Southern coastal region characterized by mild winters and humid warm summers and then the disease progressed towards the lowland areas of the Indus plain with cool winters, hot summers and monsoon rainfall. Based on this survey, new risk maps and infection estimates were identified reflecting public health burden imposed by dengue at the national level. CONCLUSIONS Our study showed that dengue is common in the three provinces of Pakistan, i.e., Khyber Pakhtunkhwa (KP), Punjab and Sindh. Based on the literature review as well as on our study analysis the current expansion of dengue seems multifactorial and may include climate change, virus evolution, and societal factors such as rapid urbanization, population growth and development, socioeconomic factors, as well as global travel and trade. Due to inadequate remedial strategies, effective vector control measures are essential to target the dengue vector mosquito where high levels of human-vector contact occur. The known social, economic, and disease burden of dengue is alarming globally and it is evident that the wider impact of this disease is grossly underestimated. An international multi-sectoral response, outlined in the WHO Global Strategy for Dengue Prevention and Control, 2012-2020, is now essential to reduce the significant influence of this disease in Dengue endemic areas. Overall gaps were identified in knowledge around seroprevalence, dengue incidence, vector control, genotype evolution and age-stratified serotype circulation.
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Affiliation(s)
- Jehangir Khan
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080 Guangdong China
- Sun Yat-sen University-Michigan State University Joint Center of Vector Control for Tropical Diseases, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080 Guangdong China
- Department of Zoology, Abdul Wali Khan University Mardan (AWKUM), Mardan, Khyber Pakhtunkhwa Pakistan
- Key Laboratory of Tropical Diseases and Control of the Ministry of Education, Guangzhou, 510080 China
| | - Inamullah Khan
- Nuclear Institute for Food and Agriculture (NIFA), Peshawar, Khyber Pakhtunkhwa Pakistan
| | - Abdul Ghaffar
- Department of Meteorology, COMSATS University (CUI), Islamabad, Pakistan
| | - Bushra Khalid
- Evolution and Ecology Program, International Institute for Applied Systems Analysis, Laxenburg, Austria
- Earth System Physics, The Abdus Salam, International Centre for Theoretical Physics, Trieste, Italy
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Yaqub T, Shabbir MZ, Mukhtar N, Tahir Z, Abbas T, Amir E, Defang G. Detection of selected arboviral infections in patients with history of persistent fever in Pakistan. Acta Trop 2017; 176:34-38. [PMID: 28754252 DOI: 10.1016/j.actatropica.2017.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
Abstract
Surveillance is a valuable tool for understanding prevailing and previously undiagnosed infections in a geographic area. We examined 480 archived serum samples from patients with history of persistent fever (>40°C, 60-72h) who were referred to hospitals in Rawalpindi/Islamabad, Lahore, and Faisalabad districts for dengue antibody detection in 2014-15. Each sample was processed for detection of antigens and seroconversion, using real-time polymerase chain reaction and enzyme linked immunosorbent assay, respectively, against dengue haemorrhagic fever (DHF) virus serotypes 1-4, West Nile virus fever (WNVF), Crimean-Congo haemorrhagic fever (CCHF), and Chikungunya virus (CGV). The presence of antigens and antibodies to at least one of the studied viral haemorrhagic fevers (VHFs) was detected in 465 (96.8%, 95% CI: 94.9-98.1) and 442 samples (92.1%, 95% CI: 89.3-94.2), respectively. No sera were found positive to CCHF. There was a significant association between gender and positivity to at least one of the VHFs (χ2=8.12, df=1, p<0.005). Except for DHF serotype 2 and 3 (ττ=0.41), Goodman and Kruskal's Tau statistic revealed no significant association for occurrence of different viruses within the studied population (ττ=0-0.06). Cosinor analysis confirmed significant seasonality, with a higher number of cases of persistent fever in August through November, peaking in October. The study suggests circulation of multiple arthropod-borne viral infections and, in addition to DHF, ascertain the needs for screening patients for CGV and WNVF too. It also demonstrates the necessity of well-integrated disease surveillance in several geographic regions and at-risk populations in Pakistan to develop appropriate disease and vector control strategies.
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Rafique I, Saqib MAN, Munir MA, Qureshi H, Taseer IUH, Iqbal R, Ahmed W, Akhtar T, Rizwanullah. Asymptomatic dengue infection in adults of major cities of Pakistan. ASIAN PAC J TROP MED 2017; 10:1002-1006. [PMID: 29111183 DOI: 10.1016/j.apjtm.2017.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/18/2017] [Accepted: 09/07/2017] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To determine the asymptomatic dengue infection in adults of Pakistani population. METHODS This study was conducted in five major cities (Islamabad, Karachi, Lahore, Multan, and Peshawar) of Pakistan. A total of 5 230 adults aged 18 years and above without a history of dengue fever at any point in their life were enrolled from participating laboratories. Those who were confirmed for dengue previously were excluded. Of the total, 62.6% (n = 3 276) were male with an average age of 34.6 years. Participants were briefed about the objectives of the study, and written consent was obtained to perform dengue IgG test using enzyme linked immunosorbent assay. The brief information related to age, gender and area was also taken on proforma. RESULTS Overall 32.3% (n = 1 691) was having asymptomatic dengue infection which was 67.5% (n = 756) in Karachi followed by 39.1% (n = 391) in Islamabad, 29.9% (n = 316) in Lahore and 21% (n = 228) in Peshawar and none from Multan. More males were affected with asymptomatic dengue infection than females. The asymptomatic dengue infection was significantly higher in different cities; however, there was no significant difference with respect to age groups. CONCLUSIONS The asymptomatic dengue infection is higher in cities i.e. Karachi, Islamabad and Lahore which are at risk of developing secondary dengue infections. There is a need of awareness among the public about secondary dengue infection.
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Affiliation(s)
- Ibrar Rafique
- Pakistan Health Research Council, Head Office, Islamabad, Pakistan
| | | | | | - Huma Qureshi
- Pakistan Health Research Council, Head Office, Islamabad, Pakistan
| | - Ijaz-Ul-Haq Taseer
- Pakistan Health Research Council, Research Centre, Nishtar Medical College, Multan, Pakistan
| | - Rizwan Iqbal
- Pakistan Health Research Council, Research Centre, King Edward Medical University, Lahore, Pakistan
| | - Waqaruddin Ahmed
- Pakistan Health Research Council, Research Centre, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Tasleem Akhtar
- Pakistan Health Research Council, Research Centre, Khyber Medical College, Peshawar, Pakistan
| | - Rizwanullah
- Pakistan Health Research Council, Head Office, Islamabad, Pakistan
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Nava-Aguilera E, Morales-Pérez A, Balanzar-Martínez A, Rodríguez-Ramírez O, Jiménez-Alejo A, Flores-Moreno M, Gasga-Salinas D, Legorreta-Soberanis J, Paredes-Solís S, Morales-Nava PA, de Lourdes Soto-Ríos M, Ledogar RJ, Coloma J, Harris E, Andersson N. Dengue occurrence relations and serology: cross-sectional analysis of results from the Guerrero State, Mexico, baseline for a cluster-randomised controlled trial of community mobilisation for dengue prevention. BMC Public Health 2017; 17:435. [PMID: 28699560 PMCID: PMC5506575 DOI: 10.1186/s12889-017-4291-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The Mexican arm of the Camino Verde trial of community mobilisation for dengue prevention covered three coastal regions of Guerrero state: Acapulco, Costa Grande and Costa Chica. A baseline cross-sectional survey provided data for community mobilisation and for adapting the intervention design to concrete conditions in the intervention areas. Methods Trained field teams constructed community profiles in randomly selected clusters, based on observation and key informant interviews. In each household they carried out an entomological inspection of water containers, collected information on socio-demographic variables and cases of dengue illness among household members in the last year, and gathered paired saliva samples from children aged 3–9 years, which were subjected to ELISA testing to detect recent dengue infection. We examined associations with dengue illness and recent dengue infection in bivariate and then multivariate analysis. Results In 70/90 clusters, key informants were unable to identify any organized community groups. Some 1.9% (1029/55,723) of the household population reported dengue illness in the past year, with a higher rate in Acapulco region. Among children 3–9 years old, 6.1% (392/6382) had serological evidence of recent dengue infection. In all three regions, household use of anti-mosquito products, household heads working, and households having less than 5 members were associated with self-reported dengue illness. In Acapulco region, people aged less than 25 years, those with a more educated household head and those from urban sites were also more likely to report dengue illness, while in Costa Chica and Costa Grande, females were more likely to report dengue illness. Among children aged 3–9 years, those aged 3–4 years and those living in Acapulco were more likely to have evidence of recent dengue infection. Conclusions The evidence from the baseline survey provided important support for the design and implementation of the trial intervention. The weakness of community leadership and the relatively low rates of self-reported dengue illness were challenges that the Mexican intervention team had to overcome. The higher dengue illness occurrence among women in Costa Grande and Costa Chica may help explain why women participated more than men in activities during the Camino Verde trial.
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Affiliation(s)
- Elizabeth Nava-Aguilera
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico.
| | - Arcadio Morales-Pérez
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico
| | - Alejandro Balanzar-Martínez
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico
| | - Ofelia Rodríguez-Ramírez
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico
| | - Abel Jiménez-Alejo
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico
| | - Miguel Flores-Moreno
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico
| | - David Gasga-Salinas
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico
| | - José Legorreta-Soberanis
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico
| | - Sergio Paredes-Solís
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico
| | | | | | | | - Joséfina Coloma
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA
| | - Neil Andersson
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico.,Department of Family Medicine, McGill University, Montreal, Canada
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Humphrey JM, Cleton NB, Reusken CBEM, Glesby MJ, Koopmans MPG, Abu-Raddad LJ. Dengue in the Middle East and North Africa: A Systematic Review. PLoS Negl Trop Dis 2016; 10:e0005194. [PMID: 27926925 PMCID: PMC5142774 DOI: 10.1371/journal.pntd.0005194] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 11/17/2016] [Indexed: 12/19/2022] Open
Abstract
Background Dengue virus (DENV) infection is widespread and its disease burden has increased in past decades. However, little is known about the epidemiology of dengue in the Middle East and North Africa (MENA). Methodology / Principal Findings Following Cochrane Collaboration guidelines and reporting our findings following PRISMA guidelines, we systematically reviewed available records across MENA describing dengue occurrence in humans (prevalence studies, incidence studies, and outbreak reports), occurrence of suitable vectors (Aedes aegypti and Aedes albopictus), and DENV vector infection rates. We identified 105 human prevalence measures in 13 of 24 MENA countries; 81 outbreaks reported from 9 countries from 1941–2015; and reports of Ae. aegypti and/or Ae. albopictus occurrence in 15 countries. The majority of seroprevalence studies were reported from the Red Sea region and Pakistan, with multiple studies indicating >20% DENV seroprevalence in general populations (median 25%, range 0–62%) in these subregions. Fifty percent of these studies were conducted prior to 1990. Multiple studies utilized assays susceptible to serologic cross-reactions and 5% of seroprevalence studies utilized viral neutralization testing. There was considerable heterogeneity in study design and outbreak reporting, as well as variability in subregional study coverage, study populations, and laboratory methods used for diagnosis. Conclusions / Significance DENV seroprevalence in the MENA is high among some populations in the Red Sea region and Pakistan, while recent outbreaks in these subregions suggest increasing incidence of DENV which may be driven by a variety of ecologic and social factors. However, there is insufficient study coverage to draw conclusions about Aedes or DENV presence in multiple MENA countries. These findings illustrate the epidemiology of DENV in the MENA while revealing priorities for DENV surveillance and Aedes control. Dengue is a mosquito-transmitted flavivirus whose global distribution and disease incidence has increased in recent decades. In the Middle East and North Africa, the epidemiology of dengue remains poorly characterized despite increasing reports of outbreaks and transmission in new areas. In order to understand the evidence supporting the epidemiology of this virus in the region and the areas in need of further research, we conducted a systematic review of studies reporting human prevalence, incidence, and infection rates in the virus’ main mosquito vectors, Aedes aegypti and Aedes albopictus. Among the studies identified, the Red Sea subregion and Pakistan reported the highest seroprevalence estimates for dengue. However, we encountered substantial heterogeneity in the distribution, quality, and quantity of published studies. These findings inform future research and surveillance priorities for DENV in the MENA region.
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Affiliation(s)
- John M. Humphrey
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
- * E-mail:
| | - Natalie B. Cleton
- Erasmus Medical Centre, Rotterdam, The Netherlands
- National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands
| | | | - Marshall J. Glesby
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
- Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
| | - Marion P. G. Koopmans
- Erasmus Medical Centre, Rotterdam, The Netherlands
- National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands
| | - Laith J. Abu-Raddad
- Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
- Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar
- College of Public Health, Hamad bin Khalifa University, Qatar Foundation, Education City, Doha, Qatar
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Seroprevalence and epidemiological status of dengue viral infection in remote areas of Pakistan. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2016. [DOI: 10.1016/s2222-1808(16)61128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Dengue fever virus in Pakistan: effects of seasonal pattern and temperature change on distribution of vector and virus. Rev Med Virol 2016; 27. [DOI: 10.1002/rmv.1899] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 02/01/2023]
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Khan E, Farooqi JQ, Barr KL, Prakoso D, Nasir A, Kanji A, Shakoor S, Malik FR, Hasan R, Lednicky JA, Long MT. Flaviviruses as a Cause of Undifferentiated Fever in Sindh Province, Pakistan: A Preliminary Report. Front Public Health 2016; 4:8. [PMID: 26909342 PMCID: PMC4754388 DOI: 10.3389/fpubh.2016.00008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/17/2016] [Indexed: 11/13/2022] Open
Abstract
Arboviral diseases are expanding worldwide, yet global surveillance is often limited due to diplomatic and cultural barriers between nations. With human encroachment into new habitats, mosquito-borne viruses are also invading new areas. The actual prevalence of expanding arboviruses is unknown in Pakistan due to inappropriate diagnosis and poor testing for arboviral diseases. The primary objective of this study was to document evidence of flavivirus infections as the cause of undifferentiated fever in Pakistan. Through a cooperative effort between the USA and Pakistan, patient exposure to dengue virus (DENV), West Nile virus (WNV), and Japanese encephalitis virus (JEV) was examined in Sindh Province for the first time in decades. Initial results from the 2015 arbovirus season consisting of a cross-sectional study of 467 patients in 5 sites, DENV NS1 antigen was identified in 63 of the screened subjects, WNV IgM antibodies in 16 patients, and JEV IgM antibodies in 32 patients. In addition, a number of practical findings were made including (1) in silico optimization of RT-PCR primers for flavivirus strains circulating in the Middle East, (2) shipping and storage of RT-PCR master mix and other reagents at ambient temperature, (3) Smart phone applications for the collection of data in areas with limited infrastructure, and (4) fast and reliable shipping for transport of reagents and specimens to and from the Middle East. Furthermore, this work is producing a group of highly trained local scientists and medical professionals disseminating modern scientific methods and more accurate diagnostic procedures to the community.
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Affiliation(s)
- Erum Khan
- Department of Pathology, Aga Khan University, Karachi, Pakistan; Department of Microbiology, Aga Khan University, Karachi, Pakistan
| | - Joveria Q Farooqi
- Department of Pathology, Aga Khan University, Karachi, Pakistan; Department of Microbiology, Aga Khan University, Karachi, Pakistan
| | - Kelli L Barr
- Emerging Diseases and Arbopathogens Research and Testing Laboratory, Department of Infectious Diseases and Pathology, University of Florida , Gainesville, FL , USA
| | - Dhani Prakoso
- Department of Environmental and Global Health, Emerging Pathogens Institute, University of Florida , Gainesville, FL , USA
| | - Amna Nasir
- Department of Pathology, Aga Khan University, Karachi, Pakistan; Department of Microbiology, Aga Khan University, Karachi, Pakistan
| | - Akbar Kanji
- Department of Pathology, Aga Khan University, Karachi, Pakistan; Department of Microbiology, Aga Khan University, Karachi, Pakistan
| | - Sadia Shakoor
- Department of Pathology, Aga Khan University, Karachi, Pakistan; Department of Microbiology, Aga Khan University, Karachi, Pakistan
| | - Faisal Riaz Malik
- Department of Pathology, Aga Khan University, Karachi, Pakistan; Department of Microbiology, Aga Khan University, Karachi, Pakistan
| | - Rumina Hasan
- Department of Pathology, Aga Khan University, Karachi, Pakistan; Department of Microbiology, Aga Khan University, Karachi, Pakistan
| | - John A Lednicky
- Department of Environmental and Global Health, Emerging Pathogens Institute, University of Florida , Gainesville, FL , USA
| | - Maureen T Long
- Emerging Diseases and Arbopathogens Research and Testing Laboratory, Department of Infectious Diseases and Pathology, University of Florida , Gainesville, FL , USA
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Khan J, Khan I, Amin I. A Comprehensive Entomological, Serological and Molecular Study of 2013 Dengue Outbreak of Swat, Khyber Pakhtunkhwa, Pakistan. PLoS One 2016; 11:e0147416. [PMID: 26848847 PMCID: PMC4746065 DOI: 10.1371/journal.pone.0147416] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 01/04/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Aedes aegypti and Aedes albopictus play a fundamental role in transmission of dengue virus to humans. A single infected Aedes mosquito is capable to act as a reservoir/amplifier host for dengue virus and may cause epidemics via horizontal and vertical modes of dengue virus (DENV) transmission. The present and future dengue development can be clarified by understanding the elements which help the dissemination of dengue transmission. The current study deals with molecular surveillance of dengue in addition to ecological and social context of 2013 dengue epidemics in Swat, Pakistan. METHODS Herein, we reported dengue vectors surveillance in domestic and peridomistic containers in public and private places in 7 dengue epidemic-prone sites in District Swat, Pakistan from July to November 2013. Using the Flaviviruses genus-specific reverse transcriptase (RT) semi nested-PCR assay, we screened blood samples (N = 500) of dengue positive patients, 150 adult mosquito pools and 25 larval pools. RESULTS The 34 adult and 7 larval mosquito pools were found positive. The adult positive pools comprised 30 pools of Ae. aegypti and 4 pools of Ae. albopictus, while among the 7 larval pools, 5 pools of Ae. aegypti and 2 pools of Ae. albopictus were positive. The detected putative genomes of dengue virus were of DENV-2 (35% in 14 mosquito pools & 39% in serum) and DENV-3 (65% in 27 mosquito pools & 61% in serum). The higher vector density and dengue transmission rate was recorded in July and August (due to favorable conditions for vector growth). About 37% of Ae. aegpti and 34% Ae. albopictus mosquitoes were collected from stagnant water in drums, followed by drinking water tanks (23% & 26%), tires (20% & 18%) and discarded containers (10% & 6%). Among the surveyed areas, Saidu was heavily affected (26%) by dengue followed by Kanju (20% and Landikas (12%). The maximum infection was observed in the age group of <15 (40%) followed by 15-45 (35%) and >45 (25%) years and was more in males (55.3%) as compare to females (44.7%). The increase in vector mosquito density and the subsequent viral transmission was determined by a complex interplay of ecological, biological and social factors. CONCLUSION The suitable environmental conditions and discriminable role of Aedes through trans-ovarial transmission of DENV is indispensable in the recent geographic increase of dengue in Pakistan. Climate change affects the survival and dispersion of vectors as well as the transmission rates of dengue. Control of Aedes mosquitoes (vectors) and elimination of breeding sources must be emphasized and prioritized. Such actions may not only reduce the risk of dengue transmission during epidemics, but also minimize the chances of dengue viruses establishment in new (non endemic) areas of the region.
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Affiliation(s)
- Jehangir Khan
- Zoology Department, Abdul Wali Khan University Mardan (AWKUM), Bunir Campus, Khyber Pakhtunkhwa (KPK), Pakistan
- * E-mail:
| | - Inamullah Khan
- Nuclear Institute of Food and Agriculture (NIFA), G.T Road, Tarnab Peshawar, Pakistan
| | - Ibne Amin
- Zoology Department, Abdul Wali Khan University Mardan (AWKUM), Bunir Campus, Khyber Pakhtunkhwa (KPK), Pakistan
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Akram M, Idrees M. Complete genome sequencing and comparative analysis of three dengue virus type 2 Pakistani isolates. Virusdisease 2016; 27:27-33. [PMID: 26925441 DOI: 10.1007/s13337-015-0279-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/09/2015] [Indexed: 10/22/2022] Open
Abstract
Dengue is currently one of the most important arthropod borne human viral diseases caused by a flavivirus named as dengue virus. It is now endemic in Pakistan since many dengue fever outbreaks have been observed in Pakistan during the last three decades. Major serotype of dengue virus circulating in Pakistan is serotype 2. Complete genome sequences of three Pakistani dengue virus serotype 2 isolates were generated. Analysis of complete genome sequences showed that Pakistani isolates of dengue virus serotype 2 belonged to cosmopolitan genotype. This study identifies a number of amino acid substitutions that were introduced in local dengue virus serotype 2 isolate over the years. The study provides a significant insight into the evolution of serotype 2 of dengue virus in Pakistan. This is the first report of complete genome sequence information of dengue virus from the most recent outbreak (2013) in Punjab, Pakistan.
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Affiliation(s)
- Madiha Akram
- Division of Molecular Virology, National Centre of Excellence in Molecular Biology, University of the Punjab, Lahore, 53700 Pakistan
| | - Muhammad Idrees
- Centre for Applied Molecular Biology, University of the Punjab, 87-West 14 Canal Bank Road Thokar Niaz Baig, Lahore, 53700 Pakistan
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Haider Z, Ahmad FZ, Mahmood A, Waseem T, Shafiq I, Raza T, Qazi J, Siddique N, Humayun MA. Dengue fever in Pakistan: a paradigm shift; changing epidemiology and clinical patterns. Perspect Public Health 2015; 135:294-8. [PMID: 26342006 DOI: 10.1177/1757913915599019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dengue fever has huge public health implications and affects over 100 million people worldwide. This review pictures the current situation of Dengue in Pakistan and presents a review of published literature. Pakistan has seen recurrent epidemics of Dengue Fever recently. Unfortunately, these epidemics are becoming more severe in their clinical manifestation. Pakistan experienced large epidemics of dengue fever during 2008, 2010 and 2011 affecting thousands of people and claiming hundreds of deaths. A comparison of data during these epidemics indicates a shift from mild to a more severe disease, which could be interpreted as an epidemiologic transition pattern in the country. Expansion of Dengue in Pakistan seems to be multifactorial, including the climate change, frequent natural disasters, vector resistance to insecticides and lack of resources. This highlights the need for rigorous vector control. Continuing education of primary care physicians is crucial for early appropriate management to reduce mortality.
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Affiliation(s)
| | | | | | - Tariq Waseem
- King Edward Medical University, Lahore, Pakistan
| | | | | | - Javaria Qazi
- Department of Biotechnology, Quaid-e-Azam University, Islamabad, Pakistan
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Mohsin SN, Mahmood S, Amar A, Ghafoor F, Raza SM, Saleem M. Association of FcγRIIa Polymorphism with Clinical Outcome of Dengue Infection: First Insight from Pakistan. Am J Trop Med Hyg 2015; 93:691-6. [PMID: 26240159 DOI: 10.4269/ajtmh.15-0199] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/17/2015] [Indexed: 02/03/2023] Open
Abstract
Dengue illness has been a major health concern in Pakistan during the last decade. Dengue infection can result in a spectrum of clinically distinct outcomes, ranging from asymptomatic infection to potentially life-threatening forms of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). A single-nucleotide polymorphism in FcγRIIa (rs1801274) results in altered affinity of the receptor for different subclasses of immunoglobulin G, and is a key player in determining the susceptibility to or protection from severe clinical infection of dengue. In this study, we analyzed the allelic and genotypic distribution of rs1801274 in subjects of Pakistani origin with subclinical dengue infection (n = 40), dengue fever (DF) (n = 40), and DHF/DSS (n = 30). We found that HH homozygotes and heterozygotes were significantly more likely to develop clinical dengue (odds ratio [OR] = 3.21, 95% confidence interval [CI] = 1.29-7.97, P = 0.009), either DF (OR = 2.82, 95% CI = 1.00-7.97, P = 0.045) or DHF/DSS (OR = 3.90, 95% CI = 1.13-13.07, P = 0.024) than the asymptomatic dengue infection. Results of allelic distribution comparisons and logistic regression analysis also supported the same relationship. The results suggest complex nature of interacting factors in determining the course for severe dengue illness.
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Affiliation(s)
- Saima Naz Mohsin
- Pakistan Medical Research Council Research Centre, National Health Research Complex, Shaikh Zayed Medical Complex, Lahore, Pakistan; Institute of Biochemistry and Biotechnology, University of the Punjab, Lahore, Pakistan; Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore, Pakistan; Department of Physiology and Cell Biology, University of Health Sciences, Lahore, Pakistan
| | - Saqib Mahmood
- Pakistan Medical Research Council Research Centre, National Health Research Complex, Shaikh Zayed Medical Complex, Lahore, Pakistan; Institute of Biochemistry and Biotechnology, University of the Punjab, Lahore, Pakistan; Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore, Pakistan; Department of Physiology and Cell Biology, University of Health Sciences, Lahore, Pakistan
| | - Ali Amar
- Pakistan Medical Research Council Research Centre, National Health Research Complex, Shaikh Zayed Medical Complex, Lahore, Pakistan; Institute of Biochemistry and Biotechnology, University of the Punjab, Lahore, Pakistan; Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore, Pakistan; Department of Physiology and Cell Biology, University of Health Sciences, Lahore, Pakistan
| | - Farkhanda Ghafoor
- Pakistan Medical Research Council Research Centre, National Health Research Complex, Shaikh Zayed Medical Complex, Lahore, Pakistan; Institute of Biochemistry and Biotechnology, University of the Punjab, Lahore, Pakistan; Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore, Pakistan; Department of Physiology and Cell Biology, University of Health Sciences, Lahore, Pakistan
| | - Syed Mohsin Raza
- Pakistan Medical Research Council Research Centre, National Health Research Complex, Shaikh Zayed Medical Complex, Lahore, Pakistan; Institute of Biochemistry and Biotechnology, University of the Punjab, Lahore, Pakistan; Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore, Pakistan; Department of Physiology and Cell Biology, University of Health Sciences, Lahore, Pakistan
| | - Mahjabeen Saleem
- Pakistan Medical Research Council Research Centre, National Health Research Complex, Shaikh Zayed Medical Complex, Lahore, Pakistan; Institute of Biochemistry and Biotechnology, University of the Punjab, Lahore, Pakistan; Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore, Pakistan; Department of Physiology and Cell Biology, University of Health Sciences, Lahore, Pakistan
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Computational prediction and analysis of envelop glycoprotein epitopes of DENV-2 and DENV-3 Pakistani isolates: a first step towards Dengue vaccine development. PLoS One 2015; 10:e0119854. [PMID: 25775090 PMCID: PMC4361635 DOI: 10.1371/journal.pone.0119854] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 01/16/2015] [Indexed: 02/04/2023] Open
Abstract
Dengue fever of tropics is a mosquito transmitted devastating disease caused by dengue virus (DENV). There is no effective vaccine available, so far, against any of its four serotypes (DENV-1, DENV-2, DENV-3, and DENV-4). There is a need for the development of preventive and therapeutic vaccines against DENV to decrease the prevalence of dengue fever, especially in Pakistan. In this research, linear and conformational B-cell epitopes of envelope glycoprotein of DENV-2 and DENV-3 (the most prevalent serotypes in Pakistan) were predicted. We used Kolaskar and Tongaonkar method for linear epitope prediction, Emini’s method for surface accessibility prediction and Karplus and Schulz’s algorithm for flexibility determination. To propose three dimensional epitopes, the E proteins for both serotypes were homology modeled by using Phyre2 V 2.0 server, and ElliPro was used for the prediction of surface epitopes on their globular structure. Total 21 and 19 linear epitopes were predicted for DENV-2 and DENV-3 Pakistani isolates respectively. Whereas, 5 and 4 discontinuous epitopes were proposed for DENV-2 and DENV-3 Pakistani isolates respectively. Moreover, the values of surface accessibility, flexibility and solvent-accessibility can be helpful in analyzing vaccines against DENV-2 and DENV-3. In conclusion, the proposed continuous and discontinuous antigenic peptides can be valuable candidates for diagnostic and therapeutics of DENV.
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Kotaki T, Yamanaka A, Mulyatno KC, Churrotin S, Labiqah A, Sucipto TH, Soegijanto S, Kameoka M, Konishi E. Continuous dengue type 1 virus genotype shifts followed by co-circulation, clade shifts and subsequent disappearance in Surabaya, Indonesia, 2008-2013. INFECTION GENETICS AND EVOLUTION 2014; 28:48-54. [PMID: 25219342 DOI: 10.1016/j.meegid.2014.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/07/2014] [Accepted: 09/01/2014] [Indexed: 12/30/2022]
Abstract
Four serotypes of dengue virus (DENV-1 to DENV-4) and their genotypes are distributed in tropical and subtropical regions. Indonesia has been recently suggested as the origin of some dengue virus genotypes. In Surabaya, the second biggest city of Indonesia, we previously reported a shift of the predominantly circulating serotype from DENV-2 to DENV-1 in November 2008, followed by a genotype shift of DENV-1 from genotype IV (GIV) to genotype I (GI) in September 2009, based on nucleotide sequences in the envelope protein coding region. Since then, GI strains had predominantly circulated until December 2010. In this report, we investigated further DENV-1 transitions in Surabaya during 2011-2013 in order to comprehend dengue dynamics during 2008-2013 in more detail. From January 2011 through December 2011, only GIV strains were isolated, indicating that a genotype shift again took place from GI to GIV. In January 2012, GI and GIV strains started co-circulating, which continued until June 2013. To further investigate this phenomenon, analysis was performed at a clade level. GI and GIV strains isolated in Surabaya formed four and three distinct clades, respectively. Concomitant with co-circulation, new clade strains appeared in both genotypes. In contrast, some previously circulating clades were not isolated during co-circulation, indicating clade shifts. Among our Surabaya isolates, nucleotide and amino acid differences in the E region were, respectively, 1.0-2.3% and 0.2-1.0% for GI isolates and 2.0-6.3% and 0.0-1.8% for GIV isolates. Several characteristic amino acid substitutions in the envelope ectodomain were observed in some clades. After July 2013, DENV-1 strains were not isolated and were replaced with DENV-2. This study showed that continuous shifts of more than one genotype resulted in their co-circulation and subsequent disappearance and suggested the relevance of clade replacement to genotype co-circulation and disappearance in Surabaya.
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Affiliation(s)
- Tomohiro Kotaki
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, JI, Mulyorejo, Surabaya 60115, Indonesia; Center for Infectious Diseases, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
| | - Atsushi Yamanaka
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, JI, Mulyorejo, Surabaya 60115, Indonesia; BIKEN Endowed Department of Dengue Vaccine Development, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand; BIKEN Endowed Department of Dengue Vaccine Development, Research Institute for Microbial Diseases, Osaka University, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan(1).
| | - Kris Cahyo Mulyatno
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, JI, Mulyorejo, Surabaya 60115, Indonesia.
| | - Siti Churrotin
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, JI, Mulyorejo, Surabaya 60115, Indonesia.
| | - Amaliah Labiqah
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, JI, Mulyorejo, Surabaya 60115, Indonesia.
| | - Teguh Hari Sucipto
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, JI, Mulyorejo, Surabaya 60115, Indonesia.
| | - Soegeng Soegijanto
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, JI, Mulyorejo, Surabaya 60115, Indonesia.
| | - Masanori Kameoka
- Center for Infectious Diseases, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan; Department of International Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, Hyogo 654-0142, Japan.
| | - Eiji Konishi
- Center for Infectious Diseases, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan; BIKEN Endowed Department of Dengue Vaccine Development, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand; BIKEN Endowed Department of Dengue Vaccine Development, Research Institute for Microbial Diseases, Osaka University, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan(1).
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Raza FA, Rehman SU, Khalid R, Ahmad J, Ashraf S, Iqbal M, Hasnain S. Demographic and clinico-epidemiological features of dengue fever in Faisalabad, Pakistan. PLoS One 2014; 9:e89868. [PMID: 24595236 PMCID: PMC3940608 DOI: 10.1371/journal.pone.0089868] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/24/2014] [Indexed: 11/19/2022] Open
Abstract
This cross-sectional study was carried out to explore the epidemiological and clinical features of dengue fever in Faisalabad, Pakistan during 2011 and 2012. During the study period, anti-dengue IgM positive cases were reported in the post-monsoon period during the months of August-December. Certain hotspots for the dengue infection were identified in the city that coincide with the clusters of densely populated urban regions of the city. Out of total 299 IgM positive patients (male 218 and female 81); there were 239 dengue fever (DF) and 60 dengue hemorrhagic fever (DHF) patients. There was decrease in the median age of dengue patients from 31 years in 2011 to 21.5 years in 2012 (p<0.001). Abdominal pain was seen in 35% DHF patients followed by nausea in 28.3%, epistaxis in 25% and rash in 20% patients (p<0.05). Patients reported to be suffering from high-grade fever for an average of 8.83 days in DHF as compared to 5.82 days in DF before being hospitalized. Co-morbidities were found to be risk factor for the development of DHF in dengue patients. Clinical and laboratory features of dengue cases studied could be used for the early identification of patients at risk of severe dengue fever.
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Affiliation(s)
- Faiz Ahmed Raza
- Pakistan Medical Research Council, Research Centre, Punjab Medical College, Faisalabad, Pakistan
- Department of Microbiology and Molecular Genetics, University of the Punjab, Quaid-e-Azam Campus, Lahore, Pakistan
- * E-mail:
| | - Shafiq ur Rehman
- Department of Microbiology and Molecular Genetics, University of the Punjab, Quaid-e-Azam Campus, Lahore, Pakistan
| | - Ruqyya Khalid
- School of Biological Sciences, University of the Punjab, Quaid-e-Azam Campus, Lahore, Pakistan
| | - Jameel Ahmad
- Department of Pathology, Allied Hospital, Faisalabad, Pakistan
| | - Sajjad Ashraf
- Nano Bio Energy Engineering School of Integrative Engineering, Chung-Ang University, Seoul, Korea
| | - Mazhar Iqbal
- Pakistan Medical Research Council, Research Centre, Punjab Medical College, Faisalabad, Pakistan
| | - Shahida Hasnain
- Department of Microbiology and Molecular Genetics, University of the Punjab, Quaid-e-Azam Campus, Lahore, Pakistan
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Koo C, Nasir A, Hapuarachchi HC, Lee KS, Hasan Z, Ng LC, Khan E. Evolution and heterogeneity of multiple serotypes of Dengue virus in Pakistan, 2006-2011. Virol J 2013; 10:275. [PMID: 24007412 PMCID: PMC3844417 DOI: 10.1186/1743-422x-10-275] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/30/2013] [Indexed: 11/16/2022] Open
Abstract
Background Even though dengue has been recognized as one of the major public health threats in Pakistan, the understanding of its molecular epidemiology is still limited. The genotypic diversity of Dengue virus (DENV) serotypes involved in dengue outbreaks since 2005 in Pakistan is not well studied. Here, we investigated the origin, diversity, genetic relationships and geographic distribution of DENV to understand virus evolution during the recent expansion of dengue in Pakistan. Methods The study included 200 sera obtained from dengue-suspected patients from 2006 to 2011. DENV infection was confirmed in 94 (47%) sera by a polymerase chain reaction assay. These included 36 (38.3%) DENV-2, 57 DENV-3 (60.6%) and 1 DENV-4 (1.1%) cases. Sequences of 13 whole genomes (6 DENV-2, 6 DENV-3 and 1 DENV-4) and 49 envelope genes (26 DENV-2, 22 DENV-3 and 1 DENV-4) were analysed to determine the origin, phylogeny, diversity and selection pressure during virus evolution. Results DENV-2, DENV-3 and DENV-4 in Pakistan from 2006 to 2011 shared 98.5-99.6% nucleotide and 99.3-99.9% amino acid similarity with those circulated in the Indian subcontinent during the last decade. Nevertheless, Pakistan DENV-2 and DENV-3 strains formed distinct clades characterized by amino acid signatures of NS2A-I116T + NS5-K861R and NS3-K590R + NS5-S895L respectively. Each clade consisted of a heterogenous virus population that circulated in Southern (2006–2009) and Northern Pakistan (2011). Conclusions DENV-2, DENV-3 and DENV-4 that circulated during 2006–2011 are likely to have first introduced via the southern route of Pakistan. Both DENV-2 and DENV-3 have undergone in-situ evolution to generate heterogenous populations, possibly driven by sustained local DENV transmission during 2006–2011 periods. While both DENV-2 and DENV-3 continued to circulate in Southern Pakistan until 2009, DENV-2 has spread in a Northern direction to establish in Punjab Province, which experienced a massive dengue outbreak in 2011.
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Affiliation(s)
- Carmen Koo
- Environmental Health Institute, National Environment Agency, [as part of its work as a] WHO Collaborating Centre for Reference and Research of Arbovirus and their Associated Vectors, 11, Biopolis Way, #06-05-08, 138667 Singapore, Singapore.
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Hashmi AM, Butt Z, Idrees Z, Niazi M, Yousaf Z, Haider SF, Bhatti MR. Anxiety and depression symptoms in patients with dengue fever and their correlation with symptom severity. Int J Psychiatry Med 2013; 44:199-210. [PMID: 23586276 DOI: 10.2190/pm.44.3.b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To study the prevalence of anxiety and depression symptoms in patients with dengue and to examine their correlation with symptom severity. METHODS In this cross sectional study, 531 consecutive patients who met the World Health Organization criteria for dengue fever admitted to Mayo Hospital, Lahore between September and November 2011 were administered the Hospital Anxiety and Depression Scale (HADS). In addition to the HADS, the severity of their symptoms, like headache, myalgias/arthralgias, fever, and retro/periorbital pain, was assessed on a 3-point scale (mild, moderate, and severe). RESULTS About 60% of the patients in our study met the criteria for anxiety and 62.2% of the patients met criteria for depression. Severity of fever, headache, myalgias and arthralgias, and retro/periorbital pain was positively correlated with both anxiety (Correlation coefficients: 0.148, 0.247, 0.184, 0.184 respectively and P < 0.01 for all) and depression scores (Correlation coefficients: 0.098, 0.154, 0.131, 0.125 respectively and P value < 0.01 for all). The strongest correlation was found between severity of headache and scores for both anxiety and depression. Both mean anxiety and depression scores were significantly higher in patients with platelet count below median (30,000/mm3) than in patients with platelet count above median (9.1 +/- 4.7 vs 8.2 +/- 4.7, P < 0.03, and 9.5 +/- 4.5 vs 8.5 +/- 4.5, P < 0.01, respectively). CONCLUSION A majority of patients with dengue have anxiety and depression symptoms. Psychiatric evaluation should be done in all Dengue patients so timely treatment can be initiated.
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Affiliation(s)
- Ali M Hashmi
- King Edward Medical University/Mayo Hospital, Pakistan.
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Ali A, Rehman HU, Nisar M, Rafique S, Ali S, Hussain A, Nausheen, Idrees M, Sabri S, Zada H, Hussain S. Seroepidemiology of dengue fever in Khyber Pakhtunkhawa, Pakistan. Int J Infect Dis 2013; 17:e518-23. [PMID: 23523057 DOI: 10.1016/j.ijid.2013.01.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 12/27/2012] [Accepted: 01/09/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dengue is the most important vector-borne disease in many different parts of the world and is expanding into other areas of the globe without hindrance. The morbidity and mortality due to dengue complications are increasing globally at an alarming rate. Although transmission of the dengue virus has been documented in well-characterized areas of Pakistan, its incidence in Khyber Pakhtunkhawa has not been characterized. To address this issue we aimed to determine the seroprevalence of dengue (IgM and IgG) antibodies and the disease symptoms in the population of Khyber Pakhtunkhawa, and to investigate the incidence of dengue fever in different seasons and in urban as well as in rural areas. METHODS From August to October 2011, data of suspected dengue patients were collected from different primary, secondary, and tertiary collection centers situated in Khyber Pakhtunkhawa in order to determine the actual seroprevalence of dengue antibodies (IgM and IgG) in Khyber Pakhtunkhawa. RESULTS A total 612 subjects with a suspected infection were enrolled in our study. Of the 612 suspected cases, 319 were found positive for dengue IgG, IgM, or both IgG and IgM. The overall weighted prevalence of dengue-specific antibodies (IgM and/or IgG) was 52.12%. Overall, of the 52.12%, 31.86% (95% confidence interval (CI) 28.17-35.55) were positive for dengue IgM and 20.26% (95% CI 17.03-23.39) were positive for dengue IgG. Only 23 (3.75%) samples showed both IgG and IgM antibodies. A higher prevalence of IgM (39.35%, 95% CI 32.84-45.86) and IgG (22.42%, 95% CI 16.86-27.98) antibodies was found in the age group 21-30 years as compared to the children age group (≤10 years) and the oldest age group (≥51 years). The mean age of the febrile cohort was 53.16 ± 44.22 years, ranging from 4 to 85 years. Age group was not statistically associated with IgM (p=0.64) or IgG (p=0.49) positivity. A higher seroprevalence of IgM (37.24%, 95%CI 32.84-45.86) was observed in males as compared to females (IgM 17.88%, 95% CI 11.11-24.65) while higher seroprevalnce of IgG (22.76%, 95% CI 15.35-30.17) was seen in females as compared to males (IgG 17.58%, 95% CI 14.21-20.95). Gender was not significantly associated with IgM (p=0.06) or IgG (p=0.53) positivity. Dengue IgM (35.38%, 95% CI 38.61-62.91) and IgG (50.76%, 95% CI 38.61-62.91) were higher in patients who had a history of travel to a dengue endemic area as compared to those who did not (IgM 33%, 95% CI 29.06-36.94, and IgG 15%, 95% CI 12.01-17.99). History of travel to an endemic area was significantly associated with IgM (p=0.023) and IgG (p=0.041) positivity. A higher incidence of IgM (41.13%, 95% CI 35.55-46.71) and IgG (27.42%, 95% CI 22.36-32.48) was observed in urban areas than in rural areas (IgM 23%, 95% CI 18.34- 27.66, and IgG 13.41%, 95% CI 9.63-17.19). IgM (p=0.0005) and IgG (p=0.0007) positivity was significantly associated with area of residence. Symptoms including fever (p=0.007), headache (p=0.001), Skin rash (0.005), joint pain (0.004) and Fatigue were significantly linked to dengue fever. IgM and IgG antibodies were more frequently seen in the post-monsoon season (68.33%) than in the monsoon period (31.68%). The death ratio in the overall weighted prevalence was 2.19%. CONCLUSION The results of the present cohort study of febrile subjects show that young people and males are more susceptible to dengue fever. Dengue infection was most prominent in the post-monsoon season, in urban areas, and in patients with a history of travel to an endemic locality. Furthermore seven deaths were found in our cohort study.
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Affiliation(s)
- Amjad Ali
- Department of Biotechnology University of Malakand, Chakdara, Khyber Pakhtunkhawa, Pakistan
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A brief review on dengue molecular virology, diagnosis, treatment and prevalence in Pakistan. GENETIC VACCINES AND THERAPY 2012; 10:6. [PMID: 22929369 PMCID: PMC3478998 DOI: 10.1186/1479-0556-10-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 08/22/2012] [Indexed: 11/10/2022]
Abstract
Dengue virus infection is a serious health problem infecting 2.5 billion people worldwide. Dengue is now endemic in more than 100 countries, including Pakistan. Each year hundreds of people get infected with dengue in Pakistan. Currently, there is no vaccine available for the prevention of Dengue virus infection due to four viral serotypes. Dengue infection can cause death of patients in its most severity, meanwhile many antiviral compounds are being tested against dengue virus infection to eradicate this disease but still there is a need to develop an efficient, low-cost and safe vaccine that can target all the four serotypes of dengue virus. This review summarizes dengue molecular virology, important drug targets, prevalence in Pakistan, diagnosis, treatment and medicinal plant inhibitors against dengue.
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Nieto NC, Khan K, Uhllah G, Teglas MB. The emergence and maintenance of vector-borne diseases in the khyber pakhtunkhwa province, and the federally administered tribal areas of pakistan. Front Physiol 2012; 3:250. [PMID: 22934007 PMCID: PMC3429027 DOI: 10.3389/fphys.2012.00250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 06/18/2012] [Indexed: 11/04/2022] Open
Abstract
Human populations throughout much of the world are experiencing unprecedented changes in their relationship to the environment and their interactions with the animals with which so many humans are intimately dependent upon. These changes result not only from human induced changes in the climate, but also from population demographic changes due to wars, social unrest, behavioral changes resulting from cultural mixing, and large changes in land-use practices. Each of these social shifts can affect the maintenance and emergence of arthropod vectors disease or the pathogenic organisms themselves. A good example is the country of Pakistan, with a large rural population and developing urban economy, it also maintains a wide diversity of entomological disease vectors, including biting flies, mosquitoes, and ticks. Pathogens endemic to the region include the agents of piroplasmosis, rickettsiosis, spirochetosis, and viral hemorrhagic fevers and encephalitis. The northwestern region of the country, including the Khyber Pakhtunkhwa Province (KPK), formerly the North-West Frontier Provence (NWFP), and the Federally Administered Tribal Areas (FATA) are mountainous regions with a high degree of habitat diversity that has recently undergone a massive increase in human population density due to an immigrating refugee population from neighboring war-torn Afghanistan. Vector-borne diseases in people and livestock are common in KPK and FATA regions due to the limited use of vector control measures and access to livestock vaccines. The vast majority of people in this region live in abject poverty with >70% of the population living directly from production gained in animal husbandry. In many instances whole families live directly alongside their animal counterparts. In addition, there is little to no awareness of the threat posed by ticks and transmission of either zoonotic or veterinary pathogens. Recent emergence of Crimean–Congo hemorrhagic fever virus in rural populations, outbreaks of Dengue hemorrhagic fever have been reported in the region, and high prevalence of cattle infected and co-infected with multiple species of hemoparasites (Theileria, Babesia, Anaplasma). The emergence of which has followed the increased density of the rural population due to an influx of refugees from violent conflicts in Afghanistan and is exacerbated by an already impoverished society and wide diversity of potential arthropod vectors. These human outbreaks may be exacerbated by episodes of social upheaval but are also tied to the historically close association of people in the region with their livestock and subsequent zoonosis that result from spillover from co-habitation with infected domestic animals.
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Affiliation(s)
- Nathan C Nieto
- Department of Agriculture, Nutrition, and Veterinary Science, University of Nevada Reno, NV, USA
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Co-circulation of two genotypes of dengue virus serotype 3 in Guangzhou, China, 2009. Virol J 2012; 9:125. [PMID: 22721418 PMCID: PMC3463466 DOI: 10.1186/1743-422x-9-125] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 06/14/2012] [Indexed: 11/14/2022] Open
Abstract
Dengue is emerging as the most important mosquito borne viral disease in the world. In mainland China, sporadic and large outbreaks of dengue illness caused by the four serotypes of dengue virus (DENV-1 to DENV-4) have been well documented. Guangdong province is the major affected area in China, and DENV-1 has dominantly circulated in Guangdong for a long time. In this study, a family cluster of DENV-3 infection in Guangzhou was described. Three cases were diagnosed as dengue fever based on clinical manifestation, serological and RT-PCR assays. Two DENV-3 strains were isolated in C6/36 cells and the complete genome sequences were determined. Phylogenetic analysis revealed that the new DENV-3 isolates from the family cluster were grouped within genotype III. Considering the fact that several DENV-3 strains within genotype V were also identified in Guangzhou in 2009, at least two genotypes of DENV-3 co-circulated in Guangzhou. Careful investigation and virological analysis should be warranted in the future.
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Gijavanekar C, Drabek R, Soni M, Jackson GW, Strych U, Fox GE, Fofanov Y, Willson RC. Detection and typing of viruses using broadly sensitive cocktail-PCR and mass spectrometric cataloging: demonstration with dengue virus. J Mol Diagn 2012; 14:402-7. [PMID: 22579629 DOI: 10.1016/j.jmoldx.2012.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 01/19/2012] [Accepted: 02/03/2012] [Indexed: 10/28/2022] Open
Abstract
Virus detection and taxonomic identification of serotypes, strains, or genotypes provide important information relevant for diagnosis, and for the epidemiological characterization and tracking of new strains in an endemic region. In the specific case of dengue virus, rapid serotype identification can also be useful in the treatment of secondary infections that may cause the more severe dengue hemorrhagic fever and dengue shock syndrome. In this work, dengue virus was used as a model to test a new approach of combining broadly sensitive RT-PCR amplification of nearly any virus strain with subsequent serotype- and finer-level identification by mass spectrometry. PCR primers were appended with promoter sequences, such that the resulting PCR products could be transcribed into RNA. RNA fragments generated by guanosine-specific RNase T(1) digestion were analyzed by matrix-assisted laser desorption/ionization-time of flight mass spectrometry. Viral serotypes were identified by comparing the pattern of observed fragment masses to a mass database. The database was created by computationally fragmenting 2517 dengue strains after each guanosine residue using the same primers. Computationally, all 2517 strains in the mass database were correctly identified at the serotype level from the predicted PCR product. The methodology was successfully demonstrated experimentally by identifying the serotypes of eight test strains using mosquito cell cultures infected with strains of all four serotypes and with full-length cDNA clones.
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Affiliation(s)
- Charul Gijavanekar
- Department of Biology and Biochemistry, University of Houston, TX 77204, USA
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Fatima Z, Idrees M, Bajwa MA, Tahir Z, Ullah O, Zia MQ, Hussain A, Akram M, Khubaib B, Afzal S, Munir S, Saleem S, Rauff B, Badar S, Naudhani M, Butt S, Aftab M, Ali L, Ali M. Serotype and genotype analysis of dengue virus by sequencing followed by phylogenetic analysis using samples from three mini outbreaks-2007-2009 in Pakistan. BMC Microbiol 2011; 11:200. [PMID: 21906394 PMCID: PMC3180347 DOI: 10.1186/1471-2180-11-200] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 09/10/2011] [Indexed: 11/24/2022] Open
Abstract
Background Since the first reported outbreak of dengue hemorrhagic fever in Pakistan, several mini outbreaks have erupted in the region. Dengue virus serotype 3 (DEN-3) was first documented in 2005 outbreak in Karachi. Reports show that serotype 3 is prevalent in Lahore since 2008. Serotype 2 (DEN-2) is the major circulating serotype in Pakistan as it is documented since 1994. We have conducted a detailed study of three outbreaks of dengue virus infection that occurred in years 2007, 2008 and 2009 in Lahore by using molecular techniques such as PCR and nucleotide sequencing of the C-prM gene junction of Dengue virus. Results Through the analysis of 114 serum samples collected over the period of three years (2007-2009), total 20 patients were found to be infected with dengue virus. In year 2007, four were positive for serotype 2 and one sample was positive for serotype DEN-3. In 2008, five samples had concurrent infection with serotypes DEN-2 and DEN-3 while three samples were infected only with serotype DEN-2. In year 2009, one sample had concurrent infection with serotypes DEN-2 and DEN-3 while six were positive for serotype DEN-2 only. Conclusions Our study showed that serotype DEN-2 was dominant in positive samples of dengue virus infection collected during the period of three years (2007-2009). The other serotype present was serotype DEN-3. Genotypes of serotype DEN-2 and serotype DEN-3 were subtype IV and subtype III, respectively.
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Affiliation(s)
- Zareen Fatima
- Division of Molecular Virology, CEMB University of the Punjab, 87-West Canal Bank Road, Thokar Niaz Baig, Lahore-53700, Pakistan
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Jahan F. Dengue Fever (DF) in Pakistan. ASIA PACIFIC FAMILY MEDICINE 2011; 10:1. [PMID: 21349169 PMCID: PMC3050821 DOI: 10.1186/1447-056x-10-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 02/24/2011] [Indexed: 05/20/2023]
Abstract
Dengue is a widespread mosquito-borne infection in human beings, which in recent years has become a major international public health concern. Symptomatic dengue virus infections can present with a wide range of clinical manifestations, from a mild febrile illness to a life-threatening shock syndrome. Both viral and host factors are thought to contribute to the manifestations of disease in each infected. It is important to understand its burden on health care, morbidity and mortality. Early diagnosis and suspicion of DF in primary care might reduce the complications if handled properly. We must understand the depth of the problem in terms of its transmission, clinical presentation, diagnosis, management and prevention.
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Affiliation(s)
- Fridous Jahan
- Family Medicine Department, Aga Khan University Hospital, Stadium Road PO Box 3500, Postal Code 74800, Karachi, Pakistan.
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Khan E, Kisat M, Khan N, Nasir A, Ayub S, Hasan R. Demographic and clinical features of dengue fever in Pakistan from 2003-2007: a retrospective cross-sectional study. PLoS One 2010; 5:e12505. [PMID: 20856935 PMCID: PMC2938342 DOI: 10.1371/journal.pone.0012505] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 07/27/2010] [Indexed: 11/19/2022] Open
Abstract
Background Demographic features of dengue fever have changed tremendously in Pakistan over the past two decades. Small scale studies from all over the country have reported different aspects of individual outbreaks during this time. However, there is scarcity of data looking at the overall trend of dengue virus infection in the country. In this study, we examined annual trends, seasonality, and clinical features of dengue fever in the Pakistani population. Methods Demographic information and dengue IgM status of all patients tested for dengue IgM antibody at Aga Khan University Hospital from January 2003 to December 2007 were analyzed to look for trends of IgM-positive cases in Pakistan. In addition, clinical and biochemical parameters were abstracted retrospectively from medical records of all patients hospitalized with IgM-proven dengue fever between January 2006 and December 2007. These patients were categorized into dengue fever and dengue hemorrhagic fever according to the WHO severity grading scale. Results Out of a total of 15040 patients (63.2% male and 36.8% female), 3952 (26.3%) tested positive for dengue IgM antibody. 209 IgM proven dengue patients were hospitalized during the study period. During 2003, IgM positive cases were seen only during the months of July-December. In contrast, such cases were detected throughout the year from the 2004–2007. The median age of IgM positive patients decreased every year from 32.0 years in 2003 to 24.0 years in 2007 (p<0.001). Among hospitalized patients, nausea was the most common presenting feature found in 124/209 (59.3%) patients. Children presented with a higher median body temperature than adults (p = 0.010). In addition, neutropenia was seen more commonly in children while raised serum ALT levels were seen more commonly in adults (both p = 0.006). While a low total white cell count was more common in patients with dengue fever as compared to Dengue Hemorrhagic Fever (p = 0.020), neutropenia (p = 0.019), monocytosis (p = 0.001) and raised serum ALT level (p = 0.005) were observed more commonly in the latter group. Conclusions Dengue virus is now endemic in Pakistan, circulating throughout the year with a peak incidence in the post monsoon period. Median age of dengue patients has decreased and younger patients may be more susceptible. Total and differential leukocyte counts may help identify patients at risk of hemorrhage.
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Affiliation(s)
- Erum Khan
- Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan.
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Multiple dengue serotypes and high frequency of dengue hemorrhagic fever at two tertiary care hospitals in Lahore during the 2008 dengue virus outbreak in Punjab, Pakistan. Int J Infect Dis 2010; 14 Suppl 3:e54-9. [PMID: 20171916 DOI: 10.1016/j.ijid.2009.10.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 10/09/2009] [Accepted: 10/15/2009] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of this study was to investigate the clinical characteristics of patients with dengue viral infection during the 2008 outbreak in Lahore in order to better understand the clinical pattern and severity of disease in Lahore. METHODS We analyzed the clinical characteristics of 110 patients infected with dengue virus; data were collected on standardized data collection sheets at two tertiary care hospitals from September to December 2008. Dengue infection was confirmed serologically or by real-time polymerase chain reaction (RT-PCR). RESULTS Out of the total of 110 dengue infected patients, 70 were male and 40 were female. The most common symptoms included fever (100%), myalgia (68.2%), headache (55.5%), nausea (39.1%), skin rash (53.6%), mucocutaneous hemorrhagic manifestations (58.2%), and ocular pain (20%). Classic dengue fever (DF) was seen in 41.8% of the patients, 56.4% had dengue hemorrhagic fever (DHF), and only 1.8% developed dengue shock syndrome (DSS). The mean duration of fever was 6 days. Thrombocytopenia, leukopenia, and abnormal aspartate aminotransferase (AST)/alanine aminotransferase (ALT) were more frequently encountered in DHF and DSS as compared to DF. Viral RNA detection was done by RT-PCR in 17 patients. Ten patients had DEN4, five had DEN2, and two had DEN3 serotypes. The majority of the patients recovered completely without complications. CONCLUSION The high frequency of DHF during the 2008 outbreak and the presence of three different dengue serotypes, emphasize the need to prevent and control dengue infection. Health authorities should consider strengthening surveillance for dengue infection, given the potential for future outbreaks with increased severity. It is also suggested that primary care physicians should be educated regarding recognition of DHF and to identify patients at high risk of developing DHF and DSS.
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