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Phadungsombat J, Nakayama EE, Shioda T. Unraveling Dengue Virus Diversity in Asia: An Epidemiological Study through Genetic Sequences and Phylogenetic Analysis. Viruses 2024; 16:1046. [PMID: 39066210 PMCID: PMC11281397 DOI: 10.3390/v16071046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Dengue virus (DENV) is the causative agent of dengue. Although most infected individuals are asymptomatic or present with only mild symptoms, severe manifestations could potentially devastate human populations in tropical and subtropical regions. In hyperendemic regions such as South Asia and Southeast Asia (SEA), all four DENV serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) have been prevalent for several decades. Each DENV serotype is further divided into multiple genotypes, reflecting the extensive diversity of DENV. Historically, specific DENV genotypes were associated with particular geographical distributions within endemic regions. However, this epidemiological pattern has changed due to urbanization, globalization, and climate change. This review comprehensively traces the historical and recent genetic epidemiology of DENV in Asia from the first time DENV was identified in the 1950s to the present. We analyzed envelope sequences from a database covering 16 endemic countries across three distinct geographic regions in Asia. These countries included Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka from South Asia; Cambodia, Laos, Myanmar, Thailand, and Vietnam from Mainland SEA; and Indonesia, the Philippines, Malaysia, and Singapore from Maritime SEA. Additionally, we describe the phylogenetic relationships among DENV genotypes within each serotype, along with their geographic distribution, to enhance the understanding of DENV dynamics.
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Affiliation(s)
| | | | - Tatsuo Shioda
- Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan; (J.P.); (E.E.N.)
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Anantharaj A, Agrawal T, Shashi PK, Tripathi A, Kumar P, Khan I, Pareek M, Singh B, Pattabiraman C, Kumar S, Pandey R, Chandele A, Lodha R, Whitehead SS, Medigeshi GR. Neutralizing antibodies from prior exposure to dengue virus negatively correlate with viremia on re-infection. COMMUNICATIONS MEDICINE 2023; 3:148. [PMID: 37857747 PMCID: PMC10587183 DOI: 10.1038/s43856-023-00378-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND India is hyperendemic to dengue and over 50% of adults are seropositive. There is limited information on the association between neutralizing antibody profiles from prior exposure and viral RNA levels during subsequent infection. METHODS Samples collected from patients with febrile illness was used to assess seropositivity by indirect ELISA. Dengue virus (DENV) RNA copy numbers were estimated by quantitative RT-PCR and serotype of the infecting DENV was determined by nested PCR. Focus reduction neutralizing antibody titer (FRNT) assay was established using Indian isolates to measure the levels of neutralizing antibodies and also to assess the cross-reactivity to related flaviviruses namely Zika virus (ZIKV), Japanese encephalitis virus (JEV) and West Nile virus (WNV). RESULTS In this cross-sectional study, we show that dengue seropositivity increased from 52% in the 0-15 years group to 89% in >45 years group. Antibody levels negatively correlate with dengue RNAemia on the day of sample collection and higher RNAemia is observed in primary dengue as compared to secondary dengue. The geometric mean FRNT50 titers for DENV-2 is significantly higher as compared to the other three DENV serotypes. We observe cross-reactivity with ZIKV and significantly lower or no neutralizing antibodies against JEV and WNV. The FRNT50 values for international isolates of DENV-1, DENV-3 and DENV-4 is significantly lower as compared to Indian isolates. CONCLUSIONS Majority of the adult population in India have neutralizing antibodies to all the four DENV serotypes which correlates with reduced RNAemia during subsequent infection suggesting that antibodies can be considered as a good correlate of protection.
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Affiliation(s)
- Anbalagan Anantharaj
- Bioassay laboratory and Clinical and Cellular Virology lab, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Tanvi Agrawal
- Bioassay laboratory and Clinical and Cellular Virology lab, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Pooja Kumari Shashi
- Bioassay laboratory and Clinical and Cellular Virology lab, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Alok Tripathi
- Bioassay laboratory and Clinical and Cellular Virology lab, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Parveen Kumar
- Bioassay laboratory and Clinical and Cellular Virology lab, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Imran Khan
- Bioassay laboratory and Clinical and Cellular Virology lab, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Madhu Pareek
- Bioassay laboratory and Clinical and Cellular Virology lab, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Balwant Singh
- Bioassay laboratory and Clinical and Cellular Virology lab, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | | | - Saurabh Kumar
- Bioassay laboratory and Clinical and Cellular Virology lab, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Rajesh Pandey
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) laboratory, Division of Immunology and Infectious Disease Biology, CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Anmol Chandele
- ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Stephen S Whitehead
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Guruprasad R Medigeshi
- Bioassay laboratory and Clinical and Cellular Virology lab, Translational Health Science and Technology Institute, Faridabad, Haryana, India.
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Garcia--Van Smévoorde M, Piorkowski G, Emboulé L, Dos Santos G, Loraux C, Guyomard-Rabenirina S, Joannes MO, Fagour L, Najioullah F, Cabié A, de Lamballerie X, Vega-Rúa A, Césaire R, Calvez E. Phylogenetic Investigations of Dengue 2019-2021 Outbreak in Guadeloupe and Martinique Caribbean Islands. Pathogens 2023; 12:1182. [PMID: 37764990 PMCID: PMC10534936 DOI: 10.3390/pathogens12091182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Dengue fever has been a public health problem in the Caribbean region since 1981, when it first reappeared in Cuba. In 1989, it was reported in Martinique and Guadeloupe (two French islands 200 km apart); since then, DENV has caused several epidemics locally. In 2019-2021, DENV-1, DENV-2, and DENV-3 were detected. Serotype distribution was differentiated, with DENV-2 and DENV-3 predominating in Guadeloupe and Martinique, respectively. Complete genome sequencing was carried out on 32 specimens, and phylogenic analysis identified the circulation of genotype V for DENV-1, cosmopolitan genotype for DENV-2, and genotype III for DENV-3. However, two distinct circulating groups were identified for DENV-1 and DENV-3, suggesting independent introductions. Overall, despite the context of the COVID-19 pandemic and the associated travel restrictions, these results confirm the active circulation of DENV and specific epidemiological features on each of the two islands. Such differences may be linked to the founder effect of the various introduction events, and to local factors such as the population immunity and the transmission capacity of the vectors. Further genomic and epidemiological characterization of DENV strains remains essential to understand how dengue spreads in each specific geographical context and to prevent future epidemics.
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Affiliation(s)
- Margot Garcia--Van Smévoorde
- Vector Control Research Laboratory, Transmission Reservoir and Pathogens Diversity Unit, Institut Pasteur de la Guadeloupe, Les Abymes 97139, Guadeloupe;
| | - Géraldine Piorkowski
- Unité des Virus Emergents (UVE), Aix-Marseille Univ-IRD 190-Inserm 1207, 13005 Marseille, France; (G.P.); (X.d.L.)
- National Reference Center for Arboviruses, National Institute of Health and Medical Research (Inserm), 13005 Marseille, France
- French Armed Forces Biomedical Research Institute (IRBA), 91220 Brétigny-sur-Orge, France
| | - Loic Emboulé
- Molecular Genetics and Inherited Red Blood Cell Diseases Laboratory, University Hospitals of Guadeloupe, Pointe-à-Pitre 97159, Guadeloupe;
| | - Georges Dos Santos
- Department of Virology, University Hospitals of Martinique, Fort-de-France, 97200 Martinique, France; (G.D.S.); (L.F.)
- Pathogenesis and Controle of Chronic and Emerging Infections, French National Blood Service (EFS), National Institute of Health and Medical Research (Inserm), University of Montpellier, 34000 Montpellier, France; (A.C.); (R.C.)
- University of Antilles, Pointe-à-Pitre 97110, Guadeloupe
| | - Cécile Loraux
- Department of Virology, University Hospitals of Guadeloupe, Pointe-à-Pitre 97159, Guadeloupe;
| | - Stéphanie Guyomard-Rabenirina
- Microbial Ecosystems Interaction Laboratory, Transmission Reservoir and Pathogens Diversity Unit, Institut Pasteur de la Guadeloupe, Les Abymes 97139, Guadeloupe;
| | - Marie-Odile Joannes
- Department of Hematology Immunology Histocompatibility, University Hospitals of Guadeloupe, Pointe-à-Pitre 97159, Guadeloupe;
| | - Laurence Fagour
- Department of Virology, University Hospitals of Martinique, Fort-de-France, 97200 Martinique, France; (G.D.S.); (L.F.)
| | - Fatiha Najioullah
- Department of Clinical Research and Innovation, University Hospitals of Martinique, Fort-de-France, 97200 Martinique, France;
| | - André Cabié
- Pathogenesis and Controle of Chronic and Emerging Infections, French National Blood Service (EFS), National Institute of Health and Medical Research (Inserm), University of Montpellier, 34000 Montpellier, France; (A.C.); (R.C.)
- University of Antilles, Pointe-à-Pitre 97110, Guadeloupe
- Department of Infectious and Tropical Diseases, University Hospitals of Martinique, Fort-de-France, 97200 Martinique, France
| | - Xavier de Lamballerie
- Unité des Virus Emergents (UVE), Aix-Marseille Univ-IRD 190-Inserm 1207, 13005 Marseille, France; (G.P.); (X.d.L.)
- National Reference Center for Arboviruses, National Institute of Health and Medical Research (Inserm), 13005 Marseille, France
| | - Anubis Vega-Rúa
- Vector Control Research Laboratory, Transmission Reservoir and Pathogens Diversity Unit, Institut Pasteur de la Guadeloupe, Les Abymes 97139, Guadeloupe;
| | - Raymond Césaire
- Pathogenesis and Controle of Chronic and Emerging Infections, French National Blood Service (EFS), National Institute of Health and Medical Research (Inserm), University of Montpellier, 34000 Montpellier, France; (A.C.); (R.C.)
- University of Antilles, Pointe-à-Pitre 97110, Guadeloupe
- Department of Virology, University Hospitals of Guadeloupe, Pointe-à-Pitre 97159, Guadeloupe;
| | - Elodie Calvez
- Vector Control Research Laboratory, Transmission Reservoir and Pathogens Diversity Unit, Institut Pasteur de la Guadeloupe, Les Abymes 97139, Guadeloupe;
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Mustafa Z, Khan HM, Azam M, Sami H, Ali SG, Ahmad I, Raza A, Khan MA. Insight into the seroepidemiology and dynamics of circulating serotypes of dengue virus over a 4 year period in western Uttar Pradesh, India. Access Microbiol 2023; 5:acmi000567.v4. [PMID: 37424567 PMCID: PMC10323805 DOI: 10.1099/acmi.0.000567.v4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
An important public health problem in India is dengue infection, with every year seeing an increase in cases of dengue fever. Dengue affects all individuals irrespective of their gender and age, although the infection rate is higher among males and younger people. Despite low severity in general, dengue virus can cause severe health conditions in some individuals. Genetic characterization of circulating endemic dengue virus (DENV) serotypes plays a significant role in providing epidemiological knowledge and subsequent vaccine development. In the present study, over a 4 year period, we assessed DENV transmission dynamics in major regions of western Uttar Pradesh in North India. ELISA tests were used to diagnose dengue, and PCRs were used to determine the circulating serotype. We found that dengue infection peaks after the rainy season and affects all sexes and ages. A total of 1277 individuals were found positive for dengue; among them, 61.7 % were male and 38.3 % were female. DEN-1 was found in 23.12 %, DEN-2 in 45 %, DEN-3 in 29.06 % and DEN-4 in 1.5 % of the dengue-infected individuals. All four DENV serotypes were circulating in the study area, and DENV serotype-2 (DEN-2) was the most prevalent serotype.
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Affiliation(s)
- Zeeshan Mustafa
- Department of Microbiology, J.N. Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Haris Manzoor Khan
- Department of Microbiology, J.N. Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Mohd Azam
- College of Applied Medical Sciences, Al-Qassim University, Buraydah, Qassim KSA, Saudi Arabia
| | - Hiba Sami
- Department of Microbiology, J.N. Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Syed Ghazanfar Ali
- Viral Research & Diagnostic Laboratory, Department of Microbiology, J.N. Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Islam Ahmad
- Viral Research & Diagnostic Laboratory, Department of Microbiology, J.N. Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Adil Raza
- Department of Microbiology, J.N. Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Mohammad Azam Khan
- Department of Statistics & Operational Research, Aligarh Muslim University, Aligarh, UP, India
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Islam A, Deeba F, Tarai B, Gupta E, Naqvi IH, Abdullah M, Dohare R, Ahmed A, Almajhdi FN, Hussain T, Parveen S. Global and local evolutionary dynamics of Dengue virus serotypes 1, 3, and 4. Epidemiol Infect 2023; 151:e127. [PMID: 37293986 PMCID: PMC10540175 DOI: 10.1017/s0950268823000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/01/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
Evolutionary studies on Dengue virus (DENV) in endemic regions are necessary since naturally occurring mutations may lead to genotypic variations or shifts in serotypes, which may lead to future outbreaks. Our study comprehends the evolutionary dynamics of DENV, using phylogenetic, molecular clock, skyline plots, network, selection pressure, and entropy analyses based on partial CprM gene sequences. We have collected 250 samples, 161 in 2017 and 89 in 2018. Details for the 2017 samples were published in our previous article and that of 2018 are presented in this study. Further evolutionary analysis was carried out using 800 sequences, which incorporate the study and global sequences from GenBank: DENV-1 (n = 240), DENV-3 (n = 374), and DENV-4 (n = 186), identified during 1944-2020, 1956-2020, and 1956-2021, respectively. Genotypes V, III, and I were identified as the predominant genotypes of the DENV-1, DENV-3, and DENV-4 serotypes, respectively. The rate of nucleotide substitution was found highest in DENV-3 (7.90 × 10-4 s/s/y), followed by DENV-4 (6.23 × 10-4 s/s/y) and DENV-1 (5.99 × 10-4 s/s/y). The Bayesian skyline plots of the Indian strains revealed dissimilar patterns amongst the population size of the three serotypes. Network analyses showed the presence of different clusters within the prevalent genotypes. The data presented in this study will assist in supplementing the measures for vaccine development against DENV.
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Affiliation(s)
- Arshi Islam
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, India
| | - Farah Deeba
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, India
| | - Bansidhar Tarai
- Department of Microbiology and Infection Control, Max Superspeciality Hospital, New Delhi, India
| | - Ekta Gupta
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Irshad H. Naqvi
- Dr. M.A. Ansari Health Centre, Jamia Millia Islamia, New Delhi, India
| | - Mohd. Abdullah
- Dr. M.A. Ansari Health Centre, Jamia Millia Islamia, New Delhi, India
| | - Ravins Dohare
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, India
| | - Anwar Ahmed
- Centre of Excellence in Biotechnology Research, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Fahad N. Almajhdi
- Centre of Excellence in Biotechnology Research, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Tajamul Hussain
- Centre of Excellence in Biotechnology Research, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Shama Parveen
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, India
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Ibemgbo SA, Nyodu R, Chaudhary S, Verma DK, Dixit K, Nayak K, Rani V, Gaind R, Chandele A, Sunil S. Short communication: Virological and B cell profiles of chikungunya and Dengue virus co-infections in Delhi during 2017-2019. Virus Res 2022; 320:198888. [PMID: 35977625 DOI: 10.1016/j.virusres.2022.198888] [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: 07/26/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022]
Abstract
With explosive epidemics of chikungunya in India since 2004, chikungunya virus (CHIKV) now co-circulates in geographical areas where Dengue virus (DENV) is already endemic and thus provides opportunity for the same mosquito to be infected with both viruses. Although there are excellent studies that have addressed the clinical of mono and co-infection, we have little to no knowledge on the current viral sequences that pre-dominate co-infections, and the B cell response elicited. In this study, we analyzed febrile patients that were confirmed to have DENV-CHIKV co-infections and asked the following questions: 1) what is the frequency of co-infections found in a single cycle of transmission; 2) what are the viral sequences associated with them; 3) what does the antibody secreting cell / plasmablast response look like in patients that are co-infected with both viruses. We report those co-infections occur at a frequency of 6.7% in the transmission cycle, and while DENV-3 is now frequently detected, we do not see a serotype bias in the patients that are co-infected with ESCA strain of CHIKV. Moreover, the effector B cell response (plasmablasts) observed are specific to both infecting viruses indicating no overt bias. Further studies to associate whether any of these properties have a bearing on clinical disease manifestation will be both timely and important.
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Affiliation(s)
- Sylvester Agha Ibemgbo
- Vector Borne Diseases Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Rajni Nyodu
- ICGEB-Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Sakshi Chaudhary
- Vector Borne Diseases Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Dileep Kumar Verma
- Vector Borne Diseases Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Kritika Dixit
- ICGEB-Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Kaustuv Nayak
- ICGEB-Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Vandana Rani
- Dept of Microbiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Rajni Gaind
- Dept of Microbiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Anmol Chandele
- ICGEB-Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India.
| | - Sujatha Sunil
- Vector Borne Diseases Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India.
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Incidence of lab-confirmed dengue fever in a pediatric cohort in Delhi, India. PLoS Negl Trop Dis 2022; 16:e0010333. [PMID: 35390000 PMCID: PMC9017938 DOI: 10.1371/journal.pntd.0010333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/19/2022] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Our aim was to estimate the overall and age-specific incidence of lab-confirmed dengue fever using ELISA based assays among children 6 months to 15 years in Delhi. Methods We enrolled a cohort of 984 children aged 6 months to <14 years in South Delhi and followed-up weekly for fever for 24 months or till 15 completed years of child-age. Households of the enrolled children were geo-tagged. NS1, IgM and IgG assays were conducted using ELISA method to confirm dengue fever in children with ≥3 consecutive days of fever. Molecular typing was done in a subset of NS1 positive cases to identify the circulating serotypes. Principal findings We had a total of 1953 person-years (PY) of follow up. Overall, there were 4208 episodes of fever with peaks during June to November. The overall incidence (95%CI) of fever was 215/100 PY (209 to 222). A total of 74/1250 3-day fever episodes were positive for acute dengue fever (NS1 and/or IgM positive). The overall incidence (95%CI) of acute dengue fever was 37.9 (29.8 to 47.6) per 1000 PY; highest among children aged 5 to 10 years (50.4 per 1000 PY, 95% CI 36.5 to 67.8). Spatial autocorrelation analysis suggested a clustering pattern for the dengue fever cases (Moran’s Index 0.35, z-score 1.8, p = 0.06). Dengue PCR was positive in 16 of the 24 specimens tested; DEN 3 was the predominant serotype identified in 15/24 specimens. Conclusions We found a high incidence of dengue fever among under 15-year children with clustering of cases in the community. DEN 3 was the most commonly circulating strain encountered. The findings underscore the need for development of affordable pre-vaccination screening strategy as well as newer dengue vaccines for young children while continuing efforts in vector control. South Asian countries especially the Indian subcontinent contributes the highest to the global burden of dengue. The number of dengue cases reported in India is likely an underestimate of the actual disease burden and there is a clear lack in the availability of population-based data on incidence of dengue in India. In our pediatric cohort of 984 children aged 6 months to 15 years from Delhi, India, we found a high incidence of lab-confirmed dengue fever, with the highest burden among 5 to 10 year old children. Dengue fever was observed to be highest in the post-monsoon months with significant clustering of cases in the community. DEN 3 was the most commonly circulating strain encountered. Given the high burden in children, the findings highlight the need for strengthening efforts to developing newer dengue vaccines for younger children.
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Padhi A, Gupta E, Singh G, Parveen S, Islam A, Tarai B. Circulation of DENV-3 Genotype 3 during 2017 to 2018 in Delhi: A Single-Center Hospital-Based Study. J Lab Physicians 2022; 14:21-26. [PMID: 36186256 PMCID: PMC9519262 DOI: 10.1055/s-0041-1734017] [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] [Indexed: 11/21/2022] Open
Abstract
Introduction Delhi is hyperendemic for dengue virus (DENV) where all the four DENV have previously been reported. A constant vigilance of circulating DENV serotypes is important in surveillance, since the introduction of a new variant to areas affected by preexisting serotypes constitutes a risk factor for dengue hemorrhagic fever and dengue shock syndrome. Objectives This retrospective study was performed with an objective to determine the circulating serotype and genotype of DENV in acute phase blood samples of patients who have reported to a tertiary liver care hospital in New Delhi during the last 2 years (2017-2018). Methods The data of clinician-initiated testing for dengue nonstructural protein 1 (NS1) antigen (Ag) was searched in the institutional hospital information system. The serum sample of dengue NS1 Ag-positive cases confirmed by enzyme-linked immunosorbent assay (ELISA; PANBIO, Gyeonggi-do, ROK) and a fever duration of less than 5 days were retrieved from the laboratory archive. The DENV serotyping on these sample was performed by reverse transcriptase polymerase chain reaction (RT-PCR). Sequencing and phylogenetic analysis was done for the capsid premembrane (CprM) region to determine the genotype. Results A total of 440 acute-phase samples were received. Twenty one (4.77%) were positive for dengue NS1 Ag with a mean age of 35.1 years and male-to-female ratio of 1.1:1. Eight cases (38.09%) were positive by dengue RT-PCR and all belonged to DENV-3 serotypes. Phylogenetic tree analysis revealed DENV-3 clustered to genotype III with 100% homology with 2008 Indian subcontinent strain. Conclusion This study revealed circulation of DENV-3, genotype III in Delhi from 2017 to 2018, similar to the 2008 viral type. Virological surveillance is an important exercise to be done for viral infections with public threat and outbreak potential.
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Affiliation(s)
- Abhishek Padhi
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | - Ekta Gupta
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | - Gaurav Singh
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | - Shama Parveen
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, Delhi, India
| | - Arshi Islam
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, Delhi, India
| | - Bansidhar Tarai
- Department of Microbiology and Infection Control, Max Superspeciality Hospital, New Delhi, Delhi, India
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Pathak B, Chakravarty A, Krishnan A. High viral load positively correlates with thrombocytopenia and elevated haematocrit in dengue infected paediatric patients. J Infect Public Health 2021; 14:1701-1707. [PMID: 34655984 DOI: 10.1016/j.jiph.2021.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Dengue fever is one of the major viral diseases worldwide transmitted by mosquitoes. Depending on the severity of disease it can range from mild fever to severe fatal cases. Rapid decline of platelet levels is one of indicators of clinical worsening. The role of viral factors in dengue pathogenesis and correlation with clinical and laboratory parameters remain unclear. METHODS Between September 2017 to December 2018, 102 dengue confirmed paediatric cases were analysed for various viral and host parameters. Based on symptoms, they were classified into dengue without warning signs (DOS), dengue with warning signs (DWS) and severe dengue (SD) as per 2009 WHO classification. Quantitative analysis of NS1, IgM and IgG in were done by ELISA. IgM/IgG ratio revealed primary or secondary dengue infection. Serotyping of virus in serum was done by nested multiplex RT-PCR. Viral load (VL) was determined by quantitative real time polymerase chain reaction. Association between VL and NS1 in patient sera with clinical and laboratory parameters was statistically analysed. RESULTS It was found that disease severity (as per 2009 WHO classification) significantly associated with secondary dengue infection. DENV3 was found to be the only serotype detected. The present study reports neither NS1 nor VL significantly associated with disease severity or type of infection (primary or secondary). However, VL positively correlated with haematocrit (p < 0.05). Viral load above 106 copies/mL was found in 61% of patients. Further, high viral load (>106 copies/mL) negatively correlated with platelet levels (p < 0.05). CONCLUSION Thus, viral load could be an important predictive parameter in dengue related severe symptoms like thrombocytopenia and elevated hematocrit when it goes above a certain threshold (>106 copies/ mL).
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Affiliation(s)
- Bharti Pathak
- Department of Molecular Medicine, School of Interdisciplinary Sciences & Technology, Jamia Hamdard, New Delhi 110062, India
| | - Aparna Chakravarty
- Department of Paediatrics, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Anuja Krishnan
- Department of Molecular Medicine, School of Interdisciplinary Sciences & Technology, Jamia Hamdard, New Delhi 110062, India.
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Gowri Sankar S, Mowna Sundari T, Alwin Prem Anand A. Emergence of Dengue 4 as Dominant Serotype During 2017 Outbreak in South India and Associated Cytokine Expression Profile. Front Cell Infect Microbiol 2021; 11:681937. [PMID: 34447698 PMCID: PMC8382982 DOI: 10.3389/fcimb.2021.681937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/12/2021] [Indexed: 12/23/2022] Open
Abstract
Dengue virus (DENV) infection is prevalent in tropical and subtropical regions of the world, which is fatal if untreated symptomatically. Emergence of new genotype within serotypes led to enhanced severity. The objective of the study is to identify the molecular characteristics of the DENV circulated during 2017 outbreak in Tamil Nadu, India, and to investigate the role of inflammatory cytokines in different “serotypes” and in “dengue severity”. A total of 135 suspected samples were tested for DENV infection using IgM, IgG, and qPCR assay; where 76 samples were positive for DENV and analyzed for 12 inflammatory cytokines using ELISA. Serotyping shows 14 DENV-1, 22 DENV-2, 7 DENV-3, and 33 DENV-4, where DENV-4 was predominant. Among 76, 42 isolates were successfully sequenced for C-prM region and grouped. A lineage shift was observed in DENV-4 genotype. Irrespective of serotypes, IFNγ was significantly elevated in all serotypes than control as well as in primary infection than secondary, indicating its role in immune response. GM-CSF and IP-10 were significantly elevated in secondary infection and could be used as prognostic biomarkers for secondary infection. Our observation shows differential cytokine expression profile varied with each serotype, indicating serotype/genotype-specific viral proteins might play a major role in dengue severity. DENV-4 as dominant serotype was reported in Tamil Nadu for the first time during an outbreak with a mixed Th1/Th17 cytokine expression profile that correlated with disease severity. We conclude it is essential to identify circulating viral genotype and their fitness by mutational analysis to correlate with disease severity and immune status, as this correlation will be helpful in diagnostics and therapeutics applications.
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Affiliation(s)
- S Gowri Sankar
- Department of Molecular Biology, Indian Council of Medical Research (ICMR)-Vector Control Research Center - Field Station, Madurai, India
| | - T Mowna Sundari
- Department of Biotechnology - Bioinformatics Infrastructure Facilities (DBT-BIF) Centre (Under DBT Biotechnology Information System Network (BTISNet) Scheme), Lady Doak College, Madurai, India.,Department of Biotechnology, Lady Doak College, Madurai, India
| | - A Alwin Prem Anand
- Institute of Clinical Anatomy and Cell Analysis, University of Tuebingen, Tuebingen, Germany
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11
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Tsheten T, Gray DJ, Clements ACA, Wangdi K. Epidemiology and challenges of dengue surveillance in the WHO South-East Asia Region. Trans R Soc Trop Med Hyg 2021; 115:583-599. [PMID: 33410916 DOI: 10.1093/trstmh/traa158] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/02/2020] [Accepted: 11/18/2020] [Indexed: 11/13/2022] Open
Abstract
Dengue poses a significant health and economic burden in the WHO South-East Asia Region. Approaches for control need to be aligned with current knowledge on the epidemiology of dengue in the region. Such knowledge will ensure improved targeting of interventions to reduce dengue incidence and its socioeconomic impact. This review was undertaken to describe the contemporary epidemiology of dengue and critically analyse the existing surveillance strategies in the region. Over recent decades, dengue incidence has continued to increase with geographical expansion. The region has now become hyper-endemic for multiple dengue virus serotypes/genotypes. Every epidemic cycle was associated with a change of predominant serotype/genotype and this was often associated with severe disease with intense transmission. Classical larval indices are widely used in vector surveillance and adult mosquito samplings are not implemented as a part of routine surveillance. Further, there is a lack of integration of entomological and disease surveillance systems, often leading to inaction or delays in dengue prevention and control. Disease surveillance does not capture all cases, resulting in under-reporting, and has thus failed to adequately represent the true burden of disease in the region. Possible solutions include incorporating adult mosquito sampling into routine vector surveillance, the establishment of laboratory-based sentinel surveillance, integrated vector and dengue disease surveillance and climate-based early warning systems using available technologies like mobile apps.
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Affiliation(s)
- Tsheten Tsheten
- Department of Globa l Health, Research School of Population Health, Australian National University, Canberra, Australia.,Royal Centre for Disease Control, Ministry of Health, Bhutan
| | - Darren J Gray
- Department of Globa l Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Perth, Australia.,Telethon Kids Institute, Nedlands, Australia
| | - Kinley Wangdi
- Department of Globa l Health, Research School of Population Health, Australian National University, Canberra, Australia
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12
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Ahsan A, Haider N, Kock R, Benfield C. Possible Drivers of the 2019 Dengue Outbreak in Bangladesh: The Need for a Robust Community-Level Surveillance System. JOURNAL OF MEDICAL ENTOMOLOGY 2021; 58:37-39. [PMID: 32725192 DOI: 10.1093/jme/tjaa150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Atik Ahsan
- LEARN Dengue Outbreak Project, The Start Fund Bangladesh, Dhaka, Bangladesh
| | - Najmul Haider
- The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, United Kingdom
| | - Richard Kock
- The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, United Kingdom
| | - Camilla Benfield
- The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, United Kingdom
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13
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Islam A, Abdullah M, Tazeen A, Naqvi IH, Kazim SN, Ahmed A, Alamery SF, Malik A, Parveen S. Circulation of dengue virus serotypes in hyperendemic region of New Delhi, India during 2011-2017. J Infect Public Health 2020; 13:1912-1919. [PMID: 33148496 DOI: 10.1016/j.jiph.2020.10.009] [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: 01/28/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Dengue fever has become a hampering menace in New Delhi India, since the disease has become hyperendemic, due to circulation of multiple serotypes of dengue virus (DENV). This hyperendemicity poses a greater risk of secondary infections in human health system. This is a major issue which leads to apprehension amongst the researchers and health organizations and thus requires regular epidemiological surveillance. METHODS We analyzed the prevalence and serotypic distribution of dengue fever cases reported from the Southern part of New Delhi during continued surveillance from 2011 to 2017. The blood samples for the investigation were obtained from the patients suspected with dengue fever attending the OPD at a local Health Centre. The data for 2011-2016 was already published from our laboratory. The samples collected during 2017 were serotyped and characterized in the present study. RESULTS A total of 565 samples (59%) were positive for DENV of 958 samples tested by RT-PCR during 7 years (2011-2017). Our study has shown that most infections were caused by DENV-2 during 2011-2015. The data has shown occurrence of all four serotypes of DENV during 2015 and predominance of DENV-3 in 2016 and 2017. Further, predominant combination of DENV-1 and DENV-2 was found in most of the co-infections. To the best of our knowledge this is the first study showing the epidemiological trend of dengue fever in reference to the circulating DENV serotypes and co-infections from a hyperendemic region of New Delhi during 2011-2017. CONCLUSIONS This hyperendemic pattern of DENV and instantaneous shift in circulation of its serotypes is likely pose a greater risk of secondary infections. Inclusion of comprehensive community and hospital surveillance of dengue fever will assist in formulation and implementation of effective control measures.
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Affiliation(s)
- Arshi Islam
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, India
| | - Mohd Abdullah
- Dr. M.A. Ansari Health Centre, Jamia Millia Islamia, New Delhi, India
| | - Ayesha Tazeen
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, India
| | - Irshad H Naqvi
- Dr. M.A. Ansari Health Centre, Jamia Millia Islamia, New Delhi, India
| | - Syed Naqui Kazim
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, India
| | - Anwar Ahmed
- Centre of Excellence in Biotechnology Research, College of Science, King Saud University, Riyadh, Saudi Arabia; Protein Research Chair, Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Salman Freeh Alamery
- Centre of Excellence in Biotechnology Research, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Ajamaluddin Malik
- Protein Research Chair, Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Shama Parveen
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, India.
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14
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Mitochondrial Import of Dengue Virus NS3 Protease and Cleavage of GrpEL1, a Cochaperone of Mitochondrial Hsp70. J Virol 2020; 94:JVI.01178-20. [PMID: 32581108 DOI: 10.1128/jvi.01178-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 12/12/2022] Open
Abstract
Dengue virus infections, which have been reported in nearly 140 countries, pose a significant threat to human health. The genome of dengue virus encodes three structural and seven nonstructural (NS) proteins along with two untranslated regions, one each on both ends. Among them, dengue protease (NS3) plays a pivotal role in polyprotein processing and virus multiplication. NS3 is also known to regulate several host proteins to induce and maintain pathogenesis. Certain viral proteins are known to interact with mitochondrial membrane proteins and interfere with their functions, but the association of a virus-coded protein with the mitochondrial matrix is not known. In this report, by using in silico analysis, we show that NS3pro alone is capable of mitochondrial import; however, this is dependent on its innate mitochondrial transport signal (MTS). Transient-transfection and protein import studies confirm the import of NS3pro to the mitochondrial matrix. Similarly, NS3pro-helicase (amino acids 1 to 464 of NS3) also targets the mitochondria. Intriguingly, reduced levels of matrix-localized GrpE protein homolog 1 (GrpEL1), a cochaperone of mitochondrial Hsp70 (mtHsp70), were noticed in NS3pro-expressing, NS3pro-helicase-expressing, and virus-infected cells. Upon the use of purified components, GrpEL1 undergoes cleavage, and the cleavage sites have been mapped to KR81A and QR92S. Importantly, GrpEL1 levels are seriously compromised in severe dengue virus-infected clinical samples. Our studies provide novel insights into the import of NS3 into host mitochondria and identify a hitherto unknown factor, GrpEL1, as a cleavage target, thereby providing new avenues for dengue virus research and the design of potential therapeutics.IMPORTANCE Approximately 40% of the world's population is at risk of dengue virus infection. There is currently no specific drug or potential vaccine for these infections. Lack of complete understanding of the pathogenesis of the virus is one of the hurdles that must be overcome in developing antivirals for this virus infection. In the present study, we observed that the dengue virus-coded protease imports to the mitochondrial matrix, and our report is the first ever of a virus-coded protein, either animal or human, importing to the mitochondrial matrix. Our analysis indicates that the observed mitochondrial import is due to an inherited mitochondrial transport signal. We also show that matrix-localized GrpE protein homolog 1 (GrpEL1), a cochaperone of mitochondrial Hsp70 (mtHsp70), is also the substrate of dengue virus protease, as observed in vitro and ex vivo in virus-infected cells and dengue virus-infected clinical samples. Hence, our studies reveal an essential aspect of the pathogenesis of dengue virus infections, which may aid in developing antidengue therapeutics.
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Feng K, Zheng X, Wang R, Gao N, Fan D, Sheng Z, Zhou H, Chen H, An J. Long-Term Protection Elicited by a DNA Vaccine Candidate Expressing the prM-E Antigen of Dengue Virus Serotype 3 in Mice. Front Cell Infect Microbiol 2020; 10:87. [PMID: 32257963 PMCID: PMC7089926 DOI: 10.3389/fcimb.2020.00087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/19/2020] [Indexed: 01/12/2023] Open
Abstract
Dengue virus (DENV) is the causative agent of dengue, and its incidence has increased 30-fold in the past five decades. Among the four cocirculating serotypes, DENV3 is associated with an increased number of severe infections and has become widespread. Vaccination is the mainstay of prevention in reducing disease burden. Previously, the protective efficacy of DNA vaccine candidates toward DENV1, 2, and 4 was confirmed in mice. In this study, a DNA vaccine candidate (pVAX1-D3ME) expressing the prM and E proteins of DENV3 was constructed, and then the immunogenicity and protection were assessed in mice to further develop a tetravalent dengue vaccine. Moreover, the cross-reactive immune responses against the other three serotypes were investigated. The results showed that three doses of 50 μg of pVAX1-D3ME were sufficient to induce strong antigen-specific T cell responses and robust and consistent neutralizing antibodies. Additionally, immunization with pVAX1-D3ME offered protective immunity against not only DENV3 but also the other three serotypes, which could be observed even after 12 months. This study shows great promise for the further evaluation of a dengue tetravalent DNA vaccine candidate in large animal models, including non-human primates.
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Affiliation(s)
- Kaihao Feng
- Department of Microbiology and Parasitology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Xiaoyan Zheng
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ran Wang
- Department of Microbiology and Parasitology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Na Gao
- Department of Microbiology and Parasitology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Dongying Fan
- Department of Microbiology and Parasitology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Ziyang Sheng
- Department of Microbiology and Parasitology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Hongning Zhou
- Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan Institute of Parasitic Diseases, Pu'er, China
| | - Hui Chen
- Department of Microbiology and Parasitology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Jing An
- Department of Microbiology and Parasitology, School of Basic Medical Sciences, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
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16
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Barde PV, Shukla MK, Joshi P, Sahare L, Ukey MJ. Molecular studies on dengue viruses detected in patients from Central India. Indian J Med Microbiol 2019; 37:12-18. [PMID: 31424004 DOI: 10.4103/ijmm.ijmm_18_377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose Dengue viruses (DENVs), the causative agents of dengue (DEN), are classified into four serotypes and several genotypes. Identifying circulating serotypes and genotypes has clinical and epidemiological importance; however, limited information in this regard is available from Central India. This laboratory-based study was done to fill this lacuna. Materials and Methods The samples collected in the acute phase of illness were subjected to DEN NS1 ELISA, and NS1-positive samples (n = 80) were subjected to serotyping; representative samples from each serotype were sequenced to identify genotypes. Results Seventy-one (88.75%) samples could be serotyped. All the four DENV serotypes with dominance of DENV-3 (n = 33; 47%) were detected. DENV-4 was detected after a gap of 3 years. Cases with multiple DENV serotype infection were identified. Genotyping showed that DENV-1 belonging to genotype III, DENV-2 cosmopolitan (IV), DENV-3 genotype III lineage C and DENV-4 genotype I were in circulation in the year 2016. Conclusion Our study documents the molecular characteristics of DENV circulating in the area. Detection of heterologous DENV serotype with dominance of DENV-3 emphasises the need for regular molecular monitoring.
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Affiliation(s)
- Pradip V Barde
- Division of Virology and Zoonoses, ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Mohan K Shukla
- Division of Virology and Zoonoses, ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Piyush Joshi
- Division of Virology and Zoonoses, ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Lalit Sahare
- Division of Virology and Zoonoses, ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Mahendra J Ukey
- Division of Virology and Zoonoses, ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
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Agarwal A, Gupta S, Chincholkar T, Singh V, Umare IK, Ansari K, Paliya S, Yadav AK, Chowdhary R, Purwar S, Biswas D. Co-circulation of dengue virus serotypes in Central India: Evidence of prolonged viremia in DENV-2. INFECTION GENETICS AND EVOLUTION 2019; 70:72-79. [DOI: 10.1016/j.meegid.2019.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 02/15/2019] [Accepted: 02/20/2019] [Indexed: 01/01/2023]
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