Dengue in parts of the Guinea Savannah region of Nigeria and the risk of increased transmission

Whole genome sequencing unravels cryptic circulation of divergent dengue virus lineages in the rainforest region of Nigeria

Dengue is often misclassified and underreported in Africa due to inaccurate differential diagnoses of nonspecific febrile illnesses such as malaria, sparsity of diagnostic testing and poor clinical and genomic surveillance. There are limited reports on the seroprevalence and genetic diversity of dengue virus (DENV) in humans and vectors in Nigeria. In this study, we investigated the epidemiology and genetic diversity of dengue in the rainforest region of Nigeria. We screened 515 febrile patients who tested negative for malaria and typhoid fever in three hospitals in Oyo and Ekiti States in southern Nigeria with a combination of anti-dengue IgG/IgM/NS1 rapid test kits and metagenomic sequencing. We found that approximately 28% of screened patients had previous DENV exposure, with the highest prevalence in persons over sixty. Approximately 8% of the patients showed evidence of recent or current infection, and 2.7% had acute infection. Following sequencing of sixty samples, we assembled twenty DENV-1 genomes (3 complete and 17 partial). We found that all assembled genomes belonged to DENV-1 genotype III. Our phylogenetic analyses showed evidence of prolonged cryptic circulation of divergent DENV lineages in Oyo state. We were unable to resolve the source of DENV in Nigeria owing to limited sequencing data from the region. However, our sequences clustered closely with sequences in Tanzania and sequences reported in Chinese with travel history to Tanzania in 2019. This may reflect the wider unsampled bidirectional transmission of DENV-1 in Africa, which strongly emphasizes the importance of genomic surveillance in monitoring ongoing DENV transmission in Africa.

Dengue outbreaks in northern Nigeria: Evaluating the recommended Takeda vaccine and future prevention strategies

Dengue fever, caused by the dengue virus (DENV), poses a significant public health challenge globally, with Nigeria experiencing sporadic outbreaks. A clear understanding of the dengue burden has not been achieved in Nigeria, just as in other African countries. Understanding the epidemiology and burden of dengue fever is essential for effective prevention and control strategies. This paper examines the recent dengue outbreaks in northern Nigeria, particularly in Sokoto state, and evaluates the recommended Takeda dengue vaccine (TDV) along with future prevention strategies. Despite limited surveillance and underreporting, dengue fever is endemic in Nigeria (with over 5 million cases and 5000 dengue-related deaths in 2023), with recent outbreaks indicating a growing concern. The TDV, a live attenuated tetravalent vaccine, has shown promise in preventing dengue fever, but challenges such as vaccine acceptance and accessibility need to be addressed. Global urbanization contributes to the disease's spread, which is influenced by factors such as population density, cultural beliefs, water storage practices, hygiene, and water supply accessibility. Future prevention strategies must focus on government intervention, community practices, and innovative vector control measures to mitigate the spread of DENV in Nigeria. This study will serve as a valuable reference for policymakers, researchers, and clinicians in the management and control of DENV in Nigeria and Africa as a whole.

Addressing the Dengue fever challenges in Nigeria: A narrative review and recommendations for control

Dengue fever is a mosquito-borne viral infection that continues to pose a significant public health threat globally, including Nigeria. Here, we provided a review of dengue fever outbreaks in Nigeria from 1972 to 2023, examining the epidemiology, prevention strategies, challenges faced in combating the disease, and recommendations to mitigate its spread and transmission. We utilized scholarly databases such as PubMed and Google Scholar in writing this paper. The search keywords like, "dengue fever", "break-bone fever", "dengue fever virus" "outbreak", "Nigeria", "prevalence", and "epidemiology", were used to get appropriate published articles about the subject areas. Over the past five decades, Nigeria has experienced intermittent outbreaks of dengue fever, with varying degrees of severity and geographic distribution. Factors such as urbanization, climate change, and inadequate healthcare infrastructure have contributed to the resurgence and spread of the disease in the country. Despite efforts to control dengue transmission through vector control measures and public health interventions, challenges persist, including limited surveillance capacity, diagnostic delays, and gaps in vector control strategies. The emergence of new dengue virus serotypes and the potential for co-circulation with other arboviruses further complicate control efforts. This review highlights the importance of strengthening surveillance systems, enhancing vector control measures, improving diagnostic capabilities, and increasing public awareness to effectively mitigate the burden of dengue fever in Nigeria. Collaboration between government agencies, healthcare providers, researchers, and international partners is crucial in addressing the growing threat of dengue fever and reducing its impact on public health in Nigeria.

Analysis of dengue fever disease in West Africa

Dengue fever disease (DFD) which is caused by four antigenically distinct dengue viruses (DENV) presents a global health threat, with tropical and subtropical regions at a greater risk. The paucity of epidemiological data on dengue in West African subregion endangers efforts geared toward disease control and prevention. A systematic search of DFD prevalence, incidence, and DENV-infected Aedes in West Africa was conducted in PubMed, Scopus, African Index Medicus, and Google Scholar in line with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. A total of 58 human prevalence studies involving 35,748 people from 8 countries were identified. Two incidence and six DENV-infected studies were also reviewed. Nigeria and Burkina Faso contributed the majority of the prevalence studies which spanned between 1968 and 2018, with a considerable variation in coverage among the countries reviewed in this study. An average prevalence of 20.97% was observed across both general prevalence and acute DENV infection study categories, ranging between 0.02% and 93%. The majority of these studies were conducted in acute febrile patients with a prevalence range of 0.02-93% while 19% (n = 11) of all studies were general population-based studies and reported a prevalence range of 17.2-75.8%. DENV-infected Aedes aegypti were reported in four out of the five countries with published reports; with DENV-2 found circulating in Cape Verde, Senegal, and Burkina Faso while DENV-3 and DENV-4 were also reported in Senegal and Cape Verde, respectively. High prevalence of DFD in human populations and the occurrence of DENV-infected A. aegypti have been reported in West Africa, even though weaknesses in study design were identified. Epidemiological data from most countries and population in the subregion were scarce or non-existent. This study highlights the epidemic risk of DFD in West Africa, and the need for research and surveillance to be prioritized to fill the data gap required to enact effective control measures.

Changing Ecotypes of Dengue Virus 2 Serotype in Nigeria and the Emergence of Cosmopolitan and Asian I Lineages, 1966–2019

Dengue virus (DENV) is a leading mosquito-borne virus with a wide geographical spread and a major public health concern. DENV serotype 1 (DENV-1) and serotype 2 (DENV-2) were first reported in Africa in 1964 in Ibadan, Nigeria. Although the burden of dengue is unknown in many African countries, DENV-2 is responsible for major epidemics. In this study, we investigated the activities of DENV-2 to determine the circulating strains and to appraise the changing dynamics in the epidemiology of the virus in Nigeria. Nineteen DENV-2 sequences from 1966–2019 in Nigeria were retrieved from the GenBank of the National Center of Biotechnology Information (NCBI). A DENV genotyping tool was used to identify the specific genotypes. The evolutionary history procedure was performed on 54 DENV-2 sequences using MEGA 7. There is a deviation from Sylvatic DENV-2 to other genotypes in Nigeria. In 2019, the Asian I genotype of DENV-2 was predominant in southern Edo State, located in the tropical rainforest region, with the first report of the DENV-2 Cosmopolitan strain. We confirmed the circulation of other non-assigned genotypes of DENV-2 in Nigeria. Collectively, this shows that DENV-2 dynamics have changed from Sylvatic transmission reported in the 1960s with the identification of the Cosmopolitan strain and Asian lineages. Sustained surveillance, including vectorial studies, is required to fully establish the trend and determine the role of these vectors.

Recurrent Episodes of Some Mosquito-Borne Viral Diseases in Nigeria: A Systematic Review and Meta-Analysis

Different ecological zones favor the breeding of Aedes species. The molecular epidemiology of dengue virus (DENV), yellow fever virus (YFV), and Chikungunya virus (CHIKV) was determined from outbreaks and surveillance activities in Nigeria. Twenty-eight DENV, twenty-five YFV, and two CHIKV sequences from Nigeria were retrieved from GenBank. Genotyping was performed with a genome detective typing tool. The evolutionary comparison was performed by the Maximum Likelihood method on MEGA. Chi-square was used to compare the association between the proportions of viral infections at different times. Six DENV-1 were detected in 1964, 1965, 1978, 2007, and 2018. Nineteen DENV-2 strains were reported, four belonging to sylvatic VI, one belonging to cosmopolitan II, and twelve to Asian I genotype V. DENV-2 genotype VI was detected in 1966, and genotypes II and V in 2019. All three DENV-3 were detected in 2018, while only one DENV-4 was identified in 2019. YFV was reported in 1946 and then in the 60s, 70s, 80s, 90s, 2018, and 2019 with reports to date. CHIKV is still circulating following its identification in 1964 and 1965. Recurrent episodes of dengue, Chikungunya, and yellow fever continue unabated. Vector control initiatives and immunization should be greatly sustained.

Socioeconomic risk markers of arthropod-borne virus (arbovirus) infections: a systematic literature review and meta-analysis

Introduction

Arthropod-borne viruses (arboviruses) are of notable public health importance worldwide, owing to their potential to cause explosive outbreaks and induce debilitating and potentially life-threatening disease manifestations. This systematic review and meta-analysis aims to assess the relationship between markers of socioeconomic position (SEP) and infection due to arboviruses with mosquito vectors.

Methods

We conducted a systematic search on PubMed, Embase, and LILACS databases to identify studies published between 1980 and 2020 that measured the association of SEP markers with arbovirus infection. We included observational studies without geographic location or age restrictions. We excluded studies from grey literature, reviews and ecological studies. Study findings were extracted and summarised, and pooled estimates were obtained using random-effects meta-analyses.

Results

We identified 36 observational studies using data pertaining to 106 524 study participants in 23 geographic locations that empirically examined the relationship between socioeconomic factors and infections caused by seven arboviruses (dengue, chikungunya, Japanese encephalitis, Rift Valley fever, Sindbis, West Nile and Zika viruses). While results were varied, descriptive synthesis pointed to a higher risk of arbovirus infection associated with markers of lower SEP, including lower education, income poverty, low healthcare coverage, poor housing materials, interrupted water supply, marital status (married, divorced or widowed), non-white ethnicities and migration status. Pooled crude estimates indicated an increased risk of arboviral infection associated with lower education (risk ratio, RR 1.5 95% CI 1.3 to 1.9); I²=83.1%), interruption of water supply (RR 1.2; 95% CI 1.1 to 1.3; I²=0.0%) and having been married (RR 1.5 95% CI 1.1 to 2.1; I²=85.2%).

Conclusion

Evidence from this systematic review suggests that lower SEP increases the risk of acquiring arboviral infection; however, there was large heterogeneity across studies. Further studies are required to delineate the relationship between specific individual, household and community-level SEP indicators and arbovirus infection risks to help inform targeted public health interventions.

PROSPERO registration number

CRD42019158572.

Temporal Evaluation of Insecticide Resistance in Populations of the Major Arboviral Vector Aedes Aegypti from Northern Nigeria

To support evidence-based control measures, two Nigerian Aedes populations (BUK and Pantami) were characterised. Larval bioassay using temephos and deltamethrin revealed a significant increase in deltamethrin resistance, with LC50 of 0.018mg/L (resistance ratio compared to New Orleans, RR = 2.250) in 2018 increasing ~6-fold, by 2019 (LC50 = 0.100mg/L, RR = 12.5), and ~11-fold in 2020 (LC50 = 0.198mg/L, RR = 24.750). For the median deltamethrin concentration (0.05mg/L), a gradual decrease in mortality was observed, from 50.6% in 2018, to 44.9% in 2019, and 34.2% in 2020. Extremely high DDT resistance was observed, with <3% mortalities and LT50s of 352.87 min, 369.19 min and 406.94 min in 2018, 2019 and 2020, respectively. Significant temporal increase in resistance was observed towards ƛ-cyhalothrin (a type II pyrethroid) over three years. Synergist bioassays with diethylmaleate and piperonylbutoxide significantly recovered DDT and ƛ-cyhalothrin susceptibility respectively, implicating glutathione S-transferases and CYP450s. Cone bioassays revealed increased resistance to the PermaNet® 3.0, side panels (mortalities of 94% in 2018, 66.4% in 2019, and 73.6% in 2020), while full susceptibility was obtained with the roof of PermaNet® 3.0. The F1534C kdr mutation occurred in low frequency, with significant correlation between heterozygote genotypes and DDT resistance. This temporal increase in resistance is a major challenge for control of this vector of public health importance.

Dengue Virus Infection and Associated Risk Factors in Africa: A Systematic Review and Meta-Analysis

Dengue contributes a significant burden on global public health and economies. In Africa, the burden of dengue virus (DENV) infection is not well described. This review was undertaken to determine the prevalence of dengue and associated risk factors. A literature search was done on PubMed/MEDLINE, Scopus, Embase, and Google Scholar databases to identify articles published between 1960 and 2020. Meta-analysis was performed using a random-effect model at a 95% confidence interval, followed by subgroup meta-analysis to determine the overall prevalence. Between 1960 and 2020, 45 outbreaks were identified, of which 17 and 16 occurred in East and West Africa, respectively. Dengue virus serotype 1 (DENV-1) and DENV-2 were the dominant serotypes contributing to 60% of the epidemics. Of 2211 cases reported between 2009 and 2020; 1954 (88.4%) were reported during outbreaks. Overall, the prevalence of dengue was 29% (95% CI: 20-39%) and 3% (95% CI: 1-5%) during the outbreak and non-outbreak periods, respectively. Old age (6/21 studies), lack of mosquito control (6/21), urban residence (4/21), climate change (3/21), and recent history of travel (3/21) were the leading risk factors. This review reports a high burden of dengue and increased risk of severe disease in Africa. Our findings provide useful information for clinical practice and health policy decisions to implement effective interventions.