Global spread and persistence of dengue

Epidemiology and global spread of emerging tick-borne Alongshan virus

The emergence and spread of novel viral pathogens is a major threat to human health, particularly in the context of climate and human-induced change in land use. Alongshan virus (ALSV) is a tick-borne virus associated with human disease, which was first identified in northeast China. More recently, several studies reported the emergence of ALSV in mammalian and arthropod hosts in multiple different countries outside of Asia, and the first viral genome sequencing data has become available. ALSV is a member of the Jingmenvirus group closely related to the Flaviviridae family. Unusually, the positive-sense, single-stranded RNA genome of ALSV is segmented and consists of four distinct segments, two of which show homology with the NS3 and NS5 protein encoding regions of non-segmented flaviviruses. Transmission of arthropod-borne pathogens will likely increase in the future due to environmental change mediated by a variety of environmental and ecological factors and increasing human encroachment into wild animal habitats. In this review, we present current knowledge of global ALSV distribution and emergence patterns, highlight genetic diversity, evolution and susceptible species. Finally, we discuss the role of this emerging tick-borne virus in the context of urbanization and global health.

High-throughput peptide array analysis and computational techniques for serological profiling of flavivirus infections: Implications for diagnostics and vaccine development

Arthropod-borne viruses, such as dengue virus (DENV), pose significant global health threats, with DENV alone infecting around 400 million people annually and causing outbreaks beyond endemic regions. This study aimed to enhance serological diagnosis and discover new drugs by identifying immunogenic protein regions of DENV. Utilizing a comprehensive approach, the study focused on peptides capable of distinguishing DENV from other flavivirus infections through serological analyses. Over 200 patients with confirmed arbovirus infection were profiled using high-density pan flavivirus peptide arrays comprising 6253 peptides and the computational method matrix of local coupling energy (MLCE). Twenty-four peptides from nonstructural and structural viral proteins were identified as specifically recognized by individuals with DENV infection. Six peptides were confirmed to distinguish DENV from Zika virus (ZIKV), West Nile virus (WNV), Yellow Fever virus (YFV), Usutu virus (USUV), and Chikungunya virus (CHIKV) infections, as well as healthy controls. Moreover, the combination of two immunogenic peptides emerged as a potential serum biomarker for DENV infection. These peptides, mapping to highly accessible regions on protein structures, show promise for diagnostic and prophylactic strategies against flavivirus infections. The described methodology holds broader applicability in the serodiagnosis of infectious diseases.

The N and C-terminal deleted variant of the dengue virus NS1 protein is a potential candidate for dengue vaccine development

NS1 is an elusive dengue protein, involved in viral replication, assembly, pathogenesis, and immune evasion. Its levels in blood plasm are positively related to disease severity like thrombocytopenia, hemorrhage, and vascular leakage. Despite its pathogenic roles, NS1 is being used in various vaccine formulations due to its sequence conservancy, ability to produce protective antibodies and low risk for inducing antibody-dependent enhancement. In this study, we have used bioinformatics tools and reported literature to develop an NS1 variant (dNS1). Molecular docking studies were performed to evaluate the receptor-binding ability of the NS1 and dNS1 with TLR4. NS1 and dNS1 (153 to 312 amino acid region) genes were cloned, expressed and protein was purified followed by refolding. Docking studies showed the binding of NS1 and dNS1 with the TLR4 receptor which suggests that N and C-terminal sequences of NS1 are not critical for receptor binding. Antibodies against NS1 and dNS1 were raised in rabbits and binding affinity of anti-dNS1 anti-NS1 sera was evaluated against both NS1 and dNS1. Similar results were observed through western blotting which highlight that N and C-terminal deletion of NS1 does not compromise the immunogenic potential of dNS1 hence, supports its use in future vaccine formulations as a substitute for NS1.

Zafirlukast, as a viral inactivator, potently inhibits infection of several flaviviruses, including Zika virus, dengue virus, and yellow fever virus

Zika virus (ZIKV) is one of the mosquito-borne flaviviruses that exhibits a unique tropism to nervous systems and is associated with Guillain-Barre syndrome and congenital Zika syndrome (CZS). Dengue virus (DENV) and yellow fever virus (YFV), the other two mosquito-borne flaviviruses, have also been circulating for a long time and cause severe diseases, such as dengue hemorrhagic fever and yellow fever, respectively. However, there are no safe and effective antiviral drugs approved for the treatment of infections or coinfections of these flaviviruses. Here, we found that zafirlukast, a pregnancy-safe leukotriene receptor antagonist, exhibited potent antiviral activity against infections of ZIKV strains from different lineages in different cell lines, as well as against infections of DENV-2 and YFV 17D. Mechanistic studies demonstrated that zafirlukast directly and irreversibly inactivated these flaviviruses by disrupting the integrity of the virions, leading to the loss of viral infectivity, hence inhibiting the entry step of virus infection. Considering its efficacy against flaviviruses, its safety for pregnant women, and its neuroprotective effect, zafirlukast is a promising candidate for prophylaxis and treatment of infections or coinfections of ZIKV, DENV, and YFV, even in pregnant women.

Epidemiological, virological and clinical characterization of a Dengue/Zika outbreak in the Caribbean region of Costa Rica 2017-2018

The increase in incidence and geographical expansion of viruses transmitted by the Aedes mosquitoes, such as dengue (DENV) and zika (ZIKV) in the Americas, represents a burden for healthcare systems in tropical and subtropical regions. These and other under-detected arboviruses co-circulate in Costa Rica, adding additional complexity to their management due to their shared epidemiological behavior and similarity of symptoms in early stages. Since diagnostics of febrile illness is mostly based on clinical symptoms alone, we gathered acute-phase serum and urine from 399 samples of acute dengue-like cases from two healthcare facilities of Costa Rica, during an outbreak of arboviruses from July 2017 to May 2018, and tested them using molecular and serological methods. The analyses showed that of the clinically presumptive arbovirus cases that were reported, only 39.4% (n=153) of the samples were confirmed positive by RT-PCR to be DENV (DENV (10.3%), CHIKV (0.2%), ZIKV (27.3%), or mixed infections (1.5%). RT-PCR for other alphaviruses and flaviviruses, and PCR for Leptospira sp were negative. Furthermore, to assess flavivirus positivity in post-acute patients, the negative sera were tested against Dengue-IgM. 20% of sera were found positive, confounding even more the definitive number of cases, and emphasizing the need of several distinct diagnostic tools for accurate diagnostics. Molecular characterization of the prM and E genes from isolated viruses revealed that the American/Asian genotype of DENV-2 and the Asian lineage of ZIKV were circulating during this outbreak. Two different clades of DENV-2 American/Asian genotype were identified to co-circulate in the same region and a difference in the platelet and leukocyte count was noted between people infected with each clade, suggesting a putative distinct virulence. Our study sheds light on the necessity for healthcare strategies in managing arbovirus outbreaks, emphasizing the importance of comprehensive molecular and serological diagnostic approaches, as well as molecular characterization. This approach aids in enhancing our understanding of the clinical and epidemiological aspects of arboviral diseases during outbreaks. Our research highlights the need to strengthen training programs for health professionals and the need to increase research-based on laboratory evidence for diagnostic accuracy, guidance, development and implementation of public health interventions and epidemiological surveillance.

Exploring Dengue Dynamics: A Multi-Scale Analysis of Spatio-Temporal Trends in Ibagué, Colombia

Our study examines how dengue fever incidence is associated with spatial (demographic and socioeconomic) alongside temporal (environmental) factors at multiple scales in the city of Ibagué, located in the Andean region of Colombia. We used the dengue incidence in Ibagué from 2013 to 2018 to examine the associations with climate, socioeconomic, and demographic factors from the national census and satellite imagery at four levels of local spatial aggregation. We used geographically weighted regression (GWR) to identify the relevant socioeconomic and demographic predictors, and we then integrated them with environmental variables into hierarchical models using integrated nested Laplace approximation (INLA) to analyze the spatio-temporal interactions. Our findings show a significant effect of spatial variables across the different levels of aggregation, including human population density, gas and sewage connection, percentage of woman and children, and percentage of population with a higher education degree. Lagged temporal variables displayed consistent patterns across all levels of spatial aggregation, with higher temperatures and lower precipitation at short lags showing an increase in the relative risk (RR). A comparative evaluation of the models at different levels of aggregation revealed that, while higher aggregation levels often yield a better overall model fit, finer levels offer more detailed insights into the localized impacts of socioeconomic and demographic variables on dengue incidence. Our results underscore the importance of considering macro and micro-level factors in epidemiological modeling, and they highlight the potential for targeted public health interventions based on localized risk factor analyses. Notably, the intermediate levels emerged as the most informative, thereby balancing spatial heterogeneity and case distribution density, as well as providing a robust framework for understanding the spatial determinants of dengue.

Research progress toward the influence of mosquito salivary proteins on the transmission of mosquito-borne viruses

Mosquito-borne viruses (MBVs) are a large class of viruses transmitted mainly through mosquito bites, including dengue virus, Zika virus, Japanese encephalitis virus, West Nile virus, and chikungunya virus, which pose a major threat to the health of people around the world. With global warming and extended human activities, the incidence of many MBVs has increased significantly. Mosquito saliva contains a variety of bioactive protein components. These not only enable blood feeding but also play a crucial role in regulating local infection at the bite site and the remote dissemination of MBVs as well as in remodeling the innate and adaptive immune responses of host vertebrates. Here, we review the physiological functions of mosquito salivary proteins (MSPs) in detail, the influence and the underlying mechanism of MSPs on the transmission of MBVs, and the current progress and issues that urgently need to be addressed in the research and development of MSP-based MBV transmission blocking vaccines.

Wolbachia invasion dynamics of a random mosquito population model with imperfect maternal transmission and incomplete CI

In this work, we formulate a random Wolbachia invasion model incorporating the effects of imperfect maternal transmission and incomplete cytoplasmic incompatibility (CI). Under constant environments, we obtain the following results: Firstly, the complete invasion equilibrium of Wolbachia does not exist, and thus the population replacement is not achievable in the case of imperfect maternal transmission; Secondly, imperfect maternal transmission or incomplete CI may obliterate bistability and backward bifurcation, which leads to the failure of Wolbachia invasion, no matter how many infected mosquitoes would be released; Thirdly, the threshold number of the infected mosquitoes to be released would increase with the decrease of the maternal transmission rate or the intensity of CI effect. In random environments, we investigate in detail the Wolbachia invasion dynamics of the random mosquito population model and establish the initial release threshold of infected mosquitoes for successful invasion of Wolbachia into the wild mosquito population. In particular, the existence and stability of invariant probability measures for the establishment and extinction of Wolbachia are determined.

Polyubiquitin protein of Aedes aegypti as an interacting partner of dengue virus envelope protein

Dengue virus (DENV) is an arbovirus that comprises four antigenically different serotypes. Aedes aegypti (Diptera: Culicidae) acts as the principal vector for DENV transmission, and vector control is crucial for dengue fever epidemic management. To design effective vector control strategies, a comprehensive understanding of the insect vector and virus interaction is required. Female Ae. aegypti ingests DENV during the acquisition of a blood meal from an infected human. DENV enters the insect midgut, replicates inside it and reaches the salivary gland for transmitting DENV to healthy humans during the subsequent feeding cycles. DENV must interact with the proteins present in the midgut and salivary glands to gain entry and accomplish successful replication and transmission. Ae. aegypti midgut cDNA library was prepared, and yeast two-hybrid screening was performed against the envelope protein domain III (EDIII) protein of DENV-2. The polyubiquitin protein was selected from the various candidate proteins for subsequent analysis. Polyubiquitin gene was amplified, and the protein was purified in a heterologous expression system for in vitro interaction studies. In vitro pull-down assay presented a clear interaction between polyubiquitin protein and EDIII. To further confirm this interaction, a dot blot assay was employed, and polyubiquitin protein was found to interact with DENV particles. Our results enable us to suggest that polyubiquitin plays an important role in DENV infection within mosquitoes.

Dengue Cases Presenting to the Emergency Department of a Tertiary Care Hospital in Late 2021: A Cross-Sectional Study in Karachi

Objectives: Dengue Fever (DF) is an arboviral disease caused by the Dengue virus (DENV). This study aims to assess the association of dengue prevalence with patients' residential areas and hematological laboratory findings (Total platelet count, immunoglobulins, and dengue antigens) during COVID-19 pandemic. Methods: A retrospective study was conducted at the Emergency department of Jinnah Postgraduate Medical Center, Karachi from October to December 2021. All the patients irrespective of their ages presenting to the ED with either of the following complaints: fever; GIT problems; vomiting; body ache; bleeding were included in our study. Results: Our study comprised 189 patients in total in which the females (n = 172) outnumbered the males (n = 17). Out of all, 84.7% of the patients were febrile having a low-grade fever on average. Korangi district had the most dengue cases, while Keamari had the fewest. There was no significant association reported between mean platelet count, mean TLC, and mean hemoglobin levels with dengue positivity. Conclusion: There is a concerning rise in DF cases in Karachi, particularly in the Korangi district. Despite the COVID-19 pandemic, DF demands urgent attention.

A Review of Pathogens Transmitted by the Container-Inhabiting Mosquitoes, Aedes Albopictus, A Global Public Health Threat

Dengue virus (DENV), Chikungunya virus (CHIKV), and Zika virus (ZIKV) are highly pathogenic human arboviruses transmitted by the Aedes (Stegomyia) albopictus (Skuse) (Diptera: Culicidae) or Ae. Albopictus mosquito. These arboviruses are responsible for causing fever, hemorrhagic conditions, and neurological diseases in humans post-bite from an infected Aedes mosquito. Over the past 80 years, the Ae. albopictus has infested every habitable continent, bar Antarctica, thereby escalating the probability of global insect-borne infectious disease outbreaks. This research follows the global transmission pattern of Ae. albopictus and provides a summary of disease prevention and control strategies for mosquito-borne infections, as implemented by the World Health Organization (WHO) and both Asian and European countries. Consequently, this study can aid in the prevention and control of mosquito-borne diseases while acting as a basis for international collaboration on effectively managing arbovirus infection issues in public health.

Circulation of Dengue Virus Serotype 1 Genotype V and Dengue Virus Serotype 2 Genotype III in Tocantins State, Northern Brazil, 2021-2022

In Brazil, the state of Tocantins, located in north-central Brazil, has experienced a significant number of cases of arboviral disease, particularly Dengue virus (DENV). This study aimed to deepen the knowledge on DENV circulation within that state by conducting full genome sequencing of viral genomes recovered from 61 patients between June 2021 and July 2022. There were a total of 8807 and 20,692 cases in 2021 and 2022, respectively, as reported by the state's Secretary of Health. Nucleotide sequencing confirmed the circulation of DENV serotype 1, genotype V and DENV serotype 2, genotype III in the State. Younger age groups (4 to 43 years old) were mostly affected; however, no significant differences were detected regarding the gender distribution of cases in humans. Phylogenetic analysis revealed that the circulating viruses belong to DENV-1 genotype V American and DENV-2 genotype III Southeast Asian/American. The Bayesian analysis of DENV-1 genotype V genomes sequenced here are closely related to genomes previously sequenced in the state of São Paulo. Regarding the DENV-2 genotype III genomes, these clustered in a distinct, well-supported subclade, along with previously reported isolates from the states of Goiás and São Paulo. The findings reported here suggest that multiple introductions of these genotypes occurred in the Tocantins state. This observation highlights the importance of major population centers in Brazil on virus dispersion, such as those observed in other Latin American and North American countries. In the SNP analysis, DENV-1 displayed 122 distinct missense mutations, while DENV-2 had 44, with significant mutations predominantly occurring in the envelope and NS5 proteins. The analyses performed here highlight the concomitant circulation of distinct DENV-1 and -2 genotypes in some Brazilian states, underscoring the dynamic evolution of DENV and the relevance of surveillance efforts in supporting public health policies.

Structural and functional basis of low-affinity SAM/SAH-binding in the conserved MTase of the multi-segmented Alongshan virus distantly related to canonical unsegmented flaviviruses

Alongshan virus (ALSV), a newly discovered member of unclassified Flaviviridae family, is able to infect humans. ALSV has a multi-segmented genome organization and is evolutionarily distant from canonical mono-segmented flaviviruses. The virus-encoded methyltransferase (MTase) plays an important role in viral replication. Here we show that ALSV MTase readily binds S-adenosyl-L-methionine (SAM) and S-adenosyl-L-homocysteine (SAH) but exhibits significantly lower affinities than canonical flaviviral MTases. Structures of ALSV MTase in the free and SAM/SAH-bound forms reveal that the viral enzyme possesses a unique loop-element lining side-wall of the SAM/SAH-binding pocket. While the equivalent loop in flaviviral MTases half-covers SAM/SAH, contributing multiple hydrogen-bond interactions; the pocket-lining loop of ALSV MTase is of short-length and high-flexibility, devoid of any physical contacts with SAM/SAH. Subsequent mutagenesis data further corroborate such structural difference affecting SAM/SAH-binding. Finally, we also report the structure of ALSV MTase bound with sinefungin, an SAM-analogue MTase inhibitor. These data have delineated the basis for the low-affinity interaction between ALSV MTase and SAM/SAH and should inform on antiviral drug design.

Response to insecticides and underlying mechanisms of resistance in the field populations of Aedes aegypti Linnaeus (Diptera: Culicidae) in Puducherry, India

Background & objectives

Mosquito-borne diseases are major threats to human health worldwide. Successful control of vector mosquitoes requires periodic updates on their response to the insecticides that are in use. Different classes of neurotoxic insecticides have been used in vector control programs. Ae. aegypti and Ae. albopictus are the primary vectors of dengue and have developed resistance to organophosphates and synthetic pyrethroids that are used in vector control programs. Monitoring insecticide pressure and studying the underlying mechanisms of resistance in the field populations of Aedes aegypti are important to formulate resistant management strategies for their control programs.

Methods

Aedes aegypti were collected from study sites Lawspet and Abishegapakkam and F1 progeny was subject to biochemical assays to determine the enzyme activity. Insecticide susceptibility tests were conducted to determine vector susceptibility/resistance to malathion and deltamethrin. Adult dried mosquitoes were subjected to multiplex PCR to detect point mutation in the VGSC gene.

Results

Insecticide susceptibility test results revealed that Aedes aegypti is resistant to malathion and incipient resistance to deltamethrin has emerged. It was observed that β-esterase and monoxygense activity were significantly higher in Lawspet sample than the laboratory strain, whereas it was comparatively lower in Abishegapakkam sample than laboratory strain. Multiplex PCR assays showed no kdr mutation in all Ae. aegypti strains.

Interpretation & conclusion

Monitoring insecticide resistance in Ae. aegypti would help the local health authorities to implement a rationalized approach for insecticide use in vector control.

Quantifying the impact of Wolbachia releases on dengue infection in Townsville, Australia

From October 2014 to February 2019, local authorities in Townsville, North Queensland, Australia continually introduced Wolbachia-infected mosquitoes to control seasonal outbreaks of dengue infection. In this study, we develop a mathematical modelling framework to estimate the effectiveness of this intervention as well as the relative dengue transmission rates of Wolbachia-infected and wild-type mosquitoes. We find that the transmission rate of Wolbachia-infected mosquitoes is reduced approximately by a factor of 20 relative to the uninfected wild-type population. In addition, the Townsville Wolbachia release program led to a 65% reduction in predicted dengue incidence during the release period and over 95% reduction in the 24 months that followed. Finally, to investigate the potential impact of other Wolbachia release programs, we use our estimates of relative transmissibility to calculate the relationship between the reproductive number of dengue and the proportion of Wolbachia-infected mosquitoes in the vector population.

Environmental Change, Changing Biodiversity, and Infections-Lessons for Kidney Health Community

There is a direct and accelerating connection between ongoing environmental change, the unprecedented decline in biodiversity, and the increase in infectious disease epidemiology worldwide. Rising global temperatures are threatening the biodiversity that underpins the richness and diversity of flora and fauna species in our ecosystem. Anthropogenic activities such as burning fossil fuels, deforestation, rapid urbanization, and expanding population are the primary drivers of environmental change resulting in biodiversity collapse. Climate change is influencing the emergence, prevalence, and transmission of infectious diseases both directly and through its impact on biodiversity. The environment is gradually becoming more suitable for infectious diseases by affecting a variety of pathogens, hosts, and vectors and by favoring transmission rates in many parts of the world that were until recently free of these infections. The acute effects of these zoonotic, vector and waterborne diseases are well known; however, evidence is emerging about their role in the development of chronic kidney disease. The pathways linking environmental change and biodiversity loss to infections impacting kidney health are diverse and complex. Climate change and biodiversity loss disproportionately affect the vulnerable and limit their ability to access healthcare. The kidney health community needs to contribute to the issue of environmental change and biodiversity loss through multisectoral action alongside government, policymakers, advocates, businesses, and the general population. We describe various aspects of the environmental change effects on the transmission and emergence of infectious diseases particularly focusing on its potential impact on kidney health. We also discuss the adaptive and mitigation measures and the gaps in research and policy action.

Epidemiological Characteristics and Economic Burden of Dengue in Zhejiang Province, China

Dengue imposes a heavy economic burden on families and society. We used surveillance data reported in 2019 to characterize the dengue epidemic in Zhejiang Province, China, which provided guidance for dengue prevention and control. Dengue epidemics mostly occurred in July to October. People aged 30-44 years, males, and commercial service workers were more likely to suffer from dengue. The epidemic areas were mainly in Hangzhou and Wenzhou. Meanwhile, we assessed the economic cost of dengue in the province from both family and organizational perspectives. The direct economic burden of dengue patients was estimated to be USD 405,038.25, and the indirect economic burden was USD 140,364.90, for a total economic burden of USD 543,213.00. The direct economic burden of dengue patients should be reduced by increasing the coverage and reimbursement of health insurance. Additionally, the total annual cost of dengue prevention and control for the government and organizational sectors was estimated to be USD 7075,654.83. Quantifying the dengue burden is critical for developing disease control strategies, allocating public health resources, and setting health policy priorities.

Direct and indirect effects of age on dengue severity: The mediating role of secondary infection

Severe dengue occurrence has been attributed to increasing age and different dengue virus (DENV) serotypes that cause secondary infections and immune-enhancing phenomena. Therefore, we examined if the effect of age on dengue severity was mediated by infectivity status while controlling for sex and region. Further, we assessed the spatial clustering of dengue severity for individuals with primary and secondary infection across Mexican municipalities. Health data from 2012 to 2017 was retrieved from Mexico's Ministry of Health. A mediation analysis was performed using multiple logistic regression models based on a directed acyclic graph. The models were explored for the direct effect of age on dengue severity and its indirect impact through secondary infection. In addition, severe dengue clusters were determined in some Northeastern and Southeastern municipalities through spatial analysis. We observed a nonlinear trend between age and severe dengue. There was a downward trend of severe dengue for individuals between 0 and 10 years and an upward trend above 10 years. The effect of age on dengue severity was no longer significant for individuals between 10 and 60 years after introducing infectivity status into the model. The mediating role of infectivity status in the causal model was 17%. Clustering of severe dengue among individuals with primary infection in the Northeastern region may point to the high prevalence of DENV-3 in the region. Public health efforts may prevent secondary infection among infants and the aged. In addition, there should be a further investigation into the effect of DENV-3 in individuals with primary disease.

Higher-temperature-adapted dengue virus serotype 2 strain exhibits enhanced virulence in AG129 mouse model

The factors that drive dengue virus (DENV) evolution, and selection of virulent variants are yet not clear. Higher environmental temperature shortens DENV extrinsic incubation period in mosquitoes, increases human transmission, and plays a critical role in outbreak dynamics. In the present study, we looked at the effect of temperature in altering the virus virulence. We found that DENV cultured at a higher temperature in C6/36 mosquito cells was significantly more virulent than the virus grown at a lower temperature. In a mouse model, the virulent strain induced enhanced viremia and aggressive disease with a short course, hemorrhage, severe vascular permeability, and death. Higher inflammatory cytokine response, thrombocytopenia, and severe histopathological changes in vital organs such as heart, liver, and kidney were hallmarks of the disease. Importantly, it required only a few passages for the virus to acquire a quasi-species population harboring virulence-imparting mutations. Whole genome comparison with a lower temperature passaged strain identified key genomic changes in the structural protein-coding regions as well as in the 3'UTR of the viral genome. Our results point out that virulence-enhancing genetic changes could occur in the dengue virus genome under enhanced growth temperature conditions in mosquito cells.

Dengue virus neutralizing antibody: a review of targets, cross-reactivity, and antibody-dependent enhancement

Dengue is the most common viral infection spread by mosquitoes, prevalent in tropical countries. The acute dengue virus (DENV) infection is a benign and primarily febrile illness. However, secondary infection with alternative serotypes can worsen the condition, leading to severe and potentially fatal dengue. The antibody raised by the vaccine or the primary infections are frequently cross-reactive; however, weakly neutralizing, and during subsequent infection, they may increase the odds of antibody-dependent enhancement (ADE). Despite that, many neutralizing antibodies have been identified against the DENV, which are thought to be useful in reducing dengue severity. Indeed, an antibody must be free from ADE for therapeutic application, as it is pretty common in dengue infection and escalates disease severity. Therefore, this review has described the critical characteristics of DENV and the potential immune targets in general. The primary emphasis is given to the envelope protein of DENV, where potential epitopes targeted for generating serotype-specific and cross-reactive antibodies have critically been described. In addition, a novel class of highly neutralizing antibodies targeted to the quaternary structure, similar to viral particles, has also been described. Lastly, we have discussed different aspects of the pathogenesis and ADE, which would provide significant insights into developing safe and effective antibody therapeutics and equivalent protein subunit vaccines.

Bioinsecticidal activity of cajeput oil to pyrethroid-susceptible and -resistant mosquitoes

Mosquito-borne diseases are a significant threat to human health. The frequent and repetitive application of insecticides can result in the selection of resistant mosquito populations leading to product failures for reducing community disease transmission. It is important that new interventions are discovered and developed for reducing mosquito populations and, in turn, protecting human health. Plant essential oils are promising chemical interventions for reducing mosquito populations. The myrtle family, Myrtaceae, has numerous species to be studied as potential bioinsecticides. Here, we combined toxicological, biochemical, and neurophysiological approaches to provide evidence for cajeput oil and terpene constituents to elicit bioinsecticidal activity to pyrethroid-susceptible and -resistant Aedes aegypti. We show cajeput oil terpenes to enhance cAMP production, increase ACh levels, inhibit in vivo and in vitro AChE activity, and disrupt spike discharge frequencies of the mosquito CNS. This study presents the first report on the bioinsecticidal activity of cajeput oil terpenes to pyrethroid-susceptible and -resistant mosquitoes and provides comparative data for the octopaminergic system as a putative molecular target for the bioinsecticides with implications for resistance management.

Epidemiological Investigation of the 2019 Dengue Outbreak in Dhaka, Bangladesh

Introduction. Bangladesh experienced its largest dengue epidemic in 2019. Our objective was to investigate the epidemiological, clinical, and laboratory characteristics of the hospital-admitted dengue patients during this epidemic. Methods. This cross-sectional study was conducted among 369 adult dengue patients admitted to two tertiary care hospitals in Dhaka, Bangladesh, from June to September 2019. The disease severity was determined according to the WHO’s 2009 classification. Results. The average age of the patients was 33.3 (SD 14) years with a predominance of men. Almost 10% developed severe dengue (plasma leakage 67%, clinical bleeding 25%, and organ involvement 25%). Fever, headache, retro-orbital pain, diarrhea, and warning signs such as abdominal pain, clinical fluid accumulation, and persistent vomiting were the most common clinical presentations. Thrombocytopenia, leukopenia, elevated HCT levels, and ALT/AST were common laboratory findings. Conclusions. Severe dengue was mostly attributable to plasma leakage with warning signs, especially abdominal pain, clinical fluid accumulation, persistent vomiting, and altered hematological parameters which might assist in the early prediction of severe dengue.

N-sulfonyl peptide-hybrids as a new class of dengue virus protease inhibitors

Dengue virus (DENV) from the Flaviviridae family causes an epidemic disease that seriously threatens human life. The viral serine protease NS2B-NS3 is a promising target for drug development against DENV and other flaviviruses. We here report the design, synthesis, and in-vitro characterization of potent peptidic inhibitors of DENV protease with a sulfonyl moiety as N-terminal cap, thereby creating sulfonamide-peptide hybrids. The in-vitro target affinities of some synthesized compounds were in the nanomolar range, with the most promising derivative reaching a K_i value of 78 nM against DENV-2 protease. The synthesized compounds did not have relevant off-target activity nor cytotoxicity. The metabolic stability of compounds against rat liver microsomes and pancreatic enzymes was remarkable. In general, the integration of sulfonamide moieties at the N-terminus of peptidic inhibitors proved to be a promising and attractive strategy for further drug development against DENV infections.

Co-infection of dengue, scrub typhus, and typhoid during dengue outbreak in Nepal, 2022: A case report

In midst of the recent dengue outbreak in Nepal, in 2022, the risk of co-infection increases and may lead to fatal outcomes if the diagnosis of multiple infections is delayed. Thus, all available diagnostic approaches must be taken to decrease the burden of illness and lessen mortality.

Potential Protective Effect of Dengue NS1 Human Monoclonal Antibodies against Dengue and Zika Virus Infections

Due to the lack of an effective therapeutic treatment to flavivirus, dengue virus (DENV) nonstructural protein 1 (NS1) has been considered to develop a vaccine owing to its lack of a role in antibody-dependent enhancement (ADE). However, both NS1 and its antibody have shown cross-reactivity to host molecules and have stimulated anti-DENV NS1 antibody-mediated endothelial damage and platelet dysfunction. To overcome the pathogenic events and reactogenicity, human monoclonal antibodies (HuMAbs) against DENV NS1 were generated from DENV-infected patients. Herein, the four DENV NS1-specific HuMAbs revealed the therapeutic effects in viral neutralization, reduction of viral replication, and enhancement of cell cytolysis of DENV and zika virus (ZIKV) via complement pathway. Furthermore, we demonstrate that DENV and ZIKV NS1 trigger endothelial dysfunction, leading to vascular permeability in vitro. Nevertheless, the pathogenic effects from NS1 were impeded by 2 HuMAbs (D25-4D4C3 and D25-2B11E7) and also protected the massive cytokines stimulation (interleukin [IL-]-1b, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL-8, IL-9, IL-13, IL-17, eotaxin, granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, Inducible protein-10, monocyte chemoattractant protein-1, macrophage inflammatory protein [MIP]-1 α, MIP-1β, tumor necrosis factor-α, platelet-derived growth factor, and RANTES). Collectively, our findings suggest that the novel protective NS1 monoclonal antibodies generated from humans has multiple therapeutic benefits against DENV and ZIKV infections.

Aminotransferasas y perfil lipídico en pacientes ecuatorianos con infección activa por virus dengue

El dengue es la arbovirosis con mayor incidencia a nivel mundial. Aproximadamente 100 millones de casos de dengue con signos de alarma y entre 250.000 y 500.000 casos de dengue grave, se registran anualmente. En Ecuador, en los últimos cuatro años se han registrado 83.472 casos de dengue. Estudios previos evidencian un incremento de los casos que cursan con disfunción hepática. El objetivo de este estudio fue analizar la asociación entre los niveles séricos de las enzimas aspartato aminotransferasa y alanino aminotransferasa y el perfil lipídico en pacientes con infección confirmada de Dengue. Se estudiaron 110 pacientes seleccionados sin distingo de edad, género o procedencia, cuyo diagnóstico fue confirmado virológica y serológicamente. Se incluyó un grupo control seronegativo al virus. En el perfil lipídico se evidenciaron diferencias significativas (p<0,003) en los valores de colesterol total y en infecciones secundarias; mientras que la frecuencia de elevación de ambas aminotransferasas fue alta en pacientes con dengue, no obstante, al comparar cuantitativamente los valores séricos no arrojaron cambios significativos, ni asociación. Se confirma la endemicidad del dengue, los cambios en el perfil lipídico, sin embargo, es evidente la necesidad de estudios poblacionales tomando en cuenta la genética de las poblaciones

Neighboring mutation-mediated enhancement of dengue virus infectivity and spread

Frequent turnover of dengue virus (DENV) clades is one of the major forces driving DENV persistence and prevalence. In this study, we assess the fitness advantage of nine stable substitutions within the envelope (E) protein of DENV serotypes. Two tandem neighboring substitutions, threonine to lysine at the 226th (T226K) and glycine to glutamic acid at the 228th (G228E) residues in the DENV2 Asian I genotype, enhance virus infectivity in either mosquitoes or mammalian hosts, thereby promoting clades turnover and dengue epidemics. Mechanistic studies indicate that the substitution-mediated polarity changes in these two residues increase the binding affinity of E for host C-type lectins. Accordingly, we predict that a G228E substitution could potentially result in a forthcoming epidemic of the DENV2 Cosmopolitan genotype. Investigations into the substitutions associated with DENV fitness in hosts may offer mechanistic insights into dengue prevalence, thus providing a warning of potential epidemics in the future.

Dengue Prediction in Latin America Using Machine Learning and the One Health Perspective: A Literature Review

Dengue fever is a serious and growing public health problem in Latin America and elsewhere, intensified by climate change and human mobility. This paper reviews the approaches to the epidemiological prediction of dengue fever using the One Health perspective, including an analysis of how Machine Learning techniques have been applied to it and focuses on the risk factors for dengue in Latin America to put the broader environmental considerations into a detailed understanding of the small-scale processes as they affect disease incidence. Determining that many factors can act as predictors for dengue outbreaks, a large-scale comparison of different predictors over larger geographic areas than those currently studied is lacking to determine which predictors are the most effective. In addition, it provides insight into techniques of Machine Learning used for future predictive models, as well as general workflow for Machine Learning projects of dengue fever.

Updating the Insecticide Resistance Status of Aedes aegypti and Aedes albopictus in Asia: A Systematic Review and Meta-Analysis

Background: Aedes aegypti and Aedes albopictus are two important vectors of several important arboviruses, including the dengue, chikungunya, and Zika viruses. Insecticide application is an important approach to reduce vector abundance during Aedes spp.-borne outbreaks in the absence of effective vaccines and treatments. However, insecticide overuse can result in the development of resistance, and careful monitoring of resistance markers is required. Methods: This meta-analysis and systematic review explored the spatial and temporal patterns of insecticide resistance in Asia from 2000 to 2021. PubMed, Scopus, EbscoHost, and Embase were used to enhance the search capability. The random-effects model was applied for the 94 studies that met our inclusion criteria for qualitative synthesis and meta-analysis. Results: Four major insecticides were studied (malathion, dichlorodiphenyltrichloroethane, permethrin, and deltamethrin). Dichlorodiphenyltrichloroethane resistance rates were high in both Ae. aegypti and Ae. albopictus (68% and 64%, respectively). Conversely, malathion resistance was less prevalent in Ae. aegypti (3%), and deltamethrin resistance was less common in Ae. albopictus (2%). Ae. aegypti displayed consistently high resistance rates (35%) throughout the study period, whereas the rate of insecticide resistance in Ae. albopictus increased from 5% to 12%. The rates of the major kdr mutations F1534C, V1016G, and S989P were 29%, 26%, and 22%, respectively. Conclusions: Insecticide resistance in both Ae. aegypti and Ae. albopictus is widespread in Asia, although the rates vary by country. Continuous monitoring of the resistance markers and modification of the control strategies will be important for preventing unexpected outbreaks. This systematic review and meta-analysis provided up-to-date information on insecticide resistance in dengue-endemic countries in Asia.

Three highly variable genome regions of the four dengue virus serotypes can accurately recapitulate the CDS phylogeny

The circulation of the four-dengue virus (DENV) serotypes has significantly increased in recent years, accompanied by an increase in viral genetic diversity. In order to conduct disease surveillance and understand DENV evolution and its effects on virus transmission and disease, efficient and accurate methods for phylogenetic classification are required. Phylogenetic analysis of different viral genes sequences is the most used method, the envelope gene (E) being the most frequently selected target. We explored the genetic variability of the four DENV serotypes throughout their complete coding sequence (CDS) of sequences available in GenBank and used genomic regions of different variability rate to recapitulate the phylogeny obtained with the DENV CDS. Our results indicate that the use of high or low variable regions accurately recapitulate the phylogeny obtained with CDS of sequences from different DENV genotypes. However, when analyzing the phylogeny of a single genotype, highly variable regions performed better in recapitulating the distance branch length, topology, and support of the CDS phylogeny. The use of three concatenated highly variable regions was not statistically different in distance branch length and support to that obtained in CDS phylogeny.•This study demonstrated the ability of highly variable regions of the DENV genome to recapitulate the phylogeny obtained with the full coding sequence (CDS).•The use of genomic regions of high or low variability did not affect the performance in recapitulating the phylogeny obtained with CDS from different genotypes. However, when phylogeny was analyzed for sequences from a single genotype, highly variable regions performed better in recapitulating the distance branch length, topology, and support of the CDS phylogeny.•The use of concatenated highly variable genome regions represent a useful option for recapitulating genome-wide phylogenies in analyses of sequences belonging to the same DENV genotype.

Recent advances in natural products as potential inhibitors of dengue virus with a special emphasis on NS2b/NS3 protease

Dengue virus (DENV) is an arbovirus widespread through tropical and subtropical areas. It is transmitted to humans through Aedes mosquitoes. Infections with DENV can lead to a series of complications, including dengue fever, dengue haemorrhagic fever, or dengue shock syndrome, which might manifest through secondary infections because of a vulnerable immune system. To date, only one tetravalent DENV vaccine is approved to be administered to children whom have been previously DENV-infected and between 9 and 16 years of age. One of the key targets in discovering DENV antiviral agents is the NS2b/NS3 protease. This protease is a crucial enzyme complex for the proteolytic and cleavage activities of the translated polyprotein during DENV life cycle. Several studies were conducted to discover potential antivirals from natural sources or synthetic compounds and peptides. In this review, we describe the recent studies from the past five years dealing with isolated natural products as potential inhibitors of DENV with a greater focus on inhibiting the NS2b/NS3 protease. This review describes recent discoveries in anti-DENV potential of isolated phytochemicals belonging to different groups including fatty acids, glucosides, terpenes and terpenoids, flavonoids, phenolics, chalcones, acetamides, and peptides. Curcumin, quercetin, and myricetin were found to act as non-competitive inhibitors for the NS2b/NS3 protease enzyme. In some studies, the molecular targets of some of these compounds are yet to be identified using in-silico and in-vitro approaches. So far, none of the isolated natural products was tested clinically for the management of DENV infections. The discussed studies demonstrate that natural products are a rich source of potential anti-DENV compounds. However, not all of these compounds were studied for their kinetic molecular mechanism and type of inhibition. In-silico studies provided an ample number of phytochemical hits to be tested experimentally as DENV protease inhibitors. In conclusion, derivatives of these natural products can be designed and synthesised, which could enhance their specificity and efficacy towards the protease. Other sources of natural products, such as fungi, bacterial toxins, marine organisms, and animals, should also be explored towards discovering more potential and effective DENV NS2b/NS3 protease inhibitors.

Serological cross-reactivity among common flaviviruses

The Flavivirus genus is made up of viruses that are either mosquito-borne or tick-borne and other viruses transmitted by unknown vectors. Flaviviruses present a significant threat to global health and infect up to 400 million of people annually. As the climate continues to change throughout the world, these viruses have become prominent infections, with increasing number of infections being detected beyond tropical borders. These include dengue virus (DENV), West Nile virus (WNV), Japanese encephalitis virus (JEV), and Zika virus (ZIKV). Several highly conserved epitopes of flaviviruses had been identified and reported to interact with antibodies, which lead to cross-reactivity results. The major interest of this review paper is mainly focused on the serological cross-reactivity between DENV serotypes, ZIKV, WNV, and JEV. Direct and molecular techniques are required in the diagnosis of Flavivirus-associated human disease. In this review, the serological assays such as neutralization tests, enzyme-linked immunosorbent assay, hemagglutination-inhibition test, Western blot test, and immunofluorescence test will be discussed. Serological assays that have been developed are able to detect different immunoglobulin isotypes (IgM, IgG, and IgA); however, it is challenging when interpreting the serological results due to the broad antigenic cross-reactivity of antibodies to these viruses. However, the neutralization tests are still considered as the gold standard to differentiate these flaviviruses.

Importance of Public Transport Networks for Reconciling the Spatial Distribution of Dengue and the Association of Socio-Economic Factors with Dengue Risk in Bangkok, Thailand

Dengue is the most widespread mosquito-borne viral disease of man and spreading at an alarming rate. Socio-economic inequality has long been thought to contribute to providing an environment for viral propagation. However, identifying socio-economic (SE) risk factors is confounded by intra-urban daily human mobility, with virus being ferried across cities. This study aimed to identify SE variables associated with dengue at a subdistrict level in Bangkok, analyse how they explain observed dengue hotspots and assess the impact of mobility networks on such associations. Using meteorological, dengue case, national statistics, and transport databases from the Bangkok authorities, we applied statistical association and spatial analyses to identify SE variables associated with dengue and spatial hotspots and the extent to which incorporating transport data impacts the observed associations. We identified three SE risk factors at the subdistrict level: lack of education, % of houses being cement/brick, and number of houses as being associated with increased risk of dengue. Spatial hotspots of dengue were found to occur consistently in the centre of the city, but which did not entirely have the socio-economic risk factor characteristics. Incorporation of the intra-urban transport network, however, much improved the overall statistical association of the socio-economic variables with dengue incidence and reconciled the incongruous difference between the spatial hotspots and the SE risk factors. Our study suggests that incorporating transport networks enables a more real-world analysis within urban areas and should enable improvements in the identification of risk factors.

Temporal trend and spatial clustering of the dengue fever prevalence in West Java, Indonesia

Dengue fever is a notable vector-borne viral disease, currently becoming the most dreaded worldwide health problem in terms of the number of people affected. A data set of confirmed dengue incidences collected in the province of West Java has allowed us to explore dengue's temporal trends and spatial distributions to obtain more obvious insights into its spatial-temporal evolution. We utilized the Richards model to estimate the growth rate and detect the peak (or turning point) of the dengue infection wave by identifying the temporal progression at each location. Using spatial analysis of geo-referenced data from a local perspective, we investigated the changes in the spatial clusters of dengue cases and detected hot spots and cold spots in each weekly cycle. We found that the trend of confirmed dengue incidences significantly increases from January to March. More than two-third (70.4%) of the regions in West Java had their dengue infection turning point ranging from the first week of January to the second week of March. This trend clearly coincides with the peak of precipitation level during the rainy season. Further, the spatial analysis identified the hot spots distributed across central, northern, northeastern, and southeastern regions in West Java. The densely populated areas were likewise seen to be associated with the high-risk areas of dengue exposure. Recognizing the peak of epidemic and geographical distribution of dengue cases might provide important insights that may help local authorities optimize their dengue prevention and intervention programs.

Targeting Emerging RNA Viruses by Engineered Human Superantibody to Hepatitis C Virus RNA-Dependent RNA Polymerase

RNA-dependent RNA polymerase (RdRp) is a unique and highly conserved enzyme across all members of the RNA virus superfamilies. Besides, humans do not have a homolog of this protein. Therefore, the RdRp is an attractive target for a broadly effective therapeutic agent against RNA viruses. In this study, a formerly generated cell-penetrating human single-chain antibody variable fragment (superantibody) to a conformational epitope of hepatitis C virus (HCV) RdRp, which inhibited the polymerase activity leading to the HCV replication inhibition and the host innate immunity restoration, was tested against emerging/reemerging RNA viruses. The superantibody could inhibit the replication of the other members of the Flaviviridae (DENV serotypes 1−4, ZIKV, and JEV), Picornaviridae (genus Enterovirus: EV71, CVA16), and Coronaviridae (genus Alphacoronavirus: PEDV, and genus Betacoronavirus: SARS-CoV-2 (Wuhan wild-type and the variants of concern), in a dose-dependent manner, as demonstrated by the reduction of intracellular viral RNAs and numbers of the released infectious particles. Computerized simulation indicated that the superantibody formed contact interfaces with many residues at the back of the thumb domain (thumb II site, T2) of DENV, ZIKV, JEV, EV71, and CVA16 and fingers and thumb domains of the HCV and coronaviruses (PEDV and SARS-CoV-2). The superantibody binding may cause allosteric change in the spatial conformation of the enzyme and disrupt the catalytic activity, leading to replication inhibition. Although the speculated molecular mechanism of the superantibody needs experimental support, existing data indicate that the superantibody has high potential as a non-chemical broadly effective anti-positive sense-RNA virus agent.

Genetic Adaptation by Dengue Virus Serotype 2 to Enhance Infection of Aedes aegypti Mosquito Midguts

Dengue viruses (DENVs), serotypes 1–4, are arthropod-borne viruses transmitted to humans by mosquitoes, primarily Aedes aegypti. The transmission cycle begins when Ae. aegypti ingest blood from a viremic human and the virus infects midgut epithelial cells. In studying viruses derived from the DENV2 infectious clone 30P-NBX, we found that when the virus was delivered to female Ae. aegypti in an infectious blood meal, the midgut infection rate (MIR) was very low. To determine if adaptive mutations in the DENV2 envelope (E) glycoprotein could be induced to increase the MIR, we serially passed 30P-NBX in Ae. aegypti midguts. After four passages, a single, non-conservative mutation in E protein domain II (DII) nucleotide position 1300 became dominant, resulting in replacement of positively-charged amino acid lysine (K) at position 122 with negatively-charged glutamic acid (E; K122E) and a significantly-enhanced MIR. Site directed mutagenesis experiments showed that reducing the positive charge of this surface-exposed region of the E protein DII correlated with improved Ae. aegypti midgut infection.

Can Modern Molecular Modeling Methods Help Find the Area of Potential Vulnerability of Flaviviruses?

Flaviviruses are single-stranded RNA viruses that have emerged in recent decades and infect up to 400 million people annually, causing a variety of potentially severe pathophysiological processes including hepatitis, encephalitis, hemorrhagic fever, tissues and capillaries damage. The Flaviviridae family is represented by four genera comprising 89 known virus species. There are no effective therapies available against many pathogenic flaviviruses. One of the promising strategies for flavivirus infections prevention and therapy is the use of neutralizing antibodies (NAb) that can disable the virus particles from infecting the host cells. The envelope protein (E protein) of flaviviruses is a three-domain structure that mediates the fusion of viral and host membranes delivering the infectious material. We previously developed and characterized 10H10 mAb which interacts with the E protein of the tick-borne encephalitis virus (TBEV) and many other flaviviruses’ E proteins. The aim of this work was to analyze the structure of E protein binding sites recognized by the 10H10 antibody, which is reactive with different flavivirus species. Here, we present experimental data and 3D modeling indicating that the 10H10 antibody recognizes the amino acid sequence between the two cysteines C92-C116 of the fusion loop (FL) region of flaviviruses’ E proteins. Overall, our results indicate that the antibody-antigen complex can form a rigid or dynamic structure that provides antibody cross reactivity and efficient interaction with the fusion loop of E protein.

Dynamic Interactions of Post Cleaved NS2B Cofactor and NS3 Protease Identified by Integrative Structural Approaches

Diseases caused by flaviviruses such as dengue virus (DENV) and West Nile Virus (WNV), are a serious threat to public health. The flavivirus single-stranded RNA genome is translated into a polyprotein which is cleaved into three structural proteins and seven non-structural proteins by the viral and cellular proteases. Non-structural (NS) protein 3 is a multifunctional protein that has N-terminal protease and C-terminal helicase domains. The NS3 protease requires co-factor NS2B for enzymatic activity and folding. Due to its essential role in viral replication, NS2B-NS3 protease is an attractive target for antiviral drugs. Despite the availability of crystal structures, dynamic interactions of the N- and C-termini of NS2B co-factor have been elusive due to their flexible fold. In this study, we employ integrative structural approaches combined with biochemical assays to elucidate the dynamic interactions of the flexible DENV4 NS2B and NS3 N- and C-termini. We captured the crystal structure of self-cleaved DENV4 NS2B₄₇NS3 protease in post cleavage state. The intermediate conformation adopted in the reported structure can be targeted by allosteric inhibitors. Comparison of our new findings from DENV4 against previously studied ZIKV NS2B-NS3 proteins reveals differences in NS2B-NS3 function between the two viruses. No inhibition of protease activity was observed for unlinked DENV NS2B-NS3 in presence of the cleavage site while ZIKV NS2B-NS3 cleavage inhibits protease activity. Another difference is that binding of the NS2B C-terminus to DENV4 eNS2B₄₇NS3Pro active site is mediated via interactions with P4-P6 residues while for ZIKV, the binding of NS2B C-terminus to active site is mediated by P1-P3 residues. The mapping of NS2B N- and C-termini with NS3 indicates that these intermolecular interactions occur mainly on the beta-barrel 2 of the NS3 protease domain. Our integrative approach enables a comprehensive understanding of the folding and dynamic interactions of DENV NS3 protease and its cofactor NS2B.

Detection of Dengue Virus From Aedes aegypti (Diptera, Culicidae) in Field-Caught Samples From Makkah Al-Mokarramah, Kingdom of Saudi Arabia, Using RT-PCR

Dengue fever (DF) is endemic to Makkah and Jeddah, the Kingdom of Saudi Arabia (KSA). However, until recently, the circulation of dengue virus (DENV) in Aedes mosquitoes in these areas was unknown. Serological surveillance of DENV in Ae aegypti is a powerful tool for early detection of dengue outbreaks and essential for developing effective control strategies. Therefore, this research aimed to examine a sample of adult Ae aegypti mosquitoes from Makkah, KSA, to detect DENV. In total, 1295 Ae aegypti mosquitoes were collected from the field from target areas of Makkah with a high incidence and prevalence of DF. The samples were divided into 259 coded pools (five mosquitoes in each) and preserved in 1.5 mL plastic tubes. The tubes were labeled, capped, and stored at-86°C until use. RT-PCR was used to detect DENV in the samples. All positive pools were confirmed by RT-PCR. The RT-PCR products were analyzed by gel electrophoresis (1.5% agarose in Tris-acetate EDTA buffer), stained with ethidium bromide, and visualized. DENV was isolated from six female Ae Aegypti collected from six pools (out of 259 pools). No other viruses were detected. Only five of the nine target localities had positive pools. Samples from the remaining four localities yielded negative results. Four DENV-positive mosquitoes were collected at the aquatic stages, and two were collected at the adult stage. These results show the circulation of DENV in adult mosquitoes and offspring, indicating vertical transmission of DENV. In conclusion, this study found that, in Makkah, DENV is circulating in dengue vectors with a high significance rate, suggesting the possibility of a dengue outbreak in the future; therefore, a sensitive surveillance system is vital to predict the outbreak and for early intervention and control.

Phylogeographic dynamics of the arthropod vector, the blacklegged tick (Ixodes scapularis)

BACKGROUND

The emergence of vector-borne pathogens in novel geographic areas is regulated by the migration of their arthropod vectors. Blacklegged ticks (Ixodes scapularis) and the pathogens they vector, including the causative agents of Lyme disease, babesiosis and anaplasmosis, continue to grow in their population sizes and to expand in geographic range. Migration of this vector over the previous decades has been implicated as the cause of the re-emergence of the most prevalent infectious diseases in North America.

METHODS

We systematically collected ticks from across New York State (hereafter referred to as New York) from 2004 to 2017 as part of routine tick-borne pathogen surveillance in the state. This time frame corresponds with an increase in range and incidence of tick-borne diseases within New York. We randomly sampled ticks from this collection to explore the evolutionary history and population dynamics of I. scapularis. We sequenced the mitochondrial genomes of each tick to characterize their current and historical spatial genetic structure and population growth using phylogeographic methods.

RESULTS

We sequenced whole mitochondrial genomes from 277 ticks collected across New York between 2004 and 2017. We found evidence of population genetic structure at a broad geographic scale due to differences in the relative abundance, but not the composition, of haplotypes among sampled ticks. Ticks were often most closely related to ticks from the same and nearby collection sites. The data indicate that both short- and long-range migration events shape the population dynamics of blacklegged ticks in New York.

CONCLUSIONS

We detailed the population dynamics of the blacklegged tick (Ixodes scapularis) in New York during a time frame in which tick-borne diseases were increasing in range and incidence. Migration of ticks occurred at both coarse and fine scales in the recent past despite evidence of limits to gene flow. Past and current tick population dynamics have implications for further range expansion as habitat suitability for ticks changes due to global climate change. Analyses of mitochondrial genome sequencing data will expound upon previously identified drivers of tick presence and abundance as well as identify additional drivers. These data provide a foundation on which to generate testable hypotheses on the drivers of tick population dynamics occurring at finer scales.

An overview of chikungunya virus molecular biology, epidemiology, pathogenesis, treatment and prevention strategies

The chikungunya virus (CHIKV) causes a devastating musculoskeletal inflammatory disease with symptoms of headache, rash, polyarthralgia, fever and myalgia. CHIKV has appeared intermittently around the world and in different ecological zones of Pakistan. Aedes mosquito species are the main vectors of CHIKV transmission and cause high disease rates in the urban transmission cycle. Even though the CHIKV is responsible for many cases of disease, no authorized antibodies or antiviral treatments are available, and prevention is the primary countermeasure. This review describes an update on CHIKV molecular biology, replication cycle, epidemiology, ecological factors, clinical manifestations and treatment and suggests a way forward to control and prevent this infection strategically in the future.

Interspecific mating bias may drive Aedes albopictus displacement of Aedes aegypti during its range expansion

Aedes albopictus is the most invasive mosquito in the world and often displaces Ae. aegypti in regions where their populations overlap. Interspecific mating has been proposed as a possible cause for this displacement, but whether this applies across the range of their sympatry remains unclear. Aedes albopictus and Ae. aegypti collected from allopatric and sympatric areas in China were allowed to interact in cage experiments with different crosses and sex-choices. The results confirm that asymmetric interspecific mating occurs in these populations with matings between allopatric Ae. albopictus males and Ae. aegypti females being significantly higher (55.2%) than those between Ae. aegypti males and Ae. albopictus females (27.0%), and sympatric mosquitoes showed a similar but lower frequency bias, 25.7% versus 6.2%, respectively. The cross-mated females can mate second time (remate) with the respective conspecific males and the 66.7% remating success of female Ae. albopictus was significantly higher than the 9.3% of Ae. aegypti females. Furthermore, 17.8% of the matings of Ae. albopictus males exposed to mixed pools of Ae. albopictus and Ae. aegypti females and 9.3% of the matings of Ae. aegypti males with mixed Ae. aegypti and Ae. albopictus females were interspecific. The difference in the length of clasper between male Ae. albopictus (0.524 mm) and Ae. aegypti (0.409 mm) may be correlated with corresponding mates. We conclude that stronger Ae. albopictus male interspecific mating and more avid female intraspecific remating result in a satyr effect and contribute to competitive displacement of Ae. aegypti as allopatric Ae. albopictus invade during range expansion.

Association between densities of adult and immature stages of Aedes aegypti mosquitoes in space and time: implications for vector surveillance

BACKGROUND

Mosquito control is currently the main tool available to contain the spread of several arboviruses in Brazil. We have evaluated the association between entomological surveys of female adult Aedes aegypti and the Breteau index (BI) in space and time in a hyperendemic area, and compared the human resources costs required to measure each of these indicators.

METHODS

Entomological surveys were conducted between 2016 and 2019 in Vila Toninho, a neighborhood in the city of São José do Rio Preto, Brazil. Monthly records of collected mosquito specimens were made and then grouped by season.

RESULTS

Our findings showed that adult and immature mosquitoes are more related in time than in space, possibly due to differences in their habitats or in climate variables. Bayesian temporal modeling revealed that an increase in 1 standard deviation in the BI was associated with a 27% increase in the number of adult female mosquitoes when adjusted for climatic conditions. The cost of entomological surveys of adult mosquitoes was found to be 83% lower than the cost of determining the BI when covering the same geographic area.

CONCLUSIONS

For fine-scale assessments, a simple measure of adult Ae. aegypti abundance may be more realistic than aquatic indicators, but the adult indices are not necessarily the only reliable measure. Surveying adult female mosquitoes has significant potential for optimizing vector control strategies because, unlike the BI, this tool provides an effective indicator for micro-areas within an urban region. It should be noted that the results of the present study may be due to specific features of of the study area, and future studies should analyze whether the patterns found in the study neighborhood are also found in other regions.

Flavivirus Entry Inhibitors

Flaviviruses, including Dengue virus, Zika virus, Yellow fever virus, Japanese encephalitis virus, West Nile virus, cause thousands of deaths and millions of illnesses each year. The large outbreak of ZIKV in 2016 reminds us that flaviviruses can pose a serious threat to human safety and public health as emerging and re-emerging viruses. However, there are no specific drugs approved for the treatment of flavivirus infections. Due to no need to enter the cells, viral entry inhibitors have the unique advantage in suppressing viral infections. Flaviviruses bind to receptors and attach to the cell surface, then enter the endosome in a clathrin-dependent manner and finalizes the viral entry process after fusion with the cell membrane in a low pH environment. Small molecules, antibodies or peptides can inhibit flavivirus entry by targeting the above processes. Here, we focus on flavivirus entry inhibitors with well-defined target and antiviral activity. We hope that our review will provide a theoretical basis for flavivirus treatment and drug research and help to accelerate the clinical application of flavivirus entry inhibitors.

Dengue infection with warning signs: The 2019 epidemic

Background

Dengue is a common arthropod-borne viral disease with a variable clinical spectrum, course, and outcome.

Method

We conducted a prospective observational study describing the clinical profile of patients hospitalized for dengue with warning signs during the 2019 epidemic.

Result

A total of 1349 patients with dengue, including 459 with warning signs, were seen. It predominantly affects the younger subset of both sexes. A higher proportion of females presented with either a platelet count less than 20,000/mm³ or a rapid fall in platelets. Bleeding manifestations of varying severity were observed in one-fifth of them. Severe bleeding was universal at a platelet count less than 10,000/mm³. Platelet transfusion was indicated in 17 (7.3%) males and 25 (11%) females, with females requiring it at a higher platelet count. While hepatic involvement was frequent, others such as myocarditis, encephalitis, and pancreatitis were infrequent. Coinfections observed included malaria, scrub typhus, and enteric fever. The case fatality rate for the patients with dengue and those with warning manifestations was 0.4% and 1.3%, respectively.

Conclusions

Dengue epidemics often overwhelm health-care resources. Such epidemics can be successfully managed using a protocolized approach, modified as per the available resources. Platelet transfusions are lifesaving at a count less than 10,000/mm³. With meticulous supportive care, the case fatality rate can be reduced to less than 0.5%.

A wMel Wolbachia variant in Aedes aegypti from field-collected Drosophila melanogaster with increased phenotypic stability under heat stress

Mosquito‐borne diseases remain a major cause of morbidity and mortality. Population replacement strategies involving the wMel strain of Wolbachia are being used widely to control mosquito‐borne diseases. However, these strategies may be influenced by temperature because wMel is vulnerable to heat. wMel infections in Drosophila melanogaster are genetically diverse, but few transinfections of wMel variants have been generated in Aedes aegypti. Here, we successfully transferred a wMel variant (termed wMelM) originating from a field‐collected D. melanogaster into Ae. aegypti. The new wMelM variant (clade I) is genetically distinct from the original wMel transinfection (clade III), and there are no genomic differences between wMelM in its original and transinfected host. We compared wMelM with wMel in its effects on host fitness, temperature tolerance, Wolbachia density, vector competence, cytoplasmic incompatibility and maternal transmission under heat stress in a controlled background. wMelM showed a higher heat tolerance than wMel, likely due to higher overall densities within the mosquito. Both wMel variants had minimal host fitness costs, complete cytoplasmic incompatibility and maternal transmission, and dengue virus blocking under laboratory conditions. Our results highlight phenotypic differences between Wolbachia variants and wMelM shows potential as an alternative strain in areas with strong seasonal temperature fluctuations.

Empirical Modeling of COVID-19 Evolution with High/Direct Impact on Public Health and Risk Assessment

This report develops a conceivable mathematical model for the transmission and spread of COVID-19 in Romania. Understanding the early spread dynamics of the infection and evaluating the effectiveness of control measures in the first wave of infection is crucial for assessing and evaluating the potential for sustained transmission occurring in the second wave. The main aim of the study was to emphasize the impact of control measures and the rate of case detection in slowing the spread of the disease. Non pharmaceutical control interventions include government actions, public reactions, and other measures. The methodology consists of an empirical model, taking into consideration the generic framework of the Stockholm Environment Institute (SEI) Epidemic–Macroeconomic Model, and incorporates the effect of interventions through a multivalued parameter, a stepwise constant varying during different phases of the interventions designed to capture their impact on the model. The model is mathematically consistent and presents various simulation results using best-estimated parameter values. The model can be easily updated later in response to real-world alterations, for example, the easing of restrictions. We hope that our simulation results may guide local authorities to make timely, correct decisions for public health and risk assessment.

Periodic Orbits of a Mosquito Suppression Model Based on Sterile Mosquitoes

In this work, we investigate the existence and stability of periodic orbits of a mosquito population suppression model based on sterile mosquitoes. The model switches between two sub-equations as the actual number of sterile mosquitoes in the wild is assumed to take two constant values alternately. Employing the Poincaré map method, we show that the model has at most two T-periodic solutions when the release amount is not sufficient to eradicate the wild mosquitoes, and then obtain some sufficient conditions for the model to admit a unique or exactly two T-periodic solutions. In particular, we observe that the model displays bistability when it admits exactly two T-periodic solutions: the origin and the larger periodic solution are asymptotically stable, and the smaller periodic solution is unstable. Finally, we give two numerical examples to support our lemmas and theorems.

Herpes Zoster in a Patient With Dengue Infection: A Case Report of a Rare Co-Infection

Dengue is an infectious disease that plays an essential role in morbidity and mortality in developing countries. Occasionally, it presents with rare presentations and co-infections. Co-infection of herpes zoster and dengue is possible in countries such as these where both infections are common. Varicella-zoster infection is one of the self-limiting viral infections, and dengue fever is an endemic infection in Sri Lanka. When there is suspicion in diagnosis due to a change of natural course or overlapping of clinical features, concurrent co-infections have to be strongly suspected. We present the case of a 46-year-old female who had herpes zoster and dengue infection and was managed with a multidisciplinary team approach. The patient improved without any complications.

Evaluation of an ivermectin-based attractive targeted sugar bait (ATSB) against Aedes aegypti in Tanzania

Background The control of vector borne arboviral diseases such as Dengue is mainly achieved by reducing human-vector contact and controlling the vectors through source reduction and environmental management. These measures are constrained by labour intensity, insecticide resistance and pro-active community participation. The current study intended to develop and test an ivermectin-based attractive-targeted sugar bait (ATSB) against Aedes aegypti. Methods The 48hour lethal concentration (LC90) of ivermectin against Ae. aegypti was determined through serial dilution experiment where five 30cm x 30cm x 30cm cages were set; into each, a 10% sugar solution treated with ivermectin were introduced. 40 Ae. aegypti were released into each cage and observed for mortality after 4, 8, 24 and 48 hours. The ivermectin-based ATSB was evaluated in a semi field system where ATSB and attractive sugar bait (ASB) were deployed into each compartment of the semi field and 100 female Ae. aegypti were released every day and recaptured the next day through human land catch and Bio-gent sentinel trap. The developed and semi-field tested ATSB was further tested in the field by deploying them in garages. Results The ivermectin 48hr LC90 of male and female Ae. aegypti was found to be 0.03% w/v. In the semi field system, the ATSB significantly reduced a free-flying population of Ae. aegypti within 24 hours (incidence rate ratio (IRR) = 0.62; [95% confidence interval (95%CI); 0.54-0.70] and p-value < 0.001). However, in the field, the ATSBs required the addition of yeast as a carbon dioxide source to efficiently attract Ae. aegypti mosquitoes to feed. Conclusion Ivermectin is an active ingredient that can be used in an ATSB for Ae. aegypti depopulation. However, further research is needed to improve the developed and tested ATSB to compete with natural sources of sugar in a natural environment.