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Vicco A, McCormack C, Pedrique B, Ribeiro I, Malavige GN, Dorigatti I. A scoping literature review of global dengue age-stratified seroprevalence data: estimating dengue force of infection in endemic countries. EBioMedicine 2024; 104:105134. [PMID: 38718682 PMCID: PMC11096825 DOI: 10.1016/j.ebiom.2024.105134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Dengue poses a significant burden worldwide, and a more comprehensive understanding of the heterogeneity in the intensity of dengue transmission within endemic countries is necessary to evaluate the potential impact of public health interventions. METHODS This scoping literature review aimed to update a previous study of dengue transmission intensity by collating global age-stratified dengue seroprevalence data published in the Medline, Embase and Web of Science databases from 2014 to 2023. These data were then utilised to calibrate catalytic models and estimate the force of infection (FOI), which is the yearly per-capita risk of infection for a typical susceptible individual. FINDINGS We found a total of 66 new publications containing 219 age-stratified seroprevalence datasets across 30 endemic countries. Together with the previously available average FOI estimates, there are now more than 250 dengue average FOI estimates obtained from seroprevalence studies from across the world. INTERPRETATION The results show large heterogeneities in average dengue FOI both across and within countries. These new estimates can be used to inform ongoing modelling efforts to improve our understanding of the drivers of the heterogeneity in dengue transmission globally, which in turn can help inform the optimal implementation of public health interventions. FUNDING UK Medical Research Council, Wellcome Trust, Community Jameel, Drugs for Neglected Disease initiative (DNDi) funded by the French Development Agency, Médecins Sans Frontières International; Swiss Agency for Development and Cooperation and UK aid.
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Affiliation(s)
- Anna Vicco
- Department of Molecular Medicine, University of Padua, Padua, Italy; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Jameel Institute, Imperial College London, London, United Kingdom.
| | - Clare McCormack
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Jameel Institute, Imperial College London, London, United Kingdom
| | - Belen Pedrique
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Isabela Ribeiro
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | | | - Ilaria Dorigatti
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Jameel Institute, Imperial College London, London, United Kingdom.
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Rakotomalala FA, Bouillin J, Randriarimanana SD, Thaurignac G, Maharavo L, Raberahona M, Razafindrakoto L, Rasoanarivo J, Rakoto-Andrianarivelo M, Rakoto DAD, Babin FX, Rasamoelina T, Delaporte E, Samison LH, Peeters M, Nerrienet E, Ayouba A. High Seroprevalence of IgG Antibodies to Multiple Arboviruses in People Living with HIV (PLWHIV) in Madagascar. Viruses 2023; 15:2258. [PMID: 38005934 PMCID: PMC10674502 DOI: 10.3390/v15112258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
To estimate the prevalence of IgG antibodies against six arboviruses in people living with HIV-1 (PLWHIV) in Madagascar, we tested samples collected between January 2018 and June 2021. We used a Luminex-based serological assay to detect IgG antibodies against antigens from Dengue virus serotypes 1-4 (DENV1-4), Zika virus (ZIKV), West Nile virus (WNV), Usutu virus (USUV), Chikungunya virus (CHIKV), and O'nyong nyong virus (ONNV). Of the 1036 samples tested, IgG antibody prevalence was highest for ONNV (28.4%), CHIKV (26.7%), WNV-NS1 (27.1%), DENV1 (12.4%), USUV (9.9%), and DENV3 (8.9%). ZIKV (4.9%), DENV2 (4.6%), WNV-D3 (5.1%), and DENV4 (1.4%) were lower. These rates varied by province of origin, with the highest rates observed in Toamasina, on the eastern coast (50.5% and 56.8%, for CHIKV and ONNV, respectively). The seroprevalence increased with age for DENV1 and 3 (p = 0.006 and 0.038, respectively) and WNV DIII (p = 0.041). The prevalence of IgG antibodies against any given arborvirus varied over the year and significantly correlated with rainfalls in the different areas (r = 0.61, p = 0.036). Finally, we found a significant correlation between the seroprevalence of antibodies against CHIKV and ONNV and the HIV-1 RNA plasma viral load. Thus, PLWHIV in Madagascar are highly exposed to various arboviruses. Further studies are needed to explain some of our findings.
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Affiliation(s)
- Fetra Angelot Rakotomalala
- Centre d’Infectiologie Charles Mérieux, Université d’Antananarivo, Antananarivo 101, Madagascar; (F.A.R.); (S.D.R.); (L.M.); (M.R.-A.); (T.R.); (L.H.S.)
- TransVIHMI, University of Montpellier, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD), 34394 Montpellier, France; (J.B.); (G.T.); (E.D.); (M.P.)
- Ecole Doctorale Sciences de la Vie et de l’Environnement, Université d’Antananarivo, Antananarivo 101, Madagascar;
| | - Julie Bouillin
- TransVIHMI, University of Montpellier, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD), 34394 Montpellier, France; (J.B.); (G.T.); (E.D.); (M.P.)
| | - Santatriniaina Dauphin Randriarimanana
- Centre d’Infectiologie Charles Mérieux, Université d’Antananarivo, Antananarivo 101, Madagascar; (F.A.R.); (S.D.R.); (L.M.); (M.R.-A.); (T.R.); (L.H.S.)
| | - Guillaume Thaurignac
- TransVIHMI, University of Montpellier, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD), 34394 Montpellier, France; (J.B.); (G.T.); (E.D.); (M.P.)
| | - Luca Maharavo
- Centre d’Infectiologie Charles Mérieux, Université d’Antananarivo, Antananarivo 101, Madagascar; (F.A.R.); (S.D.R.); (L.M.); (M.R.-A.); (T.R.); (L.H.S.)
- Ecole Doctorale Sciences de la Vie et de l’Environnement, Université d’Antananarivo, Antananarivo 101, Madagascar;
| | - Mihaja Raberahona
- Service des Maladies Infectieuses, Centre Hôspitalier Universitaire Joseph Raseta de Befelatanana, Antananarivo 101, Madagascar;
| | - Lucien Razafindrakoto
- Service de Pneumo-Phtisiologie, Centre Hospitalier Universitaire Analakininina, Toamasina 501, Madagascar;
| | - Jasmina Rasoanarivo
- Secrétariat Exécutif du Comité National de la Lutte Contre le SIDA, Antananarivo 101, Madagascar;
| | - Mala Rakoto-Andrianarivelo
- Centre d’Infectiologie Charles Mérieux, Université d’Antananarivo, Antananarivo 101, Madagascar; (F.A.R.); (S.D.R.); (L.M.); (M.R.-A.); (T.R.); (L.H.S.)
| | - Danielle Aurore Doll Rakoto
- Ecole Doctorale Sciences de la Vie et de l’Environnement, Université d’Antananarivo, Antananarivo 101, Madagascar;
| | | | - Tahinamandranto Rasamoelina
- Centre d’Infectiologie Charles Mérieux, Université d’Antananarivo, Antananarivo 101, Madagascar; (F.A.R.); (S.D.R.); (L.M.); (M.R.-A.); (T.R.); (L.H.S.)
| | - Eric Delaporte
- TransVIHMI, University of Montpellier, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD), 34394 Montpellier, France; (J.B.); (G.T.); (E.D.); (M.P.)
| | - Luc Hervé Samison
- Centre d’Infectiologie Charles Mérieux, Université d’Antananarivo, Antananarivo 101, Madagascar; (F.A.R.); (S.D.R.); (L.M.); (M.R.-A.); (T.R.); (L.H.S.)
| | - Martine Peeters
- TransVIHMI, University of Montpellier, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD), 34394 Montpellier, France; (J.B.); (G.T.); (E.D.); (M.P.)
| | | | - Ahidjo Ayouba
- TransVIHMI, University of Montpellier, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD), 34394 Montpellier, France; (J.B.); (G.T.); (E.D.); (M.P.)
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Ebogo‐Belobo JT, Kenmoe S, Abanda NN, Bowo‐Ngandji A, Mbaga DS, Magoudjou‐Pekam JN, Kame‐Ngasse GI, Tchatchouang S, Menkem EZ, Okobalemba EA, Noura EA, Meta‐Djomsi D, Maïdadi‐Foudi M, Kenfack‐Zanguim J, Kenfack‐Momo R, Kengne‐Nde C, Esemu SN, Mbacham WF, Sadeuh‐Mba SA, Ndip L, Njouom R. Contemporary epidemiological data of Rift Valley fever virus in humans, mosquitoes and other animal species in Africa: A systematic review and meta-analysis. Vet Med Sci 2023; 9:2309-2328. [PMID: 37548116 PMCID: PMC10508527 DOI: 10.1002/vms3.1238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/29/2023] [Accepted: 07/21/2023] [Indexed: 08/08/2023] Open
Abstract
Rift Valley fever (RVF) is a severe zoonotic mosquito-borne disease that represents an important threat to human and animal health, with major public health and socioeconomic impacts. This disease is endemic throughout many African countries and the Arabian Peninsula. This systematic review with meta-analysis was conducted to determine the RVF prevalence in humans, mosquitoes and other animal species in Africa. The review also provides contemporary data on RVF case fatality rate (CFR) in humans. In this systematic review with meta-analysis, a comprehensive literature search was conducted on the PubMed, Embase, Web of Science and Global Index Medicus databases from January 2000 to June 2022 to identify relevant studies. Pooled CFR and prevalence estimates were calculated using the random-effects model. Subgroup analysis and sensitivity analysis were performed, and the I2 -statistic was used to investigate a potential source of heterogeneity. A total of 205 articles were included in the final analysis. The overall RVF CFR in humans was found to be 27.5% [95% CI = 8.0-52.5]. The overall pooled prevalence was 7.8% [95% CI = 6.2-9.6] in humans and 9.3% [95% CI = 8.1-10.6] in animals, respectively. The RVF prevalence in individual mosquitoes ranged from 0.0% to 25%. Subgroup analysis showed substantial heterogeneity with respect to geographical regions and human categories. The study shows that there is a correspondingly similar prevalence of RVF in human and animals; however, human CFR is much higher than the observed prevalence. The lack of a surveillance programme and the fact that this virus has subclinical circulation in animals and humans could explain these observations. The implementation of a One Health approach for RVF surveillance and control would be of great interest for human and animal health.
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Affiliation(s)
- Jean Thierry Ebogo‐Belobo
- Centre for Research on Health and Priority PathologiesInstitute of Medical Research and Medicinal Plants StudiesYaoundeCameroon
- Department of BiochemistryFaculty of SciencesThe University of Yaounde IYaoundéCameroon
| | - Sebastien Kenmoe
- Department of Microbiology and ParasitologyUniversity of BueaBueaCameroon
| | - Ngu Njei Abanda
- Virology DepartmentCentre Pasteur of CameroonYaoundéCameroon
| | - Arnol Bowo‐Ngandji
- Department of MicrobiologyFaculty of SciencesThe University of Yaounde IYaoundéCameroon
| | - Donatien Serge Mbaga
- Department of MicrobiologyFaculty of SciencesThe University of Yaounde IYaoundéCameroon
| | | | - Ginette Irma Kame‐Ngasse
- Centre for Research on Health and Priority PathologiesInstitute of Medical Research and Medicinal Plants StudiesYaoundeCameroon
| | | | | | | | - Efietngab Atembeh Noura
- Centre for Research on Health and Priority PathologiesInstitute of Medical Research and Medicinal Plants StudiesYaoundeCameroon
| | - Dowbiss Meta‐Djomsi
- Research Centre on Emerging and Re‐Emerging DiseasesInstitute of Medical Research and Medicinal Plants StudiesYaoundeCameroon
| | - Martin Maïdadi‐Foudi
- Research Centre on Emerging and Re‐Emerging DiseasesInstitute of Medical Research and Medicinal Plants StudiesYaoundeCameroon
| | | | - Raoul Kenfack‐Momo
- Department of BiochemistryFaculty of SciencesThe University of Yaounde IYaoundéCameroon
| | - Cyprien Kengne‐Nde
- Epidemiological Surveillance, Evaluation and Research UnitNational AIDS Control CommitteeYaoundéCameroon
| | | | - Wilfred Fon Mbacham
- Department of BiochemistryFaculty of SciencesThe University of Yaounde IYaoundéCameroon
| | - Serge Alain Sadeuh‐Mba
- Virology DepartmentCentre Pasteur of CameroonYaoundéCameroon
- Maryland Department of AgricultureSalisbury Animal Health LaboratorySalisburyMarylandUSA
| | - Lucy Ndip
- Department of Microbiology and ParasitologyUniversity of BueaBueaCameroon
| | - Richard Njouom
- Virology DepartmentCentre Pasteur of CameroonYaoundéCameroon
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Nooh F, Chernet A, Reither K, Okuma J, Brattig NW, Utzinger J, Probst-Hensch N, Paris DH, Dreyfus A. Prevalence of fever of unidentified aetiology in East African adolescents and adults: a systematic review and meta-analysis. Infect Dis Poverty 2023; 12:55. [PMID: 37231500 DOI: 10.1186/s40249-023-01105-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Primary health care settings and hospitals of low- and middle-income countries have few accessible diagnostic tools and limited laboratory and human resources capacity to identify multiple pathogens with high accuracy. In addition, there is a paucity of information on fever and its underlying aetiology in the adolescent and adult population in East Africa. The purpose of this study was to estimate the pooled prevalence of fever of unidentified aetiology among adolescent and adult febrile patients seeking health care in East Africa. METHODS We pursued a systematic review using readily available electronic databases (i.e. PubMed, Cumulative Index to Nursing & Allied Health Literature, Scopus, Cochrane Library and Web of Science) without language restriction from inception date of the respective databases to October 31, 2022. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Identified studies were screened for relevance. Further analyses based on pre-set eligibility criteria were carried out for final inclusion. Two reviewers independently screened and extracted data. Risk of study bias was assessed. Meta-analysis of the prevalence of fever of unidentified aetiology was performed. RESULTS We identified 14,029 articles of which 25 were eligible for inclusion, reporting data from 8538 participants. The pooled prevalence of febrile cases with unidentified aetiology was 64% [95% confidence interval (CI): 51-77%, I2 = 99.6%] among febrile adolescents and adults in East Africa. For the proportion of patients with identified aetiology, the studies documented bacterial pathogens (human bloodstream infections), bacterial zoonotic pathogens and arboviruses as the main non-malarial causative agents in East Africa. CONCLUSIONS Our study provides evidence that almost two-thirds of adolescent and adult febrile patients attending health care facilities in East Africa might receive inappropriate treatments due to unidentified potential life-threatening fever aetiology. Hence, we call for a comprehensive fever syndromic surveillance to broaden a consequential differential diagnosis of syndromic fever and to considerably improve the course of patients' disease and treatment outcomes.
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Affiliation(s)
- Faisal Nooh
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland.
- University of Basel, Basel, Switzerland.
- College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia.
- College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somaliland.
| | - Afona Chernet
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - James Okuma
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Norbert W Brattig
- Department Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Daniel H Paris
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Anou Dreyfus
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Section of Epidemiology, University of Zürich, Zurich, Switzerland
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Skalinski LM, Santos AES, Paixão E, Itaparica M, Barreto F, da Conceição Nascimento Costa M, Teixeira MG. Chikungunya seroprevalence in population-based studies: a systematic review and meta-analysis. Arch Public Health 2023; 81:80. [PMID: 37127721 PMCID: PMC10150504 DOI: 10.1186/s13690-023-01081-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 04/06/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Seroprevalence studies about chikungunya infection are usually conducted after epidemics to estimate the magnitude of the attack. This study aimed to estimate the seroprevalence of CHIKV by WHO region, considering the periods of introduction of the virus in these regions and its potential to lead to epidemics. METHODS We systematically reviewed Medline/Pubmed, Embase, Lilacs, Scopus and Web of Science for original articles published up to 2020. Cohort, case-control and cross-sectional studies were eligible for inclusion, based on the results of laboratory diagnosis of previous or previous and recent infection. Those conducted with symptomatic individuals were excluded. RESULTS 596 articles were identified, 197 full-text were reviewed and 64 were included, resulting in 71 seroprevalences. Most were cross-sectional studies (92%), between 2001 and 2020 (92%), with population of all ages (55%), conducted in Kenya (10.9%), Brazil (9.4%) and French Polynesia (7.8%). The pooled estimates were 24% (95%CI 19-29; I2 = 99.7%; p < 0.00), being 21% (95%CI 13-30; I2 = 99.5%; p < 0.00) for adults, 7% (95%CI 0-23; I2 = 99.7%; p < 0.00) for children and 30% (95%CI 23-38; I2 = 99.7%; p < 0.00) for all ages. The higher seroprevalences were found in African, the Americas and South-East Asian Regions. CONCLUSIONS The great heterogeneity of seroprevalences points to the persistence of viral circulation. Even where the seroprevalence is high, the population replacement and the absence of vaccines mean that the risk of virus spread and epidemics remains. REGISTRATION PROSPERO CRD42020166227.
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Affiliation(s)
- Lacita Menezes Skalinski
- Universidade Estadual de Santa Cruz, Rodovia Jorge Amado, km 16, s/n, Salobrinho, Ilhéus, CEP 45662-900, BA, Brasil.
- Instituto de Saúde Coletiva/ Universidade Federal da Bahia, Rua Basílio da Gama, s/n, Campus Canela, Salvador, CEP 40110-040, BA, Brazil.
| | - Aline Elena Sacramento Santos
- Instituto de Saúde Coletiva/ Universidade Federal da Bahia, Rua Basílio da Gama, s/n, Campus Canela, Salvador, CEP 40110-040, BA, Brazil
| | - Enny Paixão
- London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Martha Itaparica
- Instituto de Saúde Coletiva/ Universidade Federal da Bahia, Rua Basílio da Gama, s/n, Campus Canela, Salvador, CEP 40110-040, BA, Brazil
| | - Florisneide Barreto
- Instituto de Saúde Coletiva/ Universidade Federal da Bahia, Rua Basílio da Gama, s/n, Campus Canela, Salvador, CEP 40110-040, BA, Brazil
| | | | - Maria Glória Teixeira
- Instituto de Saúde Coletiva/ Universidade Federal da Bahia, Rua Basílio da Gama, s/n, Campus Canela, Salvador, CEP 40110-040, BA, Brazil
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Khan A, Bisanzio D, Mutuku F, Ndenga B, Grossi-Soyster EN, Jembe Z, Maina PW, Chebii PK, Ronga CO, Okuta V, LaBeaud AD. Spatiotemporal overlapping of dengue, chikungunya, and malaria infections in children in Kenya. BMC Infect Dis 2023; 23:183. [PMID: 36991340 PMCID: PMC10053720 DOI: 10.1186/s12879-023-08157-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
Malaria, chikungunya virus (CHIKV), and dengue virus (DENV) are endemic causes of fever among children in Kenya. The risks of infection are multifactorial and may be influenced by built and social environments. The high resolution overlapping of these diseases and factors affecting their spatial heterogeneity has not been investigated in Kenya. From 2014-2018, we prospectively followed a cohort of children from four communities in both coastal and western Kenya. Overall, 9.8% were CHIKV seropositive, 5.5% were DENV seropositive, and 39.1% were malaria positive (3521 children tested). The spatial analysis identified hot-spots for all three diseases in each site and in multiple years. The results of the model showed that the risk of exposure was linked to demographics with common factors for the three diseases including the presence of litter, crowded households, and higher wealth in these communities. These insights are of high importance to improve surveillance and targeted control of mosquito-borne diseases in Kenya.
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Affiliation(s)
- Aslam Khan
- Stanford University School of Medicine, Stanford, CA, USA.
- Center for Academic Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA.
| | | | | | | | | | - Zainab Jembe
- Msambweni County Referral hospital, Msambweni, Kenya
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A Retrospective Study of the Seroprevalence of Dengue Virus and Chikungunya Virus Exposures in Nigeria, 2010–2018. Pathogens 2022; 11:pathogens11070762. [PMID: 35890007 PMCID: PMC9318586 DOI: 10.3390/pathogens11070762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 02/01/2023] Open
Abstract
Arboviruses are important public health threats in many regions of the world. Nigeria has experienced outbreaks of arboviruses over the past decades, leading to concerns of widespread endemicity, which are frequently misdiagnosed. This study aimed to determine the seroprevalence of dengue virus (DENV) (a flavivirus) and chikungunya virus (CHIKV) (an alphavirus) infections in three major population centers of Nigeria. A convenience sample of 701 sera was collected from both healthy and febrile participants between August 2010 and March 2018. Sera were tested for prior exposure to CHIKV virus and DENV using indirect IgG ELISA. Results showed that 54.1% (379/701) of participants were seropositive for anti-DENV antibodies, 41.3% (290/701) were seropositive for anti-CHIKV antibodies, and 20.1% (141/701) had previous exposure to both. The seropositivity for prior CHIKV exposure and prior exposure to DENV and CHIKV was significantly associated with age (CHIKV: OR = 2.7 (95% CI: 1.7–4.3); DENV and CHIKV: OR = 2.2 (95% CI: 1.2–4.0) for adults compared to participants under 18 years old). Overall, the high seropositivity across all age groups suggests that arboviral infections are prevalent in Nigeria and indicates that surveillance and further epidemiological studies are required to determine the true burden of these infections and the spectrum of diseases associated with these exposures.
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Power GM, Vaughan AM, Qiao L, Sanchez Clemente N, Pescarini JM, Paixão ES, Lobkowicz L, Raja AI, Portela Souza A, Barreto ML, Brickley EB. Socioeconomic risk markers of arthropod-borne virus (arbovirus) infections: a systematic literature review and meta-analysis. BMJ Glob Health 2022; 7:bmjgh-2021-007735. [PMID: 35428678 PMCID: PMC9014035 DOI: 10.1136/bmjgh-2021-007735] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/02/2022] [Indexed: 02/04/2023] Open
Abstract
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.
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Affiliation(s)
- Grace M Power
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Aisling M Vaughan
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Luxi Qiao
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nuria Sanchez Clemente
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Julia M Pescarini
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Enny S Paixão
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ludmila Lobkowicz
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Amber I Raja
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - André Portela Souza
- São Paulo School of Economics and Center for Applied Microeconomic Studies, Getulio Vargas Foundation, São Paulo, Brazil
| | - Mauricio Lima Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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9
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Uncovering the Burden of Dengue in Africa: Considerations on Magnitude, Misdiagnosis, and Ancestry. Viruses 2022; 14:v14020233. [PMID: 35215827 PMCID: PMC8877195 DOI: 10.3390/v14020233] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 01/27/2023] Open
Abstract
Dengue is a re-emerging neglected disease of major public health importance. This review highlights important considerations for dengue disease in Africa, including epidemiology and underestimation of disease burden in African countries, issues with malaria misdiagnosis and co-infections, and potential evidence of genetic protection from severe dengue disease in populations of African descent. The findings indicate that dengue virus prevalence in African countries and populations may be more widespread than reported data suggests, and that the Aedes mosquito vectors appear to be increasing in dissemination and number. Changes in climate, population, and plastic pollution are expected to worsen the dengue situation in Africa. Dengue misdiagnosis is also a problem in Africa, especially due to the typical non-specific clinical presentation of dengue leading to misdiagnosis as malaria. Finally, research suggests that a protective genetic component against severe dengue exists in African descent populations, but further studies should be conducted to strengthen this association in various populations, taking into consideration socioeconomic factors that may contribute to these findings. The main takeaway is that Africa should not be overlooked when it comes to dengue, and more attention and resources should be devoted to this disease in Africa.
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10
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Lobkowicz L, Power GM, De Souza WV, Montarroyos UR, Martelli CMT, de Araùjo TVB, Bezerra LCA, Dhalia R, Marques ETA, Miranda-Filho DDB, Brickley EB, Ximenes RADA. Neighbourhood-level income and Zika virus infection during pregnancy in Recife, Pernambuco, Brazil: an ecological perspective, 2015-2017. BMJ Glob Health 2021; 6:bmjgh-2021-006811. [PMID: 34857522 PMCID: PMC8640636 DOI: 10.1136/bmjgh-2021-006811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/28/2021] [Indexed: 11/24/2022] Open
Abstract
Zika virus (ZIKV) infections during pregnancy can lead to adverse neurodevelopmental and clinical outcomes in congenitally infected offspring. As the city of Recife in Pernambuco State, Brazil—the epicentre of the Brazilian microcephaly epidemic—has considerable disparities in living conditions, this study used an ecological approach to investigate the association between income at the neighbourhood level and the risk of ZIKV infections in pregnant individuals between December 2015 and April 2017. The spatial distribution of pregnant individuals with ZIKV infection was plotted on a map of Recife stratified into four categories based on mean monthly income of household heads. Additionally, a Poisson regression model with robust variance was fitted to compare proportions of ZIKV infections among pregnant individuals in relation to the mean monthly income of household heads, based on the 2010 census data, across 94 neighbourhoods in Recife. The results provide evidence that the risk of ZIKV infection to pregnant individuals was higher among those residing in lower-income neighbourhoods: relative to neighbourhoods that had a mean monthly income of ≥5 times minimum wage, neighbourhoods with <1 and 1 to <2 times minimum wage had more than four times the risk (incidence rate ratio, 95% CI 4.08, 1.88 to 8.85 and 4.30, 2.00 to 9.20, respectively). This study provides evidence of a strong association between neighbourhood-level income and ZIKV infection risks in the pregnant population of Recife. In settings prone to arboviral outbreaks, locally targeted interventions to improve living conditions, sanitation, and mosquito control should be a key focus of governmental interventions to reduce risks associated with ZIKV infections during pregnancy.
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Affiliation(s)
- Ludmila Lobkowicz
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Grace M Power
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.,MRC Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, Bristol, UK
| | | | | | | | | | | | - Rafael Dhalia
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Ernesto T A Marques
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil.,Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Interna, Universidade de Pernambuco, Recife, PE, Brasil.,Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, PE, Brasil
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11
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Mwanyika GO, Mboera LEG, Rugarabamu S, Ngingo B, Sindato C, Lutwama JJ, Paweska JT, Misinzo G. Dengue Virus Infection and Associated Risk Factors in Africa: A Systematic Review and Meta-Analysis. Viruses 2021; 13:536. [PMID: 33804839 PMCID: PMC8063827 DOI: 10.3390/v13040536] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 01/09/2023] Open
Abstract
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.
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Affiliation(s)
- Gaspary O. Mwanyika
- SACIDS Africa Centre of Excellence for Infectious Diseases, Sokoine University of Agriculture, P.O. Box 3297 Morogoro, Tanzania; (G.O.M.); (L.E.G.M.); (S.R.); (B.N.); (C.S.)
- Department of Veterinary Microbiology, Parasitology and Biotechnology, Sokoine University of Agriculture, P.O. Box 3015 Morogoro, Tanzania
- Department of Health Science and Technology, Mbeya University of Science and Technology, P.O. Box 131 Mbeya, Tanzania
| | - Leonard E. G. Mboera
- SACIDS Africa Centre of Excellence for Infectious Diseases, Sokoine University of Agriculture, P.O. Box 3297 Morogoro, Tanzania; (G.O.M.); (L.E.G.M.); (S.R.); (B.N.); (C.S.)
| | - Sima Rugarabamu
- SACIDS Africa Centre of Excellence for Infectious Diseases, Sokoine University of Agriculture, P.O. Box 3297 Morogoro, Tanzania; (G.O.M.); (L.E.G.M.); (S.R.); (B.N.); (C.S.)
- Department of Veterinary Microbiology, Parasitology and Biotechnology, Sokoine University of Agriculture, P.O. Box 3015 Morogoro, Tanzania
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65595 Dar es Salaam, Tanzania
| | - Baraka Ngingo
- SACIDS Africa Centre of Excellence for Infectious Diseases, Sokoine University of Agriculture, P.O. Box 3297 Morogoro, Tanzania; (G.O.M.); (L.E.G.M.); (S.R.); (B.N.); (C.S.)
- Biology Department, St. John’s University of Tanzania, P.O. Box 47 Dodoma, Tanzania
| | - Calvin Sindato
- SACIDS Africa Centre of Excellence for Infectious Diseases, Sokoine University of Agriculture, P.O. Box 3297 Morogoro, Tanzania; (G.O.M.); (L.E.G.M.); (S.R.); (B.N.); (C.S.)
- Tabora Research Centre, National Institute for Medical Research, P.O. Box 482 Tabora, Tanzania
| | - Julius J. Lutwama
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, P.O. Box 49 Entebbe, Uganda;
| | - Janusz T. Paweska
- National Health Laboratory Service, National Institute for Communicable Diseases, Sandringham, 2192 Johannesburg, South Africa;
| | - Gerald Misinzo
- SACIDS Africa Centre of Excellence for Infectious Diseases, Sokoine University of Agriculture, P.O. Box 3297 Morogoro, Tanzania; (G.O.M.); (L.E.G.M.); (S.R.); (B.N.); (C.S.)
- Department of Veterinary Microbiology, Parasitology and Biotechnology, Sokoine University of Agriculture, P.O. Box 3015 Morogoro, Tanzania
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12
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Périssé ARS, Souza-Santos R, Duarte R, Santos F, de Andrade CR, Rodrigues NCP, Schramm JMDA, da Silva ED, Jacobson LDSV, Lemos MCF, Sobral A. Zika, dengue and chikungunya population prevalence in Rio de Janeiro city, Brazil, and the importance of seroprevalence studies to estimate the real number of infected individuals. PLoS One 2020; 15:e0243239. [PMID: 33332373 PMCID: PMC7746276 DOI: 10.1371/journal.pone.0243239] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/17/2020] [Indexed: 11/20/2022] Open
Abstract
In the last 40 years, Latin America countries, including Brazil, have suffered from the emergence and reemergence of arboviruses, first Dengue (DENV) and recently Zika (ZIKV) and Chikungunya (CHIKV). All three arboviruses are currently endemic in Brazil and have caused major outbreaks in recent years. Rio de Janeiro city, host of the last Summer Olympic Games and the Football World Cup, has been specially affected by them. A surveillance system based on symptomatic reports is in place in Rio, but the true number of affected individuals is unknown due to the great number of Zika, Dengue and Chikungunya asymptomatic cases. Seroprevalence studies are more suitable to evaluate the real number of cases in a given population. We performed a populational seroprevalence survey in Rio, with recruitment of a sample of volunteers of all ages and gender from July to October 2018, within randomly selected census tracts and household. A total of 2,120 volunteers were interviewed and tested with rapid immunochromatographic test for ZIKV, DENV and CHIKV. Individuals with positive results for IgG and/or IgM from only one virus were classified accordingly, while those with test results positive for both ZIKV and DENV were classified as flaviviruses. We corrected for sample design and non-response in data analysis, and calculated point estimate prevalence and 95% confidence intervals for each virus. Arbovirus prevalence in the Rio's population (n = 6,688,927) was estimated at 48.6% [95% CI 44.8–52.4] (n = 3,254,121) for flaviviruses and at 18.0% [95% CI 14.8–21.2] (n = 1,204,765) for CHIKV. Approximately 17.0% [95% CI 14.1–20.1] (n = 1,145,674) of Rio´s population had no contact with any of the three arboviruses. The reported cases of Zika, Dengue and Chikungunya by the current surveillance system in place is insufficient to estimate their real numbers, and our data indicate that Zika seroprevalence could be at least five times and Chikungunya 45 times bigger. The high number of individuals having never been infected by any of the three arboviruses, may indicate a proper scenario for future outbreaks.
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Affiliation(s)
- André Reynaldo Santos Périssé
- Departamento de Ciências Biológicas, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
- * E-mail: ,
| | - Reinaldo Souza-Santos
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Rosemere Duarte
- Departamento de Ciências Biológicas, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Fernanda Santos
- Departamento de Ciências Biológicas, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Célia Regina de Andrade
- Departamento de Epidemiologia e Métodos Quantitativos, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Nádia Cristina Pinheiro Rodrigues
- Centro de Saúde Escola Germano Sinval Faria, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Joyce Mendes de Andrade Schramm
- Departamento de Epidemiologia e Métodos Quantitativos, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Ludmilla da Silva Viana Jacobson
- Departamento de Estatística, Instituto de Matemática e Estatística, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brasil
| | | | - Andrea Sobral
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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13
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Lim JK, Matendechero SH, Alexander N, Lee JS, Lee KS, Namkung S, Andia E, Oyembo N, Lim SK, Kanyi H, Bae SH, Yang JS, Ochola MA, Edwards T, Yoon IK, Njenga SM. Clinical and epidemiologic characteristics associated with dengue fever in Mombasa, Kenya. Int J Infect Dis 2020; 100:207-215. [PMID: 32891734 PMCID: PMC7670221 DOI: 10.1016/j.ijid.2020.08.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Information on dengue in Africa is limited. To estimate the proportion of dengue-positive cases among febrile patients and describe clinical indicators of dengue, we conducted passive health facility-based fever surveillance in Mombasa, Kenya. METHODS Non-malarial febrile patients between one and 55 years were enrolled at three health facilities between March 2016 and May 2017. Acute and convalescent blood samples were collected with an interval of 10-21 days. Acute samples were tested with dengue RDT and a selected subset with RT-PCR, and acute/convalescent samples with IgM/IgG ELISA. RESULTS Among 482 enrollees, 295 (61.2%) were dengue-positive based on laboratory results. The surveillance covered the beginning of a dengue outbreak in April-May 2017, during which 73.9% of enrollees were dengue-positive. By contrast, during the non-outbreak period, 54.6% were dengue-positive. Dengue case status was positively associated with rash, fatigue, headache, retro-orbital pain, nausea/vomiting, nose bleeding, gum bleeding, loss of appetite, myalgia, and arthralgia. Dengue-positive cases in our study had mostly mild disease, with only two requiring observation, and no DHF. CONCLUSIONS The clinical response was generally mild relative to what was observed in SE Asia and the Americas. Given the high level of DENV transmission in Mombasa, more data would be needed to further understand the disease burden and improve case detection for surveillance/monitoring of outbreaks.
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Affiliation(s)
- Jacqueline Kyungah Lim
- International Vaccine Institute, Seoul, Republic of Korea; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
| | | | - Neal Alexander
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Jung-Seok Lee
- International Vaccine Institute, Seoul, Republic of Korea
| | - Kang Sung Lee
- International Vaccine Institute, Seoul, Republic of Korea
| | - Suk Namkung
- International Vaccine Institute, Seoul, Republic of Korea
| | - Esther Andia
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Noah Oyembo
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Sl-Ki Lim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Henry Kanyi
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - So Hee Bae
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jae Seung Yang
- International Vaccine Institute, Seoul, Republic of Korea
| | - Mary A Ochola
- Coast Provincial General Hospital, Mombasa County, Kenya
| | - Tansy Edwards
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - In-Kyu Yoon
- Coalition for Epidemic Preparedness Innovations (CEPI), Washington, D.C., USA
| | - Sammy M Njenga
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
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14
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Cattarino L, Rodriguez-Barraquer I, Imai N, Cummings DAT, Ferguson NM. Mapping global variation in dengue transmission intensity. Sci Transl Med 2020; 12:12/528/eaax4144. [PMID: 31996463 DOI: 10.1126/scitranslmed.aax4144] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/12/2019] [Accepted: 01/02/2020] [Indexed: 12/28/2022]
Abstract
Intervention planning for dengue requires reliable estimates of dengue transmission intensity. However, current maps of dengue risk provide estimates of disease burden or the boundaries of endemicity rather than transmission intensity. We therefore developed a global high-resolution map of dengue transmission intensity by fitting environmentally driven geospatial models to geolocated force of infection estimates derived from cross-sectional serological surveys and routine case surveillance data. We assessed the impact of interventions on dengue transmission and disease using Wolbachia-infected mosquitoes and the Sanofi-Pasteur vaccine as specific examples. We predicted high transmission intensity in all continents straddling the tropics, with hot spots in South America (Colombia, Venezuela, and Brazil), Africa (western and central African countries), and Southeast Asia (Thailand, Indonesia, and the Philippines). We estimated that 105 [95% confidence interval (CI), 95 to 114] million dengue infections occur each year with 51 (95% CI, 32 to 66) million febrile disease cases. Our analysis suggests that transmission-blocking interventions such as Wolbachia, even at intermediate efficacy (50% transmission reduction), might reduce global annual disease incidence by up to 90%. The Sanofi-Pasteur vaccine, targeting only seropositive recipients, might reduce global annual disease incidence by 20 to 30%, with the greatest impact in high-transmission settings. The transmission intensity map presented here, and made available for download, may help further assessment of the impact of dengue control interventions and prioritization of global public health efforts.
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Affiliation(s)
- Lorenzo Cattarino
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.
| | | | - Natsuko Imai
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Derek A T Cummings
- Department of Biology and Emerging Pathogens Institute, University of Florida, P. O. Box 100009, Gainesville, FL 32610, USA
| | - Neil M Ferguson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
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15
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Kisuya B, Masika MM, Bahizire E, Oyugi JO. Seroprevalence of Zika virus in selected regions in Kenya. Trans R Soc Trop Med Hyg 2020; 113:735-739. [PMID: 31639184 DOI: 10.1093/trstmh/trz077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/03/2019] [Accepted: 07/09/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Zika virus pandemic in South America in 2015-2016 and the association of Zika virus infection with neurological complications such as microcephaly in newborns distressed the global community. There is limited data on the prevalence of Zika virus in Kenya despite evidence of its circulation in East Africa. This study aimed at assessing the seroprevalence of Zika virus in selected areas in Kenya. METHODS Healthy adult human sera originally collected from Nairobi, Eldoret and Kisumu from 2009 to 2014 and archived at the University of Nairobi laboratories were examined for Zika virus antibodies. An IgG-based ELISA was used to screen 577 sera. Any serum tested positive by ELISA was confirmed for Zika virus infection by plaque reduction neutralization test (PRNT). RESULTS The seroprevalence of Zika virus in the study population was about 0.2 % (1/577) as confirmed by PRNT. Additionally, three sera that were false positive by ELISA for Zika virus were confirmed as positive for dengue virus by PRNT. CONCLUSION There was evidence of low previous exposure to Zika virus in the study population. Of the three regions in Kenya where sera for this study were obtained, only Kisumu County had one case of previous exposure to Zika virus.
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Affiliation(s)
- Bramuel Kisuya
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Moses M Masika
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Esto Bahizire
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.,International Center for Advanced Research and Training (ICART), Bukavu, DR Congo.,Center of Research in Natural Sciences of Lwiro, Bukavu, DR Congo
| | - Julius O Oyugi
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.,University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
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16
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Buchwald AG, Hayden MH, Dadzie SK, Paull SH, Carlton EJ. Aedes-borne disease outbreaks in West Africa: A call for enhanced surveillance. Acta Trop 2020; 209:105468. [PMID: 32416077 DOI: 10.1016/j.actatropica.2020.105468] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/29/2020] [Accepted: 03/29/2020] [Indexed: 01/06/2023]
Abstract
Arboviruses transmitted by Aedes mosquitoes are a growing global concern; however, there remain large gaps in surveillance of both arboviruses and their vectors in West Africa. We reviewed over 50 years of data including outbreak reports, peer-reviewed literature, and prior data compilations describing Zika, dengue, and chikungunya, and their vectors in West Africa. Large outbreaks of dengue, Zika, and chikungunya have recently occurred in the region with over 27,000 cases of Aedes-borne disease documented since 2007. Recent arboviral outbreaks have become more concentrated in urban areas, and Aedes albopictus, recently documented in the region, has emerged as an important vector in several areas. Seroprevalence surveys suggest reported cases are a gross underestimate of the underlying arboviral disease burden. These findings indicate a shifting epidemiology of arboviral disease in West Africa and highlight a need for increased research and implementation of vector and disease control. Rapid urbanization and climate change may further alter disease patterns, underscoring the need for improved diagnostic capacity, and vector and disease surveillance to address this evolving health challenge.
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17
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Kimata Y, Borus P, Nzunza R, Ofula V, Chepkorir E, Waihenya R, Sang R. Serological Evidence of Chikungunya Virus Infection Among Suspected Measles Cases in Selected Regions of Kenya: 2008-2014. Vector Borne Zoonotic Dis 2020; 20:903-909. [PMID: 32845826 DOI: 10.1089/vbz.2019.2593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Chikungunya virus (family Togavirdae and genus Alphavirus) is an emerging and reemerging virus of public health importance both regionally and globally. In Kenya, about 50-60% of the suspected measles cases remain undiagnosed once measles and rubella is ruled out by immunoglobulin M (IgM) ELISA thus prompted the need to do differential diagnosis on the measles/rubella negative samples. Nothing is known about the role played by chikungunya infection among these suspected measles cases. Febrile rash illness is a common clinical presentation of arboviruses, including chikungunya. In this study, we conducted a serosurvey to explore the possible role of chikungunya infections among suspected measles cases in Kenya that had tested negative for measles and rubella. Sera were tested by commercially available ELISA for the presence of IgG and IgM antibodies against the chikungunya virus. All positive samples for chikungunya by ELISA were confirmed by plaque reduction neutralization test (PRNT), and to rule out cross-reactivity with other alphaviruses a panel of viruses was used, namely o' nyong' nyong, Semliki Forest, and Sindbis viruses. Of the 392 serum samples screened, 0.3% (n = 1) tested positive for IgM antibodies, while 4.6% (n = 18) tested positive for IgG antibodies against the chikungunya virus. PRNT results indicated 2 (11%) chikungunya positives and 7 (38.9%) o' nyong' nyong positives. We recommend awareness among health care providers and improved surveillance for these arboviruses by both serology and molecular testing. Testing for other pathogens should also be done to improve disease detection and diagnosis.
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Affiliation(s)
- Yvonne Kimata
- School of Biomedical Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Peter Borus
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rosemary Nzunza
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Victor Ofula
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edith Chepkorir
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Rebecca Waihenya
- School of Biomedical Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Rosemary Sang
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
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18
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Yao MX, Wu SZ, Wang GL, Wang XJ, Fan WJ, Zhang WG, Yang LL, Sun DP, Liu JY, Wu JL, Zhai WJ, Wang ZQ, Wei JT, Jing X, Ding SJ, Wang XJ, Ma MJ. Imported dengue serotype 1 outbreak in a non-endemic region, China, 2017: A molecular and seroepidemiological study. J Infect 2020; 81:304-310. [PMID: 32535157 DOI: 10.1016/j.jinf.2020.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/02/2020] [Accepted: 06/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Beginning in June 2017, numerous dengue virus (DENV) infections occurred in the Jining City of Shandong Province, formerly a dengue-free region in East China. We sought to describe the clinical and epidemiological features of this outbreak. METHODS We reviewed the clinical records and epidemiological data regarding a case series of patients diagnosed with DENV in Jining City, from June 30 to September 14, 2017. Diagnosis was confirmed by molecular method, culture, or rapid diagnostic tests. Sequencing of the DENV envelope gene or the whole viral genome was performed for 11 patients. Additionally, neutralizing antibodies against DENV was measured among patients and residents from their same villages. RESULTS Data from 150 patients were evaluated in this outbreak. None were diagnosed with dengue hemorrhagic fever or dengue shock syndrome. The patients' ages ranged between 2-88 years (median 51 years, [IQR=37.5-64.3]), and 100 (66.7%) were female. Epidemiological analyses implicated a man who had visited Saudi Arabia as the likely source of the outbreak. Phylogenetic studies identified DENV serotype 1. Most of the patients demonstrated increases of neutralizing antibody titers one year after infection compared with titers three months after infection. The residents living in dengue-affected villages had a significant higher seroprevalence of 21.2% (95%CI 16.9-25.5) than residents (3.2%, 95%CI-0.36-6.7) living in a non-dengue-affected village. CONCLUSIONS This report documents the first dengue outbreak in Shandong Province, China, in more than 60 years. It underscores the need for medical providers to record patients' travel histories and to consider dengue in their differential diagnoses.
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Affiliation(s)
- Ming-Xiao Yao
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Department of viral Infectious disease control and prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Shu-Zhi Wu
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Department of viral Infectious disease control and prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Guo-Lin Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Xue-Jun Wang
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Department of viral Infectious disease control and prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Wen-Juan Fan
- Jining Center for Disease Control and Prevention, Jining, China
| | - Wei-Guo Zhang
- Jiaxiang Center for Disease Control and Prevention, Jining, China
| | - Lin-Lin Yang
- Jining Center for Disease Control and Prevention, Jining, China
| | - Da-Peng Sun
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Department of viral Infectious disease control and prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Jia-Ye Liu
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Department of viral Infectious disease control and prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Ju-Long Wu
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Department of viral Infectious disease control and prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Wen-Ji Zhai
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Department of viral Infectious disease control and prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Zhi-Qiang Wang
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Department of viral Infectious disease control and prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Jia-Te Wei
- School of Public Health, Shandong University, Jinan, China
| | - Xiao Jing
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Department of viral Infectious disease control and prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Shu-Jun Ding
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Department of viral Infectious disease control and prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, China.
| | - Xian-Jun Wang
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Department of viral Infectious disease control and prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, China.
| | - Mai-Juan Ma
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
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Barsosio HC, Gitonga JN, Karanja HK, Nyamwaya DK, Omuoyo DO, Kamau E, Hamaluba MM, Nyiro JU, Kitsao BS, Nyaguara A, Mwakio S, Newton CR, Sang R, Wright D, Sanders EJ, Seale AC, Agoti CN, Berkley JA, Bejon P, Warimwe GM. Congenital microcephaly unrelated to flavivirus exposure in coastal Kenya. Wellcome Open Res 2020; 4:179. [PMID: 32175480 PMCID: PMC7059837 DOI: 10.12688/wellcomeopenres.15568.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Zika virus (ZIKV) was first discovered in East Africa in 1947. ZIKV has caused microcephaly in the Americas, but it is not known whether ZIKV is a cause of microcephaly in East Africa. Methods: We used surveillance data from 11,061 live births at Kilifi County Hospital in coastal Kenya between January 2012 and October 2016 to identify microcephaly cases and conducted a nested case-control study to determine risk factors for microcephaly. Gestational age at birth was estimated based on antenatal ultrasound scanning ('Scanned cohort') or last menstrual period ('LMP cohort', including births ≥37 weeks' gestation only). Controls were newborns with head circumference Z scores between >-2 and ≤2 SD that were compared to microcephaly cases in relation to ZIKV exposure and other maternal and newborn factors. Results: Of the 11,061 newborns, 214 (1.9%, 95%CI 1.69, 2.21) had microcephaly. Microcephaly prevalence was 1.0% (95%CI 0.64, 1.70, n=1529) and 2.1% (95%CI 1.81, 2.38, n=9532) in the scanned and LMP cohorts, respectively. After excluding babies <2500 g (n=1199) in the LMP cohort the prevalence was 1.1% (95%CI 0.93, 1.39). Microcephaly showed an association with being born small for gestational age (p<0.001) but not with ZIKV neutralising antibodies (p=0.6) or anti-ZIKV NS1 IgM response (p=0.9). No samples had a ZIKV neutralising antibody titre that was at least fourfold higher than the corresponding dengue virus (DENV) titre. No ZIKV or other flavivirus RNA was detected in cord blood from cases or controls. Conclusions: Microcephaly was prevalent in coastal Kenya, but does not appear to be related to ZIKV exposure; the ZIKV response observed in our study population was largely due to cross-reactive responses to DENV or other related flaviviruses. Further research into potential causes and the clinical consequences of microcephaly in this population is urgently needed.
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Affiliation(s)
- Hellen C Barsosio
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | | | | | - Everlyn Kamau
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Joyce U Nyiro
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Amek Nyaguara
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Stella Mwakio
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Charles R Newton
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Daniel Wright
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,The Jenner Institute, University of Oxford, Oxford, UK
| | | | - Anna C Seale
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,London School of Hygiene & Tropical Medicine, London, UK
| | | | - James A Berkley
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - George M Warimwe
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
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20
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Masika MM, Korhonen EM, Smura T, Uusitalo R, Vapalahti K, Mwaengo D, Jääskeläinen AJ, Anzala O, Vapalahti O, Huhtamo E. Detection of dengue virus type 2 of Indian origin in acute febrile patients in rural Kenya. PLoS Negl Trop Dis 2020; 14:e0008099. [PMID: 32126086 PMCID: PMC7069648 DOI: 10.1371/journal.pntd.0008099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 03/13/2020] [Accepted: 01/29/2020] [Indexed: 01/25/2023] Open
Abstract
Dengue virus (DENV) has caused recent outbreaks in coastal cities of Kenya, but the epidemiological situation in other areas of Kenya is largely unknown. We investigated the role of DENV infection as a cause of acute febrile disease in non-epidemic settings in rural and urban study areas in Kenya. Altogether, 560 patients were sampled in 2016–2017 in rural Taita–Taveta County (n = 327) and urban slums of Kibera, Nairobi (n = 233). The samples were studied for DENV IgM, IgG, NS1 antigen and flaviviral RNA. IgG seroprevalence was found to be higher in Taita–Taveta (14%) than in Nairobi (3%). Five Taita–Taveta patients were positive for flaviviral RNA, all identified as DENV-2, cosmopolitan genotype. Local transmission in Taita–Taveta was suspected in a patient without travel history. The sequence analysis suggested that DENV-2 strains circulating in coastal and southern Kenya likely arose from a single introduction from India. The molecular clock analyses dated the most recent ancestor to the Kenyan strains a year before the large 2013 outbreak in Mombasa. After this, the virus has been detected in Kilifi in 2014, from our patients in Taita–Taveta in 2016, and in an outbreak in Malindi in 2017. The results highlight that silent transmission occurs between epidemics and also affects rural areas. More information is needed to understand the local epidemiological characteristics and future risks of dengue in Kenya. Dengue virus (DENV) is an emerging mosquito-borne global health threat in the tropics and subtropics. The majority of the world’s population live in areas at risk of dengue that can cause a wide variety of symptoms from febrile illness to haemorrhagic fever. Information of DENV in Africa is limited and fragmented. In Kenya, dengue is a recognized disease in coastal cities that have experienced recent outbreaks. We investigated the role of DENV infection as a cause of acute febrile disease in non-epidemic settings in rural and urban study areas in Kenya. We found DENV-2 in five febrile patients from rural Taita–Taveta, where no dengue has been reported before. Genetic analysis of the virus suggests it to be most likely of Indian origin. This Indian origin DENV-2 was detected in the Mombasa outbreak in 2013, in Kilifi in 2014, in Taita–Taveta in 2016 (our study samples) and again in the Malindi outbreak in 2017. The results suggest that dengue is unrecognized in rural Kenya and more studies are needed for local risk assessment. Our findings of virus transmission between epidemics contribute to better understanding of the epidemiological situation and origins of DENV in Kenya.
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Affiliation(s)
- Moses Muia Masika
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Essi M. Korhonen
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Teemu Smura
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
| | - Ruut Uusitalo
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
- Department of Geosciences and Geography, University of Helsinki, Helsinki, Finland
| | - Katariina Vapalahti
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
| | - Dufton Mwaengo
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Anne J. Jääskeläinen
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
- Department of Virology and Immunology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Omu Anzala
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Olli Vapalahti
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
- Department of Virology and Immunology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eili Huhtamo
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
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21
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Tigoi C, Sang R, Chepkorir E, Orindi B, Arum SO, Mulwa F, Mosomtai G, Limbaso S, Hassan OA, Irura Z, Ahlm C, Evander M. High risk for human exposure to Rift Valley fever virus in communities living along livestock movement routes: A cross-sectional survey in Kenya. PLoS Negl Trop Dis 2020; 14:e0007979. [PMID: 32084127 PMCID: PMC7055907 DOI: 10.1371/journal.pntd.0007979] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 03/04/2020] [Accepted: 12/09/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Multiple outbreaks of Rift Valley Fever (RVF) with devastating effects have occurred in East Africa. These outbreaks cause disease in both livestock and humans and affect poor households most severely. Communities living in areas practicing nomadic livestock movement may be at higher risk of infection. This study sought to i) determine the human exposure to Rift Valley fever virus (RVFV) in populations living within nomadic animal movement routes in Kenya; and ii) identify risk factors for RVFV infection in these communities. Methods A cross-sectional descriptive study design was used. Samples were collected from the year 2014 to 2015 in a community-based sampling exercise involving healthy individuals aged ≥18 years from Isiolo, Tana River, and Garissa counties. In total, 1210 samples were screened by ELISA for the presence of immunoglobulin IgM and IgG antibodies against RVFV. Positive results were confirmed by plaque reduction neutralization test. Results Overall, IgM and IgG prevalence for all sites combined was 1.4% (95% CI 0.8–2.3%) and 36.4% (95% CI 33.8–39.2%), respectively. Isiolo County recorded a non-significant higher IgG prevalence of 38.8% than Garissa 35.9% and Tana River 32.2% (Chi square = 2.5, df = 2, p = 0.287). Males were significantly at higher risk of infection by RVFV than females (OR = 1.67, 95% CI 1.17–2.39, p<0.005). Age was significantly associated with RVFV infection (Wald Chi = 94.2, df = 5, p<0.0001). Individuals who had regular contact with cattle (OR = 1.38, 95%CI 1.01–1.89) and donkeys (OR = 1.38, 95%CI 1.14–1.67), or contact with animals through birthing (OR = 1.69, 95%CI 1.14–2.51) were significantly at a greater risk of RVFV infection than those who did not. Conclusion This study demonstrated that although the Isiolo County has been classified as being at medium risk for RVF, virus infection appeared to be as prevalent in humans as in Tana River and Garissa, which have been classified as being at high risk. Populations in these counties live within nomadic livestock movement routes and therefore at risk of being exposed to the RVFV. Interventions to control RVFV infections therefore, should target communities living along livestock movement pathways. Rift Valley fever (RVF) is a neglected mosquito-borne zoonotic disease that causes major outbreaks and economic harm to human and ruminants health leading to increased poverty within affected communities. RVF is caused by RVF virus (RVFV) affecting humans and a wide range of ruminants. The virus is transmitted through bites from mosquitoes and exposure to blood, body fluids, or tissues of infected ruminants. It was first isolated in Kenya in 1930 and several outbreaks have been recorded in many countries in sub-Saharan Africa. We studied pastoralist communities living along livestock migratory routes. Migratory livestock do move long distances in search of water and pasture and may be at higher risk of exposure to RVFV. We also determined risk factors for RVFV infection by studying age, gender, contact with animals through birthing, and occupation. Prevention and control of RVFV infection can target significant risk factors to prevent spread and re-occurrence of outbreaks.
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Affiliation(s)
- Caroline Tigoi
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya
- * E-mail:
| | - Rosemary Sang
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edith Chepkorir
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya
| | - Benedict Orindi
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya
| | | | - Francis Mulwa
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya
| | - Gladys Mosomtai
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya
| | - Samson Limbaso
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Osama A. Hassan
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden
| | - Zephania Irura
- Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Clas Ahlm
- Department of Clinical Microbiology, Infection and Immunology, Umeå University, Umeå, Sweden
| | - Magnus Evander
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden
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22
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Lubisi BA, Ndouvhada PN, Neiffer D, Penrith ML, Sibanda DR, Bastos A. Seroprevalence of Rift valley fever in South African domestic and wild suids (1999-2016). Transbound Emerg Dis 2019; 67:811-821. [PMID: 31655018 DOI: 10.1111/tbed.13402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 09/26/2019] [Accepted: 10/03/2019] [Indexed: 01/09/2023]
Abstract
Rift valley fever (RVF) is a vector-borne viral disease of domestic ruminants, camels and man, characterized by widespread abortions and neonatal deaths in animals, and flu-like symptoms, which can progress to hepatitis and encephalitis in humans. The disease is endemic in Africa, Saudi Arabia and Yemen, and outbreaks occur after periods of high rainfall, or in environments supporting the proliferation of RVF virus (RVFV)-infected mosquito vectors. The domestic and wild animal maintenance hosts of RVFV, which may serve as sources of virus during inter-epidemic periods (IEPs) and contribute to occurrence of sporadic outbreaks, remain unknown, although reports indicate that the African buffalo (Syncerus caffer) may play a role. Due to the close proximity of the habitats of domestic pigs and warthogs to those of known domestic and wild ruminant RVFV maintenance hosts respectively, our study investigated their possible role in the epidemiology of RVF in South Africa by evaluating RVFV exposure and seroconversion in suids. A total of 107 warthog and 3,984 domestic pig sera from 2 and all 9 provinces of South Africa, respectively, were screened for presence of RVFV neutralizing antibodies using the virus neutralization test (VNT). Sero-positivity rates of 1.87% (95% CI: 0.01%-6.9%) and 0.68% (95% CI: 0.49%-1.04%) were observed for warthogs and domestic pigs, respectively, but true prevalence rates, taking test sensitivity and specificity into account, were lower for both groups. There was a strong association between the results of the two groups (χ2 = 0.75, p = .38), and differences in prevalence between the epidemic and IEPs were non-significant for all suid samples tested (p > .05). This study, which provides the first evidence of probable exposure and infection of South African domestic pigs and warthogs to RVFV, indicates that further investigations are warranted, to fully clarify the role of suids in the epidemiology of RVF.
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Affiliation(s)
- Baratang Alison Lubisi
- Agricultural Research Council-Onderstepoort Veterinary Institute, Onderstepoort, South Africa.,Department of Zoology & Entomology, Mammal Research Institute, University of Pretoria, Hatfield, South Africa
| | - Phumudzo Nomicia Ndouvhada
- Agricultural Research Council-Onderstepoort Veterinary Institute, Onderstepoort, South Africa.,Department of Agriculture and Animal Health, College of Agriculture and Environmental Sciences, University of South Africa, Roodepoort, South Africa
| | - Donald Neiffer
- Wildlife Health Sciences, National Zoological Park, Smithsonian Conservation Biology Institute, Washington, DC, USA
| | - Mary Louise Penrith
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
| | - Donald-Ray Sibanda
- Department of Agriculture and Animal Health, College of Agriculture and Environmental Sciences, University of South Africa, Roodepoort, South Africa
| | - Armanda Bastos
- Department of Zoology & Entomology, Mammal Research Institute, University of Pretoria, Hatfield, South Africa.,Centre for Veterinary Wildlife Studies, Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
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23
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Kimathi D, Juan A, Bejon P, Grais RF, Warimwe GM. Randomized, double-blinded, controlled non-inferiority trials evaluating the immunogenicity and safety of fractional doses of Yellow Fever vaccines in Kenya and Uganda. Wellcome Open Res 2019; 4:182. [PMID: 31984244 PMCID: PMC6971842 DOI: 10.12688/wellcomeopenres.15579.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2019] [Indexed: 01/22/2023] Open
Abstract
Introduction: Yellow fever is endemic in specific regions of sub-Saharan Africa and the Americas, with recent epidemics occurring on both continents. The yellow fever vaccine is effective, affordable and safe, providing life-long immunity following a single dose vaccination. However, the vaccine production process is slow and cannot be readily scaled up during epidemics. This has led the World Health Organization (WHO) to recommend the use of fractional doses as a dose-sparing strategy during epidemics, but there are no randomized controlled trials of fractional yellow fever vaccine doses in Africa. Methods and analysis: We will recruit healthy adult volunteers, adults living with HIV, and children to a series of randomized controlled trials aiming to determine the immunogenicity and safety of fractional vaccine doses in comparison to the standard vaccine dose. The trials will be conducted across two sites; Kilifi, Kenya and Mbarara, Uganda. Recruited participants will be randomized to receive fractional or standard doses of yellow fever vaccine. Scheduled visits will include blood collection for serum and peripheral blood mononuclear cells (PBMCs) before vaccination and on various days - up to 2 years - post-vaccination. The primary outcome is the rate of seroconversion as measured by the plaque reduction neutralization test (PRNT 50) at 28 days post-vaccination. Secondary outcomes include antibody titre changes, longevity of the immune response, safety assessment using clinical data, the nature and magnitude of the cellular immune response and post-vaccination control of viremia by vaccine dose. Ethics and dissemination: The clinical trial protocols have received approval from the relevant institutional ethics and regulatory review committees in Kenya and Uganda, and the WHO Ethics Review Committee. The research findings will be disseminated through open-access publications and presented at relevant conferences and workshops. Registration: ClinicalTrials.gov NCT02991495 (registered on 13 December 2016) and NCT04059471 (registered on 15 August 2019).
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Affiliation(s)
- Derick Kimathi
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - George M Warimwe
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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24
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Inziani M, Adungo F, Awando J, Kihoro R, Inoue S, Morita K, Obimbo E, Onyango F, Mwau M. Seroprevalence of yellow fever, dengue, West Nile and chikungunya viruses in children in Teso South Sub-County, Western Kenya. Int J Infect Dis 2019; 91:104-110. [PMID: 31712089 DOI: 10.1016/j.ijid.2019.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/01/2019] [Accepted: 11/03/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Arboviruses often cause widespread morbidity in children in endemic regions. Data on the burden of arboviruses in Kenyan children are limited. OBJECTIVES This study was performed to determine the seroprevalence of yellow fever (YFV), dengue (DENV), West Nile (WNV), and chikungunya (CHIKV) viruses among children 1-12 years of age at two health facilities in Teso South Sub-County in Western Kenya. METHODS In a hospital-based cross-sectional survey, a questionnaire was used to collect socio-demographic information. Serum drawn from the children was tested for IgA/IgM/IgG serocomplex antibodies to selected arboviruses using indirect ELISA and plaque reduction neutralization tests. RESULTS A total of 182 (27.7%) of the 656 participants tested were positive for any arbovirus antibody. Of these, 4.4% (29/656) tested positive for YFV, 9.6% (62/649) for WNV, 5.6% (36/649) for CHIKV, 1.4% (5/368) for DENV1, 9% (59/656) for DENV2, and 19.7% (40/203) for DENV3. Neutralizing antibodies to CHIKV were found in 77.8% (42/54) of participants, to YFV in 15.8% (3/19), to DENV2 in 58% (29/50), and to WNV in 8% (1/55). Sex, age, urban residence, schooling, and lack of vaccination were associated with arbovirus exposure. CONCLUSIONS This study confirmed that children under 12 years of age in Teso South Sub-County are exposed to ongoing arbovirus infections early in life.
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Affiliation(s)
- Mary Inziani
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya.
| | - Ferdinard Adungo
- Centre for Infectious and Parasitic Diseases Control Research (CIPDCR), Kenya Medical Research Institute, Busia, Kenya
| | - Janet Awando
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Richelle Kihoro
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Shingo Inoue
- Nagasaki University Africa Research Station, Nairobi, Kenya
| | - Kouichi Morita
- Nagasaki University Institute of Tropical Medicine, Nagasaki, Japan
| | - Elizabeth Obimbo
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Francis Onyango
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Matilu Mwau
- Centre for Infectious and Parasitic Diseases Control Research (CIPDCR), Kenya Medical Research Institute, Busia, Kenya
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25
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Obaidat MM, Roess AA. First report on seroprevalence and risk factors of dengue virus in Jordan. Trans R Soc Trop Med Hyg 2019; 112:279-284. [PMID: 29992312 DOI: 10.1093/trstmh/try055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/31/2018] [Indexed: 12/27/2022] Open
Abstract
Background There are no data available on dengue epidemiology in Jordan. This is the first study of the seroprevalence and risk factors of dengue virus (DENV) infection in Jordan. Methods Sera samples from 892 apparently healthy individuals from all over Jordan were tested for DENV by enzyme-linked immunosorbent assay and a validated questionnaire was completed by all participants to identify and rank possible risk factors. Results The seroprevalence was 24.6% (95% confidence interval 21.8 to 27.5). In univariate regression analysis, age, education, history of travel, living in rainy areas and practicing agriculture were significantly (p<0.05) associated with seropositivity. The multivariate logistic regression model showed that those who live in a rainy climate (odd ratio [OR] 1.7), are older (OR 2.3), have a history of international travel (OR 1.5) and are male with a history of international travel had a significantly greater odds of DENV seropositivity (OR 3.4). Conclusions These data suggest that DENV circulates in Jordan and that cases may be imported or locally transmitted. Further research is needed to determine the circulating DENV serotypes and vectors in Jordan. Given the high rate of DENV seropositivity, dengue should be considered as a differential diagnosis in febrile diseases in Jordan, especially among populations living in rainy climates.
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Affiliation(s)
- Mohammad M Obaidat
- Department of Veterinary Pathology and Public Health, Faculty of Veterinary Medicine, Jordan University of Science and Technology, Ar-Ramtha, Irbid 22110, Jordan
| | - Amira A Roess
- Department of Global Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, DC 20052, USA
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Geleta EN. Serological evidence of dengue fever and its associated factors in health facilities in the Borena Zone, South Ethiopia. Res Rep Trop Med 2019; 10:129-136. [PMID: 31695553 PMCID: PMC6717856 DOI: 10.2147/rrtm.s218586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/06/2019] [Indexed: 12/23/2022] Open
Abstract
Background Dengue fever (DF) is a re-emerging public health threat in Ethiopia. Yet, little is known about the epidemiology and risk factors of dengue infection in the region. In this study, the seroprevalence and associated risk factors of dengue virus infection were assessed in the Borena Zone health facilities. Methods A hospital-based cross-sectional study was conducted from July to August 2016. A total of 519 consecutive acute febrile patients attending the outpatient departments of Teltelle Health Center, Yabello and Moyale Hospital were enrolled. Data on socio-demographic and environmental risk factors were collected using a structured questionnaire. Three to five milliliter blood samples were collected from all participants and screened for dengue virus exposure using indirect immunofluorescent assay. Results The overall prevalence of anti-DENV IgG and IgM was 22.9% and 7.9%, respectively. DF serostatus was influenced by gender (adjusted odd ratio (AOR)=1.72; 95% CI 1.01–2.94), place of residence (AOR=2.69; 95%CL 1.55–4.64) that had a higher rate of exposure and recalling of a recent mosquito bite (AOR=2.98; 95% CI 1.51–5.89) probably imply recent and/or ongoing active transmission. Conclusion This study showed that DF could potentially emerge as a public health threat in the study area. In addition to that, the observed low awareness of participants underlines the urgent need for further community-based studies to determine the environmental, and host factors that determine the extent of exposure to dengue virus infection in the area for appropriate control and prevention planning.
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Entomological assessment of dengue virus transmission risk in three urban areas of Kenya. PLoS Negl Trop Dis 2019; 13:e0007686. [PMID: 31442223 PMCID: PMC6728053 DOI: 10.1371/journal.pntd.0007686] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/05/2019] [Accepted: 08/05/2019] [Indexed: 12/24/2022] Open
Abstract
Urbanization is one of the major drivers of dengue epidemics globally. In Kenya, an intriguing pattern of urban dengue virus epidemics has been documented in which recurrent epidemics are reported from the coastal city of Mombasa, whereas no outbreaks occur in the two major inland cities of Kisumu and Nairobi. In an attempt to understand the entomological risk factors underlying the observed urban dengue epidemic pattern in Kenya, we evaluated vector density, human feeding patterns, vector genetics, and prevailing environmental temperature to establish how these may interact with one another to shape the disease transmission pattern. We determined that (i) Nairobi and Kisumu had lower vector density and human blood indices, respectively, than Mombasa, (ii) vector competence for dengue-2 virus was comparable among Ae. aegypti populations from the three cities, with no discernible association between susceptibility and vector cytochrome c oxidase subunit 1 gene variation, and (iii) vector competence was temperature-dependent. Our study suggests that lower temperature and Ae. aegypti vector density in Nairobi may be responsible for the absence of dengue outbreaks in the capital city, whereas differences in feeding behavior, but not vector competence, temperature, or vector density, contribute in part to the observed recurrent dengue epidemics in coastal Mombasa compared to Kisumu. Dengue is a viral disease of global public health significance owing to rapid spread and increasing disease burden. Urbanization is an important risk factor for dengue emergence. In Kenya, repeated outbreaks of the disease have occurred in the urban areas of Mombasa but not in Nairobi and Kisumu, despite the presence of susceptible human hosts and the primary vector, Aedes aegypti throughout these areas. We set out to determine whether this trend is related to variations in biological parameters of the vector, Ae. aegypti between these areas. Our findings show that (i) Ae. aegypti had lower density and human blood feeding ability in Nairobi and Kisumu, respectively, compared to Mombasa, (ii) the ability of Ae. aegypti populations from the three cities to transmit dengue-2 virus was comparable with no observed association between susceptibility and vector genetic variation, and (iii) vector competence was temperature-dependent. Based on this, it appears that higher temperature and Ae. aegypti vector density explains the higher risk of dengue virus transmission in Mombasa, compared to Nairobi, whereas differences in feeding behavior of Ae. aegypti may be responsible for the lower risk at Kisumu.
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Manu SK, Bonney JHK, Pratt D, Abdulai FN, Agbosu EE, Frimpong PO, Adiku TK. Arbovirus circulation among febrile patients at the greater Accra Regional Hospital, Ghana. BMC Res Notes 2019; 12:332. [PMID: 31186058 PMCID: PMC6560752 DOI: 10.1186/s13104-019-4378-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/07/2019] [Indexed: 01/03/2023] Open
Abstract
Objective Arboviruses, Dengue and Chikungunya have become major international public health concerns due to their epidemics and introduction in new areas. In Ghana, little is known is about Dengue and Chikungunya viruses though the country has been listed as part of the 34 countries in which the viruses are endemic. This has been attributed partly to the lack of diagnostic tools for these viruses in several health facilities and institutions across the country. The purpose of this study was to detect and characterize these viral pathogens among febrile patients in Accra Ghana. Results This hospital-based cross-sectional study enrolled 260 suspected Dengue and/or Chikungunya febrile patients who submitted their clinical specimens of serum. Out of the total number tested with both molecular and serological tools, Chikungunya and Dengue specific total antibodies were detected from 72 (27.69%) and 180 (69.23%) respectively. None of the participants tested positive for Dengue and Chikungunya by reverse transcription-polymerase chain reaction (RT-PCR) and with the Dengue-specific NS1 antigen strip kits. Our findings suggested that Dengue and Chikungunya viruses may be circulating but are being missed among febrile patients. Differential diagnosis work-up in febrile patients should be made to include Dengue and Chikungunya infections.
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Affiliation(s)
- Simon Kofi Manu
- Department of Microbiology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.,Department of Virology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, P.O. Box LG 581, Accra, Ghana
| | - Joseph Humphrey Kofi Bonney
- Department of Virology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, P.O. Box LG 581, Accra, Ghana.
| | - Deborah Pratt
- Department of Virology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, P.O. Box LG 581, Accra, Ghana
| | | | - Eudosia Esinam Agbosu
- Department of Virology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, P.O. Box LG 581, Accra, Ghana
| | | | - Theophilus Korku Adiku
- Department of Microbiology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.,Department of Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
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Chepkorir E, Tchouassi DP, Konongoi SL, Lutomiah J, Tigoi C, Irura Z, Eyase F, Venter M, Sang R. Serological evidence of Flavivirus circulation in human populations in Northern Kenya: an assessment of disease risk 2016-2017. Virol J 2019; 16:65. [PMID: 31101058 PMCID: PMC6525424 DOI: 10.1186/s12985-019-1176-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/06/2019] [Indexed: 01/05/2023] Open
Abstract
Background Yellow fever, Dengue, West Nile and Zika viruses are re-emerging mosquito-borne Flaviviruses of public health concern. However, the extent of human exposure to these viruses and associated disease burden in Kenya and Africa at large remains unknown. We assessed the seroprevalence of Yellow fever and other Flaviviruses in human populations in West Pokot and Turkana Counties of Kenya. These areas border Uganda, South Sudan and Ethiopia where recent outbreaks of Yellow fever and Dengue have been reported, with possibility of spillover to Kenya. Methodology Human serum samples collected through a cross-sectional survey in West Pokot and Turkana Counties were screened for neutralizing antibodies to Yellow fever, Dengue-2, West Nile and Zika virus using the Plaque Reduction Neutralization Test (PRNT). Seroprevalence was compared by county, site and important human demographic characteristics. Adjusted odds ratios (aOR) were estimated using Firth logistic regression model. Results Of 877 samples tested, 127 neutralized with at least one of the four flaviviruses (14.5, 95% CI 12.3–17.0%), with a higher proportion in Turkana (21.1%, n = 87/413) than in West Pokot (8.6%, n = 40/464). Zika virus seroprevalence was significantly higher in West Pokot (7.11%) than in Turkana County (0.24%; χ2P < 0.0001). A significantly higher Yellow fever virus seroprevalence was also observed in Turkana (10.7%) compared to West Pokot (1.29%; χ2 P < 0.0001). A high prevalence of West Nile virus was detected in Turkana County only (10.2%) while Dengue was only detected in one sample, from West Pokot. The odds of infection with West Nile virus was significantly higher in males than in females (aOR = 2.55, 95% CI 1.22–5.34). Similarly, the risk of Zika virus infection in West Pokot was twice higher in males than females (aOR = 2.01, 95% CI 0.91–4.41). Conclusion Evidence of neutralizing antibodies to West Nile and Zika viruses indicates that they have been circulating undetected in human populations in these areas. While the observed Yellow Fever prevalence in Turkana and West Pokot Counties may imply virus activity, we speculate that this could also be as a result of vaccination following the Yellow Fever outbreak in the Omo river valley, South Sudan and Uganda across the border. Electronic supplementary material The online version of this article (10.1186/s12985-019-1176-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E Chepkorir
- International Centre of Insect Physiology and Ecology, P. O. Box 30772-00100, Nairobi, Kenya. .,Center for Viral Zoonoses, Department of Medical Virology, University of Pretoria, P. O. Box 323, Arcadia, 0007, South Africa.
| | - D P Tchouassi
- International Centre of Insect Physiology and Ecology, P. O. Box 30772-00100, Nairobi, Kenya
| | - S L Konongoi
- Center for Virus Research, Kenya Medical Research Institute, P. O. Box 54628-00200, Nairobi, Kenya
| | - J Lutomiah
- Center for Virus Research, Kenya Medical Research Institute, P. O. Box 54628-00200, Nairobi, Kenya
| | - C Tigoi
- International Centre of Insect Physiology and Ecology, P. O. Box 30772-00100, Nairobi, Kenya
| | - Z Irura
- Division of Disease Surveillance and Response, Ministry of Health, P. O. Box 20781-00202, Nairobi, Kenya
| | - F Eyase
- Jomo Kenyatta University of Agriculture and Technology, P.O. Box 606, Village Market, Nairobi, Kenya
| | - M Venter
- Center for Viral Zoonoses, Department of Medical Virology, University of Pretoria, P. O. Box 323, Arcadia, 0007, South Africa
| | - R Sang
- International Centre of Insect Physiology and Ecology, P. O. Box 30772-00100, Nairobi, Kenya
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Sanou AS, Dirlikov E, Sondo KA, Kagoné TS, Yameogo I, Sow HE, Adjami AG, Traore SM, Dicko A, Tinto B, Diendere EA, Ouedraogo-Konate SMWK, Kiemtore T, Kangoye DT, Sangare L, Dama ETH, Fuller JA, Major CG, Tosado-Acevedo R, Sharp TM, Koné RG, Bicaba BW. Building Laboratory-Based Arbovirus Sentinel Surveillance Capacity During an Ongoing Dengue Outbreak, Burkina Faso, 2017. Health Secur 2019; 16:S103-S110. [PMID: 30480496 DOI: 10.1089/hs.2018.0048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In West Africa, identification of nonmalarial acute febrile illness (AFI) etiologic pathogens is challenging, given limited epidemiologic surveillance and laboratory testing, including for AFI caused by arboviruses. Consequently, public health action to prevent, detect, and respond to outbreaks is constrained, as experienced during dengue outbreaks in several African countries. We describe the successful implementation of laboratory-based arbovirus sentinel surveillance during a dengue outbreak in Burkina Faso during fall 2017. We describe implementation, surveillance methods, and associated costs of enhanced surveillance during an outbreak response as an effort to build capacity to better understand the burden of disease caused by arboviruses in Burkina Faso. The system improved on existing routine surveillance through an improved case report form, systematic testing of specimens, and linking patient information with laboratory results through a data management system. Lessons learned will improve arbovirus surveillance in Burkina Faso and will contribute to enhancing global health security in the region. Elements critical to the success of this intervention include responding to a specific and urgent request by the government of Burkina Faso and building on existing systems and infrastructure already supported by CDC's global health security program.
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Affiliation(s)
- Anselme Simeon Sanou
- Anselme Simeon Sanou, MD, is Senior Surveillance Advisor, the Division for Global Health Protection/Burkina Faso Country Office, US Centers for Disease Control and Prevention , Ouagadougou, Burkina Faso
| | - Emilio Dirlikov
- Emilio Dirlikov, PhD, is Emergency Public Health Epidemiologist, Division for Global Health Protection/Emergency Recovery and Response Branch/Global Rapid Response Team, the US Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Kongnimissom Apoline Sondo
- Kongnimissom Apoline Sondo, MD, is Head of the Service, Service of Infectious Diseases, the Centre Hospitalier Universitaire Yalgado Ouedraogo , Ouagadougou, Burkina Faso
| | - Thérèse Samdapawindé Kagoné
- Thérèse Samdapawindé Kagoné, PhD, is Head of the Viral Hemorrhagic Fever laboratory, the Laboratoire National de Référence des Fièvres Hémorragiques Virales , Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Issaka Yameogo
- Issaka Yameogo, MD, is a Medical Epidemiologist, the Direction de la Protection de la Santé de la Population, Ministère de la Sante, Ouagadougou, Burkina Faso
| | - Hyacinthe Euvrard Sow
- Hyacinthe Euvrard Sow, MD, is a Medical Epidemiologist, the Direction de la Protection de la Santé de la Population, Ministère de la Sante, Ouagadougou, Burkina Faso
| | - Aimé Gilles Adjami
- Aimé Gilles Adjami, PhD, is a Biologist and Executive Director, DAVYCAS International , Ouagadougou, Burkina Faso
| | - Siriky Martin Traore
- Siriky Martin Traore, PharmD, is a Medical Biologist, the Direction de la Protection de la Santé de la Population, Ministère de la Sante, Ouagadougou, Burkina Faso
| | - Amadou Dicko
- Amadou Dicko, DVM, is a Researcher, the Laboratoire National de Référence des Fièvres Hémorragiques Virales , Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Bachirou Tinto
- Bachirou Tinto, PharmD, is a Researcher, the Laboratoire National de Référence des Fièvres Hémorragiques Virales , Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Eric Arnaud Diendere
- Eric Arnaud Diendere, MD, is Infectiologist, Service of Infectious Diseases, the Centre Hospitalier Universitaire Yalgado Ouedraogo , Ouagadougou, Burkina Faso
| | - Sonia Marie W K Ouedraogo-Konate
- Sonia Marie W. K. Ouedraogo-Konate, MD, is a Medical Epidemiologist, the Direction de la Protection de la Santé de la Population, Ministère de la Sante, Ouagadougou, Burkina Faso
| | - Tanga Kiemtore
- Tanga Kiemtore, is Data Manager, the Direction de la Protection de la Santé de la Population, Ministère de la Sante, Ouagadougou, Burkina Faso
| | - David Tiga Kangoye
- David Tiga Kangoye, MD, is an Immuno Epidemiologist, Head of the Department of Public Health, the Centre Hospitalier Universitaire Yalgado Ouedraogo , Ouagadougou, Burkina Faso
| | - Lassana Sangare
- Lassana Sangare, PhD, is Virologist, Head of the Department of laboratories, the Centre Hospitalier Universitaire Yalgado Ouedraogo , Ouagadougou, Burkina Faso
| | - Emilie T H Dama
- Emilie T. H. Dama, PhD, is Senior Laboratory Advisor, the Division for Global Health Protection/Burkina Faso Country Office, US Centers for Disease Control and Prevention , Ouagadougou, Burkina Faso
| | - James A Fuller
- James A. Fuller, PhD, is an Epidemiologist, Division for Global Health Protection/Global Disease Detection Operations Center, the US Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Chelsea G Major
- Chelsea G. Major, MPH, is a Public Health Advisor, the National Center for Emerging and Zoonotic Infectious Diseases/Division of Vector-Borne Diseases/Dengue Branch, US Centers for Disease Control and Prevention , San Juan, Puerto Rico
| | - Rafael Tosado-Acevedo
- Rafael Tosado-Acevedo, PhD, is a Microbiologist, the National Center for Emerging and Zoonotic Infectious Diseases/Division of Vector-Borne Diseases/Dengue Branch, US Centers for Disease Control and Prevention , San Juan, Puerto Rico
| | - Tyler M Sharp
- Tyler M. Sharp, PhD, is an Epidemiologist, the National Center for Emerging and Zoonotic Infectious Diseases/Division of Vector-Borne Diseases/Dengue Branch, US Centers for Disease Control and Prevention , San Juan, Puerto Rico
| | - Rebecca Greco Koné
- Rebecca Greco Koné, MPH, is Country Director, the Division for Global Health Protection/Burkina Faso Country Office, US Centers for Disease Control and Prevention , Ouagadougou, Burkina Faso
| | - Brice Wilfried Bicaba
- Brice Wilfried Bicaba, MD, is Director, the Direction de la Protection de la Santé de la Population, Ministère de la Sante, Ouagadougou, Burkina Faso
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Chikungunya virus infection prevalence in Africa: a contemporaneous systematic review and meta-analysis. Public Health 2018; 166:79-88. [PMID: 30468973 DOI: 10.1016/j.puhe.2018.09.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/20/2018] [Accepted: 09/27/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The (re)emergence of chikungunya virus (CHIKV) in Africa requires better knowledge on the epidemiology of CHIKV infection in the continent for efficient public health strategies. We aimed to describe the epidemiology of CHIKV infection in Africa, a neglected tropical disease (NTD). STUDY DESIGN This was a systematic review with meta-analysis of studies reporting CHIKV infection prevalence. We searched Embase, PubMed, Africa Journal Online and Global Index Medicus to identify observational studies published from January 2000 to September 2017. METHODS We used a random-effect model to pool the prevalence of CHIKV infections reported with their 95% confidence interval (CI). Heterogeneity was assessed via the Chi-squared test on Cochran's Q statistic. Review registration is in PROSPERO CRD42017080395. RESULTS A total of 39 studies (37,881 participants; 18 countries) were included. No study was reported from Southern Africa. Thirty-two (82.0%), seven (18.0%) and no studies had low, moderate and high risk of bias, respectively. Outside outbreak periods, the pooled immunoglobulin M (IgM) and immunoglobulin G (IgG) seroprevalence was 9.7% (95% CI 3.0-19.6; 16 studies) and 16.4% (95% CI 9.1-25.2; 23 studies), respectively. The IgM seroprevalence was lower in Northern Africa, and there was no difference for IgG prevalence across regions in Africa. The IgM and IgG seroprevalences were not different between acute and non-acute febrile participants. The seroprevalence was not associated with GPS coordinates (latitude, longitude and altitude). CONCLUSIONS Although considered a NTD, we find high prevalence of CHIKV infection in Africa. As such, chikungunya fever should deserve more attention from healthcare providers, researchers, policymakers and stakeholders from many sectors.
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Ajamma YU, Onchuru TO, Ouso DO, Omondi D, Masiga DK, Villinger J. Vertical transmission of naturally occurring Bunyamwera and insect-specific flavivirus infections in mosquitoes from islands and mainland shores of Lakes Victoria and Baringo in Kenya. PLoS Negl Trop Dis 2018; 12:e0006949. [PMID: 30452443 PMCID: PMC6287884 DOI: 10.1371/journal.pntd.0006949] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 12/10/2018] [Accepted: 10/26/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Many arboviruses transmitted by mosquitoes have been implicated as causative agents of both human and animal illnesses in East Africa. Although epidemics of arboviral emerging infectious diseases have risen in frequency in recent years, the extent to which mosquitoes maintain pathogens in circulation during inter-epidemic periods is still poorly understood. This study aimed to investigate whether arboviruses may be maintained by vertical transmission via immature life stages of different mosquito vector species. METHODOLOGY We collected immature mosquitoes (egg, larva, pupa) on the shores and islands of Lake Baringo and Lake Victoria in western Kenya and reared them to adults. Mosquito pools (≤25 specimens/pool) of each species were screened for mosquito-borne viruses by high-resolution melting analysis and sequencing of multiplex PCR products of genus-specific primers (alphaviruses, flaviviruses, phleboviruses and Bunyamwera-group orthobunyaviruses). We further confirmed positive samples by culturing in baby hamster kidney and Aedes mosquito cell lines and re-sequencing. PRINCIPAL FINDINGS Culex univittatus (2/31pools) and Anopheles gambiae (1/77 pools) from the Lake Victoria region were positive for Bunyamwera virus, a pathogenic virus that is of public health concern. In addition, Aedes aegypti (3/50), Aedes luteocephalus (3/13), Aedes spp. (2/15), and Culex pipiens (1/140) pools were positive for Aedes flaviviruses at Lake Victoria, whereas at Lake Baringo, three pools of An. gambiae mosquitoes were positive for Anopheles flavivirus. These insect-specific flaviviruses (ISFVs), which are presumably non-pathogenic to vertebrates, were found in known medically important arbovirus and malaria vectors. CONCLUSIONS Our results suggest that not only ISFVs, but also a pathogenic arbovirus, are naturally maintained within mosquito populations by vertical transmission, even in the absence of vertebrate hosts. Therefore, virus and vector surveillance, even during inter-epidemics, and the study of vector-arbovirus-ISFV interactions, may aid in identifying arbovirus transmission risks, with the potential to inform control strategies that lead to disease prevention.
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Affiliation(s)
| | - Thomas Ogao Onchuru
- International Centre of Insect Physiology and Ecology (icipe), Nairobi, Kenya
- Department of Evolutionary Ecology, Institute of Organismic and Molecular Evolution, Johannes Gutenberg University, Mainz, Germany
| | - Daniel O. Ouso
- International Centre of Insect Physiology and Ecology (icipe), Nairobi, Kenya
| | - David Omondi
- International Centre of Insect Physiology and Ecology (icipe), Nairobi, Kenya
- Biochemistry and Molecular Biology Department, Egerton University, Egerton, Kenya
| | - Daniel K. Masiga
- International Centre of Insect Physiology and Ecology (icipe), Nairobi, Kenya
| | - Jandouwe Villinger
- International Centre of Insect Physiology and Ecology (icipe), Nairobi, Kenya
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Konongoi SL, Nyunja A, Ofula V, Owaka S, Koka H, Koskei E, Eyase F, Langat D, Mancuso J, Lutomiah J, Sang R. Human and entomologic investigations of chikungunya outbreak in Mandera, Northeastern Kenya, 2016. PLoS One 2018; 13:e0205058. [PMID: 30308064 PMCID: PMC6181335 DOI: 10.1371/journal.pone.0205058] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/19/2018] [Indexed: 01/14/2023] Open
Abstract
Chikungunya is a reemerging vector borne pathogen associated with severe morbidity in affected populations. Lamu, along the Kenyan coast was affected by a major chikungunya outbreak in 2004. Twelve years later, we report on entomologic investigations and laboratory confirmed chikungunya cases in northeastern Kenya. Patient blood samples were received at the Kenya Medical Research Institute (KEMRI) viral hemorrhagic fever laboratory and the immunoglobulin M enzyme linked immunosorbent assay (IgM ELISA) was used to test for the presence of IgM antibodies against chikungunya and dengue. Reverse transcription polymerase chain reaction (RT-PCR) utilizing flavivirus, alphavirus and chikungunya specific primers were used to detect acute infections and representative PCR positive samples sequenced to confirm the circulating strain. Immature mosquitoes were collected from water-holding containers indoors and outdoors in the affected areas in northeastern Kenya. A total of 189 human samples were tested; 126 from Kenya and 63 from Somalia. 52.9% (100/189) tested positive for Chikungunya virus (CHIKV) by either IgM ELISA or RT-PCR. Sequence analysis of selected samples revealed that the virus was closely related to that from China (2010). 29% (55/189) of the samples, almost all from northeastern Kenya or with a history of travel to northern Kenya, tested positive for dengue IgM antibodies. Entomologic risk assessment revealed high house, container and Breteau indices of, 14.5, 41.9 and 17.1% respectively. Underground water storage tanks were the most abundant, 30.1%, of which 77.4% were infested with Aedes aegypti mosquitoes. These findings confirm the presence of active chikungunya infections in the northeastern parts of Kenya. The detection of dengue IgM antibodies concurrently with chikungunya virus circulation emphasizes on the need for improved surveillance systems and diagnostic algorithms with the capacity to capture multiple causes of arbovirus infections as these two viruses share common vectors and eco-systems. In addition sustained entomological surveillance and vector control programs targeting most productive containers are needed to monitor changes in vector densities, for early detection of the viruses and initiate vector control efforts to prevent possible outbreaks.
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Affiliation(s)
- Samson Limbaso Konongoi
- Kenya Medical Research Institute, Nairobi, Kenya
- United States Army Medical Research Directorate, Nairobi, Kenya
| | - Albert Nyunja
- United States Army Medical Research Directorate, Nairobi, Kenya
| | - Victor Ofula
- United States Army Medical Research Directorate, Nairobi, Kenya
| | - Samuel Owaka
- United States Army Medical Research Directorate, Nairobi, Kenya
| | - Hellen Koka
- United States Army Medical Research Directorate, Nairobi, Kenya
| | - Edith Koskei
- United States Army Medical Research Directorate, Nairobi, Kenya
| | - Fredrick Eyase
- United States Army Medical Research Directorate, Nairobi, Kenya
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Daniel Langat
- Kenya Ministry of Health -Division of Disease Surveillance and Response, Nairobi, Kenya
| | - James Mancuso
- United States Army Medical Research Directorate, Nairobi, Kenya
| | - Joel Lutomiah
- Kenya Medical Research Institute, Nairobi, Kenya
- United States Army Medical Research Directorate, Nairobi, Kenya
| | - Rosemary Sang
- Kenya Medical Research Institute, Nairobi, Kenya
- United States Army Medical Research Directorate, Nairobi, Kenya
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Kariuki Njenga M, Bett B. Rift Valley Fever Virus—How and Where Virus Is Maintained During Inter-epidemic Periods. CURRENT CLINICAL MICROBIOLOGY REPORTS 2018. [DOI: 10.1007/s40588-018-0110-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Fritzell C, Rousset D, Adde A, Kazanji M, Van Kerkhove MD, Flamand C. Current challenges and implications for dengue, chikungunya and Zika seroprevalence studies worldwide: A scoping review. PLoS Negl Trop Dis 2018; 12:e0006533. [PMID: 30011271 PMCID: PMC6062120 DOI: 10.1371/journal.pntd.0006533] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 07/26/2018] [Accepted: 05/16/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Arboviral infections are a public health concern and an escalating problem worldwide. Estimating the burden of these diseases represents a major challenge that is complicated by the large number of unapparent infections, especially those of dengue fever. Serological surveys are thus required to identify the distribution of these diseases and measure their impact. Therefore, we undertook a scoping review of the literature to describe and summarize epidemiological practices, findings and insights related to seroprevalence studies of dengue, chikungunya and Zika virus, which have rapidly expanded across the globe in recent years. METHODOLOGY/PRINCIPAL FINDINGS Relevant studies were retrieved through a literature search of MEDLINE, WHOLIS, Lilacs, SciELO and Scopus (2000 to 2018). In total, 1389 publications were identified. Studies addressing the seroprevalence of dengue, chikungunya and/or Zika written in English or French and meeting the inclusion and exclusion criteria were included. In total, 147 studies were included, from which 185 data points were retrieved, as some studies used several different samples. Most of the studies were exclusively conducted on dengue (66.5%), but 16% were exclusively conducted on chikungunya, and 7 were exclusively conducted on Zika; the remainder were conducted on multiple arboviruses. A wide range of designs were applied, but most studies were conducted in the general population (39%) and in households (41%). Although several assays were used, enzyme-linked immunosorbent assays (ELISAs) were the predominant test used (77%). The temporal distribution of chikungunya studies followed the virus during its rapid expansion since 2004. The results revealed heterogeneity of arboviruses seroprevalence between continents and within a given country for dengue, chikungunya and Zika viruses, ranging from 0 to 100%, 76% and 73% respectively. CONCLUSIONS/SIGNIFICANCE Serological surveys provide the most direct measurement for defining the immunity landscape for infectious diseases, but the methodology remains difficult to implement. Overall, dengue, chikungunya and Zika serosurveys followed the expansion of these arboviruses, but there remain gaps in their geographic distribution. This review addresses the challenges for researchers regarding study design biases. Moreover, the development of reliable, rapid and affordable diagnosis tools represents a significant issue concerning the ability of seroprevalence surveys to differentiate infections when multiple viruses co-circulate.
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Affiliation(s)
- Camille Fritzell
- Epidemiology Unit, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | - Dominique Rousset
- National Reference Laboratory for Arboviruses, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | - Antoine Adde
- Epidemiology Unit, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | - Mirdad Kazanji
- Epidemiology Unit, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | | | - Claude Flamand
- Epidemiology Unit, Institut Pasteur de la Guyane, Cayenne, French Guiana
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Obonyo M, Fidhow A, Ofula V. Investigation of laboratory confirmed Dengue outbreak in North-eastern Kenya, 2011. PLoS One 2018; 13:e0198556. [PMID: 29879159 PMCID: PMC5991696 DOI: 10.1371/journal.pone.0198556] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 05/21/2018] [Indexed: 01/24/2023] Open
Abstract
The first laboratory confirmed dengue outbreak in Kenya was reported in coastal towns of Malindi and Kilifi in 1982. Since then, no other outbreak had been confirmed in Kenya. Dengue outbreak was confirmed among African Mission soldiers in Somalia (AMISOM) between May to October 2011. From September 2011, an upsurge of febrile patients who were negative for malaria on microscopy were reported in several health facilities in Mandera town, an adjacent area to Somalia in northern Kenya. We investigated a suspected dengue outbreak in Mandera town from 26th September 2011 to 5th October 2011. A suspected case was defined as acute onset of fever with two or more of the following: headache, arthralgia, myalgia, rash and hemorrhages and negative malaria microscopy results in a person presenting to a health facility in Mandera town from 1st August to 2nd October 2011. We prospectively identified new cases meeting the suspect case definition from 2nd October to 5th October 2011 and we collected blood samples from consenting patients. Blood was collected into plastic vacutainers and stored in dry shipper at -80oc to laboratory for dengue virus testing using real time reverse transcriptase polymerase chain reaction (rRT-PCR). We administered a standardized form to obtain clinical information. We calculated descriptive statistics to describe the outbreak. A total of 1,332 patients had been line listed by the district surveillance team, of which 381 (29%) met our suspect case definition of dengue. Cases peaked between 10th September and 1st October 2011 and thereafter declined. We prospectively identified 33 cases meeting the suspect case definition, of whom 30 (91%) were positive for dengue virus serotype 3 by PCR. Among the 30 laboratory confirmed patients, 20 (67%) required hospitalization (Median hospitalization period, two days with a range: 1-4 days)). And of these, 26 (86%) patients reported aches and pain, 16 (53%) reported vomiting, and four (13%) gingival bleeding. Twenty-three (77%) received anti-malarial therapy. Among laboratory-confirmed dengue patients, seven (23%) had malaria co-infection. This was the second confirmed Dengue outbreak in Kenya, and highlighted the need for improved surveillance to better define disease burden and continuous education to medical personnel to improve detection and clinical management. We also recommended enhanced community education for disease prevention.
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Affiliation(s)
- Mark Obonyo
- Kenya Field Epidemiology and Laboratory Training Program, Ministry of Public Health and Sanitation, Nairobi, Kenya
- * E-mail:
| | - Ahmed Fidhow
- Kenya Field Epidemiology and Laboratory Training Program, Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Victor Ofula
- Arbovirology/Viral Hemorrhagic Fever Laboratory, Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
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Ferede G, Tiruneh M, Abate E, Wondimeneh Y, Damtie D, Gadisa E, Howe R, Aseffa A, Tessema B. A serologic study of dengue in northwest Ethiopia: Suggesting preventive and control measures. PLoS Negl Trop Dis 2018; 12:e0006430. [PMID: 29852020 PMCID: PMC5978788 DOI: 10.1371/journal.pntd.0006430] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/04/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Dengue is one of the most serious and rapidly spreading arboviral diseases in the world. Despite many acute febrile illnesses in Ethiopia, the burden of illness due to dengue in the country is largely unknown. Thus, the present study aimed to provide the first baseline data on seroprevalence and associated risk factors of dengue virus (DENV) infection in the country. METHODS A cross-sectional study of febrile patients who were visiting Metema and Humera hospitals in Northwest Ethiopia from March 2016 to May 2017 was conducted. Blood samples were collected from each participant and serum samples were separated and tested for IgM and IgG antibodies against DENV infection by enzyme-linked immunosorbent assay (ELISA). Risk factors associated with the prevalence of anti-DENV antibodies were tested using logistic regression analysis. RESULTS Of the 600 samples tested, the overall seroprevalence against DENV infection was 33.3%, while the seroprevalence by the study area was 40% in Metema and 27.5% in Humera. The overall prevalence of IgM and IgG antibodies against DENV infection was 19% and 21% respectively. Of these, 6.7% were positive for both IgM and IgG antibodies. Residence and occupational status were significantly associated with the prevalence of anti-DENV IgM seropositivity and anti-DENV IgM-/G+serostatus. The seasonal variation was significantly associated with the prevalence of anti-DENV IgM but not with anti-DENV IgM-/G+serostatus. The prevalence of anti-DENV IgM-/G+serostatus was significantly higher in Metema than Humera. High prevalence of anti-DENV IgM seropositivity was found in the summer and spring, with a peak in the month of August. The presence of uncovered water either indoor or outdoor and lack of mosquito net use was identified as risk factors for DENV infection. CONCLUSIONS These findings provide the preliminary data on seroprevalence and associated risk factors of DENV infection in the country. The presence of antibodies against DENV infection indicates dengue as one of the causes of undifferentiated febrile illnesses in the study areas. This suggests that prevention and control measures should be designed considering the risk factors identified by this study. Furthermore, we recommend a large-scale study to include DENV infection in the differential diagnosis of all febrile illnesses in Ethiopia.
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Affiliation(s)
- Getachew Ferede
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Moges Tiruneh
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ebba Abate
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yitayih Wondimeneh
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | | | - Rawleigh Howe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Belay Tessema
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ferede G, Tiruneh M, Abate E, Kassa WJ, Wondimeneh Y, Damtie D, Tessema B. Distribution and larval breeding habitats of Aedes mosquito species in residential areas of northwest Ethiopia. Epidemiol Health 2018; 40:e2018015. [PMID: 29748457 PMCID: PMC5968207 DOI: 10.4178/epih.e2018015] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/22/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The Aedes mosquito is a vector for transmitting many arboviruses. Knowledge of the breeding habitat of this vector is vital for implementing appropriate interventions. Thus, this study was conducted to determine the breeding habitats and presence of Aedes mosquito species in the study areas. METHODS A house-to-house cross-sectional survey of Aedes mosquito breeding habitats was carried out in Metema and Humera, Ethiopia, in August 2017. All available water-holding containers present in and around houses were inspected for the presence of immature stages of Aedes mosquitoes, and they were collected and reared to the adult stage for species identification. In the larval survey, the house index, container index, and Breteau index were computed as risk indices. RESULTS Of the 384 houses surveyed for the presence of Aedes mosquito larval breeding, 98 were found to be positive for larvae. During the survey, a total of 566 containers were inspected, of which 186 were found to be infested with Aedes mosquito larvae, with a container index of 32.9, a house index of 25.5, and a Breteau index of 48.4. The most common Aedes mosquito breeding habitats were discarded tires (57.5%), followed by mud pots (30.0%). Of the 1,077 larvae and pupae collected and reared, Aedesaegypti (49.3%), Ae. vittatus (6.5%), and Culex species (44.2%) were identified. CONCLUSIONS Discarded tires were the most preferred breeding habitats for Aedes mosquitoes. Moreover, Ae. aegypti, the main vector of dengue and other arboviruses, was identified for the first time in this region, suggesting a high potential for arbovirus transmission in the study areas.
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Affiliation(s)
- Getachew Ferede
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Moges Tiruneh
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ebba Abate
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Wondmeneh Jemberie Kassa
- Department of Biology, College of Natural and Computational Sciences, University of Gondar, Gondar, Ethiopia
| | - Yitayih Wondimeneh
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Belay Tessema
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Luo S, Cui W, Li C, Ling F, Fu T, Liu Q, Ren J, Sun J. Seroprevalence of dengue IgG antibodies in symptomatic and asymptomatic individuals three years after an outbreak in Zhejiang Province, China. BMC Infect Dis 2018; 18:92. [PMID: 29471783 PMCID: PMC5824482 DOI: 10.1186/s12879-018-3000-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 02/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cross-reacting antibodies enhanced dengue infection in humans and antibody dependent enhancement (ADE) have been proposed as early mechanisms underlying DHF/DSS. However, the duration of dengue IgG antibodies in the body as well as factors associated with said duration remain unclear. METHODS Blood samples from 59 dengue symptomatic persons and 48 asymptomatic individuals were collected. Study participant demographic information (including age in 2009, gender, and place of residence) were also collected. Serum samples were tested for dengue specific IgG by Panbio dengue IgG indirect enzyme-linked immunosorbent assay (ELISA). Chi-square tests and logistic regression analysis of dengue IgG antibodies seroprevalence divided by gender, age groups, and symptomatic or asymptomatic infection were conducted using the Statistical Package for the Social Sciences. RESULTS Overall, 70 (65.42%) blood samples were seropositive for dengue IgG antibodies with similar seroprevalences found when dividing by gender and different age groups. However, seroprevalence of dengue IgG antibodies in samples from dengue symptomatic persons was significantly higher than that in samples from asymptomatic individuals (96.61% vs 27.08%) according to multivariable logistic regression analysis, the odds ratio (OR) of the factor was 76.731. CONCLUSIONS Dengue IgG antibodies were detectable in samples from most individuals three years after infection. Dengue symptomatic persons had a higher dengue IgG prevalence compared to asymptomatic individuals.
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Affiliation(s)
- Shuying Luo
- Yiwu Municipal Center for Disease Control and Prevention, Yiwu, China
| | - Weihong Cui
- Yantai Municipal Center for Disease Control and Prevention, Yantai, China
| | - Chan Li
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Feng Ling
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Tao Fu
- Yiwu Municipal Center for Disease Control and Prevention, Yiwu, China
| | - Qiyong Liu
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiangping Ren
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jimin Sun
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China. .,State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Takaya S, Kutsuna S, Nakayama E, Taniguchi S, Tajima S, Katanami Y, Yamamoto K, Takeshita N, Hayakawa K, Kato Y, Kanagawa S, Ohmagari N. Chikungunya Fever in Traveler from Angola to Japan, 2016. Emerg Infect Dis 2018; 23:156-158. [PMID: 27983938 PMCID: PMC5176218 DOI: 10.3201/eid2301.161395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Simultaneous circulation of multiple arboviruses presents diagnostic challenges. In May 2016, chikungunya fever was diagnosed in a traveler from Angola to Japan. Travel history, incubation period, and phylogenetic analysis indicated probable infection acquisition in Angola, where a yellow fever outbreak is ongoing. Thus, local transmission of chikungunya virus probably also occurs in Angola.
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Mugabe VA, Ali S, Chelene I, Monteiro VO, Guiliche O, Muianga AF, Mula F, António V, Chongo I, Oludele J, Falk K, Paploski IA, Reis MG, Kitron U, Kümmerer BM, Ribeiro GS, Gudo ES. Evidence for chikungunya and dengue transmission in Quelimane, Mozambique: Results from an investigation of a potential outbreak of chikungunya virus. PLoS One 2018; 13:e0192110. [PMID: 29415070 PMCID: PMC5802900 DOI: 10.1371/journal.pone.0192110] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/18/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In January 2016, health authorities from Zambézia province, Mozambique reported the detection of some patients presenting with fever, arthralgia, and a positive result for chikungunya in an IgM-based Rapid Diagnostic Test (RDT). We initiated a study to investigate a potential chikungunya outbreak in the city of Quelimane. METHODS/PRINCIPAL FINDINGS From February to June 2016, we conducted a cross-sectional study enrolling febrile patients attending five outpatient health units in Quelimane. Serum from each patient was tested for CHIKV and DENV, using IgM and IgG ELISA and qRT-PCR. Patients were also tested for malaria by RDT. Entomological surveys were performed around patients' households, and we calculated the proportion of positive ovitraps and the egg density per trap. A total of 163 patients were recruited, of which 99 (60.7%) were female. The median age was 28 years. IgM and IgG anti-CHIKV antibodies were identified in 17 (10.4%) and 103 (63.2%) patients, respectively. Plaque reduction neutralization assay confirmed the presence of anti-CHIKV antibodies in a subset of 11 tested patients with positive IgG results. IgM anti-DENV antibodies were found in 1 (0.9%) of 104 tested patients. Malaria was diagnosed in 35 (21.5%) patients, 2 of whom were also IgM-positive for CHIKV. Older age and lower education level were independently associated with the prevalence of IgG anti-CHIKV antibodies. Immature forms of Aedes aegypti were collected in 16 (20.3%) of 79 surveyed households. We also found that 25.0% (16/64) of the traps were positive, with an average of 90.8 eggs per pallet. CONCLUSIONS Our investigation demonstrated that no CHIKV outbreak was ongoing in Quelimane; rather, endemic transmission of the virus has been ongoing. Aedes aegypti mosquitoes are abundant, but dengue cases occurred only sporadically. Further population-based cohort studies are needed to improve our understanding of aspects related to the dynamics of arboviral transmission in Mozambique, as well as in other parts of Sub-Saharan Africa.
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Affiliation(s)
- Vánio André Mugabe
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil
- Universidade Pedagógica de Quelimane, Zambézia, Mozambique
| | - Sadia Ali
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Imelda Chelene
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | | | - Onélia Guiliche
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | | | - Flora Mula
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Virgílio António
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Inocêncio Chongo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - John Oludele
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Kerstin Falk
- Public Health Agency of Sweden, Stockholm, Sweeden
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Igor A. Paploski
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil
| | - Mitermayer G. Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Uriel Kitron
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil
- Emory University, Atlanta, GE, United States of America
| | - Beate M. Kümmerer
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - Guilherme S. Ribeiro
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil
| | - Eduardo Samo Gudo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
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Weetman D, Kamgang B, Badolo A, Moyes CL, Shearer FM, Coulibaly M, Pinto J, Lambrechts L, McCall PJ. Aedes Mosquitoes and Aedes-Borne Arboviruses in Africa: Current and Future Threats. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020220. [PMID: 29382107 PMCID: PMC5858289 DOI: 10.3390/ijerph15020220] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 12/21/2022]
Abstract
The Zika crisis drew attention to the long-overlooked problem of arboviruses transmitted by Aedes mosquitoes in Africa. Yellow fever, dengue, chikungunya and Zika are poorly controlled in Africa and often go unrecognized. However, to combat these diseases, both in Africa and worldwide, it is crucial that this situation changes. Here, we review available data on the distribution of each disease in Africa, their Aedes vectors, transmission potential, and challenges and opportunities for Aedes control. Data on disease and vector ranges are sparse, and consequently maps of risk are uncertain. Issues such as genetic and ecological diversity, and opportunities for integration with malaria control, are primarily African; others such as ever-increasing urbanization, insecticide resistance and lack of evidence for most control-interventions reflect problems throughout the tropics. We identify key knowledge gaps and future research areas, and in particular, highlight the need to improve knowledge of the distributions of disease and major vectors, insecticide resistance, and to develop specific plans and capacity for arboviral disease surveillance, prevention and outbreak responses.
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Affiliation(s)
- David Weetman
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
| | - Basile Kamgang
- Centre for Research in Infectious Diseases, Yaoundé PO Box 13501, Cameroon.
| | - Athanase Badolo
- Laboratoire d'Entomologie Fondamentale et Appliquée (LEFA), Université Ouaga 1 Pr Joseph Ki-Zerbo, Ouagadougou 03 BP 7021, Burkina Faso.
| | - Catherine L Moyes
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7LF, UK.
| | - Freya M Shearer
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7LF, UK.
| | - Mamadou Coulibaly
- University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali.
| | - João Pinto
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira 100, 1349-008 Lisbon, Portugal.
| | - Louis Lambrechts
- Insect-Virus Interactions, Department of Genomes and Genetics, Institut Pasteur, 75015 Paris, France.
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 2000, 75015 Paris, France.
| | - Philip J McCall
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
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Lim JK, Carabali M, Lee JS, Lee KS, Namkung S, Lim SK, Ridde V, Fernandes J, Lell B, Matendechero SH, Esen M, Andia E, Oyembo N, Barro A, Bonnet E, Njenga SM, Agnandji ST, Yaro S, Alexander N, Yoon IK. Evaluating dengue burden in Africa in passive fever surveillance and seroprevalence studies: protocol of field studies of the Dengue Vaccine Initiative. BMJ Open 2018; 8:e017673. [PMID: 29358421 PMCID: PMC5780679 DOI: 10.1136/bmjopen-2017-017673] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/25/2017] [Accepted: 10/18/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Dengue is an important and well-documented public health problem in the Asia-Pacific and Latin American regions. However, in Africa, information on disease burden is limited to case reports and reports of sporadic outbreaks, thus hindering the implementation of public health actions for disease control. To gather evidence on the undocumented burden of dengue in Africa, epidemiological studies with standardised methods were launched in three locations in Africa. METHODS AND ANALYSIS In 2014-2017, the Dengue Vaccine Initiative initiated field studies at three sites in Ouagadougou, Burkina Faso; Lambaréné, Gabon and Mombasa, Kenya to obtain comparable incidence data on dengue and assess its burden through standardised hospital-based surveillance and community-based serological methods. Multidisciplinary measurements of the burden of dengue were obtained through field studies that included passive facility-based fever surveillance, cost-of-illness surveys, serological surveys and healthcare utilisation surveys. All three sites conducted case detection using standardised procedures with uniform laboratory assays to diagnose dengue. Healthcare utilisation surveys were conducted to adjust population denominators in incidence calculations for differing healthcare seeking patterns. The fever surveillance data will allow calculation of age-specific incidence rates and comparison of symptomatic presentation between patients with dengue and non-dengue using multivariable logistic regression. Serological surveys assessed changes in immune status of cohorts of approximately 3000 randomly selected residents at each site at 6-month intervals. The age-stratified serosurvey data will allow calculation of seroprevalence and force of infection of dengue. Cost-of-illness evaluations were conducted among patients with acute dengue by Rapid Diagnostic Test. ETHICS AND DISSEMINATION By standardising methods to evaluate dengue burden across several sites in Africa, these studies will generate evidence for dengue burden in Africa and data will be disseminated as publication in peer-review journals in 2018.
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Affiliation(s)
- Jacqueline Kyungah Lim
- Global Dengue and Aedes-transmitted Diseases Consortium, International Vaccine Institute, Gwanak-gu, The Republic of Korea
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mabel Carabali
- Global Dengue and Aedes-transmitted Diseases Consortium, International Vaccine Institute, Gwanak-gu, The Republic of Korea
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Jung-Seok Lee
- Development and Delivery, International Vaccine Institute, Gwanak-gu, The Republic of Korea
| | - Kang-Sung Lee
- Development and Delivery, International Vaccine Institute, Gwanak-gu, The Republic of Korea
| | - Suk Namkung
- Global Dengue and Aedes-transmitted Diseases Consortium, International Vaccine Institute, Gwanak-gu, The Republic of Korea
| | - Sl-Ki Lim
- Global Dengue and Aedes-transmitted Diseases Consortium, International Vaccine Institute, Gwanak-gu, The Republic of Korea
| | - Valéry Ridde
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Jose Fernandes
- Centre de Recherches Médicales de Lambaréné, Fondation Internationale de l'Hôpital Albert Schweitzer, Lambaréné, Gabon
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, Fondation Internationale de l'Hôpital Albert Schweitzer, Lambaréné, Gabon
| | | | - Meral Esen
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Esther Andia
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute, Nairobi, Kenya
| | - Noah Oyembo
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute, Nairobi, Kenya
| | - Ahmed Barro
- Program Equité, Action-Gouvernance-Integration-Reinforcement, Ouagadougou, Burkina Faso
| | - Emmanuel Bonnet
- UMI Résiliences, Institut de recherche pour le developpement (IRD), Paris, France
| | - Sammy M Njenga
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute, Nairobi, Kenya
| | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, Fondation Internationale de l'Hôpital Albert Schweitzer, Lambaréné, Gabon
| | - Seydou Yaro
- Centre Muraz, Bobo Dioulasso, Hauts Bassins, Burkina Faso
| | - Neal Alexander
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - In-Kyu Yoon
- Global Dengue and Aedes-transmitted Diseases Consortium, International Vaccine Institute, Gwanak-gu, The Republic of Korea
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Ndenga BA, Mutuku FM, Ngugi HN, Mbakaya JO, Aswani P, Musunzaji PS, Vulule J, Mukoko D, Kitron U, LaBeaud AD. Characteristics of Aedes aegypti adult mosquitoes in rural and urban areas of western and coastal Kenya. PLoS One 2017; 12:e0189971. [PMID: 29261766 PMCID: PMC5736227 DOI: 10.1371/journal.pone.0189971] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/05/2017] [Indexed: 01/26/2023] Open
Abstract
Aedes aegypti is the main vector for yellow fever, dengue, chikungunya and Zika viruses. Recent outbreaks of dengue and chikungunya have been reported in Kenya. Presence and abundance of this vector is associated with the risk for the occurrence and transmission of these diseases. This study aimed to characterize the presence and abundance of Ae. aegypti adult mosquitoes from rural and urban sites in western and coastal regions of Kenya. Presence and abundance of Ae. aegypti adult mosquitoes were determined indoors and outdoors in two western (urban Kisumu and rural Chulaimbo) and two coastal (urban Ukunda and rural Msambweni) sites in Kenya. Sampling was performed using quarterly human landing catches, monthly Prokopack automated aspirators and monthly Biogents-sentinel traps. A total of 2,229 adult Ae. aegypti mosquitoes were collected: 785 (35.2%) by human landing catches, 459 (20.6%) by Prokopack aspiration and 985 (44.2%) by Biogents-sentinel traps. About three times as many Ae. aegypti mosquitoes were collected in urban than rural sites (1,650 versus 579). Comparable numbers were collected in western (1,196) and coastal (1,033) sites. Over 80% were collected outdoors through human landing catches and Prokopack aspiration. The probability of collecting Ae. aegypti mosquitoes by human landing catches was significantly higher in the afternoon than morning hours (P<0.001), outdoors than indoors (P<0.001) and in urban than rural sites (P = 0.008). Significantly more Ae. aegypti mosquitoes were collected using Prokopack aspiration outdoors than indoors (P<0.001) and in urban than rural areas (P<0.001). Significantly more mosquitoes were collected using Biogents-sentinel traps in urban than rural areas (P = 0.008) and in western than coastal sites (P = 0.006). The probability of exposure to Ae. aegypti bites was highest in urban areas, outdoors and in the afternoon hours. These characteristics have major implications for the possible transmission of arboviral diseases and for the planning of surveillance and control programs.
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Affiliation(s)
| | - Francis Maluki Mutuku
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Harun Njenga Ngugi
- Department of Biological Sciences, Chuka University, Chuka, Kenya
- Department of Zoology, University of Nairobi, Nairobi, Kenya
| | - Joel Omari Mbakaya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Peter Aswani
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - John Vulule
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Dunstan Mukoko
- Vector Borne Disease Control Unit, Ministry of Health, Nairobi, Kenya
| | - Uriel Kitron
- Department of Environmental Sciences, Emory University, Atlanta, Georgia, United States of America
| | - Angelle Desiree LaBeaud
- Department of Pediatrics, Stanford University, Stanford, California, United States of America
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45
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Grossi-Soyster EN, Cook EAJ, de Glanville WA, Thomas LF, Krystosik AR, Lee J, Wamae CN, Kariuki S, Fèvre EM, LaBeaud AD. Serological and spatial analysis of alphavirus and flavivirus prevalence and risk factors in a rural community in western Kenya. PLoS Negl Trop Dis 2017; 11:e0005998. [PMID: 29040262 PMCID: PMC5659799 DOI: 10.1371/journal.pntd.0005998] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/27/2017] [Accepted: 09/27/2017] [Indexed: 01/29/2023] Open
Abstract
Alphaviruses, such as chikungunya virus, and flaviviruses, such as dengue virus, are (re)-emerging arboviruses that are endemic in tropical environments. In Africa, arbovirus infections are often undiagnosed and unreported, with febrile illnesses often assumed to be malaria. This cross-sectional study aimed to characterize the seroprevalence of alphaviruses and flaviviruses among children (ages 5-14, n = 250) and adults (ages 15 ≥ 75, n = 250) in western Kenya. Risk factors for seropositivity were explored using Lasso regression. Overall, 67% of participants showed alphavirus seropositivity (CI95 63%-70%), and 1.6% of participants showed flavivirus seropositivity (CI95 0.7%-3%). Children aged 10-14 were more likely to be seropositive to an alphavirus than adults (p < 0.001), suggesting a recent transmission period. Alphavirus and flavivirus seropositivity was detected in the youngest participants (age 5-9), providing evidence of inter-epidemic transmission. Demographic variables that were significantly different amongst those with previous infection versus those without infection included age, education level, and occupation. Behavioral and environmental variables significantly different amongst those in with previous infection to those without infection included taking animals for grazing, fishing, and recent village flooding. Experience of recent fever was also found to be a significant indicator of infection (p = 0.027). These results confirm alphavirus and flavivirus exposure in western Kenya, while illustrating significantly higher alphavirus transmission compared to previous studies.
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Affiliation(s)
- Elysse N. Grossi-Soyster
- Departments of Pediatrics, Infectious Disease Division, Stanford University School of Medicine, Stanford, California, United States of America
| | - Elizabeth A. J. Cook
- Zoonotic and Emerging Diseases Group, International Livestock Research Institute, Nairobi, Kenya
- Centre for Immunity, Infection and Evolution, Institute for Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | - William A. de Glanville
- Zoonotic and Emerging Diseases Group, International Livestock Research Institute, Nairobi, Kenya
- Centre for Immunity, Infection and Evolution, Institute for Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | - Lian F. Thomas
- Zoonotic and Emerging Diseases Group, International Livestock Research Institute, Nairobi, Kenya
- Centre for Immunity, Infection and Evolution, Institute for Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | - Amy R. Krystosik
- Departments of Pediatrics, Infectious Disease Division, Stanford University School of Medicine, Stanford, California, United States of America
| | - Justin Lee
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California, United States of America
| | - C. Njeri Wamae
- Department of Microbiology, School of Medicine, Mount Kenya University, Thika, Kenya
| | - Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Eric M. Fèvre
- Zoonotic and Emerging Diseases Group, International Livestock Research Institute, Nairobi, Kenya
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Neston, United Kingdom
| | - A. Desiree LaBeaud
- Departments of Pediatrics, Infectious Disease Division, Stanford University School of Medicine, Stanford, California, United States of America
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46
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Homenauth E, Kajeguka D, Kulkarni MA. Principal component analysis of socioeconomic factors and their association with malaria and arbovirus risk in Tanzania: a sensitivity analysis. J Epidemiol Community Health 2017; 71:1046-1051. [PMID: 28822980 DOI: 10.1136/jech-2017-209119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/01/2017] [Accepted: 08/07/2017] [Indexed: 11/03/2022]
Abstract
Principal component analysis (PCA) is frequently adopted for creating socioeconomic proxies in order to investigate the independent effects of wealth on disease status. The guidelines and methods for the creation of these proxies are well described and validated. The Demographic and Health Survey, World Health Survey and the Living Standards Measurement Survey are examples of large data sets that use PCA to create wealth indices particularly in low and middle-income countries (LMIC), where quantifying wealth-disease associations is problematic due to the unavailability of reliable income and expenditure data. However, the application of this method to smaller survey data sets, especially in rural LMIC settings, is less rigorously studied.In this paper, we aimed to highlight some of these issues by investigating the association of derived wealth indices using PCA on risk of vector-borne disease infection in Tanzania focusing on malaria and key arboviruses (ie, dengue and chikungunya). We demonstrated that indices consisting of subsets of socioeconomic indicators provided the least methodologically flawed representations of household wealth compared with an index that combined all socioeconomic variables. These results suggest that the choice of the socioeconomic indicators included in a wealth proxy can influence the relative position of households in the overall wealth hierarchy, and subsequently the strength of disease associations. This can, therefore, influence future resource planning activities and should be considered among investigators who use a PCA-derived wealth index based on community-level survey data to influence programme or policy decisions in rural LMIC settings.
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Affiliation(s)
- Esha Homenauth
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Debora Kajeguka
- Department of Microbiology and Immunology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Manisha A Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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47
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Ngugi HN, Mutuku FM, Ndenga BA, Musunzaji PS, Mbakaya JO, Aswani P, Irungu LW, Mukoko D, Vulule J, Kitron U, LaBeaud AD. Characterization and productivity profiles of Aedes aegypti (L.) breeding habitats across rural and urban landscapes in western and coastal Kenya. Parasit Vectors 2017; 10:331. [PMID: 28701194 PMCID: PMC5508769 DOI: 10.1186/s13071-017-2271-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/04/2017] [Indexed: 01/19/2023] Open
Abstract
Background Aedes aegypti, the principal vector for dengue and other emerging arboviruses, breeds preferentially in various man-made and natural container habitats. In the absence of vaccine, epidemiological surveillance and vector control remain the best practices for preventing dengue outbreaks. Effective vector control depends on a good understanding of larval and adult vector ecology of which little is known in Kenya. In the current study, we sought to characterize breeding habitats and establish container productivity profiles of Ae. aegypti in rural and urban sites in western and coastal Kenya. Methods Twenty sentinel houses in each of four study sites (in western and coastal Kenya) were assessed for immature mosquito infestation once a month for a period of 24 months (June 2014 to May 2016). All water-holding containers in and around the households were inspected for Ae. aegypti larvae and pupae. Results Collections were made from a total of 22,144 container visits: Chulaimbo (7575) and Kisumu (8003) in the west, and from Msambweni (3199) and Ukunda (3367) on the coast. Of these, only 4–5.6% were positive for Ae. aegypti immatures. In all four sites, significantly more positive containers were located outdoors than indoors. A total of 17,537 Ae. aegypti immatures were sampled from 10 container types. The most important habitat types were buckets, drums, tires, and pots, which produced over 75% of all the pupae. Key outdoor containers in the coast were buckets, drums and tires, which accounted for 82% of the pupae, while pots and tires were the only key containers in the western region producing 70% of the pupae. Drums, buckets and pots were the key indoor containers, producing nearly all of the pupae in the coastal sites. No pupae were collected indoors in the western region. The coastal region produced significantly more Ae. aegypti immatures than the western region both inside and outside the sentinel houses. Conclusions These results indicate that productive Ae. aegypti larval habitats are abundant outdoors and that only a few containers produce a majority of the pupae. Although the numbers were lower, productive habitats were detected within households. Targeting source reduction efforts towards these productive containers both inside and outside homes is likely to be a cost-effective way to reduce arboviral transmission in these regions.
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Affiliation(s)
- Harun N Ngugi
- Department of Biological Sciences, Chuka University, Chuka, Kenya. .,Department of Zoology, School of Biological Sciences University of Nairobi, Nairobi, Kenya.
| | - Francis M Mutuku
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Bryson A Ndenga
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Joel O Mbakaya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Peter Aswani
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Lucy W Irungu
- Department of Zoology, School of Biological Sciences University of Nairobi, Nairobi, Kenya
| | - Dunstan Mukoko
- Vector Borne Disease Unit, Center for Global Health and Diseases, Nairobi, Kenya
| | - John Vulule
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Uriel Kitron
- Department of Environmental Sciences, Emory University, Atlanta, GA, USA
| | - Angelle D LaBeaud
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California, USA
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48
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Kajeguka DC, Msonga M, Schiøler KL, Meyrowitsch DW, Syrianou P, Tenu F, Alifrangis M, Mosha FW, Kavishe RA. Individual and environmental risk factors for dengue and chikungunya seropositivity in North-Eastern Tanzania. Infect Dis Health 2017. [DOI: 10.1016/j.idh.2017.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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49
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Wahid B, Ali A, Rafique S, Idrees M. Global expansion of chikungunya virus: mapping the 64-year history. Int J Infect Dis 2017; 58:69-76. [PMID: 28288924 DOI: 10.1016/j.ijid.2017.03.006] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/03/2017] [Accepted: 03/07/2017] [Indexed: 10/20/2022] Open
Abstract
Chikungunya virus (CHIKV) is a mosquito-transmitted alphavirus that is emerging as a global threat because of the highly debilitating nature of the associated disease and unprecedented magnitude of its spread. Chikungunya originated in Africa and has since spread across the entire globe causing large numbers of epidemics that have infected millions of people in Asia, the Indian subcontinent, Europe, the Americas, and Pacific Islands. Phylogenetic analysis has identified four different genotypes of CHIKV: Asian, West African, East/Central/South African (ECSA), and Indian Ocean Lineage (IOL). In the absence of well-designed epidemiological studies, the aim of this review article was to summarize the global epidemiology of CHIKV and to provide baseline data for future research on the treatment, prevention, and control of this life-threatening disease.
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Affiliation(s)
- Braira Wahid
- Centre for Applied Molecular Biology, 87 West Canal Bank Road, Thokar Niaz Baig, University of the Punjab, Lahore, Pakistan.
| | - Amjad Ali
- Centre for Applied Molecular Biology, 87 West Canal Bank Road, Thokar Niaz Baig, University of the Punjab, Lahore, Pakistan.
| | - Shazia Rafique
- Centre for Applied Molecular Biology, 87 West Canal Bank Road, Thokar Niaz Baig, University of the Punjab, Lahore, Pakistan.
| | - Muhammad Idrees
- Centre for Applied Molecular Biology, 87 West Canal Bank Road, Thokar Niaz Baig, University of the Punjab, Lahore, Pakistan; Vice Chancellor Hazara University, Mansehra, Pakistan.
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50
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Ali S, Gugliemini O, Harber S, Harrison A, Houle L, Ivory J, Kersten S, Khan R, Kim J, LeBoa C, Nez-Whitfield E, O’Marr J, Rothenberg E, Segnitz RM, Sila S, Verwillow A, Vogt M, Yang A, Mordecai EA. Environmental and Social Change Drive the Explosive Emergence of Zika Virus in the Americas. PLoS Negl Trop Dis 2017; 11:e0005135. [PMID: 28182667 PMCID: PMC5300271 DOI: 10.1371/journal.pntd.0005135] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Since Zika virus (ZIKV) was detected in Brazil in 2015, it has spread explosively across the Americas and has been linked to increased incidence of microcephaly and Guillain-Barré syndrome (GBS). In one year, it has infected over 500,000 people (suspected and confirmed cases) in 40 countries and territories in the Americas. Along with recent epidemics of dengue (DENV) and chikungunya virus (CHIKV), which are also transmitted by Aedes aegypti and Ae. albopictus mosquitoes, the emergence of ZIKV suggests an ongoing intensification of environmental and social factors that have given rise to a new regime of arbovirus transmission. Here, we review hypotheses and preliminary evidence for the environmental and social changes that have fueled the ZIKV epidemic. Potential drivers include climate variation, land use change, poverty, and human movement. Beyond the direct impact of microcephaly and GBS, the ZIKV epidemic will likely have social ramifications for women's health and economic consequences for tourism and beyond.
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Affiliation(s)
- Sofia Ali
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Olivia Gugliemini
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Serena Harber
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Alexandra Harrison
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Lauren Houle
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Javarcia Ivory
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Sierra Kersten
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Rebia Khan
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Jenny Kim
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Chris LeBoa
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Emery Nez-Whitfield
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Jamieson O’Marr
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Emma Rothenberg
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - R. Max Segnitz
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Stephanie Sila
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Anna Verwillow
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Miranda Vogt
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Adrienne Yang
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Erin A. Mordecai
- Department of Biology, Stanford University, Stanford, California, United States of America
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