1
|
Dayarathna S, Senadheera B, Jeewandara C, Dissanayake M, Bary F, Ogg GS, Malavige GN. Dengue NS1 interaction with lipids alters its pathogenic effects on monocyte derived macrophages. J Biomed Sci 2024; 31:86. [PMID: 39232783 PMCID: PMC11373103 DOI: 10.1186/s12929-024-01077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 08/21/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND While dengue NS1 antigen has been shown to be associated with disease pathogenesis in some studies, it has not been linked in other studies, with the reasons remaining unclear. NS1 antigen levels in acute dengue are often associated with increased disease severity, but there has been a wide variation in results based on past dengue infection and infecting dengue virus (DENV) serotype. As NS1 engages with many host lipids, we hypothesize that the type of NS1-lipid interactions alters its pathogenicity. METHODS Primary human monocyte derived macrophages (MDMs) were co-cultured with NS1 alone or with HDL, LDL, LPS and/or platelet activating factor (PAF) from individuals with a history of past dengue fever (DF = 8) or dengue haemorrhagic fever (DHF = 8). IL-1β levels were measured in culture supernatants, and gene expression analysis carried out in MDMs. Monocyte subpopulations were assessed by flow cytometry. Hierarchical cluster analysis with Euclidean distance calculations were used to differentiate clusters. Differentially expressed variables were extracted and a classifier model was developed to differentiate between past DF and DHF. RESULTS Significantly higher levels of IL-1β were seen in culture supernatants when NS1 was co-cultured with LDL (p = 0.01, median = 45.69 pg/ml), but lower levels when NS1 was co-cultured with HDL (p = 0.05, median = 4.617 pg/ml). MDMs of those with past DHF produced higher levels of IL-1β when NS1 was co-cultured with PAF (p = 0.02). MDMs of individuals with past DHF, were significantly more likely to down-regulate RPLP2 gene expression when macrophages were co-cultured with either PAF alone, or NS1 combined with PAF, or NS1 combined with LDL. When NS1 was co-cultured with PAF, HDL or LDL two clusters were detected based on IL10 expression, but these did not differentiate those with past DF or DHF. CONCLUSIONS As RPLP2 is important in DENV replication, regulating cellular stress responses and immune responses and IL-10 is associated with severe disease, it would be important to further explore how differential expression of RPLP2 and IL-10 could lead to disease pathogenesis based on NS1 and lipid interactions.
Collapse
Affiliation(s)
- Shashika Dayarathna
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Bhagya Senadheera
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Chandima Jeewandara
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Madushika Dissanayake
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Farha Bary
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Graham S Ogg
- MRC Translational Immune Discovery Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Gathsaurie Neelika Malavige
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
- MRC Translational Immune Discovery Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.
| |
Collapse
|
2
|
Brook CE, Rozins C, Bohl JA, Ahyong V, Chea S, Fahsbender L, Huy R, Lay S, Leang R, Li Y, Lon C, Man S, Oum M, Northrup GR, Oliveira F, Pacheco AR, Parker DM, Young K, Boots M, Tato CM, DeRisi JL, Yek C, Manning JE. Climate, demography, immunology, and virology combine to drive two decades of dengue virus dynamics in Cambodia. Proc Natl Acad Sci U S A 2024; 121:e2318704121. [PMID: 39190356 DOI: 10.1073/pnas.2318704121] [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: 11/03/2023] [Accepted: 07/31/2024] [Indexed: 08/28/2024] Open
Abstract
The incidence of dengue virus disease has increased globally across the past half-century, with highest number of cases ever reported in 2019 and again in 2023. We analyzed climatological, epidemiological, and phylogenomic data to investigate drivers of two decades of dengue in Cambodia, an understudied endemic setting. Using epidemiological models fit to a 19-y dataset, we first demonstrate that climate-driven transmission alone is insufficient to explain three epidemics across the time series. We then use wavelet decomposition to highlight enhanced annual and multiannual synchronicity in dengue cycles between provinces in epidemic years, suggesting a role for climate in homogenizing dynamics across space and time. Assuming reported cases correspond to symptomatic secondary infections, we next use an age-structured catalytic model to estimate a declining force of infection for dengue through time, which elevates the mean age of reported cases in Cambodia. Reported cases in >70-y-old individuals in the 2019 epidemic are best explained when also allowing for waning multitypic immunity and repeat symptomatic infections in older patients. We support this work with phylogenetic analysis of 192 dengue virus (DENV) genomes that we sequenced between 2019 and 2022, which document emergence of DENV-2 Cosmopolitan Genotype-II into Cambodia. This lineage demonstrates phylogenetic homogeneity across wide geographic areas, consistent with invasion behavior and in contrast to high phylogenetic diversity exhibited by endemic DENV-1. Finally, we simulate an age-structured, mechanistic model of dengue dynamics to demonstrate how expansion of an antigenically distinct lineage that evades preexisting multitypic immunity effectively reproduces the older-age infections witnessed in our data.
Collapse
Affiliation(s)
- Cara E Brook
- Department of Ecology and Evolution, University of Chicago, Chicago, IL 60637
| | - Carly Rozins
- Department of Science, Technology, and Society, York University, Toronto, ON M3J 1P3, Canada
| | - Jennifer A Bohl
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, NIH, Rockville, MD 20892
| | - Vida Ahyong
- Chan Zuckerberg Biohub, San Francisco, CA 94158
| | - Sophana Chea
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, NIH, Phnom Penh 120801, Cambodia
| | | | - Rekol Huy
- National Center for Parasitology, Entomology, and Malaria Control, Phnom Penh 120801, Cambodia
| | - Sreyngim Lay
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, NIH, Phnom Penh 120801, Cambodia
| | - Rithea Leang
- National Center for Parasitology, Entomology, and Malaria Control, Phnom Penh 120801, Cambodia
| | - Yimei Li
- Department of Ecology and Evolution, University of Chicago, Chicago, IL 60637
| | - Chanthap Lon
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, NIH, Phnom Penh 120801, Cambodia
| | - Somnang Man
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, NIH, Phnom Penh 120801, Cambodia
- National Center for Parasitology, Entomology, and Malaria Control, Phnom Penh 120801, Cambodia
| | - Mengheng Oum
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, NIH, Phnom Penh 120801, Cambodia
| | - Graham R Northrup
- Center for Computational Biology, University of California, Berkeley, CA 94720
| | - Fabiano Oliveira
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, NIH, Rockville, MD 20892
| | - Andrea R Pacheco
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, NIH, Phnom Penh 120801, Cambodia
| | - Daniel M Parker
- Department of Population Health and Disease Prevention, University of California, Irvine, CA 92697
- Department of Epidemiology and Biostatistics, University of California, Irvine, CA 92697
| | - Katherine Young
- Department of Biological Sciences, University of Texas, El Paso, TX 79968
| | - Michael Boots
- Department of Integrative Biology, University of California, Berkeley, CA 94720
| | | | | | - Christina Yek
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, NIH, Rockville, MD 20892
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, NIH, Phnom Penh 120801, Cambodia
| | - Jessica E Manning
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, NIH, Rockville, MD 20892
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, NIH, Phnom Penh 120801, Cambodia
| |
Collapse
|
3
|
Fernando L, Kastner R, Wickramasinghe P, Fernando AD, Gunasekera D, Nguyen VH, Liu M, LeFevre I, Wallace D, Folschweiller N, Biswal S. Role of the dengue vaccine TAK-003 in an outbreak response: Modeling the Sri Lanka experience. PLoS Negl Trop Dis 2024; 18:e0012376. [PMID: 39173075 DOI: 10.1371/journal.pntd.0012376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 07/16/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Outbreaks of dengue can overburden hospital systems, drastically reducing capacity for other care. The 2017 dengue serotype 2 (DENV-2) outbreak in Sri Lanka coincided with vaccination in an ongoing phase 3 efficacy trial of a tetravalent dengue vaccine, TAK-003 (NCT02747927). Here, we present data on the efficacy of TAK-003 following two doses of the vaccine administered 3 months apart in participants aged 4-16 years in Sri Lanka. In addition, we have used the 2017 outbreak dynamics to model the potential impact of TAK-003 on virologically confirmed dengue (VCD) cases and hospitalizations during an outbreak situation. METHODOLOGY/PRINCIPAL FINDINGS Modeling was performed using an age-structured, host-vector, spatial and stochastic transmission model, assuming 65% vaccine coverage and 30 days until initiation of vaccination. Efficacy of TAK-003 against VCD and hospitalized VCD cases was based on data against DENV-2 from the first year of the phase 3 trial. Vaccine efficacy and safety findings in Sri Lanka were in line with those of the overall trial population. The efficacy estimates in Sri Lanka up to the first 12 months after the second dose of TAK-003 were 94.7% and 95.7% against VCD and hospitalized VCD cases, respectively. Modeling of the trial data over an extended geographic area showed a substantial reduction in cases and a flattening of outbreak curves from TAK-003 use. The baseline vaccination scenario (initiation at 30 days, 65% target coverage, vaccine effective at 14 days, 70% hospitalization rate, VE of 95% for VCD and 97% for hospitalized VCD, and 47% for asymptomatic) resulted in a 69.1% reduction in VCD cases and 72.7% reduction in VCD hospitalizations compared with no vaccination. An extreme high scenario (vaccination initiated at Day 15, 80% coverage rate, baseline VE) resulted in 80.3% and 82.3% reduction in VCD and VCD hospitalizations, respectively. Vaccine performance, speed of vaccination campaign initiation, and vaccine coverage were key drivers in reducing VCD cases and hospitalizations. CONCLUSIONS/SIGNIFICANCE Overall, the study and modelling results indicate that TAK-003 has the potential of meaningful utility in dengue outbreaks in endemic areas.
Collapse
Affiliation(s)
- LakKumar Fernando
- Centre for Clinical Management of Dengue & Dengue Haemorrhagic Fever, Negombo General Hospital, Negombo, Sri Lanka
| | - Randee Kastner
- Takeda Vaccines, Inc., Boston, Massachusetts, United States of America
| | | | | | - Dulanie Gunasekera
- Faculty of Medical Sciences, University of Sri Jayawardenenpura, Colombo, Sri Lanka
| | | | - Mengya Liu
- Takeda Vaccines, Inc., Boston, Massachusetts, United States of America
| | - Inge LeFevre
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Derek Wallace
- Takeda Vaccines, Inc., Boston, Massachusetts, United States of America
| | | | - Shibadas Biswal
- Takeda Vaccines, Inc., Boston, Massachusetts, United States of America
| |
Collapse
|
4
|
Abeygoonawardena H, Dassanayake K, Kariyawasam J, Chathuranga T, Sundralingam T, Gunasekara H, Wevita S, Premawansa G, Premawansa S, Wijewickrama A, Wijesinghe N, Navaratne V, Weiskopf D, Sette A, Punchihewa C, De Silva AD. Identifying the strains of dengue circulating in the western province of Sri Lanka during 2019-2022. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003150. [PMID: 39012856 PMCID: PMC11251588 DOI: 10.1371/journal.pgph.0003150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/23/2024] [Indexed: 07/18/2024]
Abstract
A study conducted from July 2019 to May 2022 at several hospitals in the Western Province, Sri Lanka, focused on dengue virus strains during the COVID-19 pandemic. Among 417 febrile patients, 47% were PCR-positive for dengue. Serotyping revealed DENV-1 (12.8%), DENV-2 (46.4%), DENV-3 (37.2%), and DENV-4 (3.6%). Sequencing identified two genotypically distinct variants of DENV-3 and two genotypically distinct variants of DENV-1, while DENV-2 showed a single genotype cluster. Notably, the study found concurrent circulation of two DENV-3 and two DENV-1 genotypes, along with DENV-2, during the pandemic in the area. This data suggests the presence of multiple dengue strains, including several DENV-1 and DENV-3 variants, without major epidemic outbreaks reported in the Western Province. Continuous monitoring and research are essential to understand the dynamics of these dengue strains in the context of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Harshi Abeygoonawardena
- Faculty of Medicine, General Sir John Kotelawala Defence University, Kandawala Estate Ratmalana, Sri Lanka
| | - Kanchana Dassanayake
- Faculty of Medicine, General Sir John Kotelawala Defence University, Kandawala Estate Ratmalana, Sri Lanka
| | - Jayani Kariyawasam
- Faculty of Medicine, General Sir John Kotelawala Defence University, Kandawala Estate Ratmalana, Sri Lanka
| | - Teshan Chathuranga
- Faculty of Medicine, General Sir John Kotelawala Defence University, Kandawala Estate Ratmalana, Sri Lanka
| | | | - Hansani Gunasekara
- Faculty of Medicine, General Sir John Kotelawala Defence University, Kandawala Estate Ratmalana, Sri Lanka
| | - Sathyani Wevita
- Faculty of Medicine, General Sir John Kotelawala Defence University, Kandawala Estate Ratmalana, Sri Lanka
| | | | | | | | - Namal Wijesinghe
- Faculty of Medicine, General Sir John Kotelawala Defence University, Kandawala Estate Ratmalana, Sri Lanka
| | - Varuna Navaratne
- Faculty of Medicine, General Sir John Kotelawala Defence University, Kandawala Estate Ratmalana, Sri Lanka
| | - Daniela Weiskopf
- La Jolla Institute for Immunology, Center for Infectious Disease and Vaccine Research, La Jolla, California, United States of America
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, California, United States of America
| | - Alessandro Sette
- La Jolla Institute for Immunology, Center for Infectious Disease and Vaccine Research, La Jolla, California, United States of America
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, California, United States of America
| | | | - Aruna Dharshan De Silva
- Faculty of Medicine, General Sir John Kotelawala Defence University, Kandawala Estate Ratmalana, Sri Lanka
- La Jolla Institute for Immunology, Center for Infectious Disease and Vaccine Research, La Jolla, California, United States of America
| |
Collapse
|
5
|
Dalpadado R, Amarasinghe D, Gunathilaka N, Wijayanayake AN. Forecasting dengue incidence based on entomological indices, population density, and meteorological and environmental variables in the Gampaha District of Sri Lanka. Heliyon 2024; 10:e32326. [PMID: 38912438 PMCID: PMC11190721 DOI: 10.1016/j.heliyon.2024.e32326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/29/2024] [Accepted: 06/01/2024] [Indexed: 06/25/2024] Open
Affiliation(s)
- Rasika Dalpadado
- Regional Director of Health Services Office, Gampaha District, Gampaha, Sri Lanka
- Department of Zoology and Environmental Management, Faculty of Science, University of Kelaniya, Dalugama, Sri Lanka
| | - Deepika Amarasinghe
- Department of Zoology and Environmental Management, Faculty of Science, University of Kelaniya, Dalugama, Sri Lanka
| | - Nayana Gunathilaka
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | |
Collapse
|
6
|
Dayarathna S, Senadheera B, Jeewandara C, Dissanayaka M, Bary F, Ogg GS, Malavige GN. Dengue NS1 interaction with lipids alters its pathogenic effects on monocyte derived macrophages. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.24.24307786. [PMID: 38854029 PMCID: PMC11160833 DOI: 10.1101/2024.05.24.24307786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background While dengue NS1 antigen has been shown to be associated with disease pathogenesis in some studies, it has not been linked in other studies, with the reasons remaining unclear. NS1 antigen levels in acute dengue are often associated with increased disease severity, but there have been a wide variation in results based on past dengue infection and infecting dengue virus (DENV) serotype. As NS1 engages with many host lipids, we hypothesize that the type of NS1-lipid interactions alters its pathogenicity. Methods Primary human monocyte derived macrophages (MDMs) were co-cultured with NS1 alone or with HDL, LDL, LPS and/or platelet activating factor (PAF) from individuals with a history of past dengue fever (DF=8) or dengue haemorrhagic fever (DHF=8). IL-1β levels were measured in culture supernatants, and gene expression analysis carried out in MDMs. Monocyte subpopulations were assessed by flow cytometry. Hierarchical cluster analysis with Euclidean distance calculations were used to differentiate clusters. Differentially expressed variables were extracted and a classifier model was developed to differentiate between past DF and DHF. Results Significantly higher levels of IL-1β were seen in culture supernatants when NS1 was co-cultured with LDL (p=0.01), but with lower levels with HDL (p=0.05). MDMs of those past DHF produced more IL-1β when NS1 with PAF (p=0.02). MDMs of individuals with past DHF, were significantly more likely to down-regulate RPLP2 gene expression when macrophages were co-cultured with either PAF alone, or NS1 combined with PAF, or NS1 combined with LDL. When NS1 was co-cultured with PAF, HDL or LDL two clusters were detected based on IL10 expression, but these did not differentiate those with past DF or DHF. Conclusions As RPLP2 is important in DENV replication and in regulating cellular stress responses and immune responses and IL-10 is associated with severe disease, it would be important to further explore how differential expression of RPLP2 and IL-10 could lead to disease pathogenesis based on NS1 and lipid interactions.
Collapse
Affiliation(s)
- Shashika Dayarathna
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - Bhagya Senadheera
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - Chandima Jeewandara
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - Madushika Dissanayaka
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - Farha Bary
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - Graham S Ogg
- MRC Translational Immune Discovery Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Gathsaurie Neelika Malavige
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
- MRC Translational Immune Discovery Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
- Prof. Neelika Malavige DPhil (Oxon), FRCP (Lond), FRCPath (UK), Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka.
| |
Collapse
|
7
|
Ariyaratne D, Senadheera B, Kuruppu H, Jayadas TTP, Gomes L, Ranasinghe D, Bary F, Wijewickrama A, Márquez Aguilar S, Bennett S, Jeewandara C, Malavige GN. Simultaneous co-circulation of two genotypes of dengue virus serotype 3 causing a large outbreak in Sri Lanka in year 2023. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.09.24307112. [PMID: 38766092 PMCID: PMC11100923 DOI: 10.1101/2024.05.09.24307112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
As many other countries, Sri Lanka experienced a marked rise in the number of dengue cases in 2023, with an unusual pattern of disease epidemiology. This rise coincided with the emergence of dengue virus (DENV) serotype 3 in Sri Lanka as the predominant serotype after 2009. Interestingly, a discrepancy between NS1 rapid antigen test positivity and quantitative real time PCR positivity was observed, with 50% of NS1 positive samples being negative by molecular diagnostics. Following sequencing of the DENV-3 strains in 2023, we identified two DENV-3 genotypes (I and III) co-circulating. While DENV-3 genotype III was detected by the modified CDC DENV-3 primers, genotype I evaded detection due to key mutations at forward and reverse primer binding sites. The co-circulation of multiple genotypes associated with an increase in cases highlights the importance of continuous surveillance of DENVs to identify mutations resulting in non-detection by diagnostics and differences in virulence.
Collapse
Affiliation(s)
| | | | | | | | - Laksiri Gomes
- University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Farha Bary
- University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | | | | | | | | |
Collapse
|
8
|
Malavige GN, Ogg GS. Molecular mechanisms in the pathogenesis of dengue infections. Trends Mol Med 2024; 30:484-498. [PMID: 38582622 DOI: 10.1016/j.molmed.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/08/2024]
Abstract
Dengue is the most rapidly emerging climate-sensitive infection, and morbidity/mortality and disease incidence are rising markedly, leading to healthcare systems being overwhelmed. There are currently no specific treatments for dengue or prognostic markers to identify those who will progress to severe disease. Owing to an increase in the burden of illness and a change in epidemiology, many patients experience severe disease. Our limited understanding of the complex mechanisms of disease pathogenesis has significantly hampered the development of safe and effective treatments, vaccines, and biomarkers. We discuss the molecular mechanisms of dengue pathogenesis, the gaps in our knowledge, and recent advances, as well as the most crucial questions to be answered to enable the development of therapeutics, biomarkers, and vaccines.
Collapse
Affiliation(s)
- Gathsaurie Neelika Malavige
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka; Medical Research Council (MRC) Translational Immune Discovery Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.
| | - Graham S Ogg
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka; Medical Research Council (MRC) Translational Immune Discovery Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
9
|
Shahrin L, Nowrin I, Afrin S, Rahaman MZ, Al Hasan MM, Saif-Ur-Rahman KM. Monitoring and evaluation practices and operational research during public health emergencies in southeast Asia region (2012-2022) - a systematic review. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 21:100340. [PMID: 38361592 PMCID: PMC10866922 DOI: 10.1016/j.lansea.2023.100340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 11/01/2023] [Accepted: 11/22/2023] [Indexed: 02/17/2024]
Abstract
This systematic review aimed to explore the monitoring and evaluation (M&E) and operational research (OR) practices during public health emergencies (PHE) in the southeast Asian region (SEAR) over the last decade. We searched electronic databases and grey literature sources for studies published between 2012 and 2022. The studies written in English were included, and a narrative synthesis was undertaken. A total of 29 studies were included in this review. Among these 25 studies documented M&E and four studies documented OR practices. The majority of the studies were from India and Bangladesh, with no evidence found from Sri Lanka, Bhutan, Myanmar, and Timor-Leste. M&E of surveillance programs were identified among which PHE due to COVID-19 was most prevalent. M&E was conducted in response to COVID-19, cholera, Nipah, Ebola, Candida auris, and hepatitis A. OR practice was minimal and reported from India and Indonesia. India conducted OR on COVID-19 and malaria, whereas Indonesia focused on COVID-19 and influenza. While most SEAR countries have mechanisms for conducting M&E, there is a noticeable limitation in OR practices. There is a compelling need to develop a standard framework for M&E. Additionally, enhancing private sector engagement is crucial for strengthening preparedness against PHE. Furthermore, there is a necessity to increase awareness about the importance of conducting M&E and OR during PHE.
Collapse
Affiliation(s)
- Lubaba Shahrin
- Clinical and Diagnostic Services, icddr,b, Dhaka, Bangladesh
- Nutrition Research Division, icddr,b, Dhaka, Bangladesh
| | - Iffat Nowrin
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Sadia Afrin
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Md Zamiur Rahaman
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | | | - KM Saif-Ur-Rahman
- College of Medicine, Nursing, and Health Sciences, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
| |
Collapse
|
10
|
Shuai Y, Lou Y, Zhu L, Chen W, Jiang T. Oral Complications related to tropical infectious Diseases: an introduction and analysis of survey data. BMC Oral Health 2023; 23:788. [PMID: 37875907 PMCID: PMC10599019 DOI: 10.1186/s12903-023-03514-w] [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: 02/26/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUNDS The non-indigenous tropical infectious diseases that occur in the non-tropics arise from personnel communication between locals and visitors. Many of these infectious diseases involve oral complications. It is very important for practitioners to manage such cases based on a clear understanding of the association between tropical infectious diseases and oral health. In this study, we summarize the oral complications related to tropical infectious diseases and investigate the understanding of infectious disease practitioners in relation to the association between these conditions. In addition, we provide supportive advice to facilitate the oral management of tropical infectious diseases. METHODS First, we investigate the oral complications related to tropical infectious diseases by performing an appropriate literature search. Then, we analyzed the understanding of 207 Chinese practitioners specializing in infectious diseases in relation to the association between these two conditions by applying a bespoke online questionnaire. RESULTS Analysis revealed that the Chinese practitioners had very poor attitudes and knowledge relating to the association between tropical infectious diseases and oral health. Different backgrounds had no significant impact on the understanding of Chinese practitioners with regards to the association between tropical infectious diseases and oral health. CONCLUSION Many oral complications are related to tropical infectious diseases. The understanding of Chinese practitioners with regards to the association between infectious disease and oral health was very inadequate. It is essential to promote publicity and education relating to infectious tropical diseases and oral health.
Collapse
Affiliation(s)
- Yi Shuai
- Department of Stomatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
- Department of Stomatology, General Hospital of Eastern Theater Command, PLA, Nanjing, 210002, Jiangsu, China.
| | - Yanfeng Lou
- Department of Stomatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
- Department of Stomatology, General Hospital of Eastern Theater Command, PLA, Nanjing, 210002, Jiangsu, China
| | - Lei Zhu
- Department of Stomatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
- Department of Stomatology, General Hospital of Eastern Theater Command, PLA, Nanjing, 210002, Jiangsu, China
| | - Wei Chen
- Department of Stomatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
- Department of Stomatology, General Hospital of Eastern Theater Command, PLA, Nanjing, 210002, Jiangsu, China.
| | - Tao Jiang
- Department of Stomatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
- Department of Stomatology, General Hospital of Eastern Theater Command, PLA, Nanjing, 210002, Jiangsu, China.
| |
Collapse
|
11
|
Nwe KM, Ngwe Tun MM, Muthugala R, Nabeshima T, Balingit JC, Rajamanthri L, Jayawardana D, Attanayake S, Inoue S, Takamatsu Y, Urano T, Morita K. Clinical, Virological, and Immunological Features in Cosmopolitan Genotype DENV-2-Infected Patients during a Large Dengue Outbreak in Sri Lanka in 2017. Am J Trop Med Hyg 2023; 109:917-925. [PMID: 37696512 PMCID: PMC10551097 DOI: 10.4269/ajtmh.22-0780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/05/2023] [Indexed: 09/13/2023] Open
Abstract
In 2017, Sri Lanka experienced its largest dengue epidemic and reported severe and unusual presentations of dengue with high morbidity. This outbreak was associated with the reemergence of dengue virus-2 (DENV-2), with the responsible strain identified as a variant of the previously circulating DENV-2 cosmopolitan genotype. In this study, we characterized the DENV-2 cosmopolitan genotype from patients during this epidemic. Also, we identified host factors that contributed to the severity of dengue infection in patients infected with this particular virus. Ninety-one acute serum samples from patients at the National Hospital in Kandy were randomly selected. Of these, 40.2% and 48.9% were positive for dengue IgM and IgG, respectively. NS1 antigen levels were significantly higher in primary infections. The severe dengue (SD) and dengue with warning signs (DWWS) groups exhibited significantly higher viral genome and infectivity titers than the dengue without warning signs (DWoWS) group. The highest viremia level was observed in SD patients. As for host cytokine response, interferon α (IFN-α) levels were significantly higher in the DWoWS group than in the DWWS and SD groups, whereas interleukin (IL)-12p40 and tumor necrosis factor α (TNF-α) levels in SD patients were significantly higher than in the other two groups. The TNF-α, IL-4, and monocyte chemoattractant protein-1 concentrations were positively correlated with NS1 antigen levels. From whole-genome analysis, NS4 had the highest frequency of amino acid variants, followed by the E gene. Our study suggests that viremia levels and immune responses contributed to SD outcomes, and these findings may help in identifying an effective therapeutic strategy against SD infection.
Collapse
Affiliation(s)
- Khine Mya Nwe
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Department of Tropical Viral Vaccine Development, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Center for Vaccines and Therapeutic Antibodies for Emerging Infectious Diseases, Shimane University, Izumo, Japan
| | | | - Takeshi Nabeshima
- Kenya Research Station, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Jean Claude Balingit
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Department of Tropical Viral Vaccine Development, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | | | | | | | - Shingo Inoue
- Kenya Research Station, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Yuki Takamatsu
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Takeshi Urano
- Center for Vaccines and Therapeutic Antibodies for Emerging Infectious Diseases, Shimane University, Izumo, Japan
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Department of Tropical Viral Vaccine Development, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- DEJIMA Infectious Disease Research Alliance, Nagasaki University, Nagasaki, Japan
| |
Collapse
|
12
|
Ngwe Tun MM, Raini SK, Fernando L, Gunawardene Y, Inoue S, Takamatsu Y, Urano T, Muthugala R, Hapugoda M, Morita K. Epidemiological evidence of acute transmission of Zika virus infection in dengue suspected patients in Sri-Lanka. J Infect Public Health 2023; 16:1435-1442. [PMID: 37517370 DOI: 10.1016/j.jiph.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Zika Virus (ZIKV) is a re-emerging, arthropod-borne flavivirus transmitted by Aedes mosquitoes (Ae. aegypti and Ae. albopictus). The coexistence of dengue virus (DENV) and ZIKV concurrently has been associated with a wide array of neurological complications, which may influence the clinical outcomes of infections. Sri Lanka witnessed a severe dengue epidemic in 2017, characterized by extraordinary and severe disease manifestations with considerable morbidity. Therefore, this study assessed the potential occurrence of ZIKV infection during DENV outbreak in Sri Lanka from 2017 to 2019, which could bear substantial implications for public health. METHODS Five hundred ninety-five serum samples were procured from individuals suspected of dengue and admitted to Kandy National Hospital between 2017 and 2018 and the Negombo District General Hospital between 2018 and 2019. These samples underwent quantitative real-time RT-PCR (qRT-PCR) to identify the presence of the ZIKV gene, while enzyme-linked immunosorbent assay was employed to detect ZIKV-specific IgM and IgG antibodies. Focus reduction neutralization tests were subsequently conducted to confirm ZIKV infection. RESULTS Among the 595 serum samples, 6 (1.0%) tested positive for ZIKV using qRT-PCR. Anti-ZIKV IgM and IgG were identified in 18.0% and 38.6% patients. Sixty-six (11.0%) samples demonstrated the presence of anti-ZIKV IgM and IgG. Within ZIKV IgM-positive samples, 2.2% exhibited neutralizing antibodies against ZIKV. Through the implementation of qRT-PCR, ZIKV IgM detection, and neutralization testing, 2% and 3.7% cases of ZIKV infections were confirmed in the Kandy and Negombo regions, respectively. CONCLUSION This study is the inaugural endeavor to substantiate the existence of ZIKV infection in Sri Lanka utilizing molecular and serological analysis. The findings of this investigation imply that ZIKV was circulating throughout the 2017-2019 DENV outbreak. These results underscore the necessity for improved preparedness for future outbreaks, fortifying governmental policies on public health, and establishing effective early warning systems regarding the emergence of these viruses.
Collapse
Affiliation(s)
- Mya Myat Ngwe Tun
- Department of Tropical Viral Vaccine Development, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; Center for Vaccines and Therapeutic Antibodies for Emerging Infectious Diseases, Shimane University, Izumo, Japan.
| | - Sandra Kendra Raini
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan
| | - Lakkumar Fernando
- Centre for Clinical Management of Dengue & Dengue Haemorrhagic Fever, District General Hospital, Negombo 11500, Sri Lanka
| | - Yins Gunawardene
- Molecular Medicine Unit, Faculty of Medicine, University of Kelaniya, Ragama 11010, Sri Lanka
| | - Shingo Inoue
- Kenya Research Station, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan
| | - Yuki Takamatsu
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan
| | - Takeshi Urano
- Center for Vaccines and Therapeutic Antibodies for Emerging Infectious Diseases, Shimane University, Izumo, Japan
| | - Rohitha Muthugala
- Department of Virology, National Hospital Kandy, Kandy 20000, Sri Lanka
| | - Menaka Hapugoda
- Molecular Medicine Unit, Faculty of Medicine, University of Kelaniya, Ragama 11010, Sri Lanka
| | - Kouichi Morita
- Department of Tropical Viral Vaccine Development, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; DEJIMA Infectious Disease Research Alliance, Nagasaki University, Nagasaki 852-8523, Japan
| |
Collapse
|
13
|
Abeygoonawardena H, Wijesinghe N, Navaratne V, Balasuriya A, Nguyen TTN, Moi ML, De Silva AD. Serological Evidence of Zika virus Circulation with Dengue and Chikungunya Infections in Sri Lanka from 2017. J Glob Infect Dis 2023; 15:113-120. [PMID: 37800085 PMCID: PMC10549900 DOI: 10.4103/jgid.jgid_195_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/23/2023] [Accepted: 06/20/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Arbovirus diseases remain a public health threat in Sri Lanka. Dengue is endemic and two outbreaks of chikungunya infections have been reported. There is limited data on Zika virus (ZIKV) infections in Sri Lanka, and this could be due to a lack of comprehensive ZIKV surveillance. Our aim was to determine the presence of antibodies to dengue, chikungunya, and Zika infections in adults from a suburban population in Sri Lanka. Methods A total of 149 healthy adult volunteers over 18 years of age (mean age: 43±14 years, males - 43%), with no prior diagnosed arboviral infections and no history of overseas travel, participated in the study. ELISA and neutralization assays were carried out to detect past dengue, chikungunya, or Zika infections. Results A total of 94.6% (141/149) of the participants demonstrated dengue IgG antibodies, 37.5% (56/149) were positive for chikungunya IgG, and 5.3% (8/149) were positive for anti-ZIKV IgG antibodies. Neutralization assays confirmed ZIKV-specific antibodies in 6.7% (10/149), when 40/149 of the participating population were tested. Conclusion This clearly demonstrated past ZIKV infections in this population. In addition, this study indicates that >90% of individuals had asymptomatic dengue but no serious symptoms. These results provide a cross-sectional view on the DENV, ZIKV, and CHIKV epidemic status and demonstrate a need for the implementation of enhanced surveillance and more effective measures against the spread of these arbovirus diseases.
Collapse
Affiliation(s)
- Harshi Abeygoonawardena
- Department of Clinical Sciences, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Namal Wijesinghe
- Department of Clinical Sciences, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Varuna Navaratne
- Department of Paraclinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Aindralal Balasuriya
- Department of Paraclinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Thi Thanh Ngan Nguyen
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Meng Ling Moi
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Department of Developmental Medical Sciences, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aruna Dharshan De Silva
- Department of Paraclinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| |
Collapse
|
14
|
Maduranga S, Valencia BM, Sigera C, Adikari T, Weeratunga P, Fernando D, Rajapakse S, Lloyd AR, Bull RA, Rodrigo C. Genomic Surveillance of Recent Dengue Outbreaks in Colombo, Sri Lanka. Viruses 2023; 15:1408. [PMID: 37515097 PMCID: PMC10384240 DOI: 10.3390/v15071408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
All four serotypes of the dengue virus (DENV1-4) cause a phenotypically similar illness, but serial infections from different serotypes increase the risk of severe disease. Thus, genomic surveillance of circulating viruses is important to detect serotype switches that precede community outbreaks of disproportionate magnitude. A phylogenetic analysis was conducted on near full length DENV genomes sequenced from serum collected from a prospective cohort study from the Colombo district, Sri Lanka during a 28-month period using Oxford nanopore technology, and the consensus sequences were analyzed using maximum likelihood and Bayesian evolutionary analysis. From 523 patients, 328 DENV sequences were successfully generated (DENV1: 43, DENV2: 219, DENV3:66). Most circulating sequences originated from a common ancestor that was estimated to have existed from around 2010 for DENV2 and around 2015/2016 for DENV1 and DENV3. Four distinct outbreaks coinciding with monsoon rain seasons were identified during the observation period mostly driven by DENV2 cosmopolitan genotype, except for a large outbreak in 2019 contributed by DENV3 genotype I. This serotype switch did not result in a more clinically severe illness. Phylogeographic analyses showed that all outbreaks started within Colombo city and then spread to the rest of the district. In 2019, DENV3 genotype I, previously, rarely reported in Sri Lanka, is likely to have contributed to a disease outbreak. However, this did not result in more severe disease in those infected, probably due to pre-existing DENV3 immunity in the community. Targeted vector control within Colombo city before anticipated seasonal outbreaks may help to limit the geographic spread of outbreaks.
Collapse
Affiliation(s)
- Sachith Maduranga
- School of Biomedical Sciences, UNSW Sydney, Sydney, NSW 2052, Australia
- Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | | | - Chathurani Sigera
- Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
| | - Thiruni Adikari
- School of Biomedical Sciences, UNSW Sydney, Sydney, NSW 2052, Australia
| | | | - Deepika Fernando
- Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
| | - Senaka Rajapakse
- Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
| | - Andrew R Lloyd
- Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Rowena A Bull
- School of Biomedical Sciences, UNSW Sydney, Sydney, NSW 2052, Australia
- Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Chaturaka Rodrigo
- School of Biomedical Sciences, UNSW Sydney, Sydney, NSW 2052, Australia
- Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| |
Collapse
|
15
|
Zargari Marandi R, Leung P, Sigera C, Murray DD, Weeratunga P, Fernando D, Rodrigo C, Rajapakse S, MacPherson CR. Development of a machine learning model for early prediction of plasma leakage in suspected dengue patients. PLoS Negl Trop Dis 2023; 17:e0010758. [PMID: 36913411 PMCID: PMC10035900 DOI: 10.1371/journal.pntd.0010758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/23/2023] [Accepted: 02/24/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND At least a third of dengue patients develop plasma leakage with increased risk of life-threatening complications. Predicting plasma leakage using laboratory parameters obtained in early infection as means of triaging patients for hospital admission is important for resource-limited settings. METHODS A Sri Lankan cohort including 4,768 instances of clinical data from N = 877 patients (60.3% patients with confirmed dengue infection) recorded in the first 96 hours of fever was considered. After excluding incomplete instances, the dataset was randomly split into a development and a test set with 374 (70%) and 172 (30%) patients, respectively. From the development set, five most informative features were selected using the minimum description length (MDL) algorithm. Random forest and light gradient boosting machine (LightGBM) were used to develop a classification model using the development set based on nested cross validation. An ensemble of the learners via average stacking was used as the final model to predict plasma leakage. RESULTS Lymphocyte count, haemoglobin, haematocrit, age, and aspartate aminotransferase were the most informative features to predict plasma leakage. The final model achieved the area under the receiver operating characteristics curve, AUC = 0.80 with positive predictive value, PPV = 76.9%, negative predictive value, NPV = 72.5%, specificity = 87.9%, and sensitivity = 54.8% on the test set. CONCLUSION The early predictors of plasma leakage identified in this study are similar to those identified in several prior studies that used non-machine learning based methods. However, our observations strengthen the evidence base for these predictors by showing their relevance even when individual data points, missing data and non-linear associations were considered. Testing the model on different populations using these low-cost observations would identify further strengths and limitations of the presented model.
Collapse
Affiliation(s)
- Ramtin Zargari Marandi
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Preston Leung
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Daniel Dawson Murray
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Chaturaka Rodrigo
- Viral Immunology Systems Program (VISP), Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Cameron Ross MacPherson
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
16
|
Liyanage P, Tozan Y, Overgaard HJ, Aravinda Tissera H, Rocklöv J. Effect of El Niño-Southern Oscillation and local weather on Aedes dvector activity from 2010 to 2018 in Kalutara district, Sri Lanka: a two-stage hierarchical analysis. Lancet Planet Health 2022; 6:e577-e585. [PMID: 35809587 DOI: 10.1016/s2542-5196(22)00143-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Dengue, transmitted by Aedes mosquitoes, is a major public health problem in Sri Lanka. Weather affects the abundance, feeding patterns, and longevity of Aedes vectors and hence the risk of dengue transmission. We aimed to quantify the effect of weather variability on dengue vector indices in ten Medical Officer of Health (MOH) divisions in Kalutara, Sri Lanka. METHODS Monthly weather variables (rainfall, temperature, and Oceanic Niño Index [ONI]) and Aedes larval indices in each division in Kalutara were obtained from 2010 to 2018. Using a distributed lag non-linear model and a two-stage hierarchical analysis, we estimated and compared division-level and overall relationships between weather and premise index, Breteau index, and container index. FINDINGS From Jan 1, 2010, to Dec 31, 2018, three El Niño events (2010, 2015-16, and 2018) occurred. Increasing monthly cumulative rainfall higher than 200 mm at a lag of 0 months, mean temperatures higher than 31·5°C at a lag of 1-2 months, and El Niño conditions (ie, ONI >0·5) at a lag of 6 months were associated with an increased relative risk of premise index and Breteau index. Container index was found to be less sensitive to temperature and ONI, and rainfall. The associations of rainfall and temperature were rather homogeneous across divisions. INTERPRETATION Both temperature and ONI have the potential to serve as predictors of vector activity at a lead time of 1-6 months, while the amount of rainfall could indicate the magnitude of vector prevalence in the same month. This information, along with knowledge of the distribution of breeding sites, is useful for spatial risk prediction and implementation of effective Aedes control interventions. FUNDING None.
Collapse
Affiliation(s)
- Prasad Liyanage
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden; Ministry of Health, Colombo, Sri Lanka.
| | - Yesim Tozan
- School of Global Public Health, New York University, New York, NY, USA
| | - Hans J Overgaard
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway; Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden; Heidelberg Institute of Global Health and Interdisciplinary Centre for Scientific Computing, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
17
|
Weerasinghe NP, Bodinayake CK, Wijayaratne WMDGB, Devasiri IV, Dahanayake NJ, Kurukulasooriya MRP, Premamali M, Sheng T, Nicholson BP, Ubeysekera HA, de Silva AD, Østbye T, Woods CW, Tillekeratne LG, Nagahawatte ADS. Direct and indirect costs for hospitalized patients with dengue in Southern Sri Lanka. BMC Health Serv Res 2022; 22:657. [PMID: 35578247 PMCID: PMC9112532 DOI: 10.1186/s12913-022-08048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Southern Province of Sri Lanka is endemic with dengue, with frequent outbreaks and occurrence of severe disease. However, the economic burden of dengue is poorly quantified. Therefore, we conducted a cost analysis to assess the direct and indirect costs associated with hospitalized patients with dengue to households and to the public healthcare system. Methods From June 2017–December 2018, we prospectively enrolled children and adults with acute dengue hospitalized at the largest, public tertiary-care (1800 bed) hospital in the Southern Province, Sri Lanka. We administered a structured questionnaire to obtain information regarding direct costs spent by households on medical visits, medications, laboratory testing, and travel for seeking care for the illness. Indirect costs lost by households were estimated by identifying the days of work lost by patients and caregivers and school days lost by children. Direct hospital costs were estimated using gross costing approach and adjusted by multiplying by annual inflation rates in Sri Lankan rupees and converted to US dollars. Results A total of 1064 patients with laboratory-confirmed dengue were enrolled. The mean age (SD) was 35.9 years (15.6) with male predominance (66.2%). The mean durations of hospitalization for adults and paediatric patients were 3.86 (SD = 1.51) and 4 (SD = 1.32) days, respectively. The per-capita direct cost borne by the healthcare system was 233.76 USD, and was approximately 14 times greater than the per-capita direct cost borne by households (16.29 USD, SD = 14.02). The per-capita average number of loss of working days was 21.51 (SD = 41.71), with mean per-capita loss of income due to loss of work being 303.99 USD (SD = 569.77), accounting for over 70% of average monthly income. On average, 10.88 days (SD = 10.97) of school days were missed due to the dengue episode. School misses were expected to reduce future annual income of affected children by 0.44%. Conclusions Dengue requiring hospitalization had a substantial economic burden on the public healthcare system in Sri Lanka and the affected households. These findings emphasize the importance of strengthening dengue control activities and improved use of hospital-based resources for care to reduce the economic impact of dengue in Sri Lanka.
Collapse
Affiliation(s)
- N P Weerasinghe
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka. .,Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
| | - C K Bodinayake
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA.,Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - W M D G B Wijayaratne
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - I V Devasiri
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Department of Pediatrics, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - N J Dahanayake
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - M R P Kurukulasooriya
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - M Premamali
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - T Sheng
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Department of Medicine, Duke University, Durham, NC, USA
| | - B P Nicholson
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Institute for Medical Research, Durham, NC, USA
| | | | - A D de Silva
- Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - T Østbye
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA.,Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | - C W Woods
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - L G Tillekeratne
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA.,Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Department of Medicine, Duke University, Durham, NC, USA
| | - A De S Nagahawatte
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA
| |
Collapse
|
18
|
Paulson W, Kodali NK, Balasubramani K, Dixit R, Chellappan S, Behera SK, Balabaskaran Nina P. Social and housing indicators of dengue and chikungunya in Indian adults aged 45 and above: Analysis of a nationally representative survey (2017-18). Arch Public Health 2022; 80:125. [PMID: 35443704 PMCID: PMC9022351 DOI: 10.1186/s13690-022-00868-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Dengue and chikungunya (CHIKV) are the two major vector-borne diseases of serious public health concern in India. Studies on socioeconomic and housing determinants of dengue and CHIKV at a pan-India level are lacking. Here, we took advantage of the recently carried out Longitudinal Ageing Study in India (LASI) carried out across all the states and Union Territories of India to study the social indicators of dengue and CHIKV in India. Methods LASI-1 (2017-2018) data on the self-reported period prevalence of dengue and CHIKV from 70,932 respondents aged ≥45 years were used for this analysis. The state-wise distribution of dengue and CHIKV was mapped. Prevalence was estimated for each study variable, and the difference was compared using the χ2 test. The adjusted odds ratios (AOR) of the socioeconomic and housing variables for dengue and CHIKV were estimated using the multiple logistic regression model. Results Urban residence is the major socio-economic indicator of dengue and CHIKV (dengue AOR: 1.57, 95% CI: 1.18-2.11; CHIKV AOR: 1.84, 95% CI: 1.36-2.49). The other notable indicator is wealth; rich respondents have higher odds of dengue and CHIKV. Adults older than 54 years and those with high school education and above are associated with a lower likelihood of dengue and CHIKV. In addition, CHIKV is associated with scheduled and forward castes, households with improper toilet facilities, open defecation, and kutcha house type. Conclusions Despite the limitation that the data is only from adults ≥ 45, this analysis provides important insights into the socioeconomic and housing variables associated with higher odds of dengue and CHIKV in India. Understanding these determinants may assist in the national planning of prevention and control strategies for dengue and CHIKV. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00868-5.
Collapse
Affiliation(s)
- Winnie Paulson
- Department of Epidemiology and Public Health, School of Life Sciences, Central University of Tamil Nadu, Tiruvarur, India
| | - Naveen Kumar Kodali
- Department of Epidemiology and Public Health, School of Life Sciences, Central University of Tamil Nadu, Tiruvarur, India
| | - Karuppusamy Balasubramani
- Department of Geography, School of Earth Sciences, Central University of Tamil Nadu, Tiruvarur, India
| | - Rashi Dixit
- Department of Epidemiology and Public Health, School of Life Sciences, Central University of Tamil Nadu, Tiruvarur, India
| | - Savitha Chellappan
- Indian Council of Medical Research- National Institute of Traditional Medicine, Belagavi, India
| | - Sujit Kumar Behera
- Department of Epidemiology and Public Health, School of Life Sciences, Central University of Tamil Nadu, Tiruvarur, India
| | - Praveen Balabaskaran Nina
- Department of Epidemiology and Public Health, School of Life Sciences, Central University of Tamil Nadu, Tiruvarur, India.
| |
Collapse
|
19
|
Thadchanamoorthy V, Dayasiri K. Expanded dengue syndrome presenting with acute liver failure, acute kidney injury, pancreatic involvement, coagulopathy, and multiple intracranial hemorrhages in a young child: a case report. J Med Case Rep 2022; 16:123. [PMID: 35346359 PMCID: PMC8961966 DOI: 10.1186/s13256-022-03348-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/27/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Dengue is a mosquito-borne viral infection that typically occurs in tropical and subtropical countries. The clinical manifestations of dengue infection range from an asymptomatic subclinical course to severe dengue shock syndrome. Besides, dengue can affect any organ in the body and can present with atypical manifestations.
Case presentation
We report a 6-year-old previously healthy Tamil child who had dengue complicated with multiorgan involvement. She initially presented with high fever, headache, body aches for 5 days, blood and mucus diarrhea, hematuria, and right knee joint swelling for 2 days. Dengue NS1 antigen was positive on day 2 of febrile illness. She was managed symptomatically in the local hospital for 3 days and transferred to the tertiary care hospital for further management. She was eventually diagnosed as having dengue hemorrhagic fever complicated with multiorgan involvement including acute liver failure, pancreatic involvement, coagulopathy, arthritis, acute kidney injury, and multiple intracranial hemorrhages. The constellation of disease manifestations was identified as expanded dengue syndrome. She was managed with fresh blood, platelet, and cryoprecipitate transfusions and intravenous antibiotics in addition to renal and liver support in the intensive care unit. On day 14 of illness, she deteriorated while on the ventilator and died due to multiple intracranial hemorrhages.
Conclusion
The reported child with dengue hemorrhagic fever developed several unusual presentations such as acute liver and renal failure, disseminated intravascular coagulopathy, pancreatic involvement, and multiple intracranial hemorrhages, which form part of expanded dengue syndrome. In the seriously unwell child, it is important to look for unusual complications actively to improve outcomes.
Collapse
|
20
|
Hopkins HK, Traverse EM, Barr KL. Viral Parkinsonism: An underdiagnosed neurological complication of Dengue virus infection. PLoS Negl Trop Dis 2022; 16:e0010118. [PMID: 35139081 PMCID: PMC8827468 DOI: 10.1371/journal.pntd.0010118] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022] Open
Abstract
Dengue virus (DENV) is a flavivirus that is a significant cause of human disease costing billions of dollars per year in medical and mosquito control costs. It is estimated that up to 20% of DENV infections affect the brain. Incidence of DENV infections is increasing, which suggests more people are at risk of developing neurological complications. The most common neurological manifestations of DENV are encephalitis and encephalopathy, and movement disorders such as parkinsonism have been observed. Parkinsonism describes syndromes similar to Parkinson’s Disease where tremors, stiffness, and slow movements are observed. Parkinsonism caused by viral infection is characterized by patients exhibiting at least two of the following symptoms: tremor, bradykinesia, rigidity, and postural instability. To investigate DENV-associated parkinsonism, case studies and reports of DENV-associated parkinsonism were obtained from peer-reviewed manuscripts and gray literature. Seven reports of clinically diagnosed DENV-associated parkinsonism and 15 cases of DENV encephalitis, where the patient met the case criteria for a diagnosis of viral parkinsonism were found. Clinically diagnosed DENV-associated parkinsonism patients were more likely to be male and exhibit expressionless face, speech problems, and lymphocytosis. Suspected patients were more likely to exhibit tremor, have thrombocytopenia and low hemoglobin. Viral parkinsonism can cause a permanent reduction in neurons with consequential cognitive and behavior changes, or it can leave a latent imprint in the brain that can cause neurological dysfunction decades after recovery. DENV-associated parkinsonism is underdiagnosed and better adherence to the case definition of viral parkinsonism is needed for proper management of potential sequalae especially if the patient has an ongoing or potential to develop a neurodegenerative disease. Dengue Virus (DENV) causes generalized fever in most patients and is transmitted via Aedes aegypti mosquitos. A small proportion of DENV infected patients have neurological complications associated with the critical phase of the illness. The usual neurological manifestations are encephalitis and encephalopathy, but there can also be movement disorders such as parkinsonism. DENV patients with parkinsonism present with tremor, bradykinesia, instability, and rigidity on top of the typical febrile manifestations of the disease. We searched the literature and uncovered 7 cases of clinically diagnosed DENV parkinsonism patients and 15 cases of suspected DENV parkinsonism. We found that the clinically diagnosed patients were more likely to be male, have expressionless face, speech issues and lymphocytosis. The suspected cases often had a diagnosis of encephalitis and were more likely to have tremors, thrombocytopenia, and low hemoglobin.
Collapse
Affiliation(s)
- Hannah K. Hopkins
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, Florida, United States of America
| | - Elizabeth M. Traverse
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, Florida, United States of America
| | - Kelli L. Barr
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, Florida, United States of America
- * E-mail:
| |
Collapse
|
21
|
Faruk MO, Jannat SN, Rahman MS. Impact of environmental factors on the spread of dengue fever in Sri Lanka. INTERNATIONAL JOURNAL OF ENVIRONMENTAL SCIENCE AND TECHNOLOGY : IJEST 2022; 19:10637-10648. [PMID: 35043053 PMCID: PMC8758894 DOI: 10.1007/s13762-021-03905-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/11/2021] [Accepted: 12/30/2021] [Indexed: 05/09/2023]
Abstract
Dengue fever is a mosquito-borne viral disease caused by the dengue virus of the Flaviviridae family and is responsible for colossal health and economic burden worldwide. This study aimed to investigate the effect of environmental, seasonal, and spatial variations on the spread of dengue fever in Sri Lanka. The study used secondary data of monthly dengue infection and the monthly average of environmental parameters of 26 Sri Lankan regions from January 2015 to December 2019. Besides the descriptive measurements, Kendall's tau_b, Spearman's rho, and Kruskal-Wallis H test have been performed as bivariate analyses. The multivariate generalized linear negative binomial regression model was applied to determine the impacts of meteorological factors on dengue transmission. The aggregate negative binomial regression model disclosed that precipitation (odds ratio: 0.97, p < 0.05), humidity (odds ratio: 1.05, p < 0.01), and air pressure (odds ratio: 1.46, p < 0.01) were significantly influenced the spread of dengue fever in Sri Lanka. The bioclimatic zone is the vital factor that substantially affects the dengue infection, and the wet zone (odds ratio: 6.41, p < 0.05) was more at-risk than the dry zone. The climate season significantly influenced dengue fever transmission, and a higher infection rate was found (odds ratio: 1.46, p < 0.01) in the northeast monsoon season. The findings of this study facilitate policymakers to improve the existing dengue control strategies focusing on the meteorological condition in the local as well as global perspectives.
Collapse
Affiliation(s)
- M. O. Faruk
- Department of Statistics, Noakhali Science and Technology University, Noakhali, Chittagong, 3814 Bangladesh
| | - S. N. Jannat
- Department of Statistics, Noakhali Science and Technology University, Noakhali, Chittagong, 3814 Bangladesh
| | - Md. S. Rahman
- One Health Center for Research and Action, Akbarshah, Chattogram, 4207 Bangladesh
| |
Collapse
|
22
|
Sri Lanka's fight against COVID-19: a brief overview. PANDEMIC RISK, RESPONSE, AND RESILIENCE 2022. [PMCID: PMC9212225 DOI: 10.1016/b978-0-323-99277-0.00031-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Sri Lanka was endorsed by the World Health Organization as a country that made immense progress in controlling the COVID-19 pandemic. This chapter focuses on the health-care structure, strategic use of Police, Tri-forces, and other government entities, media support, traditional social practices, the public responsiveness, and even the geographic location of the country that contribute to the overall control of the pandemic and management of the disease plausibly. Despite the nearly successful achievement, the country has faced economic, political, and social challenges during this critical period, through which many lessons are learnt. Sri Lanka has had few H1N1 outbreaks in the recent past. However, till the spread of COVID-19, the current population had not experienced the spread of a highly contagious disease in the country. Therefore, this chapter aims to share the novel experience, strategies used, challenges faced, and ways adapted in confronting COVID-19 as a country.
Collapse
|
23
|
Ariyaratne D, Gomes L, Jayadas TTP, Kuruppu H, Kodituwakku L, Jeewandara C, Pannila Hetti N, Dheerasinghe A, Samaraweera S, Ogg GS, Malavige GN. Epidemiological and virological factors determining dengue transmission in Sri Lanka during the COVID-19 pandemic. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000399. [PMID: 36962516 PMCID: PMC10021909 DOI: 10.1371/journal.pgph.0000399] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/19/2022] [Indexed: 11/19/2022]
Abstract
With the onset of the COVID-19 pandemic in early 2020 there was a drastic reduction in the number of dengue cases in Sri Lanka, with an increase towards the end of 2021. We sought to study the contribution of virological factors, human mobility, school closure and mosquito factors in affecting these changes in dengue transmission in Sri Lanka during this time. To understand the reasons for the differences in the dengue case numbers in 2020 to 2021 compared to previous years, we determined the association between the case numbers in Colombo (which has continuously reported the highest number of cases) with school closures, stringency index, changes in dengue virus (DENV) serotypes and vector densities. There was a 79.4% drop in dengue cases from 2019 to 2020 in Colombo. A significant negative correlation was seen with the number of cases and school closures (Spearman's r = -0.4732, p <0.0001) and a negative correlation, which was not significant, between the stringency index and case numbers (Spearman's r = -0.3755 p = 0.0587). There was no change in the circulating DENV serotypes with DENV2 remaining the most prevalent serotype by early 2022 (65%), similar to the frequencies observed by end of 2019. The Aedes aegypti premise and container indices showed positive but insignificant correlations with dengue case numbers (Spearman r = 0.8827, p = 0.93). Lockdown measures, especially school closures seemed to have had a significant impact on the number of dengue cases, while the vector indices had a limited effect.
Collapse
Affiliation(s)
- Dinuka Ariyaratne
- Department of Immunology and Molecular Medicine, Allergy Immunology and Cell Biology Unit, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Laksiri Gomes
- Department of Immunology and Molecular Medicine, Allergy Immunology and Cell Biology Unit, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Tibutius T P Jayadas
- Department of Immunology and Molecular Medicine, Allergy Immunology and Cell Biology Unit, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Heshan Kuruppu
- Department of Immunology and Molecular Medicine, Allergy Immunology and Cell Biology Unit, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Chandima Jeewandara
- Department of Immunology and Molecular Medicine, Allergy Immunology and Cell Biology Unit, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | | | | | - Graham S Ogg
- Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Gathsaurie Neelika Malavige
- Department of Immunology and Molecular Medicine, Allergy Immunology and Cell Biology Unit, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
24
|
Ahmed A, Hounsell KG, Sadiq T, Naguib M, Koswin K, Dharmawansa C, Rasan T, McGahan AM. Eliminating malaria in conflict zones: public health strategies developed in the Sri Lanka Civil War. BMJ Glob Health 2022; 6:bmjgh-2021-007453. [PMID: 34969681 PMCID: PMC8718488 DOI: 10.1136/bmjgh-2021-007453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/29/2021] [Indexed: 11/26/2022] Open
Abstract
Despite the 26-year long civil war, Sri Lanka was declared malaria-free by WHO in 2016. This achievement was the result of nearly 30 years of elimination efforts following the last significant resurgence of malaria cases in Sri Lanka. The resurgence occurred in 1986–1987, when about 600 000 cases of malaria were detected. Obstacles to these efforts included a lack of healthcare workers in conflict zones, a disruption of vector control efforts, gaps in the medication supply chain, and rising malaria cases among the displaced population. This article seeks to describe the four strategies deployed in Sri Lanka to mitigate the aforementioned obstacles to ultimately achieve malaria elimination. The first approach was the support for disease elimination by the government of Sri Lanka and the Liberation Tamil Tigers of Elam. The second strategy was the balance of centralised leadership of the federal government and the decentralised programme operation at the regional level. The third strategy was the engagement of non-governmental stakeholders to fill in gaps left by the conflict to continue the elimination efforts. The last strategy is the ongoing efforts by the government, military and non-profit organisations to prevent the reintroduction of malaria. The lessons learnt from Sri Lanka have important implications for malaria-endemic nations that are in conflict such as Ethiopia, Afghanistan, Yemen and Somalia. To accomplish the World Health Assembly goal of reducing the global incidence and mortality of malaria by 90% by 2030, significant efforts are required to lessen the disease burden in conflict zones. In addition to the direct impacts of conflict on population health, conflicts may lead to increased risk of spread of malaria, both within a country and consequently, abroad.
Collapse
Affiliation(s)
- Abrar Ahmed
- Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Department of Human Biology, University of Toronto Faculty of Arts and Science, Toronto, Ontario, Canada
| | | | - Talha Sadiq
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada.,Natural Resources Canada, Ottawa, Ontario, Canada
| | - Mariam Naguib
- Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kirstyn Koswin
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada.,Global Affairs Canada, Ottawa, Ontario, Canada
| | - Chetha Dharmawansa
- Department of Energy, Environment and Climate Change, Asian Institute of Technology, Khlong Nueng, Thailand
| | | | - Anita M McGahan
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada .,Rotman School of Management, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Jayadas TTP, Kumanan T, Gomes L, Jeewandara C, Malavige GN, Ranasinghe D, Jadi RS, Ramasamy R, Surendran SN. Regional Variation in Dengue Virus Serotypes in Sri Lanka and Its Clinical and Epidemiological Relevance. Diagnostics (Basel) 2021; 11:2084. [PMID: 34829432 PMCID: PMC8618005 DOI: 10.3390/diagnostics11112084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 01/19/2023] Open
Abstract
Dengue is a significant health concern in Sri Lanka, but diagnosis of the infecting dengue virus (DENV) serotype has hitherto been largely restricted to the Colombo district in the western province. Salinity tolerant Aedes vectors are present in the island's northern Jaffna peninsula, which is undergoing rapid groundwater salinization. Virus serotypes were determined by RT-qPCR in 107 and 112 patients diagnosed by NS1 antigen positivity from the Jaffna district in 2018 and 2019, respectively, and related to clinical characteristics. DENV1 and DENV2 were the most common serotypes in both years. Infections with multiple serotypes were not detected. DENV1 was significantly more prevalent in 2019 than 2018, while DENV3 was significantly more prevalent in 2018 than 2019 among the Jaffna patients. Limited genomic sequencing identified DENV1 genotype-I and DENV3 genotype-I in Jaffna patients in 2018. Dengue was more prevalent in working age persons and males among the serotyped Jaffna patients. DENV1 and DENV2 were the predominant serotypes in 2019 in the Colombo district. However, DENV1 and DENV3 were significantly more prevalent in Colombo compared with Jaffna in 2019. The differences in the prevalence of DENV1 and DENV3 between the Jaffna and Colombo districts in 2019 have implications for dengue epidemiology and vaccination. Salinity-tolerant Aedes vector strains, widespread in the Jaffna peninsula, may have contributed to differences in serotype prevalence compared with the Colombo district in 2019. Significant associations were not identified between virus serotypes and clinical characteristics among Jaffna patients.
Collapse
Affiliation(s)
| | | | - Laksiri Gomes
- Centre for Dengue Research, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka; (L.G.); (C.J.); (G.N.M.); (D.R.)
| | - Chandima Jeewandara
- Centre for Dengue Research, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka; (L.G.); (C.J.); (G.N.M.); (D.R.)
| | - Gathsaurie N. Malavige
- Centre for Dengue Research, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka; (L.G.); (C.J.); (G.N.M.); (D.R.)
| | - Diyanath Ranasinghe
- Centre for Dengue Research, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka; (L.G.); (C.J.); (G.N.M.); (D.R.)
| | - Ramesh S. Jadi
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7290, USA;
| | - Ranjan Ramasamy
- Department of Zoology, University of Jaffna, Jaffna 40000, Sri Lanka;
| | | |
Collapse
|
26
|
Ariyaratne M, Gunasekara P, Wajirasena PH, Rathnayake DM, Dilani D, Chathuranga T, Gomes L, Jayatunga D, Wewita S, Meegahage T, Jayasinghearachchi HS, Wijewickrama A, Malavige G, De Silva AD. Comparison of two rapid test kits with real time polymerase chain reaction for early diagnosis of dengue in Sri Lanka. J Immunoassay Immunochem 2021; 43:213-221. [PMID: 34724872 DOI: 10.1080/15321819.2021.1984252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Dengue is among the deadliest insect-borne diseases circulating in Sri Lanka. Most of the infections that are diagnosed early are manageable. However, delays in diagnosis may cause fatalities. We evaluated the dengue NS1 antigen card and NS1 SD kit for early diagnosis of dengue using samples from 116 RT-PCR-positive patients admitted within 5 days of the fever onset. RT-PCR tests were performed as standard tests. IgM and IgG ELISA tests were carried out to identify primary and secondary infections. Of the 116 patients who tested positive for dengue using PCR, 48 were positive using NS1 antigen card and 45 were positive using NS1 SD. Patients with 100 copies or higher viral load showed a higher sensitivity in both antigen card and NS1 SD. Of 34 primary infections evaluated, 23 were positive by NS1 antigen card, while the positivity was 21 by NS1 SD. Of the 30 secondary infections evaluated, 15 were positive by NS1 antigen card while 14 by NS1 SD. Our findings showed that while the rapid tests are convenient and much easier to use than PCR, they are less sensitive and need improvement. Until then, clinical diagnosis should have more emphasis on the early diagnosis of dengue.
Collapse
Affiliation(s)
- Mhjd Ariyaratne
- Biomedical Lab-2, Department of Paraclinical Science, Faculty of Medicine, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka.,Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Peshala Gunasekara
- Biomedical Lab-2, Department of Paraclinical Science, Faculty of Medicine, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Poornima Hasanthi Wajirasena
- Biomedical Lab-2, Department of Paraclinical Science, Faculty of Medicine, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka.,National Institute of Infectious Diseases, Angoda, Sri Lanka
| | - Dilini Malsha Rathnayake
- Biomedical Lab-2, Department of Paraclinical Science, Faculty of Medicine, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka.,National Institute of Infectious Diseases, Angoda, Sri Lanka
| | - Desha Dilani
- Biomedical Lab-2, Department of Paraclinical Science, Faculty of Medicine, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Teshan Chathuranga
- Biomedical Lab-2, Department of Paraclinical Science, Faculty of Medicine, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Laksiri Gomes
- Biomedical Lab-2, Department of Paraclinical Science, Faculty of Medicine, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Dadl Jayatunga
- Biomedical Lab-2, Department of Paraclinical Science, Faculty of Medicine, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka.,National Institute of Infectious Diseases, Angoda, Sri Lanka
| | - Sjc Wewita
- Biomedical Lab-2, Department of Paraclinical Science, Faculty of Medicine, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka.,National Institute of Infectious Diseases, Angoda, Sri Lanka
| | - Thilini Meegahage
- Biomedical Lab-2, Department of Paraclinical Science, Faculty of Medicine, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka.,National Institute of Infectious Diseases, Angoda, Sri Lanka
| | - Himali S Jayasinghearachchi
- Biomedical Lab-2, Department of Paraclinical Science, Faculty of Medicine, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | | | - Gathsaurie Malavige
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - A D De Silva
- Biomedical Lab-2, Department of Paraclinical Science, Faculty of Medicine, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| |
Collapse
|
27
|
Vitamin D Deficiency in Dengue Hemorrhagic Fever and Dengue Shock Syndrome among Sri Lankan Children: A Case-Control Study. J Trop Med 2021; 2021:4173303. [PMID: 34691194 PMCID: PMC8531817 DOI: 10.1155/2021/4173303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/05/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Dengue fever is a vector-borne disease associated with a significant public health impact. The clinical picture ranges from undifferentiated fever to more severe forms such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Compared to healthy controls, we explored the likelihood of having vitamin D deficiency (VDD) among children with severe dengue infection. Methods This case-control study compared hospitalized children (2 months to 12 years) with DHF and DSS with radiologically confirmed plasma leak with age-matched healthy controls. The association of 25-hydroxy vitamin D [25(OH)D] level, age, sex, and socioeconomic status with DHF/DSS was assessed using univariate and multivariate logistic regression. Results Forty children with DHF/DSS were compared with 52 healthy controls. Mean (SD) age was 8.8 (2.9) years and 7.9 (3.7) years among cases and controls, respectively. Most (n = 28, 70%) had DHF. In multivariate logistic regression, the likelihood of having VDD [25(OH)D < 20 ng/mL] was 3.6 times higher in cases compared to controls (Odds Ratio (OR): 3.65, 95% Confidence Interval (CI): 1.461, 9.102, p=0.006). When serum 25(OH)D was used as a continuous independent variable, the strength of the association between DHF/DSS and serum 25(OH)D was weak but statistically significant; the likelihood of having DHF/DSS is 0.94 times less with 1 ng/mL increase in serum 25(OH)D (OR: 0.940, 95% CI: 0.887, 0.995, p=0.03). Conclusion The present study suggests that the likelihood of having VDD among children with DHF/DSS is higher than that in their healthy counterparts. Thus, further studies are critical in confirming whether vitamin D repletion is beneficial in preventing severe forms of dengue in the quest to reduce the morbidity and mortality associated with dengue infection.
Collapse
|
28
|
Rodrigo C, Sigera C, Fernando D, Rajapakse S. Plasma leakage in dengue: a systematic review of prospective observational studies. BMC Infect Dis 2021; 21:1082. [PMID: 34670495 PMCID: PMC8527656 DOI: 10.1186/s12879-021-06793-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
Plasma leakage is a precursor to life-threatening complications of dengue, but this group is poorly defined and not often reported in literature. Patients with Dengue haemorrhagic fever (DHF) as defined in the 1997 World Health Organization classification are often reported, and they all have plasma leakage, but some patients with plasma leakage do not meet the definition of DHF. The study aims to estimate the frequency of plasma leakage and DHF (as a surrogate of plasma leakage) in dengue and its variations based on virus serotype, geography, patient gender and pre-existing immunity to dengue. PUBMED, Scopus, EMBASE, CINAHL and Web of Science were searched for prospective observational studies reporting on plasma leakage or DHF. Quality of data was assessed using the NIH quality assessment tool for cohort studies. Forty-three studies that recruited 15,794 confirmed dengue patients were eligible. Cumulative frequency of plasma leakage was 36.8% (15 studies, 1642/4462, 95% CI 35.4-38.2%), but surprisingly the estimated cumulative frequency of DHF was higher (45.7%, 32 studies, 4758/10417, 95% CI 44.7-46.6%), indicating that current medical literature over-reports DHF or under-reports plasma leakage. Therefore, a reliable estimate for the proportion of dengue patients developing plasma leakage cannot be derived from existing medical literature even after applying rigorous inclusion criteria to select homogenous studies. Plasma leakage is an important marker of "at-risk" dengue patients and standardizing its definition, diagnosis and reporting should be a priority in research and global policy.
Collapse
Affiliation(s)
- Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, UNSW Sydney, Sydney, NSW, 2052, Australia.
- Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Chathurani Sigera
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka
| | - Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka
| |
Collapse
|
29
|
Sigera C, Rodrigo C, de Silva NL, Weeratunga P, Fernando D, Rajapakse S. Direct costs of managing in-ward dengue patients in Sri Lanka: A prospective study. PLoS One 2021; 16:e0258388. [PMID: 34624062 PMCID: PMC8500425 DOI: 10.1371/journal.pone.0258388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The cost in managing hospitalised dengue patients varies across countries depending on access to healthcare, management guidelines, and state sponsored subsidies. For health budget planning, locally relevant, accurate costing data from prospective studies, is essential. OBJECTIVE To characterise the direct costs of managing hospitalised patients with suspected dengue infection in Sri Lanka. METHODS Colombo Dengue Study is a prospective single centre cohort study in Sri Lanka recruiting suspected hospitalised dengue fever patients in the first three days of fever and following them up until discharge. The diagnosis of dengue is retrospectively confirmed and the cohort therefore has a group of non-dengue fever patients with a phenotypically similar illness, managed as dengue while in hospital. The direct costs of hospital admission (base and investigation costs, excluding medication) were calculated for all recruited patients and compared between dengue and non-dengue categories as well as across subgroups (demographic, clinical or temporal) within each of these categories. We also explored if excluding dengue upfront, would lead to an overall cost saving in several hypothetical scenarios. RESULTS From October 2017 to February 2020, 431 adult dengue patients and 256 non-dengue fever patients were recruited. The hospitalisation costs were USD 18.02 (SD: 4.42) and USD 17.55 (SD: 4.09) per patient per day for dengue and non-dengue patients respectively (p>0.05). Laboratory investigations (haematological, biochemical and imaging) accounted for more than 50% of the total cost. The costs were largely homogenous in all subgroups within or across dengue and non-dengue categories. Excluding dengue upfront by subsidised viral genomic testing may yield overall cost savings for non-dengue patients. CONCLUSION As non-dengue patients incur a similar cost per day as the dengue patients, confirming dengue diagnosis using subsidised tests for patients presenting in the first three days of fever may be cost-efficient.
Collapse
Affiliation(s)
- Chathurani Sigera
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, Sydney, NSW, Australia
| | - Nipun L. de Silva
- Department of Clinical Sciences, Faculty of Medicine, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Praveen Weeratunga
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| |
Collapse
|
30
|
Karunaratna S, Ranaweera D, Vitharana H, Ranaweera P, Mendis K, Fernando D. Thrombocytopenia in Malaria: A Red-Herring for Dengue, Delaying the Diagnosis of Imported Malaria. J Glob Infect Dis 2021; 13:172-176. [PMID: 35017873 PMCID: PMC8697816 DOI: 10.4103/jgid.jgid_9_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 07/09/2021] [Accepted: 08/03/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Fever and thrombocytopenia, often presenting features of malaria, are also the hallmarks of dengue infections. This study examines the degree and duration of thrombocytopenia in imported malaria infections in Sri Lanka and the extent to which this could provide a false trail in favor of a dengue diagnosis. Methods The data of all confirmed malaria cases reported in Sri Lanka from 2017 to 2019 were extracted from the national malaria database. These included detailed histories, the time to malaria diagnosis, platelet counts, and in 2019, the trail of diagnostic procedures. Results Over the 3 years, 158 malaria cases (157 imported and one introduced) were reported. Platelet counts were available in 90.5% (n = 143) of patients among whom 86% (n = 123) showed a thrombocytopenia (<150,000 cells/μl) and in nearly a third (n = 52) a severe thrombocytopenia (<50,000 cells/μl). Only 30% of patients (n = 48) were diagnosed with malaria within 3 days of the onset of symptoms, while in 37% (n = 58) it took 7 or more days. Platelet counts where significantly higher in patients who had symptoms for 7 days or more compared to those who had symptoms for <7 days (χ2 = 6.888, P = 0.009). Dengue fever was suspected first in 30% (n = 16) of the total malaria patients reported in 2019. Conclusions Low platelet counts could delay suspecting and testing for malaria. Eliciting a history of travel to a malaria-endemic country could provide an important and discerning clue to suspect and test for malaria in such patients.
Collapse
Affiliation(s)
| | | | | | | | - Kamini Mendis
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| |
Collapse
|
31
|
Dissanayake DMDIB, Gunaratne WMSN, Kumarihamy KWMPP, Kularatne SAM, Kumarasiri PVR. Use of intravenous N-acetylcysteine in acute severe hepatitis due to severe dengue infection: a case series. BMC Infect Dis 2021; 21:978. [PMID: 34544380 PMCID: PMC8454086 DOI: 10.1186/s12879-021-06681-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background Dengue fever is a common mosquito borne viral infection. Severe dengue fever associated severe hepatitis carries high mortality. Based on the beneficial effect of N-acetylcysteine (NAC) in paracetamol poisoning and non-acetaminophen induced liver failure, it is used in dengue fever associated hepatitis in clinical practice. We aim to study the reversal of liver enzymes with NAC in the setting of severe hepatitis due to severe dengue infection. Methods A retrospective analysis was conducted on hospitalized 30 adults with severe dengue fever with severe hepatitis. These 30 patients had aspartate transaminase (AST) and alanine transaminases (ALT) more than 500 U/L and/or PT INR (prothrombin time and international normalized ratio) more than 1.5. They were treated with NAC infusion of 100 mg/h for 3 to 5 days. Results The mean age of the group was 49.9 ± 11.46 years and 18 (60%) patients were males. Nineteen patients (63%) developed dengue shock. Of them 12 patients (40%) developed hepatic encephalopathy. Median AST on the day of administration of NAC was 1125 U/L interquartile range (IQR) 1653.25 while median ALT was 752 (IQR 459.25). There was a statistically significant reduction of both ALT (p = 0.034) and AST (p = 0.049) from day 1 to 4 after NAC infusion. Rise of platelet count between day 1 and day 4 also showed statistically significant difference (p = 0.011) but the reduction of prothrombin time and international normalized ratio (PT/INR) from 1 to day 4 did not show statistical significance difference. Mean duration of treatment with NAC was 3.61 ± 0.75 days while mean length of hospital stay was 6.2 ± 1.27 days. Only one patient died (3.3%). None of the patients reported adverse drug reaction due to NAC. Conclusion Majority of patients demonstrated marked clinical and biochemical improvements and they recovered fully. We observed faster and significant recovery of liver enzymes following administration of NAC. Based on the above findings, this study provides preliminary evidence for the beneficial effect of NAC in severe hepatitis in dengue infection with greater survival benefits.
Collapse
Affiliation(s)
| | | | | | - S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - P V R Kumarasiri
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| |
Collapse
|
32
|
Malavige GN, Jeewandara C, Ghouse A, Somathilake G, Tissera H. Changing epidemiology of dengue in Sri Lanka-Challenges for the future. PLoS Negl Trop Dis 2021; 15:e0009624. [PMID: 34411101 PMCID: PMC8375976 DOI: 10.1371/journal.pntd.0009624] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Dengue infections are on the rise in Sri Lanka and are spreading to all areas in the country. Here, we discuss the changes in dengue epidemiology in Sri Lanka in relation to changes in age distribution, changes in seroprevalence rates over time, and possible reasons contributing to such changes. METHODS AND FINDINGS Although the incidence of dengue increased 20-fold from the year 2000 to 2012 and a further 3-fold from 2012 to 2019, this increase is not reflected in a similar increase in the age-stratified seropositivity rates for dengue. For instance, the annual seroconversion rates were 0.76% in 2013 and 0.91% in 2017. The annual seroconversion rates in the 6 to 17 age group were 1.5% per year in 2003, 3.9% in 2013, and 4.1% in 2017. In addition, although a 13-fold increase in dengue was seen in those who were <19 years of age, a 52.4-fold increase was seen in the 40- to 59-year age group. The case fatality rates (CFRs) have similarly changed, with 61.8% of deaths occurring in those <19 years of age in the year 2000, while in 2012 to 2018, the highest CFR were seen in those who were aged 20 to 39 years. Although there has been a marked increase in the number of cases, the vector densities did not change during a 4-year period. The proportion of adult individuals experiencing a secondary dengue infection has also remained between 65% and 75% between the years 2004 and 2018. CONCLUSIONS A change in the ratio of symptomatic to asymptomatic infections can give rise to changes in the reported incidence of dengue. In order to take an appropriate policy decision in dengue control activities, it would be important to study the changes in virus serotypes, vector dispersion, and densities. Further, the contribution of the rise in metabolic diseases to an increase in the symptomatic as well as more severe infections due to dengue is explored.
Collapse
Affiliation(s)
- Gathsaurie Neelika Malavige
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Allergy Immunology and Cell Biology Unit (AICBU), Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Chandima Jeewandara
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Allergy Immunology and Cell Biology Unit (AICBU), Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Azhar Ghouse
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka
| | - Gayasha Somathilake
- Allergy Immunology and Cell Biology Unit (AICBU), Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | |
Collapse
|
33
|
Priyangika DKD, Premawansa G, Adikari M, Thillainathan S, Premawansa S, Jayamanne BDW, Premaratna R. Predictive value of hepatic transaminases during febrile phase as a predictor of a severe form of Dengue: analysis of adult Dengue patients from a tertiary care setting of Sri Lanka. BMC Res Notes 2021; 14:251. [PMID: 34193263 PMCID: PMC8243863 DOI: 10.1186/s13104-021-05670-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 06/23/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Dengue viral infection is an ongoing epidemic in Sri Lanka, causing significant mortality and morbidity. A descriptive-analytical study was carried out using serologically confirmed Dengue patients during a 6 month period. The relationship between the elevation of hepatic enzymes and severity of Dengue was assessed after stratifying recorded maximum AST/ALT (SGOT/SGPT) values 2-15 times elevated and by the phases of the illness. Sensitivity, specificity, predictive values, and ROC curves were assessed using maximum values for AST and ALT. RESULTS Out of 255 patients, 107(42%) were females. The majority (52.9%) were in the 20-39 year age group. Only 19.6% had DHF. No statistically significant difference was noticed in the values of maximum transaminases during the febrile phase among DF and DHF patients. Higher sensitivity and low specificity with the 1-5 times elevation range was noticed, and a higher cut-off level of more than 5 times elevation showed low sensitivity and higher specificity. The combination of both transaminases cut-offs with age and sex also does not show clinically significant predictability of severe disease. The AST and ALT elevations are not showing discriminatory predictive value on dengue severity. As different serotypes cause different epidemics, it is important to carry out large-scale specific studies considering the serotypes.
Collapse
Affiliation(s)
| | | | | | | | - Sunil Premawansa
- Zoology and Environmental Science, Faculty of Science, University of Colombo, Colombo, Sri Lanka
| | | | - Ranjan Premaratna
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| |
Collapse
|
34
|
Sigera PC, Rajapakse S, Weeratunga P, De Silva NL, Gomes L, Malavige GN, Rodrigo C, Fernando SD. Dengue and post-infection fatigue: findings from a prospective cohort-the Colombo Dengue Study. Trans R Soc Trop Med Hyg 2021; 115:669-676. [PMID: 33099653 DOI: 10.1093/trstmh/traa110] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Previous studies on post-infection fatigue in dengue are few but suggest that up to 25% of dengue patients may suffer from fatigue. This study aimed to evaluate the prevalence and associations of post-infection fatigue in dengue patients compared with non-dengue fever patients. METHODS Post-infection fatigue and its demographic and clinical associations were assessed in adult dengue and non-dengue fever patients 2 months after the acute infection in a prospective cohort study in Sri Lanka. Fatigue at 2 months (primary endpoint) was assessed with the fatigue questionnaire as a dichotomous outcome based on a pre-recommended cut-off (score ≥4) and as the total score from the questionnaire (higher score indicates more fatigue). RESULTS Of 260 patients, 158 had dengue and, of these, 51 (32%) had fatigue at 2 months. Risk was higher in dengue patients (vs non-dengue; relative risk [RR] 4.93 [95% confidence interval {CI} 2.3 to 10.4]) and more so in female dengue patients (vs male dengue patients; RR 2.45 [95% CI 1.24 to 4.86]). Severe dengue patients had a higher mean fatigue score (p=0.024). CONCLUSIONS Post-infection fatigue is an underappreciated burden of this widely prevalent infection. Our findings are useful to triage patients at risk of fatigue for follow-up.
Collapse
Affiliation(s)
- Ponsuge C Sigera
- Department of Parasitology, Faculty of Medicine, University of Colombo, 00800, Colombo 08, Sri Lanka
| | - Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 00800, Colombo 08, Sri Lanka
| | - Praveen Weeratunga
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 00800, Colombo 08, Sri Lanka
| | - Nipun L De Silva
- Department of Clinical Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, 10390, Ratmalana, Sri Lanka
| | - Laksiri Gomes
- Centre for Dengue Research, Faculty of Medical Sciences, University of Sri Jayewardenepura, 10250, Nugegoda, Sri Lanka
| | - Gathsaurie N Malavige
- Centre for Dengue Research, Faculty of Medical Sciences, University of Sri Jayewardenepura, 10250, Nugegoda, Sri Lanka
| | - Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Sumadhya D Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, 00800, Colombo 08, Sri Lanka
| |
Collapse
|
35
|
Effect of Prior Symptomatic Dengue Infection on Dengue Haemorrhagic Fever (DHF) in Children. J Trop Med 2021; 2021:8842799. [PMID: 34122560 PMCID: PMC8192182 DOI: 10.1155/2021/8842799] [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: 07/27/2020] [Accepted: 05/28/2021] [Indexed: 11/18/2022] Open
Abstract
Pathogenesis of dengue haemorrhagic fever is not fully understood, but it is thought that there is antibody enhancement during the secondary infection, which causes severe dengue haemorrhagic fever (DHF). Therefore, patients who have DHF should have a documented history of symptomatic dengue infection in the past. A retrospective descriptive-analytical study was conducted at the University Paediatric Unit at Lady Ridgeway Hospital for Children, Colombo, Sri Lanka. All children who had fulfilled the criteria for DHF admitted to the unit from April 2018 to September 2018 were recruited into the study. Relevant data were collected from bed head tickets. One hundred and eighty-four children were included in the final analysis. Thirty-three (17.9%) had a past history of documented symptomatic dengue infection, while 82.1% did not have a documented dengue infection. Twelve patients had dengue shock syndrome, and none of them had previously documented symptomatic dengue fever. Dextran was used in 96 patients in the critical phase. Twelve (42%) patients with past documented symptomatic dengue fever needed dextran while 84 (54.9%) patients without a documented past history of dengue fever needed dextran. In our clinical observation, we noticed that children with DHF mostly did not have a documented symptomatic prior dengue infection, while those with a documented symptomatic prior infection had a milder subsequent illness. In fact, the majority (82.1%) of patients with DHF did not have documented previous symptomatic dengue infection. It was also observed that the clinical course of subsequent dengue infection was less severe in patients with previously documented symptomatic dengue fever. This finding should be further evaluated in a larger scale study minimizing the all-confounding factors. This fact is more important in selecting recipients for vaccines against the dengue virus, which are supposed to produce immunity against the virus without causing the severe disease.
Collapse
|
36
|
Liyanage P, Rocklöv J, Tissera HA. The impact of COVID-19 lockdown on dengue transmission in Sri Lanka; A natural experiment for understanding the influence of human mobility. PLoS Negl Trop Dis 2021; 15:e0009420. [PMID: 34111117 PMCID: PMC8192006 DOI: 10.1371/journal.pntd.0009420] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/28/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dengue is one of the major public health problems in Sri Lanka. Its outbreak pattern depends on a multitude of drivers, including human mobility. Here we evaluate the impact of COVID-19 related mobility restriction (lockdown) on the risk of dengue in Sri Lanka. METHODOLOGY Two-stage hierarchical models were fitted using an interrupted time-series design based on the notified dengue cases, January 2015 to July 2020. In the first stage model, the district level impact was estimated using quasi-Poisson regression models while accounting for temporal trends. Estimates were pooled at zonal and national levels in the second stage model using meta-analysis. The influence of the extended period of school closure on dengue in children in the western province was compared to adults. FINDINGS Statistically significant and homogeneous reduction of dengue risk was observed at all levels during the lockdown. Overall an 88% reduction in risk (RR 0.12; 95% CI from 0.08 to 0.17) was observed at the national level. The highest impact was observed among children aged less than 19 years showing a 92% reduction (RR 0.8; 95% CI from 0.03 to 0.25). We observed higher impact in the dry zone having 91% reduction (RR 0.09; 95% CI from 0.05 to 0.15) compared to wet zone showing 83% reduction (RR 0.17; 95% CI from 0.09 to 0.30). There was no indication that the overall health-seeking behaviour for dengue had a substantial influence on these estimates. SIGNIFICANCE This study offers a broad understanding of the change in risk of dengue during the COVID-19 pandemic and associated mobility restrictions in Sri Lanka. The analysis using the mobility restrictions as a natural experiment suggests mobility patterns to be a very important driver of dengue transmission.
Collapse
Affiliation(s)
- Prasad Liyanage
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Ministry of Health, Colombo, 01000, Sri Lanka
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | | |
Collapse
|
37
|
Sonali Fernando E, Headley TY, Tissera H, Wilder-Smith A, De Silva A, Tozan Y. Household and Hospitalization Costs of Pediatric Dengue Illness in Colombo, Sri Lanka. Am J Trop Med Hyg 2021; 105:110-116. [PMID: 33999848 DOI: 10.4269/ajtmh.20-1179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/02/2021] [Indexed: 01/31/2023] Open
Abstract
Dengue, a mosquito-borne viral infection that affects millions around the world, poses a substantial economic burden in endemic countries. We conducted a prospective costing study in hospitalized pediatric dengue patients at the Lady Ridgeway Hospital for Children (LRHC), a public pediatric hospital in Colombo district, Sri Lanka, to assess household out-of-pocket and hospitalization costs of dengue in pediatric patients during peak dengue transmission season. Between August and October 2013, we recruited 216 hospitalized patients (aged 0-3 years, 27%; 4-7 years, 29%; 8-12 years, 42%) who were clinically or laboratory diagnosed with dengue. Using 2013 US dollars, household out-of-pocket spending, on average, was US$59 (SD 49) per episode and increased with disease severity (DF, US$52; DHF/DSS, US$78). Pediatric dengue patients received free-of-charge medical care during hospitalization at LRHC, and this places a high financial burden on hospitals. The direct medical cost of hospitalization was US$68.0 (SD 31.4) for DF episode, and US$122.7 (SD 65.2) for DHF/DSS episode. Yet a hospitalized dengue illness episode still accounted for 20% to 35% of household monthly income due to direct and indirect costs. Additionally, a majority of caregivers (70%) sought outpatient care before hospitalization, most of whom (81%) visited private health facilities. Our findings indicate that hospitalized pediatric dengue illness poses a nontrivial cost burden to households and healthcare systems, emphasizing the importance of preventing and controlling the transmission of dengue in endemic countries.
Collapse
Affiliation(s)
| | - Tyler Y Headley
- 2Department of Political Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Annelies Wilder-Smith
- 4Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,5Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.,6Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Amala De Silva
- 7Department of Economics, University of Colombo, Colombo, Sri Lanka
| | - Yesim Tozan
- 2Department of Political Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.,8School of Global Public Health, New York University, New York, New York
| |
Collapse
|
38
|
Ngwe Tun MM, Muthugala R, Rajamanthri L, Nabeshima T, Buerano CC, Morita K. Emergence of genotype I of dengue virus serotype 3 during severe dengue epidemic in Sri Lanka, 2017. Jpn J Infect Dis 2021; 74:443-449. [PMID: 33642435 DOI: 10.7883/yoken.jjid.2020.854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During the 2017 outbreak of severe dengue in Sri Lanka, dengue virus (DENV) serotypes 2, 3 and 4 were co-circulating. Based on our previous study on the 295 patients from the National Hospital Kandy in Sri Lanka between March 2017-January 2018, the dominant infecting serotype was DENV-2. Here, we aimed to characterize the DENV-3 strains from non-severe and severe dengue patients from our previous study population. Patients' clinical records and previous laboratory tests including dengue-specific nonstructural protein 1 antigen rapid test, IgM-capture and IgG enzyme-linked immunosorbent assays, were analyzed together with the present results of real-time reverse transcription polymerase chain reaction, and next-generation sequencing of DENV-3. Based on complete genome analysis, DENV-3 isolates belonged to two different clades of genotype I and were genetically close to the strains from Indonesia, China, Singapore, Malaysia and Australia. There were sixteen amino acid changes among DENV-3 isolates, and the greater number of changes was found in nonstructural than structural proteins. The emergence of DENV-3 genotype I was noted for the first time in Sri Lanka. Continuous monitoring of this newly emerged genotype and other DENV serotypes/genotypes are needed to determine their effects on future outbreaks and to understand the molecular epidemiology of dengue.
Collapse
Affiliation(s)
- Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Japan
| | | | | | - Takeshi Nabeshima
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Japan
| | | | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Japan
| |
Collapse
|