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Low GKK, Jiee SF, Masilamani R, Shanmuganathan S, Rai P, Manda M, Omosumwen OF, Kagize J, Gavino AI, Azahar A, Jabbar MA. Routine blood parameters of dengue infected children and adults. A meta-analysis. Pathog Glob Health 2023; 117:565-589. [PMID: 36593636 PMCID: PMC10392251 DOI: 10.1080/20477724.2022.2161864] [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] [Indexed: 01/04/2023] Open
Abstract
The World Health Organization (WHO) has revised dengue case classification in 2009 to better reflect the severity of the disease. However, there was no comprehensive meta-analysis of pooled routine blood parameters according to the age or the categories of the 2009 WHO classification. This study aimed to meta-analyze the routine blood parameters of dengue infected children and adults. Electronic search was performed with eligible articles included for review. Meta-analysis was conducted for six blood parameters stratified into children, adults and all ages, which were further grouped into the three 2009 WHO case classifications (dengue without warning signs, DwoWS; dengue with warning signs, DwWS; severe dengue, SD), non-severe dengue (non-SD) and 'All' cases. A total of 55 articles were included in the meta-analysis. Fifteen studies were conducted in the children's age category, 31 studies in the adult category and nine studies in all ages. The four selected pooled blood parameters for children were white blood cell (WBC) (×103/L) with 5.11 (SD), 5.64 (DwWS), 5.52 (DwoWS) and 4.68 (Non-SD) hematocrit (HCT) (%) with 36.78 (SD), 40.70 (DwWS), 35.00 (DwoWS) and 29.78 (Non-SD) platelet (PLT) (×103/µL) with 78.66 (SD), 108.01 (DwWS), 153.47 (DwoWS) and 108.29 (non-SD); and aspartate aminotransferase (AST) (/µL) with 248.88 (SD), 170.83 (DwWS), 83.24 (DwoWS) and 102.99 (non-SD). For adult, WBC were 4.96 (SD), 6.44 (DwWS), 7.74 (DwoWS) and 3.61 (non-SD); HCT were 39.50 (SD), 39.00 (DwWS), 37.45 (DwoWS) and 41.68 (non-SD); PLT were 49.62 (SD), 96.60 (DwWS), 114.37 (DwoWS) and 71.13 (non-SD); and AST were 399.50 (SD), 141.01 (DwWS), 96.19 (DwoWS) and 118.13 (non-SD). These blood parameters could not differentiate between each dengue severity according to the WHO 2009 classification, SD, DwoWS, DwWS and non-SD, because the timing of blood drawing was not known and there was an overlapping confidence interval among the clinical classification. Hence, these pooled blood parameter values could not be used to guide clinicians in management and did not correlate with severity as in previous scientific literatures and guidelines.
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Affiliation(s)
- Gary KK Low
- Research Operations, Nepean Hospital, Kingswood, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sam Froze Jiee
- Sarawak State Health Department, Ministry of Health Malaysia, Sri Aman District Health Office, Sri Aman, Sarawak, Malaysia
| | - Retneswari Masilamani
- Department of Population Medicine, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
| | - Selvanaayagam Shanmuganathan
- Quality Unit, Hospital Kulim, Kulim, Kedah, Malaysia
- Menzies Centre Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Health Vertical, Torrens University Australia, Sydney, New South Wales, Australia
| | - Pramila Rai
- Health Vertical, Torrens University Australia, Sydney, New South Wales, Australia
| | - Mitali Manda
- Hammondcare Neringah Hospital, Wahroonga,New South Wales, Australia
| | - Osamudiamen Favour Omosumwen
- Department of Addiction and Community Health Professional, Faculty of Health and Social Science, Sundance College Edmonton, Edmonton, Alberta, Canada
| | - Jackob Kagize
- Health Vertical, Torrens University Australia, Sydney, New South Wales, Australia
| | - Alex I. Gavino
- Centre for Health Futures, Torrens University Australia, Sydney, New South Wales, Australia
- Public Health Department, Torrens University Australia, Sydney, New South Wales, Australia
| | - Aizad Azahar
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mohammed Abdulrazzaq Jabbar
- Department of Population Medicine, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
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A Six Years (2010-2016) Longitudinal Survey of the Four Serotypes of Dengue Viruses in Lao PDR. Microorganisms 2023; 11:microorganisms11020243. [PMID: 36838207 PMCID: PMC9959689 DOI: 10.3390/microorganisms11020243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/16/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023] Open
Abstract
Dengue fever is the most prevalent arthropod-borne viral infection of humans in tropical and subtropical countries. Since 1979, dengue has been reported to be endemic in the Lao People's Democratic Republic (PDR), as in many countries in Southeast Asia, with a complex circulation of the four dengue viruses' serotypes (DENV-1 to DENV-4). By sequencing the complete envelope protein, we explored a panel of samples from five Lao Provinces (Vientiane capital, Luangprabang, Bolikhamxay, Saravane, Attapeu) to enrich knowledge about the co-circulation of DENVs in Lao PDR between 2010 and 2016. Phylogenetic analyses highlighted the specific circulation of DENV-1 genotype I, DENV-2 genotype Asian I, DENV-4 genotype I and the co-circulation of DENV-3 genotype II and III. The continuous co-circulation of the four serotypes was underlined, with genotype or cluster shifts among DENV-3 and DENV-1. These data suggested the emergence or re-emergence of DENV strains associated with epidemic events, potentially linked to the exchanges within the territory and with neighboring countries. Indeed, the increasing local or regional connections favored the dissemination of new isolates or new clusters around the country. Since 2012, the surveillance and alert system created in Vientiane capital by the Institut Pasteur du Laos appears to be a strategic tool for monitoring the circulation of the four serotypes, especially in this endemic country, and allows for improving dengue epidemiological knowledge to anticipate epidemic events better.
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Han A, Sun B, Sun Z, Xu X, Yang Q, Xie D, Guan W, Lou Y. Molecular Characterization and Phylogenetic Analysis of the 2019 Dengue Outbreak in Wenzhou, China. Front Cell Infect Microbiol 2022; 12:829380. [PMID: 35663472 PMCID: PMC9161089 DOI: 10.3389/fcimb.2022.829380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/25/2022] [Indexed: 01/03/2023] Open
Abstract
In 2019, a dengue outbreak occurred with 290 confirmed cases in Wenzhou, a coastal city in southeast China. To identify the origin of the dengue virus (DENV) from this outbreak, viral RNA was extracted from four serum samples and sequenced for whole genome analysis. Then, phylogenetic analysis, gene mutation, secondary structure prediction, selection pressure analysis, and recombination analysis were performed. DENV strains Cam-03 and Cam-11 were isolated from patients traveling from Cambodia, while ZJWZ-18 and ZJWZ-62 strains were isolated from local patients without a record of traveling abroad. The whole genome sequence of all four strains was 10,735 nucleotides long. Phylogenetic tree analysis showed that the four strains belonged to genotype 1 of DENV-1, but the local Wenzhou strains and imported strains clustered in different branches. ZJWZ-18 and ZJWZ-62 were closely related to strain MF033254-Singapore-2016, and Cam-03 and Cam-11 were closely related to strain AB608788-China : Taiwan-1994. A comparison of the coding regions between the local strains and the DENV-1 standard strain (EU848545-Hawaii-1944) showed 82 amino acid mutations between the two strains. A total of 55 amino acid mutations were found between the coding regions of the local and imported strains. The overall secondary structure of the 3' UTR of the local strains had changed: apparent changes in the head and tail position were observed when compared to DENV-1 standard strain. Furthermore, selection pressure analysis and recombination detection using the 4 isolates and 41 reference strains showed two credible positive selection sites and eight credible recombination events, which warrant further studies. This study may enhance the understanding of viral replication, infection, evolution, virulence, and pathogenicity of DENV.
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Affiliation(s)
- Axiang Han
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, China, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
- Department of Clinical Laboratory, Ningbo First Hospital, Ningbo, China
| | - Baochang Sun
- Department of Laboratory, Wenzhou Center for Disease Control and Prevention, Wenzhou, China
| | - Zhewei Sun
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, China, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Xuelian Xu
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, China, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Qiongying Yang
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, China, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Danli Xie
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, China, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Wanchun Guan
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, China, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Yongliang Lou
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, China, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
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Acute-phase Serum Cytokine Levels and Correlation with Clinical Outcomes in Children and Adults with Primary and Secondary Dengue Virus Infection in Myanmar between 2017 and 2019. Pathogens 2022; 11:pathogens11050558. [PMID: 35631079 PMCID: PMC9144711 DOI: 10.3390/pathogens11050558] [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: 02/15/2022] [Revised: 04/19/2022] [Accepted: 05/02/2022] [Indexed: 01/27/2023] Open
Abstract
The dengue virus (DENV) has been endemic in Myanmar since 1970, causing outbreaks every 2–3 years. DENV infection symptoms range from mild fever to lethal hemorrhage. Clinical biomarkers must be identified to facilitate patient risk stratification in the early stages of infection. We analyzed 45 cytokines and other factors in serum samples from the acute phase of DENV infection (within 3–5 days of symptom onset) from 167 patients in Yangon, Myanmar, between 2017 and 2019. All of the patients tested positive for serum DENV nonstructural protein 1 antigen (NS1 Ag); 78.4% and 62.9% were positive for immunoglobulin M (IgM) and G (IgG), respectively; and 18.0%, 19.8%, and 11.9% tested positive for serotypes 1, 3, and 4, respectively. Although the DENV-4 viral load was significantly higher than those of DENV-1 or DENV-3, disease severity was not associated with viral load or serotype. Significant correlations were identified between disease severity and CCL5, SCF, PDGF-BB, IL-10, and TNF-α levels; between NS1 Ag and SCF, CCL5, IFN-α, IL-1α, and IL-22 levels; between thrombocytopenia and IL-2, TNF-α, VEGF-D, and IL-6 levels; and between primary or secondary infection and IL-2, IL-6, IL-31, IL-12p70, and MIP-1β levels. These circulating factors may represent leading signatures in acute DENV infections, reflecting the clinical outcomes in the dengue endemic region, Myanmar.
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Knockdown Resistance Mutations in the Voltage-Gated Sodium Channel of Aedes aegypti (Diptera: Culicidae) in Myanmar. INSECTS 2022; 13:insects13040322. [PMID: 35447764 PMCID: PMC9028491 DOI: 10.3390/insects13040322] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022]
Abstract
Simple Summary Knockdown resistance (kdr) mutations in the voltage-gated sodium channel (VGSC) of mosquitoes confer resistance to pyrethroid insecticides. Analysis of kdr mutations in Aedes aegypti mosquitoes collected from five different townships in the Mandalay area, Myanmar, revealed high levels of validated kdr mutations in domains II and III of vgsc. Moreover, high frequencies of concurrent kdr mutations were also detected. The results of this study suggest that kdr mutations associated with pyrethroid resistance are widespread in the Ae. aegypti population of the study area. Our results provide a valuable molecular basis to understand the pyrethroid resistance status of the Ae. aegypti population in the area and underscore the need for an effective vector control program in Myanmar. Abstract Aedes aegypti is an important mosquito vector transmitting diverse arboviral diseases in Myanmar. Pyrethroid insecticides have been widely used in Myanmar as the key mosquito control measure, but the efforts are constrained by increasing resistance. Knockdown resistance (kdr) mutations in the voltage-gated sodium channel (VGSC) are related to pyrethroid resistance in Ae. aegypti. We analyzed the patterns and distributions of the kdr mutations in Ae. aegypti in the Mandalay area of Myanmar. The segment 6 regions of domains II and III of vgsc were separately amplified from individual Ae. aegypti genomic DNA via polymerase chain reaction. The amplified gene fragments were sequenced. High proportions of three major kdr mutations, including S989P (54.8%), V1016G (73.6%), and F1534C (69.5%), were detected in the vgsc of Ae. aegypti from all studied areas. Other kdr mutations, T1520I and F1534L, were also found. These kdr mutations represent 11 distinct haplotypes of the vgsc population. The S989P/V1016G/F1534C was the most prevalent, followed by S989P/V1016V and V1016G/F1534C. A quadruple mutation, S989P/V1016G/T1520I/F1534C, was also identified. High frequencies of concurrent kdr mutations were observed in vgsc of Myanmar Ae. aegypti, suggesting a high level of pyrethroid resistance in the population. These findings underscore the need for an effective vector control program in Myanmar.
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Menter DG, Afshar-Kharghan V, Shen JP, Martch SL, Maitra A, Kopetz S, Honn KV, Sood AK. Of vascular defense, hemostasis, cancer, and platelet biology: an evolutionary perspective. Cancer Metastasis Rev 2022; 41:147-172. [PMID: 35022962 PMCID: PMC8754476 DOI: 10.1007/s10555-022-10019-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/04/2022] [Indexed: 01/08/2023]
Abstract
We have established considerable expertise in studying the role of platelets in cancer biology. From this expertise, we were keen to recognize the numerous venous-, arterial-, microvascular-, and macrovascular thrombotic events and immunologic disorders are caused by severe, acute-respiratory-syndrome coronavirus 2 (SARS-CoV-2) infections. With this offering, we explore the evolutionary connections that place platelets at the center of hemostasis, immunity, and adaptive phylogeny. Coevolutionary changes have also occurred in vertebrate viruses and their vertebrate hosts that reflect their respective evolutionary interactions. As mammals adapted from aquatic to terrestrial life and the heavy blood loss associated with placentalization-based live birth, platelets evolved phylogenetically from thrombocytes toward higher megakaryocyte-blebbing-based production rates and the lack of nuclei. With no nuclei and robust RNA synthesis, this adaptation may have influenced viral replication to become less efficient after virus particles are engulfed. Human platelets express numerous receptors that bind viral particles, which developed from archetypal origins to initiate aggregation and exocytic-release of thrombo-, immuno-, angiogenic-, growth-, and repair-stimulatory granule contents. Whether by direct, evolutionary, selective pressure, or not, these responses may help to contain virus spread, attract immune cells for eradication, and stimulate angiogenesis, growth, and wound repair after viral damage. Because mammalian and marsupial platelets became smaller and more plate-like their biophysical properties improved in function, which facilitated distribution near vessel walls in fluid-shear fields. This adaptation increased the probability that platelets could then interact with and engulf shedding virus particles. Platelets also generate circulating microvesicles that increase membrane surface-area encounters and mark viral targets. In order to match virus-production rates, billions of platelets are generated and turned over per day to continually provide active defenses and adaptation to suppress the spectrum of evolving threats like SARS-CoV-2.
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Affiliation(s)
- David G Menter
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Vahid Afshar-Kharghan
- Division of Internal Medicine, Benign Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - John Paul Shen
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephanie L Martch
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anirban Maitra
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Scott Kopetz
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kenneth V Honn
- Department of Pathology, Bioactive Lipids Research Program, Wayne State University, 5101 Cass Ave. 430 Chemistry, Detroit, MI, 48202, USA
- Department of Pathology, Wayne State University School of Medicine, 431 Chemistry Bldg, Detroit, MI, 48202, USA
- Cancer Biology Division, Wayne State University School of Medicine, 431 Chemistry Bldg, Detroit, MI, 48202, USA
| | - Anil K Sood
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
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Luvai EAC, Kyaw AK, Sabin NS, Yu F, Hmone SW, Thant KZ, Inoue S, Morita K, Ngwe Tun MM. Evidence of Chikungunya virus seroprevalence in Myanmar among dengue-suspected patients and healthy volunteers in 2013, 2015, and 2018. PLoS Negl Trop Dis 2021; 15:e0009961. [PMID: 34851949 PMCID: PMC8635363 DOI: 10.1371/journal.pntd.0009961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/01/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Chikungunya virus (CHIKV) is a mosquito-borne virus known to cause acute febrile illness associated with debilitating polyarthritis. In 2019, several institutions in Myanmar reported a CHIKV outbreak. There are no official reports of CHIKV cases between 2011 and 2018. Therefore, this study sought to determine the seroprevalence of CHIKV infection before the 2019 outbreak. METHODS A total of 1,544 serum samples were collected from healthy volunteers and patients with febrile illnesses in Yangon, Mandalay, and the Myeik district in 2013, 2015, and 2018. Participants ranged from one month to 65 years of age. Antibody screening was performed with in-house anti-CHIKV IgG and IgM ELISA. A neutralization assay was used as a confirmatory test. RESULTS The seroprevalence of anti-CHIKV IgM and anti-CHIKV IgG was 8.9% and 28.6%, respectively, with an overall seropositivity rate of 34.5%. A focus reduction neutralization assay confirmed 32.5% seroprevalence of CHIKV in the study population. Age, health status, and region were significantly associated with neutralizing antibodies (NAbs) and CHIKV seropositivity (p < 0.05), while gender was not (p = 0.9). Seroprevalence in 2013, 2015, and 2018 was 32.1%, 28.8%, and 37.3%, respectively. Of the clinical symptoms observed in participants with fevers, arthralgia was mainly noted in CHIKV-seropositive patients. CONCLUSION The findings in this study reveal the circulation of CHIKV in Myanmar's Mandalay, Yangon, and Myeik regions before the 2019 CHIKV outbreak. As no treatment or vaccine for CHIKV exists, the virus must be monitored through systematic surveillance in Myanmar.
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Affiliation(s)
- Elizabeth Ajema Chebichi Luvai
- Department of Virology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Department of Biomedical Sciences and Technology, School of Health and Biomedical Sciences, The Technical University of Kenya, Nairobi, Kenya
| | - Aung Kyaw Kyaw
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Nundu Sabiti Sabin
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Fuxun Yu
- Guizhou Provincial People’s Hospital, Guiyang City, Guizhou Province, China
| | - Saw Wut Hmone
- Department of Pathology, University of Medicine-1, Lanmadaw township, Yangon, Myanmar
| | - Kyaw Zin Thant
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Shingo Inoue
- Department of Virology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
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Poltep K, Phadungsombat J, Nakayama EE, Kosoltanapiwat N, Hanboonkunupakarn B, Wiriyarat W, Shioda T, Leaungwutiwong P. Genetic Diversity of Dengue Virus in Clinical Specimens from Bangkok, Thailand, during 2018-2020: Co-Circulation of All Four Serotypes with Multiple Genotypes and/or Clades. Trop Med Infect Dis 2021; 6:tropicalmed6030162. [PMID: 34564546 PMCID: PMC8482112 DOI: 10.3390/tropicalmed6030162] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Dengue is an arboviral disease highly endemic in Bangkok, Thailand. To characterize the current genetic diversity of dengue virus (DENV), we recruited patients with suspected DENV infection at the Hospital for Tropical Diseases, Bangkok, during 2018-2020. We determined complete nucleotide sequences of the DENV envelope region for 111 of 276 participant serum samples. All four DENV serotypes were detected, with the highest proportion being DENV-1. Although all DENV-1 sequences were genotype I, our DENV-1 sequences were divided into four distinct clades with different distributions in Asian countries. Two genotypes of DENV-2 were identified, Asian I and Cosmopolitan, which were further divided into two and three distinct clades, respectively. In DENV-3, in addition to the previously dominant genotype III, a cluster of 6 genotype I viruses only rarely reported in Thailand was also observed. All of the DENV-4 viruses belonged to genotype I, but they were separated into three distinct clades. These results indicated that all four serotypes of DENV with multiple genotypes and/or clades co-circulate in Bangkok. Continuous investigation of DENV is warranted to further determine the relationship between DENV within Thailand and neighboring countries in Southeast Asia and Asia.
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Affiliation(s)
- Kanaporn Poltep
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (K.P.); (N.K.)
- Mahidol-Osaka Center for Infectious Diseases (MOCID), Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (J.P.); (E.E.N.)
- The Monitoring and Surveillance Center for Zoonotic Diseases in Wildlife and Exotic Animals, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom 73170, Thailand;
| | - Juthamas Phadungsombat
- Mahidol-Osaka Center for Infectious Diseases (MOCID), Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (J.P.); (E.E.N.)
- Department of Viral Infections, Research Institute for Microbial Diseases (RIMD), Osaka University, Osaka 565-0871, Japan
| | - Emi E. Nakayama
- Mahidol-Osaka Center for Infectious Diseases (MOCID), Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (J.P.); (E.E.N.)
- Department of Viral Infections, Research Institute for Microbial Diseases (RIMD), Osaka University, Osaka 565-0871, Japan
| | - Nathamon Kosoltanapiwat
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (K.P.); (N.K.)
| | - Borimas Hanboonkunupakarn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
| | - Witthawat Wiriyarat
- The Monitoring and Surveillance Center for Zoonotic Diseases in Wildlife and Exotic Animals, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom 73170, Thailand;
| | - Tatsuo Shioda
- Mahidol-Osaka Center for Infectious Diseases (MOCID), Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (J.P.); (E.E.N.)
- Department of Viral Infections, Research Institute for Microbial Diseases (RIMD), Osaka University, Osaka 565-0871, Japan
- Correspondence: (T.S.); (P.L.)
| | - Pornsawan Leaungwutiwong
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (K.P.); (N.K.)
- Correspondence: (T.S.); (P.L.)
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Ngwe Tun MM, Pandey K, Nabeshima T, Kyaw AK, Adhikari M, Raini SK, Inoue S, Dumre SP, Pandey BD, Morita K. An Outbreak of Dengue Virus Serotype 2 Cosmopolitan Genotype in Nepal, 2017. Viruses 2021; 13:v13081444. [PMID: 34452310 PMCID: PMC8402744 DOI: 10.3390/v13081444] [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: 06/14/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022] Open
Abstract
Dengue virus (DENV) is one of the most prevalent neglected tropical diseases, with half of the world's population at risk of infection. In Nepal, DENV was first reported in 2004, and its prevalence is increasing every year. The present study aimed to obtain and characterize the full-length genome sequence of DENV from the 2017 outbreak. Hospital-based surveillance was conducted in two provinces of Nepal during the outbreak. Acute-phase serum samples were collected from 141 clinically suspected dengue patients after the rainy season. By serological and molecular techniques, 37 (26.9%) and 49 (34.8%), respectively, were confirmed as dengue patients. The cosmopolitan genotype of DENV-2 was isolated from 27 laboratory-confirmed dengue patients. Genomic analysis showed many amino acid substitutions distributed mainly among the E, NS3, and NS5 genes. Phylogenetic analyses of the whole genome sequence revealed two clades (Asian and Indian) among DENV-2 isolates from Nepal. The DENV isolates from hilly and Terai areas were similar to Asian and Indian strains, respectively. Further genomic study on different DENV serotypes is warranted to understand DENV epidemics in Nepal, where there are limited scientific resources and infrastructure.
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Affiliation(s)
- Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; (M.M.N.T.); (T.N.); (A.K.K.); (S.K.R.); (S.I.)
| | - Kishor Pandey
- Central Department of Zoology, Institute of Science and Technology, Tribhuvan University, Kathmandu 44060, Nepal;
| | - Takeshi Nabeshima
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; (M.M.N.T.); (T.N.); (A.K.K.); (S.K.R.); (S.I.)
| | - Aung Kyaw Kyaw
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; (M.M.N.T.); (T.N.); (A.K.K.); (S.K.R.); (S.I.)
| | - Mandira Adhikari
- Shi-Gan International College of Science and Technology, Kathmandu 44060, Nepal;
| | - Sandra Kendra Raini
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; (M.M.N.T.); (T.N.); (A.K.K.); (S.K.R.); (S.I.)
| | - Shingo Inoue
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; (M.M.N.T.); (T.N.); (A.K.K.); (S.K.R.); (S.I.)
| | - Shyam Prakash Dumre
- Central Department of Microbiology, Institute of Science and Technology, Tribhuvan University, Kirtipur 44618, Nepal;
| | - Basu Dev Pandey
- Ministry of Health and Population, Kathmandu 44060, Nepal
- Correspondence: (B.D.P.); (K.M.); Tel.: +977-9851065451 (B.D.P.); +81-95-819-7827 (K.M.)
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; (M.M.N.T.); (T.N.); (A.K.K.); (S.K.R.); (S.I.)
- Correspondence: (B.D.P.); (K.M.); Tel.: +977-9851065451 (B.D.P.); +81-95-819-7827 (K.M.)
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10
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Ngwe Tun MM, Hmone SW, Soe AM, Luvai E, Nwe KM, Inoue S, Buerano CC, Thant KZ, Morita K. Zika virus infection in asymptomatic persons in Myanmar, 2018. Trans R Soc Trop Med Hyg 2021; 114:440-447. [PMID: 32043531 DOI: 10.1093/trstmh/trz134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 10/14/2019] [Accepted: 12/06/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Zika virus (ZIKV) is a mosquito-borne flavivirus. Outbreaks of ZIKV infection have occurred in Africa, Southeast Asia, the Pacific Islands, the Americas and the Caribbean. Although most ZIKV infections are asymptomatic, cases of neurological manifestations have been described. The aim of the present study was to identify the prevalence of ZIKV infection among the asymptomatic persons in Myanmar in 2018. METHODS A total of 284 serum samples from apparently healthy persons were collected from Yangon, Myanmar in 2018. They were analysed for ZIKV infection by immunoglobulin M (IgM) capture enzyme-linked immunosorbent assay (ELISA), IgG indirect ELISA, 50% focus reduction neutralization test, real-time reverse transcription polymerase chain reaction (RT-PCR) and conventional RT-PCR. RESULTS Of the 284 apparently healthy persons, 31.3% were positive for the presence of IgM against ZIKV and 94.3% were positive for anti-flavivirus IgG. Among the ZIKV IgM-positive samples, we confirmed ZIKV infection in 15.8% of asymptomatic persons by neutralization test and real-time RT-PCR. CONCLUSIONS We conclude that ZIKV infection was increasing among asymptomatic persons in the same area in Myanmar during 2018 compared with 2017. It is highly recommended to strengthen the surveillance system for ZIKV to prevent possible outbreaks.
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Affiliation(s)
- Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan, PO 852-8523
| | - Saw Wut Hmone
- Department of Pathology, University of Medicine-1, No. 245, Lanmadaw township, Yangon, Myanmar, PO 11131
| | - Aung Min Soe
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan, PO 852-8523.,Virology Research Division, Department of Medical Research, No. 16, Pyin Oo lwin, Myanmar, PO 05062
| | - Elizabeth Luvai
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan, PO 852-8523
| | - Khine Mya Nwe
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan, PO 852-8523
| | - Shingo Inoue
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan, PO 852-8523
| | - Corazon C Buerano
- Research and Biotechnology, St Luke's Medical Center, Rodriguez Sr. Ave., Quezon City, Philippines, PO 1112
| | - Kyaw Zin Thant
- Virology Research Division, Department of Medical Research, No. 16, Pyin Oo lwin, Myanmar, PO 05062
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan, PO 852-8523
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11
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Kulkarni R, Shrivastava S, Patil HP, Tiraki D, Mishra AC, Arankalle VA. Correlation of serostatus and viraemia levels among Indian dengue patients at the time of first diagnosis. Trans R Soc Trop Med Hyg 2021; 114:513-520. [PMID: 32484863 DOI: 10.1093/trstmh/traa027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/03/2020] [Accepted: 04/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Dengue is a public health problem worldwide. Therapeutic monoclonal antibodies (MAbs) against dengue virus (DENV) are likely to be available soon. In view of the feasibility issues pertaining to pretreatment viraemia quantitation for therapy decisions, we conducted this study for investigation of a correlation between patient serostatus (NS1/immunoglobulin M [IgM]/IgG) and viraemia levels among Indian dengue patients at the time of first diagnosis. METHODS The study included 297 serum samples from dengue patients in Pune, India. The samples were tested for NS1, IgM and IgG (capture enzyme-linked immunosorbent assay [ELISA] for identifying secondary dengue) using Panbio ELISAs. Quantitation of viraemia was conducted using an NS1 ELISA-based 50% tissue culture infectious dose (TCID50) test in Vero cells. RESULTS Viraemia was detectable only among NS1-positive patients (n = 229, range 0.5-8.3 logTCID50/ml) with a mean titre of 1.9 logTCID50/ml. Among the NS1-positive patients, DENV titres were higher in IgM-negative than IgM-positive patients (p < 0.0001) and in primary (IgG < 18 Panbio units) versus secondary (IgG > 22 Panbio units) dengue patients (p = 0.002). Virus titres were higher during the first 3 days of illness and decreased later (p = 0.005). CONCLUSIONS The study provides a range of infectious DENV titres in relation to serologic status among dengue patients in India. The data suggest the possibility of using serological markers (NS1/IgM) as a basis for treatment decisions.
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Affiliation(s)
- Ruta Kulkarni
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune-Satara Road, Katraj-Dhankawadi, Pune 411043, India
| | - Shubham Shrivastava
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune-Satara Road, Katraj-Dhankawadi, Pune 411043, India
| | - Harshad P Patil
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune-Satara Road, Katraj-Dhankawadi, Pune 411043, India
| | - Divya Tiraki
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune-Satara Road, Katraj-Dhankawadi, Pune 411043, India
| | - Akhilesh Chandra Mishra
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune-Satara Road, Katraj-Dhankawadi, Pune 411043, India
| | - Vidya A Arankalle
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune-Satara Road, Katraj-Dhankawadi, Pune 411043, India
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12
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Tsheten T, Gray DJ, Clements ACA, Wangdi K. Epidemiology and challenges of dengue surveillance in the WHO South-East Asia Region. Trans R Soc Trop Med Hyg 2021; 115:583-599. [PMID: 33410916 DOI: 10.1093/trstmh/traa158] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/02/2020] [Accepted: 11/18/2020] [Indexed: 11/13/2022] Open
Abstract
Dengue poses a significant health and economic burden in the WHO South-East Asia Region. Approaches for control need to be aligned with current knowledge on the epidemiology of dengue in the region. Such knowledge will ensure improved targeting of interventions to reduce dengue incidence and its socioeconomic impact. This review was undertaken to describe the contemporary epidemiology of dengue and critically analyse the existing surveillance strategies in the region. Over recent decades, dengue incidence has continued to increase with geographical expansion. The region has now become hyper-endemic for multiple dengue virus serotypes/genotypes. Every epidemic cycle was associated with a change of predominant serotype/genotype and this was often associated with severe disease with intense transmission. Classical larval indices are widely used in vector surveillance and adult mosquito samplings are not implemented as a part of routine surveillance. Further, there is a lack of integration of entomological and disease surveillance systems, often leading to inaction or delays in dengue prevention and control. Disease surveillance does not capture all cases, resulting in under-reporting, and has thus failed to adequately represent the true burden of disease in the region. Possible solutions include incorporating adult mosquito sampling into routine vector surveillance, the establishment of laboratory-based sentinel surveillance, integrated vector and dengue disease surveillance and climate-based early warning systems using available technologies like mobile apps.
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Affiliation(s)
- Tsheten Tsheten
- Department of Globa l Health, Research School of Population Health, Australian National University, Canberra, Australia.,Royal Centre for Disease Control, Ministry of Health, Bhutan
| | - Darren J Gray
- Department of Globa l Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Perth, Australia.,Telethon Kids Institute, Nedlands, Australia
| | - Kinley Wangdi
- Department of Globa l Health, Research School of Population Health, Australian National University, Canberra, Australia
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13
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Emergence of a Novel Dengue Virus 3 (DENV-3) Genotype-I Coincident with Increased DENV-3 Cases in Yangon, Myanmar between 2017 and 2019. Viruses 2021; 13:v13061152. [PMID: 34208667 PMCID: PMC8235066 DOI: 10.3390/v13061152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022] Open
Abstract
Dengue fever, caused by the mosquito-borne dengue virus (DENV), has been endemic in Myanmar since 1970 and it has become a significant public health burden. It is crucial that circulating DENV strains are identified and monitored, and that their transmission efficiency and association with disease severity is understood. In this study, we analyzed DENV-1, DENV-2, DENV-3, and DENV-4 serotypes in 1235 serum samples collected in Myanmar between 2017 and 2019. Whole-genome sequencing of DENV-1–4 demonstrated that most DENV-1–4 strains had been circulating in Myanmar for several years. We also identified the emergence of DENV-3 genotype-I in 2017 samples, which persisted through 2018 and 2019. The emergence of the strain coincided with a period of increased DENV-3 cases and marked changes in the serotype dynamics. Nevertheless, we detected no significant differences between serum viral loads, disease severity, and infection status of individuals infected with different DENV serotypes during the 3-year study. Our results not only identify the spread of a new DENV-3 genotype into Yangon, Myanmar, but also support the importance of DENV evolution in changing the epidemic dynamics in endemic regions.
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14
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Ngwe Tun MM, Kyaw AK, Nabeshima T, Soe AM, Nwe KM, Htet KKK, Aung TH, Htwe TT, Aung T, Myaing SS, Mar TT, Lwin EP, Thu HM, Thant KZ, Morita K. Detection of genotype-1 of dengue virus serotype 3 for the first time and complete genome analysis of dengue viruses during the 2018 epidemic in Mandalay, Upper Myanmar. PLoS One 2021; 16:e0251314. [PMID: 34086703 PMCID: PMC8177515 DOI: 10.1371/journal.pone.0251314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Dengue (DEN) is a neglected tropical disease, and surveillance of dengue virus (DENV) serotypes and genotypes is critical for the early detection of outbreaks. Risk factors for outbreaks include the emergence of new genotypes and serotype shifting. Methodology and principal findings To understand the genomic and viral characteristics of DENV-infected patients, we conducted a cross-sectional descriptive study among pediatric patients admitted at the 550-bedded Mandalay Children Hospital during the 2018 DEN endemic season. We conducted virus isolation, serological tests, viremia level measurement, and whole-genome sequencing. Among the 202 serum samples, we detected 85 samples with DENV (46 DENV-1, 10 DENV-3, 26 DENV-4 and three multiple serotype co-infections) via reverse transcription quantitative/real-time PCR (RT-qPCR), and we obtained 49 DENV isolates (31 DENV-1, 10 DENV-3 and 8 DEN-4). We did not detect DENV-2 in this study. The viral genome levels in serum did not differ significantly among virus serotypes, infection status (primary versus secondary) and disease severity. Based on the phylogenetic analysis, we identified DENV-1 genotype-1, DENV-4 genotype-1 and DENV-3 genotype-3 and genotype-1 which was detected for the first time. Next-generation sequencing analysis revealed greater frequencies of nonsynonymous and synonymous mutations per gene in the nonstructural genes. Moreover, mutation rates were also higher among DENV-1. Conclusion/Significance In conclusion, there was an increasing trend of DENV-3 cases during DENV endemic season in 2018 with the first detection of the genotype 1. However, DENV-1 has remained the predominant serotype in this study area since 2013, and we identified stop codon mutations in the DENV-1 genome. This report is the first to feature a complete genome analysis of the strains of DENV-3 and DENV-4 circulating among pediatric patients in Myanmar. This study highlighted the importance of annual surveillance for a better understanding of the molecular epidemiology of DENVs.
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Affiliation(s)
- Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- * E-mail: (MMNT); (KM)
| | - Aung Kyaw Kyaw
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Takeshi Nabeshima
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Aung Min Soe
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Khine Mya Nwe
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Kyaw Ko Ko Htet
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Thet Htoo Aung
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Thein Thein Htwe
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Thidar Aung
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Su Su Myaing
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Tu Tu Mar
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Ei Phyu Lwin
- Department of Medical Services, 550 Bedded Children Hospital (Mandalay), Ministry of Health and Sports, Mandalay, Myanmar
| | - Hlaing Myat Thu
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | | | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- * E-mail: (MMNT); (KM)
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15
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Kyaw AK, Ngwe Tun MM, Naing ST, Htwe TT, Mar TT, Khaing TM, Aung T, Aye KS, Thant KZ, Morita K. Inapparent dengue virus infection among students in Mandalay, Myanmar. Trans R Soc Trop Med Hyg 2021; 114:57-61. [PMID: 31638146 DOI: 10.1093/trstmh/trz071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/18/2019] [Accepted: 07/02/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A school- and laboratory-based cross-sectional descriptive study was conducted to find out the burden of inapparent dengue virus (DENV) infection in Mandalay where DENV is endemic and there is circulation of all four DENV serotypes. METHODS A total of 420 students who had no history of fever and visited the hospital within 6 months were recruited from three monastic schools. Serum samples were collected and the DENV genome was checked by conventional one-step RT-PCR and anti-DENV IgM and IgG antibodies were determined. Inapparent dengue (DEN) infection is defined as individuals who were either RT-PCR-positive or anti-DENV IgM-positive with no clinical manifestations or mild symptoms, and which are not linked to a visit to a healthcare provider. RESULTS Among 420 students, 38 students (9.0%, 95% CI, 6.4 to 12.2) were confirmed as recent inapparent DEN infection. The DENV serotype-1 was detected in six students. Thirty-one out of 38 (81.6%) laboratory-confirmed inapparent DEN-infected students had primary infections and seven (18.4%) had secondary infections. CONCLUSION This study explored the prevalence of inapparent DEN infection rate in urban monastic schools in Mandalay and showed that the rate of primary infection among inapparent DENV-infected children was high.
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Affiliation(s)
- Aung Kyaw Kyaw
- Department of Medical Research, Pyin Oo Lwin Branch, Ward No (16), Near Anisakhan Airport, Pyin Oo Lwin, Mandalay Region, Myanmar, PO-05062
| | - Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto Nagasaki, Japan, PO 852-8523
| | - Shine Thura Naing
- Department of Medical Research, Pyin Oo Lwin Branch, Ward No (16), Near Anisakhan Airport, Pyin Oo Lwin, Mandalay Region, Myanmar, PO-05062
| | - Thein Thein Htwe
- Department of Medical Research, Pyin Oo Lwin Branch, Ward No (16), Near Anisakhan Airport, Pyin Oo Lwin, Mandalay Region, Myanmar, PO-05062
| | - Tu Tu Mar
- Department of Medical Research, Pyin Oo Lwin Branch, Ward No (16), Near Anisakhan Airport, Pyin Oo Lwin, Mandalay Region, Myanmar, PO-05062
| | - Tin Moe Khaing
- Department of Medical Research, Pyin Oo Lwin Branch, Ward No (16), Near Anisakhan Airport, Pyin Oo Lwin, Mandalay Region, Myanmar, PO-05062
| | - Thidar Aung
- Department of Medical Research, Pyin Oo Lwin Branch, Ward No (16), Near Anisakhan Airport, Pyin Oo Lwin, Mandalay Region, Myanmar, PO-05062
| | - Khin Saw Aye
- Department of Medical Research, Pyin Oo Lwin Branch, Ward No (16), Near Anisakhan Airport, Pyin Oo Lwin, Mandalay Region, Myanmar, PO-05062
| | - Kyaw Zin Thant
- Department of Medical Research, Pyin Oo Lwin Branch, Ward No (16), Near Anisakhan Airport, Pyin Oo Lwin, Mandalay Region, Myanmar, PO-05062
| | - Kouichi Morita
- Department of Medical Research, Pyin Oo Lwin Branch, Ward No (16), Near Anisakhan Airport, Pyin Oo Lwin, Mandalay Region, Myanmar, PO-05062
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16
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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.
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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
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17
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Naw H, Su MNC, Võ TC, Lê HG, Kang JM, Jun H, Mya YY, Myint MK, Lee J, Sohn WM, Kim TS, Na BK. Overall Prevalence and Distribution of Knockdown Resistance (kdr) Mutations in Aedes aegypti from Mandalay Region, Myanmar. THE KOREAN JOURNAL OF PARASITOLOGY 2021; 58:709-714. [PMID: 33412777 PMCID: PMC7806427 DOI: 10.3347/kjp.2020.58.6.709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/18/2020] [Indexed: 12/02/2022]
Abstract
Knockdown resistance (kdr) mutations in the voltage-gated sodium channel (VGSC) of mosquitoes confer resistance to insecticides. Although insecticide resistance has been suspected to be widespread in the natural population of Aedes aegypti in Myanmar, only limited information is currently available. The overall prevalence and distribution of kdr mutations was analyzed in Ae. aegypti from Mandalay areas, Myanmar. Sequence analysis of the VGSC in Ae. aegypti from Myanmar revealed amino acid mutations at 13 and 11 positions in domains II and III of VGSC, respectively. High frequencies of S989P (68.6%), V1016G (73.5%), and F1534C (40.1%) were found in domains II and III. T1520I was also found, but the frequency was low (8.1%). The frequency of S989P/V1016G was high (55.0%), and the frequencies of V1016G/F1534C and S989P/V1016G/F1534C were also high at 30.1% and 23.5%, respectively. Novel mutations in domain II (L963Q, M976I, V977A, M994T, L995F, V996M/A, D998N, V999A, N1013D, and F1020S) and domain III (K1514R, Y1523H, V1529A, F1534L, F1537S, V1546A, F1551S, G1581D, and K1584R) were also identified. These results collectively suggest that high frequencies of kdr mutations were identified in Myanmar Ae. aegypti, indicating a high level of insecticide resistance.
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Affiliation(s)
- Haung Naw
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju 52727, Korea.,Department of Convergence Medical Science, Gyeongsang National University, Jinju 52727, Korea
| | - Mya Nilar Chaw Su
- Department of Medical Research Pyin Oo Lwin Branch, Pyin Oo Lwin, Myanmar
| | - Tuấn Cường Võ
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju 52727, Korea.,Department of Convergence Medical Science, Gyeongsang National University, Jinju 52727, Korea
| | - Hương Giang Lê
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju 52727, Korea.,Department of Convergence Medical Science, Gyeongsang National University, Jinju 52727, Korea
| | - Jung-Mi Kang
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju 52727, Korea.,Department of Convergence Medical Science, Gyeongsang National University, Jinju 52727, Korea
| | - Hojong Jun
- Department of Tropical Medicine, Inha University College of Medicine, Incheon 22212, Korea
| | - Yi Yi Mya
- Department of Medical Research Pyin Oo Lwin Branch, Pyin Oo Lwin, Myanmar
| | - Moe Kyaw Myint
- Department of Medical Research Pyin Oo Lwin Branch, Pyin Oo Lwin, Myanmar
| | - Jinyoung Lee
- Department of Tropical Medicine, Inha University College of Medicine, Incheon 22212, Korea
| | - Woon-Mok Sohn
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju 52727, Korea
| | - Tong-Soo Kim
- Department of Tropical Medicine, Inha University College of Medicine, Incheon 22212, Korea
| | - Byoung-Kuk Na
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju 52727, Korea.,Department of Convergence Medical Science, Gyeongsang National University, Jinju 52727, Korea
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18
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Ngwe Tun MM, Moriuchi M, Toizumi M, Luvai E, Raini S, Kitamura N, Takegata M, Nguyen HAT, Moi ML, Buerano CC, Anh DD, Yoshida LM, Morita K, Moriuchi H. Congenital Zika Virus Infection in a Birth Cohort in Vietnam, 2017-2018. Am J Trop Med Hyg 2021; 103:2059-2064. [PMID: 32815502 PMCID: PMC7646788 DOI: 10.4269/ajtmh.20-0286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To detect congenital ZIKV infection (CZI) in a birth cohort and among high-risk neonates in Vietnam, we collected umbilical cord blood plasma samples of newly delivered babies and peripheral plasma samples of high-risk neonates in Nha Trang, central Vietnam, between July 2017 and September 2018. Samples were subjected to serological and molecular tests. Of the 2013 newly delivered babies, 21 (1%) were positive for Zika virus (ZIKV) IgM and 1,599 (79%) for Flavivirus IgG. Among the 21 ZIKV IgM-positives, 11 were confirmed to have CZI because their plasma samples had anti-ZIKV neutralization titers ≥ 4 times higher than those against dengue virus (DENV)-1 to 4 and Japanese encephalitis virus (JEV) and were tested for the ZIKV RNA positive by real-time reverse transcription–PCR. Therefore, the incidence of CZI in our birth cohort was approximately 0.5%. Of the 150 high-risk neonates, three (2%) and 95 (63%) were positive for ZIKV IgM and Flavivirus IgG antibodies, respectively. None of the three ZIKV IgM-positives had ≥ 4 times higher anti-ZIKV neutralization titers than those against DENV-1 to 4 and JEV, and were therefore considered as probable CZI. Our results indicate that CZI is not rare in Vietnam. Although those with confirmed CZI did not show apparent symptoms suspected of congenital Zika syndrome at birth, detailed examinations and follow-up studies are needed to clarify the CZI impact in Vietnam. This is the first report of CZI cases in a birth cohort in Asia.
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Affiliation(s)
- Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine and Leading Program, Nagasaki University, Nagasaki, Japan
| | - Masako Moriuchi
- Department of Pediatrics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Michiko Toizumi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Elizabeth Luvai
- Department of Virology, Institute of Tropical Medicine and Leading Program, Nagasaki University, Nagasaki, Japan
| | - Sandra Raini
- Department of Virology, Institute of Tropical Medicine and Leading Program, Nagasaki University, Nagasaki, Japan
| | - Noriko Kitamura
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Mizuki Takegata
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | | | - Meng Ling Moi
- Department of Virology, Institute of Tropical Medicine and Leading Program, Nagasaki University, Nagasaki, Japan
| | - Corazon C Buerano
- Research and Biotechnology, St. Luke's Medical Center, Quezon City, Philippines
| | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine and Leading Program, Nagasaki University, Nagasaki, Japan
| | - Hiroyuki Moriuchi
- Department of Pediatrics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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19
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Morsy S, Hashan MR, Hieu TH, Mohammed AT, Elawady SS, Ghosh P, Elgendy MA, Le HH, Hamad WMA, Iqtadar S, Dumre SP, Hirayama K, Huy NT. The association between dengue viremia kinetics and dengue severity: A systemic review and meta-analysis. Rev Med Virol 2020; 30:1-10. [PMID: 32856357 DOI: 10.1002/rmv.2121] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/29/2022]
Abstract
In this study, we aim to assess the association of dengue viremia with dengue severity. The study protocol was developed and registered in PROSPERO (CRD42016039864). We searched nine databases to find potential papers. Studies meeting the inclusion criteria were included. We, based our analysis on three outcomes which are disease severity, dengue serotype and disease infection type. Thirty studies with 3316 patients were included. Our analysis revealed that viremia is significantly higher in dengue hemorrhagic fever patients than dengue fever in days 5 to 6. Regarding the serotype of dengue, the maximum viremia titre of serotype 1 was significantly higher than serotype 3 and the viremia in dengue serotype 2 was significantly higher than serotype 4 in days 2 to 4. However, comparison of the daily viremia level between the primary and secondary dengue infection revealed that secondary infection was significantly higher than the primary infection on seventh day and on the eighth day. Viremia is strongly associated with disease severity and type of infection which gave viremia a high indicative power to be used as a clinical predictor. Dengue serotype is also associated with viral load with higher viremia in DENV-2/1.
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Affiliation(s)
- Sara Morsy
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.,Online research Club (http://www.onlineresearchclub.org), Nagasaki, Japan
| | - Mohammad Rashidul Hashan
- Online research Club (http://www.onlineresearchclub.org), Nagasaki, Japan.,Respiratory and Enteric Infections Department, Infectious Disease Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Truong Hong Hieu
- Online research Club (http://www.onlineresearchclub.org), Nagasaki, Japan.,University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Abdelrahman Tarek Mohammed
- Online research Club (http://www.onlineresearchclub.org), Nagasaki, Japan.,Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Sameh Samir Elawady
- Online research Club (http://www.onlineresearchclub.org), Nagasaki, Japan.,Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Prithwish Ghosh
- Online research Club (http://www.onlineresearchclub.org), Nagasaki, Japan.,College Medicine and Sagore Dutta Hospital, West Bengal University of Health Science, West Bengal, India
| | - Manal A Elgendy
- Online research Club (http://www.onlineresearchclub.org), Nagasaki, Japan.,Biochemistry and Molecular Biology, Ain Shams University, Cairo, Egypt
| | - Huu-Hoai Le
- Online research Club (http://www.onlineresearchclub.org), Nagasaki, Japan.,Saigon General Hospital, Ho Chi Minh City, Vietnam
| | - Walid Mohamed Attiah Hamad
- Online research Club (http://www.onlineresearchclub.org), Nagasaki, Japan.,Internal Medicine Department Infectious Diseases Unit, Zagazig University, Zagazig, Egypt
| | - Somia Iqtadar
- Online research Club (http://www.onlineresearchclub.org), Nagasaki, Japan.,Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Shyam Prakash Dumre
- Department of Immunogenetics, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Nguyen Tien Huy
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.,Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
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20
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Ngwe Tun MM, Nguyen TTT, Ando T, Dumre SP, Soe AM, Buerano CC, Nguyen MT, Le NTN, Pham VQ, Nguyen TH, Le TQM, Morita K, Hasebe F. Clinical, Virological, and Cytokine Profiles of Children Infected with Dengue Virus during the Outbreak in Southern Vietnam in 2017. Am J Trop Med Hyg 2020; 102:1217-1225. [PMID: 32189614 DOI: 10.4269/ajtmh.19-0607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Dengue virus (DENV) infection is a major cause of morbidity and mortality in Vietnam, and the incidence is higher and more consistent in the southern part of the country. This study investigated the circulation of DENV serotypes, viremia levels, immunological status, and cytokine levels, with disease severities among children infected in 2017 in Ho Chi Minh City, Southern Vietnam. Acute and convalescent serum samples were collected from clinically diagnosed dengue children. They were confirmed to have DENV infection by NS1 antigen, IgM and IgG ELISAs, virus isolation, and conventional and real-time RT-PCR. Measurement of 10 cytokine levels was performed in the serum samples. All the children were dengue IgM positive; 28% and 72% of them had primary and secondary DENV infections, respectively, whereas 54% of those with secondary infection were children with dengue with warning signs and with severe dengue. Any or mixed infection of the four serotypes of DENV RNA was detected in 58 children. Twenty DENV strains (DENV-1 = 16 and DENV-4 = 4) were isolated. Levels of IFN-γ, TNF-α, MCP-1, IL-10, and IL-6 were significantly higher in severe dengue cases. We report the predominance of DENV-1 over other serotypes in the 2017 dengue outbreak in Southern Vietnam. Our data showed that cytokine expressions were correlated with dengue pathogenesis and may help in identifying an effective therapeutic strategy.
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Affiliation(s)
- Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Thi Thu Thuy Nguyen
- Department of Virology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tsuyoshi Ando
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Shyam Prakash Dumre
- Department of Immunogenetics, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Aung Min Soe
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Corazon C Buerano
- Research and Biotechnology, St Luke's Medical Center, Quezon City, Philippines
| | - Minh Tuan Nguyen
- Dengue Department, Children Hospital No. (1), Ho Chi Minh, Vietnam
| | | | - Van Quang Pham
- ICU Department, Children Hospital No. (1), Ho Chi Minh, Vietnam
| | | | - Thi Quynh Mai Le
- Department of Virology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Futoshi Hasebe
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Center of International Collaboration Research, Nagasaki University, Nagasaki, Japan
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21
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Calvez E, Somlor S, Viengphouthong S, Balière C, Bounmany P, Keosenhom S, Caro V, Grandadam M. Rapid genotyping protocol to improve dengue virus serotype 2 survey in Lao PDR. PLoS One 2020; 15:e0237384. [PMID: 32764809 PMCID: PMC7413503 DOI: 10.1371/journal.pone.0237384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/24/2020] [Indexed: 12/30/2022] Open
Abstract
Dengue fever is one of the major public health problems in Lao PDR. Over the last decade, dengue virus (DENV) epidemics were characterized by a novel predominant serotype accompanied by at least two other serotypes. Since 2008, DENV-2 circulated at a low level in Lao PDR but its epidemiologic profile changed at the end of 2018. Indeed, the number of confirmed DENV-2 cases suddenly increased in October 2018 and DENV-2 became predominant at the country level in early 2019. We developed a Genotype Screening Protocol (GSP) to determine the origin(s) of the Lao DENV-2 and study their genetic polymorphism. With a good correlation with full envelope gene sequencing data, this molecular epidemiology tool evidence the co-circulation of two highly polymorphic DENV-2 genotypes, i.e. Asian I and Cosmopolitan genotypes, over the last five years, suggesting multiple introductions of DENV-2 in the country. GSP approach provides relevant first line information that may help countries with limited laboratory resources to reinforce their capabilities to DENV-2 and to follow the epidemics progresses and assess situations at the regional level.
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Affiliation(s)
- Elodie Calvez
- Institut Pasteur du Laos, Vientiane, Lao People’s Democratic Republic
- * E-mail:
| | - Somphavanh Somlor
- Institut Pasteur du Laos, Vientiane, Lao People’s Democratic Republic
| | | | | | | | - Sitsana Keosenhom
- Institut Pasteur du Laos, Vientiane, Lao People’s Democratic Republic
| | | | - Marc Grandadam
- Institut Pasteur du Laos, Vientiane, Lao People’s Democratic Republic
- Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
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22
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Ngwe Tun MM, Muthugala R, Nabeshima T, Soe AM, Dumre SP, Rajamanthri L, Jayawardana D, Attanayake S, Inoue S, Morita K. Complete genome analysis and characterization of neurotropic dengue virus 2 cosmopolitan genotype isolated from the cerebrospinal fluid of encephalitis patients. PLoS One 2020; 15:e0234508. [PMID: 32555732 PMCID: PMC7302667 DOI: 10.1371/journal.pone.0234508] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/26/2020] [Indexed: 01/18/2023] Open
Abstract
Dengue virus (DENV) infection remains a major public health concern in many parts of the world, including Southeast Asia and the Americas. Sri Lanka experienced its largest dengue outbreak in 2017. Neurological symptoms associated with DENV infection have increasingly been reported in both children and adults. Here, we characterize DENV type 2 (DENV-2) strains, which were isolated from cerebrospinal fluid (CSF) and/or serum of patients with dengue encephalitis. Acute serum and CSF samples from each patient were subjected to dengue-specific non-structural protein 1 (NS1) antigen test, IgM and IgG enzyme-linked immunosorbent assay (ELISA), virus isolation, conventional and real-time polymerase chain reaction (PCR), and next-generation sequencing (NGS). Among the 5 dengue encephalitis patients examined, 4 recovered and 1 died. DENV-2 strains were isolated from serum and/or CSF samples of 3 patients. The highest viral genome levels were detected in the CSF and serum of the patient who succumbed to the illness. A phylogenetic tree revealed that the DENV-2 isolates belonged to a new clade of cosmopolitan genotype and were genetically close to strains identified in China, South Korea, Singapore, Malaysia, Thailand, and the Philippines. According to the NGS analysis, greater frequencies of nonsynonymous and synonymous mutations per gene were identified in the nonstructural genes. The full genomes of serum- and CSF-derived DENV-2 from the same patient shared 99.7% similarity, indicating that the virus spread across the blood-brain barrier. This is the first report to describe neurotropic DENV-2 using whole-genome analysis and to provide the clinical, immunological, and virological characteristics of dengue encephalitis patients during a severe dengue outbreak in Sri Lanka in 2017.
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Affiliation(s)
- Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | | | - Takeshi Nabeshima
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Aung Min Soe
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Shyam Prakash Dumre
- Department of Immunogenetics, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | | | | | | | - Shingo Inoue
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
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23
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Uttayamakul S, Reawrang S, Nitiyanontakij R, Phadungsombat J, Nakayama E, Suttha P, Moolasart V, Shioda T. Molecular Characteristics of Dengue Viruses in Patients Hospitalized at the Bamrasnaradura Infectious Diseases Institute, Thailand. Jpn J Infect Dis 2020; 73:411-420. [PMID: 32475871 DOI: 10.7883/yoken.jjid.2020.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dengue virus (DENV), one of the rapidly spreading mosquito-borne pathogens, causes acute febrile illness with various clinical symptoms. Four DENV serotypes are known, designated DENV-1 to 4. We previously determined whole-genome sequences of 21 DENV isolates during 2016-2017 and reported the emergence of the Cosmopolitan genotype of DENV-2 and genotype III of DENV-3 in Thailand. The objective of this study, conducted in 2018 at the Bamrasnaradura Infectious Diseases Institute, was to study the prevalence of DENV genotype. A total of 100 patients, hospitalized with severe dengue infection, were enrolled with written informed consent. Serum specimens were tested by multiplex real-time reverse transcription-polymerase chain reaction. Among them, 94 were DENV-positive, with 46 DENV-1, 38 DENV-2, 10 DENV-4, and no DENV-3 cases. Nucleotide sequence of DENV gene for envelope-protein was determined in 73 cases. Genotyping of the sequences revealed 40 cases with DENV-1 genotype I, 26 with DENV-2, that included 18 of Cosmopolitan and 8 Asian I genotypes, and 7 with DENV-4 genotype I. DENV-1 was the most prevalent in this study, and the frequency of DENV-2 Cosmopolitan genotype appears to have increased since our previous study, indicating that genotypic diversity of DENV is increasing in Thailand.
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Affiliation(s)
- Sumonmal Uttayamakul
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Thailand
| | - Sarinee Reawrang
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Thailand
| | - Ravee Nitiyanontakij
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Thailand
| | - Juthamas Phadungsombat
- Mahidol-Osaka Center for Infectious Diseases (MOCID), Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Emi Nakayama
- Mahidol-Osaka Center for Infectious Diseases (MOCID), Faculty of Tropical Medicine, Mahidol University, Thailand.,Research Institute for Microbial Diseases, Osaka University, Japan
| | - Patama Suttha
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Thailand
| | - Visal Moolasart
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Thailand
| | - Tatsuo Shioda
- Mahidol-Osaka Center for Infectious Diseases (MOCID), Faculty of Tropical Medicine, Mahidol University, Thailand.,Research Institute for Microbial Diseases, Osaka University, Japan
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24
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Kyaw AK, Ngwe Tun MM, Naing ST, Htet KKK, Htwe TT, Khaing YY, Tu Mar T, Aung T, Win KN, Tar T, Aye KS, Thant KZ, Morita K. Evaluation of commercially available three dengue rapid diagnostic test kits for diagnosis of acute dengue virus infection at the point-of-care setting in Myanmar. J Virol Methods 2019; 273:113724. [PMID: 31437465 DOI: 10.1016/j.jviromet.2019.113724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 08/05/2019] [Accepted: 08/18/2019] [Indexed: 11/19/2022]
Abstract
Early and accurate diagnosis of dengue virus (DENV) infection is very important and Rapid Diagnostic Test (RDT) Kits are been used as a point-of-care test to check DENV infection. A Hospital and Laboratory-based descriptive study was conducted at 550-bedded Mandalay Children Hospital in 2018. Acute-phase serum samples were collected from 202 dengue suspected patients to evaluate the efficacy of RDT Kits for the diagnosis of DENV infection. Commercially available three test kits which include: ((i) CareUs Dengue Combo, Korea, (ii) Humasis Dengue Combo, Korea and (iii) Wondfo Dengue Combo, China) were validated against WHO-based reference standard tests. 140/202 patients (69.3%) was confirmed to have DENV infection. All four serotypes of dengue viruses (57 DENV-1, 7 DENV-2, 6 DENV-3 and 10 DENV-4) were identified from 80 dengue confirmed patients and DENV-1 was the dominant serotype. Combining the NS-1 antigen and IgM antibody results from the CareUs Dengue Combo Kit gave the best sensitivity (92.1%, 95% CI 86.4%-96.0%) and specificity (75.8%, 95%CI 63.3%-85.8%). Among the three RDT Kits, the performance of CareUS Kit was better than the other two. This study explored the evidence of the usefulness of RDT Kits at the point-of-care setting for diagnosis of acute dengue infection.
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Affiliation(s)
- Aung Kyaw Kyaw
- Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Myanmar
| | - Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Japan.
| | - Shine Thura Naing
- Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Myanmar
| | - Kyaw Ko Ko Htet
- Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Myanmar
| | - Thein Thein Htwe
- Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Myanmar
| | - Yin Yin Khaing
- Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Myanmar
| | - Tu Tu Mar
- Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Myanmar
| | - Thidar Aung
- Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Myanmar
| | - Khin Nilar Win
- 550-bedded Mandalay Children Hospital, Ministry of Health and Sports, Myanmar
| | - Thi Tar
- 550-bedded Mandalay Children Hospital, Ministry of Health and Sports, Myanmar
| | - Khin Saw Aye
- Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Myanmar
| | - Kyaw Zin Thant
- Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Myanmar
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Japan
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25
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Hamel R, Surasombatpattana P, Wichit S, Dauvé A, Donato C, Pompon J, Vijaykrishna D, Liegeois F, Vargas RM, Luplertlop N, Missé D. Phylogenetic analysis revealed the co-circulation of four dengue virus serotypes in Southern Thailand. PLoS One 2019; 14:e0221179. [PMID: 31415663 PMCID: PMC6695175 DOI: 10.1371/journal.pone.0221179] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/31/2019] [Indexed: 12/15/2022] Open
Abstract
Dengue fever is caused by dengue viruses (DENV) from the Flavivirus genus and is the most prevalent arboviral disease. DENV exists in four immunogenically distinct and genetically-related serotypes (DENV-1 to 4), each subdivided in genotypes. Despite the endemicity of all four DENV serotypes in Thailand, no prior study has characterized the circulation of DENV in the southern provinces of the country. To determine the genetic diversity of DENV circulating in Southern Thailand in 2015 and 2016, we investigated 46 viruses from 182 patients' sera confirmed positive for DENV by serological and Nested RT-PCR tests. Our dataset included 2 DENV-1, 20 DENV-2, 9 DENV-3 and 15 DENV-4. Phylogenetic analysis was performed on viral envelop sequences. This revealed that part of the identified genotypes from DENV-1 and DENV-4 had been predominant in Asia (genotype I for both serotypes), while genotype II for DENV-4 and the Cosmopolitan genotype DENV-2 were also circulating. Whereas DENV-3 genotype II had been predominantly detected in South East Asia during the previous decades, we found genotype III and genotype I in Southern Thailand. All DENV genotype identified in this study were closely related to contemporary strains circulating in Southeast Asian countries, emphasizing the regional circulation of DENV. These results provide new insights into the co-circulation of all four DENV serotypes in Southern Thailand, confirming the hyperendemicity of DENV in the region. These findings also suggest a new trend of dissemination for some DENV serotypes with a possible shift in genotype distribution; as recently observed in other Asian countries.
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Affiliation(s)
- Rodolphe Hamel
- MIVEGEC UMR 224, Université de Montpellier, IRD, CNRS, Montpellier, France.,Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | | | - Alexandra Dauvé
- Department of Entomology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Celeste Donato
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Australia
| | - Julien Pompon
- MIVEGEC UMR 224, Université de Montpellier, IRD, CNRS, Montpellier, France.,Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Dhanasekaran Vijaykrishna
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Australia.,Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Florian Liegeois
- MIVEGEC UMR 224, Université de Montpellier, IRD, CNRS, Montpellier, France
| | - Ronald Morales Vargas
- Department of Entomology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Natthanej Luplertlop
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Dorothée Missé
- MIVEGEC UMR 224, Université de Montpellier, IRD, CNRS, Montpellier, France
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26
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Zeng Z, Shi J, Guo X, Mo L, Hu N, Sun J, Wu M, Zhou H, Hu Y. Full-length genome and molecular characterization of dengue virus serotype 2 isolated from an imported patient from Myanmar. Virol J 2018; 15:131. [PMID: 30126417 PMCID: PMC6102819 DOI: 10.1186/s12985-018-1043-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 08/14/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Dengue is the most common mosquito-borne infection worldwide and a serious threat to global public health. Sporadic dengue virus serotype 2 (DENV-2) imported cases from Myanmar have been documented almost every year in Yunnan Province of China since 2005. However, the complete genome sequences of DENV-2 isolates imported from Myanmar are not available. METHODS The full-length genome of the DENV-2 strain (YNPE2), isolated from an imported case from Myanmar in 2013, was identified by the next-generation sequencing. The extreme ends of the viral genome were validated by 5'/3' RACE and Sanger sequencing. Furthermore, phylogenetic, recombination and selection pressure analyses were conducted for the molecular characterization of YNPE2 strain. RESULTS Whole-genome sequencing revealed that the full-length sequence of YNPE2 strain was 10,724 bases, with an open reading frame encoding for 3391 amino acids. The YNPE2 strain had 99.0% nucleotide identity and 99.8% amino acid identity with two closely related strains, ThD2_0078_01 strain (DQ181797) and DENV-2/TH/BID-V2157/200 strain (FJ639832). The phylogenetic analysis suggested that the YNPE2 strain belonged to Asian I genotype and was likely derived from Thailand strain (DQ181797). Moreover, selection pressure analysis revealed two amino acid sites of the NS4B and NS5 proteins, with important evidence of positive selection. CONCLUSION This study revealed the first complete genome sequence and molecular characterization of a DENV-2 strain (YNPE2) isolated from an imported case from Myanmar, thus providing a valuable reference genome source for future surveillance, epidemiology and vaccine development of DENV-2 virus in Yunnan, China.
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Affiliation(s)
- Zhaoping Zeng
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China.,Yunnan Key Laboratory of Vaccine Research and Development of Severe Infectious Disease, Kunming, 650118, China
| | - Jiandong Shi
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China.,Yunnan Key Laboratory of Vaccine Research and Development of Severe Infectious Disease, Kunming, 650118, China
| | - Xiaofang Guo
- Yunnan Provincial Center of Arborvirus Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases, Pu'er, 665000, Yunnan, China
| | - Ling Mo
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China.,Yunnan Key Laboratory of Vaccine Research and Development of Severe Infectious Disease, Kunming, 650118, China
| | - Ningzhu Hu
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China.,Yunnan Key Laboratory of Vaccine Research and Development of Severe Infectious Disease, Kunming, 650118, China
| | - Jing Sun
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China.,Yunnan Key Laboratory of Vaccine Research and Development of Severe Infectious Disease, Kunming, 650118, China
| | - Meini Wu
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China.,Yunnan Key Laboratory of Vaccine Research and Development of Severe Infectious Disease, Kunming, 650118, China
| | - Hongning Zhou
- Yunnan Provincial Center of Arborvirus Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases, Pu'er, 665000, Yunnan, China.
| | - Yunzhang Hu
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China. .,Yunnan Key Laboratory of Vaccine Research and Development of Severe Infectious Disease, Kunming, 650118, China.
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27
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Shrestha P, Roberts T, Homsana A, Myat TO, Crump JA, Lubell Y, Newton PN. Febrile illness in Asia: gaps in epidemiology, diagnosis and management for informing health policy. Clin Microbiol Infect 2018; 24:815-826. [PMID: 29581051 DOI: 10.1016/j.cmi.2018.03.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/12/2018] [Accepted: 03/16/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Increasing evidence is becoming available on the aetiology and management of fevers in Asia; the importance of these fevers has increased with the decline in the incidence of malaria. AIMS To conduct a narrative review of the epidemiology and management of fevers in South and South-East Asia and to highlight gaps in our knowledge that impair evidence-based health policy decisions. SOURCES A narrative review of papers published since 2012 on developments in fever epidemiology, diagnosis and treatment in South and South-East Asia. The papers that the authors felt were pivotal, from their personal perspectives, are discussed. CONTENT We identified 100 studies. Among the 30 studies (30%)-including both children and adults-that investigated three or more pathogens, the most frequently reported fever aetiology was dengue (reported by 15, 50%), followed by leptospirosis (eight, 27%), scrub typhus (seven, 23%) and Salmonella serovar Typhi (six, 20%). Among four studies investigating three or more pathogens in children, dengue and Staphylococcus aureus were the most frequent, followed by non-typhoidal Salmonella spp, Streptococcus pneumoniae, Salmonella serovar Typhi, and Orientia tsutsugamushi. Increased awareness is needed that rickettsial pathogens are common but do not respond to cephalosporins, and that alternative therapies, such as tetracyclines, are required. IMPLICATIONS Many key gaps remain, and consensus guidelines for study design are needed to aid comparative understanding of the epidemiology of fevers. More investment in developing accurate and affordable diagnostic tests for rural Asia and independent evaluation of those already on the market are needed. Treatment algorithms, including simple biomarker assays, appropriate for empirical therapy of fevers in different areas of rural Asia should be a major aim of fever research. Enhanced antimicrobial resistance (AMR) surveillance and openly accessible databases of geography-specific AMR data would inform policy on empirical and specific therapy. More investment in innovative strategies facilitating infectious disease surveillance in remote rural communities would be an important component of poverty reduction and improving public health.
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Affiliation(s)
- P Shrestha
- Infectious Diseases Data Observatory, University of Oxford, UK
| | - T Roberts
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Madihol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - A Homsana
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - T O Myat
- Department of Microbiology, University of Medicine 1, Yangon, Myanmar; Centre for International Health, University of Otago, Dunedin, New Zealand
| | - J A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Y Lubell
- Madihol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, UK
| | - P N Newton
- Infectious Diseases Data Observatory, University of Oxford, UK; Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Centre for Tropical Medicine and Global Health, University of Oxford, UK.
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Oo PM, Wai KT, Harries AD, Shewade HD, Oo T, Thi A, Lin Z. The burden of dengue, source reduction measures, and serotype patterns in Myanmar, 2011 to 2015-R2. Trop Med Health 2017; 45:35. [PMID: 29118655 PMCID: PMC5667489 DOI: 10.1186/s41182-017-0074-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/18/2017] [Indexed: 12/24/2022] Open
Abstract
Background Myanmar is currently classified as a high burden dengue country in the Asian Pacific region. The Myanmar vector-borne diseases control (VBDC) program has collected data on dengue and source reduction measures since 1970, and there is a pressing need to collate, analyze, and interpret this information. The aim of this study was to describe the burden of hospital-based dengue disease, dengue control measures, and serotype patterns in Myanmar between 2011 and 2015. Methods This was a cross-sectional study using annual records from the Dengue Fever/Dengue Hemorrhagic Fever Prevention and Control Project in Myanmar. Results Between 2011 and 2015, there were a total of 89,832 cases and 393 deaths in hospitals, with 97% of cases being in children. In 2013 and 2015, there was an increased number of cases, respectively at 21,942 and 42,913, while during the other 3 years, numbers ranged from 4738 to 13,806. The distribution of dengue deaths each year mirrored the distribution of cases. Most cases (84%) occurred in the wet season and 54% occurred in the delta/lowlands. Case fatality rate (CFR) was highest in 2014 at 7 per 1000 dengue cases, while in the other years, it ranged from 3 to 5 per 1000 cases. High CFR per 1000 were also observed in infants < 1 year (CFR = 8), adults ≥ 15 years (CFR = 7), those with disease severity grade IV (CFR = 17), and those residing in hilly regions (CFR = 9). Implementation and coverage of dengue source reduction measures, including larval control, space spraying, and health education, all increased between 2012 and 2015, although there was low coverage of these interventions in households and schools and for water containers. In the 2013 outbreak, dengue virus serotype 1 predominated, while in the 2015 outbreak, serotypes 1, 2, and 4 were those mainly in circulation. Conclusion Dengue is a serious public health disease burden in Myanmar. More attention is needed to improve monitoring, recording, and reporting of cases, deaths, and vector control activities, and more investment is needed for programmatic research.
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Affiliation(s)
- Pwint Mon Oo
- Central Vector Borne Disease Control Programme, Department of Public Health, Ministry of Health and Sport, Nay Pyi Taw, Myanmar
| | | | - Anthony D Harries
- International Union against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene and Tropical Medicine, London, UK
| | - Hemant Deepak Shewade
- International Union against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - Tin Oo
- Department of Medical Research, Yangon, Myanmar
| | - Aung Thi
- Central Vector Borne Disease Control Programme, Department of Public Health, Ministry of Health and Sport, Nay Pyi Taw, Myanmar
| | - Zaw Lin
- Central Vector Borne Disease Control Programme, Department of Public Health, Ministry of Health and Sport, Nay Pyi Taw, Myanmar
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