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Hcini N, Lambert V, Picone O, Carod JF, Carles G, Pomar L, Epelboin L, Nacher M. Arboviruses and pregnancy: are the threats visible or hidden? Trop Dis Travel Med Vaccines 2024; 10:4. [PMID: 38355934 PMCID: PMC10868105 DOI: 10.1186/s40794-023-00213-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/22/2023] [Indexed: 02/16/2024] Open
Abstract
Mosquito-borne arboviral diseases are a global concern and can have severe consequences on maternal, neonatal, and child health. Their impact on pregnancy tends to be neglected in developing countries. Despite hundreds of millions of infections, 90% pregnancies being exposed, scientific data on pregnant women is poor and sometimes non-existent. Recently and since the 2016 Zika virus outbreak, there has been a newfound interest in these diseases. Through various neuropathogenic, visceral, placental, and teratogenic mechanisms, these arbovirus infections can lead to fetal losses, obstetrical complications, and a wide range of congenital abnormalities, resulting in long-term neurological and sensory impairments. Climate change, growing urbanization, worldwide interconnectivity, and ease of mobility allow arboviruses to spread to other territories and impact populations that had never been in contact with these emerging agents before. Pregnant travelers are also at risk of infection with potential subsequent complications. Beyond that, these pathologies show the inequalities of access to care on a global scale in a context of demographic growth and increasing urbanization. It is essential to promote research, diagnostic tools, treatments, and vaccine development to address this emerging threat.Background The vulnerability of pregnant women and fetuses to emergent and re-emergent pathogens has been notably illustrated by the outbreaks of Zika virus. Our comprehension of the complete scope and consequences of these infections during pregnancy remains limited, particularly among those involved in perinatal healthcare, such as obstetricians and midwives. This review aims to provide the latest information and recommendations regarding the various risks, management, and prevention for pregnant women exposed to arboviral infections.
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Affiliation(s)
- Najeh Hcini
- Department of Obstetrics and Gynecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana.
- CIC Inserm 1424 and DFR Santé Université Guyane, Cayenne, French Guiana, France.
| | - Véronique Lambert
- Department of Obstetrics and Gynecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana
| | - Olivier Picone
- Department of Obstetrics and Gynecology, Hôpital Louis Mourier, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique : Hôpitaux de Paris, Université Paris Diderot, CEDEX, Colombes, France
| | - Jean-Francois Carod
- Department of Biology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana
| | - Gabriel Carles
- Department of Obstetrics and Gynecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana
| | - Léo Pomar
- Materno-Fetal and Obstetrics Research Unit, Department "Woman-Mother-Child", Lausanne University Hospital, Lausanne, Switzerland
| | - Loïc Epelboin
- Department of Infectious and Tropical Diseases, Cayenne General Hospital, Cayenne, French Guiana, France
| | - Mathieu Nacher
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC1424, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
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Watanabe S, Vasudevan SG. Clinical and experimental evidence for transplacental vertical transmission of flaviviruses. Antiviral Res 2023; 210:105512. [PMID: 36572192 DOI: 10.1016/j.antiviral.2022.105512] [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: 12/02/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
The Zika virus (ZIKV) epidemic outbreak in Americas in 2016 attracted global attention because of the association of the virus infection with severe birth defects such as microcephaly, mediated through transplacental virus transmission during pregnancy. Less well-known, but also reported is the increasing evidence that prenatal vertical transmission can be caused by other flaviviruses such as dengue virus (DENV). Currently, the mechanism(s) that cause the vertical transmission of flaviviruses is understudied. Here we review the published reports of clinical evidence of intrauterine transmission of ZIKV and other flaviviruses. We also discuss the animal models for flavivirus infection during pregnancy that have been developed to study the mechanisms underlying the transplacental transmission of flaviviruses in order to develop potential countermeasures for its prevention.
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Affiliation(s)
- Satoru Watanabe
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road, 169857, Singapore.
| | - Subhash G Vasudevan
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road, 169857, Singapore
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3
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Rathore SS, Oberoi S, Hilliard J, Raja R, Ahmed NK, Vishwakarma Y, Iqbal K, Kumari C, Velasquez-Botero F, Nieto-Salazar MA, Cortes GAM, Akomaning E, Musa IEM. Maternal and foetal-neonatal outcomes of dengue virus infection during pregnancy. Trop Med Int Health 2022; 27:619-629. [PMID: 35689528 DOI: 10.1111/tmi.13783] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Given that women of reproductive age in dengue-endemic areas are at risk of infection, it is necessary to determine whether dengue virus (DENV) infection during pregnancy is associated with adverse outcomes. The aim of this systematic review and meta-analysis is to investigate the consequences of DENV infection in pregnancy on various maternal and foetal-neonatal outcomes. METHODS A systematic literature search was undertaken using PubMed, Google Scholar, and Embase till December 2021. Mantel-Haenszel risk ratios were calculated to report overall effect size using random effect models. The pooled prevalence was computed using the random effect model. All statistical analyses were performed on MedCalc Software. RESULT We obtained data from 36 studies involving 39,632 DENV-infected pregnant women. DENV infection in pregnancy was associated with an increased risk of maternal mortality (OR = 4.14 [95% CI, 1.17-14.73]), stillbirth (OR = 2.71 [95% CI, 1.44-5.10]), and neonatal deaths (OR = 3.03 [95% CI, 1.17-7.83]) compared with pregnant women without DENV infection. There was no significant statistical association established between maternal DENV infection and the outcomes of preterm birth, maternal bleeding, low birth weight in neonates, and risk of miscarriage. Pooled prevalences were 14.9% for dengue shock syndrome, 14% for preterm birth, 13.8% for maternal bleeding, 10.1% for low birth weight, 6% for miscarriages, and 5.6% for stillbirth. CONCLUSION DENV infection in pregnant women may be associated with adverse outcomes such as maternal mortality, stillbirth, and neonatal mortality. Hence, pregnant women should be considered an at-risk population for dengue management programmes.
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Affiliation(s)
- Sawai Singh Rathore
- Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Sharvi Oberoi
- Internal Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, Maharashtra, India
| | - Jonathan Hilliard
- College of Medicine, All Saints University College of Medicine, Amos Vale, Saint Vincent and the Grenadines
| | - Ritesh Raja
- Internal Medicine, China Three Georges University, Yichang, Hubei Province, China
| | | | - Yogesh Vishwakarma
- Internal Medicine, American University of Barbados, Wildey, St. Michael, Barbados
| | - Kinza Iqbal
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Chandani Kumari
- Internal Medicine, American University of Barbados, Wildey, St. Michael, Barbados
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4
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Watanabe S, Chan KWK, Tan NWW, Mahid MBA, Chowdhury A, Chang KTE, Vasudevan SG. Experimental evidence for a high rate of maternal-fetal transmission of dengue virus in the presence of antibodies in immunocompromised mice. EBioMedicine 2022; 77:103930. [PMID: 35290828 PMCID: PMC8921544 DOI: 10.1016/j.ebiom.2022.103930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Congenital disorders associated with prenatal vertical transmission of Zika virus (ZIKV) is well established since the 2016 outbreak in the Americas. However, despite clinical reports of similar mode of transmission for other flaviviruses such as dengue virus (DENV), the phenomenon has not been experimentally explored. Methods Pregnant AG129 mice were infected with DENV1 in the presence or absence of enhancing antibodies at different gestational time points. ZIKV was used for comparison. We quantified viral load in fetus and placentas and performed comprehensive gene expression profiling in the maternal (decidua) and fetal portion of placenta separately. Findings We demonstrate in a laboratory experimental setting that DENV can be transmitted vertically in a gestation stage-dependent manner similar to ZIKV, and this incidence drastically increases in the presence of enhancing antibodies. Interestingly, a high rate of DENV fetal infection occurs even though the placental viral load is significantly lower than that found in ZIKV-infected dams. Comprehensive gene expression profiling revealed DENV infection modulates a variety of inflammation-associated genes comparable to ZIKV in decidua and fetal placenta in early pregnancy. Interpretation Our findings suggest that the virus-induced modulation of host gene expression may facilitate DENV to cross the placental barrier in spite of lower viral burden compared to ZIKV. This mouse model may serve to identify the host determinants required for the vertical transmission of flaviviruses and develop appropriate countermeasures. Funding National Medical Research Council/Open Fund Individual Research Grant MOH-000524 (SW), MOH-000086 and OFIRG20nov-0017 (SGV).
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Affiliation(s)
- Satoru Watanabe
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road 169857, Singapore.
| | - Kitti Wing Ki Chan
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road 169857, Singapore
| | - Nicole Wei Wen Tan
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road 169857, Singapore
| | | | - Avisha Chowdhury
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road 169857, Singapore
| | - Kenneth Tou En Chang
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road 169857, Singapore; Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - Subhash G Vasudevan
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road 169857, Singapore; Institute for Glycomics, Griffith University, Gold Coast Campus, Queensland 4222, Australia.
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Sinha R, Datta M, Singh V. A study on maternal and foetal prognosis and predictive factors for adverse outcome in pregnant patients with dengue in an endemic state of India. J Family Med Prim Care 2022; 11:912-917. [PMID: 35495816 PMCID: PMC9051706 DOI: 10.4103/jfmpc.jfmpc_633_21] [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: 03/04/2021] [Revised: 06/21/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022] Open
Abstract
Aims: Dengue fever is a major health problem with high morbidity and mortality especially during epidemic season; pregnant females being no exception. But, there is paucity of published data on dengue fever during pregnancy. Hence, this study was planned to study the clinical profile, maternal outcome and predictors of poor outcome in pregnant dengue patients. Materials and Methods: All pregnant females attending labour room of Tata Main Hospital, Jamshedpur from April 2016 to October2020 with acute febrile illness caused by dengue virus at any gestational age were included in the study. Diagnosis of dengue was made by detection of NS1 antigen or dengue serology. A predesigned proforma was used to record materno-foetal outcomes and were analysed. Results: Dengue was the cause of fever in 7.1% febrile patients. Maternal complications included abortions (26%), abruptio (1.9%), postpartum haemorrhage (11.9%) . Of all the pregnant dengue patients, five had severe dengue(SD) with high mortality (3/5; 60%). Fetal complications were intrauterine death(7.7%),preterm(42.3%). Thrombocytopenia and elevated transaminases were associated with adverse outcome. Conclusions: Dengue fever in pregnancy is associated with poor outcomes more in cases of SD rather than dengue fever . Pregnant females with high risk predictors should be identified and managed aggressively in intensive care units to improve outcomes.
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Wang J, Sun J, Sun L, Ye Y, Chen H, Xiao J, He G, Hu J, Chen G, Zhou H, Dong X, Ma W, Zhang B, Liu T. The Seroprevalence of Dengue Virus Infection and Its Association With Iron (Fe) Level in Pregnant Women in Guangzhou, China. Front Med (Lausanne) 2021; 8:759728. [PMID: 34957145 PMCID: PMC8702999 DOI: 10.3389/fmed.2021.759728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
Dengue fever is regarded as the most prevalent mosquito-borne viral disease in humans. However, information of dengue virus (DENV) infection in pregnant women and the influence factors remain unclear. In this study, we extracted information of 2,076 pregnant women from the Prenatal Environment and Offspring Health (PEOH) birth cohort conducted since 2016 in Guangzhou, China. Peripheral blood and clean midstream urine samples of participants were collected during their hospitalization for childbirth. Indirect enzyme-linked immunosorbent assay (ELISA) was used to detect immunoglobulin G (IgG) antibodies of DENV in serum samples, and inductively coupled plasma mass spectrometry (ICP-MS) was applied to determine the Fe concentrations in the urine samples, which were then adjusted for by urine creatinine and transformed by natural logarithm (ln-Fe). The seroprevalence of DENV IgG antibody in all included participants was 2.22% (46/2,076). We observed higher seroprevalence of IgG antibody in women aged ≥35 years (2.9%), education ≤ 12 years (2.5%), yearly income per capita <100,000 yuan (2.4%), no use of air-conditioner (2.4%), no use of mosquito coils (2.3%), and no exercise during pregnancy (4.1%). A U-shaped relationship was found between ln-Fe concentration and the risk of positive IgG antibody. Compared with women with ln-Fe concentration of 2.0–2.9 μg/g creatinine, slightly higher risks of positive IgG antibody were found among women with ≤2.0 (RR = 4.16, 95% CI: 0.78, 19.91), 3.0–3.9 (RR = 1.93, 95% CI: 0.65, 7.08), 4.0–4.9 (RR = 2.19, 95% CI: 0.65, 8.51), and ≥5.0 μg/g creatinine of ln-Fe (RR = 2.42, 95% CI: 0.46, 11.33). Our findings suggested that the seroprevalence of dengue IgG antibody in pregnant women was comparable to the general population in Guangzhou, China. The risk of DENV infection may be associated with maternal demographic characteristics and behaviors. Both maternal low and high Fe concentrations may be positively associated with the risk of DENV infection.
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Affiliation(s)
- Jiong Wang
- School of Public Health, Southern Medical University, Guangzhou, China.,Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jiufeng Sun
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Limei Sun
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yufeng Ye
- Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Hanwei Chen
- Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Guanhao He
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jianxiong Hu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Guimin Chen
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - He Zhou
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Xiaomei Dong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Wenjun Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Bo Zhang
- Food Safety and Health Research Center, School of Public Health, Southern Medical University, Guangzhou, China
| | - Tao Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,School of Public Health, Southern Medical University, Guangzhou, China
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da Encarnação Sá-Guimarães T, Salles TS, Rocha Dos Santos C, Moreira MF, de Souza W, Caldas LA. Route of Zika virus infection in Aedes aegypti by transmission electron microscopy. BMC Microbiol 2021; 21:300. [PMID: 34717555 PMCID: PMC8557066 DOI: 10.1186/s12866-021-02366-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/19/2021] [Indexed: 12/20/2022] Open
Abstract
Background Zika fever has been a global health security threat, especially in the tropical and subtropical regions where most of the cases occur. The disease is caused by Zika virus (ZIKV), which belongs to the family Flaviviridae, genus Flavivirus. The virus is transmitted by Aedes mosquitoes, mostly by Aedes aegypti, during its blood meal. In this study we present a descriptive analysis, by transmission electron microscopy (TEM), of ZIKV infection in A. aegypti elected tissues at the 3rd day of infection. ZIKV vertical transmission experiments by oral infection were conducted to explore an offspring of natural infection. Results Gut and ovary tissues harbored a higher number of viral particles. The ZIKV genome was also detected, by RT-qPCR technique, in the organism of orally infected female mosquitoes and in their eggs laid. Conclusions The data obtained suggest that the ovary is an organ susceptible to be infected with ZIKV and that virus can be transmitted from mother to a fraction of the progeny.
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Affiliation(s)
| | - Tiago Souza Salles
- Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro, CEP 21941-909, Rio de Janeiro, RJ, Brazil.,Instituto Nacional de Ciência e Tecnologia em Entomologia Molecular, CEP 21941-902, Rio de Janeiro, RJ, Brazil
| | - Carlucio Rocha Dos Santos
- Laboratório de Fisiologia e Controle de Artrópodes Vetores, Instituto Oswaldo Cruz, CEP 21040-900, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Monica Ferreira Moreira
- Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro, CEP 21941-909, Rio de Janeiro, RJ, Brazil.,Instituto Nacional de Ciência e Tecnologia em Entomologia Molecular, CEP 21941-902, Rio de Janeiro, RJ, Brazil
| | - Wanderley de Souza
- Universidade Federal do Rio de Janeiro, Centro Nacional de Biologia Estrutural e Bioimagem (CENABIO), CEP 21941-902, Rio de Janeiro, RJ, Brazil.,Instituto de Biofísica Carlos Chagas Filho, Laboratório de Ultraestrutura Celular Hertha Meyer, Universidade Federal do Rio de Janeiro, CEP 21941-902, Rio de Janeiro, RJ, Brazil
| | - Lucio Ayres Caldas
- Instituto de Biofísica Carlos Chagas Filho, Laboratório de Ultraestrutura Celular Hertha Meyer, Universidade Federal do Rio de Janeiro, CEP 21941-902, Rio de Janeiro, RJ, Brazil. .,Duque de Caxias, Universidade Federal do Rio de Janeiro, Núcleo Multidisciplinar de Pesquisa UFRJ-Xerém em Biologia - NUMPEX-BIO, RJ, CEP: 25265-970, Rio de Janeiro, Brazil.
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do Nascimento Einloft AB, Moreira TR, Wakimoto MD, Franceschini SDCC, Cotta RMM, da Costa GD. Data quality and arbovirus infection associated factors in pregnant and non-pregnant women of childbearing age in Brazil: A surveillance database analysis. One Health 2021; 12:100244. [PMID: 33898725 PMCID: PMC8056397 DOI: 10.1016/j.onehlt.2021.100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 10/26/2022] Open
Abstract
The dengue surveillance system in Brazil has registered changes in the disease's morbidity and mortality profile over successive epidemics. Vulnerable groups, such as pregnant women, have been particularly hard hit. This study assessed the quality of notifications of dengue cases among pregnant women and non-pregnant women of childbearing age in Brazil, in addition to discussing the factors associated with arbovirus infection in the group of pregnant women. We carried out a retrospective study of cases registered in the national arbovirus surveillance system between 2007 and 2017. The indicator for assessing quality was incompleteness. Logistic regression was used to analyze the association between dengue during pregnancy and sociodemographic, epidemiological, clinical, and laboratory variables. The incompleteness of the data in the notification form for dengue cases in women of childbearing age and pregnant women indicates a significant loss of information. Dengue was shown to be positively associated with Social Determinants of Health in both groups, with more severe effects among pregnant women. The incompleteness of the data can limit the quality of information from the notification system and the national assessment of the situation of the disease in women of childbearing age and pregnant women.
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Affiliation(s)
| | - Tiago Ricardo Moreira
- Department of Medicine and Nursing, Federal University of Viçosa, Viçosa, MG 36570-900, Brazil
| | - Mayumi Duarte Wakimoto
- Fundação Oswaldo Cruz (Fiocruz), RJ. Instituto Nacional de Infectologia Evandro Chagas, Brazil
| | | | | | - Glauce Dias da Costa
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, MG 36570-900, Brazil
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Elaagip A, Alsedig K, Altahir O, Ageep T, Ahmed A, Siam HA, Samy AM, Mohamed W, Khalid F, Gumaa S, Mboera L, Sindato C, Elton L, Zumla A, Haider N, Kock R, Abdel Hamid MM. Seroprevalence and associated risk factors of Dengue fever in Kassala state, eastern Sudan. PLoS Negl Trop Dis 2020; 14:e0008918. [PMID: 33296362 PMCID: PMC7752093 DOI: 10.1371/journal.pntd.0008918] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 12/21/2020] [Accepted: 10/25/2020] [Indexed: 12/14/2022] Open
Abstract
Dengue is a rapidly growing public health threat in Kassala state, eastern Sudan. The objective of this study was to determine the seroprevalence, entomological transmission indices, and socioeconomic risk factors associated with dengue in this region. A cross-sectional community-based study was conducted in four dengue-endemic sites; Khatmia, West Gash, Thoriba, and Shokriya between March 2016 to March 2017. Enzyme-linked immunosorbent assay (ELISA) of immunoglobulin G (IgG) was used to determine the prevalence of dengue virus among the study participants. An entomological survey was conducted using pyrethrum spray catch and dipping for the collection of adults and aquatic stages of Aedes aegypti, respectively. Ribonucleic acid was extracted from the buffy coat of participants as well as from adult female Ae. aegypti to assess the possible circulation of dengue virus using Reverse Transcription Polymerase Chain Reaction (RT-PCR). Multiple logistic regression model was used to estimate the association between potential risk factors and dengue seropositivity. A total of 409 persons were recruited to the study: 45.5% were in the 20–39 years’ age category; 57.9% were living in houses with 6–10 persons; and 29.1% had at most secondary school education. In the majority (65.8%) of the households, the socioeconomic status was low (P<0.001). Long-lasting insecticide-treated bed nets were used in 56.5% of the households. Over three-quarters (77.8%) claimed not to have experienced febrile illness in the last three months. Routine entomological survey across Kassala state identified a total of 3,304 larvae and 390 pupae Ae. aegypti, respectively. The overall house index was 32.8% and Breteau Index was 35.96% (146/406). The overall pupal demographic index was 13.31%, and the pupal children index was 97.26%. Antibodies against IgG were detected from 66 (42.04%) out of a total of 157 sera. Twenty-two positive sera (75.9%) were collected from Khatmia. A total of 329 adults Ae. aegypti were identified but only one (0.3%) was positive for DENV in Khatmia. Finally, four independent risk factors were identified to derive dengue circulation in Kassala: elder age (> 60 years) (OR 6.31, CI 1.09–36.36); type of bathroom (OR 3.52, CI 1.35–9.20); using water-based air conditioner (OR 6.90, CI 1.78–26.85) and previous infection of any household member with dengue (OR 28.73, CI 3.31–249.63). Our findings suggest that Kassala state is facing an increasing occurrence of dengue and emphasizes the need for developing appropriate interventions to address the identified risk factors, and place control programs into actions. Establishment of routine dengue epidemiological and entomological surveillance, and climate warning systems will contribute to early warning and timely detection and response to emerging outbreaks. Dengue is a rapidly growing public health threat in Sudan. Kassala state is facing a major outbreak of the mosquito-borne dengue virus. This recent outbreak alarmed the local health authorities to establish a successful control program. However, lack of data obstructs their roles to achieve this goal. Here, we provided a detailed picture on the seroprevalence of dengue virus, entomological indices, and natural mosquito infection across Kassala state, Sudan. The study also identified key factors associated with the recent dengue outbreaks in Sudan. All these findings marked the importance to establish successful routine vector and dengue surveillance. These active surveillances should consider sensitive early warning systems providing early anticipation and timely detection and response to the future outbreaks in Sudan.
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Affiliation(s)
- Arwa Elaagip
- Department of Parasitology and Medical Entomology, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
- Department of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
- * E-mail: (AE); (MMAH)
| | - Khider Alsedig
- Department of Medical Entomology, National Public Health Laboratory, Federal Ministry of Health, Khartoum, Sudan
| | - Omnia Altahir
- Department of Epidemiology, Tropical Medicine Research Institute, National Center for Research, Khartoum, Sudan
| | - Tellal Ageep
- Department of Epidemiology, Tropical Medicine Research Institute, National Center for Research, Khartoum, Sudan
| | - Ayman Ahmed
- Department of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Hanaa Adli Siam
- Department of Medical Entomology, National Public Health Laboratory, Federal Ministry of Health, Khartoum, Sudan
| | - Abdallah M. Samy
- Entomology Department, Faculty of Science, Ain Shams University, Abbassia, Cairo, Egypt
| | - Waleed Mohamed
- Department of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Fatima Khalid
- Department of Biochemistry, Faculty of Medicine and Health Sciences, University of Kassala, Kassala, Sudan
| | - Suhaib Gumaa
- Department of Immunology and Biotechnology, Tropical Medicine Research Institute, National Center for Research, Khartoum, Sudan
| | - Leonard Mboera
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Calvin Sindato
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
- National Institute for Medical Research, Tabora, Tanzania
| | - Linzy Elton
- Centre for Clinical Microbiology, Department of Infection, Division of Infection and Immunity, Royal Free Campus, University College London, London, United Kingdom
| | - Alimuddin Zumla
- Centre for Clinical Microbiology, Department of Infection, Division of Infection and Immunity, Royal Free Campus, University College London, London, United Kingdom
| | - Najmul Haider
- Royal Veterinary College (RVC), London, United Kingdom
| | - Richard Kock
- Royal Veterinary College (RVC), London, United Kingdom
| | - Muzamil Mahdi Abdel Hamid
- Department of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
- * E-mail: (AE); (MMAH)
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10
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Nujum ZT, Nirmala C, Vijayakumar K, Saboora Beegum M, Jyothi R. Incidence and outcomes of dengue in a cohort of pregnant women from an endemic region of India: obesity could be a potential risk for adverse outcomes. Trans R Soc Trop Med Hyg 2020; 113:242-251. [PMID: 30892646 DOI: 10.1093/trstmh/trz003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/27/2018] [Accepted: 01/16/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The primary objectives of the study were to determine the incidence of dengue and outcomes associated with dengue among pregnant women. METHODS A prospective cohort study was done among 1579 antenatal women in an endemic region in India. Dengue immunoglobulin G (IgG) was tested in 490 women at baseline. Follow-up phone calls and visits were done until 1 week after delivery. In 70 seronegative women, dengue IgG was repeated to identify seroconversion. Incidence proportions, incidence rates, relative risks, attributable risks and population attributable risks along with their 95% confidence intervals (CIs) were calculated. Propensity score methods were used for multivariate assessment of confounding and analysis was repeated with a matched dataset. RESULTS The seroprevalence of dengue was 30.41% (95% CI 26.45 to 34.59). NS1 positivity detected 78% of dengue in pregnancy. There were no abortions or maternal or newborn deaths. Dengue was significantly associated with delivery complications (adjusted odds ratio [OR] 10.28 [95% CI 4.79 to 22.01]), newborn problems (adjusted OR 5.29 [95% CI 2.89 to 9.70]) and newborn admissions (adjusted OR 5.24 [95% CI 2.36 to 11.65]). Overweight dengue patients had a significantly higher risk of preterm deliveries and higher adverse outcome scores. CONCLUSIONS Screening of febrile antenatal women for dengue in endemic areas can result in early diagnosis and reduce complications. The dual burden of communicable and non-communicable diseases in pregnancy is a real challenge.
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Affiliation(s)
- Zinia T Nujum
- Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Chellamma Nirmala
- Obstetrics and Gynaecology, Government Medical College, Thiruvananthapuram, India
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High Seroprevalence of Dengue Virus Infection in Sudan: Systematic Review and Meta-Analysis. Trop Med Infect Dis 2020; 5:tropicalmed5030120. [PMID: 32708492 PMCID: PMC7559303 DOI: 10.3390/tropicalmed5030120] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022] Open
Abstract
The goal of this study was to systematically review the published data on dengue virus (DENV) seroprevalence in Sudan and to estimate disease burden through meta-analysis. We searched, reviewed, and extracted online available reports on DENV in Sudan. Among 168 identified records, 19 were selected. Dengue infections were documented in 11/18 states. The overall seroprevalence of DENV in Sudan was estimated to be 27%, while the prevalence of dengue IgM was 22% and IgG was 38%. The prevalence of dengue estimated from community and hospital-based cross-sectional studies were 26% and 30% respectively. Additionally, one cohort study and a single PCR-based study reported a prevalence of 1% and 4%, respectively. Regional analysis revealed that the variation in seroprevalence in East, North, West, and Central Sudan was 23%, 24%, 36% and 43%, respectively. Interestingly, we found that DENV is circulating countrywide with a significant spatiotemporal variation in the disease seroprevalence. Furthermore, publications on dengue prevalence are temporally and geographically fragmented, perhaps due to limited resources. However, this gap in data and knowledge highlights the urgent need for a country-wide surveillance system and continued study of dengue burden in Sudan to accurately estimate the disease prevalence and determine the associated risk factors.
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12
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Recent transmission of dengue virus and associated risk Facors among residents of Kassala state, eastern Sudan. BMC Public Health 2020; 20:530. [PMID: 32306941 PMCID: PMC7168835 DOI: 10.1186/s12889-020-08656-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/05/2020] [Indexed: 12/26/2022] Open
Abstract
Background Acute arboviral infections are distributed worldwide including Sudan, and dengue fever (DENV) is not an exception. The virus activity has recently been frequently reported in Kassala State, eastern Sudan. However, an appropriate epidemiological study would be necessary to provide accurate and precise estimates of the magnitude of recent DENV transmission in this area of endemicity. Methods In the present investigation, a cross sectional study was conducted to advance beyond the current knowledge of the epidemiology of the disease in Kassala State. The prevalence of the disease was estimated and associated risk factors were determined. Sampled sera were collected and screened for recent dengue transmissionas as determined by DENV-IgM enzyme-linked immunosorbent assay (ELISA). The collection of data for risk assessment was supported by a well designed structured questionnaire. Results The prevalence of recent DENV infection was estimated to be (11.42%). Potential risk factors to DENV seropsitivity include, age (OR = 3.24, CI = 1.81–5.77,p-value = 0.001); low income (OR = 3.75, CI = 1.57–8.93, p-value = 0.027); mosquito control (OR = 4.18, CI = 2.33–7.51, p-value = 0.004); and localities. Conclusion The present study showed a high rate of circulating DENV IgM antibodies among the participants of the study (11.42%), suggesting recent transmission of DENV in Kassala State, eastern Sudan. The frequent occurrence of DENV infections necessitates the need for improved surveillance programs and prevention measures to combat this important arboviral disease in Sudan.
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Naik S, Robinson ML, Alexander M, Chandanwale A, Sambarey P, Kinikar A, Bharadwaj R, Sapkal GN, Chebrolu P, Deshpande P, Kulkarni V, Nimkar S, Mave V, Gupta A, Mathad J. Intensified Short Symptom Screening Program for Dengue Infection during Pregnancy, India. Emerg Infect Dis 2020; 26:738-743. [PMID: 32186485 PMCID: PMC7101120 DOI: 10.3201/eid2604.191476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Mosquitoborne diseases (e.g., malaria, dengue, and chikungunya) are endemic to India and pose diagnostic challenges during pregnancy. We evaluated an intensified short symptom screening program in India to diagnose dengue during pregnancy. During October 2017–January 2018, we screened pregnant women during antenatal surveillance for symptoms of mosquitoborne diseases (fever only, fever with conjunctivitis, fever with rash, or all 3 symptoms) within the previous 15 days. Of 5,843 pregnant women screened, 52 were enrolled and tested for dengue, chikungunya, and Zika viruses by using a Trioplex real-time reverse transcription PCR. Of 49 who had complete results, 7 (14%) were dengue positive. Of these ocular pain was seen in 4 (57%) and conjunctivitis in 7 (100%). Intensified symptom screening using conjunctivitis, in addition to rash, in pregnant women with fever might improve dengue case detection and can be included in routine symptom screening during pregnancy.
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14
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Ahmed A, Dietrich I, LaBeaud AD, Lindsay SW, Musa A, Weaver SC. Risks and Challenges of Arboviral Diseases in Sudan: The Urgent Need for Actions. Viruses 2020; 12:E81. [PMID: 31936607 PMCID: PMC7019415 DOI: 10.3390/v12010081] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 12/16/2022] Open
Abstract
The risk of emergence and/or re-emergence of arthropod-borne viral (arboviral) infections is rapidly growing worldwide, particularly in Africa. The burden of arboviral infections and diseases is not well scrutinized because of the inefficient surveillance systems in endemic countries. Furthermore, the health systems are fully occupied by the burden of other co-existing febrile illnesses, especially malaria. In this review we summarize the epidemiology and risk factors associated with the major human arboviral diseases and highlight the gap in knowledge, research, and control in Sudan. Published data in English up to March 2019 were reviewed and are discussed to identify the risks and challenges for the control of arboviruses in the country. In addition, the lack of suitable diagnostic tools such as viral genome sequencing, and the urgent need for establishing a genomic database of the circulating viruses and potential sources of entry are discussed. Moreover, the research and healthcare gaps and global health threats are analyzed, and suggestions for developing strategic health policy for the prevention and control of arboviruses with focus on building the local diagnostic and research capacity and establishing an early warning surveillance system for the early detection and containment of arboviral epidemics are offered.
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Affiliation(s)
- Ayman Ahmed
- Institute of Endemic Diseases, University of Khartoum, Khartoum 11111, Sudan
- Institute for Human Infections and Immunity, Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77755, USA
- World Reference Center for Emerging Viruses and Arboviruses, University of Texas Medical Branch, Galveston, TX 77755, USA
| | | | | | - Steve W. Lindsay
- Department of Biosciences, Durham University, Durham DH1 3LE, UK
| | - Ahmed Musa
- Institute of Endemic Diseases, University of Khartoum, Khartoum 11111, Sudan
| | - Scott C. Weaver
- Institute for Human Infections and Immunity, Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77755, USA
- World Reference Center for Emerging Viruses and Arboviruses, University of Texas Medical Branch, Galveston, TX 77755, USA
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Abstract
Dengue virus (DENV) belongs to the family Flaviviridae, genus Flavivirus. It is a single-stranded positive-sense ribonucleic acid virus with 10,700 bases. The genus Flavivirus includes other arthropod borne viruses such as yellow fever virus, West Nile virus, Zika virus, tick-borne encephalitis virus. It infects ~50–200 million people annually, putting over 3.6 billion people living in tropical regions at risk and causing ~20,000 deaths annually. The expansion of dengue is attributed to factors such as the modern dynamics of climate change, globalization, travel, trade, socioeconomics, settlement, and also viral evolution. There are four antigenically different serotypes of DENV based on the differences in their viral structural and nonstructural proteins. DENV infection causes a spectrum of illness ranging from asymptomatic to dengue fever to severe dengue shock syndrome. Infection with one serotype confers lifelong immunity against that serotype, but heterologus infection leads to severe dengue hemorrhagic fever due to antibody-dependent enhancement. Diagnosis of dengue infections is based mainly on serological detection of either antigen in acute cases or antibodies in both acute and chronic infection. Viral detection and real-time PCR detection though helpful is not feasible in resource poor setup. Treatment of dengue depends on symptomatic management along with fluid resuscitation and may require platelet transfusion. Although vaccine development is in late stages of development, developing a single vaccine against four serotypes often causes serious challenges to researchers; hence, the main stay of prevention is vector control and management.
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16
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Sondo KA, Ouattara A, Diendéré EA, Diallo I, Zoungrana J, Zémané G, Da L, Gnamou A, Meda B, Poda A, Zamané H, Ouédraogo A, Ouédraogo M, Thieba/Bonané B. Dengue infection during pregnancy in Burkina Faso: a cross-sectional study. BMC Infect Dis 2019; 19:997. [PMID: 31771564 PMCID: PMC6880640 DOI: 10.1186/s12879-019-4587-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 10/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dengue fever is prevalent in the world; in recent years, several outbreaks occurred in West Africa. It affects pregnant women. We aimed to assess the consequences of dengue fever on pregnant women and their fetuses during dengue epidemic in Burkina Faso. METHODS We conducted a cross-sectional study from November 1, 2015 to January 31, 2017 in 15 public and private health facilities in Ouagadougou, using secondary data. Immunochromatographic rapid test Duo detecting specific antibodies, immunoglobin M/G and /or dengue non structural antigen1 virus was used to diagnose dengue cases. RESULTS Out of 399 (48%) women registered during the study period, 25 (6%) were pregnant. The average age of pregnant women was 30 years, with 18 and 45 years as extremes. The main symptoms were fever (92%) and headache (92%). Nine patients (36%) had severe dengue characterized by bleeding (16%), neurological symptoms (16%) and acute respiratory distress (8%). Eight (32%) of the 25 women had early miscarriage and 8 (32%) women gave birth to viable fetuses. Among those with viable babies, 5 (20%) presented post-partum hemorrhage and 3 (12%) presented early delivery. The main fetal complications included 3 cases of acute fetal distress (12%). One case of maternal death (4%) and 4 cases of neonatal mortality (44.5%) were notified. CONCLUSION Dengue fever occurring during pregnancy increases maternal and neonatal mortality. Its severe complications require specific monitoring of pregnant women until delivery.
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Affiliation(s)
- Kongnimissom Apoline Sondo
- Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso.
- Department of Infectious Diseases (Yalgado Ouedraogo Teaching Hospital), Ouagadougou, Burkina Faso.
| | - Adama Ouattara
- Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
- Obstetrics and Gynecology Departement (Yalgado Ouedraogo Teaching Hospital), Ouagadougou, Burkina Faso
| | - Eric Arnaud Diendéré
- Department of Infectious Diseases (Yalgado Ouedraogo Teaching Hospital), Ouagadougou, Burkina Faso
| | - Ismaèl Diallo
- Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | - Jacques Zoungrana
- Higher Health Science Institute, Polytechnic University of Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Guelilou Zémané
- Department of Infectious Diseases (Yalgado Ouedraogo Teaching Hospital), Ouagadougou, Burkina Faso
| | - Léa Da
- Department of Infectious Diseases (Yalgado Ouedraogo Teaching Hospital), Ouagadougou, Burkina Faso
| | - Arouna Gnamou
- Department of Infectious Diseases (Yalgado Ouedraogo Teaching Hospital), Ouagadougou, Burkina Faso
| | - Bertrand Meda
- Health Science Research Institute of Ouagadougou (Biomedical department), Ouagadougou, Burkina Faso
| | - Armel Poda
- Higher Health Science Institute, Polytechnic University of Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Hyacinthe Zamané
- Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
- Obstetrics and Gynecology Departement (Yalgado Ouedraogo Teaching Hospital), Ouagadougou, Burkina Faso
| | - Ali Ouédraogo
- Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
- Obstetrics and Gynecology Departement (Yalgado Ouedraogo Teaching Hospital), Ouagadougou, Burkina Faso
| | - Macaire Ouédraogo
- Higher Health Science Institute, Polytechnic University of Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Blandine Thieba/Bonané
- Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
- Obstetrics and Gynecology Departement (Yalgado Ouedraogo Teaching Hospital), Ouagadougou, Burkina Faso
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17
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Almeida Bentes A, Kroon EG, Romanelli RMDC. Neurological manifestations of pediatric arboviral infections in the Americas. J Clin Virol 2019; 116:49-57. [DOI: 10.1016/j.jcv.2019.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 01/17/2023]
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18
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Langerak T, Mumtaz N, Tolk VI, van Gorp ECM, Martina BE, Rockx B, Koopmans MPG. The possible role of cross-reactive dengue virus antibodies in Zika virus pathogenesis. PLoS Pathog 2019; 15:e1007640. [PMID: 30998804 PMCID: PMC6472811 DOI: 10.1371/journal.ppat.1007640] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Zika virus (ZIKV) has been known for decades to circulate in Africa and Asia. However, major complications of a ZIKV infection have recently become apparent for reasons that are still not fully elucidated. One of the hypotheses for the seemingly increased pathogenicity of ZIKV is that cross-reactive dengue antibodies can enhance a ZIKV infection through the principle of antibody-dependent enhancement (ADE). Recently, ADE in ZIKV infection has been studied, but conclusive evidence for the clinical importance of this principle in a ZIKV infection is lacking. Conversely, the widespread circulation of ZIKV in dengue virus (DENV)-endemic regions raises new questions about the potential contribution of ZIKV antibodies to DENV ADE. In this review, we summarize the results of the evidence to date and elaborate on other possible detrimental effects of cross-reactive flavivirus antibodies, both for ZIKV infection and the risk of ZIKV-related congenital anomalies, DENV infection, and dengue hemorrhagic fever.
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Affiliation(s)
- Thomas Langerak
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Noreen Mumtaz
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Vera I. Tolk
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eric C. M. van Gorp
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Byron E. Martina
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Barry Rockx
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marion P. G. Koopmans
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
- * E-mail:
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19
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A Stillborn Multiple Organs' Investigation from a Maternal DENV-4 Infection: Histopathological and Inflammatory Mediators Characterization. Viruses 2019; 11:v11040319. [PMID: 30986974 PMCID: PMC6521294 DOI: 10.3390/v11040319] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 12/11/2022] Open
Abstract
Dengue virus (DENV) is an emerging virus involved in outbreaks in Brazil. The association between the virus and vertical transmission, with disorders in the placenta, has raised a worldwide concern. On the 29th gestational week, a pregnant woman presented severe complications due to a DENV infection leading to maternal and fetus death. Postmortem analysis of fetal organs demonstrated the presence of DENV using reverse transcriptase polymerase chain reaction (RT-PCR) in the fetal brain and DENV non-structural protein 3 (NS3) staining in placenta and several peripheral fetal tissues, such as the brain, liver, lungs, and spleen. Histological analysis of the placenta and fetal organs revealed different types of tissue abnormalities, which included inflammation, hemorrhage, edema, and necrosis in placenta and tissue disorganization in the fetus, such as spongiform parenchyma, microglial inflammation, steatosis, hyalinose arteriolar, inflammatory cells in the alveolar septa, and disorganization of the lymphoid follicle. Increased cellularity (macrophage, Hofbauer cells and TCD8+ lymphocytes) and up-regulation of inflammatory mediators such as IFN-γ, TNF-α, RANTES/CCL5, MCP1/CCL2, and VEGF/R2 were detected in the liver, lung, spleen, brain, and placenta, supporting placental and fetus peripheral tissues inflammation. Maternal infection leading to the production of those vascular mediators may alter the vascular permeability, facilitating the virus entry and tissue and barrier dysfunction.
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20
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The First Outbreak of Dengue Fever in Greater Darfur, Western Sudan. Trop Med Infect Dis 2019; 4:tropicalmed4010043. [PMID: 30823624 PMCID: PMC6473713 DOI: 10.3390/tropicalmed4010043] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/15/2019] [Accepted: 02/27/2019] [Indexed: 11/16/2022] Open
Abstract
Dengue virus (DENV) is an arthropod-borne virus (arbovirus) transmitted by the Aedes mosquitoes, mainly Aedes aegypti. Dengue fever is a rapidly growing disease with expanding geographical distribution worldwide. We investigated a high number of non-malaria febrile cases reported to health clinics in refugee camps in the five states of Darfur between August 2015 and March 2016. The clinical presentation of cases and case definition criteria suggested involvement of one or more arboviral hemorrhagic fevers. Out of 560 suspected cases, we collected and analyzed 204 blood samples and serologically positive samples were confirmed by PCR. We identified 32 (15.7%) dengue viral infections, six West Nile virus infections, and three Crimean–Congo viral infections. Dengue infections were found in four out of the five Darfur states. We reported the first dengue fever outbreak in the Darfur region. Our results highlight the need for public health education and further molecular, phylogenetic, and entomological investigations for a better understanding of the disease transmission and the associated risk factors in the region.
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Humphrey JM, Al-Absi ES, Hamdan MM, Okasha SS, Al-Trmanini DM, El-Dous HG, Dargham SR, Schieffelin J, Abu-Raddad LJ, Nasrallah GK. Dengue and chikungunya seroprevalence among Qatari nationals and immigrants residing in Qatar. PLoS One 2019; 14:e0211574. [PMID: 30703150 PMCID: PMC6355019 DOI: 10.1371/journal.pone.0211574] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/12/2018] [Indexed: 12/12/2022] Open
Abstract
The objective of this study is to characterize the seroprevalence of anti-dengue (DENV) and anti-chikungunya (CHIKV) antibodies among blood donors residing in Qatar who are Middle East and North Africa (MENA) nationals and non-nationals. Sera were collected from adult blood donors in Qatar from 2013 to 2016 and tested for anti-DENV and anti-CHIKV IgG using commercial microplate enzyme-linked immunosorbent assays. Age-specific seroprevalence was summarized by region/nationality: Asia (India, Philippines), Middle East (Iran, Jordan, Lebanon, Pakistan, Palestine, Syria, Yemen), North Africa (Egypt, Sudan), Qatar. The adjusted odds of anti-DENV and anti-CHIKV IgG seropositivity was estimated by logistic regression. Among 1,992 serum samples tested, Asian nationals had higher adjusted odds of being seropositive for anti-DENV antibodies compared to nationals of the Middle East (aOR 0.05, 95% CI 0.04-0.07), North Africa (aOR 0.14, 95% CI 0.10-0.20), and Qatar (aOR 0.01, 95% CI 0.01-0.03). Asian nationals also had higher adjusted odds of being seropositive for anti-CHIKV antibodies compared to those from the Middle East (aOR 0.14, 95% CI 0.07-0.27), North Africa (aOR 0.50, 95% CI 0.26-0.96), and Qatar (aOR 0.38, 95% CI 0.15-0.96). The adjusted odds of being anti-DENV seropositive was higher among anti-CHIKV seropositive adults, and vice versa (aOR 1.94, 95% CI 1.09-3.44), suggesting co-circulation of these viruses. DENV and CHIKV exposure is lower in Qatar and MENA nationals compared to Asian nationals suggesting a lower burden of DENV and CHIKV disease in the MENA. Antibodies to both viruses were detected in nationals from most MENA countries, supporting the need to better understand the regional epidemiology of these viruses.
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Affiliation(s)
- John M. Humphrey
- Division of Infectious Diseases, Department of Medicine, Indiana University, Indianapolis, IN, United States of America
- * E-mail: (GKN); (JMH)
| | - Enas S. Al-Absi
- Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
- BioMedical Research Center, Qatar University, Doha, Qatar
| | - Munia M. Hamdan
- Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
- BioMedical Research Center, Qatar University, Doha, Qatar
| | - Sara S. Okasha
- Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
- BioMedical Research Center, Qatar University, Doha, Qatar
| | - Diyna M. Al-Trmanini
- Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
- BioMedical Research Center, Qatar University, Doha, Qatar
| | - Hend G. El-Dous
- Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
- BioMedical Research Center, Qatar University, Doha, Qatar
| | - Soha R. Dargham
- Infectious Disease Epidemiology Group, Weill Cornell Medicine‐Qatar, Cornell University, Qatar Foundation—Education City, Doha, Qatar
| | - John Schieffelin
- Section of Infectious Diseases, Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine‐Qatar, Cornell University, Qatar Foundation—Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, NY, United States of America
| | - Gheyath K. Nasrallah
- Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
- BioMedical Research Center, Qatar University, Doha, Qatar
- * E-mail: (GKN); (JMH)
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Soghaier MA, Abdelgadir DM, Abdelkhalig SM, Kafi H, Zarroug IMA, Sall AA, Eldegai MH, Elageb RM, Osman MM, Khogali H. Evidence of pre-existing active Zika virus circulation in Sudan prior to 2012. BMC Res Notes 2018; 11:906. [PMID: 30567583 PMCID: PMC6299991 DOI: 10.1186/s13104-018-4027-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 12/17/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The purpose of this study is to provide the first evidence of Zika virus circulation (ZIK) in Sudan. Zika virus was first isolated in the Zika forest of Uganda in 1947, and in 2016, the World Health Assembly declared it a public health emergency of international concern. The discovery of Zika virus circulation in Sudan came as a secondary finding in a 2012 country-wide yellow fever prevalence study, when laboratory tests were done to exclude cross-reactions between flaviviruses. The study was cross-sectional community-based, with randomly selected participants through multi-stage cluster sampling. A sub-set of samples were tested for the Zika virus using ELISA, and the ones that demonstrated reactive results were subsequently tested by PRNT. RESULTS The prevalence of Zika IgG antibodies among ELISA-tested samples was 62.7% (59.4 to 66.1, 95% CI), and only one sample was found positive when tested by PRNT. This provided the first documented evidence for the pre-existing circulation of Zika virus circulation in Sudan. This evidence provides the foundation for future research in this field, and further structured studies should be conducted to determine the epidemiology and burden of the disease.
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Affiliation(s)
- Mohammed A. Soghaier
- Epidemiology and Zoonotic Diseases Department, Federal Ministry of Health, Osman Digna Street with Nile Avenue, PO Box 303, 1111 Khartoum, Sudan
| | - Deena M. Abdelgadir
- Epidemiology and Zoonotic Diseases Department, Federal Ministry of Health, Osman Digna Street with Nile Avenue, PO Box 303, 1111 Khartoum, Sudan
| | - Sozan M. Abdelkhalig
- The Department of Epidemiology, National Public Health Laboratory, Federal Ministry of Heath, Khartoum, Sudan
| | - Hamoda Kafi
- Department of Integrated Vector Management, Federal Ministry of Health, Khartoum, Sudan
| | - Isam M. A. Zarroug
- The Department of Medical Entomology, National Public Health Laboratory, Federal Ministry of Health, Khartoum, Sudan
| | | | - Mawahib H. Eldegai
- The Department of Epidemiology, National Public Health Laboratory, Federal Ministry of Heath, Khartoum, Sudan
| | - Rehab M. Elageb
- The Department of Epidemiology, National Public Health Laboratory, Federal Ministry of Heath, Khartoum, Sudan
| | - Muntasir M. Osman
- Epidemiology and Zoonotic Diseases Department, Federal Ministry of Health, Osman Digna Street with Nile Avenue, PO Box 303, 1111 Khartoum, Sudan
| | - Hayat Khogali
- Epidemiology and Zoonotic Diseases Department, Federal Ministry of Health, Osman Digna Street with Nile Avenue, PO Box 303, 1111 Khartoum, Sudan
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Basurko C, Everhard S, Matheus S, Restrepo M, Hildéral H, Lambert V, Boukhari R, Duvernois JP, Favre A, Valmy L, Nacher M, Carles G. A prospective matched study on symptomatic dengue in pregnancy. PLoS One 2018; 13:e0202005. [PMID: 30281605 PMCID: PMC6169853 DOI: 10.1371/journal.pone.0202005] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/26/2018] [Indexed: 11/18/2022] Open
Abstract
Dengue fever is an increasing problem worldwide, but consequences during pregnancy remain unclear. Much of the available literature suffers from methodological biases that compromise the validity of clinical recommendations. We conducted a matched cohort study during an epidemic in French Guiana to compare events and pregnancy outcomes between two paired groups of pregnant women: women having presented with symptomatic dengue during pregnancy (n = 73) and women having had neither fever nor dengue during pregnancy (n = 219). Women in each arm were matched by place of follow up, gestation weeks at inclusion, and place of residence. Dengue infection was considered to be confirmed if viral RNA, N S1 antigen, the seroconversion of IgM antibodies or the presence of IgM was detected in collected samples. According to the 2009 WHO classification, 27% of the women with symptomatic dengue had at least one clinical or biological warning sign. These complications occurred after the 28th week of gestation in 55% of cases. The medical history, socioeconomic status and demographic characteristics were included in multivariate analysis. Exposure to dengue during pregnancy was not significantly associated with prematurity, small for gestational age infants, hypertension or emergency caesarian section. Maternal dengue with warning signs was a risk factor for peripartum hemorrhage with adjusted relative risk = 8.6(95% CI = 1.2–62). There was a near significant association between dengue and in utero death (p = 0.09). This prospective comparative study underlined the importance of taking into account potential confounders between exposure to dengue and the occurrence of obstetrical events. It also confirms the need for increased vigilance for pregnant women with dengue, particularly for women who present with severe dengue.
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Affiliation(s)
- Célia Basurko
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
- Equipe EA3593, Ecosystèmes amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana, France
- * E-mail: (CB); (MN)
| | - Sibille Everhard
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
| | - Séverine Matheus
- Laboratoire de virologie, Centre National de Référence des Arbovirus, Institut Pasteur de la Guyane Cayenne, French Guiana, France
| | - Marion Restrepo
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
- Service de gynécologie et d'obstétrique, Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana, France
- Pôle de santé publique, Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana, France
| | - Hélène Hildéral
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
| | - Véronique Lambert
- Service de gynécologie et d'obstétrique, Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana, France
| | - Rachida Boukhari
- Service d'analyses médicales, Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana, France
| | - Jean-Pierre Duvernois
- Service de gynécologie et d'obstétrique, Centre médico-chirurgical de Kourou, Croix Rouge Française, Kourou, French Guiana, France
| | - Anne Favre
- Réseau périnat de Guyane, Cayenne, French Guiana, France
| | - Larissa Valmy
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
| | - Mathieu Nacher
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
- Equipe EA3593, Ecosystèmes amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana, France
- * E-mail: (CB); (MN)
| | - Gabriel Carles
- Service de gynécologie et d'obstétrique, Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana, France
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Eldigail MH, Adam GK, Babiker RA, Khalid F, Adam IA, Omer OH, Ahmed ME, Birair SL, Haroun EM, AbuAisha H, Karrar AE, Abdalla HS, Aradaib IE. Prevalence of dengue fever virus antibodies and associated risk factors among residents of El-Gadarif state, Sudan. BMC Public Health 2018; 18:921. [PMID: 30053811 PMCID: PMC6062928 DOI: 10.1186/s12889-018-5853-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 07/17/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Dengue fever, caused by dengue virus (DENV), has become one of the most important mosquito-borne viral diseases with a steady rise in global incidence, including the Sudan. Sporadic cases and frequent acute febrile illness outbreaks, compatible with Dengue fever, have been reported in El-Gadarif State, Sudan. However, diagnosis was based almost exclusively on clinical signs without confirmatory laboratory investigations. Despite the magnitude of the problem in El-Gadarif State, no information is currently available with regard to the epidemiology of the disease in this State. El-Gadarif State is one of the largest commercial centers in the Sudan. The objective of the present investigation is to estimate the prevalence of DENV antibodies, and determine the potential risk factors associated with seropositivity among residents of El-Gadarif State. METHODS A cross sectional study was conducted in a total of 701residents randomly selected from all 10 localities in El-Gadarif State. The sera from the 701 residents were tested for the presence of DENV-specific immunoglobulin G (IgG) antibodies using a commercially available Anti-dengue IgG enzyme-linked immunosorbent assay (ELISA). RESULTS Among the 701 residents, 334 residents (47.6%) were seropositive for DENV. Mosquito control (OR = 2.73, CI = 1.37-5.87, p-value = 0.001); low income (OR = 2.31, CI: 1.71-6.36, p value = 0.032); sleeping out-doors (OR = 3.73, CI = 2.63-6.23, p-value = 0.013), and localities were determined as potential risk factors for contracting DENV infection. CONCLUSIONS The prevalence rate of DENV antibodies among residents of El-Gadarif State is significantly high (47.6%). Further epidemiologic studies including, distribution of mosquito vectors and implementation of improved surveillance are urgently warranted for better prediction and prevention of a possible DENV outbreak in El-Gadarif State, Sudan.
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Affiliation(s)
- Mawahib H. Eldigail
- 0000 0001 0674 6207grid.9763.bMolecular Biology Laboratory (MBL), Department of Clinical Medicine, Faculty of Veterinary Medicine, University of Khartoum, P.O. Box 32, Khartoum North, Sudan
| | - Gamal K. Adam
- Department of Medical laboratory Sciences, Faculty of Medicine, University of Elgadarif, Elgadarif, Sudan
| | - Rabie A. Babiker
- Department of Medical laboratory Sciences, Faculty of Medicine, University of Elgadarif, Elgadarif, Sudan
| | - Fatima Khalid
- 0000 0004 0447 6858grid.412060.1Department of Microbiology, Faculty of Science, University of Kassala, Kassala, Sudan
| | - Ibrahim A. Adam
- 0000 0001 0674 6207grid.9763.bMolecular Biology Laboratory (MBL), Department of Clinical Medicine, Faculty of Veterinary Medicine, University of Khartoum, P.O. Box 32, Khartoum North, Sudan
| | - Osama H. Omer
- 0000 0001 0674 6207grid.9763.bMolecular Biology Laboratory (MBL), Department of Clinical Medicine, Faculty of Veterinary Medicine, University of Khartoum, P.O. Box 32, Khartoum North, Sudan
| | - Mohamed E. Ahmed
- grid.440839.2Deanship of Scientific research, Alneelain University, Khartoum, Sudan
| | - Sara L. Birair
- grid.440839.2Deanship of Scientific research, Alneelain University, Khartoum, Sudan
| | - Eltahir M. Haroun
- grid.442398.0Deanship of Scientific research, International University of Africa, Khartoum, Sudan
| | - Hassan AbuAisha
- grid.442398.0Deanship of Scientific research, International University of Africa, Khartoum, Sudan
| | - Abdelrahim E. Karrar
- 0000 0001 0674 6207grid.9763.bMolecular Biology Laboratory (MBL), Department of Clinical Medicine, Faculty of Veterinary Medicine, University of Khartoum, P.O. Box 32, Khartoum North, Sudan
| | - Hamid S. Abdalla
- 0000 0001 0674 6207grid.9763.bMolecular Biology Laboratory (MBL), Department of Clinical Medicine, Faculty of Veterinary Medicine, University of Khartoum, P.O. Box 32, Khartoum North, Sudan
| | - Imadeldin E. Aradaib
- 0000 0001 0674 6207grid.9763.bMolecular Biology Laboratory (MBL), Department of Clinical Medicine, Faculty of Veterinary Medicine, University of Khartoum, P.O. Box 32, Khartoum North, Sudan
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Adam A, Schüttoff T, Reiche S, Jassoy C. High seroprevalence of dengue virus indicates that dengue virus infections are frequent in central and eastern Sudan. Trop Med Int Health 2018; 23:960-967. [PMID: 29907989 DOI: 10.1111/tmi.13116] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To determine the seroprevalence of dengue in central and eastern Sudan and the breadth of neutralising antibody responses. METHODS Blood was drawn from 483 patients with fever who visited outpatient clinics in Port Sudan, Red Sea state, in three towns in Kassala state and in El Obeid, North Kordofan, in December 2012 and January 2013. Sera were tested for dengue virus IgG and IgM by ELISA (Panbio) and sera without serologic evidence of acute infection (IgM negative) were used for the analysis of the seroprevalence. DENV neutralisation tests were performed to determine the specificity of the ELISA and to examine the degree of cross-neutralisation of multiple DENV serotypes. RESULTS Sixty-seven per cent (302 of 448) of the sera were dengue virus IgG-positive. The seroprevalence in Port Sudan was 89% (106 of 119 sera), in Kassala 61% (128 of 209) and in North Kordofan 56.7% (68 of 120). Thirty-one of 32 ELISA-positive sera neutralised dengue viruses indicating that the ELISA was highly specific. The majority of the sera broadly neutralised all four dengue virus serotypes indicating multiple infections. CONCLUSIONS The majority of the population in central and eastern Sudan has been infected with dengue viruses, many people repeatedly. The high seroprevalence underscores the need for extended dengue surveillance in Sudan, broad disease awareness in medical institutions and in the population and diagnostic capacity building for severe dengue infections.
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Affiliation(s)
- Awadalkareem Adam
- Institute for Virology, University Clinics and Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Tom Schüttoff
- Institute for Virology, University Clinics and Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Sven Reiche
- Institute for Virology, University Clinics and Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Christian Jassoy
- Institute for Virology, University Clinics and Medical Faculty, University of Leipzig, Leipzig, Germany
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26
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Paixao ES, Harron K, Campbell O, Teixeira MG, Costa MDCN, Barreto ML, Rodrigues LC. Dengue in pregnancy and maternal mortality: a cohort analysis using routine data. Sci Rep 2018; 8:9938. [PMID: 29967399 PMCID: PMC6028487 DOI: 10.1038/s41598-018-28387-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/20/2018] [Indexed: 11/26/2022] Open
Abstract
Dengue is a mosquito-borne disease with major public health importance due to its growing incidence and geographical spread. There is a lack of knowledge on its contribution to maternal death. We conducted a population-based cohort study to investigate the association between symptomatic dengue during pregnancy and deaths in Brazil from 2007 to 2012. We did this by linking routine records of confirmed dengue cases to records of deaths of women who had a live birth. Using the Firth method, we estimated odds ratios for maternal deaths associated with dengue during pregnancy. Dengue increased the risk of maternal death by 3 times (95%CI,1.5-5.8) and dengue haemorrhagic fever increased the risk of maternal death by 450 times (95%CI,186.9-1088.4) when compared to mortality of pregnant women without dengue. The increase in risk occurred mostly during acute dengue 71.5 (95%CI,32.8-155.8), compared with no dengue cases. This study showed an increased risk of adverse outcomes in pregnant women with dengue. Therefore in areas where dengue is circulating, the health of pregnant women should be not only a public health priority, but health professionals attending pregnant women with dengue should more closely observe these patients to be able to intervene in a timely way and avoid deaths.
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Affiliation(s)
- Enny S Paixao
- London School of Hygiene and Tropical Medicine. Keppel St, Bloomsbury, London, WC1E 7HT, United Kingdom.
- Instituto de Saúde Coletiva. Rua Basílio da Gama, s/n.Canela, CEP 40110040, Salvador, Bahia, Brazil.
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, CEP 41745-715, Salvador, Bahia, Brazil.
| | - Katie Harron
- London School of Hygiene and Tropical Medicine. Keppel St, Bloomsbury, London, WC1E 7HT, United Kingdom
| | - Oona Campbell
- London School of Hygiene and Tropical Medicine. Keppel St, Bloomsbury, London, WC1E 7HT, United Kingdom
| | - Maria Glória Teixeira
- Instituto de Saúde Coletiva. Rua Basílio da Gama, s/n.Canela, CEP 40110040, Salvador, Bahia, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, CEP 41745-715, Salvador, Bahia, Brazil
| | | | - Mauricio L Barreto
- Instituto de Saúde Coletiva. Rua Basílio da Gama, s/n.Canela, CEP 40110040, Salvador, Bahia, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, CEP 41745-715, Salvador, Bahia, Brazil
| | - Laura C Rodrigues
- London School of Hygiene and Tropical Medicine. Keppel St, Bloomsbury, London, WC1E 7HT, United Kingdom
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, CEP 41745-715, Salvador, Bahia, Brazil
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Maternal, Fetal, and Neonatal Outcomes in Pregnant Dengue Patients in Mexico. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9643083. [PMID: 29607328 PMCID: PMC5828467 DOI: 10.1155/2018/9643083] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/02/2017] [Accepted: 11/12/2017] [Indexed: 01/25/2023]
Abstract
To increase our understanding of the consequences of dengue virus infection during pregnancy, a retrospective analysis was performed on the medical records of all completed pregnancies (live births and pregnancy losses) at nine public hospitals in the Gulf of Mexico from January to October 2013. Eighty-two patients developed clinical, laboratory-confirmed dengue virus infections while pregnant. Of these, 54 (65.9%) patients were diagnosed with dengue without warning signs, 15 (18.3%) patients were diagnosed with dengue with warning signs, and 13 (15.9%) patients had severe dengue. Five (38.5%) patients with severe dengue experienced fetal distress and underwent emergency cesarean sections. Four patients delivered apparently healthy infants of normal birthweight while the remaining patient delivered a premature infant of low birthweight. Patients died of multiple organ failure during or within 10 days of the procedure. Severe dengue was also associated with obstetric hemorrhage (30.8%, four cases), preeclampsia (15.4%, two cases), and eclampsia (7.7%, one case). These complications were less common or absent in patients in the other two disease categories. Additionally, nonsevere dengue was not associated with maternal mortality, fetal distress, or adverse neonatal outcomes. In summary, the study provides evidence that severe dengue during pregnancy is associated with a high rate of fetal distress, cesarean delivery, and maternal mortality.
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28
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Iqtadar S, Akbar N, Mehmood M, Abaidullah S. Clinical Audit of Dengue Related Deaths in 2011-Mayo Hospital Lahore Pakistan. Pak J Med Sci 2017; 33:1070-1073. [PMID: 29142540 PMCID: PMC5673709 DOI: 10.12669/pjms.335.13051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Objective: Dengue infection has evolved into an epidemic during last few years in Pakistan and has been associated with poor outcomes. Literature with respect to mortality risk factors in Dengue infection is not sufficient. This compelled us to conduct this study to find out major contributory factors to death in patients with dengue viral infection at one of Asia’s ancient hospital setting with an aim to recognize complications at earliest and improve case management in future. Methods: A retrospective observational study of 95 adult dengue deaths was performed at Mayo Hospital Lahore from July 1st 2011 to 31st December 2011 during a major dengue epidemic. Patients who tested positive by dengue IgM in the presence of acute fever fulfilling the World Health Organization criteria for Dengue Fever, Dengue Hemorrhagic Fever or Dengue Shock Syndrome and died within same setting, were included. Data regarding demographic profile, clinical and laboratory parameters along with treatment details were obtained and analysed. All records examined were anonymized. Results: Median age was 36 years (range13-80 years) among 95 deaths due to Dengue. Male gender comprised 60 (63.1%). Co-morbidities existed in 74 (77.9%) with hypertension in 21 (22.1%) diabetes in 11 (11.58%), liver disease in 9 (9.47%) and ischemic heart disease in 8(8.4%) cases. Patients presented at second day of fever for admission (range 1-8 days) and death occurred at a median of 4 days (range 30 minutes to 23 days). Hospital stay was for less than a week for seventy nine (83.2%) patients and 16 (16.8%) were admitted for more than 7 days. Critical care was required in 67(71%). Severe hepatitis occurred in 41 (43.1%), acute renal impairment occurred in 32 (33.7%) and disseminated intravascular coagulation in 16 (16.8%). Deaths were due to prolonged shock 49 (51.5%) fluid overload 46 (48.4%) and massive bleeding 18(19%) leading to organ failure. Conclusion: Decompensated shock complicated by either massive plasma leakage, frank bleeding, multi organ failure or deranged clotting profile results in enhanced mortality in Dengue infection. Co-morbidities especially Diabetes are poor prognostic factors in predicting Dengue mortality.
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Affiliation(s)
- Somia Iqtadar
- Somia Iqtadar, FCPS. Department of Medicine, Mayo Hospital, Lahore, Pakistan
| | - Nabeel Akbar
- Nabeel Akbar, MBBS. Department of Cardiology, Punjab Institute of Cardiology, Lahore, Pakistan
| | - Mehreen Mehmood
- Mehreen Mehmood, MBBS. Department of Medicine, Mayo Hospital, Lahore, Pakistan
| | - Sajid Abaidullah
- Sajid Abaidullah, FCPS. Department of Medicine, Mayo Hospital, Lahore, Pakistan
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Abstract
Arboviruses are emerging infectious diseases with the ability to expand geographically and rapidly affect large populations. The recent epidemic caused by the Zika virus in the Americas and congenital Zika syndrome associated with maternal infection has called out attention to the importance of studying arboviruses during pregnancy. This is a review on selected arboviruses infections during gestation, including Zika, Chikungunya, Dengue and Yellow Fever viruses. Issues such as historical overview, pathogenesis, transmission, clinical conditions, diagnosis, treatment and prevention are addressed.
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30
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Roles of Interferons in Pregnant Women with Dengue Infection: Protective or Dangerous Factors. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2017; 2017:1671607. [PMID: 29081814 PMCID: PMC5610849 DOI: 10.1155/2017/1671607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/01/2017] [Accepted: 08/06/2017] [Indexed: 01/13/2023]
Abstract
Dengue infection is a serious public health problem in tropical and subtropical areas. With the recent outbreaks of Zika disease and its reported correlation with microcephaly, the large number of pregnancies with dengue infection has become a serious concern. This review describes the epidemiological characteristics of pregnancy with dengue and the initial immune response to dengue infection, especially in IFNs production in this group of patients. Dengue is much more prevalent in pregnant women compared with other populations. The severity of dengue is correlated with the level of IFNs, while the serum IFN level must be sufficiently high to maintain the pregnancy and to inhibit virus replication.
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31
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Dengue virus infection during pregnancy increased the risk of adverse fetal outcomes? An updated meta-analysis. J Clin Virol 2017; 94:42-49. [DOI: 10.1016/j.jcv.2017.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/10/2017] [Accepted: 07/12/2017] [Indexed: 01/11/2023]
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32
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Dengue infection during pregnancy and risk of preterm birth. THE LANCET. INFECTIOUS DISEASES 2017; 17:885-886. [DOI: 10.1016/s1473-3099(17)30298-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 04/21/2017] [Indexed: 11/23/2022]
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Charlier C, Beaudoin MC, Couderc T, Lortholary O, Lecuit M. Arboviruses and pregnancy: maternal, fetal, and neonatal effects. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 1:134-146. [PMID: 30169203 DOI: 10.1016/s2352-4642(17)30021-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/27/2017] [Accepted: 06/27/2017] [Indexed: 12/19/2022]
Abstract
Arboviruses are an expanding public health threat, with pregnant women facing unique complications from arbovirus infections. These infections, such as dengue and Crimean-Congo haemorrhagic fever, can be more severe in pregnant women than in the general population. Vertical transmission is reported for many arboviruses and can severely affect pregnancy outcome. Indeed, arboviruses-particularly flaviviruses and alphaviruses-are associated with increased risks of fetal loss and premature birth. Arboviruses can be teratogenic, as is the case for Zika virus and Venezuelan equine encephalitis virus. Finally, intrapartum transmission can result in severe neonatal infections, as is true for chikungunya virus. Although the global burden of arboviruses is well recognised, few studies have provided data on arbovirus infection specifically in the context of maternal and child health. Epidemiological and clinical studies are therefore needed to better assess the burden of arbovirus infections during pregnancy and to improve the prevention and clinical management of these viral infections. In this Review, we analyse the information available and identify gaps in knowledge that require further assessment.
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Affiliation(s)
- Caroline Charlier
- Institut Pasteur, Biology of Infection Unit, Paris, France; Inserm U1117, Paris, France; Paris-Descartes University, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Marie-Claude Beaudoin
- Paris-Descartes University, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France; Division of Medical Microbiology and Infectious Diseases, Laval University and CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Thérèse Couderc
- Institut Pasteur, Biology of Infection Unit, Paris, France; Inserm U1117, Paris, France
| | - Olivier Lortholary
- Paris-Descartes University, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Lecuit
- Institut Pasteur, Biology of Infection Unit, Paris, France; Inserm U1117, Paris, France; Paris-Descartes University, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Abstract
PURPOSE OF REVIEW While the Zika virus (ZIKV) has been noted for its distinct neurotropism and identified as a significant cause for a congenital infection syndrome, there has been increased recognition of the importance to better understand the clinical impact of non-congenital ZIKV infection in infants and children. This article reviews reports of perinatal and breast milk transmission of ZIKV and summarizes current clinical outcome data of pediatric non-congenital ZIKV infection. RECENT FINDINGS Perinatal transmission and presence of infective ZIKV particles in breast milk have been reported. Most symptomatic non-congenital ZIKV infection in infants and children is mild and self-limited, but long-term follow-up studies are lacking. The mechanism and impact of perinatal and breast milk transmission is unclear. The current WHO infant feeding guidelines in areas of ZIKV transmission support breastfeeding. Unless any scientific data raise concern regarding transmission via breastfeeding, the current guidelines should continue to be followed. Prospective population-based cohort studies to investigate maternal, perinatal, infant, and child outcomes are needed.
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Affiliation(s)
- Stefan H F Hagmann
- Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center, Northwell Health, 269-01 76th Avenue, New Hyde Park, NY, 11040, USA.
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Feitoza HAC, Koifman S, Koifman RJ, Saraceni V. Dengue infection during pregnancy and adverse maternal, fetal, and infant health outcomes in Rio Branco, Acre State, Brazil, 2007-2012. CAD SAUDE PUBLICA 2017; 33:e00178915. [PMID: 28614453 DOI: 10.1590/0102-311x00178915] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 06/24/2016] [Indexed: 11/22/2022] Open
Abstract
The effects of dengue infection during pregnancy have not been previously studied in Rio Branco, Acre State, Brazil. The aim of this study was to determine the risks of maternal, fetal, and infant complications resulting from dengue infection during pregnancy. The study compared two cohorts of pregnant women, exposed versus unexposed to dengue virus, from 2007 to 2012. Incidence rates and risk ratios were estimated for maternal, fetal, and infant complications. In the exposed cohort there were 3 fetal deaths and 5 neonatal deaths. Two maternal deaths were identified in the exposed cohort, as opposed to none in the unexposed group (p = 0.040). The exposed cohort showed a risk ratio (RR) of 3.4 (95%CI: 1.02-11.23) for neonatal death. The risk ratio for early neonatal death was 6.8 (95%CI: 1.61-28.75). Ten infant deaths occurred in children of exposed pregnant women and 7 in unexposed (RR = 6.0; 95%CI: 2.24-15.87). Women infected with dengue virus in pregnancy showed increased risk ratio for maternal, neonatal, and infant mortality.
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Affiliation(s)
| | | | - Rosalina Jorge Koifman
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Valéria Saraceni
- Superintendência de Vigilância em Saúde, Secretaria Municipal de Saúde, Rio de Janeiro, Brasil† Falecido
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36
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Gautret P, Mouffok N, Parola P. North Africa. Infect Dis (Lond) 2017. [DOI: 10.1002/9781119085751.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Philippe Gautret
- Unité de Recherche sur les maladies Infectieuses et Tropicales Emergentes; Aix-Marseille Université; Marseille France
| | - Nadjet Mouffok
- Service des Maladies Infectieuses; Centre Hospitalier Universitaire d'Oran; Oran Algeria
| | - Philippe Parola
- Unité des Rickettsies, Faculté de Médecine; Université de la Méditerranée; Marseille France
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Dengue. NEGLECTED TROPICAL DISEASES 2017. [PMCID: PMC7123783 DOI: 10.1007/978-3-319-68493-2_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Dengue is one of the most important mosquito-borne viral infections caused by single-stranded RNA virus that are transmitted by the Aedes aegypti and Aedes albopictus mosquito species. Dengue is endemic in over 140 countries in Asia, the USA, the Eastern Mediterranean, and Africa. The World Health Organization (WHO) estimated that there are more than 2.5 billion people—mainly occurs in children living in tropical and subtropical countries—at risk of dengue infection with one or more dengue viruses. There are estimated nearly 100 million symptomatic dengue infections occurring worldwide annually, nearly 75% in Asia and the Western Pacific region [1]. During the past decades, the outbreaks of dengue infection have been reported throughout the world with increased severity. Ecologic and demographic changes are considered to be the contributing factors to the emergence of dengue infection in the past decades. Dengue has expanded into new countries and into urban settings associated with increased distribution of A. aegypti, population growth, urbanization, development of slums, migration of population, movement of dengue virus by infected travelers, trade development, and improved diagnostic capabilities in medical practice [2, 3]. Increased transmission of dengue virus in tropical urban areas has been created by substandard housing and crowding as well as deterioration in water, sewer, and waste management systems, all of which are intimately associated with unplanned urbanization [4–7]. So it is likely that dengue will expand its geographic reach and become an increasing burden on health resources in affected areas during the next decade. An effective vector-control management is the only means to reduce dengue infection in endemic areas. Because vector control has achieved only limited success so far in reducing the transmission of dengue, the usage of effective dengue vaccine in target population along with the preventive measures already used such as raising public awareness may be the means to effectively control of this disease in endemic area [8].
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Humphrey JM, Cleton NB, Reusken CBEM, Glesby MJ, Koopmans MPG, Abu-Raddad LJ. Dengue in the Middle East and North Africa: A Systematic Review. PLoS Negl Trop Dis 2016; 10:e0005194. [PMID: 27926925 PMCID: PMC5142774 DOI: 10.1371/journal.pntd.0005194] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 11/17/2016] [Indexed: 12/19/2022] Open
Abstract
Background Dengue virus (DENV) infection is widespread and its disease burden has increased in past decades. However, little is known about the epidemiology of dengue in the Middle East and North Africa (MENA). Methodology / Principal Findings Following Cochrane Collaboration guidelines and reporting our findings following PRISMA guidelines, we systematically reviewed available records across MENA describing dengue occurrence in humans (prevalence studies, incidence studies, and outbreak reports), occurrence of suitable vectors (Aedes aegypti and Aedes albopictus), and DENV vector infection rates. We identified 105 human prevalence measures in 13 of 24 MENA countries; 81 outbreaks reported from 9 countries from 1941–2015; and reports of Ae. aegypti and/or Ae. albopictus occurrence in 15 countries. The majority of seroprevalence studies were reported from the Red Sea region and Pakistan, with multiple studies indicating >20% DENV seroprevalence in general populations (median 25%, range 0–62%) in these subregions. Fifty percent of these studies were conducted prior to 1990. Multiple studies utilized assays susceptible to serologic cross-reactions and 5% of seroprevalence studies utilized viral neutralization testing. There was considerable heterogeneity in study design and outbreak reporting, as well as variability in subregional study coverage, study populations, and laboratory methods used for diagnosis. Conclusions / Significance DENV seroprevalence in the MENA is high among some populations in the Red Sea region and Pakistan, while recent outbreaks in these subregions suggest increasing incidence of DENV which may be driven by a variety of ecologic and social factors. However, there is insufficient study coverage to draw conclusions about Aedes or DENV presence in multiple MENA countries. These findings illustrate the epidemiology of DENV in the MENA while revealing priorities for DENV surveillance and Aedes control. Dengue is a mosquito-transmitted flavivirus whose global distribution and disease incidence has increased in recent decades. In the Middle East and North Africa, the epidemiology of dengue remains poorly characterized despite increasing reports of outbreaks and transmission in new areas. In order to understand the evidence supporting the epidemiology of this virus in the region and the areas in need of further research, we conducted a systematic review of studies reporting human prevalence, incidence, and infection rates in the virus’ main mosquito vectors, Aedes aegypti and Aedes albopictus. Among the studies identified, the Red Sea subregion and Pakistan reported the highest seroprevalence estimates for dengue. However, we encountered substantial heterogeneity in the distribution, quality, and quantity of published studies. These findings inform future research and surveillance priorities for DENV in the MENA region.
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Affiliation(s)
- John M. Humphrey
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
- * E-mail:
| | - Natalie B. Cleton
- Erasmus Medical Centre, Rotterdam, The Netherlands
- National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands
| | | | - Marshall J. Glesby
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
- Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
| | - Marion P. G. Koopmans
- Erasmus Medical Centre, Rotterdam, The Netherlands
- National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands
| | - Laith J. Abu-Raddad
- Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
- Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar
- College of Public Health, Hamad bin Khalifa University, Qatar Foundation, Education City, Doha, Qatar
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Baudin M, Jumaa AM, Jomma HJE, Karsany MS, Bucht G, Näslund J, Ahlm C, Evander M, Mohamed N. Association of Rift Valley fever virus infection with miscarriage in Sudanese women: a cross-sectional study. LANCET GLOBAL HEALTH 2016; 4:e864-e871. [PMID: 27692776 DOI: 10.1016/s2214-109x(16)30176-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/27/2016] [Accepted: 07/14/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Rift Valley fever virus is an emerging mosquito-borne virus that causes infections in animals and human beings in Africa and the Arabian Peninsula. Outbreaks of Rift Valley fever lead to mass abortions in livestock, but such abortions have not been identified in human beings. Our aim was to investigate the cause of miscarriages in febrile pregnant women in an area endemic for Rift Valley fever. METHODS Pregnant women with fever of unknown origin who attended the governmental hospital of Port Sudan, Sudan, between June 30, 2011, and Nov 17, 2012, were sampled at admission and included in this cross-sectional study. Medical records were retrieved and haematological tests were done on patient samples. Presence of viral RNA as well as antibodies against a variety of viruses were analysed. Any association of viral infections, symptoms, and laboratory parameters to pregnancy outcome was investigated using Pearson's χ2 test. FINDINGS Of 130 pregnant women with febrile disease, 28 were infected with Rift Valley fever virus and 31 with chikungunya virus, with typical clinical and laboratory findings for the infection in question. 15 (54%) of 28 women with an acute Rift Valley fever virus infection had miscarriages compared with 12 (12%) of 102 women negative for Rift Valley fever virus (p<0·0001). In a multiple logistic regression analysis, adjusting for age, haemorrhagic disease, and chikungunya virus infection, an acute Rift Valley fever virus infection was an independent predictor of having a miscarriage (odds ratio 7·4, 95% CI 2·7-20·1; p<0·0001). INTERPRETATION This study is the first to show an association between infection with Rift Valley fever virus and miscarriage in pregnant women. Further studies are warranted to investigate the possible mechanisms. Our findings have implications for implementation of preventive measures, and evidence-based information to the public in endemic countries should be strongly recommended during Rift Valley fever outbreaks. FUNDING Schlumberger Faculty for the Future, CRDF Global (31141), the Swedish International Development Cooperation Agency, the County Council of Västerbotten, and the Faculty of Medicine, Umeå University.
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Affiliation(s)
- Maria Baudin
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden
| | - Ammar M Jumaa
- Department of Obstetrics and Gynaecology, Red Sea University, Port Sudan, Sudan
| | - Huda J E Jomma
- Department of Parasitology and Medical Entomology, Port Sudan Ahlia College, Port Sudan, Sudan
| | - Mubarak S Karsany
- Faculty of Medical Laboratory Sciences, Karary University, Khartoum, Sudan
| | - Göran Bucht
- Swedish Defence Research Agency, CBRN Defence and Security, Umeå, Sweden
| | - Jonas Näslund
- Swedish Defence Research Agency, CBRN Defence and Security, Umeå, Sweden
| | - Clas Ahlm
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
| | - Magnus Evander
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden.
| | - Nahla Mohamed
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden
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Affiliation(s)
- Yin Mo
- Ministry of Health Holdings, University Medicine Cluster, National University Health System, 1 Maritime Square, Singapore 099253, Singapore Division of Infectious Diseases, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, 119228, Singapore
| | - Brenda Mae Alferez Salada
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, 119228, Singapore
| | - Paul Anantharajah Tambyah
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, 119228, Singapore Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Rd 119228, NUHS Tower Block, Level 11, Singapore 117597, Singapore
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Grischott F, Puhan M, Hatz C, Schlagenhauf P. Non-vector-borne transmission of Zika virus: A systematic review. Travel Med Infect Dis 2016; 14:313-30. [PMID: 27425793 DOI: 10.1016/j.tmaid.2016.07.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/07/2016] [Accepted: 07/07/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Increasing numbers of confirmed cases of Zika virus (ZIKV) infection resulting from non-mosquito-borne transmission have been reported. METHODS We performed a systematic literature review (PRISMA guidelines) on intrauterine, intrapartum, sexual and animal bite ZIKV transmission. The presence of the virus in breast milk, urine, saliva and blood transfusions was also reviewed. RESULTS The search resulted in 285 papers of possible relevance, of which we included 53 in the systematic review. Mother-to-child transmission was most frequently described with adverse infant outcomes including microcephaly, intracranial calcification and fetal death. Zika virus RNA has been detected in amniotic fluid, breast milk, seminal fluid, saliva, urine and blood. Semen and blood products have proved to be infectious. Male-to-female and male-to-male ZIKV transmission is documented. There are contradictory results concerning the infectiousness of breast milk and urine and data on saliva, animal bites, transplantation, needlestick injury and laboratory work are inconclusive. CONCLUSIONS Our systematic analysis shows that non-vector-borne ZIKV transmission plays a role in the spread of ZIKV and has great societal impact. It has important public health implications for the prevention and control of ZIKV globally and will be a basis for policy and further research.
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Affiliation(s)
- Franca Grischott
- University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travellers' Health, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Milo Puhan
- University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travellers' Health, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Christoph Hatz
- University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travellers' Health, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, 8001 Zurich, Switzerland; Swiss Tropical and Public Health Institute, Department of Medicine and Diagnostics, University of Basel, Socinstrasse 57, 4051 Basel, Switzerland
| | - Patricia Schlagenhauf
- University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travellers' Health, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, 8001 Zurich, Switzerland.
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Paixão ES, Teixeira MG, Costa MDCN, Rodrigues LC. Dengue during pregnancy and adverse fetal outcomes: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2016; 16:857-865. [DOI: 10.1016/s1473-3099(16)00088-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
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Chan JFW, Choi GKY, Yip CCY, Cheng VCC, Yuen KY. Zika fever and congenital Zika syndrome: An unexpected emerging arboviral disease. J Infect 2016; 72:507-24. [PMID: 26940504 PMCID: PMC7112603 DOI: 10.1016/j.jinf.2016.02.011] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 02/18/2016] [Accepted: 02/20/2016] [Indexed: 02/09/2023]
Abstract
Unlike its mosquito-borne relatives, such as dengue, West Nile, and Japanese encephalitis viruses, which can cause severe human diseases, Zika virus (ZIKV) has emerged from obscurity by its association with a suspected "congenital Zika syndrome", while causing asymptomatic or mild exanthematous febrile infections which are dengue- or rubella-like in infected individuals. Despite having been discovered in Uganda for almost 60 years, <20 human cases were reported before 2007. The massive epidemics in the Pacific islands associated with the ZIKV Asian lineage in 2007 and 2013 were followed by explosive outbreaks in Latin America in 2015. Although increased mosquito breeding associated with the El Niño effect superimposed on global warming is suspected, genetic changes in its RNA virus genome may have led to better adaptation to mosquitoes, other animal reservoirs, and human. We reviewed the epidemiology, clinical manifestation, virology, pathogenesis, laboratory diagnosis, management, and prevention of this emerging infection. Laboratory diagnosis can be confounded by cross-reactivity with other circulating flaviviruses. Besides mosquito bite and transplacental transmission, the risk of other potential routes of transmission by transfusion, transplantation, sexual activity, breastfeeding, respiratory droplet, and animal bite is discussed. Epidemic control requires adequate clearance of mosquito breeding grounds, personal protection against mosquito bite, and hopefully a safe and effective vaccine.
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Affiliation(s)
- Jasper F W Chan
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Garnet K Y Choi
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Cyril C Y Yip
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vincent C C Cheng
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kwok-Yung Yuen
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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de Paula Freitas B, de Oliveira Dias JR, Prazeres J, Sacramento GA, Ko AI, Maia M, Belfort R. Ocular Findings in Infants With Microcephaly Associated With Presumed Zika Virus Congenital Infection in Salvador, Brazil. JAMA Ophthalmol 2016; 134:529-535. [PMID: 26865554 DOI: 10.1001/jamaophthalmol.2016.0267] [Citation(s) in RCA: 356] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The Zika virus (ZIKV) has rapidly reached epidemic proportions, especially in northeastern Brazil, and has rapidly spread to other parts of the Americas. A recent increase in the prevalence of microcephaly in newborn infants and vision-threatening findings in these infants is likely associated with the rapid spread of ZIKV. Objective To evaluate the ocular findings in infants with microcephaly associated with presumed intrauterine ZIKV infection in Salvador, Bahia, Brazil. Design, Setting, and Participants Case series at a tertiary hospital. Twenty-nine infants with microcephaly (defined by a cephalic circumference of ≤32 cm) with a presumed diagnosis of congenital ZIKV were recruited through an active search and referrals from other hospitals and health unities. The study was conducted between December 1 and December 21, 2015. Interventions All infants and mothers underwent systemic and ophthalmic examinations from December 1 through December 21, 2015, in the Roberto Santos General Hospital, Salvador, Brazil. Anterior segment and retinal, choroidal, and optic nerve abnormalities were documented using a wide-field digital imaging system. The differential diagnosis included toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, syphilis, and human immunodeficiency virus, which were ruled out through serologic and clinical examinations. Main Outcomes and Measures Ocular abnormalities associated with ZIKV. Results Twenty-three of 29 mothers (79.3%) reported suspected ZIKV infection signs and symptoms during pregnancy, 18 in the first trimester, 4 in the second trimester, and 1 in the third trimester. Of the 29 infants (58 eyes) examined (18 [62.1%] female), ocular abnormalities were present in 17 eyes (29.3%) of 10 children (34.5%). Bilateral findings were found in 7 of 10 patients presenting with ocular lesions, the most common of which were focal pigment mottling of the retina and chorioretinal atrophy in 11 of the 17 eyes with abnormalities (64.7%), followed by optic nerve abnormalities in 8 eyes (47.1%), bilateral iris coloboma in 1 patient (2 eyes [11.8%]), and lens subluxation in 1 eye (5.9%). Conclusions and Relevance Congenital infection due to presumed ZIKV exposure is associated with vision-threatening findings, which include bilateral macular and perimacular lesions as well as optic nerve abnormalities in most cases.
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Affiliation(s)
| | - João Rafael de Oliveira Dias
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| | - Juliana Prazeres
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| | | | - Albert Icksang Ko
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Salvador, Brazil4Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Maurício Maia
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
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Ribeiro CF, Lopes VGS, Brasil P, Silva LED, Ribeiro PHFJ, Ugenti LC, Nogueira RMR. DENGUE DURING PREGNANCY: ASSOCIATION WITH LOW BIRTH WEIGHT AND PREMATURITY. Rev Inst Med Trop Sao Paulo 2016; 58:8. [PMID: 26910454 PMCID: PMC4793949 DOI: 10.1590/s1678-9946201658008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/29/2015] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the effects of dengue virus infection during
pregnancy and its correlation with low birth weight, prematurity, and asphyxia. A
non-concurrent cohort study reveals the association of dengue during pregnancy with
prematurity and low birth weight, when birth occurred during the maternal-fetal
viremia period (p = 0.016 and p < 0.0001, respectively).
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Affiliation(s)
| | | | - Patricia Brasil
- Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, RJ, Brasil,
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Deepanjali S, Naik RR, Mailankody S, Kalaimani S, Kadhiravan T. Dengue Virus Infection Triggering Thrombotic Thrombocytopenic Purpura in Pregnancy. Am J Trop Med Hyg 2015; 93:1028-30. [PMID: 26283741 DOI: 10.4269/ajtmh.15-0326] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/06/2015] [Indexed: 12/25/2022] Open
Abstract
We report a case of thrombotic thrombocytopenic purpura (TTP) that immediately followed symptomatic dengue virus infection in a pregnant lady. The patient developed dengue fever at 16 weeks of gestation, resulting in spontaneous abortion. Subsequently, fever reappeared with persistent thrombocytopenia and jaundice. Investigations revealed microangiopathic hemolysis; there was no evidence of disseminated intravascular coagulation. The TTP episode resolved after six cycles of therapeutic plasma exchange with fresh-frozen plasma. An ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 motif 13 repeats) activity assay, done during convalescence, showed normal activity. The patient had an uneventful second pregnancy and has remained free of TTP recurrence for more than 2 years now. We review the pathophysiological basis of TTP in dengue infection, and suggest that jaundice with disproportionate elevation of serum aspartate aminotransferase level in a patient with dengue should arouse the suspicion of TTP.
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Affiliation(s)
- Surendran Deepanjali
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raghuramulu R Naik
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sharada Mailankody
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sivamani Kalaimani
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Tamilarasu Kadhiravan
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Carabali M, Hernandez LM, Arauz MJ, Villar LA, Ridde V. Why are people with dengue dying? A scoping review of determinants for dengue mortality. BMC Infect Dis 2015; 15:301. [PMID: 26223700 PMCID: PMC4520151 DOI: 10.1186/s12879-015-1058-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 07/23/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Dengue is a viral disease whose clinical spectrum ranges from unapparent to severe forms and fatal outcomes. Although dengue death is 99% avoidable, every year around 20,000 deaths are estimated to occur in more than 100 countries. We consider that, along with biological factors, social determinants of health (SDHs) are related to dengue deaths as well. METHODS A scoping review was conducted to explore what has been written about the role of SDHs in dengue mortality. The inclusion criteria were that documents (grey or peer-reviewed) had to include information about dengue fatal cases in humans and be published between 1997 and 2013 and written in English, Spanish, Portuguese or French. The search was conducted using a set of key words related to dengue mortality in several electronic databases: PubMed, LILACS, COCHRANE, Scielo, Science Direct, WHOLIS, OpenGrey, OpenSingle and Google Scholar. Information on SDHs was categorized under individual, social and environmental, and health systems dimensions. A summative content analysis using QDA Miner was conducted to assess the frequency of information on SDHs and its contextual meaning in the reviewed literature. The role of each SDH in dengue mortality was assessed using content analysis results. RESULTS From a total of 971 documents retrieved, 78 met the criteria. Those documents were published in the Americas region (50.0%), Asia (38.4%), Europe (9.0%) and Africa (2.6%). The described SDHs related to dengue deaths included, in the individual dimension: age, ethnicity, education, type of infection and immunological status; and in the social dimension: poverty and care-seeking behavior. The health systems dimension included access, opportunity, and quality of care, as well as health staff knowledge. Ethnicity was considered a determinant that depends on cultural and socioeconomic conditions. CONCLUSIONS Along with biological factors, there are several SDHs related to dengue mortality. However, only a few of these have been systematically analyzed, suggesting the need for more studies on this subject to inform the design and implementation of sustainable interventions to decrease dengue mortality. These findings nevertheless provide a better understanding of the non-biological factors involved in dengue mortality.
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Affiliation(s)
- Mabel Carabali
- International Vaccine Institute, Dengue Vaccine Initiative, SNU Research Park, San 4-8, Nakseongdae-dong, Seoul, Gwanak-gu, 151-919, South Korea.
| | - Libia Milena Hernandez
- Centro de Atencion y Diagnostico de Enfermedades Infecciosas (CDI), Bucaramanga, Santander, Colombia.
| | - Maria Jose Arauz
- School of Public Health (ESPUM), University of Montreal, Montreal, Quebec, Canada.
| | - Luis Angel Villar
- Universidad Industrial de Santander, Bucaramanga, Santander, Colombia.
| | - Valéry Ridde
- School of Public Health (ESPUM), University of Montreal, Montreal, Quebec, Canada.
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Quebec, Canada.
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Singla N, Arora S, Goel P, Chander J, Huria A. Dengue in pregnancy: an under–reported illness, with special reference to other existing co–infections. ASIAN PAC J TROP MED 2015; 8:206-8. [DOI: 10.1016/s1995-7645(14)60316-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/20/2015] [Accepted: 02/15/2015] [Indexed: 10/23/2022] Open
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Abdalla TM, Karsany MS, Ali AA. Correlation of measles and dengue infection in Kassala, Eastern Sudan. J Med Virol 2014; 87:76-8. [PMID: 24980486 DOI: 10.1002/jmv.24001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2014] [Indexed: 11/06/2022]
Abstract
Using the clinical case definition adopted by the World Health Organization, a total of 275 suspected cases of measles were enrolled in this study during January-March 2012 in Kassala Teaching Hospital, Eastern Sudan. Various clinical manifestations (fever, headache, cough, coryza, conjunctivitis, skin rash, vomiting, diarrhoea, convulsion, and hemorrhagic manifestations) were reported among these patients. Blood was withdrawn from the first 64 (23.3%) patients. Two samples were hemolyzed and only 60 samples (21.8%) were investigated for measles and dengue IgM antibodies. Antibodies for measles, dengue, and co-infection were detected in the plasma of 12 (20%), seven (11.7%), and 10 (16.7%) samples, respectively. Although there was no significant difference in age, residence, occupation, and vaccination status among the different groups, a high proportion of male patients (P = 0.011), severe cases (P = 0.004), and death ((P = 0.001) were reported among co-infected cases.
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Besnard M, Lastère S, Teissier A, Cao-Lormeau VM, Musso D. Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014. Euro Surveill 2014. [DOI: 10.2807/1560-7917.es2014.19.13.20751] [Citation(s) in RCA: 517] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- M Besnard
- Centre hospitalier de Polynésie française, Hôpital du Taaone, Tahiti, French Polynesia
| | - S Lastère
- Centre hospitalier de Polynésie française, Hôpital du Taaone, Tahiti, French Polynesia
| | - A Teissier
- Institut Louis Malardé, Tahiti, French Polynesia
| | | | - D Musso
- Institut Louis Malardé, Tahiti, French Polynesia
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