Another dengue fever outbreak in Eastern Ethiopia-An emerging public health threat

Evaluation of clinical and laboratory characteristics of dengue viral infection and risk factors of dengue hemorrhagic fever: a multi-center retrospective analysis

BACKGROUND

Dengue Viral Infection (DVI) has become endemic in Pakistan since the first major outbreak in Karachi in 1996. Despite aggressive measures taken by relevant authorities, Pakistan has been dealing with a worsening dengue crisis for the past two decades. DHF is severe form of dengue infection which is linked with significant morbidity and mortality. Early identification of severe dengue infections can reduce the morbidity and mortality. In this context we planned current study in which we find out the different factors related with DHF as well as clinical laboratory features of DHF and compare them to DF so that patients can be best evaluated for DHF and managed accordingly at admission.

METHODS

Retrospective study conducted over a period of 6 years (2013-2018) in two tertiary care hospitals in Pakistan. Data were collected by using a pre-structured data collection form. Data were statistically analyzed to determine the clinical and laboratory characteristics of DVI and risk factors of dengue hemorrhagic fever (DHF).

RESULTS

A total 512 dengue cases (34.05 ± 15.08 years; Male 69.53%) were reviewed. Most common clinical manifestations of DVI were fever (99.60%), headache (89.1%), chills (86.5%), rigors (86.5%), myalgia (72.3%). Less common clinical manifestations were vomiting (52.5%), arthralgia (50.2%) and skin rashes (47.5%). Furthermore, nasal bleeding (44.1%), gum bleeding (32.6%), pleural effusion (13.9%) and hematuria (13.1%) were more profound clinical presentations among DHF patients. Mortality rate was 1.5% in this study. Logistic regression analysis indicated that delayed hospitalization (OR: 2.30) and diabetes mellitus (OR:2.71), shortness of breath (OR:2.21), association with risk groups i.e., living near stagnant water, travelling to endemic areas, living in endemic regions (OR:1.95), and presence of warning signs (OR:2.18) were identified as risk factors of DHF. Statistically we found that there is strong association of diabetes mellitus (DM) with DHF while the patient suffering from DM individually had higher odds (2.71) of developing DHF than patients without disease.

CONCLUSIONS

The current study demonstrated that the clinical and laboratory profiles of DF and DHF are significantly distinct. Significant predictors of DHF were advanced age, diabetes mellitus, ascites, pleural effusion, thick gallbladder and delayed hospitalization. The identification of these factors at early stage provides opportunities for the clinicians to identify high risk patients and to reduce dengue-related morbidity and mortality.

A dengue virus infection in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Dengue is caused by a positive-stranded RNA virus called dengue virus, which is spread by Aedes mosquito species. It is a fast-growing acute febrile disease with potentially lethal consequences that is a global public health problem, mostly in tropical and subtropical countries. In Ethiopia, dengue fever is understudied, although the virus is still being transmitted and viral infection rates are rising. This systematic review and meta-analysis was aimed at estimating the pooled prevalence of DENV infection in Ethiopia.

METHODS

A literature search was done on the PubMed, Hinari and Google Scholar databases to identify studies published before July, 2023. Random effects and fixed effects models were used to estimate the pooled prevalence of all three markers. The Inconsistency Index was used to assess the level of heterogeneity.

RESULTS

A total of 11 studies conducted on suspected individuals with dengue fever and acutely febrile participants were included in this review. The majority of the studies had a moderate risk of bias and no study had a high risk of bias. A meta-analysis estimated a pooled IgG prevalence of 21% (95% CI: 19-23), a pooled IgM prevalence of 9% (95%CI: 4-13) and a pooled DENV-RNA prevalence of 48% (95% CI: 33-62). There is evidence of possible publication bias in IgG but not in the rest of the markers.

CONCLUSION

Dengue is prevalent among the dengue fever suspected and febrile population in Ethiopia. Healthcare providers, researchers and policymakers should give more attention to dengue fever.

Spatiotemporal distribution of climate-sensitive disease incidences in ethiopia: a longitudinal retrospective analysis of Malaria, Meningitis, Cholera, Dysentery, Leishmaniasis and Dengue fever between 2010 and 2022/2023

BACKGROUND

Understanding the temporal and geographic distribution of disease incidences is crucial for effective public health planning and intervention strategies. This study presents a comprehensive analysis of the spatiotemporal distribution of disease incidences in Ethiopia, focusing on six major diseases: Malaria, Meningitis, Cholera and Dysentery, over the period from 2010 to 2022, whereas Dengue Fever and Leishmaniasis from 2018 to 2023.

METHODS

Using data from Ethiopian public health institute: public health emergency management (PHEM), and Ministry of Health, we examined the occurrence and spread of each disease across different regions of Ethiopia. Spatial mapping and time series analysis were employed to identify hotspots, trends, and seasonal variations in disease incidence.

RESULTS

The findings reveal distinct patterns for each disease, with varying cases and temporal dynamics. Monthly wise, Malaria exhibits a cyclical pattern with a peak during the rainy and humid season, while Dysentery, Meningitis and Cholera displays intermittent incidences. Dysentery cases show a consistent presence throughout the years, while Meningitis remains relatively low in frequency but poses a potential threat due to its severity. Dengue fever predominantly occurs in the eastern parts of Ethiopia. A significant surge in reported incident cases occurred during the years 2010 to 2013, primarily concentrated in the Amhara, Sidama, Oromia, Dire Dawa, and Benishangul-Gumuz regions.

CONCLUSIONS

This study helps to a better understanding of disease epidemiology in Ethiopia and can serve as a foundation for evidence-based decision-making in disease prevention and control. By recognizing the patterns and seasonal changes associated with each disease, health authorities can implement proactive measures to mitigate the impact of outbreaks and safeguard public health in the region.

Breeding habitats, bionomics and phylogenetic analysis of Aedes aegypti and first detection of Culiseta longiareolata, and Ae. hirsutus in Somali Region, eastern Ethiopia

INTRODUCTION

Arboviral diseases, such as dengue, chikungunya, yellow fever, and Zika, are caused by viruses that are transmitted to humans through mosquito bites. However, the status of arbovirus vectors in eastern Ethiopia is unknown. The aim of this study was to investigate distribution, breeding habitat, bionomics and phylogenetic relationship of Aedes aegypti mosquito species in Somali Regional State, Eastern Ethiopia.

METHODS

Entomological surveys were conducted in four sites including Jigjiga, Degehabur, Kebridehar and Godey in 2018 (October to December) to study the distribution of Ae. aegypti and with a follow-up collection in 2020 (July-December). In addition, an investigation into the seasonality and bionomics of Ae. aegypti was conducted in 2021 (January-April) in Kebridehar town. Adult mosquitoes were collected from indoor and outdoor locations using CDC light traps (LTs), pyrethrum spray collection (PSCs), and aspirators. Larvae and pupae were also collected from a total of 169 water-holding containers using a dipper between October and November 2020 (rainy season) in Kebridehar town. The species identification of wild caught and reared adults was conducted using a taxonomic key. In addition, species identification using mitochondrial and nuclear genes maximum likelihood-based phylogenetic analysis was performed.

RESULTS

In the 2018 collection, Ae. aegypti was found in all study sites (Jigjiga, Degahabour, Kebridehar and Godey). In the 2020-2021 collection, a total of 470 (Female = 341, Male = 129) wild caught adult Ae. aegypti mosquitoes were collected, mostly during the rainy season with the highest frequency in November (n = 177) while the lowest abundance was in the dry season (n = 14) for both February and March. The majority of Ae. aegypt were caught using PSC (n = 365) followed by CDC LT (n = 102) and least were collected by aspirator from an animal shelter (n = 3). Aedes aegypti larval density was highest in tires (0.97 larvae per dip) followed by cemented cisterns (0.73 larvae per dip) and the Relative Breeding Index (RBI) was 0.87 and Container Index (CI) was 0.56. Genetic analysis of ITS2 and COI revealed one and 18 haplotypes, respectively and phylogenetic analysis confirmed species identification. The 2022 collection revealed no Ae. aegpti, but two previously uncharacterized species to that region. Phylogenetic analysis of these two species revealed their identities as Ae. hirsutus and Culiseta longiareolata.

CONCLUSION

Data from our study indicate that, Ae. aegypti is present both during the wet and dry seasons due to the availability of breeding habitats, including water containers like cemented cisterns, tires, barrels, and plastic containers. This study emphasizes the necessity of establishing a national entomological surveillance program for Aedes in Somali region.

Detection of dengue virus infection in children presenting with fever in Hawassa, southern Ethiopia

Dengue fever is a mosquito-borne viral infection, with rising incidence globally. Eastern Ethiopia has had dengue fever outbreaks in recent years. However, the extent to which the infection contributes to hospital presentation among children with fever in southern Ethiopia is unknown. We examined 407 stored plasma samples collected to investigate the aetiology of fever in children aged at least 2 months and under 13 years presenting to the outpatient of the largest tertiary hospital in southern Ethiopia. We analyzed samples for dengue virus non-structural 1 antigen using enzyme-linked immunosorbent assay. The median (interquartile range) age of the 407 children examined was 20 (10-48) months, and 166 (40.8%) of the children were females. Of 407 samples analyzed, 9 (2.2%) were positive for dengue virus non-structural 1 antigen, of whom 2 were initially treated with antimalarial drugs despite having negative malaria microscopy, and 1 of the 8 patients had a persistent fever at the seventh day of follow-up time. The presence of active dengue virus infection in the study area highlights the need for studies at the community level as well as the integration of dengue diagnostics into fever-management strategies. Further research to characterize circulating strains is warranted.

A systematic review of published literature on mosquito control action thresholds across the world

BACKGROUND

Despite the use of numerous methods of control measures, mosquito populations and mosquito-borne diseases are still increasing globally. Evidence-based action thresholds to initiate or intensify control activities have been identified as essential in reducing mosquito populations to required levels at the correct/optimal time. This systematic review was conducted to identify different mosquito control action thresholds existing across the world and associated surveillance and implementation characteristics.

METHODOLOGY/PRINCIPAL FINDINGS

Searches for literature published from 2010 up to 2021 were performed using two search engines, Google Scholar and PubMed Central, according to PRISMA guidelines. A set of inclusion/exclusion criteria were identified and of the 1,485 initial selections, only 87 were included in the final review. Thirty inclusions reported originally generated thresholds. Thirteen inclusions were with statistical models that seemed intended to be continuously utilized to test the exceedance of thresholds in a specific region. There was another set of 44 inclusions that solely mentioned previously generated thresholds. The inclusions with "epidemiological thresholds" outnumbered those with "entomological thresholds". Most of the inclusions came from Asia and those thresholds were targeted toward Aedes and dengue control. Overall, mosquito counts (adult and larval) and climatic variables (temperature and rainfall) were the most used parameters in thresholds. The associated surveillance and implementation characteristics of the identified thresholds are discussed here.

CONCLUSIONS/SIGNIFICANCE

The review identified 87 publications with different mosquito control thresholds developed across the world and published during the last decade. Associated surveillance and implementation characteristics will help organize surveillance systems targeting the development and implementation of action thresholds, as well as direct awareness towards already existing thresholds for those with programs lacking available resources for comprehensive surveillance systems. The findings of the review highlight data gaps and areas of focus to fill in the action threshold compartment of the IVM toolbox.

Epidemiology, biology, pathogenesis, clinical manifestations, and diagnosis of dengue virus infection, and its trend in Ethiopia: a comprehensive literature review

Dengue fever is a dengue virus infection, emerging rapidly and posing public health threat worldwide, primarily in tropical and subtropical countries. Nearly half of the world's population is now at risk of contracting the dengue virus, including new countries with no previous history-like Ethiopia. However, little is known about the epidemiology and impact of the disease in different countries. This is especially true in countries, where cases have recently begun to be reported. This review aims to summarize epidemiology, biology, pathogenesis, clinical manifestations, and diagnosis of dengue virus infection and its trend in Ethiopia. It may help countries, where dengue fever is not yet on the public health list-like Ethiopia to alert healthcare workers to consider the disease for diagnosis and treatment. The review retrieved and incorporated 139 published and organizational reports showing approximately 390 million new infections. About 100 million of these infections develop the clinical features of dengue, and thousands of people die annually from severe dengue fever in 129 countries. It is caused by being bitten by a dengue virus-infected female mosquito, primarily Aedes aegypti and, lesser, Ae. albopictus. Dengue virus is a member of the Flavivirus genus of the Flaviviridae family and has four independent but antigen-related single-stranded positive-sense RNA virus serotypes. The infection is usually asymptomatic but causes illnesses ranging from mild febrile illness to fatal dengue hemorrhagic fever or shock syndrome. Diagnosis can be by detecting the virus genome using nucleic acids amplification tests or testing NS1 antigen and/or anti-dengue antibodies from serum, plasma, circulating blood cells, or other tissues. Dengue cases and outbreaks have increased in recent decades, with a significant public health impact. Ethiopia has had nearly annual outbreaks since 2013, devastating an already fragmented health system and economy. Standardization of medication, population-level screening for early diagnosis and prompt treatment, and minimization of mosquito bites reduce overall infection and mortality rates.

Towards environmental detection, quantification, and molecular characterization of Anopheles stephensi and Aedes aegypti from experimental larval breeding sites

The invasion and establishment of An. stephensi mosquitoes in the Horn of Africa represents a significant regional threat, which may jeopardise malaria control, particularly in urban areas which were formally free from disease transmission. Novel vector surveillance methods are urgently needed, both agnostic to mosquito larval morphology, and simple to implement at the sampling stage. Using new multiplex TaqMan assays, specifically targeting An. stephensi and Ae. aegypti, we validated the use of environmental DNA (eDNA) for simultaneous vector detection in shared artificial breeding sites. Study findings demonstrated that An. stephensi and Ae. aegypti eDNA deposited by as few as one second instar larva in 1L of water was detectable. Characterization of molecular insecticide resistance mechanisms, using novel amplicon-sequencing panels for both vector species, was possible from eDNA shed by as few as 16-32 s instar larvae in 50 ml of water. An. stephensi eDNA, derived from emergent pupae for 24 h, was remarkably stable, and still detectable ~ 2 weeks later. eDNA surveillance has the potential to be implemented in local endemic communities and at points of country entry, to monitor the spread of invasive vector species. Further studies are required to validate the feasibility of this technique under field conditions.

Dengue Fever Outbreak Investigation in Werder Town, Dollo Zone, Somali Region, Ethiopia

Background

Dengue fever (DF) is a mosquito-borne disease caused by the dengue virus. DF is endemic to many tropical and subtropical countries around the world. In Ethiopia, DF emerged in 2013 and caused a serious public health problem.

Objective

We investigated the outbreak to describe by time, place, person, and to identify risk factors associated with the outbreak in Werder town, Dollo Zone, Somali Region, Ethiopia.

Methods

Descriptive and case-control studies (1:2 ratio) were conducted. We used the World Health Organization (WHO) case definition to identify cases in Werder town from December 10, 2020, to January 4, 2021. Controls were selected from the same town that did not suffer from DF. Serum samples were tested by reverse transcription polymerase chain reaction (RT-PCR) to detect the dengue virus and to identify serotypes. A structured questionnaire was used to collect socio-demographic, behavioural, and environmental characteristics.

Results

We identified a total of 57 cases and 114 controls. The overall attack rate was 334.41/100,000 with a zero case fatality rate. Six out of twenty serum samples tested positive for the DEN-3 serotype. In multivariate analysis, not hearing of DF (Adjusted odd ratio (AOR): 2.2, 95% CI: 1.015-4.701), not knowing the mode of transmission (AOR: 2.9, 95% CI: 1.338-6.831), not using long-lasting insecticidal net (LLITN) (AOR: 4.4, 95% CI: 1.592-12.330) and not spraying insecticide (AOR: 3.6, 95% CI: 1.591-8.098) were statistically significant risk factors associated with DF outbreak. However, wearing long sleeves (AOR: 0.435, 95% CI: 0.206-0.918) was a protective factor for the DF outbreak.

Conclusion

DF outbreak in Werder town has been confirmed. The present study provides evidence-based information regarding the identified risk factors that have contributed to the occurrence of DF outbreaks. We recommended implementing vector control measures and strengthening dengue surveillance systems is strongly advised.

Knowledge, attitude, and practices of the community toward dengue fever in Shabwah Governorate, Yemen: a descriptive study

BACKGROUND

In Yemen, dengue fever (DF) is a widespread, locally endemic infectious disease, with high morbidity and mortality which mainly affects impoverished regions. Thus, this study aims to evaluate the knowledge, attitudes, and behaviors of the Shabwah community in Yemen regarding DF characteristics and prevention.

METHODS

The present study is a cross-sectional community-based study conducted in Shabwah Governorate, Yemen, between June 2021 and November 2021. Simple random sampling was used to select the sample (n = 370), and a validated closed-ended questionnaire was used to collect data.

RESULTS

In total, 370 individuals participated in this study; most respondents were female (N = 247, 66.8%), and more than half (N = 214, 57.8%) were younger than age 30. More than 50% of the population had completed a primary or secondary school, while approximately 33.03% of them were illiterate. Furthermore, more than half (53.5%) of the population had good knowledge of DF, while most of those educated at a university level (64.1%) had good attitude toward DF. Most of the population (68.4%) had good practice toward DF. Moreover, participants with a university level education, followed by those who completed secondary school, had significantly higher knowledge and practice scores than primary school and illiteracy (P = 0.05).

CONCLUSION

The results of the study indicate that the residents of Yemen's Shabwah Governorate are well-informed about the symptoms and signs of DF, have a positive attitude toward the disease, and employ appropriate preventive measures. Health education via various media should be mandated to increase community awareness and dispel misconceptions about DF.

Epidemiological, Entomological, and Climatological Investigation of the 2019 Dengue Fever Outbreak in Gewane District, Afar Region, North-East Ethiopia

Dengue Fever (DF) is an important arthropod-borne viral infection that has repeatedly occurred as outbreaks in eastern and northeastern Ethiopia since 2013. A cross-sectional epidemiological outbreak investigation was carried out from September to November 2019 on febrile patients (confirmed malaria negative) who presented with suspected and confirmed DF at both public and private health facilities in Gewane District, Afar Region, northeastern Ethiopia. Entomological investigation of containers found in randomly selected houses belonging to DF-positive patients was undertaken to survey for the presence of Aedes larvae/pupae. A total of 1185 DF cases were recorded from six health facilities during the 3-month study period. The mean age of DF cases was 27.2 years, and 42.7% of cases were female. The most affected age group was 15−49 years old (78.98%). The total case proportions differed significantly across age groups when compared to the population distribution; there were approximately 15% and 5% higher case proportions among those aged 15−49 years and 49+ years, respectively. A total of 162 artificial containers were inspected from 62 houses, with 49.4% found positive for Aedes aegypti larva/pupae. Aedes mosquitoes were most commonly observed breeding in plastic tanks, tires, and plastic or metal buckets/bowls. World Health Organization entomological indices classified the study site as high risk for dengue virus outbreaks (House Index = 45.2%, Container Index = 49.4%, and Breteau Index = 129). Time series climate data, specifically rainfall, were found to be significantly predictive of AR (p = 0.035). Study findings highlight the importance of vector control to prevent future DF outbreaks in the region. The scarcity of drinking water and microclimatic conditions may have also contributed to the occurrence of this outbreak.

Uncovering the Burden of Dengue in Africa: Considerations on Magnitude, Misdiagnosis, and Ancestry

Dengue is a re-emerging neglected disease of major public health importance. This review highlights important considerations for dengue disease in Africa, including epidemiology and underestimation of disease burden in African countries, issues with malaria misdiagnosis and co-infections, and potential evidence of genetic protection from severe dengue disease in populations of African descent. The findings indicate that dengue virus prevalence in African countries and populations may be more widespread than reported data suggests, and that the Aedes mosquito vectors appear to be increasing in dissemination and number. Changes in climate, population, and plastic pollution are expected to worsen the dengue situation in Africa. Dengue misdiagnosis is also a problem in Africa, especially due to the typical non-specific clinical presentation of dengue leading to misdiagnosis as malaria. Finally, research suggests that a protective genetic component against severe dengue exists in African descent populations, but further studies should be conducted to strengthen this association in various populations, taking into consideration socioeconomic factors that may contribute to these findings. The main takeaway is that Africa should not be overlooked when it comes to dengue, and more attention and resources should be devoted to this disease in Africa.

Review of the ecology and behaviour of Aedes aegypti and Aedes albopictus in Western Africa and implications for vector control

Western Africa is vulnerable to arboviral disease transmission, having recently experienced major outbreaks of chikungunya, dengue, yellow fever and Zika. However, there have been relatively few studies on the natural history of the two major human arbovirus vectors in this region, Aedes aegypti and Ae. albopictus, potentially limiting the implementation of effective vector control. We systematically searched for and reviewed relevant studies on the behaviour and ecology of Ae. aegypti and Ae. albopictus in Western Africa, published over the last 40 years. We identified 73 relevant studies, over half of which were conducted in Nigeria, Senegal, or Côte d'Ivoire. Most studies investigated the ecology of Ae. aegypti and Ae. albopictus, exploring the impact of seasonality and land cover on mosquito populations and identifying aquatic habitats. This review highlights the adaptation of Ae. albopictus to urban environments and its invasive potential, and the year-round maintenance of Ae. aegypti populations in water storage containers. However, important gaps were identified in the literature on the behaviour of both species, particularly Ae. albopictus. In Western Africa, Ae. aegypti and Ae. albopictus appear to be mainly anthropophilic and to bite predominantly during the day, but further research is needed to confirm this to inform planning of effective vector control strategies. We discuss the public health implications of these findings and comment on the suitability of existing and novel options for control in Western Africa.

Field efficacy of ethnomedicinal plant smoke repellency against Anopheles arabiensis and Aedes aegypti

The repellency effect of smoke from burning Azadirachta indica, Eucalyptus camaldulensis and Ocimum forskolin plants to reduce human-mosquito biting activity. Ground mixed powders of the plant leaves produced smoke by direct burning and thermal expulsion on the traditional stoves in experimental huts against An. arabiensis and Ae. aegypti. A four-by-four Latin-square design was used to assign treatment and control experimental huts over different nights. In the treatment huts, the percent repellency of the smoke produced by burning powdered plant mixtures of the plants were determined by reduction mosquito density. There was a reduction on An. arabiensis (93.75%, P < 0.001) and Ae. aegypti (92%, P < 0.001) respectively, for huts with burning powder versus no treatment. Overall, plant mixed powders tested by both methods of application offered significant protection (>90%) against both mosquito species tested and has the potential to be used as an alternative mosquito control method.