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Vu DM, Krystosik AR, Ndenga BA, Mutuku FM, Ripp K, Liu E, Bosire CM, Heath C, Chebii P, Maina PW, Jembe Z, Malumbo SL, Amugongo JS, Ronga C, Okuta V, Mutai N, Makenzi NG, Litunda KA, Mukoko D, King CH, LaBeaud AD. Detection of acute dengue virus infection, with and without concurrent malaria infection, in a cohort of febrile children in Kenya, 2014-2019, by clinicians or machine learning algorithms. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001950. [PMID: 37494331 PMCID: PMC10370704 DOI: 10.1371/journal.pgph.0001950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023]
Abstract
Poor access to diagnostic testing in resource limited settings restricts surveillance for emerging infections, such as dengue virus (DENV), to clinician suspicion, based on history and exam observations alone. We investigated the ability of machine learning to detect DENV based solely on data available at the clinic visit. We extracted symptom and physical exam data from 6,208 pediatric febrile illness visits to Kenyan public health clinics from 2014-2019 and created a dataset with 113 clinical features. Malaria testing was available at the clinic site. DENV testing was performed afterwards. We randomly sampled 70% of the dataset to develop DENV and malaria prediction models using boosted logistic regression, decision trees and random forests, support vector machines, naïve Bayes, and neural networks with 10-fold cross validation, tuned to maximize accuracy. 30% of the dataset was reserved to validate the models. 485 subjects (7.8%) had DENV, and 3,145 subjects (50.7%) had malaria. 220 (3.5%) subjects had co-infection with both DENV and malaria. In the validation dataset, clinician accuracy for diagnosis of malaria was high (82% accuracy, 85% sensitivity, 80% specificity). Accuracy of the models for predicting malaria diagnosis ranged from 53-69% (35-94% sensitivity, 11-80% specificity). In contrast, clinicians detected only 21 of 145 cases of DENV (80% accuracy, 14% sensitivity, 85% specificity). Of the six models, only logistic regression identified any DENV case (8 cases, 91% accuracy, 5.5% sensitivity, 98% specificity). Without diagnostic testing, interpretation of clinical findings by humans or machines cannot detect DENV at 8% prevalence. Access to point-of-care diagnostic tests must be prioritized to address global inequities in emerging infections surveillance.
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Affiliation(s)
- David M Vu
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California, United States of America
| | - Amy R Krystosik
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California, United States of America
| | - Bryson A Ndenga
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Francis M Mutuku
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Kelsey Ripp
- University of Global Health Equity, Butaro, Rwanda
| | - Elizabeth Liu
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California, United States of America
| | - Carren M Bosire
- Department of Pure and Applied Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Claire Heath
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California, United States of America
| | - Philip Chebii
- Vector-Borne Diseases Unit, Msambweni County Referral Hospital, Msambweni, Kwale, Kenya
| | | | - Zainab Jembe
- Vector-Borne Diseases Unit, Diani Health Center, Ukunda, Kwale, Kenya
| | - Said Lipi Malumbo
- Vector-Borne Diseases Unit, Msambweni County Referral Hospital, Msambweni, Kwale, Kenya
| | - Jael Sagina Amugongo
- Vector-Borne Diseases Unit, Msambweni County Referral Hospital, Msambweni, Kwale, Kenya
| | - Charles Ronga
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Victoria Okuta
- Paediatric Department, Obama Children's Hospital, Jaramogi Oginga Odinga Referral Hospital, Kisumu, Kenya
| | - Noah Mutai
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Nzaro G Makenzi
- Department of Pure and Applied Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Kennedy A Litunda
- Department of Pure and Applied Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Dunstan Mukoko
- Vector-Borne Diseases Unit, Ministry of Health, Nairobi, Kenya
| | - Charles H King
- Department of Pathology, Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - A Desiree LaBeaud
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California, United States of America
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Peña-García VH, Mutuku FM, Ndenga BA, Mbakaya JO, Ndire SO, Agola GA, Mutuku PS, Malumbo SL, Ng'ang'a CM, Andrews JR, Mordecai EA, LaBeaud AD. The Importance of Including Non-Household Environments in Dengue Vector Control Activities. Viruses 2023; 15:1550. [PMID: 37515236 PMCID: PMC10384488 DOI: 10.3390/v15071550] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Most vector control activities in urban areas are focused on household environments; however, information relating to infection risks in spaces other than households is poor, and the relative risk that these spaces represent has not yet been fully understood. We used data-driven simulations to investigate the importance of household and non-household environments for dengue entomological risk in two Kenyan cities where dengue circulation has been reported. Fieldwork was performed using four strategies that targeted different stages of mosquitoes: ovitraps, larval collections, Prokopack aspiration, and BG-sentinel traps. Data were analyzed separately between household and non-household environments to assess mosquito presence, the number of vectors collected, and the risk factors for vector presence. With these data, we simulated vector and human populations to estimate the parameter m and mosquito-to-human density in both household and non-household environments. Among the analyzed variables, the main difference was found in mosquito abundance, which was consistently higher in non-household environments in Kisumu but was similar in Ukunda. Risk factor analysis suggests that small, clean water-related containers serve as mosquito breeding places in households as opposed to the trash- and rainfall-related containers found in non-household structures. We found that the density of vectors (m) was higher in non-household than household environments in Kisumu and was also similar or slightly lower between both environments in Ukunda. These results suggest that because vectors are abundant, there is a potential risk of transmission in non-household environments; hence, vector control activities should take these spaces into account.
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Affiliation(s)
- Víctor Hugo Peña-García
- Department of Biology, Stanford University, Stanford, CA 94305, USA
- School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Francis M Mutuku
- Department of Environmental and Health Sciences, Technical University of Mombasa, Mombasa 80110, Kenya
| | | | | | | | | | - Paul S Mutuku
- Vector Borne Disease Control Unit, Msambweni County Referral Hospital, Msambweni, Kwale County 80404, Kenya
| | - Said L Malumbo
- Vector Borne Disease Control Unit, Msambweni County Referral Hospital, Msambweni, Kwale County 80404, Kenya
| | - Charles M Ng'ang'a
- Vector Borne Disease Control Unit, Msambweni County Referral Hospital, Msambweni, Kwale County 80404, Kenya
| | - Jason R Andrews
- School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Erin A Mordecai
- Department of Biology, Stanford University, Stanford, CA 94305, USA
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Khan A, Bisanzio D, Mutuku F, Ndenga B, Grossi-Soyster EN, Jembe Z, Maina PW, Chebii PK, Ronga CO, Okuta V, LaBeaud AD. Spatiotemporal overlapping of dengue, chikungunya, and malaria infections in children in Kenya. BMC Infect Dis 2023; 23:183. [PMID: 36991340 PMCID: PMC10053720 DOI: 10.1186/s12879-023-08157-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
Malaria, chikungunya virus (CHIKV), and dengue virus (DENV) are endemic causes of fever among children in Kenya. The risks of infection are multifactorial and may be influenced by built and social environments. The high resolution overlapping of these diseases and factors affecting their spatial heterogeneity has not been investigated in Kenya. From 2014-2018, we prospectively followed a cohort of children from four communities in both coastal and western Kenya. Overall, 9.8% were CHIKV seropositive, 5.5% were DENV seropositive, and 39.1% were malaria positive (3521 children tested). The spatial analysis identified hot-spots for all three diseases in each site and in multiple years. The results of the model showed that the risk of exposure was linked to demographics with common factors for the three diseases including the presence of litter, crowded households, and higher wealth in these communities. These insights are of high importance to improve surveillance and targeted control of mosquito-borne diseases in Kenya.
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Affiliation(s)
- Aslam Khan
- Stanford University School of Medicine, Stanford, CA, USA.
- Center for Academic Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA.
| | | | | | | | | | - Zainab Jembe
- Msambweni County Referral hospital, Msambweni, Kenya
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Masika MM, Korhonen EM, Smura T, Uusitalo R, Ogola J, Mwaengo D, Jääskeläinen AJ, Alburkat H, Gwon YD, Evander M, Anzala O, Vapalahti O, Huhtamo E. Serological Evidence of Exposure to Onyong-Nyong and Chikungunya Viruses in Febrile Patients of Rural Taita-Taveta County and Urban Kibera Informal Settlement in Nairobi, Kenya. Viruses 2022; 14:v14061286. [PMID: 35746757 PMCID: PMC9230508 DOI: 10.3390/v14061286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/28/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023] Open
Abstract
Several alphaviruses, such as chikungunya (CHIKV) and Onyong-nyong (ONNV), are endemic in Kenya and often cause outbreaks in different parts of the country. We assessed the seroprevalence of alphaviruses in patients with acute febrile illness in two geographically distant areas in Kenya with no previous record of alphavirus outbreaks. Blood samples were collected from febrile patients in health facilities located in the rural Taita-Taveta County in 2016 and urban Kibera informal settlement in Nairobi in 2017 and tested for CHIKV IgG and IgM antibodies using an in-house immunofluorescence assay (IFA) and a commercial ELISA test, respectively. A subset of CHIKV IgG or IgM antibody-positive samples were further analyzed using plaque reduction neutralization tests (PRNT) for CHIKV, ONNV, and Sindbis virus. Out of 537 patients, 4 (0.7%) and 28 (5.2%) had alphavirus IgM and IgG antibodies, respectively, confirmed on PRNT. We show evidence of previous and current exposure to alphaviruses based on serological testing in areas with no recorded history of outbreaks.
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Affiliation(s)
- Moses Muia Masika
- KAVI Institute of Clinical Research, University of Nairobi, POB 19676, Nairobi 00202, Kenya; (J.O.); (O.A.)
- Department of Medical Microbiology, University of Nairobi, POB 19676, Nairobi 00202, Kenya;
- Correspondence: ; Tel.: +254-721770306
| | - Essi M. Korhonen
- Department of Virology, University of Helsinki, 00014 Helsinki, Finland; (E.M.K.); (T.S.); (R.U.); (A.J.J.); (H.A.); (O.V.); (E.H.)
- Department of Veterinary Biosciences, University of Helsinki, 00014 Helsinki, Finland
| | - Teemu Smura
- Department of Virology, University of Helsinki, 00014 Helsinki, Finland; (E.M.K.); (T.S.); (R.U.); (A.J.J.); (H.A.); (O.V.); (E.H.)
- HUS Diagnostic Center, HUSLAB, Virology and Immunology, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Ruut Uusitalo
- Department of Virology, University of Helsinki, 00014 Helsinki, Finland; (E.M.K.); (T.S.); (R.U.); (A.J.J.); (H.A.); (O.V.); (E.H.)
- Department of Veterinary Biosciences, University of Helsinki, 00014 Helsinki, Finland
- Department of Geosciences and Geography, University of Helsinki, 00014 Helsinki, Finland
| | - Joseph Ogola
- KAVI Institute of Clinical Research, University of Nairobi, POB 19676, Nairobi 00202, Kenya; (J.O.); (O.A.)
- Department of Medical Microbiology, University of Nairobi, POB 19676, Nairobi 00202, Kenya;
| | - Dufton Mwaengo
- Department of Medical Microbiology, University of Nairobi, POB 19676, Nairobi 00202, Kenya;
| | - Anne J. Jääskeläinen
- Department of Virology, University of Helsinki, 00014 Helsinki, Finland; (E.M.K.); (T.S.); (R.U.); (A.J.J.); (H.A.); (O.V.); (E.H.)
- HUS Diagnostic Center, HUSLAB, Virology and Immunology, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Hussein Alburkat
- Department of Virology, University of Helsinki, 00014 Helsinki, Finland; (E.M.K.); (T.S.); (R.U.); (A.J.J.); (H.A.); (O.V.); (E.H.)
| | - Yong-Dae Gwon
- Department of Clinical Microbiology, Umeå University, 90185 SE Umeå, Sweden; (Y.-D.G.); (M.E.)
| | - Magnus Evander
- Department of Clinical Microbiology, Umeå University, 90185 SE Umeå, Sweden; (Y.-D.G.); (M.E.)
| | - Omu Anzala
- KAVI Institute of Clinical Research, University of Nairobi, POB 19676, Nairobi 00202, Kenya; (J.O.); (O.A.)
- Department of Medical Microbiology, University of Nairobi, POB 19676, Nairobi 00202, Kenya;
| | - Olli Vapalahti
- Department of Virology, University of Helsinki, 00014 Helsinki, Finland; (E.M.K.); (T.S.); (R.U.); (A.J.J.); (H.A.); (O.V.); (E.H.)
- Department of Veterinary Biosciences, University of Helsinki, 00014 Helsinki, Finland
- HUS Diagnostic Center, HUSLAB, Virology and Immunology, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Eili Huhtamo
- Department of Virology, University of Helsinki, 00014 Helsinki, Finland; (E.M.K.); (T.S.); (R.U.); (A.J.J.); (H.A.); (O.V.); (E.H.)
- Department of Veterinary Biosciences, University of Helsinki, 00014 Helsinki, Finland
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Power GM, Vaughan AM, Qiao L, Sanchez Clemente N, Pescarini JM, Paixão ES, Lobkowicz L, Raja AI, Portela Souza A, Barreto ML, Brickley EB. Socioeconomic risk markers of arthropod-borne virus (arbovirus) infections: a systematic literature review and meta-analysis. BMJ Glob Health 2022; 7:bmjgh-2021-007735. [PMID: 35428678 PMCID: PMC9014035 DOI: 10.1136/bmjgh-2021-007735] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/02/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction Arthropod-borne viruses (arboviruses) are of notable public health importance worldwide, owing to their potential to cause explosive outbreaks and induce debilitating and potentially life-threatening disease manifestations. This systematic review and meta-analysis aims to assess the relationship between markers of socioeconomic position (SEP) and infection due to arboviruses with mosquito vectors. Methods We conducted a systematic search on PubMed, Embase, and LILACS databases to identify studies published between 1980 and 2020 that measured the association of SEP markers with arbovirus infection. We included observational studies without geographic location or age restrictions. We excluded studies from grey literature, reviews and ecological studies. Study findings were extracted and summarised, and pooled estimates were obtained using random-effects meta-analyses. Results We identified 36 observational studies using data pertaining to 106 524 study participants in 23 geographic locations that empirically examined the relationship between socioeconomic factors and infections caused by seven arboviruses (dengue, chikungunya, Japanese encephalitis, Rift Valley fever, Sindbis, West Nile and Zika viruses). While results were varied, descriptive synthesis pointed to a higher risk of arbovirus infection associated with markers of lower SEP, including lower education, income poverty, low healthcare coverage, poor housing materials, interrupted water supply, marital status (married, divorced or widowed), non-white ethnicities and migration status. Pooled crude estimates indicated an increased risk of arboviral infection associated with lower education (risk ratio, RR 1.5 95% CI 1.3 to 1.9); I2=83.1%), interruption of water supply (RR 1.2; 95% CI 1.1 to 1.3; I2=0.0%) and having been married (RR 1.5 95% CI 1.1 to 2.1; I2=85.2%). Conclusion Evidence from this systematic review suggests that lower SEP increases the risk of acquiring arboviral infection; however, there was large heterogeneity across studies. Further studies are required to delineate the relationship between specific individual, household and community-level SEP indicators and arbovirus infection risks to help inform targeted public health interventions. PROSPERO registration number CRD42019158572.
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Affiliation(s)
- Grace M Power
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Aisling M Vaughan
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Luxi Qiao
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nuria Sanchez Clemente
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Julia M Pescarini
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Enny S Paixão
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ludmila Lobkowicz
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Amber I Raja
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - André Portela Souza
- São Paulo School of Economics and Center for Applied Microeconomic Studies, Getulio Vargas Foundation, São Paulo, Brazil
| | - Mauricio Lima Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Uncovering the Burden of Dengue in Africa: Considerations on Magnitude, Misdiagnosis, and Ancestry. Viruses 2022; 14:v14020233. [PMID: 35215827 PMCID: PMC8877195 DOI: 10.3390/v14020233] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 01/27/2023] Open
Abstract
Dengue is a re-emerging neglected disease of major public health importance. This review highlights important considerations for dengue disease in Africa, including epidemiology and underestimation of disease burden in African countries, issues with malaria misdiagnosis and co-infections, and potential evidence of genetic protection from severe dengue disease in populations of African descent. The findings indicate that dengue virus prevalence in African countries and populations may be more widespread than reported data suggests, and that the Aedes mosquito vectors appear to be increasing in dissemination and number. Changes in climate, population, and plastic pollution are expected to worsen the dengue situation in Africa. Dengue misdiagnosis is also a problem in Africa, especially due to the typical non-specific clinical presentation of dengue leading to misdiagnosis as malaria. Finally, research suggests that a protective genetic component against severe dengue exists in African descent populations, but further studies should be conducted to strengthen this association in various populations, taking into consideration socioeconomic factors that may contribute to these findings. The main takeaway is that Africa should not be overlooked when it comes to dengue, and more attention and resources should be devoted to this disease in Africa.
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Gerken KN, LaBeaud AD, Mandi H, L’Azou Jackson M, Breugelmans JG, King CH. Paving the way for human vaccination against Rift Valley fever virus: A systematic literature review of RVFV epidemiology from 1999 to 2021. PLoS Negl Trop Dis 2022; 16:e0009852. [PMID: 35073355 PMCID: PMC8812886 DOI: 10.1371/journal.pntd.0009852] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/03/2022] [Accepted: 12/22/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rift Valley fever virus (RVFV) is a lethal threat to humans and livestock in many parts of Africa, the Arabian Peninsula, and the Indian Ocean. This systematic review's objective was to consolidate understanding of RVFV epidemiology during 1999-2021 and highlight knowledge gaps relevant to plans for human vaccine trials. METHODOLOGY/PRINCIPAL FINDINGS The review is registered with PROSPERO (CRD42020221622). Reports of RVFV infection or exposure among humans, animals, and/or vectors in Africa, the Arabian Peninsula, and the Indian Ocean during the period January 1999 to June 2021 were eligible for inclusion. Online databases were searched for publications, and supplemental materials were recovered from official reports and research colleagues. Exposures were classified into five groups: 1) acute human RVF cases, 2) acute animal cases, 3) human RVFV sero-surveys, 4) animal sero-surveys, and 5) arthropod infections. Human risk factors, circulating RVFV lineages, and surveillance methods were also tabulated. In meta-analysis of risks, summary odds ratios were computed using random-effects modeling. 1104 unique human or animal RVFV transmission events were reported in 39 countries during 1999-2021. Outbreaks among humans or animals occurred at rates of 5.8/year and 12.4/year, respectively, with Mauritania, Madagascar, Kenya, South Africa, and Sudan having the most human outbreak years. Men had greater odds of RVFV infection than women, and animal contact, butchering, milking, and handling aborted material were significantly associated with greater odds of exposure. Animal infection risk was linked to location, proximity to water, and exposure to other herds or wildlife. RVFV was detected in a variety of mosquito vectors during interepidemic periods, confirming ongoing transmission. CONCLUSIONS/SIGNIFICANCE With broad variability in surveillance, case finding, survey design, and RVFV case confirmation, combined with uncertainty about populations-at-risk, there were inconsistent results from location to location. However, it was evident that RVFV transmission is expanding its range and frequency. Gaps assessment indicated the need to harmonize human and animal surveillance and improve diagnostics and genotyping. Given the frequency of RVFV outbreaks, human vaccination has strong potential to mitigate the impact of this now widely endemic disease.
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Affiliation(s)
- Keli N. Gerken
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - A. Desirée LaBeaud
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Henshaw Mandi
- Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
| | | | | | - Charles H. King
- Center for Global Health and Diseases, Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
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Shah MM, Ndenga BA, Mutuku FM, Vu DM, Grossi-Soyster EN, Okuta V, Ronga CO, Chebii PK, Maina P, Jembe Z, Bosire CM, Amugongo JS, Sahoo MK, Huang C, Weber J, Edgerton SV, Hortion J, Bennett SN, Pinsky BA, LaBeaud AD. High Dengue Burden and Circulation of 4 Virus Serotypes among Children with Undifferentiated Fever, Kenya, 2014-2017. Emerg Infect Dis 2021; 26:2638-2650. [PMID: 33079035 PMCID: PMC7588514 DOI: 10.3201/eid2611.200960] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Little is known about the extent and serotypes of dengue viruses circulating in Africa. We evaluated the presence of dengue viremia during 4 years of surveillance (2014–2017) among children with febrile illness in Kenya. Acutely ill febrile children were recruited from 4 clinical sites in western and coastal Kenya, and 1,022 participant samples were tested by using a highly sensitive real-time reverse transcription PCR. A complete case analysis with genomic sequencing and phylogenetic analyses was conducted to characterize the presence of dengue viremia among participants during 2014–2017. Dengue viremia was detected in 41.9% (361/862) of outpatient children who had undifferentiated febrile illness in Kenya. Of children with confirmed dengue viremia, 51.5% (150/291) had malaria parasitemia. All 4 dengue virus serotypes were detected, and phylogenetic analyses showed several viruses from novel lineages. Our results suggests high levels of dengue virus infection among children with undifferentiated febrile illness in Kenya.
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Climate predicts geographic and temporal variation in mosquito-borne disease dynamics on two continents. Nat Commun 2021; 12:1233. [PMID: 33623008 PMCID: PMC7902664 DOI: 10.1038/s41467-021-21496-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 01/26/2021] [Indexed: 11/08/2022] Open
Abstract
Climate drives population dynamics through multiple mechanisms, which can lead to seemingly context-dependent effects of climate on natural populations. For climate-sensitive diseases, such as dengue, chikungunya, and Zika, climate appears to have opposing effects in different contexts. Here we show that a model, parameterized with laboratory measured climate-driven mosquito physiology, captures three key epidemic characteristics across ecologically and culturally distinct settings in Ecuador and Kenya: the number, timing, and duration of outbreaks. The model generates a range of disease dynamics consistent with observed Aedes aegypti abundances and laboratory-confirmed arboviral incidence with variable accuracy (28–85% for vectors, 44–88% for incidence). The model predicted vector dynamics better in sites with a smaller proportion of young children in the population, lower mean temperature, and homes with piped water and made of cement. Models with limited calibration that robustly capture climate-virus relationships can help guide intervention efforts and climate change disease projections. The effects of climate on vector-borne disease systems are highly context-dependent. Here, the authors incorporate laboratory-measured physiological traits of the mosquito Aedes aegypti into climate-driven mechanistic models to predict number, timing, and duration of outbreaks in Ecuador and Kenya.
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Shah MM, Ndenga BA, Mutuku FM, Okuta V, Ronga CO, Chebii PK, Maina P, Jembe Z, Sahoo MK, Huang C, Weber J, Pinsky BA, LaBeaud AD. No Evidence of O'nyong-nyong Viremia among Children with Febrile Illness in Kenya (2015-2018). Am J Trop Med Hyg 2021; 104:1435-1437. [PMID: 33617476 PMCID: PMC8045621 DOI: 10.4269/ajtmh.20-0580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 01/10/2021] [Indexed: 11/07/2022] Open
Abstract
O'nyong-nyong virus (ONNV) is a little-known arbovirus causing intermittent, yet explosive, outbreaks in Africa. It is closely related to chikungunya virus, an emerging infectious disease. O'nyong-nyong virus causes a self-limited illness characterized by bilateral polyarthritis, rash, low-grade fever, and lymphadenopathy. In 1959, an extensive outbreak of ONNV occurred in East Africa, and decades later, another large outbreak was documented in Uganda in 1996. Limited evidence for interepidemic transmission is available, although serologic studies indicate a high prevalence of exposure. 1,045 febrile child participants in western and coastal Kenya were tested for the presence of ONNV using a multiplexed real-time reverse transcriptase-PCR assay. More than half of the participants had malaria parasitemia, and there was no evidence of active ONNV viremia in these participants. Further work is required to better understand the interepidemic circulation of ONNV and to reconcile evidence of high serologic exposure to ONNV among individuals in East Africa.
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Affiliation(s)
- Melisa M. Shah
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Bryson A. Ndenga
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Francis M. Mutuku
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Victoria Okuta
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Charles O. Ronga
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | | | | | - Malaya K. Sahoo
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - ChunHong Huang
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Jenna Weber
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Benjamin A. Pinsky
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Angelle Desiree LaBeaud
- Division of Infectious Disease, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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11
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Matheson AI, Mogeni OD, Lacsina JR, Ochieng M, Audi A, Bigogo G, Neatherlin J, Margolis HS, Fields B, Ahenda P, Walson JL, Montgomery JM. No Evidence of Acute Dengue Virus Infections at a Rural Site in Western Kenya, 2011 and 2013. Am J Trop Med Hyg 2020; 103:2054-2058. [PMID: 32876014 DOI: 10.4269/ajtmh.20-0132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The incidence and spread of dengue virus (DENV) have increased rapidly in recent decades. Dengue is underreported in Africa, but recent outbreaks and seroprevalence data suggest that DENV is widespread there. A lack of ongoing surveillance limits knowledge about its spatial reach and hinders disease control planning. We sought to add data on dengue distribution in Kenya through diagnostic testing of serum specimens from persons with an acute febrile illness (AFI) attending an outpatient clinic in rural western Kenya (Asembo) during rainy seasons. Patients with symptoms not likely to be misclassified as dengue (e.g., diarrhea and anemia), those with a positive diagnostic laboratory results which explained their febrile illness, or those with serum collected more than 5 days after fever onset were excluded. However, febrile patients with a positive malaria smear were included in the study. We used reverse transcription polymerase chain reaction (RT-PCR) to test for DENV and IgM anti-DENV to test for recent infection. Of the 615 serum specimens available for testing, none were dengue positive by either RT-PCR or IgM anti-DENV testing. Dengue did not appear to be a cause of febrile illness in this area of western Kenya, although our relatively small sample size may not have identified DENV infections occurring at low incidence. A more widespread AFI surveillance system that includes dengue diagnostic testing by RT-PCR and antibody-based methods is required to more definitively gauge the size and geographic distribution of DENV infection in western Kenya.
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Affiliation(s)
- Alastair I Matheson
- Department of Global Health, University of Washington, Seattle, Washington.,Department of Epidemiology, University of Washington, Seattle, Washington
| | - Ondari D Mogeni
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Joshua R Lacsina
- Department of Medicine, University of Washington, Seattle, Washington
| | - Melvin Ochieng
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Allan Audi
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Godfrey Bigogo
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | - John Neatherlin
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Harold S Margolis
- Dengue Branch, Division of Vectorborne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Barry Fields
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Petronella Ahenda
- School of Public Health, Texas A&M University, College Station, Texas
| | - Judd L Walson
- Department of Medicine, University of Washington, Seattle, Washington.,Department of Global Health, University of Washington, Seattle, Washington.,Department of Epidemiology, University of Washington, Seattle, Washington
| | - Joel M Montgomery
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Mordecai EA, Ryan SJ, Caldwell JM, Shah MM, LaBeaud AD. Climate change could shift disease burden from malaria to arboviruses in Africa. Lancet Planet Health 2020; 4:e416-e423. [PMID: 32918887 PMCID: PMC7490804 DOI: 10.1016/s2542-5196(20)30178-9] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 05/28/2023]
Abstract
Malaria is a long-standing public health problem in sub-Saharan Africa, whereas arthropod-borne viruses (arboviruses) such as dengue and chikungunya cause an under-recognised burden of disease. Many human and environmental drivers affect the dynamics of vector-borne diseases. In this Personal View, we argue that the direct effects of warming temperatures are likely to promote greater environmental suitability for dengue and other arbovirus transmission by Aedes aegypti and reduce suitability for malaria transmission by Anopheles gambiae. Environmentally driven changes in disease dynamics will be complex and multifaceted, but given that current public efforts are targeted to malaria control, we highlight Ae aegypti and dengue, chikungunya, and other arboviruses as potential emerging public health threats in sub-Saharan Africa.
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Affiliation(s)
- Erin A. Mordecai
- Biology Department, Stanford University, 371 Serra Mall, Stanford, CA, United States
| | - Sadie J. Ryan
- Department of Geography, University of Florida, Gainesville, FL, United States; Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States; School of Life Sciences, College of Agriculture, Engineering, and Science, University of KwaZulu Natal, KwaZulu Natal, South Africa
| | - Jamie M. Caldwell
- Biology Department, Stanford University, 371 Serra Mall, Stanford, CA, United States
| | - Melisa M. Shah
- Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - A. Desiree LaBeaud
- Department of Pediatrics, Division of Infectious Disease, School of Medicine, Stanford University, Stanford, CA, United States
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13
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Evidence of transovarial transmission of Chikungunya and Dengue viruses in field-caught mosquitoes in Kenya. PLoS Negl Trop Dis 2020; 14:e0008362. [PMID: 32559197 PMCID: PMC7329127 DOI: 10.1371/journal.pntd.0008362] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 07/01/2020] [Accepted: 05/04/2020] [Indexed: 01/14/2023] Open
Abstract
Arboviruses are among the most important emerging pathogens due to their increasing public health impact. In Kenya, continued population growth and associated urbanization are conducive to vector spread in both urban and rural environments, yet mechanisms of viral amplification in vector populations is often overlooked when assessing risks for outbreaks. Thus, the characterization of local arbovirus circulation in mosquito populations is imperative to better inform risk assessments and vector control practices. Aedes species mosquitoes were captured at varying stages of their life cycle during different seasons between January 2014 and May 2016 at four distinct sites in Kenya, and tested for chikungunya (CHIKV), dengue (DENV) and Zika (ZIKV) viruses by RT-PCR. CHIKV was detected in 45 (5.9%) and DENV in 3 (0.4%) mosquito pools. No ZIKV was detected. Significant regional variation in prevalence was observed, with greater frequency of CHIKV on the coast. DENV was detected exclusively on the coast. Both viruses were detected in immature mosquitoes of both sexes, providing evidence of transovarial transmission of these arboviruses in local mosquitoes. This phenomenon may be driving underlying viral maintenance that may largely contribute to periodic re-emergence among humans in Kenya. Transovarial transmission, or vertical transmission, is the spread of a pathogen from parent to offspring. It has been observed that some mosquito-borne viruses can be transmitted from female mosquitoes to their offspring during follicle development or during oviposition. The occurrence of transovarial transmission is evident in the presence of virally infected male mosquitoes, which typically do not take bloodmeals, and the presence of virus in immature mosquitoes of any sex. Transovarial transmission aids in the amplification of mosquito-borne viruses in the environment by increasing the number of infected mosquitoes in a given region, thus expanding the possibility of viral transmission to humans. The combination of transovarial transmission and the preservation of viable eggs during dry seasons may trigger sudden amplification of the virus after rainy periods, resulting in an outbreak. This study provides some of the first evidence of transovarial transmission of chikungunya and dengue viruses in Aedes aegypti mosquitoes in Africa during interepidemic periods, which has important implications for local virus persistence and epidemic patterns.
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14
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Forsyth JE, Mutuku FM, Kibe L, Mwashee L, Bongo J, Egemba C, Ardoin NM, LaBeaud AD. Source reduction with a purpose: Mosquito ecology and community perspectives offer insights for improving household mosquito management in coastal Kenya. PLoS Negl Trop Dis 2020; 14:e0008239. [PMID: 32392226 PMCID: PMC7241847 DOI: 10.1371/journal.pntd.0008239] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/21/2020] [Accepted: 03/20/2020] [Indexed: 01/17/2023] Open
Abstract
Understanding mosquito breeding behavior as well as human perspectives and practices are crucial for designing interventions to control Aedes aegypti mosquito-borne diseases as these mosquitoes primarily breed in water-holding containers around people's homes. The objectives of this study were to identify productive mosquito breeding habitats in coastal Kenya and to understand household mosquito management behaviors and their behavioral determinants. The field team conducted entomological surveys in 444 households and semi-structured interviews with 35 female caregivers and 37 children in Kwale County, coastal Kenya, between May and December 2016. All potential mosquito habitats with or without water were located, abundances of mosquito immatures measured and their characteristics recorded. Interviews explored household mosquito management behaviors and their behavioral determinants. 2,452 container mosquito habitats were counted containing 1,077 larvae and 390 pupae, predominantly Aedes species. More than one-third of the positive containers were found outside houses in 1 of the 10 villages. Containers holding water with no intended purpose contained 55.2% of all immature mosquitoes. Containers filled with rainwater held 95.8% of all immature mosquitoes. Interviews indicated that households prioritize sleeping under bednets as a primary protection against mosquito-borne disease because of concern about night-time biting, malaria-transmitting Anopheles mosquitoes. Respondents had limited knowledge about the mosquito life cycle, especially with respect to day-time biting, container-breeding Aedes mosquitoes. Therefore, respondents did not prioritize source reduction. Most mosquitoes breed in containers that have no direct or immediate purpose ("no-purpose containers"). These containers may be left unattended for several days allowing rainwater to collect, and creating ideal conditions for mosquito breeding. An intervention that requires little effort and targets only the most productive containers could effectively reduce mosquito indices and, relatedly, mosquito-borne disease risk.
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Affiliation(s)
- Jenna E. Forsyth
- Emmett Interdisciplinary Program in Environment and Resources, Stanford University, Stanford, California, United States of America
- * E-mail:
| | - Francis M. Mutuku
- Technical University of Mombasa, Mombasa, Kenya
- Vector-Borne Disease Unit, Msambweni County Referral Hospital, Msambweni, Kenya
| | - Lydiah Kibe
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Luti Mwashee
- Technical University of Mombasa, Mombasa, Kenya
- Vector-Borne Disease Unit, Msambweni County Referral Hospital, Msambweni, Kenya
| | - Joyce Bongo
- Vector-Borne Disease Unit, Msambweni County Referral Hospital, Msambweni, Kenya
| | - Chika Egemba
- Stanford University School of Medicine, Stanford, California, United States of America
| | - Nicole M. Ardoin
- Emmett Interdisciplinary Program in Environment and Resources, Graduate School of Education, and Woods Institute for the Environment, Stanford University, Stanford, California, United States of America
| | - A. Desiree LaBeaud
- Stanford University School of Medicine, Stanford, California, United States of America
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