A serologic study of dengue in northwest Ethiopia: Suggesting preventive and control measures

Getachew Ferede, Moges Tiruneh, Ebba Abate, Yitayih Wondimeneh, Demekech Damtie, Endalamaw Gadisa, Rawleigh Howe, Abraham Aseffa, Belay Tessema, Getachew Ferede, Moges Tiruneh, Ebba Abate, Yitayih Wondimeneh, Demekech Damtie, Endalamaw Gadisa, Rawleigh Howe, Abraham Aseffa, Belay Tessema

Abstract

Background: Dengue is one of the most serious and rapidly spreading arboviral diseases in the world. Despite many acute febrile illnesses in Ethiopia, the burden of illness due to dengue in the country is largely unknown. Thus, the present study aimed to provide the first baseline data on seroprevalence and associated risk factors of dengue virus (DENV) infection in the country.

Methods: A cross-sectional study of febrile patients who were visiting Metema and Humera hospitals in Northwest Ethiopia from March 2016 to May 2017 was conducted. Blood samples were collected from each participant and serum samples were separated and tested for IgM and IgG antibodies against DENV infection by enzyme-linked immunosorbent assay (ELISA). Risk factors associated with the prevalence of anti-DENV antibodies were tested using logistic regression analysis.

Results: Of the 600 samples tested, the overall seroprevalence against DENV infection was 33.3%, while the seroprevalence by the study area was 40% in Metema and 27.5% in Humera. The overall prevalence of IgM and IgG antibodies against DENV infection was 19% and 21% respectively. Of these, 6.7% were positive for both IgM and IgG antibodies. Residence and occupational status were significantly associated with the prevalence of anti-DENV IgM seropositivity and anti-DENV IgM-/G+serostatus. The seasonal variation was significantly associated with the prevalence of anti-DENV IgM but not with anti-DENV IgM-/G+serostatus. The prevalence of anti-DENV IgM-/G+serostatus was significantly higher in Metema than Humera. High prevalence of anti-DENV IgM seropositivity was found in the summer and spring, with a peak in the month of August. The presence of uncovered water either indoor or outdoor and lack of mosquito net use was identified as risk factors for DENV infection.

Conclusions: These findings provide the preliminary data on seroprevalence and associated risk factors of DENV infection in the country. The presence of antibodies against DENV infection indicates dengue as one of the causes of undifferentiated febrile illnesses in the study areas. This suggests that prevention and control measures should be designed considering the risk factors identified by this study. Furthermore, we recommend a large-scale study to include DENV infection in the differential diagnosis of all febrile illnesses in Ethiopia.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Dengue study areas-Humera and Metema…
Fig 1. Dengue study areas-Humera and Metema hospital, and other recent outbreaks in Dire Dawa town.
Red: current dengue sero-study areas; green: recent dengue reported area in Ethiopia.
Fig 2. Seroprevalence of DENV infection, from…
Fig 2. Seroprevalence of DENV infection, from March 2016 to May 2017.
Blue: total number of study participants; red: study participants negative against anti-DENV antibodies; green: study participants positive against anti-DENV antibodies.
Fig 3. Month-wise distributions of antibodies against…
Fig 3. Month-wise distributions of antibodies against DENV infection, from March 2016 to May 2017.
Blue diamonds: study participants with only anti-DENV IgM positive cases; red squares: study participants with only anti-DENV IgG positive cases; green triangles: study participants with both IgM and IgG positive cases.

References

    1. Yong Y, Thayan R, Chong H, Tan C, Sekaran S. Rapid Detection and Serotyping of Dengue Virus by Multiplex RT-PCR and Real-Time SYBER Green RT-PCR. Sing Med J. 2007;48:662.
    1. WHO-TDR. Dengue: guidelines for diagnosis, treatment, prevention, and control- New Edition. Geneva, Switzerland: World Health Organisation; 2009
    1. WHO. Global strategy for dengue prevention and control 2012–2020. World Health Organization; 2012:1–43.
    1. Bhatt S, Gething P, Brady O, Messina J, Farlow A, Moyes CL, et al. The global distribution and burden of dengue. Nature. 2013;496:504–7. doi:
    1. Kyle J, Harris E. Global spread and persistence of dengue. Annu Rev Microbiol. 2008;62:71–92. doi:
    1. Ananda A, Joel N, Kuritsky G, William L, Harold S, Margolis H. Dengue virus infection in Africa. Emerg Infect Dis. 2011;17:1349–54 doi:
    1. Tajeldin A, AbdelAziem A, Mubarak K, Ishag A. Epidemiology of Dengue Infections in Kassala, Eastern Sudan. J Med Virol. 2012;84:500–3. doi:
    1. Watts D, EI-Tigani A, Botros B, Salib A, Olmn J, McCarthy M. Arthropod-borne viral infections associated with a fever outbreak in the northern province of Sudan. J Trop Med Hyg. 1994;97:228–30.
    1. Abdulmumini U, Jacob D, Diana R, Araia B, Yohannes G, Goitom M, et al. Dengue fever outbreaks in Eritrea, 2005–2015. A case for strengthening surveillance, control, and reporting. Glob Health Res Policy. 2016;1:17 doi:
    1. Caroline O, Petronella A, Aymond N, Stella G, Cyrus W. Seroprevalence of Infections with Dengue, Rift Valley Fever and Chikungunya Viruses in Kenya. PLoS One. 2015;10:e0132645 doi:
    1. Andayi F, Charrel R, Kieffer A, Richet H, Pastorino B, Leparc I. A Sero-epidemiological Study of Arboviral Fevers in Djibouti, Horn of Africa. PLoS Negl Trop Dis. 2014;8:e3299 doi:
    1. Abyot BW, Mesfin M, Wubayehu K, Esayas K, Milliyon W, Abiy G, et al. The first acute febrile illness investigation associated with dengue fever in Ethiopia, 2013: A descriptive analysis. Ethiop J Health Dev. 2014;28:155–61.
    1. Mekuria Y. A catalog of the culicine mosquito fauna of Ethiopia and their distribution in the country. Eth Med J. 1968;6 73.
    1. Mekuria Y, Assefa S, Mebrahtu Y. Culicine mosquitoes (Diptera: Culicidae) of Ethiopia: checklist and distribution. Eth Med J. 1978;16:71.
    1. Yusuf MA, Ali AS. Epidemiology of Dengue Fever in Ethiopian Somali Region: Retrospective Health Facility-Based Study. CAJPH. 2016;2:51–6.
    1. Gubler D. Dengue, Urbanization and Globalization: The Unholy Trinity of the 21(st) Century. Trop Med Health. 2011;39:3–11.
    1. Karoli R, Fatima J, Siddiqi Z, Kazmi K, Sultania A. Clinical profile of dengue infection at a teaching hospital in North India. J Infect Dev Ctries. 2012;6:551–4.
    1. SABIN A. Research on dengue during World War II. Am J Trop Med Hyg. 1952;1:30
    1. WHO report on global surveillance of epidemic-prone infectious diseases. World Health Organization, Geneva. 2005.
    1. Ligon B. Dengue fever and dengue hemorrhagic fever: a review of the history, transmission, treatment, and prevention. Semin Pediatr Infect Dis. 2005;16:60–5. doi:
    1. Ahmad S, Ali R, Shah S, Ilahi I. To evaluate the epidemiological trend of dengue fever in a teaching hospital at district swats Pakistan. App Sci Report. 2014;6:78–81.
    1. Feleke S, Animut A, Belay M. Prevalence of malaria among acute febrile patients clinically suspected of having malaria in the Zeway Health Center, Ethiopia. Jpn J Infect Dis. 2015;68:55–9. doi:
    1. Mayfong M, Josée C, Vilada C, Audrey D-P, DanielH P, Rattanaphone P, et al. Causes of non-malarial fever in Laos: a prospective study. Lancet Glob Health. 2013;1:e46–54. doi:
    1. EUROIMMUN. Medizinische Labordiagnostika AG, Lübeck, Germany. Available from: .
    1. Gubler D. Dengue and Dengue hemorrhagic fever. Clin Microbiol Rev. 1999;11:480–97.
    1. Gubler D. The global emergence/resurgence of arboviral diseases as public health problems. Arch Med Res. 2002;33:330–42.
    1. Shepard D, Coudeville L, Halasa Y, Zambrano B, Dayan G. Economic impact of dengue illness in the Americas. Am J Trop Med Hyg. 2011;84:200–7. doi:
    1. Guha-Sapir D, Schimmer B. Dengue fever: new paradigms for a changing epidemiology. Emerg Themes Epidemiol. 2005;2:10.1186/742-7622-2-1.
    1. Gibbons R, Vaughn D. Dengue: an escalating problem. BMJ. 2002;324:1563–6.
    1. Francesco V, Emanuele N, Silvia M, Monica S, Maria G, Nazario B, et al. Seroprevalence of dengue infection: a cross-sectional survey in mainland Tanzania and on Pemba Island, Zanzibar. Int J Infect Dis. 2012;16:e44–e6. doi:
    1. Sujet L, Surapee A, Chuleeporn J, Pawinee D, Sathit P, Wisanu W, et al. Prevalence and characteristics of dengue and chikungunya infections among acute febrile patients in Nong Khai province, Thailand. Southeast Asian J Trop Med public health. 2013;44.
    1. Ooi E, Gubler D. Global spread of epidemic dengue: the influence of environmental change. Future Virol. 2009;4:571–80.
    1. Maria G, Scott B, Harvey A, Philippe B, Jeremy F, Duane J, et al. Dengue: a continuing global threat. Nat Rev Microbiol. 2010;8:S7–S16. doi:
    1. Lindegren G, Vene S, Lundkvist A, Falk K. Optimized Diagnosis of Acute Dengue Fever in Swedish Travelers by a Combination of Reverse Transcription-PCR and Immunoglobulin M Detection. J Clin Microbiol. 2005;43:2850–5. doi:
    1. Calisher C, Karabatsos N, Dalrymple J, Shope R, Porterfield J, Westaway E, et al. Antigenic relationships between flaviviruses as determined by cross-neutralization tests with polyclonal antisera. J Gen Virol. 1989;70:37–43. doi:
    1. Naoufel K, Farhat C, Muhammad I, Imed H, Mohamed A, Dalinda A, et al. Clinical Manifestations and Biological Markers Noted in Adults Infected by Dengue Virus in Najran Region: Study of 60 Cases. Clin Res Infect Dis. 2016;3:1024.
    1. Abhinav J, Asha S, Pinakin P, Mitali D, Shrikant S, Pallav P, et al. A clinico-hematological profile of dengue outbreak among healthcare professionals in a tertiary care hospital of Ahmedabad with analysis on economic impact. Nat J Com Med. 2013;4:286–90.
    1. Adarsh E, Subramanian V. Clinical profile of dengue infection in a tertiary care hospital. Indian J Child Health. 2015; 2:68–71.
    1. Narayanan M, Aravind M, Thilothammal N, Prema R, Sargunam C, Ramamurty N. Dengue fever epidemic in Chennai—A study of clinical profile and outcome. Indian Pediatr. 2002;39:1027–33.
    1. Malavige G, Fernando S, Fernando D, Seneviratne S. Dengue viral infections. Postgrad Med J. 2004;80:588–601. doi:
    1. Halstead S. Immune enhancement of viral infection. Prog Allergy. 1982;31:202–9
    1. Imrie A, Meeks J, Gurary A, Sukhbaatar M, Truong T. Antibody to dengue 1 detected more than 60 years after infection. Viral Immunol. 2007;20:672–5. doi:
    1. Schwartz E, Mileguir F, Grossman Z, Mendelson E. Evaluation of ELISA-based serodiagnosis of dengue fever in travelers. J Clin Virol. 2000;19:169–73.
    1. VidhyaRani R, Sundararajan T, Rajesh S, Jeyamurugan T. A Study on Common Etiologies of Acute Febrile Illness Detectable by Microbiological Tests in a Tertiary Care Hospital. Int J Curr Microbiol Appl Sci. 2016;5:670–4.
    1. Priyadarshini S, Nirupa S, Vidhya R, Preethi V. A study on the prevalence of dengue fever in Kelambakkam in comparison to an earlier study. Indian J Microbiol Res. 2016; 3:102–6.
    1. Dawurung J, Baba M, Stephen G, Jonas S, Bukbuk D, Dawurung C. Serological evidence of acute dengue virus infection among febrile patients attending Plateau State Specialist Hospital Jos, Nigeria Report and Opinion. 2010;2:71–6.
    1. Yik W, Tun Y, Li W, Lee C, Grace Y, Lyn J, et al. Seroepidemiology of Dengue Virus Infection Among Adults in Singapore. Ann Acad Med Singapore. 2009;38:667–75.
    1. Mohammed S, Sayed H, Kamal E, Somia O, Osama S, Mark B, et al. Cross-sectional community-based study of the socio-demographic factors associated with the prevalence of dengue in the eastern part of Sudan in 2011. BMC Public Health. 2015;15:558 doi:
    1. Gupta G, Shah Y, Poudel A, Pun R, Pant K, Kshetri R, et al. Serological and Molecular Study of Dengue Viruses in Different Hospitals of Nepal. Nepal J Med Sci. 2013;2:20–5.
    1. Theeraphap C, Pongthep A, Sommawan N, Sataporn H. Larval habitats and distribution patterns of Aedes aegypti (Linnaeus) and Aedes albopictus (Skuse), in Thailand. Southeast Asian J Trop Med and Public Health. 2003;34:531
    1. Garg A, Garg J, Rao Y, Upadhyay G, Sakhuja S. Prevalence of dengue among clinically suspected febrile episodes at a teaching hospital in North India. J Infect Dis Immunity. 2011;3:85–9.
    1. Gunasekaran P, Kaveri K, Mohana S, Arunagiri K, Babu B, Priya P. Dengue disease status in Chennai (2006–2008): A retrospective analysis. Indian J Med Res. 2011;133:322–5.
    1. Tank A, Jain M. Trend of dengue in a tertiary care hospital of Surat city, western India. Nat J Comm Med. 2012;3:302–4.
    1. Gómez-Dantés H, Willoquet J. Dengue in the Americas: challenges for prevention and control. Cad Saude Publica. 2009;25:S19–31.
    1. Mohammed S, Syed M, Omrana P, Syed A, Mubarak K, Mutasim E, et al. Dengue fever in a border state between Sudan and Republic of South Sudan: Epidemiological Perspectives. J Public Health Epidemiol. 2013;5:319–24.
    1. Sadia N, Muhammad A, Muhammad A, Ahmad R, Bahar M. The epidemiology of dengue fever in district Faisalabad, Pakistan. Int J Sci Res. 2015;5,:ISSN 2250-3153.
    1. Kholedi A, Balubaid O, Milaat W, Kabbash A, Ibrahim A. Factors associated with the spread of dengue fever in Jeddah Governorate, Saudi Arabia. East Mediterr Health J. 2012;18:15–23.
    1. Mammen M, Pimgate C, Koenraadt C, Rothman A, Aldstadt J. Spatial and temporal clustering of dengue virus transmission in Thai villages. PLoS Med. 2008;5:e205 doi:

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