Contribution of Dengue Fever to the Burden of Acute Febrile Illnesses in Papua New Guinea: An Age-Specific Prospective Study

Abstract

Malaria is a major contributor to the burden of febrile illnesses in Papua New Guinea (PNG). Dengue fever (DF) is likely to contribute; however, its epidemiology in PNG is poorly understood. We performed a prospective age-stratified study in outpatient clinics investigating the prevalence of DF; 578 patients were enrolled, and 317 patients with a negative rapid diagnostic test (RDT) for malaria were tested for dengue. Malaria was confirmed in 52% (301/578, 95% confidence interval [CI] = 48–56%), DF was diagnosed in 8% (46/578, 95% CI = 6–10%), and 40% (95% CI = 36–44%) had neither diagnosis. Among the 317 malaria RDT-negative patients, 14% (45/317, 95% CI = 10–18%) had DF. The seroprevalence of dengue immunoglobulin G (IgG) was 83% (204/247, 95% CI = 78–87%), and no dengue hemorrhagic fever was seen. This study provides good evidence for the first time that DF is common in PNG and is responsible for 8% of fever episodes. The common occurrence of DF in a population with presumed previous exposure to dengue is an important observation.

Detection of Chikungunya and West Nile viruses in febrile patients in Ile-Ife Osun State, Nigeria using real time reverse transcription-polymerase chain reaction (RT-PCR)

“…Consequently, this may result in the slow identification of an arboviral disease outbreak and potentially high morbidity and mortality (Monlun et al, 1993;WHO, 2010;Baba et al, 2013). Arboviral and malaria parasite co-infections have previously been reported in Papua New Guinea (Senn et al, 2011), Senegal (Robin et al, 1980) and in European travellers in Senegal, Guinea and Sierra Leone (Charrel et al, 2005) but little has been said and known about arboviruses only in patients presenting with fever especially in Africa. Case definition and adequate surveillance, therefore, are major challenges.…”

Prevalence of Patients with Acute Febrile Illnesses and Positive Dengue NS1 Tests in a Tertiary Hospital in Papua New Guinea

“…2 However, despite the predominance of dengue virus and vectors in this region, DF is rarely diagnosed in Papua New Guinea (PNG), and dengue hemorrhagic fever has not been reported apart from an unconfirmed outbreak more than a decade ago. 3 Nevertheless, this may be a reflection of (1) the lack of viral diagnostic facilities in PNG, (2) the fact that previous dengue investigations have been conducted in predominantly rural populations, [3][4][5] and (3) the low index of clinical suspicion among health workers in PNG.…”

“…Nevertheless, this may be a reflection of (1) the lack of viral diagnostic facilities in PNG, (2) the fact that previous dengue investigations have been conducted in predominantly rural populations, [3][4][5] and (3) the low index of clinical suspicion among health workers in PNG.…”

“…Second, serotyping of dengue viruses and confirmatory diagnosis using more sensitive molecular methods were not possible. Although the dengue NS1 antigen test proved to be a cost-effective diagnostic tool for our setting that can be used under field conditions, which was shown in this study as well as in a previous study, 4 additional validation studies comparing its use with more sensitive diagnostic methods are needed. Third, we were unable to further identify pathogens in 80% of our patients.…”

“…We showed a high prevalence rate of 14.9% compared with 8% in a previous report from the north coast of PNG that used the NS1 and serology tests in paired samples. 4 In addition, malaria, which is often considered endemic in PNG, contributed only 1.5% of cases, whereas chikungunya accounted for 2.1% of cases. Findings from this study support our hypothesis that a lack of viral diagnostic facilities compounded by the lack of dengue baseline prevalence data and the low index of clinical suspicion by health workers may have contributed to an underestimation of the true burden of DF in PNG.…”