Dengue fever in Saudi Arabia: A review of environmental and population factors impacting emergence and spread

Altassan, Kholood K.; Morin, Cory W.; Shocket, Marta S.; Ebi, Kris; Hess, Jeremy

doi:10.1016/j.tmaid.2019.04.006

Cited by 34 publications

(46 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1,17 Indeed, arthropod-borne infections accounted for 67.8% of the febrile cases in this cohort, with majority being DENV. Although DENV transmission is generally reported to be sensitive to environmental factors, 28 the number of DENV cases was constant throughout the study period despite changes in temperature, humidity and rainfall (Supplementary figure 1). Instead, seasonality was observed for malaria, and it has been shown that changes in temperature control the Anopheles mosquito life cycle and parasite development, thus regulating disease transmission.…”

Section: Discussionmentioning

confidence: 99%

“…29 This suggests that the activity of different vectors and pathogens could be regulated by environmental factors at different levels, and understanding the dynamics of climate and vector is important in the effective planning and implementation of routine control measures. 28 Because of the similar clinical presentations and overlapping endemicity of malaria, DENV and CHIKV infections in tropical regions, simultaneous infections with more than one of the pathogen are very likely to be underreported and misdiagnosed as a mono-infection. 16 DENV-CHIKV co-infections have been described in 26 different countries, including Yemen.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Systematic analysis of disease‐specific immunological signatures in patients with febrile illness from Saudi Arabia

et al. 2020

View full text Add to dashboard Cite

Objectives Little is known about the prevalence of febrile illness in the Arabian region as clinical, laboratory and immunological profiling remains largely uncharacterised. Methods A total of 2018 febrile patients from Jazan, Saudi Arabia, were recruited between 2014 and 2017. Patients were screened for dengue and chikungunya virus, Plasmodium, Brucella, Neisseria meningitidis, group A streptococcus and Leptospira. Clinical history and biochemical parameters from blood tests were collected. Patient sera of selected disease‐confirmed infections were quantified for immune mediators by multiplex microbead‐based immunoassays. Results Approximately 20% of febrile patients were tested positive for one of the pathogens, and they presented overlapping clinical and laboratory parameters. Nonetheless, eight disease‐specific immune mediators were identified as potential biomarkers for dengue (MIP‐1α, MCP‐1), malaria (TNF‐α), streptococcal and meningococcal (eotaxin, GRO‐α, RANTES, SDF‐1α and PIGF‐1) infections, with high specificity and sensitivity profiles. Notably, based on the conditional inference model, six of these mediators (MIP‐1α, TNF‐α, GRO‐α, RANTES, SDF‐1α and PIGF‐1) were revealed to be 68.4% accurate in diagnosing different febrile infections, including those of unknown diseases. Conclusions This study is the first extensive characterisation of the clinical analysis and immune biomarkers of several clinically important febrile infections in Saudi Arabia. Importantly, an immune signature with robust accuracy, specificity and sensitivity in differentiating several febrile infections was identified, providing useful insights into patient disease management in the Arabian Peninsula.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systematic analysis of disease‐specific immunological signatures in patients with febrile illness from Saudi Arabia

et al. 2020

View full text Add to dashboard Cite

show abstract

“…This eventually suggests that transmission of dengue virus (or both virus and mosquito) during the mass migration before the Eid was likely the most significant factor behind the geographical distribution of the diseases. From a public health standpoint, such mass mobility events (e.g., Eid exodus, Hajj pilgrimage, migration during the Chinese New Year) can sometimes be reasons for major concern if their location and timing coincide with major outbreak [11]. Such unexpected coincidence could facilitate outbreaks (especially with highly contagious viruses) morphing into an epidemic or even pandemic (depending on other factors like ease of transmission and favorability of climate factors).…”

Section: Discussionmentioning

confidence: 99%

Dengue in a crowded megacity: Lessons learnt from 2019 outbreak in Dhaka, Bangladesh

et al. 2020

View full text Add to dashboard Cite

Dengue is a mosquito-borne viral disease commonly reported in the tropical regions of the world. The presence of two mosquito vectors (Aedes aegypti is highly urban, while A. albopictus is less urban) throughout the year makes dengue fever an endemic disease in a number of countries. Among the predicting variables, a rise of temperature and rainfall have shown to be associated with the number of dengue cases [1]. While relatively less emphasized compared to the climatic factors, mass movement is particularly important during large-scale outbreaks. This article presents a case based on the available data from the 2019 outbreak in Bangladesh, where the dengue fever was initially concentrated in Dhaka, the capital city. Dhaka is one of the most crowded megacities in the world, with over 19 million people distributed over 453 square km (spatial density of 41,000/square km) [2]. It is a hub of all key administrative, educational, and industrial activities in Bangladesh. Hence, a considerable proportion of the Bangladeshi population prefers to live in the city for better income, quality education, and better facilities overall. The 2019 dengue outbreak in Dhaka was the most intense since the emergence of dengue outbreaks in late the 1990s in Bangladesh [3]. According to Directorate General of Health Services (DGHS), Bangladesh, a total of 100,201 confirmed dengue cases were admitted in hospitals between January and December 2019; 51,179 cases were reported in Dhaka city and 49,022 across the rest of Bangladesh [4]. This implies a 10-fold increase in hospitalized cases compared with the largest outbreak before 2019. Since the first major outbreak in 2000, all four serotypes (DEN-1-4) were reported in Dhaka city until 2003, a with higher prevalence of DEN-3 serotype. After a hiatus (2013-2016), DEN-3 serotype re-emerged in 2017, and this serotype has been reported to be the most frequently identified during the 2019 outbreak [5,6]. Anecdotal evidence from medical practitioners suggests that dengue patients manifested with a spectrum of atypical symptoms in the 2019 outbreak, which can be related to serodiversity of the viral strains. A recently published nationwide seroprevalence study (2014-2015) showed that 24% of participants had past history of dengue infection in Bangladesh [7]. Seropositivity of the infected individuals was largely confined to three big cities, namely Dhaka, Chittagong, and Khulna, indicating that circulation of dengue virus was not high in the semi-urban and rural areas of Bangladesh [7]. Notably, all major dengue outbreaks in Bangladesh showed a tendency to remain confined mostly in Dhaka city [7], and the 2019 outbreak showed the same trend PLOS NEGLECTED TROPICAL DISEASES

show abstract

“…In the same period, 406 cases of Khumra fever were reported in KSA with no clear seasonality and none of the cases occurred in Makkah. The flavivirus, DENV, is the most prevalent of the mosquito-borne viruses in KSA and has been documented in the country since the early 1990s [ 7 , 23 ]. Three serotypes of DENV (1, 2, and 3) are known to be endemic and circulating in KSA with DENV-2 being the predominant serotype [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…The flavivirus, DENV, is the most prevalent of the mosquito-borne viruses in KSA and has been documented in the country since the early 1990s [ 7 , 23 ]. Three serotypes of DENV (1, 2, and 3) are known to be endemic and circulating in KSA with DENV-2 being the predominant serotype [ 23 ]. A recent seroprevalence study using samples from Makkah in 2015–2016 also identified DENV-4 in the country [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Lack of Zika Virus and Other Recognized Flaviviruses among the Mosquito Vectors during and Post the Hajj Mass Gathering

Yezli

Yasir

Yassin

et al. 2021

IJERPH

View full text Add to dashboard Cite

Makkah city, Kingdom of Saudi Arabia (KSA), contains many of the world’s mosquito vectors of parasitic and arboviral disease and is the site of the Hajj mass gathering. As such there is a risk of exportation and globalization of vector-borne viruses, including the re-emerging Zika virus (ZIKV). There was international concern regarding the introduction of ZIKV to KSA and potential international spread of the virus following the 2016 Hajj which took place few days after the Rio summer Olympics at the height of the ZIKV pandemic. We aimed to detect flaviviruses, including ZIKV, circulating among mosquito hosts in the city of Makkah during and post the 2016 Hajj pilgrimage. Mosquitos (adults and larvae) were sampled from 15 sites in Makkah city during and post the 2016 Hajj and identified to species by morphological keys. Mosquitos were pooled according to date of collection, location, and species. A Pan-Flaviviruses RT-PCR assay that enables identification of 51 flaviviruses species and three tentative species was used to detect flavivirus RNA directly from mosquito homogenates. Between the 10 September and 6 October 2016, 9412 female mosquitos were collected. Of these, 81.3% were Aedes aegypti, 18.6% were Culex species, and 0.1% were Anopheles species. Of the total 493 mosquito pools generated, 242 (49%) were positive by the Pan-Flaviviruses primer set. Sequence analysis revealed that none of the mosquitos carried a pathogenic flavivirus, including ZIKV, but were infected with a novel insect-specific flavivirus. We found no pathogenic flaviviruses circulating in Makkah city during and post the 2016 Hajj and no evidence of introduction of ZIKV through the pilgrimage. Enhanced vector-borne diseases surveillance, prevention, and control are crucial in KSA especially during international mass gatherings such as the annual Hajj to prevent outbreaks and the spread of viruses with epidemic and pandemic potentials.

show abstract

Dengue fever in Saudi Arabia: A review of environmental and population factors impacting emergence and spread

Cited by 34 publications

References 43 publications

Systematic analysis of disease‐specific immunological signatures in patients with febrile illness from Saudi Arabia

Systematic analysis of disease‐specific immunological signatures in patients with febrile illness from Saudi Arabia

Dengue in a crowded megacity: Lessons learnt from 2019 outbreak in Dhaka, Bangladesh

Lack of Zika Virus and Other Recognized Flaviviruses among the Mosquito Vectors during and Post the Hajj Mass Gathering

Contact Info

Product

Resources

About