Phylogenetic characterization of circulating Dengue and Alkhumra Hemorrhagic Fever viruses in western Saudi Arabia and lack of evidence of Zika virus in the region: A retrospective study, 2010‐2015

Abstract

Flaviviruses represent a global public health concern. They consist of ∼70 viruses with almost half of them causing human diseases with unspecified febrile illnesses. Cities in western Saudi Arabia are endemic for viruses (DENV) with sporadic infections due to Alkhumra hemorrhagic fever virus (AHFV). They also represent a major destination for travelers coming for annual religious pilgrimages (Hajj and Umrah) from all over the world. However, whether other flaviviruses are circulating is not known because of the limited number of surveillance studies. Here, we retrospectively screened 690 samples for flaviviruses in samples from patients with unexplained febrile illnesses between 2010 and 2015 in western Saudi Arabia using a pan-flaviviruses RT-PCR assay. Despite Zika virus RNA was not detected, this study confirms circulation and/or sporadic spread of DENV-2, DENV-3, and AHFV, higher prevalence of DENV-2, and a role for visitors from DENV endemic countries in DENV importation into the Kingdom. Further analysis also showed very low genetic diversity of AHFV confirming its slow microevolution. Accordingly, continuous and prospective surveillance for flaviviruses using such assay are warranted in Saudi Arabia which receives millions of Muslims annually to implement effective control measures in light of the global widespread and outbreaks of several flaviviruses.

The prevalence of dengue virus serotypes in asymptomatic blood donors reveals the emergence of serotype 4 in Saudi Arabia

“…In this context, several studies have shown independent multiple introductions of DENV-1 (lineage India-2 and lineage Asia-2) and DENV-2 (Cosmopolitan genotype and DENV-2-Jeddah-2014) in the Western province of the kingdom between the years 1994 and 2014 [10, 11, 25]. Additionally, the most recent report by the United Nations has estimated that 10 million migrant workers are living in KSA and many of them are from India and Pakistan where DENV-4 is endemic [28–30].…”

Molecular Analysis of Targeted Insecticide Resistance Gene Mutations in field Aedes Aegypti and Culex Quinquefasciatus Mosquito Vectors of Arboviruses from Saudi Arabia

“…At least four vector-borne viruses, including dengue virus (DENV), Alkhurma hemorrhagic fever virus, Rift Valley fever virus, and Crimean-Congo hemorrhagic fever virus have been circulating in Saudi Arabia [6]. The most important of them is dengue, with most of the disease burden and severity, mainly prevalent in the western and southwestern regions in Jeddah and Makkah, of Saudi Arabia [7][8][9].…”

“…Saudi Arabia was once a dengue-free country till the rst dengue outbreak in Jeddah in 1994 [11]. Now all the four DENV serotypes (DENV1-4) have been reported in Jeddah and Makkah [6,8,12]. Jeddah is the nancial and diplomatic center in Saudi Arabia, and is the major point-of-entry to the Holy city of Makkah (only 80 km SE of Jeddah) for millions of visitors of perennial religious rituals for pilgrimage (Hajj) and Umrah as well as workers and other visitors.…”

Dengue Virus Type 2 Infection in a Traveler Returning from Saudi Arabia to Japan

“…In western Saudi Arabia, three serotypes of DENV (DENV-1, DENV-2, and DENV-3) have been commonly isolated from 1994 to 2015 (7,8). Zaki et al 7performed a phylogenetic analysis of the DENV-2 E gene with strains isolated from Saudi Arabia between 1994 and 2004 and showed that all isolates belonged to the Cosmopolitan genotype.…”