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

Abstract

Abstract. Because the prevalence of dengue fever in urban settings in Papua New Guinea is unknown, we investigated the presence of dengue using the NS1 antigen test in an outpatient-based prospective observational study at Port Moresby General Hospital. Of 140 patients with acute febrile illnesses, dengue fever was diagnosed in 14.9% (20 of 134; 95% confidence interval [95% CI] = 9.6-22.4). Malaria (2 of 137; 1.5%; 95% CI = 0.3-5.7), chikungunya (3 of 140; 2.1%; 95% CI = 0.6-6.6), and bacterial bloodstream infections (0 of 80; 0%; 95% CI = 0-5.7) were uncommon. Dengue fever should no longer be considered rare in Papua New Guinea.Globally, an estimated 50-100 million cases of dengue fever (DF) and hundreds of thousands of dengue hemorrhagic fever cases occur annually.1 In the Asia Pacific region, dengue is recognized as an emerging vector-borne disease.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. 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.Because the prevalence of DF in urban PNG is unknown, we hypothesized that it may be an important cause of acute febrile illnesses and conducted a prospective observational study at Port Moresby General Hospital, the main tertiary hospital in PNG, between February and August of 2013. Patients were recruited through the Adult's and Children's Outpatient Departments. Children were defined as age 14 years. Study inclusion criteria included (1) an axillary temperature 38 C or a history of fever in the past 5 days, (2) clinical signs and symptoms suggestive of an acute febrile illness, and (3) a signed informed consent by the patient or a guardian. Those who did not fulfill the inclusion criteria and infants age 1 month were excluded. Demographic data, relevant clinical signs, symptoms, and basic clinical assessments were recorded on standardized case report forms by a study clinician (V.A.). Ethical approval was obtained from the University of Papua New Guinea School of Medicine and Health Sciences Ethics Committee and the Medical Research Advisory Committee of PNG.A diagnosis of dengue was based on the serological detection of NS1 antigens. The Bio-Rad Platellia Dengue NS1 antigen assay was used, and results were classified as negative, equivocal, or positive based on a signal ratio of 0.5, 0.5-1.0, or 1.0, respectively. A diagnosis of malaria was based on microscopic examination of thick blood smears. Chikungunya was investigated by use of an immunoglobulin M (IgM) antibody immunochromatographic rapid diagnostic test (BIOLINE, Kyonggido, Korea) with polymerase chain reaction confirmation in positive cases as part of an outbreak investigation. 6Biochemistry...

Dengue viruses in Papua New Guinea: evidence of endemicity and phylogenetic variation, including the evolution of new genetic lineages

“…To date, only serological studies have provided evidence suggesting continual DENV transmission exists in PNG. 20 , 45 , 46 The molecular data we present here are also limited by the periodical sampling of DENV strains imported into Australia from PNG. However, molecular assessment of circulating DENV strains is essential to understanding genetic diversity, transmission dynamics and disease risks within PNG.…”

Clinical profile of Thrombocytopenia in Acute Febrile Illnesses; a hospital-based study

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