Climate and visitors as the influencing factors of dengue fever in Badung District of Bali, Indonesia.

Badung district has recorded the highest dengue fever (DF) in Bali Province. This research presents the distribution of DF in Badung district and analyses its association with climate and visitors. The monthly data of DF, climate and number of visitors during January 2013 to December 2017 were analysed using Poisson Regression. A total of 10,689 new DF cases were notified from January 2013 to December 2017. DF in 2016 was recorded as the heaviest incidence. Monthly DF cases have positive association with average temperature (0.59 (95% CI: 0.56-.62)), precipitation (5.7 x 10-4 (95% CI: 3.8 x 10-4 - 7.6 x 10-4)), humidity (.014 (95% CI: 0.003-.025)) and local visitors (7.40 x 10-6 95% CI: 5.88 x 10-6 : 8.91 x 10-6). Negative association was shown between DF cases with foreign visitors (-2.18 x 10-6 (95% CI: -2.50 x 10-6 : -1.87 x 10-6)). This study underlines the urgency to integrate climate and tourism for DF surveillance.

Co-circulation and co-infections of all dengue virus serotypes in Hyderabad, India 2014.

The burden of dengue virus infections increased globally during recent years. Though India is considered as dengue hyper-endemic country, limited data are available on disease epidemiology. The present study includes molecular characterization of dengue virus strains occurred in Hyderabad, India, during the year 2014. A total of 120 febrile cases were recruited for this study, which includes only children and 41 were serologically confirmed for dengue positive infections using non-structural (NS1) and/or IgG/IgM ELISA tests. RT-PCR, nucleotide sequencing and evolutionary analyses were carried out to identify the circulating serotypes/genotypes. The data indicated a high percent of severe dengue (63%) in primary infections. Simultaneous circulation of all four serotypes and co-infections were observed for the first time in Hyderabad, India. In total, 15 patients were co-infected with more than one dengue serotype and 12 (80%) of them had severe dengue. One of the striking findings of the present study is the identification of serotype Den-1 as the first report from this region and this strain showed close relatedness to the Thailand 1980 strains but not to any of the strains reported from India until now. Phylogenetically, all four strains of the present study showed close relatedness to the strains, which are reported to be high virulent.

Leptospirosis and Dengue Coinfection-Associated Multi-Organ Dysfunction Syndrome: A Case Report.

Dengue and leptospirosis are frequently discussed separately, with dengue causing rash and leptospirosis causing jaundice. Currently, there are more and more reports of coinfections. The comparable clinical symptoms of both infections make it challenging to distinguish between leptospirosis and dengue. Differentiating between leptospirosis and dengue is crucial since leptospirosis has a more favorable prognosis with early antibiotic therapy, whereas dengue does not have a specific treatment, although early detection is essential for close monitoring and cautious fluid management. Here, we highlight a case of dengue virus and leptospirosis coinfection in a female who presented with acute febrile illness, dyspnea, and altered sensorium, which progressed to multiorgan dysfunction syndrome, involving the neurological, respiratory, hepatic, and hematological systems.

In Silico-Based Identification of Natural Inhibitors from Traditionally Used Medicinal Plants that can Inhibit Dengue Infection.

Dengue fever (DF) is an endemic disease that has become a public health concern around the globe. The NS3 protease-helicase enzyme is an important target for the development of antiviral drugs against DENV (dengue virus) due to its impact on viral replication. Inhibition of the activity of the NS3 protease-helicase enzyme complex significantly inhibits the infection associated with DENV. Unfortunately, there are no scientifically approved antiviral drugs for its prevention. However, this study has been developed to find natural bioactive molecules that can block the activity of the NS3 protease-helicase enzyme complex associated with DENV infection through molecular docking, MM-GBSA (molecular mechanics-generalized born surface area), and molecular dynamics (MD) simulations. Three hundred forty-two (342) compounds selected from twenty traditional medicinal plants were retrieved and screened against the NS3 protease-helicase protein by molecular docking and MM-GBSA studies, where the top six phytochemicals have been identified based on binding affinities. The six compounds were then subjected to pharmacokinetics and toxicity analysis, and we conducted molecular dynamics simulations on three protein-ligand complexes to validate their stability. Through computational analysis, this study revealed the potential of the two selected natural bioactive inhibitors (CID-440015 and CID-7424) as novel anti-dengue agents.

Manic Episode Following Dengue Fever: A Case Report.

Dengue fever, a mosquito-borne viral disease, can present with a variety of symptoms, ranging from mild flu-like illness to more severe conditions such as dengue hemorrhagic fever and dengue shock syndrome. Although neurological symptoms such as headaches, dizziness, and altered sensorium are more frequently observed, psychiatric symptoms such as euphoria, delusions, hallucinations, and aggression, though rare, can occur. We present the case of a previously healthy 22-year-old male from South Asia who developed manic and psychotic symptoms, including insomnia, irritability, grandiosity, and auditory hallucinations, following his recovery from dengue fever. His psychiatric symptoms emerged shortly after discharge and necessitated psychiatric intervention with olanzapine, a second-generation antipsychotic, chosen for its suitability in managing manic symptoms. This case underscores the importance of considering psychiatric evaluations in the management of dengue fever, especially in endemic areas. The pathophysiology of dengue's neuropsychiatric effects remains complex and multifactorial, necessitating further research. This case report aims to highlight the potential for significant psychiatric manifestations post-dengue fever, advocate for increased clinical awareness and research to investigate any potential correlation between dengue fever and psychiatric symptoms, and improve patient outcomes.

Societal knowledge, attitude, and practices towards dengue and associated factors in epidemic-hit areas: Geoinformation assisted empirical evidence.

Dengue is one of Pakistan's major health concerns. In this study, we aimed to advance our understanding of the levels of knowledge, attitudes, and practices (KAPs) in Pakistan's Dengue Fever (DF) hotspots. Initially, at-risk communities were systematically identified via a well-known spatial modeling technique, named, Kernel Density Estimation, which was later targeted for a household-based cross-sectional survey of KAPs. To collect data on sociodemographic and KAPs, random sampling was utilized (n = 385, 5 % margin of error). Later, the association of different demographics (characteristics), knowledge, and attitude factors-potentially related to poor preventive practices was assessed using bivariate (individual) and multivariable (model) logistic regression analyses. Most respondents (>90 %) identified fever as a sign of DF; headache (73.8 %), joint pain (64.4 %), muscular pain (50.9 %), pain behind the eyes (41.8 %), bleeding (34.3 %), and skin rash (36.1 %) were identified relatively less. Regression results showed significant associations of poor knowledge/attitude with poor preventive practices; dengue vector (odds ratio [OR] = 3.733, 95 % confidence interval [CI ] = 2.377-5.861; P < 0.001), DF symptoms (OR = 3.088, 95 % CI = 1.949-4.894; P < 0.001), dengue transmission (OR = 1.933, 95 % CI = 1.265-2.956; P = 0.002), and attitude (OR = 3.813, 95 % CI = 1.548-9.395; P = 0.004). Moreover, education level was stronger in bivariate analysis and the strongest independent factor of poor preventive practices in multivariable analysis (illiterate: adjusted OR = 6.833, 95 % CI = 2.979-15.672; P < 0.001) and primary education (adjusted OR = 4.046, 95 % CI = 1.997-8.199; P < 0.001). This situation highlights knowledge gaps within urban communities, particularly in understanding dengue transmission and signs/symptoms. The level of education in urban communities also plays a substantial role in dengue control, as observed in this study, where poor preventive practices were more prevalent among illiterate and less educated respondents.

A Study on the Clinical Profile of Patients Presenting With Dengue Fever and the Precision Prediction of Dengue Severity Using Platelet Count at Presentation.

Background The most prevalent arbovirus infection in the world, dengue, has become a serious public health issue. This study aims to examine the clinical characteristics of individuals who present with dengue fever and use platelet count prediction to estimate the severity of dengue. Materials and methods This observational, cross-sectional study was conducted at Dr. D. Y. Patil Medical Hospital, Pune, Maharashtra, India, from February 2022 to May 2024. A total of 100 patients older than 12 years old who had dengue fever (presenting within three days of the first symptom) and were dengue NS1 antigen-positive in the laboratory were included. Patients under 12 years of age and pregnant women were excluded. Also excluded were patients with a history of prior dengue infection and patients on medications causing thrombocytopenia, such as antiplatelets (aspirin). Written informed consent was obtained from each patient. For adolescent boys and girls aged 13-18, consent was obtained from a parent or legal guardian along with the adolescent's assent. Data were collected through physical examinations and laboratory investigations. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York), with descriptive statistics and tests for nonparametric data, setting the significance at p<0.05. Results The average age of the study participants was 29.48 ± 10.62 years, with 24% in the 0-20 year age group, 36% in the 21-30 age group, 24% in the 31-40 age group, 12% in the 41-50 age group, 3% in the 51-60 age group, and 1% in the 61-70 age group. Men comprised 65% of the population, with 35% being women. Weakness was the most prevalent symptom, followed by nausea and fever with chills. Patients with dengue fever without warning indications had a median platelet count of 114,000/µL upon admission; those with dengue fever with warning signs had a median count of 35,500/µL; and those with severe dengue had a median count of 25,000/µL. These distinctions attained statistical significance, underscored by p-values of <0.001. The predictive model for severe dengue using platelet count on presentation demonstrated a robust capacity to anticipate severe dengue with a noteworthy association (p<0.04), indicating an increased risk of severe dengue with a lower platelet count (<25,000/µL, odds ratio (OR) 7.5). Conclusion Dengue was more common in the young population, with a predominance of male patients. Weakness was the most common symptom. Patients with a platelet count less than 25,000/µL had 7.5 times more odds of developing severe dengue.

Dengue Fever Accompanied by Neurological Manifestations: Challenges and Treatment.

Dengue, commonly referred to as 'breakbone fever,' is a mosquito-borne arboviral infection transmitted by Aedes aegypti, featuring an average incubation period of approximately seven days. Key cytokines such as interferon-gamma (IFN-γ), tumor necrosis factor (TNF)-α, and interleukin (IL)-10 are pivotal in the pathogenesis of dengue. Travelers are particularly susceptible to contracting dengue fever, with disease severity often associated with CD8+ T cell response. Without proper hospitalization during severe cases like dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS), mortality rates can escalate to 50%. Dengue fever can lead to various complications, including neurological manifestations such as encephalopathy, encephalitis, cerebral venous thrombosis, myelitis, posterior reversible encephalopathy syndrome, strokes (both ischemic and hemorrhagic), immune-mediated neurological syndromes (such as mononeuropathy, acute transverse myelitis, Guillain-Barre syndrome, and acute disseminated encephalomyelitis), and neuromuscular complications. Treatment protocols typically involve assessing disease activity using composite indices, pursuing treatment objectives, and administering intravenous fluids according to symptomatology. Given the absence of specific antiviral treatment for dengue, supportive care, particularly hydration, remains paramount during the early stages. It is crucial to recognize that dengue viruses may contribute to the development of neurological disorders, particularly in regions where dengue is endemic. Furthermore, there is a necessity for well-defined criteria for specific neurological complications. Primary prevention strategies primarily revolve around vector control measures, which play a critical role in curtailing the spread of dengue.

Clinical Profile of Dengue Seropositive Infection From a Tertiary Care Hospital Situated in Mysuru, South India.

Introduction Dengue, a viral infection transmitted by Aedes mosquitoes, has become a significant global health concern. Its incidence has surged dramatically over the past decades, with severe cases potentially leading to life-threatening conditions such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Despite its prevalence in tropical regions, including India, the clinical manifestations of dengue can vary widely, sometimes presenting atypically. Recent outbreaks, particularly in Northern India, underscore the urgency of understanding and managing this disease. This study focuses on the clinical and laboratory findings of hospitalized dengue fever patients from January 2022 to January 2023, aiming to provide insights for effective patient care and mortality reduction. Methods This was a prospective study at JSS (Jagadguru Sri Shivarathreeshwara) Medical College and Hospital, Mysuru, Karnataka, India (January 2022-January 2023). Blood samples from suspected dengue patients presenting acute febrile symptoms were collected. NS1 antigen and IgM antibody were detected using enzyme-linked immunosorbent assay (ELISA). Patients positive for dengue NS1 antigen and IgM antibodies were included in the study, excluding those with co-infections or comorbidities. Results A nine-month study at JSS Hospital (January 2022-January 2023) screened 1019 samples, identifying 316 dengue cases. Among these, 84.8% were dengue fever and 15.1% were DHF/DSS. Male predominance (60.1%) was noted, with peak incidence in the age groups of 11-20 years (29.11%) and 0-10 years (27.53%). Common symptoms included fever (98.1%), headache (32.91%), myalgia (40.87%), and vomiting (42.7%). Thrombocytopenia was found in 60.6% of cases. NS1 was detected in 56% of patients and IgM was positive in 20.8% of the patients. Comorbidities like type 2 diabetes mellitus (T2DM) (7.59%) and hypertension (7.27%) were observed. Among severe cases, 43.6% had platelet counts <1 lakh/cumm, and 27.5% required intravenous fluids. Seven deaths occurred, primarily in patients with comorbidities and severe dengue. Discussion and conclusion High dengue seropositivity among males (60.12%) compared to females (39.87%) was noted, possibly due to varied exposures. Patients aged 11-20 years had the highest dengue infection, with a peak in admissions during the rainy season. Thrombocytopenia (60.6%) and comorbidities like T2DM and HTN were common, with seven fatalities linked to severe dengue and comorbidities, emphasizing the need for early recognition and management to reduce mortality.

Tracing down the Updates on Dengue Virus-Molecular Biology, Antivirals, and Vaccine Strategies.

BACKGROUND: Nearly half of the world is at risk of developing dengue infection. Dengue virus is the causative agent behind this public healthcare concern. Millions of dengue cases are reported every year, leading to thousands of deaths. The scientific community is working to develop effective therapeutic strategies in the form of vaccines and antiviral drugs against dengue. METHODS: In this review, a methodological approach has been used to gather data from the past five years to include the latest developments against the dengue virus. RESULTS: Different therapeutics and antiviral targets against the dengue virus are at different stages of development, but none have been approved by the FDA. Moreover, various vaccination strategies have also been discussed, including attenuated virus vaccines, recombinant subunit vaccines, viral vector vaccines, DNA vaccines, nanotechnology, and plant-based vaccines, which are used to develop effective vaccines for the dengue virus. Many dengue vaccines pass the initial phases of evaluation, but only two vaccines have been approved for public use. DENGVAXIA is the only FDA-approved vaccine against all four stereotypes of the dengue virus, but it is licensed for use only in individuals 6-16 years of age with laboratory-confirmed previous dengue infection and living in endemic countries. Takeda is the second vaccine approved for use in the European Union, the United Kingdom, Brazil, Argentina, Indonesia, and Thailand. It produced sustained antibody responses against all four serotypes of dengue virus, regardless of previous exposure and dosing schedule. Other dengue vaccine candidates at different stages of development are TV-003/005, TDENV PIV, V180, and some DNA vaccines. CONCLUSION: There is a need to put more effort into developing effective vaccines and therapeutics for dengue, as already approved vaccines and therapeutics have limitations. DENGVAXIA is approved for use in children and teenagers who are 6-16 years of age and have confirmed dengue infection, while Takeda is approved for use in certain countries, and it has withdrawn its application for FDA approval.

Reversible Splenial Lesion Syndrome Associated With Dengue Encephalopathy: A Case Report.

Infection with the dengue virus can present with a variety of clinical manifestations that can range from asymptomatic or mild disease to severe hemorrhagic shock. In this report, we present a 25-year-old female patient with complaints of fever, headache, vomiting, and a reeling sensation for two days. On further examination, the workup for meningitis was negative, and the patient tested positive for dengue IgM antibodies. The MRI brain showed a restricted central lesion involving the splenium of the corpus callosum in favor of a cytotoxic lesion of the corpus callosum and a transient lesion of the splenium. Based on the MRI, a diagnosis of reversible splenial lesion syndrome (RESLES) was confirmed. Supportive treatment was initiated, and the patient made a complete recovery with no neurological deficits. A repeat MRI of the brain was done one month later, and it revealed complete resolution of the splenial lesion. If dengue fever is treated effectively, it frequently has a favorable prognosis with remission of uncommon, distinct radiological associations.

Dengue Fever-Induced Hypokalemic Paralysis in a Pregnant Patient: An Uncommon Presentation of a Common Disease.

Dengue fever is a globally prevalent, viral disease transmitted by Aedes mosquitoes, which is becoming increasingly common and can cause a range of symptoms, including fever, flu-like symptoms, and circulatory failure. Although it is classified as a non-neurotropic virus, research has suggested that dengue fever can also affect the nervous system and lead to conditions such as myositis, Guillain-Barré syndrome, or hypokalemic paralysis. We describe a case study of a young pregnant female with dengue-associated hypokalemic paralysis, who made a full recovery within 48 hours of receiving potassium supplementation. The case underscores the importance of recognizing and treating neurological complications of dengue fever promptly, particularly in areas where the disease is prevalent.

A short communication of 2022 dengue outbreak in Bangladesh: a continuous public health threat.

Dengue virus infection, a highly prominent health concern, has caused many health complications, positive cases, and deaths in Bangladesh in previous years. However, the prevalence of this infection and fatality rates in 2022 has shattered all prior records. The dengue virus vector, mosquitoes, found a high prevalence of infection due to the weather's favorable conditions for breeding in the months of June and July. While there is presently no particular vaccination for dengue infection, awareness of its epidemiology, pathogenesis, signs, and symptoms may aid in the development of improved diagnostic and treatment strategies. The government should also improve the infrastructure of cities to make prevent mosquito breeding and the spread of dengue infection.

Dengue and Chikungunya Co-Infection-Associated Multi-Organ Dysfunction Syndrome: A Case Report.

Dengue and chikungunya infections are increasing globally, especially in India. While the majority of patients settle with symptomatic management, some develop life-threatening complications. Here we discuss a case of co-infection between dengue virus (DENV-2) and chikungunya virus (CHIKV) in a young Indian male who presented with an acute febrile illness that progressed to multi-organ dysfunction involving the hepatic, nervous, respiratory, and hematological systems. We discuss the management of this complicated case and attempt to generate awareness regarding the severity of co-infection by these viruses.

Dengue, Chikungunya, and Zika: The Causes and Threats of Emerging and Re-emerging Arboviral Diseases.

The recent emergence and re-emergence of viral infections transmitted by vectors, Zika, chikungunya, dengue, and others, is a cause for international concern. Here, we provide a summary of the current understanding of the transmission, clinical features, diagnosis, global burden, and the likelihood of future epidemics by these viruses. Arboviruses transmitted by mosquitoes are challenging to diagnose and can have surprising clinical complications. Dengue, chikungunya, and Zika are the most important diseases caused by arboviruses worldwide, especially in tropical and subtropical regions. These are transmitted to humans by day-biting Aedes aegypti and Aedes albopictus mosquitoes. In India, the increase in the incidence of dengue and chikungunya cases is primarily linked to the dissemination of Aedes aegypti. A rapid and accurate diagnosis is paramount for effectively controlling dengue outbreaks. As there is no vaccination or specific treatment available for these viruses, vector control is the only comprehensive solution available.

Predictive Factors for the Complications of Dengue Fever in Children: A Retrospective Analysis.

Background and objective Dengue fever (DF) and its complications - dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) - are major public health problems in Southeast Asia. Predicting the development of DHF and DSS using hematological parameters and ultrasonic signs of vascular leakage will help in reducing morbidity and mortality associated with these diseases. Hence, this study aimed to test the association of platelets and packed cell volume (PCV) on day one (D1) of admission with gallbladder wall thickness (GWT) and ascites, which herald the onset of DHF and DSS. Methods The electronic health records of 52 pediatric patients admitted during a mini-outbreak were analyzed to assess platelets and PCV on D1, laboratory and ultrasonography findings, and outcomes. Correlations between D1 hematological parameters and GWT and ascites were tested. Results There was a positive correlation between GWT of more than 5 mm and ascites. However, there was no significant correlation of platelets and PCV on D1 with either GWT or ascites and consequently DHF or DSS. All the patients responded to fluid, blood, and supportive therapy. There were no mortalities. Conclusion Patients who develop GWT after DF are at an increased risk of developing ascites that deteriorate to DHF and DSS. D1 platelets and PCV are not reliable indicators for predicting the progression or worsening of the disease in the pediatric population.

Increase in cases of dengue in China, 2004-2016: A retrospective observational study.

BACKGROUND: Dengue fever (DF) is a vector-bore infectious disease that can infect humans, and has been recognized as a global public health threat, with significant morbidity and mortality rates. METHOD: To describe the epidemiological profile of DF in China during 2004-2016, the morbidity data of DF by age-group, season (different months) and geographic location (different provinces) were obtained from the public health science data center of China for subsequent epidemiological analysis. RESULTS: The results showed that the incidence of DF shows striking annual variations, and two large outbreaks occurred in 2006-2007 and during 2012-2015. The results of the average morbidity rates (cases/100,000 population) for human DF indicated that among all dengue fever cases, Guangdong in southern area of China had the highest rates (3.8160 cases/100,000 population), followed by Yunnan (0.6614 cases/100,000 population), Fujian (0.3463 cases/100,000 population) and Guangxi (0.1474 cases/100,000 population). Epidemic peaks occurred in late June and early November, and the incidence rate among middle-aged people (30-45 years old) was relatively high, followed by rates among 15-29 and 45-59 age groups. CONCLUSION: In this study, we demonstrated the epidemiological profile of DF circulating in China and revealed the geographic distribution, dynamic transmission, seasonal asymmetries and age distribution, which will provide guidelines on the prevention and control of DF in China. The present investigation is useful in the risk assessment of DF transmission, to predict DF outbreaks and the prevention and control strategies should be used along with surveillance to reduce the spread of DF in China.

A survey of clinical and laboratory characteristics of dengue fever epidemic from 2014 to 2018 in Guangzhou, China.

BACKGROUND: In 2014, a serious dengue outbreak occurred in Guangzhou, South China. In this study, the clinical and laboratory characteristics of dengue fever (DF) group and other febrile illnesses (OFI) group in Guangzhou were described. METHODS: Clinical and laboratory data collected by studying 1,792 patients from Nanfang Hospital, Southern Medical University during 2014 and 2018. Laboratory data was analyzed by SPSS 22.0 statistical software including Full blood counts (SYSMEX XE-5000), Laboratory Biochemical tests (Roche Cobas 8000), Dengue virus RNA (RT-PCR-Fluorescence Probing) and Dengue IgG/IgM Antibody (Colloidal Gold), Dengue Virus NS1 (ELISA). RESULTS: In the DF group and OFI group, gender ratios were 1.08:1 (male/female, P>0.05) and 1.45:1 (male/female, P<0.05). Adults aged 25-34 years old (29.4%) with the main peak appeared in the DF group, and the same main peak appeared in the OFI group: 25-34 years old (25.13%). Patients were from Medical emergency (41.2% DF group, 29.4% OFI group). The distribution of fever days before treatment was mainly focused within 5 days, with a main peak in the 2 fever days before treatment (24.6%) in the DF group and the main peak in 1 fever day before treatment (46.9%) in OFI group. The major symptoms of the DF group were presented with were fever (100%), myalgia (34.77%), pharyngeal hyperemia (31.33%), headache (25.65%), adenoids (19.62%), and rash (13.25%). In the OFI group, Pharyngeal hyperemia was the most common clinical symptom, accounting for 27.24%, and the next symptom was adenoids (21.26%). The sensitivity and specificity of DV RNA were 61.54%, 100%, respectively, compared to the DF Nonstructural protein 1 (NS1). Dengue virus (DENV) Immunoglobulin M (IgM) IgM in both groups was statistically significant, with DENV-IgM in the DF group were stronger (Z=-7.863, P<0.001), and DENV immunoglobulin G (IgG) were no statistically significant (Z=-1.212, P=0.226). In DF group, 37.14% of serum samples had elevated Alanine transaminase (ALT) levels, 76.85% of them had elevated aspartate aminotransferase (AST) levels, 32.08% of them had elevated creatine kinase (CK) levels, and 2.67% of them had elevated C-reaction protein (CRP) levels, compared with 13.51% of them had elevated ALT levels, 30.65% of them had elevated AST levels, 6.06% of them had elevated CK levels and 69.35% of them had elevated CRP levels of the OFI patients. The prominent manifestations were thrombocytopenia (occurring in 28.07% of the DF group, compared to 5.18% of OFI group) and leucopenia (occurring in 43.27% of DF group and 3.63% of OFI group). The DF incidence of all fever cases was 49.0% within three months in 2014, compared with 1.4% in 2015, 0% in 2016, 0.9% in 2017 and 6.4% in 2018 (P<0.001). DF and OFI can occur in any age and sex. DF occurred in the young and the old, OFI occurred in children and youth. The clinical symptoms of myalgia, headache, rash, weak, Chills, follicular hyperplasia in both groups were statistically significant (P<0.001). CONCLUSIONS: IgM can be easily recognized for early diagnoses, DENV-RNA had lower sensitivity and higher specificity, and DF NS1 enzyme-linked immunosorbent assay (ELISA) has a higher sensitive and specificity. DF is a serious public health problem and an emerging continuous threat in Guangzhou. In high-prevalence areas, effective epidemic monitoring and prevention measures need to be undertaken. After the unprecedented outbreak in 2014, on account of the government and citizen paying more attention to the DF epidemic, the cases of DF were decreased significantly from 2015 to 2018.

Cost-Effectiveness of Dengue Vaccination in Indonesia: Considering Integrated Programs with Wolbachia-Infected Mosquitos and Health Education.

Despite the fact that morbidity and mortality rates due to dengue infection in Indonesia are relatively high, a dengue vaccination has not yet been introduced. Next to vaccination, Wolbachia-infected mosquitoes and health education have been considered to be potential interventions to prevent dengue infection in Indonesia. This study was aimed to analyse the cost-effectiveness of dengue vaccination in Indonesia whilst taking Wolbachia and health education programs into account. An age-structured decision tree model was developed to assess the cost-effectiveness. Approximately 4,701,100 children were followed-up in a 10-year time horizon within a 1-year analytical cycle. We compared three vaccination strategies: one focussing on vaccination only, another combining vaccination and a Wolbachia program, and a third scenario combining vaccination and health education. All scenarios were compared with a no-intervention strategy. The result showed that only vaccination would reduce dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) by 123,203; 97,140 and 283 cases, respectively. It would save treatment cost at $10.3 million and $6.2 million from the healthcare and payer perspectives, respectively. The combination of vaccination and a Wolbachia program would reduce DF, DHF and DSS by 292,488; 230,541; and 672 cases, respectively. It would also save treatment cost at $24.3 million and $14.6 million from the healthcare and payer perspectives, respectively. The combination of vaccination and health education would reduce DF, DHF, and DSS by 187,986; 148,220; and 432 cases, respectively. It would save treatment cost at $15.6 million and $9.4 million from the healthcare and payer perspectives, respectively. The incremental cost-effectiveness ratios (ICERs) from the healthcare perspective were estimated to be $9,995, $4,460, and $6,399 per quality-adjusted life year (QALY) gained for the respective scenarios. ICERs from the payer perspective were slightly higher. It can be concluded that vaccination combined with a Wolbachia program was confirmed to be the most cost-effective intervention. Dengue infection rate, vaccine efficacy, cost of Wolbachia program, underreporting factor for hospitalization, vaccine price and mortality rate were considered to be the most influential parameters affecting the ICERs.

Can Radiology Play a Role in Early Diagnosis of Dengue Fever?

BACKGROUND: Dengue fever (DF) is a viral hemorrhagic fever causing severe morbidity and mortality in affected patients. AIMS: The purpose of our study was to evaluate the changing trends in radiological findings in DF, to find if ultrasound is useful in the diagnosis of DF during an epidemic in absence of serological tests, and also to investigate the effects of DF in pregnancy. MATERIALS AND METHODS: A prospective study was conducted in 2013 comprising of 400 patients who were serologically positive for dengue. Out of these, radiological investigations were conducted for 107 patients who were analyzed. RESULTS: Out of the 107 patients, 85 patients underwent ultrasound, 12 computed tomography (CT) scans of brain or paranasal sinuses, and 21 chest radiography. The maximum numbers of patients (79%) were in the age group of 20-50 years. The most common ultrasound finding was hepatomegaly that was seen in 62% of the patients. Other findings were splenomegaly (45%), gallbladder (GB) wall edema (45%), right-sided pleural effusion (37%), bilateral pleural effusion (22%), and ascites (36%). Out of 10 pregnant patients, 5 had oligohydramnios, 2 had intrauterine growth restriction, 2 had intrauterine fetal demise, and 5 had a normal antenatal ultrasound. CONCLUSION: Ultrasound findings of hepatosplenomegaly, GB wall edema, right-sided or bilateral pleural effusion, and ascites in patients presenting with signs and symptoms of DF during an epidemic are virtually diagnostic of DF. There have been recent changing trends with hepatosplenomegaly being the more common manifestation, in comparison to ascites and GB wall edema. DF also has catastrophic effects in pregnancy such as oligohydramnios and intrauterine fetal demise.