Underrecognition of Dengue during 2013 Epidemic in Luanda, Angola - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC
Volume 21, Number 8—August 2015
Synopsis
Underrecognition of Dengue during 2013 Epidemic in Luanda, Angola
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Tyler M. Sharp , Rosa Moreira, Maria José Soares, Lúis Miguel da Costa, Jennifer Mann, Mark DeLorey, Elizabeth Hunsperger, Jorge L. Muñoz-Jordán, Candimar Colón, Harold S. Margolis, Adelaide de Caravalho, and Kay M. Tomashek
Abstract
During the 2013 dengue epidemic in Luanda, Angola, 811 dengue rapid diagnostic test–positive cases were reported to the Ministry of Health. To better understand the magnitude of the epidemic and identify risk factors for dengue virus (DENV) infection, we conducted cluster surveys around households of case-patients and randomly selected households 6 weeks after the peak of the epidemic. Of 173 case cluster participants, 16 (9%) exhibited evidence of recent DENV infection. Of 247 random cluster participants, 25 (10%) had evidence of recent DENV infection. Of 13 recently infected participants who had a recent febrile illness, 7 (54%) had sought medical care, and 1 (14%) was hospitalized with symptoms consistent with severe dengue; however, none received a diagnosis of dengue. Behavior associated with protection from DENV infection included recent use of mosquito repellent or a bed net. These findings suggest that the 2013 dengue epidemic was larger than indicated by passive surveillance data.
Dengue is a potentially fatal acute febrile illness caused by any of 4 mosquito-transmitted dengue viruses (DENV-1–4). The disease is endemic throughout the tropics (1), but is underrecognized in sub-Saharan Africa (2,3), where an estimated 64 million DENV infections occurred in 2010 (4). Although dengue was identified in travelers returning from Angola in the 1980s (5), locally acquired cases had not been reported until an outbreak in 2013 that was initially thought to have resulted from importation of DENV by immigrant workers from Asia. However, the only virus detected during the outbreak was a strain of DENV-1 that molecular epidemiologic analysis indicated had been circulating in western and west-central Africa for roughly 4 decades (6–9), demonstrating regional endemicity of dengue.
During the 2013 epidemic, the Angola Ministry of Health was notified of a total of 1,214 dengue case-patients, nearly all (98%) of whom resided in the capital, Luanda, which has an estimated population of 3–14 million (Angola Ministry of Health and World Health Organization, unpub. data). Serum specimens from suspected cases were tested with a dengue rapid diagnostic test (RDT; SD BIOLINE Dengue Duo, Standard Diagnostics, Haryana, India), and positive cases were defined by detection of nonstructural protein 1 antigen, anti-DENV IgM, or both. In total, specimens from 811 (67%) persons with suspected dengue tested RDT-positive, including those from 246 (30%) hospitalized patients and from 11 (1.4%) patients who died. The highest weekly incidence occurred during May 17–23, 2013, when 125 cases were reported, of which 101 (81%) were RDT-positive.
Dengue is a focal disease, and cases frequently cluster around the households of infected persons (10,11). Previous household-based cluster investigations in Indonesia (12), Nicaragua (13), Thailand (14), and Vietnam (15) demonstrated DENV infection rates of 2.2%–12.4% among persons residing within 10–100 m of index case-patients. These studies enabled detection of unrecognized dengue cases and identification of household risk factors for DENV infection, such as the presence of uncovered water storage containers (12) and lack of piped household water supply (14). Household-based cluster investigations are therefore a useful tool to estimate the extent of dengue in regions where case reporting may be suboptimal and can also facilitate identification of local risk factors for DENV infection.
Dr. Sharp is a lieutenant commander in the US Public Health Service and a health scientist at CDC Dengue Branch in San Juan, Puerto Rico. His research and public health interests include the epidemiology and pathobiology of dengue and other tropical acute febrile illnesses.
Acknowledgments
We thank Isabel Joao for assistance with field investigation logistics, Victor Luteganya for assistance with data management, Sheryl Shapiro and Jacqueline Weaver for assistance with specimen shipment, Laura Wright for assistance with map creation, and Ray A. Arthur and Serena Fuller for outbreak response support and coordination.
We acknowledge the CDC Global Disease Detection Operations Center Outbreak Response Contingency Fund for financial support of the field investigation.
References
- World Health Organization. Dengue: guidelines for diagnosis, treatment, prevention and control. Geneva: The Organization; 2009.
- Amarasinghe A, Kuritsk JN, Letson GW, Margolis HS. Dengue virus infection in Africa. Emerg Infect Dis. 2011;17:1349–54 .PubMed
- Jaenisch T, Junghanss T, Wills B, Brady OJ, Eckerle I, Farlow A, Dengue expansion in Africa-not recognized or not happening? Emerg Infect Dis.2014;20:•••. DOIPubMed
- Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, The global distribution and burden of dengue. Nature. 2013;496:504–7.DOIPubMed
- Bakker RC, Veenstra J, Dingemans-Dumas AM, Wetsteyn J, Kager PA. Imported dengue in the Netherlands. J Travel Med. 1996;3:204–8.DOIPubMed
- Schwartz E, Meltzer E, Mendelson M, Tooke A, Steiner F, Gautret P, Detection on four continents of dengue fever cases related to an ongoing outbreak in Luanda, Angola, March to May 2013. Euro Surveill. 2013;18:20488 .PubMed
- Sessions OM, Khan K, Hou Y, Meltzer E, Quam M, Schwartz E, Exploring the origin and potential for spread of the 2013 dengue outbreak in Luanda, Angola. Glob Health Action. 2013;6:218–22.
- Centers for Disease Control and Prevention. Ongoing dengue epidemic—Angola, June 2013. MMWR Morb Mortal Wkly Rep. 2013;62:504–7.PubMed
- Parreira R, Conceicao C, Centeno-Lima S, Marques N, Saraiva da Cunha J, Abreu C, Angola’s 2013 dengue outbreak: clinical, laboratory and molecular analyses of cases from four Portuguese institutions. J Infect Dev Ctries. 2014;8:1210–5. DOIPubMed
- Morrison AC, Getis A, Santiago M, Rigau-Perez JG, Reiter P. Exploratory space-time analysis of reported dengue cases during an outbreak in Florida, Puerto Rico, 1991–1992. Am J Trop Med Hyg. 1998;58:287–98 .PubMed
- Salje H, Lessler J, Endy TP, Curriero FC, Gibbons RV, Nisalak A, Revealing the microscale spatial signature of dengue transmission and immunity in an urban population. Proc Natl Acad Sci U S A. 2012;109:9535–8. DOIPubMed
- Beckett CG, Kosasih H, Faisal I. Nurhayati, Tan R, Widjaja S, et al. Early detection of dengue infections using cluster sampling around index cases. Am J Trop Med Hyg. 2005;72:777–82.
- Reyes M, Mercado JC, Standish K, Matute JC, Ortega O, Moraga B, Index cluster study of dengue virus infection in Nicaragua. Am J Trop Med Hyg.2010;83:683–9. DOIPubMed
- Mammen MP, Pimgate C, Koenraadt CJ, Rothman AL, Aldstadt J, Nisalak A, Spatial and temporal clustering of dengue virus transmission in Thai villages. PLoS Med. 2008;5:e205. DOIPubMed
- Anders KL, Nga LH, Thuy NT, Ngoc TV, Tam CT, Tai LT, Households as foci for dengue transmission in highly urban Vietnam. PLoS Negl Trop Dis.2015;9:e0003528. DOIPubMed
- Santiago GA, Vergne E, Quiles Y, Cosme J, Vazquez J, Medina JF, Analytical and clinical performance of the CDC real time RT-PCR assay for detection and typing of dengue virus. PLoS Negl Trop Dis. 2013;7:e2311. DOIPubMed
- Miagostovich MP, Nogueira RM, dos Santos FB, Schatzmayr HG, Araujo ES, Vorndam V. Evaluation of an IgG enzyme-linked immunosorbent assay for dengue diagnosis. J Clin Virol. 1999;14:183–9. DOIPubMed
- Ellis EM, Neatherlin JC, Delorey M, Ochieng M, Mohammed AH, Mogeni DO, A household aerosurvey to estimate the magnitude of a dengue outbreak in Mombasa, Kenya, 2013. PLoS Negl Trop Dis. 2015;9:e0003733 . DOIPubMed
- Sharp TM, Hunsperger E, Santiago GA, Munoz-Jordan JL, Santiago LM, Rivera A, Virus-specific differences in rates of disease during the 2010 dengue epidemic in Puerto Rico. PLoS Negl Trop Dis. 2013;7:e2159. DOIPubMed
- Villar LA, Rojas DP, Besada-Lombana S, Sarti E. Epidemiological trends of dengue disease in Colombia (2000–2011): a systematic review. PLoS Negl Trop Dis. 2015;9:e0003499. DOIPubMed
- Teixeira MG, Siqueira JB Jr, Ferreira GL, Bricks L, Joint G. Epidemiological trends of dengue disease in Brazil (2000–2010): a systematic literature search and analysis. PLoS Negl Trop Dis. 2013;7:e2520. DOIPubMed
- Stoler J, Al Dashti R, Anto F, Fobil JN, Awandare GA. Deconstructing “malaria”: West Africa as the next front for dengue fever surveillance and control. Acta Trop. 2014;134:58–65. DOIPubMed
- Stoler J, Delimini RK, Bonney JH, Oduro AR, Owusu-Agyei S, Fobil JN, Evidence of recent dengue exposure among malaria parasite-positive children in three urban centers in Ghana. Am J Trop Med Hyg. 2015;92:497–500 . DOIPubMed
- Crump JA, Morrissey AB, Nicholson WL, Massung RF, Stoddard RA, Galloway RL, Etiology of severe non-malaria febrile illness in northern Tanzania: a prospective cohort study. PLoS Negl Trop Dis. 2013;7:e2324. DOIPubMed
- Thwing JI, Mihigo J, Fernandes AP, Saute F, Ferreira C, Fortes F, How much malaria occurs in urban Luanda, Angola? A health facility-based assessment. Am J Trop Med Hyg. 2009;80:487–91 .PubMed
- Stoddard ST, Forshey BM, Morrison AC, Paz-Soldan VA, Vazquez-Prokopec GM, Astete H, House-to-house human movement drives dengue virus transmission. Proc Natl Acad Sci U S A. 2013;110:994–9. DOIPubMed
- Yoon IK, Getis A, Aldstadt J, Rothman AL, Tannitisupawong D, Koenraadt CJ, Fine scale spatiotemporal clustering of dengue virus transmission in children and Aedes aegypti in rural Thai villages. PLoS Negl Trop Dis. 2012;6:e1730. PMID: 22816001
- Cummings DA, Irizarry RA, Huang NE, Endy TP, Nisalak A, Ungchusak K, Travelling waves in the occurrence of dengue haemorrhagic fever in Thailand. Nature. 2004;427:344–7. DOIPubMed
- Sharp TW, Wallace MR, Hayes CG, Sanchez JL, DeFraites RF, Arthur RR, Dengue fever in US troops during Operation Restore Hope, Somalia, 1992–1993. Am J Trop Med Hyg. 1995;53:89–94 .PubMed
- Chadee DD, Corbet PS. A night-time role of the oviposition site of the mosquito, Aedes aegypti (L.) (Diptera: Culicidae). Ann Trop Med Parasitol.1990;84:429–33 .PubMed
- Harrington LC, Ponlawat A, Edman JD, Scott TW, Vermeylen F. Influence of container size, location, and time of day on oviposition patterns of the dengue vector, Aedes aegypti, in Thailand. Vector Borne Zoonotic Dis. 2008;8:415–23. DOIPubMed
- Calisher CH, Karabatsos N, Dalrymple JM, Shope RE, Porterfield JS, Westaway EG, Antigenic relationships between flaviviruses as determined by cross-neutralization tests with polyclonal antisera. J Gen Virol. 1989;70:37–43. DOIPubMed
- Parreira R, Centeno-Lima S, Lopes A, Portugal-Calisto D, Constantino A, Nina J. Dengue virus serotype 4 and chikungunya virus coinfection in a traveller returning from Luanda, Angola. Euro Surveill. 2014;19:20730 .PubMed
- Meltzer E, Lustig Y, Glichinsky O, Steiner F, Schwartz E. Probable importation of dengue virus type 4 to Angola from Brazil. Emerg Infect Dis.2014;20:1775–6. DOIPubMed
- Lam PK, Tam DT, Diet TV, Tam CT, Tien NT, Kieu NT, Clinical characteristics of dengue shock syndrome in Vietnamese children: a 10-year prospective study in a single hospital. Clin Infect Dis. 2013;57:1577–86. DOIPubMed
- Teixeira MG, Andrade AM, Costa Mda C, Castro JN, Oliveira FL, Goes CS, East/Central/South African genotype chikungunya virus, Brazil, 2014.Emerg Infect Dis. 2015;21:906–7 PubMed. DOIPubMed
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Suggested citation for this article: Sharp TM, Moreira R, Soares MJ, da Costa LM, Mann J, DeLorey M, et al. Underrecognition of dengue during 2013 epidemic in Luanda, Angola. Emerg Infect Dis. 2015 Aug [date cited]. http://dx.doi.org/10.3201/eid2108.150368
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