Volume 25, Number 7—July 2019
Dispatch
Dengue Outbreak during Ongoing Civil War, Taiz, Yemen
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KhairAlah A. Alghazali, Boon-Teong Teoh, Shih-Keng Loong, Sing-Sin Sam, Nurul-Asma-Anati Che-Mat-Seri, Nur-Izyan Samsudin, Che-Norainon Yaacob, Noor-Syahida Azizan, Adrian Oo, Nur-Adilah Baharudin, Kim-Kee Tan, Juraina Abd-Jamil, Siti-Sarah Nor’e, Chee-Sieng Khor, Jefree Johari, Mohammed A.K. Mahdy, and Sazaly AbuBakar
Abstract
We identified dengue in ≈51% of patients given a clinical diagnosis of suspected dengue in Taiz, Yemen, during 2016. The cosmopolitan genotype of dengue virus type 2 was most common; viruses appeared to have originated in Saudi Arabia. Damage to public health infrastructure during ongoing civil war might enable dengue to become endemic to Yemen.
The association between wars and dengue virus (DENV) transmission has been well-recognized. During World War II (1939–1945), extensive ecologic disruption and demographic changes created an abundance of ideal breeding sites for Aedes aegypti mosquitoes, as well as pools of susceptible military personnel and displaced populations to support the spread of dengue (1). After World War II, unprecedented population growth and rapid unplanned urbanization exacerbated the epidemic spread of dengue to the major cities of Southeast Asia and the Pacific regions (2).
The current civil war in Yemen, which started in March 2015 (3), has caused widespread destruction of the infrastructure of this country and displaced >2.2 million persons into living in cramp shelters with inadequate healthcare support. The sum of human displacement, damaged infrastructure, and poor hygiene conditions (3–5) has created an ideal environment for spread of infectious diseases, including mosquitoborne diseases. In particular, the war has created numerous potential mosquito-breeding sites, such as open water storage containers, areas with inadequate drainage, discarded plastic containers in which water accumulates, and puddles of water (6).
In 2015, a total of >6,777 suspected dengue cases were recorded in Yemen, which suggested that the country was experiencing an unprecedented increase in the number of dengue cases (7). Taiz, a governorate in southwestern Yemen, experienced fierce fighting related to the civil war (5). An extreme spike in dengue cases was recorded in this governorate beginning in August 2015, soon after the start of the war. A total of 1,178 suspected dengue cases were reported during weeks 32–36 (7) in comparison to only 54 suspected dengue cases during the same period in 2013 (8). We report the prevalence, detection, and isolation of DE
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