Lim Jacqueline Kyungah, Fernandes José Francisco, Yoon In-Kyu, Lee Jung-Seok, Mba Regis Obiang, Lee Kang Sung, Namkung Suk, Yang Jae Seung, Bae So Hee, Lim Sl-Ki, Lell Bertrand, Esen Meral, Loembe Marguerite Massinga, Kremsner Peter G, Alexander Neal, Agnandji Selidji Todagbe
International Vaccine Institute, Seoul, Republic of Korea.
Centre de Recherches Médicales de Lambaréné, Campus CERMEL, Lambaréné, Gabon.
PLoS Negl Trop Dis. 2021 Feb 10;15(2):e0008861. doi: 10.1371/journal.pntd.0008861. eCollection 2021 Feb.
In Africa, information on dengue is limited to outbreak reports and focused on some countries with continuing transmission in West and East Africa. To estimate the proportion of dengue-positive cases among febrile patients and identify clinical indicators of dengue cases, we conducted passive facility-based fever surveillance in a catchment area population of 70,000 residents of Lambaréné and its surroundings in Gabon.
Non-malarial febrile patients with current fever or history of fever (≤7 days) between 1 and 55 years of age, were enrolled at Albert Schweitzer Hospital (ASH). Acute (visit 1, day of enrollment) and convalescent blood samples were collected between 10 and 21 days after enrollment. Acute/convalescent samples were tested with IgM/IgG ELISA, and a selected subset of acute samples with RT-PCR.
Among 682 non-malarial febrile patients enrolled, 119 (17.4%) were identified as dengue-positive (94 dengue-confirmed and 25 dengue-probable cases). Of these dengue-positive cases, 14 were confirmed with PCR, and based on serotyping, two infections were identified to be DENV-2 and two were DENV-3. The majority of our enrolled patients were <25 years of age and close to 80% of our dengue-positive cases were <15 years of age. In adjusted analyses, retro-orbital pain and abdominal pain were 2.7 and 1.6 times more frequently found among dengue-positive cases, compared to non-dengue cases.
Lambaréné is not considered dengue-endemic. However, one in six non-malarial febrile episodes was found to be dengue-positive in the study period. Dengue should be considered more frequently in clinicians' diagnosis among non-malarial febrile patients in Lambaréné. Given the lack of data on dengue in Gabon, additional prospective and longitudinal studies would help to further define the burden and patterns of dengue for improved case detection.
在非洲，关于登革热的信息仅限于疫情报告，且集中在西非和东非一些持续有传播的国家。为了估计发热患者中登革热阳性病例的比例并确定登革热病例的临床指标，我们在加蓬兰巴雷内及其周边地区7万居民的集水区人群中开展了基于医疗机构的被动发热监测。
年龄在1至55岁之间、有当前发热或发热史（≤7天）的非疟疾发热患者在阿尔贝特·施韦泽医院（ASH）入组。在入组后10至21天采集急性期（就诊1，入组当天）和恢复期血样。急性期/恢复期样本用IgM/IgG酶联免疫吸附测定法检测，一部分急性期样本用逆转录聚合酶链反应检测。
在入组的682例非疟疾发热患者中，119例（17.4%）被确定为登革热阳性（94例登革热确诊病例和25例登革热疑似病例）。在这些登革热阳性病例中，14例通过聚合酶链反应确诊，根据血清分型，确定2例感染为登革病毒2型，2例为登革病毒3型。我们入组的大多数患者年龄小于25岁，近80%的登革热阳性病例年龄小于15岁。在调整分析中，与非登革热病例相比，登革热阳性病例中眶后疼痛和腹痛的出现频率分别是其2.7倍和1.6倍。
兰巴雷内不被认为是登革热流行地区。然而，在研究期间，六分之一的非疟疾发热发作被发现为登革热阳性。在兰巴雷内非疟疾发热患者的临床诊断中，应更频繁地考虑登革热。鉴于加蓬缺乏登革热数据，更多的前瞻性和纵向研究将有助于进一步明确登革热的负担和模式，以改善病例检测。
