Dengue Fever Outbreak in Delhi,North India: A Clinico-Epidemiological Study

Background:Dengue viruses, single-stranded positive polarity ribonucleic acid (RNA) viruses of the family Flaviviridae, are the most common cause of arboviral disease in the world. We report a clinico-epidemiological study of the dengue fever outbreak of 2010 from a tertiary care hospital in Delhi, North India.Objectives:Objectives of the study were to know the incidence of laboratory-confirmed dengue cases among the clinically suspected patients; to study the clinical profile of dengue-positive cases; and to co-relate the above with the prevalent serotype and environmental conditions.Results:Out of the 4,370 serum samples, 1,700 were positive for dengue-virus-specific IgM antibodies (38.9%). Prevalent serotype was dengue virus type-1. Thrombocytopenia and myalgia was seen in 23.1% and 18.3% of the 1,700 dengue IgM-positive patients, respectively. Also, 10.3% of 1,700 were dengue hemorrhagic fever (DHF) patients; and the mortality in serologically confirmed dengue fever cases was 0.06%.Conclusions:A change in the predominant circulating serotype, unprecedented rains, enormous infrastructure development, and increased reporting due to improved diagnostic facilities were the factors responsible for the unexpected number of dengue fever cases confronted in 2010.     

First outbreak of dengue hemorrhagic fever,Bangladesh

During the first countrywide outbreak of dengue hemorrhagic fever in Bangladesh, we conducted surveillance for dengue at a hospital in Dhaka. Of 176 patients, primarily adults, found positive for dengue, 60.2% had dengue fever, 39.2% dengue hemorrhagic fever, and 0.6% dengue shock syndrome. The Dengue virus 3 serotype was detected in eight patients.     

Transition in the Cause of Fever from Malaria to Dengue,Northwestern Ecuador, 1990–2011

In tropical areas, the predominant cause of fever has historically been malaria. However by 2011, among febrile patients in northwestern Ecuador, dengue was identified in 42% and malaria in none. This finding suggests a transition in the cause of fever from malaria to other illnesses, such as dengue.     

Hantavirus infections in humans and commensal rodents in Singapore

To determine the extent of hantavirus infection in Singapore, serological studies using the indirect immunofluorescent antibody (IFA) test were conducted on commensal rodents and on human patients in 4 diagnostic groups. Virus isolation using a Vero E6 cell line was performed on hantaviral antigen-positive rodent lung tissue. Of 142 rodents and 3 insectivores studied, 37 (26%) were seropositive for IFA. Rattus norvegicus was the predominant species captured, with the highest species-specific seropositive rate of 32% (36 of 113). A hantavirus strain, R36, was isolated from one R. norvegicus. Seropositive rates for human patients were: 8% respectively for dengue haemorrhagic fever suspects and for non-A non-B hepatitis patients, 3% for leptospirosis suspects and 2% for acute nephritis patients. 2 patients had marked liver dysfunction but mild renal involvement. This hepatitis-like manifestation appears to be a clinical variant of hantavirus infection.     

Evaluation of dengue fever reports during an epidemic,Colombia

OBJECTIVE

To assess the validity of dengue fever reports and how they relate to the definition of case and severity.

METHODS

Diagnostic test assessment was conducted using cross-sectional sampling from a universe of 13,873 patients treated during the fifth epidemiological period in health institutions from 11 Colombian departments in 2013. The test under analyses was the reporting to the National Public Health Surveillance System, and the reference standard was the review of histories identified by active institutional search. We reviewed all histories of patients diagnosed with dengue fever, as well as a random sample of patients with febrile syndromes. The specificity and sensitivity of reports were estimated for this purpose, considering the inverse of the probability of being selected for weighting. The concordance between reporting and the findings of the active institutional search was calculated using Kappa statistics.

RESULTS

We included 4,359 febrile patients, and 31.7% were classified as compatible with dengue fever (17 with severe dengue fever; 461 with dengue fever and warning signs; 904 with dengue fever and no warning signs). The global sensitivity of reports was 13.2% (95%CI 10.9;15.4) and specificity was 98.4% (95%CI 97.9;98.9). Sensitivity varied according to severity: 12.1% (95%CI 9.3;14.8) for patients presenting dengue fever with no warning signs; 14.5% (95%CI 10.6;18.4) for those presenting dengue fever with warning signs, and 40.0% (95%CI 9.6;70.4) for those with severe dengue fever. Concordance between reporting and the findings of the active institutional search resulted in a Kappa of 10.1%.

CONCLUSIONS

Low concordance was observed between reporting and the review of clinical histories, which was associated with the low reporting of dengue fever compatible cases, especially milder cases.     

广州市2006-2012年重点媒介传染病流行特征分析

目的 探讨广州市重点媒介传染病流行病学特征,为媒介传染病防控提供科学依据.方法 从国家疾病监测信息报告管理信息系统中收集广州市2006-2012年重点媒介传染病报告病例基本信息以及个案调查流行病学信息,用描述性流行病学方法分析广州市重点媒介传染病的流行病学特征.结果 2006-2012年,广州市共报告6种媒介传染病5828例,其中肾综合征出血热（HFRS）、登革热、钩端螺旋体（钩体）病、疟疾、流行性乙型脑炎（乙脑）和恙虫病年平均发病率分别为1.01/10万、1.37/10万、0.10/10万、0.18/10万、0.02/10万和4.72/10万.登革热和恙虫病发病季节性特征明显,中心城区HFRS和登革热发病构成比较大,钩体病、疟疾、乙脑和恙虫病发病以城乡结合部和农村区域为主,除乙脑发病以儿童为主外,其余各媒介传染病发病职业分布广泛,年龄以中老年为主.结论 广州市媒介传染病发病整体相对平稳,但近年来有小幅上升趋势,发病风险仍然存在,应加强监测和预防控制工作.     

广州市海珠区2012年登革热流行特征分析

目的分析2012年海珠区登革热流行特点,以期更好地做好登革热防制工作。方法收集临床医生报告的疑似登革热病例血清样本,采用ELISA和免疫层析法（ICT）检测特异性IgM抗体,比较2种检测方法的差异。分析登革热流行特征。结果2012年海珠区登革热病例临床表现以发热、皮疹、头痛及肌肉骨关节痛为主,并伴有谷丙转氨酶升高（49．35％）,白细胞减少（31．17％）及血小板降低（22．08％）。登革热病毒IgM抗体可在2～22d内检出,ELISA检测阳性率达42．54％,高于ICT检出率（34．81％）;发病高峰为10月,中青年为主要发病人群。结论2012年海珠区登革热疫情呈散发状态,大多数病例具有典型的临床表现,及时采集患者血清和特异性IgM抗体检测对登革热疫情控制具有重要意义。     

Who brings dengue into North Queensland? A descriptive,exploratory study

Objective: To describe the demographics, patterns of assessment and treatment of people visiting a regional emergency department with potential diagnoses of malaria or dengue fever. Design: To identify potential dengue fever cases, we used an indicator of recent overseas travel and fever that is a request for malaria testing. A chart audit of 301 medical records of people between 2008 and 2010 was conducted to describe patient characteristics, diagnostic tests performed and treatment. Setting: A regional hospital located in the wet tropics. Results: Malaria testing was most often performed on Australian citizens (64.1%), medical evacuees (20.3%) and tourists (18.6%). Overall, 49.8% of patients tested for malaria did not also have a dengue test, despite being indicated in 54% of this group. People tested for malaria usually lived in a residential house or unit (69.7%). Only 9% were staying in hotels and hostels . Oceania was the most commonly visited region in the two weeks prior to presentation. Malaria was diagnosed in 17.3% and dengue fever in 12% of patients tested. Patients with dengue fever were more likely than patients with malaria to self‐refer to hospital, be staying in commercial accommodation and to have recently travelled to Southeast Asia. Conclusion: Both dengue fever and malaria occur predominantly in residents who reside in non‐commercial accommodation. Efforts to identify imported dengue fever cases should focus on both tourists and local residents returning from overseas countries.     

登革热传入防城港口岸的风险因素分析及检疫对策

〔目的〕通过风险分析,评估登革热传入防城港口岸的风险,为实施检疫措施提供依据。〔方法〕对防城港口岸的自然地理条件、周边疫情、交通运输状况、口岸蚊媒监测情况、口岸地区人群发病及输入性病例情况等因素进行分析。〔结果〕防城港口岸地理条件适宜登革热病原及媒介的生存及繁衍传代;周边国家疫情严竣,给与之有着经常性贸易往来的防城港口岸构成严重威胁;存在通过交通工具携带而输入登革热病人、潜伏期带毒者或带毒蚊媒的可能;近3年来防城港口岸伊蚊的布雷图指数和密度较低,伊蚊的传播引起登革热流行风险较低;防城港口岸所在地区未发现登革热病例,也无输入性登革热病例。〔结论〕登革热传入防城港口岸的可能性及危险性不容忽视,应加强入境检验检疫工作。     

Dot enzyme immunoassay: an alternative diagnostic aid for dengue fever and dengue haemorrhagic fever.

A dot enzyme immunoassay (DEIA) for the detection of antibodies to dengue virus was tested for use as a tool in the presumptive diagnosis of dengue fever and dengue haemorrhagic fever. Paired sera from the following groups of patients were tested using the DEIA and the haemagglutination inhibition (HI) test: those with primary dengue fever; those experiencing a second dengue infection; and febrile patients who did not have dengue. The data obtained show that the DEIA can be effectively used at a serum dilution of 1:1000 to confirm presumptive recent dengue in patients with a second dengue infection. However, demonstration of seroconversion proved necessary for patients with primary dengue. At a serum dilution of 1:1000 the DEIA has a specificity of 97.3%. The role of this simple and rapid test in improving the effectivity of programmes for the control of dengue virus infection is discussed.     

揭阳市登革热临床及流行病学特点(附52例临床分析)

目的探讨某地区登革热的临床及流行病学特点.方法对1997～2002年该地区3次登革热流行期间在某院住院的52例患者临床资料进行分析.结果患者年龄6～68岁(以成年农民多见),平均32岁;男37例,女15例.临床症状有急性发热(100.00%),皮疹(76.92%),出血倾向(30.77%),淋巴结肿大(69.23%),关节肌肉疼痛(86.54%),头痛(73.01%),厌食(65.38%),恶心(15.38%),呕吐(7.69%).结论登革热起病缓慢,症状不典型,容易被漏诊.生活条件及生活环境较差,蚊虫多,是成年农民发病率高的原因.     

登革热伴出血与伴出疹患者实验室检查的特征分析

目的 分析比较2014年广东省登革热暴发流行期间登革热伴出血与登革热伴出疹患者的实验室检查特征.方法 将广州市第八人民医院收治的51例登革热伴出血与151例登革热伴出疹的住院患者纳入研究,采用实时荧光PCR方法检测登革病毒(DENV)核酸,ELISA测定DENV的IgM和IgG抗体,流式细胞术检测CD37CD47CD8+淋巴细胞亚群;比较两组研究病例的实验室资料,并进行统计学分析.结果 登革热伴出血患者的中性粒细胞、AST、血浆凝血酶原时间、活化部分凝血酶时间和尿蛋白阳性率分别为(56.77±19.11)×109/L、80.00(45.00,109.00) U/L、13.40(12.85,13.95)s、47.50(42.90,53.20)s和44.7％,均高于登革热伴出疹患者,差异有统计学意义(t=2.591,Z=2.495、3.184、2.435,x2=9.786,P均＜0.05或＜0.01);登革热伴出血患者的单核细胞、嗜酸性粒细胞、CD4+、CD8+、PLT、凝血酶原活动度和血浆纤维蛋白原分别为(9.79±4.96)×109/L、[0.10 (0.00,1.00)]×109/L、372 (220,585)个/μL、258 (155,466)个/μL、[53.00 (32.00,82.00)]×109/L、[93.55(86.57,102.66)]％和2.48(2.04,2.92) g/L,均低于登革热伴出疹患者,差异有统计学意义(t=-2.045,Z=-4.054、-1.962、-2.676、-3.806、-2.876和-2.111,P均＜0.05或＜0.01).登革病毒IgM抗体阳性166例(83.42％),IgG抗体阳性33例(16.58％).89例患者DENV核酸分型分析显示,DENV-1感染81例(91.01％),DENV-2感染3例(3.37％),DENV-1和DENV-2混合感染4例(4.49％),DENV-3感染1例(1.12％).另外,51例登革热伴出血患者中重症登革热9例(17.65％),151例登革热发热伴出疹的患者中重症登革热2例(1.32％),差异有统计学意义(x2=16.684,P＜0.01).结论 2014年广东省登革热暴发流行中,大部分登革热患者为初次的DENV-1感染;登革热伴出血患者在凝血功能、肝肾功能及免疫功能等方面明显较登革热伴出疹患者差;在临床上,应警惕发热伴出血患者发展为重症登革热.     

Infections in travellers arriving from Australia

An unwell traveller whose itinerary has included Australia may be infected with agents that are uniquely found in that country or by more cosmopolitan agents that exist there. This brief review will discuss some of the more common or important infectious disease diagnoses and discuss some features that can be elicited on examination or from the history that would be useful in directing investigation and treatment. Diseases discussed include epidemic polyarthritis, dengue fever, Murray Valley encephalitis, melioidosis, leptospirosis, Buruli ulcer, scrub typhus and spotted fever.     

Dengue haemorrhagic fever in children in Delhi.

An epidemic of dengue haemorrhagic fever occurred in Delhi during 1988. A total of 21 paediatric patients with dengue haemorrhagic fever/dengue shock syndrome were evaluated from September to November 1988. All the patients had fever, restlessness, ecchymotic spots and ascites. Pleural effusion occurred in 19 patients (90%), and 18 (86%) exhibited each of the following: vomiting, thrombocytopenia, and haemoconcentration. Hepatomegaly was observed in 15 patients (71%) and splenomegaly in three (14%). Titres of haemagglutination inhibition (HI) antibodies against dengue virus type 2 were raised in all the 15 cases from whom sera were collected during the acute stage. Convalescent sera from five patients had increased titres of HI antibodies to dengue virus type 2. The remaining 10 cases exhibited raised IgM antibody levels against dengue virus type 2. The fatality rate for serologically proven cases was 13% (2 of 15 patients), while for all patients (including those diagnosed clinically (6) and serologically (15)) it was 33.3% (7 of 21). Patients who survived had no sequelae, except one who had transient hypertension that lasted for two weeks.     

Murine Typhus and Leptospirosis as Causes of Acute Undifferentiated Fever, Indonesia

To investigate rickettsioses and leptospirosis among urban residents of Semarang, Indonesia, we tested the blood of 137 patients with fever. Evidence of Rickettsia typhi, the agent of murine typhus, was found in 9 patients. Another 9 patients showed inconclusive serologic results. Thirteen patients received a diagnosis of leptospirosis. No dual infections were detected.     

Notes from the field: investigation of leptospirosis underreporting - Puerto Rico, 2010

Leptospirosis, a zoonosis transmitted through contact with the urine of infected animals, either directly or through exposure to contaminated water or soil, is a frequent cause of acute febrile illness (AFI) and can be difficult to distinguish from dengue in areas where both are endemic. Approximately 5%-10% of patients with leptospirosis are affected severely; the case-fatality rate in those with severe disease is 5%-15%. Early identification of leptospirosis cases and early administration of penicillin G or doxycycline can reduce the duration and severity of illness.     

登革热并发病毒性心肌炎的临床特点

目的探讨2007年珠海流行的登革热并发病毒性心肌炎的临床特点。方法对2007年8月至10月间中山大学附属第五医院收治的125例登革热住院患者的临床症状、心肌酶及心电图特征进行分析。结果本次流行的登革热患者并发病毒性心肌炎者24例,占19.2%,其中10例伴有心律失常,无心功能不全者,均治愈出院。结论2007年珠海流行的登革热并发病毒性心肌炎症状较轻,临床转归较好,但发病率较高;对登革热患者进行心电图及心肌酶检测是非常重要的。     

Upward trend in dengue incidence among hospitalized patients, United States

International travel and a global expansion of dengue fever have the potential to increase the incidence of dengue in the United States. We conducted a retrospective cohort analysis of trends in dengue among hospitalized patients by using the National Inpatient Sample (2000-2007); the number of cases more than tripled (p<0.0001).     

广东和香港地区2004-2006年输入性登革热病例流行病学分析

目的 对广东和香港(粤港)地区2004-2006年报告的输入性登革热病例情况进行流行病学分析及比较.方法 通过广东省登革热疫情监测报告系统收集广东省输入性登革热的流行资料,香港的资料由香港卫生署卫生防护中心提供;对收集到的两地资料进行描述性流行病学分析.结果 2004-2006年广东省报告输入性登革热病例数44例,香港报告93例;广东省病例的输入国主要是新加坡(13例)、印度尼西亚(9例)、柬埔寨(6例),香港病例的输入国主要是印度尼西亚(31例)、菲律宾(16例)、泰国(15例);两地发病高峰期均为7-9月,非高峰期香港的病例数高于广东省;两地病例的男女性别比:广东省1.2:1,香港1.1:1;广东省病例年龄从6～80岁,大部分为20～39岁(占63.6%,28/44),职业以商业及服务业、家务及待业为主(占40.9%,18/44);香港病例年龄从10～72岁,大部分为20～39岁(占58.1%,54/93),职业以商业及服务业、工人为主(占47.3%,44/93);广东省入境前发病的病例比入境后发病多(27:17),而香港入境前发病的病例比入境后发病少(35:57);两地病例从发病到诊断的平均时间间隔分别为7 d和9 d.结论 造成粤港两地登革热输入的主要原因是旅游及商务人员在夏季与东南亚国家之间的频繁往来.     

2014年广州市花都区登革热暴发流行病学调查

摘要:目的　对广州市花都区2014年登革热流行病学特征进行分析,综合评价预防控制措施的效果,为今后有效防控登革热疫情提供参考依据和实践经验。方法　应用流行病学方法调查分析登革热疫情的流行病学特点,用布雷图指数和病例发病趋势评价所采取预防控制措施的效果。结果　2014年广州市花都区发生登革热流行,9月1日-11月20日共发现543例,累计发病率 56.30/10万,重症病例2例,无死亡病例。疫情持续 78 d,疫情高峰出现在10月中旬,病例主要集中于花都区城区4个街道与狮岭镇,发病人群以青壮年为主,女性高于男性,职业以家务及待业、农村居民、工人为主,大多数病例表现典型、轻型登革热症状。采集406例进行血标本检测,233 例登革热 IgM 抗体和 IgG 抗体阳性,67 例登革热病毒核酸阳性,106 例登革热IgM 抗体阳性。采取综合预防控制措施后,平均布雷图指数下降到4.52,11月份登革热发病率明显下降,疫情得到有效控制。结论　2014年广州市花都区登革热呈暴发高流行态势,流行特征与广东省、广州市一致。经采取综合防控措施后,疫情得到全面控制。