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- Title
Clinical and epidemiologic characteristics associated with dengue during and outside the 2016 outbreak identified in health facility-based surveillance in Ouagadougou, Burkina Faso.
- Authors
Lim, Jacqueline K.; Seydou, Yaro; Carabali, Mabel; Barro, Ahmed; Dahourou, Desire Lucien; Lee, Kang Sung; Nikiema, Teguewende; Namkung, Suk; Lee, Jung-Seok; Shin, Mee Young; Bonnet, Emmanuel; Kagone, Therese; Kaba, Losseni; Edwards, Tansy; Somé, Paul-André; Yang, Jae Seung; Alexander, Neal; Yoon, In-Kyu; Ridde, Valéry
- Abstract
Background: In Africa, the magnitude of dengue virus (DENV) transmission is largely unknown. In Burkina Faso, several outbreaks have been reported and data are often based on findings from outbreak investigations. Methods: To better understand dengue epidemiology and clinical characteristics in Burkina Faso, a fever surveillance study was conducted among patients aged 1–55 years, who presented with non-malarial febrile illness at five primary healthcare facilities in Ouagadougou, Burkina Faso from December 2014 to February 2017, encompassing a 3-month dengue outbreak in September-November 2016. Acute and convalescent blood samples were collected within an interval of 10–21 days between visits. Acute samples were tested with dengue rapid diagnostic tests (RDT) and a selected subset with RT-PCR, and all acute/convalescent samples with IgM/IgG ELISA. Results: Among 2929 non-malarial febrile patients, 740 (25%) were dengue–positive based on RT-PCR and/or IgM/IgG ELISA; 428 out of 777 patients (55%) and 312 out of 2152 (14%) were dengue-positive during outbreak and non-outbreak periods, respectively. There were 11% (316/2929) and 4% (129/2929) patients showing positive for NS1 and IgM, on the RDT, respectively. DENV 2 predominated during the outbreak, whereas DENV 3 predominated before the outbreak. Only 25% of dengue-positive cases were clinically diagnosed with suspected dengue. The odds of requiring observation for ≤3 days (versus routine outpatient care) were 11 times higher among dengue-positive cases than non-dengue cases. In adjusted analyses, dengue-positivity was associated with rash and retro-orbital pain (OR = 2.6 and 7.4, respectively) during the outbreak and with rash and nausea/vomiting (OR = 1.5 and 1.4, respectively) during the non-outbreak period. Conclusion: Dengue virus is an important pathogen in Burkina Faso, accounting for a substantial proportion of non-malarial fevers both during and outside outbreak, but is only infrequently suspected by clinicians. Additional longitudinal data would help to further define characteristics of dengue for improved case detection and surveillance. Author summary: There is not much evidence on dengue in Africa, relative to the Asia-Pacific and Latin American regions. To estimate the proportion of dengue among patients with fever, and to identify clinical features of dengue during outbreak and non-outbreak periods, we studied 2929 patients with non-malarial fever, aged 1–55 years, who attended five primary healthcare centers in Ouagadougou, Burkina Faso. Patients were tested with a rapid test for dengue, and further tests were carried out on paired blood samples taken 10–21 days apart. Overall, a quarter of non-malarial febrile episodes identified between December 2014 and February 2017 were dengue-positive. Dengue-positive cases were 11 times more likely than non-dengue cases to require observation for ≤3 days. During the study period in 2016, there was a dengue outbreak where more than half of non-malarial febrile patients were identified to be dengue-positive. DENV 2 was the main serotype in circulation during the outbreak, whereas DENV 3 was the main serotype before the outbreak. Rash and retro-orbital pain were more frequently found among dengue-positive cases, compared to non-dengue cases, during the outbreak. During the non-outbreak period, rash and nausea/vomiting were more likely in dengue-positive versus non-dengue cases. There was a low level of clinical suspicion of dengue even during the 2016 outbreak. Therefore, a broader use of rapid diagnostic tests and more epidemiologic data would help to improve dengue case detection and surveillance in Burkina Faso.
- Subjects
BURKINA Faso; OUAGADOUGOU (Burkina Faso); DENGUE hemorrhagic fever; DENGUE; HEALTH facilities; DENGUE viruses; OUTPATIENT medical care
- Publication
PLoS Neglected Tropical Diseases, 2019, Vol 13, Issue 12, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0007882