Efficacy and Safety of Low Dose, Short Course Eltrombopag in Management of DF and DHF

Background: Dengue is the most widespread aedes mosquito borne viral disease which infects more than 50 million people every year. The clinical symptoms of dengue may vary from mild fever to life-threatening incidents. Eltrombopag, a non-peptide, oral TPO-R agonist, small molecular weight is quandaries with the transmembrane domain of a TPO receptor and persuades the Janus Kinase/Signal transducer and activator of transcription pathway, with a significant rise in platelet production.Material & Methods:This study was a cross-sectional observational study which was conducted at Tairunnesa Memorial Medical College and Hospital (TMMCH), Gazipur and Shin Shin Japan Hospital, Uttara, Dhaka. The study was conducted in between July 2021- December 2021. The sample size for this study was 100.Results:The mean age in group 1 was 25� in group 2 29�and in control group 29� The mean Baseline PLT * 109 /L for group 1 was 57�, for group 2, 51� and for control group 54�. Mean of systolic baseline BP (mmHg) for group 1 was 103.55� 5.04 for group 2 was 105.38�.34 and for control group was 101.97�28 and followed by the mean of diastolic baseline BP (mmHg) was 72.83�56, 72.84�.93 and 71.97�75. AEs was found in 4(12.1%) cases of group 1 where in group 2 it was 2(5.9%) and in control group was 3(9.1%). In day 7, the recovery rate of group 1 was 93.9% and in group 2 the recovery rate was 94.1%.Conclusions:Dengue is a vector-borne viral disease which needs medical assistance because it may lead to life-threatening outcome. Eltrombopag can be considered as a therapeutic option to increase the PLT counts in DF and DHF patients in the management of thrombocytopenia.

Dengue in India: An Overview

Background: Dengue fever has become a major public health concern in our country, causing significant morbidity and mortality. Because there is no definite drug or commercially available vaccine for dengue, prevention is the only option. As a result, early reporting of dengue cases is required in order to implement preventive measures before the disease spreads to epidemic proportions. Therefore, healthcare providers should notify every dengue incident to local authorities in the current format, including the District Health Officer or Chief Medical Officer of district concerned and the Municipal Health Officer of municipality concerned every week (daily during the transmission period). Materials and Methods: The data on dengue (2015-2021 till Oct.) was available at the National Vector Borne Disease Control Programme under the Ministry of Health & Family Welfare, Government of India, and has been used in this paper. Results and discussion: During the last two decades (2000-2009 and 2010-2019), significant geographical spread of the dengue has been experienced in India with the repeated outbreaks, and an 11 fold increase in number of cases. Despite an increase in the incidence of dengue fever, the case fatality rate in India has decreased from 3.3% in 1996 to 0.4% in 2010 to 0.1% in 2019. Early diagnosis and timely referral play a critical role in bringing down Case Fatality Rate (CFR). Conclusion: Dengue is a manifestation arising from the process of increasing vector density and adaptation to human habitation, as well as human lifestyle transformation, unplanned developmental activities exacerbated by climate change.

Diffuse alveolar hemorrhage complicating dengue haemorrhagic fever in a 15-year-old boy: A case report

Rationale: Dengue fever is a viral infection that is spread through the bites of infected female Aedes mosquitos. It can cause life threatening complications, including dengue haemorrhagic fever (DHF) and dengue shock syndrome. Patient concerns: A 15-year-old male presented with fever and petechiae and later developed hemoptysis. Diagnosis: Dengue fever with DHF with diffuse alveolar hemorrhage. Interventions: Invasive ventilation with high positive end expiratory pressure, multiple transfusions of packed red blood cells, fresh frozen plasma, single donor platelets and inotropic support Outcomes: The patient was stabilized and discharged on minimal supplemental oxygen. Lessons: Diffuse alveolar hemorrhage, although very rare, should be considered in a patient with dengue who presents with hemoptysis. The treatment is directed at providing respiratory and circulatory support, and preventing the progression of microcirculation damage.

Whether Platelet Count Really Influences the Outcome of Dengue Patients? A Study Done at Tertiary Care Centre in North Karnataka Region

In many parts of India, Dengue has become a major public health problem and Kalaburagi District in North Karnataka region was previously not known to be an endemic area for dengue. Three clinical syndromes, classic dengue fever, dengue haemorrhagic fever and dengue shock syndrome are seen with dengue virus infection. This present study was undertaken to find out whether platelet count really influences the outcome of dengue patients in a tertiary health care centre in Kalaburagi, Karnataka.METHODSAbout hundred patients admitted in our hospital with positive Dengue NS1 and Dengue IgM were selected. The follow up of patients is done from the onset of fever to up to twelve days or until their recovery according to discharge criteria of WHO whichever of them is earlier.RESULTSIn this study, 100 cases were studied, out of which Dengue fever was seen in 73 cases, Dengue Hemorrhagic Fever in 17 cases and Dengue Shock Syndrome in 10 cases was seen based on WHO criteria. In this study, 99 percent patients had fever. In this study 73 percent of patients were Dengue NS1 Positive and 27 percent of patients were Dengue IgM Positive. In present study, continuously increasing pattern of platelet count was seen in 55 percent cases; initial fall then rise of platelet count was seen in 38 percent cases and persistently low pattern of platelet count was seen in 7 percent cases. This study showed that 30 percent of patients had bleeding manifestations and bleeding manifestations were maximum in patients having low platelet counts. In the present study, 92% cases improved and 8% cases expired.CONCLUSIONSAmong the three clinical syndromes, Dengue fever was more common than dengue haemorrhagic fever and dengue shock syndrome. It was found that platelet count influenced the outcome of dengue patients. Management of dengue case is mainly supportive

Clinical and laboratory profile of children with dengue fever admitted at a tertiary care hospital in Mangalore, Karnataka, India: a retrospective study

Background: Dengue fever caused by dengue virus is a self-limiting acute febrile illness transmitted by Aedes aegypti, a daytime biting mosquito. Dengue virus belongs to family of Flaviviridae and there are 4 serotypes. A fifth serotype DENV-5 was isolated in 2013 which was said to cause mild form of the disease. In 2019 total numbers of dengue cases are 10,524 in Karnataka which is 138% increase over 2018 (4,427 cases).Methods: A retrospective conducted in Yenepoya Medical College hospital from January 2017 to July 2019 for a period of 2' years. Medical records of children who were diagnosed with dengue fever were retrieved and analyzed. Clinical and laboratory findings were noted down. Clinical course and outcome were noted down from the case sheet and cases were classified as per WHO 2011 classification.Results: 97 children diagnosed with dengue fever were included in the study. Common age group was 5-15 years. 49.5% had dengue fever, 40.2% had dengue haemorrhagic fever (DHF) and 10.3% had expanded dengue syndrome. Fever was the main complaint. Children with dengue fever presented with vomiting, abdominal pain, myalgia, arthralgia in descending order of frequency. Children with DHF, petechiae were seen in 38% patients. Among bleeding manifestations, epistaxis was more common. Children with expanded dengue syndrome had atypical manifestations.Conclusions: Dengue fever like any other viral illness, presents with prodromal symptoms which should be picked up at the earliest with high index of suspicion in children coming from endemic area. Identification of atypical manifestations and co-infections at the earliest and prompt treatment avoids serious life-threatening complications.

A study on awareness and prevention of dengue fever among outpatients attending a health centre in the rural area of Kancheepuram district

Background: Dengue fever has become one of the major public health problems in all developing countries. It is essential to create awareness among people as it can be prevented by simple practices. The study was conducted to find the awareness among the people thus determining the need to educate the people regarding the preventive measures of dengue fever.Methods: This was a cross-sectional community-based study conducted among the outpatients and their attenders visiting a Rural Health Training Center of private Medical College and Hospital, belonging to Alandur block in Kancheepuram district, Tamil Nadu during January 2019 to March 2019. 260 subjects within the age group of 18 to 82 years were selected by convenient sampling method. The data was collected by interviewing and by using questionnaires. Analysis of the structured data was done using SPSS software version 16.Results: The study included 260 respondents who gave their consent for the study. 60.8% of the study group were males. Mean age of the study group was 35.36 years. 58.1% of the individuals were educated more that 10th standard. Knowledge about the mode of transmission was correctly stated by 85.8%. Around 15% were not aware of breeding places of mosquitoes.Conclusions: From this study it was evident that there is a definite gap in understanding the various aspects of dengue fever. Thus, we conclude that regular awareness programs should be conducted in the form of campaigns and house visits to create awareness among all individuals.

Is the clinicopathological profile of dengue syndrome changing?: a 6 year study of different epidemics at a tertiary care center in India

Background: As an arthropod-borne viral disease, dengue epidemics has created much public health hazards in tropical countries. In the national capital of India, there has been more than six epidemics. Dengue remains a notifiable disease in India. It is important that we understand the changing clinicopathological profile of this viral infection to prepare ourselves better for any impending future epidemic. This study done at a tertiary care center looks into the recent epidemics to understand the changing trends in the disease profile in two phases of three years each. Further, authors also assessed the utility of the tourniquet test in dengue syndrome.Methods: 260 serologically confirmed patients were recruited in two phases of the study. We evaluated them for clinical, epidemiological and pathological profile of dengue and trends in haematological, biochemical and radiological parameters during the course of the disease and its correlation with the severity of the disease.Results: Fever, headache, body ache, pharyngeal and conjunctival congestion, rhinitis, rash and diarrhea incidences were similar in both epidemics. Lymphadenopathy was seen in 18(18%) patients compared to 40(25%) in the second epidemic. More number of hemorrhagic manifestations with GI and retinal bleed was seen compared to earlier epidemics, which had higher liver involvement.Conclusions: Although the presentation of the disease has not shown a drastic change over the last decades, the severity varies depending on the predominant serotype. Patients with evidence of serositis, increased activated lymphocytes has a longer course in disease with poorer outcome. Early rising haematocrit, ALT/AST ratio, LDH and deranged coagulation parameters are important tools in triaging patients for priority of urgent care and hospitalization in a scenario of a future outbreak.

Assay of Proinflannatory Cytokines (IL-6, IFN γ, TNFα) and its Correlation with Disease Severity in Dengue Fever

Introduction: Dengue fever is the most common mosquitoborne viral illness in humans. Study was done to determinethe serum levels of pro -inflammatory cytokines (IL-6,IFgamma and TNF alpha) in patients with dengue infection andto determine the correlation of level of cytokine with diseaseseverity, platelet count and SGOT values.Material and methods: Preserved samples of patients withthe clinical features compatible with dengue infection andNSI antigen positivity admitted during the month of Mayand June 2016 in Pushpagiri Institute of Medical science andResearch Centre, Thiruvalla were analysed for levels of pro-inflammatory cytokines (IL-6, IF gamma, and TNF alpha).Disease severity of Dengue patients was assessed from theclinical details obtained from medical records. Total samplesused in this study were 80 of which 49 were patients withdengue fever,11 were patients with severe dengue,10 werepatients with other febrile illness and 10 are from healthyindividuals.Results: The levels of all three cytokines were found to beelevated in the infected groups (dengue and severe dengue)when compared to the control groups (healthy and nondengue). The level of interleukin 6 and TNF alpha were foundto be significantly elevated (p value <0.05) in the severe formof dengue. However no statistically significant difference(p value <0.05) between the infected and control group wasfound in Interferon gamma although it showed an elevation inthe infected group. It was observed that all the three cytokinesshowed a negative correlation with platelet count.Conclusions: IL6 and TNF alpha correlated with diseaseseverity suggesting that these cytokines can be used as amarker to predict the severity of the disease. Thus, necessarytreatments and precaution can be taken in advance. TNFalpha correlated with the degree of thrombocytopenia and IL6correlated with level of SGOT.

Assay of Proinflannatory Cytokines (IL-6, IFN γ, TNFα) and its Correlation with Disease Severity in Dengue Fever

Introduction: Dengue fever is the most common mosquitoborne viral illness in humans. Study was done to determinethe serum levels of pro -inflammatory cytokines (IL-6, IFNgamma and TNF alpha) in patients with dengue infectionand to determine the correlation of level of cytokine withdisease severity, platelet count and SGOT values.Material and methods: Preserved samples of patients withthe clinical features compatible with dengue infection andNSI antigen positivity admitted during the month of Mayand June 2016 in Pushpagiri Institute of Medical science andResearch Centre, Thiruvalla were analysed for levels of pro-inflammatory cytokines (IL-6, IFN gamma, and TNF alpha).Disease severity of Dengue patients was assessed from theclinical details obtained from medical records. Total samplesused in this study were 80 of which 49 were patients withdengue fever,11 were patients with severe dengue,10 werepatients with other febrile illness and 10 are from healthyindividuals.Results: The levels of all three cytokines were found to beelevated in the infected groups (dengue and severe dengue)when compared to the control groups (healthy and nondengue). The level of interleukin 6 and TNF alpha were foundto be significantly elevated (p value <0.05) in the severe formof dengue. However no statistically significant difference(p value <0.05) between the infected and control group wasfound in Interferon gamma although it showed an elevation inthe infected group. It was observed that all the three cytokinesshowed a negative correlation with platelet count.Conclusions: IL6 and TNF alpha correlated with diseaseseverity suggesting that these cytokines can be used as amarker to predict the severity of the disease. Thus, necessarytreatments and precaution can be taken in advance. TNFalpha correlated with the degree of thrombocytopenia and IL6correlated with level of SGOT.

Clinical and laboratory profile of dengue fever: a retrospective study

Background: The global incidence of dengue has grown dramatically in recent decade. Half of world’s population is now at risk. India represents significantly a larger burden, accounting for nearly 34% of the global burden of dengue infection. Dengue infection needs to be addressed as a single disease with different clinical presentations ranging from asymptomatic conditions to severe clinical courses that may lead to high morbidity and mortality.Method: This was retrospective observational study carried out during period of July 2017 to April 2018, to study clinical profile and laboratory parameters in dengue fever patients. Confirmed dengue cases having NS1 positive or IgM positive or having both NS1 and IgM positive or dengue ELISA reactive, having minimum one CBC reports done and not having other confounding factor such as co-infection, bone marrow diseases etc. that may altered clinical and laboratory results are included in study. Statistical analysis was done by SPSS software version 18.0.Results: Out of 48 confirmed dengue cases maximum patients 58.33% was from young age group (21 to 40 years) with M:F ratio was 2.43:1. Fever was found in 100% patients, in order of frequency followed by headache, bodyache, abdominal pain, weakness, retro-orbital pain, anorexia, dry cough, back pain, nausea, diarrhoea, vomiting, rash, joint pain, itching and malena.NS1was positive in 41.67% cases, dengue ELISA in 31.25%, IgM was positive in 20.83% cases, and both NS1 and IgM positive were in 4.17% cases. TLC count was low 35.42%, high in 12.50% of cases and remaining had normal TLC count. Platelet count was ranged between normal platelet counts to thrombocytopenia. One case had platelet count less than 20000. Out of 48 patients, 2 (4.17%) had malena.Conclusion: In this study, fever was found in all patients, and headache, body ache and weakness were common symptoms, but significant number of patients also had gastroentstinal and respiratory symptoms like abdominal pain, nausea, diarrhea, vomiting and dry cough. TLC count ranging from normal TLC, leukopenia to leucocytosis. Large number of patients had low platelet count that shows dengue fever had varied clinical presentation.

A study on the outbreak of dengue fever in a tertiary care children's hospital in southern Tamil Nadu, India

Background: Dengue fever is the most rapidly spreading mosquito-borne viral disease in the world.Incidence has increased 230-fold with increasing geographic expansion with potential for further spread. The rapidly expanding global footprint of dengue is a public health challenge with an economic burden. This study's objective is to assess the outbreak of epidemic of dengue fever in a tertiary care children hospital and to describe their socio-demographic, clinical outcome and serological profile.Methods: It is an observational descriptive study conducted for a period of 1 year in less than 12 years old children in a tertiary care hospital at Southern Tamil Nadu.Results: Among the 360 children admitted with dengue fever, there were 198 boys (55%) and 162 (45%) were girls. Maximum incidence of dengue incidence was seen in infants less than 1 year (25%). The highest number of cases were admitted during September and October. The most common affected age group was less than 3 years with 179 (49%). Among the cases, 297 (82%) were of severe dengue which constitute dengue haemorrhagic fever-183(38%) and Dengue shock syndrome 114 (62%). Serological analysis showed NS1 Ag was positive in 144 children (40%), Dengue IgM was positive in 54 children (15%), both IgM and IgG positive in 126 children (35%) and IgG was positive in 36 children (10%). Out of the total children admitted with dengue fever, the case fatality was 0.5% (2 children).Conclusions: This study highlights the importance of WHO clinical criteria for early diagnosis of severe dengue. Moreover, the early and intensive management reduces the mortality significantly.

Effect of co morbidities on the clinical outcome of Dengue fever

Background: Dengue is the most rapidly spreading mosquito-borne viral disease in the world. A number of Dengue Haemorrhagic Fever (DHF) risk factors had been suggested. However, these risk factors may not be generalized to all populations and epidemics for screening and clinical management of patients at risk of developing DHF/ Dengue shock syndrome (DSS).Methods: A hospital based prospective case control study was done by taking 40 cases each of dengue fever with diabetes mellitus, hypertension, diabetes and hypertension and 30 cases of dengue with asthma/COPD and these patients were compared with controls of 100 patients with dengue fever but no comorbidities. All patients had Dengue serology NS1 or IgM positive.Results: Patients admitted with dengue fever with comorbidities had increased duration of hospitalization with P value of 0.012. The clinical outcome of the 250 patients. In the subgroup of dengue fever patients with DM and Dengue fever with DM and HTN, they were noted to have a 2.69 and 3.06 times increased risk effect of DHF.Conclusions: Dengue fever with DM or DM with HTN have a higher risk of developing DHF when compared with patients with dengue fever with no comorbidities. This finding helps us in triaging patients with comorbidities who develop dengue fever for specialized care and closer clinical monitoring.

Clinical profile of dengue fever in children presented at a tertiary care hospital

Background: Dengue fever is a benign syndrome caused by an arthropod-borne virus and is characterized by Biphasic fever, myalgia, and arthralgia, rash, leucopenia, and lymphadenopathy. Dengue hemorrhagic fever and dengue shock syndrome are a severe, often fatal febrile disease caused by 1 of 4 dengue virus. It is characterized by increased capillary permeability, abnormalities of hemostasis and protein-losing shock syndrome. The aim of this study was to assess the clinical profile, complications and outcome of dengue infection in children.Methods: All children attending the hospital with symptoms and signs suggestive of dengue fever were tested for NS1 antigen and IgM/ IgG dengue antibody serology (depending on the day of fever) by enzyme-linked immunosorbent assay (ELISA) technique.Results: Of the 174-dengue serology positive children, fever was the most common major symptom (97.7%) followed by vomiting (85.6%), loss of appetite (81.6%), abdominal pain (77%), body pain/leg pain (62.6%). Severe dengue as per WHO criteria was seen in 29 (16.7%) children. Thrombocytopenia (platelet count less 1,00,000) was observed in 82 children (47%), Platelet count less than 20,000 in 8 children (4.5%). Dengue shock syndrome was seen it 26 children (15%). Mortality was nil.Conclusions: In children, if symptoms like fever, vomiting, loss of appetite, abdominal pain and body pain are present, a strong possibility of dengue fever is present especially in an epidemic setting. Early suspicion and effective management can reduce the severity.

Primary dengue haemorrhagic fever in patients from northeast of Brazil is associated with high levels of interferon-β during acute phase

Dengue is an acute febrile disease caused by the mosquito-borne dengue virus (DENV) that according to clinical manifestations can be classified as asymptomatic, mild or severe dengue. Severe dengue cases have been associated with an unbalanced immune response characterised by an over secretion of inflammatory cytokines. In the present study we measured type I interferon (IFN-I) transcript and circulating levels in primary and secondary DENV infected patients. We observed that dengue fever (DF) and dengue haemorrhagic fever (DHF) patients express IFN-I differently. While DF and DHF patients express interferon-α similarly (52,71 ± 7,40 and 49,05 ± 7,70, respectively), IFN- β were associated with primary DHF patients. On the other hand, secondary DHF patients were not able to secrete large amounts of IFN- β which in turn may have influenced the high-level of viraemia. Our results suggest that, in patients from our cohort, infection by DENV serotype 3 elicits an innate response characterised by higher levels of IFN- β in the DHF patients with primary infection, which could contribute to control infection evidenced by the low-level of viraemia in these patients. The present findings may contribute to shed light in the role of innate immune response in dengue pathogenesis.

Primary dengue virus infections induce differential cytokine production in Mexican patients

Severe dengue pathogenesis is not fully understood, but high levels of proinflammatory cytokines have been associated with dengue disease severity. In this study, the cytokine levels in 171 sera from Mexican patients with primary dengue fever (DF) and dengue haemorrhagic fever (DHF) from dengue virus (DENV) 1 (n = 116) or 2 (n = 55) were compared. DF and DHF were defined according to the patient’s clinical condition, the primary infections as indicated by IgG enzymatic immunoassay negative results, and the infecting serotype as assessed by real-time reverse transcription-polymerase chain reaction. Samples were analysed for circulating levels of interleukin (IL)-12p70, interferon (IFN)-γ, tumour necrosis factor (TNF)-α, IL-6, and IL-8 using a commercial cytometric bead array. Significantly higher IFN-γ levels were found in patients with DHF than those with DF. However, significantly higher IL-12p70, TNF-α, and IL-6 levels were associated with DHF only in patients who were infected with DENV2 but not with DENV1. Moreover, patients with DF who were infected with DENV1 showed higher levels of IL-12p70, TNF-α, and IL-6 than patients with DHF early after-fever onset. The IL-8 levels were similar in all cases regardless of the clinical condition or infection serotype. These results suggest that the association between high proinflammatory cytokine levels and dengue disease severity does not always stand, and it once again highlights the complex nature of DHF pathogenesis.

A Prospective Study to Assess the Clinical Manifestations and Trend of Dengue Cases Admitted in a Tertiary Care Hospital.

Background: Dengue fever is one of the most common Arbo virus mediated epidemics, causing major concerns in India since the last two decades. Many parts of India, including the Maharashtra region, are now endemic for the Dengue infection. Dengue fever (DF), Dengue haemorrhagic fever (DHF) and Dengue shock syndrome (DSS) are different modes of presentation of the disease. Our study has a objective to study the clinical manifestations, trend and outcome of all confirmed dengue cases admitted in a tertiary care hospital. Methods: This prospective study done on patients diagnosed with dengue fever with one or more warning signs attending the outpatient department and indoor of Dr. D. Y. Patil Medical College, Kolhapur, a tertiary care centre in the state were included in the study. 125 patients were included on the basis of inclusion and exclusion criteria in the study period from March 2014 to December 2014. Results: Out of 125 patients diagnosed Dengue cases, 83 (66.4%) were males and 42 (33.6%) were females and Maximum number of cases were in the age group of 31–45 years, 53 (42.4%) and the least cases were reported above 60 years age group, 4%. The most common presentation was fever 125 (99.1%) followed by myalgia 88 (70.4%), vomiting 54 (43.2%), headache 58 (46.4%), abdominal pain 42 (33.6%), skin rash 32 (25.6%). Bleeding from different sites of the body was evident in 18 patients (14.4%). In bleeding manifestations, petechiae 24 (19.2%) was the most common presentation. Conclusion: The study highlighted the high prevalence of Dengue cases in Kolhapur region. Therefore, clinicians are required to suspect Dengue in all cases of fever presenting at the hospital. Prompt diagnosis and early treatment can decrease the mortality associated with Dengue.

Detection of NS1 antigen, IgM antibody for the diagnosis of dengue infection in patients with acute febrile illness.

Background: Dengue is an endemic viral disease affecting tropical and subtropical regions around the world. Infection with any 1 of 4 dengue viruses produces with spectrum of clinical illness ranging from a mild undifferentiated febrile illness to dengue fever (DF) to dengue haemorrhagic fever (DHF), a potentially life threatening disease. The mortality and morbidity of DHF can be reduced by early diagnosis, hospitalisation and careful supportive care. Detection of non-structural antigen (NS1 Ag), IgM and IgG antibody may help in the early diagnosis. Methods: The present study was taken from the Pt J N M Medical College, Raipur (CG.) department of Microbiology. The one year study from August 2014 to July 2015 detection of NS1 Ag and IgM antibody. Elisa were tested a penal compared of 1637 serum specimens collected from acute febrile patients. Out of 1637 patients 538_were found to have acute dengue infection by detection of NS1Ag and anti-dengue IgM Elisa. Results: Out of 1637 patients 538- were found to acute dengue infection. Out of 538– NS1 161—IgM 294 positive. Males are more affected than females and 21 to 30 year age group were more infected. Dengue illness were more in rainy and post rainy season. Conclusions: The present study showed that dengue serological tests have a significant role in the early diagnosis of dengue fever, Hence, it is recommended to do the serological tests (NS1 Ag, IgM, IgG Ab) early in all suspected dengue cases so that, we can diagnosis early and initiate necessary treatment.

An evaluation of the surveillance system for dengue virus infections in Maldives.

Background: Dengue is endemic in Maldives. The largest epidemic to date was in 2011. This study evaluates the surveillance system for dengue during 2011, identifies gaps and suggests ways to improve. Methods: This evaluation of the national surveillance system for dengue was done in September to October 2012, using an evaluation tool based on United States Centers for Disease Control and Prevention (US CDC) guidelines. Staff involved in surveillance of different levels, and doctors expected to notify, were interviewed, and surveillance data from the Health Protection Agency (HPA) were compared by use of an independent database of the country’s national referral hospital in Malé, Indira Gandhi Memorial Hospital (IGMH), to assess sensitivity and timeliness. Results: National surveillance is conducted by HPA, which collects information daily from a network of health facilities. Standard case definitions were published, but they were not easily accessible to clinicians. The quality of data was acceptable. Information is disseminated as annual communicable disease reports to health facilities and uploaded onto the official website. The timeliness of reporting was good (median 2 days). However, the usefulness for early warning of outbreaks was limited, owing to central and peripheral resource limitations. Data were useful for planning. Sensitivity was 0.54. Acceptability by clinicians was poor, owing to the lack of feedback reaching them. The reporting rate was high from the paediatric ward in IGMH (85%), where the responsibility of notifying was also assigned to ward in-charge and support staff, but it was extremely low from the medical ward (1.7%), where only doctors were given the responsibility. Conclusion: This evaluation shows the performance of the dengue surveillance system was good overall. However, clinicians need more regular feedback. The performance could be improved significantly by written protocols, legislature and assigning the responsibility of surveillance in hospitals to ward managers in addition to doctors.

Seroprevalence of dengue virus in a tertiary care hospital, Andhra Pradesh, South India.

Background: Dengue fever and Dengue Haemorrhagic fever (DF/DHF) is an acute viral disease caused by Dengue virus. The infection is transmitted by the bite of an infected female mosquito- Aedes aegypti. The Dengue virus causes significant morbidity and mortality in many parts of the world, including India, where it was first isolated in Calcutta, West Bengal during 1945. This study was conducted to know the seroprevalence of Dengue virus in a tertiary care hospital, Hyderabad Methods: Blood for serological studies are carefully collected taking due universal precautions from suspected DF/DHF cases (a) as soon as possible after hospital admission or attendance. All the patients were screened for anti-Dengue IgG and IgM antibodies By Enzyme Immunoassay. The study period was 18 months from 2012. Results: From a total of 1327serum samples tested were screened for Dengue IgM and IgG among which 706(53.2%) were positive. 125(17.7%) were only IgM positive and 198(28.05%) of the tested samples showed only IgG positive. 383(54.25%) of the tested samples revealed positive for both IgM and IgG antibodies. Conclusion: Surveillance is prerequisite for monitoring the dengue situation in the area and should be carried out regularly for early detection of an impending outbreak and to initiate timely preventive and control measures.

RNAi: antiviral therapy against dengue virus

Dengue virus infection has become a global threat affecting around 100 countries in the world. Currently, there is no licensed antiviral agent available against dengue. Thus, there is a strong need to develop therapeutic strategies that can tackle this life threatening disease. RNA interference is an important and effective gene silencing process which degrades targeted RNA by a sequence specific process. Several studies have been conducted during the last decade to evaluate the efficiency of siRNA in inhibiting dengue virus replication. This review summarizes siRNAs as a therapeutic approach against dengue virus serotypes and concludes that siRNAs against virus and host genes can be next generation treatment of dengue virus infection.