Emergence of Epidemic Dengue-1 Virus in the Southern Province of Sri Lanka.
Abstract
BACKGROUND: Dengue is a frequent cause of acute febrile illness with an expanding
global distribution. Since the 1960s, dengue in Sri Lanka has been documented primarily
along the heavily urbanized western coast with periodic shifting of serotypes. Outbreaks
from 2005-2008 were attributed to a new clade of DENV-3 and more recently to a newly
introduced genotype of DENV-1. In 2007, we conducted etiologic surveillance of acute
febrile illness in the Southern Province and confirmed dengue in only 6.3% of febrile
patients, with no cases of DENV-1 identified. To re-evaluate the importance of dengue
as an etiology of acute febrile illness in this region, we renewed fever surveillance
in the Southern Province to newly identify and characterize dengue. METHODOLOGY/PRINCIPAL
FINDINGS: A cross-sectional surveillance study was conducted at the largest tertiary
care hospital in the Southern Province from 2012-2013. A total of 976 patients hospitalized
with acute undifferentiated fever were enrolled, with 64.3% male and 31.4% children.
Convalescent blood samples were collected from 877 (89.6%). Dengue virus isolation,
dengue RT-PCR, and paired IgG ELISA were performed. Acute dengue was confirmed as
the etiology for 388 (39.8%) of 976 hospitalizations, with most cases (291, 75.0%)
confirmed virologically and by multiple methods. Among 351 cases of virologically
confirmed dengue, 320 (91.2%) were due to DENV-1. Acute dengue was associated with
self-reported rural residence, travel, and months having greatest rainfall. Sequencing
of selected dengue viruses revealed that sequences were most closely related to those
described from China and Southeast Asia, not nearby India. CONCLUSIONS/SIGNIFICANCE:
We describe the first epidemic of DENV-1 in the Southern Province of Sri Lanka in
a population known to be susceptible to this serotype because of prior study. Dengue
accounted for 40% of acute febrile illnesses in the current study. The emergence of
DENV-1 as the foremost serotype in this densely populated but agrarian population
highlights the changing epidemiology of dengue and the need for continued surveillance
and prevention.
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https://hdl.handle.net/10161/13031Published Version (Please cite this version)
10.1371/journal.pntd.0004995Publication Info
Bodinayake, Champica K; Tillekeratne, L Gayani; Nagahawatte, Ajith; Devasiri, Vasantha;
Kodikara Arachichi, Wasantha; Strouse, John J; ... Reller, Megan E (2016). Emergence of Epidemic Dengue-1 Virus in the Southern Province of Sri Lanka. PLoS Negl Trop Dis, 10(10). pp. e0004995. 10.1371/journal.pntd.0004995. Retrieved from https://hdl.handle.net/10161/13031.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Megan Elizabeth Reller
Associate Professor of Medicine
John J. Strouse
Associate Professor of Medicine
My research has focused on the epidemiology, risk factors, and prevention of the pulmonary
and central nervous system complications of sickle cell disease and includes retrospective
and prospective cohort studies and clinical trials. I received my Ph.D. in clinical
investigation from the Johns Hopkins Bloomberg School of Public Health for a series
of studies to identify predictors of cognitive function in children with sickle cell
disease. This work has expanded to the evaluation
Gayani Tillekeratne
Assistant Professor of Medicine
Global healthAntimicrobial resistance/ stewardshipAcute respiratory tract infections Emerging
infections/ dengue
Christopher Wildrick Woods
Wolfgang Joklik Distinguished Professor of Global Health
1. Emerging Infections 2. Global Health 3. Epidemiology of infectious diseases
4. Clinical microbiology and diagnostics 5. Bioterrorism Preparedness 6. Surveillance
for communicable diseases 7. Antimicrobial resistance
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