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Dengue Virus, Nepal

2008; Centers for Disease Control and Prevention; Volume: 14; Issue: 3 Linguagem: Inglês

10.3201/eid1403.070473

1080-6059

Basu Dev Pandey, Kouichi Morita, Santa Raj Khanal, Tomohiko Takasaki, Isao Miyazaki, Tetsuro Ogawa, Shingo Inoue, Ichiro Kurane,

Viral Infections and Outbreaks Research

To the Editor: Dengue virus belongs to the genus Flavivirus, family Flaviviridae. It has 4 serotypes: dengue virus type 1 (DENV-1), dengue virus type 2 (DENV-2), dengue virus type 3 (DENV-3), and dengue virus type 4 (DENV-4). Dengue virus is maintained in a cycle between humans and Aedes aegypti, domestic day-biting mosquitoes. Dengue virus induces clinical illness, which ranges from a nonspecific viral syndrome (dengue fever [DF]) to severe and fatal hemorrhagic disease (dengue hemorrhagic fever [DHF]). DF/DHF occurs primarily in tropical and subtropical areas of the world. Domestic dengue virus infection occurs in >100 countries; >2.5 billion persons live in these areas. Approximately 100 million cases of DF, 500,000 cases of DHF, and several thousand deaths occur annually worldwide (1). During the past decades, dengue virus has emerged in southern Asia; DF/DHF epidemics have occurred in Bhutan, India, Maldives, Bangladesh, and Pakistan (2–4). From August through November 2006, the number of febrile patients increased in 4 major hospitals in the Terai region of Nepal: Nepalgunj Medical College, Bheri Zonal Hospital in Nepalgunj, Tribhuban Hospital in Dang, and Narayani subregional hospital in Birgunj. Patients with severe symptoms were referred to Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, for diagnosis and treatment. The clinical features in most patients were consistent with signs of DF, but some patients showed signs (high fever, rash, ecchymosis, epistaxis, positive tourniquet test, liver dysfunction, and thrombocytopenia [platelet count 100 deaths (6). The first DF case in Nepal was reported in 2004 (7). Further, the first DENV-2 strain of Nepal origin was isolated from a Japanese traveler who visited Nepal and in which DF developed after the patient returned to Japan. The isolated DENV-2 (GenBank accession no. {type:entrez-nucleotide,attrs:{text:AB194882,term_id:55771291}}AB194882) was 98% homologous with DENV-2 isolated in India (8). The prevalence of dengue virus antibody was reported to be 10.4% in the southwestern region of Nepal (9). These reports suggest that dengue virus has been circulating in Nepal for several years. Thus, DF/DHF has likely been misdiagnosed and illness caused by dengue virus underestimated in Nepal. In contrast, Japanese encephalitis has been a public health problem in southwestern region of Nepal, and large epidemics have occurred almost every year since 1978 (10). Nepal has no dengue surveillance programs, and health professionals do not usually consider dengue as a differential diagnosis. The emergence occurred in the lowland Terai belt region, which borders the state of Bihar, India. The Aedes mosquito is known to persist in this region. The emerging DENV-2 is likely to have been introduced into Nepal from India.