Dengue infection in India: A systematic review and meta-analysis

Abstract

IntroductionDengue is the most extensively spread mosquito-borne disease; endemic in more than 100 countries. Information about dengue disease burden, its prevalence, incidence and geographic distribution is critical in planning appropriate control measures against dengue fever. We conducted a systematic review and meta-analysis of dengue fever in IndiaMethodsWe searched for studies published until 2017 reporting the incidence, the prevalence or case fatality of dengue in India. Our primary outcomes were (a) prevalence of laboratory confirmed dengue infection among clinically suspected patients, (b) seroprevalence in the general population and (c) case fatality ratio among laboratory confirmed dengue patients. We used binomial–normal mixed effects regression model to estimate the pooled proportion of dengue infections. Forest plots were used to display pooled estimates. The metafor package of R software was used to conduct meta-analysis.ResultsOf the 2285 identified articles on dengue, we included 233 in the analysis wherein 180 reported prevalence of laboratory confirmed dengue infection, seven reported seroprevalence as evidenced by IgG or neutralizing antibodies against dengue and 77 reported case fatality. The overall estimate of the prevalence of laboratory confirmed dengue infection among clinically suspected patients was 38.3% (95% CI: 34.8%–41.8%). The pooled estimate of dengue seroprevalence in the general population and CFR among laboratory confirmed patients was 56.9% (95% CI: 37.5–74.4) and 2.6% (95% CI: 2–3.4) respectively. There was significant heterogeneity in reported outcomes (p-values<0.001).ConclusionsIdentified gaps in the understanding of dengue epidemiology in India emphasize the need to initiate community-based cohort studies representing different geographic regions to generate reliable estimates of age-specific incidence of dengue and studies to generate dengue seroprevalence data in the country.

Epidemiology of dengue fever in India, based on laboratory surveillance data, 2014–2017

“…While dengue positivity was high in all age groups, most laboratory confirmed patients were older than 20 years. This finding is consistent with the meta-analysis of published studies from India until 2017 which reported the mean age of laboratory confirmed dengue patients to be 22 years (Ganeshkumar et al, 2018).…”

Detection of dengue virus type 2 of Indian origin in acute febrile patients in rural Kenya

“…This suggests that dispersal of DENV-2 between Africa and India has occurred more than once. Globalization has probably facilitated the introduction of the Indian DENV to Kenya, as Kenya along with other African countries interacts actively with India for trade and travel [47], and India is hyperendemic for DENV [48].…”

Preparing for the dengue explosion in Kathmandu, Nepal

“…Excessive fluid administration will cause volume overload and pulmonary oedema, thus increasing mortality. 1, 3 Increased mortality has been seen in many previous outbreaks (as high as 25% in south India during 2008), 6 which could be due to improper fluid management.…”

“…Nepal should think ahead by learning lessons from the countries who suffered the onslaught of dengue in the past, 5,6 and apply lessons learnt to effectively combat the disease in future by formulating awareness…”