Dengue outbreaks in the COVID-19 era: Alarm raised for Asia

Lu, Xinting; Bambrick, Hilary; Pongsumpun, Puntani; Dhewantara, Pandji Wibawa; Toàn, Đỗ Thị Thanh

doi:10.1371/journal.pntd.0009778

Cited by 21 publications

(24 citation statements)

References 22 publications

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“…Subgroup analysis revealed that the pooled RR in non-endemic areas (RR = 0.15, 95% CI: 0.10–0.21) was lower than that of endemic countries (RR = 0.52, 95% CI: 0.39–0.71) ( Figure 2A ). Twenty-nine effect indicator values from six studies (with analytic methods classified as BC) ( Ullrich et al., 2021 ; Liyanage et al., 2021 ; Conceição et al., 2021 ; Xiao et al., 2021 ; Lu et al., 2021 ; Chen et al., 2022 )were pooled to reveal an RR of 0.39 (95% CI: 0.28–0.55) through the effect/CI data setting. The pooled estimate in endemic group was nine times higher than that in non-endemic group, a pooled RR 0.06 (95% CI: 0.02-0.25) and 0.55 (95% CI: 0.44-0.68) respectively, in 2020 ( Figure 2B ).…”

Section: Resultsmentioning

confidence: 99%

Effects of COVID-19 Non-Pharmacological Interventions on Dengue Infection: A Systematic Review and Meta-Analysis

Dong

et al. 2022

Front. Cell. Infect. Microbiol.

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Non-pharmacological interventions (NPIs) implemented during the coronavirus disease 2019 (COVID-19) pandemic have demonstrated significant positive effects on other communicable diseases. Nevertheless, the response for dengue fever has been mixed. To illustrate the real implications of NPIs on dengue transmission and to determine the effective measures for preventing and controlling dengue, we performed a systematic review and meta-analysis of the available global data to summarize the effects comprehensively. We searched Embase, PubMed, and Web of Science in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines from December 31, 2019, to March 30, 2022, for studies of NPI efficacy on dengue infection. We obtained the annual reported dengue cases from highly dengue-endemic countries in 2015–2021 from the European Centre for Disease Prevention and Control to determine the actual change in dengue cases in 2020 and 2021, respectively. A random-effects estimate of the pooled odds was generated with the Mantel-Haenszel method. Between-study heterogeneity was assessed using the inconsistency index (I2) and subgroup analysis according to country (dengue-endemic or non-endemic) was conducted. This review was registered with PROSPERO (CRD42021291487). A total of 17 articles covering 32 countries or regions were included in the review. Meta-analysis estimated a pooled relative risk of 0.39 (95% CI: 0.28–0.55), and subgroup revealed 0.06 (95% CI: 0.02-0.25) and 0.55 (95% CI: 0.44-0.68) in dengue non-endemic areas and dengue-endemic countries, respectively, in 2020. The majority of highly dengue-endemic countries in Asia and Americas reported 0–100% reductions in dengue cases in 2020 compared to previous years, while some countries (4/20) reported a dramatic increase, resulting in an overall increase of 11%. In contrast, there was an obvious reduction in dengue cases in 2021 in almost all countries (18/20) studied, with an overall 40% reduction rate. The overall effectiveness of NPIs on dengue varied with region and time due to multiple factors, but most countries reported significant reductions. Travel-related interventions demonstrated great effectiveness for reducing imported cases of dengue fever. Internal movement restrictions of constantly varying intensity and range are more likely to mitigate the entire level of dengue transmission by reducing the spread of dengue fever between regions within a country, which is useful for developing a more comprehensive and sustainable strategy for preventing and controlling dengue fever in the future.

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Section: Resultsmentioning

confidence: 99%

Effects of COVID-19 Non-Pharmacological Interventions on Dengue Infection: A Systematic Review and Meta-Analysis

Dong

et al. 2022

Front. Cell. Infect. Microbiol.

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“…During the COVID-19 pandemic, several dengue-endemic countries in Asia and South America have experienced concurrent outbreaks of dengue and COVID-19 [ 1 , 2 , 3 , 4 ]. In the early stages of illness, dengue and COVID-19 can be difficult to distinguish because clinical and laboratory features may potentially overlap, presenting as undifferentiated fever associated with nonspecific signs and symptoms [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…During overlapping “twin-demics” of dengue and COVID-19, all cases of undifferentiated febrile illness may need to be managed as COVID-19 until proved otherwise via diagnostic testing, with significant implications on healthcare resources. Misdiagnosis or delay in diagnosis of dengue is also conceivable because of the similarities in clinical manifestations of these two diseases [ 4 , 5 ]. Reliance on diagnostic testing to distinguish these two diseases further strains laboratory capacity, especially in resource-limited settings where molecular testing for SARS-CoV-2 and dengue may be unavailable [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Dengue and COVID-19: Managing Undifferentiated Febrile Illness during a “Twindemic”

Wee

Sim

et al. 2022

TropicalMed

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Background: During the COVID-19 pandemic, distinguishing dengue from COVID-19 in endemic areas can be difficult, as both may present as undifferentiated febrile illness. COVID-19 cases may also present with false-positive dengue serology. Hospitalisation protocols for managing undifferentiated febrile illness are essential in mitigating the risk from both COVID-19 and dengue. Methods: At a tertiary hospital contending with COVID-19 during a dengue epidemic, a triage strategy of routine COVID-19 testing for febrile patients with viral prodromes was used. All febrile patients with viral prodromes and no epidemiologic risk for COVID-19 were first admitted to a designated ward for COVID-19 testing, from January 2020 to December 2021. Results: A total of 6103 cases of COVID-19 and 1251 cases of dengue were managed at our institution, comprising a total of 3.9% (6103/155,452) and 0.8% (1251/155,452) of admissions, respectively. A surge in dengue hospitalisations in mid-2020 corresponded closely with the imposition of a community-wide lockdown. A total of 23 cases of PCR-proven COVID-19 infection with positive dengue serology were identified, of whom only two were true co-infections; both had been appropriately isolated upon admission. Average length-of-stay for dengue cases initially admitted to isolation during the pandemic was 8.35 days (S.D. = 6.53), compared with 6.91 days (S.D. = 8.61) for cases admitted outside isolation (1.44 days, 95%CI = 0.58–2.30, p = 0.001). Pre-pandemic, only 1.6% (9/580) of dengue cases were admitted initially to isolation-areas; in contrast, during the pandemic period, 66.6% (833/1251) of dengue cases were initially admitted to isolation-areas while awaiting the results of SARS-CoV-2 testing. Conclusions: During successive COVID-19 pandemic waves in a dengue-endemic country, coinfection with dengue and COVID-19 was uncommon. Routine COVID-19 testing for febrile patients with viral prodromes mitigated the potential infection-prevention risk from COVID-19 cases, albeit with an increased length-of-stay for dengue hospitalizations admitted initially to isolation.

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“…While the health care facilities in many countries are overwhelmed due to the ongoing COVID-19 pandemic, many countries in Asia are further affected due to the double burden of dengue and COVID-19 [ 13 , 14 ]. Both dengue and COVID-19 can have a somewhat similar clinical presentation with fever, myalgia, headaches, loss of appetite and especially in children sore throat [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of rupatadine in reducing the incidence of dengue haemorrhagic fever in patients with acute dengue: A randomised, double blind, placebo-controlled trial

et al. 2022

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Background Rupatadine was previously shown to reduce endothelial dysfunction in vitro, reduced vascular leak in dengue mouse models and to reduce the extent of pleural effusions and thrombocytopenia in patients with acute dengue. Therefore, we sought to determine the efficacy of rupatadine in reducing the incidence of dengue haemorrhagic fever (DHF) in patients with acute dengue. Methods and findings A phase 2, randomised, double blind, placebo controlled clinical trial was carried out in patients with acute dengue in Sri Lanka in an outpatient setting. Patients with ≤3 days since the onset of illness were either recruited to the treatment arm of oral rupatadine 40mg for 5 days (n = 123) or the placebo arm (n = 126). Clinical and laboratory features were measured daily to assess development of DHF and other complications. 12 (9.7%) patients developed DHF in the treatment arm compared to 22 (17.5%) who were on the placebo although this was not significant (p = 0.09, relative risk 0.68, 95% CI 0.41 to 1.08). Rupatadine also significantly reduced (p = 0.01) the proportion of patients with platelet counts <50,000 cells/mm3 and significantly reduced (p = 0.04) persisting vomiting, headache and hepatic tenderness (p<0.0001) in patients. However, there was no difference in the duration of illness and in the proportion of individuals who required hospital admission in both treatment arms. Only 2 patients on rupatadine and 3 patients on the placebo developed shock, while bleeding manifestations were seen in 6 patients on rupatadine and 7 patients on the placebo. Conclusions Rupatadine appeared to be safe and well tolerated and showed a trend towards a reducing proportion of patients with acute dengue who developed DHF. It usefulness when used in combination with other treatment modalities should be explored. Trial registration International Clinical Trials Registration Platform: SLCTR/2017/024.

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Dengue outbreaks in the COVID-19 era: Alarm raised for Asia

Cited by 21 publications

References 22 publications

Effects of COVID-19 Non-Pharmacological Interventions on Dengue Infection: A Systematic Review and Meta-Analysis

Effects of COVID-19 Non-Pharmacological Interventions on Dengue Infection: A Systematic Review and Meta-Analysis

Dengue and COVID-19: Managing Undifferentiated Febrile Illness during a “Twindemic”

Efficacy of rupatadine in reducing the incidence of dengue haemorrhagic fever in patients with acute dengue: A randomised, double blind, placebo-controlled trial

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