High Dengue Burden and Circulation of 4 Virus Serotypes among Children with Undifferentiated Fever, Kenya, 2014–2017

Abstract

Little is known about the extent and serotypes of dengue viruses circulating in Africa. We evaluated the presence of dengue viremia during 4 years of surveillance (2014–2017) among children with febrile illness in Kenya. Acutely ill febrile children were recruited from 4 clinical sites in western and coastal Kenya, and 1,022 participant samples were tested by using a highly sensitive real-time reverse transcription PCR. A complete case analysis with genomic sequencing and phylogenetic analyses was conducted to characterize the presence of dengue viremia among participants during 2014–2017. Dengue viremia was detected in 41.9% (361/862) of outpatient children who had undifferentiated febrile illness in Kenya. Of children with confirmed dengue viremia, 51.5% (150/291) had malaria parasitemia. All 4 dengue virus serotypes were detected, and phylogenetic analyses showed several viruses from novel lineages. Our results suggests high levels of dengue virus infection among children with undifferentiated febrile illness in Kenya.

Dengue Virus Infection and Associated Risk Factors in Africa: A Systematic Review and Meta-Analysis

“…The findings from previous studies [ 90 , 91 ] show that co-morbidities increase the risk of severe disease and fatal outcomes among dengue patients. Our results show that in the past decade (2010–2020), malaria and dengue co-infections were the most prevalent, followed by dengue and chikungunya co-infection [ 24 , 31 , 40 , 43 , 53 , 56 , 79 , 92 , 93 , 94 , 95 ]. A similar occurrence pattern of malaria and dengue co-infection dominance followed by dengue and chikungunya co-infection was previously reported [ 96 ].…”

“…Spill-over of sylvatic DENV-2 strains from forest Aedes mosquitoes into a human transmission cycle possibly facilitates the spread into urban or new geographical areas with the potential to cause epidemics [ 85 , 86 ]. Further, increasing recognition of DENV as the cause of undifferentiated febrile syndromes [ 87 ], and the availability of more sensitive and specific molecular-based laboratory tests in the past decade, may have contributed to more detection and reporting of DENV serotypes [ 51 , 56 , 88 ].…”

Impact of recent climate extremes on mosquito-borne disease transmission in Kenya

“…Since DENV is heavily underreported in the region, all enrolled participants were tested for dengue and malaria. In a study of undifferentiated fever in Kenya between 2014–2017, 150 (51.5%) of 291 participants with dengue viremia were malaria smear positive, suggesting a large overlap in infections [ 38 ]. Additionally, flaviviruses, which include West Nile virus (WNV), ZIKA virus (ZIKAV), and yellow fever virus (YFV), have the potential to cross-react with DENV.…”

Concurrent circulation of dengue serotype 1, 2 and 3 among acute febrile patients in Cameroon

“…In Africa, dengue outbreaks have been recorded more frequently in many countries including Gabon, Angola, Mozambique, Kenya, Ethiopia, Sudan and Burkina Faso (6)(7)(8). All four DENV serotypes have been widely reported across Africa and the co-circulation of two or more serotypes, first reported from Gabon in 2013 ( 8) is becoming more common, e.g.…”

“…All four DENV serotypes have been widely reported across Africa and the co-circulation of two or more serotypes, first reported from Gabon in 2013 ( 8) is becoming more common, e.g. Kenya (7), Burkina Faso (6), Nigeria (9), Tanzania (10) raising fears that severe dengue will be seen more frequently in future outbreaks in Africa.. In Cameroon numerous studies over the past twenty years have reported seroprevalence rates in rural and urban areas in Cameroon, with no major outbreak notifications (11,12).…”