Repetitive dengue outbreaks in East Africa: A proposed phased mitigation approach may reduce its impact

Abstract

Dengue outbreaks have persistently occurred in eastern African countries for several decades. We assessed each outbreak to identify risk factors and propose a framework for prevention and impact mitigation. Seven out of ten countries in eastern Africa and three islands in the Indian Ocean have experienced dengue outbreaks between 1823 and 2014. Major risk factors associated with past dengue outbreaks include climate, virus and vector genetics and human practices. Appropriate use of dengue diagnostic tools and their interpretation are necessary for both outbreak investigations and sero-epidemiological studies. Serosurvey findings during inter-epidemic periods have not been adequately utilised to prevent re-occurrence of dengue outbreaks. Local weather variables may be used to predict dengue outbreaks, while entomological surveillance can complement other disease-mitigation efforts during outbreaks and identify risk-prone areas during inter-epidemic periods. The limitations of past dengue outbreak responses and the enormous socio-economic impacts of the disease on human health are highlighted. Its repeated occurrence in East Africa refutes previous observations that susceptibility may depend on race. Alternate hypotheses on heterotypic protection among flaviviruses may not be applied to all ecologies. Prevention and mitigation of severe dengue outbreaks should necessarily consider the diverse factors associated with their occurrence. Implementation of phased dengue mitigation activities can enforce timely and judicious use of scarce resources, promote environmental sanitation, and drive behavioural change, hygienic practices and community-based vector control. Understanding dengue epidemiology and clinical symptoms, as determined by its evolution, are significant to preventing future dengue epidemics.

The plasma virome of febrile adult Kenyans shows frequent parvovirus B19 infections and a novel arbovirus (Kadipiro virus)

“…Dengue infection can induce high fever and has been repeatedly detected in East Africa starting in 1982 (Baba et al, 2016;Johnson et al, 1982;Mease et al, 2011). Its detection in febrile Kenyan adults sampled for this study is also consistent with its detection in an outbreak reported from Mombasa, Kenya in 2013 (Ellis et al, 2015).…”

Evidence Decision-Making Policy Practice in Emerging Pandemics and Epidemics Threats Preparedness and Response Operations in Africa

“…This did not only distribute evidence more widely, but also produced explicit rather than evidence idleness [8,12]. Eventually, evidence management and sharing process thus became responsible to drive the shared behavioural changes and best practices with an understanding at the same time, important to improve of the overall preparedness, emergency response to care service delivery for impact [17,27].…”

“…Translation of knowledge-based in meeting the public needs, aspirations and expectations should be made clear at the outset, but understanding and trust may develop over time through seeing tangible benefits/gains from the collaborative endeavor [8,9]. Moreover, mutual and participative learning and better appreciation about each other's perspectives and contributions may lead to optimization on the full capacities and potential of all stakeholders to better preventive and curative processes and outcomes through the generation of more relevant and applicable knowledge.…”

“…Building and maintaining new, proactive and productive partnerships and collaboration to public health needs and demands require new momentum and leadership commitments and investments efforts, which is currently poorly advocated and neglected by governments, policy-makers and programs implementers across Africa [2,5,6]. Strengthening translation capabilities to ease of access on the use of information for quality, effective and reliable evidence understanding of the mechanisms that influence decision making is essential for devising strategies that encourage the effective use of information in decision making processes within the array of programs performance metrics associated with research [7,8]. More generally, mobilizing resources to undertake any type of research takes time to establish, by which time, the clinical/service question may have become less relevant or even redundant, clinical and implementation themes, had created silos, and reduced the opportunities for interaction, communication given attention to vulnerable or at-risk groups [4,9,10].…”

“…The evidence co-production emphasizes the importance of engaging and integrating the multiple perspectives of stakeholders that can shape the understanding, and processes of quality evidence production and uptake strategies [10]. Stakeholders coproduction partnership and cooperation requires both an organizational and a resource infrastructure, and, therefore, enabling political environment to foster mutual learning and shared experiences of evidence translation research, clinical and academic partnership network exploration and utilization in providing health for all [4,6,8]. There is an urgent need to understand evidence uptake impact in revamping public health, community seeking and participatory attitudes and behavior to successfully health outcomes and economic benefits.…”