Dengue in Western Uganda: a prospective cohort of children presenting with undifferentiated febrile illness
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RESEARCH ARTICLE
Open Access
Dengue in Western Uganda: a prospective cohort of children presenting with undifferentiated febrile illness Ross M. Boyce1,2* , Matthew Collins3, Rabbison Muhindo2, Regina Nakakande2, Emily J. Ciccone1, Samantha Grounds1,4, Daniel Espinoza3, Yerun Zhu3, Michael Matte2, Moses Ntaro2, Dan Nyehangane2,5, Jonathan J. Juliano1 and Edgar M. Mulogo2
Abstract Background: The spatial distribution and burden of dengue in sub-Saharan Africa remains highly uncertain, despite high levels of ecological suitability. The goal of this study was to describe the epidemiology of dengue among a cohort of febrile children presenting to outpatient facilities located in areas of western Uganda with differing levels of urbanicity and malaria transmission intensity. Methods: Eligible children were first screened for malaria using rapid diagnostic tests. Children with a negative malaria result were tested for dengue using a combination NS1/IgM/IgG rapid test (SD Bioline Dengue Duo). Confirmatory testing by RT-PCR was performed in a subset of participants. Antigen-capture ELISA was performed to estimate seroprevalence. Results: Only 6 of 1416 (0.42%) children had a positive dengue rapid test, while none of the RT-PCR results were positive. ELISA testing demonstrated reactive IgG antibodies in 28 (2.2%) participants with the highest prevalence seen at the urban site in Mbarara (19 of 392, 4.9%, p < 0.001). Conclusions: Overall, these findings suggest that dengue, while present, is an uncommon cause of non-malarial, pediatric febrile illness in western Uganda. Further investigation into the eocological factors that sustain low-level transmission in urban settings are urgently needed to reduce the risk of epidemics. Keywords: Dengue, Fever, Arbovirus, Epidemiology, Uganda
Background Dengue is a mosquito-borne viral disease that is estimated to cause upwards of 400 million infections each year [1, 2]. While more than half of the world’s population is thought to be at risk, the global burden of dengue remains highly uncertain [3]. Nowhere is this epidemiological uncertainty more pronounced than in Africa, * Correspondence: [email protected] 1 Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA 2 Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, Mbarara, Uganda Full list of author information is available at the end of the article
where the requisite laboratory infrastructure to distinguish dengue from other causes of febrile illness is not routinely available [4, 5]. Despite limited data, there is reasonable consensus for the existence of endemic dengue transmission in many countries, with modeling frameworks suggesting that Africa’s disease burden may be similar to that of other high transmission areas, such as the Americas [1]. The East African highlands, including areas of Uganda, Rwanda, and Burundi, represent a region of especially high uncertainly [3]. While previous studies of pediatric admissio
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