The east coast districts are the possible epicenter of severe dengue in Sabah

Background: Malaysia recorded the highest number of dengue cases between 2014 and 2017. There are 13 states and three federal territories in Malaysia, and each area varies in their prevalence of dengue. Sabah is one of the states situated in Borneo, Malaysia. Although dengue has been increasing for the last several years, no study was being done to understand the burden and serotype distribution of the dengue virus (DENV) in Sabah. Therefore, the present study was carried out to understand the epidemiology of the dengue infection and the factors responsible for severe dengue in Sabah. Methods: Data on dengue infection were extracted from the dengue database of the state of Sabah from 2013 through 2018. DENV NS-1-positive serum samples from multiple sites throughout Sabah were sent to the state public health laboratory, Kota Kinabalu Public Health Laboratory, for serotype determination. The analysis of factors associated with severe dengue was determined from the data of 2018 only. Results: In 2013, there were 724 dengue cases; however, from 2014, dengue cases increased exponentially and resulted in 3423 cases in 2018. Increasing dengue cases also led to increased dengue mortality. The number of dengue deaths in 2013 was only five which then gradually increased, and in 2018, 29 patients died. This is an increase of 580% from 2013 to 2018. Deaths were considerably more in the districts of the east coast of Sabah compared with districts in the west coast. During the study period, all DENV serotypes could be identified as serotypes circulating in Sabah. In 2018, the predominant serotype was DENV-3. The monthly peak of dengue infection varied in different years. In the logistic regression analysis, it was identified that children were 6.5 times, patients infected with mixed serotype of DENV were 13 times, and cases from the districts of the east coast were 5.2 times more likely to develop severe dengue. Conclusions: An increasing trend of dengue infection has been observed in Sabah. The burden of dengue, severe dengue, and mortality was noted especially in the districts of the east coast of Sabah. Severe dengue was most likely developed in children, cases from the east coast, and patients infected with mixed serotype of DENV

The circulating serotypes of dengue in Sabah, Malaysian Borneo

Background: Dengue is a mosquito borne arbovirus affecting humans and dengue infection has become a major public health problem in Asia Pacific countries. The virus is a positive sense, single-stranded enveloped RNA virus of the genus flavivirus. Malaysia is a dengue endemic country where all four dengue serotypes (DENV-1,-2,-3 and -4) have been reported but serotype data of Sabah is lacking. The aim of this study was to determine the circulating serotypes and other risk factors for dengue patients in Sabah. Methods: This was a cross sectional study, conducted during 2013–2015. A total 579 NS1- positive serum samples obtained from dengue patients were included from Public Health Laboratory of Sabah. All the samples had previously been tested for NS1 dengue using SD Bioline kit. Dengue viral RNA was extracted from NS1-positive serum using QIAmp Viral RNA Mini Kit (Qiagen, Hilden, Germany) according to the manufacturer’s instructions. The NS1Ag positive samples were tested further by real time polymerase chain reaction (PCR) and reverse transcriptase PCR (RTPCR). Results: From 579 examined samples, 58% were from male patients and 42% were from females. Regarding circulating serotypes in the year 2013, DEN-4 was the predominant serotype at 84.54%, followed by DEN-1 (37.24%), DEN2 (18.12%) and DEN-3 (15.10%). In the year 2014, DEN1 was predominant (89.64%) followed by DEN-2 (31.22%), DEN-4 (10.75%) and DEN-3 (9.7%). Interestingly, in the year 2015, DEN-2 (45%) was predominant followed by DEN-1 (27%), DEN-4 (16%) and DEN-3 (12%). The number of patients with multiple serotype co-infections has seen increased in 2015. Conclusions: Our results show that the circulating serotypes is changing within different years. Therefore, early detection of circulating serotypes could be an important approach to prevent severe clinical outcomes during dengue outbreaks. It will be interesting to examine molecular characteristics and phylogenetic analysis of dengue in this geographical area

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security