Komal Raj Rijal1, Bipin Adhikari2,3, Bindu Ghimire4, Binod Dhungel4, Uttam Raj Pyakurel5, Prakash Shah5, Anup Bastola6, Binod Lekhak4, Megha Raj Banjara4, Basu Dev Pandey5, Daniel M Parker7, Prakash Ghimire4. 1. Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal. komal.rijal@cdmi.tu.edu.np. 2. Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK. 3. Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand. 4. Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal. 5. Epidemiology and Diseases Control Division (EDCD), Department of Health Service, Ministry of Health and Population, Teku, Kathmandu, Nepal. 6. Sukraraj Tropical and Infectious Disease Hospital Teku, Kathmandu, Nepal. 7. University of California, Irvine, CA, USA.
Abstract
BACKGROUND: Dengue is one of the newest emerging diseases in Nepal with increasing burden and geographic spread over the years. The main objective of this study was to explore the epidemiological patterns of dengue since its first outbreak (2006) to 2019 in Nepal. METHODS: This study is a retrospective analysis that covers the last 14 years (2006-2019) of reported dengue cases from Epidemiology Diseases Control Division (EDCD), Ministry of Health and Population, Government of Nepal. Reported cases were plotted over time and maps of reported case incidence were generated (from 2016 through 2019). An ecological analysis of environmental predictors of case incidence was conducted using negative binomial regression. RESULTS: While endemic dengue has been reported in Nepal since 2006, the case load has increased over time and in 2019 a total of 17 992 dengue cases were reported from 68 districts (from all seven provinces). Compared to the case incidence in 2016, incidence was approximately five times higher in 2018 [incidence rate ratio (IRR): 4.8; 95% confidence interval (CI) 1.5-15.3] and over 140 times higher in 2019 (IRR: 141.6; 95% CI 45.8-438.4). A one standard deviation increase in elevation was associated with a 90% decrease in reported case incidence (IRR: 0.10; 95% CI 0.01-0.20). However, the association between elevation and reported cases varied across the years. In 2018 there was a cluster of cases reported from high elevation Kaski District of Gandaki Province. Our results suggest that dengue infections are increasing in magnitude and expanding out of the lowland areas to higher elevations over time. CONCLUSIONS: There is a high risk of dengue outbreak in the lowland Terai region, with increasing spread towards the mid-mountains and beyond as seen over the last 14 years. Urgent measures are required to increase the availability of diagnostics and resources to mitigate future dengue epidemics.
BACKGROUND: Dengue is one of the newest emerging diseases in Nepal with increasing burden and geographic spread over the years. The main objective of this study was to explore the epidemiological patterns of dengue since its first outbreak (2006) to 2019 in Nepal. METHODS: This study is a retrospective analysis that covers the last 14 years (2006-2019) of reported dengue cases from Epidemiology Diseases Control Division (EDCD), Ministry of Health and Population, Government of Nepal. Reported cases were plotted over time and maps of reported case incidence were generated (from 2016 through 2019). An ecological analysis of environmental predictors of case incidence was conducted using negative binomial regression. RESULTS: While endemic dengue has been reported in Nepal since 2006, the case load has increased over time and in 2019 a total of 17 992 dengue cases were reported from 68 districts (from all seven provinces). Compared to the case incidence in 2016, incidence was approximately five times higher in 2018 [incidence rate ratio (IRR): 4.8; 95% confidence interval (CI) 1.5-15.3] and over 140 times higher in 2019 (IRR: 141.6; 95% CI 45.8-438.4). A one standard deviation increase in elevation was associated with a 90% decrease in reported case incidence (IRR: 0.10; 95% CI 0.01-0.20). However, the association between elevation and reported cases varied across the years. In 2018 there was a cluster of cases reported from high elevation Kaski District of Gandaki Province. Our results suggest that dengue infections are increasing in magnitude and expanding out of the lowland areas to higher elevations over time. CONCLUSIONS: There is a high risk of dengue outbreak in the lowland Terai region, with increasing spread towards the mid-mountains and beyond as seen over the last 14 years. Urgent measures are required to increase the availability of diagnostics and resources to mitigate future dengue epidemics.
Authors: Nikos Vasilakis; Jane Cardosa; Kathryn A Hanley; Edward C Holmes; Scott C Weaver Journal: Nat Rev Microbiol Date: 2011-06-13 Impact factor: 60.633
Authors: Shyam P Dumre; Geeta Shakya; Kesara Na-Bangchang; Veerachai Eursitthichai; Hans Rudi Grams; Senendra R Upreti; Prakash Ghimire; Khagendra KC; Ananda Nisalak; Robert V Gibbons; Stefan Fernandez Journal: Am J Trop Med Hyg Date: 2013-02-18 Impact factor: 2.345
Authors: Henrik Salje; Derek A T Cummings; Isabel Rodriguez-Barraquer; Leah C Katzelnick; Justin Lessler; Chonticha Klungthong; Butsaya Thaisomboonsuk; Ananda Nisalak; Alden Weg; Damon Ellison; Louis Macareo; In-Kyu Yoon; Richard Jarman; Stephen Thomas; Alan L Rothman; Timothy Endy; Simon Cauchemez Journal: Nature Date: 2018-05-23 Impact factor: 49.962