VIROLOGY


called Dengvaxia and its use is limited to those who have had previous infection.14


Recent advances in development of an attenuated dengue virus vaccine have showed promising results, and the vaccine known by the trade name Qdenga has been licensed for use in several countries, covers all four virus strains, and does not appear to have antibody-dependant enhancement effects in clinical trials.15 The European Union licensed the vaccine for over four-year-olds in 2022.16 However, access to vaccination is currently limited to those who have had dengue in the past or those who work with the virus. Currently there are no specific antiviral agents for dengue virus infections, and treatment is limited to the symptoms it causes. Patients should remain hydrated and take paracetamol for pain and fever relief. Drugs that have anticoagulant properties, namely, acetylsalicylic (aspirin) containing, and anti-inflammatory (ibuprofen) drugs, should be avoided.10 For patients who develop severe disease, hospital stay and close observation, possibly with intensive care nursing, may be required. Prophylactic treatment with platelets to combat thrombocytopenia is not considered beneficial and may lead to a fluid overload. Furthermore, administration of corticosteroids has thus far not demonstrated benefit, and should not be used.10 As there is no specific treatment and vaccination being currently limited in its supply, the most effective way to prevent dengue disease is to prevent being bitten by the vector. Education is imperative in endemic areas and WHO has effective guidelines available both for the public and healthcare professionals.4 It suggests that when in an endemic area the usual covering of skin with effective clothing and use of mosquito nets are indicated. To complement this the use of insect repellents, coils and vaporisers are advised. Public health measures to prevent mosquitos from accessing egg- laying habitats, including drainage of stagnant water, use of oils, insecticides and covering of domestic water storage containers with regular cleaning, are advised.4


Conclusion In conclusion, there is considerable evidence to show that we need to increase our awareness, knowledge and diagnostic capability across the UK and Europe for infectious diseases that this vector and others can bring to our shores. Interestingly at the European Society of Clinical Microbiology


Diagnosis is often difficult without clinical suspicion and travel knowledge. Moreover, a lack of knowledge in both endemic and non-endemic areas makes diagnosing this disease particularly difficult


and Infectious Disease (ESCMID) Global conference held in Barcelona in April 2024, the Aedes mosquito and diseases it can carry were a significant topic of discussion. It is now time to understand these diseases and their epidemiology as they are moving out of the tropics.


References 1 European Centre for Disease Prevention


and Control. Dengue. ECDC, 2024. www.ecdc.europa.eu/en/dengue


2 World Health Organization. Dengue – Global situation. Geneva: WHO, 2023. https://www.who.int/emergencies/ disease-outbreak-news/item/2023- DON498


3 Colón-González FJ, Sewe MO, Tompkins AM et al. Projecting the risk of mosquito-borne diseases in a warmer and more populated world: a multi- model, multi-scenario intercomparison modelling study. Lancet Planet Health. 2021;5(7):e404-e414. doi:10.1016/S2542- 5196(21)00132-7 Correction in Lancet Planet Health. 2021 Aug;5(8):e504]. doi: 10.1016/S2542-5196(21)00207-2.


4 World Health Organization. Dengue and severe dengue fact sheet. Geneva: (WHO, 2024. https://www.who.int/news- room/fact-sheets/detail/dengue-and- severe-dengue


5 Zerfu B, Kassa T, Legesse M. Epidemiology, biology, pathogenesis, clinical manifestations, and diagnosis of dengue virus infection, and its trend in Ethiopia: a comprehensive literature review. Trop Med Health. 2023;51(1):11. doi:10.1186/s41182-023-00504-0


6 World Health Organization. Dengue: guidelines for diagnosis, treatment, prevention and control. Geneva: WHO, 2009. https://www.who.int/publications/i/ item/9789241547871


7 Pan American Health Organization. Epidemiological Update Increase in dengue cases in the Region of the Americas. PAHO, 29 March 2024. https://www.paho.org/en/documents/ epidemiological-update-increase-dengue- cases-region-americas-29-march-2024


8 Public Health England. Dengue fever: guidance, data and analysis. London: PHE, 2009. www.gov.uk/government/ collections/dengue-fever-guidance-data- and-analysis


WWW.PATHOLOGYINPRACTICE.COM JUNE 2024


9 World Health Organization. Neglected Tropical Diseases. Geneva: WHO, 2024. https://www.who.int/health-topics/ neglected-tropical-diseases


10 Centers for Disease Control and Prevention. Dengue. Atlanta: CDC, 2023. www.cdc.gov/dengue/index.html


11 Hasan S, Jamdar SF, Alalowi M, Al Ageel Al Beaiji SM. Dengue virus: A global human threat: Review of literature. J Int Soc Prev Community Dent. 2016;6(1):1-6. doi:10.4103/2231-0762.175416


12 World Health Organization. Second WHO Model List of Essential In Vitro Diagnostics. Geneva: WHO, 2024. www.who.int/publications/i/item/WHO- MVP-EMP-2019.05


13 Certest Biotec. Viasure Diagnostic Assays. www.certest.es/viasure/


14 Thomas SJ. Is new dengue vaccine efficacy data a relief or cause for concern?. NPJ Vaccines. 2023;8(1):55. doi:10.1038/s41541-023-00658-2


15 Biswal S, Reynales H, Saez-Llorens X et al. Efficacy of a Tetravalent Dengue Vaccine in Healthy Children and Adolescents. N Engl J Med. 2019;381(21):2009-2019. doi:10.1056/NEJMoa1903869


16 European Medicines Agency. New vaccine to protect people in the EU and worldwide against dengue. Amsterdam: EMA, 2022. https://www.ema.europa.eu/ en/news/new-vaccine-protect-people-eu- and-worldwide-against-dengue


Dr Neil Bentley OBE is an experienced biomedical scientist with over 40 years of science, management and leadership experience within the field of pathology and public health. In a 25-year career with Public Health England (PHE) he was most recently Deputy Director Pathogen Genomics-COVID Programme until October 2022, previously he was Head of Specialist Microbiology Technical Services at PHE’s National Infection Service. He is currently Scientific Officer at Pro-Lab Diagnostics.


Pro-Lab Diagnostics The Viasure range of assays from Certest Biotec are available in the UK from Pro-Lab Diagnostics.


0151 353 1613 uksupport@pro-lab.com www.pro-lab.co.uk


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