Oman Medical Journal | 2019
Dengue Fever: An Emerging Disease in Oman Requiring Urgent Public \u2028Health Interventions
Abstract
Dengue, the most widespread mosquitoborne viral infection in humans, is an emerging public health problem in countries of the Eastern Mediterranean region threatening national, regional, and global health security.1,2 The disease is endemic in more than 128 countries in the African, Americas, Eastern Mediterranean, Southeast Asian, and the Western Pacific regions3,4 with estimates of 390 million cases representing 17% of the global burden of infectious diseases in 2013.5 Outbreaks and sporadic cases of dengue, denguelike disease, and dengue hemorrhagic fever (DHF) have been reported across the Eastern Mediterranean region, from Pakistan, Saudi Arabia, Yemen, Somalia, Sudan, Djibouti, and Oman (travel-related).6–9 Dengue fever (DF) is a self-limiting illness with clinical manifestations evoking a common viral illness. However, a few patients will develop DHF, which is a serious and potentially life-threatening disease.2 Aedes aeg ypti is the primary vector transmitting the dengue virus and three other viruses causing yellow fever, chikungunya, and Zika fever.2,10 In Oman, DF and DHF are notifiable diseases.8 Between 2001 and 2017, 173 cases were reported, and all were travel-related.8,9 Between 2013 and 2017, the annual notification rate of dengue exhibited an upward trend from 0.3 to 1 per 100 000 population, and the case fatality rate was 0.01%.8 Cases were mainly reported from the Muscat (9.6/100 000), Dhofar (2.4/100 000), and North Batinah (2/100 000) governorates. Ninety-five percent of cases were foreign-born adults from India, Sri Lanka, Pakistan, and other Asian nationalities. Only two indigenous cases of DF were reported both from the Dhofar governorate; a suspected case in 2004 (personal communication) and a confirmed case in 2009.8,11 In 2006, a one-year entomological survey was conducted in the Muscat governorate. Three Aedes species were discovered (A. arabiensis, A. granti, and A. vittatus), but the vector of dengue, A. aegypti, was not found. However, in December of 2018, entomological surveys yielded the vector A. aegypti in A ́Seeb, Busher, and Muttrah in the Muscat governorate. A similar survey was conducted in the Dhofar governorate in 2008, 2010, and 2012 and A. aegypti was captured in Sarfet, Deem, and Dhalqut with 10% of households positive for breeding. Other species found were A. vittatus and A. arabiensis.8,12 The vector breeding was continuously observed from July to August. In 2018, a total of 67 DF cases were notified, of which 30 cases (44.8%) were travel-related. None developed DHF, and no mortality was recorded. Between 12 November 2018 and 6 January 2019, 40 indigenous DF cases were reported13 and confirmed by using the immunoglobulin M antibody-capture enzyme-linked immunosorbent assay (MACELISA) or the polymerase chain reaction. During the same period, 14 cases were admitted to our hospital, 64% were male. The patients mean age was 43.4 years. Nine out of 14 cases were Omani, and five (35.7%) were foreign-born persons residing in Oman. All except one had no recent travel history to countries in which dengue was endemic (within 30 days of disease onset). All cases were residing in A ́Seeb namely Al Hail and Al Mawaleh. All patients presented with fever, myalgia, and editorial Oman Medical Journal [2019], Vol. 34, No. 2: 91-93