This document summarizes a presentation on the seroepidemiology of dengue fever in Khyber Pakhtunkhwa, Pakistan. Key findings include: - A study of 612 suspected dengue patients found 319 positive for dengue antibodies, with the highest rates in Peshawar district. - Males and individuals with a history of travel to endemic areas had higher rates of IgM antibodies, indicating primary infection. - 20.21% of subjects were positive for IgG antibodies, indicating secondary infection. - Dengue cases peaked in September with 4 deaths, and were most common in post-monsoon season and urban areas.

1. Presentation Topic:
Seroepidemiology of dengue fever
in Khyber Pakhtunkhwa, Pakistan
Subject: Epidemiology
Muhammad Abbas
7th Semester
Roll.No:14-009
Rehman College of Allied Health sciences Hayatabad Peshawar

2. Introduction
 Dengue is a most significant febrile illness caused by a single
stranded an enveloped RNA virus belongs to the family
Flaviviridae, (genus Flavivrus.)

3. Intro Cont….
 Four distinctive antigenically related dengue virus serotypes:
DENV-1, DENV-2, DENV-3, and DENV-4.

4. Intro Cont….
 Medical manifestations of dengue infection range from asymptomatic,to mild flu-
like symptoms,to severe life-threatening dengue complications,such as dengue shock
syndrome and dengue hemorrhagic fever.

5. History
 Since the first isolation of the dengue virus in Japan in 1943, it has
been active sporadically in different parts of the world.

6. Cont….
 The earliest well-known outbreak of DHF (Dengue hemorrhagic
fever) occurred in the city of Manila, Philippines in 1953–1954. It
has now been transmitted geographically from Southeast Asian
states to Asian states including Sri Lanka, India, and Pakistan

7. Cont….
 The first case of DHF in Pakistan was reported in 1994 and since
then its prevalence has increased rapidly. Pakistan was considered
a non-endemic country until 1993, but is now considered endemic
for dengue.

8. Cont….
 In 2005 an outbreak of dengue with DENV-3 serotype was
documented in Karachi. Khan and his colleagues found co
circulation of serotypes DENV-2 and DENV-3 and concluded that
dengue is now hyperendemic in Pakistan.

9. Data collection
 Data were collected from different primary, secondary, and tertiary
collection centers situated in KPK.
 A total of 612 patients with a suspected infection were selected for
the study; 489 (79.90%) were males and 123 (20.09%) were
females.

10. Results
 Sum of 612 dengue suspected subjects were enrolled in this setup.
Of the 612 suspected cases, 319 were seen positive for dengue
IgG, IgM.

11. Distribution of dengue fever by gender in the different
districts of KPK
 Serum was collected from 612 suspected
dengue patients
 from the following districts: Peshawar (n =
148), Mansehra
 (n = 61), Abbottabad (n = 59), Mardan (n =
64), Nowshera
 (n = 37), Swat (n = 24), Kohat (n = 31), Dir
(lower) (n = 22),
 Haripur (n = 29), Charsadda (n = 24),
Shangla (n = 33), Bannu
 (n = 27), Karak (n = 21), Swabi (n = 15),
and Dera Ismail khan
 (n = 17). A total of 319 (52.12%) samples
were found ELISApositive
 for dengue antibodies: 195 IgM (31.86%)
and 124 IgG
 (20.26%). The highest seropositivity of IgM
and IgG was reported
 from the district of Peshawar (n = 93,
29.15%), followed by
 Mansehra (n = 40, 12.5%), Abbottabad (n =
39, 12.2%), Mardan
 (n = 38, 11.9%), Nowshera (n = 17, 5.32%),
Swat (n = 14, 4.38%),
 Kohat (n = 13, 4%), Dir (lower) (n = 13,
4%), Haripur (n = 12,
 3.76%), Charsadda (n = 10, 13.13%),
Shangla (n = 8, 2.50%), Bannu
 (n = 7, 2.19%), Karak (n = 6,1.88%), Swabi
(n = 5,1.56%),and Dera
 Ismail Khan (n = 4, 1.25%)

13. Dengue fever confirmation by IgM and selected variables in
dengue patients of KPK
 Out of the 612 study subjects, 31.86% (95% confidence interval
(CI) 28.17–35.55) were found to be IgM-positive (primary
infection). The most prevalent incidence of IgM antibodies was
observed in males (37.24%, 95% CI 32.96–41.52), compared to
females.

14.  Most of the IgM antibodies were found positive in patients with a
history of travel to an endemic area. Travel history was strongly
associated with IgM-positive subjects

15. Dengue fever confirmation by IgG and selected variables in
dengue patients of KPK
 Out of the 612 study subjects, 20.21% (95% CI 17.03–23.39)
were detected positive for dengue IgG (secondary infection).

17. Monthly distribution of dengue cases and deaths in
year 2011 in KPK
 A high incidence of dengue was observed in September(n = 216),
including four deaths. In October, 98 cases were detected and two
patients died; furthermore, five cases were diagnosed in August
and one death occurred

18. Discussion
 This is the first large-scale seroprevalence study of dengue
infection reported from Khyber Pakhtunkhawa Province of
Pakistan.

19.  In a study from Singapore, reported that fever, headache, joint
pain, fatigue, and skin rashes were statistically associated with
dengue.
 Similarly, the majority of our entire febrile cohort were
symptomatic and symptoms were statistically related to dengue
infection. Fever, headache, joint pain, and fatigue, as well as skin
rashes were statistically linked with dengue infection.

20. Conclusion
 In conclusion, these results indicate a large earlier exposure of the
people of KPK to dengue. The present febrile cohort study showed
that young people and males are more disposed to dengue fever.
Dengue infection was most frequent in the post-monsoon season,
in urban areas, and in patients with a history of travel to an
endemic area.

21. References
1. Naeem-Ullah U, Akram W. Dengue knowledge, attitudes and practices in
Multan, Pakistan: an urban area at the verge of dengue infestation. Public
Health 2009;123:452–3.
2. Chakravarti A, Kumaria R, Berry N, Sharma VK. Serodiagnosis of dengue
infection
by rapid immunochromatography test in a hospital setting in Delhi, 1999–
2001. Dengue Bull 2002;26:936–9.
3. Halstead S, Suaya J, Shepard D. The burden of dengue infection. Lancet
2007;369:1411–2.
4. Gupta E, Dar L, Kapoor G, Broor S. The changing epidemiology of dengue in
Delhi, India. Virol J 2006;3:92.
5. Gubler DJ, Clark GG. Dengue/dengue hemorrhagic fever: the emergence of a
global health problem. Emerg Infect Dis 1999;52:55–7.