Volume 96, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Epidemiological data on dengue in Africa are still scarce. We investigated imported dengue infection among travelers with a high proportion of subjects from Africa over a 9-year period. From January 2005 to December 2013, blood samples from travelers with clinical suspicion of dengue were analyzed. Dengue was diagnosed using serological, antigen detection, and molecular methods. Subjects were classified according to birthplace (Europeans versus non-Europeans) and last country visited. Overall, 10,307 serum samples corresponding to 8,295 patients were studied; 62% were European travelers, most of them from Spain, and 35.9% were non-Europeans, the majority of whom were born in Africa (mainly Equatorial Guinea) and Latin America (mainly Bolivia, Ecuador, and Colombia). A total of 492 cases of dengue were identified, the highest number of cases corresponding to subjects who had traveled from Africa ( = 189), followed by Latin America ( = 174) and Asia ( = 113). The rate of cases for Africa (4.5%) was inferior to Asia (9%) and Latin America (6.1%). Three peaks of dengue were found (2007, 2010, and 2013) which correlated with African cases. A total of 2,157 of past dengue infections were diagnosed. Non-Europeans who had traveled from Africa had the highest rate of past infection (67.8%), compared with non-Europeans traveling from Latin America (38.7%) or Asia (35%). Dengue infection in certain regions of Africa is underreported and the burden of the disease may have a magnitude similar to endemic countries in Latin America. It is necessary to consider dengue in the differential diagnosis of other febrile diseases in Africa.


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  1. Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, Drake JM, Brownstein JS, Hoen AG, Sankoh O, Myers MF, George DB, Jaenisch T, Wint GR, Simmons CP, Scott TW, Farrar JJ, Hay SI, , 2013. The global distribution and burden of dengue. Nature 496: 504507.[Crossref] [Google Scholar]
  2. Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Hoen AG, Moyes CL, Farlow AW, Scott TW, Hay SI, , 2012. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis 6: e1760.[Crossref] [Google Scholar]
  3. Messina JP, Brady OJ, Scott TW, Zou C, Pigott DM, Duda KA, Bhatt S, Katzelnick L, Howes RE, Battle KE, Simmons CP, Hay SI, , 2014. Global spread of dengue virus types: mapping the 70 year history. Trends Microbiol 22: 138146.[Crossref] [Google Scholar]
  4. World Health Organization, 2012. Global Strategy for Dengue Prevention and Control, 2012–2020. WHO Report. Geneva, Switzerland: World Health Organization. [Google Scholar]
  5. Messina JP, Brady OJ, Pigott DM, Brownstein JS, Hoen AG, Hay SI, , 2014. A global compendium of human dengue virus occurrence. Sci Data 1: 140004.[Crossref] [Google Scholar]
  6. Organization for Economic Cooperation and Development (OECD), 2013. International Migration Outlook 2013: Spain. Paris, France: OECD Publishing. [Google Scholar]
  7. Schaffner F, Mathis A, , 2014. Dengue and dengue vectors in the WHO European region: past, present, and scenarios for the future. Lancet Infect Dis 14: 12711280.[Crossref] [Google Scholar]
  8. United Nations Statistic Division, 2016. Available at: http://unstats.un.org/unsd/methods/m49/m49regin.htm. Accessed December 29, 2016.
  9. Gurukumar KR, Priyadarshini D, Patil JA, Bhagat A, Singh A, Shah PS, Cecilia D, , 2009. Development of real time PCR for detection and quantitation of dengue viruses. Virol J 6: 10.[Crossref] [Google Scholar]
  10. Ito M, Takasaki T, Yamada K, Nerome R, Tajima S, Kurane I, , 2004. Development and evaluation of fluorogenic TaqMan reverse transcriptase PCR assays for detection of dengue virus types 1 to 4. J Clin Microbiol 42: 59355937.[Crossref] [Google Scholar]
  11. Peeling RW, Artsob H, Pelegrino JL, Buchy P, Cardosa MJ, Devi S, Enria DA, Farrar J, Gubler DJ, Guzman MG, Halstead SB, Hunsperger E, Kliks S, Margolis HS, Nathanson CM, Nguyen VC, Rizzo N, Vázquez S, Yoksan S, , 2010. Evaluation of diagnostic tests: dengue. Nat Rev Microbiol 8 (Suppl 12): S30S38.[Crossref] [Google Scholar]
  12. Cheesbrough M, , 1987. Medical Laboratory Manual for Tropical Countries, Vol. I, 2nd edition. Cambridge, United Kingdom: University Press. [Google Scholar]
  13. Were F, , 2012. The dengue situation in Africa. Paediatr Int Child Health 32 (Suppl 1): 1821.[Crossref] [Google Scholar]
  14. Amarasinghe A, Kuritsk JN, Letson GW, Margolis HS, , 2011. Dengue virus infection in Africa. Emerg Infect Dis 17: 13491354. [Google Scholar]
  15. Jaenisch T, Junghanss T, Wills B, Brady OJ, Eckerle I, Farlow A, Hay SI, McCall PJ, Messina JP, Ofula V, Sall AA, Sakuntabhai A, Velayudhan R, Wint GR, Zeller H, Margolis HS, Sankoh O, Dengue in Africa Study Group; , 2014. Dengue expansion in Africa—not recognized or not happening? Emerg Infect Dis 20: e140487.[Crossref] [Google Scholar]
  16. Massad E, Wilder-Smith A, , 2009. Risk estimates of dengue in travelers to dengue endemic areas using mathematical models. J Travel Med 16: 191193.[Crossref] [Google Scholar]
  17. Baba M, Logue CH, Oderinde B, Abdulmaleek H, Williams J, Lewis J, Laws TR, Hewson R, Marcello A, D'Agaro P, , 2013. Evidence of arbovirus co-infection in suspected febrile malaria and typhoid patients in Nigeria. J Infect Dev Ctries 7: 5159.[Crossref] [Google Scholar]
  18. Faye O, Ba Y, Faye O, Talla C, Diallo D, Chen R, Mondo M, Ba R, Macondo E, Siby T, Weaver SC, Diallo M, Sall AA, , 2014. Urban epidemic of dengue virus serotype 3 infection, Senegal, 2009. Emerg Infect Dis 20: 456459. [Google Scholar]
  19. Klarkowski D, O'Brien DP, Shanks L, Singh KP, , 2014. Causes of false-positive HIV rapid diagnostic test results. Expert Rev Anti Infect Ther 12: 4962.[Crossref] [Google Scholar]
  20. Vairo F, Nicastri E, Yussuf SM, Cannas A, Meschi S, Mahmoud MA, Mohamed AH, Maiko PM, De Nardo P, Bevilacqua N, Castilletti C, Di Caro A, Racalbuto V, Ippolito G, , 2014. IgG against dengue virus in healthy blood donors, Zanzibar, Tanzania. Emerg Infect Dis 20: 465468.[Crossref] [Google Scholar]
  21. Verschueren J, Cnops L, van Esbroeck M, , 2015. Twelve years of dengue surveillance in Belgian travellers and significant increases in the number of cases in 2010 and 2013. Clin Microbiol Infect 21: 867872.[Crossref] [Google Scholar]
  22. Pan American Health Organization (PAHO), 2016. Number of Reported Cases of Dengue and Severe Dengue (SD) in the Americas by Country. Available at: http://www.paho.org/hq/index.php?option=com_topics&view=readall&cid=3274&Itemid=40734&lang=en. Accessed December 29, 2016. [Google Scholar]
  23. Bureau of Epidemiology, MoPH, Thailand, 2016. Natural Disease Surveillance (Report 506): Dengue Fever. Available at: http://www.boe.moph.go.th/boedb/surdata/506wk/y58/en/d66_2658_en.pdf. Accessed December 29, 2016. [Google Scholar]
  24. Limkittikul K, Brett J, L'Azou M, , 2014. Epidemiological trends of dengue disease in Thailand (2000–2011): a systematic literature review. PLoS Negl Trop Dis 8: e3241.[Crossref] [Google Scholar]
  25. Bhatnagar S, Lal V, Gupta SD, Gupta OP, , 2012. Forecasting incidence of dengue in Rajasthan, using time series analyses. Indian J Public Health 56: 281285.[Crossref] [Google Scholar]
  26. Schwartz E, Weld LH, Wilder-Smith A, von Sonnenburg F, Keystone JS, Kain KC, Torresi J, Freedman DO, GeoSentinel Surveillance Network; , 2008. Seasonality, annual trends, and characteristics of dengue among ill returned travelers, 1997–2006. Emerg Infect Dis 14: 10811088.[Crossref] [Google Scholar]
  27. Sessions OM, Khan K, Hou Y, Meltzer E, Quam M, Schwartz E, Gubler DJ, Wilder-Smith A, , 2013. Exploring the origin and potential for spread of the 2013 dengue outbreak in Luanda, Angola. Glob Health Action 6: 21822.[Crossref] [Google Scholar]
  28. Centers for Disease Control and Prevention (CDC), 2010. Travel-associated dengue surveillance: United States, 2006–2008. Morb Mortal Wkly Rep 59: 715719. [Google Scholar]
  29. Epelboin L, Hanf M, Dussart P, Ouar-Epelboin S, Djossou F, Nacher M, Carme B, , 2012. Is dengue and malaria co-infection more severe than single infections? A retrospective matched-pair study in French Guiana. Malar J 11: 142.[Crossref] [Google Scholar]

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  • Received : 28 Apr 2016
  • Accepted : 02 Dec 2016
  • Published online : 06 Feb 2017

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