Volume 85, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Malaria is a major contributor to the burden of febrile illnesses in Papua New Guinea (PNG). Dengue fever (DF) is likely to contribute; however, its epidemiology in PNG is poorly understood. We performed a prospective age-stratified study in outpatient clinics investigating the prevalence of DF; 578 patients were enrolled, and 317 patients with a negative rapid diagnostic test (RDT) for malaria were tested for dengue. Malaria was confirmed in 52% (301/578, 95% confidence interval [CI] = 48–56%), DF was diagnosed in 8% (46/578, 95% CI = 6–10%), and 40% (95% CI = 36–44%) had neither diagnosis. Among the 317 malaria RDT-negative patients, 14% (45/317, 95% CI = 10–18%) had DF. The seroprevalence of dengue immunoglobulin G (IgG) was 83% (204/247, 95% CI = 78–87%), and no dengue hemorrhagic fever was seen. This study provides good evidence for the first time that DF is common in PNG and is responsible for 8% of fever episodes. The common occurrence of DF in a population with presumed previous exposure to dengue is an important observation.


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  1. Gubler D, Zaki S, Nelson AM, Horsburgh CR, , 1998. Dengue and other viral hemorrhagic fevers. , eds. Pathology of Emerging Infections. Washington, DC: ASM Press.
  2. World Health Organization, 2009. Dengue WHO: Guidelines for the Diagnosis, Treatment, Prevention, and Control. Geneva, Switzerland: World Health Organization.
  3. Deen JL, Harris E, Wills B, Balmaseda A, Hammond SN, Rocha C, Dung NM, Hung NT, Hien TT, Farrar JJ, , 2006.The WHO dengue classification and case definitions: time for a reassessment. Lancet 368: 170173.[Crossref]
  4. Shibani B, Lucy CSL, Axel K, , 2006. Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever. Trop Med Int Health 11: 12381255.[Crossref]
  5. Raymond CSS, Eng Eong O, Hwee Bee W, Nicholas IP, , 2005. An outbreak of primary dengue infection among migrant Chinese workers in Singapore characterized by prominent gastrointestinal symptoms and a high proportion of symptomatic cases. J Clin Virology 33: 336340.[Crossref]
  6. McBride WJ, Mullner H, LaBrooy JT, Wronski I, , 1998. The 1993 dengue 2 epidemic in Charters Towers, North Queensland: clinical features and public health impact. Epidemiol Infect 121: 151156.[Crossref]
  7. Halstead S, , 2003. Neutralization and antibody-dependent enhancement of dengue viruses. Adv Virus Res 60: 421467.[Crossref]
  8. Kuno G, , 2009. Emergence of the severe syndrome and mortality associated with dengue and dengue-like illness: historical records (1890 to 1950) and their compatibility with current hypotheses on the shift of disease manifestation. Clin Microbiol Rev 22: 186201.[Crossref]
  9. Halstead S, Nimmannitya S, Yamarat C, Russell P, , 1967. Hemorrhagic fever in Thailand; recent knowledge regarding etiology. Jpn J Med Sci Biol Dec(20 Suppl): 96103.
  10. Russell PK, Yuill TM, Nisalak A, Udomsakdi S, Gould DJ, Winter PE, , 1968. An insular outbreak of dengue hemorrhagic fever: II. Virologic and serologic studies. Am J Trop Med Hyg 17: 600608.
  11. Morens D, , 1994. Antibody-dependent enhancement of infection and the pathogenesis of viral disease. Clin Infect Dis 19: 500512.[Crossref]
  12. Stephens H, , 2010. HLA and other gene associations with dengue disease severity. Curr Top Microbiol Immunol 338: 99114.
  13. WHO, 2009. Available at: www.wpro.who.int/NR/rdonlyres/AB5C4FB4-58C5-4CFA-BD92-03C107E62B6F/0/DenguesituationinWPRO_2009.gif. Accessed April 21, 2011.
  14. Bouldouyre MA, Baumann F, Berlioz-Arthaud A, Chungue E, Lacassin F, , 2006. Factors of severity at admission during an epidemic of dengue 1 in New Caledonia (South Pacific) in 2003. Scand J Infect Dis 38: 675681.[Crossref]
  15. Nuegoonpipat A, Berlioz-Arthaud A, Chow V, Endy T, Lowry K, Mai le Q, Ninh TU, Pyke A, Reid M, Reynes JM, Su Yun ST, Thu HM, Wong SS, Holmes EC, Aaskov J, , 2004. Sustained transmission of dengue virus type 1 in the Pacific due to repeated introductions of different Asian strains. Virology 329: 505512.[Crossref]
  16. Rodhain F, Gaxotte P, Boutonnier A, , 1980. Results of an entomological survey of mosquitoes (diptera:Culicidae) in Hermit Islands and Wuvulu Island (Papua, New Guinea). Bull Soc Pathol Exot 73: 214219.
  17. Wang E, Ni H, Xu R, Barrett AD, Watowich SJ, Gubler DJ, Weaver SC, , 2000. Evolutionary relationships of endemic/epidemic and sylvatic dengue viruses. J Virol 74: 32273234.[Crossref]
  18. Zigas VDR, , 1973. An outbreak of dengue in the Rabaul community. P N G Med J 16: 4245.
  19. Gaxotte P, Rodhain F, Ardoin P, Hannoun C, , 1975. A sero-epidemiologic survey on arbovirus in Wuvulu Island. Trop Geogr Med 27: 405408.
  20. Kiedrzynski T, Souarès Y, , 1995. Dengue in the Pacific: an updated story. Pacific Health Dialog 5: 129136.
  21. Hanna JNRS, Richards AR, Taylor CT, Pyke AT, Montgomery BL, Piispanen JP, Morgan AK, Humphreys JL, , 2006. Multiple outbreaks of dengue serotype 2 in north Queensland. Aust N Z J Public Health 30: 220225.[Crossref]
  22. Richards AL, Bagus R, Baso SM, Follows GA, Tan R, Graham RR, Sandjaja B, Corwin AL, Punjabi N, , 1997. The first reported outbreak of dengue hemorrhagic fever in Irian Jaya, Indonesia. Am J Trop Med Hyg 57: 4955.
  23. Cuzzubbo AJ, Vaughn DW, Nisalak A, Solomon T, Kalayanarooj S, Aaskov J, Dung NM, Devine PL, , 2000. Comparison of PanBio dengue duo IgM and IgG capture ELISA and venture technologies dengue IgM and IgG dot blot. J Clin Virol 16: 135144.[Crossref]
  24. Porter KR, Widjaja S, Lohita HD, Hadiwijaya SH, Maroef CN, Suharyono W, Tan R, , 1999. Evaluation of a commercially available immunoglobulin M capture enzyme-linked immunosorbent assay kit for diagnosing acute dengue infections. Clin Diagn Lab Immunol 6: 741744.
  25. Vaughn DW, Nisalak A, Kalayanarooj S, Solomon T, Dung NM, Cuzzubbo A, Devine PL, , 1998. Evaluation of a rapid immunochromatographic test for diagnosis of dengue virus infection. J Clin Microbiol 36: 234238.
  26. Watanaveeradej V, Endy TP, Samakoses R, Kerdpanich A, Simasathien S, Polprasert N, Aree C, Vaughn DW, Ho C, Nisalak A, , 2003. Transplacentally tranferred maternal-infant antibodies to dengue virus. Am J Trop Med Hyg 69: 123128.
  27. Chau TN, Hieu NT, Anders KL, Wolbers M, Lien le B, Hieu LT, Hien TT, Hung NT, Farrar J, Whitehead S, Simmons CP, , 2009. Dengue virus infections and maternal antibody decay in a prospective birth cohort study of Vietnamese infants. J Infect Dis 200: 18931900.[Crossref]
  28. Vallée J, Dubot-Pérès A, Ounaphom P, Sayavong C, Bryant J, Gonzalez J, , 2009. Spatial distribution and risk factors of dengue and Japanese encephalitis virus infection in urban settings: the case of Vientiane, Lao PDR. Trop Med Int Health 14: 11341142.[Crossref]
  29. Darcy A, Clothier H, Phillips D, Bakote'e B, Stewart T, , 2001. Solomon Islands dengue seroprevalence study–previous circulation of dengue confirmed. P N G Med J 44: 4347.
  30. Pengsaa K, Limkittikul K, Luxemburger C, Yoksan S, Chambonneau L, Ariyasriwatana C, Lapphra K, Chanthavanich P, Lang J, Sabchareon A, , 2008. Age-specific prevalence of dengue antibodies in Bangkok infants and children. Pediatr Infect Dis J 27: 461463.[Crossref]
  31. Hanson J, Taylor C, Richards A, Smith I, Boutlis C, , 2004. Japanese encephalitis acquired near Port Moresby: implications for residents and travellers to Papua New Guinea. Med J Aust 181: 282283.
  32. Johansen CA, van den Hurk AF, Ritchie SA, Zborowski P, Nisbet DJ, Paru R, Bockarie MJ, Macdonald J, Drew AC, Khromykh TI, Mackenzie JS, , 2000. Isolation of Japanese encephalitis virus from mosquitoes (Diptera: Culicidae) collected in the Western Province of Papua New Guinea, 1997–1998. Am J Trop Med Hyg 62: 631638.
  33. James A, , 2008. Potts ALR. Clinical and laboratory features that distinguish dengue from other febrile illnesses in endemic populations. Trop Med Int Health 13: 13281340.[Crossref]
  34. Schexneider KI, Reedy EA, , 2005. Thrombocytopenia in dengue fever. Curr Hematol Rep 4: 145148.[Crossref]
  35. Tanner L, Schreiber M, Low JG, Ong A, Tolfvenstam T, Lai YL, Ng LC, Leo YS, Thi Puong L, Vasudevan SG, Simmons CP, Hibberd ML, Ooi EE, , 2008. Decision tree algorithms predict the diagnosis and outcome of dengue fever in the early phase of illness. PLoS Negl Trop Dis 2: e196.[Crossref]
  36. Gregory CJ, Santiago LM, Arguello DF, Hunsperger E, Tomashek KM, , 2010. Clinical and laboratory features that differentiate dengue from other febrile illnesses in an endemic area—Puerto Rico, 2007–2008. Am J Trop Med Hyg 82: 922929.[Crossref]
  37. Halstead SB, Streit TG, Lafontant JG, Putvatana R, Russell K, Sun W, Kanesa-Thasan N, Hayes CG, Watts DM, , 2001. Haiti: absence of dengue hemorrhagic fever despite hyperendemic dengue virus transmission. Am J Trop Med Hyg 65: 180183.
  38. Halstead SB, , 2008. Dengue. London: Imperial College Press.[Crossref]
  39. Rodhain F, Gaxotte P, , 1977. An entomological survey on the mosquitoes of Wuvulu Island, Papua-New Guinea. Southeast Asian J Trop Med Public Health 8: 7779.

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  • Received : 30 Aug 2010
  • Accepted : 27 Mar 2011

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