Dengue Virus and Japanese Encephalitis Virus Epidemiological Shifts in Nepal: A Case of Opposing Trends

Shyam P. Dumre Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand; National Public Health Laboratory, Ministry of Health and Population, Kathmandu, Nepal; Central Department of Microbiology, Tribhuwan University, Kathmandu, Nepal; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Geeta Shakya Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand; National Public Health Laboratory, Ministry of Health and Population, Kathmandu, Nepal; Central Department of Microbiology, Tribhuwan University, Kathmandu, Nepal; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Kesara Na-Bangchang Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand; National Public Health Laboratory, Ministry of Health and Population, Kathmandu, Nepal; Central Department of Microbiology, Tribhuwan University, Kathmandu, Nepal; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Veerachai Eursitthichai Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand; National Public Health Laboratory, Ministry of Health and Population, Kathmandu, Nepal; Central Department of Microbiology, Tribhuwan University, Kathmandu, Nepal; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Hans Rudi Grams Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand; National Public Health Laboratory, Ministry of Health and Population, Kathmandu, Nepal; Central Department of Microbiology, Tribhuwan University, Kathmandu, Nepal; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Senendra R. Upreti Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand; National Public Health Laboratory, Ministry of Health and Population, Kathmandu, Nepal; Central Department of Microbiology, Tribhuwan University, Kathmandu, Nepal; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Prakash Ghimire Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand; National Public Health Laboratory, Ministry of Health and Population, Kathmandu, Nepal; Central Department of Microbiology, Tribhuwan University, Kathmandu, Nepal; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Khagendra KC Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand; National Public Health Laboratory, Ministry of Health and Population, Kathmandu, Nepal; Central Department of Microbiology, Tribhuwan University, Kathmandu, Nepal; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Ananda Nisalak Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand; National Public Health Laboratory, Ministry of Health and Population, Kathmandu, Nepal; Central Department of Microbiology, Tribhuwan University, Kathmandu, Nepal; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Robert V. Gibbons Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand; National Public Health Laboratory, Ministry of Health and Population, Kathmandu, Nepal; Central Department of Microbiology, Tribhuwan University, Kathmandu, Nepal; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Stefan Fernandez Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand; National Public Health Laboratory, Ministry of Health and Population, Kathmandu, Nepal; Central Department of Microbiology, Tribhuwan University, Kathmandu, Nepal; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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We report on the changing epidemiology of two important flaviviruses in Nepal: Japanese encephalitis (JE) and dengue viruses. Morbidity and mortality in Nepal is in the thousands since JE was introduced in 1978. Nepal launched an extensive laboratory-based JE surveillance in 2004. Nepal experienced a remarkable reduction in disease burden after mass immunizations from 2005 to 2010, when 2,040 JE infections and 205 JE-related deaths were confirmed. With its emergence in 2006, dengue has become a significant challenge in the country, highlighted by a sudden outbreak in 2010 that resulted in 359 confirmed dengue infections. Currently, both viruses cocirculate in Nepal. Here, we document the remarkable expansion of dengue in Nepal, which urgently requires national surveillance to refine the burden and make recommendations regarding control and prevention programs. We believe that the use of existing JE surveillance network for integrated dengue surveillance may represent the most appropriate alternative.

Author Notes

* Address correspondence to Stefan Fernandez, United States Army Medical Command—Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), APO AP 96546, 315/6 Rajvithi Road, Bangkok 10400, Thailand. E-mail: stefan.fernandez@afrims.org

Financial support: The dengue component of this study was partly supported by World Health Organization—Special Program for Research and Training in Topical Diseases, Geneva, Switzerland Leadership Training Grant A80350 (to S.P.D.).

Authors' addresses: Shyam P. Dumre, Kesara Na-Bangchang, Veerachai Eursitthichai, and Hans Rudi Grams, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand, E-mails: shyamprad@hotmail.com, kesaratmu@yahoo.com, veebkk@gmail.com, and rgrams@alfa.ac.th. Geeta Shakya and Khagendra KC, National Public Health Laboratory, Ministry of Health and Population, Kathmandu, Nepal, E-mails: nphl@wlink.com.np and khaggu17@hotmail.com. Senendra R. Upreti, Ministry of Health and Population, Kathmandu, Nepal, E-mail: senendraupreti933@hotmail.com. Prakash Ghimire, Central Department of Microbiology, Tribhuwan University, Kathmandu, Nepal, E-mail: prakashghimire@yahoo.com. Ananda Nisalak, Robert V. Gibbons, and Stefan Fernandez, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand, E-mails: anandan@afrims.org, robert.gibbons@afrims.org, and stefan.fernandez@afrims.org.

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