Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jan 19, 2021
Date Accepted: Jun 21, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Risk factors associated with Dengue fever outbreak in Islamabad, Pakistan
ABSTRACT
Background:
On 23rd Oct 2016, 79 dengue fever cases were reported from the Union Council (UC) Tarlai to Federal Disease Surveillance and Response Unit Islamabad. A team was deputed to investigate the suspected dengue outbreak.
Objective:
This study was aimed to determine the extent of the outbreak and identify the possible risk factors.
Methods:
Active case finding was conducted through a house-to-house survey. A case was defined as, acute onset of Fever ≥ 38 ℃ in a resident of Tarlai from Oct 2-Nov 11, 2016, with a positive NS-1 test, and any two of the following signs and symptoms; retro-orbital/ocular pain, headache, rash, myalgia, arthralgia, and hemorrhagic manifestations. A structured questionnaire was used to collect data. Age and sex-matched controls (1:1) were identified from the same area. Blood samples were taken and sent to the National Institute of Health for genotype identification.
Results:
During the active case search, 145 cases of dengue fever were identified by surveying 928 houses from 23rd Oct to 11th Nov 2016. Attack rate (AR) was 17.0/10,000 population. The mean age was 34.4±14.4 years. More than half of the cases were male (n=80, 55.2%). Among all cases, 29% belong to the 25-34 years age group while the highest attack rate was found in 35-44 years (AR 35.6/10,000) followed by 55-64 years (AR 35.5/10,000). All five blood samples tested positive for NS-1 (genotype DENV-2). The most frequent presenting sin/symptom was fever and headache (100%). Stagnant water around houses (OR = 4.86, CI: 2.94 -8.01, P<0.0001), presence of flower pots in-home (OR = 2.73, CI: 1.67-4.45, P<0.0001), and open water container (OR 2.24, CI: 1.36-3.60, P<0.0001) showed higher odds among cases. While. use of bed nets (OR 0.44, CI: 0.25-0.77, P 0.003), insecticidal spray (OR 0.33, CI: 0.22-0.55, P<0.0001), door screening (OR 0.27, CI: 0.15-0.46, P<0.0001), use of mosquito coil/mat (OR 0.26, CI: 0.16-0.44, P<0.0001) and cleanliness in house (OR 0.12, CI: 0.05-0.26, P<0.0001) showed a significant protective effect.
Conclusions:
Stagnant water acting as breeding grounds for vector was the probable cause of the spread of the outbreak. The establishment of a surveillance and early reporting system and the use of protective measures against the vector is strongly recommended.
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