Abstract
Dengue virus (DENV) infection has garnered a global interest in the past few decades. Nevertheless, its epidemiology in certain developing and low-income regions remains poorly understood, due to the absence of comprehensive surveillance and reporting systems. This systematic review and meta-analysis aimed to determine the prevalence of DENV infection in the population of Sub-Saharan Africa using DENV infection markers, and to track any changes in its prevalence during the past ten years. It was conducted in accordance with the PRISMA guidelines, targeting the literature available at MEDLINE/PubMed, ScienceDirect, Cochrane library and Google Scholar. All articles published in English language between January 2010 and June 2020 were screened for eligibility. Random effects model was used to calculate the pooled prevalence of all infection markers. The Inconsistency Index (I 2) was used to assess the level of heterogeneity between studies. Subgroup analysis according to country and time-frame of studies was conducted to provide possible explanations to substantial heterogeneity. The critical appraisal tool for prevalence studies designed by the Joanna Briggs Institute (JBI) was used to assess the risk of bias in all included studies. A total of 84 articles, covering 21 countries, were included in this review. Quantitative meta-analysis estimated a pooled IgG prevalence of 25% (95% CI: 21-29%, I 2 = 99%), a pooled IgM prevalence of 10% (95% CI: 9-11%, I 2 = 98%) and a pooled DENV RNA prevalence of 14% (95% CI: 12-16%, I 2 = 99%). Evidence for possible publication bias was also found in all three meta-analyses. Subgroup analysis according to the time of sample collection was performed to closely track the changing prevalence of DENV infection markers between 2010 and 2019. This meta-analysis estimates a high prevalence of DENV infection in Sub-Saharan Africa. More cost-efficient vector control strategies should be designed and implemented in order to adapt to the low-resource nature of this region.
Highlights
Dengue virus (DENV) is an arthropod-transmitted, positive stranded RNA virus of the family Flaviviridae and the genus Flavivirus
The pathogenesis of severe DENV infections has been a subject of study for decades and a number of virus-related risk factors have been identified, the most important of which is the antibodydependent enhancement (ADE) of secondary DENV infections when caused by heterologous DENV serotypes
A total of 1093 studies were identified from the electronic literature search, of which 84 studies were included in this review (Figure 1)
Summary
Dengue virus (DENV) is an arthropod-transmitted, positive stranded RNA virus of the family Flaviviridae and the genus Flavivirus. There are four distinct serotypes of Dengue virus (DENV 1-4), all of which are transmitted by Aedes mosquitos, mainly Aedes aegypti and to a lesser degree by Aedes albopictus (World Health Organization, 2014; Guzman et al, 2016). The World Health Organization (WHO) estimates that 100-400 million DENV infections occur annually, with an 8-fold increase in global incidence observed over the past 20 years; from 505,430 cases in 2000, to over 2.4 million in 2010, and 4.2 million in 2019. A marked increase in fatalities due to DENV infections was noted in certain regions of the world such as the Eastern Mediterranean Region, where the reported deaths increased from 960 in 2000 to 4032 in 2015 (World Health Organization, 2014). Several hostrelated risk factors, such as the ethnicity and genetic makeup of patients, are reported to affect the clinical course of the disease (PP et al, 1987; Chaturvedi et al, 2006)
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