Abstract
Dengue used to be recognized as an imported and sporadic disease in China. Since June 2014, an unexpected large dengue outbreak has attacked Guangzhou, China, resulting in more than 40,000 cases. Among the 1,942 laboratory-confirmed hospitalized dengue cases, 121 were diagnosed as severe dengue according to the 2009 WHO guideline, and 2 patients finally died. Laboratory diagnosis and virus isolation demonstrated that the majority (96%) cases were caused by dengue virus serotype 1 (DENV-1), and the others by serotype 2 (DENV-2). 14 DENV strains were isolated from the sera of acute-phase dengue patients during this outbreak, and the complete envelope (E) gene of 12 DENV-1 strains and two DENV-2 strains were determined using RT-PCR assay. Phylogenetic analysis based on the E gene revealed the DENV-1 strains isolated during the outbreak belonged to genotype I and V, respectively. These isolates formed three clades. DENV-2 isolates were assigned to the same clade belonging to genotype cosmopolitan. These strains isolated in 2014 were closely related to the isolates obtained from the same province, Guangdong, in 2013. No amino acid mutations known to increase virulence were identified throughout the E protein of isolates in 2014. These results indicate that dengue is turning into endemic in Guangdong, China, and extensive seroepidemiological investigation and mosquito control measures are critically needed in the future.
Highlights
Today, dengue is well known as the most prevalent and worldwide expansive mosquito-borne viral disease of human beings, with an increasing frequency and magnitude of epidemics and severe disease
These results suggested that multiple sources of dengue virus serotype 1 (DENV-1) and DENV-2 strains were responsible for this severe outbreak, and most stains have circulated in Guangdong for a long time
The 2014 dengue outbreak in Guangdong province is the largest one in China, and has raised the concern of public health authorities for the etiology of the novel DENV
Summary
Dengue is well known as the most prevalent and worldwide expansive mosquito-borne viral disease of human beings, with an increasing frequency and magnitude of epidemics and severe disease. Several sporadic epidemics have been reported in several provinces in Southern China [6, 7]. Previous epidemiological and phylogenetic analysis has deduced all these autochthonous epidemics are caused by imported cases from South-East Asia [8, 9]. An unexpected dengue outbreak attacked Guangzhou, resulting in 43,031 laboratory-confirmed dengue cases as of Oct, 2014. This outbreak is the largest and most severe epidemic of dengue fever documented in China [6], and we reported the main epidemiological and virological features of this outbreak in this study
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