Capacity development of tertiary healthcare centres to manage the Dengue and Chikungunya epidemics in Bangladesh using a rapid molecular diagnostic method

Dengue and Chikungunya are vector-borne acute febrile diseases transmitted to humans through Aedes mosquito bites (1). Clinical manifestations of Dengue virus infection range from asymptomatic to mild fever with spontaneous remission and fatal Dengue hemorrhagic fever/ Dengue shock syndrome (2).According to the latest report by DGHS, 58,209 patients required hospitalisation from Dengue with 254 fatalities in 2022, whereas 13,176 patients were affected by the last Chikungunya outbreak in 2017 (3–5).

Routine serological tests for Dengue and Chikungunya shows variable sensitivities therefore not reliable  to ensure early treatment (6,7). Molecular diagnosis by RT-PCR is the most prudent approach in diagnosing Dengue and Chikungunya infections, however it is not suitable for routine application at public healthcare facilities due to its cost and need for expertise. As the differential diagnosis of both diseases warrants distinct case management, a rapid and confirmatory diagnostic method is crucial for early and accurate diagnosis.

icddr,b led study aimed to build up the technical capacity of a recently developed point-of-need mobile suitcase lab operating Recombinase Aided Amplification (RAA) assay which circumvents the limitations of RT-PCR in terms of feasibility, time and cost (8).  The molecular assay provides a cost-effective means for detection of the infection in less than 30 minutes. The mobile suitcase lab can also perform assays at remote healthcare settings. The study funded by the Islamic Development Bank (IsDB) will help in building the capacity for molecular detection of Dengue and Chikungunya in four tertiary health centers which will be self-sustaining to provide patient service in the future.

A dissemination seminar was held on December 7, 2022 at icddr,b's Sasakawa Auditorium to present the findings of the study. Dr Tahmeed Ahmed, Executive Director, at icddr,b attended as the Chairperson. Prof. Dr Md. Nazmul Islam, Director, Disease Control & Line Director, CDC, DGHS; Brig. Gen. Md. Zobaidur Rahman, Chief Health Officer, DNCC; and Md. Robiul Islam, Project Management Specialist, IsDB Regional Hub, Dhaka attended as Special Guests.

The study revealed that the RT-RAA assay could detect highest proportion of dengue infected individuals compared to NS1 RDT, IgM RDT and RT-PCR. The assay is also highly efficient in detecting both primary and secondary dengue infection. Although the routine NS1 RDT was similarly effective in detecting primary infection, it failed to detect secondary dengue infections in a high proportion of the samples. Moreover, the effectiveness of NS1 RDT declines from day 5, whereas the RT-RAA assay could detect dengue infection up to 14 days. RT-RAA assay could be a powerful addition to the current serological assays, especially in detecting secondary dengue infections.

The assay in mobile suitcase lab was recommended to be scaled up at rest of the public hospitals in Dhaka city and gradually to other dengue endemic zones as a simple, reliable, rapid and cost-effective diagnostic tool. As dengue case fatality rate is higher in secondary infections, the technology could save more lives by early and accurate detection of the secondary dengue infections, especially in highly endemic countries including Bangladesh. The technology is a step forward in the field of dengue diagnostics and can be a powerful addition to routine diagnostic tools in Bangladesh.

Participants from the DGHS, partnered institutions, and icddr,b also attended the seminar.



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