Displaying publications 21 - 40 of 121 in total

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  1. Faisal T, Taib MN, Ibrahim F
    Med Biol Eng Comput, 2010 Mar;48(3):293-301.
    PMID: 20016950 DOI: 10.1007/s11517-009-0561-x
    Even though the World Health Organization criteria's for classifying the dengue infection have been used for long time, recent studies declare that several difficulties have been faced by the clinicians to apply these criteria. Accordingly, many studies have proposed modified criteria to identify the risk in dengue patients based on statistical analysis techniques. None of these studies utilized the powerfulness of the self-organized map (SOM) in visualizing, understanding, and exploring the complexity in multivariable data. Therefore, this study utilized the clustering of the SOM technique to identify the risk criteria in 195 dengue patients. The new risk criteria were defined as: platelet count less than or equal 40,000 cells per mm(3), hematocrit concentration great than or equal 25% and aspartate aminotransferase (AST) rose by fivefold the normal upper limit for AST/alanine aminotransfansferase (ALT) rose by fivefold the normal upper limit for ALT. The clusters analysis indicated that any dengue patient fulfills any two of the risk criteria is consider as high risk dengue patient.
    Matched MeSH terms: Dengue/diagnosis; Severe Dengue/diagnosis*
  2. Ngim CF, Husain SMT, Hassan SS, Dhanoa A, Ahmad SAA, Mariapun J, et al.
    PLoS Negl Trop Dis, 2021 05;15(5):e0009445.
    PMID: 34014983 DOI: 10.1371/journal.pntd.0009445
    BACKGROUND: Dengue fever is the most common mosquito-borne infection worldwide where an expanding surveillance and characterization of this infection are needed to better inform the healthcare system. In this surveillance-based study, we explored the prevalence and distinguishing features of dengue fever amongst febrile patients in a large community-based health facility in southern peninsular Malaysia.

    METHODS: Over six months in 2018, we recruited 368 adults who met the WHO 2009 criteria for probable dengue infection. They underwent the following blood tests: full blood count, dengue virus (DENV) rapid diagnostic test (RDT), ELISA (dengue IgM and IgG), nested RT-PCR for dengue, multiplex qRT-PCR for Zika, Chikungunya and dengue as well as PCR tests for Leptopspira spp., Japanese encephalitis and West Nile virus.

    RESULTS: Laboratory-confirmed dengue infections (defined by positive tests in NS1, IgM, high-titre IgG or nested RT-PCR) were found in 167 (45.4%) patients. Of these 167 dengue patients, only 104 (62.3%) were positive on rapid diagnostic testing. Dengue infection was significantly associated with the following features: family or neighbours with dengue in the past week (AOR: 3.59, 95% CI:2.14-6.00, p<0.001), cutaneous rash (AOR: 3.58, 95% CI:1.77-7.23, p<0.001), increased temperature (AOR: 1.33, 95% CI:1.04-1.70, p = 0.021), leucopenia (white cell count < 4,000/μL) (AOR: 3.44, 95% CI:1.72-6.89, p<0.001) and thrombocytopenia (platelet count <150,000/μL)(AOR: 4.63, 95% CI:2.33-9.21, p<0.001). Dengue infection was negatively associated with runny nose (AOR: 0.47, 95% CI:0.29-0.78, p = 0.003) and arthralgia (AOR: 0.42, 95% CI:0.24-0.75, p = 0.004). Serotyping by nested RT-PCR revealed mostly mono-infections with DENV-2 (n = 64), DENV-1 (n = 32) and DENV-3 (n = 17); 14 co-infections occurred with DENV-1/DENV-2 (n = 13) and DENV-1/DENV-4 (n = 1). Besides dengue, none of the pathogens above were found in patients' serum.

    CONCLUSIONS: Acute undifferentiated febrile infections are a diagnostic challenge for community-based clinicians. Rapid diagnostic tests are increasingly used to diagnose dengue infection but negative tests should be interpreted with caution as they fail to detect a considerable proportion of dengue infection. Certain clinical features and haematological parameters are important in the clinical diagnosis of dengue infection.

    Matched MeSH terms: Dengue/diagnosis*
  3. Jahanshahi P, Zalnezhad E, Sekaran SD, Adikan FR
    Sci Rep, 2014 Jan 24;4:3851.
    PMID: 24458089 DOI: 10.1038/srep03851
    Surface plasmon resonance (SPR) is a medical diagnosis technique with high sensitivity and specificity. In this research, a new method based on SPR is proposed for rapid, 10-minute detection of the anti-dengue virus in human serum samples. This novel technique, known as rapid immunoglobulin M (IgM)-based dengue diagnostic test, can be utilized quickly and easily at the point of care. Four dengue virus serotypes were used as ligands on a biochip. According to the results, a serum volume of only 1 μl from a dengue patient (as a minimized volume) is required to indicate SPR angle variation to determine the ratio of each dengue serotype in samples with 83-93% sensitivity and 100% specificity.
    Matched MeSH terms: Dengue/diagnosis*
  4. Kong YY, Thay CH, Tin TC, Devi S
    J Virol Methods, 2006 Dec;138(1-2):123-30.
    PMID: 17000012 DOI: 10.1016/j.jviromet.2006.08.003
    The use of the polymerase chain reaction (PCR) in molecular diagnosis is now accepted worldwide and has become an essential tool in the research laboratory. In the laboratory, a rapid detection, serotyping and quantitation, one-step real-time RT-PCR assay was developed for dengue virus using TaqMan probes. In this assay, a set of forward and reverse primers were designed targeting the serotype conserved region at the NS5 gene, at the same time flanking a variable region for all four serotypes which were used to design the serotype-specific TaqMan probes. This multiplex one-step RT-PCR assay was evaluated using 376 samples collected during the year 2003. These groups included RNA from prototype dengue virus (1-4), RNA from acute serum from which dengue virus was isolated, RNA from tissue culture supernatants of dengue virus isolated, RNA from seronegative acute samples (which were culture and IgM negative) and RNA from samples of dengue IgM positive sera. The specificity of this assay was also evaluated using a panel of sera which were positive for other common tropical disease agents including herpes simplex virus, cytomegalovirus, measles virus, varicella-zoster virus, rubella virus, mumps virus, WWF, West Nile virus, Japanese encephalitis virus, S. typhi, Legionella, Leptospira, Chlamydia, and Mycoplasma. The sensitivity, specificity and real-time PCR efficiency of this assay were 89.54%, 100% and 91.5%, respectively.
    Matched MeSH terms: Dengue/diagnosis
  5. Yong YK, Thayan R, Chong HT, Tan CT, Sekaran SD
    Singapore Med J, 2007 Jul;48(7):662-8.
    PMID: 17609830
    Dengue fever and dengue haemorrhagic fever currently rank highly among the newly-emerging infectious diseases, and are considered to be the most important arboviral disease worldwide. The definitive diagnosis is culture analysis, but practical considerations limit its use. Also, the period for viral detection is limited. Within a day or two after fever subsides, rising levels of antibodies interfere with viral cultures. An alternative to this quandary is the use of viral RNA detection assays. In our laboratory, a reverse transcriptase polymerase chain reaction (RT-PCR) assay was developed using a set of degenerate primers.
    Matched MeSH terms: Dengue/diagnosis*
  6. Lam SK
    Malays J Pathol, 1993 Jun;15(1):9-12.
    PMID: 8277797
    Matched MeSH terms: Dengue/diagnosis*
  7. Fadilah SA, Sahrir S, Raymond AA, Cheong SK, Aziz JA, Sivagengei K
    PMID: 10928365
    Activation of immunoregulatory T lymphocyte subsets has been observed in dengue viral infection, being more evident in dengue hemorrhagic fever (DHF) than in classical dengue fever (DF). There are, however, as yet no well-defined host markers to determine which patients with dengue viral infection will develop severe complications during the acute febrile stage of the disease. A study was performed to compare the cellular immune status in DHF, DF and non-dengue viral infections (NDF) in order to determine the value of these parameters in distinguishing DHF from classic DF and other viral infections during the acute febrile stage of the disease. This study involved 109 febrile patients admitted because of suspected DHF. Fifty patients were serologically confirmed cases of dengue infection, of which 25 had grade 1 or 2 DHF. There was a reduction in total T (CD3), CD4 and CD8 cells in DHF and demonstrated that a low level of CD3, CD4, CD8 and CD5 cells discriminated DHF from DF patients during the febrile stage of the illness. In contrast, B (CD19) cells and natural killer (NK) cells did not appear to be discriminatory in this study. Receiver operating characteristic (ROC) curve analysis showed that a combination of CD3 cell of < or = 45% and CD5 cell of < or = 55% was the best marker to identify DHF patients (sensitivity = 84% and specificity = 52% for CD3 cell of < or = 45%; sensitivity = 92% and specificity = 71% for CD5 cell of < or = 55%). CD4 cell of < or = 25% and CD8 cell < or = 30% were equally good in discriminating DHF from DF patients. On the other hand, the ROC curves indicated no clear difference between the immunoregulatory cell counts in DF from NDF Lymphopenia, atypical lymphocytosis and thrombocytopenia were significantly more evident in dengue compared to non-dengue infection but did not appear to be discriminatory among DHF and DF patients. The reduction in CD3, CD4, CD8, CD5 cells correlated with the degree of thrombocytopenia in DHF (p < 0.05) which suggests that these cells probably participate in a common pathogenetic mechanism.
    Matched MeSH terms: Dengue/diagnosis*; Severe Dengue/diagnosis*
  8. Chin CK, Kang BH, Liew BK, Cheah PC, Nair R, Lam SK
    J Trop Med Hyg, 1993 Aug;96(4):259-63.
    PMID: 8345549
    A prospective study on the practicality of an out-patient management protocol for dengue infection in adults was carried out during a 2-month period. Doctors were requested to follow the protocol and assessment was done on the patients' outcome, the admission rate, and the compliance to the protocol by doctors and patients. One hundred and sixty-two patients (mean age 27.3 years) were clinically diagnosed to have dengue illness. Among them, 82.7% had dengue fever (DF); 13.0% had dengue haemorrhagic fever (DHF) and 4.3% had dengue shock syndrome (DSS). Dengue aetiology was confirmed in 69.4% of the DF group and 85.7% of the DHF and DSS groups. There were no deaths among the 162 patients. The admission rate was 43.8%. A high compliance rate of 86.4% by the doctors and a low patient default rate of 16.4% showed that the protocol was practical.
    Matched MeSH terms: Dengue/diagnosis
  9. Tamibmaniam J, Hussin N, Cheah WK, Ng KS, Muninathan P
    PLoS One, 2016;11(8):e0161696.
    PMID: 27551776 DOI: 10.1371/journal.pone.0161696
    BACKGROUND: WHO's new classification in 2009: dengue with or without warning signs and severe dengue, has necessitated large numbers of admissions to hospitals of dengue patients which in turn has been imposing a huge economical and physical burden on many hospitals around the globe, particularly South East Asia and Malaysia where the disease has seen a rapid surge in numbers in recent years. Lack of a simple tool to differentiate mild from life threatening infection has led to unnecessary hospitalization of dengue patients.

    METHODS: We conducted a single-centre, retrospective study involving serologically confirmed dengue fever patients, admitted in a single ward, in Hospital Kuala Lumpur, Malaysia. Data was collected for 4 months from February to May 2014. Socio demography, co-morbidity, days of illness before admission, symptoms, warning signs, vital signs and laboratory result were all recorded. Descriptive statistics was tabulated and simple and multiple logistic regression analysis was done to determine significant risk factors associated with severe dengue.

    RESULTS: 657 patients with confirmed dengue were analysed, of which 59 (9.0%) had severe dengue. Overall, the commonest warning sign were vomiting (36.1%) and abdominal pain (32.1%). Previous co-morbid, vomiting, diarrhoea, pleural effusion, low systolic blood pressure, high haematocrit, low albumin and high urea were found as significant risk factors for severe dengue using simple logistic regression. However the significant risk factors for severe dengue with multiple logistic regressions were only vomiting, pleural effusion, and low systolic blood pressure. Using those 3 risk factors, we plotted an algorithm for predicting severe dengue. When compared to the classification of severe dengue based on the WHO criteria, the decision tree algorithm had a sensitivity of 0.81, specificity of 0.54, positive predictive value of 0.16 and negative predictive of 0.96.

    CONCLUSION: The decision tree algorithm proposed in this study showed high sensitivity and NPV in predicting patients with severe dengue that may warrant admission. This tool upon further validation study can be used to help clinicians decide on further managing a patient upon first encounter. It also will have a substantial impact on health resources as low risk patients can be managed as outpatients hence reserving the scarce hospital beds and medical resources for other patients in need.

    Study site: single ward, in Hospital Kuala Lumpur, Malaysia
    Matched MeSH terms: Severe Dengue/diagnosis*
  10. George R
    Malays J Pathol, 1993 Jun;15(1):25-7.
    PMID: 8277785
    Matched MeSH terms: Dengue/diagnosis*
  11. Tong SF, Aziz NA, Chin GL
    Med J Malaysia, 2007 Dec;62(5):390-3.
    PMID: 18705473 MyJurnal
    Thrombocytopaenia is often relied upon as an important criterion for the diagnosis of dengue infection among patients presenting with an acute non-specific febrile illness. This study was aimed to assess usefulness of thrombocytopaenia in the diagnosis of acute dengue virus infection. This was a clinic based prospective cohort study from May to November 2003. Consecutive patients presenting with acute non-specific febrile illness of less than two weeks were selected from two urban primary care centres. We did full blood count examination (FBC) on the day of visit and dengue serology on day five of illness for all patients enrolled. We repeated the FBC examination for patients who had initial normal platelet counts. Thrombocytopaenia was defined as platelet count < 150 X 10(9)/L. Eighty-seven patients enrolled in the study. Complete data was available for 73 patients. The prevalence of acute dengue virus infection was 27.6%. The sensitivity and specificity were 88% and 71% respectively. The likelihood of acute dengue infection in the presence of thrombocytopaenia was 2.52 and likelihood of not having dengue infection in normal platelet count patients was 5.22. Thrombocytopaenia has fair predictive value in diagnosing acute dengue virus infection. It was more useful to exclude than to diagnose dengue infection.

    Study site: Primary Care Centre of Hospital Universiti
    Kebangsaan Malaysia (HUKM) and Batu 9 Health Clinic Hulu Langat,
    Matched MeSH terms: Dengue/diagnosis*
  12. Low GK, Looi SY, Yong MH, Sharma D
    J Vector Borne Dis, 2018 10 4;55(2):79-88.
    PMID: 30280705 DOI: 10.4103/0972-9062.242568
    Diagnosing severe dengue from those who do not develop complication is important to prevent death. The objective of this systematic review was to evaluate the diagnostic test accuracy of ultrasonography in differentiating severe dengue from nonsevere dengue; and to assess if ultrasonography/ultrasound can be used as a predictive (screening) and diagnostic tool in the course of dengue infection. An electronic search was conducted in different databases via OvidSP platform. The included studies were cohort studies between 1995 and 2016 wherein cases were confirmed by dengue blood test. Severity of dengue was assessed and compared using standard WHO references. The methodological quality of the paper was assessed by two independent reviewers by using QUADAS-2 tool. In total 12 studies were included in this review after suitable screening. Overall, the studies included had a low and unclear risk of bias. Seven out of nine studies that compared severe dengue and nonsevere dengue, performed an ultrasonography on gallbladder (wall thickness cutoff-3 mm) with a sensitivity of 24.2-100% and a specificity of 13.2-98.7%. Other parameters such as splenic subcapsular fluid collection, pericardial fluid and hepatic subcapsular fluid collection had a specificity of >90%, though the sensitivity was poor. There were insufficient evidence that ultrasonography is able to differentiate severe dengue from nonsevere dengue accurately. The predictive and diagnostic value of ultrasonography could not be concluded due to insufficient reporting on the temporality of the ultrasonography performed with regard to the diagnosis. However, it might serve as an adjunct investigation to support the clinical diagnosis.
    Matched MeSH terms: Severe Dengue/diagnosis*
  13. Md-Sani SS, Md-Noor J, Han WH, Gan SP, Rani NS, Tan HL, et al.
    BMC Infect Dis, 2018 05 21;18(1):232.
    PMID: 29783955 DOI: 10.1186/s12879-018-3141-6
    BACKGROUND: Increasing incidence of dengue cases in Malaysia over the last few years has been paralleled by increased deaths. Mortality prediction models will therefore be useful in clinical management. The aim of this study is to identify factors at diagnosis of severe dengue that predicts mortality and assess predictive models based on these identified factors.

    METHOD: This is a retrospective cohort study of confirmed severe dengue patients that were admitted in 2014 to Hospital Kuala Lumpur. Data on baseline characteristics, clinical parameters, and laboratory findings at diagnosis of severe dengue were collected. The outcome of interest is death among patients diagnosed with severe dengue.

    RESULTS: There were 199 patients with severe dengue included in the study. Multivariate analysis found lethargy, OR 3.84 (95% CI 1.23-12.03); bleeding, OR 8.88 (95% CI 2.91-27.15); pulse rate, OR 1.04 (95% CI 1.01-1.07); serum bicarbonate, OR 0.79 (95% CI 0.70-0.89) and serum lactate OR 1.27 (95% CI 1.09-1.47), to be statistically significant predictors of death. The regression equation to our model with the highest AUROC, 83.5 (95% CI 72.4-94.6), is: Log odds of death amongst severe dengue cases = - 1.021 - 0.220(Serum bicarbonate) + 0.001(ALT) + 0.067(Age) - 0.190(Gender).

    CONCLUSION: This study showed that a large proportion of severe dengue occurred early, whilst patients were still febrile. The best prediction model to predict death at recognition of severe dengue is a model that incorporates serum bicarbonate and ALT levels.

    Matched MeSH terms: Severe Dengue/diagnosis
  14. Yuliarto S, Susanto WP, Kadafi KT, Ratridewi I, Olivianto E
    Trop Biomed, 2021 Jun 01;38(2):129-133.
    PMID: 34172701 DOI: 10.47665/tb.38.2.048
    We describe a child with acute fever and abdominal pain who developed rash and edema of extremities. Blood test revealed thrombocytopenia, lymphopenia, positive dengue-IgM, and hypoalbuminemia with elevated procalcitonin. Right pleural effusion revealed from chest x-ray. Diagnosed as dengue hemorrhagic fever (DHF) grade 1, however, at 7th day of illness, altered mental status, respiratory and circulatory failure occurred. Laboratory examination showed marked thrombocytopenia, transaminitis, metabolic acidosis, elevated D-dimer, decrease fibrinogen, and elevated cardiac marker (troponin I and CKMB). The patient then developed catecholamine-resistant shock and did not survive after 48 hours. Although rapid test of SARS CoV-2 infection was negative, rapid deterioration with some unusual clinical feature suggest multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 infection. This case raises an awareness of MIS-C that clinical features resemble dengue infection.
    Matched MeSH terms: Severe Dengue/diagnosis*
  15. Zainah S, Wahab AH, Mariam M, Fauziah MK, Khairul AH, Roslina I, et al.
    J Virol Methods, 2009 Feb;155(2):157-60.
    PMID: 19022293 DOI: 10.1016/j.jviromet.2008.10.016
    The performance of a commercial immunochromatography test for rapid detection of dengue NS1 antigen present in serum or plasma of patients was evaluated against a commercial dengue NS1 antigen-capture ELISA. The rapid immunochromatography test gave an overall sensitivity of 90.4% with a specificity of 99.5%. The sensitivity was highest for serum samples from which virus was isolated (96.3%) and lowest for those from which virus was not isolated and RT-PCR was negative (76.4%). The sensitivity was significantly higher for serum samples from patients with acute primary dengue (92.3%) than those from patients with acute secondary dengue (79.1%). The positive predictive value and negative predictive value of this commercial immunochromatography test were 99.6% and 87.9% respectively.
    Matched MeSH terms: Dengue/diagnosis*
  16. Rosly NZ, Ahmad SA, Abdullah J, Yusof NA
    Sensors (Basel), 2016 Aug 25;16(9).
    PMID: 27571080 DOI: 10.3390/s16091365
    In the present study, the construction of arrays on silicon for naked-eye detection of DNA dengue was demonstrated. The array was created by exposing a polyethylene glycol (PEG) silane monolayer to 254 nm ultraviolet (UV) light through a photomask. Formation of the PEG silane monolayer and photomodifed surface properties was thoroughly characterized by using atomic force microscopy (AFM), X-ray photoelectron spectroscopy (XPS), and contact angle measurements. The results of XPS confirmed that irradiation of ultraviolet (UV) light generates an aldehyde functional group that offers conjugation sites of amino DNA probe for detection of a specific dengue virus target DNA. Employing a gold enhancement process after inducing the electrostatic interaction between positively charged gold nanoparticles and the negatively charged target DNA hybridized to the DNA capture probe allowed to visualize the array with naked eye. The developed arrays demonstrated excellent performance in diagnosis of dengue with a detection limit as low as 10 pM. The selectivity of DNA arrays was also examined using a single base mismatch and noncomplementary target DNA.
    Matched MeSH terms: Dengue/diagnosis*
  17. Choi JR, Hu J, Wang S, Yang H, Wan Abas WA, Pingguan-Murphy B, et al.
    Crit Rev Biotechnol, 2017 Feb;37(1):100-111.
    PMID: 26912259
    Dengue endemic is a serious healthcare concern in tropical and subtropical countries. Although well-established laboratory tests can provide early diagnosis of acute dengue infections, access to these tests is limited in developing countries, presenting an urgent need to develop simple, rapid, and robust diagnostic tools. Point-of-care (POC) devices, particularly paper-based POC devices, are typically rapid, cost-effective and user-friendly, and they can be used as diagnostic tools for the prompt diagnosis of dengue at POC settings. Here, we review the importance of rapid dengue diagnosis, current dengue diagnostic methods, and the development of paper-based POC devices for diagnosis of dengue infections at the POC.
    Matched MeSH terms: Dengue/diagnosis*
  18. Chin CK
    Malays J Pathol, 1993 Jun;15(1):21-3.
    PMID: 8277784
    Dengue fever is endemic in Malaysia with frequent epidemics especially in urban areas. This infection can present in a wide range of severity, from a nonspecific febrile illness to life threatening dengue haemorrhagic fever and dengue shock syndrome. It is worth noting that dengue haemorrhagic fever comprised 11.2% of all reported cases in Malaysia in 1991.Patients tend to consult their primary care physicians early. It is the duty of the primary care physicians to make an accurate diagnosis and to detect the complications. However, there has not been any known reliable predictor for the occurrence of complications during the early stage of the illness. Hence, primary care physicians often face the problem of having to deal with this uncertainty. Referring all these patients to the hospitals for admission is obviously not practical but managing them at home may involve high risks. In order to assist primary care physicians, the Primary Care Unit in the University Hospital uses a set of guidelines for the outpatient management of the infection. These guidelines and their assessment will be discussed.
    Study site: Primary Care clinic, University Malaya Medical Centre, Kuala Lumpur, Malaysia
    Matched MeSH terms: Dengue/diagnosis
  19. Jahanshahi P, Sekaran SD, Adikan FR
    Med Biol Eng Comput, 2015 Aug;53(8):679-87.
    PMID: 25791696 DOI: 10.1007/s11517-015-1262-2
    Evaluation of binding between analytes and its relevant ligands on surface plasmon resonance (SPR) biosensor is of considerable importance for accurate determination and screening of an interference in immunosensors. Dengue virus serotype 2 was used as a case study in this investigation. This research work compares and interprets the results obtained from analytical analysis with the experimental ones. Both the theoretical calculations and experimental results are verified with one sample from each category of dengue serotypes 2 (low, mid, and high positive), which have been examined in the database of established laboratorial diagnosis. In order to perform this investigation, the SPR angle variations are calculated, analyzed, and then validated via experimental SPR angle variations. Accordingly, the error ratios of 5.35, 6.54, and 3.72% were obtained for the low-, mid-, and high-positive-specific immune globulins of patient serums, respectively. In addition, the magnetic fields of the biosensor are numerically simulated to show the effect of different binding mediums.
    Matched MeSH terms: Dengue/diagnosis*
  20. Wilder-Smith A, Tissera H, AbuBakar S, Kittayapong P, Logan J, Neumayr A, et al.
    Glob Health Action, 2018;11(1):1549930.
    PMID: 30560735 DOI: 10.1080/16549716.2018.1549930
    BACKGROUND: Dengue fever persists as a major global disease burden, and may increase as a consequence of climate change. Along with other measures, research actions to improve diagnosis, surveillance, prevention, and predictive models are highly relevant. The European Commission funded the DengueTools consortium to lead a major initiative in these areas, and this review synthesises the outputs and findings of this work conducted from 2011 to 2016. Research areas: DengueTools organised its work into three research areas, namely [1] Early warning and surveillance systems; [2] Strategies to prevent dengue in children; and [3] Predictive models for the global spread of dengue. Research area 1 focused on case-studies undertaken in Sri Lanka, including developing laboratory-based sentinel surveillance, evaluating economic impact, identifying drivers of transmission intensity, evaluating outbreak prediction capacity and developing diagnostic capacity. Research area 2 addressed preventing dengue transmission in school children, with case-studies undertaken in Thailand. Insecticide-treated school uniforms represented an intriguing potential approach, with some encouraging results, but which were overshadowed by a lack of persistence of insecticide on the uniforms with repeated washing. Research area 3 evaluated potential global spread of dengue, particularly into dengue-naïve areas such as Europe. The role of international travel, changing boundaries of vectors, developing models of vectorial capacity under different climate change scenarios and strategies for vector control in outbreaks was all evaluated.

    CONCLUDING REMARKS: DengueTools was able to make significant advances in methods for understanding and controlling dengue transmission in a range of settings. These will have implications for public health agendas to counteract dengue, including vaccination programmes.

    OUTLOOK: Towards the end of the DengueTools project, Zika virus emerged as an unexpected epidemic in the central and southern America. Given the similarities between the dengue and Zika viruses, with vectors in common, some of the DengueTools thinking translated readily into the Zika situation.

    Matched MeSH terms: Dengue/diagnosis
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