title: Flaviviruses as a Cause of Undifferentiated Fever in Sindh Province, Pakistan: A Preliminary Report.
abstract: Arboviral diseases are expanding worldwide, yet global surveillance is often limited due to diplomatic and cultural barriers between nations. With human encroachment into new habitats, mosquito-borne viruses are also invading new areas. The actual prevalence of expanding arboviruses is unknown in Pakistan due to inappropriate diagnosis and poor testing for arboviral diseases. The primary objective of this study was to document evidence of flavivirus infections as the cause of undifferentiated fever in Pakistan. Through a cooperative effort between the USA and Pakistan, patient exposure to dengue virus (DENV), West Nile virus (WNV), and Japanese encephalitis virus (JEV) was examined in Sindh Province for the first time in decades. Initial results from the 2015 arbovirus season consisting of a cross-sectional study of 467 patients in 5 sites, DENV NS1 antigen was identified in 63 of the screened subjects, WNV IgM antibodies in 16 patients, and JEV IgM antibodies in 32 patients. In addition, a number of practical findings were made including (1) in silico optimization of RT-PCR primers for flavivirus strains circulating in the Middle East, (2) shipping and storage of RT-PCR master mix and other reagents at ambient temperature, (3) Smart phone applications for the collection of data in areas with limited infrastructure, and (4) fast and reliable shipping for transport of reagents and specimens to and from the Middle East. Furthermore, this work is producing a group of highly trained local scientists and medical professionals disseminating modern scientific methods and more accurate diagnostic procedures to the community.
authors.affiliation: Department of Pathology, Aga Khan University, Karachi, Pakistan; Department of Microbiology, Aga Khan University, Karachi, Pakistan.
authors.forename: Erum
authors.initials: E
authors.lastname: Khan
authors.affiliation: Department of Pathology, Aga Khan University, Karachi, Pakistan; Department of Microbiology, Aga Khan University, Karachi, Pakistan.
authors.forename: Joveria Q
authors.initials: JQ
authors.lastname: Farooqi
authors.affiliation: Emerging Diseases and Arbopathogens Research and Testing Laboratory, Department of Infectious Diseases and Pathology, University of Florida , Gainesville, FL , USA.
authors.forename: Kelli L
authors.initials: KL
authors.lastname: Barr
authors.affiliation: Department of Environmental and Global Health, Emerging Pathogens Institute, University of Florida , Gainesville, FL , USA.
authors.forename: Dhani
authors.initials: D
authors.lastname: Prakoso
authors.affiliation: Department of Pathology, Aga Khan University, Karachi, Pakistan; Department of Microbiology, Aga Khan University, Karachi, Pakistan.
authors.forename: Amna
authors.initials: A
authors.lastname: Nasir
authors.affiliation: Department of Pathology, Aga Khan University, Karachi, Pakistan; Department of Microbiology, Aga Khan University, Karachi, Pakistan.
authors.forename: Akbar
authors.initials: A
authors.lastname: Kanji
authors.affiliation: Department of Pathology, Aga Khan University, Karachi, Pakistan; Department of Microbiology, Aga Khan University, Karachi, Pakistan.
authors.forename: Sadia
authors.initials: S
authors.lastname: Shakoor
authors.affiliation: Department of Pathology, Aga Khan University, Karachi, Pakistan; Department of Microbiology, Aga Khan University, Karachi, Pakistan.
authors.forename: Faisal Riaz
authors.initials: FR
authors.lastname: Malik
authors.affiliation: Department of Pathology, Aga Khan University, Karachi, Pakistan; Department of Microbiology, Aga Khan University, Karachi, Pakistan.
authors.forename: Rumina
authors.initials: R
authors.lastname: Hasan
authors.affiliation: Department of Environmental and Global Health, Emerging Pathogens Institute, University of Florida , Gainesville, FL , USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Lednicky
authors.affiliation: Emerging Diseases and Arbopathogens Research and Testing Laboratory, Department of Infectious Diseases and Pathology, University of Florida , Gainesville, FL , USA.
authors.forename: Maureen T
authors.initials: MT
authors.lastname: Long
keywords: Japanese encephalitis virus; West Nile virus; arbovirus; dengue viruses; flavivirus; transboundary diseases