title: Presence of three dengue serotypes in Ouagadougou (Burkina Faso): research and public health implications.
abstract: BACKGROUND
  The significant malaria burden in Africa has often eclipsed other febrile illnesses. Burkina Faso's first dengue epidemic occurred in 1925 and the most recent in 2013. Yet there is still very little known about dengue prevalence, its vector proliferation, and its poverty and equity impacts.
  
  
  METHODS
  An exploratory cross-sectional survey was performed from December 2013 to January 2014. Six primary healthcare centers in Ouagadougou were selected based on previously reported presence of Flavivirus. All patients consulting with fever or having had fever within the previous week and with a negative rapid diagnostic test (RDT) for malaria were invited to participate. Sociodemographic data, healthcare use and expenses, mobility, health-related status, and vector control practices were captured using a questionnaire. Blood samples of every eligible subject were obtained through finger pricks during the survey for dengue RDT using SD BIOLINE Dengue Duo (NS1Ag and IgG/IgM)® and to obtain blood spots for reverse transcription polymerase chain reaction (RT-PCR) analysis. In a sample of randomly selected yards and those of patients, potential Aedes breeding sites were found and described. Larvae were collected and brought to the laboratory to monitor the emergence of adults and identify the species.
  
  
  RESULTS
  Of the 379 subjects, 8.7 % (33/379) had positive RDTs for dengue. Following the 2009 WHO classification, 38.3 % (145/379) had presumptive, probable, or confirmed dengue, based on either clinical symptoms or laboratory testing. Of 60 samples tested by RT-PCR (33 from the positive tests and 27 from the subsample of negatives), 15 were positive. The serotypes observed were DENV2, DENV3, and DENV4. Odds of dengue infection in 15-to-20-year-olds and persons over 50 years were 4.0 (CI 95 %: 1.0-15.6) and 7.7 (CI 95 %: 1.6-37.1) times higher, respectively, than in children under five. Average total spending for a dengue episode was 13 771 FCFA [1 300-67 300 FCFA] (1$US = 478 FCFA). On average, 2.6 breeding sites were found per yard. Potential Aedes breeding sites were found near 71.4 % (21/28) of patients, but no adult Aedes were found. The most frequently identified potential breeding sites were water storage containers (45.2 %). Most specimens collected in yards were Culex (97.9 %).
  
  
  CONCLUSIONS
  The scientific community, public health authorities, and health workers should consider dengue as a possible cause of febrile illness in Burkina Faso.
authors.affiliation: Department of Social and Preventive Medicine, University of Montreal School of Public Health (ESPUM), Montréal, Canada. valery.ridde@umontreal.ca.|University of Montreal Public Health Research Institute (IRSPUM), Pavillon 7101 Avenue du Parc, P.O. Box 6128, Centre-ville Station, Montreal, Quebec, H3C 3J7, Canada. valery.ridde@umontreal.ca.
authors.forename: Valéry
authors.initials: V
authors.lastname: Ridde
authors.affiliation: University of Montreal Public Health Research Institute (IRSPUM), Pavillon 7101 Avenue du Parc, P.O. Box 6128, Centre-ville Station, Montreal, Quebec, H3C 3J7, Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Agier
authors.affiliation: Identités et Différenciations de l'Environnement des Espaces et des Sociétés - Caen (IDEES), University of Caen Basse-Normandie, Caen, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bonnet
authors.affiliation: International Vaccine Institute, Dengue Vaccine Initiative, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, Korea.
authors.forename: Mabel
authors.initials: M
authors.lastname: Carabali
authors.affiliation: Institut de Recherche en Sciences de la Santé (IRSS), B.P. 545, Bobo-Dioulasso, Burkina Faso.
authors.forename: Kounbobr Roch
authors.initials: KR
authors.lastname: Dabiré
authors.affiliation: Unité Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Institut de recherche pour le développement (IRD), B.P. 171, Bobo-Dioulasso, Burkina Faso.
authors.forename: Florence
authors.initials: F
authors.lastname: Fournet
authors.affiliation: Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P. 7192, Ouagadougou, Burkina Faso.
authors.forename: Antarou
authors.initials: A
authors.lastname: Ly
authors.affiliation: Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P. 7192, Ouagadougou, Burkina Faso.
authors.forename: Ivlabèhiré Bertrand
authors.initials: IB
authors.lastname: Meda
authors.affiliation: Grupo de Virus Emergentes y Enfermedad, Departamento de Microbiología Universidad del Valle, Cali, Colombia.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Parra
mesh_terms: D000293:Adolescent; D000328:Adult; D000330:Aedes / Q000821:virology; D000368:Aged; D000818:Animals; D002050:Burkina Faso / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003715:Dengue / Q000453:epidemiology / Q000821:virology*; D003716:Dengue Virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Acute febrile non-malaria cases; Aedes; Burkina Faso; Cost; Dengue; Fever; Health system; Mobility