title: Dengue outbreak in Swat and Mansehra, Pakistan 2013: An epidemiological and diagnostic perspective.
abstract: OBJECTIVE
  To high light some epidemiological, clinical and diagnostic features of dengue fever during an outbreak and the role of different diagnostic techniques to achieve the highest level of accuracy in results.
  
  
  METHODS
  Blood samples (n = 323) were collected along with epidemiological and clinical data from suspected dengue patients who visited different hospitals in Swat and Mansehra district of Pakistan between May-November 2013 during a dengue outbreak. Samples were tested for the detection of viral nucleic acid by real-time PCR, non structural protein-1 (NS1) antigen and IgM antibodies by ELISA.
  
  
  RESULTS
  Out of 323 cases with clinical dengue infection, 304 were positive by one or more diagnostic parameter; 201 samples were positive by real-time PCR, 209 were positive by NS1 ELISA and 190 were positive by IgM antibodies. Sensitivities of real-time PCR and NS1 ELISA were comparable for early diagnosis of dengue virus infection, IgM antibody detection assay was found useful for the diagnosis in the samples collected later than day 5 of onset.
  
  
  CONCLUSIONS
  The use of real-time PCR or detection of non structural protein NS1 by ELISA followed by IgM antibodies detection can be recommended for early diagnosis of dengue virus infection with a high level of accuracy.
authors.affiliation: Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan; Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Suleman
authors.affiliation: Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan.
authors.forename: Rani
authors.initials: R
authors.lastname: Faryal
authors.affiliation: Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan.
authors.forename: Uzma Bashir
authors.initials: UB
authors.lastname: Aamir
authors.affiliation: Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan.
authors.forename: Muhammad Masroor
authors.initials: MM
authors.lastname: Alam
authors.affiliation: Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan.
authors.forename: Nadia
authors.initials: N
authors.lastname: Nisar
authors.affiliation: Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan.
authors.forename: Salmaan
authors.initials: S
authors.lastname: Sharif
authors.affiliation: Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan.
authors.forename: Shahzad
authors.initials: S
authors.lastname: Shaukat
authors.affiliation: Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan.
authors.forename: Adnan
authors.initials: A
authors.lastname: Khurshid
authors.affiliation: Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan.
authors.forename: Mehar
authors.initials: M
authors.lastname: Angez
authors.affiliation: Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan.
authors.forename: Massab
authors.initials: M
authors.lastname: Umair
authors.affiliation: Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Mujtaba
authors.affiliation: Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan.
authors.forename: Mian Muhammad
authors.initials: MM
authors.lastname: Sufian
authors.affiliation: Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan.
authors.forename: Yasir
authors.initials: Y
authors.lastname: Arshad
authors.affiliation: Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan.
authors.forename: Lubna
authors.initials: L
authors.lastname: Rehman
authors.affiliation: Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan. Electronic address: sohailz@live.com.
authors.forename: Syed Sohail Zahoor
authors.initials: SSZ
authors.lastname: Zaidi
keywords: Dengue virus; Diagnosis; Epidemiology; Khyber Pakhtunkhwa; NS1 antigen; Pakistan