title: Multiple Introductions of Dengue 2 Virus Strains into Saudi Arabia from 1992 to 2014.
abstract: Dengue is a significant arboviral infection that represents a major public health concern worldwide. The infection is endemic in most parts of South East Asia, sub-Saharan Africa, and Latin America. Among the four dengue virus (DENV) serotypes, DENV-2 has been reported to be the predominant serotype in Saudi Arabia since 1992. However, virological and epidemiological data of DENV-2 from Saudi Arabia are severely deficient and require further investigations.
  
  
  
  Full genome sequencing of a recent DENV-2 isolate and phylogenetic analysis of all available DENV-2 sequences from Saudi Arabia.
  
  
  
  Based on full genome and envelope (E) gene sequence, we show that a recent isolate (DENV-2-Jeddah-2014) belongs to the Indian subcontinent lineage of the Cosmopolitan genotype with close similarity to recent strains from Pakistan. Interestingly, the E gene sequence of DENV-2-Jeddah-2014 isolate was slightly divergent from those previously identified in Saudi Arabia between 1992 and 2004 with three to nine amino acid (aa) substitutions. While our data show that the Cosmopolitan genotype is still circulating in Saudi Arabia, they highlight four distinct genetic groups suggesting at least four independent introductions into the Kingdom.
  
  
  
  The close clustering of DENV-2 isolates reported from Saudi Arabia between 1992 and 2014 with strains from countries providing the highest numbers of pilgrims attending either Hajj or Umrah pilgrimages (Indonesia, Pakistan, India) clearly suggests a role for pilgrims or expatriates coming from DENV endemic countries in DENV-2 importation into Saudi Arabia. Accordingly, continuous monitoring of the circulation of DENVs in Saudi Arabia must be implemented to undertake effective control and management strategies in the Kingdom. Screening of the pilgrims coming to perform Hajj and Umrah might help prevent the introduction of new DENV strains, which is expected to increase the burden of the disease not only in Saudi Arabia but also in other countries.
authors.affiliation: 1 Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University , Jeddah, Saudi Arabia .
authors.forename: Sherif A
authors.initials: SA
authors.lastname: El-Kafrawy
authors.affiliation: 1 Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University , Jeddah, Saudi Arabia .
authors.forename: Sayed S
authors.initials: SS
authors.lastname: Sohrab
authors.affiliation: 1 Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University , Jeddah, Saudi Arabia .
authors.forename: Said Abol
authors.initials: SA
authors.lastname: Ela
authors.affiliation: 2 Insect Pest Control Laboratory, Joint FAO/IAEA Programme of Nuclear Techniques in Food and Agriculture , Vienna, Austria .|3 Pests and Plant Protection Department, National Research Center , Cairo, Egypt .
authors.forename: Adly M M
authors.initials: AM
authors.lastname: Abd-Alla
authors.affiliation: 1 Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University , Jeddah, Saudi Arabia .|4 Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University , Jeddah, Saudi Arabia .
authors.forename: Rowa
authors.initials: R
authors.lastname: Alhabbab
authors.affiliation: 1 Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University , Jeddah, Saudi Arabia .
authors.forename: Suha A
authors.initials: SA
authors.lastname: Farraj
authors.affiliation: 1 Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University , Jeddah, Saudi Arabia .
authors.forename: Norah A
authors.initials: NA
authors.lastname: Othman
authors.affiliation: 1 Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University , Jeddah, Saudi Arabia .
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Hassan
authors.affiliation: 5 Laboratoire de Pathologie Comparée, Université Montpellier 2 , Montpellier, France .
authors.forename: Max
authors.initials: M
authors.lastname: Bergoin
authors.affiliation: 6 Aix Marseille Université, IRD French Institute of Research for Development , EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", and IHU Méditerranée Infection, APHM Public Hospitals of Marseille, Marseille, France .
authors.forename: Raphaelle
authors.initials: R
authors.lastname: Klitting
authors.affiliation: 1 Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University , Jeddah, Saudi Arabia .|6 Aix Marseille Université, IRD French Institute of Research for Development , EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", and IHU Méditerranée Infection, APHM Public Hospitals of Marseille, Marseille, France .
authors.forename: Remi N
authors.initials: RN
authors.lastname: Charrel
authors.affiliation: 1 Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University , Jeddah, Saudi Arabia .|7 Department of Medical Microbiology and Parasitology Faculty of Medicine, King Abdulaziz University , Jeddah, Saudi Arabia .
authors.forename: Anwar M
authors.initials: AM
authors.lastname: Hashem
authors.affiliation: 8 Department of Medicine, Faculty of Medicine, King Abdulaziz University , Jeddah, Saudi Arabia .
authors.forename: Tariq A
authors.initials: TA
authors.lastname: Madani
authors.affiliation: 1 Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University , Jeddah, Saudi Arabia .|4 Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University , Jeddah, Saudi Arabia .
authors.forename: Esam I
authors.initials: EI
authors.lastname: Azhar
mesh_terms: D003715:Dengue / Q000453:epidemiology* / Q000821:virology*; D003716:Dengue Virus / Q000145:classification*; D016679:Genome, Viral; D005838:Genotype; D006801:Humans; D010802:Phylogeny; D012529:Saudi Arabia / Q000453:epidemiology
keywords: Dengue virus; Full genome; Jeddah; Phylogenetic analysis sequencing; Saudi Arabia