title: Phylogenetic characterization of circulating Dengue and Alkhumra Hemorrhagic Fever viruses in western Saudi Arabia and lack of evidence of Zika virus in the region: A retrospective study, 2010-2015.
abstract: Flaviviruses represent a global public health concern. They consist of ∼70 viruses with almost half of them causing human diseases with unspecified febrile illnesses. Cities in western Saudi Arabia are endemic for viruses (DENV) with sporadic infections due to Alkhumra hemorrhagic fever virus (AHFV). They also represent a major destination for travelers coming for annual religious pilgrimages (Hajj and Umrah) from all over the world. However, whether other flaviviruses are circulating is not known because of the limited number of surveillance studies. Here, we retrospectively screened 690 samples for flaviviruses in samples from patients with unexplained febrile illnesses between 2010 and 2015 in western Saudi Arabia using a pan-flaviviruses RT-PCR assay. Despite Zika virus RNA was not detected, this study confirms circulation and/or sporadic spread of DENV-2, DENV-3, and AHFV, higher prevalence of DENV-2, and a role for visitors from DENV endemic countries in DENV importation into the Kingdom. Further analysis also showed very low genetic diversity of AHFV confirming its slow microevolution. Accordingly, continuous and prospective surveillance for flaviviruses using such assay are warranted in Saudi Arabia which receives millions of Muslims annually to implement effective control measures in light of the global widespread and outbreaks of several flaviviruses.
authors.affiliation: Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Moneerah S
authors.initials: MS
authors.lastname: Al-Saeed
authors.affiliation: 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: 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: Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Tagreed L
authors.initials: TL
authors.lastname: Al-Subhi
authors.affiliation: 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: Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Arwa
authors.initials: A
authors.lastname: Alsultan
authors.affiliation: Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Huda G
authors.initials: HG
authors.lastname: Ben Helaby
authors.affiliation: Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Mustafa M
authors.initials: MM
authors.lastname: Alshawdari
authors.affiliation: 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: Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.|UMR "Emergence des Pathologies Virales" (EPV: Aix-Marseille university-IRD 190-Inserm 1207-EHESP), Marseille, France.|Institut hospitalo-universitaire Méditerranée infection, APHM Public Hospitals of Marseille, Marseille, France.
authors.forename: Remi N
authors.initials: RN
authors.lastname: Charrel
authors.affiliation: Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.|Faculty of Applied Medical Sciences, Department of Medical Laboratory Technology, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Esam I
authors.initials: EI
authors.lastname: Azhar
authors.affiliation: Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.|Faculty of Medicine, Department of Medical Microbiology and Parasitology, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Anwar M
authors.identifier: 0000-0002-8471-7011
authors.initials: AM
authors.lastname: Hashem
mesh_terms: D003716:Dengue Virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D004669:Encephalitis Viruses, Tick-Borne / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D005334:Fever / Q000453:epidemiology* / Q000209:etiology*; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D010802:Phylogeny; D015995:Prevalence; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012529:Saudi Arabia / Q000453:epidemiology; D000071244:Zika Virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*
keywords: Alkhumra hemorrhagic fever; Saudi Arabia; dengue; flaviviruses