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Support in controlling the Dengue fever outbreak in Sri Lanka

Glove box training at the University of Colombo, Sri Lanka. Source: RKI/Andreas Nitsche

By the end of the year 2017, approximately 186,000 cases of Dengue fever had been reported in Sri Lanka, 400 of which were fatal – an almost four-fold increase compared to the case numbers in 2016. In 2018, more than 9.000 infections with several fatalities have already been reported. The Sri Lankan Ministry of Health, Nutrition & Indigenous Medicine has recently asked the Robert Koch Institute (RKI) for assistance. In the context of an SEEG mission (Schnell einsetzbare Expertengruppe Gesundheit – Rapidly Deployable Expert Group Health), experts of the RKI, the Gesellschaft für Internationale Zusammenarbeit (GIZ – Society for International Cooperation) and the Bernhard Nocht Institute for Tropical Medicine (BNITM) help to test patient samples for Dengue viruses. This expert group is backed by the Global Health Protection Programme (GHPP) of the German Ministry of Health (BMG) in the form of personnel. Since 2016, GHPP has been giving support to national structures in Sri Lanka in establishing laboratory capacities in order to implement reliable laboratory diagnostics locally.

Dengue fever is the clinically most relevant mosquito-borne virus infection. It is endemic in over 100 tropical and subtropical regions, among these Southeast Asia, tropical Africa and the Caribbean. At the onset of the disease, symptoms can hardly be differentiated from those of influenza-like diseases. Later on, in addition to fever of up to 40°C, patients develop severe headache, nausea, vomiting, muscle and joint pains and a rash that can last up to a week. Severe courses of disease with dyspnoea, haemorrhages and organ damage can become fatal.

The etiological agent of Dengue fever is a flavivirus, the so-called Dengue virus, with four different serotypes and their respective numerous genotypes. A previous Dengue virus infection usually confers life-long immunity; however, it only protects exclusively against further infections with the same serotype. In case the patients concerned are infected with another serotype, the probability of the disease taking a severe haemorrhagic course and even becoming fatal is increased.
There is no specific treatment. A timely monitoring and treatment in an intensive care unit may save lives. Therefore an early and unambiguous diagnosis of a Dengue virus infection including serotyping is of great relevance. All four known Dengue virus serotypes are circulating in Sri Lanka. To diagnose Dengue fever, physicians are presently mainly using rapid tests which however are not particularly reliable and, above all, cannot differentiate the individual serotypes. Therefore it is the aim of the present mission to enable the employees of the North Colombo Teaching Hospital and the University of Colombo to identify Dengue fever infections including the various serotypes by using molecular methods. In this way those patients at risk of a severe course of disease due to a Dengue virus infection with a particular serotype can be identified more rapidly and be taken into intensive care.

In the context of GHPP of the BMG, a cooperation has been created during the past years between the Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1, headed by Prof. Dr. Andreas Nitsche) at RKI, and the North Colombo Teaching Hospital and the University of Colombo. The experts have been jointly establishing for instance methods for the molecular diagnostics of highly pathogenic viruses in Sri Lanka, such as the Japanese encephalitis virus or the Dengue viruses.

Since 2016 the GHPP of the BMG has been supporting partner countries – predominantly in Africa – in developing measures to prevent epidemics. The programme is put into practice by the RKI, the Paul Ehrlich Institute (PEI), the BNITM and the Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, BfArM). As a consequence of the Ebola crisis in West Africa, the Federal Ministry for Economic Cooperation and Development (Bundesministerium für wirtschaftliche Zusammenarbeit und Entwicklung, BMZ) in cooperation with the BMG has established SEEG to be able to help partner countries with preparation for infectious disease outbreaks and their management. SEEG is a cooperation between the Robert Koch Institute (RKI), the Bernhard Nocht Institute for Tropical Medicine (BNITM) and the Society for International Cooperation (Gesellschaft für Internationale Zusammenarbeit – GIZ).

Date: 26.03.2018