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Home , Japanese encephalitis, West Nile fever

Short note

Point-of-care diagnostics for dengue, , Japanese and West Nile

Subhash C. Arya and Nirmala Agarwal

Sant Parmanand Hospital, 18 Alipore Road, Delhi-110054

The global resurgence of dengue in otherwise sample was positive for two , viz. JEV naive locations has been associated with and (WNV).[6] concurrent dissemination of identical - borne viral . Concurrent infection by There has been no chemotherapy available (DENV) and chikungunya virus for patients with JEV, DENV, CHIKV or WNV. (CHIKV) has been known for several Such cases require appropriate clinical decades.[1] Nevertheless, recent global CHIKV management and public health response. During dissemination[2] or its local re-emergence[3] after the initial stage of illness the clinical presentations a gap has been intriguing. Increased are ambiguous and are accompanied by . intercontinental travel has blown up the ghost These cases are highly infectious with their blood of the traditional endemic foci of CHIKV and teeming with viral RNA. If bitten by the has resulted in CHIKV patients being found in vector, they would contribute to the United States.[4] Moreover, there could dissemination. Moreover, they are likely to be even be coincidental episodes of the Japanese offered empirical doses of antibiotics by the encephalitis virus (JEV) infection. During the clinicians. Any point-of-care indication about JEV, early 1940s, there were dengue outbreaks in DENV, CHIKV or WNV would be imperative Guam, followed, during 1947, by the from the clinical and public health perspective. concurrent of mumps virus and JEV. That would necessitate initiating appropriate anti- Serological investigations in children aged 10 vector measures attuned to vector biology. years or less during 1953 had revealed Vectors transmitting JE and dengue/chikungunya/ neutralizing to JEV, and DENV-1 and - West Nile would be controlled by entirely 2 among those born before 1947.[5] different strategies.

In , during 1997, concurrent infection A commercial diagnostic kit for the field was detected in Haryana state in the north of diagnosis of (JE) antiviral the country. In a follow-up study of a dengue IgM has been evaluated recently.[7] Rather than outbreak, out of 30 samples collected, a multi-step, time-consuming format, the on- eight cases were found positive for dengue IgM the-spot point-of-care diagnostic would address , two were positive for all the three the ground realities in the JE-endemic areas. infections, viz. DENV, JEV and WNV, while one Without prejudice to the conventional -

E-mail: [email protected]

176 Dengue Bulletin – Volume 31, 2007 Dengue, chikungunya, Japanese encephalitis and West Nile virus linked immunosorbent assay (ELISA), a simpler the Bio-Check Plus Dengue G/M Cassette Test on-the-spot diagnostic would assist health care (Brittney). Recent introduction of a rapid, providers better. Obviously, immunochromatographic kit for chikungunya has (IgM)-based assays would be adequate for both been a positive feature.[9] JE and chikungunya. Nevertheless, for dengue, additional markers would be essential. The International organizations including the immunological response during the secondary World Health Organization, the Programme for or tertiary dengue episodes is secondary rather Appropriate Technology in Health (PATH) and than a primary one. The initial immunological the Centers for Disease Control and Prevention response would be towards IgG production (CDC) would be obliged to encourage rather than IgM. Dengue non-structural , standardization of a concurrent point-of-care NS1, has been reported to be better than IgM diagnostic for JE, dengue, chikungunya and in cases of primary or secondary infections.[8] . A multifaceted but cost- Immunochromatographic assay kits for a point- effective rapid assay format would be a valuable of-care dengue IgG and IgM detection have armour for clinicians and public health been popular for a while, namely, the Panbio personnel to diagnose dengue, chikungunya, Dengue Duo IgM and IgG Rapid Strip test, and Japanese encephalitis and West Nile fever.

References

[1] Myers RM, Carey DE. Concurrent isolation dengue, through 1957. Am J Trop Med Hyg. from patient of two , Chikungunya 1958 Jul; 7(4): 441-67. and dengue type 2. Science. 1967 Sep 15; 157(794): 1307-8. [6] Katyal R, Bhardwaj M, Harit AK, Sharma SK, Kumar K, Gill KS. Dengue, Japanese [2] Simon F, Parola P, Grandadam M, Fourcade encephalitis and West Nile flaviviral infections S, Oliver M, Brouqui P, Hance P, Kraemer P, Ali detected during a dengue outbreak in Sonepat Mohamed A, de Lamballerie X, Charrel R, district, Haryana state, India. Dengue Bulletin. Tolou H. Chikungunya infection: an emerging 2004 Dec; 28: 24-28. rheumatism among travelers returned from Indian Ocean islands. Report of 47 cases. [7] Jacobson JA, Hills SL, Winkler JL, Mammen Medicine (Baltimore). 2007 May; 86(3): 123- M, Thaisomboonsuk B, Marfin AA, Gibbons 37. RV. Evaluation of three immunoglobulin M antibody capture enzyme-linked [3] AbuBakar S, Sam IC, Wong PF, MatRahim N, immunosorbent assays for the diagnosis of Hooi PS, Roslan N. Reemergence of endemic Japanese encephalitis. Am J Trop Med Hyg. Chikungunya, . Emerg Infect Dis. 2007 2007 Jul; 77(1): 164-8. Jan; 13(1): 147-9. [8] Kumarasamy V, Chua SK, Hassan Z, Wahab [4] Centers for Disease Control and Prevention AH, Chem YK, Mohamad M, Chua KB. (CDC). Update: chikungunya fever diagnosed Evaluating the sensitivity of a commercial among international travelers–United States, dengue NS1 antigen-capture ELISA for early 2006. MMWR Morb Mortal Wkly Rep. 2007 diagnosis of dengue virus infection. Mar 30; 56(12): 276-7. Singapore Med J. 2007 Jul; 48(7): 669-73. [5] Hammon WM, Tigertt WD, Sather GE, Berge [9] CTK Biotech. Onsite Rapid Test for the TO, Meiklejohn G. Epidemiologic studies of detection of Chikungunya fever. San Diego, CA: concurrent virgin epidemics of Japanese B CTK Biotech. (http://www.ctkbiotech.com/ encephalitis and of mumps on Guam, 1947- Default.aspx?tabid=118 – accessed 11 August 1948, with subsequent observations including 2008).

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