Epidemiological and Molecular Characterization of Dengue Virus Circulating in Bhutan, 2013-2014

Abstract

Dengue is one of the most significant public health problems in tropical and subtropical countries, and is increasingly being detected in traditionally non-endemic areas. In Bhutan, dengue virus (DENV) has only recently been detected and limited information is available. In this study, we analyzed the epidemiological and molecular characteristics of DENV in two southern districts in Bhutan from 2013–2014. During this period, 379 patients were clinically diagnosed with suspected dengue, of whom 119 (31.4%) were positive for DENV infection by NS1 ELISA and/or nested RT-PCR. DENV serotypes 1, 2 and 3 were detected with DENV-1 being predominant. Phylogenetic analysis of DENV-1 using envelope gene demonstrated genotype V, closely related to strains from northern India. Author Summary: We describe the epidemiological and molecular features of DENV currently circulating in the two southwestern districts of Bhutan, demonstrating a shift in serotype dominance from previous DENV-3 (2004–2006) to current DENV-1 (2013–2014). The presence of the dengue virus in Bhutan is a relatively recent one. Unfortunately, dengue epidemiological and molecular data in this country is scarce. A fever outbreak in 2013 and 2014 saw patients seeking care at medical facilities in two district of southwestern Bhutan bordering with India. Analyses of serum specimens collected from these patients indicated that dengue virus was at least a major source of this outbreak. These specimens were analyzed in the Public Health Laboratory in Bhutan and in AFRIMS, Thailand. With a combination of three different assays, we established that 31% of all cases captured were caused by dengue virus, although the proportion was higher in 2013 than in 2014. Three different serotypes of dengue virus were found: DENV-1, -2 and -3. No DENV-4 was found. We successfully isolated DENV-1, from which was sequenced the E gene for further analyses. Our analyses revealed that the current DENV-1 in Bhutan probably originated from India.

Publication information

Originally published in PLOS Neglected Tropical Diseases on 2015-08-21. Original DOI: 10.1371/journal.pntd.0004010.

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