Introduction
Since the primary traveler case of dengue was reported in Tehran in 2008, Dengue virus (DENV) has regularly unfold all through Iran, with a steady improve in reported instances (1). As a mosquito-borne flavivirus transmitted by Aedes (Stegomyia) aegypti and Ae. (Stegomyia) albopictus mosquitoes, DENV shares its vectors with different notable viruses corresponding to chikungunya (CHIKV), Zika (ZIKV), and yellow fever (2). DENV has 4 serotypes (DENV-1 to DENV-4), every with distinct genotypes. DENV-2, ceaselessly related to extreme infections and epidemics, consists of six genotypes: Asian/American, Asian I, Asian II, Cosmopolitan, American, and sylvatic (3).
Dengue fever presents a variety of medical manifestations, from asymptomatic infections to gentle flu-like syndromes, dengue fever (DF), and extreme dengue illness (SDD), encompassing dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) (4). Neurological issues might embody encephalopathy, encephalitis, seizures, intracranial hemorrhage, and Guillain-Barré syndrome (GBS) (5). With a 2.5% mortality price, dengue poses a major international well being concern, with the World Health Organization reporting an 8-fold improve in instances between 2000 and 2019 (from 505,430 to five.2 million) (6). In 2023, a worldwide resurgence was noticed, characterised by a marked rise in outbreaks in beforehand unaffected areas. Climate change-induced mosquito inhabitants progress is predicted to additional increase dengue-endemic areas and improve the at-risk inhabitants (7). One dengue vaccine, Dengvaxia®, is authorised within the United States for people aged 9–16 with a historical past of dengue an infection residing in high-risk areas (8, 9).
Epidemiological trajectories of Dengue virus in Iran
Dengue fever has change into a major public well being concern in Iran since 2008, following the affirmation of the primary case in a 58-year-old girl from Tehran with a journey historical past to Malaysia (1). Subsequent investigations revealed a gradual unfold of the Dengue virus (DENV) throughout the nation, elevating questions in regards to the epidemiological trajectories of this mosquito-borne flavivirus. A retrospective examine performed on 300 beforehand collected samples (2000–2012), primarily from the Sistan and Baluchistan province, detected 15 (5%) optimistic instances via serology and three (1%) optimistic instances via serology plus polymerase chain response (PCR) for DF. Notably, 7 (46.7%) of the 15 seropositive instances had no journey historical past outdoors Iran, with six originating from Sistan and Baluchestan, a area adjoining to Pakistan with a hot-dry local weather conducive to Aedes mosquito emergence (10). Further proof of DENV circulation emerged from Chabahar (2013), the place 30 out of 540 samples examined optimistic, and 11 had been equivocal for DENV IgG antibodies utilizing the ELISA methodology (11). Additionally, a 32-year-old girl with a current journey historical past to India was recognized with DENV in October 2015, highlighting the position of worldwide journey in illness transmission (12). In Zahedan (2013–2015), a examine involving 60 sufferers revealed proof of previous or current DENV publicity in 13 people, with IgM antibodies detected in 6.5% of sufferers (13). Notably, none of those sufferers had a journey historical past outdoors Iran, emphasizing the potential for native DENV transmission (13). A case report from 2016 documented a 39-year-old girl with a journey historical past to Malaysia being recognized with DENV in Sabzevar metropolis (14). Further proof of DENV circulation was present in a examine performed between December 2016 and November 2017 on the National Measles Laboratory in Tehran, the place 82 out of 1,306 examined sera had been dengue seropositive (15) (Table 1).
Table 1. Summary of printed articles reporting DENV in Iran.
Recently, the Ministry of Health and Medical Education in Iran reported 137 dengue fever instances from 15 May to 10 July 2024. Only one affected person succumbed to the an infection, with most contaminated sufferers having a journey historical past to endemic international locations corresponding to Pakistan, the United Arab Emirates, Oman, and West Africa (Benin). Notably, twelve sufferers from Bandar Lengeh, Hormozgan Province, had no journey historical past to overseas international locations, indicating the presence of mosquito vectors in Iran (16).
The rise of Dengue virus endemic in Iran: Sistan and Baluchistan province on the forefront
Located within the southeastern area of Iran, Sistan and Baluchistan province has witnessed a surge in Dengue virus (DENV) endemic instances, positioning itself as a focus within the nation (13) (Figure 1). This improvement is a results of numerous elements working collectively, such because the province’s geographical place, the presence of Aedes mosquito vectors, the area’s local weather, and its worldwide commerce connections.
Figure 1. Epidemiology of dengue in Iran. (A) The map exhibits cumulative dengue instances (ELISA-confirmed) in Iran from 2008 to 2024. (B) Annual reported seropositive dengue instances (ELISA-confirmed) in Iran from 2008 to 2024.
One main contributing issue to the unfold of DENV in Sistan and Baluchistan is its geographical proximity to Pakistan, a rustic additionally coping with DF endemics. The shared border between Iran and Pakistan permits for the attainable motion of contaminated people throughout the border, heightening the chance of DENV transmission within the province. A examine showcased this connection, with 46.7% of 15 seropositive instances having no journey historical past outdoors Iran, and 6 instances originating from Sistan and Baluchestan province (10).
Another contributor to the potential for DENV transmission in Iran is the presence of Aedes mosquito vectors, significantly Aedes albopictus and Aedes aegypti. Ae. albopictus was first reported in Chabahar, Sistan and Baluchestan Province, whereas Ae. aegypti was noticed in Bandar Lengeh, Hormozgan Province (17, 18). Although the institution of those Aedes mosquito species in Iran stays unconfirmed, continued monitoring and surveillance are needed because of the predicted chance of their presence in studied space based mostly on modeling. It seems that these species haven’t but tailored to the weather conditions of those areas (19, 20).
Additionally, local weather change projections point out that northern and southern areas of Iran, together with Sistan and Baluchistan, are extra vulnerable to DENV transmission attributable to favorable weather conditions for mosquito vectors (21). Studies performed in Iran have proven the next prevalence of Ae. albopictus within the southern areas of Sistan and Baluchestan Province (17, 22). This highlights the significance of incorporating local weather information into public well being methods to counteract the impression of local weather change on illness dynamics.
International commerce, significantly maritime transportation, additionally considerably influences the potential unfold of DENV and its vectors. Shipping containers and vessels might function excellent habitats for Aedes mosquitoes, permitting them to disperse to new areas (23). With Sistan and Baluchistan strategically situated alongside worldwide commerce routes, common and correct monitoring of entomological exercise at these entry factors is essential to attenuate the danger of DENV and its vectors being launched and unfold (24).
Preliminary genomic surveillance of Dengue virus in Iran
Figure 2. A neighbor-net community evaluation was performed to look at the phylogenetic relationships amongst DENV-1 genotypes, utilizing partial nucleotide sequences of the capsid and premembrane genes (511 nucleotides) from numerous DENV strains. The standardized DENV pressure nomenclature and corresponding GenBank accession numbers are offered for every sequence included within the evaluation. DENV strains from Iran are highlighted in daring inside the community (31).
Seroprevalence, extreme manifestations, and deaths brought on by Dengue virus
While a complete systematic overview assessing the seroprevalence of DENV throughout Iran has but to be performed, a number of current research present helpful insights into the prevalence of DENV antibodies in particular areas and populations. One large-scale examine performed from September 2017 to June 2018 collected 1,257 serum samples from six provinces: Bushehr, Hormozgan, Sistan and Baluchestan, Khuzestan (southern areas), and Gilan and Mazandaran (northern areas). The examine included sufferers aged 15 years or older with a earlier historical past of fever, headache, physique ache, arthralgia, or rash sickness. Using Euroimmune ELISA kits, 74 (5.9%) serum samples had been discovered reactive for DENV IgG antibodies, with optimistic instances recognized primarily within the southern areas of Khuzestan and Bushehr (32). In one other examine, investigators examined the seroprevalence of DENV in 60 suspected sufferers from southeastern Iran. The outcomes confirmed that IgG antibodies had been detected in 5% (3 sufferers) of the cohort (13). Although a nationwide systematic overview of DENV seroprevalence continues to be wanted to achieve an entire understanding of the illness burden in Iran, these research spotlight the presence of DENV publicity in numerous areas and emphasize the significance of continued surveillance and focused interventions. Further analysis is warranted to observe the altering epidemiology of DENV in Iran and inform public well being insurance policies to mitigate the unfold of the virus.
Dengue fever, as outlined by the World Health Organization (WHO), is an acute febrile sickness lasting 2–7 days, usually presenting with a minimum of two of the next manifestations: headache, retro-orbital ache, myalgia, arthralgia, rash, hemorrhagic manifestation, and leukopenia (33). Iranian sufferers exhibit a variety of extreme manifestations that require cautious monitoring and administration. Leukopenia and thrombocytopenia have been recognized as the most typical laboratory abnormalities in Iranian sufferers with dengue fever (1, 14, 34). While these sufferers usually obtain supportive care, together with fluid resuscitation, electrolyte substitute, and transfusions when needed, you will need to observe that antiviral remedy is just not routinely administered in these instances. Fortunately, regardless of the severity of signs, intensive care has not been required for a lot of the sufferers in query (13). The medical course of dengue fever in Iranian sufferers is usually characterised by excessive fever, with temperatures as much as 38°C. Additional signs embody headache, gentle rash, bodily ache, nausea, lethargy, vomiting blood, and bone ache. Myalgia, particularly, has been reported with a severity rating of 6–7 out of 10 in some instances (13, 14). The vary of signs related to DENV infections highlights the significance of immediate analysis and acceptable supportive care to stop issues and guarantee optimum affected person outcomes.
DSS, a extreme type of dengue characterised by hemorrhagic fever and circulatory failure, is related to considerably excessive mortality charges. According to international estimates, roughly 390 million dengue infections and 96 million symptomatic instances happen yearly, together with over 2 million instances of DHF and round 15,000 deaths (35). The case-fatality price of DHF is round 5%, with the World Health Organization estimating greater than 20,000 deaths every year (36, 37). In Southeast Asia, the estimated lifetime variety of dengue infections per individual is round 3.3, with an general annual an infection price of 5%. This price is increased amongst youngsters underneath 15 (12.5%) in comparison with adults (2.8%) (38). Although there’s restricted rigorous proof on the mortality price of DENV in Iran, sporadic deaths have been reported through the years, emphasizing the necessity for continued surveillance and analysis to higher perceive the illness’s burden and enhance prevention methods within the nation.
Dengue virus in Iran: a name for motion
Conclusion
Addressing the danger of dengue epidemics in Iran is essential, given the institution of Ae. aegypti in southern Iran and dengue outbreaks in neighboring international locations. Since no efficient vaccine or particular remedy exists, well being training and vector management are probably the most very important instruments for prevention and management. Educating healthcare staff is especially essential, as they’re answerable for illness prevention, management, and administration. Investing of their capability can enhance dengue case administration and the general healthcare system.
Data availability assertion
Author contributions
ZH: Writing – unique draft, Writing – overview & enhancing. FH: Visualization, Writing – unique draft. FM: Investigation, Writing – overview & enhancing. MZ: Conceptualization, Supervision, Writing – overview & enhancing.
Funding
Conflict of curiosity
Publisher’s observe
References
1. Mardani, M, Abbasi, F, Aghahasani, M, and Ghavam, B. First Iranian imported case of dengue. Int J Prev Med. (2013) 4:1075.
Google Scholar
2. Guzman, MG, Halstead, SB, Artsob, H, Buchy, P, Farrar, J, Gubler, DJ, et al. Dengue: a seamless international menace. Nat Rev Microbiol. (2010) 8:S7–S16. doi: 10.1038/nrmicro2460
PubMed Abstract | Crossref Full Text | Google Scholar
3. Waman, VP, Kolekar, P, Ramtirthkar, MR, Kale, MM, and Kulkarni-Kale, U. Analysis of genotype variety and evolution of dengue virus serotype 2 utilizing full genomes. PeerJ. (2016) 4:e2326. doi: 10.7717/peerj.2326
PubMed Abstract | Crossref Full Text | Google Scholar
4. Zhang, H, Zhou, Y, Peng, H, Zhang, X, Zhou, F, Liu, Z, et al. Predictive signs and indicators of extreme dengue illness for sufferers with dengue fever: a meta-analysis. Biomed Res Int. (2014) 2014:359308:1–10. doi: 10.1155/2014/359308
Crossref Full Text | Google Scholar
6. Park, J, Kim, J, and Jang, Y-S. Current standing and views on vaccine improvement towards dengue virus an infection. J Microbiol. (2022) 60:247–54. doi: 10.1007/s12275-022-1625-y
PubMed Abstract | Crossref Full Text | Google Scholar
7. Ritu, MR, Sikder, D, Patwary, MM, Tamim, AR, and Rodriguez-Morales, AJ. Climate change, urbanization and resurgence of dengue in Bangladesh. New Microbes New Infect. (2024) 59:101414. doi: 10.1016/j.nmni.2024.101414
Crossref Full Text | Google Scholar
8. World Health Organization, Special Programme for Research, Training in Tropical Diseases, World Health Organization. Department of Control of Neglected Tropical Diseases, World Health Organization. Epidemic and Pandemic Alert. World Health Organization. Dengue: tips for analysis, remedy, prevention and management. Geneva: World Health Organization (2009).
Google Scholar
9. Paz-Bailey, G. Dengue vaccine: suggestions of the advisory committee on immunization practices, United States, 2021. MMWR Recomm Rep. (2021) 70:1–16. doi: 10.15585/mmwr.rr7006a1
Crossref Full Text | Google Scholar
10. Chinikar, S, Ghiasi, SM, Shah-Hosseini, N, Mostafavi, E, Moradi, M, Khakifirouz, S, et al. Preliminary examine of dengue virus an infection in Iran. Travel Med Infect Dis. (2013) 11:166–9. doi: 10.1016/j.tmaid.2012.10.001
PubMed Abstract | Crossref Full Text | Google Scholar
11. Aghaie, A, Aaskov, J, Chinikar, S, Niedrig, M, Banazadeh, S, and Mohammadpour, HK. Frequency of dengue virus an infection in blood donors in Sistan and Baluchestan province in Iran. Transfus Apher Sci. (2014) 50:59–62. doi: 10.1016/j.transci.2013.07.034
PubMed Abstract | Crossref Full Text | Google Scholar
12. Baniasadi, V, Salehi-Vaziri, M, Jalali, T, Azad-Manjiri, S, Mohammadi, T, Khakifirouz, S, et al. An imported case of dengue fever in Iran, 2015. Iran J Virol. (2016) 10:31–4. doi: 10.21859/isv.10.1.31
Crossref Full Text | Google Scholar
13. Heydari, M, Metanat, M, Rouzbeh-Far, M-A, Tabatabaei, SM, Rakhshani, M, Sepehri-Rad, N, et al. Dengue fever as an rising an infection in Southeast Iran. Am J Trop Med Hyg. (2018) 98:1469–71. doi: 10.4269/ajtmh.17-0634
PubMed Abstract | Crossref Full Text | Google Scholar
14. Ebrahimi, M, Abadi, A, Bashizadeh-Fakhar, H, and Fahimi, E. Dengue fever in Iran: a case report. Zahedan. J Res Med Sci. (2016) 18. doi: 10.17795/zjrms-9953
Crossref Full Text | Google Scholar
15. Tavakoli, F, Rezaei, F, Shafiei-Jandaghi, NZ, Shadab, A, and Mokhtari-Azad, T. Seroepidemiology of dengue and chikungunya fever in sufferers with rash and fever in Iran, 2017. Epidemiol Infect. (2020) 148:e42. doi: 10.1017/S0950268820000114
PubMed Abstract | Crossref Full Text | Google Scholar
17. Doosti, S, Yaghoobi-Ershadi, MR, Schaffner, F, Moosa-Kazemi, SH, Akbarzadeh, Okay, Gooya, MM, et al. Mosquito surveillance and the primary document of the invasive mosquito species Aedes (Stegomyia) albopictus (Skuse)(Diptera: Culicidae) in southern Iran. Iran J Public Health. (2016) 45:1064.
Google Scholar
18. Dorzaban, H, Soltani, A, Alipour, H, Hatami, J, Jaberhashemi, SA, Shahriari-Namadi, M, et al. Mosquito surveillance and the primary document of morphological and molecular-based identification of the invasive species Aedes (Stegomyia) aegypti (Diptera: Culicidae) in southern Iran. Experimental Parasitology. (2022) 236:108235.
Google Scholar
19. Nejati, J, Bueno-Marí, R, Collantes, F, Hanafi-Bojd, AA, Vatandoost, H, Charrahy, Z, et al. Potential threat areas of Aedes albopictus in South-Eastern Iran: a vector of dengue fever, zika, and chikungunya. Front Microbiol. (2017) 8:1660. doi: 10.3389/fmicb.2017.01660
PubMed Abstract | Crossref Full Text | Google Scholar
20. Nejati, J, Baygi, MZ, and Bueno-Mari, R. Dengue fever: the specter of rising ailments coinciding the Corona disaster in southeastern Iran. Health Scope. (2022) 11. doi: 10.5812/jhealthscope-122450
Crossref Full Text | Google Scholar
21. Sedaghat, MM, Omid, FB, Karimi, M, Haghi, S, and Hanafi-Bojd, AA. Modelling the chance of presence of Aedes aegypti and Aedes albopictus in Iran till 2070. Asian Pac J Trop Med. (2023) 16:16–25. doi: 10.4103/1995-7645.368017
Crossref Full Text | Google Scholar
22. Kollars, TM Jr. Potential for the invasive species Aedes albopictus and arboviral transmission via the Chabahar port in Iran. Iran J Med Sci. (2018) 43:393–400.
PubMed Abstract | Google Scholar
23. Banu, S, Hu, W, Hurst, C, and Tong, S. Dengue transmission within the Asia-Pacific area: impression of local weather change and socio-environmental elements. Trop Med Int Health. (2011) 16:598–607. doi: 10.1111/j.1365-3156.2011.02734.x
PubMed Abstract | Crossref Full Text | Google Scholar
24. Mohammadi, A, Mostafavi, E, Zaim, M, Enayati, A, Basseri, HR, Mirolyaei, A, et al. Imported tires; a possible supply for the entry of Aedes invasive mosquitoes to Iran. Travel Med Infect Dis. (2022) 49:102389. doi: 10.1016/j.tmaid.2022.102389
PubMed Abstract | Crossref Full Text | Google Scholar
25. Bakhshi, H, Mousson, L, Moutailler, S, Vazeille, M, Piorkowski, G, Zakeri, S, et al. Detection of arboviruses in mosquitoes: proof of circulation of chikungunya virus in Iran. PLoS Negl Trop Dis. (2020) 14:e0008135. doi: 10.1371/journal.pntd.0008135
PubMed Abstract | Crossref Full Text | Google Scholar
26. Amin, M, Zaim, M, Edalat, H, Basseri, HR, Yaghoobi-Ershadi, MR, Rezaei, F, et al. Seroprevalence examine on West Nile virus (WNV) an infection, a hidden viral illness in Fars province, southern Iran. J Arthropod Borne Dis. (2020) 14:173. doi: 10.18502/jad.v14i2.3735
Crossref Full Text | Google Scholar
27. Chinikar, S, Goya, M, Shirzadi, M, Ghiasi, S, Mirahmadi, R, Haeri, A, et al. Surveillance and laboratory detection system of Crimean-Congo haemorrhagic fever in Iran. Transbound Emerg Dis. (2008) 55:200–4. doi: 10.1111/j.1865-1682.2008.01028.x
PubMed Abstract | Crossref Full Text | Google Scholar
28. Hill, V, Githinji, G, Vogels, CB, Bento, AI, Chaguza, C, Carrington, CV, et al. Toward a worldwide virus genomic surveillance community. Cell Host Microbe. (2023) 31:861–73. doi: 10.1016/j.chom.2023.03.003
PubMed Abstract | Crossref Full Text | Google Scholar
29. Foudeh, AM, Didar, TF, Veres, T, and Tabrizian, M. Microfluidic designs and strategies utilizing lab-on-a-chip units for pathogen detection for point-of-care diagnostics. Lab Chip. (2012) 12:3249–66. doi: 10.1039/c2lc40630f
Crossref Full Text | Google Scholar
30. Chinikar, S, and Shahhosseini, N. Phylogenetic evaluation on rising arboviruses in Iran. Int J Infect Dis. (2016) 53:160. doi: 10.1016/j.ijid.2016.11.391
Crossref Full Text | Google Scholar
31. Shahhosseini, N, Chinikar, S, Nowotny, N, Fooks, AR, and Schmidt-Chanasit, J. Genetic evaluation of imported dengue virus strains by Iranian vacationers. Asian Pac J Trop Dis. (2016) 6:850–3. doi: 10.1016/S2222-1808(16)61144-1
Crossref Full Text | Google Scholar
32. Vasmehjani, AA, Rezaei, F, Farahmand, M, Mokhtari-Azad, T, Yaghoobi-Ershadi, MR, Keshavarz, M, et al. Epidemiological proof of mosquito-borne viruses amongst individuals and vectors in Iran: a examine from north to south. Virol Sin. (2022) 37:149–52. doi: 10.1016/j.virs.2022.01.005
PubMed Abstract | Crossref Full Text | Google Scholar
33. World Health Organization. Guidelines for remedy of dengue fever. World Health Organization. (1999).
Google Scholar
34. Khalili, M, Aflatoonian, MR, Hemati, M, Mostafavi, E, and Aflatoonian, B. Dengue fever serology in febrile sufferers in Southeast Iran. J Kerman Univ Med Sci. (2019) 26:90–4. doi: 10.22062/jkmu.2019.87278
Crossref Full Text | Google Scholar
35. Bhatt, S, Gething, PW, Brady, OJ, Messina, JP, Farlow, AW, Moyes, CL, et al. The international distribution and burden of dengue. Nature. (2013) 496:504–7. doi: 10.1038/nature12060
PubMed Abstract | Crossref Full Text | Google Scholar
36. Ong, A, Sandar, M, Chen, MI, and Sin, LY. Fatal dengue hemorrhagic fever in adults throughout a dengue epidemic in Singapore. Int J Infect Dis. (2007) 11:263–7. doi: 10.1016/j.ijid.2006.02.012
Crossref Full Text | Google Scholar
38. Bhattacharya, M, Maitra, S, Ganguly, A, Bhattacharya, A, and Sinha, A. Dengue: a rising menace — a snapshot of current info, figures & treatments. Int J Biomed Sci. (2013) 9:61–7. doi: 10.59566/IJBS.2013.9061
PubMed Abstract | Crossref Full Text | Google Scholar
39. Zaim, M, Enayati, A, Sedaghat, M, and Goya, M. Guide to prevention and management of Ae. Aegypti and Ae. Albopictus in Iran. Tehran: Ministry of Health and Medical Education (2020).
Google Scholar
40. Redoni, M, Yacoub, S, Rivino, L, Giacobbe, DR, Luzzati, R, and Di Bella, S. Dengue: standing of present and under-development vaccines. Rev Med Virol. (2020) 30:e2101. doi: 10.1002/rmv.2101
PubMed Abstract | Crossref Full Text | Google Scholar
41. Nikookar, SH, Moosazadeh, M, Fazeli-Dinan, M, Zaim, M, Sedaghat, MM, and Enayati, A. Knowledge, angle, and follow of healthcare staff relating to dengue fever in Mazandaran Province, northern Iran. Front Public Health. (2023) 11:1129056. doi: 10.3389/fpubh.2023.1129056
PubMed Abstract | Crossref Full Text | Google Scholar
42. Abbasi, M, Zaim, M, Moosazadeh, M, Alizadeh, M, Dorosti, A, Khayatzadeh, S, et al. Uncovering the information hole: a web-based survey of healthcare suppliers’ understanding and administration of dengue fever in East Azerbaijan, Iran. PLoS One. (2024) 19:e0305528. doi: 10.1371/journal.pone.0305528
PubMed Abstract | Crossref Full Text | Google Scholar