Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
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Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
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Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : DC19 - DC23 Full Version

Emergence of Dengue as a Febrile Illness in Rewa and Nearby Districts of Madhya Pradesh During the Year, 2021: A Cross-sectional Study


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55546.16339
Taruna Singh, Amaresh Nigudgi, Vijay Tiwari, Pramod Kushwaha, Ashutosh Garg

1. Assistant Professor, Department of Microbiology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India. 2. Professor, Department of Microbiology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India. 3. Assistant Professor, Department of Microbiology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India. 4. Assistant Professor, Department of Microbiology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India. 5. Demonstrator, Department of Microbiology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India.

Correspondence Address :
Dr. Pramod Kushwaha,
Assistant Professor, Department of Microbiology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India.
E-mail: pkvacantstare@gmail.com

Abstract

Introduction: Dengue is a mosquito borne viral disease, found in tropical and subtropical countries. Dengue virus (DENV) infected mosquitoes of Aedes species are crucial for the transmission of disease. It has emerged as a threat to the public health systems. Dengue is endemic in many parts of India but still the status of dengue cases in Rewa Madhya Pradesh is not reported convincingly.

Aim: To investigate the presence of dengue in Rewa district of Madhya Pradesh.

Materials and Methods: This cross-sectional study was conducted in the Department of Microbiology at Shyam Shah Medical college Rewa under National Vector Borne Disease Control Programme (NVBDCP), Rewa, Madhya Pradesh, India, including 1113 Outpatient/Inpatient Department samples received during March 2021 to October 2021. Blood samples were collected from patients having febrile illness and after serum separation, serum were subjected to NS1 Enzyme Linked Immunosorbent Assay (ELISA) test. Descriptive statistics and Chi-square tests were applied for data analysis.

Results: A total of 1113 sample were received and tested for dengue NS1 out of that 108 sample were found NS1 positive by ELISA. The cases of dengue started from the month of July 2021. But in the month of October dengue positivity was highest in number. Dengue cases reported were 297 (6.73%) in the rainy season (July-August), but the dengue positivity increased (713, 9.3%) in the post rainy season (September-October). Overall prevalence of dengue was higher in the 21-30 years (34.3%) age group followed by 11-20 years (24.1%), 31-40 years (18.5%), 41-50 years (18.5%), 51-60 years (7.4%) and >60 years (3.70%) age groups with respect to total positive cases. The prevalence of dengue was higher in male (12.94%) in comparison to females (5.54%).

Conclusion: This study warrants the dengue virus infection as one of the important causes of fever during rainy and post rainy season in this region. Early diagnosis and reporting of cases are important for the better management of disease.

Keywords

Dengue virus, Enzyme-linked immunosorbent assay, Fever, Serology

Dengue fever is a viral disease transmitted by infected Aedes aegypti mosquitoes in tropical and subtropical regions. It is a major public health problem especially in tropical region (1). The incidence of dengue cases have increased over the years. The morbidity and mortality associated with dengue virus were reported significantly in many parts of the world, including India (2). According to an estimate 3.9 billion people are at risk of dengue viruses’ infection. 70% of the actual burden is bearded in Asia itself (3). In India, the number of dengue cases and severity of illness have been increasing year by year (4). Geographical distribution of DENV includes not only urban but also semi urban and rural areas (5).

Dengue viruses (DENV) belong to the genus Flavivirus of family Flaviviridae. It is a single stranded Ribonucleic Acid (RNA) virus and has four distinct serotypes (DENV 1-4) (6). Usually, the condition of dengue disease occurs suddenly after 2 to 7 days of incubation with the onset of a high fever. Fever may be accompanied by headache, myalgia, thrombocytopenia, hemorrhagic manifestation, arthralgia and rigors (7),(8). Dengue infection can also cause severe disease lead to hemorrhagic manifestation, bleeding, plasma leakage, and organ impairment (9). In some cases, conditions of Dengue Hemorrhagic Fever (DHF) and/or Dengue Shock Syndrome (DSS) appeared that are fatal (7),(8),]10]. The DHF and DSS case fatality rate can be as high as > 40% (11).

Increased aspartate and alanine aminotransferase liver enzyme levels are other prominent clinical characteristics of dengue patients (9). Circulation of all DENV 1-4 serotypes has already been reported in Central India, Madhya Pradesh (12),(13). Several reports of febrile illness like typhoid, malaria in Rewa district of Madhya Pradesh are available but exclusively dengue prevalence has not been studied for this region (14),(15). This study aimed to determine the emergence and presence of DENV in Rewa district of Madhya Pradesh in year 2021.

Material and Methods

This cross-sectional study was conducted in the Department of Microbiology at Shyam Shah Medical college Rewa under National Vector Borne Disease Control Programme (NVBDCP), Rewa, Madhya Pradesh, India, including 1113 Outpatient/Inpatient Department (OPD/IPD) samples received during March 2021 to October 2021. Shyam Shah Medical College Rewa was authorized for serology based dengue / chikungunya testing as Sentinel Surveillance Hospitals (SSH) by National Vector Borne Disease Control Programme (NVBDCP), Government of India in year 2021 (16). Briefly, clinically suspected dengue febrile Outpatient/Inpatient Department cases were sent to the Department of Microbiology for serological diagnosis under the programme of NVBDCP. All details including symptoms, case history and consent (from clinician and patient/guardian of patient) were taken for serological diagnosis as per case report, Case Record Form (CRF), of Department of Health Research (DHR)- Indian Council of Medical Research (ICMR) (CRF format was provided by ICMR-National Institute of Epidemiology under DHR-ICMR VRDL Network as Department of Microbiology SSMC Rewa is a part of the VRDL network). Based on the serological diagnosis results for dengue under NVBDCP programme in year 2021, data were analysed (before rainy season: March-June; rainy season: July-August; post rainy season: September-October).

Inclusion and Exclusion criteria: As per NVBDCP program inclusion and exclusion criteria were based on clinical diagnosis. Briefly, clinically dengue suspected OPD/IPD patients who presented with an acute febrile illness or following clinical features were included in the study: fever, headache, myalgia, thrombocytopenia, hemorrhagic manifestation, arthralgia, rigors. Confirmed or suspected cases for other infections like malaria, hepatitis B, hepatitis C, scrub typhus and leptospirosis were excluded for dengue diagnosis.

Diagnosis of Dengue by NS1 ELISA: The testing was done retrospectively as batched samples using Dengue NS1 Antigen ELISA, (J.Mitra, India) by serum/blood samples collected from OPD/IPD patients. As per the manufacturer's specifications, this is a qualitative ELISA for the detection of NS1 antigen in human serum. Briefly 50 μL of serum samples with positive and negative control were separately added to the plate. Then 100 μL of Horseradish Peroxidase (HRP) labelled diluted (1:50) conjugate was added to each well followed by primary incubation at 37°C for 90 min. After incubation, the plate was washed 6 times with a 1x wash buffer. Then 150 μL of working substrate Tetramethyl Benzidine/Hydrogen Peroxide (TMB/H2O2) was added to each well and incubated at room temperature for 30 min in dark. Then 100 μL of stop solution was added to each well and the plate was read at 450 nm with a microplate reader.

Statistical Analysis

Descriptive statistics were applied for data analysis. Statistical significance was evaluated using Chi-square tests. The level of statistical significance was kept at p-value <0.05. Analysis was performed by using statistical software GraphPad PRISM 8.0.2.

Results

Over last decades dengue has emerged as a predominant febrile illness in India including Madhya Pradesh and other states. However status of dengue in Rewa has not been shown convincingly till date. As per our previous records of dengue testing in Department of Microbiology, SSMC, Rewa, only four positive cases out of 370 samples in year 2017 (unpublished data) were observed. During 2018-2020 no dengue positive cases in Rewa was recorded. In year 2021 dengue cases were increased in Rewa. Hereby, authors are showing the status of dengue cases in Rewa and nearby districts during the 2021 (tested and identified under NVBDCP programme).

Incidences of dengue cases in Rewa and other nearby districts of Madhya Pradesh: Serological diagnosis (based on NS1 Ag ELISA) was carried to know the incidence of dengue fever. The NS1 Ag ELISA was reactive with all four dengue virus serotypes. We identified positive cases regardless of serotypes. A total of 1113 serum samples were tested. Out of 1113 samples, 527 samples were collected from IPD cases and remaining 586 samples were collected from OPD. Over all positivity was 9.70 % (n=108). Out of 108 positive cases, 72 samples were collected from IPD cases and remaining 36 samples were collected from OPD. The prevalence of dengue fever was significantly higher (p-value <0.0001, Odd ratio: 1.630 to 3.962) in males (12.94%, n=81) in comparison to females (5.54%, n=27), (Table/Fig 1).

Out of 108 dengue positive cases, the number of positive cases were higher in Rewa (n=90) followed by Satna (n=9), Panna (n=4), Sidhi (n=4) and Shahdol (n=1), (Table/Fig 2).

Distribution of dengue cases: Month wise and season wise incidence of dengue cases were analysed to know the trend of dengue in respect to month and season. To show the particular month and season wise trend of dengue, dengue positivity (%) of each month and season were calculated out of sample tested during that month and season only. The dengue cases were started from the month of July (161 cases) and initially the positivity was 6.83% (11/161). In month of August, the positivity was 6.62% (n=9/136). Then, the dramatic increase in dengue cases were observed in September (10.27%, n=34/331). In October, dengue cases were further increased (14.14%, n=54/382). Season wise distribution of dengue cases revealed that, before the rainy season (March-June) dengue cases were not seen. However in the rainy season (July-August) dengue positivity was 6.73% (n=20/297). After the rainy season dengue (September - October) positivity increased and it was 12.3% (n=88/713). This seasonal variability was significant (p-value <0.001) in terms of dengue positive cases in the rainy and post rainy (Table/Fig 3).

Age group wise distribution and locality of Dengue positive cases: The age group of 21-30 years was highly affected with dengue (37, 34.3%) followed by 11-20 years (26, 24.1%), 31-40 years (20, 18.5%), 41-50 years (9, 8.3%), 51-60 years (8, 7.4%), 1-10 years (4, 3.7%) and >60 years (4, 3.7%). Overall 64, 79.01% of males and 22, 81.48% females in rural areas were found more affected with dengue. However, in urban areas dengue positivity was 17, 20.99% in males and 5, 18.52% in females (Table/Fig 4), (Table/Fig 5).

Clinical manifestation of dengue positive cases: The most common clinical features were fever, headache, myalgia, thrombocytopenia, hemorrhagic manifestation, arthralgia, rigors. All positive samples (N=108) were having fever history (100%). Headache, myalgia and arthralgia were also evident in dengue positive cases which may include thrombocytopenia, hemorrhagic manifestation, rigors (Table/Fig 6).

Discussion

Dengue cases have emerged and grown dramatically around the world over past decades. Late or misdiagnosis of Dengue as other febrile illnesses is still a major problem in the management of disease burden (17). According to an estimate 96 million dengue cases manifest clinically out of 390 million of dengue cases per year. 70% of the actual burden is in Asia (3). In 2020, during covid-19 pandemic dengue affected many countries including India and still continues to affect in 2021 (2). In 2020, 44585 dengue cases along with 56 deaths were reported in India as per National Vector Borne Diseases Control Programme (NVBDCP). Total 806 cases were reported from Madhya Pradesh (MP) without any deaths. But in the year 2021 (till October) MP has a contribution of 11354 cases out of 123106 (including 90 deaths) cases in India (18). At the end of 2015, Madhya Pradesh raked 14th countrywide in the number of dengue cases (2108 cases with 8 death) reported (18). Now MP ranked 3rd in the number of dengue cases (11354 cases) (18). As per NVBDCP dengue cases has been drastically increased from 2015 to the end of 2021 (Table/Fig 7) (18).

This dramatic increase in dengue cases in Madhya Pradesh raises the concern about the development of better disease management strategies to combat dengue and other vector borne diseases. Similar situation was observed in neighbour state of Madhya Pradesh i.e. Chhattisgarh, Gujarat, Maharashtra, Rajasthan and Uttar Pradesh. In these states also, drastic increase in dengue cases were seen from 2015 to the end of 2021 (Table/Fig 7) (18). As per study of Indian Council of Medical Research- National Institute of Malaria Research (ICMR-NIMR), New Delhi, 11 districts of Madhya Pradesh were identified as dengue infected areas (i.e. Ashoknagar, Bhopal, Chhindwada, Gwalior, Indore, Jabalpur, Mandla, Morena, Narsinghpur, Sagar and Shivpuri) (19). In Rewa and nearby districts of Madhya Pradesh Dengue cases are still under reported (19). Although, authors have observed four dengue positive cases in Rewa out of 370 during 2017, but during 2018-2020 authors have not found any positive dengue cases (unpublished data). In view of this, the present cross-sectional study was conducted under NVBDCP program in SSMC Rewa Madhya Pradesh to elucidate the emergence of dengue cases in this region during 2021.

Current study observed 9.70 % Dengue positivity (based on NS1 ELISA) in Rewa including nearby districts (Satna, Panna, Sidhi and Shahdol). The positivity of this region was slightly higher than the overall dengue positivity (9.47%) in Madhya Pradesh for the year 2021 (18). The number of positive samples was higher in Rewa in comparison to other nearby districts. New dengue cases were reported in July during the rainy season and at the end of October (after the rainy season) the number of dengue cases dramatically increased. The ICMR-NIMR study in Madhya Pradesh has shown that dengue cases were recorded during the monsoon (June-August) and post-monsoon seasons (September-November). Maximum cases (70%) of the cases were reported between September and November (19). Disease prone environment exposure due to water logging and mosquito breeding could be one of the regions for the incidence of dengue cases in Rewa and nearby districts. As it is already well established that stored water due to extended rainy season, with ambient relative humidity and temperature, favours the breeding of Aedes aegypti (a vector of dengue virus) (20),(21).

The prevalence of dengue fever was significantly (p-value <0.0001) higher in males in comparison to females. The present study showed higher dengue prevalence in males is concurrent with other studies (20). Dengue positivity was highest (77.78%) in the adult age group (18-59 years) followed by 15-18 (13.89%), >60 (4.63%), 9-14 (4%) and 1-4 (4%) age group, out of all positive samples. Other studies have also shown higher dengue prevalence in persons ranging between the ages of 20 years to 59 years (60.54%, 36384 cases out of 60096 positive cases) (22). Another study of ICMR also supports these findings as they have shown 56.2 % dengue positivity in 18-45 year age group (23). Authors observed that 75.61 % (62 out of 82 positive cases) of male dengue cases were belongs to 20-59 year age group. In case of female it was 84.62% (22 out of 26 positive cases) in 20-59 year age group. Thus male and females of this age group (20-59 year) have more risk of dengue.

Dengue cases were detected from both rural and urban areas. Usually urban areas are thought to be more prone for dengue because mosquito find more breeding grounds in urban area as there are more drains, deserted coolers, flower pots, unused tyres etc (24). But authors observed higher dengue prevalence in rural areas in both male (79.01%) and female (81.48%) when compared to urban areas. The region behind this could be the frequent travelling of rural people for their livelihood and water logging/ staging in and after the rainy season (20),(21),(25).

The most common clinical feature in dengue positive cases was fever (100%), as dengue is one of the leading causes of febrile illness in Asia (26). Other clinical features were also evident i.e. headache (52.78%), myalgia (38.89%), and arthralgia (32.41%). Hemorrhagic manifestation was observed in only one case and thrombocytopenia was observed in nine cases. Several clinical features in dengue positive cases have already been shown by other researchers such as fever (93%), headache (71%), retro-orbital pain (35%), body aches (66%), joint pain (44%), rash (21%) , nausea (30%), diarrhea (10%), sore throat (38%) and cough (38%). These clinical features were suggestive for selection of suspected dengue cases (27). It is an alarming situation for dengue emergence even in rural area of Rewa and other nearby districts of Madhya Pradesh. Government authorities need to take vital steps to combated and control the dengue with special emphasis in rural area as they have limited access of health facilities.

Limitation(s)

There were several limitations in this study as some epidemiological factors like travelling, socio-cultural habits were not collected that may influenced the seropositivity. Differential diagnosis were not carried for dengue negative but symptomatic cases as samples were referred as clinically suspected dengue cases.

Conclusion

This study elucidates the emergence of dengue in Rewa and other nearby districts of Madhya Pradesh. Males have more at risk of dengue infection in comparison to females. It has reached rural areas during the rainy and post rainy season. Now the time has come to initiate continuous surveillance and individual and community action for dengue control not only in urban area but also in rural areas.

Acknowledgement

Authors acknowledge the Dean, Shyam Shah Medical College, Rewa for his support. Financial support and consumables were provided by the National Vector Borne Disease Control Programme, India.

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DOI and Others

DOI: 10.7860/JCDR/2022/55546.16339

Date of Submission: Feb 14, 2022
Date of Peer Review: Mar 10, 2022
Date of Acceptance: Apr 11, 2022
Date of Publishing: May 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

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• iThenticate Software: Mar 09, 2022 (9%)

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