{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T16:13:02Z","timestamp":1784563982025,"version":"3.55.0"},"reference-count":42,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,10,11]]},"abstract":"<jats:p>Dengue virus (DENV) is expanding toward previously nonendemic areas. DENV has recently been introduced in Nepal with limited information. We report the clinical features and serotype distribution of DENV in Nepal during the 2010 outbreaks. A total of 1,215 clinical dengue cases at two major hospitals of central and western Nepal were investigated. Demographic, clinical, and laboratory parameters were recorded. Serum specimens were tested for DENV by IgM\/IgG enzyme-linked immunosorbent assays (ELISAs) and reverse transcription polymerase chain reaction (RT-PCR). We confirmed DENV infection in 403 (33%) patients from 12 districts with an estimated case fatality rate of 1.5%. DENV infection was more common in adults (87%) and urban settings (74%). We detected all four serotypes but DENV-1 and -2 were mainly responsible for major outbreaks (92%). Overall, 60% of all DENV infections were secondary and 17% were severe dengue; both being more frequent among the DENV-2 infections. Rash, bleeding, abdominal pain, hepatomegaly, elevated liver enzymes, and thrombocytopenia were significantly more common in severe dengue compared with nonsevere infections. We also confirmed the expansion of dengue to hill urban areas (DENV-1 and -2), including the capital Kathmandu (altitude, 1,300 m) though &gt; 90% cases were from southern plains. Differential clinical and laboratory features probably help in clinical decisions. Multiple serotypes circulation and elevated secondary infections pose potential risk of severe outbreaks and deaths in the future. Therefore, a country with recent dengue introduction, like Nepal, urgently requires a systematic surveillance and appropriate control measures in place to respond to any disastrous outbreaks.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0221","type":"journal-article","created":{"date-parts":[[2017,10,12]],"date-time":"2017-10-12T06:03:13Z","timestamp":1507788193000},"page":"1062-1069","source":"Crossref","is-referenced-by-count":38,"title":["Dengue Virus Serotypes 1 and 2 Responsible for Major Dengue Outbreaks in Nepal: Clinical, Laboratory, and Epidemiological Features"],"prefix":"10.4269","volume":"97","author":[{"given":"Shyam Prakash","family":"Dumre","sequence":"first","affiliation":[{"name":"Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan;"},{"name":"Graduate Program in Biomedical Sciences, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renu","family":"Bhandari","sequence":"additional","affiliation":[{"name":"Kantipur College of Medical Sciences, Kathmandu, Nepal;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geeta","family":"Shakya","sequence":"additional","affiliation":[{"name":"National Public Health Laboratory, Ministry of Health and Population, Kathmandu, Nepal;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjaya Kumar","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Walter Reed AFRIMS Research Unit, Kathmandu, Nepal;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahamoud Sama","family":"Cherif","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakash","family":"Ghimire","sequence":"additional","affiliation":[{"name":"Tribhuvan University, Kathmandu, Nepal;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chonticha","family":"Klungthong","sequence":"additional","affiliation":[{"name":"Virology Department, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In-Kyu","family":"Yoon","sequence":"additional","affiliation":[{"name":"Virology Department, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand;"},{"name":"International Vaccine Institute, Seoul, Republic of Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Hirayama","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kesara","family":"Na-Bangchang","sequence":"additional","affiliation":[{"name":"Graduate Program in Biomedical Sciences, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand;"},{"name":"Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Virology Department, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet","first-page":"1644","article-title":"Dengue","volume":"370","author":"Halstead","year":"2007"},{"key":"b2","series-title":"Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control","author":"WHO","year":"2009"},{"key":"b3","series-title":"Nature","first-page":"504","article-title":"The global distribution and burden of dengue","volume":"496","author":"Bhatt","year":"2013"},{"key":"b4","series-title":"Am J Trop Med Hyg","first-page":"743","article-title":"The economic burden of 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