BugOut: Virgin helps the British Virgin Islands tackle ZIka

British Virgin Islands unite against Zika & dengue

Empowering communities to tackle Zika, dengue, and chikungunya

When you think of the British Virgin Islands (BVI), it’s probably sun, sea, and sand that spring to mind. But, like all tropical destinations, this popular holiday destination is not immune to the threat of mosquito-borne diseases – including dengue, Zika, and chikungunya.

We spoke with Jonathan Oakes, General Manager of BVI’s Eustatia Island and primary director of the BugOut project, and Sarina Hancock, BugOut project coordinator, to find out how the local community is taking on mosquitoes … and winning!

Over the past two years, Eustatia has seen an estimated reduction in mosquito populations of around 90 percent, thanks to consistent and thorough source reduction, larvicidal application and mosquito traps. These practices have now been incorporated into a larger program to benefit the local community under the BugOut program.

Island communities working together

The sun-soaked BVI make up the eastern island group of the Virgin Islands archipelago that lies between the Caribbean Sea and the Atlantic Ocean. The four main islands of Tortola, Virgin Gorda, Anegada and Jost Van Dyke are surrounded by another fifty or so smaller islands, with the 28,000-population inhabiting around 15 of those. Tourism accounting for almost half of the BVI’s national income; the number of tourists and cruise passengers visiting the islands every year is in the hundreds of thousands.

While some of Virgin Gorda’s smaller neighbors – Necker Island, Eustatia Island, and Moskito Island – had been fighting mosquitoes for years, Virgin Gorda itself was at higher risk of dengue and chikungunya flare ups.

Is low-cost travel spurring dengue outbreaks?

“Three or four years ago I began researching everything that is possible and rumored to be possible around fighting mosquitos,” says Jonathan. “There was a lot of misinformation and a lot of apathy, so we decided to create a program around it. We approached government officials and community leaders and everyone welcomed the concept.”

Image of indoor places to check for mosquito breeding grounds.

Image via bugoutbvi.org

The Virgin Gorda community began working together with neighboring islands to establish innovative strategies for controlling mosquitoes.

BugOut is born

The BugOut program was born during the summer of 2015. It describes itself as a “collaborative and sustainable non-profit program for controlling mosquitoes and the spread of mosquito-borne diseases on the Island of Virgin Gorda.”

From day one, the BugOut team based its approach on three pillars:

Community First: providing its communities and businesses with the tools and information they need to make an impact at an individual, household, family and community level
Safe and Effective Control: using mosquito control methods, tools, and technologies that are safe and effective, without sacrificing human or environmental health
Good Data and Fast Iterations: consulting with the best minds in the world to help build an effective program that constantly improves

Community engagement and empowerment

“Mosquito-borne diseases are not a problem that any one task force is going to solve for everyone,” says Jonathan. “Mosquitos need to be dealt with by each and every person in the community.”

To spread that message, the BugOut team visited schools, churches and other community places across Virgin Gorda. Sarina says, “We gave everyone we spoke to a list of steps to take home to pass onto their neighbors and their friends.”

BugOut has put its words into action too, arranging eight community clean-ups over the past year. Around 60 volunteers took part each time. Jonathan comments: “The success of the clean-ups is a great testament to how engaged the community is and how willing they are to donate their time and energy.”

But community involvement doesn’t stop there. Community leaders are invited to join the BugOut steering committee where they can be involved in decisions about what needs to be done. “We want to do something that is accepted by the community.”

BugOut’s community-led Steering Committee includes stakeholders from all aspects of island life: government representatives, pest control experts, social and religious leaders, medical representatives, business owners and non-profit leaders. Government representatives from various entities including Tourism, Disaster Management, Waste Management, Medical Health and Environmental Health attend and this helps channel cooperative resources towards the common goal of mosquito eradication.

Environmentally sensitive methods and technologies

Eustatia Island is proud of its self-sustainability and environmental stewardship: it produces its own power from solar, water from desalinization and its organic agriculture practices are part of a long-term effort to restore the native landscape of the island.

When it comes to pest control methods, Eustatia strives to be a responsible consumer, limiting the use of strong chemicals. Its primary larvicide, for instance, is Bacillus Thuringiensis (BTI), a natural yeast.

A resident of nearby Moskito Island and a strong supporter of BugOut, Richard Branson has offered the program his team’s wealth of knowledge on environmentally sustainable solutions in addition to funds and publicity. “Richard Branson’s head of wildlife sits on our steering committee,” says Jonathan. “He promotes natural interventions really strongly – whether it be geckos and frogs or bats or plant deterrents such as lemon grass and chamomile.”

Data-gathering made simple

The island’s 4,000 residents are also being asked to help the BugOut team collect data on the island’s mosquito populations. Using a slick mobile app based on the Magpi data collection platform users simply take a photo on their smartphone, add a description and send it out to BugOut, where the field team processes the photos as they come in. Born out of the data collection needs of the Ebola crisis, Magpi is both inexpensive and intuitive. The BugOut team then shares the processed data with two task forces in the field: BugOut’s own along with the BVI government’s own.

The BugOut team then shares the processed data with two task forces in the field: BugOut’s own along with the BVI government’s own. “When we ask government to help us clean up larger scale mosquito problems, we give them a prioritized list so their task force doesn’t have to use up valuable time locating the problem areas,” states Jonathan.

The BugOut field team is also exploring the use of Magpi to gather its own data, in place of the expensive licensed GIS mapping tools commonly used in government vector control programs. “It would be the same platform whether it’s a 12-year-old using it or our paid field agents using it to document every single residence on the island during their house to house inspections,” says Jonathan.BugOut’s field agents and field program align with the BVI government’s vector control program as part of a public-private partnership. Through careful testing and research of control methods and technologies, BugOut has been able to incorporate a strong focus on sustainability into the BVI vector control methods.

BugOut’s field agents and field program align with the BVI government’s vector control program as part of a public-private partnership. Through careful testing and research of control methods and technologies, BugOut has been able to incorporate a strong focus on sustainability into the BVI vector control methods.

Looking forward

While year one focused mainly on community outreach and engagement next year BugOut hopes to really step up the game on field operations, putting real scientific data behind the initiative. The team also plans to augment its efforts around education, empowerment, and clean-up with a greater focus on larvicidal control and elimination of breeding sites. Budgeted to operate on Virgin Gorda for a period of three years, one of BugOut’s major aims is to share all the information on what it’s doing – what works and what doesn’t – with the other islands.

Budgeted to operate on Virgin Gorda for a period of three years, one of BugOut’s major aims is to share all the information on what it’s doing – what works and what doesn’t – with the other islands.“We want to be an open book,” says Jonathan.

“We want to share information that can benefit other communities as well. That’s important because people often shy away from showing any weaknesses or downfalls on projects with a public face.”

Jonathan and Sarina hope that doing so will enable other communities to follow in their footsteps.

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Potential dengue treatment on the horizon

Researchers hope that understanding the ‘mechanism of action’ of a well-established HIV treatment could lead to the development of a future dengue cure – easing the burden on millions.

Dengue treatment is often limited to hydration and pain control with symptoms normally last from 2-7 days. But, the impact of the disease can last a lot longer. For families affected by dengue, the financial impact alone can be unbearable. According to the International Federation of the Red Cross, the family’s main provider can lose up to 19 days’ work – and wages – by being incapacitated themselves or caring for sick relatives.

But the family’s income is lost when they need it more than ever. On average, 45 percent of dengue treatment costs are borne by the patient’s family and these can be triple the family’s normal monthly income.

The costs of dengue are not completely understood in many dengue-endemic countries which continue to struggle with the economic burden.

Minimizing the impact of this disease on the world’s most vulnerable communities is one of the top priorities for biopharmaceutical company Ennaid Therapeutics. The company is developing nine novel anti-viral drugs – including one for treating dengue.

Developing a dengue treatment

Founded in 2012, Ennaid identifies early-stage science that could potentially lead to profitable therapeutic cures for previously incurable diseases – mostly neglected tropical diseases (NTDs).

“We seek out early-stage, proprietary, innovative science that’s sitting on research shelves with its patent life ticking away,” comments Darnisha Harrison, Ennaid’s Founder and CEO. “We bring cures to life by taking the science, licensing it and rapidly and safely developing it into therapeutic cures.”

Although Ennaid is currently focused on developing an antiviral to treat Zika Virus, an anti-viral for dengue fever treatment is following a close second on its agenda.

Learn more about measuring the true cost of dengue

Repurposing HIV treatment

Zika and dengue are both envelope viruses, which means they have a protective coating of proteins surrounding them. Darnisha explains how these proteins help an envelope virus to infect its host: “These envelope proteins bind the virus to the healthy host cell in a human’s body. The viruses are then able to release their viral material into the healthy host cell, infecting the cell.”

Dengue belongs to the Flaviviridae family of envelope viruses, which also includes the West Nile virus, yellow fever virus, and Hepatitis C. Another family of envelope viruses, known as Retroviridae, includes HIV and Hepatitis B.

Based on deep understanding of envelope viruses, Ennaid realized it could potentially develop effective and well-tolerated treatments for dengue and Zika. Its knowledge and understanding of a drug that disrupts the HIV virus have enabled it to develop a similar approach for disrupting dengue and Zika.

The drug, which is called enfuvirtide and goes by the brand name of Fuzeon, is a peptide inhibitor: a drug based on a peptide (a short chain of amino acids) that can interfere with a virus’s normal processes. The FDA approved Fuzeon for treating HIV in 2013.

“My discovery scientists at Tulane University had done extensive work with enfuvirtide,” states Darnisha. “With Fuzeon’s clinical success, they concluded peptide inhibitors could be effective and well-tolerated drugs for viral infections.”

Promising results

Ennaid is now developing a therapeutic treatment for both dengue and Zika by drawing parallels from the success of enfuvirtide. To date, their treatment is undergoing further pre-clinical testing, completing feasibility studies along with safety and toxicity testing.

Tests have shown that the treatment is effective in blocking the dengue virus from entering into the healthy host cell, inhibiting viral infection.

“Our treatment has shown above 99 percent inhibition of the four strains of dengue virus in-vitro and when our peptide was administered to mice, none displayed an increase in toxicity or morbidity above the healthy level,” comments Darnisha.

The results of preclinical efficacy studies are expected within six months. “We are continuing dose range-finding studies in animals and plan to then move into the clinical trials during the first quarter of 2017,” states Darnisha.

Clinical trials

Ennaid is also in the final stages of selecting its manufacturing partner for the finished drug product that will be used in clinical trials.

The clinical trials will allow Ennaid to test the safety and efficacy of its treatment in patients who have symptoms of, or who have actually contracted the viruses. Since the timeframe for dengue symptoms is short, the clinical trials should allow Ennaid to establish the efficacy of its dengue drug fairly quickly. Possible locations for these trials will be assessed at a meeting with the FDA – the US Federal Drug Administration. Options might potentially include a trial in the US territory of Puerto Rico alongside a parallel trial in a non-US territory endemic country.

Possible locations for these trials will be assessed at a meeting with the FDA – the US Federal Drug Administration. Options might potentially include a trial in the US territory of Puerto Rico alongside a parallel trial in a non-US territory endemic country.

Pending successful clinical trials, Ennaid will be looking for a buyout by a larger pharmaceutical company to further develop, commercialize and distribute these drugs to the regions of the world that need them most.

Accelerated approval

Ennaid hopes to get its new treatment to market in around six years rather than the normal 10-15 years since it meets the criteria for FDA’s Priority Review.

New drugs for dealing with neglected tropical diseases such as dengue may fall under what the FDA designates as Priority Review, which means the FDA will aim to act on the drug’s review application within six months. This is compared to ten months under Standard Review.

Darnisha explains more: “With an accelerated review designation, we can possibly provide a clinical protocol that condenses certain phases of the clinical trial. That will help us focus on safety and efficacy while expediting the actual clinical trial.

With clinical trials expected to begin next year, parallels drawn from this HIV treatment could become a source of real hope for a new dengue therapeutic. After all, by slowing disease progression, Ennaid’s treatment would not only reduce the number of cases of severe dengue and hospitalizations; it would also compliment vaccines by slowing the spread of the dengue when patients actually contract the disease.

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Combating growing insecticide resistance

Image of am child sleeping under a mosqutio net, to stay protected from 'dengue mosquitoes'.

Image courtesy of IVCC

Insecticide resistance has reached a tipping point. “Mosquitoes have developed resistance to all the major classes of insecticides,” says Dr. Sarah Rees, Portfolio Manager at the Innovation Vector Control Consortium (IVCC). “This makes the development of new insecticides for vector control increasingly urgent.”

But getting new insecticides to market can take a great deal of time and money. And even when new products arrive, encouraging organizations to adopt them and people to use them can be challenging.

Breaking down the barriers to insecticide innovation

Established in 2005, the IVCC public-private product development partnership is helping to bring new classes of insecticides to market more rapidly. A not-for-profit company, IVCC works with multiple stakeholders to remove the barriers to innovation in the vector control.

As a registered charity, IVCC’s work depends on donations. Major donors include The Bill & Melinda Gates Foundation, UKAID, USAID and the Swiss Agency for Development and Cooperation. IVCC uses those funds to develop new insecticides, in agreement with funders.

“Our role is to ensure funders’ money is spent appropriately and not wasted on something that isn’t likely to work or isn’t going to be safe,” says Dr. Rees.

Scientists from IVCC look for new ways to contol mosquito populations to combat insecticide resistance.

Image courtesy of IVCC

At the same time, IVCC is also challenging stakeholders on accelerating the development of new products. It wants to see the same principles and urgency seen during the Ebola crisis applied to combatting other diseases.

Partnerships crucial to success

IVCC’s agro-chemical partners are critical to the development of new insecticides. They hold the specialized infrastructure, resources and expertise needed to develop and then manufacture these products.

The partners begin the development process, which involves screening millions of potential compounds for likely candidates. These are then examined further for potency, safety and cost efficacy. With safety regulations around pesticides very significant, IVCC must ensure early on that it’s not investing in a product that isn’t going to be safe. At the same time, it must also ensure the product won’t require a complex manufacturing process or expensive ingredients.

After numerous iterations, IVCC and its partners settle on a particular chemistry that looks promising. Dr. Rees explains the next steps: “We take the chemical out to the field and test it for its effectiveness against wild mosquitoes and also for resistance.”

If it’s still looking promising, the very expensive parts of the process begin: safety studies and scaling up for manufacture. “We have to look long and hard at these potential products to ensure they’re really going make it before we decide to invest,” adds Dr. Rees.

A commercially viable product

IVCC mostly works with big companies, for product development at least. It’s very important that the insecticide manufacturers stay on board throughout the process and for years to come. They have the expertise needed not only to develop and manufacture the products; but also to sustain them in the marketplace when they come up for safety reviews, for instance.

“The partners are mainly commercial organizations,” explains Dr. Rees. “It’s a difficult and volatile market and we’re asking them to focus their world-class experts on our challenges. Putting forward a good business case for them to put time and effort into the development of these insecticides is crucial.”

The agrochemical companies need to be confident that governments and charities will adopt their products and that people will use them. This means they must ensure these innovations deliver better value than, and are at least as easy to use as, their predecessors.

“You’ve got to think about people’s lifestyles and how you can give them protection, in a way that makes them want to take up that protection.”

Novel chemistry faces tough competition

But many of the existing products, which often don’t work well, are old and generic. Their price has dropped over the years. To be commercially attractive, any new products will need to be able to command a higher price than these in the marketplace.

“We’ll be producing better quality products that break the resistance,” says Dr. Rees. “But procurement agencies are tempted to make decisions guided by lower prices even when the products are less effective. One of our challenges will be getting a common understanding about value for money.”

Dr. Rees also emphasizes the importance of creating a product that people actually want to adopt: “You’ve got to think about people’s lifestyles and how you can give them protection, in a way that makes them want to take up that protection.”

Find out what we could do better when it comes to vector control

IVCC works with smaller organizations too. “We want to partner with people who have the right expertise and resources for different parts of our process,” adds Dr. Rees. “A large commercial agrochemical manufacturer might, for example, partner with a smaller organization that could deliver these insecticides in different ways.”

Malaria and dengue: common challenges

IVCC is currently developing compounds that are active against resistant strains of the Anopheles genus of mosquito, which transmits malaria. Anopheline mosquitoes tend to be active at night when people are at home sleeping, so chemicals need to work well as an indoor residual spray or on a bed net. However, IVCC’s industry partners begin their development processes by first screening against an easy-to-culture mosquito such as Aedes, which is a vector of dengue, Zika, and other neglected tropical diseases.

Image of a scientists work on new forms of mosquito control.

Image courtesy of IVCC

“We know that the chemicals might also be useful against Aedes,” says Dr. Rees. “Our safety and manufacturing processes would be exactly the same for Aedes, but Aedes mosquitos tend to be more active in the daytime when people are out of their homes and so the challenge is how to protect people against day flying, outdoor living mosquitos. We’d need to explore whether you could put the chemical into a fogging, or similar, device.”

A sustainable solution

Nevertheless, the resistance challenge applies equally to malaria and dengue. “It’s really important that we bring new products to market in a way that’s sustainable,” says Dr. Rees. “We have to be careful that we don’t overuse them otherwise resistance will build up and we’ll be left with nothing again.”

Insecticides are a vital ingredient in the fight against vector-borne diseases such as malaria and dengue. Integrated vector management will be crucial to ensuring they are not overused and, once on the market, continue to provide protection for many years to come.

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Measuring the true cost of dengue (Infographic)

Image of boy who was infected by Dengue.

This 9 year old boy from San Pablo City was infected by Dengue.

The global burden of dengue is thought to be substantial, but unrecognized and unreported infections, along with challenges around data access and quality, have made estimating its true burden difficult. Diverse sources have estimated the annual number of symptomatic dengue cases globally at anywhere between nine million and 100 million.

“Many countries have dengue surveillance systems that, while they provide very important information, don’t capture every case,” explains Donald Shepard, Professor at the Schneider Institutes for Health Policy at Brandeis University in Massachusetts. “And economic studies have looked at anywhere from 20 to 60 or 70 countries, while 141 around the world have dengue transmission.”

Infographic: The global cost of dengue

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Beyond solving technical problems

With the cost of dengue not well understood, dengue-endemic countries are struggling not only to track health progress and make decisions around health policy, but also to assess emerging preventative and control strategies.

Professor Shepard elaborates: “New dengue prevention and control technologies are becoming available. The first dengue vaccine has just been licensed in a few countries, for instance. That now leaves an important political and economic question: ‘How should these technologies be used to impact the disease?’.”

Answering that question will help countries decide which existing technologies they should adopt to help them fight dengue today, while guiding the continued development of promising new tools.

Extrapolating limited data on dengue

Professor Shepard was the primary author of a recent ‘cost of illness’ study into the global burden of dengue. Supported by Sanofi Pasteur, the study provides an objective, systematic and comparable measure of the global economic and disease burden of dengue.

Dengue in 2013:
58.40 million symptomatic dengue infections
13,586 fatal cases
Annual global costs of US$8.89 billion:
– 46.0% from non-fatal hospitalized cases
– 33.6% from non-fatal ambulatory cases
– 8.5% from non-medical cases
– 11.9% from fatal cases

The most comprehensive of its kind on dengue, the study was extensive. “Our team searched for and analysed relevant dengue articles published between 1995 and 2013 and systematically assembled and analysed the latest estimates from a wealth of diverse sources,” reveals Professor Shepard. “We also systematically reviewed published literature and responses to a survey of international experts.”

The study covers all 141 countries with active dengue transmission, despite a complete picture not being available for many of the countries. The team had to extrapolate systematically from the available information it had to build a complete picture.

Non-medical cases underestimated in the past

The study found that around 34 percent of global cases of dengue were non-medical cases: cases treated outside of the formal health sector. Previous studies have made the assumption that all symptomatic dengue cases got treatment in the formal healthcare sector. “Some people simply bear the fever at home; not every case consults with a medical professional,” says Professor Shepard.

Understanding the number of non-medical dengue cases is important. While they didn’t consume healthcare resources, they did still add to the economic burden of dengue. As Professor Shepard notes: “If children have dengue, for instance, then they cause an economic loss to their families because a parent would likely have to give up work to take care of them until they recover.”

Cutting the cost of dengue

The study provides both global and regional estimates on the cost of dengue, broken down by country and various short- and long-term costs. By putting a value on the size of the dengue problem, these estimates will help governments and donors make better-informed decisions around their dengue programmes.

“In most countries the public purse has more demands than it can satisfy,” says Professor Shepard. “Defining dengue in monetary terms means the disease can be compared with other economic problems. Public health systems can then leverage that information to secure resources from their Ministry of Finance – and possibly the donor community – to control the disease.”

More than that, the estimates allow the magnitude (and cost) of the dengue problem to be compared to the cost of trying to fix it. This cost/benefit analysis will encourage countries to allocate funds to their Ministry of Health to expand programmes to control the disease.

“Very often a society can substantially reduce its costs by endeavouring to fix the dengue problem rather than continuing to suffer the economic burden,” adds Professor Shepard.

A substantiated investment

Quantifying the burden of dengue will also encourage the use and development of new technologies. Professor Shepard uses the Philippines to illustrate how. Having licensed the vaccine at the end of 2015, the Philippines is the first country in the world to introduce the dengue vaccine in the public sector. It plans to vaccinate one million school children.

“Researchers in the Philippines, in collaboration with Brandeis, previously found that dengue cost their country $345 million in 2012 for healthcare alone, not counting lost productivity” he added. “This finding helped inform the country’s decision to commit US$73.5 million to its school-based vaccination programme.”

A conservative estimate

Despite quantifying the cost of dengue, Professor Shepard believes the study underestimates the true burden of dengue.

“The study didn’t put an economic value on the intangible: on the discomfort from having this illness or the anguish people feel when a loved one is ill or even dies,” elaborates Professor Shepard. “Additionally, other dengue burdens cannot be quantified yet. A country’s economy could be affected by loss of tourism by dengue, for example.” Both dengue and the Zika virus are causing great concern in Rio ahead of the forthcoming Olympic Games.

The professor suggests a number of approaches could improve future estimates, including merging multiple data sources (such as cohort and surveillance data), adjusting for unrecognized dengue cases and using modelling techniques to estimate dengue incidence in locations with limited data.

“Our hope is that a greater understanding of the main factors driving uncertainty around the burden of dengue will allow current estimates to be improved and, consequently, drive the evaluation of existing and potential future preventive and treatment approaches,” concludes Professor Shepard.

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Learn more about the burden of dengue in our short-film.

Watch ‘The Lingering Effect of Dengue Fever’.

Timely warnings of dengue outbreaks on the horizon

Watch out for Aedes mosquitoes, the vector that spreads dengue fever.

Limiting dengue outbreaks requires rapid action; early warning systems need to be prompt and efficient. But current dengue reporting systems are often delayed, holding up outbreak responses.

“Detecting a dengue outbreak in its early stages means fewer people get sick,” says Doctor Ronald Skewes-Ramm, Director General of Epidemiology at the Dominican Republic’s Ministry of Health. “Fewer people suffer, and the cost of treating and containing the disease is significantly less.”

Dr. Skewes-Ramm is the Dominican Republic’s collaborator in a global project to develop a new model for dengue surveillance and outbreak response. The initiative is a collaboration between the Special Programme for Research and Training in Tropical Diseases (TDR) and International Research Consortium on Dengue Risk Assessment, Management and Surveillance (IDAMS).

IDAMS International Stakeholder Evaluation Meeting . Photograph by Hanspeter Trefzer, courtesy of Katholische Akademie, Freiburg

Currently in its second phase, the project aims to help dengue-affected countries implement more efficient, affordable, evidence-based outbreak early warning systems. “Our aim is to significantly improve a country’s capacity to detect and respond to dengue outbreaks,” comments Dr. Leigh Bowman, Epidemiologist at the Liverpool School of Tropical Medicine and project research team member.

Phase I: Identifying potential outbreak indicators

The first stage of the project, a ‘retrospective study’ which ran during 2013 and 2014, aimed to identify possible dengue outbreak signs. Five countries took part: Brazil, Mexico, Dominican Republic, Malaysia, and Vietnam.

Local teams on the ground collected data on a wide variety of possible indicators. In the Dominican Republic, for instance, Dr. Skewes-Ramm assembled surveillance data on all local outbreaks since 1997. It included information such as gender, age, date of onset, where the person was treated, symptoms, serotype (if known) and more for around 80,000 dengue cases.

With data from the five countries collected, the research team set about its analysis. “We modeled the historical data, then looked forward to seeing if we could explain the onset of a dengue outbreak by a prior change in one of the indicators,” explains Doctor Bowman.

The team found a combination of just two factors consistently arose before an outbreak: an increase in probable cases and a shift in mean temperature. “We were surprised to discover that certain indicators are predictive of outbreaks irrespective of the country context, especially considering that transmission is driven by many factors that vary from country to countries, such as herd immunity and the person-vector contact ratio,” adds Doctor Bowman.

The dengue analysis helped the team to create the early warning system.

Phase II: Verifying the system

Fast forward about a year to mid-2015. The project team is ready to prove the effectiveness of its prospective early warning system. They’ve developed a simplified Excel version of their model that will be relatively easy for local programme managers and regional epidemiologists in the study countries to test.

Four of the original countries take part in this ‘prospective study’: Mexico, Malaysia, Brazil and Dominican Republic. Twenty districts were identified in each country; ten would act as control areas while the others would use the early warning system. “Our hope is to mitigate or even prevent the number of outbreaks that occur in the intervention districts in comparison to the control districts,” says Doctor Bowman.

The trial will run until mid-2017 to allow the team to capture two rainy seasons in each country. Doctor Bowman explains why: “We must also capture any changes in the variables during the dry season that may be indicative of an outbreak in the following wet season.”

Spreadsheets are currently being completed, and the research team has its first few months of data. Local program managers record interventions taking place: which alarm signals they responded to initially when the intervention started and finished, along with several other factors.

Tailored responses

The project isn’t just about the early warning system detecting potential outbreaks ahead of time; it’s also about delivering appropriate responses when alarm indicators are identified. “If the alarm signals from each of the indicators are relatively weak, an intervention requiring relatively few resources is chosen,” comments Dr. Bowman. “As they strengthen – indicating there’s a higher risk of an outbreak – interventions become more resource-intensive.”

Those interventions, whatever their intensity, are aligned to each local region. Each district has the autonomy to implement interventions as they see fit. “They might decide to run a community-based campaign, and they determine whether it involves leaflets or radio announcements and how long it is going to continue for,” Doctor Bowman says.

International Stakeholder Evaluation Meeting. Photograph by Hanspeter Trefzer, courtesy of Katholische Akademie, Freiburg

An integrated approach

The prospective early warning systems are fully aligned with the World Health Organization’s Integrated Vector Management approach.

“Our plan is to capture dengue, chikungunya, and Zika incident case data,” reveals Dr. Bowman. “That way we can see whether the vector control interventions are working for not only dengue but also for chikungunya and Zika.”

After all, Aedes aegypti and Aedes albopictus – the predominant mosquito vectors of dengue – are also primarily responsible for the transmission of chikungunya and Zika. “We are interested in gaining a better understanding of the impact of vector control, as there are so few studies that robustly capture its effectiveness against both the mosquito and virus transmission,” elaborates Doctor Bowman.

A recent study published by Doctor Bowman et al. demonstrated “the remarkable paucity of reliable evidence for the effectiveness of any dengue vector control method.” It suggests prioritising studies of higher quality to evaluate and compare methods to optimise cost-effective dengue prevention.

More work to do

Further challenges still lie ahead; one being how an outbreak should be defined. Outbreaks are currently characterized by the number of cases relative to previous years – and that can change over time. “Defining a dengue outbreak is important,” notes Doctor Bowman. “As soon as we term a group of cases an outbreak, it starts a cascade of responses.”

Another challenge lies in understanding how to predict the magnitude of any outbreak. The retrospective study – like many models around the world – didn’t quantify the magnitude of an outbreak. Doctor Bowman confirms, “Being able to respond to the correct magnitude and at the correct time means resources can be used more cost-effectively.”

Understanding the stage of the outbreak is also important. The response needs to be intensive during the early stages of an outbreak, more than towards the end when there’s a natural burn out among the population because immunity has increased.

A positive impact

Even though it is still on-going, the project has already had a positive influence on the countries involved. “Previously, we only had a gut feeling of what the indicators for an outbreak were,” Dr. Skewes-Ramm tells us. “If there were a change in temperature or a lot of rainfall, we would expect a lot more mosquitoes. Now we know we have to act if there is also a change in the number of cases or a change in the circulating serotype.”

And whatever the project uncovers, as a bare minimum it will have improved the data collection, surveillance and reporting capabilities of the countries involved. “Our project will help standardize in-country dengue reporting systems and provide a framework that could be rolled out to other countries as well,” concludes Doctor Bowman.

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Asia Charter calls for collaborative, integrated action on dengue

by Gary Finnegan

Aedes aegypti is a mosquito that spreads, dengue fever, Chikungunya, Zika, yellow fever and other diseases.

Experts say it’s time to act and prevent dengue outbreaks

A coalition of dengue fever experts issued a powerful call-to-action in a bid to inject new momentum into the urgent battle against the disease.

The unprecedented move follows the inaugural Asia Dengue Summit which took place in January. The event attracted scientists and health professionals from 22 countries, putting a strong emphasis on the need for an integrated approach to the serious dengue fever outbreaks affecting the region.

Now, the four major global health organisations that put together the Summit have released a new ‘Charter’ urging authorities to prioritise dengue and coordinate their efforts. The statement is endorsed by the Asian Dengue Vaccination Advocacy (ADVA), SEAMEO Troped Network (SEAMEO), the Dengue Vaccine Initiative and Fondation Merieux.

The charter is designed to address the enormous challenges Asian nations are facing in contributing to the WHO goal of reducing dengue mortality by 50% and morbidity by 25% by the year 2020.

Asia has the highest dengue burden in the world with an estimated 70% of the global population at risk. Governments in the worst-hit countries spend nearly US $6.5 billion annually in both direct medical and indirect costs due to dengue.

The coalition says the growing threat warrants urgent and immediate action that can contain the rapid spread of dengue in Asia where nearly 67 million people contract the disease each year.

Professor Usa Thisyakorn, Professor of Pediatrics at Chulalongkorn University and Chairman of ADVA, described the January summit as “an historic event” that illustrated the commitment of health leaders and experts to unite against dengue. The Charter will build on its success.

“The success of the Summit signals a new awareness on the urgency for disease control and prevention,” she said. “The Charter calls on regional governments to support collaborative efforts in successfully combating the increasing incidence of dengue and calls on appropriate actions to achieve this.”

This was echoed by Dr Pratap Singhasivanon, Secretary-General of the Southeast Asian Ministers of Education Organisation Tropical Medicine and Public Health Network.

“By fostering greater cooperation between various agencies and organisations, we can maximise the use of our resources in raising dengue as a health priority in this most affected region,” he said.

The alarming rise of dengue cases shows no signs of reversing. Experts are warning that climate change, urbanisation and the effect of this year’s El Nino are combining to exacerbate the dengue problem in several Asian countries.

The arrival of the first dengue vaccine – which has already been approved and used in The Philippines – marks the beginning of a new chapter in the history of public health.

It is, perhaps, no surprise that the Charter calls on countries to develop and implement dengue vaccination programmes in concert with other control strategies.

The integrated approach that was to the fore at the Asia Dengue Summit is also strongly heard in the call-to-action which urges greater effort to combine the potential power of surveillance, vector control, communications and other tools to defeat the disease.

The coalition describes vaccines as a useful addition to existing dengue prevention and control programmes, and calls for further investment in research.

“It is imperative for research and development to continue in the field of dengue prevention and control, and to ensure related research initiatives which have long-term positive impacts, are funded sustainably,” said Dr In-Kyu Yoon, Director of the Dengue Vaccine Initiative.

Financial support for R&D is a crucial piece of the puzzle, according to the organisations behind the Charter.

“Sustainable financing models are integral to the success of dengue prevention and control programs,” says Dr Valentina Picot, Scientific and Research Advisor of Fondation Mérieux. “This has to be a shared responsibility between regional entities and global organisations such as the WHO, to assist countries in obtaining sustainable financing to support the implementation of vaccination programs as part of a holistic solution to alleviate dengue burden in the region.”

Meanwhile, the need for action in Asia is reinforced by data showing that Thailand recorded 140,000 dengue cases last year – the highest since the 1987 crisis when 170,000 people were affected. In Singapore, the number of cases is expected to exceed 30,000, eclipsing the 2013 record of 22,170.

For Asia, answers to the call-to-action cannot come quickly enough.

Asia Dengue Summit Charter

·      Calls on countries to develop and implement dengue vaccination programmes that are carefully controlled and closely integrated with other control strategies

·      Calls on countries to ensure that, if dengue vaccine is introduced, implementation programmes are monitored and evaluated for safety, effectiveness and acceptance with good communications, active surveillance, laboratory support and clinical management

·      Calls for integration of efforts by various initiatives and associations to monitor developments in vaccine and vector control implementation and to engage governments and international organisations for vaccine introduction in endemic countries

·      Calls for the political will and commitment to accelerate effective dengue prevention and control interventions, including strengthening health systems and ensuring sustainable financing

·      Calls on relevant organisations and institutions to continue performing and supporting research to further enhance the impact of vaccination, including biomedical and clinical research, mathematical modelling, implementation and operational research, and post-licensure studies

·       Calls on the WHO and other global and regional organisations and initiatives to give higher priority to dengue prevention and control, provide continued leadership, guidance and technical support to countries on the possible introduction of dengue vaccine, and assist with implementation strategies, as well as assisting countries in obtaining sustainable financing

View the Call-to-Action Charter

Could a protein be key to new dengue drug discoveries?

Each year, up to 396 million people are infected with the dengue virus (DENV), leading to an estimated 100 million dengue cases. Annually, hospitals around the globe admit around 500,000 victims (mainly children) with severe dengue. About 2.5% of those affected die, but in some regions, the fatality ratio can be as high as 20%. Severe dengue is a leading cause of hospitalization and death among children in Asia and Latin America, and with no dengue drug treatment available, the numbers are expected to rise.

These WHO estimates on the burden of dengue are shocking. With incidence growing dramatically in recent decades, the WHO set out objectives to ‘reduce mortality and morbidity from dengue by 2020 by at least 50% and 25% respectively’ in its Global Strategy for Dengue Prevention and Control 2012-2020.

The fight against severe dengue intensifies

One of the leading causes of death in patients with severe dengue is something called vascular leakage, in which fluids and small molecules flow out of blood vessels. In severe dengue, vascular leakage leads to the familiar symptoms of fluid accumulating in the lungs and other parts of the body, resulting in shock and circulatory failure. Otherwise healthy people can die in 24 to 48 hours.

A team of researchers at the School of Public Health at the University of California, Berkeley, are investigating how severe dengue causes vascular leakage. Led by Dr. Eva Harris, a professor of infectious diseases, their findings could open up new possibilities for saving the lives of people who are at risk of succumbing to severe dengue.

NS1 holds the key

Dr. Harris and her team have been studying dengue for many years, both at UC Berkeley and in Nicaragua through collaborative research projects. In the course of their research, they noticed a distinct protein that might play a fundamental role in bringing about vascular leakage in people with severe dengue – a non-structural DENV protein called NS1.

image, doctor collecting samples in Nicaragua for dengue.

Annual Collection of Serological Samples for the UC Berkeley/Nicaraguan Ministry of Health Pediatric Dengue Cohort Study in Managua, Nicaragua, monitored here by Eva Harris (right). Photo credit, Alejandro Belli.

Dengue virus is made up of just ten proteins, each with different characteristics and different roles to play in the life cycle of dengue infection, immune evasion, and disease.

In the first part of their research into NS1, the team found that vaccination with NS1 induced an immune response that protected mice from lethal DENV-induced vascular leakage and produced antibodies that could protect against the disease. “We had found NS1 on its own caused vascular leakage,” reveals Dr. Harris. “But we didn’t know how.”

In the second part of their research, studies focused on understanding how the NS1 protein caused permeability in human endothelial cells (cells that line blood vessels). The team has now identified two novel mechanisms by which NS1 causes endothelial leakage. “When this happens in the lung, for instance, lung tissue could become more permeable and result in the symptoms of severe dengue,” explains Dr. Harris.

Potential new types of vaccine and dengue drug treatments

The research could lead to new kinds of vaccines and new therapies for people at risk of contracting severe dengue. “We are already working on a research project that combines recombinant NS1 with new vaccine adjuvants,” comments Dr. Harris. “This could lead to a new vaccine or a new component that could be added to existing dengue vaccines.”

“This could lead to a new vaccine or a new component that could be added to existing dengue vaccines.”

It also opens the door for developing therapeutic treatments that could protect against vascular leakage for anyone who has contracted dengue and is at risk of severe dengue.

Watch Professor Harris explain her team’s findings below, and find out why she says that the NS1 protein should be considered part of the causal factors in severe dengue.

“Dengue is a very difficult disease that needs to be attacked on many different fronts.”

These new possibilities give real hope that there might one day be a cure for this potentially deadly infection.

Could this be the first step in stopping deaths of dengue?

Study: Modeling the impact of climate change on dengue

It may seem like the result of just one tiny bite, but dengue transmission is in fact, a complex issue. Many factors affect the dynamics of dengue transmission: local vector control efforts, socio-economic conditions, cultural behaviors, local infrastructure, and climate change, to name a few.

A multi-disciplinary team from the National Center for Atmospheric Research (NCAR) and the University of Arizona has been investigating dengue transmission patterns in cities with high vector populations along the US-Mexico border. Dr. Kacey Ernst, an epidemiologist and Associate Professor in the Epidemiology and Biostatistics Department at the University of Arizona, and Dr. Mary Hayden, a behavioral scientist at the Research Applications Laboratory at NCAR, are leading the research at their respective institutions.

Scientists have been aware for some time that the dengue-transmitting Aedes aegypti mosquito has been moving north from Mexico into the US. Why are some areas of the US seeing sporadic local dengue transmission while others – some with large Aedes aegypti populations – are seeing none?

Climate change, dengue and the tales of two US cities

Past research had concluded that social factors prevented dengue emergence in the US, while lower standards of living were responsible for the high levels of dengue transmission in Mexico. The research team was not convinced this was entirely true.

[image courtesy of the University of Arizona and NCAR]

So, in 2012, to determine if other factors were coming into play, they compared two cities in the US – Key West, Florida, and Tucson, Arizona. Both cities had abundant Aedes aegypti populations, the first with dengue transmission and the second without. Could environmental aspects or human behaviors explain the emergence of dengue in some cities but not others?

“So why didn’t we see dengue in Tucson?” asks Dr. Hayden. “The potential for it to emerge was clearly there because of the city’s proximity to the US-Mexico border. Approximately 13,000 people a day cross the border from Mexico into the US – many from dengue-endemic countries.”

Although, both Tucson and Key West have the vector and are in locations where there is frequent travel from dengue endemic countries (Key West from Caribbean travel), Tucson had yet to see locally acquired cases of dengue. This led the team to draw the hypothesis that the climate was unsuitable for mosquitoes in the Arizona city. “If mosquitoes are not surviving long enough to acquire and then develop the virus to the point where they can infect someone, the transmission cycle will not be completed,” Dr. Ernst comments.

A similar story in Mexico

The hypothesis needed to be confirmed. More recently, the team compared two Mexican cities south of the border. Again, both had the vector in abundance, but only one had local dengue transmission.

“Nogales, a Mexican city just south of the border, has few of the infrastructural amenities found in the US yet still has no local dengue transmission,” reveals Dr. Ernst. “Hermosillo, a larger Mexican city around 200 kilometers further south and with fewer Aedes aegypti mosquitoes and somewhat better infrastructure, is endemic.”

Convinced that social factors were not behind the absence of dengue transmission in Nogales, the study team set about determining whether their earlier hypothesis was correct.

The study team has collected wild adult Aedes aegypti mosquitoes across six sites near the US-Mexico border. “The entomology lab at the University of Arizona, [run by Drs. Mike Riehle and Kathleen Walker] is aging the mosquitoes we catch to see whether they live long enough to survive the extrinsic incubation period for the virus (the time it takes for a mosquito that bites an infectious person to be able to transmit dengue virus to another person),” comments Dr. Hayden.

By aging the mosquitoes, the lab will be able to determine whether climate is one factor limiting dengue transmission cycles. They expect to find that the mosquitoes collected from sites with higher humidity and warmer temperatures – but not too hot — will be older than those collected from sites with cooler, drier conditions.

By aging the mosquitoes, the lab will be able to determine whether climate is limiting dengue transmission cycles. They expect to find that the mosquitoes collected from sites with higher humidity and warmer temperatures – but not too hot — will be older than those collected from sites with cooler, drier conditions.

Dr. Ernst explains how temperature might limit the cycles. “The critical survival length is a range. The incubation period the virus needs to mature is temperature-dependent. So the hotter it is the shorter the time they need to live. But if you reach really high temperatures, then it is detrimental to the mosquitoes’ survival.”

They also expect to find mosquitoes surviving to an older age in households with more vegetation, more people and indoor resting sites, more water storage, no competing vector species, and no control methods.

New models could help predict dengue transmission patterns

Another member of the NCAR team, meteorologist Dr. Andrew Monaghan, has worked with models demonstrating that areas with cooler and drier temperatures will result in fewer mosquitoes surviving past the incubation periods. The models also demonstrate the climatic thresholds at which this will occur. The team hopes this will also help prove their hypothesis.

“We can use models for surveillance and to better understand dengue transmission,” he explains. “Models can help us answer some of those questions where field work is too costly.”

A previous surveillance project, for example, strung together multiple models to produce a map of dengue risk. The first, a sophisticated weather model, generated fine-scale hourly weather fields. The second took data from a container distribution survey, along with the weather fields, to simulate the water height and temperature in those containers where mosquitoes spend their immature stages. The final two models simulated the Aedes aegypti lifecycles and dengue transmission, resulting in a dengue risk map.

When the team investigated the differences between Nogales and Hermosillo, Dr. Monaghan and a colleague from NASA, Dr. Cory Morin, then used a model to simulate some of the larger dengue outbreaks in Hermosillo over recent years. “We then used the climate data from Nogales to drive the exact same model and found we were not able to simulate dengue transmission,” he adds. The team then dug into the model to find out why.

The results are currently undergoing peer review, so we’ll have to wait to find out the answer. But if the hypothesis is correct, increased temperatures driven by climate change could have serious implications for transmission in regions on the margins of dengue epidemics.

Could this mean even faster growth of the dengue issue in the coming years?

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Learn more about the lasting effects of dengue below

Helping Asia through a dengue crisis

When it comes to the current dengue crisis in Asia, the region is largely at climate’s mercy. Short term, raised temperatures driven by a strong El Niño have led to large-scale dengue outbreaks in 2015. We spoke to Patrick Fuller, communications manager for the International Federation of Red Cross and Red Crescent Societies (IFRC) Asia Pacific Zone, about the dengue situation in Southeast Asia, how the IFRC is helping and what more could be done.

“You always get dengue spikes during a monsoon, but this year’s (2015) El Niño has caused climatic shifts with less rainfall in some countries and more in others,” explains Patrick. “We’ve seen dengue spikes in the Philippines, Vietnam, Malaysia, India and Indonesia, but Thailand and Cambodia have been hit the hardest. Cases in Thailand have tripled this year and Cambodia has seen a 350 percent increase on last year.”

Asia was hit hard by dengue crisis in 2015

Asia was hit hard by a dengue crisis in 2015

IFRC’s health sector activities in Asia Pacific – in the Pacific, East Asia, Southeast Asia and South Asia – are very broad. The movement helps to support the work of national societies across the region, which covers a total of 37 countries. Each national society helps vulnerable people within its own borders, working in conjunction with the IFRC movement.

The dengue crisis left hospitals overwhelmed

Big spikes in dengue and people requiring hospitalization mean hospitals simply don’t have the bed space. After all, hospitals only have a limited number of many beds.

Patrick reveals how the IFRC is lending a hand, “In the Philippines this year, for example, the Philippine Red Cross set up a couple of hundred bed hospital tents in the Cavite province to support local health structures and equip them with blood supplies and other materials needed. They were just overwhelmed. It was the same story in Thailand.”

In parallel, the Philippine Red Cross put out an appeal to the public to donate blood to boost available supplies.

Patrick sees so many people attending hospital as a positive. “It means people recognise the symptoms of the disease, which is a step forwards. In Thailand, a survey by the Ministry of Health showed that more than 80 percent of Thais know about dengue fever.”

Taking awareness to a new level

The survey also found, however, that only 20 percent of people had actually done something in their communities to eradicate the larvae of the mosquitoes responsible for spreading dengue. Patrick comments, “In general, raising awareness around dengue tends to be reactive rather than proactive. That needs to change. There has to be higher level of awareness surrounding the dangers of this disease – not just during emergency situations, but throughout the year.”

The IFRC is focusing much of its efforts on community-based interventions, prioritizing health awareness and education. Not only does it broadcast public health messages on the mass media channels people are reading and listening to, but its volunteers spread the message from house to house and raise awareness in schools.

Patrick sights Vietnam Red Cross as a good example, “Vietnam are strong on mobilizing mass media; using volunteers to go out and distribute leaflets to households, schools and students; and putting up posters on the symptoms of dengue, explaining how people can prevent mosquitoes from breeding around their houses. This really has an impact.”

Rapid urbanisation and the multiplication of construction sites in Asia have contributed to the proliferation of dengue.

Increased civic responsibility

Alongside health education and awareness, behavior change is really critical. An increased level of civic responsibility is needed to help contain and eradicate dengue.

“In some countries our volunteers run clean-up campaigns where they tell people to keep the areas around their homes, their communities and anywhere where the dengue mosquito can breed clear from garbage,” reveals Patrick. “These societies have the capacity and the funding to do this as part of their partnerships with other organizations and with local government.”

In parallel with this type of approach, some countries are considering how they can be more stringent with the local population. Local authorities are considering imposing cash fines on the people and businesses that don’t co-operate with the health authorities to stop the virus.

Patrick reveals why, “In Asia, dengue is largely an urban disease and we are seeing such rapid urbanization. There are construction sites everywhere in major Asian cities, providing the ideal conditions for the spread of disease.”

Dengue is hitting Asia really hard this year, and with climate change and the outlook for years to come is looking equally bleak.

Help us spread the word on what communities can do to halt dengue in its tracks. Whether you’re in Asia or elsewhere across the globe, share your stories about how community is helping to stop the spread of dengue.

New rapid dengue test could transform diagnostics

Dengue test delivers results

A team of scientists from the Universities of Denmark and Queensland published a paper in the Nature journal Scientific Reports describing the development of a new state-of-the-art dengue test. The diagnostic tool could help advance the fight against dengue fever.

This innovation is a quick dengue test that accurately detects one of the biomarkers of the virus, and is being further developed to detect additional biomarkers. The portable technology would bring laboratory-quality diagnostics to the field, making it possible to diagnose dengue fever with a procedure as simple as that of a glucose pinprick test.

Blu-ray and a drop of blood

The team of researchers developed the biosensor based on existing Blu-ray consumer electronics combined with nanoparticle physics. They modified the Blu-ray unit to read a special cartridge containing a drop of blood mixed with magnetic nanoparticles to detect a key biomarker of dengue, known as NS1.

Thanks to this combination of technologies, clinicians can quickly and easily detect the presence of the NS1 molecule in the blood as well as immediately quantify the level of the biomarker. Dengue fever can be diagnosed by isolation of the virus, by blood serum tests, or by molecular methods.

Current dengue fever diagnostic tools consist either of traditional laboratory tests, which are time-consuming and require sophisticated equipment and trained experts, or else are very rudimentary, such as a paper strip test based on color-change, which is neither laboratory-grade nor quantitative.

According to Dr. Pratit Samdani, Associate Professor and Head of the Medicine Unit at G T Hospital and Sir J J Group of Hospitals in Mumbai, serum-based testing does not always yield conclusive results. “With the mutation of the virus, getting a serological diagnoses is not very easy in the first few days and sometimes it takes as much as a week to get a diagnosis,” he says. “If we had a sensitive and specific test available for dengue, using only a drop of blood, it would be a wonderful thing,” adds Dr. Samdani, who has already treated some 500 dengue patients in 2015 alone. “A quick diagnostic tool would be a big boon for the medical fraternity and patients.”

Dengue diagnostics expert, Professor Shamala Devi Sekaran of the Department of Medical Microbiology, Faculty of Medicine, University of Malaya, agrees: “General practitioners, in particular, want something quick, simple and definitive to use in diagnosing dengue fever.”

“Basically, it’s like a Nespresso coffee machine, where different cartridges can be introduced in the machine to perform different tests…”

According to Dr. Marco Donolato, formerly researcher at the Technical University of Denmark and now Chief Scientific Officer of the startup company BluSense Diagnostics, and one of the authors of the paper published in the Nature journal, their new technology is a “cheap and easy to use system, as simple to manipulate as a standard Blu-ray disc player.” Yet, he emphasizes, it can accurately detect the biomarker with the same sensitivity as specialized laboratory machinery.

Simple and quantitative

“We have demonstrated in the paper just published in Nature that we can detect the NS1 biomarker,” explains Dr. Donolato. “Since doctors would like to have three parameters tested, we are working on expanding the diagnostic capability to include other biomarkers in the same test.”

One of the key aspects of this technology is that the test uses just a single drop of blood from a pinprick to the finger with results in just seven minutes. “The fact that the test is easy enough to do and it can be done using whole blood rather than first separating the serum is significant,” emphasizes Prof. Sekaran, who has no affiliation with the paper’s authors or the company commercializing the product. This is in contrast to a hospital test in which significant amounts of blood are drawn and the laboratory results take several hours or days. Thus, treatment can be started immediately after the results are known.

Is low-cost travel spurring dengue outbreaks?

The device itself is compact, meaning it can be kept in a doctor’s office or brought along with a field technician to the most remote villages. And, because it has the ability to be cloud-connected, it could contribute to easily mapping outbreaks of the disease, suggests Dr. Donolato. In addition, the quantitative value of the diagnostic allows for a tailored treatment. “It is very important that it provides a quantitative level of NS1, which allows for more accurate diagnosis,” explains Prof. Sekaran.

Broader significance

According to Dr. Donolato, the nanotechnology crucial to this diagnostic tool, which consists of magnetic nanoparticles that mix with the blood droplet, means the system can be used to test for the existence of other parameters in addition to NS1. What is more, this nanotechnology is compatible with more than just the detection of dengue fever, but can also be used to detect biomarkers for a broader range of disorders, such as diabetes and other infectious diseases.

“Basically, it’s like a Nespresso coffee machine, where different cartridges can be introduced in the machine to perform different tests,” says Dr. Donolato. The spin-off company, BluSense Diagnostics, is working to bring this technology to market as quickly as possible. “A tool like BluSense sounds awesome, and I’m sure it would work very well in metropolitan areas, but there could be challenges in smaller towns, including cost, shelf-life, and availability of a technician or doctor,” says Dr. Samdani. “More important is the specificity and the sensitivity. It needs to be scalable, comparable and better than the antigen and antibody test, which of course the paper does mention.”

“It still needs to be tested out in the field,” adds Prof. Sekaran. The BluSense team is now developing the final system, which will be field-tested in 2016, according to Dr. Donolato. If the tests are conclusive, and the device receives regulatory approval, hospitals may soon equip themselves with a tool that could significantly increase effectiveness in dengue diagnosis.