Arboviral diseases: the emergence of a major yet ignored public health threat in Africa
Authors: Ayman Ahmed, Yousif Ali, Nouh Saad Mohamed
Journal: The Lancet Planetary Health (2020)

The view of Mordecai and colleagues1Mordecai EA Ryan SJ Caldwell JM Shah MM LaBeaud AD Climate change could shift disease burden from malaria to arboviruses in Africa.Lancet Planet Health. 2020; 4: e416-e423Summary Full Text Full Text PDF PubMed Scopus (16) Google Scholar has highlighted the potential change in the burden of vector-borne diseases in Africa due to climate change. However, in Sudan, as well as substantiating the switch from the great burden of malaria to arboviral diseases, we would like to report that it is already taking place, at least in the eastern region of the country, Red Sea state, the coastal area of Red Sea. In 2019, 28 861 cases of chikungunya virus were confirmed by PCR and reported;2Ayman A Dietrich I LaBeaud AD Lindsay SW Musa A Weaver SC Risks and challenges of arboviral diseases in Sudan: the urgent need for actions.Viruses. 2020; 12: 81Crossref Scopus (11) Google Scholar however, the state only reported 6023 cases of malaria during the same year (epidemiological reports of Sudan federal Ministry of Health). An additional 19 873 cases of chikungunya virus were reported from the subcoastal state of Kassala in this timeframe.2Ayman A Dietrich I LaBeaud AD Lindsay SW Musa A Weaver SC Risks and challenges of arboviral diseases in Sudan: the urgent need for actions.Viruses. 2020; 12: 81Crossref Scopus (11) Google Scholar More importantly, an unusual outbreak of Rift Valley fever virus has occurred mainly in the river Nile state. In total, 1129 human cases were reported and 1104 (98%) of such cases reported abortion, death, or both, among domestic animals, indicating the co-occurrence of disease epizootic and epidemic.3Ayman A Yousif Ali Adel Elduma et al.Unique outbreak of Rift Valley fever in Sudan, 2019.Emerg Infect Dis. 2020; (published online Nov 10.)https://doi.org/10.3201/eid2612.201599Google Scholar Additionally, over the past five years in the Darfur region, Dengue virus emerged in 2014 and West Nile virus emerged in 2015 for the first time.4Ayman A Ali Y Elmagboul B et al.Dengue fever in the Darfur area, western Sudan.Emerging Infect Dis. 2019; 25: 2125-2126Google Scholar, 5Ayman A Elduma A Magboul B Higazi T Ali Y The first outbreak of dengue fever in greater Darfur, western Sudan.Trop Med Infect Dis. 2019; 4: 43Crossref Scopus (14) Google Scholar This rapid change in disease burden is alarming, particularly because it is happening in Africa, where most communities are poor and health systems are overwhelmingly occupied with the burden of malaria. Additionally, local operational expertise in the implementation of prevention and control measures for vector-borne diseases, surveillance systems, diagnostic capacities, and health-care services in Africa are mainly oriented around malaria because of the long-term investment made by the Global Fund, governments, and other donors over the past decades. These malaria-oriented health systems have ignored many other infectious diseases, including arboviruses and viral haemorrhagic fevers. This neglect in Sudan is underscored by the heavy reliance of disease control programmes on microscopic and clinical diagnosis, which usually results in arboviral infections being misdiagnosed and mistakenly treated as malaria.5Ayman A Elduma A Magboul B Higazi T Ali Y The first outbreak of dengue fever in greater Darfur, western Sudan.Trop Med Infect Dis. 2019; 4: 43Crossref Scopus (14) Google Scholar Despite the growing risk of arboviral diseases in Sudan, there is still no control programme, health policy, or national reference laboratory for the confirmation of arboviral disease epidemics on time.2Ayman A Dietrich I LaBeaud AD Lindsay SW Musa A Weaver SC Risks and challenges of arboviral diseases in Sudan: the urgent need for actions.Viruses. 2020; 12: 81Crossref Scopus (11) Google Scholar Governments and health systems in Africa need to be alarmed about this rapidly growing public health threat of arboviral diseases in their countries. Additionally, actions must be taken to increase local capacity for the early detection and response to arboviral diseases as soon as they emerge, as well as to control arbovirus endemics and prevent arboviral epidemics and epizootics. We declare no competing interests. Climate change could shift disease burden from malaria to arboviruses in AfricaMalaria is a long-standing public health problem in sub-Saharan Africa, whereas arthropod-borne viruses (arboviruses) such as dengue and chikungunya cause an under-recognised burden of disease. Many human and environmental drivers affect the dynamics of vector-borne diseases. In this Personal View, we argue that the direct effects of warming temperatures are likely to promote greater environmental suitability for dengue and other arbovirus transmission by Aedes aegypti and reduce suitability for malaria transmission by Anopheles gambiae. Full-Text PDF Open Access