Evolving epidemiology, clinical features, and genotyping of dengue outbreaks in Bangladesh, 2000-2024: a systematic review

Abstract

Background: The 2023 dengue outbreak has proven that dengue is not only an endemic disease but also an emerging health threat in Bangladesh. Integrated studies on the epidemiology, clinical characteristics, seasonality, and genotype of dengue are limited. This study was conducted to determine recent trends in the molecular epidemiology, clinical features, and seasonality of dengue outbreaks.

Methods: We analyzed data from 41 original studies, extracting epidemiological information from all 41 articles, clinical symptoms from 30 articles, and genotypic diversity from 11 articles. The study adhered to the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement and Cochrane Collaboration guidelines.

Results: A total of 565,438 dengue cases and 2,587 fatalities were documented from January 2000 to March 2024. Notably, 60% of cases during the 2019 and 2023 outbreaks were reported in regions previously considered non-endemic. Fatalities were more frequent among women (70%). The majority of the studies (95-100%) used the NS1Ag test, followed by IgG or IgM and RT-PCR tests. New hotspots of dengue transmission were identified in the southern (Khulna, 10.8% and Barishal, 11.8%) and southeastern (Chattogram, 13.8%) regions of Bangladesh. Serotyping was conducted on 92.4% (1,456 of 1,575) of isolates between 2012 and 2023. Of the four serotypes, DENV3 was the most prevalent (57%), followed by DENV2 (30%), DENV1 (11%), and DENV4 (<1%). Genotype DENV3-I (43 of 59 isolates) was the most prevalent, followed by DENV3-II (8 of 59). The highest frequency of dengue cases was observed in August (26.3%), followed by September (22.5%), October (20.2%), and November (13.08%). Fever (90.51, 95% CI 85-100%) was the most prevalent symptom, followed by headache (57.98, 95% CI 12-100%), vomiting (51.16, 95% CI 23-91%), abdominal pain (34.12, 95% CI 12-85%), and myalgia (25.53, 95% CI 13-85%), respectively.

Conclusion: This study provides integrated insights into the molecular epidemiology, clinical features, seasonality, and transmission of dengue in Bangladesh and highlights research gaps for future studies.

Keywords: Bangladesh; dengue; epidemiology; outbreak; seasonality.

Figure 1

Selection and screening procedures of original studies. The excluded articles were irrelevant, duplicate, systematic reviews other than original studies and failed to meet inclusion criteria.

Figure 2

Trends of cases, fatalities, and CFR among the residents in Bangladesh.

Figure 3

Spatial distribution of indigenous and transported cases (A) during 2000–2011 and (B) 2012–2023. The blue color indicated indigenous cases in specific regions, while the green color indicated transported cases. The red star indicated a hotspot of outbreaks. During 2000–2011, the majority of indigenous cases were confined to central regions in Bangladesh. However, from 2012 to 2023, the southern and southeastern regions became highly infected, and indigenous cases became more common throughout Bangladesh.

Figure 4

(A) Proportionate frequency of serotypes of dengue virus in Bangladesh during 2000–2024. (B) Temporal distributions of serotypes of dengue virus in Bangladesh.

Figure 5

(A) Monthly distribution of cases of dengue outbreaks during 2008–2023 in Bangladesh. (B) Frequency distribution of cases of dengue virus, average temperature and rainfall in Bangladesh.