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Med J Armed Forces India. 2016 April; 72(2): 194–195.
Published online 2016 February 23. doi:  10.1016/j.mjafi.2015.11.015
PMCID: PMC4878941

Fifth serotype of dengue virus: What we should prepare for?

Beuy Joob[low asterisk]
Sanitation 1 Medical Academic Center, Bangkok, Thailand

Dear Editor,

We read with extreme interest the original article titled “Discovery of fifth serotype of dengue virus (DENV-5): A new public health dilemma in dengue control” by Mustafa et al. published in Med J Armed Forces India 2015:71:67–70.1

The author mentioned that “the likely cause of emergence of the new serotype could be genetic recombination, natural selection and genetic bottlenecks1” and also noted that “there is no indication of the presence of DENV-5 in India1.” Mustafa et al.1 also discussed on the problems with developing vaccine and vector control. For sure, there are limited reports on DENV-5. However, it should be noted that the diagnostic tool for DENV-5 is limitedly available. In the area with heavy endemic of dengue, there can be many underdiagnosed cases. In addition, the serotyping is not routinely done in several settings.2 Without a report does not mean there is actually no case or there would not be any case in the future. Preparedness should be discussed. First, knowledge is very important. Education to the general practitioners, physician, medical personnel, and public health care workers is needed. Gathering information, sharing, and distributing information among the group should be done. This can be the key factor in successful disease surveillance on the new upcoming disease. Second, there should be preparation for a new diagnostic tool for the new DENV-5. This can be the way for early diagnosis and prompt management of the problem. Finally, it should be noted that not only DENV-5 infections but also other virus infections are considered important new emerging hemorrhagic diseases that we have to follow and correspond.3

References

1. Mustafa M.S., Rasotgi V., Jain S., Gupta V. Discovery of fifth serotype of dengue virus (DENV-5): a new public health dilemma in dengue control. Med J Armed Forces India. 2015;71(January (1)):67–70. [PubMed]
2. Wiwanitkit V. Dengue fever: diagnosis and treatment. Expert Rev Anti Infect Ther. 2010;8(July (7)):841–845. [PubMed]
3. Wiwanitkit S., Wiwanitkit V. Acute viral hemorrhage disease: a summary on new viruses. J Acute Dis. 2015;4(4):271–272.
M.S. Mustafa, Lt Col

Reply

Dear Editor,

On behalf of the authors, I thank the readers for their keen interest and valuable comments regarding our article. The following comments are submitted herewith in response to the readers:

  • 1.
    Although there is no indication of the existence of DENV-5 in India, the presence of DENV-5 cannot be ruled out in toto; especially in inaccessible forest canopies where non-human primate hosts are found in abundance and deforestation activities are being resorted to; leading to disturbance in the ecological balance and a possible spillover from the sylvatic to the human cycle.
  • 2.
    As has been rightly brought out by the readers, the diagnostic tools for DENV-5 are limited and cases of DENV-5 may not be diagnosed even if they occur. The role of health education of the general public and more importantly; the health care workers at the community level using a bottoms up approach cannot be over-emphasised. They play an important role in creation of an information superhighway as far as disease diagnosis, treatment and prevention is considered.
  • 3.
    Newer diagnostic modalities need to be developed with more stress on serological identification of DENV-5; which, as of now seems to be difficult in a poor resource setting such as ours; with dengue being a disease more of the rural and per-urban areas where such facilities are either poorly developed or may be even non-existent.
  • 4.
    We agree with the readers that the present day scenario requires surveillance for disease with a high case fatality ratio such as Ebola and other haemorrhagic fevers, SARS, influenza, MERS and other respiratory infection viruses. DENV-5 on the other hand; with the limited data available, is a milder infection.

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