1 Mbiri ya Mliri wa Dengue: Vuto Lokula Padziko Lonse la Zaumoyo wa Anthu

Dengue ndi matenda opatsirana ndi udzudzu omwe amayamba chifukwa cha kachilombo ka dengue (DENV), komwe kwakhala matenda ofala kwambiri padziko lonse lapansi, zomwe zikuika pachiwopsezo chachikulu pa thanzi la anthu. M'zaka makumi awiri zapitazi, kuchuluka kwa matenda a dengue padziko lonse kwawonjezeka kwambiri, ndipo chiwerengero cha milandu yomwe yanenedwa chikuwonjezeka kawiri pachaka kuyambira 2021 [1]. Mu Disembala 2023, Bungwe la World Health Organization (WHO) linalengeza zadzidzidzi padziko lonse lapansi la dengue kuti lilimbikitse ntchito yogwirizana yapadziko lonse lapansi yothandiza. Ziwerengero za epidemiological kuchokera ku WHO zikusonyeza kuti anthu pafupifupi 3.9 biliyoni padziko lonse lapansi ali pachiwopsezo chotenga matenda a dengue, ndipo matenda okwana 390 miliyoni amapezeka pachaka—omwe 96 miliyoni amapezeka ngati milandu yodziwika bwino yachipatala [1,2].

2 Mfundo Zazikulu za Epidemiology

Makhalidwe a matenda a dengue amapangidwa ndi kuyanjana kwa zinthu zomwe zimayambitsa matenda, chilengedwe cha tizilombo toyambitsa matenda, chitetezo cha mthupi cha munthu, komanso momwe zinthu zilili m'madera osiyanasiyana. Kumvetsetsa bwino makhalidwe amenewa n'kofunika kwambiri kuti pakhale njira zopewera komanso zowongolera matenda komanso njira zolondola zodziwira matenda.

2.1 Ma Vector Otumizira ndi Ma Pattern Otumizira ku Mizinda

Kachilombo ka Dengue kamafalikira kwambiri ndiAedes aegypti ndi Aedes albopictusUdzudzu. Pakati pa mitundu iyi ya udzudzu, Aedes aegypti imadziwika kuti ndi ventricle yofunika kwambiri yopatsirana, yomwe imadziwika ndi "kusintha kwakukulu kwa anthu" komanso kufalikira kwakukulu m'malo otentha komanso m'matauni. Mosiyana ndi udzudzu wina womwe umayambitsa matenda a arbovirus, Aedes aegypti ili ndi makhalidwe otsatirawa okhudza kufalikira kwa matendawa:

-Kukonda kubereketsa m'malo omwe anthu amabadwira (monga zidebe zosungira madzi, matayala otayidwa)

-Kuchuluka kwa magazi a anthu monga gwero la michere

-Khalidwe lodyetsa masana

Makhalidwe amenewa amatanthauza kuti dengue ndi matenda wamba"Matenda opatsirana m'mizinda,"ndi mphamvu yofalitsa matendawa ikukwera kwambiri m'madera okhala anthu ambiri. Kafukufuku wokhudzana ndi WHO wasonyeza kuti m'mizinda yomwe muli anthu ambiri, kuchuluka kwa udzudzu pakati pa anthu kumatha kukweza kwambiri chiwerengero choyambira cha kubereka (R₀) cha DENV, motero kufulumizitsa kufalikira kwa miliri [2].

2.2 Kufalikira kwa Zochitika Padziko Lonse ndi Zinthu Zoyambitsa

Malinga ndi malipoti a WHO, chiwerengero cha anthu omwe apezeka ndi matenda a dengue padziko lonse chawonjezeka kwambiri m'zaka makumi awiri zapitazi [1,3]. Kukwera kumeneku kumachitika makamaka chifukwa cha zinthu zotsatirazi:

(1) Kusintha kwa Nyengo: Kukwera kwa kutentha kwa dziko lonse sikuti kumangowonjezera malo okhala oyenera tizilombo toyambitsa matenda komanso kumachepetsa nthawi yoti DENV ikule m'thupi mwa udzudzu, zomwe zimapangitsa kuti matendawa afalikire bwino. WHO yatsimikizira kuti kusintha kwa udzudzu komwe kumachitika chifukwa cha nyengo kwatsimikizira kuti ndi njira yodalirika yodziwira momwe matenda a dengue amafalikira m'malo osiyanasiyana.

(2) Kukula kwa mizinda: Kukula kwadzidzidzi komanso kosakonzekera kwapangitsa kuti pakhale malo ambiri oberekera tizilombo toyambitsa udzudzu, pomwe kuchuluka kwa anthu kwalimbitsa kupitiliza kwa unyolo wofalitsa wa DENV.

(3) Kusuntha kwa Anthu Padziko Lonse: Kuyenda padziko lonse lapansi ndi malonda kwathandiza kufalitsa mwachangu kwa DENV kudutsa malire, zomwe zalimbikitsa kusintha kuchoka ku milandu yochokera kunja kupita ku kufalikira kosalekeza kwa anthu am'deralo. Deta yowunikira ya WHO ikuwonetsa kuti pakati pa 2010 ndi 2021, United States inanena kuti anthu 7,528 omwe ali ndi matenda a dengue oyendera limodzi ndi maulendo, pakati pawo 3,135 amafunika kugonekedwa m'chipatala ndipo 19 adapha anthu.

(4) Kufalikira kwa Ma Vector: Padziko lonse lapansi, kuchuluka kwa udzudzu wa Aedes aegypti ndi Aedes albopictus kukupitirira kukula, ndipo udzudzu wa Aedes ukufalikira kwambiri m'madera ena a ku Ulaya. Chifukwa chake, dengue yasintha kuchoka pa mliri wachikhalidwe wa m'chigawo kupita ku chiopsezo cha thanzi la anthu padziko lonse lapansi.

2.3 Njira Zolumikizirana Magazi ndi Matenda Obwerezabwereza mu Multi-Serotype

Kachilombo ka Dengue kali ndi ma serotype anayi osiyana ndi antigen (DENV-1 mpaka DENV-4). Kutenga kachilombo ka serotype imodzi kumapereka chitetezo cha nthawi yayitali ku serotype yeniyeniyo koma chitetezo cha kanthawi kochepa komanso pang'ono ku ma serotype ena atatu. Anthu ambiri ali pachiwopsezo cha DENV, ndipo ndi anthu ochepa okha omwe ali ndi kachilomboka omwe akudwala matenda [2].

M'madera omwe ali ndi matendawa, ma serotype angapo a DENV nthawi zambiri amayendera limodzi nthawi imodzi, zomwe zimapangitsa kuti anthu athe kudwala matenda osiyanasiyana a dengue moyo wawo wonse. Kafukufuku wa WHO wapeza kuti multi-serotype co-circulation ndi yomwe imayambitsa kufalikira kwa matenda a dengue nthawi ndi nthawi [1].

2.4 Matenda achiwiri ndi kuwonjezeka kwa chitetezo cha mthupi chomwe chimadalira chitetezo cha mthupi

Chochitika chofunikira komanso chapadera mu matenda a dengue ndiKupititsa patsogolo kwa ma antibodies (ADE). Pa nthawi ya matenda achiwiri ndi serotype ya DENV yosiyana, ma antibodies osaletsa omwe amapangidwa panthawi ya matendawa oyamba amathandizira kulowa kwa kachilombo m'ma monocytes ndi ma macrophages, motero kumawonjezera kuchulukitsa kwa kachilombo. Njira imeneyi imadziwika kwambiri ndi WHO ngati chinthu chachikulu chomwe chimayambitsa matenda a dengue, kuphatikizapo dengue hemorrhagic fever ndi dengue shock syndrome [1].

Deta ya matenda a WHO imasonyeza nthawi zonse kuti anthu omwe ali ndi matenda a dengue yachiwiri ali pachiwopsezo chachikulu chotenga matenda oopsa poyerekeza ndi omwe ali ndi matenda oyamba—khalidwe lomwe ndi lofunika kwambiri pakuwunika matenda ndi kuyang'anira matenda. Ndikofunikira kudziwa kuti ngakhale chiopsezo cha matenda oopsa chimawonjezeka panthawi ya matenda achiwiri, matenda aliwonse a DENV serotype amatha kupita ku dengue yoopsa [1].

2.5 Zizindikiro Zachipatala Zosadziwika ndi Chiwopsezo Chodziwira Matenda Molakwika

Zizindikiro za matenda a dengue sizimadziwika bwino, makamaka kumayambiriro kwa matendawa, nthawi zambiri zimafanana ndi za matenda ena opatsirana ndi udzudzu (monga chikungunya ndi kachilombo ka Zika) komanso matenda ena opumira. WHO ikunena kuti 40-80% ya matenda a DENV ndi osawonetsa zizindikiro [3].

Zizindikiro zachipatala zomwe zimapezeka nthawi zambiri zimaphatikizapo:

-Malungo aakulu (osapitirira kwa masiku 2-7, omwe angakhale a biphasic)

-Kupweteka mutu kwambiri komanso kupweteka kumbuyo kwa maso (retro-orbital pain)

-Kupweteka kwa minofu ndi mafupa (komwe nthawi zambiri kumatchedwa "matenda a mafupa osweka")

- Matuza a macular kapena maculopapular

- Kutuluka magazi pang'ono (monga ecchymosis, epistaxis, kutuluka magazi m'mimba)

Matenda a dengue nthawi zambiri amagawidwa m'magawo atatu osiyana: gawo la malungo, gawo lofunika kwambiri, ndi gawo lochira. Pafupifupi odwala ochepera 5% omwe ali ndi zizindikiro amakula kukhala matenda a dengue oopsa. Chifukwa chosowa zizindikiro zinazake zachipatala, matenda otengera zizindikiro zachipatala ndi ovuta, zomwe zimawonjezera chiopsezo cha matenda olakwika komanso osapezeka ndi matendawa. Bungwe la WHO likugogomezera momveka bwino kuti matenda okha ndi osakwanira kuti atsimikizire kulondola, zomwe zimapangitsa kuti kutsimikizira kwa labotale kukhale kofunika kwambiri [1].

 Mfundo 3 Zofunika Kwambiri kuchokera ku WHO “Kuyesa Kachilombo ka Dengue mu Laboratory: Malangizo Akanthawi, Epulo 2025″

Mu Epulo 2025, Bungwe la Zaumoyo Padziko Lonse linatulutsa malangizo atsopano okhudza kuyesa kwa DENV m'ma laboratories, popereka malangizo odalirika aukadaulo okhudza matenda a dengue padziko lonse lapansi. Malangizowa akuphatikiza umboni waposachedwa kwambiri pa kuyesa kwa dengue m'ma laboratories pankhani ya ngozi yapadziko lonse lapansi ya dengue ndipo amapereka malangizo othandiza ogwirizana ndi malo omwe ali ndi magawo osiyanasiyana azinthu.

3.1 Mfundo Zofunikira za Njira Yoyesera

Malangizowa akugogomezera kuti kuzindikira matenda a dengue kuyenera kugwiritsa ntchito njira yoyezera matenda yokhala ndi zizindikiro zambiri kutengera gawo la matenda [1]. Popeza palibe njira yodziwira matenda yomwe ingagwiritsidwe ntchito ponseponse, njira zoyezera ziyenera kusinthidwa kuti zigwirizane ndi zochitika za m'deralo, poganizira zinthu zofunika izi [1]:

-Gawo la matenda: Chiwerengero cha masiku omwe munthu akuyamba zizindikiro chimatsimikizira njira yoyenera yoyesera

-Mtundu wa chitsanzo: Kuyenerera kwa magazi athunthu, plasma, kapena seramu kuti apeze DENV

-Epidemiology ya m'chigawo: Ma serotypes a DENV omwe amafalikira m'deralo komanso kufalikira kwa ma arbovirus ena pamodzi

-Chiwopsezo cha matenda opatsirana pamodzi: M'madera omwe ma arbovirus amafalikira mosiyanasiyana, kuyezetsa kwa multiplex kuyenera kuganiziridwa kuti kusiyanitsa pakati pa tizilombo toyambitsa matenda osiyanasiyana.

3.2 Njira Yoyesera Yogwiritsa Ntchito Gawo

Malinga ndi malangizo a WHO, kuyezetsa kwa dengue mu labotale kuyenera kuchitika nthawi zonse kutengera gawo la matenda [1,2]:

(1) Kuyesa kwa Acute Phase (≤ masiku 7 pambuyo poyambira)

-Kuyesa kwa Nucleic Acid (Kuyesa kwa Molecular): Reverse transcription-polymerase chain reaction (RT-PCR) ndi njira zina zama molekyulu zimazindikira DENV RNA yokhala ndi mphamvu yayikulu.

-Kuyesa kwa Antigen: Kuzindikira antigen ya NS1, komwe kumapezeka mkati mwa masiku 1-3 kuchokera pamene yayamba.

Mu gawo loopsa, kuchuluka kwa viremia kumakhala kwakukulu, ndipo mayeso a nucleic acid ndi antigen amapeza mphamvu yabwino kwambiri.

(2) Kuyesa kwa Gawo Lochira (masiku ≥4 pambuyo poyambira)

-Kuyesa kwa Maselo: Ma antibodies a IgM nthawi zambiri amapezeka pafupifupi tsiku lachinayi pambuyo pa chiyambi.

-Nthawi zambiri, ma antibodies a IgM amakhalapo kwa masiku 14-20, ndipo nthawi zina, kupirira kumatha kupitirira masiku 90.

-Kuyesa kwa IgG kuli ndi phindu lochepa pakupeza matenda a dengue chifukwa cha ma antibodies omwe angathe kufalikira kuchokera ku matenda a flavivirus kapena katemera wakale.

(3) Njira Yodziwira Mlandu Yomwe Ikukayikiridwa

Malangizowa akuphatikizapo njira yodziwira matenda a matenda a dengue omwe akuganiziridwa kuti ndi ofala, ndipo akupereka njira zoyenera zoyesera kutengera masiku omwe zizindikirozo zayamba: Kuyesa kwa antigen ya NS1 ndi kuyesa kwa nucleic acid ndi njira zazikulu zoyambira, pomwe kuyesa kwa serological ndiye njira yayikulu mu gawo lotsatira.

3.3 Njira Yoyesera Kuwunika ndi Kusankha Magwiridwe Antchito

Malinga ndi WHO, kuwunika mwadongosolo magwiridwe antchito ndi zochitika zoyenera pa mayeso osiyanasiyana a dengue ndi motere:

Malangizo 4 Okhudza Kuzindikira Dengue ya Macro & Micro-Test Kuchokera ku Scenario

Pofuna kuthandizira kupewa ndi kuwongolera matenda a dengue, Macro & Micro-Test imapereka njira yolumikizirana yowunikira matenda yomwe imaphatikizapo kufufuza mwachangu, kutsimikizira kwa mamolekyulu, ndi kuyang'anira majini, kukwaniritsa zosowa zosiyanasiyana pazigawo zosiyanasiyana zowongolera kufalikira kwa matendawa.

4.1 Chitsanzo 1: Kuwunika Mwachangu ndi Kuyang'anira Molunjika

Imagwira ntchito kuzipatala za malungo, zipatala zoyamwitsa, kuyezetsa anthu omwe ali ndi kachilomboka, komanso kuyika anthu m'malo ogona/kuika anthu m'malo ogona.

-Mayeso Ofulumira a Dengue Virus NS1 Antigen: Amazindikira matenda oyamba (masiku 1-3 pambuyo poyambira) ndi zotsatira za mphindi 15 za kuyesedwa mwachangu.

-Kuyesa kwa Antibody wa Dengue Virus IgM/IgG: Kusiyanitsa matenda oyamba/achiwiri kuti muwone ngati matendawo ali pachiwopsezo chachikulu.

-Mayeso Ofulumira Ophatikizana a Dengue Virus NS1 Antigen + IgM/IgG: Amazindikira nthawi imodzi ma antigen ndi ma antibodies kuti adziwe matenda onse.

-Chikungunya Virus IgM/IgG Antibody Test: Chimathandiza kuzindikira matenda osiyanasiyana pogwiritsa ntchito dengue kuti tidziwe bwino tizilombo toyambitsa matenda.

4.2 Chitsanzo Chachiwiri: Kuzindikira Matenda Molondola ndi Kuyankha Mwadzidzidzi

-Chida Chodziwira Matenda a Dengue Virus I/II/III/IV Nucleic Acid: Chimazindikira ndikusiyanitsa ma serotypes anayi (malire ozindikira makope 500/mL) kuti apeze kufalikira kwa matendawa.

-Chida cha PCR cha Lyophilized Dengue Virus: Chosavuta kunyamula kutentha kwa chipinda, choyenera madera omwe alibe zinthu zambiri komanso kufalikira kwadzidzidzi.

-Dengue/Zika/Chikungunya Multiplex Real-Time PCR Kit: Imazindikira ma arbovirus atatu nthawi imodzi kuti ipeze matenda osiyanasiyana m'matenda ovuta.

Ma reagent onse omwe ali pamwambapa amagwirizana ndi AIO 800 Fully Automated Sample-to-Answer System, amachepetsa kugwiritsa ntchito ndi manja komanso kuipitsidwa kwa zinthu zosiyanasiyana, komanso akuwongolera magwiridwe antchito komanso chitetezo cha chilengedwe.

4.3 Chitsanzo Chachitatu: Kuyang'anira Majini ndi Kusanthula Mzere wa Mavairasi

Imagwira ntchito ku ma laboratories a dziko lonse, mabungwe ofufuza zaumoyo wa anthu onse, mogwirizana ndi momwe WHO imaonera NGS.

Mayankho a Macro & Micro-Test okhudza kuyang'anira majini amathandizira kutsata ma genome onse kuti apeze kachilombo, kufotokozera bwino za unyolo wopatsirana, kuyang'anira mitundu yosiyanasiyana, komanso kusintha njira za katemera. Amathandizira ntchito zoyendetsedwa ndi manja/zokha, kukonza njira yopitira patsogolo komanso kuberekana, zomwe zimathandiza ma laboratories kusintha kuchoka pa kuyesa kwachizolowezi kupita ku kuyang'anira kwapamwamba, mogwirizana ndi zomwe WHO ikufuna kulimbitsa kuyang'anira kusintha kwa kachilombo.

4.4 Kufunika kwa Mayankho Ogwirizana

Macro & Micro-Test imapereka njira zonse zodziwira matenda a arbovirus, kuthandizira gawo lililonse la kasamalidwe ka mliri: zida zowunikira mwachangu malo otsogola azaumoyo, kutsimikizira kwa mamolekyulu kuti adziwe matenda molondola, komanso kuthekera kosanthula majini onse kuti ayang'anire matenda. Ndi mayeso ogwira ntchito bwino, njira zosinthira, komanso nsanja zokonzekera zokha, mayankho awa amapatsa mphamvu ma laboratories ndi machitidwe azaumoyo kuti alimbikitse kukonzekera ndi kuyankha ku zoopsa zomwe zikubwera padziko lonse lapansi.

Zolemba

[1] Bungwe la Zaumoyo Padziko Lonse. Kuyesa kwa Dengue mu Laboratory: Malangizo a Nthawi Yochepa, Epulo 2025. Geneva: Bungwe la Zaumoyo Padziko Lonse; 2025.

[2] Gulu Lolangiza Zaukadaulo la WHO Global Arbovirus Initiative. Kulimbitsa Kukonzekera Padziko Lonse ndi Kuyankha ku Ziwopsezo za Matenda a Arbovirus: Kuyitanitsa Kuchitapo Kanthu. Lancet Infect Dis. 2026;26(1):15-17.

[3] Kachilombo ka Lancet. Kuthana ndi Vuto la Kuzindikira Matenda a Dengue. Kachilombo ka Lancet. 2025;6(7):101190.