Dr. Tanvir Rahman (Bangladesh Agricultural University): dengue & chikungunya in Bangladesh

Dr. Tanvir Rahman is a researcher in the Department of Microbiology and Hygiene at the Bangladesh Agricultural University. In this Infectious Thoughts interview, Dr. Rahman speaks about the current challenges in Bangladesh posed by co-endemic dengue, chikungunya and zika and the urgent partnerships and strategies needed to close current gaps in diagnostics, awareness building and surveillance, including the important role of a World Dengue Day in accelerating these goals.

Dengue, Chikungunya, and Zika are the amongst the most pertinent major heath concerns for Bangladesh What is mission critical in terms of effective prevention and control?

Dengue, Chikungunya, and Zika are major health concern globally including Bangladesh. Despite preventive and control measures, every year there are dengue outbreaks in Bangladesh. Early detection of agents and their vectors are key components of any disease

prevention and control strategy.

Effective active surveillance system both for the viruses and the vectors and implementation of prevention and control measures in right time in right place are the mission critical in Bangladesh in terms of effective prevention and control of these diseases.

Given the clinical similarities between dengue and Chikungunya what would be the major challenges faced in Bangladesh?

Both the dengue and Chikungunya virus spread through Aedes mosquitoes. There are reports on the occurrence of dengue and Chikungunya infection simultaneously. In addition, co-infection of dengue and Chikungunya may also occur. Because of the similarities of clinical findings between dengue and Chikungunya in many cases the actual prevalence and incidence of these diseases remain under or over estimated. So a major need that Bangladesh is facing in this respect is for a rapid and reliable cost-effective differential diagnosis system to distinguish dengue from Chikungunya at community level.

We are hearing a lot of background talk regarding lab capacity building and lab capacity strengthening: what upgrades to Bangladeshi lab facilities do you think are needed to overcome these challenges?

Confirmation of the diagnosis of dengue is based on the molecular detection of the dengue virus from clinical samples. In other cases it relies on the detection on antibodies specific for the dengue virus. We need adequate molecular diagnostic facilities such as real-time and quantitative RT-PCR and sequencing service at regional lever (district level) along with facilities for ELISA. In addition, we need more constant supply of nucleic acid extraction kit, primers and probes, RT kit and thermocyclers, sequencers etc to keep these labs in function all the time, in addition to skilled lab technicians. Provision of time to time monitoring of the lab activities and training of the lab technician need to be in action. Linkages with other regional labs (such as the establishment of LabNet, a network of labs working on dengue) are also vital in this respect.

These lab facilities are primarily run by government agencies and so what concrete steps can they take to overcome these challenges?

The government could provide the lab facilities to NGOs (Non Governmental Organizations) working for the promotion of health at local community level who already have some lab setup for diagnosis of certain diseases. This will allow the rapid detection of dengue but also other arboviruses in many of the remote and rural areas to accelerate targeted effective preventive and control measures. In addition, private and international funding agencies and organizations (WHO, FAO etc) also need to contribute more in this kind of activities

In your opinion how would having a World Dengue Day (WDD) help to achieve this and would a WDD help to drive partnerships?

On the WDD, I anticipate some great results in terms of education and partnerships. It will be very good if the concerned authorities could organize activities and programs for building public awareness on dengue (providing information on questions such as: what is it? how it spread? how to control? etc) and its consequences on heath and society. This