1 Isizinda Sobhubhane Lwe-Dengue: Inselele Ekhulayo Yezempilo Yomphakathi Yomhlaba Wonke

I-Dengue yisifo esibangelwa yigciwane esibangelwa yi-dengue virus (DENV), esivele njengesifo esisakazeka ngokushesha emhlabeni jikelele, esibeka usongo olukhulu ekuphepheni kwempilo yomphakathi. Eminyakeni engamashumi amabili edlule, ukwanda kwe-dengue emhlabeni wonke kukhuphuke kakhulu, kanti inani lamacala abikiwe liphindeka kabili ngonyaka kusukela ngo-2021 [1]. NgoDisemba 2023, i-World Health Organization (WHO) yamemezela isimo esiphuthumayo somhlaba wonke se-dengue ukuze kuqiniswe imizamo yokusabela ehlelekile yamazwe ngamazwe. Izilinganiso ze-Epidemiological ezivela kwi-WHO zibonisa ukuthi cishe abantu abayizigidi eziyizinkulungwane ezingu-3.9 emhlabeni wonke basengozini yokutheleleka yi-dengue, kanti ukutheleleka okulinganiselwa kuzigidi ezingu-390 kwenzeka minyaka yonke—okukhona abayizigidi ezingu-96 ababonakala njengamacala abonakalayo emitholampilo [1,2].

2 Okuvelele Kwe-Epidemiological

Izici ze-epidemiological ze-dengue zibunjwa ukusebenzisana kwezici ze-viral, i-vector ecology, izimpendulo zomzimba zomsingathi, kanye nezimo zenhlalo nezemvelo. Ukuqonda okuphelele kwalezi zici kubalulekile ekuthuthukiseni amasu okuvimbela nokulawula asebenzayo kanye nezindlela zokuxilonga ezinembile.

2.1 Amavektha Okudlulisa kanye Namaphethini Okudlulisa Emadolobheni

Igciwane le-dengue lidluliselwa kakhulu yi-u-Aedes aegypti kanye no-Aedes albopictusomiyane. Phakathi kwalezi zinhlobo ze-vector, i-Aedes aegypti ibhekwa njenge-vector ebaluleke kakhulu yokudlulisela, ebonakala “ngokuzivumelanisa nezimo kwabantu” okuphezulu kanye nokusabalala kabanzi ezindaweni zasemadolobheni ezishisayo nezingaphansi kwezindawo ezishisayo. Ngokungafani nezinye i-vector zomiyane ze-arboviral pathogens, i-Aedes aegypti ikhombisa izici ezilandelayo ezibalulekile ze-epidemiological:

-Ukukhetha ukufuya ezindaweni ezibangela imvelaphi yabantu (isb., izitsha zokugcina amanzi, amathayi alahliwe)

-I-tropism enamandla yegazi lomuntu njengomthombo wezakhamzimba

-Ukuziphatha kokudla emini

Lezi zici zichaza i-dengue njengento evamile"Isifo esithathelwanayo sasemadolobheni,"kanye nokusebenza kahle kokudluliselana okuphakeme kakhulu ezindaweni ezinabantu abaningi. Izifundo ezihlobene ne-WHO zibonise ukuthi ezindaweni zasemadolobheni ezinabantu abaningi, ukwanda kwemvamisa yokuxhumana komiyane nabantu kungakhuphula kakhulu inani lokuzala eliyisisekelo (R₀) le-DENV, ngaleyo ndlela kusheshiswe ukusabalala kwezifo eziwumshayabhuqe [2].

2.2 Izitayela Zokusabalala Komhlaba Wonke kanye Nezici Ezibangela Ukukhathazeka

Ngokusho kwemibiko ye-WHO, inani lomhlaba wonke lamacala e-dengue abikiwe liye landa kakhulu eminyakeni engamashumi amabili edlule [1,3]. Lokhu kukhuphuka kubangelwa kakhulu yizici ezilandelayo ezixhumene:

(1) Ukushintsha Kwesimo Sezulu: Ukwenyuka kwamazinga okushisa emhlabeni wonke akugcini nje ngokwandisa ububanzi bezindawo zokuhlala ezifanele zezilwane ezithwala omiyane kodwa futhi kufinyeza isikhathi sokufukamela ngaphandle kwe-DENV ngaphakathi kwesilwane esithwala omiyane, ngaleyo ndlela kuthuthukisa ukusebenza kahle kokudlulisela. Ukwehluka okubangelwa yisimo sezulu ekubuneni komiyane kuye kwaqinisekiswa yi-WHO njengesibikezelo esithembekile sesimo sezulu sokuqubuka kodenga.

(2) Ukufudukela emadolobheni: Ukwanda okusheshayo nokungahleliwe kwamadolobha kudale izindawo eziningi zokuzalela zezilwane ezithwala omiyane, kuyilapho ukwanda kwabantu kuqinise ukuqhubeka kwezindlela zokudlulisela ze-DENV.

(3) Ukunyakaza Kwabantu Bomhlaba Wonke: Ukuhamba kwamazwe ngamazwe kanye nokuhweba kuye kwenza kwaba lula ukudluliswa okusheshayo kwe-DENV, okukhuthaza ukuguquka kusuka emacaleni angenisiwe kuya ekudlulisweni okuqhubekayo kwendawo. Idatha yokuqapha ye-WHO ikhombisa ukuthi phakathi kuka-2010 no-2021, i-United States ibike amacala e-dengue ahlobene nokuhamba angu-7,528, phakathi kwawo angu-3,135 adinga ukulaliswa esibhedlela kanti angu-19 aholela ekufeni.

(4) Ukwanda Kokusatshalaliswa Kwe-Vector: Emhlabeni jikelele, ububanzi bendawo ye-Aedes aegypti kanye ne-Aedes albopictus buyaqhubeka nokukhula, kanti omiyane be-Aedes banda kakhulu ezingxenyeni ezithile zeYurophu. Ngenxa yalokho, i-dengue ishintshe kusukela ekubeni ubhubhane lwesifunda oluvamile lwaba usongo lwempilo yomphakathi emhlabeni jikelele.

2.3 Izindlela Zokujikeleza kwegazi Eziningi kanye Nezindlela Zokuphinde Utheleleke

Igciwane le-dengue liqukethe ama-serotype amane ahlukene ngokwe-antigen (i-DENV-1 kuya ku-DENV-4). Ukutheleleka nge-serotype eyodwa kunikeza isivikelo sokuzivikela sesikhathi eside kulolo hlobo oluthile lwe-serotype kodwa kuphela isivikelo sesikhashana nesiyingxenye ngokumelene nezinye izinhlobo ezintathu ze-serotype. Isibalo sabantu bonke sisengozini ye-DENV, kanye neqembu elincane labantu abangenwe yileli gciwane abanesifo somtholampilo [2].

Ezindaweni ezivame ukusabalala, ama-serotype amaningi e-DENV avame ukujikeleza kanyekanye, okuholela ekutheni abantu babe nokutheleleka kwe-dengue okuningi empilweni yabo yonke. Izifundo ze-WHO ze-epidemiological zikhombe ukujikeleza kwe-multi-serotype njengembangela eyinhloko yokuqubuka kwe-dengue ngezikhathi ezithile [1].

2.4 Ukutheleleka Kwesibili kanye Nokuthuthukiswa Okuxhomeke Kuma-Antibody

Isenzakalo esibucayi nesiyingqayizivele ku-dengue epidemiology yilesiukuthuthukiswa okuncike kuma-antibody (i-ADE)Ngesikhathi sokutheleleka kwesibili nge-serotype ye-DENV ehlukile, ama-antibodies angakhiqizi akhiqizwa ngesikhathi sokutheleleka okuyinhloko enza kube lula ukungena kwegciwane kuma-monocytes nama-macrophage, ngaleyo ndlela kuthuthukisa ukuphindaphindeka kwegciwane. Le ndlela iqashelwa kabanzi yi-WHO njengesici esiyinhloko esibangela izifo ku-dengue enzima, okuhlanganisa umkhuhlane we-dengue ophuma igazi kanye ne-dengue shock syndrome [1].

Idatha ye-WHO epidemiological ikhombisa njalo ukuthi abantu abanesifo sesibili sodenga banengozi enkulu kakhulu yokuthola isifo esibi uma kuqhathaniswa nalabo abanesifo sokuqala—isici esibaluleke kakhulu ekuqapheni isifo kanye nokuphathwa kwezokwelapha. Kubalulekile ukuqaphela ukuthi nakuba ingozi yesifo esibi ikhuphuka ngesikhathi sokutheleleka kwesibili, ukutheleleka nganoma yiluphi uhlobo lwe-DENV kungaqhubekela phambili ku-dengue enzima [1].

2.5 Ukubonakaliswa Kwemitholampilo Okungacacisiwe kanye Nengozi Yokuhlonza Okungalungile

Izimpawu zemitholampilo ze-dengue azicaci kahle, ikakhulukazi ezigabeni zokuqala zokugula, zivame ukuhambisana nezezinye izifo ezibangelwa amagciwane ezithwalwa omiyane (isb., amagciwane e-chikungunya kanye ne-Zika) kanye nezifo ezithile zokuphefumula. Izilinganiso ze-WHO zibonisa ukuthi u-40-80% wezifo ze-DENV azinazimpawu [3].

Izimpawu ezijwayelekile zemitholampilo zifaka:

-Umkhuhlane omkhulu (oqhubeka izinsuku ezingu-2-7, okungaba yi-biphasic)

-Ikhanda elibuhlungu kakhulu kanye nobuhlungu be-retro-orbital (ubuhlungu ngemuva kwamehlo)

-Ubuhlungu bemisipha namalunga (ngokuvamile okubizwa ngokuthi “umkhuhlane wethambo eliphukile”)

-Ukuqhuma kwe-macular noma i-maculopapular

-Izimpawu zokopha okuncane (isb., i-ecchymosis, i-epistaxis, ukopha kwe-gingival)

I-dengue enezimpawu ivame ukuhlukaniswa ngezigaba ezintathu ezihlukene: isigaba somkhuhlane, isigaba esibucayi, kanye nesigaba sokululama. Cishe ngaphansi kuka-5% weziguli ezinezimpawu ziqhubekela ku-dengue enzima. Ngenxa yokuntuleka kwezici ezithile zezokwelapha, ukuxilongwa okusekelwe kuphela ezimpawini zezokwelapha kuyinselele, okwandisa ingozi yokuhlonza okungalungile kanye nokungahlolwa kahle. I-WHO igcizelela ngokusobala ukuthi ukuxilongwa kwezokwelapha kuphela akwanele ukuqinisekisa ukunemba, okwenza ukuqinisekiswa kwelabhorethri kube yinto ebalulekile [1].

 Amaphuzu Amathathu Abalulekile avela ku-WHO “Ukuhlolwa Kwelabhorethri Kwegciwane Le-Dengue: Isiqondiso Sesikhashana, Ngo-Ephreli 2025”

Ngo-Ephreli 2025, i-World Health Organization yakhipha isiqondiso sesikhashana esibuyekeziwe mayelana nokuhlolwa kwelebhu ye-DENV, inikeza isiqondiso sobuchwepheshe esinegunya sokuxilonga i-dengue yomhlaba wonke. Lesi siqondiso sihlanganisa ubufakazi bamuva mayelana nokuhlolwa kwelebhu ye-dengue kumongo wesimo esiphuthumayo se-dengue emhlabeni wonke futhi sinikeza izincomo ezisebenzayo ezenzelwe izilungiselelo ezinamazinga ahlukahlukene ezinsizakusebenza.

3.1 Izimiso Eziyisisekelo Zesu Lokuhlola

Lesi siqondiso sigcizelela ukuthi ukuxilongwa kwe-dengue kumele kusetshenziswe isu lokuhlola elihlanganisiwe elinamamaki amaningi ngokusekelwe esigabeni sokugula [1]. Njengoba kungekho algorithm yokuxilonga ebanzi, amasu okuhlola kufanele avumelane nezimo zendawo ze-epidemiological, kucatshangelwa izici ezilandelayo ezibalulekile [1]:

-Isigaba sokutheleleka: Inani lezinsuku zokuqala kwezimpawu linquma indlela yokuhlola efanele kakhulu

-Uhlobo lwesampula: Ukufaneleka kwegazi eliphelele, i-plasma, noma i-serum ukuthola i-DENV

-I-epidemiology yesifunda: Ama-serotype e-DENV ajikelezayo endaweni kanye nokujikeleza kwegazi kwamanye ama-arbovirus

-Ingozi yokutheleleka kanyekanye: Ezindaweni ezine-arbovirus ejikeleza ngokuhambisana, ukuhlolwa kwe-multiplex kufanele kucatshangelwe ukuhlukanisa phakathi kwezifo ezibangelwa amagciwane ezahlukene

3.2 Isu Lokuhlola Elisekelwe Ezigabeni

Ngokusho kwesiqondiso se-WHO, ukuhlolwa kwelabhorethri ye-dengue kufanele kulandele amafasitela esikhathi acacile ngokusekelwe esigabeni sokugula [1,2]:

(1) Ukuhlolwa Kwesigaba Esiphuthumayo (≤izinsuku ezingu-7 ngemuva kokuqala)

-Ukuhlolwa kwe-Nucleic Acid (Ukuhlolwa kwe-Molecular): Ukusabela kwe-reverse transcription-polymerase chain (RT-PCR) kanye nezinye izindlela zama-molecule kuthola i-DENV RNA ngokuzwela okuphezulu.

-Ukuhlolwa kwe-Antigen: Ukutholwa kwe-antigen ye-NS1, okutholakala zingakapheli izinsuku ezingu-1-3 ngemuva kokuqala.

Ngesikhathi sesigaba esibucayi, amazinga e-viremia aphezulu kakhulu, kanti ukuhlolwa kwe-nucleic acid kanye ne-antigen kufinyelela ukuzwela okuhle kakhulu.

(2) Ukuhlolwa Kwesigaba Sokuphulukiswa (≥izinsuku ezingu-4 ngemva kokuqala)

-Ukuhlolwa kwe-Serological: Ama-antibodies e-IgM avame ukutholakala cishe ngosuku lwesine ngemuva kokuqala.

-Ezimweni eziningi, ama-antibodies e-IgM ahlala izinsuku ezingu-14-20, kanti kwezinye izimo, ukuphikelela kungaqhubeka kuze kube yizinsuku ezingu-90.

-Ukuhlolwa kwe-IgG kunenani elilinganiselwe lokuxilongwa kwe-dengue ebukhali ngenxa yama-antibodies angaba khona asebenzayo avela ekuthelelekeni noma ekugonyweni kwangaphambilini kwe-flavivirus.

(3) I-Algorithm Yokuxilonga Icala Okusolwayo

Lesi siqondiso sihlanganisa i-algorithm yokuxilonga yamacala okusolwa ukuthi awekho udenga, sincoma izindlela ezifanele zokuhlola ezisekelwe ezinsukwini zokuqala kwezimpawu: Ukuhlolwa kwe-antigen ye-NS1 kanye nokuhlolwa kwe-nucleic acid kuyizindlela eziyinhloko esigabeni sokuqala, kuyilapho ukuhlolwa kwe-serological kuyindlela eyinhloko esigabeni esilandelayo.

3.3 Indlela Yokuhlola Ukuhlolwa Nokukhethwa Kokusebenza

Ngokusho kwe-WHO, ukuhlolwa okuhlelekile kokusebenza kanye nezimo ezifanele zokuhlolwa okuhlukahlukene kodenga kungokulandelayo:

Izincomo zomkhiqizo ezine ze-Macro & Micro-Test Dengue Detection by Scenario

Ukusekela ukuvimbela nokulawula udenga, i-Macro & Micro-Test inikeza iphothifoliyo yokuxilonga ehlanganisiwe ehlanganisa ukuhlolwa okusheshayo, ukuqinisekiswa kwama-molecular, kanye nokubhekwa kwe-genomic, ukuhlangabezana nezidingo kuzo zonke izigaba zokuphathwa kokuqubuka kwesifo.

4.1 Isimo 1: Ukuhlolwa Okusheshayo Nokubhekwa Okuqondiwe

Isebenza emitholampilo yomkhuhlane, ezikhungweni zokunakekelwa kwempilo okuyisisekelo, ekuhlolweni komphakathi kokuqubuka kwesifo, kanye nasekuhlukanisweni kwechweba/umngcele.

-Ukuhlolwa Okusheshayo Kwegciwane Le-Dengue NS1 Antigen: Kuthola ukutheleleka kusenesikhathi (izinsuku ezingu-1-3 ngemuva kokuqala) ngemiphumela yemizuzu engu-15 yokuhlolwa okusheshayo.

-Ukuhlolwa Kwama-Antibody Egciwane Le-Dengue IgM/IgG: Kuhlukanisa ukutheleleka okuyinhloko/kwesibili ukuze kuhlolwe ingozi enkulu yesifo.

-Ukuhlolwa Okusheshayo Okuhlanganisiwe Kwegciwane Le-Dengue NS1 Antigen + IgM/IgG: Kutholakala ngesikhathi esisodwa i-antigen nama-antibodies ukuze kutholakale ukuxilongwa okuphelele.

-Ukuhlolwa kwe-Antibody ye-Chikungunya Virus IgM/IgG: Kuvumela ukuxilongwa okuhlukile nge-dengue ukuhlonza amagciwane ngokunembile.

4.2 Isimo 2: Ukuxilongwa Okunembile kanye Nokusabela Okuphuthumayo

-Ikhithi Yokuthola I-Dengue Virus I/II/III/IV Nucleic Acid: Ithola futhi ihlukanise ama-serotypes amane (umkhawulo wokuthola amakhophi angu-500/mL) wokulandelela ukuqubuka kwalesi sifo.

-Ikhithi ye-PCR ye-Dengue Virus ephilisiwe: Iyathuthwa ekushiseni kwegumbi, ifanele izindawo ezilinganiselwe izinsiza kanye nokuqubuka okungazelelwe.

-I-Dengue/Zika/Chikungunya Multiplex Real-Time PCR Kit: Ithola ama-arbovirus amathathu ngesikhathi esisodwa ukuze kutholakale ukuxilongwa okuhlukile okuphumelelayo ekuqubukeni okuyinkimbinkimbi.

Zonke izithasiselo ezingenhla ziyahambisana ne-AIO 800 Fully Automated Sample-to-Answer System, zinciphisa ukusebenza ngesandla kanye nokungcoliswa okuhlukahlukene, futhi zithuthukisa ukusebenza kahle kanye nokuphepha kwezinto eziphilayo.

4.3 Isimo 3: Ukuhlolwa Kwezakhi Zofuzo kanye Nokuhlaziywa Kozalo Lwegciwane

Kusebenza kuma-laboratory kazwelonke okubhekisela kuwo, izikhungo zocwaningo lwezempilo zomphakathi, okuhambisana nokubekwa kwe-WHO kwe-NGS.

Izixazululo zokuqapha i-genomic ze-Macro & Micro-Test zisekela ukulandelana kwe-genome ephelele yokulandelela igciwane, ukucaciswa kochungechunge lokudlulisela, ukuqapha okuhlukile, kanye nokulungiswa kwesu lokugoma. Zisekela ukuhamba komsebenzi ngesandla/okuzenzakalelayo, zithuthukisa ukuphuma kanye nokuphindaphinda, zivumela amalabhorethri ukuthi athuthuke kusukela ekuhlolweni okuvamile kuya ekuhlolweni okuthuthukisiwe, okuhambisana nokugcizelela kwe-WHO ekuqiniseni ukuqapha kokuvela kwegciwane.

4.4 Inani Lezixazululo Ezihlanganisiwe

I-Macro & Micro-Test inikeza izixazululo eziphelele zokuxilonga zokutholwa kwe-arbovirus, isekela isigaba ngasinye sokuphathwa kokuqubuka: amathuluzi okuhlola okusheshayo kwezilungiselelo zezempilo ezingaphambili, ukuqinisekiswa kwama-molecule kokuxilongwa okunembile, kanye namakhono okuhlaziya i-genome ephelele yokuqapha kwe-epidemiological. Ngokuhlolwa kokusebenza okuphezulu, imisebenzi eguquguqukayo, kanye namapulatifomu alungele ukwenza izinto ngokuzenzakalela, lezi zixazululo zinika amandla ama-laboratories kanye nezinhlelo zezempilo zomphakathi ukuqinisa ukulungela kanye nokuphendula ezinsongweni ze-arbovirus ezivelayo emhlabeni jikelele.

Izinkomba

[1] Inhlangano Yezempilo Yomhlaba. Ukuhlolwa Kwelabhorethri Kwegciwane Le-Dengue: Isiqondiso Sesikhashana, Ephreli 2025. IGeneva: Inhlangano Yezempilo Yomhlaba; 2025.

[2] Iqembu Lokweluleka Ngobuchwepheshe Le-WHO Global Arbovirus Initiative. Ukuqinisa Ukulungela Komhlaba Wonke Nokuphendula Ezinsongweni Zezifo Ezibangelwa Yi-Arboviral: Ukubizelwa Esenzweni. I-Lancet Infect Dis. 2026;26(1):15-17.

[3] I-Lancet Microbe. Ukunqoba Inkinga Yokuxilonga I-Dengue. I-Lancet Microbe. 2025;6(7):101190.