1 Imvelaphi yoBubhubhani beDengue: Umngeni oQhubekela phambili kwiMpilo yoLuntu kwiHlabathi liphela

I-Dengue sisifo esibangelwa yintsholongwane esibangelwa yintsholongwane ye-dengue (DENV), esivele njengesifo se-arboviral esisasazeka ngokukhawuleza kwihlabathi liphela, sibeka umngcipheko omkhulu kukhuseleko lwempilo yoluntu. Kwiminyaka engamashumi amabini edlulileyo, ukwanda kwesifo se-dengue kwihlabathi liphela kuye kwanda kakhulu, kunye nenani lamatyala abikiweyo aphindaphindeka kabini ngonyaka ukusukela ngo-2021 [1]. NgoDisemba ka-2023, i-World Health Organisation (WHO) yabhengeza imeko engxamisekileyo ye-dengue kwihlabathi liphela ukuqinisa imizamo yokusabela edibeneyo yamazwe ngamazwe. Uqikelelo lwe-Epidemiological oluvela kwi-WHO lubonisa ukuba malunga ne-3.9 yeebhiliyoni zabantu kwihlabathi liphela basengozini yokosulelwa yi-dengue, kunye nosulelo oluqikelelwa kwi-390 yezigidi ezenzeka minyaka le—apho izigidi ezingama-96 zibonakala njengeziganeko ezibonakalayo ngokwezonyango [1,2].

2 Izinto ezibalulekileyo ze-Epidemiological

Iimpawu ze-epidemiological ze-dengue zibunjwa kukunxibelelana kwezinto ezibangelwa ziintsholongwane, i-vector ecology, iimpendulo zomzimba zomntu, kunye neemeko zentlalo nemeko-bume. Ukuqonda ngokupheleleyo ezi mpawu kubalulekile ekuphuhlisweni kwamaqhinga okuthintela nokulawula asebenzayo kunye neendlela ezichanekileyo zokuxilonga.

2.1 IiVektha zoThutho kunye neePateni zoThutho lwasezidolophini

Intsholongwane yeDengue idluliselwa kakhulu yiuAedes aegypti kunye noAedes albopictusiingcongconi. Phakathi kwezi ntlobo ze-vector, i-Aedes aegypti ibonwa njengeyona vector iphambili yokudlulisela, ebonakaliswa "kukuguquguquka okuphezulu kwabantu" kunye nokusasazwa ngokubanzi kwiindawo zasezidolophini ezishushu nezishushu. Ngokungafaniyo nezinye ii-vector ze-moth ze-arboviral pathogens, i-Aedes aegypti ibonisa ezi mpawu zilandelayo ziphambili ze-epidemiological:

-Ukukhetha ukufuya kwiindawo ezibangela imvelaphi yabantu (umz., izikhongozeli zokugcina amanzi, amatayara alahliweyo)

-I-tropism enamandla yegazi lomntu njengomthombo wezondlo

-Ukuziphatha kokutya emini

Ezi mpawu zichaza i-dengue njengento eqhelekileyo"Isifo esosulelayo sasezidolophini,"kunye nokusebenza kakuhle kokusasaza kunyuswe kakhulu kwiindawo ezinabantu abaninzi. Izifundo ezinxulumene ne-WHO zibonise ukuba kwiindawo zasezidolophini ezixineneyo, ukwanda kokunxibelelana kweengcongconi nabantu kunokunyusa kakhulu inani lokuzala elisisiseko (R₀) le-DENV, ngaloo ndlela kukhawuleziswe ukusasazeka kwezifo ezibulalayo [2].

2.2 Iindlela Zokusasazeka Kwehlabathi kunye Nezinto Ezibangela Uxinzelelo

Ngokweengxelo ze-WHO, inani lehlabathi leziganeko ze-dengue ezibikiweyo liye landa kakhulu kwiminyaka engamashumi amabini edlulileyo [1,3]. Olu tshintsho luqhutywa ikakhulu zezi zinto zilandelayo zidibeneyo:

(1) Utshintsho lweMozulu: Ukunyuka kwamaqondo obushushu kwihlabathi akupheleli nje ekwandiseni uluhlu lweendawo ezifanelekileyo zokuhlala kwezinambuzane kodwa kukwanciphisa ixesha lokufukama kwe-DENV ngaphakathi kwesilwanyana esithwala iingcongconi, ngaloo ndlela kuphucula ukusebenza kakuhle kokusasazwa kwazo. Utshintsho olubangelwa yimozulu kubuninzi beengcongconi luqinisekiswe yi-WHO njengesibikezelo esithembekileyo sendlela yokuqhambuka kwe-dengue okwenzeka ngayo kwiindawo ezithile.

(2) Ukufudukela ezidolophini: Ukwanda kwezixeko ngokukhawuleza nangokungacwangciswanga kudale iindawo ezininzi zokuzalela iintsholongwane zengcongconi, ngelixa ukwanda koxinano lwabantu kuye komeleza ukuqhubeka kweentambo zokusasaza ze-DENV.

(3) Intshukumo Yabemi Behlabathi: Ukuhambahamba kunye norhwebo lwamazwe ngamazwe kuye kwenza kube lula ukudluliselwa ngokukhawuleza kwe-DENV, okukhuthaza utshintsho ukusuka kwiimeko ezingenisiweyo ukuya kusulelo lwasekuhlaleni oluqhubekayo. Idatha yokujonga ye-WHO ibonisa ukuba phakathi kowama-2010 nowama-2021, i-United States ibike iimeko ze-dengue ezingama-7,528 ezinxulumene nokuhamba, apho ezingama-3,135 zafuna ukulaliswa esibhedlele kwaye ezili-19 zabangela ukufa.

(4) Ukwanda kweVector Distribution: Kwihlabathi liphela, uluhlu lweendawo zeAedes aegypti kunye neAedes albopictus luyaqhubeka nokwanda, kunye neengcongconi zeAedes ezikhula kwiindawo ezithile zaseYurophu. Ngenxa yoko, idengue iguquke ukusuka ekubeni yibhubhane yengingqi eqhelekileyo ukuya ekubeni yingxaki yempilo yoluntu kwihlabathi liphela.

2.3 Iindlela zokujikeleza kwegazi kunye nosulelo lwe-Multi-Serotype

Intsholongwane yeDengue iquka ii-serotypes ezine ezahlukeneyo ngokwe-antigen (i-DENV-1 ukuya kwi-DENV-4). Ukosuleleka yi-serotype enye kunika ukhuselo lwexesha elide kwi-serotype ethile kodwa kuphela ukhuselo lwexeshana noluncinci kwezinye ii-serotypes ezintathu. Uluntu ngokubanzi luchaphazeleka yi-DENV ngokubanzi, kunye neqela elincinci labantu abasulelekileyo abanesifo [2].

Kwiindawo ezixhaphakileyo, ii-serotypes ezininzi ze-DENV zihlala zijikeleza ngaxeshanye, nto leyo ebangela ukuba abantu babe nethuba lokufumana usulelo oluninzi lwe-dengue ubomi babo bonke. Izifundo ze-WHO ze-epidemiological zichonge i-multi-serotype co-circulation njengeyona nto iphambili ekuqhambukeni kwe-dengue rhoqo [1].

2.4 Usulelo lwesibini kunye nokuphuculwa kokuxhomekeka kumajoni omzimba

Isiganeko esibalulekileyo nesingaqhelekanga kwi-dengue epidemiology yiUkuphuculwa okuxhomekeke kwi-antibody (ADE)Ngexesha losulelo lwesibini olune-serotype ye-DENV eyahlukileyo, ii-antibodies ezingezizo ezithintela ulwelo eziveliswa ngexesha losulelo lokuqala zinceda ukungena kwentsholongwane kwii-monocytes kunye nee-macrophages, ngaloo ndlela ziphucula ukuphindaphinda kwentsholongwane. Le ndlela iqatshelwa ngokubanzi yi-WHO njengeyona nto iphambili kwi-dengue enzima, kubandakanya i-dengue hemorrhagic fever kunye ne-dengue shock syndrome [1].

Idatha ye-WHO epidemiological ibonisa rhoqo ukuba abantu abanosulelo lwesibini sedengue banomngcipheko ophezulu kakhulu wokufumana isifo esibi xa kuthelekiswa nabo banosulelo lokuqala—uphawu olubaluleke kakhulu ekujongeni isifo kunye nolawulo lweklinikhi. Kubalulekile ukuqaphela ukuba nangona umngcipheko wesifo esibi uphezulu ngexesha losulelo lwesibini, usulelo olunayo nayiphi na i-DENV serotype lunokuqhubela phambili luye kwi-dengue enzima [1].

2.5 Iimpawu zeKliniki ezingachazwanga kunye nomngcipheko wokuxilongwa gwenxa

Iimpawu zeklinikhi ze-dengue azibonakali ngokucacileyo, ingakumbi kwizigaba zokuqala zesifo, zihlala zifana nezo zezinye izifo ezibangelwa yingcongconi (umz., i-chikungunya kunye neentsholongwane zeZika) kunye nezinye izifo zokuphefumla. Uqikelelo lwe-WHO lubonisa ukuba ama-40-80% osulelo lwe-DENV alunazimpawu [3].

Iimpawu eziqhelekileyo zeklinikhi ziquka:

-Umkhuhlane oqatha (ohlala iintsuku ezi-2-7, onokuba yi-biphasic)

-Intloko ebuhlungu kakhulu kunye nentlungu ebuyela umva (intlungu engasemva kwamehlo)

-Intlungu yemisipha namalungu (ebizwa ngokuba yi-"breakbone fever")

-Irhashalala le-macular okanye le-maculopapular

-Iimpawu zokopha kancinci (umz., i-ecchymosis, i-epistaxis, ukopha kwamazinyo)

I-dengue eneempawu idla ngokwahlulwahlulwa ibe ngamanqanaba amathathu ahlukeneyo: isigaba somkhuhlane, isigaba esibalulekileyo, kunye nesigaba sokuchacha. Phantse ngaphantsi kwe-5% yezigulane ezineempawu ziqhubekela kwi-dengue enzima. Ngenxa yokungabikho kweempawu ezithile zonyango, ukuxilongwa okusekelwe kwiimpawu zonyango kuphela kunzima, nto leyo enyusa umngcipheko wokuxilongwa gwenxa kunye nokuxilongwa okungaphelelanga. I-WHO igxininisa ngokucacileyo ukuba ukuxilongwa kwezonyango kuphela akwanelanga ukuqinisekisa ukuchaneka, okwenza ukuqinisekiswa kwelebhu kube yinto ebalulekileyo [1].

 Amanqaku ama-3 aphambili avela kwi-WHO “Uvavanyo lweDengue kwiLabhoratri: Isikhokelo seThutyana, ngo-Epreli 2025”

Ngo-Epreli 2025, i-World Health Organisation yakhupha isikhokelo sexeshana esihlaziyiweyo malunga novavanyo lwelabhoratri lwe-DENV, inika isikhokelo sobugcisa esinegunya sokuchongwa kwe-dengue kwihlabathi liphela. Esi sikhokelo sidibanisa ubungqina bamva nje malunga novavanyo lwelabhoratri ye-dengue kwimeko yengxamiseko ye-dengue yehlabathi eqhubekayo kwaye inika iingcebiso ezisebenzayo ezenzelwe iimeko ezinamanqanaba ahlukeneyo ezixhobo.

3.1 Imigaqo esisiseko yeqhinga lovavanyo

Esi sikhokelo sigxininisa ukuba ukuxilongwa kwe-dengue kufuneka kusetyenziswe icebo lokuvavanya elidibeneyo elinama-multi-markers ngokusekelwe kwinqanaba lokugula [1]. Ngenxa yokungabikho kwe-algorithm yokuxilonga ebanzi, amaqhinga okuvavanya kufuneka ahlengahlengiswe ngokweemeko zengingqi ze-epidemiological, kuthathelwa ingqalelo ezi zinto zilandelayo ziphambili [1]:

-Inqanaba lokusuleleka: Inani leentsuku zokuqala emva kokubonakaliswa kweempawu lilo elimisela eyona ndlela ifanelekileyo yovavanyo

-Uhlobo lwesampulu: Ukufaneleka kwegazi elipheleleyo, iplasma, okanye i-serum ekufumaneni i-DENV

-I-epidemiology yengingqi: Ii-serotypes ze-DENV ezijikeleza kwindawo kunye nokujikeleza kunye nezinye ii-arboviruses

-Umngcipheko wosulelo oluhlangeneyo: Kwimimandla enokujikeleza kwe-arbovirus okugqithanayo, uvavanyo lwe-multiplex kufuneka luqwalaselwe ukwahlula phakathi kwezifo ezahlukeneyo.

3.2 Icebo lovavanyo olusekelwe kwisigaba

Ngokwesikhokelo se-WHO, uvavanyo lwelabhoratri ye-dengue lufanele lulandele amaxesha acacileyo asekelwe kwinqanaba lokugula [1,2]:

(1) Uvavanyo lweSigaba esiNgxamisekileyo (≤iintsuku ezi-7 emva kokuqala)

-Uvavanyo lwe-Nucleic Acid (Uvavanyo lweMolecular): I-Reverse transcription-polymerase chain reaction (RT-PCR) kunye nezinye iindlela ze-molecular zibona i-DENV RNA enovakalelo oluphezulu.

-Uvavanyo lwe-Antigen: Ukufunyanwa kwe-antigen ye-NS1, ebonakala kwiintsuku ezi-1-3 emva kokuqala.

Ngexesha lesigaba esibukhali, amanqanaba e-viremia aphezulu, kwaye uvavanyo lwe-nucleic acid kunye ne-antigen lufumana uvakalelo oluphezulu.

(2) Uvavanyo lweSigaba sokuPhila (≥iintsuku ezi-4 emva kokuqala)

-Uvavanyo lweSerological: Ii-antibodies ze-IgM zihlala zibonakala malunga nosuku lwesine emva kokuqala.

-Kwiimeko ezininzi, ii-antibodies ze-IgM zihlala iintsuku ezili-14-20, kwaye kwezinye iimeko, ukuqina kunokufikelela kwiintsuku ezingama-90.

Uvavanyo lwe-IgG lunexabiso elilinganiselweyo lokuxilongwa kwe-dengue ebukhali ngenxa yee-antibodies ezinokuthi zisebenze ngokunqamlezayo ezivela kusulelo lwe-flavivirus lwangaphambili okanye ugonyo.

(3) I-Algorithm Yokuxilonga Amatyala Okurhanelekayo

Esi sikhokelo siquka i-algorithm yokuxilonga kwiimeko ezirhanelwayo ze-dengue, sicebisa iindlela ezifanelekileyo zovavanyo ezisekelwe kwiintsuku emva kokuqala kweempawu: Uvavanyo lwe-antigen ye-NS1 kunye novavanyo lwe-nucleic acid zezona ndlela ziphambili kwisigaba sokuqala, ngelixa uvavanyo lwe-serological luyindlela ephambili kwisigaba esilandelayo.

3.3 Indlela yoVavanyo Uvavanyo kunye noKhetho lokuSebenza

Ngokutsho kwe-WHO, uvavanyo olucwangcisiweyo lokusebenza kunye neemeko ezifanelekileyo zovavanyo lwe-dengue zezi zilandelayo:

Iingcebiso ezi-4 zeMveliso yokuFumanisa iDengue kwiMacro nakwiMicro-Test ngokweScenario

Ukuxhasa ukuthintela nokulawula i-dengue, iMacro & Micro-Test ibonelela ngepotifoliyo yokuxilonga edibeneyo egubungela uhlolo olukhawulezileyo, ukuqinisekiswa kwemolekyuli, kunye nokuhlolwa kwe-genomic, ukuhlangabezana neemfuno kuzo zonke izigaba ezahlukeneyo zolawulo lobhubhane.

4.1 Imeko 1: Ukuhlolwa Okukhawulezileyo kunye nokubekwa esweni okujoliswe kuko

Isebenza kwiikliniki zomkhuhlane, kwiindawo zonyango oluphambili, ekuhlolweni koluntu oluqhambukileyo, nakwindawo yokuvalelwa yedwa echwebeni/emngceleni.

-Uvavanyo lwe-NS1 Antigen olukhawulezayo lwe-Dengue Virus: Lufumanisa usulelo kwangethuba (iintsuku ezi-1-3 emva kokuqala) kunye neziphumo zemizuzu eli-15 zokuxilongwa ngokukhawuleza.

-Uvavanyo lwe-Dengue Virus IgM/IgG Antibody: Luhlula usulelo oluphambili/olwesibini ukuze kuvavanywe umngcipheko wesifo onzima.

-Uvavanyo olukhawulezayo oluDibeneyo lwe-NS1 Antigen + IgM/IgG: Ngaxeshanye lubona i-antigen kunye nee-antibodies ukuze kufunyanwe isifo ngokupheleleyo.

-Uvavanyo lweChikungunya Virus IgM/IgG Antibody: Luvumela ukuxilongwa okwahlukileyo ngedengue ukuze kuchongwe iintsholongwane ngokuchanekileyo.

4.2 Imeko yesi-2: Ukuxilongwa ngokuchanekileyo kunye nokuphendula ngexesha likaxakeka

-Isixhobo sokubona i-Dengue Virus I/II/III/IV Nucleic Acid: Sibona kwaye sahlule ii-serotypes ezi-4 (umda wokufumanisa iikopi ezingama-500/mL) zokulandelela ubhubhane.

-Isixhobo se-PCR se-Dengue Virus esifakwe i-Lyophilized: Siyathuthwa ngobushushu begumbi, sifanelekile kwiindawo ezinqongopheleyo nezixhobo kunye nokuqhambuka ngequbuliso.

-I-Dengue/Zika/Chikungunya Multiplex Real-Time PCR Kit: Ifumana ii-arbovirus ezintathu ngaxeshanye ukuze ifumane ukuxilongwa okusebenzayo kokwahluka kwiintsholongwane ezinzima.

Zonke ii-reagents ezingentla ziyahambelana neNkqubo ye-AIO 800 Fully Automated Sample-to-Answer, inciphisa ukusebenza ngesandla kunye nongcoliseko oludibanisayo, kwaye iphucula ukusebenza kakuhle kunye nokhuseleko lwezinto eziphilayo.

4.3 Imeko 3: Uhlolo lweGenomic kunye noHlalutyo loMnombo weNtsholongwane

Isebenza kwiilabhoratri zesizwe, amaziko ophando lwezempilo karhulumente, ngokuhambelana nokubekwa kwe-NGS yi-WHO.

Izisombululo zokujonga i-genomic zeMacro & Micro-Test zixhasa ulandelelwano lwe-genome epheleleyo yokulandelela intsholongwane, ukucaciswa kwetyathanga lokudluliselwa kwentsholongwane, ukujonga okwahlukileyo, kunye nokulungiswa kwesicwangciso sokugonya. Zixhasa ukuhamba komsebenzi ngesandla/ngokuzenzekelayo, ziphucula ukuphuma kunye nokuphindaphinda, zivumela iilabhoratri ukuba ziphucuke ukusuka kuvavanyo oluqhelekileyo ukuya kuhlolo oluphambili, ngokuhambelana nokugxininisa kwe-WHO ekuqiniseni ukujonga ukuvela kwentsholongwane.

4.4 Ixabiso leZisombululo eziDibeneyo

I-Macro & Micro-Test ibonelela ngezisombululo ezipheleleyo zokuxilonga ukufunyanwa kwe-arbovirus, ixhasa inqanaba ngalinye lolawulo lobhubhane: izixhobo zokuhlola ngokukhawuleza izicwangciso zonyango oluphambili, ukuqinisekiswa kwemolekyuli yokuxilongwa ngokuchanekileyo, kunye nobuchule bohlalutyo lwe-genome epheleleyo yokujonga i-epidemiological. Ngovavanyo olusebenza kakuhle, imisebenzi eguquguqukayo, kunye namaqonga alungele ukuzenzela, ezi zisombululo zixhobisa iilabhoratri kunye neenkqubo zempilo yoluntu ukuba zomeleze ukulungela kunye nokuphendula kwizisongelo ze-arbovirus ezivelayo kwihlabathi liphela.

Iireferensi

[1] Umbutho wezeMpilo weHlabathi. Uvavanyo lweLebhu lweNtsholongwane yeDengue: Isikhokelo seThutyana, ngo-Epreli 2025. eGeneva: Umbutho wezeMpilo weHlabathi; 2025.

[2] Iqela leeNgcebiso zoBugcisa le-WHO Global Arbovirus Initiative. Ukuqinisa ukulungela kweHlabathi kunye nokuphendula kwiingozi zeSifo se-Arboviral: Ubizo lokuSebenza. I-Lancet Infect Dis. 2026;26(1):15-17.

[3] I-Lancet Microbe. Ukoyisa Ingxaki Yokuxilongwa Kwe-Dengue. I-Lancet Microbe. 2025;6(7):101190.