Dengue fever as an emerging disease in Afghanistan: Epidemiology of the first reported cases.

• First autochthonous DENV cases were detected by the surveillance system in 2019. • Sustained and strengthened surveillance is required for early detection of DENV. • Afghanistan needs to develop preparedness and a response plan for DENV. • The cross-border spread of DENV has been reported between Afghanistan and Pakistan. • Enhanced cross-border collaboration is needed for active response and preventing the spread. This paper aims to describe the epidemiological characteristics and clinical manifestations of the first 15 dengue fever cases reported in Afghanistan. A retrospective descriptive analysis of the data on confirmed dengue cases detected by the national disease surveillance system was conducted. Epidemiological, socio-demographic, clinical, laboratory and outcome data from the cases were analyzed. Between May and December 2019, 62 samples were tested for DENV, among which 15 (24.2%) were positive. Seven of the cases were probable autochthonous with no travel history, the other seven cases had a travel history to dengue-endemic countries (five Pakistan, two India) and the travel history for one of the cases was not known. The 15 confirmed cases were reported from six provinces, seven cases (46.7%) were reported from Nangarhar Province, two (13%) from Paktya, and one (6.7%) from Paktika province, bordering with Pakistan, three (20%) were reported from Kabul, and one each (each 6.7%) from Faryab and Laghman provinces. All of the cases manifested fever, headache, myalgia, and arthralgia. Other clinical features were low platelet count (50%), pain behind eyes (36%), rash, and nausea/vomiting (each 21%). For the first time, the surveillance system detected and reported locally acquired DENV cases in Afghanistan, mostly in provinces bordering with Pakistan. Population movements between Afghanistan and Pakistan facilitate the cross-border spread of DENV between two countries. [ABSTRACT FROM AUTHOR]