Dengue Cases in the Eastern Region of Afghanistan, 2021–2023

Abstract

Background and Aims: Dengue fever is an emerging public health concern in eastern Afghanistan, with reported cases increasing in recent years. This study investigated the epidemiologic distribution, demographic patterns, and clinical characteristics of dengue cases from 2021 to 2023 to identify temporal trends and guide control strategies in the region. Materials and Methods: A retrospective analysis of suspected and confirmed dengue cases from four eastern Afghan provinces (2021–2023) was conducted using HMIS data. WHO-defined suspected cases and laboratory-confirmed cases (NS1, IgM RDT/ELISA, RT-PCR) were included, with discordant results resolved by prioritizing RT-PCR and duplicates were removed. Demographic, clinical, hospitalization (>24 h), and outcome data were analyzed using descriptive statistics and logistic regression, with model fit assessed using Hosmer-Lemeshow. Results: Between 2021 and 2023, 3,766 dengue cases were reported in eastern Afghanistan, predominantly in Nangarhar (98.2%). Cases increased annually from 709 to 1,711, peaking in October–November. Most patients were male (63.9%) and aged 11–30 years (51.6%). Fever (98.2%), headache (96.2%), and myalgia (95.8%) were common; bleeding occurred in 2.6%. Hospitalization (admission for >24 hours) affected 382 patients (10.1%) and two deaths (0.05%) were recorded. Hospitalization was strongly associated with bleeding, province of residence, male gender, and infection during October–December (p < 0.05). Conclusion: Dengue cases in eastern Afghanistan, especially Nangarhar, increased 2021–2023, peaking late summer–autumn. Young adults and males were most affected, with bleeding predicting hospitalization. Strengthened vector control, community awareness, early diagnosis, and cross-border surveillance are critically important to preventing outbreaks.