Short Communication For reprint orders, please contact: reprints@futuremedicine.com Dengue outbreak 2018 in district Shangla KPK; clinical features and laboratory markers of dengue virus infection Faheem Anwar 1 , Muhammad Tayyab* ,2 , Muhammad Salman** ,3 , Abdullah 3 , Misbahud Din 4 , Jawad Khan 1 & Ihteshamul Haq 5 1 Department of Genetics, Hazara University, Mansehra Pakistan 2 Institute of Biotechnology & Genetic Engineering (IBGE), The University of Agriculture, Peshawar, Pakistan 3 Department of Microbiology & Biotechnology, Abasyn University, Peshawar, Pakistan 4 Department of Biotechnology, Quaid-I-Azam University, Islamabad, Pakistan 5 Graduate School of Biotechnology & Oriental Medicine Kyunghee University, Suwon, South Korea * Author for correspondence: tayyab bbt@yahoo.com **Author for correspondence: s.amazai@yahoo.com Aim: To analyze and quantify the 2018 dengue outbreak which occurred in district Shangla, Pakistan. Ma- terials & methods: 964 suspected dengue samples were collected and examined for clinical manifestation and laboratory markers. Results: In all, 375 suspected cases were confrmed with dengue virus infection using nonstructural protein 1 (NS1) antigen, immunoglobulin M (IgM) & Immunoglobulin G (IgG) anti- bodies and real-time PCR whereas PCR was 92.2% sensitive. The most prevalent serotype was dengue virus 3 (60.26%). The male/female ratio was 1.84 and the most highly affected tehsil was Alpuri. The most affected age group was 16–40 years (70.4%). A signifcant number of cases were reported in September (48.54%). Conclusion: Recurrence of the dengue outbreaks in the study area could alarmingly increase the mortality rate, therefore, proper measures are essential to control dengue epidemics in the future. First draft submitted: 7 October 2019; Accepted for publication: 12 October 2020; Published online: 27 October 2020 Keywords: dengue • NS1 • outbreak 2018 • real-time PCR • Shangla Dengue is a vector-borne viral infection which affects more than a hundred million human beings, with a mortality rate of 30,000 per year worldwide [1]. Dengue is a single stranded positive sense RNA virus that belongs to Flavivirus genus of Flaviviridae family [2,3]. There are four antigenically different serotypes of dengue virus (DENV-1, DENV- 2, DENV-3 and DENV-4) [4,5]. Even serotype 5 (DENV-5) has been identified using neutralization techniques [6,7]. Latest studies from Pakistan confirmed the prevalence of serotype 2, 3 and 4 in Punjab. Serotypes 2 and 3 in the Swat region of Khyber Pakhtunkhwa (KP) were reported with high morbidity and mortality [3,8]. The vectors for the above mentioned viruses are the female Aedes mosquitos belonging to the order Diptera and Culicidae family named Aedes aegypti, commonly known as the yellow-fever mosquito (primary vector), and Aedes albopictus, known as the Asian tiger mosquito (secondary vector) [9,10]. The dengue fever occurs in three main phases: mild dengue fever, severe (intense) dengue-hemorrhagic fever and fatal dengue shock syndrome. In Pakistan, the dengue fever has been endemic in the last few years, where highest morbidity and mortality were reported in the postmonsoon season. Various regions of the country have faced some deadly epidemics of dengue infection along with extensive human health problems and deaths. Since 2010, increased outbreaks in various regions have been reported. For the very first pandemic in Lahore in 2011, the largest outbreaks were reported with more than 360 deaths. Later, the second outbreak causing more than eight thousand morbidities and 57 deaths were reported in Swat in 2013. Recently, several huge outbreaks from KP reported about 24,938 cases along with 70 deaths [3,11,12]. Hence, the present study was aimed to examine the recent outbreak of 2018, which occurred in district Shangla of KP, Pakistan. Clinical manifestation and laboratory markers were also evaluated for dengue virus infection. Future Virol. (Epub ahead of print) ISSN 1746-0794 10.2217/fvl-2019-0130 C  2020 Future Medicine Ltd