Climate, sociodemographic factors, and increasing urbanization influence the spread of dengue. It is also affected by several unique factors, including a large number of migrant workers and religious pilgrims from other dengue-endemic areas in the Middle East, North Africa, and Asia.
There are historical references to diseases similar to dengue in the Arabian Peninsula dating back to the 19th and early 20th centuries.
1993: The first documented case in Saudi Arabia occurred in November 1993 in Jeddah (DENV-2). 1994: In February 1994, a surveillance system was established; that year, 289 confirmed cases were reported in Jeddah. Small outbreaks of no more than 15 cases were reported in Jeddah during the following years. 2004: After a decade of sporadic outbreaks, the disease was declared endemic in 2004. This designation still persists. From 2004 to 2015, significantly larger outbreaks occurred, mainly during the rainy season, extending beyond Jeddah to the nearby cities of Mecca, Al-Madinah, Jizan, and Najran. 2008: The first cases were reported in Al-Madinah (DENV-1 and DENV-2 serotypes). 2009: The Ministry of Health reported a total of 3,350 cases and estimated the case fatality rate at 4.6 per thousand. 2015: The incidence rate was 13.68 per 100,000 person-years. 2018: A sharp increase in Aedes density occurred by the end of the year. Indeed, these rains may have contributed to the early appearance of the dengue peak in 2019.
Currently, the disease remains endemic in the country and has one of the highest disease burdens in the Middle East. The disease is confined to the western and southwestern regions of Saudi Arabia, where Aedes aegypti exists.
Cases of Dengue in Mecca
The Hajj presents an opportunity to expand the exchange of infectious viruses, such as the dengue virus, among pilgrims.
2006-2008: A total of 159 cases were admitted to a tertiary hospital in Mecca. 77% of these cases occurred during the spring and early summer. 2008-2012: An increase in construction works in Mecca raised the number of cases, with 4,187 cases reported. Probably due to the increase in stagnant water.
Serotypes
Most cases in Saudi Arabia had mild disease and were related to serotypes 1 to 3, but not to serotype 4.
Climate
Saudi Arabia is mainly composed of harsh desert landscapes, with sand dunes, gravel plains, and salt flats interspersed with few lakes or streams. The climate is extremely arid: precipitation is rare in most of the country, with an average precipitation of around 100 mm per year, which usually occurs during the rainy season in March and April. Average temperatures inland range from 45 °C in summer to just over 0 °C in winter; during the short and milder seasons of spring and autumn.
References
- Al-Tawfiq JA, Memish ZA. Dengue Hemorrhagic Fever Virus in Saudi Arabia: A Review. Vector Borne Zoonotic Dis. 2018 Feb;18(2):75-81. doi: 10.1089/vbz.2017.2209. Epub 2018 Jan 10.
- Altassan KK, Morin C, Shocket MS, Ebi K, Hess J. Dengue fever in Saudi Arabia: A review of environmental and population factors impacting emergence and spread. Travel Med Infect Dis. 2019 Jul-Aug;30:46-53. doi: 10.1016/j.tmaid.2019.04.006. Epub 2019 Apr 10.
- Alhaeli A, Bahkali S, Ali A, Househ MS, El-Metwally AA. The epidemiology of Dengue fever in Saudi Arabia: A systematic review. J Infect Public Health. 2016 Mar-Apr;9(2):117-24. doi: 10.1016/j.jiph.2015.05.006. Epub 2015 Jun 20.
- Melebari S, Bakri R, Hafiz A, Qabbani F, Khogeer A, Alharthi I, Alhazmi S, Almalki Y, Bulkhi R, Gammash R, Hakim A, Alkhyami A, Bazaid M, Mohammad T. The epidemiology and incidence of dengue in Makkah, Saudi Arabia, during 2017-2019. Saudi Med J. 2021 Nov;42(11):1173-1179. doi: 10.15537/smj.2021.42.11.20210124.
- Al-Nefaie H, Alsultan A, Abusaris R. Temporal and spatial patterns of dengue geographical distribution in Jeddah, Saudi Arabia. J Infect Public Health. 2022 Sep;15(9):1025-1035. doi: 10.1016/j.jiph.2022.08.003. Epub 2022 Aug 10.
- Joob B, Wiwanikit V. Dengue fever in Saudi Arabia. Saudi Med J. 2017 Dec;38(12):1264. doi: 10.15537/smj.2017.12.21335.
- Hashem AM, Sohrab SS, El-Kafrawy SA, Abd-Alla AMM, El-Ela SA, Abujamel TS, Hassan AM, Farraj SA, Othman NA, Charrel RN, Azhar EI. Diversity of dengue virus-3 genotype III in Jeddah, Saudi Arabia. Acta Trop. 2018 Jul;183:114-118. doi: 10.1016/j.actatropica.2018.04.002.
