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  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">IPROC</journal-id>
      <journal-id journal-id-type="nlm-ta">iproc</journal-id>
      <journal-title>Iproceedings</journal-title>
      <issn pub-type="epub">2369-6893</issn>
      <publisher>
        <publisher-name>JMIR Publications</publisher-name>
        <publisher-loc>Toronto, Canada</publisher-loc>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">v8i1e36466</article-id>
      <article-id pub-id-type="pmid"/>
      <article-id pub-id-type="doi">10.2196/36466</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Abstract</subject>
        </subj-group>
        <subj-group subj-group-type="article-type">
          <subject>Abstract</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Dengue Fever Outbreak in Al-Garrahi District, Al-Hudaydah Governorate, Yemen, 2019</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="editor">
          <name>
            <surname>Khader</surname>
            <given-names>Yousef</given-names>
          </name>
        </contrib>
      </contrib-group>
      <contrib-group>
        <contrib id="contrib1" contrib-type="author" corresp="yes" equal-contrib="yes">
          <name name-style="western">
            <surname>Al-Jamrah</surname>
            <given-names>Khaled Mohammed</given-names>
          </name>
          <degrees>BSc, MSc</degrees>
          <xref rid="aff1" ref-type="aff">1</xref>
          <address>
            <institution>Yemen-FETP</institution>
            <institution>Ministry of Public Health and Population</institution>
            <addr-line>Alhasabah area</addr-line>
            <addr-line>Sana'a, 37970</addr-line>
            <country>Yemen</country>
            <phone>967 777950053</phone>
            <email>khjamrah2010@gmail.com</email>
          </address>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0002-2862-1031</ext-link>
        </contrib>
        <contrib id="contrib2" contrib-type="author">
          <name name-style="western">
            <surname>Nassar</surname>
            <given-names>Abdulkareem</given-names>
          </name>
          <degrees>MPH</degrees>
          <xref rid="aff1" ref-type="aff">1</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0002-0496-8444</ext-link>
        </contrib>
        <contrib id="contrib3" contrib-type="author">
          <name name-style="western">
            <surname>Mohathab</surname>
            <given-names>Ibrahim</given-names>
          </name>
          <degrees>BSc</degrees>
          <xref rid="aff2" ref-type="aff">2</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0003-1914-3848</ext-link>
        </contrib>
        <contrib id="contrib4" contrib-type="author">
          <name name-style="western">
            <surname>Al Amad</surname>
            <given-names>Mohammed</given-names>
          </name>
          <degrees>MPH</degrees>
          <xref rid="aff1" ref-type="aff">1</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0002-1566-4964</ext-link>
        </contrib>
      </contrib-group>
      <aff id="aff1">
        <label>1</label>
        <institution>Yemen-FETP</institution>
        <institution>Ministry of Public Health and Population</institution>
        <addr-line>Sana'a</addr-line>
        <country>Yemen</country>
      </aff>
      <aff id="aff2">
        <label>2</label>
        <institution>Malaria Control Program</institution>
        <institution>Ministry of Public Health and Population</institution>
        <addr-line>Al-Hudaydah</addr-line>
        <country>Yemen</country>
      </aff>
      <author-notes>
        <corresp>Corresponding Author: Khaled Mohammed Al-Jamrah <email>khjamrah2010@gmail.com</email></corresp>
      </author-notes>
      <pub-date pub-type="collection">
        <season>Jan-Dec</season>
        <year>2022</year>
      </pub-date>
      <pub-date pub-type="epub">
        <day>11</day>
        <month>2</month>
        <year>2022</year>
      </pub-date>
      <volume>8</volume>
      <issue>1</issue>
      <elocation-id>e36466</elocation-id>
      <history>
        <date date-type="received">
          <day>16</day>
          <month>1</month>
          <year>2022</year>
        </date>
        <date date-type="accepted">
          <day>19</day>
          <month>1</month>
          <year>2022</year>
        </date>
      </history>
      <copyright-statement>©Khaled Mohammed Al-Jamrah, Abdulkareem Nassar, Ibrahim Mohathab, Mohammed Al Amad. Originally published in Iproceedings (https://www.iproc.org), 11.02.2022.</copyright-statement>
      <copyright-year>2022</copyright-year>
      <license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/">
        <p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in Iproceedings, is properly cited. The complete bibliographic information, a link to the original publication on https://www.iproc.org/, as well as this copyright and license information must be included.</p>
      </license>
      <self-uri xlink:href="https://www.iproc.org/2022/1/e36466" xlink:type="simple"/>
      <abstract>
        <sec sec-type="background">
          <title>Background</title>
          <p>Dengue fever (DF) has re-emerged in Yemen with a higher frequency during the last years. On November 6, 2019, an increased number of suspected DF cases in Al-Garrahi district was reported. On November 7, 2019, a team was sent to investigate.</p>
        </sec>
        <sec sec-type="objective">
          <title>Objective</title>
          <p>This study aims to confirm the existence of an outbreak, describe the outbreak characteristics, and recommend suitable intervention for control.</p>
        </sec>
        <sec sec-type="methods">
          <title>Methods</title>
          <p>A descriptive study was conducted. The World Health Organization case definition was used to identify patients. An active search from house to house, along with entomological investigation and health education, was conducted. A line list was used to collect data. Blood specimens were collected and tested by enzyme-linked immunosorbent assay for dengue IgM. Frequency, percentage, and rates were calculated, and the population from the central statistical organization was used.</p>
        </sec>
        <sec sec-type="results">
          <title>Results</title>
          <p>A total of 2067 cases met the case definition. Of them, 51% were males and 32% were aged &lt;10 years. All patients complained of fever, headache, and arthralgia (100%), followed by myalgia and retro-orbital pain (67% and 39%, respectively). The first case patient was in week 41, and the peak was reached with 1058 patients in week 46. The overall attack rate was 16 of 1000, significantly higher among patients aged 10 years to &lt;50 years and ≥50 years compared with patients aged &lt;10 years (17 and 19/1000 vs 14/1000; <italic>P</italic>&lt;.001). Of 20 tested blood samples, 12 (60%) were IgM positive. The house index was 70%, the container index was 50%, and the Breteau index was 140. Vector control measures with community participation were intensified in week 46, and patient cases decreased to 140 in week 48.</p>
        </sec>
        <sec sec-type="conclusions">
          <title>Conclusions</title>
          <p>A dengue outbreak was confirmed in Al-Garrahi district. The spread of infection was facilitated by storing water and the presence of indoor larvae. The findings emphasize the importance of health awareness and community participation for containing DF outbreaks.</p>
        </sec>
      </abstract>
      <kwd-group>
        <kwd>dengue fever</kwd>
        <kwd>outbreak investigation</kwd>
        <kwd>Yemen</kwd>
        <kwd>FETP</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <back>
    <app-group>
      <supplementary-material id="app1">
        <label>Multimedia Appendix 1</label>
        <p>A line-list was used to collect data.</p>
        <media xlink:href="iproc_v8i1e36466_app1.docx" xlink:title="DOCX File , 14 KB"/>
      </supplementary-material>
      <supplementary-material id="app2">
        <label>Multimedia Appendix 2</label>
        <p>Epidemic curve of suspected DF cases by day of onset, Al-Garrahi district, Al-Hodiedah governorate, Nov 2019.</p>
        <media xlink:href="iproc_v8i1e36466_app2.png" xlink:title="PNG File , 15 KB"/>
      </supplementary-material>
      <supplementary-material id="app3">
        <label>Multimedia Appendix 3</label>
        <p>Distribution of suspected DF cases by age, Al-Garrahi district, Al-Hodiedah governorate, Nov 2019.</p>
        <media xlink:href="iproc_v8i1e36466_app3.png" xlink:title="PNG File , 13 KB"/>
      </supplementary-material>
      <supplementary-material id="app4">
        <label>Multimedia Appendix 4</label>
        <p>Distribution of suspected DF cases by gender, Al-Garrahi district, Al-Hodiedah governorate, Nov 2019.</p>
        <media xlink:href="iproc_v8i1e36466_app4.png" xlink:title="PNG File , 11 KB"/>
      </supplementary-material>
      <supplementary-material id="app5">
        <label>Multimedia Appendix 5</label>
        <p>Distribution of suspected DF cases by symptoms, Al-Garrahi district, Al-Hodiedah governorate, Nov 2019.</p>
        <media xlink:href="iproc_v8i1e36466_app5.png" xlink:title="PNG File , 20 KB"/>
      </supplementary-material>
      <supplementary-material id="app6">
        <label>Multimedia Appendix 6</label>
        <p>Dengue fever outbreak in Al-Garrahi District, Al-Hudaydah Governorate, Yemen, 2019.</p>
        <media xlink:href="iproc_v8i1e36466_app6.pptx" xlink:title="PPTX File , 2011 KB"/>
      </supplementary-material>
    </app-group>
    <glossary>
      <title>Abbreviations</title>
      <def-list>
        <def-item>
          <term id="abb1">DF</term>
          <def>
            <p>dengue fever</p>
          </def>
        </def-item>
      </def-list>
    </glossary>
  </back>
</article>
