The largest dengue outbreak in the history of Nepal occurred in 2022, with a significant number of casualties. It affected all 77 districts, with the nation’s capital, Kathmandu (altitude 1300 m), being the hardest hit. However, the molecular epidemiology of this outbreak, including the dengue virus (DENV) serotype(s) responsible for this epidemic, remain unknown. Here, we report the epidemic trends, clinico-laboratory features, and virus serotypes and their viral load profiles that are associated with this outbreak in Nepal. Dengue-suspected febrile patients were investigated by routine laboratory, serological, and molecular tools, including a real-time quantitative polymerase chain reaction (qRT-PCR). Of the 538 dengue-suspected patients enrolled, 401 (74.5%) were diagnosed with dengue. Among these dengue cases, 129 (32.2%) patients who required hospital admission had significant associations with myalgia, rash, diarrhea, retro-orbital pain, bleeding, and abdominal pain. DENV-1, -2, and -3 were identified during the 2022 epidemic, with a predominance of DENV-1 (57.1%) and DENV-3 (32.1%), exhibiting a new serotype addition. We found that multiple serotypes circulated in 2022, with a higher frequency of hospitalizations, more severe dengue, and more deaths than in the past. Therefore, precise mapping of dengue and other related infections through integrated disease surveillance, evaluation of the dynamics of population-level immunity and virus evolution should be the urgent plans of action for evidence-based policy-making for dengue control and prevention in the country.

In 2023, Nepal faced its second largest dengue outbreak ever, following a record-breaking number of dengue cases in 2022, characterized by the expansion of infections into areas of higher altitudes. However, the characteristics of the 2023 circulating dengue virus (DENV) and the vector density remain poorly understood. Therefore, we performed DENV serotyping, clinical and laboratory assessment, and entomological analysis of the 2023 outbreak in central Nepal. A total of 396 fever cases in Dhading hospital suspected of being DENV positive were enrolled, and blood samples were collected and tested by different techniques including PCR. Of these, 278 (70.2%) had confirmed DENV infection. Multiple serotypes (DENV-1, -2, and -3) were detected. DENV-2 (97.5%) re-emerged after six years in Dhading while DENV-3 was identified for the first time. Dengue inpatients had significantly higher frequency of anorexia, myalgia, rash, diarrhea, nausea, vomiting, abdominal pain, and thrombocytopenia (p < 0.05). In this area, Aedes mosquitoes largely predominated (90.7%) with the majority being A. aegypti (60.7%). We also found high levels of Aedes index (20.0%) and container index (16.7%). We confirmed multiple DENV serotype circulation with serotype re-emergence and new serotype introduction, and high vector density in 2023. These findings call for the urgent initiation and scaling up of DENV molecular surveillance in human and mosquito populations for dengue control and prevention in Nepal.

Viral infections have been associated with multiple sclerosis (MS), an immune-mediated disease in the central nervous system (CNS). Since Theiler’s murine encephalomyelitis virus (TMEV) can induce MS-like demyelination, TMEV infection is the most widely used viral model for MS. Although the precise pathophysiology is unknown, altered fecal bacterial populations were associated with distinct immune gene expressions in the CNS. We aimed to determine the role of gut microbiota in TMEV infection by administering an antibiotic cocktail in drinking water before (prophylactic administration) or after (therapeutic administration) TMEV infection. The antibiotic administration reduced total eubacteria, including the phyla Bacillota and Bacteroidota, but increased the phylum Pseudomonadata in feces. Prophylactic administration did not alter TMEV-induced inflammatory demyelination clinically or histologically, without changes in anti-viral IgG1/IgG2c levels or lymphoproliferative responses; therapeutic administration temporarily suppressed the neurological signs. Although antibiotic treatment had minimal effects on TMEV infection, adding metronidazole and ampicillin in drinking water substantially reduced water intake in the antibiotic group of mice, resulting in significant body weight loss. Since dehydration and stress could affect immune responses and gut microbiota, caution should be exercised when planning or evaluating the oral antibiotic cocktail treatment in experimental animals.

Dengue has been a serious public health concern in Nepal since the past few years, with concurrent big outbreaks occurring in 2022–2024. This cross-sectional study was conducted among febrile patients visiting hospitals in Mahottari district in southern Nepal. A total of 2141 dengue-suspected patients were investigated by routine laboratory assays and serological and molecular techniques, including real-time quantitative polymerase chain reaction (RT-qPCR). Among them, 455 (21.3%) were confirmed as dengue cases. The majority of dengue cases (435, 95.6%) had a primary dengue infection. The total bilirubin level was significantly higher in secondary dengue infection than in primary (p = 0.032). The major dengue virus (DENV) serotypes responsible for this outbreak were DENV-1 (45.5%) and DENV-2 (40.9%), while 13.6% patients had DENV-3 infection. DENV-3 infection showed a significantly higher viral load (median: 7.71 Log₁₀ copies/mL; range: 6.48–7.94) compared to DENV-1 (6.72 Log₁₀ copies/mL; 5.49–7.17) and DENV-2 (4.76 Log₁₀ copies/mL; 2.32–6.96). Adult patients exhibited a significantly higher viral load than children (p = 0.035). NS1- and IgM-positive as well as admitted patients had a higher viral load (p < 0.05). Co-circulation of multiple serotypes (DENV-1, -2, -3) was confirmed with the first introduction of DENV-1 and DENV-3 in Mahottari and surrounding areas in the 2023 outbreak. Identification of the circulating DENV serotypes is crucial to understanding the epidemiological trend and dynamics of population immunity. These findings underscore the need of nation-wide integrated surveillance, including genomic data generation, in Nepal for disease control, prevention, and potential vaccine implication.

: The dengue virus (DENV) and chikungunya virus (CHIKV) infection present with similar symptoms and are transmitted by Aedes mosquitoes. Until now, there have been no reported cases of DENV and CHIKV being detected in mosquitoes in Nepal. This study identified circulating arboviruses from mosquitoes collected in the capital city Kathmandu, and Dhading, Bhaktapur, and Lalitpur districts of Central Nepal in 2023. Of 105 Aedes pooled samples, 16 (15.2%) were positive for DENV, and six (5.7%) were positive for CHIKV by quantitative real-time polymerase chain reaction. DENV-2 was the most common serotype (11.4%), aligning with recent outbreaks in Nepal in 2023, followed by DENV-3 and DENV-4 (1.9% each). To the best of our knowledge, our study is the first report to detect DENV and CHIKV in Aedes mosquitoes circulating in Nepal. This study highlights the need for mosquito surveillance to prevent future outbreaks of mosquito-borne diseases in Nepal.

Lipid A is a component of lipopolysaccharide (LPS) of Gram-negative bacteria. Previously, we demonstrated that synthesized lipid A derived from Alcaligenes faecalis (ALA) could enhance antigen-specific immunoglobulin (Ig) A and T helper (Th) 17 responses, when ALA was co-administered experimentally with an antigen as a vaccine adjuvant. This raised concerns about the safety of the ALA usage, since IgA and Th17 responses have been suggested to play a pathogenic role in several immune-mediated diseases, including multiple sclerosis (MS). We investigated whether ALA administrations could exacerbate an animal model of MS, Theiler’s murine encephalomyelitis virus (TMEV) infection. TMEV-infected SJL/J mice were administered ALA at various time points, and their neurological signs were observed for 7 weeks. We found that ALA administrations did not exacerbate TMEV-induced inflammatory disease or viral persistence in the central nervous system (CNS), clinically or histologically. Furthermore, ALA administrations did not enhance TMEV-specific humoral and cellular responses, including IgA and Th17 responses. On the other hand, principal component analysis (PCA) of the fecal, not the ileal, samples showed significant changes in the microbiota, characterized by increases in the relative abundance of bacteria belonging to the phylum Bacteroidota, including the genera Alistipes and Bacteroides. Therefore, ALA injections could be safe for use in immune-mediated diseases, whose immunopathology has been associated with IgA and Th17 responses.