1 Icyorezo cya Dengue: Ikibazo cy’ubuzima rusange gikomeje kwiyongera ku isi

Dengue ni indwara iterwa n’umubu iterwa na virusi ya dengue (DENV), yagaragaye nk’indwara ya arbovirus ikwirakwira cyane ku isi, ikaba ibangamiye cyane umutekano w’ubuzima rusange. Mu myaka makumyabiri ishize, umubare w’abandura dengue ku isi wikubye kabiri buri mwaka kuva mu 2021 [1]. Mu Kuboza 2023, Umuryango Mpuzamahanga wita ku Buzima (OMS) watangaje ko ari ikibazo cyihutirwa ku isi mu rwego rwo gushimangira ingamba mpuzamahanga zo kurwanya indwara. Igereranya ry’ibiza rya OMS rigaragaza ko abantu bagera kuri miliyari 3.9 ku isi bashobora kwandura dengue, aho abantu bagera kuri miliyoni 390 bandura buri mwaka—muri bo miliyoni 96 bagaragara nk’abarwayi basanzwe barwaye [1,2].

Ibintu 2 by'ingenzi ku bijyanye n'icyorezo

Imiterere y’indwara ya dengue iterwa n’uburyo ibintu bitera indwara bihurirana, ibidukikije, uburyo ubudahangarwa bw’umubiri bw’umuntu butera indwara, ndetse n’imiterere y’imibereho n’ibidukikije. Gusobanukirwa neza ibi biranga indwara ni ingenzi kugira ngo habeho ingamba zo kwirinda no kurwanya indwara ndetse n’uburyo bwo kuyisuzuma neza.

2.1 Ibyuma bikwirakwiza amakuru n'imiterere y'ikwirakwiza ry'amakuru mu mijyi

Virusi ya Dengue yandurira cyane cyane muAedes aegypti na Aedes albopictusImibu. Muri ubwo bwoko bw’imibu, Aedes aegypti izwiho kuba ikwirakwizwa ry’ibintu bikomeye cyane, irangwa no “kwihuza n’abantu” no gukwirakwira mu mijyi yo mu turere dushyuha n’utwo mu turere dushyuha. Bitandukanye n’izindi mibu zitera indwara zandura, Aedes aegypti igaragaza ibi bikurikira by’ingenzi mu ndwara:

-Gukunda kororera mu bidukikije bikomoka ku bantu (urugero: ibikoresho byo kubikamo amazi, amapine yajugunywe)

-Uburyo bukomeye bwo gukabya amaraso y'umuntu nk'isoko y'intungamubiri

-Imyitwarire yo kugaburira ku manywa

Izi ngeso zisobanura indwara ya dengue nk'indwara isanzwe"Indwara zandura zo mu mijyi,"hamwe n’ubushobozi bwo kwanduzanya bwiyongereye cyane mu duce dutuwe cyane. Ubushakashatsi bwakozwe na OMS bwagaragaje ko mu mijyi irimo ubucucike bwinshi, kwiyongera k’inshuro umubu uhura n’abantu bishobora kongera cyane umubare w’ibanze w’ikwirakwizwa rya DENV, bityo bikihutisha ikwirakwira ry’ibyorezo [2].

2.2 Ikwirakwira ry'Isi n'Ibintu Biyitera Iterambere

Nk’uko raporo za OMS zibivuga, umubare w’abanduye dengue ku isi wagaragaye wiyongereye cyane mu myaka makumyabiri ishize [1,3]. Uku kwiyongera kw’iyi ndwara ahanini guterwa n’ibintu bikurikira bifitanye isano:

(1) Imihindagurikire y'Ikirere: Ubushyuhe bwiyongera ku isi ntibwongera gusa imiterere y'ahantu hakwiriye ho gutura imibu itera imibu, ahubwo bunagabanya igihe cyo kwibasira DENV mu mubiri w’umubu, bityo bikanongera ubushobozi bwo kwanduzanya. Ihindagurika ry’ubucucike bw’imibu riterwa n’ikirere ryemejwe na OMS nk'ikintu cyizewe giteganya uko icyorezo cya dengue gitera mu gihe runaka.

(2) Gukura mu mijyi: Kwaguka kw'imijyi vuba kandi bitateguwe byatumye habaho ahantu henshi ho kororokera imyuka itera imibu, mu gihe ukwiyongera kw'abaturage biyongereyeho uburyo bwo gukwirakwiza DENV.

(3) Urugendo rw'abaturage ku isi: Ingendo mpuzamahanga n'ubucuruzi byorohereje ikwirakwizwa ryihuse rya DENV mu bihugu bitandukanye, bitera ihinduka kuva ku barwayi binjijwe mu mahanga bajya ku ikwirakwizwa rihoraho mu gihugu. Imibare y'igenzura rya OMS igaragaza ko hagati ya 2010 na 2021, Leta Zunze Ubumwe za Amerika zatangaje ko abantu 7,528 banduye dengue baterwa n'ingendo, muri bo 3,135 basabwaga kujya mu bitaro naho 19 bagahita bapfa.

(4) Kwaguka kw'udukoko twangiza ibidukikije: Ku isi yose, imiterere y'udukoko twa Aedes aegypti na Aedes albopictus ikomeje kwiyongera, aho imibu ya Aedes ikomeje kwiyongera mu bice bimwe na bimwe by'i Burayi. Kubera iyo mpamvu, dengue yavuye ku cyorezo gisanzwe cyo mu karere igera ku kibazo cy'ubuzima rusange ku isi.

2.3 Uburyo bwo kuzenguruka kw'amaraso mu buryo bwa Multi-Serotype no kongera kwandura

Virusi ya Dengue igizwe na serotype enye zitandukanye na antigen (DENV-1 kugeza kuri DENV-4). Kwandura serotype imwe bitanga ubudahangarwa bw'igihe kirekire kuri serotype runaka ariko bikaba birinda by'igihe gito kandi igice kimwe kuri serotype eshatu. Abaturage muri rusange ni bo bashobora kwandura DENV, aho itsinda ry'abantu banduye gusa bagira indwara zo kwandura [2].

Mu turere twanduye, ubwoko bwinshi bwa DENV bukunze kuzenguruka icyarimwe, bigatuma abantu bashobora kwandura indwara nyinshi za dengue mu buzima bwabo bwose. Ubushakashatsi bwa OMS ku ndwara bwagaragaje ko uburyo bwo kuzenguruka amaraso mu bwoko bwa multi-serotype ari cyo kintu cy’ingenzi gitera indwara za dengue zikunze kugaragara mu gihe runaka [1].

2.4 Ubwandu bwa kabiri n'ubwiyongere bw'uturemangingo tw'umubiri dushingiye ku budahangarwa bw'umubiri

Ikintu cy’ingenzi kandi kidasanzwe mu bijyanye n’icyorezo cya dengue nikongera imbaraga zishingiye ku budahangarwa bw'umubiri (ADE). Mu gihe cy’ubwandu bwa kabiri hamwe na serotype ya DENV itandukanye, ubudahangarwa bw’umubiri budakora neza bukorwa mu gihe cy’ubwandu bwa mbere bworohereza virusi kwinjira muri monocytes na macrophages, bityo bigatuma virusi ziyongera. Ubu buryo bwemerwa cyane na OMS nk'ikintu gikomeye gitera indwara ya dengue ikomeye, harimo indwara ya dengue iterwa no kuva amaraso menshi hamwe n’indwara ya dengue [1].

Amakuru y’ibiza bya OMS agaragaza ko abantu banduye dengue ya kabiri bafite ibyago byinshi byo kurwara indwara zikomeye ugereranije n’abafite ubwandu bw’ibanze—ikimenyetso gifite akamaro kanini mu gukurikirana indwara no kuzivura. Ni ngombwa kumenya ko nubwo ibyago byo kurwara indwara zikomeye byiyongera mu gihe cy’ubwandu bw’ibanze, kwandura serotype iyo ari yo yose ya DENV bishobora kugera kuri dengue ikomeye [1].

2.5 Ibimenyetso by'ubuvuzi bitari ibyavuzwe n'ibyago byo gusuzuma indwara nabi

Ibimenyetso bya dengue ntabwo byihariye, cyane cyane mu ntangiriro z'indwara, akenshi bihurirana n'iby'izindi ndwara zandurira mu mibu (urugero: virusi ya chikungunya na Zika) ndetse n'izindi ndwara z'ubuhumekero. Icyegeranyo cya OMS kigaragaza ko 40-80% by'ubwandu bwa DENV nta bimenyetso bifatika bugaragaza [3].

Ibimenyetso bisanzwe by’ubuvuzi birimo:

-Umuriro ukabije (ukomeza iminsi 2-7, ushobora kuba urwaye indwara ebyiri)

-Kubabara umutwe cyane no kubabara inyuma y'amaso (retro-orbital)

-Kubabara imitsi n'ingingo (bikunze kwitwa "umuti wo kubabara amagufwa")

-Ibisebe byo mu macular cyangwa maculopapular

-Ibimenyetso byoroheje byo kuva amaraso (urugero: ecchymosis, epistaxis, kuva amaraso mu gingival)

Indwara ya dengue igaragara mu byiciro bitatu bitandukanye: icyiciro cy’ubushyuhe, icyiciro cy’ingenzi, n’icyiciro cyo gukira. Hafi 5% by’abarwayi bafite ibimenyetso batera indwara ya dengue ikomeye. Bitewe no kutagira ibimenyetso byihariye by’ubuvuzi, gusuzuma indwara hashingiwe gusa ku bimenyetso by’ubuvuzi biragoye, ibyo byongera ibyago byo kwigwa nabi no kudapimwa neza. OMS ishimangira ku buryo bweruye ko gusuzuma indwara byonyine bidahagije kugira ngo hamenyekane ukuri, bigatuma icyemezo cya laboratwari kiba ari ngombwa [1].

 Ingingo 3 z'ingenzi zavuye muri OMS “Gupima Virusi ya Dengue muri Laboratwari: Ubuyobozi bw'agateganyo, Mata 2025″

Muri Mata 2025, Umuryango Mpuzamahanga wita ku Buzima wasohoye amabwiriza avuguruye y’agateganyo ku igeragezwa rya laboratwari ya DENV, atanga ubuyobozi bw’ikoranabuhanga buhamye bwo gusuzuma dengue ku isi. Aya mabwiriza ahuza ibimenyetso bishya ku igeragezwa rya laboratwari ya dengue mu rwego rw’ubutabazi bw’ibanze bwa dengue kandi atanga inama zifatika zijyanye n’imiterere y’aho indwara iherereye ku rwego rw’umutungo itandukanye.

3.1 Amahame shingiro y'Ingamba zo Gupima

Ubuyobozi bushimangira ko gusuzuma indwara ya dengue bigomba gukoresha ingamba zo gupima indwara hifashishijwe ibimenyetso byinshi bishingiye ku cyiciro cy’indwara [1]. Bitewe n’uko nta buryo rusange bwo gusuzuma indwara, ingamba zo gupima zigomba guhuzwa n’imiterere y’aho indwara ziherereye, hashingiwe ku bintu by’ingenzi bikurikira [1]:

-Intambwe yo kwandura: Umubare w'iminsi nyuma yo kugaragaza ibimenyetso ni wo ugena uburyo bwiza bwo gupima

- Ubwoko bw'icyitegererezo: Uburyo amaraso yose, plasma, cyangwa serum bikwiranye mu gupima DENV

-Indwara zo mu karere: Serotypes za DENV zikwirakwira mu gace hamwe n'ikwirakwira ry'izindi virusi za arbovirusi

-Ingaruka zo kwandura hamwe: Mu turere dufite imiyoboro ya arbovirus ihurirana, hakwiye kwitabwaho isuzuma rya multiplex kugira ngo hamenyekane ubwoko butandukanye bw'udukoko twanduzanya.

3.2 Ingamba zo Gupima mu Bice Bikuru

Dukurikije amabwiriza ya OMS, gupima indwara ya dengue muri laboratwari bigomba gukurikiza igihe gisobanutse neza hashingiwe ku ntera y'uburwayi [1,2]:

(1) Gupima mu cyiciro cy’indwara y’icyorezo (≤iminsi 7 nyuma yo gutangira)

-Gupima aside ya Nucleic (Gupima Molecular): Reverse transcription-polymerase chain reaction (RT-PCR) n'ubundi buryo bwa molekile bupima DENV RNA ifite ubushobozi bwo kumva ibintu byinshi.

-Gupima Antigen: Gupima antigen ya NS1, bishobora kugaragara mu minsi 1-3 nyuma yo gutangira.

Mu gihe cy’icyorezo, urugero rwa virusi rugaragara cyane, kandi isuzuma rya aside nucleique na antigen rigera ku buhanga bukwiye.

(2) Ikizamini cyo Gukira (≥iminsi 4 nyuma yo gutangira)

-Isuzuma rya serologiya: Ubudahangarwa bwa IgM busanzwe bushobora kugaragara ahagana ku munsi wa kane nyuma yo gutangira.

-Mu bihe byinshi, uturemangingo twa IgM dukomeza iminsi 14-20, kandi mu bihe bimwe na bimwe, gukomeza kwandura bishobora kugeza ku minsi 90.

-Gupima IgG bifite agaciro gake mu gusuzuma indwara ya dengue bitewe n'uko hari abasirikare bashobora kuba baranduye virusi ya flavivirus cyangwa bakingiwe mbere.

(3) Algorithm yo gusuzuma ikibazo ikekwaho

Muri ubwo buyobozi harimo uburyo bwo gusuzuma indwara z’abakekwaho indwara ya dengue, butanga inama ku buryo bukwiye bwo gupima hashingiwe ku minsi mike nyuma yo kugaragaza ibimenyetso: Gupima antigen ya NS1 no gupima aside nucleic ni bwo buryo bw’ibanze mu cyiciro cya mbere, mu gihe gupima serologiya ari bwo buryo bw’ibanze mu cyiciro cya nyuma.

3.3 Uburyo bwo Gusuzuma Imikorere n'Amahitamo by'Uburyo bwo Gupima

Nk’uko OMS ibivuga, isuzumabumenyi rusange ry’imikorere n’uburyo bwo gupima indwara ya dengue butandukanye ni ibi bikurikira:

Inama 4 zo Gupima Dengue mu Gupima Macro na Micro-Test hakurikijwe Imiterere

Kugira ngo Macro & Micro-Test ishyigikire gukumira no kurwanya dengue, itanga porogaramu ihuriweho yo gusuzuma indwara ikubiyemo gusuzuma byihuse, kwemeza molekile, no kugenzura genomike, ihaza ibyifuzo mu byiciro bitandukanye byo kurwanya icyorezo.

4.1 Icyitegererezo cya 1: Gusuzuma byihuse no kugenzura byimbitse

Bikoreshwa mu mavuriro avura umuriro, mu bigo nderabuzima by'ibanze, mu gupima icyorezo mu baturage, no mu kato k'icyambu/umupaka.

-Ikizamini cyihuse cya Virusi ya Dengue NS1 Antigen: Kigaragaza ubwandu hakiri kare (iminsi 1-3 nyuma yo gutangira) hagatangwa ibisubizo by'iminota 15 ku gupima byihuse.

-Ikizamini cya Virusi ya Dengue IgM/IgG Antibody: Gitandukanya ubwandu bw'ibanze n'ubwa kabiri kugira ngo harebwe ibyago bikomeye by'indwara.

-Ikizamini cyihuse cya virusi ya Dengue NS1 Antigen + IgM / IgG: Gusuzuma icyarimwe antigen n'uturemangingo tw'umubiri kugira ngo hamenyekane indwara yose.

-Ikizamini cya Chikungunya Virus IgM/IgG Antibody Test: Gifasha mu gusuzuma indwara ya dengue mu buryo butandukanye kugira ngo hamenyekane neza indwara ziterwa n'iyo ndwara.

4.2 Urugero rwa 2: Gusuzuma neza no Gutabara mu buryo bwihutirwa

-Kit yo Gupima Virusi ya Dengue I/II/III/IV: Ipima kandi igatandukanya serotypes 4 (aho umuntu ashobora kuyipima ni kopi 500/mL) kugira ngo hamenyekane icyorezo.

-Kit ya PCR ya virusi ya Dengue ikoze mu buryo bwa Lyophilized: Ishobora kwimurwa mu bushyuhe bw'icyumba, ikwiriye ahantu hadafite amikoro menshi ndetse n'icyorezo gitunguranye.

-Dengue/Zika/Chikungunya Multiplex Real-Time PCR Kit: Isuzuma icyarimwe virusi 3 za arbovirusi kugira ngo imenye neza indwara zitandukanye mu ndwara zikomeye.

Ibikoresho byose byavuzwe haruguru bihuye na sisitemu ya AIO 800 Fully Automated Sample-to-Answer System, bigabanya imikorere y'intoki n'iyanduzwa ry'ibicuruzwa, kandi binoza imikorere myiza n'umutekano w'ibinyabuzima.

4.3 Icyitegererezo cya 3: Igenzura ry’imiterere y’uturemangingo n’isesengura ry’uruhererekane rw’abanduye virusi

Bikoreshwa muri laboratwari z’igihugu, ibigo by’ubushakashatsi ku buzima rusange, bihuye n’uko OMS ishyira NGS mu mwanya wayo.

Ibisubizo byo kugenzura genome bya Macro & Micro-Test bishyigikira uburyo genome yose ikurikiranwa mu gukurikirana virusi, gusobanura neza uruhererekane rw'ikwirakwizwa ry'ibicurane, gukurikirana ubwoko butandukanye, no guhindura ingamba z'inkingo. Bishyigikira uburyo bwo gukora intoki/imashini, kunoza uburyo bwo gutanga no kongera kubyara, bigatuma laboratwari zongera ubushobozi bwo kuva ku isuzuma risanzwe kugera ku igenzura rigezweho, hakurikijwe uko OMS ishimangira gushimangira igenzura ry'ihindagurika rya virusi.

4.4 Agaciro k'ibisubizo bihujwe

Macro & Micro-Test itanga ibisubizo byuzuye byo gusuzuma indwara ya arbovirus, ishyigikira buri cyiciro cyo kurwanya icyorezo: ibikoresho byihuse byo gusuzuma imiterere y’ubuzima, kwemeza molekile kugira ngo hamenyekane neza indwara, n’ubushobozi bwo gusesengura genome yose mu kugenzura indwara. Hamwe n’ibizamini bikora neza, imikorere yoroshye, hamwe na porogaramu ziteguye kwikora, ibi bisubizo biha imbaraga laboratwari na sisitemu z’ubuzima rusange mu gukomeza kwitegura no guhangana n’ibibazo bivuka ku isi yose.

Amareferensi

[1] Ishami ry'Umuryango w'Abibumbye ryita ku Buzima. Gupima Virusi ya Dengue muri Laboratwari: Ubuyobozi bw'agateganyo, Mata 2025. Jeneve: Ishami ry'Umuryango w'Abibumbye ryita ku Buzima; 2025.

[2] Itsinda ry'Abajyanama mu bya Tekiniki rya OMS Global Arbovirus Initiative. Gushimangira ukwitegura no guhangana n'ibibazo by'indwara za Arbovirus ku Isi: Guhamagarira abantu kugira icyo bakora. Lancet Infect Dis. 2026;26(1):15-17.

[3] Mikorobe ya Lancet. Gutsinda ikibazo cyo gusuzuma Dengue. Mikorobe ya Lancet. 2025;6(7):101190.