The Aedes aegypti mosquito, the primary vector of dengue, zika, chikungunya, and yellow fever in rural and urban areas, is largely determined by the local climate. To better coordinate vector control efforts, a thorough evaluation of the times when variations in climate conditions impact the number of human cases is necessary.

The Ghana Health Service (GHS) reported a dengue outbreak in a few areas in the Eastern Region. Investigations were sparked by unusual cases of clinical malaria that did not improve with antimalarial medication. Following laboratory validation, dengue was determined to cause these cases.

This article describes the laboratory processes, epidemiological investigation, and public health consequences in the Akyemansa district. Dengue is a mosquito-borne viral infection that is spread by Aedes mosquitoes and has emerged as a significant public health concern globally. An estimated 400 million people get
dengue every year; however, about 80% of cases have no symptoms.

In recent years, dengue disease has become a serious global health concern. According to estimates, the number of cases rose from 505,430 in 2000 to 5.2 million in 2019. Since most dengue cases are mild, self-managed, and asymptomatic, they are either underreported or frequently misdiagnosed as other febrile illnesses.

On July 13, 2024, uncommon presentations of malaria-like diseases were noted in a few districts of Ghana's Eastern Region. Additional research was warranted because some instances showed not responding to antimalarial medications. Nine of the original cases had dengue verified by further laboratory analysis, which led to a thorough inquiry into the outbreak of dengue.

In the Akyemansa district of Eastern Ghana, the emergence of dengue masking as a malaria outbreak occurred, affecting various demographic groups initially at Kwaboadi No. 2 and later spreading throughout the entire district. This article aims to summarize the key findings, epidemiological features, and implications that occurred in Akyemansa district. Also, the conclusions and remedial actions are outlined in this report.

The Akyemansa district's Epidemic Response Team and Public Health Emergency
The Management Committee (PHEMC) was triggered upon the confirmation of three (3) dengue cases in the district on July 8, 2024, and these cases were reported at Kwaboadi No. 2. For laboratory confirmation, 116 samples in all were gathered in the district and submitted to the Noguchi Memorial Institute for Medical Research (NMIMR). Age, sex, and place of residence were among the epidemiological data gathered for each verified case.

Any person with an acute febrile illness lasting 2–7 days who presents with at least two of the following symptoms: headache, retro-orbital pain, myalgia, arthralgia, rash, or leukopenia is considered to have dengue.

A 35.3% case positivity rate was found in the 18 dengue-positive samples out of the 51 that were examined. 33 of the samples tested negative and 65 are still depending. With 12 (66.7%) females and 6 (33.5%) males, the sex distribution of confirmed cases revealed a small female predominance. Out of the 18 cases detected in the district, one case was admitted to hospital and seventeen cases were under home care.

The many age groups that were impacted highlight the necessity of widespread monitoring. With a peak in the 30-39 age range, the majority of cases fall into these age groups. This could be a result of a biological predisposition unique to this age group or career exposure. Notable is the absence of cases in the age ranges of 0–14 and 40–44 underreporting or immunity or pending lab results.
possible contributory factors for the zero reporting among these age groups.

The majority of cases (55.6%) occurred among farmers, followed by traders (22.2%) and students (16.7%). Conspicuously, one healthcare worker was also affected. The outbreak was primarily concentrated within the Akyemansa district, with the highest number of cases reported at Brenase Poly Clinic. Other affected facilities included Ayirebi, Otwereso, Abenase, Akokoaso, and Kwaboadi No. 2. Despite active cases and surveillance in the district, four cases were detected outside the district, with three in Birim Central and one in Birim North.

In tropical and subtropical climates, differentiating between dengue and malaria can be difficult, as seen by the rise in dengue cases exhibiting symptoms similar to those of malaria. There may be a chance for broader community transmission in the Akyemansa district, given the comparatively high case-positive rate. To identify potential risk factors, more research is necessary, given the preponderance of female cases. A concerted effort involving epidemiologists, entomologists, and health authorities is needed to address the dengue outbreak in the district.

Validation in the laboratory is still necessary for precise diagnosis and
efficient management. It takes community involvement and vigilance to stop the spread of disease and safeguard public health. Given the varied demographics affected, public health interventions should be tailored to address the specific needs of farmers, traders, students, and health workers.

The detection of cases outside the district highlights the importance of cross-border surveillance and collaboration with neighbouring districts. In tropical nations like Ghana, controlling the dengue epidemic is one of the most pressing
public health issues. To better target vector control efforts and other policies, it is important to have a better understanding of the long-term and multi-scale effects of predicting dengue in Ghana based on climate conditions and the growth of Aedes aegypti populations.

This preliminary report provides an initial overview of the dengue outbreak in Akyemansa district. Further investigation is required to elucidate the complete epidemiological picture, including factors such as age distribution, clinical manifestations, and environmental risk factors. The findings emphasize the need for comprehensive dengue prevention and control strategies, including vector control, early case detection, and public awareness campaigns. Targeted public health interventions require a more thorough study, which should include clinical characteristics, case distribution, and potential risk factors.

To prevent future outbreaks, it is vital to expand healthcare facilities' ability to diagnose dengue. Additionally, it is important to reduce the population of mosquitoes by putting into practice efficient vector control strategies in the district. Moreover, healthcare providers in the district have to boost health education about dengue symptoms and prevention in the
community.

Furthermore, it is very significant to carry out additional epidemiological studies to determine the causes and risk factors of dengue transmission in the community by a team of specialists.

Lastly, a robust surveillance system should be put in place to find dengue cases early.

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