Le Infezioni in Medicina, n. 2, 157-167, 2024

doi: 10.53854/liim-3202-5


Addressing the Dengue fever challenges in Nigeria: A narrative review and recommendations for control

Ridwan Olamilekan Adesola1, Favour Akinfemi Ajibade1, Ibrahim Idris2, Godfred Yawson Scott3, Mahmud Ibrahim Agaie4

1Department of Veterinary Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria;

2Faculty of Veterinary Medicine, Usmanu Dafodiyo University, Sokoto, Nigeria;

3Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;

4School of Health Sciences, Department of Medical Laboratory Science, Biaka University Institute of Buea, Cameroon

Article received 16 February 2024, accepted 18 April 2024

Corresponding author

Ibrahim Idris

E-mail: ibrahimvet095@gmail.com


Dengue fever is a mosquito-borne viral infection that continues to pose a significant public health threat globally, including Nigeria. Here, we provided a review of dengue fever outbreaks in Nigeria from 1972 to 2023, examining the epidemiology, prevention strategies, challenges faced in combating the disease, and recommendations to mitigate its spread and transmission. We utilized scholarly databases such as PubMed and Google Scholar in writing this paper. The search keywords like, “dengue fever”, “break-bone fever”, “dengue fever virus” “outbreak”, “Nigeria”, “prevalence”, and “epidemiology”, were used to get appropriate published articles about the subject areas. Over the past five decades, Nigeria has experienced intermittent outbreaks of dengue fever, with varying degrees of severity and geographic distribution. Factors such as urbanization, climate change, and inadequate healthcare infrastructure have contributed to the resurgence and spread of the disease in the country. Despite efforts to control dengue transmission through vector control measures and public health interventions, challenges persist, including limited surveillance capacity, diagnostic delays, and gaps in vector control strategies. The emergence of new dengue virus serotypes and the potential for co-circulation with other arboviruses further complicate control efforts. This review highlights the importance of strengthening surveillance systems, enhancing vector control measures, improving diagnostic capabilities, and increasing public awareness to effectively mitigate the burden of dengue fever in Nigeria. Collaboration between government agencies, healthcare providers, researchers, and international partners is crucial in addressing the growing threat of dengue fever and reducing its impact on public health in Nigeria.

Keywords: Dengue fever, Nigeria, outbreaks, epidemiology, surveillance, vector control, public health.


Dengue fever (break-bone fever) is the most widespread disease caused by the dengue fever virus (DENV). DENV is carried by infected mosquitoes, especially Aedes species [1, 2]. DENV has four serotypes (1-4) with 62-67% sequence homology [3-5]. DENV genotypic classification was based on the patient’s immune responses to dengue fever [6]. Homologous DENV serotypes confer protection against secondary infection, but heterogenous serotypes confer transient protection [7].

According to the World Health Organization, dengue fever is endemic in more than 100 countries, with most incidents occurring in the Americas, Southeast Asia, and the Western Pacific [8]. The earliest known cases of dengue fever in Africa were recorded in Zanzibar, Tanzania, in 1823 and 1870 [5]. Later, in the early 1900s, unsubstantiated outbreaks of dengue fever were reported in several other African nations [6]. More than 20 laboratory-confirmed dengue fever epidemics were recorded in more than 20 African countries between 1960 and 2017, despite many outbreaks being never formally reported [6, 7].

Dengue fever is endemic in almost every state in Nigeria and is among the primary causes of feverish diseases that are misdiagnosed [8]. Dengue fever is distributed in both urban and rural regions, while reports of cases were historically more common in urban areas [9]. Nigeria has inadequate surveillance for dengue fever because the virus is not a public health priority, there is a lack of public awareness of it, and healthcare professionals do not fully understand its clinical presentation, as evidenced by the misdiagnosis and underdiagnosis of the viral infection in many unclassified febrile illnesses [10]. Nigeria’s dengue disease burden may be significantly underestimated [11]. A country is considered hyperendemic for dengue if all four serotypes are circulating concurrently [12].

The primary approaches for preventing and managing DENV transmission are case detection, management, and vector control [12]. Making informed decisions about the most effective use of current and emerging preventive and control methods in Nigeria requires up-to-date knowledge about the burden, incidence, and geographic distribution of dengue fever. To address this need, we provided an updated review of dengue fever outbreaks in Nigeria from 1972 to 2023, examining the epidemiology, prevention strategies, challenges faced in combating the disease, and recommendations to mitigate its spread and transmission.


In writing this review, we utilized scholarly databases such as PubMed and Google Scholar. The search keywords “dengue fever”, “break-bone fever”, “dengue fever virus” “outbreak”, “Nigeria”, “prevalence”, and “epidemiology”, were used to get appropriate published articles about the subject areas. This review includes data exclusively from studies conducted in Nigeria that focus on the epidemiology or clinical aspects of dengue fever, while excluding studies on other topics.


Dengue fever: past and present

Dengue fever has a long history, with the earliest documented case of a disease resembling it noted in a Chinese medical encyclopaedia dating back to 992 AD [13]. The disease was referred to as ‘water poison’ and was associated with flying insects [14]. The primary vector, Aedes aegypti mosquitoes, which are central to the emergence of the disease as a public health problem, spread out of Africa in the 15th to 19th centuries, partly due to increased globalization secondary to the slave trade, and is widely distributed through the tropical and subtropical regions of the world [15]. Although there have been descriptions of dengue fever epidemics since the 17th century, the earliest credible records of such outbreaks were from 1779 and 1780, when an epidemic struck Asia, Africa, and North America. From that time, epidemics were infrequent until the 1940s [16]. Transmission by Aedes mosquitos was confirmed in 1906, and dengue fever was the second disease (after yellow fever) to be shown to be caused by a virus in 1907 [17].

Dengue virus was first described in Nigeria in the 1960s in Ibadan [18]. Although there were numerous reports of isolated outbreaks in Nigeria after 1960 (Table 1), many of the outbreaks were likely unreported, unidentified, or neglected due to a lack of diagnostic tools and uninformed health professionals in medical facilities about the disease [19]. Additionally, most cases of dengue fever are misdiagnosed as malaria or typhoid fever in most healthcare facilities [20]. In Nigeria, dengue fever is endemic in almost all states and may be the leading cause of unclassified febrile illness [21]. Dengue fever has a different prevalence in urban and rural areas and has been reported predominantly in urban areas rather than rural areas [21].

Table 1 - Summary of dengue fever cases recorded in Nigeria from 1972 to 2023.

According to Emeribe et al. [21], surveillance of dengue fever in Nigeria is subpar [21]. There is a lack of public awareness of the virus and a lack of understanding by medical professionals, resulting in the misdiagnosis and underdiagnosis of the viral infection evident by the many categorized febrile illnesses [22]. However, the importance and knowledge of the disease are fast-growing. Recent IgM seroprevalence surveys conducted in Enugu and Lagos showed that 44.70% and 24.90% of participants, respectively, were seropositive for anti-dengue antibodies [23, 24]. Additionally, dengue NS1, IgM, and IgG seroprevalence surveys among febrile Nigerian patients in rural areas of Southwestern Nigeria who presented with malaria and typhoid fevers showed a prevalence of 29.4% (315/1074) [20].

These high prevalence rates of both symptomatic dengue virus infections and dengue IgM antibodies suggest that dengue may be endemic and that, frontline healthcare personnel may have missed numerous infections. There is evidence of high vector density in Nigeria’s densely populated cities, with a high density of the Aedes aegypti mosquito that transmits dengue, yellow fever (YFV), and chikungunya, and the same applies to the Anopheles mosquito that transmits malaria, masking the diagnosis of dengue fever [25, 26].

The recent outbreak of dengue fever reported by the Nigeria Centre for Disease Control and Prevention on December 16th, 2023, in Sokoto, Nigeria, further highlights the growing significance of the disease [27]. So far, there have been 13 confirmed cases in the state. These findings suggest that dengue fever is a growing public health problem in Nigeria, the extent of which needs to be more clearly defined, with a dire need for an effective response to prevent and control the disease to safeguard public health.

In Table 1 are reported various studies that have detected dengue fever virus in different geographical locations of Nigeria from the past (1972) to the present (2023). Plateau State has been shown to have the highest number of cases of dengue fever in Nigeria. Also, all four serotypes of dengue fever virus (DENV-1 to -4) available in different parts of Nigeria have been shown in Table 1. There have been similarities and differences between the past and present outbreaks of dengue fever in Nigeria. Enzyme Linked Immunosorbent Assay (ELISA) has been the most frequently used diagnostic method for the detection of dengue fever. This is in support of our claim for the need for molecular diagnostic tools in Nigeria. The methods of control of dengue fever are the same during the outbreaks. Vector control and supportive therapy are the only methods used to prevent and control dengue in Nigeria. Furthermore, most of the outbreaks have been attributed to adult individuals rather than children. These might be as a result of higher exposure of adults to mosquito bites than children [81].


Exhaustion of medical facilities: In Nigeria, dengue fever epidemics frequently strain existing limited medical facilities. There is a rise in hospital admissions during significant outbreaks of dengue fever. As a result, there are several challenges facing the country’s health services, including a lack of hospital beds, drugs, hospital supplies, and laboratory reagents and equipment.

Limited educational and sensitization program about dengue fever: Education prospects in Nigeria are dire. The Federal Government claims a countrywide literacy rate of 69%, however this number conceals substantial regional variations. Yobe, with 7.23% of the population, had the lowest literacy rate in 2017, followed by Zamfara (19.16%), Katsina (10.36%), and Sokoto (15.01%), according to a National Bureau of Statistics report [82]. The Nigerian health authorities have reported the highest outbreaks of dengue fever in Sokoto State between 2016 and 2019 [83]. The lack of comprehensive education to recognize the clinical presentation and symptoms of dengue fever, coupled with the misdiagnosis of the disease as malaria by healthcare professionals, could contribute to this situation. Implementing an extensive national campaign and sensitization program is imperative for the current management and future disease eradication efforts.

Mosquito breeding site: One of the significant challenges contributing to the increasing cases of dengue fever in Nigeria is the proliferation of mosquito breeding sites. The conducive environment for mosquito breeding, such as stagnant water in containers, discarded tires, and other receptacles, provides ample opportunities for Aedes mosquitoes, the primary vectors of dengue fever, to reproduce rapidly. Inadequate sanitation infrastructure, urbanization, and poor waste management techniques all contribute to the problem by giving mosquitoes more places to breed.

COVID-19 pandemic: The occurrence of COVID-19 in Nigeria affected the healthcare system severely. The attention of many healthcare practitioners was on the eradication and control of COVID-19. Most of the other febrile infectious diseases such as dengue fever were neglected which has resulted in the increasing alarming rate of dengue in Nigeria.

Lack of DENV blood screening facilities: Although dengue spread through transfusion is uncommon, Nigeria does not have a licensed donor screening test for DENV. As a result, during epidemics, many blood donations cannot be collected. Strict donor selection protects blood-transmitted DENV, but it is labor-intensive, expensive, jeopardizes supply sufficiency, and might not be feasible.

Recommendation to mitigate the current and future outbreaks


In Nigeria, dengue cases are underreported due to inadequate surveillance and misdiagnoses. Determining the extent of dengue fever in the nation and gathering information for health planning, which includes budgeting for diagnosis, treatment, and control, would be made easier with the help of accurate case reporting. To help with timely and accurate identification of the causative agent and control of dengue fever epidemics, the federal government should prioritize capacity building for monitoring and emergency response systems, laboratory diagnosis, and infrastructure. Currently, the nation’s laboratory diagnostic capabilities for dengue are limited to a small number of setups and personnel. It is necessary to fortify these labs, construct new ones, and stock them with cutting-edge technology including test reagents, contemporary equipment, and trained personnel.

Authors’ contribution

All authors contributed equally to writing the manuscript.

Conflict of interest

The authors declare that they have no competing interests.

Ethical clearance

Not Available.


No funding.


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