1 Te Papamuri o te Mate Urutā Dengue: He Wero Hauora Tūmatanui e Piki Ana i te Ao

Ko te Dengue he mate huaketo tere e haria ana e te namu, nā te huaketo dengue (DENV), kua puta ake nei hei mate arboviral tino tere te horapa puta noa i te ao, ā, he tūmomo mōrearea nui ki te haumarutanga hauora tūmatanui. I roto i ngā tekau tau e rua kua pahure ake nei, kua tino piki ake te maha o ngā mate dengue puta noa i te ao, ā, kua piki rua te maha o ngā keehi kua pūrongohia i ia tau mai i te tau 2021 [1]. I te Hakihea 2023, i whakapuaki te World Health Organization (WHO) i tētahi āhuatanga ohorere dengue puta noa i te ao hei whakapakari i ngā mahi urupare ā-ao kua whakaritea. E whakaatu ana ngā whakatau tata mate urutā mai i te WHO e tata ana ki te 3.9 piriona tāngata puta noa i te ao kei te mōrearea ki te pangia e te dengue, me te tata ki te 390 miriona mate e puta ana i ia tau—e 96 miriona o ēnei e puta ana hei keehi e kitea ana i te taha hauora [1,2].

2 Ngā Kaupapa Matua o te Mate Urutā

Ko ngā āhuatanga mate urutā o te dengue ka hangaia e te taunekeneke o ngā āhuatanga huaketo, te rauropi kawe, ngā urupare ārai mate o te tangata, me ngā āhuatanga pāpori-taiao. He mea nui te māramatanga whānui ki ēnei āhuatanga mō te whakawhanake i ngā rautaki ārai me te whakahaere whai hua me ngā huarahi tātaritanga tika.

2.1 Ngā Wāhanga Tuku me ngā Tauira Tuku Tāone

Ko te huaketo dengue ka horahia i te nuinga o te wā eAedes aegypti me Aedes albopictuswaeroa. I roto i ēnei momo kawe, ko Aedes aegypti te kawe tino nui o te huaketo, e tohuhia ana e te "kaha urutau o te tangata" me te horapa whānui i roto i ngā taiao tāone nui me te rohe pārūrū. Kāore i rite ki ētahi atu kawe waeroa o ngā mate huakita arbovirus, e whakaatu ana a Aedes aegypti i ngā āhuatanga mate urutā matua e whai ake nei:

-He pai ake te whakaputa uri i roto i ngā taiao e hangai ana ki te tangata (hei tauira, ngā ipu rokiroki wai, ngā potae kua panga)

-He kaha te kaha o te toto tangata hei puna matūkai

-Te whanonga whāngai i te awatea

Mā ēnei āhuatanga ka kitea te dengue hei mate noa"mate urutā o te tāone,"me te pikinga nui o te whai huatanga o te tuku i roto i ngā wāhi taupori kikī. Kua whakaatuhia e ngā rangahau e pā ana ki te WHO i roto i ngā tāone nui kikī, ka taea e te pikinga o te auau o te whakapā atu a te namu ki te tangata te whakanui ake i te tau whakaputa uri taketake (R₀) o te DENV, ā, ka tere ake te horapa o ngā mate urutā [2].

2.2 Ngā Auahatanga o te Horahanga o te Ao me ngā Take Whakatairanga

E ai ki ngā pūrongo a te WHO, kua tino piki haere te maha o ngā keehi dengue puta noa i te ao i roto i ngā tekau tau e rua kua pahure ake nei [1,3]. Ko te nuinga o tēnei ia pikinga e ahu mai ana i ngā āhuatanga e hono tahi ana:

(1) Huringa Āhuarangi: Ko te pikinga o te pāmahana o te ao, ehara i te mea ka whakawhānui noa i te whānuitanga whenua o ngā nohoanga e tika ana mō ngā kawe namu, engari ka whakapoto hoki i te wā whakatipu o waho o te DENV i roto i te manaaki namu, ā, ka whakarei ake i te whai huatanga o te tuku. Kua whakamanahia e te WHO ngā rerekētanga i puta mai i te āhuarangi o te kiato namu hei tohu pono mō ngā whanaketanga ā-wāhi, ā-wā hoki o ngā pakarutanga dengue.

(2) Te Noho Tāone: Nā te tere me te kore whakamahere o te horapa o ngā tāone kua nui ngā kāinga whakatipu mō ngā kawe namu, ā, nā te pikinga o te taupori kua whakakaha ake te haere tonu o ngā mekameka tuku DENV.

(3) Te Nekehanga o te Taupori o te Ao: Nā te haereere me te hokohoko o te ao i āwhina te tere o te horapa o te mate urutā DENV ki ngā rohe, me te whakatairanga i te whakawhiti mai i ngā kēhi kawemai ki te horapa ā-rohe tonu. E whakaatu ana ngā raraunga tirotiro a te WHO i waenga i te tau 2010 me te tau 2021, i ripoatahia e te United States he 7,528 ngā kēhi dengue e pā ana ki te haereere, ā, 3,135 i roto i ēnei i hiahiatia he whakaurunga hōhipera, ā, 19 i mate.

(4) Te Whanuitanga o te Tohatoha o te Kaituku: Kei te whānui haere tonu te whānuitanga o ngā waeroa Aedes aegypti me Aedes albopictus puta noa i te ao, ā, kei te piki haere te noho o ngā waeroa Aedes ki ētahi wāhi o Ūropi. Nō reira, kua whanake te dengue mai i te mate urutā ā-rohe ki te riri hauora tūmatanui o te ao.

2.3 Ngā Tikanga Whakawhitiwhiti Kōrero me te Whakahokinga Anō o ngā Serotype Maha

E whā ngā momo huaketo Dengue e wehewehe ana i ngā momo huaketo (DENV-1 ki te DENV-4). Mā te pangia e tētahi momo huaketo ka roa te ārai mate ki taua momo huaketo, engari ka roa noa te wā e ārai ana i ngā momo huaketo e toru. He ngāwari te pangia e te mate DENV i te nuinga o te taupori, ā, he iti noa iho te hunga kua pangia e pāngia ana e te mate [2].

I ngā rohe whānui, he maha ngā momo DENV e horapa tahi ana i te wā kotahi, ā, ka hua ake te tūponotanga ka pāngia ngā tāngata e ngā mate dengue maha puta noa i ō rātou oranga. Kua tautuhia e ngā rangahau mate urutā a te WHO ko te horapa tahi maha-momo he take matua o ngā pakarutanga dengue auau [1].

2.4 Te Mate Tuarua me te Whakarei Ake i te Paturopi

He āhuatanga tino nui, ahurei hoki i roto i te mate urutā dengue kote whakarei ake e whakawhirinaki ana ki te paturopi (ADE)I te wā o te mate tuarua me te momo DENV heterologous, ka āwhina ngā paturopi kore-whakakore i puta i te wā o te mate tuatahi ki te whakauru i te huaketo ki roto i ngā monocyte me ngā macrophages, ā, ka whakanui ake i te whakaputanga huaketo. E mōhio whānuitia ana tēnei tikanga e te WHO hei take matua mō te mate dengue kino, tae atu ki te kirika toto dengue me te mate dengue shock syndrome [1].

E whakaatu tonu ana ngā raraunga mate urutā o te WHO he nui ake te tūponotanga o te hunga whai mate dengue tuarua ki te pangia e te mate kino ki te hunga whai mate tuatahi—he āhuatanga nui tēnei mō te tirotiro mate me te whakahaere haumanu. He mea nui kia mōhiotia ahakoa te pikinga o te tūponotanga o te mate kino i te wā o te mate tuarua, ka taea e te mate o tētahi momo DENV te whanake hei dengue kino [1].

2.5 Ngā Whakaaturanga Hauora Kore-Motuhake me te Mōrearea Tātaritanga Hē

Kāore i te tino kitea ngā āhuatanga haumanu o te dengue, inā koa i ngā wāhanga tōmua o te mate, he maha ngā wā ka taupatupatu ki ngā āhuatanga o ētahi atu mate huaketo e kawea ana e te namu (hei tauira, te chikungunya me ngā huaketo Zika) me ētahi mate manawa. E ai ki ngā whakatau a te WHO he 40-80% o ngā mate DENV kāore he tohu [3].

Ko ngā āhuatanga haumanu noa ko:

-Te kirika nui (e mau tonu ana mō ngā rā 2-7, ka rua pea ngā wā e pāngia ana)

-Te mamae nui o te upoko me te mamae o muri o ngā kanohi (te mamae i muri i ngā kanohi)

-Te mamae o ngā uaua me ngā hononga (e mōhiotia whānuitia ana ko te "kirika whati wheua")

-Pōuri macular, maculopapular rānei

-Ngā tohu toto ngawari (hei tauira, te ecchymosis, te epistaxis, te toto kapia)

Ko te dengue tohumate e wehea ana kia toru ngā wāhanga motuhake: te wāhanga kirika, te wāhanga tino kino, me te wāhanga whakaora. Tata ki te iti iho i te 5% o ngā tūroro tohumate ka ahu whakamua ki te dengue kino. Nā te kore o ngā āhuatanga haumanu motuhake, he uaua te tautuhi i runga i ngā tohu haumanu anake, ka nui ake te tūponotanga o te tautuhi hē me te kore tautuhi tika. E whakanui ana te WHO kāore e ranea te tautuhi haumanu anake hei whakarite i te tika, ā, he mea nui te whakaū taiwhanga [1].

 3 Ngā Kaupapa Matua mai i te WHO "Whakamātautau Taiwhanga mō te Huaketo Dengue: Aratohu Wā poto, Paenga-whāwhā 2025"

I te marama o Āperira 2025, i tukuna e te Whakahaere Hauora o te Ao he aratohu wā poto hou mō ngā whakamātautau taiwhanga mō te DENV, e whakarato ana i ngā aratohu hangarau whai mana mō te tautuhi i te mate dengue ā-ao. Ka whakakotahihia e tēnei aratohu ngā taunakitanga hou mō ngā whakamātautau taiwhanga dengue i roto i te horopaki o te ohorere dengue ā-ao e haere tonu ana, ā, ka tukuna he taunakitanga mahi e hāngai ana ki ngā tautuhinga me ngā taumata rauemi rerekē.

3.1 Ngā Mātāpono Taketake o te Rautaki Whakamātautau

E whakanui ana te aratohu me whakamahi te tātaritanga mate dengue i tētahi rautaki whakamātautau maha-tohu i runga i te taumata o te mate [1]. Nā te korenga o tētahi pūnaha tātaritanga whānui, me urutau ngā rautaki whakamātautau ki ngā horopaki mate urutā ā-rohe, me te whai whakaaro ki ngā āhuatanga matua e whai ake nei [1]:

-Wāhanga pangia: Ko te maha o ngā rā i muri i te tīmatanga o te tohu ka whakatau i te tikanga whakamātautau tino tika

-Momo tauira: Te pai o te toto katoa, te plasma, te serum rānei mō te kimi i te DENV

-Matū urutā ā-rohe: Ngā momo DENV e horapa ana i te rohe me te horapa tahi o ētahi atu huakita pūngāwerewere

-Te tūponotanga o te pangia tahi: I ngā rohe e taupatupatu ana te tohanga o te arbovirus, me whai whakaaro ki te whakamātautau maha-pūnaha hei wehewehe i waenga i ngā mate rerekē

3.2 Rautaki Whakamātautau Ā-Wāhanga

E ai ki ngā aratohu a te WHO, me whai ngā whakamātautau taiwhanga dengue i ngā wā mārama i runga i te taumata o te mate [1,2]:

(1) Whakamātautau Wāhanga Whakamataku (≤7 ngā rā i muri i te tīmatanga)

-Whakamātautau Waikawa Karihi (Whakamātautau Ngota): Mā te tauhohenga mekameka whakawhiti-polymerase whakamuri (RT-PCR) me ētahi atu tikanga ngota ka kitea te RNA DENV me te tino aro.

-Whakamātautau Paturopi: Te kimi i te paturopi NS1, ka taea te kite i roto i te 1-3 rā i muri i te tīmatanga.

I te wā whakapeka, he teitei noa ngā taumata viremia, ā, mā te whakamātautau waikawa karihi me te antigen ka eke ki te tairongo tino pai.

(2) Whakamātautau Wāhanga Whakaora (≥4 rā i muri i te tīmatanga)

-Whakamātautau Serological: Ka kitea ngā paturopi IgM i te rā 4 i muri i te tīmatanga.

-I te nuinga o te wā, ka mau tonu ngā paturopi IgM mō ngā rā 14-20, ā, i ētahi wā, ka roa pea te mau tonu ki te 90 rā.

-He iti noa te uara o te whakamātautau IgG mō te tautuhi i te mate dengue whakapeka nā te mea ka puta pea he paturopi whakawhiti-tauhohe mai i te mate flavivirus o mua, i te werohanga rānei.

(3) Rautaki Tātaritanga Take Whakapae

Kei roto i te aratohu he pūnaha tātaritanga mō ngā take dengue e whakapaetia ana, e taunaki ana i ngā tikanga whakamātautau tika i runga i ngā rā i muri i te tīmatanga o te tohu: Ko te whakamātautau antigen NS1 me te whakamātautau waikawa karihi ngā huarahi matua i te wāhanga tōmua, ko te whakamātautau serological te tikanga matua i te wāhanga o muri.

3.3 Aromatawai me te Kōwhiringa Mahi o te Tikanga Whakamātautau

E ai ki te WHO, ko te aromatawai pūnaha o te mahi me ngā āhuatanga e tika ana mō ngā whakamātautau dengue e whai ake nei:

4 Ngā Taunakitanga Hua mō te Kimi Dengue i roto i te Whakamātautau Matotoru me te Iti, mā te Horopaki

Hei tautoko i te aukati me te whakahaere i te dengue, ka whakaratohia e Macro & Micro-Test he kohinga tātaritanga whakauru e kapi ana i te tirotiro tere, te whakaū ira, me te tirotiro ira, hei whakatutuki i ngā hiahia puta noa i ngā wāhanga whakahaere pakarutanga rerekē.

4.1 Horopaki 1: Te Tirotiro Tere me te Aroturukitanga Whaiaro

E pā ana ki ngā wāhi rongoā kirika, ngā whare tiaki hauora tuatahi, te tirotiro hapori mō te pakarutanga mai o te mate urutā, me te taratahi tauranga/rohe.

-Whakamātautau Tere mō te Dengue Virus NS1 Antigen: Ka kitea te mate wawe (1-3 rā i muri i te tīmatanga) me ngā hua 15-meneti mō te aromatawai tere.

-Whakamātautau Paturopi IgM/IgG mō te Huaketo Dengue: Ka wehewehe i ngā mate tuatahi/tuarua hei aromatawai i te mōrearea nui o te mate.

-Whakamātautau Tere Whakakotahi mō te Mate Pūngāwerewere Dengue NS1 + IgM/IgG: Ka kitea ngātahi te mate pūngāwerewere me ngā paturopi hei tātaritanga whānui.

-Whakamātautau Paturopi IgM/IgG mō te Huaketo Chikungunya: Mā te tātaritanga rerekētanga me te dengue ka taea te tautuhi tika i ngā mate pukupuku.

4.2 Horopaki 2: Te Tātaritanga Tika me te Urupare Āwhati

-Kete Kimi Waikawa Matū mō te Huaketo Dengue I/II/III/IV: Ka kitea, ka wehewehe hoki i ngā momo mate e 4 (te rohenga kimi 500 tārua/mL) hei whai i ngā pakarutanga.

-Kete PCR mō te Huaketo Dengue Lyophilized: Ka taea te kawe i roto i te pāmahana rūma, he pai mō ngā wāhi he iti ngā rauemi me ngā pakarutanga ohorere.

-Kete PCR Wā-Tūturu mō te Dengue/Zika/Chikungunya: Ka kitea ngātahitia ngā huaketo ārai mate e toru hei tātaritanga rerekētanga whai hua i roto i ngā pakarutanga uaua.

He hototahi ngā matū katoa o runga ake nei ki te Pūnaha Tauira-ki-te-Whakautu Aunoa AIO 800, e whakaiti ana i te mahi ā-ringa me te whakawhiti-paru, ā, e whakapai ake ana i te whai huatanga me te haumaru koiora.

4.3 Horopaki 3: Te Aroturukitanga Ira me te Tātaritanga Whakapapa Huaketo

E pā ana ki ngā taiwhanga tohutoro ā-motu, ngā whare rangahau hauora tūmatanui, e hangai ana ki te tūnga o te WHO mō ngā NGS.

Ka tautokohia e ngā otinga tirotiro ira a Macro & Micro-Test te raupapatanga ira katoa mō te whai i te huaketo, te whakamārama i te mekameka tuku, te aroturuki i ngā momo rerekētanga, me te whakarerekētanga rautaki kano kano. Ka tautokohia e rātou ngā rerengamahi ā-ringa/aunoa, ka whakapai ake i te putanga me te kaha ki te whakaputa anō, ka taea ai e ngā taiwhanga te whakapai ake i te whakamātautau noa ki te tirotiro matatau, e rite ana ki te arotahi a te WHO ki te whakapakari i te aroturukitanga whanaketanga huaketo.

4.4 Te Uara o ngā Otinga Whakauru

Ka whakaratohia e Macro & Micro-Test ngā otinga tātaritanga katoa mō te kimi i te arbovirus, e tautoko ana i ia wāhanga o te whakahaere pakarutanga: ngā taputapu tirotiro tere mō ngā tautuhinga hauora o mua, te whakaū irahiko mō te tātaritanga tika, me ngā āheinga tātaritanga ira-katoa mō te tirotiro mate urutā. Mā ngā whakamātautau mahi-teitei, ngā rerengamahi ngāwari, me ngā tūāpapa aunoa-rite, ka whakamanahia e ēnei otinga ngā taiwhanga me ngā pūnaha hauora tūmatanui ki te whakapakari i te whakarite me te urupare ki ngā tūmomo riri arbovirus puta noa i te ao.

Ngā Tohutoro

[1] Te Whakahaere Hauora o te Ao. Whakamātautau Taiwhanga mō te Huaketo Dengue: Aratohu Wā poto, Paenga-whāwhā 2025. Geneva: Te Whakahaere Hauora o te Ao; 2025.

[2] Rōpū Tohutohu Hangarau Kaupapa Arbovirus Ao o te WHO. Te Whakapakari i te Whakaritenga Ao me te Urupare ki ngā Tūraru Mate Arboviral: He Karanga ki te Mahi. Lancet Infect Dis. 2026;26(1):15-17.

[3] Te Pūtaiao Lancet. Te wikitoria i te raruraru o te tātaritanga mate Dengue. Pūtaiao Lancet. 2025;6(7):101190.