Dengue seroprevalence and force of primary infection in a representative population of urban dwelling Indonesian children

Abstract

BackgroundIndonesia reports the second highest dengue disease burden in the world; these data are from passive surveillance reports and are likely to be significant underestimates. Age-stratified seroprevalence data are relatively unbiased indicators of past exposure and allow understanding of transmission dynamics.Methodology/Principal FindingsTo better understand dengue infection history and associated risk factors in Indonesia, a representative population-based cross-sectional dengue seroprevalence study was conducted in 1–18-year-old urban children. From October to November 2014, 3,210 children were enrolled from 30 geographically dispersed clusters. Serum samples were tested for anti-dengue IgG antibodies by indirect ELISA. A questionnaire investigated associations between dengue serologic status and household socio-demographic and behavioural factors. Overall, 3,194 samples were tested, giving an adjusted national seroprevalence in this urban population of 69.4% [95% CI: 64.4–74.3] (33.8% [95% CI: 26.4–41.2] in the 1–4-year-olds, 65.4% [95% CI: 69.1–71.7] in the 5–9-year-olds, 83.1% [95% CI: 77.1–89.0] in the 10–14-year-olds, and 89.0% [95% CI: 83.9–94.1] in the 15–18-year–olds). The median age of seroconversion estimated through a linear model was 4.8 years. Using a catalytic model and considering a constant force of infection we estimated 13.1% of children experience a primary infection per year. Through a hierarchical logistic multivariate model, the subject’s age group (1–4 vs 5–9 OR = 4.25; 1–4 vs. 10–14 OR = 12.60; and 1–4 vs 15–18 OR = 21.87; p<0.0001) and the number of cases diagnosed in the household since the subject was born (p = 0.0004) remained associated with dengue serological status.Conclusions/SignificanceThis is the first dengue seroprevalence study in Indonesia that is targeting a representative sample of the urban paediatric population. This study revealed that more than 80% of children aged 10 years or over have experienced dengue infection at least once. Prospective incidence studies would likely reveal dengue burdens far in excess of reported incidence rates.

Spatiotemporal Variability in Dengue Transmission Intensity in Jakarta, Indonesia

“…find that the force of infection estimate obtained with model 1 variant PS fitted to average annual case notification data reported between 2008 and 2017 in Jakarta province (0.130 (95%CrI: 0.129-0.131)) is similar to the estimate obtained from seroprevalence data collected in 2014 in 30 urban subdistricts of Indonesia (0.14 (95%CI: 0.133-0.147))(5,25).We observed significant spatiotemporal heterogeneity in force of infection within Jakarta province, with long-term spatial clustering of both high and low transmission intensity subdistricts. Our analysis identified a hot-spot of dengue transmission in the southeast of Jakarta province and clustering of low transmission intensity in the region of Central Jakarta.Subdistrict population density was found to have a weak association with dengue transmission intensity, explaining approximately 5% of the variation in subdistrict force of infection estimates during the period of 2008-2017, with higher average annual force of infection associated with greater population densities (for details see SI sections 3.5 and Figure S8).…”

Dengue modeling in rural Cambodia: statistical performance versus epidemiological relevance

“…Figure 11). The values for primary infections are coherent with other studies in Vietnam or Indonesia who analyzed seroprevalence data or seroconversion data [40, 55, 56, 57, 52]. The incidence proportion is highly variable from one year to the next, especially in models with two strains.…”

“…These values are in the range of the measures of seroprevalence in several Asian countries [51]. As the measures reveal large differences between countries [51, 40, 52, 53], a seroprevalence survey in Cambodia would be particularly useful to evaluate which scenario is more plausible.…”

Dengue viruses circulating in Indonesia: A systematic review and phylogenetic analysis of data from five decades

“…Currently, Indonesia reports the highest average number of annual dengue cases in Asia, with frequent epidemic cycles . In 2014, the adjusted national seroprevalence of dengue was 69.4%, ranging from 33.8% in the 1 to 4 years age group to 89.0% in the 15 to 18 years age group .…”